Excerpts from Therapy For Therapists (a guide to changing lives)

This book has taken three years to write. I, myself, have been writing on almost every one of those days. Still, there is much we never got to which I know to be important. Content for volume two? Perhaps.

My point for saying this? I find it hard to choose which excerpts to include. Above all, I want to offer a few useful things. Supervision. In-office aggression. On being yourself. Certainly these three topics warrant serious consideration. Sadly, few schools teach how these three things go together. They should. Supervision should encourage therapists to be themselves, including when dealing with in-office aggression.

 

Supervision and Supervising

Prior to my private practice, my employers supplied supervision. But when I started my practice, I had no supervisor. So I needed to hire someone. My first supervisor was a psychologist named Aaron, some of whose advice has stayed with me to this day. For one thing, whenever a client asked where something came from, he famously and always gave the same answer—"It was your mother."

The thing I remember most though was something he told me in our first supervision. He told me anger and dependence are two sides of the same coin. Over the years, I've tried to pay attention to this as when I haven’t, I’ve paid a price.

For instance, one client who grew too dependent on me got mad one day, and as she ran from the room she dumped an entire extra-large, steaming-hot, Dunkin Donuts coffee on my week old office rug. Another client got so mad, he reached behind him, grabbed a floor lamp, and repeatedly beat it against the wall until it resembled a pretzel. Another client got so mad at me, he told lies about me to twelve of my clients. He lied so convincingly, most of them quit. And another time, a client got so mad at me, he threatened my life—more than once.

My point?

No therapist can afford to be without supervision. No one. No exceptions. Of course, years into your career, this can evolve into peer supervision. In fact, even though I was paying for individual supervision during my first six years, I founded a peer supervision group. To be honest, I gained a lot from this group. And today, I supervise a number of therapists in private practice, as well as college students getting their counseling / social work degrees.

Why mention giving, as well as receiving, supervision? Maintaining a fresh perspective requires that I keep giving back. Which is why I constantly push my supervisees to come up with challenging questions. This then challenges me to evaluate myself and to keep growing. As I’ve said, either I walk the walk or I have no business being a therapist.

My supervising others also improves my own practice skills. Having to find ways to help my supervisees means I get better at teaching my clients about themselves. And since the heart and soul of my therapy is to teach my clients to see their natures, I keep growing as a person—and so do they.

One final thing. What about questions from clients or supervisees as to how good other therapists are? Perhaps they are feeling protective. Perhaps they are asking if this other therapist might be someone to refer to. Here, I divide my answers into those for clients and those for supervisees.

For clients, I generally say something like, “I can’t say. I don't know them personally.” Know I say this even when I do know of them. But for supervisees, if I know them, I usually do add a bit more detail.

What about when I personally know of times when a therapist has been unethical, useless, or harmful? Here, I still try not to bad mouth this other therapist. But I do try to find a way to [1] hint at my lack of trust for this person, and [2], suggest a therapist who I do trust. Unless, of course, the potential for harm includes things like sexual line-crossing or risks to children. In which case, I make an exception to my usual rule and flat out tell them. But I limit this to what I personally know to be true.

Noticing the Direction of Aggression

I’ve mentioned several times that my first job as a therapist was as the family therapist in an inpatient rehab. There I worked on a twenty bed adolescent unit. One day, as I was walking in the hallway between the adolescent and adult units, I saw ahead of me three men struggling—and failing—to get a fifteen year old girl into the psychiatrist's office.

As I stood there waiting for this to be resolved, I was amazed by how they couldn't get her to move. To be honest, she wasn't that big. Nor was she violent. Rather she was simply trying to escape their hold on her. But at some point, the psychiatrist, Dr. Rowe, came out and asked her to come in. And as the door shut, we all stood there and listened for violence.

There was none.

Later, I stopped by this psychiatrist’s office to ask him about what had happened. Let me note, Dr. Rowe was probably one of the best psychiatrists I’ve ever known. Far from simply prescribing pills or wrongly believing his MD qualified him to do talk therapy, he actually had a genuine therapist’s manner and skills. And I’d really been impressed by how he’d handled that girl, especially since she was on my unit.

Much of what was said I don’t remember. But what I do remember guided me as my lamp was being destroyed. I asked Dr. Rowe if he’d been worried that that girl would destroy things on his desk—his personal photos and such. What he told me has stayed with me my whole career.

He said, when someone is being violent, notice the direction of this violence. By this, I mean, is it coming toward you or away from you? The girl in the hallway that day was fiercely struggling to break free. And her every effort was to move back and away from the men trying to physically control her.

Likewise the man in my office who destroyed my floor lamp all those years ago. He’d lost control, turned away from me, grabbed the lamp and banged it against the wall behind him. When he then regained some degree of control, he turned back to me and calmly said, “I'll pay for the lamp.” At which point, I wisely avoided talking about my lamp. Rather I got him to talk about his angry rages.

Dr. Rowe’s advice was the only thing grounding me that day. His knowledge allowed me to sit quietly and to watch and wait for the storm to pass. And it did. I then spoke calmly to this man without once shaming him for what he’d done. So while I had been unnerved, I had also been calm. As the cliche says, “A little knowledge goes a long way.”

Now make note of the two directions my client took that day. His violence toward the lamp was directed away from me—his offer to pay for the lamp was directed toward me. Realize these two directions indicate he had a significant degree of self control—as well as the self-awareness, no matter how small, that he did not want to harm me.

Contrast this with a man who had been coming many years, then one day simply lashed out at me. As far as I know, nothing had happened in the room to set him off. He’d come in angry and my trying to calm him down had set him off. And in less than ten minutes, he was in my face, screaming and demanding that I, “ANSWER HIS QUESTION!”

To this day, I have no clue what his question was. I’d tried and failed to get him to clarify what he was asking, to no avail. The point is, he had been physically aggressive and the direction of this aggression was toward me. Sadly, I’d had no choice but to ask this person, a man who'd been coming to me for many years, to leave.

I remember sitting at my desk after he left and noticing my hands shaking. I also recall my stomach twitching and upset. Over the years, there had been times like this wherein I’d worried about my client’s welfare afterwards. This time, I so clearly registered how afraid I’d been—and that my fear had not been an overreaction. Rather it had been warranted.

The next day, I wrote this man an email telling him I could no longer see him. For obvious reasons, I’d chosen to email him rather than to make a phone call. I then made referrals for him to two other therapists I knew. I then with kindness, suggested he please consider going to talk to someone about his rage.

There are many things to consider in this event. But the main one is the direction of his aggression. To be honest, I never saw this coming and had known this man for years. And yes, in hindsight, there were clues that he’d been brimming with anger for a while. For one thing, he’d lost several of his closest life-long friends due to arguments in the prior two years.

The thing that really matters here though is how I handled—then processed, his aggression. Clearly I could no longer help him. So I referred him out. But I also did not make the kind of mistakes I made many times early on.

I did not blame myself for not seeing this coming.

I did not make my future safety negotiable.

On Being Yourself as a Therapist

Why am I saying you should not try to imitate famous therapists?

For one thing, you are not—nor will you ever be—Carl Rogers, Carl Jung, or Pierre Janet. For another, reducing to such simple phrases the things masters like Rogers did amounts to hubris at its highest level. In truth, these masters were masters precisely because they were being authentic.

Ironically, this means, if you truly want to imitate them, BE YOURSELF.

Of course, it can take a therapist years to acquire this level of skill. Most of these years get spent trying—and learning to let go of—urges to copy others. And yes, watching films of the great therapists can often inspire (I want to be that good at helping people), peak your interest (how exactly did she connect those two things?), and get you to notice your weaknesses (do I leave too little space between questions; am I too uncomfortable with silence?). But attempting to copy famous therapists will quickly and thoroughly undermine your confidence. And in the end, the self doubt created by doing this will definitely make you ineffective.