I have made it no secret that I do not want to pursue a career as a clinician. It’s not that I dislike therapy; it’s that I have a pie chart dilemma. The only steadfast rule of pie charts is that there is a finite amount of space. A bigger slice in one area means a smaller slice in another.
Students learn from their early graduate school days that they cannot be good at everything, and that they ought to pick a path—in clinical psychology, this choice is typically between clinician and researcher. I have chosen the latter.
For me, then, more clinical time means less research time.
But this is the reality—students pursuing advanced graduate degrees in clinical psychology are required to complete a certain number of clinical hours. Hundreds of hours, in fact. So for the entirety of graduate school, clinical work will cut out a chunk of my week that could have been dedicated to research.
What I do with this time is my choice.
Here are five tips for making the most of being a therapist when, well, you don’t want to be a therapist:
1. Resign to Lost Time
This is step #1. Clinical work is most challenging when I am thinking about all the other tasks I could be doing. I feel derailed and thwarted, anxious about precious research time slipping away.
Resigning to the fact that these time slots are pre-filled helps me be more present with my client, and when I am more present, I am able to intentionally harness the benefits of clinical work. I enjoy therapy more frequently and more intensely, and I avoid squandering away opportunity.
2. Untangle Your Frustration
All therapists have felt frustrated with therapy. If you are dreading therapy sessions each week, challenge yourself to figure out why. Is it because…
- Your client is not making progress?
- You are reacting strongly to something in your clients that is present in yourself?
- You are thinking about everything else you could / should / would be doing? (see “Resign to Lost Time” above)
- You worry you are not qualified to be someone’s weekly therapist?
- You are anxious about your supervisor reprimanding you?
- You dislike the administrative activities (e.g., writing session notes)?
- Your client is not on board with the treatment plan?
- You don’t believe in what you are doing?
- You feel like a hypocrite?
Use your frustration as information; it tells you that something is not going right. When we are unable to describe the source of our emotions (such as anger), we have more difficulty regulating emotions and pursuing meaningful goals.
Figure out what is bothering you and make changes accordingly.
3. Unleash Your Creativity
I once had a client who refused to speak to me because she was angry that her mother brought her to therapy against her will.
She was admirably persistent: she did not utter a word for 149 consecutive therapy minutes, hardly acknowledging my existence. I tried every foolproof strategy—humor, silence, an icebreaker, questions, pretending I could relate to teenage pop culture, more questions… nothing worked.
On minute 150, right before exiting the room, my client made eye contact for the first time and said, “I hate your outfit.” Huh? She followed up with, “The shoes, they don’t belong with the pants. You need a closed toe shoe. And the shirt is just wrong.”
Next session I brought in Vogue magazine. Silence squashed.
When you are in the room with someone who is hurting, you need to be able to empathize and connect with them in that moment. You have to give them a reason to trust you. Therapy is replete with opportunities for creativity, even for the most rigid manual-based advocates. Clinical psychology is a beautifully imperfect convergence of science and art.
I haven’t yet read a manual that suggests bringing Vogue to therapy.
4. Find the Rewards
The ultimate reward of conducting therapy is to change a person’s life. For me, that chance in itself is a privilege. But deciphering if and how and when that change happens is complicated.
What is “successful” therapy—reducing symptom severity? Reducing functional impairment? Completing an 8-week protocol in only 8 weeks?
Humans are messy and so is therapy. Rather than waiting for discrete rewards to come, such as when your client presents you with a card that says you have changed their life (personal frequency count: 1), you can intentionally find the rewards throughout the process.
Did your client initiate small talk with a classmate? Did your client challenge and reframe one self-defeating thought? Or refrain from drinking wine for one evening?
Here’s an example a colleague shared with me:
“Yesterday my client brought me flowers. She has not made a ton of progress, and she is not overly interested in seeking my approval. She just brought me flowers to thank me for being there. I think that is it. It is not necessarily seeing them ‘cured’ that keeps me in the game and gives me energy week to week. It is knowing, even after the hardest session where I feel like I messed up a therapy skill or the client cried the whole time, that I was there…when so many other people aren’t…and truly believing that that matters for something.”
Celebrate the wins.
5. Humanize Your Research
My ideal Tuesday morning is spent holed up in the back corner of my favorite coffee shop, muting the world with my oversized noise-canceling headphones and working on a manuscript. This work is made more meaningful by conducting therapy with people that are struggling with same psychological difficulties I am writing about.
But therapy is not just a reminder that the participants are living breathing humans with feelings, fears, and fantasies. Therapy is a reminder that humans are complicated, and consequently, so is the research about them.
For this reason, therapy is the perfect place to transform your clinical experiences into mini case studies. Use the nuances of the interpersonal interactions that occur in the therapy room to think more deeply about research. Doing so will help you ask and answer novel questions, measure difficult constructs, and design efficacious studies.
And of course, there’s the added bonus of crawling out from behind your laptop and feeling human. Another colleague summed this up:
“As much as I enjoy analyzing parents’ salivary cortisol levels or examining teenagers’ brains, therapy allows us to peer inside people’s hearts. Psychologists are like the collective Giver! We have access to a never-ending stream of pain, pleasure, secrets, memories, and experiences. I think there is something really powerful about being present with someone and listening—really listening—to them. Perhaps the most quintessential human desire is to be loved, but to be understood is a close second.”
This article was originally published on October 19, 2015.
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