image man in therapy


…or therapists, for that matter 😉 .

So it’s Sunday morning and I’m trying to think of a compelling psychological topic for the blog and I’m coming up empty:

“Three Reasons Your Childhood Matters In Adulthood,”

“Why Suicidality Is A Family Problem Which Requires A Family Solution,”

“Anxious Adults Raise Anxious Children.”

And then it hits me…I’m worried about my teenage son’s emotional development and I’m trying to “force” the psychological insight. Because that always works. For those of you who have adolescents (and God bless you), you know that reasoning with a teen is like nailing jello to a tree. They’re supposed to be obnoxious, I get that, but without mental health, how will they become independent thinkers and form healthy relationships? Better yet, how do any of us develop emotional maturity and learn to manage stress?

The short answer is you do your best and act like an adult when tempers flare. The long answer is you commit to getting curious about your thoughts, feelings, actions and the quality of your relationships.


The following mental health tips are from a chapter in “How To Think Like A Shrink: A Crash Course In Clinical Skills Preparation for Grad Students and Rookie Therapists,” an ebook I created years ago.

Although the target audience is counselors in training, the lessons are applicable to many settings and occupations. In fact, when my kid finally wakes up, I’m gonna have him read it, too 😉


39 Psychological Hacks: A Cheatsheet for Rookie Therapists (AKA the CliffsNotes version):

 

1. Contrary to popular belief, therapists do not give advice (psychological crises, exempted). We help people understand their thought process and develop solid problem-solving techniques. Also, being a therapist is much different from being a good a friend with a knack for solving people’s problems.

2. Remind others that you’re a learner; not the agency’s therapist. Internship is about testing out the lab, making mistakes and gaining experience.


3. Boundaries are the key to a healthy life. Conceptualize becoming BFF with the almighty “no” at some point in the not so distant future.


4. Practice flexibility. Get comfortable operating in a fly by the seat of your big girl or big boy pants environment.


5. Never tire of the retort, “Well, what do you think?” As trite as it may seem, the point is to introduce curiosity in your client’s thought process. Caveat: Don’t overuse it. Assume a recent death in the family feels like total shit, as does the spouse who discovered their partner’s infidelity.


6. Don’t believe everything you read, hear in lecture, or copy from your agency mission statement. Ask questions, challenge authority, and wonder why? Just don’t be rude about it.


7. Accept that the world and the workplace are largely hierarchical. There’s a reason you’re sitting in class and not running NASW or The American Psychological Association. Cement that into your lovely head, and let it take residence until you blow out the candles on your birthday cake seventeen years hence….


8. Check your ego at the door (where it will hopefully stay forever). Save the whine for the bottle. Nobody likes a complainer.


9. Understand that humor and humility help any intervention.

10. If you are interested in becoming a couples counselor and your school or program offers limited training, hightail it to the nearest workshop, couples mentor, and intensive training program. Treating couples ranks as difficult as treating chronic depression (in my humble opinion and experience).

11. Work hard. Think quicker and smarter than the rest. Graciously pay your dues. Help others without expecting anything in return. Acting smart will not win any counseling karma points. Worse, you’ll be the outcast eating your kale, strawberry and avocado salad solo while your cohort cavorts during lunch break.

12. Arrange to do a “Community Road Trip,” and Ride-Along with law enforcement so you get a feel for where your clients live, work, socialize, shop, etc.

13. “What are we not talking about today?” and “Who’s in the room with us right now?” are useful questions when chitchat threatens to eat up the therapy hour. More of an advanced clinical skill, but critical for modeling authentic communication and cutting to the chase.

14. Get the most out of your Field Instructor. Maximize your precious supervision. Always bring a notepad, and lots of questions. Review feedback afterwards. Kiss every Process Recording that’s required of you for they are invaluable to clinical growth.

15. Recognize the difference between a feeling and a thought.

16. Recognize the difference between a thought and a feeling.

17. The goal of feelings is to feel them. Humans have a strong tendency towards denial, avoidance and unhealthy coping mechanisms to deal with (or repress) psychological pain.

18. “We repeat what we don’t repair,” is one badass quote to describe our tendency to gravitate toward the familiar, no matter how traumatic or dysfunctional.

19. Speak up if something isn’t quite right during internship. You will find that unaddressed problems are like family secrets—they grow toxic with time.

20. Keep it clear, concise, and to the point when writing client case notes. Always remember, If it’s not documented, it didn’t happen. Though it pains me to have to say this, here goes: Case notes are objective and factual so no emojis or WTFs, k?

21. Never wear flip flops, Louboutins, tank tops, and glittery eye shadow, unless your internship agency is named The Beach or October 31st.

22. If you’re thinking “my internship sucks!” ask, “Could I be part of the problem?” We create our reality through our thoughts, emotions, and behaviors.

23. If a young client asks for a hug and you deem this appropriate, a “side hug” (embracing side to side, rather than front to front) is recommended.

24. When an adult client cries nonstop during the intake (especially when counseling is mandated) offer a break, an understanding word, a tissue, and keep going. Tears are sometimes a socially acceptable way of communicating, “Fuck you. Leave me alone. I don’t want to answer your probing questions.”

25. Nobody just snaps. There’s always an escalation with violent behavior. Look for increases in frequency and intensity leading up to the disturbing incident(s).

26. Counseling is not an alternative to discipline. And discipline is the antidote for unruly behavior in young clients.

27. Remember to include cigarette use when screening for substance abuse. Cigarette addiction is an indicator of depression.

28. Refrain from lead questions such as “were you abused as a child?” Ask instead, “how would your parents discipline?” or “how did you first experience sexuality?”

25. When young clients (especially teens) repeatedly answer your questions with “I don’t know,” respond with “Hmm, let’s pretend you did know…”

26. How well people deal with death is usually identical to how well they have dealt with life. Just wait until you’ve counseled and compared a few grief cases. Those clients with a mostly solid background and intact ego recover remarkably well.

27. The ways people relate to you in everyday life can tell you a lot about their deeper issues, even in a very short time. My clinical supervisor, Reevah Simon, LCSW would tell us it takes about 15 minutes to get to know someone.

28. You can tell a tremendous amount about somebody’s emotional stability and character by the way they say goodbye to you. People who cling or drag out goodbyes often have deep-seated issues with separation. Of course, we all have issues with separation; it’s a matter of degree. Those from loving, stable backgrounds carry a symbolic warm, fuzzy teddy bear that helps them cope with saying goodbye and being alone. Without this security blanket of loving memories, being alone or saying goodbye can be hell.

29. Children have one shot at childhood. And for the love of God, if you are working for, or considering a career with Children’s Protective Services (CPS), read this. Next, pass it along. I beg of you.

30. Issues in children can be traced to issues with parents. Caveat: The connection is not always linear. It’s not that mom is encouraging Junior to yell at his teachers, but she’s not insisting that he stop either…Anti-authority is a theme worth exploring in many cases when kids act defiantly.

31. People in authority rarely exercise their authority. Case in point: While working at a residential group home, it was discovered that 15 year-old “Fiona” stole make-up from a department store. When I contacted the store manager, she assured me she would “teach Fiona a lesson” when I brought her in. Said teachable moment consisted of manager crying when Fiona recounted her traumatic childhood, and sending Sticky Fingers Fiona off with more complimentary booty than she originally lifted. God Bless America.

32. Focus more on understanding than fixing. A therapist’s job is not to give advice – we have friends and family for that. Good therapists help you understand yourself and your problems better so you live with more intention and self-awareness. When we rush to offer solutions, the Big Picture benefits are lost. Worse, clients won’t understand why they do what they do, and why they see the world the way they do.

33. The goal of therapy is not to get clients to change as much as it is to find out why they do not change. And people change when ready—psychological misery or dysfunction be damned.

34. When clients tell you they have no control over their emotions, ask where are the two places people end up when they choose to not control their emotions (hint: prison and a psychiatric hospital). Remind them that they’re in session with you. “The good news is you have control of your emotions, the bad news is you must take responsibility for your choices.”

35. Feeling nervous about your first appointment, intake, or group, means you value the work. Worry when you no longer feel any anxiety about the job.

36. Listening without speaking or offering solutions are great skills to add to the tool kit. Silence is a golden therapeutic technique (I totally sucked at that one in grad school, btw).

37. Make love to the reframe.

38. Keep the wedding 5×7 and baby’s first birthday pics at home. Clients have enough to deal with, and images of you and your happiness may bring unwanted stress for them.

39. Your goal as a therapist is not to be liked by your caseload. Save the likes for your Facebook page when you have a badass private practice, like me! “I love my therapist” are words your client should never utter. If this happens, you’re not doing your job, baby.

Moral of the grad school story: CliffsNotes have their place, but the therapy room is not one of them. Please don’t let this be the only chapter you read.

***

If you want to learn more about clinical work or how to understand why you do what you do, check out: How to Think Like A Shrink… it’s a fast, fun read full of ALL the lessons I learned 10 years post-grad.


Thank you for being here!

Please share the good mental health word on Facebook or Twitter.

Yours in solid psychological insight,

—Linda Esposito, LCSW