One of the scariest things therapists work with is suicidality.
Suddenly, therapy feels like, and sometimes is, a life-or-death situation, one where clinicians hold a great deal of responsibility. To make matters worse, suicide continues to be one of the leading causes of death in the U.S. , and many believe the prevalence rates are a gross underestimate .
The numbers highlight the inevitability of encountering suicidality in our line of work. Early-career psychologists and practicum students may feel overwhelmed by the intensity and risk of working with suicidal clients.
I vividly remember my first experience providing psychotherapy for a patient with psychotic symptoms. In fact, not only was this patient my first with psychosis, but they were my first individual therapy patient ever. As a practicum student at a partial hospitalization program, I was caught off-guard when my patient endorsed auditory hallucinations during an initial intake. Thoughts and doubts such as “I don’t know what I’m doing” and “Could I make my client’s symptoms worse?” flooded my mind.
Ultimately, it was a rewarding experience, and I enjoyed bearing witness to my client’s growth, impressive resilience and resolve. However, there are many things I wish I had known ahead of this first experience. Therefore, this article aims to use my experience as a reference point to provide a brief snapshot of important domains to consider when treating psychosis for the first time.
A new client recently asked me where I would be traveling for an upcoming trip as we looked at our schedules to make her next appointment. When she expressed further curiosity about the conference I would be attending, I explained that it was an annual conference of the society for psychoanalysis and psychoanalytic psychology. A fairly surprised look appeared on her face, and she questioned, “like Freud?”
I readily picked up on her discomfort with the thought of psychoanalysis or being psychoanalyzed. I clarified that she was not meeting with me for psychoanalysis and offered some explanation of basic psychodynamic principles and how these applied to our initial goals for therapy. She seemed to accept my explanation, but mostly just seemed glad to know she wasn’t meeting for psychoanalysis.
Psychodynamic therapy is one of several approaches to therapy used today. However, it is often misunderstood and dismissed as an outmoded approach or historical artifact. It is also often misrepresented in popular culture and sometimes seen as irrelevant to the quick-fix demands of the public and the limitations of insurance.
In India, mental health problems are rising at an alarming rate. This fact calls into question the efficacy of prevailing modalities of counseling. The pandemic has shifted previously abstract concerns into more concrete problems: it is now essential to rethink our lives through a different lens. Thus, it is imperative to introduce an alternative process that works at the root of pressing issues, where doubts, confusion, and thoughts can be communicated and discussed with an expert. Philosophical counseling is a contemporary counseling approach where the concerns of the counselee (client) are resolved using different philosophical tools and methods, enabling clients to cultivate what may be described as their inner philosopher. It is an integrated process of humanistic practice and rationality. This process works through an extensive exchange of dialogues and discussions about clients’ beliefs, actions, values, purposes, and commitments, not only what they presently are but also whether and to what extent they may or can be altered or strengthened. Understanding Philosophy “Philosophy” is a word we use in our day-to-day language, but do we understand this subject’s real essence? It encompasses the topics of epistemology (what is knowledge?),... Continue Reading
As helping professionals, we share a united goal of empowering the individuals with whom we work to meet their goals. Though it remains important to address social issues on a large scale (e.g., protests, donations, advocating for policy change), a lot of what we do as helpers happens one-on-one. That is, most of us work to empower individuals interpersonally through therapy.
With this in mind, I would like to share tangible ways to support LGBTQQIA (Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, Asexual) and/or gender non-conforming (individuals who do not identify as cisgender, meaning they have gender identities that do not match the sex they were assigned at birth, and/or those who reject the gender binary, or do not identify as male or female) clients in session while also acknowledging the importance of social justice advocacy on a much larger scale.
“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... Continue Reading
“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... Continue Reading
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.
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.
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... Continue Reading
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