Some Clinical Insights and Resources
by Robin Gray, LMFT
In this article for The Pulse I’m going to look at some clinical insights I’ve gleaned in my almost 30 (!) years of therapeutic practice, along with resources that could be beneficial for private practices. Since I’m starting to think about retiring sooner than later, I’ll also write a bit about that. I will be using the term client for efficiency, but know I’m referring to couple and family work as well.
Probably one of the most important lessons I’ve learned about doing clinical work is to not be afraid of the pain people bring into the room. If the therapist is afraid of or uncomfortable with a client’s sadness, grief or even anger, the client will more often than not be aware of it at some level. This could potentially cause her/him to be less willing or able to continue to share those feelings.
Fear also makes it hard for the therapist to interact authentically, making it difficult for the client to get access to the help she/he needs. In short, if the therapist is afraid to explore the effects of pain on the client, the therapy process can be less helpful.
Another clinical insight I have is regarding how often it is helpful to see a client. For me this has changed over time as I was trained that it was important to see clients weekly until the therapy ended. (The ending of therapy is on a continuum from the goals have been met to the client unexpectedly stops coming just when you think you were getting somewhere!)
I have come to believe it is partly dependent on the person’s schedule and finances, on the level of distress she/he is experiencing and her/his preference. As a general rule, if the client reports or presents as highly distressed I suggest she/he come once a week for a month then together evaluate whether to continue to meet weekly or less often.
If the person seeking help is experiencing a lower level of pain, together we decide the schedule that is best for her/him. It can be useful to have sessions every other week (sometimes less) to give the client time to process the work that’s been done and give them the insights they need to do better therapeutic work in the long term.
I may be preaching to the choir, but it is important to check in with clients during every session to make sure the therapy is going in the direction that is best for them, because you don’t know if you don’t ask! Questions like “are we talking about what’s important right now?” or “is there something else you need to discuss?” are examples. At the end of each session I ask whether the session had been helpful, and if not what would have been more helpful.
The bottom line is it’s all about respect, which shows up in research findings that the therapeutic relationship is more important than any other factor (e.g., theoretical preference) for successful outcomes.
Resources for private practice of course include FSTNW, for which I am personally grateful and so glad at its success (applause to Board members, Kirk Roberts and Chris Crosser!). I also recommend, especially to newer therapists, to contact someone who’s been doing the work for a few years and request an informational interview. It’s a great way for more seasoned therapists to mentor and “give back” and for new therapists to gain insight and resources.
Where do you find these ‘seasoned therapists’? A great place to start is to utilize the FSTNW listserv (firstname.lastname@example.org).
For people who are interested in medical family therapy I would suggest contacting your provider, or any friends who are providers (which is how I got into it way back in 1990!) for a conversation about your interest and potentially theirs, and for possible referrals to other providers. Again, a great way to use our listserv to ask for resources.
In planning for retirement it is important to consider not only finances, but what you want the transition to look like. For some people picking a date, transitioning clients and leaving the practice is optimal. For others a gradual reduction of clients over time is preferable. Making sure you’re financially secure is, of course, necessary. A financial advisor can be helpful in that effort. This is another time when seeking advice from other therapists, or friends, who have experienced retirement can be informative.
Maybe I’ll write about it in a couple of years after I’ve experienced it!
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