Book Review: The Making of a Therapist, by Louis Cozolino

Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

The full title of this book is The Making of a Therapist: A Practical Guide for the Inner Journey, which should give you a pretty good idea about what's inside. The permission to "start off by not knowing a single thing about psychotherapy" (p. xxi) is given because this book is intended for beginning psychotherapists who...well...probably don't know a single thing about psychotherapy. And may be feeling boatloads of anxiety about it. Not that I know anything about that.

Cozolino articulates that "a basic goal of this book is to give beginning therapists permission to feel what they inevitably will feel--uncertainty, confusion, and fear--while also offering some strategies and advice for dealing with common situations that all therapists face" (p. xx). He's big on giving permission, which somewhat allays the fear that whispers, "if you're prepared to start seeing clients, why do you feel like you've got no idea what you're doing??"

He believes that graduate training for psychotherapists focuses on the what rather than the how of therapy, and there's not enough room for exploring and developing the inner world of the new therapist. So while we may be armed with theory and interventions and even some good idea of what questions we should be asking clients, we're not as well prepared for the interpersonal nature of therapy. To assist in nurturing this critical part of training, Cozolino has structured this book somewhat chronologically. He begins the journey with "Getting Through Your First Sessions" before moving on to "Getting to Know Your Clients" and finally guiding the reader to "Getting to Know Yourself." If you're not doing your own personal therapy as you begin seeing clients, you may find this last part especially helpful and supportive.

The Making of a Therapist a wonderful balance of Cozolino's anecdotal personal experiences as a beginning therapist, his observations of students and supervisees over the years, and advice that somehow manages to be both pragmatic and inspirational. It's an easy read, and something I'll imagine I'll find myself coming back to as I hit rough patches in fieldwork. But the lasting lesson of this book is to give yourself permission to be open to and aware of all you don't know--it seems it's in those moments where the real making happens.

 

Points of Interest:

Book Review: Deliberate Practice for Psychotherapists, by Tony Rousmaniere

~ Tony Rousmaniere,  Deliberate Practice for Psychotherapists

~ Tony Rousmaniere, Deliberate Practice for Psychotherapists

In Dr. Benjamin Caldwell's book Saving Psychotherapy, he outlines four tasks that psychotherapists must embrace to help "save" the field of psychotherapy. If you've read my review of the book, you know how much it resonated with me. However, the final task (accepting accountability for the quality of our work by deliberately working to better our skills) has haunted me.

I do want to be the best therapist I can be, but I've felt a little lost about how exactly I'm supposed to work on my skills to get there. The unarticulated message I've received during my first year of graduate training has been that "getting good" just happens through some alchemy of learning theory, being congruent, asking circular questions, avoiding microaggressions, and seeing clients. Lots of clients. (I'm obviously being reductive for the lulz--I think my program is doing the best they can within the current paradigm of therapist training. Even so...) 

It's this last bit, simply seeing lots of clients, that really hasn't been sitting well with me. Learn by doing just seems like a cop-out, like no one was able to figure out how to teach something so they presumed the best way to learn must be the way they learned, which is by muddling through until it gets easier. That's all fine and good when we're talking about needlepoint or something. But I'm being asked to help people who are having serious life problems. Needlepoint this is not.

And y'know what, since you bring up needlepoint . . . there's actually a deliberate way to work on getting better at needlepoint. Samplers. Young girls used to work on them to perfect their skills before they were married off and had to work on their husbands' socks or waistcoats or whatever.

 
A sampler! Click to enlarge.

A sampler! Click to enlarge.

 

Where's the sampler for psychotherapy??

<<MUCH FANFARE>> Meet Tony Rousmaniere, author of Deliberate Practice for Psychotherapists: A Guide to Improving Clinical EffectivenessY'all, I'm a little frustrated I haven't been assigned this book in any one of my classes yet. Why wouldn't you assign a beginning graduate student a step-by-step guide to becoming an effective clinician? I am forever grateful to my friend and colleague, Ben Fineman, who recommended this book to me and lent me his copy. Because what Rousmaniere has to offer is, in fact, a sampler for psychotherapy.

Rousmaniere begins with his own experience as a clinician in training, despairing about the fact that no matter how hard he tried, about half of his clients were not benefiting from therapy. As it turns out, this is not an outlier--in fact, this rate is about average. Which seems to directly contradict the research presented by Caldwell as a beacon of hope in Saving Psychotherapy--that therapy is effective. How can half of clients not benefit from therapy if therapy itself is effective? The problem, Rousmaniere and Caldwell seem to agree, lies with therapists.

Rousmaniere argues that the current model of clinician training is a "path to competence." That is, the end goal of the current system of training and licensing therapists is simply to produce competent therapists, who have a decent success rate. But the truth is, some clinicians are better than others--and those that are better have better success rates. What makes some clinicians better than others? Rousmaniere argues these clinicians take the "path to expertise."

This path is the harder path. The research presented by Rousmaniere demonstrates that the only way to get to expertise is through deliberate practice. He takes issue with the misconception popularized by Malcolm Gladwell that it simply takes 10,000 hours of doing something repetitively to achieve mastery--what it actually takes, he says, is repeatedly and deliberately working at a level just beyond your current skill level. Simply playing tennis matches over and over will only incidentally improve your serve, but spending an hour every day drilling serves will deliberately improve your serve. This, Rousmaniere argues, is the faster and more effective path to mastery than simply muddling through a learn-by-doing process.

So how can psychotherapists deliberately practice? We can't conjure up a fake patient to do therapy with when we're off the clock (yet). The good news is--we don't need to. Rousmaniere has created a curriculum of sorts composed of several exercises designed to isolate specific psychotherapeutic skills, and the cornerstone of all of them is the humble video camera. He recommends video-taping as many of your actual sessions as possible, then using the taped sessions--both alone and with a coach--for the prescribed exercises.

For those of us in COAMFTE-accredited programs, we're already familiar with the idea of video-taping sessions; it's a requirement for our fieldwork and we can't accept a placement that won't allow recording of at least some sessions. But most other graduate programs do not require recording of sessions, and the whole idea might seem crazy. What client would be ok with this?? But apparently, clients seem to be pretty ok with the idea of their therapist recording the session both as a quality-control measure as well as a way to get more (maybe better) input.

Now, I hate watching myself on camera. But Rousmaniere points out that this very reaction is standing between me and becoming a better therapist. So while I have been dreading having to record my sessions, I'm now looking forward to it (at least I'm telling myself I am). Rousmaniere has even created an exercise specifically targeted towards working with this reaction and I can see how it would really be effective.

After reading this book, I'm now planning to make recording sessions standard in my personal practice once I'm a licensed clinician, and I'm going to try to implement deliberate practice as soon as possible.

I know what you may be thinking, because I thought it, too--what graduate student has time to do MORE practice outside of everything else?? Rousmaniere beat us to this punch, though, and he addresses the issue of not having a lot of extra time to dedicate to practice outside of work by encouraging us to start small--just a few minutes per day at first. This goes for students as well as already-practicing clinicians who are interested in upping their game. No matter who you are or what your schedule is, you can make some room in your life to work towards expertise.

And when I step back and think about it . . . a lot of Olympic athletes aren't superstars with lucrative sponsorship deals and personal assistants. They're regular people with normal jobs who happen to also have a crazy passion for shot-put or sprinting or skiing. They manage to put in the extra time and effort to become world-class athletes in order to represent their country at the Olympic Games. The least I can do to help my clients is put in the time and effort to become a world-class therapist. Now, with Rousmaniere's guide, I feel like I finally know how to get started.

 

Points of Interest:

Listen to Dr. Caldwell's podcast on iTunes!

Listen to Dr. Caldwell's podcast on iTunes!

Book Review: Saving Psychotherapy, by Benjamin E. Caldwell, PsyD

~ Benjamin E. Caldwell, PsyD,&nbsp; Saving Psychotherapy

~ Benjamin E. Caldwell, PsyD, Saving Psychotherapy

If you're a California MFT student or you're studying for the licensing exam, you're probably familiar with Ben Caldwell. I first became acquainted with his work through his excellent blog, Psychotherapy Notes. He's written an easy-to-understand textbook, Basics of California Law for LMFTs, LPCCs, and LCSWs, which is used in Law & Ethics courses as well as considered a must-have desk reference for practicing clinicians. He's also written a series of prep books for the various law and ethics exams in California, and his company, Ben Caldwell Labs, is now offering continuing education courses that meet the six hours of Law & Ethics content needed for license renewal in California. Somehow, he has also found time to be a frequent guest on some of my favorite podcastsadvocate for prelicensed MFTs, and teach at the graduate level, as well (full disclosure: I am currently a student in his Systemic Family Therapy Theories course at CSUN--the opportunity to learn from Dr. Caldwell was a major reason I wanted to attend this program).

What I'm trying to say is--if you're currently on the path to becoming a licensed MFT in California, you probably know this guy.

You've probably also gathered that he's passionate about the field of psychotherapy. If you've purchased his books before, you may have seen advertised a slim, unassuming volume entitled Saving Psychotherapy: How therapists can bring the talking cure back from the brinkIt hasn't been required reading for any of my classes yet, and I don't know why not. I think every future MFT should have to read this before embarking on the graduate school journey--it is a clear-eyed look at the current state of the profession and a clarion call to psychotherapy students and clinicians to take personal responsibility to improve the field.

The quote in the image above is from Caldwell's introduction to this book, and it sums up his underlying point--don't be intimidated by the size of the problem, because if we all pull together, we can achieve something great.

The problem, Caldwell argues, is that the field of psychotherapy is in danger. He points to research indicating that, though therapy has been shown to be effective, it is increasingly underutilized, it "isn't seen as competing well against other services, and [its] reputation as a profession is not as strong as it could be" (p. 28). Readers should not jump to scapegoat the usual suspects, however; while it may be easy to blame Big Pharma or doctors or the stigma associated with mental health services for psychotherapy's issues, it won't help anything (and it's not entirely fair).

Instead, Caldwell outlines a straightforward four-pronged plan of attack to advance the field, all underlined by the necessity of taking personal responsibility.

Task #1

He encourages us to clarify our purposes and values to ameliorate the problem of client mistrust. In this chapter, Caldwell makes an explosive claim: " Therapists who refuse to give advice are failing to fulfill their responsibilities as professionals" (p. 48). If you just re-read that sentence, I don't blame you--it runs counter to almost everything I've been taught about being a therapist so far. However, Caldwell's argument is so persuasive you just might exclaim out loud, as I did, "BY GEORGE HE'S RIGHT." 

Task #2

Fix the process of therapist training and licensure. Caldwell goes into great depth on the problems inherent in the training and licensure paradigms, both of which figure heavily in his advocacy work. The part of this section that most resonated with me was his exhortation to "let money be an explicit factor in decision-making" (p. 103), offered as a counterbalance to the general reticence on the part of most in the field to discuss financial matters.

Personally, I first ran up against this brick wall as I was attempting to determine just how much this whole "graduate school" endeavor was going to cost me. It started simply enough, when I was trying to compare tuition at different programs I wanted to apply to. THIS WAS NEARLY IMPOSSIBLE. Then, I wanted to discern the functional difference between the programs--each one seemed to toot their own horn for different reasons, and I had a hard time wrapping my head around what set each program apart. I became aware that, intentionally or not, many programs obfuscated the details of their programs. I had a lot of free time back then, so I meticulously researched until I had the answers I wanted, but then it dawned on me--there were probably A LOT of people researching these programs that did not have my levels of free time or tenacity (ok fine OCD tendencies). What were they going to do? Probably rely on advertising. That pissed me off.

Fortunately, I'm stubborn. And had a lot of free time back then. And a touch of OCD. So I researched every single MFT program in California and put it all in one place, MFT California. All the information looks the same between programs, so you can easily compare across different metrics. Most importantly? You can easily get a general idea just how expensive each program is. It's pretty enlightening. So yeah--I really liked this part of the book. 

Task #3

This idea is also near and dear to my heart--embrace science. Caldwell argues that discounting science as a therapist is a prime example "of cutting off one's nose to spite their face" (p. 37). His section on statistics in this chapter entitled "Bad Science" was incredibly helpful during my Clinical Research Methods class; if you're intimidated by the math-y-ness of the social sciences, please get this book if ONLY for this reason, because you won't be so intimidated once you're done with this section.

Incidentally, here Caldwell also touches on the issue of postmodern therapy, which is a special area of interest for me. He argues that:

Philosophically, postmodernism...does not discount science, it merely treats it as one of many ways of knowing... True postmodernism suggest that, like all ways of knowing, science can and should inform the social development of consensus around key ideas... [However,] some therapists take calls for a 'not-knowing' stance in therapy quite literally--approaching therapy as if they had never received any training, or as if it had no value in the task at hand. This is not what the developers of postmodern models had in mind. Those developers have attempted to differentiate the humility of a 'not-knowing' stance from the emptiness of a 'know-nothing' stance.  (p. 124-5)

Postmodernism's philosophical embrace of scientific knowledge as well as the more ephemeral ways of understanding really resonates with me, so I deeply appreciated how Caldwell addressed this concept.

Task #4

Finally, and perhaps most importantly, Caldwell encourages us all to accept accountability. He's a huge proponent of Scott Miller's work around clinical effectiveness. Bottom line, no model of therapy is more effective than any other, but there are clearly some therapists who are more effective than others. Miller's work centers on trying to figure out what makes those therapists better. Caldwell argues here that, as clinicians, we need to work to make ourselves better by getting our work evaluated and deliberately working to better our skills. If you really want your mind to be blown, check out this lecture from Scott Miller at the Evolution of Psychotherapy conference in 2013:

Take It Personally

Caldwell clearly articulates at the end of each chapter concrete ways you can personally take action to save psychotherapy. There are simple, common-sense measures we all can take to improve our field, such as becoming a supervisor, being a skeptic not a cynic, and gathering data on your practice. These may seem like insignificant ways to do something as monumental as "save psychotherapy," but if we each take up an oar and really put our backs into it, we can cross oceans.

And your very first step could be reading this book.

 

 

Points of Interest:

Listen to Dr. Caldwell's podcast on iTunes!

Listen to Dr. Caldwell's podcast on iTunes!

Book Review: The Book of Joy, by the Dalai Lama, Archbishop Desmond Tutu, and Douglas Abrams

Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

I'm going to be honest with you--I downloaded this audiobook because I felt like it was something I should read. I've never read anything by the Dalai Lama, I just know he is on the path to enlightenment and probably a pretty good person. It had been recommended in some Reddit thread on books for therapists, so I figured, what the heck. There are worse ways to spend in hours of traffic than listening to the wisdom of the Dalai Lama.

I am so glad I did. This book far exceeded my expectations.

First of all, I do recommend listening to the audiobook first. Douglas Abrams, the journalist who narrates this extraordinary summit between the Dalai Lama and Archbishop Desmond Tutu, reads his part, and two voice actors read the parts of the two spiritual leaders in accents I assume must approximate the real thing. The effect is utterly charming.

I think part of my eye-roll resistance to reading anything by "spiritual leaders" is that I find self-righteous seriousness insufferable. In my experience, a sense of humor is necessary to weather what life can throw at you. And I assumed the Dalai Lama and an Archbishop talking about anything would be mind-numbingly dull, even in something called The Book of Joy.

WRONNNNNG.

These two spiritual leaders are SO FUNNY. They crack jokes with each other, tease each other, and playfully slap each other. The Dalai Lama insists, "laughter is good for the heart."

Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

What makes their humor so charming, though, is their warm-heartedness. They are so loving--with each other and with literally all of humanity.

Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

Additionally, they emphasize how to be loving to yourself. Another thing I have resisted for a long time is meditation. However, there's a section at the end of the book with suggested practices if readers want to try to take action to increase their joy, and I was pleasantly surprised at how grounded the exercises are. There's nothing uncomfortably esoteric--rather, there are lovely suggestions for things like meditating in the morning to set an intention for the rest of the day. The Dalai Lama admits that sometimes, even he can't come up with an intention; on those days, he simply resolves to do his best to help others, and if he can't, at least he will try to bring no harm to others.

Perhaps the most encouraging conclusion these two great men come to in the book is that joy comes from not pursuing things but from living in community and helping others. This resonates with what has called me to pursue therapy at this point in my life--I have found it to be true, the most joyous moments in my life have come when I could be of service to others. Abrams, the narrator of sorts, includes some fascinating asides about why, scientifically speaking, we are hardwired to find service so satisfying.

No matter what else I tell you about this book, I can't possibly do it justice. I just really hope you'll read it. Its effects have been rippling through my life ever since I closed the cover, and I love how its impact is shifting my perspective. Do yourself a favor and spend some time with some of the most joyous humans on the planet.

 

Points of Interest:

Book Review: Daring Greatly, by Brené Brown, PhD, LMSW

Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

A wise teacher I once had said this about pursuing excellence:

"Whenever you're trying to get better at something, there's where you are at your starting point, and then way far ahead of you is where you want to be--mastery, the flow state, whatever. In between there is the field of suck. There is no way around the field of suck, and no one gets to skip the field of suck. We all have to wade through the field of suck before we get to mastery."

The field of suck is a frustrating place. It's disappointing, wanting to do something well and being unable to do it. To compound the problem, we frequently have to muddle through the field of suck under observation. While you're trying and failing and disappointed that you're not there yet, there are usually people WATCHING you try and fail.

For many of us, it is so humiliating to fail in front of others that we may give up. We look up from our struggle, wondering how much more we must endure, eye the distance between where we are and where we want to be, calculate how much more humiliation may be in store--and decide it's not worth it.

Does this sound familiar? Have you given up on a dream because you couldn't bear to spend one more minute in the field of suck?

Then I beg you to acquaint yourself with Brené Brown. Surely you've heard of her--the TED talk she gave in 2010 has over 30 million views:

A researcher and bestselling author, Brown focuses on courage, vulnerability, empathy, and shame. She believes "that vulnerability – the willingness to be 'all in' even when you know it can mean failing and hurting – is brave." 

You need a lot of courage to enter the field of suck, and even more courage to stay in the field of suck when the going gets rough. Brown argues the only way to muster such courage is to get comfortable with vulnerability. My wise teacher says you can't get to mastery without wading through the field of suck; Brown, in her book Daring Greatly, says that "you can't get to courage without walking through vulnerability" (sorry I haven't cited page numbers, I listened to the audiobook!).

Daring Greatly is a roadmap for cultivating courage. Even if you've seen every Brené Brown YouTube clip ever posted, getting the Full Story from the researcher/storyteller herself is another experience entirely, so I really do recommend the whole darn thing. But I'm going to focus on just one piece.

The part of the book that most resonated for me at this moment in my life--as I've just completed my first semester of graduate school--is the section on feedback.

In life, we have to deal with feedback all the time. At work, we get performance reviews; at home, we get in fights over how well we washed the dishes. Handled poorly, feedback can be hurtful. But handled wholeheartedly (Brown's big buzzword), feedback moves you forward through the field of suck. Or as Brown puts it, "without feedback there can be no transformative change."

My master's program in marriage and family therapy relies heavily on feedback as part of a learning-centered educational design. Rather than relying on grades alone, feedback in this MFT program consists of discussions about strengths and "growth edges." This means that you can't just get your report card and go hide in your car--you offer your work in class, and then you have to sit there and get feedback from your classmates as well as your professor.

I'm not going to lie, it's tough. Brown uses the word "uncomfortable" to describe these hard conversations. Sure. If you've got straight-A tendencies like me, it's "uncomfortable" like having a sharp rock in your shoe is uncomfortable. That is to say, it can be excruciating. But Brown emphasizes that the goal is not to simply become comfortable with the feedback process--the way through, she argues, is to normalize the discomfort.

This struck such a deep chord with me because, at this point in my life, I've tried all the other ways to dissipate the uncomfortableness of receiving feedback, and they don't work. It never gets easy. And what I've realized is that if I can let go of my defenses and really take in constructive feedback, I move forward through the field of suck. Other people know things I don't, and learning from them is how I can make the transformative changes I'd like to see in myself.

Normalizing discomfort, then, is how we all settle in to feedback. And according to Brown, you have a responsibility to help normalize discomfort for those around you and lead the way with the following declaration:

“We believe growth and learning are uncomfortable so it’s going to happen here, you’re going to feel that way. We want you to know it’s normal and an expectation here, you’re not alone and we ask that you stay open and lean into it.”

Letting people know that the uncomfortableness is normal, Brown argues, reduces anxiety, fear, and shame--those things that drive us out of the field of suck before we've reached our goals.

Leaning into the discomfort is, in my mind, wallowing in the field of suck. Settling in, deciding to stay awhile--opting out of surrender, no matter how unpleasant the experience. Because there is no way around the field of suck.

Making the conscious decision ahead of time to lean into the discomfort of receiving feedback has perhaps been the best thing I've done for myself in this entire graduate school process. I so passionately want to become a therapist, but I recognize I have a whole field of suck ahead of me. Wasting any energy fighting the field of suck would be counterproductive. Instead, recognizing the inevitability of discomfort has freed me to really hear feedback, to incorporate it into my own growth process. Feedback doesn't mean I've done something wrong--it means I have taken another step through the field of suck.

"Vulnerability," Brown reminds us, "is at the heart of the feedback process... [and it] never goes away, but experience gives us the knowledge that we can survive the exposure and uncertainty, and that it's worth the risk." This, I think, is a powerful argument for "[cultivating] the courage to be uncomfortable and to teach the people around us to expect discomfort as a part of growth."

I hope you've been inspired to cultivate the courage to be vulnerable and wallow in the field of suck--if you need a little help finding your way to that courage, I highly recommend Daring Greatly.

P.S. Brené Brown was on Oprah's podcast and it was soooooo good, I've posted the episodes below if you're interested!

 

Points of Interest:

Book Review: Be a Wealthy Therapist, by Casey Truffo

Be a Wealthy Therapist blog cover photo.jpg

As I researched graduate programs, I kept encountering the same lament--graduate programs do not prepare you to run your own business. If your sole intention in the mental health field is to go to work at an agency, then you should be fine, but woe be unto those who seek to run a private practice someday.

I am pretty certain I would like to have my own private practice. My work experiences thus far have made it very clear to me that it is much better to be in control of your own career than to be at the mercy of organizational forces. I fervently hope to work as part of a treatment team for my clients, but I want to set my own hours, run my own office, and have the freedom to advocate for my clients to the best of my clinical knowledge rather than be hamstrung by insurance-company executives seeking to improve the bottom line.

Therefore, I found myself much on the same page as Casey Truffo, author of Be a Wealthy Therapist: Finally, You Can Make a Living While Making a Difference. Truffo's goal is to convince therapists interested in private practice that they need not adhere to the therapist-as-ascetic paradigm. Rather, she argues that what therapists offer is a valuable service (on par, she argues, with doctors), and that we need to face whatever is blocking us from owning that reality and honoring our worth as service providers.

What really resonated with me about Truffo's message was that "wealthy" doesn't necessarily mean "a boatload of cash." It means developing the career and lifestyle you want, doing something that is meaningful and of service to humanity.

The first couple sections of her book address myths about running a private practice and the common "blocks" she has encountered in private-practice coaching clients, such as the fear of success and the idea that money and/or marketing is somehow inherently "bad." Then she segues into a couple of perspective-shifting frameworks ("Be Wealthy: The 7 Point Overview" and "The Great Marketing Reframe") before addressing what she terms the "four marketing personalities." What I most appreciated about this part of the book was the idea that no matter your personality type or your idiosyncrasies regarding marketing, there exist multiple ways for you to have the private practice you want. I really liked how empowering her message is--even if you desperately hate typical "marketing," that's no reason to give up on your dreams.

Finally, there are some exercises I really look forward to implementing a few years from now when I'm looking into launching my own private practice: "Your Marketing Plan Checklist" and "17 Things You Can Do to Grow Your Practice." 

I really wish that there was even one class on business strategies in our graduate programs that would prep us for launching into the world of private practice, but until that day comes, at least there are resources like Casey Truffo. While this book isn't going to be the only manual you'll need for setting up a private practice, it just might be an invaluable guide to getting you into the right business and marketing mindset.

 

Points of Interest:

Book Review: Letters to a Young Therapist, by Mary Pipher, Ph.D.

Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

I start my second semester of my marriage and family therapy master's program this month. This is the semester we must find our "fieldwork placement," the community site where will be seeing our very first clients. It is, of course, an intimidating proposition.

I'm not afraid of seeing my first clients--coming to this career later in life has afforded me the advantage of being already familiar, through 35 years of life experience, with much of what we're learning in our classes. However, I am still wandering into uncharted territory, and I have to admit to feeling nervous and slightly unmoored. I have such reverence for the science and craft of therapy, and I want to honor my clients' courage in seeking help by doing my best work.

We've been getting a lot of warnings about how everyone feels trepidation as they begin to see clients and that it's easy to feel overwhelmed by the process, especially in the early sessions. Recently, I stumbled across this blog post which simultaneously relieved and agitated me. On the one hand, it is written so bluntly and honestly that I feel like the author is sharing their honest truth without trying to spare my feelings, so I have a more fuller understanding of what is waiting for me on the other side of the office door. On the other hand...it makes the experience of a beginning therapist seem dire indeed. It certainly increased my anxiety level.

Which is why it was such a relief to read Mary Pipher's warm and generous Letters to a Young TherapistThis is a memoir and manifesto in the form of a series of letters from the author to her favorite graduate student, who she describes as "like most young therapists, a funny mix of scared and overconfident" (p. 44 of the ebook). That she described the exact combination of emotions I was feeling as "a funny mix" instantly soothed me a little.

Pipher shares her experience of being a therapist as well as lessons she has learned over the years. Most encouragingly, she writes of her love of being a therapist--even after so much time and so many clients. When asked if it's depressing to listen to people talk about their problems all day, she responds, "I am not listening to problems. I am listening for solutions" (p. 2). The optimistic reframe inspired me, as did her follow-up assertion that it has been her experience that clients generally want help, are ready for change, and do, in fact, make positive changes in their lives as a result of the therapy process. It's worth it, she seems to be saying.

She does not shy away from how difficult and complicated the work can be. She shares wisdom on deep topics (family dynamics, pain, happiness, and handling failures, to name a few) as well as more practical matters, like protecting one's own safety and attention to self-care. It's a thoughtful, nuanced, and detailed account of how the author's experiences have shaped her, and reveals the myriad ways we new therapists may well be shaped by the work before us.

If you're feeling a little overwhelmed about beginning to see clients--or even if you're feeling a bit of burnout and need a fresh perspective on the practice of therapy--I would definitely recommend reading this book. It may even inspire you to write some letters of your own (or a blog).