A week ago, my longtime friend Stan Smith MSW asked me to do some talks at USC. The students were fantastic- they were really attentive, experienced, knew a lot of stuff, and so cool for me to see- were really into being of service in a climate that often doesn’t support our efforts.
The talks were focused on the idea of “legitimate suffering”, mostly. It’s an idea stolen from Carl Jung, an idea near and dear to my heart for a bunch of reasons. As I always do, we spent some time addressing questions that came up from students about doing The Work.
In both classes, the question came up, “What advice do you have for someone new in the field?” This question mirrors too what a lot of our clients come in with. I think the underlying theme of this for both mental health professionals and clients is, what do we do to give/get help?
It can be a complicated question, on both sides of the office/clinics etc. As relates to depression, abuse, loss, addiction, anxiety, self esteem, relationships… whatever, if we intend to serve people suffering with it, we have a responsibility to an organized body of material that we think can be helpful. My experience is that if it is used, it’s often helpful, when it’s not used, it is not. Rarely is it simply not helpful at all. The biggest mistake in my view, is simply not having a philosophy and principles for such things. They should be agreeable both for client and caregiver, and of equal importance- they should be practical, empirical… things we can point at, that someone can do to improve the quality of their life, relationships, and decrease suffering from the things it is in our purview to treat.
We get some practical information as clinicians, some ideas framed by some “theoretical orientation” (Cognitive Behavioral Therapy, psychodynamics, Dialectical Behavioral Therapy, Jungian Psychoanalysis, etc). Often though, it reaches what some patients need, but usually in the context of that orientation specifically. It’s not to say that this information can’t be generalized, but it misses some of the fundamental aspects of what I think I’m being asked by a new clinician when they ask me what advice I have for someone new in the field. This is talked about even less with “seasoned” or experienced clinicians.
More specifically, I think I’m being asked things like;
“How do I develop my style?”
“How do I provide great service?”
“How do I avoid burnout?”
“What can I do to develop my skills in an ongoing way?”
“How do I set and problem-solve boundary issues with clients?”
“What should I do to pass my licensing exams?”
“How do I set fees/schedules/obtain clients/deal with insurance companies/etc?”
“What can I do to get a job, and to stay busy in this as a career, when the economy is bad, insurance companies are difficult, agencies and hospitals are few, and there’s little funding available?”
“How do I deal with difficulties with specific clients, or colleagues?”
As these are big questions to be tackled, and there’s certainly more, it’s better served to answer them in a book (or in school, but that happens little). Sadly, there’s really only two practical guides for therapists that specifically address these kinds of considerations. Finally getting to the point, here’s a truncated list of ideas that we discussed in these classes that I think might be helpful in some of these areas.
1. Make sure you’ve endeavored to work through your own stuff. We’re already notorious for “going into the field to figure out ourselves and our own families”. Get therapy. Go to support groups or twelve step meetings. Write, and share it with other people. Have a meditative practice…
2. Focus on putting yourself out of a job, and the rest is easier- surviving, avoiding problems like job loss or getting referrals or whatever. High quality patient care is the best way to do anything, as far as I’m concerned.
3. Spend time mulling over what a high quality of attention is, and use that everywhere in your life. Kids don’t just equate love and attention, they also feel the quality of that attention. Same with our partners, and clients. In our world, it’s one of our most-taxed commodities, and one of the greatest sources of creating or perpetuating problems. It might be argued then, that it’s one of our most viable means of solutions.
4. Read Sheldon Kopp- particularly “If You Meet the Buddha on the Road, Kill Him!” and “Back To One”. The former has the subtitle, “The Pilgrimage of Psychotherapy Patients”. Would argue as much as it’s great for them, it’s better for us. The latter is one of the two books I know about that are a practical guide for clinicians. In it, he talks about a lot of the questions above- even how he deals with running into a patient in an elevator.
5. Have principles you live your life by, and share ’em with clients. One of the things I tell my clients the first day is, I have a responsibility to try to be the healthiest person in their life. For me, that comes from principles. On a totally unrelated note, since many ask, this is also part of the source of the pet name “April 30th” for my practice. It helps as an anchor to remind me of what those principles are. It’s also a great means of putting me out of a job- if my clients leave with principles, they have methods of problem-solving, so that they don’t need to stay with me to solve them as they come up. At least, until they get good at using those methods.
6. Survive school. It’s a place to learn, not get straight A’s. There’s nothing wrong with that in and of itself, except for the fact that many of us with self esteem/perfectionism problems of our own, this can become a terrible handicap. School, in my opinion, is designed to expose us to what legislative and regulatory bodies see as the most fundamental body of material we, and they, have a responsibility to, that insures we provide service safely and ethically. It therefore almost can’t be a place where we really learn how to put ourselves out of a job. That, in part, is why I think our ongoing efforts are called a “practice”. Doing school in a way that is unhealthy (feeds perfectionism, supports us trying to fix a flagging self esteem, etc) makes us less useful long-term.
7. Remember why you got into the field in the first place. This one elegant idea can get us out of a lot of emotional, ethical, and practical scrapes. On a related note, I’ve seen some of us get so fearful of our ability to stay busy that we forget and/or compromise this idea, to the detriment of not only our clients, but in maintaining a base of people to care for. If we operate in the spirit of helpfulness, my experience has been that we can more effectively stay in jobs and clients to take care of- more than any “marketing strategy”.
8. Have a life outside of The Work. This is also a responsibility to our clients, I’d argue. Nature seems to reward diversity in most every environment. This is true too, in being a mental health provider. It keeps us culturally aware, maintains our own health in different areas of our lives, and asks us to use skills we try to teach clients. Hobbies, activities, intellectual curiosities, responsibilities, and of course relationships- but more on those below.
9. Accept that the licensing exam is unlikely to make sense, in light of what you intended for the field. Referring back to #6, my experience with MSWs, PhDs, PsyDs, MAs/MSs and etc, few of us felt like the licensing exams really asked us to know what we thought we should when we took them. This was true too, of my licensure as a Psychiatric Technician (all the way back in 1988 or so). They help regulatory bodies insure that we are safe to work, and little else.
10. Have relationships, first by working on how to be worthy of them, and make them matter. So often, I have people ask me how I’ve not just survived, but been passionate about doing The Work since 1984. That is a deep question, and really goes to how I deal with all of my feelings about all my life… hence, too big for a blog. Having relationships though, is a huge part of that. We all want love, fun, humor, depth, responsibility and etc, but my experience is that we often focus on getting these things more than we do being these things. Being these things I think makes us more likely to have them in a way that has quality, and certainly, enables us to live more gracefully with living a life where we often have to wade through human suffering. This does more to prevent “burnout” than any amount of exercise, hobbies, and etc (though I of course think these things are important too.
As per usual, this is a really truncated list, and certainly doesn’t address all of the relevant dynamics of these considerations. They do though, reflect a lot of what I wish I had as a basic framework to operate from when going through a lot of getting to mental health, and working in it since 1984. Sure gives me some parts of another book I feel a responsibility to work on…