Tag Archives: Students Audience (Grad/post-grad)

Students Audience

Learning to be fierce in the face of intraprofessional challenges

By Emily St. Amant October 5, 2022

5 Comments

I started my counseling program in 2007, so after working 15 years in the field, I have … thoughts. One of the most difficult things for me along my career journey has hands-down been dealing with other people. And I am not talking about my clients; I’m referring to other professional behavioral health providers. Looking back, I’ve had some truly memorable encounters that taught me what no book, class or training ever could. 

I want to preface this with the acknowledgment that the people whose actions I’m discussing here aren’t all good or bad. There’s a spectrum ranging from having a bad day to having a bad character, and we all bounce around on that to some extent. I’m sure others could reflect on some of my less-than-stellar moments, where I was acting out of a bruised ego or was simply hungry, and I took out my own stuff on others. We all have a shadow side. Pretending we don’t is what gets us into trouble and what causes real harm to others.

In general, I do not feel we are preparing counselors to work in an agency or organization with other types of treatment providers, other types of professionals and even our fellow professional counselors. I don’t have time to address all of that in this article, so I’ll focus on one key area I personally wasn’t adequately prepared to navigate: my working relationships with others. This is especially true in times when there was a value or priority conflict between me and the other person. There is a certain idealism that plagues training programs, including ones in the counseling field.

I have learned a lot from my experiences working in various agencies and organizations over the years. I’ve encountered people who were exceptionally kind, generous, compassionate, patient and wise. And I’ve also encountered people who shocked and angered me with the lack of empathy and respect they showed to myself and others. Later, I realized I was more disappointed and hurt than surprised or angry. I have encountered several individuals in the workplace who, if nothing else, clearly demonstrated the kind of person I do not ever want to be.

With this article, my goal is to empower other clinicians to protect themselves and be better prepared to effectively manage difficult situations in the workplace. At the same time, I hope that we will all do a better job of ensuring we are not acting in such a way that others need to protect themselves from us. Let us never be cut off from hearing what others have to say — whether it’s about our attitude, work performance and quality, or the way our behaviors affect others. And we need to stay open-minded about what others know that we do not yet understand. I admit I have failed in this endeavor in the past and will certainly fail in the future, but I think the key is to be sincere and genuinely not want to. I never want to be remembered by others as someone who hurt them or let them down.

For me to be the best counselor I can be, I can’t stop reflecting on my own personal and professional demons, deficits and errors. I can’t stop being open to feedback and seeking out opportunities for growth. Being a counselor isn’t just a professional identity or set of skills to master; it is a way of being. Who I am as a human being is shaped and molded by the values of the counseling profession. We counselors all in turn shape and mold what it means to be a counselor. Who we are as counselors not only impacts the care we provide our clients but also shapes our experiences in the workplace, the broader health care field and our world.

Learning the hard way 

Something I wish I’d been explicitly told is just because you work in mental health doesn’t mean that everyone you encounter in the workplace will care about you. In fact, if you work with enough people for enough time, you are guaranteed to cross paths with someone who does not have your best interest in mind. They will not care about your success, well-being, and physical and mental health if it gets in the way of their agenda or bottom line. Even in a nonprofit setting, people still report outcomes of some kind to their managers, financers and stakeholders, no matter what impact this has on you. Even if you play a vital role on a team that collaborates on initiatives and projects, that doesn’t always mean you will be given credit or that the workload will be distributed equally. There will always be people who are willing to sacrifice your health and career for their own benefit. They may use you to build themselves up while also holding you back or to avoid having to do the work themselves or face the consequences of their own actions. Some will see you only through the lens of what you can do for them. It’s almost as if they’re asking, “How can I use your labor, skills and expertise to shape my own reputation? How can you make me look good?” People in more powerful positions and people who hold greater influence will essentially ask you, “How can you help me?” I have had almost that exact question directed at me explicitly, but more often that intention goes unspoken. We should be cautious to avoid creating exploitative and harmful power dynamics. We should be asking those we supervise, manage and work alongside, “How can I best serve and uplift you? How can we work together toward the greater good?”

Ego is a thing. You will work with people who lack awareness of or concern for how their own behaviors impact others around them. Some therapists I’ve worked with have appeared to be two separate people: They act one way in front of management and their clients and a completely different way with their peers or subordinates. Some people will be averse to any feedback, act spitefully or haughty, or seem to be easily threatened for no clear or rational reason. I’ve encountered other clinicians whose behaviors and/or explicit statements communicate they think they are superior because of their training, education, theoretical orientation, clinical focus or specific profession. Egos are walls. They get in the way of us being able to engage with others productively and deeply. One thing I’ve realized is that if you’re dealing with someone’s ego, you’re more than likely fighting a losing battle.

You will also encounter co-workers, managers, supervisors and directors who have poor boundaries. You may witness workaholism be glorified and rewarded, and you may have unrealistic performance expectations placed on you. People are routinely punished and shamed for attempting to strike a healthy work-life balance. This can happen directly; for example, I had a past manager say to me that if I didn’t work 60 hours in a week (without overtime pay, mind you), I “didn’t care about the kids.” The retaliation for boundary setting can also happen indirectly with people being fired for “not being a good fit” or being passed over for promotions if they don’t routinely work overtime. You will also see firsthand why ethical codes are necessary regarding boundaries with clients. There’s a reason codes explicitly state not to do something: Counselors are really doing those things. 

You will meet other mental health providers who plain and simple are not healthy themselves. There is a level of gatekeeping that should happen within the mental health professions, but the gray area between observably impaired and functionally problematic is inadequately addressed in practice. There is a difference between being a “wounded healer” and not being on a healing path at all. I often use the metaphor of a “healing train.” None of us will ever get to the destination of being completely healed and perfect; what matters is staying on that train and resetting ourselves when we veer off track. Yes, practitioners are trained and have skills that are helpful to their clients even if they have never experienced a specific clinical concern themselves, but this is not the same as a counselor who believes they can be an effective provider without doing their own personal work. We all have our “stuff,” and many of us are drawn to the helping field because of our own personal experiences. No matter how much training and education we receive, if we aren’t doing the deep and difficult work of examining our own weaknesses and healing from our traumas and pain points, then we put our efficacy as a clinician at risk. This is why self-care is an ethical imperative for counselors. We can’t lead others somewhere we’ve never been before.

Truths that guide me 

These lessons have taught me a few truths along the way — ones I wish I had known from the start because they could have guided me as I managed difficult interactions or situations.

The first and most important truth is that most of the time how other people treat me has nothing to do with me. We are all working out our own “stuff” in the best ways we can, and we often experience someone wrestling with themselves as they impact us negatively. Just because someone is educated, charming, brilliant, credentialed, licensed, published or highly renowned doesn’t mean they are immune to the human experience.

You will never know everything, and that is OK. It is genuinely OK that you can’t be the best at everything. This should be obvious, but I think this is at the heart of a lot of defensiveness and problematic interpersonal behavior. Everyone turns to counselors and therapists for answers and solutions, but we ourselves are fallible, limited human beings. That is not just OK — it’s why we are so good at what we do in the first place. Because we are imperfect human beings, we can help other imperfect human beings find meaning, purpose, joy and peace. So it’s OK to not have a perfect answer to why things are the way they are and how to best live, change and cope. When we refuse this truth and believe that someway, somehow we have managed to be special and the exception, then, of course, it will be uncomfortable and painful to be confronted with the reality that implies otherwise because we will always fail at perfection. If it feels unbearably embarrassing and shameful when others find us out, which will happen, then that is something to carefully examine and reflect on. We are setting ourselves up for failure if we place unrealistic expectations on ourselves, and in turn, we are also setting those around us up for failure because this will without a doubt morph into unrealistic or even exploitative expectations of other people. This shame can lead us to act out and engage with others in harmful ways. The work of being a counselor calls for radical self-compassion, but this is impossible without also reflecting on who we are in relationships and how we are extending that compassion to others.

Success is collective. By lifting others up and supporting them, we ourselves benefit. By sabotaging or disenfranchising others, we hurt ourselves as well. I need to make sure I am doing my best to live this truth by how I engage with others, and I need to be prepared to set boundaries and make needed changes if others in my life are not. I would have left some relationships and jobs much sooner than I did if I had only believed in myself and my intentions more. Do not trust anyone who acts in a way that pushes others down in any way; just because you aren’t their current target doesn’t mean you never will be. If someone doesn’t give credit where credit is due, they are a selfish person who will never be your true ally or partner. If someone seems frequently jealous and doesn’t get excited about the success of others, they may very well be more likely to try to hold you down and sabotage your health and success. Collective action is required for success, and this has to include communities holding people accountable for their actions and inactions when needed. We should all aim to align ourselves with people and organizations that are doing the work to uplift those around them and to stand up for others as well.  

Boundaries are everything. Boundaries help us navigate the reality that we are responsible for both ourselves and each other. Yes, the adage “with great power comes great responsibility” is true, but any level of influence comes with responsibility, no matter how small or insignificant it may seem. All too often we do not acknowledge the real impact we have on each other as humans, possibly to assuage our guilt and enable our avoidance of this burden of responsibility. Any encounter between two people is an opportunity for either healing and growth or, alternatively, harm and suffering.  

Personal relationships, workplaces and workplace relationships are all vital parts of our lives that have the potential for great positive impact as well as negative or harmful consequences. I like to think of the range in terms of spice levels:

  • Mild: unhealthy
  • Medium: toxic
  • Hot: abusive
  • Scorching: violent

Anyone in a mild to moderate situation has the choice to stay and accept things as they are or work for positive change. If it’s hot or scorching, the only real way to get relief is to get away and seek emotional “burn” care.

Not all “defensiveness” is bad. It’s unacceptable how a lot of us are taught to “manage” our defensive behavior. It’s upsetting when you are confronted with someone pointing out how sensitive you are to constructive feedback, but early in our counseling careers, we need to know that our internal emotional protective system isn’t our enemy. We need to be taught to trust ourselves, to listen to how we feel and to know that sometimes defending ourselves and others is what we absolutely need to do. By not teaching this balance of managing unhealthy defensiveness, that’s often ego-driven, with the reality that there are other people who can and will harm us if we don’t protect ourselves, we set a lot of people up to essentially be conditioned to be complicit in their own abuse or oppression. Yes, we need to remain open to feedback that’s constructive and comes from someone who genuinely cares about us, but we also need to have discernment and the wisdom to know what feedback we should absorb and what we should shield ourselves from.

We must take responsibility for setting our boundaries, and we must allow others to do the same. Remember the only thing you can really control are your own words, actions and reactions, including how much you tolerate other people and situations. Emotional responses are automatic and unconscious, and although we have influence over these responses, we can’t expect ourselves to have complete control over them. They exist for a reason, and one of the main reasons we have intense emotions and anxiety is to protect ourselves. 

I’ve had clients who have asked me to help them “just deal with” the situation that’s causing them harm, but as the saying goes, “You can’t heal in the same environment that is making you sick.” Leaving is often the best solution in relationships that cause us harm, be it with an intimate partner or an employer. I now realize that when I stayed in an unhealthy or harmful situation, I was not taking responsibility to care for myself or to consider how I was affecting the other person or environment. I am not referring to what could amount to blaming the victim of abuse or the recipient of boundary violations for another’s action; it is absolutely inappropriate to place any level of responsibility on the receiver of another’s behavior. However, by staying in an unhealthy environment or indirectly enabling unhealthy behaviors, I was essentially teaching that person that what they were doing was acceptable because I stayed put and tolerated it. I was not doing my part to stop them from not only harming me but also negatively affecting others. Oof! 

It’s important to know where the line is between what you are responsible for and what the other person is responsible for. Without this line, it can be a slippery slope toward excusing, enabling and even rewarding unhealthy behaviors in the workplace and our personal lives. 

If you set enough boundaries, you are guaranteed to get pushback. And it will be uncomfortable. To take a lesson from Nedra Glover Tawwab’s book, Set Boundaries, Find Peace: A Guide to Reclaiming Yourself, the only people who have a problem with others setting boundaries are the people who are benefiting from another’s lack of boundaries. We need to be prepared for how others may react when we stand up for ourselves and refuse to be taken advantage of or treated poorly. 

People who see relationships as only transactional or who want to use you for their own purposes will absolutely get irritated or angry for your refusal to comply with their attempts at control or manipulation. Often to further manipulate the situation in their favor, they label the boundary setting or the accompanying response as the problem. This allows them to preserve their reputation at the further expense of the other person being harmed. 

All too often, we blame the person reacting to another’s behavior instead of addressing the source. This criticism, invalidation and punishment of the reaction to abuse is what is called “reactive abuse.” This line of reasoning can also be taken to its logical conclusion and turn into excusing and enabling harmful or outright criminal behavior (for example, blaming the victim of assault for what they were wearing). This is commonly discussed in the context of abusive intimate partner relationships. However, I’ve seen this play out in the workplace, and it can lead to ruptures in trust and morale and causes real psychological harm. 

Abusive behavior is always the fault of the person doing the abuse. Unhealthy behaviors are always the responsibility of the person acting inappropriately. How we manage these encounters to protect ourselves and others are, in fact, our responsibility. By standing up for ourselves, setting boundaries, and leaving harmful and abusive situations, we are also helping others. We are teaching others what’s right and what’s wrong and what they can and cannot get away with.

Not everyone deserves access to your softness. Too often I believe counselors and healers of all kinds are expected to be “nice” and to be available for everyone for anything all the time. This is far from what’s healthy, sustainable or realistic. Just because we’ve chosen a helping profession doesn’t mean we have to sacrifice our own well-being, safety or sanity. It’s taken me years to learn and truly believe that yes, I am kind and sweet and silly, but I am not “nice.” I am fierce. And that fierceness is not a flaw; it is one of my most valuable strengths.

A part of who we really are is defined by how we meet life’s most uncomfortable and distressing challenges. As counselors, we will experience some of these challenges in the workplace, so we need to be prepared to navigate these and to support others as they navigate them as well. We need more humanity, compassion and humility built into the systems that train and cultivate providers whose very effectiveness depends on their own humanity, compassion and humility.

I leave you with these three reminders: You are not a leader if you don’t build up those around you, those coming up behind you or those who are in your charge. You are not successful if you hinder the success of others. You are not a healer if you are not allowing yourself healing.

 

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Keep pushing to be better

I’ve learned so much from people who have shown me grace and patience. They showed me what’s possible and what I want to be. And I’ve also realized what I do not want to be from those who were self-focused, judgmental, and, to be perfectly blunt, haughty and elitist.

Some of my most painful and anxiety-filled moments with managers, co-workers and educators in the mental health field have taught me that I never want to:

  • Be someone who can’t be taught something new and is unable to value perspectives that differ from my own.
  • Advocate for “the way things have always been.”
  • Argue that “it’s really not that bad so nothing needs to change.”
  • Support something because “I made it through it, so everyone else should have to also.”
  • Hire people who are experts at something I am not and then fail to listen to or consider their input and feedback.
  • Assume I know what is best for another person.
  • Manipulate or coerce others into doing something against their will.
  • Use an offer of “feedback” or an explanation that I’m “just trying to help” as a way to rationalize violating someone’s boundaries.
  • Forget we all carry unseen burdens.
  • Doubt the validity of anyone else’s sincere effort or report of emotional pain.
  • Yell at a colleague. (Yes, really.)
  • Expect those I manage or supervise to meet my social and emotional needs.
  • Jump to conclusions and assume I’ve been told the whole story.
  • Throw someone else under the bus to make myself look good.
  • Make promises I can’t keep or say yes when my actions say no.
  • Disregard the needs of others and forcefully try to get my way.
  • Punish or delegitimize someone because they defend themself when they have been wronged or harmed.
  • Publicly call out people for what they’ve done wrong or criticize others in front of colleagues.
  • Tell someone else they are providing inadequate or subpar care or work because they aren’t doing things my way.
  • Look down on other helping professionals in the field who provide services to people in other ways aside from psychotherapy.
  • Consider myself a superior clinician because “I do a deeper, more meaningful and more important” type of therapy.
  • Promote the further disenfranchisement and oppression of already marginalized people.
  • Fail to look at the whole person and their situation.
  • Cause someone more harm because they were already struggling.
  • Put my own pride and ego ahead of anyone else’s health, success or well-being.
  • Fail to use my power to stop someone from hurting or mistreating others and enable them to continue perpetrating harm.
  • Allow unsupportive, counterproductive and inadequate people to persist without consequences or be rewarded.
  • Make others work harder and longer hours to pick up my slack, or if I’m their manager, tolerate someone being ineffective and causing an inequitable workload to be placed on others.
  • Offer mentorship but fail to mentor and focus on my own advancement instead.

I’ve also had the privilege to work with some from truly inspiring and wonderful people. I’ve witnessed many examples of bold and commendable actions that have left me amazed, and looking back, there have been so many seemingly quiet and mundane encounters that really were so important and affected me more than I realized at the time. These encounters taught me that I always want to strive to:

  • Give credit where credit is due.
  • Help others network and introduce people who may share common interests or support each other professionally.
  • Show others how much they mean to me.
  • Be there for others when they need it most.
  • Genuinely care about others, not just their work performance but their humanity.
  • Listen with patience and kindness when others express their concerns and how their work environment is making them feel.
  • Ensure others feel connected and that they know they belong.
  • Tell people you see how hard they are working.
  • Praise in public. Offer constructive feedback and conduct disciplinary actions in private.
  • Show up and be present during meetings.
  • Keep my word and do what I’ve said I’ll do when I’ve said I’ll do it.
  • Recognize if the success and/or advancement of others depends on me in any way, and if it does, then act accordingly and timely.
  • Remind people to care for themselves and encourage them to do things they enjoy outside of work.
  • Set boundaries and have a life. Log off on time, take time off, etc.
  • Stand up for myself and others.
  • Speak the truth to those who have more power than I do.
  • Make work fun and connect meaningfully with those around me.
  • Push back against things that are unethical or fraudulent.
  • Leave relationships and jobs that I’ve outgrown or those that are toxic and harmful.
  • Trust that others are doing the best they can.
  • Give support when it’s asked for and when it is not.
  • Take responsibility for my actions.
  • Be true to myself. By letting my playfulness, weirdness, creativity and passion be seen, I give others permission to be true to themselves as well.

Becoming the best version of yourself requires work and self-reflection. Here are some reflection questions I offer specifically related to the topic of hand:

  • What would it be like if I let go of my need to be perfect?
  • What would change if l gave myself permission to get things wrong while I am trying to get things right?
  • Am I living out my values in all my relationships?
  • How do I impact my clients, peers, mentees, co-workers and supervisees?
  • How do I see those I serve, manage and supervise? Am I seeing them as individuals I have responsibility for, or do I only see them for what they can do for me or how they reflect on my personal reputation?
  • How am I supporting and building up those I counsel, manage, supervise and work with?
  • Do I really have this person’s best interests at heart? If I do not, what am I willing to do about that?
  • What am I doing to ensure my clients, co-workers, peers, supervisees, mentees and others feel truly safe, valued and uplifted?
  • What boundaries do I need to strengthen?
  • Am I taking on anything that is actually someone else’s responsibility?
  • How can I be fierce and brave? Am I ready to take on the challenge of being assertive?
  • How can I prepare myself in case I experience pushback and negative consequences when setting boundaries and speaking truth to power?
  • Am I doing my part to take responsibility for how I impact others?
  • Am I open to receiving feedback? No, really, am I?
  • Are my own needs met? How am I ensuring I am getting my needs met and in a way that is healthy?
  • What am I doing to care for my own mental health, physical well-being and overall life satisfaction?
  • What priorities do I need to shift? What do I need to do more of? What do I need to distance myself from or let go of?

 

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Emily St. Amant is a licensed professional counselor and board approved clinical supervisor (in Tennessee). She serves as the counseling resources and continuing education specialist in the Center for Counseling Policy, Practice and Research at the American Counseling Association. Contact her at estamant@counseling.org. 

 

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Behind the scenes with a counselor-in-training

By Allison Hauser June 2, 2022

22 Comments

I put my phone down then put my hands on my head. What wasn’t my loved one getting about me being too drained to listen or utter a reply, much less give my input?

I sighed, resourced and breathed. Then, I put those same hands on the keyboard. In the engine I searched, “What it’s like to be a therapist-in-training.”

No results.

OK, “graduate student therapist … what to expect?”

Nothing.

OK, how about, “day in the life of a therapist … real experience.”

Nothing.

Oh, come on.

The resounding collective silence made my internal ruckus clang that much louder.

I had spent my entire day attuned to clients’ emotional, physical and spiritual mise-en-scènes, translating their output through my being to churn out guidance. I was out of processing. Feedback loops fried. I really needed someone else to come through for me. Please, just take one look at me and paraphrase my inner experience in a simple way. Show me you understand that I come as I am and, oh, while we’re here, if you don’t mind telling me where it is that I am …

But who will “therapize” the therapist? Typically, it’s another therapist (and then that therapist sees their therapist, who sees their therapist, and so on, until maybe that therapist sees the original and the ouroboros ingests its tail).

But my therapy appointment was on Friday. Plus, therapy requires talking, feeling and thinking, and like I said, I’m fresh out of all of that.

So, where was that quick listicle online that I could point to like, “Yes, that. That’s what’s going on”?

No processing. Just a gentle whoosh of the paper plane “Share” button and I could go night-night.

That listicle wasn’t anywhere to be found. No whoosh. (I went night-night anyway.)

The next morning, sheer frustration, chutzpah and divine guidance kicked in and wrote that article for me … and for you.

If you’re a counselor-in-training, licensed clinician or healer looking for an article to share when you’re too tired to explain to a loved one what’s going on for you, here’s that link.

If you’re a client, future counselor or that loved one … maybe this will provide insight into what’s going on for us behind the scenes.

I’m a year and a half into my master’s in counseling training. Here’s what it’s really like to be a counselor-in-training.

 

1) It really is training. Consider graduate school an initiation. I have sat in Indigenous, shamanic ceremonies and heard stories of their rigorous apprenticeships. It’s like that, but a Western version. You will be matched with a site supervisor, a school supervisor and many other supervisors as your guides. You will attend your own therapy. You will sit present with clients for hundreds of hours. You will have to sit with yourself for thousands.

2) There will never be any real “time off.” Even in the moments in which you say, “All right, this is it! My day to relax! Time to chill …” you will notice with keen sensitivity all the ways in which you can’t relax and don’t know how. Then you will process this, deep dive into your family of origin and cultural programming, and before you know it, instead of watching a dumb show on Netflix (nothing emotional, please!), you will find yourself Googling the unconscious mechanisms that fostered your patterns. Super relaxing.

Seahorse Vector/Shutterstock.com

You will finally log off of Zoom client calls for the day, only to start analyzing your housemate’s behavior based on a theoretical orientation you just learned. This will be hard to turn off and will be discomforting. I can’t unsee it, but am I really seeing what I think I am? Try on a different lens and the story changes … can’t unsee that either.

You will crave turning off your emotions. You will see all the ways in which you try to escape them. You will long for an hour of laughing with people who do their own inner work and won’t tell you anything that they need or are working on emotionally.

You will shudder when someone randomly approaches you for “free therapy.” Please, no, anything but that! You will be taken aback when you understand a friend’s patterns with greater insight yet incur mental jet lag when you’re still not quite sure what to do with said insight.

3) Be prepared to be called out. Confronted. Often. All the time. By supervisors, clients, textbooks, yourself — and then in relationship with partners, the earth, the cosmos. As you learn to deeply listen without reacting, you will become like an empty vessel. You will become detached from the self to observe You. You will assess yourself as if you were a case conceptualization. Am I, too, a clinical summary? Who is this captured on the page? This will feel dissociative and healing all at once.

Be prepared to knock your ego down by all of the notches. You will undergo ego death often, in the psychological and spiritual senses. Your core beliefs of who you are will be revealed to be an illusion, a veil you picked up somewhere but to which you have no authentic attachment. What even is this belief, and why is it in the back of my psychic closet?

There will be periods of absolutely no connection to something bigger, then times in which you can understand it all. Then, times in which you understand absolutely nothing again. If you can laugh at this, good.

You will begin to find ways to surrender — and see all the ways in which you don’t. You will question how you do everything. And I mean everything. How you react, communicate, talk, move, why you give, why you resent. Anything you do can and will be used (by you) to analyze you.

4) Relationships may require adaptation. You will sometimes log off of client calls and not be able to make eye contact with your family. You will need to learn to take a walk after work to clear your head and, realistically, sometimes you won’t be able to. Hi, uh, does my soul still shine through my bleary eyes?

Your loved ones may not understand why you can’t take their calls. Ugh. Or why you’re cold. Oof. Or why you’re tired beyond measure. Oh my. This can be isolating, but you also have such a deep understanding of others that you empathize with them too. Sure thing. Yet you can’t reach over that gap and extend yourself any further. You may feel powerless to show love when your cups (your capacities) are not filled. I’m sorry, not right now. We are experiencing an unusually high call volume. Please leave a message.

You will sometimes not have time for other relationships. You will think you have to focus on work and clients, but then you realize you can take clients only as far as you have gone. Your breakthroughs personally will carry over to your work professionally. The only way out is through — with everyone.

You will suddenly have very little capacity to hear of toxicity in others’ relationships. You will also stop coaching them through it and tell it to them straight or nod and stay in your lane. You’ll discover your limits and an enormous amount of reserve you didn’t know you had.

You will crave non-counselor-client interactions. You will cling to anyone with a light energy. You will want so badly to be friends with nontherapists, yet therapists will be the only ones who understand you in a certain way. This will be confusing and bittersweet and insular, but brilliant.

5) You will need to find new, stronger ways to self-care. You will feel frustrated when you rigorously tend to your cups and yet another client, assignment or shadow pings you into another learning lesson. You will feel like you can never fill your cups back up. This will feel daunting.

Sometimes you won’t be able to laugh or cry or respond to text messages. You’ll crave the simple things — being barefoot in dirt, the wind of spring, the blooms on the tree outside. Mother blooms, good day to you. You will stare and talk to the flowers and water the bushes. Nurture me as I nurture you. You will deepen your sense of connection to Source (God, Higher Power). Thank you.

You will have to learn what it’s like in your body to feel infiltrated by unfamiliar energies — those emanating from others both past and present, and from their past and present. You’ll have to learn how to clear those energies out of your system daily or hourly. You’ll have to remember what it’s like to feel your own energy and not get swept away in others’ emotions and stories. You’ll have to come back to yourself before you can approach friends, family and partners or you will transfer that energy onto them unwittingly. I won’t be perfect, as this is a practice.

6) Expect transformation and lots of it. If you used to undergo spiritual ceremonies, you will realize that you may no longer “need” this in the way you once thought. Every day will be a journey. Every moment carries potency and preciousness. You will also realize that I am the medicine. As you move through your own stuff, your desire for duty will expand. It is time to pay it forward — and backward.

Your grittiest shadows will emerge with a vengeance. This will be a daily confrontation, and you will need to learn to perceive this activation and flooding as “grist for the mill.” You will need to befriend any and all parts of you so that you can show up with minimal reaction and bias. Hello, demons, my old friends!

Sometimes you will fail at this and react “at” a client. Prepare to fail often. Practice being comfortable with failure. Perk up your ears the way you would with a client when your reactions to failure arise. As you evolve, listen for how these reactions change over time from hissing to droning to cooing.

They will tell you to trust the process, but the process will feel long and harrowing and may grow darker before lighter. You will cling to your faith, self-resourcing and anything that gives you center. Sometimes those things will stop soothing, and you will feel lost. Time to find other ways to come back to my inner home. There will be times when you no longer have any pacifier to ease the fuss. I accept everything I am feeling, including the lack of any current or future promise of relief. I am here with me, with it all. If you let it, this is where your power emerges in full.

There will be moments of immense breakthrough. This can be just as overwhelming as the breakdowns. You will find a newfound sense of joy, hope, peace and contentedness within. You may also suddenly see all the ways in which you were previously stuck for so long and mourn that. But then you will be filled with an immense pride for your commitment to tread and gratitude for all of your teachers, including the so-called stuckness. Sometimes you will go through periods of breakdown and breakthrough 10 times in the same day. This vacillation will ooze into your dreams, which you will record and analyze to the nth degree before reaching a point of humorous acceptance. Maybe there’s no meaning to those burnt pieces of toast I forgot to put jelly on before high school math class in space after all.

7) There will be times where you want to quit — don’t. This would be doing you a disservice. You know too much now about how and when and why you wish to quit. Learning to sabotage the self-sabotage will be next level. No subterfuge permitted within the self. This will make you impermeable to any kind of manipulation. Yet you will have to watch that you are too good at seeing, and sometimes (rarely) you will see things that aren’t there. A mirage or my intuition? You will have to remain flexible to understand that not everything is a pattern or a pattern that you have seen before. In yourself included. Wise, yet wise enough to be open to the new.

You will have periods of feeling inside-out. You will have moments where you absolutely cannot under any circumstances go any further. You will have crushing days yet accept that this is your path regardless of the weight. There will be days of endless criticism and then days of affirming gratitude for your skills. There will be days where your clients cling to you, or hate you, or make you the villain in their story. Go ahead and do what you need to do. You will feel invincible when you understand that it’s not about you and terrible when you take it to heart when you know that you “shouldn’t.” You will find compassion for yourself in all moments, the same way you do for clients.

You will start to see this work pay off in your own relationships. You will carry yourself with a more confident, happier energy. You will heal yourself and others. This is the work, and the work will ripple onto itself. You will feel a sense of mastery in “moving through” in all your messy glory. I know with my entire being who I am and what I am capable of. Always have and always will be. You will integrate this grace. I trust that I can navigate all types of waters.

You will feel freer than you did before you came here to training. You will understand that you have always, already been on this path. You will understand that there is no deviating from destiny.

As healers, we heal ourselves, but we also heal each other, together. The “You” here is really me. And the me, you.

Whoosh.

 

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Allison Hauser (she/they) is a graduate student in clinical mental health counseling with Northwestern University. At the time of writing this, they are completing their master’s-level internship and are set to graduate in 2023. In addition to being a counselor-in-training, consultant, speaker and writer, Allison walks the lifelong paths of professional international artist, healer, spiritualist, activist and musician. Find their work at allisonhauser.com, connect with them on LinkedIn, Instagram, Twitter or YouTube, and contact them at allisonhauser2023@u.northwestern.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Preparing for private practice

By Katie Bascuas April 6, 2022

2 Comments

For many counselors, making the leap into private practice can feel like something of a stab in the dark.

As Logan Williamson, a licensed professional counselor (LPC) in New Orleans, points out, most graduate counseling programs don’t teach aspiring clinicians how to run a business. “It’s unfortunate because universities seem to think that the only thing you’ll be doing for the rest of your professional life as a therapist is talking to people and writing notes,” he says. 

So, while many counselors are well-versed in theory and techniques, they often find themselves learning the administrative side of running a private practice as they go. But there are lessons to be learned from clinicians who have already blazed a path and established successful practices. 

That’s how Williamson learned much of what he needed to know to get started with his practice, New Orleans Counseling, nearly 12 years ago. “I just talked to people,” says Williamson, who was unafraid to approach other therapists and even other business owners for advice. “There is time that goes into figuring it out, and I guess that’s an animal unto itself, and you really have to put the work into it.” 

Erin M. Moss, an LPC based in Buffalo, New York, had a somewhat similar experience to Williamson when she started her practice, Erin M. Moss Mental Health Counseling, six years ago. “I had no road map or role model to look to,” says Moss, who struggled to find other African American clinicians in her area whom she could relate to and who had already established private practices. “There were about two other people that I knew of that looked like me,” Moss says. “I didn’t realize that I was filling a void in my community.”

Meanwhile, for Duncan Price, an LPC in Washington, D.C., launching a full-time private practice seemed like the next step in his career after working in community mental health and managing a part-time practice on the side for several years. Yet the shift to full-time private practice still provided Price with some surprises, from working through the administrative side of running a business to confronting issues that challenged his personal and ethical beliefs.

In reflecting on their experiences, Price, Moss and Williamson all have invaluable advice to offer other counselors who are hoping to go out on their own. While all three clinicians faced similar challenges on their road to establishing private practices, they also encountered some unique experiences and opportunities that helped to shape not only their practices but also their identities as mental health professionals. 

As Moss acknowledges, there is no one way to do private practice. And that may represent one of the most important pieces of advice about running a business as a counselor.

Prepare for insurance hurdles

One of the biggest learning curves associated with starting a private practice involves dealing with insurance. Navigating the insurance landscape can be intimidating and may even keep some counselors from maximizing the potential of their private practice.

“The good thing about taking insurance is that it keeps you very busy,” says Price, who admits that he sometimes questions his early decision to accept insurance because of the added work and responsibility that accompanies it. “I don’t think I was quite aware of the level of administrative duties, particularly with electronic filing and all the entities that are involved to get a claim processed. It took a while to get it working smoothly.”

Price adds that he has sometimes grappled with the idea of whether to take insurance at all. “It would be nice to make more money, but I can’t see myself only seeing clients who can afford to pay out of pocket or to wait for an out-of-network reimbursement,” he says. Price’s practice, DC Recovery Counseling, accepts both private insurance and Medicaid so that he can maintain a connection with the clientele he worked with in community mental health. 

Meanwhile, for Williamson, fear of the insurance world kept him from establishing a full-time caseload of private practice clients as soon as he would have liked. “I felt that there was always a sense that I wasn’t going to get paid by the insurance company for the work that I would do,” Williamson says. “So, I didn’t want to put in time to not get paid.”

After his initial hesitation, however, Williamson eventually began accepting insurance and says his practice grew substantially. “I would say that after I started taking insurance — and I only take two [providers] — it took me six months, maybe, to get a caseload where I was at 20 patients a week.”  

Williamson advises those who are interested in taking insurance to start the credentialing or paneling process early, especially if they are jumping into private practice full time as opposed to building it up on the side. The entire process can take several months — possibly longer with errors or oversights in the application process — and it can turn into a frustrating waiting game with financial consequences. 

“Insurance companies will put you through a process and after three months, they’ll kick something back to you, and they’ll say, ‘You didn’t initial on page 12 at the top,’” Williamson relates. “Now you’re kicked back another month at least or two. That’s really deflating when you’re trying to build up a business.”

Dealing with administrative headaches, which can often be insurance related, was also a bit of a shock for Moss. “There are kinks in every organization — you hear that everywhere you go,” she says. “What you don’t realize is that when all of that is under you, there are a lot of fires that you have to deal with.” 

For example, despite outsourcing her billing, Moss still encounters issues where an insurance company disputes or retracts a payment. When that happens, the onus of fixing the issue falls on her, whether that’s rectifying the problem herself or spending the money to have someone else fix it. “When you’re working for someone else, you don’t have to worry about those things,” says Moss, who acknowledges that managing the operational side of her practice has been one of her biggest challenges.

Tap prior experience

Moss, Price and Williamson all note that the realities of the administrative side of running a private practice can come as a shock. At the same time, all three point to the value of previous work experience in helping them navigate the process of establishing a practice.

Williamson, for one, acknowledges that his path to full-time private practice was a windy one, with several pit stops along the way. After leaving a thriving group practice in Colorado to move to New Orleans to be closer to family, Williamson worked several jobs in the mental health field before returning to private practice full time. He credits those jobs, which included a stint at a university counseling center, time running an applied behavior analysis clinic at a local school, and a position at a major insurance company doing inpatient psychiatric reviews, with providing him good insight into business management. 

“It was on-the-job training that I was able to take with me,” says Williamson. For example, the firsthand experience of managing billing and credentialing for an organization gave him greater confidence and understanding that he could do it later on for himself in private practice. “I think that was helpful to understand — knowing that if I needed to, I could do it, that it’s not impossible.”

Moss similarly credits jobs earlier in her career with giving her a strong foundation in not only business skills but clinical skills. “I worked everywhere, and my case management background has always been strong,” she says. “There was a client sitting with me yesterday, and she said she wanted to open a business, and right away, I gave her the contact for the Canisius Women’s Business Center. It was those early years of going into homes and linking people with services — I can still go back to that stuff.” 

Price advises counselors interested in starting a private practice to not underestimate the importance of developing strong clinical skills. “I think it takes more experience than people think it does,” Price says of clinical readiness. “I’m not saying you have to be a master, but I think it helps doing it on a part-time basis with supervision while also getting really solid training in different modalities.”

Price recommends that clinicians, especially those just starting out, seek additional training at local schools or workshops to continue expanding their skill sets and keep pace with evolving techniques. “I would strongly suggest if someone is thinking of starting a private practice, to make sure that they’re ready clinically and that they’re also investing in continued education,” he says.

Create a support network

Seeking out continuing education can also be an avenue for counselors to expand their professional networks, which can in turn be a valuable resource for private practitioners who are working solo. 

“It’s tempting to think of it as it’s only on you, but if you don’t have a professional network of people that you trust to help you make decisions, then invariably you’re not going to make the right one and put yourself at risk,” Williamson says. 

He gives the example of working with a client who was going through a divorce and having his clinical notes requested by the client’s attorney. Not wanting to be involved in a legal matter, Williamson called a clinical colleague who specializes in client issues related to divorce and asked for advice. “He helped me write my note for that session so that I could send it to the lawyer and not be called into court,” Williamson says. He also provided the client with several therapy referrals that he received from another professional contact who had a wider network in the New Orleans area. “So, I was able to take care of the patient, protect my license and also protect my time because I didn’t have to go through all of that,” Williamson says.

A solid professional network is not only a good place to turn to for advice and consultation. It can also provide socialization and collegiality, which can be lacking in private practice.

“There’s no one next door to say, ‘Hey, girl, what are you eating for lunch?’” says Moss of the lack of office camaraderie that can come with running one’s own business. She adds that she recognized the solitary nature of private practice early on. Over the years, she has actively created opportunities to build in socialization, whether that takes the form of doing administrative work occasionally at a coffee shop where she can be around other people or serving on boards and joining associations and groups where she can volunteer. 

“I’m always at the table learning from like minds in the mental health community and groups that represent some of things that speak to me and my clients,” says Moss, who currently serves on the boards of two mental health organizations in her area. “Even though I’m my own boss, I have always had my foot in the community.”

Williamson also recommends the idea of board membership and suggests that it can be a good way to give back to the community, especially if a counselor’s private practice is less community oriented. “It’s super rewarding, and it’s a low barrier for entry,” says Williamson, who served for six years on the board of a local public service provider. “The commitment is only what you want to put into it.”

Establish boundaries

Given the time commitment that comes with running a business and managing one’s professional network, and then balancing all of that with one’s personal life, setting and sticking to boundaries is another invaluable strategy to implement early on when starting a practice.  

“I used to take clients as they came,” Price says. “And just emotionally, physically, mentally, you can only work with so many clients, especially if some have difficult cases. Trying to find that balance has been hard for me.” 

It can be challenging to turn clients away, especially given the current climate of high need, but prioritizing boundaries and work-life balance is key to avoiding burnout, Moss says. “We’re processing trauma, so it’s so important to have space to not do that,” she emphasizes. “It’s important to have space and time that is just yours, whether you’re connecting with your family or friends or just yourself.”

Moss credits her early years of working for organizations and agencies with helping her realize the value of establishing a healthier work-life balance. “One of my first clinical jobs right out of grad school, they gave me a laptop and a BlackBerry, and I was so excited — like, ‘Who has a BlackBerry?’ Little did I know that was the beginning of my phone never stopping ringing,” says Moss, who now implements a hard stop for herself at 6 p.m. every day. “There’s never enough time, and there’s always something to do, so you literally have to say, ‘I’m done working.’”

Structure for the long term

Although managing a private practice — like any job — may come with certain headaches, it can also afford counselors the opportunity to create and build their dream business. 

“Essentially, private practice is what you make of it,” says Moss, who knew early on that she wanted to create a “super practice” while also developing a professional identity as a mental health advocate. “This is really your show.” 

As part of a small community of African American counselors in Buffalo, for example, Moss realized while building her practice that her scope of practice might not resemble that of other counselors, especially white counselors.

“For me, building a practice and gaining clients, it wasn’t as simple as opening the doors,” she says. “Black people needed to know that it was OK to come to therapy. I had to do a lot of work breaking stigma and free speaking to let people know that this is normal and this is a good thing.” Through that early groundwork, Moss realized a desire to become an advocate and public speaker on mental health issues. That goal has become part of her larger business strategy for her practice and her work as a mental health professional, which she hopes to continue to expand. “I’d love to do more outreach to the Black community,” Moss says. “It’s so needed.”

While having a personal brand or specialty can set private practitioners apart in the market, so can good customer service skills and transparency, says Williamson, who employs a strategy of fostering long-term relationships with his clients from the outset of their work together. 

“I set up the expectation that this is more like a primary care visit for their mental health and they’re developing a relationship with me that can last a lifetime,” he says. “So, we work on the problem at hand and get that taken care of, and they feel good and are discharged, but they always have the ability to come back and talk to someone who knows them and cares about their experience.”

Establishing strong relationships with clients is not only good for business but can also help remind clinicians of their reasons for entering the field or starting a practice, which often lead back to being of service and helping. That sense of purpose can be a source of motivation and encouragement when weathering the more challenging times of business ownership, Moss says. She advises other clinicians wanting to step out on their own to avoid too much overthinking and lean into the process. “Relax and rely on why you got into this in the first place,” she says.

Branislav Nenin/Shutterstock.com

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Katie Bascuas is a licensed graduate professional counselor and a writer in Washington, D.C. She has written for news outlets, universities and associations.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

How to land an internship you’re excited about in 48 hours or less

By Wesley Murph January 19, 2022

2 Comments

The accident happened on a sunny Saturday afternoon.

I was driving home from my internship site, where I had seen clients that morning, when I stopped at a red light. As I changed the radio station on my car’s stereo, I heard screeching tires and crunching metal.

Then, as if I were in a Steven Spielberg movie, a maroon-colored car launched over the back of my car. It landed on its side and skidded down the asphalt against oncoming traffic.

As I stared at the unfolding scene, something big plowed into the back of my car, pushing it into the car in front of me. Glass shards and taillight debris rained down inside of my car.

I glanced in the rearview mirror and saw green liquid spewing from the van that was now embedded in my car. I feared that my car would explode and that I would be burned inside. As quickly as I could, I opened the door on my car and stepped on to the slick pavement. I glanced around to make sure I wouldn’t be hit by an oncoming car and heard a woman screaming from behind the maroon car. I immediately dialed 911.

“There’s been a bad accident,” I said to the 911 operator. “I think people are hurt. Please send help quickly.”

Minutes later, several police cars arrived and began directing traffic. A firetruck and an ambulance arrived next. A first responder said the woman driving the maroon car was shaken up but was otherwise OK. Just to be safe, they were taking her to the hospital.

I sat down on the sidewalk, grateful that nobody was seriously hurt. But when I looked at my car, I knew it was totaled. I also knew I would have to find a new internship site because my site was 60 miles from my home and the majority of clients I saw were in-person.

A few days later, I emailed my internship coordinator at the graduate school I attended and told him what had happened. We met on a video call, and he said it might be three months before I was placed at a new site. “If that happens,” he said, “you may not graduate on time.”

My pulse quickened. I had been in graduate school for nearly two years, and I was six months away from graduating. I needed 150 additional direct client hours to walk with my peers, and there was no way I was going to wait three months to find a new internship site.

So, I put on my marketing hat with one goal in mind: to find a new internship site. I never imagined what would happen, but I am grateful to say that I received five internship offers in 48 hours.

I would like to share what I did so that others looking for an internship site can find one they are excited about. Or you might tweak my campaign to connect with potential supervisors and land a new job.

I can’t guarantee the results if you follow this campaign, of course. But I can say it will help you connect with counselors in your area. It will also strengthen your sense of confidence and freedom by giving you more control over your future.

Google search

The first thing you need to do is find clinical supervisors for whom you want to work.

I played around with keyword searches in Google until these searches brought me to a webpage containing nearly a hundred clinical supervisors in my area. The webpage had a picture of each supervisor, a paragraph about the supervisor, and the supervisor’s email address and phone number.

I carefully read each supervisor’s bio until I found 25 whom I wanted to contact. I then researched the various supervisors using Google to find out more about each person. I went to each supervisor’s website, if they had one, and read their “About Me” page. I wanted to make sure that I genuinely connected with each supervisor before reaching out to them in an email.

I recommend that you complete this step too. Research the clinical supervisors in your area until you have a list of folks you want to work for. Really get to know these people. What clinical theories do they practice? Have they published any studies? If so, what are the results of those studies? How did they get into counseling? Have they written any blog posts or been a guest on a podcast? If so, what did you learn from their post or podcast? Do a deep dive into these people so you can honestly say to yourself whether you would want to work with them or not.

Next, I encourage you to create an Excel or Google Sheets file to help you keep track of your campaign. I created a new Google Sheets file using these headings:

  • Full Name
  • Email
  • Phone
  • Specialty
  • When Contacted
  • Response
  • Result

I filled my Google Sheets file with the 25 clinical supervisors I liked and connected with the most. I then sent a sincere and personal email to each of these supervisors.

Cytonn Photography/Unsplash.com

Email marketing

Here is what I wrote in the email:

 

Subject Line: Clinical Supervision?

Hi (First Name of Supervisor),

 

My name is Wes.

I found your contact information online, and I connected with you because ________. I am reaching out with a question about clinical supervision.

I am completing my master’s degree in clinical mental health from Northwestern University. I am supposed to graduate in March 2022.

Last January, I started my clinical hours at an internship site in Salem, Oregon. I live in Portland, and in August I was involved in a car accident that totaled my car. I am unable to drive to Salem to complete my clinical hours and am looking for a new internship site closer to my home.

Do you know of a licensed mental health clinician in Portland who may be interested in letting me finish my clinical hours underneath their supervision?

If not, do you know someone I can contact who may know someone?

I appreciate you for taking time out of your schedule to read my email.

 

Very respectfully,

Wes

 

Notice how the first paragraph has a blank line. This is where you put the information you gathered from your research. The more specific you are, the better connection you are likely to make.

The third paragraph contains my story. It grabs my reader’s attention because it’s heart-wrenching. You may not have a story like mine. But that’s OK. You can tell your contact another powerful reason why you would like to work with them.

The results

I emailed 25 potential supervisors on a Thursday. I received 18 responses and scheduled video interviews with five of them. I interviewed with one supervisor that Thursday night, three on Friday and another one the following Monday. All five of these amazing supervisors graciously offered to take me on as their intern. Working for any of them would have been delightful, but I chose the one that aligned best with my goals.

I relayed this information to the placement team at my graduate school. A day later, the site at which I wanted to intern was approved.

I also responded to each supervisor who got back to me. I told them I was thankful that they took time out of their schedule to try to help me and that I hoped we would bump into each other at a professional conference in the future.

I made sure to sincerely thank the four sites that offered me an internship but which I politely declined. This is respectful and maintains the relationships I established with each of these generous supervisors.

I was amazed at the outpouring of support from the counseling community in my city. The counseling community in your area is likely just as supportive. All it takes is a sincere and genuine email to open a conversation with someone you admire and want to work for. Who knows what will happen? But this process gives you some control over your future instead of simply hoping that fate is on your side.

 

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Before he began a master’s degree program in mental health counseling, Wesley Murph owned two small businesses, including one that was featured on The Dog Whisperer with Cesar Millan. He currently helps couples communicate more effectively so that each person feels valued, heard and appreciated. He also works with men to resolve anger issues and relationship conflicts that are lowering their quality of life. You can find him at BuildingBetterMenPDX.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Four lessons in building therapeutic relationships

By Anne-Marie Burke November 9, 2021

3 Comments

Tell me if this resonates: You enter graduate school bright-eyed and bushy-tailed, fresh with hope and galvanized by various novel theories that promise to offer you some sliver of competence when you enter the counseling room in barely a year’s time. Like any counselor-in-training who takes seriously the ethical imperative to “do no harm,” you are practicing basic skills, reflecting on how developmental models and family systems reveal your own skeletons, and thinking to yourself, “Surely these heady ethics issues won’t come up in internship.” (They do — immediately.) 

But you are still stuck. There are nagging questions jangling in the back of your skull: “How in the world do I counsel someone? Where do I even begin? What do I do when I am totally lost in a session?” 

Seeking to know the future and set my expectations, I consulted with a diverse milieu of practitioners, doctoral students and professors. Nonetheless, satisfying answers eluded me. As my anxiety grew, I was forced to seek comfort in the cozy lap of our profession’s favorite platitude: Trust the process.

Having since finished practicum/internship, I can now appreciate the futility of trying to anticipate all that this defining year has in store for counselors-in-training. Although I cannot tell you what to expect, I can shed light on the complexity of your experience and encourage you to lean into the promise of the therapeutic alliance.

Counseling’s heartbeat

The importance of the therapeutic alliance for client change cannot be overstated. It is the heartbeat of each intervention, technique and theoretical approach in the counseling profession. Furthermore, scholarship abounds with evidence of its effectiveness in the field.  

But what is the therapeutic alliance? An agreed-upon definition is difficult to find, but two common threads are routinely mentioned:

  1. A mutual respect is present between the client and the counselor as they embark on the shared purpose of resolving the client’s issues.
  2. Once safety and trust have been established, honest disclosure from the client is required, alongside support and nonjudgmental feedback from the counselor. 

These key aspects of the therapeutic alliance have their own implications: How do we establish mutual respect? How can we ensure safety and trust? Instead, I have simplified the therapeutic alliance down to one thing: figuring out what the client needs from me in every moment. 

Branislav Nenin/Shutterstock.com

Despite initially feeling underqualified to counsel clients — some of whom were at their most vulnerable — I was not ill-equipped. Theories and hypotheses lit my path, while companions such as horizontal and vertical processing, reflecting and silence never failed to fuel my clients’ process of discovery. These tools, along with many others, emboldened me to take risks with clients that, in turn, spurred them to “try on” emotional intimacy with me.

But in the beginning, it was not pretty. Impatient with the skills I was learning, I lurched from one to the next, hoping something would stick. For example, when an open-ended question and simple reflection did not produce the kind of insight I intended, I would jump to psychoeducation or a more complex reflection rather than giving space to my client to process what I had said. Thanks to good feedback from my supervisor and group members, I gradually slowed the pace of sessions down considerably and challenged myself to “be” with my clients intentionally. As I became purposeful in my skills, particularly with reflections, rather than panicking from one to the next, my clients relaxed with me and also became purposeful in their responses. This had an opening effect that laid the groundwork for safety and trust. 

Still, I made mistakes. I went headlong into directions that clients did not buy, catapulted to interpretations that pushed them away and introduced concepts that they simply could not wrap their heads around (e.g., they have value as a person because they exist, not because of how they perform). In such moments, the therapeutic alliance can crack; it can even rupture if these moments are frequent. Even the smallest misstep can create a distance that did not exist before. Recognizing those mistakes and renewing my commitment to figuring out what the client needed from me in that moment put me back on course. 

Doing this often allowed many of my therapeutic relationships to flourish. Because of this, I found that I could also offer difficult feedback to my clients. I believe that clients show up in the therapy room similar to how they show up in everyday life. Knowing this, if they engage in a pattern of behavior with me that is detrimental to building relationships, I judiciously offer feedback regarding their impact on me. 

For example, one of my clients struggled with impulsivity during conflict. She needed to resolve issues on her terms, leaving little room for how her partner processed conflict. During a session, I noted her compulsion to speak over and over again about the conflict as if I were not even there. Because I trusted our relationship, I was able to say, “I know you care deeply about the people you love, and this conflict is wearing you thin, but as you talk about it, I feel an overwhelming need from you to repeatedly say everything you need to say rather than engage in a conversation, and this makes me feel distant from you. I wonder if others in your life feel this same disconnection when you are attempting to resolve a conflict?” 

Her normally tough exterior immediately crumbled, and she burst into tears. She responded, “I thought I was doing everything in my power to overcommunicate and show how much I care about this person, but I am definitely not doing that.” It was the therapeutic alliance that helped the client believe me because she knew I cared about her. This exchange and realization led the client to engage in productive interpersonal work from there on out.  

Navigating the frontier of uncertainty

Perhaps all this talk about therapeutic alliance comforts you. You are skilled at constantly navigating your clients’ specific sensitivities and acknowledging your own mistakes. I hope this brings you substantial peace of mind. But do not be deceived. There is something else bubbling underneath all of this, and it is magical.  

The great pleasure of the therapeutic alliance is not that you can control it. In fact, the opposite is true. You have no clue where it will take you. For instance, I recall a time when one of my clients was laughing about their dog’s odd name one moment, and the next they were divulging their mother’s rape and their subsequent childhood in victim protection. 

In every session, no matter how I prepared, I landed in uncharted territory. This uncharted territory is the fertile but painful frontier of uncertainty. In this frontier of uncertainty, I made it my singular responsibility to shepherd properly by modeling presence, authenticity, cognitive flexibility and emotional agility. As a practicum/internship student, I noticed four counterintuitive ways to navigate this frontier and build powerful therapeutic relationships. 

Lesson No. 1: Do not infantilize clients. I treat clients as the adults they are by going over my center’s attendance policy with them and charging them for no-shows and late cancellations. This can lead to some awkward conversations, and, candidly, it is tempting to not charge them. Yet when I do have these conversations, clients show up, work with me in advance to reschedule their appointments or tell me to charge them because they know the policy. 

In other words, they treat me as a human whom they can affect with their actions. It is an invitation for the client to meet me at a boundary, which, by nature, brings connection rather than pushing us away from each other. Resistance to paying indicates other boundary issues that are worth exploring together. 

Lesson No. 2: Allow clients to be the experts of their own lives. Remember the abrupt drop into uncharted territory that I mentioned earlier? Generally, a big dose of anxiety accompanies it. Here, instead of asking myself what is going on with the client right now, I quickly ask myself what is emerging inside of me at this very moment. A quick scan of my internal environment usually tells me that I am too preoccupied with looking incompetent or fearful of disappointing my clients. This makes me overly involved in my own need to find answers and not involved in my clients’ search for their answers. 

My goal is to help clients make meaning of their life, not ascribe my meaning to their life. Recognizing whose search I am in — mine or theirs — and then permitting myself to not know their answers generally allows me to enter back into the session and sync into their process. This takes us to places that my limited understanding never would have given us access to. 

Lesson No. 3: Allow clients to feel that they matter to us. One of the most effective ways I have done this is simply to ask my clients, “Are you getting what you need?” Better yet, I ask them to tell me what they got out of the session. This helps both of us know where we stand. 

We are taught in counseling skills classes to summarize a session. Doing so demonstrates that we have listened thoroughly and, more important, ensures that the client feels safe and seen. If I have not done this throughout the session, then asking the client to tell me what they got out of it at the end is not going to bring us closer. But if I have gone to great lengths to show that I have seen and heard the client throughout the session, then asking them to summarize is a good way to see where we are on the same page and where we are not. 

What stuck? What did not? We see what we are creating together, which further bonds two people. (Note: I am careful here to ensure that clients are not giving me answers for my own ego. When we have a strong bond with our clients, they might want to please us. Teaching them to discern their progress through what Carl Rogers called their own “intrinsic valuing system” rather than our “conditions of worth” is critical for their long-term success.).  

Lesson No. 4: Seek out exceptional supervision. My supervisor sharpened my attunement to the therapeutic alliance by leading me to the root of my countertransference. 

In a couple’s session, I was determined to amplify a boyfriend’s voice by redirecting to him each time that his girlfriend would cut in. It had begun sinking in that their relationship was in jeopardy, and, naturally, she was in a lot of pain. But instead of validating her pain, I stayed the course to see what was happening inside of the boyfriend. In a sense, I cut her off emotionally. 

This backfired in two ways. One, there was an insurmountable distance between the girlfriend and me for the rest of the session. And two, rather than continuing to express his own emotions and thoughts, including his desire to end the relationship, the boyfriend turned his attention to comforting and validating his girlfriend. She could not see his pain without her pain first being acknowledged, and he was in pain because he was causing her pain. And I missed it because I had my own agenda. How did this happen? 

Upon listening to the recording of the session, my supervisor nonjudgmentally asked me what my feelings were toward the girlfriend to have skipped such an important reflection. I answered that I had not wanted to allow her to monopolize the conversation in yet another session. But there was more to it below the surface. 

At the beginning of the session, the girlfriend had accused me of turning her boyfriend against her. This had caused a high amount of tension in me and a desire to defend myself, even though I knew her accusation was only a distraction from what was going on between her and her boyfriend. I knew it was much easier to blame me than for her to see the signs that had been present in their relationship for months. 

I processed the accusation as therapeutically as possible, trying to redirect her to the boyfriend’s wishes to end the relationship. But in truth, I was angry and caught off guard. I unconsciously cut myself off emotionally to her in order to align with him. This resulted in all of us being isolated from each other.

Surprise! They never came back. I failed. But in this failure, my supervisor helped me uncover an invaluable piece of guidance: I should not be afraid to ask myself what I am feeling toward a client. I find that my answers are often surprising and worthwhile. I must then assess honestly whether my feelings are affecting my desire to build a relationship with the client. Are these feelings hindering my ability to prioritize my client’s growth? This does not mean that I should just tell clients what they want to hear, but it does mean that I should guard against withholding empathy from them because of my own negative feelings.

The catalyst for change

Despite implementing good tools to enhance the therapeutic alliance, I have had several clients who simply did not want me to continue as their counselor. In some cases, it may have had absolutely nothing to do with me personally. It may have been that I reminded them of someone, that my age made them uncomfortable or any number of other reasons. One former client came to her second session only to tell me that she did not want to continue working with me and not to even bother giving her referrals. 

On the other hand, I witness so much change in other clients’ lives that I overflow with joy. I celebrate those moments and allow fulfillment to cascade through my body. Then, I stop and reflect. Coupled with those moments are the tentacles of hubris tempting me to believe that I am bigger than the therapeutic process. I am not. The therapeutic process — and my clients’ engagement in it — is the catalyst for change. It’s not about me. 

I stay bound to the therapeutic process with my clients and bound to my role in their process. I am not bigger than this process. This truth buffers me on the days (I think) I am totally ineffective and, conversely, humbles me on the days I want to take more credit than I deserve. Good news: This reality testing is also a good way to prevent burnout. 

As I write this, I find myself wishing desperately that I could tell all counselors-in-training what to expect, but I cannot. You will engage in dozens of new therapeutic relationships, all of which must be watered, pruned and loved differently. Those of us who have come before you are cheering you on. Keep doing your work, and trust that if you do, you will get more comfortable in not needing to know what to expect.

 

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Anne-Marie Burke graduated with a master’s degree from Georgia State University’s mental health counseling program. She is a clinical mental health counselor and national certified counselor practicing at Samaritan Counseling Center in Atlanta. Contact her at amburke@samaritanatlanta.org.

 

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