3 Ways to Maximize Your Clinical Hours

3 Ways to Maximize Your Clinical Hours

“I wish it need not have happened in my time,” said Frodo. “So do I,” said Gandalf, “and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.” You don’t have to be familiar with Tolkien’s epic works for those lines to resonate these days. This once-in-a-century plague has fundamentally changed what was supposed to be your perfect job, practicum, internship, and fellowship. We’ve embarked on an unexpected journey of therapy meetings over Zoom, with our sneaky sweatpants under button-ups and ties (oh yes, we all do it). We’ve dealt with the desolation of work-life boundaries, wrestled with the loss of connection with clients and coworkers, and persisted despite feeling like butter scraped over too much bread. There are fewer in-person events and responsibilities, and, for a significant chunk of 2020, there were fewer clients to see. The trend of people seeking mental health services appears to be going back up, but many of you are still struggling to get the clinical hours you need for program requirements, licensure, and financial stability. Know that you are not alone, and know that you have options. So, how should you use the time you’ve been given?  Let’s dive in. Making the Most Out...
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Let’s Not Re-Colonize our Clients: Exploring Brujería in Latinx Culture

Let’s Not Re-Colonize our Clients: Exploring Brujería in Latinx Culture

“A mi hijo la hicieron brujería,” stated the Mexican mother as she choked back tears. Both she and her husband sat in a therapist’s office as they made themselves present for a meeting regarding their son. The mother was saying that her husband’s parents cast a spell on her during her pregnancy with her son. The family had immigrated to the United States about five years ago, and it was evident that their traditions and culture were still strongly present within their family system and community. They told the therapist that this spell resulted in their son’s diagnosis of autism. Both mother and father had sought out multiple “curanderos,” or healers, to heal the child from the spell, paying thousands of dollars for his improvement and the possibility of reversing the spell. As the parents spoke, you could feel the apparent defeat and hopelessness around finding “healing” and not knowing how to move forward with the diagnosis that was given to their child.  The clinician in training was at a loss for how to help the family. The therapist had never been taught how to work with families or clients outside of Western culture. They were, however, well trained to work with clients who could understand “psychoeducation” within a...
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Uncertainty, Transference and Other Reasons Therapists Might Fail

Uncertainty, Transference and Other Reasons Therapists Might Fail

We often know our goal, but rarely what lies in our way. “There is a road, no simple highway” (Hunter, The Grateful Dead, 1970). At times, we may find that no matter what we try, we cannot seem to overcome the problem and reach our goal – our cabin on the hillside.

No matter how hard we wish, for some problems there is no simple highway – no quick-fix, deus-ex-machina, five-step solution, or magic wand.

These are the points in life when people most often turn to psychotherapy; they have tried everything and, to varying degrees, may have a fantasy that psychotherapists have some top-secret piece of advice. Especially therapists-in-training who are excited about helping, anxious to prove their competence, and unfamiliar with the uncertainty of the therapeutic process might find themselves colluding with this client’s wish for a magic solution in order to reduce both parties’ uncertainty.


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How I Failed My Client In Psychotherapy and Grew From It

How I Failed My Client In Psychotherapy and Grew From It

From Cindy’s pressed lips, lined with wrinkles that extended noticeably beyond her years, came exasperated concerns of torturous anxiety.

Deeper than her polite solemnity, there seemed to be a well of sadness. This sadness pervaded her down-turned lips, slow gate, and slumped posture. Cindy’s helpless presentation pulled at my heart-strings; in particular as a young therapist-in-training, I wanted to help. I listened empathically, encouraged her strengths, taught skills such as deep-breathing, and offered advice.

However, like clockwork, every 15 minutes Cindy’s down-turned, sad lips would slowly become pursed with frustration. Pursed like a toddler refusing a big spoonful of syrupy cough-medicine. Shutting off, and shutting me out.


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Teletherapy Isn’t Easy — But These Best Practices Can Help

Teletherapy Isn’t Easy — But These Best Practices Can Help

As Covid-19 continues to hold the world in its grasp, and we as a whole are doing everything to close in on a “new normal,” it becomes apparent that some industries are incapable of working remotely. Fortunately, much of the mental health field is able to provide services remotely, thanks to telephone and video calling technology, often called telehealth or teletherapy. But most of us did not get training in how to make the switch from working in-person to working remotely. The Japanese concept of kaizen is applicable when it comes to providing mental health services remotely. Kaizen encompasses a concept that all aspects of the organization, including all employees from the top down, are subject to continual improvements. Every process, every technique, every action should be continually reviewed and assessed for improvements. Providing teletherapy is a perfect situation in which to apply kaizen, because there are ways to keep getting better. The following list may include items that seem obvious to some.  But if you can learn even just one new thing to incorporate into your telehealth practice, then it is a noteworthy improvement. It is also a step toward embracing kaizen – and helping your clients. Oscar Wilde eloquently wrote, “To expect the unexpected shows a...
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The Ultimate Guide to Suicide Assessment

The Ultimate Guide to Suicide Assessment

Suicide is a significant public health concern. Approximately 44,965 Americans die by suicide each year [1]. This equates to approximately 123 suicides per day. Recent reports have indicated a 30% increase in suicide rates from 1999 to 2016 (10.5 per 100,000 to 13.4 per 100,000) [2]. Additionally, we know that suicide does not only affect those with a diagnosed mental health condition. The CDC data notes that approximately half of those who died by suicide between 1999 and 2016 did not have a known mental health condition [2]. Though a mental health condition can be a risk factor for suicide, other factors that can contribute to suicide include stress related to relationships, finances, jobs, housing, substance use, or physical health. The ubiquity of suicide and the increase in suicide rates over the last 17 years support the importance of community suicide education and consistent suicide assessment, intervention, and treatment among clinicians interacting with individuals at increased suicide risk.


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Introducing New Clients to Therapy

Introducing New Clients to Therapy

“What is therapy?” Have you attempted to answer this inquiry? After working in the field for more than 15 years, I’ve discovered how some clients walk into my office with a mixture of beliefs regarding therapy. It’s possible that you, too, might need to clarify for your clients accurate versus distorted facts about therapy. Let’s settle the record. Psychotherapy is a professional, yet personal, relationship which offers necessary help for the client. When it comes to doing therapy, an impressive grasp of psychological concepts alone is insufficient. The same goes for tremendous clinical skills. Unless you understand the nature of psychotherapy, it would be difficult for you to explain it to someone else. So, let’s unpack this brief definition. Therapy Is Professional For starters, zero in on the first part of the definition: psychotherapy is a professional service. The professional part of therapy distinguishes this activity from similar services. The set of laws and ethical codes which govern our field ensures only the qualified are allowed to provide psychotherapy. Psychological treatment, including therapy, is the product of years of higher education and post-graduate training—in psychological science, theories, techniques, treatment delivery, as well as law and ethics, to...
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Bisexual Mental Health and the Challenges of Internalized Biphobia

Bisexual Mental Health and the Challenges of Internalized Biphobia

Sexual-minority individuals frequently experience mental and physical health challenges, often in response to discrimination, hostility, and violence (Meyer, as cited in Heath & Mulligan, 2008).

As the research community begins to tease out the differences between the different sexual minority groups, a clear pattern of difference begins to emerge between the experiences of lesbian/gay individuals and bisexuals.


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Stop Hesitating and Start Talking to Your Black Clients About Race

Stop Hesitating and Start Talking to Your Black Clients About Race

When I lead anti-racism trainings for therapists, one of the things they share with me most often when it comes to bringing up race in their sessions is, “I didn’t know if I could do it right, so I didn’t do it.” My goal is to demystify and remove the shame that many non-black/POC therapists feel when confronted with issues related to race and equity. I created a quick one-page guide for therapists/healers to use in order to initiate conversations about race with their clients. I wanted it to be something they could use right away, and then after the session, continue to do their own work. Here it is, with resources included at the end. STOP HESITATING: A quick, highly directive guide to initiating conversation with your black clients about George Floyd, Breonna Taylor, Tony McDade, other lives lost, Minnesota, Louisville, and racial trauma 1. Not sure how to start? Pick a phrase, any phrase, and tailor to your liking: a. “I’ve been thinking about you lately with everything that has been going on in Minnesota and the racial trauma you might be experiencing. Would you like some space to process?” They may tell you no! Own your discomfort. Sit with it. Move on. b. “We don’t usually talk about race in our sessions, but I’ve been wondering how the news has been...
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4 Factors to Consider with Caribbean Clients

4 Factors to Consider with Caribbean Clients

Having grown up in Bermuda and traveled to various countries in the Caribbean, I have always had a love of Caribbean culture and customs. From the reggae/dancehall music and traditional dishes to the unique accents and dialects, Caribbean life has always been a fascination of mine. When I began my PhD program in clinical psychology in 2012, I knew that I wanted to focus much of my research and clinical work on Caribbean populations.  Research has shown that individuals from Caribbean countries are migrating to the United States in increasing frequency [1]. In an effort to provide culturally responsive and competent services, it is important to be mindful of certain factors when working with this population. 1. Diversity Although I have already used the term “Caribbean” several times, it is important to note that the Caribbean community is not by any means a homogenous group.  In fact, the Caribbean consists of various countries in the Caribbean Sea, stretching from the Bahamas in the north to the coast of South America. The Caribbean community consists of larger islands, such as Cuba, Jamaica, Puerto Rico, Haiti, and the Dominican Republic, as well as smaller islands, like St. Lucia, Barbados, Trinidad, and Tobago. Each island presents with cultural differences and...
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