Why Being a Therapist Is Better than Being a __________, at Least for Me.

When I was a kid and started thinking about what I was going to do as a “career”, I always knew I’d be a therapist or musician (as it turned out, was lucky enough to do both).  The reason is in part, growing up, I didn’t watch the usual TV shows- I was watching “The Twilight Zone”, “Kung Fu”, “Star Trek” (the original version), “M*A*S*H”.  What so intrigued me about the likes of Rod Serling, Kwai Chang Caine, James Tiberius Kirk and Benjamin “Hawkeye” Pierce was that they seemed to think there was “more” to the world, saw things others didn’t, and had deep passion.

In their wake, I tried to be “good” at lots of things.  Some of this came from feeling a deep sense of “not being enough”, and what still feels to me an unavoidable passion to do things That Matter.  The former almost killed me (as Sheldon Kopp said, “Why be perfect when you can be good enough?”), but the latter stays with me to this day… thankfully.

My first inpatient job while working on my Psychiatric Technician licensure (completed in 1988), I remember thinking how cool it was that all I needed to do my job was a black Bic medium point ball point pen, and my personhood.  In subsequent years, have come to a number of other awarenesses that have meant much to me.

It seems to me that it’s become a luxury for many of us to simply do what we would like to do, if we were to have our choice.  Many of us fall into what we do and begin to love it, maybe we do what our parents did, or simply honored a family business.  Lots of us do what we think we ought, or simply take on what feels best to serve and provide for our families.

All these are of course noble pursuits, but on the coattails of Rod Serling, Kwai Chang and Hawkeye, I have always felt compelled toward human service.  Famously, Lloyd Dobler (played by John Cusack in the film “Say Anything”) said, “I don’t want to sell anything, buy anything, or process anything as a career. I don’t want to sell anything bought or processed, or buy anything sold or processed, or process anything sold, bought, or processed, or repair anything sold, bought, or processed. You know, as a career, I don’t want to do that.”  Some of this points to why I’ve resisted other careers (and, Lloyd and I also turned to martial arts… a totally different story).

Many of us serve ourselves, but are still unsatisfied.  We work at jobs we are unhappy about, sometimes with people we are unhappy with, sometimes for things we don’t really need.  In some cases, these pursuits relieve others of resources that might be used otherwise- resources like money of course, time, and all too infrequently mentioned… our attention.  Some of these efforts are unsustainable, and environmentally unsound.

Not as if therapy, counseling, psychiatry and etc don’t have their defects that are creating some problems.  Overdiagnosis, starting with interventions like medication when arguably not called for and/or lesser interventions haven’t been endeavored, pathologizing and symptomatizing everything (often even the most understandable and euthymic kinds of feelings/emotional experience), passivity on the part of the clinician and more create big and often lifelong difficulties as well.

It’s hard though for me not to see a poor relationship with ourselves, others, our sense of worth, depression, addictions (and “codependency”), anxieties and fears, and maybe a couple more as being the soul (and result) of much human suffering.  That also creates in my view, the suffering of other creatures.  In the shadow of this, helping us through these concerns, and providing a framework for others to operate on in a like way are at this point, the most useful thing I can think of doing.  At least a thing that I’m good at.  ;-p  That’s a quip about my “musicianship”.

It is of great import to me that I have a small footprint on the planet.  Deeply concerned about where humans are going mentally, emotionally, physically and “spiritually”, I can scarcely think of a way to be more useful.  Therapy is a practical way of putting philosophy into use.

Something that matters to me a lot in light of some of the above is that it’s a great way to create something that can be easily passed on by others.  An organized, simple (but unfortunately not terribly easy…) and principled way of behaving in the world that can be shared can create great change of course.  Doing clinical supervision, teaching, giving tools to parents, or simply doing work with people who are in a place to impact others are my favorite areas of focus, and seem to be the most practical way of passing on what we’re capable of.

In the digital age, I don’t even have to use my pen or paper as often.  I get to impact people deeply, and most of what it takes is just me being as healthy a person as possible, and my time/being deeply present.  It’s also something I should be capable of doing for a long time.  I get to share and experience different people, cultures.  Many types of work are possible- use of humor, sharing resources, sharing experiences, teaching, problem-solving, processing, consulting and more.

Gratefully, all these years later, I could scarcely think of doing anything else, and still feel deeply committed to The Work.  The “how’s” and “why’s” of avoiding what some call “burnout” are an entirely different thing to write about.  Point is though, I’m so, so lucky I get to do something that I still feel so deeply passionate about, and doesn’t violate any of Lloyd’s principles.

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Clinical Supervision: A New Intern!

One of the better ways I think I can be of use to the community is by training other therapists and interns.  Have now hired and am doing clinical supervision with a new Marriage and Family Therapist Intern, Sarah Wood, MS, MFTI (#66300).

Am really happy about getting to do this.  With the Partners in Recovery program for interns sunsetting at the end of the last school semester, there’s been less opportunity to get to work with folk that way.  Am double excited about getting to do so with Sarah, because she’s already great at what she does, and really has a taste for The Work.

She comes on the recommendation of one of our last interns, Melissa Lamoureux, who was also at Partners in Recovery.  Sarah did her graduate work at the amazing program at Cal State Fullerton.  She’s done a lot of great work in the community already, specializing in therapy with children, trauma services for all ages, eating disorders/other addictions and more.

I feel like it’s a stroke of luck to get to work with her, am happy to get to recommend her services.  Please go by her website and learn more about Sarah at sarahwoodtherapy.com.  Welcome Sarah!

7400 Hours, Psychology, Clinical Supervision

About three years ago, my friend and colleague Judy McGehee LMFT (Partners in Recovery) began a supervision program for Marriage and Family Therapist interns (people that have completed their coursework for Masters degrees) and trainees (those who are about to complete Masters degree coursework).  Borne solely out of a desire to be helpful, and pass on the ability to provide effective human service, for fun and for free, Judy took on supervising 8 or so trainees and interns.  We were joined also by a visiting therapist, Ted Aaseland, Psy.D.  A little over two years ago I joined her in this endeavor, as I care deeply about passing on how to do “The Work”.

Over the course of those years, those interns provided services to the Glendora School District and elsewhere to children and adolescents for free.  Some of these turned into outpatient clients, individuals and families, also for free.  There were also public speaking engagements for adults and adolescents, professionals and non-professionals.  After all was said and done, over 7400 hours of free therapy (not including the speaking/community education efforts) were provided, all for free.

Interestingly and tragically, there are several stories that run in parallel with this one.  Before I get there though, it would be instructive to tell you a little about this process, both from the perspective of the licensed folk/interns/trainees, and from the folk we hope we were helpful to.

Will start with the experience of the trainees/interns/licensed folk.  Most universities require several hundred hours of internship/clinical experience for graduation.  The processing of these hours is supervised by a licensed therapist (who can be a supervisor, as regulated by the Board of Behavioral Sciences), and the student must pay for this process.  Most universities, in an uncomfortable wrenching of common sense, either don’t have someone to organize/and or set up/maintain these supervision placements, or they’re simply not updated for various reasons.  The student/trainee however, is still required to do this.  To add insult to injury, the trainee when in supervision, if they can find an agency, is rarely given a real experience of being supervised at their work.  It seems flabbergasting to consider this, yet it’s tragically true.

Similarly, interns (therapists just out of school) have to complete over 3000 hours of work with patients/clients, just to sit for the two licensing exams.  They have six years to complete this process, requiring continuing education to reset their chance to sit for the exams.  That means that they have to see clients, and that those hours also have to be supervised.  Related to both this issue and Judy’s (Ted’s, and mine) efforts, we were completely unable to get other clinicians to volunteer for either of these processes (for trainees or interns)- not even a couple of hours a month, let alone the minimal 2-4 hours a week.  In light of the complaints of most people we know not feeling like they received quality supervision, this is no small issue.

The second body of material that is really important here is the students and families.  There were of course the predictable experiences with clients who struggled with behavioral problems, substance use/addiction, depression, stress, bullying, pregnancy, self esteem, eating disorders, anxiety and the like.  It was also really common to have active suicidality, reports of abuse, the precursors of “thought disorders” (schizophrenia, and the like), violence, abandonment, PTSD, mood disorders (bipolar disorder and related problems) and more.  There was psychoeducation, crisis intervention, abuse reporting, ensuring of safety, documentation, creation and use of materials, referrals to resources, interfacing with administrators/Department of Children and Family Services/other clinicians/teachers/families and more, interviewing, showing up for IEP/planning meetings and more, and oh yeah… individual and family therapy.

The interns (and will give a little credit to us as well) braved all of these issues and more.  All for free.  Seven thousand, four hundred hours of it, and the attendant signing off of supervision hours.

We met weekly for all this time, as individuals and as a group, to meet the requirements for the relevant university, and for the Board of Behavioral Sciences.  We met in between to take care of paperwork.  To problem-solve.  To handle questions.  We met for lunches, at each others’ homes, in restaurants, in parking lots.  We celebrated birthdays, mourned losses, processed issues, checked one anothers’ heads.  There was a lot of happiness, crying, efforts to glean resource support to continue the work, discovery.

There’s certainly more to be said, and obviously, more work to be done.  Though this cycle of supervision is over, we still have a lot of passion and ideas for what might be next.  The whole point of writing this though, is simply to honor the work of Michael Cardenas, Eryka Gayoso, Elva Cortez, Jessica Wilson, Jeffrey Craig, Melissa Lamoureux MS, Ted Aaselund Psy.D, and most of all, Judy McGehee LMFT.  Thanks so much for making all this matter, and letting me participate.

One Less Supervisee.

Yes!  As of today, I have one less supervisee… Brendan Thyne passed the second section of his licensing exam!  He has always been a fantastic therapist, and this is a great thing to happen for everyone, patients and colleagues alike.  Brendan Thyne, LMFT.  Nicely done Bren… you rock, and can’t say enough about who you are and the work you do.

Recognition for Partners in Recovery

Last Monday (9-26-11), Judy McGehee MFT, Melissa Lamoureux MS, Erika Gayoso MA, Ted Aaselund PsyD, Michael Cardenas, Jeffrey Craig, Jessica Wilson, Elvia Cortes MA and myself were recognized by the board of the Glendora Unified School District at their monthly meeting.  Formally, the agency is called “Partners in Recovery”, a nonprofit organization of clinicians providing services in Glendora and surrounding communities.

Judy, and I have been providing clinical supervision (a necessary component for grads and soon-to-be grads to get their “hours of experience” to sit for licensure as therapists or social workers) for the above mentioned interns and trainees.  Trainees are obtaining hours to graduate with their Masters degrees, interns are working on their hours (3000 hours of service over 104 weeks) to sit for the licensing examination with the Board of Behavioral Sciences.  In turn, the supervisees (the ones above and others from previous years) have provided thousands of hours of free services to the Glendora Unified School district, from elementary thru high school.  The supervisees from Partners have been assisting with issues of depression, abuse, family discord, eating disorders, suicide, addiction, grief and loss, bullying, self esteem, anxiety problems and more.

The program has been running since 2009 with Judy at the helm, and will continue at least through this year.  Judy, Ted, and the interns/trainees are all highly skilled clinicians.  It is a fantastic way for people to get services that might not have otherwise.  Nicely done everybody.

Clinical Supervision/Partners in Recovery

Quick note from Partners in Recovery about the work we’ve been doing. They can now be found on Facebook:

“Petar Sardelich, MFT, MAC, LPT, has joined Judy McGehee, MFT in supervising La Verne University Trainees, and Interns, in the Glendora Schools Internship Program. Since September 2009, interns, therapists and trainees have been offering 40 hours per week of probono mental health counseling and education in the community. This includes Whitcomb High School, Glendora High, Sandburg and Goodard Jr. High. Community and Parent nights have educated participants about drug and alcohol abuse, building communication between parents and teens, and in March, 2011, information regarding bullying and helping individuals in combatting this behavior. PIR is a non-profit organization where volunteer therapists and board members provide mental health services and referrals in the community.”

Partners in Recovery website:
Judy McGeehee/Partners in Recovery

What We Don’t Get Taught

Have been lucky enough to do some clinical supervision with Judy McGehee.  As I’ve mentioned before, she and some interns have been providing free services to their community for some time now.  Some concerns I’ve had with other venues of supervision have come up the last couple of times we’ve met.

Clinical supervision, like therapy, is different things to different people.  Many times it’s the opportunity to “present cases”, problem-solve clinical, legal, ethical issues and etc.  It’s also a place for us to have the opportunity to discuss or work out struggles we have as therapists- something that certainly should go on for our entire careers.

One of the things I like to do in supervision is talk about the issues that are not necessarily explicitly processed when we go to school.  There’s lots of these sorts of concerns…  how to deal with our own feelings as therapists.  Issues of responsibility- where ours are vs. where the clients’ responsibilities are, how much is “enough”, concerns when we’re sometimes working harder than the client is (or not).  Handling boundaries about parents endeavoring to influence issues discussed (or simply perspectives about them), concerns that arise in couples therapy or family therapy like one person in the “group” disclosing something that affects the others outside of the “group” proper.  How to handle when a client isn’t being honest about a problem or circumstance or behavior.  Determining how to handle “terminations”- planned discharges, “therapeutic discharges”, discharges against medical advice… sometimes when a child is “pulled” from treatment by a parent against the better judgment and suggestion of the therapist.  Speaking of, there is little discussion about how to handle referrals to other types of resources or therapists.  Specific methods to avoid (or deal with) “burnout”.  Very “nuts and bolts” concerns like documentation, treatment planning, dealing with insurance companies and such.  Fee setting.  What to do if a therapist runs into a client outside of the office or other milieu.  How to handle when a client is “stonewalling”. Handling clients that are self-medicating.  My personal favorite is specific goals and underlying philosophy of our methods as therapists.  There are many, many more.

It is of course really important to do case conference, have both group and individual forums for processing what is happening with specific clients or groups and the like.  I find it of great import too however, to discuss the above issues.  It is one thing to discuss a specific case, but I think it another to discuss what it is about that case that will come up (or has) repeatedly, in a principled manner.  Would argue too that discussing issues like responsibility, boundaries, terminations, referrals etc often lead to greater resolution with clients “in the room”, as well as provide a way of generalizing our knowledge and methods, thus making it a more organized and effective way of treating folk.

Am not suggesting that these things never occur.  It has definitely been my experience however, that most of the above ideas are not discussed in depth, if at all.  Certainly concerns of symptom ID and management, differential diagnosis, theoretical orientation and etc are of great import, but it is uncomfortable and counterintuitive to run into a circumstance that occurs frequently or that is a fundamental part of operating in our discipline (treatment planning, for example) that is largely omitted from our education.

More than anything else, I think I’m advocating for more of a focus on our underlying philosophy for employing the methods that we do as therapists.  I’m not simply trying to help someone (or their parents) improve failing grades, or get someone in a relationship to be more sensitive or attentive, or even to diminish “depression”.  What I hope to achieve in most (most) circumstances, is to:

1.  Insure safety and stability necessary to do “The Work”.  (absence of suicidality, abstinence from drugs, ETOH, or a behavior, have medical concerns be ruled out by a physician, insure that necessary resources to do the work are in place, etc)

2.  Identify “issues”- the events (relationships, circumstances, etc) or other causes that prompt us to feel mad, sad, afraid, ashamed, and/or hurt and/or “behave” in ways we struggle with.

3.  Process those issues in a way that diminishes, transforms, and/or (almost) eliminates them and subsequently behaviors, choicemaking, or perspectives that might contribute to these issues in an ongoing way.

4.  Provide a “body of material” (patient education, referral sources, resources etc) that enables the client to be able to do these things without the therapist.

5.  Insure that the client has sufficient resources (support groups, family, friends, etc) that support the work and use of that material in an ongoing way.

These are an oversimplification, but I think they go beyond simply “resolving a problem”, eliminating a behavior and etc.  Much of the inner workings of these ideas don’t get processed as much as I’d hope while we’re being educated about our discipline, but again, of course this philosophy likely exists in many of our “theoretical orientations”.  In my sense of things, the presence of such a philosophy doesn’t go far enough- we as individual therapists need to have a grasp of our own sense of these things to make them as effective as possible.

Would say further that none of this is supported unless part of our own supervision is about dealing with our own experience both as a therapist, and a person outside of therapy.  My ability to problem-solve many of the issues “not discussed” above is diminished by not having the opportunity to explore these things as part of our own clinical supervision.  The largest of these things for me are the underlying treatment philosophy, and the effectiveness and grace that I deal with my own life- including my life as a therapist.

Speaking of Service…

My friend and colleague Judy McGehee MA, LMFT (www.mcgeheepartners.org) along with Ted Aaselund LMFT have been providing clinical supervision (completing hours for graduation and/or eventual licensure) for a great group of interns and trainees at Judy’s office in Glendora, California.  They have been providing sometimes up to 40 hours of services to local schools with these Masters level folk to students and families who might not get these services at all otherwise.

I have been truly humbled by the work of these people, and lucky to get to participate in part of the supervision.  We have been discussing the obvious concerns about professional standards, law and ethics concerns, types of interventions, philosophy, differential diagnosis, addiction, depression, abuse and etc.  What has been so remarkable though is the intensity of the losses and difficulties these students and families have had, but equally, the grace and commitment of the interns and Judy insuring that these folk get taken care of.

It appears now that eventually, on top of the individual services that are being provided to the educational institutions, students, and families, there may be an opportunity for a multi-family group therapy at low cost for these individuals.  This is such a great service, but sadly, there is no funding available for this to happen (space may be made available at a school).  Of course I can’t discuss the details but, there have been some huge losses for these families that they are getting little support for treating from a public standpoint, the responsibility of both the service and the internship being largely on the shoulders of Judy and the interns, a little on Ted and I (as we didn’t take this on from the beginning).  The families served aren’t just getting low-level services- they are getting truly insightful, wise, professional services thanks to the good heartedness of the people involved.

Providing clinical supervision is such an important part of what I’m lucky enough to get to do.  It means much to me that I’m in a place where I’m not just empowered to help people, but that I am empowered to help people, who can further be of service to others.  What I do, I hope, matters a great deal, and the opportunity to share some of that with other people who might further use some of that to help yet other people is amazing.

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