Why Do People Become Therapists?

Some people wonder why we become therapists.  This study discovered that people become therapists and stay in the field - despite the challenges in a lot of different ways - because they want to help people improve, simple as that.  It is a great reward to see people feel better.

https://www.psychotherapynetworker.org/blog/details/667/why-would-anybody-become-a-therapist

Why Would Anybody Become a Therapist?

Reflecting on the Soul of Our Professional Identity

Barry L. Duncan

 
 
 

It’s no secret to anybody in our field that this is a tough time to be a therapist. In public agencies, we’re underpaid, overworked, and held to unattainable “productivity standards” (24 to 28 client hours a week; 30 to 34 scheduled appointment hours to make up for cancellations and no-shows). We’re subjected to a continual onslaught of paperwork to secure payments, and frequently face cutbacks and layoff threats. While some of us still thrive in private practice, most of us make far less than we did during the “golden age” of fee-for-service insurance reimbursement. Furthermore, the nature of clinical work often is frustrating, even anxiety-provoking, exposing us to high levels of human suffering.

Adding insult to injury, the culture at large doesn’t seem to admire therapists particularly, or understand what we do. This point is clear if you take a moment to think about the portrayals of therapists by Dr. Marvin Monroe of The Simpsons or Jack Nicholson in Anger Management or Barbra Streisand in Meet the Fockers. Sure, good examples of competent clinicians exist, but they’re far outweighed by those that cast us as self-indulgent crackpots endlessly mouthing psychobabble. So, why would anybody choose to enter such a field?

To be sure, most of us didn’t choose this work because we thought we’d acquire the lifestyles of the rich and famous. A massive, 20-year, multinational study of 11,000 therapists conducted by researchers David Orlinsky of the University of Chicago and Michael Helge Rønnestad of the University of Oslo not only has the answers, but captures the heart of our aspirations and perhaps the soul of our professional identity.

For their book published in 2005, How Psychotherapists Develop, they collected and analyzed detailed reports from nearly 5,000 psychotherapists about the way they experienced their work and professional development. Since then, 6,000 more therapists have participated in the study. Therapists stay in the profession, they found, not because of material rewards or the prospect of professional advancement, but because—above all—they value connecting deeply with clients and helping them to improve. On top of that, the clinicians interviewed consistently reported a strong desire to continue learning about their profession, regardless of how long they’d been practicing. Professional growth was cited as a strong incentive and a major buffer for burnout across the board.

Orlinksy and Rønnestad termed both what therapists seek in their professional careers and the satisfaction they receive from the work they do healing involvement. This concept describes therapists’ reported experiences of being personally engaged, communicating a high level of empathy, and feeling effective and able to deal constructively with difficulties. Healing involvement represents us at our best—those times when we’re attuned to our clients and the path required for positive change becomes clearly visible; those times when we can almost feel the “texture” of our therapeutic connection and know that something powerful is happening. But what causes this, and more important, how can we make it happen more often?

We all know that healing involvement isn’t simply an inevitable outcome of sitting in an office with troubled and unhappy people for many years. According to Orlinsky and Rønnestad, it emerges from therapists’ cumulative career development, as they improve their clinical skills, increase their mastery, gradually surpass limitations, and gain a positive sense of their clinical development through the course of their careers.

But an even more powerful factor promoting healing involvement is what the authors call therapists’ sense of currently experienced growth—the feeling that we’re learning from our day-to-day clinical work, deepening and enhancing our understanding in every session. Orlinsky and Rønnestad suggest that this enlivening experience of current growth is fundamental to maintaining our positive work morale and clinical passion.

According to their study, the path to currently experienced growth is clear. It’s intimately connected to therapists’ experiences with clients and what they learn from them, and is unrelated to workshops and books trumpeting the latest and greatest advances in our field. Almost 97 percent of the therapists studied reported that learning from clients was a significant influence on their sense of development, with 84 percent rating the influence as “high.” It appears therapists genuinely believe that clients are the best teachers. But the finding that most impressed Orlinsky and Rønnestad was therapists’ inextinguishable passion to get better at what they do. Some 86 percent of the therapists in the study reported they were “highly motivated” to pursue professional development. It appears that no matter how long they’ve been in the business, therapists still want to learn more and get better.

To the question, “Why is our growth so important to us?” Orlinksky and Rønnestad posited a close link between healing involvement and currently experienced growth. The ongoing sense that we’re learning and developing in every session gives a sense of engagement, optimism, and openness to the daily grind of seeing clients. It fosters continual professional reflection, which, in turn, motivates us to seek out training, supervision, personal therapy, or whatever it takes to be able to feel that the developmental process is continuing. Borrowing a term from the late Johns Hopkins psychiatrist and common-factors theorist Jerome Frank, having a sense of currently experienced growth “remoralizes” therapists, repairing the abrasions and stressors of the work and minimizing the danger of falling into a routine and becoming disillusioned. “[It] is the balm that keeps our psychological skin permeable,” said Orlinsky. “Many believe that constantly hearing problems makes one emotionally callused and causes one to develop a ‘thick skin.’ But not therapists. We need ‘thin skin’—open, sensitive, and responsive—to connect with clients.” Currently experienced growth, then, is our greatest ally for sending the grim reaper of burnout packing—we need to feel we’re growing to fend off disenchantment.

The Importance of Measuring Outcomes

Achieving a sense of healing involvement requires a continual evaluation of where we are compared to where we’ve been. We must keep examining our clinical experiences, looking for evidence of our therapeutic mastery and mining our sessions for the golden moments that replenish us. But if our sense of healing involvement with clients is tied to our ongoing sense of making a difference, how do we know we’re truly helping? You know when a roof is tarred or a tank drained, but how do you know when psychotherapy is beneficial? Therapeutic outcomes are hard to define and harder to measure.

The research literature offers strong evidence that therapists aren’t good judges of their own performance. Consider a study by Vanderbilt University researcher Leonard Bickman and associates reported in 2005 in the Journal of Clinical Psychology: In Session in which clinicians of all types were asked to rate their job performance from A+ to F. About 66 percent ranked themselves A or better. Not one therapist rated him- or herself as being below average! If you remember how the Bell Curve works, you know that this isn’t logically possible.

It’s not that we’re naïve; it’s simply hard, if not impossible, to accurately assess your effectiveness on a client-by-client basis. For this, you need some quantitative standard as a reference point—you need to measure outcomes. I can hear you groan, but I’m not talking about outcome measurement for the sake of bureaucratic “accountability” to funding sources or for justifying your existence by demonstrating your “proof of value” or “return on investment.” Rather, measuring outcomes allows you to cut through the ambiguity of therapy, using objective evidence from your practice to help you discern your clinical development without falling prey to that perennial bugaboo of the therapeutic endeavor: wishful thinking. Taking the time to measure outcomes relates directly to both having an awareness of our mastery over time and experiencing a sense of current growth.

How does outcome measurement further cumulative career development and currently experienced growth—the two keys to greater healing involvement with clients? First, cumulative career development is another way of saying that we’re “getting better all the time.” The routine collection of outcome data allows you to determine your effectiveness over time, and gives you a base for trying out and accurately evaluating new strategies. Begin simply by entering your outcome scores into a database, and keeping track of them on an ongoing basis: intake and final session scores, average change score (the difference between average intake and final session scores), and, ultimately, the percent of your clients who benefit. If you can review and assess your clinical work through the years, you can actually learn from your experience, rather than simply repeating it and hoping for the best.

Of course, finding out how effective you really are can be risky business. What if you find out that you’re not so good? What if you discover that you’re—say it isn’t so!—just average? Measuring outcomes takes courage, but so did walking into a consulting room for the first time to counsel someone in distress—and so does doing it day in and day out.

The Orlinsky and Rønnestad study contains important information about who we are and what we have to do to remain a vital force in our clients’ lives. It shows that our professional growth is a necessary part of our identity, as is our need to harvest the experiences that replenish us. It’s not enough to be soft-hearted and empathetic. Therapists need to have a keen sense of reality-testing to keep their heads above water in this field and make sure their work continues to be fulfilling.

***

This blog is excerpted from "What Therapists Want" by Barry Duncan. The full version is available in the May/June 2011 issue, Achieving Excellence: Do We Need a New Model?

Photo © Rob Colvin/Images.com/Corbis

A Splintered Mind

I came across this song the other day, and listening to the lyrics, it reminds me a lot of patients I work with. Many times music can capture an experience or emotion.  Perhaps it might resonate with you.

 

College Students' Mental Health Journeys

COVID is affecting people of all ages, including college students. My alma mater at OSU reports on how students are getting the help they need with anxiety, depression, and other struggles that have been exacerbated by the pandemic as well. Other students should not be afraid to follow suit and take advantage of their university counseling centers.  

https://news.okstate.edu/articles/communications/2020/ripping_the_bandaid_off_depression_how_students_found_hope_on_their_mental_health_journeys.html

 

‘Ripping the Band-Aid off depression': How students found hope on their mental health journeys

Monday, November 2, 2020

Physical illness isn’t the only concern in the COVID-19 pandemic. 

The Centers for Disease Control and Prevention released a report in August that revealed about one quarter of 18-to 24-year-olds had “seriously considered” suicide in the past 30 days. 

Oklahoma State University senior Emma C* (last name abbreviated for anonymity) knows firsthand the pain, heartache and loneliness that a mental health struggle can include. Diagnosed with chronic depression and anxiety when she was 13, she went through middle and high school battling mental health challenges. 

“Anxiety and depression are really cruel beasts in tandem,” Emma said. “In high school, I had trouble maintaining relationships, and my family wasn’t super supportive of my struggles, so that made it difficult, too.” 

She started working full-time at 16 and dedicated herself to excelling in school. She used work and a deep desire to achieve to get through. It worked for a while, but she wasn’t taking care of her inner self and eventually fell apart, she said.  

“My senior year I went off the rails,” Emma said. “I was having such bad anxiety that I couldn’t even lift my pencil to take exams. I was turning in tests with my name written on the top and ‘I’m sorry’ written on the bottom. Struggling really affected my self-worth.” 

After coming to Oklahoma State University, Emma decided to make her mental health a priority. She had attended therapy sessions off and on for years, but she decided to start attending regularly. Whether to her support system or to her therapist, Emma said the first step of reaching out is the hardest part. 

“It’s like ripping the Band-Aid off depression,” she said. “It was the hardest to accept that there is nothing wrong asking for help and nothing wrong with asking repeatedly. I’m lucky to have a lovely support system with good friends, and even with them it’s hard to be vulnerable and say, ‘I’m struggling with depression right now.’” 

Kailey J*, a psychology freshman, agrees that reaching out for help and being open about mental health struggles is difficult. Although her mental health has been a struggle for years, it deteriorated once she came to college with the COVID-19 pandemic disrupting normal life. 

She feared people would treat her differently once they discovered her anxiety and depression or rush her to get over it, but through the persistence of caring friends, she slowly began to open up about her struggles. She continues to seek treatment and take an active role in managing her mental health. 

“I found hope confiding in my friends,” Kailey said. “Because even though people look like they have it all together or wouldn’t understand, they are probably going through a struggle, too. We were able to relate to each other on some level.”

Student Counseling Center coordinator Joseph Dunnigan emphasized the importance of telling a trustworthy friend or family member about your inner struggles. He said confiding in someone can help break the isolating thought patterns that sometimes come with mental health struggles.

“Talking with someone you trust provides a way to externalize these issues,” Dunnigan said. “It normalizes our experiences and reminds us that they aren’t something to be ashamed of. Mental health issues may be isolating, so when you understand that you aren’t alone in that struggle, it can be reassuring. [Sharing] activates empathy and connection.” 

Asking for Help

Although Emma and Kailey’s stories are their own, they reflect trends in college campuses nationwide. 

According to the CDC, almost three quarters of college-age adults reported struggling with at least one mental health symptom as a result of the COVID-19 pandemic. 

Reaching out to friends and creating a support system are vital steps to combating mental health challenges. Meeting with someone who is trained to listen and provide coping skills is another. 

For more resources, visit:

Student Counseling Center

Mental Health Resources

At OSU, University Counseling Services has 12 full-time counselors available to students. Because mental health is such a priority, the university offers an intake and four free sessions annually to students.  

Further sessions are $10, and that cost can be charged to a student’s bursar account. To maintain confidentiality, the charge is labeled as a health services fee for students whose family members have access to view their bursar account details. For students with financial concerns, the fee can be waived. 

“Cost should never be a barrier for students accessing mental health resources,” Dunnigan said. 

Therapy and treatments are customizable to students’ unique stories and struggles, Dunnigan said. But like all mental health services, counseling only works when it’s used. 

“In talking with a therapist, you can see different options,” Dunnigan said. “Talking about some of those concerns you may have or symptoms that make up [certain illnesses] can help you understand and learn that there are treatments.” 

For Kailey, therapy has been one of the most useful tools in her battle with mental health. 

“My therapist has given me tips and tricks to handle anxiety attacks and my mental health in general,” Kailey said. “She gives me hope and a way to express my feelings.”

Staying Afloat

Each individual has a unique mental health journey, Dunnigan said. Sometimes there’s not a quick fix, and there will be a mix of good and bad mental health days. 

“Sometimes it takes years for issues to develop,” Dunnigan said. “That means it can take time to work through them and get to this new normal of how we deal with mental health in a more positive and proactive way. In our culture, we expect to be able to pick things up or master them quickly, which isn’t realistic. Like anything, good mental health takes practice and time.”

For Emma, that realization changed how she views her own mental health.

“I always like the imagery of depression being like the tide,” Emma said. “Sometimes the tide comes in and stays longer than other days. When the tide is down, you walk on the beach and everything’s normal. Other days you are treading water, afraid you’ll drown. That’s OK. Because the most important thing about the tide is it goes out. It doesn’t stay up forever.”

On those “high-tide” days, Emma said finding little ways to care for her mental health keeps her afloat. 

“Those little things hold value and weight,” Emma said. “If you are in the depths of it right now, it’s OK if these little things are all you can do. I would always recommend drinking water and taking a 20-minute walk. Give yourself grace.”

Whether mental health struggles have been a lifelong battle or have emerged with the strain of COVID-19 or other pressures, OSU students don’t have to struggle alone, Dunnigan said. 

 

 

STORY BY: Kylee Sutherland | Communications Intern

MEDIA CONTACT: Mack Burke | Editorial Coordinator | 405.744.5540 | mack.burke_iv@okstate.edu 

Can Art Therapy Help during Pandemic Isolation?

A lot of people are trying to find ways to cope with self-isolation and social distancing during this time of managing the coronavirus pandemic. Some people are accessing art therapists in remote sessions or doing guided artwork at home. Here is an article that focuses on how making art helps people cope. 

Can Art Therapy Combat Depression During Self-Isolation And Social Distancing?

Eva Amsen 

Contributor

Many countries have currently imposed either a formal lockdown, or otherwise recommended that people stay indoors in their own homes as much as possible. This form of social distancing will help slow the spread of the coronavirus SARS-CoV-2, but it’s not always easy. However, previous research on isolated groups suggests that art therapy might offer some support.

Art therapy has been successful in combating depression among isolated populations such as prisoners ... [+]

Getty

People in isolation are at increased risk of developing mental health problems, such as depression or increased anxiety. Researchers know this from studies that have previously been done among people who were quarantined during previous disease outbreaks. 

In the 2003 SARS outbreak, for example, only those directly at risk were quarantined, and only patients were isolated. But now, during the coronavirus outbreak, many of us are stuck at home. For people who live alone, this situation is also likely to put them at risk of depression or anxiety.

Even though being isolated in this way is new for many of us, there have always been groups of the population who lived with limited social contacts. Think of prisoners, for example, or patients recovering from medical procedures that require a period in isolation. These groups have been well-studied, and researchers know quite a lot about how people fare when they’re spending a large amount of time on their own. One thing that seems to help is art therapy. 

Art therapy is a form of psychotherapy that uses the creative arts as a therapy medium. Instead of talking for an hour, you might be painting or sculpting or otherwise expressing your thoughts through a creative medium. 

As a form of guided therapy, art therapy is well-studied. Research showed that it decreased depression among inmates, and made them feel more in control of their own lives.  It relieved anxiety and depression among refugee children, cancer patients undergoing chemotherapy, tuberculosis patients in isolation, people undergoing stem cell transplants or bone marrow transplants, and several other situations where a change in circumstance and increased isolation affected people’s mental health. 

In some of these situations, people received group art therapy. Of course that’s not possible during the COVID-19 outbreak, but some art therapists are finding ways to connect with people online. The American Art Therapy Association collected resources for art therapists to help them continue to do their work during the outbreak. 

Not everyone has access to a remote therapist to guide their art therapy, so some are turning to online guides. This is different from the guided forms of art therapy that have been proven to work well with people in isolation, so it may not work as well — but with no other option for therapy, making art at home is at least a step in the right direction!

The UK’s Channel 4 is even working on a program with Turner Prize-winning artist Grayson Perry to inspire families in isolation to make art at home.  But many people have taken to simply creating art on their own to work through their thoughts while in self-isolation, and some have shared their art on social media. 

Art therapy isn’t a panacea - its effects on dementia are still debatable for example — but its use to combat depression in social isolation is well-documented, and it may just help some people currently struggling with being in lockdown.