Turning Points in Our Therapy Careers

Becoming the Change We Want to See

Psychotherapy Networker

What is a turning point, exactly? And how do you know when you've reached one in your career as a therapist? Whether it's a devastating illness, or a few simple words spoken by a wise mentor, there's no denying that even small moments can radically shift the way we think, feel, work, and behave. Here, four therapists share stories of personal and career transformation, and the moment that began it all.


1) “How Do You Identify?”

Ever since I was a teenager, I knew I wanted to help transgender people with transitioning. It pained me back then that depictions of them were limited to shock-value appearances on The Jerry Springer Show. But by the early 2000s, things had changed. Although it still hadn’t occurred to many people, including me, that someone could transition from female to male, popular media had begun covering the gender confirmation surgeries of male-to-female individuals with a modicum of respect.

By 2016, I’d earned my master’s in counseling, sold most of my belongings, and found a job with a mobile crisis team. Without having a label for it, I’d already been gender-queer for several years. When I moved on to work at a private psychiatric hospital, I met a coworker who became my best friend. One day over drinks, she asked me a question I’ll never forget: “How do you identify?”

For the first time, I explained that the label lesbian had never felt quite right. The term queer felt better, but still didn’t fully capture who I felt I was. Over the following weeks, I embarked on a deep, personal journey to answer her question, for both of us. Three months later, I was fully out as transgender, going by a more fitting name, and had started hormone replacement therapy.

I decided from then on that I’d fulfill my childhood desire and focus my private practice on working with the transgender and gender-nonconforming community. Now, in every assessment, I ask clients the same question that sparked my personal transformation: “How do you identify?” I recommend all therapists do the same. The answers they receive might surprise them.

Noah Garcia, MA, LPC-S, NCC
Austin, TX


2) Violating Dictums

My career turning point happened more than 30 years ago in front of a one-way mirror. I was in training in family therapy and seeing my first couple. I’d had almost no exposure to action-oriented approaches at that point. Prior to grad school, I’d worked at a psychoanalytically oriented treatment center, and my therapy beliefs revolved around psychodynamic dictums. I was taught to never, ever, give clients suggestions about how to behave differently. 

You can imagine how I felt sitting in front of a one-way mirror with my first couple when, after not more than 20 minutes of exploring what had brought them to therapy—fairly typical escalating fights, and the wife’s depression—my supervisor called in and told me exactly what I should suggest they do! 

I was to give the couple a paradoxical assignment to schedule their fights when they could be most expressive and alert, and then send them on their way. At her instruction, over the course of that hour, I violated every psychodynamic dictum I knew. It was like tasting some exotic raw fish delicacy—“really, I can eat this and not die?" Scary, but also exhilarating. 

My supervisor, Linda Carter, had studied with Jay Haley, Chloe Madanes, and Salvador Minuchin, and assured me that effective therapy meant moving quickly to solve problems that were due to here-and-now, vicious cycles between family members. Insights into early childhood issues alone wouldn’t change them. I went on to get supervision with other Minuchin grads, and eventually, with Sal himself, who once instructed me to playfully throw wadded up tissues at a couple who, session after session, engaged in overly serious conflicts about trivial topics. He always told us, “The therapist’s main task is to introduce novelty.” 

Over time, I’ve found ways to integrate a wide variety of theories and practices, even coming full circle to reembrace aspects of psychodynamic work. But the central premise of my integrative approach is that clients need to take chances. Insight alone is never enough. We should all be engaging in “experiments in possibility”—actions that sometimes seem almost irrational, and certainly feel artificial and awkward at first, but which hold the promise of new and better ways of being.

Peter Fraenkel, PhD
New York, NY


3) Sex and Collaboration

As a sex therapist, I’d always felt that collaboration with medical professionals would be the key to competently serving a client with sexual dysfunction. After all, I theorized, the more I was able to understand the physical components of a client’s experience, the better I could delve into psychosocial impacts.

But collaboration on this level is easier said than done. Clients are often hesitant to allow therapists to speak with their doctors. Many doctors won’t prioritize therapy as part of treatment. And many clients haven’t had doctors who validate their sexual struggles in the first place.

Indeed, medical treatment for sexual dysfunction is complex and multifaceted at best—and nonexistent at worst. I can’t tell you how many clients facing painful intimate experiences have had doctors tell them to “just have a glass of wine before sex” or “suck it up.”

I’d begun to resign myself to the idea that collaboration was more pipedream than possibility, until I hit upon a turning point. This year, an opportunity presented itself at a highly specialized hospital setting where sexual medicine experts were eager to collaborate.

I was thrilled—it wasn’t hard to see potential lasting benefits for my career—but I also knew I didn’t want to leave my beloved private practice behind. I worried that doing both would be too much.

I took the plunge last year, opting to split my time between the hospital and private practice. My days may be busier now, but it’s the kind of busy that’s reminiscent of being in grad school—with new information and opportunity around every corner. I’ve got doctors down the hall, pelvic-floor physical therapists next door, and an increasing wealth of medical knowledge.

Learning from these collaborations has brought new depth to my practice and reified my long-held suspicion that collaboration truly can make all the difference.

Rachel Zar, LMFT
Chicago, IL


4) Unexpected Gifts

I’d spent 12 years establishing a successful practice focused on individuals and couples with infertility and parenting challenges when, suddenly, my 10-year-old daughter was diagnosed with leukemia. Life as I’d always known it came to an abrupt halt.

To take better care of my daughter, I let go of parts of my practice that didn’t affect my clients, including a course I loved taking, supervising interns, and participating in my long-standing consultation group. But as her needs became both persistent and inconsistent, it was impossible to establish a reliable schedule for my clients. So rather than repeatedly rescheduling and cancelling their appointments, I finally allowed myself to take six months off of work.

Having a successful private practice that I’d strived long and hard to establish added meaning and structure to my life, as well as a steady income. Giving it up, even temporarily, was another overwhelming loss at this time.

After nearly two years of treatments and life-or-death crises, I began to have faith that my daughter would survive, and I allowed myself to fantasize about reconstructing my professional life. Yearning for stability after those precarious years, I thought about taking an agency job, even though I knew it wasn’t what I truly wanted. 

I ultimately decided to rebuild my practice and shift my specialization to cancer patients and their caregivers. Though I initially worried about the impact my countertransference would have, I’ve found it richly meaningful work. Post-traumatic growth often confers unexpected gifts on all of us.

Deena Solwren, LCSW
Pinole, CA

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Photo © iStock.Photoboyko

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Topic: Business of Therapy | Professional Development

Tags: 2020 | cancer | Careers | Depression & Grief | gay | Gays & lesbians | grief | hospital | Hospitals | Jay Haley | Minuchin | Personal & Professional Development | private practice | Professional Development | Salvador Minuchin | sex therapist | sex therapy

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