A Revealing Moment

Each week, my interns submit a summary of their clinical hours along with a “process note,” pretty standard training fare. These notes are supposed to document their internal ups and downs; the good, bad, and ugly of their week with clients whose challenges and pathologies are probably a bit above their current pay grade. Good learning opportunity, I often rationalize, especially since they have competent on-site supervisors who are there to teach, train, and support their burgeoning yet fragile clinical identities.

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If the academic/clinical interface were a bit tighter, I would have these folks work their way up from simple and acute disorders to the more severe and chronic pathologies as they evolved through their training. But such is not always possible. So, for most of my trainees, this entails some arduous hikes on those steep and unmarked learning curves that we more seasoned clinicians have experienced—and still may.

Sure, we process some of the more complex clinical challenges in class, and they are in resource-rich learning environments at their sites, but for the most part this is boots-on-the-ground OJT-101. Such was recently the case, when one of my interns wrote in his process note, “I find myself dealing with [a] therapeutic boundary [with a client who] was giving signals of perversion [related to] the dress code. I felt uncomfortable and reported [this] to my supervisor, and the client was confronted. I felt supported and protected.”

I was curious about what he actually meant by the word “perversion,” given the loaded and historically pejorative nature of the term. Upon follow-up, I discovered that in this intern’s culture, women are quickly and quite aggressively shamed and oftentimes punished by family and community if they act or dress in a way that is considered immoral and violates biblical principles.

The client was a 32-year-old female attendee in a day-treatment program who, in the intern’s words, had chosen to wear “a cut-off shirt without a bra and see-through sport leggings without panties.” In that moment of discomfort, my intern abruptly ended the session by telling the client that he had to attend an intake session. He then went to his supervisor for guidance. While I was very glad that the intern took this immediately to his supervisor who gave him the support and protection he needed at the time, I was dismayed that in that very uncomfortable moment, perhaps understandably, he simply told the client that he had an intake to perform and abruptly ended the session. He lied to her.

Apparently, this was not the first time this client had approached therapy with a male clinician in this manner; she was subsequently transferred to a seasoned female clinician after her brief visit with my intern.

In retrospect, my intern understood that this might not have been the best way to handle the situation, but he had clearly been taken off guard by this “attractive woman,” was intensely uncomfortable, and expressed concern that if he did not act immediately that his “imagination” might get ahead of him. While he momentarily considered the possible role of transference in this client’s wardrobe choice, he was even more relieved that his supervisor and the clinical director handled the situation “sensibly and professionally.”

This scenario brought me back to an incident during my own training when, during a practicum placement in a state psychiatric hospital, my supervisor decided it would be instructional to set up an intake for me with one of the “chronic” patients. Soon after being ushered into the seclusion room with me—a strange choice of setting—the patient sat down facing me with her bathrobe open and nothing underneath. All I remember about that tortuous moment in time was that I froze. As then, as if from thin air, my supervisor emerged from behind the one-way mirror and into the room. Upon my supervisor’s entry, the patient immediately sat erect, closed her bathrobe, and had the most delightful conversation with my supervisor, who later said to me, “I can write a book about any patient after meeting with them once.”

In retrospect, I believe, knowing what I later learned about this man, that it was an exercise designed to humor him and shame me. After my initial embarrassment and sense of ineptitude receded, the shame set in.

Getting back to my own intern, I was very aware of not wanting to shame him and wanting his own moment of torture to be a learning opportunity for him and the rest of the class. So I asked them all to consider what they might have said in that moment, while my intern listened in and then reflected upon their responses. These included, “I probably would have done something very similar,” “I would have told her about boundaries and that I was not comfortable continuing the session,” and “I would have ended the session and rescheduled after telling her that her attire was inappropriate for the setting.”

Each of their responses was appropriate given their level of experience, but in retrospect, I was a bit disappointed, perhaps unrealistically, that none of them had considered the possibility that this client’s choice of attire might actually not have been a choice, at least not a conscious one. So, I wondered out loud with them about the possibilities that she had been sexually assaulted or trafficked or both, and/or had come to rely on seduction to navigate relationships of power imbalance, particularly with men. It might have been erotic transference. Or perhaps, it might have been none of these, and she was simply proud of her body, and had chosen not to heed past messages around the inappropriateness of this behavior.

***

As I write this, I am an hour out from my supervision class in which I hope the incident will come up again; if it doesn’t, I will bring it back into focus. I’ll be most interested to know what about that client’s behavior triggered my intern to consider it a “perversion.” Hopefully, he will not feel the shame I did many years ago, and we will have a rich discussion.

What would you have done?
 

Jude Austin on Wisdom for Counseling Students and Educators

Into the Wilderness

Lawrence Rubin: Why did you entitle your latest book “Surviving and Thriving in Your Counseling Program?” It sounds like you’re sending them out into the wilderness with a backpack and a knife and saying, “Good luck. Let me know how you’re doing in three years.”
Jude Austin: When my brother Julius, who is also my writing partner, and I were thinking about the title for this book, that’s the image we had in our minds. You get equipped in graduate school with these different tools, skills, and attitudes and then go off and get your Ph.D., and you think you’re prepared.

But when you’re sitting in that first session unsupervised, you just feel this sense of, “I need an adult and a Swiss Army knife of some type.” So, that’s kind of what we wanted this book to be—a Swiss Army knife for counseling students and counselor educators who were reading it and feeling out of touch with their students like, “Hey, this is what they’re going through!" So yeah, we wanted it to come across as if this was your guide to surviving but also thriving in your counseling program.
LR: Sort of a field guide to counselor educators and counseling students and an army knife with different utilities. Can graduate counseling programs ever adequately prepare students for what’s to come?
JA:  
when you’re sitting in that first session unsupervised, you just feel this sense of, “I need an adult
That’s the million-dollar question. It depends on the type of program—and there are different types. You have programs that train clinicians, and then you have programs that train people who become clinicians. The counseling program that I teach in at the University of Mary Hardin Baylor focuses on the person of the therapist.

When beginning therapists (interns) are out there in the clinical wilderness, and all their practiced techniques fail, we want them to fall back on themselves as the tool. If a counseling program focuses on developing the person, their attitudes, awareness, and then helps them to develop some skills along the way, then I think that person has something solid to fall back on.
LR: What happens when you have a counselor educator who understands the importance of building self, self-esteem, and relational, not just technical, skills, paired with a student who thinks that they’re the finished product? Or perhaps an older student whose cup is already too full or a younger one who hasn’t yet been put in a position where they’ve been tested either interpersonally or emotionally?
JA: I struggle with that sometimes. We get students who come in with already-filled cups because they’ve had a successful career or currently have many competing obligations including family. They may feel like, “I know this. All I really need is for you to give me that paper at the end of this, and I’ll be fine.

I see that as an invitation to build a relationship with that student so that we can model the relationship we want them to have with clients
I see that as an invitation to build a relationship with that student so that we can model the relationship we want them to have with clients. I don’t see that confidence or arrogance as a threat, and I don’t want to humble them. I feel like that’s what a lot of counselor educators tend to do anyway; something like “We’ve got to do something that will break them down.”
LR: Drop them to their knees.
JA: Yeah, drop them to their knees! I feel like a better approach—or at least one that’s helpful for me, is to help that student understand what they do know and what they don’t know. It’s not about bringing them down to where they can sit humbly with a client. It’s about saying, “Okay, what do you have that works for you? And what do you have that doesn’t work? And how can we work around that and use it to build a better counselor?”

Getting What They Need

LR: Have you encountered such students or those who are clearly trying to work through their own issues either early on in training or while they are actually providing therapy?
JA: That’s OK, because it gives us an opportunity to help the student learn boundaries, because counseling is like that. I mean we get the clients we need, and so this isn’t going to be the first time they’re going through these kinds of issues and those issues come up. So, our job, or my job as the counselor educator, is to help that student understand that boundary.

That counseling student is actually in a good position to use the issues that they have experienced or are currently experiencing to build a better relationship with a client. And when the student is at that boundary and it is hindering the therapeutic relationship, the teaching moment is right there in front of them, as is the teaching tool for their supervisor. What you don’t want to do is set the stage where a student feels like, “I’ve got to get my shit together, or I can’t do this.” That’s just not sustainable.
LR: I like the idea that we help students understand that sometimes they get the clients they need. Try as I might to selectively place interns in facilities where they’re not going to be thrown to the lions, they invariably end up not only with clients they need but also with those who are very complex and well-beyond their skill and experience levels.
JA:
what you don’t want to do is set the stage where a student feels like, “I’ve got to get my shit together, or I can’t do this”
As far as I do it in supervision, it’s really just helping them navigate those multiple and often complex relationships. I try to do my best to encourage students to chew on things before they swallow it. We start them in practicum at our free, university-based community clinic before sending them on to internship at an outside site.

During internship, we tell them something like, “Hey, you’re going to be hearing some stuff and be asked to do some things at the site that may run counter to what we said or what we’ve trained you to do. And so, you’re out there in the world.” And so, they begin to learn, “How do I integrate some of the things I learned in school with what I’ll learn here and not allow it to negatively impact my development as a counselor?” I think the key is helping students recognize and take ownership over their own development, so they can’t be manipulated or pushed or pulled when a supervisor asks them to do something different from what they have been taught or experienced while in school.
I’ve seen many a student who goes off into a site with a supervisor who is overwhelmed or unprepared or not trained to be a supervisor because they are first and foremost a clinician. And so, students lose confidence and get set back. We as clinical educators have to help them take ownership over and protect their own personal and professional development.
LR: And we have to protect students from supervisors who might be overwhelmed, overwhelming, and/or incompetent.
JA:
we as clinical educators have to help them take ownership over and protect their own personal and professional development
Up to a point, I don’t want to rob them of the learning experience of being next to somebody who may be incompetent, unavailable, unhealthy, or who may be just not be a good role model. I want them to learn that. It’s kind of like when my son is climbing up stairs for the first time, I don’t want to be next to him and holding his hand. I want him to struggle and wait for him to ask for help.

Similarly, it’s about teaching that student when they need to come and tell me that something is beyond their capabilities, especially when they’re in internship. Because when they’re in internship, we need to make sure that they know how to strike that balance between knowing when it is necessary to ask for help and when it is not. Otherwise, they won’t build strong roots.
LR: They have to have their own immune system.
JA: Yeah, exactly.
LR: So, being a clinical educator/supervisor requires that we also strike a balance; between protecting and…
JA: …letting them struggle.
LR: Just like the APA Code of Ethics says…promoting autonomy while also making sure that they’re not a danger to themselves or others.
JA: I’ve had many supervision sessions where we’re just like, “This sucks.” You also have to build a relationship with their site supervisor. Sort of like co-parenting.

Rising or Falling

LR: If you were called on by the ACA to write a formula for predicting failure of a graduate counseling student, what would go into that equation?
JA: I had two thoughts but will share my second one first, which is about counselor educators. I’m a big believer that oftentimes our limitations as counselor educators can then become our student’s limitations. And so, if a student is failing—or failing to thrive—for some reason, then I merely have to look inward and be congruent and be healthy about the responsibility I take in that student’s failure and think, “Wow, is this a support issue? Maybe I didn’t prepare them enough. Maybe we didn’t have a big enough informed consent around what this would mean for them,” right?
LR: So, the second part of your answer, which comes first, is that if a student is on a track to fail or is failing to thrive, then it is the counselor educator’s job to look within to ask, as a parent might, “How have I failed to support this student’s thriving?”
JA:
our limitations as counselor educators can then become our student’s limitations
Yes. What are my limitations here?
LR: What’s the other part of your answer?
JA: I think sometimes they can’t be helped. And sometimes students come in not expecting how challenging the program is, not giving the challenge of this enough respect. If I were to create a formula for predicting a counseling student’s failure, I would probably say it has something to do with lack of awareness or acknowledgement of how challenging this program is, plus maybe a lack of support. They know it’s going to be hard, because it’s graduate school. But I don’t think they know how hard graduate counseling is, graduate psychology is. It asks a bunch of questions of you that, if you aren’t prepared to answer, it can have a domino effect in your relationships and your mental health and your ability to process things.
LR: Conversely, what do you think are some of the characteristics of the counseling graduate student who will thrive not only in graduate school but in their career, in their personhood, in their lives?
JA: The #1 characteristic for me is humility.
LR: Yeah, amen.
JA: And not just humility in the sense of self-deprecation. I mean this humbleness around the idea that maybe their reality isn’t the correct reality, and their willingness to allow their client’s reality to be correct for that client. It’s about cultural humility, to be able to come in and say, “Oh, man. There are some things that I don’t know. There are some things that I don’t perceive about the world like everyone else does, but I’m willing to learn.”

it’s not like people who are wounded or hurting can’t do this work. It’s just they have to work on the stuff that they need to work on
I think that’s the humility that I’m talking about, to be able to say, “Okay. Here’s my stuff. I’m going to work on my stuff.” And I think that’s the clear thing. It’s not like people who are wounded or hurting can’t do this work. It’s just they have to work on the stuff that they need to work on. And when students are aware of that and they’re doing that parallel kind of process, then it’s a beautiful thing. I feel like that’s when students can be successful.

So humility, for me, is the thing that we’re trying to foster in counseling students. And to be honest with you, a lot of the students that we accept are already good at this. We just give them skills and tools in the hopes that when they get to internship, they’ll remember who they were when they first started the program. And then when they remember that person, they can be that person with some skills and attitudes and knowledge. And so, if you can go through that process humbly, I feel like you can stay grounded and remember who you are. That’s kind of my perspective.
LR: So, it’s the counselor educator’s job to teach counseling students to hold onto who they are and maybe shave off or trim those parts of themselves that are going to get in the way, so they can become more psychologically lean but hopefully learn to become the person who is a counselor, not a counselor who is not sure who they are as a person.
JA: Yeah. Now, that sounds easier said than done. And I think that also means that as counselor educators, we have to do that too. We have to model that for students. We have to let them into our experience and our journey of becoming, step-by-step, more and more ourselves in supervision, in class. Let them into that process and show appreciation. One of the things that I say after each class is, “Thank you for letting me be myself.” And I invite students to do the same. When I mess up, when I forget my keys and I have to walk back to my car or when it’s just like it’s not a good lecture, owning that and showing them that this is what we want you to do in session.

Healer, Heal Thyself

LR: In the context of this piece of the conversation, what are your thoughts about counseling as a mandatory part of counseling training?
JA: You know, it’s strongly suggested in our program, strongly suggested. I feel like we build a culture of support in the sense that we have alumni who are now working in the field who kind of understand a little bit of what students are going through. And so we try our best to refer them out to clinicians in the area that can help. But mandatory? If I could make it mandatory, I think I would be at least a couple sessions. Just so you can see how it feels.

But making it mandatory? I feel it could be detrimental for students who aren’t ready to process their stuff. I mean if they’re not ready, it doesn’t mean that they can’t be good counselors, but here’s the thing. If you’re not working on your stuff, if you don’t go to counseling, you may become a really good technician but not a clinician. You can go and do skills, you can go and do theories, you can go in and do techniques and activities. But can you really connect with somebody? Can you have a therapeutic presence that allows that client to feel pulled toward you and can you evoke your client’s awareness? I don’t know if you can do that without working.

one of the things that I say after each class is, “Thank you for letting me be myself.” And I invite students to do the same
Yeah, it’s a dilemma. In a lot of ways, it’s safer to do rather than be, right? How can you cultivate a therapeutic environment where you feel safe enough to be? Most counseling students are going to graduate and feel like, “I know some stuff now.” But I think what makes our program special is that we really focus on training students to be, but not every student is ready for that, and that, too, is a dilemma. I notice it sometimes in clients with whom I am trying to connect on a deeper level, and they don’t want it.

They want… “Give me the coping skills. I don’t want to talk about…” And so, you have to meet that client where they are. And it’s the same thing with students and the same thing with the field, like allowing students to hear, “Hey. This is where the field is. This is what we’re trying to get you to do. We’re trying to find a balance between doing and being.”
LR: So if a student is not ready for internship for emotional, psychological reasons, what do they do instead? How do you work with a student who just is not ready for internship by all your standards but is insistent or demanding or even litigious about it?
JA: We go through this a lot. We have a couple of different options. This is not like a plug for our program, because I think most programs have this. By the time they get to internship, we want them to have a really good idea about how we feel about their potential to succeed or fail. We don’t want it to be a surprise. And so, by the time they get to internship, we’ve had that conversation where it’s like, “Hey. There’s a lot of things that you… There’s a lot of hang-ups. There’s a lot of things that could limit your success there. If you want to do it, we can’t stop you, but it may behoove you to take some time and then come back and start internship.” And if students are like, “No. I’m good. I want to do internship,” then we help them find an internship and a supervisor that could support that student’s limitations.

So, sometimes we’ll have students who are veterans, and maybe they experienced a TBI and they struggle with death work. And they acknowledge it, they know it. And so, we work with them to say, “Okay. What kind of work can you do? Where can you serve your community?" And so we try to guide them into the place where they could be most successful. But sometimes, rarely perhaps, I have students who are not ready to integrate it, and we just have to kind of let them survive… or not, you know? And when they don’t, we’re there to support them.

The Right to Fail

LR: I had a supervisor once, a very wise older woman who loved the metaphor of a safari guide. Her idea was that “As we walk through the terrain, I’ll point out the quicksand. I’ll point out the thickets and the brambles. If you choose to go into the quicksand, I’ll be waiting on the edge if I can help you.”
JA: Absolutely. And students have a right to fail. They very much have a right. And I think that’s the thing that we try to get students to understand. It’s like they’re not paying for this degree, they’re paying for an opportunity to get a degree. And if they destroy that opportunity because they go into an internship site when they’re not prepared to do so, there’s nothing that we can do about it. Those internship sites can hire you and fire you. If you get fired, there’s consequences. We’re very open about that.
LR: Do you ever experience transference/countertransference relationships with your students?
JA: I think I can answer this question in a way that’s most favorable for me [smiling]. I just genuinely care about the students and their success. When we accept a student into our program, when I’m working with a student, I see the impact they can have in their community, the ripple effect that they can have. And all I want for them is to be successful.

watching them struggle is the hardest part
And so it’s triggering because it’s like watching someone doing something that is going to hurt them but allowing them to get hurt so they learn the lesson. I think that’s the hardest part about being a counselor educator. I think that’s the countertransference, especially because I’m a relatively new dad of a two-year-old and a four-month-old. It’s like that same process of watching them go through it and identifying with that struggle.

So you just have this sense of ownership over that person’s development. And then when they get to internship, you’re letting it go and that ownership transitions to someone else—their site supervisor. And so, watching them struggle is the hardest part. And we go through that every year, because there isn’t an internship cohort that doesn’t have one or two students who is realizing at that moment like, “Oh, crap,” as they fall behind. It’s brutal because they have to watch their cohort members move forward.
LR: You clearly have a heart for your students and want them to succeed, but I want to push you on this one. What about those counseling students that you don’t like? You know, the ones that burrow under your skin or those that you simply don’t care about or like?
JA: I just try to put obstacles in their way, which means that I have to have that conversation that I don’t want to have but I know I need to have with that student earlier than other students. Like with that student that is burrowing under your skin, I very much experience a parallel process where I’m saying, “If this person is affecting me this way, they’re probably going to affect clients this way as well.”

that’s what I mean by obstacles, like slowing down their process so that they can gain awareness of how they affect other people
And so, before they even get to apply techniques, which is the second semester where they first learn how to do mock sessions, we need to have a conversation. We need to have that talk like, “Hey, you know that thing that you do in class? That’s annoying, man.” And what I try to do is say, “Whenever you…” Like if a student has a loud laugh, that’s saying like, “Pay attention to me,” right? What I try to get them to do is, “When you laugh, pay attention to everyone else’s reaction. Pay attention. Feel how you affect other people.” That’s what I mean by obstacles, like slowing down their process so that they can gain awareness of how they affect other people. Because if they’re affecting me, they’re going to affect other people.
LR: So, what you’re trying to do is not simply model empathy or pray to God that they sort it out through osmosis or some other way. Sometimes, you have to really just actively teach them what it means to be empathetic because in therapy, the audience is watching. The audience is listening
JA: Worst-case scenario, you’re doing it live in class and the student does something and you have to say, “Hey, pay attention to how everyone is feeling around you. Would anybody like to share how this person is affecting you right now?" And then sometimes I may say something like, “This is how I’m experiencing you right now. You don’t have to respond to it. This is just how I’m experiencing it. Do you want to be experienced in that way? Is that what you’re trying to get me to experience you?" And I think that’s kind of the learning that we need them to get.
LR: So, counselor educators need to manage their triggers so they can be most present for their counseling students, just as we ask counseling students to have those qualities with their clients.
JA: Exactly.

Straddling Two Worlds

LR: How do you balance on that tightrope separating the supervisory and therapeutic aspects of your role as a counselor educator?
JA: I straddle that line as carefully as possible, because that’s probably one of the most unexpected challenges my doctoral program prepared me for. And they can’t really prepare you for that. So, the way that I keep a boundary around it is that when I’m with a student, I’m always thinking about learning opportunities. I’m always thinking about teachable moments. And so, there’s times when I go there with a student, especially when we’re processing deep stuff. But there is a stopping point when it gets to, “Okay. We’ve got to stop because I feel like this is what you need to process in therapy. This is what’s affecting the client, that you need to process that in therapy.”

I’m always thinking about teachable moments
But when I can cultivate a relationship with the student or supervisee that is safe, then sometimes in supervision I may feel like being open about, “Okay. We need to work through this so that you can better work with clients,” then, “Here’s where we’re going to work, and here’s where we’re going to stop.” Does that make sense? It’s almost like an instinctual knowing of when I’m going too far, when we’re getting too deep. And I can feel that with students. I may see them becoming uncomfortable. So, I want it to be a wisdom-based engine, and I don’t want that engine to spoil over into fear, because then they’ll push away.
LR: In this context, many counselor educators are also practicing clinicians, and I wonder if that is beneficial or detrimental.
JA: I have a small private practice here in Temple, and I don’t know how I would be able to do this job without seeing a client or two a week. And it’s mainly because sometimes when I haven’t worked with clients and I’m in front of the class with the alphabet behind my name, I feel like I am The Guy. And then I go into a session, and I’m humbled and reminded, “Oh, yeah. I don’t know what the hell I’m doing,” or, “This session got away from me.”

I feel like it becomes hard to manage whenever my practice hinders my health, when I’m scheduling, managing things when it’s overwhelming, when I’m burnt out, and my students become a secondary priority. That’s when I know, okay, something’s going on. But, yeah, I work with individuals, couples, families. And I usually have about four or five clients that I’m seeing in a semester.

Lifespan Issues

LR: How, as a parent to young children and also in a sense a parent to young, evolving clinicians, do you teach them about the uncertainty and our limited ability to influence others?
JA: I think you put them in situations intentionally where it’s grey and uncertain and watch them go through it. What we try to do is have a healthy balance between safety and ambiguity. We want clinical trainees to feel safe enough to be able to feel okay floating in the wilderness somewhere. We know where they’re at. They may not know where they’re at, but we want them to feel safe to be lost a little bit.

we want clinical trainees to feel safe enough to be able to feel okay floating in the wilderness somewhere
And so, I think that’s how you train them. It’s like you intentionally scaffold and build into your program situations, places, activities where students can get a healthy dose of “I’m just going to go with it, and I’m okay because I know I have a healthy attachment to my faculty.” It’s the same thing as a new parent. It’s like I know my relationship is strong when my son can play independently and then come back and check in and then play independently and then come back and check in.

It’s like he knows that he can wander and it’s safe to come back. Same thing with students, right? We want them to go off and explore a theory, a technique or try this out or bring this into session or bring this into practice and then come back and say, “I don’t know what I did.” You know what I mean? So yeah, building that in intentionally.
LR: You’re in a unique position, Jude, because you’re learning what it means to be a parent while you are shepherding counseling students into their professional identities. It makes me wonder—what are some of the challenges that clinical educators have who are later on in their life, who are no longer dealing with raising young children but perhaps launching teenagers, or have children who are getting married, or are dealing with their own mortality? How do counselor educators separate or merge the challenges in their own personal lives with what it is their students need in theirs?
JA: I feel like the challenges that the more-experienced clinician or the counselor educator may have are the same issues that the students may have who come in as they begin a second career. It’s arrogance, you know? It’s that idea that you know everything. You don’t see yourself as a student anymore. And I think that is the downfall of a good counselor educator, is when they feel like they know all there is to know.

I think the way that they can combat that is integrating the experiences that they have but not relying solely on those experiences. I think that’s the difference—if you’re integrating them, you say, “Gosh. I remember what it was like when my kid was two or when my kid was four. I remember when my kid was 13.” That’s the emotional age of some of these students. What did I do when my kid was 13, and what did I want to do that I didn’t do that I wish I could’ve done and I can do now with this student? I feel like those are the ways that you can kind of integrate those experiences into raising students.
LR: So, it goes back to sort of a thread that’s woven its way through this interview, which is that we as counselor educators/clinicians have to continue to evolve, to look inside. We have to impose that challenge on our counseling students. We can expect no less from our counseling students than we can for ourselves.
JA:
we as counselor educators/clinicians have to continue to evolve, to look inside
And we’ve got to have the courage to let them into our journey with that. You know, we’ve got to have the courage to say, “This is life. I’m tired. I’m exhausted.” We don’t have to put on that front. Because then students will do that, and then the clients will do that, and there’d be that butterfly effect where nobody’s really being themselves.
LR: Do clinical educators get the students they need?
JA: It’s that butterfly effect, right? It’s like this parallel process where my relationship to my supervisee will impact my supervisee’s relationship to their client, which will then impact that client’s relationship to their environment. And so, a lot of the times when I’m in supervision and we’re having that come-to-Jesus moment like, “Why do you have this client,” I also have to ask myself, “Why do I need this supervisee to have that client?”

And then I may start thinking, “What do I need to do in my life in order to be able to better support this student so that they can better support this client?” That becomes the question, right? But then the beauty of supervision is that you can outwardly process that with a student so that they can learn how to do that for themselves with a client. You can say, “Gosh, man. When you’re working with this client, this is what it brings up for me. This is my hang-up, and this is where I struggle to support you. Where in your life do you feel like this client is kind of poking?" This processing and processing is a beautiful thing when it’s done right. In a lot of ways, it can feel like inception. Sometimes you’re in supervision like trying to spin a top asking, “Are we in reality, or is this a dream?”

True Cultural Awareness

LR: This next question could probably stand as its own interview, but I can’t help but ask. What are the challenges that counselor educators face in really effectively teaching these students what cultural awareness means?
JA: The first thing that comes to my mind is that we’ve got to be mindful of our fragility as counselor educators and be willing to address things that make us uncomfortable talking about, things that make us squeamish. I feel like we’ve got to be aware of that. We’ve got to be aware of our political stances and how that influences our work and how it influences our teaching. We’ve got to be aware of our perspective, our biases, our thoughts, our perceptions of individuals who don’t look like us, don’t like the same people we like, don’t pray like we pray.

we’ve got to be mindful of our fragility as counselor educators
I think the key to fostering culturally humble students and clinicians is for us as counselor educators to be humble, to be mindful of our fragility, and be courageous enough to have those conversations in class. Each diversity class that I teach feels like Thanksgiving, because a lot of people’s families are uncomfortable around that Thanksgiving table. That’s what diversity class feels like.

I feel like what we have to do is to foster this atmosphere of openness around these discussions and safety in the classrooms. What we don’t want is for students to feel the tension or the discomfort, and that hinders their ability to go there. We need them to go there. And so, we have to be aware. We have to be humble. We have to be courageous. I think those three qualities can really help develop culturally-competent students.
LR: We recently released a three-video series, Counseling African American Men, featuring Darrick Tovar-Murray from DePaul University. In the conversations between Darrick and Victor Yalom, Psychotherapy.net’s founder, the idea came up that counselors need to learn to be comfortable with discomfort, which sounds like exactly what you’re talking about.
JA: Yeah. Yeah. Yeah. We’ve got it steeped in our program. We’ve got it steeped in security and safety with a little bit of ambiguity and discomfort. It has to be equal measures. We have to steep the students in there for two years and two semesters, you know?
LR: I’ve heard of the notion of “White Fragility.” What did you mean by fragility?
JA: You know, like those developmental stages. Like whether or not you’re in the early stages of identity development. Then you’re experiencing a lot of anger, right? Because that’s fragility too, right? We talk about this in diversity class. Sometimes, as a man of color, as an African American male, I have anger toward White men, White people, especially when I feel unsafe.

sometimes we can give off the impression as counselor educators that if you are a White counselor, then you can’t do culturally sensitive work
And so, when clients come in, sometimes that anger leeches into the therapeutic relationship. And I think that’s what I mean by fragility. It’s not that you can’t be angry. It’s that you have to be mindful of “How is this going to impact my therapeutic relationship, my work, my relationship with my peers, my relationship with my supervisor? What do I need to do to work through that?
LR: When I started at the university 32 years ago, the student body was White, and I have learned to be more aware of the privilege that comes with whiteness. And I have been put in very uncomfortable situations with my students. So, this idea of a counselor educator being comfortable with discomfort and modeling it is very important.
JA: Absolutely! And a lot of that has to do with just acknowledging when “This is uncomfortable.” Like, look around the room. What have we done as a program, as an organization? What have you done individually as a student to perpetuate this sameness? Let’s have that discussion. Because I think sometimes we can give off the impression as counselor educators that if you are a White counselor, then you can’t do culturally sensitive work.

I feel like that impression is dangerous, especially for White students. There’s so much opportunity for corrective emotional experiences for clients. If we train White counselor educators well, they can go out into their communities into the field and build strong relationships and repair relationships with clients. I mean, speaking for myself as a supervisor, it meant a lot to me to work with a supervisor, like when I was a student, who was White but who came into the relationship humble, aware, willing to acknowledge things. It was kind of like, oh, okay. Okay, we can do this. And it was even more impactful sometimes when that happened.
LR: Yeah. Do you think there’s an implicit expectation that, because you are a Black man, that you have a deeper sensitivity to cultural oppression and unfairness?
JA: Yeah. Yeah. Yeah. Yeah. That’s the work we don’t get paid for. That’s fine with me, you know? That’s the stuff that they don’t add to the tenure packet. They don’t have a box for that on your year-end evaluation. It’s how many times you’re stopped in the hall and, “Hey. I’m trying to do this diversity thing.” It’s like, I’m going to Google it just as you, just as much as you.

sometimes it’s just hard. It’s like, “Man, I don’t have the bandwidth to do this when I also have to do other things”
You know, it’s that extra work that you do to support a community, the calls you get, the students that you’re supporting, the organizations you’re connected with. Sometimes you do have a deeper understanding of these diversity issues, because you have to. But sometimes it’s just hard. It’s like, “Man, I don’t have the bandwidth to do this when I also have to do other things.”

I feel like what I love the most about my faculty is that we all take equal responsibility in having those conversations. So, it doesn’t just feel like it relies on one person. But I’m blessed. My program is diverse. We have two White men, and the rest of the faculty are people of color, women of color.
We very much match our student population demographics. But, yeah, that’s the stuff you don’t get paid for. And that expectation gets you voluntold to be on committees. And I’m just like, “Gosh, man. I’m struggling too, you know?”
LR: I think we’ll stop there Jude. I want to thank you so much for sharing your wisdom and experiences from the trenches of graduate school.
JA: I hope this was meaningful for students or for whoever’s reading it.

Redesign Your Mind in an Instant

Wouldn’t it be lovely if you were able to help clients make real, significant, lasting changes right on the spot, just by providing them with a certain frame and by inviting them to do a little on-the-spot visualizing? I have. You can.

Philosophers from Marcus Aurelius to the Buddha concerned themselves with the idea that “you are what you think.” Nowadays, this age-old notion is typically explored using ideas and techniques from cognitive-behavioral therapy. These ideas have resonated for many of my clients and have been quite useful in our therapeutic work. But there is an important next step to take.

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By providing clients with the metaphor of “the room that is your mind,” I have helped them visualize “the place where they think”—really, “the place where they live”—and help them instantly change and upgrade that “place.” This simple metaphoric frame has created powerful, on-the-spot results.

In a very few words, I explain to my client that it is in their power to redesign and redecorate the room that is their mind. Then I move right onto giving some examples of what that redesigning might look like: adding windows so that a breeze can blow through, reducing inner claustrophobia; adding a calmness switch, producing immediate calm; adding an exit door, out of which repetitive, obsessive thoughts can be scooted; or repainting the walls a bright color, so as to reduce the experience of sadness.

What is rather amazing is that my clients “get” this idea instantly. They have often said that no one had ever invited them to picture their mind room before and that, without knowing it, they had been waiting for this invitation.

I was recently chatting with an interviewer about my forthcoming book, Redesign Your Mind, in which this technique is described. Even as we were speaking—even as he was asking me questions and I was answering them—he was doing this redesign work. I could tell. Then, suddenly, he smiled and said, “I’ve just repainted the walls in my mind room and I can feel the difference.” The brain is brilliant at this sort of thing, if it is presented with the invitation and offered even just the briefest of explanations.

A few days later I wrote to the interviewer, whom we’ll call John, and asked him to share his experience. What had that felt like, spontaneously doing that work right on the spot? How was it that he had done that work without my hinting or suggesting that he do it—had his own brain instantly “decided” that it was imperative that he try out the idea and paint those walls a new, bright color? Did the change that occurred feel real and significant, even fundamental? Had the change lasted?

John replied:

“The effects I experienced when you began to explain this to me were quite profound and instantaneous. It was straightforward. You told me I could put anything into the ‘room that is my mind’ such as a ‘calmness switch’ that could be flipped whenever I needed it. I pictured a red light switch, and when I flipped it, I immediately became calm, and felt it both mentally and in my body.

“You helped me construct my ideal living room, and when I painted the walls, I immediately began to experience pleasure in the color. I put large, clean windows in the room, some open so that the breeze from the beach made the flowing white curtains dance. I felt calm and joy and peace in my body, as well as my mind. And it’s not just about calm. There's a breastplate in the corner that I can don to immediately feel courageous and ready to take on the tasks I need to.

“There's also a free speech platform I can mount when I want to privately engage in any thought exercise. And there’s a back door to exit the room. As a person diagnosed with PTSD, I can utilize this to help reframe my perceptions of past events, heal, and press on with the tasks associated with my goals in life. Thank you. Thank you.”

Clients immediately brighten up when I discuss this with them. There is something amazingly invigorating about the idea of redesigning one’s mind. Maybe it puts folks in mind of magazine ads of beautiful rooms that have stirred them and moved them. Maybe the metaphor strikes them as achingly right. Maybe their “inner architect” or “inner designer” is suddenly engaged. Or maybe it simply matches their felt experience, that there is a place where they go and that they can change the look of that place—and their experience of that place.

Rather than having to arm-wrestle negative thoughts to the ground, dream up thought substitutes, or do any of the blocking, disputing, reframing, substituting, or other heavy lifting techniques from cognitive-behavioral therapy, a client gets to smile a little and laugh a little as she zips right off to her mind room. There she can change the furniture, replace her usual bed of nails with an easy chair, install a pressure release valve for immediate stress relief, or do something else quick, brilliant, and useful.

I have found this “redesign your mind” technique very helpful in addressing many challenges clients bring to our work. For the client who lacks confidence and who is having trouble speaking up, she can be invited to create a Speaker’s Corner (like the famous one in Hyde Park in London) where she can practice saying important, dangerous-feeling things in complete safety. Whether the issue is depression, anxiety, addiction, procrastination, healing from trauma, or loneliness—whatever the issue may be—there is bound to be some simple subtraction or addition she can make to her mind room that will immediately change the thoughts she thinks and her experience of life.

I invite you to look into this technique, and perhaps into your own mind room, and even, perhaps, the one you inhabit with your clients.

Less Treatment, More Therapy

"Yo, call me back ASAP!,” read the text message from Carl, a 20-year-old man who has self-identified as a gang member for the past seven years and who has struggled with anxiety and depressive symptoms, alongside antisocial personality traits.

I had an impulse to explain boundaries to Carl but decided against it. I knew that a dispassionate instructional ACA-type lecture would be distancing—especially via text.

Carl has been in counseling with me for three years as a requirement of his probation. He is a member of a local gang who has mentioned how his affiliation got him into trouble while growing up. He also shared his initial fear of telling me he was in a gang because of how I might “react” to him. I maintained a neutral position.

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Gangs were part of the social fabric of Carl’s youth—I, too, was gang affiliated. Thus, I was personally familiar with that life, but I believe that it was because I have historically been the only Black male therapist in most of the psychiatric settings in which I worked that I was often given complex and challenging cases. This often meant working with male gang members and other males who had been charged with sex offenses (perhaps a story for another time).

I returned Carl's call because I was concerned that he had done something inappropriate with which I could help him. I was also mindful of my own insecurity. I felt as though little progress had been made in our work. Carl was also inconsistent with taking medication prescribed by his psychiatrist and in attending sessions with me. Yet he constantly told me how much he “appreciated” working with me. I viewed his text as a plea that might allow me to do something meaningful with him. I hadn’t gotten his message quite yet.

Carl answered the phone on the first ring. “I am sorry about the capital letters in my text, I don't want you to worry about me. Do you have time to talk?”

He went on to say, “I need some therapy right now.” Carl mentioned that after a domestic dispute with his girlfriend, she had been considering leaving him. “I don't know why I'm so angry” and “I wish I could get over this anger,” Carl cried.

This was refreshing and far different from Carl's usual sessions, which he tended to begin with a detached, “I'm doing good. I am safe and in good health.” Eventually, I came to realize that after being in both penal and psychiatric institutions, he was used to giving knee-jerk responses to risk assessment questionnaires. After his pleasantries, there was always a laborious discussion of his video game adventures. Today was different, although I did not understand how at that exact point.

Instead, I felt anxious in that moment. This may have been my own internal reaction to Carl's sense of anxiety. However, I also felt a strong inclination to capitalize on Carl's plea for help and felt as if I needed to come up with a clever “intervention.” I had to strike while the iron was hot. Should I use CBT? I could re-emphasize the cognitive model to Carl and how his distorted thinking contributed to his ongoing patterns of anger. No. Carl had already admonished me in the past for using “big words,” referring to clinical jargon.

Maybe, EMDR?! Could some eye movements mollify his intensity? While I am trained in both interventions—and believe they have some merit—I thought it might be better to just shut up and let Carl talk.

After a while of silent sobbing, Carl exclaimed, “I think I know what this is.” He paused.

“I used to be soft” in grade school, he went on, and after years of bullying he stood up for himself. “That's when I learned that I could fight,” said Carl, his voice cracking as he held back more tears. Carl mentioned that after a while, he learned to become the aggressor as a preemptive way of sending a message that he was a formidable opponent.

I felt stuck. Was now the time for an intervention? I fought against the impulse. Instead, I simply asked, “How do you feel now?” Carl shared that he had felt a little better and that he was glad that he could “get this off my chest.” Ironically enough, almost immediately after this revelation, the call dropped. The call dropping likely saved me from myself. I had an urge to say, “I just want you to know that you're not that little boy anymore.” I probably heard this line somewhere from a supervisor in the past. I do not actually believe it. Carl knows full well that he is not the little child who was bullied, although he might still feel like it.

I wish I could say that Carl no longer expresses anger in an unhealthy manner. I believe that it will take more than one 45-minute session for that. However, I do trust that the session was meaningful to him (and in retrospect, to me as well). He appreciated that I listened to him. I appreciated that the session felt like real therapy. It involved all of the ingredients that make therapy special: attunement, minimal encouragers, brief re-statements, warmth, empathy, compassion, the list goes on.

While still a relatively new clinician, I find myself frustrated and impatient with the mental health industry. In my brief time practicing, I have noticed that I am encouraged to quickly create and implement rigid and concrete treatment plans with goals and objectives that might say things like “decrease frequency of anger by 30% by such and such date.” I am not saying we should abandon these measures. They have a place. However, it creates a false sense of urgency to “do” something in sessions in lieu of “being” myself.

I have been in my own therapy for a few years. A secret that I have not shared is that I would cringe if my own therapist held rigidly to one treatment modality. I appreciate that she is flexible and willing to meet me where I am. However, the issues I often bring to counseling pertain to deeper questions I have about the contradictory elements of life. I do not know if the cognitive model can get me through that.

It is seductive and somewhat satisfying to have a ready list of tools and interventions that I can provide to clients. It makes me feel smart and prepared. It is not as sexy to promote the tried-and-true skills that have been empirically validated. As a disclaimer, I am not saying I reject these treatment modalities. If that were the case, I would not have spent 80+ hours learning them after graduate school—I think. I am simply saying that I should not disregard the elements of psychotherapy that have, time after time, proven themselves effective in my work with clients.

I founded a clinical think tank centered on helping gang-affiliated adolescents. It began in New York and expanded to Denver. Over the four-year course of mobilizing clinicians to research evidence-based interventions to help this population (there are none), what keeps coming up are the same principles that work with Carl.

I am reminded of how fascinating it is when I ask clients what they find helpful about working with me. I almost never hear anything about a specific intervention. What I do hear is that I am “kind,” I am “engaging,” I “relate well” with them, I am there for them during difficult times, I am “real,” and other similar sentiments.

As I look back at my three years with Carl, I can see that I have been unfairly critical of myself. I had viewed our relationship as ineffectual up to that moment I discussed at the outset of this essay. I focused on select symptoms (i.e., anger) and his inconsistency in coming to sessions (I told myself that if I were a better therapist, he would not miss sessions and he would be less angry). However, I mistakenly dismissed the fact that he often expressed his appreciation for me and had adamantly refused to work with anyone else in the past. I also ignored the fact that someone who defines themselves as “solid as concrete” is capable of being vulnerable with me.

Carl appreciates me because I strive to connect with him. For the past three years, he has known he has at least one person who doesn't view him as just a gang member or someone who is antisocial. He can look forward to my showing a genuine interest in him as a person as opposed to probing for tendencies that may deviate from the norms of society.
It is my hope that fellow therapists seek to be human with their clients prior to employing so-called standardized interventions in a reactive, knee-jerk fashion. Perhaps more of a focus on therapy and less on treatment protocols will allow for the true healing power that comes with the relationship, which I thoroughly believe is the element that heals.

A Universe Opens: Reflections On My First Session as a Therapist

“Know all the theories, master all the techniques, but as you touch a human soul, be just another human soul.” —Carl G. Jung

As I stare down at the piece of paper holding a few clues to the vast mystery that will be my first-ever client, I feel a universe come into existence, a wide expanse full of potential and possibilities. The past year-and-a-half of didactic and experiential training has culminated here, in this very moment. All that I had previously read and thought about were finally lifting off the pages, out of my mind, and into the here-and-now in the form of a dynamic, real-life therapist-client relationship. As Sanmao, a Chinese feminist writer, put it, “What I learned on paper, I felt, was knowledge that had not yet been tested.” There I was — hours away from testing the knowledge I’d accumulated on a real-life, non-pretend client—sitting in the tension of opposing “what ifs:” “What if I forget everything I learned?,” “What if I’m terrible at being another human soul?,” “What if the theories are wrong?,” “What if none of the theories are applicable to me, or the client?,” “What if the theories are right?,” “What if it actually works?!”

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To alleviate some of the angst-citement—a cocktail of angst and excitement I was feeling, I decided to reach out to a handful of therapist friends—some licensed supervisors, some only a few months ahead of me—and solicit tips they might offer an intern who was about to go into their first-ever session, things they wish a mentor had told them as they were stepping into their role as a therapist for the first time. Here’s a mosaic of what they shared:

  • Check your excitement and adrenaline at the door. As exciting as it is, you are ultimately there for them.
  • Be genuine and be yourself. You don’t need to be a blank slate or do anything to prove yourself. If you’re an expressive person, allow yourself to be expressive!
  • Relate to the patient and be kind. If nothing else, focus on making yourself and the client comfortable. Validate however the client shows up in the therapy session—there’s no such thing as too much or not enough. Follow your curiosity and get to know them.
  • Ask them what they want to work on or change in their life, and then work on what they are ready and willing to work on.
  • Sit with them in their feelings. Don’t try to make them feel better. Instead, help them better feel by exploring and understanding their feelings.
  • Give them permission to feel. You can say, “I imagine if I were in your position, I might feel… Do you feel any of that?” This helps them feel less alone for something they might be feeling but are unable or afraid to name.
  • Don’t be afraid to create space. If you get flustered and don’t know what to say, you can say, “I just want to sit with this for a second before deciding where to go next or what else to explore.” You can also say, “I don’t know where to go from here,” and ask them if they have a sense of where they’d like to go next. Silence doesn’t always need to be filled. Space is comfortable and useful when it is intentional, and we make it intentional by acknowledging it: “I want to take a breath around that before saying anything. That’s a lot that you’ve been holding.”
  • Less is more. Provide a space for them to share. Bear witness to their unfolding. You don’t need to interpret, fix, advise, or do much.
  • Help your client cross the river by feeling the stones. Set small, achievable goals so they feel like progress can be made.
  • Take a moment to remember it afterwards. It’s your first one, and that’s exciting!

***

Upon wrapping up my first session, I felt a tremendous sense of relief—relief that my client hadn’t asked me whether this was my first session (though if they had, I was prepared to say something along the lines of, “If it were, what does that bring up for you?”), and relief that I’d made it to the other side of what felt like a tipping point in the evolution of this career and calling. Reflecting on the random scribbles I’d made during the session, a few twinkling stars began to emerge against the dark expanse of a nascent universe—the dawning of a new constellation, of a new relationship, with all its mystery and magic.

Sometimes I Also Feel Lazy: A Clinician Reflects on Self-Disclosure

“Sometimes I also feel lazy,” I calmly mentioned to Chris. I noticed his chest instantly decompress with a sigh, as a slight smile took shape at the corner of his mouth. As a clinician, I make calculated decisions about how and when to disclose to my clients.

Chris is a Black man in his early 20s who struggles with symptoms associated with anxiety and persistent depressive disorder. He is currently living with his parents and saving to purchase a condominium. He works in the highly competitive industry of data analysis and takes an interest in both playing the guitar and learning new languages. However, Chris has ongoing thoughts and concerns associated with where he “should” be in life compared to his peers.

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My self-disclosure came after multiple sessions of hearing Chris berate himself, thinking he is not “doing anything with my life.” According to Chris, he should be earning more money and proactively searching out new places to live. We have all dealt with clients who appear to be doing better than most but seem to treat themselves as if they are the worst.

At the moment and in looking back, I felt conflicted. Should I have revealed how proud I was of him? No, that might be taken as gratuitous praise that he believes I “say to everyone.” Or should I have simply sat back and normalized his thoughts and concerns? Well, I tried that in previous sessions. This time I had a different idea.

I recalled how Chris had seemingly put me on a pedestal in the past. He had sometimes made remarks about how “you own your own business” and had “written books.” Now was a moment that I could come across as more relatable. I have noticed that power differentials present significant challenges when working with male clients.

Chris mentioned feeling “lazy” due to his perceived lack of initiative. I responded briefly with, “Sometimes I also feel lazy.” I aimed to be succinct so that my intervention was not taken as an attempt to monopolize his session.

Self-disclosure is not without controversy. Some colleagues argue that it helps, while others suggest that it may be harmful. With Chris, I wanted to convey that I go through periods of indolence as well. As it turned out, this led to a rich discussion about how routines might work better for him than relying on motivation.

One of my concerns prior to disclosing was my experience that mental health disorders are often associated with stigma, and this may delay clients from entering therapy. Chris could have suggested that it was “easy” for me to say that I go through periods of inactivity, as I don’t struggle with anxiety and depression (though inaccurate, I was not willing to take up his session with my issues).

I have found that self-disclosure —when used appropriately—has been a powerful tool in my practice to reduce some of the stigma associated with mental health issues and their treatment, normalize my client’s experience, offer different ways of thinking and behaving, and deepen the connection between me and them.

Below are some considerations for the appropriate use of self-disclosure that I have found in my clinical work:

Cultural Sensitivity

The use of self-disclosure can be problematic if I make assumptions about my clients based upon a real or perceived similarity with them. Culture goes beyond race and ethnicity. Chris and I are of the same race, but that does not mean we have the same worldview, so I must be careful to disclose only after having a thorough understanding of the cultural factors that impact his worldview.

Authenticity

My clients appreciate me when I am real, which is also when I think I am doing my best work. I fear that my professional licensure and other symbols of my presumptive clinical expertise sometimes create distance as opposed to allowing clients to connect with me. Sharing something about myself—when relevant—can help minimize this barrier. My clients come for the clinical interventions but stay for the relationship.
Client-Focus

My goal is always to help my clients meet their needs, as opposed to having my own needs met. The above-mentioned session could have easily become a discussion about me. However, this is not what Chris was there for.

Brevity

It is their session, not mine. I do not want to elicit a caretaking response from my clients. I have written elsewhere that good therapists are in therapy themselves. Another point is that disclosure should not happen frequently, for the same reason mentioned above.

Eliciting feedback

I have found it to be important to carefully observe my client’s reactions (facial expressions, tone of voice, and body language) in order to obtain a sense of how my self-disclosure affects them. It helps when I ask clients directly how they perceive my disclosure. I was able to pay close attention to Chris’ bodily response and noticed that he found comfort in my disclosure. Further, my observation was validated by asking him what the disclosure was like for him.

Some questions that I have found helpful prior to self-disclosing include:

  • What need is driving me to share this information (is it for me, or is it for the client)?
  • How might this information be helpful?
  • Is this helpful to share now (perhaps the disclosure may be better suited for a later time)?

I have also discovered that my use of self-disclosure has not always been as helpful as I had intended. One example stems from a time when I tried to normalize medication compliance with one of my clients who was diagnosed with schizophrenia. I mentioned the fact that I have asthma and am required to take my inhaler regularly in order to maintain optimal health. The client responded by saying that he would much “prefer asthma over schizophrenia.” I attempted to salvage the moment by admitting that it was not appropriate for me to compare asthma to his lived experience. I also allowed the client to give me feedback on how the disclosure made him feel (I learned that it came across as slightly dismissive). I have found that these lapses in clinical judgment have actually strengthened my alliance with clients when I am willing to admit them. Through self-awareness and honesty, these moments have become opportunities for a deepening in my therapeutic relationships and for my client’s self-awareness and growth.

***

In my clinical experience, carefully planned self-disclosure has been a transformative tool in the relationships with several of my clients. Chris viewed my personal revelation as a breath of fresh air, and it made our work together more effective. He respected and appreciated my authentic humanity—even if it meant I was sometimes lazy.
 

Termination: A Process by Any Other Name

My client, a psychologist by training and fellow traveler through COVID’s unforgiving landscape, had initially visited with me because of anxiety and his growing difficulty managing it. Accustomed to a take-charge style that centered around scanning his environment for potential threats to his family, he had grown tired, not just of the challenges COVID presented, but from the sheer effort and energy it took to manage his anxiety. The details of our work can be found in a recent blog I wrote, so I will fast forward to the later portion of our time together when we began reviewing the path forward for him (and us)—life after therapy.

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As we reviewed his progress, it became clear to both of us that he had made significant gains in managing anxiety, breathing a bit more into his life and enjoying moments with his wife and children. All of this without the pressure that came from constantly scanning his inner and outer worlds for threats and subjugating himself to a harsh inner list-maker. His goals were being addressed and he was making significant changes and progress. The time for planning an ending to our work was approaching, so I broached the subject.

The conversation quickly pivoted to the word “termination,” and although I had used it numerous times with past clients and in my teaching and writing, it suddenly felt quite leaden rather than a natural part of the therapeutic process. Perhaps because I was particularly fond of this client, termination felt like a loss and triggered my own attachment issues and deeper existential concerns around loss.

I considered each of these and sought the wisdom of those who had come before me in order to move more comfortably into this uncomfortable space with my client (and myself). From a developmental perspective, termination suggested a separation/individuation process that, while inevitable and painful for some clients, was a harbinger of growth. From a traditional analytic perspective, termination followed resolution of the transference, awareness of defenses, strengthening of the ego, and a lifting of repression, while more contemporary analytic theory favored a more natural progression in the relationship between therapist and client. Jung believed that termination reflected the client’s awareness of a new philosophy for living—an awakening—and as such carried a more growth-oriented valence. Anchored in a more positivistic appreciation of the role of therapy, humanistic theory suggested that the final phase of treatment focused around movement towards growth and accomplishment. Finally, from a more pragmatic and behaviorally-oriented perspective, termination is the logical and planned conclusion to a predictable, scientifically-grounded, ends-oriented intervention.

And then I came across an interesting article (Maples & Walker, 2014) that reviewed and critiqued the label “termination.” I liked what these authors had to say because they, like I, had considered that termination and its historical associations and connotations were weighted down by historical attempts to find just the right name for the final episode of the therapeutic relationship, and that most of these attempts had resulted in a negativistic perception of termination, mostly around loss. In response, they proposed the concept of “consolidation,” which suggested a normative process centered around the stabilization, strengthening, and reinforcement of therapeutic gains—a preparation for the client’s journey ahead without the therapist.

All of these concepts, particularly the latter, made sense but left me wanting more. I sought something a bit more post-modern: a collaboratively derived and meaningful frame for this particular moment in the therapeutic portion of my client’s journey with me in therapy.

***

So, in our most recent session, I asked my client, “what would you like to call this phase of our work together?” And he simply said, “I’d like to call it the comfort zone!”

Seemed simple enough, but I sought clarification. What did this actually mean? His response was “I’ve gotten to a place where I am comfortable with myself.” There it was! My client was not deeply immersed in labelling this latter phase of our work, nor was he reflecting on our separation. He had done what he came for. The simplicity of his “comfort” was comforting to me because our work, and I, had helped him find his way there.

What’s in a name? Everything, as long as it is of the client’s making.

References

(1) Maples, J. L., & Walker, R. L. (2014). Consolidation rather than termination: Rethinking how psychologists label and conceptualize the final phase of psychological treatment. Professional Psychology: Research and Practice, 45(2), 104-110.

Healing the Authoritarian Wound Through Writing: 8 Writing Exercises to Share with Clients

A Therapeutic Place for Writing

Therapists endeavor to help clients handle life’s problems and their particular difficulties, including those that have come about because of the way they were treated as children, adolescents, and adults. We deal with people, and we need tools that actually help people grow, heal, and change. One great tool at our disposal is inviting clients to write.

One of the areas that interests me is the consequences of authoritarian wounding, those wounds created by prolonged contact with a family bully, like a father, mother, or sibling, with a bullying mate, authoritarian mentor, teacher, clergyman, boss, or co-worker, or with any other authoritarian who is operating in one’s sphere. I’ve written extensively on this in Helping Survivors of Authoritarian Parents, Siblings and Partners (Maisel, 2018) and in scores of blog posts for Psychology Today and The Good Men Project.

A second area that interests me is the value of writing as a useful tool that therapists and coaches can use with their clients and offer to their clients. I’ve advocated for the wisdom of inviting clients to write, most recently in Transformational Journaling for Coaches, Therapists, and Clients (Maisel, in press). In this piece, I’d like to share with you eight writing exercises that I use in my work with survivors of authoritarian wounding.

I think you’ll see how these exercises can also be used with all clients, either as is or with some tweaking. I hope that your main takeaway from this piece will be that clients can make tremendous strides in self-awareness and in healing when they write in a focused way about what matters to them. These aren’t the “describe a tree” or “describe a sunset” writing exercises that you might encounter in a writing workshop. These are therapeutic exercises that invite clients to face their experiences, learn from their experiences, and move past their experiences.

Maybe you don’t currently invite clients to write between sessions or assign any homework. You might want to rethink that a bit. Many psychotherapy clients are smart, articulate, sensitive folks who may well already keep a journal or engage in some other reflective writing or who, even if they aren’t journal-keepers, are likely to be receptive to the idea of doing some writing. If you do decide that providing writing exercises might prove a valuable therapeutic tool, here are a few points to consider:

  • I let clients know that if a given exercise doesn’t speak to them, they can write on a prompt of their own choosing or, of course, not write at all. It’s wise to give clients who’ve been wounded by an authoritarian this sort of instruction and permission, since they will have had a long, difficult history with rules and especially with the consequences of violating or ignoring rules.

  • I explain to clients that perfect knowing isn’t the goal. If they increase their awareness a little bit or heal a little bit, that is a victory and a blessing. We all have the wishful hope that we can get from a muddy understanding of something to a crystal-clear understanding of it, but perfect understanding is more than elusive, it is unattainable. I remind clients that if they get even just a little something of benefit from the exercise, that is a welcome outcome.

  • I warn clients that the exercises may well prove provocative and emotionally difficult, and I give them real permission to stop if the going gets too hard or painful. You can tie this instruction to several of the tips in the tip box provided below, for instance to the ideas of creating a support system and staying alert for triggers. Clients should be helped to understand that this work is not easy and that stopping should be viewed as a self-care strategy and not a defeat.

Before I describe exercises I have found useful with clients who have been impacted by authoritarian relationships, I would first like to describe some of the long- and short-term impacts of authoritarianism on the individual. These include (but are certainly not limited to) lifelong relationship difficulties (including serially choosing authoritarian mates); existential despair rooted in feelings of worthlessness; a pessimistic, critical attitude that makes it hard to give life a thumbs up or people the benefit of the doubt; an anxious nature that plays itself out as indecision, confusion, and an inability to make clear or strong choices; a felt lack of safety, including in the therapy session; obsessive worrying and powerful feelings of overwhelm; and a pull toward addictive behaviors.
 

Eight Writing Exercises

Here are the eight writing exercises. Each comes with three prompts, as I find it useful to provide clients with choices.

Exercise 1. This really went on (you weren’t crazy)

We can almost believe that what happened to us didn’t happen to us, maybe because we did a lot of dissociating, because other people saw the authoritarian in a different light, because we wished so hard that it wasn’t true or that bad, or for some other reason. But it did happen. Please pick one of the following three prompts to write on (they are written from your point of view):
 

1. What exactly went on? Let me pick one experience that still deeply affects me and try to describe it as carefully as I can. I do want to know for certain that what I believe went on actually did go on!

2. I want to think a little bit about how it might be to remember some of those terrible experiences without having to re-experience them and without having to be flooded with bad feelings. Can I see a way to do that?

3. I have long thought that I must be a little crazy to believe that such awful things could possibly have gone on. But they did go on. So how can I completely let go of that feeling that I was “a little crazy” for believing what, it turns out, was completely appropriate to believe?

Exercise 2. You didn’t have a choice (you didn’t choose it)
 

If your experience of dealing with an authoritarian happened in childhood, it should be clear to you that you didn’t choose to experience that wounding. But as clear as that truth may be, it’s still easy to feel complicit or as if you deserved what happened to you, maybe because you weren’t “perfect.” Now is a good moment to get clear on the fact that you didn’t choose to be abused by that authoritarian. Please pick one of the following prompts to write on: 
 

1. Is there some part of me that still thinks that I did choose my situation? How can I still be thinking that? And what can I do to stop thinking that?

2. If I’m still dealing with an authoritarian today, do I have new choices to make? Different choices to make? After all, I’m not that child any longer!

3. Because I didn’t really have a choice in the matter, I think I may have gotten it into my head that I’m not entitled to make strong choices or maybe that I’m not equal to choosing. I think I’d like to do some reflecting on that possibility.

Exercise 3. You didn’t have allies (you had to go it alone)

It is hard to overestimate the extent to which you had to go it alone. Authoritarians can’t function if everyone around them says “No!” For the authoritarian to bully others, those others must be staying silent, not fighting back, tacitly accepting the situation, or even defending the authoritarian. Maybe you were lucky to have an ally in an aunt, a sibling, or someone else, but basically you had to go it alone—the proof is that no one ever successfully stopped the bully’s behavior. Please pick one of the following prompts to write on:


1. Did I or didn’t I have any real allies during those bad times? What was the exact nature of my situation with respect to allies and/or a lack of allies?

2. If I did have a real ally during those times and he or she is still living, do I want to reach out and say something to him or her? Or maybe say something to him or her even if he or she is deceased?

3. I wonder, what are the consequences of having had to go it alone? Did that make me independent or dependent? Did it make me love solitude or recoil from solitude? Let me do a little writing and tease out those consequences.

Exercise 4. You didn’t have power (you couldn’t fight back)

Grown-ups possess all the power. Children can dream about being powerful, fantasize about being powerful, and engage in small acts of strength, but they are essentially powerless in the face of adult abuse. This true powerlessness can produce lifelong feelings of powerlessness, even though you are now an adult with all the powers of an adult. Please pick one of the following prompts to write on:

1. I want to think clearly about the ways in which I was powerless in those terrible times, primarily for the sake of making absolutely certain that I do not blame myself for not taking actions that were just not available to me.

2. How would I describe the power I now possess? Surely, I do possess some adult powers! How would I describe them? And how do I use them?

3. What would it take to transform myself into a “real life superhero?” And what would I be able to accomplish then?

Exercise 5. You couldn’t possibly understand (how could you?)

You may blame yourself for not understanding what was going on, for being too innocent, for missing what was right in front of your nose. But how could you possibly have understood? Feeling that something was seriously wrong and fully understanding the complicated dynamics of the authoritarian personality are two different things. Really, how could you have understood? Please pick one of the following prompts to write on:

1. What do I understand now that I couldn’t possibly have understood back then?

2. What intuitions that I had back then about my situation and about what was going were actually accurate? Did I maybe have some understanding of the situation that I couldn’t quite access then?

3. What additional understanding is available to me now? Is there more for me to understand?


Exercise 6. You were genuinely afraid (of course you felt scared)

Authoritarians scare us. You may have spent much of your childhood terrified. Of course you were afraid. The question to grapple with now is, do you still have to be afraid today? Please pick one of the following three prompts to write on:
 

1. I want to remember what it was like to be frightened as a child, to validate that experience. I am going to go back in memory, remember what I felt, and honor that I had those terrible experiences. But I am going to go back very carefully.

2. I know that I’ve lived in a fearful way and that I’ve been scared a lot in life. What can I do to feel safer now?

3. I want to live differently. How can I live more bravely? What would such a life look like?


Exercise 7. You were truly harmed (there were real consequences)
 

To say that you were wounded isn’t to speak metaphorically. Something in you got seriously injured. Maybe it was your willingness or your ability to deal with conflict. Maybe it was your self-image, your self-esteem, or your self-trust. Maybe it was your ability to trust others or to deeply care about others. The list of possible injuries is long. Please pick one of the following three prompts to write on:
 

1. I want to calmly and patiently identify the consequences of that wounding. That’s the important writing I’m going to undertake.

2. I think it might pay off to describe some of the ways that those consequences played themselves out. This won’t be easy, but I think that drawing a direct line between the wounding and the things I’ve done in life might prove eye-opening—and maybe I can forgive myself a little in the process.

3. I want to write about my strengths, too. I think it might be a good idea to spend as much time writing about my strengths as my injuries.


Exercise 8. Healing is possible (in part, through writing)

You may have gotten into the habit of thinking that nothing can really change in life, including, and maybe especially, your own personality. But healing, change, and growth are possible. Use your reflective writing practice to help you make the changes you identify ought to be made. Please pick one of the following three prompts to write on:
 

1. I think I’d like to describe some daily practice that will serve me as I try to shed the psychological and emotional baggage of the past.

2. I want to create some firm-but-gentle action plans that support my intention to heal, grow, and live well.

3. I want to write about a better, brighter future, one where I feel less burdened by the past and more optimistic and passionate about the future. Let me write about that.


Eight Helping Strategies

In addition to inviting clients to write, you can also make the following suggestions and work with clients on the following issues:

1. Creating physical separation

Survivors of authoritarian wounding regularly report that only physical separation between them and the authoritarian in question allowed them to feel safe and provided them with the opportunity to heal. And the wider the separation, the better! You can have very productive conversations about the need for physical separation and the practical details of such separation.

2. Creating psychological separation

Survivors are likely to still love, or feel that they ought to love, their parents; be pressured by other family members to continue to deal, psychologically and emotionally, with their parents; and never quite be able to get their parents out of their head. You might try a guided visualization where your client is invited to escort the perpetrator out of her head once and for all.

3. Ventilating and eliminating feelings of guilt

Survivors typically experience guilt. Some feel guilty about not protecting their younger siblings from the family dictator. Some feel guilty about having failed themselves or not having lived up to their potential. Some feel guilty about physically or emotionally separating from their authoritarian parent. You can help your client ventilate these feelings and begin to think thoughts that serve them better, thoughts like, “This guilt isn’t serving me.”

4. Creating a support system

My client Maria explained, “I have to be able to handle things on my own because, growing up, I lost so much power and so much self-confidence that my goal for myself is to be powerful and self-confident. However, that doesn’t mean that I have to handle every single thing alone. So I’ve created a kind of informal support team. I don’t turn to them first thing—first, I want to trust my own resources. But I’m not stubborn, and I do turn to them just as soon as I understand that I could use some help!”

5. Staying alert for triggers

In the language of the 12-step recovery movement, a trigger is an internal or external cue that is likely to cause a person in recovery to relapse and resume the addictive behavior. A trigger might be the appearance of a certain feeling, like feeling overwhelmed, seeing someone in a film or a television show in a similar situation, relationship events that mimic family-of-origin events, or encountering a certain smell (like an aftershave lotion) or a certain sound (like a door slamming). You can help your clients identify their triggers and create a plan of action to deal with those triggers.

6. Communicating with and enlisting “healthy” family members

Survivors often express that maintaining contact with family members who saw the situation the same way that they did was their number one healing and survival strategy. A client and her sisters might support one another in validating their memories (“Yes, Anna, it was that bad!”) and standing together in mutual defense and in ongoing defiance of the authoritarian parent. You can help your client identify allies and begin the process of reaching out to allies.

7. Not accepting the vision of family members who do not see the situation as your client sees it

Other family members may have had a very different experience of Mom and Dad from your client’s experience. They may have entered the family later than your client did; maybe the authoritarian had mellowed by that time, and the younger sisters and brothers did not receive the same authoritarian wounding as your client did. Maybe her siblings were in fact just as abused and traumatized as she was, but they are currently in denial about their experiences or have followed in the authoritarian’s footsteps. You can help your client deal with her siblings’ demands that she be “nicer” to the authoritarian parent and with their accusations that your client is being disloyal or ungrateful.

8. Limiting contact

Your client may still be living with the family tyrant or may have returned to live with that parent, perhaps because the parent has become infirm. If complete physical separation is out of the question and complete psychological separation is unlikely, the questions you can pose to your client are “What’s the least amount of contact that you can have with your mom?” or “How can you stay out of your dad’s way most of the time?” You can help your client think through the practical details of limiting contact and the emotional consequences of remaining in contact.

Clinical Case Applications

Let me briefly describe two client situations where reflective writing helped my clients grow in awareness and make important life changes.

One client, John, a British professor of history, had never finished writing any of the many books that he’d begun. I invited him to get some thoughts down on paper about why this might have been the case. He shared the following journal entries with me:
 

I grew up with mean parents. After years of therapy, I think I’ve come to identify a kind of demon who comes into my consciousness and does not want me to be productive or successful. That demon was born in childhood. It somehow has to do with safety. It did not feel safe living with my parents, plus they told us that the world wasn’t a safe place. They filled our lives with continual anxiety and catastrophizing.

Here’s how that all plays out now. My creativity starts to flow and then anxiety floods in. I tear up the work, I tear myself down, and I abandon the project as no good. I’m also flooded with feelings of intense dread all the time, especially at night; and during the day, I’m always finding ways of avoiding entering my writing space. And my writing space is easy enough to avoid, as I have classes to teach, committee meetings, a bit of a commute, and all the rest. It’s supremely easy to avoid my study. And my study is so lovely. I wanted to write, ‘lovely and inviting,’ but it never does invite me.


In another session, he shared the following journal entries:
 

Those demons. The demons have made it harder for me to keep meaning afloat in my life, they’ve made it harder for me to keep despair at bay, they’ve made it harder for me to live my life purposes, and they’ve contributed to my anxiety and depression diagnoses. It’s all a piece. I’ve come a certain distance in all this and I can function, but I’m still searching for answers and I’m still wanting to finish some damned book.

I think that the bottom line for me is that the demon just won’t budge, because it is about core safety. Maybe I have to celebrate lesser forms of creativity where the emotional stakes and pressures are lower. An article, maybe, though articles aren’t easy either! I haven’t found ways to conquer the demons of darkness, but I do intend to continue to work on this block through some kind of inner demon work. I haven’t quite given up. Not quite!


John and I worked together for the next three years, chatting via Skype once a month. There were many downs, but also enough ups that John did manage to finish a draft of a book, deal with its several revisions, send it on its journey into the world of academic presses, tolerate the criticisms and rejections his book initially received, enjoy the moment when it was accepted for publication, and so on. I kept reminding him, “This is the process,” and at some point, he began to laughingly beat me to the punch and become the first to announce, “I know, this is the process!” And throughout the process, he used reflective journaling and writing prompts to hold important conversations with himself and deal with the demons that were never going to fully go away.

A second client was a Parisian painter, Anne. At the time we began working together, Anne was hiding out in Provence, licking her wounds after an unsuccessful show of her paintings at a prestigious Parisian gallery. She was barely communicating with the world and painfully wondering if she should continue as an artist. The fact that she has sold paintings previously, that she had had successful shows previously, and that she was still something of a darling of the art world seemed to amount to nothing. Not in the aftermath of what she dubbed “that monumental disaster.”

We chatted over Zoom. One of my goals was to help her change her perspective. Her career certainly had taken a hit. But for her to dwell on that “disaster” amounted to a serious mistake and a recipe for despair. Focusing on that event was only one lens through which to look at her career. I quietly and carefully explained to her that she was fortunate to have had the successes she had had, that this one event might or might not signal anything in particular or auger anything in particular, and that her best path was to get on with her life and get on with her art-making—the act of which, fortunately, had lost none of its luster for her.

I asked Anne to detach from the show results. I also asked her to invite a postmortem from the gallery owner. How brave that would be, to ask him why he thought the show had produced no sales! She wasn’t sure if she was equal to that. I explained that she might get “more equal” to that bit of bravery by doing some reflective writing, maybe on her turbulent childhood, maybe on her bullying father, a famous painter who always belittled and minimized her efforts, or maybe in a more “in the moment” way by writing about her feelings about communicating with Claude, the Parisian gallery owner.

We chatted a week later. It turned out that she had journaled every day that week using the prompt: “Do I dare write to Marcel?” She explained that she had learned a lot about herself in the process, especially about her habit of fleeing at the drop of a hat. In childhood, she hadn’t been able to flee. She had been watched, controlled, commanded, and punished for taking even the smallest step out of bounds. Now, as an adult, because she could physically flee situations, that’s what she did—and far too quickly, she now understood.

Indeed, she returned to Paris, bravely met with Claude, and had that painful conversation. It turned out that Claude had very little to offer by way of explanation. People “loved the paintings.” People were “wild for the paintings.” Many expressed what Claude felt was a completely genuine desire to make a purchase. Yes, nothing had sold. But, Anne explained to me with relief, Claude was not down on her, had no intention of reducing her presence in his gallery, and in fact expressed his intention to redouble his efforts on behalf of her and her paintings.

Over the months, I learned that several paintings from the show had sold for fancy prices and that her new suite of paintings were progressing nicely. She still had to endure all the challenges that creatives must regularly endure; but her “monumental disaster” seemed clearly behind her. “And I now have a sturdy tool in my tool kit,” she explained. “I now have conversations with myself in writing where the part of me that wants a good outcome can coax my wounded self in the right direction. I now have a friend who is nicer to me than I usually am. And that friend knows all about my tendency to flee! She knows all about it—and she knows how to talk me out of running away.”
 

***


It’s likely that many of your clients have been adversely affected by an authoritarian: by a close family member like a father, mother, sibling, or mate, by someone else close, like a mentor, teacher, clergyman, or boss, or by authoritarian leaders and others in high places.

What ought you try if your client is suffering from an unhealed authoritarian wound that has produced adverse consequences? You can try any of the tips I’ve provided, any of the tactics and strategies you routinely use, and the writing exercises I’ve described. By working in this way, you will help increase your clients’ personal power, aim them in the direction of useful daily practice, help them envision and plan for the future they want, and, in the process, help them upgrade their personality, heal, and grow.


References:

Maisel, E. (2018). Helping Survivors of Authoritarian Parents, Siblings, and Partners. New York: Routledge
 

The Virtue of Metaphors

If you were to tabulate the time you spent obtaining your graduate degree, license, continuing education, and specialty training, it would be measured in years or, for some, decades. That’s an enormous amount of time thinking counselor thoughts, speaking counselor words, and problem-solving from a counseling perspective. Certainly, these are the requisite building blocks of a professional career. We wouldn’t want a counselor thinking engineer thoughts, using plumber words, and problem-solving from a chemist perspective. Even so, there is a danger in becoming so enmeshed in our counseling worldview that we lose perspective. I must continually maintain awareness that my clients are coming from a different frame of reference. If I’m not mindful, I may use jargon, aka “counselorese,” which could run the risk that my interventions won’t connect with my clients. I may also disenfranchise and come off as irrelevant to my clients. This is the opposite of what I want. I want my clients to get excited by the ideas discussed in counseling and enthusiastically think about new patterns of behavior. What are some ways of circumnavigating the counselorese problem? In discussion with colleagues about this problem, a number of ideas usually get thrown around, such as matching your language with the client’s, understanding and utilizing the client’s frame of reference, or using movie or sports analogies to explain a concept. All these are great ideas, but it is only on the rare occasion that I hear someone comment about metaphors. Which I think is unfortunate, because I find metaphors especially useful and powerful, and, most importantly, an effective way to mitigate the counselorese problem. When done right, a metaphor relevantly connects with the client’s lived experience. Let’s say you are explaining to your client, who happens to be an auto mechanic, the benefits of self-care and the client just isn’t getting the concept. So you switch gears (did you pick that up?) and compare the client’s implementing a consistent routine of self-care to a car owner’s bringing their vehicle into the shop every six months for routine maintenance. The mechanic will certainly pick up on the logic and urgency of the metaphor. And with your help, they can connect the dots to their life. Specifically as they relate to language, metaphors get you away from using technical jargon. This is important because counselorese can, in the worst-case scenario, disenfranchise the client, and at best, undermine the effectiveness of interventions. For example, with the auto mechanic client, using phrases like “check-up,” “regular maintenance,” or “run diagnostic” relates to the client while achieving a clinical purpose. Finally, metaphors paint a vivid mental picture that allows the client to explore their experience. In other words, a metaphor is a mental picture that you can walk into in order to examine parts of your life that you have never looked at. The auto mechanic client may have never considered self-care as a part of his life, but once considering that his mind and body are kind of like a car, and self-care is kind of like doing maintenance, maybe there’s something else within the metaphor that will help him to examine his relationships, beliefs, or goals. However, metaphors are not perfect and may not work for everyone. You may be working with a client who is very concrete, on whom any kind of imaginative, thought-experiment-type of exercise could be lost. So be sensitive to who your client is and their needs. You will also want to be cautious about over-using or over-relying on metaphors. Furthermore, mixing your metaphors can diminish the power of any one metaphor. Be wary of stretching your metaphor too far—adding more and more to the metaphor could eventually decrease the effectiveness of the technique. Best to keep your metaphors uncomplicated and straightforward. I recall working with a client who had a hard time understanding my conceptualization of their presenting issue. They couldn’t understand how I saw their problem, and therefore, my recommendation on how to treat the issue was going nowhere. I had to try something different. Fortunately, I knew that my client was a runner. So I used a metaphor of a marathon to help the client understand her relationship to her daughter. I shared how she was getting fatigued by sprinting when she had miles and miles before the finish line. It would be better if she conceived of her relationship as a marathon. The client really connected with this idea. She realized had to pace herself when running long-distance, and she needed to “pace” her expectations. We then discussed how the client could make her expectations realistic, how change takes time and patience, and the need for regulating emotion when things get challenging. The metaphor powerfully connected with the client and enhanced our clinical work. As you can see in the example above, I was stuck. Certainly, there were a number of options I could have tried to get things moving in the right direction, but using a metaphor worked for me, and thankfully, it worked for the client. The metaphor provided a story in which the client could evaluate herself and envision new alternatives. It helped her see where she was making mistakes and allowed her to self-correct. It grounded her daily experience where she felt unsure and confused in a narrative where she was confident and knowledgeable. The medium was the metaphor, and the message was changed.

The Performance Trap

We’ve all been there! You assigned your client some homework to do over the week, and they didn’t do it. You might be like me in that upon learning they didn’t do it, your mind starts racing with thoughts like “There must have been a problem with the homework I gave them” or “The assignment wasn’t a good fit for them; maybe they just need another idea.” At this point, I feel a tremendous pressure to not shame the client by dwelling on what they didn’t do, and to come up with another brilliant homework assignment. I’ll then start generating a new idea that I think will work perfectly for their presenting problem. I’ll put a lot of effort and enthusiasm into describing the idea, how it could help them, and how they can practically apply the concept over the next week. The client agrees to practice the idea, record some reflections, and report the following week how it went. I breathe a sigh of relief that I quickly put that fire out and have full confidence that the client is motivated and will come back next week with a glowing report about how great the homework was… I do this only to be disappointed again.

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So what is the right move at this point? Do I abandon all hope that the client will ever complete a homework assignment and therefore never give out assignments again? Do I make a paradigmatic shift and drop homework altogether from my clinical work? Or do I put my nose to the grindstone and continue generating ideas and homework assignments for the client?

Sadly, I’ve found myself stuck in the performance trap, which is the pressure to wow the client every week with a new idea. However, this option comes with many pitfalls. First, the pressure to wow the client is completely misguided. Rather than wowing the client, I should be holding them accountable. They made an agreement to do the homework, and I need to hold them to that. If the situation were reversed, I would have to be accountable to them. And, in fact, this does often happen in the clinical contexts. The client may want me to fill out some paperwork, forward their notes to another provider, provide them billing information, or email them a resource discussed in session. I agree or not, and then I am accountable to fulfilling my end of the bargain. This makes sense. That seems reasonable.

So why, then, do I drop this standard when it comes to the client? Secondly, moving on to another idea doesn’t provide any information as to why they didn’t do the homework. Maybe there is a clinically relevant reason why they didn’t do it. And, quite possibly, understanding why they didn’t do it could be the secret to unlocking the reason why they are seeing me in the first place. Thirdly, the pressure I felt to come up with great idea after great idea was removing the work from the client and placing it on myself. In essence, I was creating a context where my client was dependent on me, resulting in a situation where they didn’t value the work I was doing. Why should they have to act on an idea I suggested this week, when next week I may have something even better?

I can remember a couple with whom I had been working for a few weeks and found myself stuck in the performance trap. We had spent enough time building trust, gaining an understanding of the problem, exploring their story and relationship history that I thought they were ready to test out a few of the ideas we discussed. So I gave them a homework assignment, taking care to explain how it related to their presenting problems, how it would help them reach their treatment goals, and what the homework would look like using practical examples. The couple wholeheartedly agreed to do the homework, and the session ended with a buzz of excitement. When I asked how the homework went during our next session, they put their palms to their foreheads and said, “Whoops! We forgot.” I said, “That’s okay. No problem. Maybe the homework assignment wasn’t a good idea.” And then I proceeded to explore another idea from my therapist bag that could address the problem and get them closer to their treatment goals. Little did I know that this was the start of a trend that would last session after session. After months of getting nowhere, the couple terminated therapy. They said they liked me and appreciated my efforts, but they just weren’t getting anywhere. I now realize why.

As you can see from this scenario, I was fully engrossed in the performance trap. Sure, I felt like I was working hard for the clients, and they even appreciated my efforts, but that had no effect on their making real, tangible movement towards their goals. And that is the whole point. If my efforts are not getting the client closer to their goals, then that is cause for reflection and re-evaluation. So don’t make the same mistakes I did. Rather, follow these recommendations when giving your client homework: don’t abandon giving your client homework, keep your client accountable, understand the “why” when they don’t do homework, resist the urge to generate idea after idea, and (yes, it’s cliché but true) don’t work harder than your client.