For researchers: Why do you choose not do to therapy?

[Iwillheal]

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I had an interesting conversation with a classmate today who told me he chose pure research/academic path not because he loves research but because he hates doing therapy. My plan would be to do research, therapy, and teaching. I like variety. Those of you who are staying clear of doing therapy, what are your reasons? Brainstorm:

-love math/research much more
-are very good at research
-are just really bad at giving therapy
-financial concerns, demand in your area
-are no good at business (if you want to do PP)
-haven't worked through personal issues and are not planning to
-concern re vicarious traumatization (even if you have no mental health issues now)
-think we have no business giving people therapy till we have more empirically supported ones
-concern about causing harm to others
-personality
-tried it and hated it and don't know why but just don't want to do it
-Dr Phil 😛

And whatever else you can think of...

 

[Ollie123]

I'm not sure if this applies to me necessarily - I am certainly HEAVILY research-focused. I wouldn't mind clinical work being a small part of my career within select specialty areas, but would never want to do it full-time. However if it ever becomes the "primary" activity of my career I will likely find something else to go into as I just cannot imagine that being remotely enjoyable for me.

I actually don't mind therapy as much as I did earlier in my program. I've gotten comfortable with it. I like to think I'm pretty good at it, a belief that is further reinforced every time I see what passes for therapy out in the "real world". Honestly, its not that its "terrible" its just that it is a much less exciting process to me than other things. Yes, every client is unique, but you don't have to do this for very long before you realize that they are somehow simultaneously all unique and all pretty much the same.

I like research because I like creativity. I like coming up with ideas and novel ways to test them. I like solving difficult problems that no one else has even tried to solve (or even recognizes as problems). I like the bigger-picture perspective research offers - I can help one person at a time, or I can do research that might help millions (not that its likely...but I can dream🙂 ). The aspects of clinical work I DO enjoy are the creative/higher-level aspects of it. Diagnostics, case conceptualization, and treatment planning are fun. Actually sitting in the room with the client explaining x, y or z, going over homework, etc.....meh. Same goes for assessment. Actually administering tests is fun the first time, but miserable after that. I hate it, I'm bored out of my friggin skull within 5 minutes, and for most tests I feel like my education is being wasted doing something any sufficiently motivated 14 year old could probably do just as well with minimal training. Interpreting the tests, integrating the results, etc. - that I actually enjoy. I obviously don't mind doing some clinical work and hope to always do at least a little of that to keep me grounded and clinically "fresh".

I don't think this is the end-all, be-all of it, but I also think the reinforcement process is different. Research certainly entails massive delays in gratification. One of my mentors routinely talks about a paper he now has in press that has taken over a DECADE to produce. From the time he thought of the idea, wrote the grant (it was a monstrously large one), did the study (recruitment problems, it took ~7.5 years), figured out how to analyze it, and then actually summed up the motivation to write it. That's a long time to wait. However at the end, the product is his. With clinical work, rewards (when they happen) tend to be more immediate. However, attributions are different. I maintain that good therapy outcomes are "usually" 90% the work of the client. While not intending to diminish our role, I generally find it harder to attribute the successes to what "I" did with clients. While I don't directly control the results of a study, I do directly control most other aspects of it and certainly the end product of it - which helps me attribute my effort to the success (even if that success is incredibly delayed). Different people likely weigh the costs and benefits of those things differently, but that's where I fall - it likely plays some role in those decisions.

I think I will cut it off there as I'm rambling at this point, but that's the gist of my feelings towards it. In sum: Don't mind clinical work, but like other stuff more. Many possible reasons why.

 

[cara susanna]

Clinical work is great on paper, but in person it doesn't usually work out that way. Clients don't show, or they don't want to do the interventions that you think would help them the most, or they want to work on something vague like "self esteem" or they don't do the homework, or they vacillate between what they want etc etc.

I've gotten a lot more comfortable with therapy and I've actually gotten to the point where I somewhat enjoy it. However, I still don't think I'd want it to be the sole basis of my career.

 

[Psychadelic2012]

This is kind of what Ollie was saying: Therapy is boring. Bo-RING!! Not intellectually stimulating enough.

 

[Therapist4Chnge]

I realized I was far more interested in differential diagnosis than I was in actual psychotherapy treatment. I can't imagine see 6=8 ppl a day for therapy, I think my head would explode. I still do some supportive therapy as needed, but that is far different than putting together a formal treatment plan and seeing a patient for weeks/months at a time. It isn't about loving or hating therapy....it is about what can be interesting, billable (you need to justify your salary), and sustainable (guard against burnout).

 

[Iwillheal]

Ollie123, thank you, that was a wonderful reply. It's funny, at first I found doing assessments to be most challenging and satisfying activity I had ever engaged in. I felt like Sherlock. But that was when I used to do it sparingly. When I ended up administering whole neuropsych batteries to TBI pts over a few months, I realized I hated doing this for the rest of my life. I felt like a machine, like there was no creativity there whatsoever. I also felt sorry for the patient who had to undergo six or seven hours of testing a day.

I also appreciate the view that though a career in research requires that we accept delayed gratification, the end product is "ours" the way a patient's success is not. Food for thought.

Common point also made by everyone so far in this thread (except Cara) is that therapy is not interesting enough. I, however, find it very interesting and quite challenging. Maybe because I haven't been doing this for very long. I speculate that one of the reasons for not finding therapy interesting is that we seem to have so little control over it. As Cara points out, pts can be vague or don't show up or don't want to do what you tell them to do. Most of us here are intelligent and driven people. We want to get things done. We can have much more control over a research project than a person. At least some aspects of research. Therapy can be quite frustrating from that perspective.

Last year I asked one of my classmates if he enjoyed doing therapy. He had been working with a new patient for about a year and I wanted to see how it was going. He said, and I paraphrase, that "at first when I saw her, she was 'sort of kind of' contemplating change. Now she's moved on to 'sort of' contemplating change. I can't do anything if she doesn't want to change, if she's not ready. A few times I've found myself thinking of my research project when she starts repeating herself. And I just nod robotically."

But I think unless all you do is supportive therapy, psychotherapy can be pretty exciting. That there are commonalities (if there weren't, we couldn't help people) does not mean every patient and every problem is the same. Every person is a puzzle. You have some guidelines, you know something about human body and psyche, but how to solve the puzzle, how to reach the person, how to help them change? That's not boring, I don't think, especially if you have the freedom to use different approaches as you see fit. Of course, I don't like the fact that we don't know more about the process of change and how to bring it about. It's also frustrating to wait for people to get things done. Sometimes there are immediate results, but other times you have to be extremely patient and simply wait. And wait.

 

[bmedclinic]

iwillheal-
Your experience with neuropsych test admin mirrors mine. I did a ton of neuropsych stuff in my masters and steered clear of that for the phd for that exact reason-- and because I knew I would be bored spending the time to write the reports. Love skimming other's reports and love playing detective but I knew ultimately I'd be bored.

Per the question at hand, I think of myself as a researcher first, though I plan to have an 80-20 clinical practice/research job, if possible. I've been told by some that a goal like that ends up being 100/10 but whatever. We'll see. Right now I'm still in my 4th year, but done with coursework and working a 40- hr a week job at a comm clinic and I am bored. This setting could never be my job- I'd rather do the neuro assessment than this long term. But I'm hoping to get into a job where I'm working collaboratively with a team in a medical setting so that I can impart a little psychology into the medical world as we all work with people together.

 

[Doctor Eliza]

I work as a therapist, but my friends are employed in all sorts of different settings.

I think a big issue is not so much that researchers don't want to do therapy, it just becomes logistically very difficult with all of the other career demands. I think many, if not most, grad students go into it hoping to do research, teaching, and clinical work. However, most end up deciding to go one route or the other. I think this is especially true for folks in tenure track positions. Tenure committees are not going to be impressed with you maintaining a clinical practice instead of spending those extra hours on getting publications. My tenure track friends have satisfied their clinical interests by doing things like supervising students and teaching psychotherapy courses. Of course, after tenure you have some added flexibility and I have known one professor to return to clinical work at that time.

Best,
Dr. E

 

[cara susanna]

Thinking about this more now...

Maybe it is that therapy isn't interesting enough, I'd never thought of it that way. I dunno. I'm a pretty cold and analytic person and I would be very happy if I could just implement behavioral or DBT techniques without worrying about the relationship or warm and fuzzy stuff. Like, if I could just set up shop as an exposure therapist and do nothing but exposure I would be a pretty happy camper. However, it just doesn't work that way, unless maybe you advertise yourself as an exposure therapist. Another thing is that I like to feel like an expert and therapy discourages that, in fact if you try to look like an expert with a client you will probably not do very well in the room. And you're not an expert with the client because you don't really know the client, as you've probably heard many times, only the client is the expert on the client. Research lets me develop an actual expertise or at least feel like I'm a smart and competent person, moreso than therapy does. 🙂

 

[EmotRegulation]

As someone in my second year of a tenure-track position, I have little time to do therapy (though I've tried to keep 1-2 cases, that hasn't always worked out due to scheduling). I thought about this question a lot on internship, when I was doing (pretty much) full time clinical work, because the truth is...I love therapy. I love sitting in a room with a client listening to them, and helping them reach their mental health goals, and then thinking about them/planning/conceptualizing between sessions. I love it. But it's just not enough for me. I also love teaching, and like Ollie, I love asking questions and designing studies to answer them. Importantly for my own career path, I also really care about research mentoring, training, and clinical supervision.

I think that in most careers you have to choose the primary--research, teaching, or clinical work. But many career paths have a combination deal, it's just about what's most important to you. For me, the academic track gave me the most breadth, because I would miss everything else were I to just do clinical work, and the academic life lets me keep a little clinical work on the side. Probably a little more (up to 4-5 clients a week) after tenure.

 

[PsychPhDone]

Honestly, its not that its "terrible" its just that it is a much less exciting process to me than other things.

For me, this. 👍 I get the most pleasure out of research. I, too, like the creativity. I like the challenge of running analyses and beating SAS into submission The whole process appeals to me.

Also, like Cara, I don't mind doing therapy but have strong preferences. I don't think I'm bad at therapy, and I don't find it tremendously boring. I could see myself maybe seeing occasional clients who need exposure therapy, because I really love that. There are just only so many hours in a day, and if I'm going to work a lot, I'd like much or most of it to be research.

 

[Pragma]

I had an interesting conversation with a classmate today who told me he chose pure research/academic path not because he loves research but because he hates doing therapy. My plan would be to do research, therapy, and teaching. I like variety. Those of you who are staying clear of doing therapy, what are your reasons? Brainstorm:

-love math/research much more
-are very good at research
-are just really bad at giving therapy
-financial concerns, demand in your area
-are no good at business (if you want to do PP)
-haven't worked through personal issues and are not planning to
-concern re vicarious traumatization (even if you have no mental health issues now)
-think we have no business giving people therapy till we have more empirically supported ones
-concern about causing harm to others
-personality
-tried it and hated it and don't know why but just don't want to do it
-Dr Phil 😛

And whatever else you can think of...

Good thread.

My answer is that I lack empathy.

J/K...but not really. Therapy really burned me out, and there are so many factors going against what is needed to make an effective intervention actually work with a particular client. I respect those that do therapy, but I just find myself much better suited to teach, do assessment, and crunch numbers. It is more fun to me too, although I have to say that clinical training really promoted a lot of personal growth. I don't view the world the same way I used to.

 

[Iwillheal]

...I love therapy. I love sitting in a room with a client listening to them, and helping them reach their mental health goals, and then thinking about them/planning/conceptualizing between sessions. I love it. But it's just not enough for me. I also love teaching, and like Ollie, I love asking questions and designing studies to answer them.

It's wonderful when you can have a lot of passion for both research and therapy. Or teaching. Having more options also allows you t adapt easily to changes in economy. I know some people find teaching boring or uninteresting or just unpleasant. Personally as an introvert, I have avoided part-time teaching type positions because I don't like dealing with groups of people at the same time. I am much better one on one. So I chose to mark papers exclusively. Which is mind-numbing. Close to a hundred stats papers a week. But I do like research and therapy both...so far.

 

[cara susanna]

I also love teaching. I've said here that I think I'd prefer more of a teaching job than a research one, although I'd be happiest with a job that lets me do both.

 

[Iwillheal]

Pragma, you come across as an intelligent and quite compassionate person, so I just want to tell you that your decision to not become a therapist punishes the patients because people like me become therapists. The horror...the horror....I hope I guilted you into it now. 😉

 

[Pragma]

Pragma, you come across as an intelligent and quite compassionate person, so I just want to tell you that your decision to not become a therapist punishes the patients because people like me become therapists. The horror...the horror....I hope I guilted you into it now. 😉

Well that is very nice of you to say, iwillheal, as intelligence and compassion are not always easy to assess via a forum like this. But I think that people who do therapy full time generally represent a really a special type of person. Sure, maybe there are some people doing it that shouldn't be. But at least for me, I always looked up to some of the folks I trained with at various places, because it was clear how strongly their hearts were in their intervention and how their instincts were pretty well honed when tricky clinical situations came up. I bash therapy sometimes because of what I hear from patients, but I know there are folks out there doing great work too.

 

[Iwillheal]

Pragma, you know, I think it just bothered me when you said you lacked empathy, in your post above. I do know that people who have a lot of sympathy sometimes get burned out badly. And it is true, I may be misjudging you because it is indeed difficult to draw certain conclusions based on what people say on some forum. But you do engage in various debates on this forum and you do quite well and yet don't antagonize people (which I do at times) which shows to me the breadth of your knowledge and power of your intelligence but also your ability to empathize. Now is that the same as compassion? I don't know if "compassion" is more about empathy or sympathy. Regardless, maybe I misjudge you or maybe you think you are not the same person in a clinical situation as you are here, but I just wanted to express how you came across to "me."

Back to the subject, I have a feeling some people would not mind giving therapy at all if we were to be paid like psychiatrists or have prescription privileges. Or if we had more freedom in deciding what kind of therapy we can administer to patients. Or more job security. Because a lot of jobs involve routines and can be quite repetitive. Think about surgeons specializing in gallbladder surgery or whatever. But you get a big paycheck and that makes a big difference.

 

[Pragma]

Pragma, you know, I think it just bothered me when you said you lacked empathy, in your post above. I do know that people who have a lot of sympathy sometimes get burned out badly. And it is true, I may be misjudging you because it is indeed difficult to draw certain conclusions based on what people say on some forum. But you do engage in various debates on this forum and you do quite well and yet don't antagonize people (which I do at times) which shows to me the breadth of your knowledge and power of your intelligence but also your ability to empathize. Now is that the same as compassion? I don't know if "compassion" is more about empathy or sympathy. Regardless, maybe I misjudge you or maybe you think you are not the same person in a clinical situation as you are here, but I just wanted to express how you came across to "me."

Back to the subject, I have a feeling some people would not mind giving therapy at all if we were to be paid like psychiatrists or have prescription privileges. Or if we had more freedom in deciding what kind of therapy we can administer to patients. Or more job security. Because a lot of jobs involve routines and can be quite repetitive. Think about surgeons specializing in gallbladder surgery or whatever. But you get a big paycheck and that makes a big difference.

Thanks for the kind words. I say "lack empathy" in a tongue-in-cheek way. I think "lack patience" might be another way of saying it, particularly with people that want to come to therapy but don't want to actually do any work.

It just isn't for everyone. When I did some brief intervention work secondary to my role at the hospital on postdoc, that was different. I liked rehab too because it was time-limited, the purpose was usually clear, and there was a lot of room for interdisciplinary collaboration. But I still didn't like doing it everyday.

But for many of us, we don't know until we try things on a bit. I never saw myself as someone who would like teaching - but it really became a bright spot for me. But a big part of that is because I think I'm in a great, interesting field to teach within. If I had to teach in a science with more absolutes and less critical thinking, that would be less stimulating. Different strokes for different folks, I guess.

I'd also be lying if I didn't say that job stability played a role for me. I also prefer to work for an institution instead of myself. I don't see therapy as the best economic use of my doctoral degree + postdoc years. But even if all things payed the same and had similar time commitments, I would choose to do things like teach and do research over most forms of clinical work.

 

[KillerDiller]

I've enjoyed reading this thread because the reasons people bring up for not wanting to do therapy echo my reasons for not wanting to do research. I love the conceptualization stage of research. I like designing studies that answer questions that are interesting/important. I also love conferences: the exchanging of ideas, the opportunity to travel...the coffee and muffins that are usually provided. I'm going to miss that when I leave grad school. However, I absolutely hate the minutia of data collection and participant recruitment. I find these tedious and frustrating. By the time data collection is done, I've lost most or all of the creativity/passion I originally had for the study.

For me, therapy allows me to be creative and to come up with novel ideas in a more consistent and ongoing manner than research does. I think the same would be true for designing interventions/systems in a more administrative role. I like looking at the big picture, both in terms of each client and clients in general.

So, anyway, I don't think people who choose research have values that are so different from the people who choose clinical work. It's just a matter of finding which one is logistically easier for you to put up with.