What I Learned During My Fourth Year As A Mental Health Therapist

Today marks my fourth year as a mental health therapist.

Check out my?first,?second, or third?year here.

Let's get to it.

Here are the?top 5?things I've learned this past year.

1. Six degrees of separation

Therapists live in a world of ethics and legalities.

We're trained to understand this while treating our clients.

But this process doesn't end once treatment ends.

If anything, a deeper level of this begins outside of therapy.

After your clients have either graduated or fallen off treatment.

Where I work is considered a metropolis, meaning the mother of cities in my area.

You know what this means, right?

Whenever I run errands, I also run into

• friends
• family
• coworkers
• clients

Yes. Even in the largest city, I run into my clients.

And this can happen anywhere publically, or privately.

Location, location, behavior?

Therapists are held to a high standard. A very high standard.

You are a mental health professional that shoulders your city's pain points.

You are a mandated reporter to protect the public from potential offenders.

Believe it or not, people look up to you and pay close attention.

Close attention to your actions.

And you're in no control over how others view your actions.

But you're certainly in control of your behavior, publically and privately.

And that helps.

The reason I bring this up is because clients will run into you.

You may see them by accident at a block party.

You may see them while you pump your gas.

You may see them in your favorite restaurant.

So it matters how you present yourself.

We're not talking about perfection, we're talking about finesse.

Act as if you are representing your brand.

And that brand is you.

Act as if you are representing therapy.

And therapy is being mindful.

Have a protocol talk

In addition to representing yourself publically, it's also best to prep these potential interactions.

When I first began therapy, I learned quickly how often I ran into my clients.

So I had to start having a protocol with each client.

It looked something like this:

"Being that we live in a large town, it can seem small too. This means you and I may see each other in public sometimes. Now, I am fairly approachable; however, here are a few things to keep in mind:

• You can say 'hi' to me if you'd like.
• We won't talk about treatment, therapy, or anything related.
• If you call my name and I don't turn around it's because I didn't hear you.
• And if you'd rather me pass by you as if I didn't know you, we can do that too."

Of course, because you have different relationships with your clients, you will have different conversations.

But it's good to have an idea of what these protocol talks about so you can be prepared.

And an idea of how you can represent yourself publically.

Why?

Well, here's a very short list:

• Nobody likes to be ignored by their therapist (unless planned).
• Nobody likes to have an overbearing therapist in public.
• Some people don't like to see their therapist drinking at a bar.
• Some people are turned off seeing their therapist trolling online.
• And whatever else you can think of regarding public experiences.

Because that's the process of having six degrees of separation.

You could be connected to any other person on this planet through a series of interactions with less than six persons.

2. You've got all the answers

You may have read before that therapists don't give advice.

And if you've received advice from a therapist, I suspect it was well-intentioned.

But, getting unsolicited advice from your therapist is a no-no in our world.

Think about this for a moment:

How often have you used and practiced random advice from a stranger?

Maybe a few times, but it's not common.

Why?

Because most of us make our own decisions, for ourselves, from ourselves.

And therapy runs by the same rules.

Leggo my ego

I've told this story hundreds of times to clients, therapists, friends, and family.

During graduate school, I was told therapists don't give therapy.

I was bummed because I thought I gave wonderful advice.

At least that's what my friends had told me.

So as soon as I heard this in school, I had to relearn what therapy was really about:

Teaching others how to catch their own fish.

Not catching fish for them.

Sure, it doesn't feed your ego, but that's not what this is about.

Becoming a therapist is a job where you don't reflect your image hoping clients will 'just learn' your ways.

A therapist's job is to reflect your client's image back onto them so they can see how they think, feel, and act in their lives.

So they can choose to make adjustments as they see fit.

A game of chess

During my first official year as a therapist, I noticed some new themes.

One of which was that therapy is exactly like a game of chess.

Now I have yet to learn how to actually play, but I understand the gist.

You have one board, two players, and a lot of game pieces.

In chess, after you make your move, you then wait for the other player to make their move.

You don't make their move for them. That's their job.

Therapy emulates this.

You may share a skill or an observation, and that's you taking your turn.

And it's up to them how they receive that skill or process your observation (it's not your turn twice in a row).

Because it is your client that has all the answers, not you.

Of course, there will be times when you'll be more direct, but that comes with context.

You're no tour guide

In short, don't be a tour guide in therapy.

This assumes you know their life better than they do.

Be an active observer instead.

This means to be present, curious, ask questions, don't assume, don't pretend, relearn, and lastly, practice the child's game following the leader.

You can never go wrong when you assume your client is the leader of their life.

Because some of the greatest therapists don't have great advice.

They have a great sense of following their client's lead.

3. Don't waste from a closed door

In 2022 alone, upwards of 48% of mental health professionals experienced some degree of burnout.

Just in the United States alone, that would mean about 500,000 professionals were burning out.

Wow. That's an incomprehensible number.

So let's think smaller.

Imagine you were in a small group practice, or clinic, that had about 10 clinicians.

Following the statistic, nearly half of your team could be struggling with burnout.

Even on a smaller scale, this still impacts your team and the clients you serve.

Now let me get personal for a moment.

Entropy wins

I lost my dad to Covid a few years back.

And when I came back to work, I noticed something peculiar.

My office door was closed more often. Well, most often.

Isolation seemed to be the only thing that "helped" me.

I shut out my team and shut out myself.

Ever heard of the Law of Entropy?

According to this law, anything you isolate or close off will increase the degree of disorder.

Think about an abandoned home:

• weathering affects the roofing
• termites eat away anything wooden
• earthquakes damage the foundation

The home was isolated, and disorder took over.

The same thing happens to living organisms too.

Like a flower cut off from its resources:

• no more sunlight
• no more water
• no nitrogen
• no soil

You can expect the flower to die.

Entropy wins.

This can and does happen to mental health professionals if you are not careful enough.

Isolation isn't the solution to burnout. This enhances it.

You waste away from a closed door.

Reconnection is the solution

During a meeting with my team, I was asked if I needed anything to help me as I got back to work.

It was clear what I needed:

"Yes. In fact, what I need to do is keep my door open."

They nodded their heads. Then I said:

"And please, if anything, come and say 'hi' every now and then."

They understood that seeing smiling faces and greetings would reconnect me.

In fact, it recharged me.

Not everyone recharges from engagement with others.

I lean toward extrovertedness more so than introvertedness.

So seeing others gave me energy.

While introverts may require some alone time to recharge.

And there are clear differences between isolation and spending some alone time.

Both alone time and engaging with others are forms of reconnection.

Reconnection with yourself,

Reconnection with others.

This is you opening your door.

4. There's hope for PMH

I work for a non-profit contracted with Public Mental Health (PMH).

It's not hard to find articles, hear whispers, or see videos of PMH workers expressing their concerns or dissatisfactions with their experiences.

Unfortunately, there are plenty of negative experiences.

During graduate school, I remember one student in particular who shared something unique with me in relation to this.

They told me they had more interest in working in public mental health than private practice.

It didn’t make sense to me.

But, now that I've been able to work in PMH, some things make sense.

In a job like mine, we're considered the primary care physicians of mental health.

On any day I will work with individuals that struggle with a myriad of difficulties:

• schizophrenia
• major depression
• generalized anxiety
• post-traumatic stress
• borderline personality
• and intense crises

So there are many that decide to make a change.

The private life

I've noticed a trend of mental health professionals doing the following:

• get hired in PMH
• stay for 2-3 years
• collect required hours
• get licensed, quit their job
• begin their private practice

Many flee the hard work of Public Mental Health for a change of income, flexibility in hours, and likely, lower severity populations.

It's respectable.

In the years I have worked, it's been an honor to work with those who have taken this route in their lives.

It's helped their own mental health, and their families, and probably reduced personal burnout if that applies.

But this part of the article is going to make a case for PMH.

Because I do believe there is hope.

The turning point

There are some key reasons why I'm sticking around in PMH.

In 2018, I helped run a non-profit clinic that was set up as a group private practice.

I expected to have dozens of interactions with others a week.

Because ongoing engagement kept me recharged.

But I was wrong. This was not my experience.

Much of my past work was very isolating.

And you already know what that does to me.

Working for an amazing team in PMH has been profoundly engaging:

• I've had dozens of interactions weekly
• Team meetings are over an hour long
• Everyone takes their 15 min breaks
• You hear laughter down the halls
• Neighboring offices become family

More buy-in

Not only does having this family-type culture help, but so does training.

Here's an idea of how many expert trainings I've attended in the past 4-years:

• MyOutcomes Trained
• Suicide Prevention Trained
• EMDR Trained
• DBT Trained
• Solution-Focused Trained
• and more.

Thousands of dollars have been spent on little ol' me.

Did I mention, some CMH programs come with financial incentives?

• It costs $375.00 to study prep for your license.
• It costs $220.00 to maintain my LMFT license.
• It costs over $300.00 to maintain liability insurance.
• It costs over $300.00 to maintain required annual trainings.
• It costs over $1500 to attend important conferences.

All have been covered for me in PMH.

Did I also mention there are creative opportunities?

I've recently shared with my Program Manager that I'd like to start a Solution Focused Therapy Group where I work.

And although I am waiting for approval, this is how PMH can function.

I suspect approval will happen as I've seen others create their own groups.

It's motivating to think you'll be doing something you're passionate about.

While supporting those in the location you live in.

Leadership matters

Lastly, your leadership can matter just as much as your pay, benefits, etc.

Without strong leaders in your PMH, it's easier for the ship to sink.

Then you've got great therapists jumping ship for private practice.

But that hasn't been my experience.

From the day I was hired, to my fourth year this date, leadership has doubled and tripled down in my experience.

My leaders have their own leaders they respond to as well.

A good leader is not too proud to ask for help, and that's what I see.

A good leader is approachable both on and off the clock, and that's what I see.

A good leader is open to suggestions to enhance team morale, and that's what I see.

And a good leader will step in when you have no idea what your next move is.

That's what I see. That's what I've experienced in PMH.

Which is why I am sticking around.

And if you've got yourself a similar team, hold on. That's hope.

5. Process in a nutshell

For the longest time, I’ve noticed how difficult it can be to actually have a change in therapy.

The process part always confused me:

“Just process this with them…”

“Processing is what we do…”

“Spend time processing…”

It’s obvious to me that process is a function of healing, but it’s not obvious to me as to what that actually looks like.

Let me be the bearer of bad news:

1. Therapy is just as effective as tarot card reading
2. Therapy is just as effective as coaching

This isn’t a smear campaign for these professions.

But when one of the three costs hundreds of thousands of dollars you’d better be getting your money’s worth.

And you best understand the process:

It is the attempt to understand and highlight what’s happening in a room before, during, and after others speak.

The process is not the words you say, it's how they are said.

The process is reading the energy in the room and calling it out.

The process is slowing down and acknowledging what just happened.

Because when you've got the process right, then therapy goes right.

And if therapy goes right, healing can happen.

The formula for healing

Therapy ain’t what it used to be.

Here’s how therapy was back in the day up until now:

• insurance reimbursement was good
• people saw a therapist forever
• insurance panels changed
• stigma was alive and well
• new productivity rules
• outcomes expected
• rushed therapy

Now try your best to put all of this aside.

Healing doesn't need to come at such a cost.

Healing can come when the formula is right.

And that's called catharsis.

The word catharsis came from the Latin meaning "purification".

This isn't to be pure in a moral or spiritual sense.

It's to re-purify your mind to what it once was.

And catharsis attempts this.

Always time for change

Catharsis is nothing without change involved.

I repeat.

Experiencing intense feelings or insights mean nothing without a change of direction.

Or a change of pace.

A change that is likely to lead to meaningful experienced colored with intense emotion.

A new outcome after this has been processed (e.g., self-explored).

Here's how this actually looks:

Catharsis + Change = Processed Outcome

This change reminds me of Maslow's hierarchy.

Although he suggests self-actualization is at the top of living one's potential, that wording has not settled with me

It assumes one is done finding their potential. It's a complete process.

Often, I resort to using labels such as self-actualiz-ing as the process is ongoing.

The process is never stopping. It's lifelong.

And humans are lifelong learners. It's what we do.

And successful therapy involves this entire process.

Catharsis is good but you can have intense release of thoughts and emotions all day without learning anything.

All you learn is that you have the capability of having these emotions and releasing them, but the mode of your future release is never tapped into.

And when you decide to tap into your future self and focus in on living out a new change.

That's an ongoing development.

That's therapy.

That's the process.

__________

Wrapping things up

As much as I felt I've learned over my first four years as a therapist, there's so much more I have coming my way.

The same goes for you. Whether you're a therapist or interested in this field, you and I are lifelong learners in this field.

Fifth-year as a therapist, here we come.

Take care.

A complimentary gift for you:

100 Life Hacks ADHD Swipe File

25 Dopamine Hacks without Medication