Mandating Therapy for Clinical Students?

[JeyRo]

I'm personally suprised that there aren't more people on the virulently pro-mandated-therapy side of the aisle posting here. I have a close colleague who is an LCSW (and is top-notch, IMHO - she's one of the good ones) who would be pounding the table right now about the necessity of mandating therapy for psychologists and therapists in training.....

I get the the danger of mandating it, but I'm not entirely convinced the dangers of mandating it outweigh the (admittedly somewhat subjective) benefits of it.....

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[Pragma]

I'm personally suprised that there aren't more people on the virulently pro-mandated-therapy side of the aisle posting here. I have a close colleague who is an LCSW (and is top-notch, IMHO - she's one of the good ones) who would be pounding the table right now about the necessity of mandating therapy for psychologists and therapists in training.....

I get the the danger of mandating it, but I'm not entirely convinced the dangers of mandating it outweigh the (admittedly somewhat subjective) benefits of it.....

I guess there are some of us who would suggest that "admittedly somewhat subjective" benefits without empirical (or even consistently common-sense) backing do not constitute a mandate for receiving psychotherapy. As I am sure that you know, generally therapy works best if there is a purpose to it and if the person seeking it is behind that purpose. "Mandated" treatment is generally less effective.

I say all of this as someone who did seek my own therapy (without any mandate from my department) during graduate training for the purpose of augmenting my training. Personally, I found supervision to be much more useful in terms of promoting growth and perspective taking in the therapeutic process. I don't think that there was any harm to getting outside therapy (for me), but I could absolutely see how this sort of thing could backfire without adequate boundaries set in the first place. Also, while I appreciated my therapist, there weren't really many benefits that I can identify in terms of how they affected my own training as a therapist.

That said, I'd also suggest that most of the "therapy-types" I know probably would engage in this activity voluntarily, at a minimum out of pure curiosity. But I think it is ridiculous to suggest that "have to"

 

[Psychadelic2012]

I think that mandating personal therapy in training severely minimizes the importance of individual supervision. It isn't therapy, but it is the place where you are supposed to address your role in the process.

I strongly agree that supervision is not therapy. In fact, I think that the importance of good supervision could actually create a reason to seek out therapy, since supervision's role is to address the student's/therapist's role in the therapeutic process--there is much more to a life (especially in grad school) than being a therapist. It could make the supervision more efficient and healthy, if the student seeks their own individual therapy, so that outside issues are less likely to corrupt the therapeutic process. All speculation, though.

 

[JeyRo]

I guess there are some of us who would suggest that "admittedly somewhat subjective" benefits without empirical (or even consistently common-sense) backing do not constitute a mandate for receiving psychotherapy. As I am sure that you know, generally therapy works best if there is a purpose to it and if the person seeking it is behind that purpose. "Mandated" treatment is generally less effective.

I say all of this as someone who did seek my own therapy (without any mandate from my department) during graduate training for the purpose of augmenting my training. Personally, I found supervision to be much more useful in terms of promoting growth and perspective taking in the therapeutic process. I don't think that there was any harm to getting outside therapy (for me), but I could absolutely see how this sort of thing could backfire without adequate boundaries set in the first place. Also, while I appreciated my therapist, there weren't really many benefits that I can identify in terms of how they affected my own training as a therapist.

That said, I'd also suggest that most of the "therapy-types" I know probably would engage in this activity voluntarily, at a minimum out of pure curiosity. But I think it is ridiculous to suggest that "have to"

Technically, mandating therapy as a condition of seeking a graduate degree isn't "mandating" in the same way as, say, court-ordered treatment from a judge as a result of some legal issue. In the former case, it's merely a requirement for graduating (which may be onerous to some). In the other case, it's pretty much coercion on it's face. Two different situations from where I'm standing. And I'm philosophically staunchly opposed to coerced treatment in any form (I've read a lot of Thomas Szasz in my time).

I admit that the benefits of a therapy requirement for students is likely subjective in many cases. However, at this point, it seems that the downsides of mandating therapy for graduate students seem pretty hypothetical and somewhat subjective as well. I'd personally like to hear some actual, data-driven (or even just anecdotal) reasons why mandating therapy shouldn't happen. Maybe a horror story or two? Or a reference? Seems like both the pro and the con sides are pretty ephemeral.

To wit - I was required to do 16 hours of personal therapy as a condition of graduation. I personally appreciated the requirement as I've always felt I've had personal issues I've needed to work on, and I ended up clocking in around 60 hours before I graduated. Not only was it good to work on my personal issues, but I found that a couple of the therapists I saw early on served as really good role models for me later in life (sort of, this is how a good therapist treats his clientele!).... while good supervision can certainly help in providing that kind of role modeling, supervisors aren't therapists (and shouldn't try to be - there is a boundary), and so there are limits to that relationship.

 

[Pragma]

I strongly agree that supervision is not therapy. In fact, I think that the importance of good supervision could actually create a reason to seek out therapy, since supervision's role is to address the student's/therapist's role in the therapeutic process--there is much more to a life (especially in grad school) than being a therapist. It could make the supervision more efficient and healthy, if the student seeks their own individual therapy, so that outside issues are less likely to corrupt the therapeutic process. All speculation, though.

I am in agreement with you here. But regarding the bolded part...I see pursuing your own therapy and individual supervision as two entirely different things. What I saw earlier in the thread was people suggesting that personal therapy will give you things that, IMO, you should be getting from supervision.

Outside of actually placing you in the opposite role in the dynamic, I see little that personal therapy does for your training outside of addressing any of your own potential psychological issues. I think it would be wildly inappropriate to go see a personal therapist, while a trainee, to discuss how you are managing specific cases and your own counter-transference issues. That's what you are supposed to be doing with your supervisor.

 

[JeyRo]

i am in agreement with you here. But regarding the bolded part...i see pursuing your own therapy and individual supervision as two entirely different things. What i saw earlier in the thread was people suggesting that personal therapy will give you things that, imo, you should be getting from supervision.

Outside of actually placing you in the opposite role in the dynamic, i see little that personal therapy does for your training outside of addressing any of your own potential psychological issues. I think it would be wildly inappropriate to go see a personal therapist, while a trainee, to discuss how you are managing specific cases and your own counter-transference issues. That's what you are supposed to be doing with your supervisor.

+1

 

[AcronymAllergy]

.... while good supervision can certainly help in providing that kind of role modeling, supervisors aren't therapists (and shouldn't try to be - there is a boundary), and so there are limits to that relationship.

Although this is where direct observation of a supervisor providing therapy can come into play, and might actually allow the observer to see the interactions, styles, and techniques more "objectively" (or at least in a different light) than if one were the actual client/patient involved.

 

[Pragma]

I admit that the benefits of a therapy requirement for students is likely subjective in many cases. However, at this point, it seems that the downsides of mandating therapy for graduate students seem pretty hypothetical and somewhat subjective as well. I'd personally like to hear some actual, data-driven (or even just anecdotal) reasons why mandating therapy shouldn't happen. Maybe a horror story or two? Or a reference? Seems like both the pro and the con sides are pretty ephemeral.

Admittedly, I don't know anyone who was mandated. I do have concerns about mandating therapy and how that personal therapy is used.

Many of my concerns would be addressed if the program had clear guidelines (e.g., what is the purpose, what are the limits and why, what are the do's and don'ts, what is for supervision and what is for therapy, etc). But probably a large concern of mine is someone seeing their therapist do something, and later trying to emulate that without adequately understanding the theory behind the technique.

For example, you see a therapist as a trainee that does a paradoxical suggestion wtih you. You think that is pretty cool, and as a naive trainee, you start trying to do it with your clients, but perhaps in a way you shouldn't be and you don't even understand that it is a therapy technique that has limited applications.

Obviously I am speculating here, but I also could forsee some significant potential boundary problems. Throw more than one psychologist into the training/"personal growth" mix (supervisor vs. therapist) and you could have too many mental health professionals "spoiling the soup." Now if the program does a good job setting boundaries, that's great, but there is no guarantee that they are followed.

Oh the joys of predicting doomsday

 

[Psychadelic2012]

I am in agreement with you here. But regarding the bolded part...I see pursuing your own therapy and individual supervision as two entirely different things. What I saw earlier in the thread was people suggesting that personal therapy will give you things that, IMO, you should be getting from supervision.

Outside of actually placing you in the opposite role in the dynamic, I see little that personal therapy does for your training outside of addressing any of your own potential psychological issues. I think it would be wildly inappropriate to go see a personal therapist, while a trainee, to discuss how you are managing specific cases and your own counter-transference issues. That's what you are supposed to be doing with your supervisor.

I totally agree with you. Maybe I didn't quite word it correctly, but I do agree wholeheartedly--you said it well.

Edit: I see how I was unclear. I meant what I said (about personal issues corrupting the therapeutic process) more about how personal issues could corrupt supervision and turn it into therapy. I had a bad supervisor who tried to be my therapist at certain points, so I'm hypersensitive to that. I think, in some ways, good supervision/training will realize its limits and refer out to therapy when the trainee's issues become personal and not related to client--for example, trainee starts focusing on his/her anxiety in school when it has nothing to do with client(s). If the trainee had therapy to work that out, then supervision time could be used more efficiently.

 

[Pragma]

I totally agree with you. Maybe I didn't quite word it correctly, but I do agree wholeheartedly--you said it well.

Edit: I see how I was unclear. I meant what I said (about personal issues corrupting the therapeutic process) more about how personal issues could corrupt supervision and turn it into therapy. I had a bad supervisor who tried to be my therapist at certain points, so I'm hypersensitive to that. I think, in some ways, good supervision/training will realize its limits and refer out to therapy when the trainee's issues become personal and not related to client--for example, trainee starts focusing on his/her anxiety in school when it has nothing to do with client(s). If the trainee had therapy to work that out, then supervision time could be used more efficiently.

Yeah I think I was responding more to some earlier comments from others than you specifically. It's fun to agree

I mean, I think therapy can be great for a graduate student to say, get some ideas on how to manage stress/adjust to challenges/etc in the absence of psychopathology. But if the therapist becomes something of a mentor, I'd find that inappropriate given they are enrolled in a program already and are seeing clients under someone else's license.

Edit: In your example I can see how you mean the student is viewing supervision as therapy. That's an easier fix to me though than say, seeking out a therapist to get a second opinion, to talk about your counter-transference with your clients, and pick up new "tricks" for therapy while you are early in your training. That's why I think clarity of purpose is important. Is this for a specific issue? Is it to simply have the experience of being on the other side of the relationship? Is it to sample therapists and gets ideas to try?

 

[JeyRo]

Is it to simply have the experience of being on the other side of the relationship?

I think this is a hugely important reason why therapy for students in clinical programs should be strongly recommended, if not required. I can't help but think it makes it far easier to empathize with your patients as to what it's like to be therapy patient if you've been one yourself.

I also don't want to dispense with the idea that there are unique opportunities for role modeling available in the therapeutic relationship. I don't mean patients picking up therapy techniques from their therapists, but just learning how a professional acts with a patient.

In both cases these are forseeable benefits of students getting therapy as part of their training that are probably hard to quantify in terms of objectively verifiable outcomes. And while I agree that having training of psychologists be data-driven and empirically-validated at all levels is a great ideal, I think it's also an ultimately unrealizeable one. If we applied that standard to everything that goes on in training programs, there would be quite a lot of training activities and requirements that people consensually agree are quite helpful that would get dispensed with. Maybe that's what we want?

Students who go to therapists as part of their required (or suggested) personal therapy and then use the time to discuss cases and countertransference have some serious issues with misunderstanding their respective roles.(therapists and students both).

Finally, to end on a provocative note, I do wonder a little bit about some psychologists / therapists-in-training who are particularly, personally, viscerally opposed to the idea of receiving therapy as part of their training (and no, I'm not speaking of any posters in particular, so calm down). You have no issues, literally, no issues that might be useful to talk to with a therapist? Really? "The lady doth protest to much, methinks"? Therapists work with resistant patients too - and it's often quite productive to do so. Maybe here as well.

 

[AcronymAllergy]

I don't know about being viscerally opposed to therapy, as there are relatively few things in life about which I can think of myself as being viscerally and unequivocally opposed, but I can certainly see a student or practicing psychologist feeling as though they don't have any issues for which they feel they need to seek psychotherapeutic intervention. Perhaps part of that relates to each individual's take on the primary goals and purposes of therapy, though, or at least the therapy they would like to offer and/or participate in.

As for empathy, I can definitely see how participating in therapy could aid that process. But at the same time, I'm of the opinion that it's not a necessary component of this process (in much the same way that it isn't necessary to have abused alcohol/drugs, been depressed, experienced trauma, or been affected by phobia in order to establish significant empathy with individuals currently struggling with any of these conditions/experiences).

 

[Zebra F701]

I think we have a lot of cautions from the data about other initiatives that some argued seemed intuitively useful and were designed to be a "one size fits all, everyone will benefit approach", but which actually demonstrated to do nothing at best and to be harmful at worst (see CISD and the DARE program studies for examples).

The problem with this whole idea of a mandate is there there is no empirically supported theory to support it, much less data that points to what should be done in such mandated therapy of graduate students. So it's pseudoscientific on both levels.

It seems to me that the two sides of this are 1) people who are pro mandate because they believe it would be helpful or even necessary with no evidence for that belief and 2) people who are arguing that there is no evidence for a mandate at this time, but would not be opposed to one if data were to demonstrate that it is both helpful to training above and beyond supervision and has no iatrogenic effects.

Can't have data until you mandate it...

 

[Pragma]

You have no issues, literally, no issues that might be useful to talk to with a therapist? Really? .

To respond in a semi-provacative way - not all of us are therapy enthusiasts. Not all of us think it works for everyone, and I certainly empathize with people who don't want their time to be wasted. I think therapy works well when there is the right individual/issue/therapist/intervention fit.

TBH, I'm actually appalled by some of the things I hear about other therapists from patients/clients, and even some of the things I have therapists-in-training do in settings I have been at. I don't think it works well arbitrarily and I think that is a part of why our field is beginning to see diminishing returns financially.

I can't tell you how often I have observed people stay with clients longer than they probably should. I can't tell you how often I have had people come in for feedback from my neuropsych evals and scoff at my recommendation for therapy. Their protests didn't strike me as resistant in most cases - they basically said that they went to therapy for a long time before and felt like it was pointless, like they weren't getting anywhere, and that all the therapists wanted to do was "check-in." They didn't see tangible change. Now is it their fault? Maybe, IDK the details.

Heck, the walls were thin at my postdoc and I often could hear the therapist's conversation with the patient in the room next to me. Sometimes I heard them BS'ing about politics, etc, for the entire session. I am not saying that most therapists operate this way, but I know that some people do enough therapy where things become somewhat automatic, and financial pressures to maintain a high caseload may make termination become a low priority.

SO I hope that I don't come off as a therapy-hating lunatic, because I really am not. But I have become very selective when making referrals, because often the feedback I receive from patient's is that their past therapists weren't very directive or organized about purpose and eventually they felt they were just showing up to check in.

 

[erg923]

You have no issues, literally, no issues that might be useful to talk to with a therapist? Really?

Well of course I do (as Pragma, and all others do). But your comment makes the assumption that if I dont see a professionally trained individual for formal therapy/counseling, that I am somehow not working on said issue(s) at all. Or that others (lay persons) are incapable of fully adressing the issues.

For example, the issues I have gone though this past year have been best addressed by informal conversation with our parish priest. Other "issues" I have problem solved and processed with my wife. I can no reason why I should be required to see a therapist for these things...even if I was still in grad school when they were happening. Could they have been grist for therapy mill? Sure. But why should I be required to address them in that modality?

 

[Pragma]

You have no issues, literally, no issues that might be useful to talk to with a therapist? Really?

I do have one thing to add - I think that this form of thinking is fairly dominant within the clinical arena these days. I've encountered it in more areas than just therapy.

I have heard supervisors in the past suggest that "a little" treatment for PTSD is better than nothing. Really? Because I'd rather leave them be than start exposure only to not finish a full course of treatment. I once saw a group started in an inner city school that may have caused iatragenic effects...but the clinicians felt that their adaptation of an intervention was better than nothing.

I have heard the argument that "some treatment is better than no treatment" from residential treatment facilities seeking to recruit individuals with addiction problems leaving detox, but not having coverage for a full course of treatment.

I have been forced to see neuropsych cases where I felt we could not adequately answer the referral question and the patient was already under financial duress. Try telling a neuropsychologist that their evaluation may not make a big difference for this particular patient and see where it gets you.

Perhaps it reflects the overall economy and how we have to make decisions about referrals/service provision in general, and perhaps it also reflects a little bit of hubris on the part of us as clinicians. But I prefer not to assume that people should arbitrarily get services, even in a psychology training program.

 

[ela]

Obviously I am speculating here, but I also could forsee some significant potential boundary problems. Throw more than one psychologist into the training/"personal growth" mix (supervisor vs. therapist) and you could have too many mental health professionals "spoiling the soup." Now if the program does a good job setting boundaries, that's great, but there is no guarantee that they are followed.

Oh the joys of predicting doomsday

To the bolded; you could end up with a spolied soup...or you could end up with richer broth. Im actually inetersted in studying the ways in which therapists in training who pursue their own therapy (non-mandated) DO end up integrating these experiences with those derived from supervision. Hopefully I'll be able to add some data to the discussion. Some day.

 

[Pragma]

To the bolded; you could end up with a spolied soup...or you could end up with richer broth. Im actually inetersted in studying the ways in which therapists in training who pursue their own therapy (non-mandated) DO end up integrating these experiences with those derived from supervision. Hopefully I'll be able to add some data to the discussion. Some day.

If by "integrating" you mean working on personal issues (and not their counter-transference issues or their practicum clients' issues), then I am all for it. There is no problem with seeking help.

 

[madtofu]

My program doesn't require individual therapy (though it has a very nice arrangement with unaffiliated providers for us if we so choose - all free, no insurance documentation, no worries), but our group therapy class "lab" is an actual process group that we are required to attend for 10 weeks. It has not gone well and actually flies in the face of most of what we've been taught about how group therapy works ideally. Perhaps they wanted us to see how not to do it... I dislike it intensely and resent being forced.

 

[Iwillheal]

Are people here opposed to getting therapy, are opposed to it when school mandates it and so you end up with limited choices and potentially incompetent student therapists, or are opposed to getting therapy in general because they don't like it or feel don't need it, etc? I've known people who did not feel therapy was effective and never received therapy and so chose to work in academia after they graduated.

 

[Pragma]

Are people here opposed to getting therapy, are opposed to it when school mandates it and so you end up with limited choices and potentially incompetent student therapists, or are opposed to getting therapy in general because they don't like it or feel don't need it, etc? I've known people who did not feel therapy was effective and never received therapy and so chose to work in academia after they graduated.

Neither necessarily. I am opposed to a mandate on the general principle that I don't think therapy is arbitrarily effective for everyone/every issue. I don't think that believing it is will be helpful to the field in the long run, either.

I also don't view it as a necessary component to training, and I say that as someone who did voluntarily seek therapy during training.

 

[erg923]

Are people here opposed to getting therapy, are opposed to it when school mandates it and so you end up with limited choices and potentially incompetent student therapists, or are opposed to getting therapy in general because they don't like it or feel don't need it, etc? I've known people who did not feel therapy was effective and never received therapy and so chose to work in academia after they graduated.

I think my post was pretty clear that we NOT should be forcing anyone to address personal/emotional problems through a modality that they may not need and might not even be as effective or helpful for them as others would be. Read my post above for my personal example.

 

[AcronymAllergy]

Neither necessarily. I am opposed to a mandate on the general principle that I don't think therapy is arbitrarily effective for everyone/every issue. I don't think that believing it is will be helpful to the field in the long run, either.

I also don't view it as a necessary component to training, and I say that as someone who did voluntarily seek therapy during training.

This and erg's posts pretty much sum up my views on the issue as well, although if at some point in the future data were to come out that suggested participation in certain types of therapy led to significant improvements in clinical training, I could very well be open to changing my mind. I just don't think that will come to pass, as (like Pragma), I personally don't view therapy "as a necessary component of training." Helpful for many individuals and for a variety of reasons? Certainly, but not to the extent that it should be universally mandated for all trainees.

 

[Pragma]

Yeah good points by AA and erg. I'd also add that while I could be persuaded by replicated data, I'd need to understand the clear rationale for having someone undergo therapy and the parameters of the mandate.

As it is, graduate school already offers a number of different supportive relationships. If your program and clinical supervisor are any good, you'll also pretty extensively cover self-care and how you can be proactive about coping in a way that works for you as an individual.

 

[ClinPsychEnthus]

The masters program that I attended had a process "lab" component that was part skills building and part small group therapy process, that we were required to do for both years of the core didactic training. Contrary to your experience, it taught me a tremendous amount about the impact of group therapy, even though a ton of problems came up that had to be addressed amongst the group. I grew a lot as a person and as a clinician during that time, and I'm grateful that I experienced it.

 

[ClinPsychEnthus]

Per erg:

I think my post was pretty clear that we NOT should be forcing anyone to address personal/emotional problems through a modality that they may not need and might not even be as effective or helpful for them as others would be. Read my post above for my personal example.


Just wanted to say, +1. The possibility of forcing an ineffective "treatment" is... well, awful... especially within the context of building your career. that has way too many conflicts of interest/power, etc.

 

[AcronymAllergy]

Regarding the idea of growth (both personal and professional): I can say that I and essentially everyone else in my program experienced significant such growth just by virtue of our progression through graduate school (and clinical training) in general. I wonder if perhaps some of the reported/experienced therapy benefits would have occurred "naturally," but because of the chronological overlap, are being attributed to therapy?

No clue myself as to the answer, just thinking out loud.

 

[Ollie123]

I wonder if perhaps some of the reported/experienced therapy benefits would have occurred "naturally," but because of the chronological overlap, are being attributed to therapy?

Hence why I'm arguing for research before we jump the gun on this one We don't know at this point! I'm not by any stretch of the imagination anti-therapy. However, I will say I am proudly anti "Therapy is wonderful and magical and ideally everyone should always be in therapy at all times for everything". I'd hope any serious psychologist would be. Of course, the situation we're describing falls somewhere between those two, which is why I'm not for or against - I just want someone to back up their claims.

Reality: I'm busy. If I'm going to commit an hour to week to something (especially if I'm going to pay money for it), I expect to get something out of it. I expect competent professionals to be able to offer something more than "Trust me" - that's really all I'm asking for. Once I see a reason for it (note: Reason to me means evidence, not a well-intentioned rationalization), I'm 100% on board. It has nothing to do with liking or disliking therapy - I obviously believe very strongly that therapy can help people, hence why I chose this field. However, that's very different from thinking everyone benefits from it. I think we all too often oversell the benefits of therapy, and its our job to be honest about how we can (and cannot) help people. The reason I believe in EBP is because I believe we owe it to our clients to back that up with more than just good intentions, otherwise we may end up doing more harm than good (i.e. CISD, which others have brought up - not that I think that is likely directly applicable to the issue of students in therapy).

 

[ClinPsychEnthus]

Regarding the idea of growth (both personal and professional): I can say that I and essentially everyone else in my program experienced significant such growth just by virtue of our progression through graduate school (and clinical training) in general. I wonder if perhaps some of the reported/experienced therapy benefits would have occurred "naturally," but because of the chronological overlap, are being attributed to therapy?

No clue myself as to the answer, just thinking out loud.

Also note that the "therapy" had a large skills building component, unlike actual therapy. I actually attribute much of the growth to that, as well as being able to hear feedback from people we were practicing on...