8 Barriers to Feeling Like a Good Therapist
Updated: Jan 22, 2018
Most people work in the mental health field because they want to help people. They want to be force for positive growth and change in the world, to make a difference. Somehow these positive, if vague, goals get lost in the shuffle of making diagnoses, finding placements, and completing paperwork, paperwork, and more paperwork. Often mental health practitioners don't have the time to stop and really ask: is my work really creating positive growth and change in the world? Or maybe we don't want to stop and ask because we are afraid to know the answer. More often than not our efforts actually contribute to kicking the can of healing down the road, helping people to patch up and get back to work, keeping marginalized and oppressed people quiet as they live in intolerable circumstances, or acting as gatekeeper, deciding who gets what treatment, when, and how often.
If you are a mental health professional who has found yourself feeling incompetent, ineffective, or overwhelmed, take a look at the following 8 barriers to being a good therapist and see if any of these is getting in your way of shining your light and showing others the way:
#1 Your Values Don't Match the Values of the System You Work In
Just like I mentioned above, your motives for becoming a therapist are most likely rooted in serving others. We like to think of the mental health system as made up of a band of like-minded practitioners who all share these noble goals of improving other people's lives.
Rarely do we turn the mirror on the system and say, "does this entity really represent my values?" "What are the purposes of this system?" It is entirely possible that the mental health system does not share your values. The mental health system doesn't give a hoot about being a force for positive change. The mental health system was created for management and containment, not for healing.
Our work in the mental health system is to contain the fallout from a society built on oppression, marginalization, and hoarding of resources. We are the buffers between those holding power and those who would rise up in protest. We teach coping skills to children to get them back on track at school, we teach assertive communication to women in abusive marriages, we listen with empathy to those who have been imprisoned, abused, abandoned, exploited. Through all this listening and teaching, we hold for society, the expressions of pain that are a natural part of living in an unequal world.
For a empathic person with the values of making a positive difference in the world, the mental health system offers little chance of true job satisfaction. Your energy for resistance is swallowed up in an endless torrent of paperwork, credentialing, and proving yourself just so you can paid a tiny fraction of what your energy is worth. No wonder you feel like a failure.
#2 You Don't Have Time/Energy/Money To Work On Yourself
The therapist's job is to help people improve themselves. We sort through what people are saying and give them back reflections that help them challenge their conditioned ways of thinking and relating to others. We try to open up their view of what is possible for them, and we help them value themselves enough to set healthy boundaries and take better care of themselves. How is it that many therapists can not do the same for themselves?
The literature we are exposed to is constantly heralding the importance of self-care for therapists and other mental health professionals. We are encouraged to engage in mindfulness, hot baths, yoga, etc. We are told that we need this type of self-nourishing because our profession is inherently problematic. We are told it is hard and draining for human beings to be present with other human beings as they process and work through painful experiences.
However, focusing in individual self-care distorts the real issues. I agree that our profession is inherently problematic, but not because of the human interaction. The professional risks lie largely in the systemic issues. The mental health system is built to manage the population, not to encourage empowered healing. Yes, being present with another human as they process a painful experience is hard, but it doesn't have to be draining. In fact the beauty of the genuine human encounter can be enlivening. It's the reason most of us got into this work in the first place. The empathic human experience only becomes draining when therapists and healers have no positive outlets for processing their own reactions to their clients, when therapists and healers have to direct too much of their mental energy on mindless bureaucratic tasks. Too often the meaningful, transformative interactions that are the real essence of therapy are disrespected and cheapened through their translation into a dumbed-down progress note highlighting the behavioral aspects of the interaction.
Let's be clear about what at work drains our energy and our passion. It is not our work with clients that I hear about as problematic. What I hear the most from colleagues is the paperwork, the interactions with insurance companies, and bureaucracy at the agency, city, state, and federal levels is the source of ongoing stress and dissatisfaction. If these aspects of our jobs are what drain us, why is the focus in mainstream discussion about our profession so much on us as individuals making sure we are using our personal time to "take care of ourselves". Really we should be granted paid time to discuss and process cases, to meditate, to learn about new interventions and therapies, and to practice these new strategies and get feedback.
If you are like the army of therapists who don't have enough time or energy to take care of themselves, start thinking about love for yourself and work on yourself as a revolutionary act. When you decide to wake up in your profession, you really have an opportunity to do something better. You have an opportunity to help transform the mental health system so that it reflects the values of those of us who keep it going. To hear more about this issue, see my essay Why Compassion Fatigue is a Scam.
#3 You're Being Told the Problem is Not Really The Problem
We hear messages all the time about how to be a good therapist, and they usually come from someone trying to sell you access to a technique. "Cure PTSD in one session!" For example. These people and companies are selling you the idea that the reason you feel like a failure as a therapist is because you don't know the right techniques. Once you learn the right techniques you will excel at curing people of their symptoms and will never again experience that nagging wonder whether anything you're doing is making a difference. The trouble is learning one technique is never enough, we move on and on mastering more and more ways of doing therapy to keep ourselves from turning to face the void of incompetence that is always chasing us.
The problem is not that you don't know the right techniques. Techniques can be an interesting adjunct to the work of therapy and can help create openings when feeling stuck, but technique is not the meat and potatoes of therapy.
The real reason you have that nagging sense of failure looming around you is several fold. For one, learning technique will do nothing to improve your work as a therapist if you are not also working on yourself. Every graduate program tells you this: the most important factor in therapeutic change is the relationship between the therapist and the client. If you don't know how to successfully navigate a therapeutic relationship all the techniques in the world aren't going to make it up for you. For two, Feeling incompetent and unsure are a normal and healthy part of navigating a therapeutic relationship. This may sound insane in a system that gives us the idea that being mentally healthy means able to manage all emotions and reactions 8 out of 10 opportunities using positive coping skills. But feeling like a fraud and unsure of yourself actually means you are more likely to be open to seeing what is really going on in the therapy work you're doing. For three, Many of your clients' problems can't be solved in the therapy room. Sure you can help someone become better adapted, more productive, more assertive, and more positive. But you can't prevent them from being assaulted because they are gay. You can't protect them from racial slurs, you can't get them housing or health care, or enough food stamps to feed the family. You know the flaws in the system inside and out if you've been working long enough as a mental health professional. Many of the challenges your clients face are societal problems that become individual problems such as racism, sexism, ableism, hunger, and homelessness. Many of their problems are systemic problems, privatization of Medicaid, lack of affordable housing. In the face of a system that does not choose to lift up its most vulnerable citizens, we all feel helpless. Cut yourself some slack. It's not your fault you can't fix these problems for your clients. Feeling like it's your fault is one of those tricks the system plays on you to keep you from turning towards the power players and asking why they allow such inequities to exist. Here's a quote from the Grapes of Wrath by John Steinbeck. It's about banks, but it's also about systems in general. The way we hate the system, yet reinforce the system all at once: "It happens that every man in a bank hates what the bank does, and yet the bank does it. The bank is something more then men, I tell you. It's the monster. Men made it, but they can't control it."
#4 You Don't Know How to Use Transference and Countertransference
Transference and Countertransference are basic concepts in psychology. They are central to the understanding of the therapeutic relationship. As mentioned previously, the therapeutic relationship is the backbone of client change. How could it be that we understand the therapeutic relationship to be of central importance to making progress in counseling, yet we often fail to train new therapists in the art of making sense of and using Transference and Countertransference?
Many people know these terms as being in the wheel house of Freud. Freud has become notorious in modern psychology training programs, despite providing modern therapists with most of the method and theory they commonly use. I'm not saying there isn't room for critical analysis of Freud's theories, but I am saying if you want to be effective you should do some work to understand Transference and Countertransference.
Transference, most basically, is how the client feels towards their therapist and the ways in which prior relationships and experiences may play out in the current therapy interaction. Countertransference is the way a therapist feels towards their client and the ways that therapist can learn about the client and about themselves through examining Countertransference.
You guessed it, playing with these concepts involves a lot of soul searching and self-awareness. But it's worth it, trust me.
#5 You Want People To Like You
Many of us, when we began our training, never took the time to look deeply into why we decided to become therapists. Our surface reasons often have to do with benevolence. "I want to make a positive difference in people's lives" "I want to help someone the way my therapist helped me". Those reasons are real, don't get me wrong, but most of us harbor some underlying reasons for being therapists that we may not even be consciously aware of. Such as, "I want to be admired, and what better way than having people pay to spend time with me" or "I like being right and being able to tell people what to do" or "I like feeling indispensible to others" or "I like people telling me what a good job I am doing and how much my work means to them"
While there is nothing wrong with our more narcissistic motivations for becoming therapists, there is something wrong with not understanding ourselves. Take some time to get familiar with your "secondary gains" from being a therapist and how you invite your clients to meet those needs. When you engage in this kind of self-reflection you make more room for things to really happen in the therapy relationship. As long as you are protecting yourself it will be hard to be genuine.
#6 You Don't Understand How Societal Factors Affect the Therapy Relationship
Every therapist/client relationship is affected by the identities of the participants. Often in training programs, therapists receive a cursory introduction to being "culturally responsive", meaning familiarizing themselves with segments of the population, their worldviews and customs. Very few clinicians get a deeper understanding of how entrenched oppression is in the fabric of our society and how important it is in the therapy room.
Making "well-intentioned" hurtful statements, acting on assumptions, or living up to stereotypes of privileged identities are all therapy squashers. For example, white therapists who client are not willing to examine white privilege can create an unsafe therapeutic atmosphere for clients of color. Remember, areas where we are privileged are our blindspots, so expect to feel uncomfortable, and if someone tells you that you have acted in an offensive way, believe them.
There is a great deal of literature available on understanding the dynamics of oppression in society. You can start by reading, watching movies and documentaries, and going to lectures that will broaden your understanding of how oppression affects individuals and communities. Focus on learning about ways you are privileged so that you can develop an increasingly deeper and more realistic picture of the dynamics of oppression.
#7 You're Ignoring The Body and The Soul
Ok, this one's not your fault; it's really not. Unless you have been making a Herculean effort to seek out information, no one has every taught you how to incorporate the body and the soul into your therapy. Efforts to educate yourself in these aspects of therapy can expect to set you back numerous thousands of dollars.
However, incorporating the body and soul into therapy is really the key to long-lasting change. The field of psychology has been plodding on for decades with this image as the mind in isolation, suspended in mid-air, operating independently. The separation of mind, body, and soul is not only a sham, it interferes with the healing process. Emotions are bodily experiences. Muscles respond to memories. The soul is what helps us make meaning out of the unexplainable.
Proceed in isolation if you must, but if you want to feel like you really have a map to help your clients navigate the terrain of healing, starting learning how to integrate the mind, body, and spirit. Focusing on making change in the mind only is like trickle-down economics. Expecting the effects of change on one part of the self to find their way to the rest of the organism in any kind of a timely manner is optimistic at best.
#8 Change Doesn't Happen the Way You Are Told It Does
What we think, what we write, it gets in our heads. Take me for example, I started off in my first job out of graduate school, saying I am going to learn the language of behaviorism and be a shining example, because I used to like being perfect like that and getting tons of praise from my "superiors". So I learned how to right things like, "Client will manage trauma reactions effectively 8 out of 10 opportunities for a period of at least 2 months per clinician observation and client report". Good, right? Specific, measurable, and relevant to the diagnosis. Just what insurance companies like.
So I got to go on feeling superior with my gold star and my new language mastered, knowing I was being a good employee in the eyes of the administrators and the insurance companies. Because the bottom line of a mental health agency is really getting paid. You can do all the amazing work you want, but if you're not getting paid for it, if you can't prove progress through measurable treatment plans and standardized assessments, then it doesn't really exist. You know what happened, as I tried to play both sides, to be the darling of my praise-seeking self and my deep, soul-searching self? What happened is that reductionist, behaviorist language began to seep into my brain, even though I told myself that I would never let it in. It became so automatic I could do it in my sleep. In fact, I can still do it in my sleep. Anything that becomes automatic means that it is a habit; it made its way into my unconscious mind. Now hopefully, you already know that what is in your unconscious mind makes all the difference in the world. It is what we act from the majority of the time.
What's the big deal if that kind of language and measurement gets into the unconscious mind? It's just language anyway, right? Well, the problem is it starts to affect how you view change. Soon you find yourself saying things like, "Oh not, their PHQ-9 went up this review period!" or "Why aren't they reporting positive self-esteem 6 out of 7 days a week?!" And then you begin to feel ineffective. Whether you like it or not, these stale measurements of change are guiding your inner compass both inside the therapy room and outside of it.
In reality change doesn't happen in the smooth, glossy, predictable manner that reductionist treatment plans would have us believe. Change usually takes something like a spiral shape. We move up and around similar issues again and again, refining our approach, our knowledge, and our insight each time we revisit it. Emotional distress accompanies change. In fact deep psychological change can't happen without experiencing anxiety. Anxiety is natural when we are giving up some defense or challenging ourselves to new experiences, new horizons. If we view the anxiety as a backsliding, as impeding progress, then we undermine our own ability to manifest and acknowledge growth.
One of the most important and validating things I can do for a client is help them to see how much they've grown because small, incremental shifts often go unnoticed by the person making those shifts.
Don't underestimate how much the distilled, de-personalized aspects of your paperwork are actually affecting you, and remember that change is fluid, chaotic, and hard to pin down.
Okay, maybe now you're pissed off, or depressed, or feeling like an even worse therapist. Maybe you're revved up and ready to make change. The key to these barriers is that we also help reinforce them through the work we do, myself included! What is happening now is that we have an opportunity for a new psychology to develop, a new model of work that is focused on healing and empowerment, not on management and insurance reimbursement. Now I don't know what the whole future of the mental health system looks like, and neither do you. I am just one small piece of it. If you choose to engage in this transformation collectively, a vision will begin to develop, and, like any entity, morph over time.
The opportunity to transform the mental health system actually is in our collective hands. We have the power and the capacity to transform the way we work so that it becomes life-affirming, inspiring, and uplifting. You need it as a practitioner, and everyone who accesses the mental health system needs it too. Everyone has a role to play, everyone has a vision that will make a difference towards a system truly promotes health and well-being.