Conversations about Therapy and Training for Therapists
I spent 25 years teaching in a Counselor Training program at a small liberal arts college in Missouri. I have been in private practice as a counselor/therapist for thirty years. I began private practice five years before the state licensure law was passed in Missouri. The first year it was possible to do so I took the licensing test and, consequently, have a very low license number. It has been my privilege to serve literally over a thousand clients. I conservatively estimate that I have done more than thirty-five thousand hours of counseling sessions. This week I have had several conversations with counselors who have both graduated from and taught at the same university where I taught. We discussed the why’s and how’s of counseling. The university that we were all connected to promotes itself with a slogan about being “Life Long Learners.” I would like to think that I am still learning about many things, including counseling, even though I have now retired from an active clinical practice.
Our discussions centered around two themes. One theme was the question of how to best teach/train new therapists to be counselors. Which areas should be emphasized more: the academic knowledge, updated information about things like depression, anxiety, psychotic states, data-base information about diagnostic categories? Should we concentrate our focus on the research skills for writing “professional” quality papers? Should we standardize the course-work around the concepts advocated by the professional program certification group? (A group that publically espouses all the expected “virtues” of practicing in the public interest, but which, in its efforts to do so, acts aggressively in restraint of trade to protect its regulatory power.)
Or should we focus on teaching clinical skills? Teaching clinical skills calls for much more expertise on the part of the instructors and the program. How does a university program “teach” someone to listen with empathy? How does a student learn the best way to phrase an intervention with a client? How do you teach the novice therapist to listen to the client and not get lost in the story, but instead find a place to stand so that they can look for and see the patterns in the client’s life? What are the essential skills needed to do therapy? Can any counselor work with almost any client? Do we, as counselors, serve different markets which require different skill sets? How are those markets developed and controlled? This is the debate that is ongoing between the academicians and clinicians.
Part of the counselor education includes the formation and development of philosophy and legality. Questions are asked, such as who should control access and process? Meaning, who will be the gate-keeper for the counselor’s ability to solicit a client? Does the client have the choice to see the therapist they want? Should the decision be made by the licensing board, the insurance company or the primary care doctor? Questions need to be answered about the best techniques for use in treating each issue or diagnosis. Who owns the responsibility for the client making progress, the therapist or the client? What is the “standard of care” to be established by a degree or a license?
All of these questions are interesting to my colleagues and me. We live and breathe this stuff every day. In an effort to provide full disclosure, I must say that my group of friends/counselors are self selected. We tend to strongly agree with each other around these topics. The discussion began because of our concern that the program, which educated us and prepared us to serve, is changing in ways about which we are concerned. All of us agree that the most important part of the educational process for budding therapists is the teaching of clinical skills. We fear that the university is moving away from that focus. We worry for its students and for the clients they will eventually serve.
The second theme around which our discussions have centered is the what and how of therapy. How does therapy actually work and what is the role, or contribution, of the therapist? Most of my friends and I are from the Self Psychology orientation. We tend to think that one of the most valuable contributions made by the therapist is the creation of the safe holding environment. It is a non-judgmental experience for the client. The client is heard in a way that is empathic and accepting, even if the therapist does not approve of their behavioral choices. Heinz Kohut, the founder of this school in psychotherapy maintains that the ONLY thing a therapist has of value to contribute to the experience of the client is accurate empathic reflection of the client back to the client. The client has an “aha” experience when this happens. They feel seen and understood. They are not feeling judged or criticized. The therapist is not the critical parent who approves/disapproves or the individual who punishes, directs or controls.
It is not the job of the therapist to solve the problem for the client, or tell the client what to do. As a therapist, I cannot walk in their shoes. I can only do my best to walk beside them. One of the most impactful experiences of my life is to be in the therapy session with a client when they lay bare their innermost fears and secrets. It is an awesome way to experience the strength and resiliency of the human spirit. I am allowed to co-experience with my clients the wounds they have received, the sense they make out of these experiences and the development of their determination to walk out of the negative and hurtful miasma in which they have been living, to a path of peace and fulfillment.
I believe that when a person has the opportunity to be in the safe non-critical holding environment with a supportive connection which anchors them while they look at the things that hurt or frighten them the most, they have a true opportunity to write a new script for themselves. They can choose to walk a new path and make their lives and relationships different. They can be less bound by their past. They must accept the reality of what is and was, but they can embrace the determination to make what happens next different. My job is not to write their script, or direct their performance, my job is to ground them and “hold” them in a secure place while they look into the fiery furnace of pain or shame and then to help them select a new choice. This is done through a reality based process of calculating cost-benefit ratios to make a new script. The choice must be an honest one for them and it must be their choice, not mine. I cannot walk in their shoes and I cannot make their choices. I can respect the process and facilitate it while they learn how to write their own script.