This week’s blog goes out to all my fellow therapist pals that have had to really dig deep to muster the strength to work with a specific population of clients. The clients that push you to your utmost limits of tolerance and empathy. The really, really challenging folks that leave you sweating and tense after a session. Maybe even the pop. that you swore to yourself you would never, ever work with…but now find your biggest nightmare sitting across from you for a 50-minute endurance session.
If you are a therapist that does not know what I am referring to – lucky duck!! Just be patient, it will hit you eventually. And if you do understand what I am describing, congrats on earning your stripes. Because I believe that it is those specific clients that push you to be the very best therapist that you can be. You will learn more about yourself, your skills, and your view of the world from these people than any textbook or course study could ever teach you. From this place of real-world experience, you become a really great provider, that deserves a big ol’ pat on the back.
*If you are a client reading this week’s blog, sit back and prepare to hear some juicy deets about what really goes on in the mind of a therapist when working with a tough patient!
PREPARATION IS THE KEY
When I was in graduate school, one course presented an interesting query:
Who could you NOT work with?
As if this was an option?! I remember thinking to myself, “you don’t get to choose who comes to you for help. I will work with all of them!” Oh, young and naïve Molly, you are so sweet! I truly didn’t know that I had any choice in who my clientele would be. And that is true – in the beginning.
When you are first starting out, you are often an intern or a volunteer. You are most definitely considered low man on the totem pole. So, you take what you are given, with a smile on your face, and you do your absolute best to help every person that needs support.
It can be seen as the very best of learning experiences; you will be in contact with a wide range of people and issues, so you get exposure to myriad of therapeutic situations. And, as we know, practice makes perfect. The more people you see, the more topics you broach, the more issues that arise, the greater your skill set will grow. This also gives you the opportunity to shape your skills to target a particular group or subject.
In theory, the practicum and internship portion of your education will allow you to identify which clients you truly want to work with, feel connected to, understand and enjoy. You will create a ‘specialization and this is what will lend toward having a successful practice down the line. If you choose to work with a specific population, you sharpen your skills in that particular area and become a master of your craft. BUT if you are pressured into practicing with a population that presents a personal challenge for you – YOU WILL BE MISERABLE.
NONE of that was explained to me as I sat in class being instructed to name the specific group of clients that I would choose not to work with. I approached the enquiry with a haughty air of superiority as I continued to tell myself that I could work with anyone. Anyone! I mean, what is it called when you weed out a specific population based on personal judgments? Hmmmm…. I secretly whispered to myself that I was surrounded by bigots and close-minded fools that would never be successful or make any real difference in the field. I will admit that I literally lol-ed when a colleague/classmate spoke up and admitted, out-loud, in front of everyone, in earnest, that they would not be able to work with “gay people”. I was genuinely gobsmacked (and how often can you use that word?) and, when everyone turned to look at me as I scoffed, I realized that they were indeed asking an honest question and expecting an authentic response.
Reeling with shock, I turned inward, as I often do when faced with challenge. I was fuming and outraged, a real pillar of justice! The rest of the class was spent listening to others discuss their moral obligations and how their religious beliefs shaped their values. Blah, blah, blah. I was shut-down and passive-aggressive. My own values and beliefs were clouding my ability to listen. Sweet irony!
This assignment proved to be a real struggle for me. I dedicated my time to researching topics on racism, bigotry and discrimination rather than turning the spotlight inward and really examining my inner workings. Alas, I knew that I would have to turn in some type of well thought out final paper, so I feigned introspection and lightly touched on an area in my life that I was previously unwilling to examine. In my meditation I recognized there may have been one area of my life and history that I had been burying. So, with extraordinarily little introspection, I slapped a title on my paper and handed it in with no expectation to ever discuss the topic again. Who was going to follow-up on this? Who would ever know that I snatched an idea from a late night episode of Law & Order: SVU, wrote a last-minute diatribe on the topic and never planned to address it again? I was in the clear. A+ for Molly and freedom to move on to a new subject and separate myself even further from the close-minded jerks I was surrounded by.
But irony caught me again!
MY WORST NIGHTMARE
Fast forward two years; I am now living in a ridiculously small town on the coast of Oregon. I am finishing my master’s level coursework while working a full-time job of drudgery and misery. The time has come to find a location for my practicum – the real-world experience that all students need before being unleashed upon the professional world. My school offered zero support or assistance in this task, and I was left to fend for myself, calling and pestering every single counselor, therapist, and psychiatrist I could track down. The community was so small that I quickly exhausted the yellow pages and called every name listed, each one unanimously directing me to a singular location. Only one mental health provider in the area was qualified to provide supervision. Beggars can’t be choosers…
My first day on the job was filled with anxiety and anticipation. My big shot. Time to flex my muscles and show off all my theoretical skills. I did not fully comprehend what I was walking into. I felt timid but acted casually cool, walking in the front door wearing a V-neck, A-line dress and conservative black leggings. No one had ever talked to me about professional attire in the workplace and my current job found this type of stylish outfit appropriate for daily wear. To this day, walking into a room of twelve convicted sex offenders wearing a bright blue baby doll dress is, and may always be, the most humiliating experience of my life. All these years later, I still cringe when I think of this moment. Talk about a misfire.
My heart fell out of my butt, and I swallowed my own tongue while standing awkwardly in the doorway awaiting invitation to sit amongst the circle. Penetrating stares of the most intimidating group of men I have ever faced seemed to melt my flesh and I felt more exposed than a featherless bird fallen from the nest. My mind raced; I was a fraud, I should not be here, they are going to eat me alive! Danger, danger, danger, the red alarm of my amygdala blinked rapidly. Then I think I blacked out for 90 minutes as the group proceeded around me; discussing graphic sexual abuse, challenging defensiveness and addressing every phrase uttered that could be construed as victim blaming.
It was a master class in keeping your therapeutic calm while facing your ultimate fear.
In that brief time, I was exposed to such horrific storytelling that I shook with anger, fear, sadness and disgust for the following week. No one, I mean NO ONE, had prepared me for what I was to encounter in this job. No well-intentioned question in a single class years ago had allowed me the time and energy I needed to fully explore who, what and why certain populations would prove to be my greatest challenge.
LEARNING TO DIG DEEP
Okay, so this was not going to be my dream job. I look back now and see that I actually entered into a sort of mourning period. I needed to grieve the loss of my innocence. I needed to grieve for the victims of these heinous crimes. I needed to address past trauma that lie unresolved. I needed to confront problematic behaviors in my own current relationship. And I needed to grieve the loss of my fantasy future - That naïve, gung-ho, excited student that thought they could change the world by helping others became scared and hypervigilant. The job changed me.
You can get straight A’s, you can attend numerous trainings, you can literally write the book on a given subject, but until you are sitting alone in a room face-to-face with your most intimidating populace, you cannot begin to understand what this job feels like.
A client that seeks you out because you specialize in a subject that deeply resonates for them is a far cry from what I was to experience for the next few years. My previous notions about what therapy would be like were blasted away like a pressure washer easily erasing chalk drawings on a sidewalk. Yet, somehow, I tolerated this job.
Eventually, I was hired on as an associate and could dedicate my full work week to therapy and collecting hours required to get licensed. Day-in and day-out, 30+ hours a week, I sat with these men and listened to the most revolting stories you can imagine. I tolerated offensive language and hostility. I was overtly and covertly threatened. Most regrettably, I developed unhealthy coping skills to deal with the undercurrent of fear that I didn’t even recognize. I used food and exercise for control. I drank alcohol to dull my thoughts and sleep. I drifted further away from my partner. All said, I let the job become my life and it wrecked me.
CHOOSE YOUR CLIENTELE CAREFULLY
It has been years since I worked within the sex offender population. There are times when an old story will pop up in my memory and I cannot get my mind to release it. At times, I have looked at my own sweet daughter and burst into tears thinking of all the dangers that lurk in the world. Parts work taught me that the damaged little girl inside of me continues to need support, recognition and a sense of safety. I still get disgusted looks when I tell people that I tolerated that work for so long. I faced a lot of judgment from friends and colleagues that thought I somehow defended them and their behaviors because I could come to a place of empathy for some. It profoundly changed me but also allowed me to become a highly intuitive, tolerant and well-rounded therapist.
That population taught me that I must continue to learn and grow as a person and a professional. I go to therapy consistently and I take time to process my own emotions when clients trigger memories for me. I try to balance healthy diet and movement. And I have been sober for 16 months, as of this writing. I am healthier, happier and more successful than I previously thought possible. That population did not defeat me – they taught me.
The thought that I am required to treat anyone that seeks my help continues to be a challenge at times. I am acutely aware that I will not be a good provider for some, but that doesn’t stop me from thinking I should still try, that I should bend over backwards to help someone even when my red flags are flapping in the breeze and my gut says I will fail. I can recognize that my ego is still alive and kickin’.
This comes up for me to this day and just last week I was confronted by a highly challenging and hostile client that I catered to; only to be out time, energy and money by the end of the ordeal. I allowed that part of myself (ego) to chime in and say that I could work with anyone even though I knew it would be a mismatch (that is a story for another time). I spent years working with people that challenged me and pushed me to my limits. But now I am a single provider in a private practice, and I get to decide who I can work with.
Let my experience be an example of what can go terribly wrong when you think you can help everyone and get pushed into working with your own brand of challenging clients. There is no shame in knowing limitations. It is ok to say NO and hold boundaries.
Recognizing the type of client that will bring you inner conflict and result in a loss of balance and burnout is a requirement of the job. If you don’t learn this lesson, the energy (and sleep) you lose will not be worth it. Remember that you are an imperfect person that is hired to do a job, not an unflappable robot that fixes problems for money. You are a person first and a therapist second.
Learn this skill and you will find joy and longevity in your practice.