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An entire industry has sprung up to address the problem of compassion fatigue, but research indicates that the most commonly proposed answer, improved self-care, doesn’t work. In fact, the study of the most highly effective clinicians suggests that burnout isn’t related to caring too much, but continuing to care ineffectively.
As a practice-building coach for the last seven years, I’ve met a lot of therapists who are working hard to implement marketing strategies that just don’t work in today’s therapy environment, although they worked well in the past. So what’s changed? One word: the Internet. If the Internet continues to grow in importance as a communication and information medium, as it almost certainly will, it’ll increasingly be the most effective way for you to attract clients. So how do you create a web presence? Here are a few possibilities.
More and more clinicians today are adapting to meet the demands of the digital world and fit into the schedules and lifestyles of clients no longer willing to follow the traditional pattern of once-a-week sessions in a therapist’s office. In a consumer-driven mental health marketplace, individuals with anxiety disorders want services from the comfort of their homes. For veterans living in rural areas, remote group and individual psychotherapy for trauma offers treatment possibilities that weren’t available even a few years ago. But although telehealth has been around for decades, many clinicians are still unsure about the clinical, ethical, and legal issues that emerge as distance therapy becomes a more accepted practice.
What first made me fall in love with being a therapist was the idea that I could make a living by having conversations that cut through everyday pretenses, got directly to the heart of the matter, and helped people change their lives. That was then, and this is now. Today as a profession—and as a society—we’re much more fearbound and rule conscious than we used to be. Yet the sacred space of the therapy room is the ideal place to really exercise your creativity. It’s taken me more than 30 years to realize that it’s the combination of two strange bedfellows—imagination and repetition—that holds the key to change.
If we can bring awareness into our own pulsing bodies, we get a chance to explore the hidden well of physical discomfort caused by our memories and emotions and our crazy defenses against that discomfort. The body, you might argue, is the unconscious. No one welcomes discomfort, but the fear of becoming overwhelmed, the fear of unleashing strange forces, of “wallowing” in negativity, can funnel our energies away from tolerating even the mildest turbulence of our felt experience. In my therapy practice, I’ve learned that being present to the rich physical substrate of the body can be especially useful in couples work.
Money is an underdiscussed topic in graduate programs, supervision and peer groups, yet every therapist I know has felt the awkwardness of seeming mercenary when insisting to a client who has fallen behind that he or she needs to pay. Unfortunately, most therapists were never coached about how to reconcile the closeness of the therapeutic encounter with the fact that therapy is also a business. These days, I run into the problem of clients who don’t pay far less frequently than I used to. I attribute this to two changes I’ve made.
Many walk into the therapist’s consulting room exactly at the moment that they have been stripped to the core of their being. While not at the physical meeting-point of life and death, they are often at its emotional and spiritual equivalent. One element they seek and are desperate for is beauty; they present a situation that’s cut them off from experiencing beauty. All of which leaves us facing one piercing question: What is beautiful in your life? The therapist-client relationship is just about the last functioning shared space in this country where this question can be asked and, more important, heard. Which is why it’s so crucial that therapists find a way to ask it.
Psychiatrist Daniel Amen argues that a brain-imaging method called SPECT is an invaluable tool for understanding and treating psychiatric disorders. SPECT has been used in a huge number of research studies on almost every conceivable psychiatric and neurological condition, as well as some nonpsychiatric studies. So what is it about Amen and his mission to get therapists to use brain imaging, and SPECT in particular, as an aid to diagnosis and treatment that makes him such a lightning rod?
We Americans believe profoundly not only in the pursuit of happiness, but in our unalienable right to obtain it. Despite roughly 5,000 years of written evidence to the contrary, we believe it isn’t normal to be unhappy. But according to Steven Hayes, the creator of acceptance and commitment therapy (ACT), it’s suffering and struggle that are normal—and not the reverse. Furthermore, dealing with our inevitable psychic struggles by trying to get rid of them doesn’t work and may actually make them worse. In this interview, he explains the origins of ACT and what he sees as its future.
The aspects of our brains that evolved 50,000 years ago—which give us astonishing powers of thought, logic, imagination, empathy, and morality—also share skull space with the ancient brain equipment that we’ve inherited from our mammalian and reptilian forebears over the past several million years, including the neural circuitry involved in fear and anxiety. Some therapists bristle at the integration of neuroscience and psychotherapy, calling it irrelevant or reductionistic. But information about the brain and how it evolved helps us communicate with clients about their problems in an objective and non-shaming manner. It’s hard to grasp how the brain could be irrelevant to changing the mind.
When we learn that clients have experienced tough childhoods, sexual or emotional abuse, or significant losses, we often make immediate assumptions about their current struggles and the kind of treatment they require. In many ways, the information we gather about problematic pasts biases and blinds us. But human beings are far too complex to assume that we know how any single person assimilates his or her experiences. So why not assume resilience? Why not trust people’s abilities to rebound from adversity?
Today I attended a workshop called “Working with Black Couples: Overcoming Myths and Stereotypes,” led by Dr. Christiana Awosan. Being an African American female, this talk was very emotional and I was able to identify with some of the stereotypes that have been placed on black single heterosexual women. A big problem in black relationships, Christiana said, is not that black men and women don’t want to stay together. It’s that they don’t know how to sustain their relationship. Race is a huge contextual factor in why black couples have a hard time working through their issues. But nobody seems to be talking about this or giving voice to their oppressive experiences within society.