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Dr. Bob is Robert Hsiung, MD,
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Posted by Dinah on December 1, 2004, at 9:31:40
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by gardenergirl on November 29, 2004, at 23:05:57
re. referring out. That may indeed be good advice, but I would add to the list that therapists understand what termination of any sort does to a client, and behave accordingly. Perhaps suggest adjunct therapy, or a transitional time, or something.
Were my therapist to say that I was outside his range of expertise (and fortunately I'm not - he's had experience in the area) I would never ever go see the person he referred me to, it would cause trust problems forever, and I would have probably killed myself (I'm not being dramatic here, literal) at the perceived rejection.
I think not taking on a client outside of your ability to treat is a no-brainer. Referring out someone who's grown attached is a whole lot trickier.
Posted by Dinah on December 1, 2004, at 9:34:28
In reply to Babble Guide to Therapists: Do's and Don'ts, posted by Aphrodite on November 27, 2004, at 8:01:05
DO be flexible. Clients aren't eggs, twelve standard to the box. They're individuals.
That's my therapist's greatest strength. He's willing to evaluate what's going on and change course if necessary.
And DO be committed to the therapeutic relationship. Trust is a big issue with so many of us. Knowing that a therapist can get angry, or feel frustrated, yet remain committed to working it through, is healing in itself.
Posted by gardenergirl on December 1, 2004, at 10:14:59
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » gardenergirl, posted by Dinah on December 1, 2004, at 9:31:40
Oh I definately agree with referrals and/or terminations for long term clients. I was thinking after the initial interview or session or two, if it's outside of your realm, you really have no business beginning treatment, unless you are the only game in town. And if that's the case, you need to get a supervisor even if at a distance, ASAP.
Sometimes I think T's can get caught up in the idea that they can apply similar techniques to new (to them) problems. That's not necessarily the case.
gg
Posted by Daisym on December 1, 2004, at 10:20:11
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » Dinah, posted by gardenergirl on December 1, 2004, at 10:14:59
problem is, lots of us don't disclose the "real" problem for a long time.
then what?
ESPECIALLY PTSD...
Posted by Dinah on December 1, 2004, at 10:50:43
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » Dinah, posted by gardenergirl on December 1, 2004, at 10:14:59
Now that I definitely agree with, although as Daisy said, it sometimes takes years to come out with the sticky stuff. :)
Posted by gardenergirl on December 1, 2004, at 11:22:15
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » gardenergirl, posted by Dinah on December 1, 2004, at 10:50:43
So may times the presenting problem is the "safe" problem to deal with. Hmmm, I may even be living proof of that, too.
It certainly complicates matters. I just have seen supervisors of other trainees who take on everything and anything, and they clearly did not know enough about the specifics to be effective in treating, let alone supervising.
Ugh
gg
Posted by Soulnik on December 2, 2004, at 20:11:17
In reply to Daisy and Dinah: you are so right, posted by gardenergirl on December 1, 2004, at 11:22:15
FABULOUS TOPIC!!!
Here's my contribution:
Call when you say you're going to call. Do EXACTLY what you say you're going to do and if you can't for some reason, take responsibility.
My therapist has told me she was going to call me the during the week when I was having a particularly hard time and then she didn't! I felt deserted.
Posted by Dinah on December 2, 2004, at 23:04:24
In reply to Re: Daisy and Dinah: you are so right, posted by Soulnik on December 2, 2004, at 20:11:17
Eeek. Mine did that once. Well, not once - several times, but all in one time period years ago. I've forgiven him. But I don't think I've entirely forgotten.
Yeah, that's a biggie. Sometimes we're hanging on by our fingernails waiting for that call, but we might not seem that frantic on the surface.
Posted by daisym on December 3, 2004, at 1:15:11
In reply to Re: I have a do » Aphrodite, posted by Dinah on December 1, 2004, at 9:34:28
Do let us know of anything different that might be happening -- like painting the building, or moving the furniture, etc.
Don't share your answering machine with other therapists. Have private voice mail.
Say "Hi, how are you?" in a casual, not stopping way when we see you in public. Don't ignore us, unless you've explained ahead of time that is what you will do unless spoken to first.
Add something about gifts to your handout about what to expect while working together (do have one of those!)Be clear - either you accept token gifts or you don't.
Posted by multitask on December 3, 2004, at 11:24:14
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by Poet on November 28, 2004, at 1:34:46
Posted by multitask on December 3, 2004, at 11:27:15
In reply to Re: I have a do, posted by daisym on December 3, 2004, at 1:15:11
Don't share private details about your personal life. There has to be a balance I think. Not every therapist gets this. I had a therapist tell me... "don't give me shit today I had a hard weekend." I felt like saying I had a hard life, don't give me grief. I didn't.
Don't share details about other patients. I can't tell you how many therapists I have had that discussed that they had another client that... I totally hated that. It's like I'm here right now -- deal with me in the now.
Posted by multitask on December 3, 2004, at 11:34:14
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by Poet on November 28, 2004, at 1:34:46
(my last post disappeared... I posted two separate posts in a row because I had several ideas and wasn't able to articulate them all in one sitting...
Do not fall asleep on client. (that has to mean something I'm just not sure what)
Do not be overly emotional. Not every client needs that kind of support. I can hear a therapist better when they are factual and unemotional.
Meet the client where they are at (emotionally) not where you think they are at or where you'd like them to be at.
Posted by Joslynn on December 3, 2004, at 13:43:36
In reply to Re: I have a do, posted by multitask on December 3, 2004, at 11:27:15
I completely agree about not sharing details about their private lives or other patients!
I don't need to KNOW that your son got called into the principal's office yesterday or what you and your spouse disagree about, TMI!
And when they tell anecdotes about other clients, I wonder...will I be the illustrative anecdote to the next client who walks in?
They are not supposed to disclose details about their personal lives or other clients and you are right, it is suprising that they do this. Even ones who are otherwise really good Ts can slip in this area.
I had to bring this up to someone, with examples, and they finally got it and apologized. But it caused damage. It made me all confused.
Posted by multitask on December 3, 2004, at 16:16:26
In reply to Re: I have a do » multitask, posted by Joslynn on December 3, 2004, at 13:43:36
Joslyn,
I agree and for the same reason. I have often wondered what illustrative anecdote would be used about me to another client.
I have been in the same position where I had to bring it up to a therapist and it wasn't pretty. At first they were somewhat defensive until I gave examples than he was somewhat solemn. Sometimes I think maybe I have been in therapy too long or have educated myself too much when I can see the counter-transference before he can.
Oh well. I guess there are worse things.
Posted by simcha on December 3, 2004, at 19:00:17
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by multitask on December 3, 2004, at 11:34:14
This is a wonderful list.
Currently I'm a Marriage and Family Therapist Trainee in California. I'm in my 3rd and final year of my MA in Counseling Psychology Specializing in Transpersonal Psychology.
This list is very useful and it's stuff I'm hearing in my training. So, that's telling me that my training center is really good.
On self-disclosure: What we are taught is to not disclose at first with new clients. We are taught to be very conservative about self-disclosure... That therapist that disclosed, "I've had a bad weekend so don't give me any cr*p." was WAY out of line.
What I've been taught, and how I practice is that I will only disclose if it is somehow relevant to the client's treatment at the moment I'm disclosing. I also have to be careful about how much I disclose when I disclose. I have to make sure that it is for the benefit of the client and not just my own counter transferential need to disclose.
Thus, as you can see, I disclose very little at all. It's very rare for me to disclose. Then again I've only been seeing clients for three months now so my style will change most likely. I think I will ALWAYS be careful about self-disclosure.
Thanks, all of you for letting us know who are in the profession what we should be doing. It really helps. Of course, I'm a client too. I've been in therapy for ten years and on medication for Major Depressive Disorder with Recurrent features for about four years now. So I know what it's like to sit on in the other chair. It's very strange sitting in the therapist's chair after all these years. And I've learned alot about what to do and what not to do from therapists I've seen.
My school places a high value on self-work. That's why they require that students seek out therapy while they are in school, especially when starting to see clients. This requirement for me was a no brainer since I know I couldn't do this without the support of therapy.
Blessings and Thanks!
Simcha
Posted by mair on December 3, 2004, at 22:48:08
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by multitask on December 3, 2004, at 11:34:14
Back on the issue of procedures - take the initiative to change or reiterate or clarify them when it's necessary. I went for ever thinking it wasn't ok to ever call my T at home when she was thinking the whole time that I understood that I could.
Don't jump in too quickly to bail out a client who's struggling over what to say.
Don't finish your patient's sentences - my T does sometimes because she's either taking pity on me for struggling so much or she's impatient waiting for me to finish - I wouldn't mind so much except she very frequently supplies the wrong ending to my unfinished sentence. It makes me feel that she really doesn't understand.
This is tough, but don't always supply the rational counterpoint to a client in distress. Sometimes I don't want her to help me process my misery, but just to share it.
I also agree that it's preferable to acknowledge a patient you run into outside of the office. You don't need to stop for conversation necessarily, but the acknowledgement part is important.
Mair
Posted by dawnfawn on December 4, 2004, at 11:16:55
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by mair on December 3, 2004, at 22:48:08
1. Don't be late. If you are late don't be late at the first visit. Don't be late consistently.
2. Don't watch the clock.
3. Please remember my name and pronounce it correctly.
4. Please explain your orientation and your thoughts on how long this will take.
5. Please explain any types of take home homework or reading, don't assume I understand you.
6. Please go over your notes from last time before we meet. It is my dime we are running on here.
Posted by dawnfawn on December 4, 2004, at 11:30:02
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by dawnfawn on December 4, 2004, at 11:16:55
> 1. Don't be late. If you are late don't be late at the first visit. Don't be late consistently.
> 2. Don't watch the clock.
> 3. Please remember my name and pronounce it correctly.
> 4. Please explain your orientation and your thoughts on how long this will take.
> 5. Please explain any types of take home homework or reading, don't assume I understand you.
> 6. Please go over your notes from last time before we meet. It is my dime we are running on here.
7. Please, Please if you don't think you can help my type of problem or if you think it needs medicine or some other approach, Please do not wait until three months have gone by to let me know.
Posted by simcha on December 4, 2004, at 18:15:28
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by dawnfawn on December 4, 2004, at 11:30:02
> > 1. Don't be late. If you are late don't be late at the first visit. Don't be late consistently.
Absolutely.
> > 2. Don't watch the clock.
Sorry, this is a clinical issue. I keep the clock behind my client. I must hold the frame (keep the boundaries) to 50 minutes. It's very important to treatment because most people have some sort of issue with boundary setting. Therefore ALL clinicians MUST look at a clock. It's a clinical issue. Some of us are just more discrete about it. I even mention, "Hey we have 10 mininutes left in the session, is there anything else that is brewing that you need to address." Then at five minutes before the end I do the same. Clients seem to appreciate this because they feel included in the clinical boundary setting. I also keep a clock in the client's view that is synchronized to my clock I'm usiing. Therefore they know how much time they have.
> > 4. Please explain your orientation and your thoughts on how long this will take.
Explaining orientation is sticky. Most therapists in the San Francisco Bay Area are Psychodynamic and it often takes years to do this kind of work. I use psychodynamic techiques and I'm transpersonal so I believe that the healing comes in the relationship and the spiritual heath of the therapist. Other than that I use CBT, family systems, a little Hakomi (for body tracking), and a host of other theories that fit each client. Sometimes I don't know what orientation the client will respond to the best for a while.. I've started using sandtray with one client who is very non-verbal. This seems to work fantastically for him.
Now as for how long it takes? It takes as long as it takes... It seems that clients come in with "tip of the iceberg" issues when in fact "like all icebergs" there is a whole lot underneath. Sometimes this takes months. Sometimes it takes years. It depends on what the client wants.
> > 6. Please go over your notes from last time before we meet. It is my dime we are running on here.
No, we do not share notes unless you specifically request it in California. Then we sit with you and explain the notes. Sometimes seeing your notes is very damaging to your therapeutic process because the notes usually show a progression of unconcsious material that you may not be ready to deal with. Also clinicians may change courses in the middle of treatment if they have found that their treatment is not working for the presenting issues and/or the presenting issues is changed. Sometimes diagnosis and assessment is ahuge burden to carry for some very disturbed clients. Of course, even they have a right to see the notes. You still must ask the therapist first and process why you want to see the notes. This is a major clinical issue. The notes belong to you and yet they really don't. You have a right to see them. The clinician has a right to keep them and to be the gatemaster/
> 7. Please, Please if you don't think you can help my type of problem or if you think it needs medicine or some other approach, Please do not wait until three months have gone by to let me know.Sometimes it takes months to convince a client that they need medical attention and medication. Also, n the course of therapy, your psyche opens up and many things may bubble to the surface. This might take months or years before a therapist would feel that it would be competent to refer you to a physician for medical evaluation and treatment.
That's my two cents as a therapist in training...
Simcha
Posted by simcha on December 4, 2004, at 18:46:59
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by dawnfawn on December 4, 2004, at 11:30:02
Ooooh,
I hope I did not come across as a "know it all" in the last thread. I was just showing you what the latest training is teaching us about the issues you were bringing up...
As with anything in the psychotherapy world, these things most likely will change. After all, pscychotherapy is only just over 100 years old. It all started with Freud, the psychoanalyst coke-fiend and quack. Then there was Jung who had complete nervous breakdown after Freud severed their relationship. Can we say that Jung had some MAJOR attachment issues? lol ;-) Also Jung found it "therapeutic" to have sex with his clients. Can you imagine what modern licensing boards would have done to him? EEK!
So psychotherapy started off on very shaky ground. We are just starting to reach our adolescence as a discipline. Give us time.
Simcha
Posted by peacefeline on December 4, 2004, at 19:47:36
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » dawnfawn, posted by simcha on December 4, 2004, at 18:46:59
Simcha,
Your replies to these items was very interesting. My T doesn't say very much about what she's doing, or therapy in general (which is OK, and I'm sure she would if I asked her, but there's always so much other stuff to talk about!)
Your perspective is especially valuable b/c you can see things from both sides, the client and the T.One more for the list:
Please don't interrupt very much! I know we all interrupt as a general rule, and most of us are used to this in conversation, and it's easy to overlook when it's not done in excess. But some ideas are hard enough to get at, without being interrupted three or four times in as many minutes.Susan
Posted by 10derheart on December 4, 2004, at 20:24:35
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » dawnfawn, posted by simcha on December 4, 2004, at 18:15:28
Regarding T's notes, I think you may have misunderstood Dawnfawn's meaning...I think the idea was if T. pulls out our chart, or whatever they use to refresh their memories in preparation for the session, she prefers T.s do that before we come in. At least that's how I took it - sort of picturing a T. possibly reading quietly (or not so quietly!) to themselves while client sits, maybe feeling both impatient and uncomfortable as T. "catches up" from last time. Personally, I don't mind it (only happened rarely) as long as they interact a bit while doing it, and don't take forever. I'm guessing Dawnfawn may have had a different (more irritating) experience entirely.
But your comments on the other aspect of clients wanting to see notes were well taken. That topic has been addressed a couple of times before on this board, and it's always an interesting and eye-opening discussion, with all the different experiences people have had with this delicate and potentially explosive area.
Hope you keep posting. I'm sure most people truly appreciate your unique perspective. I have learned so much from GardenerGirl (and I know someone else is training to be a T., darn my memory..?!), and it's great to have to the chance to do the same with you. Your writing style is wonderfully clear and easy to follow (not that that's a requirement on Babble - thank goodness for me! :)) ---10DerHeart
(PS: Dawnfawn, please correct me if I clarified incorrectly on your behalf, and pardon me if I am really inarticulate today. I wrote an email to former T. a couple hours ago, and since then, my brain feels turned to mush as far as stringing together words is concerned.)
Posted by messadivoce on December 5, 2004, at 0:01:45
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » dawnfawn, posted by simcha on December 4, 2004, at 18:15:28
I feel like I have to add my $.02 about some of your comments, I can't resist. About the clock issue, my T did watch the clock but he did it very discretely and I did have a clock in my line of vision. I watched it a lot early on and it was actually used "against" me (why are you watching the clock?). But as things got more intense, I tended to place the timeframe of the session completely in his hands and not ever look.
It's probably true that some clients have "boundary issues" about time, but what I loved about my T was that he wasn't afraid to go a little over if we were deeply into an issue that was not going to be resolved quickly. Once, about 15 minutes before a session ended, I worked up the courage to tell him about a particularly traumatic event. We ended our time together 10 minutes late, but I needed that extra time to be able to finish my thoughts and process it a little before I was herded out the door. I think a good T knows when those special circumstances are occuring. I also have issues about feeling gyped (attention wise) by my dad, and when my T would give me all my time plus a little extra, that went a long way towards me trusting him.
About treatment method, if the client asks about your method, I think it's best to share honestly. Had I known that my T was psychodynamic and therefore used the relationship that we developed, I might have been more prepared for the feelings I developed for him that he encouraged. I was pretty bowled over the by love/transference and I felt pretty blindsided by it.
Posted by Susan47 on December 5, 2004, at 11:20:18
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » simcha, posted by messadivoce on December 5, 2004, at 0:01:45
So strange that I would be going into a thread I don't investigate much and this would happen. Psychodynamic? Love and Transference? Jesus, the light went on. Ah.
Is that the way my therapist operates? He kept telling me (Meat Loaf runs through myhead, "She kept on tellin' me, she kept on tellin' me, she k-e-p-t on telling me, I want you, I need you, but I'm never gonna..." )....I do my thing, other therapists do theirs, I'm not familiar with anybody else's work ..."And that's as much as he ever elaborated about his methods, if he had any. I know it felt like he was riding the crest of an emotional wave, he kept on pulling me up to ride the top of the wave, work at things from the top of my mind, try not to touch the deeper underneath.
I fell in love with him like nobody else I've ever known.
Posted by Susan47 on December 5, 2004, at 13:17:24
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » dawnfawn, posted by simcha on December 4, 2004, at 18:46:59
And here I am, *wishing* that my therapist would've had sex with me, lol!
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