Personal qualities of good therapists; motivation

[sockit]

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I've kind of posted around this before in the MA forum, but thought I'd post here, as I'm doing better in my 2nd BA than I'd expected. A PhD might be within reach, in my country at least. (Current GPA in psych: equivalent to 3.9 and trending up. Some programs here just use the GPA from the last 2 academic years [+ GRE + research, of course]).

I'm a bit like this:

- naturally a good and interested listener/prober. I probably project this and seem (well, am) non-threatening: it's common for people (acquaintances, strangers) to surprise themselves by divulging stuff to me that they've 'never told anyone before'
BUT
- though I'm always interested in folks, with age, I find myself increasingly drained by exchanges with significant negative content. I am more and more drawn to people in a 'positive' or proactive moment in their lives, or who are motivated to get to one.

- can be patient, encouraging; tend to take on mentoring roles, personally and professionally (have found this to be true in any job involving training or tutoring)
BUT
- I increasingly want to see outcomes (i.e., have my effort rewarded with results). I am not sure how well I'd do working exclusively with an unmotivated population, or one in which the nature of people's problems require long-term involvement with uncertain results (e.g. addiction, autism).

- can be warm, in my personal life, but selectively - certain personalities/behaviours make me shrink from them (in lay language: stubborn, overbearing, judgmental, combative/aggressive, or 'hysterical'/'dramatic' behaviour. Can deal with people who show these traits sometimes, or in milder forms. Don't mind teens like this, so much, because, well, they're teens, they sort of have to be/do those things).

- dislike (but don't fear) conflict, or having to expend significant energy persuading an unwilling interlocutor.

I think I could be useful to a motivated population dealing with less severe problems, most especially with your garden-variety mood disorders (anxiety, depression). Also, maybe, to teens/kids with emotional problems. Thinking counselling or educational, vs clinical psych. Possibly, cognitive neuroscience: am interested in testing, cog/neuro questions, and the in/deductive nature of the applied work (re diagnosis); unsure about working with the likeliest population (older people/stroke survivors) in a rehab capacity.

I would really appreciate any thoughts on how well I might fit within some of the fields I mentioned. Thank you in advance.

 

[sockit]

Ok, let me put some of my inarticulated questions another way.

- How important is personal warmth in establishing a rapport, with every client? How does that quality, of warmth, or what in I guess social work programs is called 'use of self' (I imagine this means: use of one's physicality, bearing, mien, nonverbal communication, empathetic attention) bear on outcomes?

- How much can you rely on professional skills to help you assist a client you might not personally like? What about populations that aren't really your bag?

- Outcomes are often long-term or uncertain; you probably don't see them, often. How does this affect your belief in the value of clinical work? How do clinicians retain a sense of professional efficacy, given this?

- I know every setting is different, but typically, how often does conflict come up? Every day, every other hour? How tough is it, really, to manage this, given professional skills, supervision, personal coping methods?

- Can burnout be avoided?

 

[MBellows]

Ok, let me put some of my inarticulated questions another way.

- How important is personal warmth in establishing a rapport, with every client? How does that quality, of warmth, or what in I guess social work programs is called 'use of self' (I imagine this means: use of one's physicality, bearing, mien, nonverbal communication, empathetic attention) bear on outcomes?

- How much can you rely on professional skills to help you assist a client you might not personally like? What about populations that aren't really your bag?

- Outcomes are often long-term or uncertain; you probably don't see them, often. How does this affect your belief in the value of clinical work? How do clinicians retain a sense of professional efficacy, given this?

- I know every setting is different, but typically, how often does conflict come up? Every day, every other hour? How tough is it, really, to manage this, given professional skills, supervision, personal coping methods?

- Can burnout be avoided?

There's a deal of research on this. I suggest searching "Therapist Variables" into your article database. I'm sure others can offer further suggestions.

The ACA released a brief from a task force on burnout.

 

[sockit]

Ah, that's great, MBellows - thank you for the keywords (and link)!

 

[HomeworkHelper]

Let me take your questions one at a time. Some of this is purely anecdotal, so other's responses will likely help bring perspective as well.

- How important is personal warmth in establishing a rapport, with every client? How does that quality, of warmth, or what in I guess social work programs is called 'use of self' (I imagine this means: use of one's physicality, bearing, mien, nonverbal communication, empathetic attention) bear on outcomes?

I'm not fully up to date on the research end of this, but anecdotally, I started my therapist training lower on the warmth side. I consistently was able to convey that I was motivated to help my clients, but did not regularly verbalize empathy or validation. My clients still responded and didn't drop out any more so than other therapists in training. I worked on this persistently, and now get consistent feedback that I establish rapport really well and verbalize empathy and validation regularly and well. So, if you're motivated, it is possible to improve warmth as you obtain more experience and training. It is likely beneficial, but probably also not sufficient, to helping clients improve.

- How much can you rely on professional skills to help you assist a client you might not personally like? What about populations that aren't really your bag?

I think pretty well, depending on who you are. I, for one, try to find something I can connect with in each client, even if it's just an understanding that they are struggling and that it must be hard being them. I just recently met with a client that is full of Axis II cluster B traits, but I imagine we will still work well together. On the other hand, I knew a trainee who could not seem to hide her frustration with clients in session. If she didn't like them, it was much more apparent. I would ask yourself how well you can get along with folks in the periphery of your life that you may not like (say, a friend of a friend or a coworker you don't particularly like). That might help you understand your own abilities in that realm.

- Outcomes are often long-term or uncertain; you probably don't see them, often. How does this affect your belief in the value of clinical work? How do clinicians retain a sense of professional efficacy, given this?

I think that depending on what client population you choose to work with, outcomes can be regularly good or regularly mixed, which is much easier to handle them consistently poor outcomes. I work with mood and anxiety disorders. Certain anxiety disorders are quite successfully treated with psychotherapy, so I tend to find outcomes are pretty positive. You might have a harder time if you choose to work with more chronic or severe populations.

- I know every setting is different, but typically, how often does conflict come up? Every day, every other hour? How tough is it, really, to manage this, given professional skills, supervision, personal coping methods?

This depends on your work environment and your interpersonal style. Are you the kind of person to find themselves in conflict with others regularly? In therapy, I haven't personally experienced conflict all that often at all...I almost never experience it. A lack of motivation for treatment is more common, but I don't consider that conflict-related. Giving a client feedback from an evaluation may feel more like conflict if a person is really invested in a particular diagnosis and they don't agree with what they're telling you. When conflict does happen, it can be unsettling, but talking with other colleagues can really help.

- Can burnout be avoided?

Perhaps by choosing which populations you would like to specialize in, you could. You'll likely have a higher chance of burnout if you are working primarily with borderline folks, for instance. Also, making sure you form good relationships with supervisors and colleagues and taking time to engage in good self-care can be helpful as well.

 

[MBellows]

Ah, that's great, MBellows - thank you for the keywords (and link)!

Apparently when counseling.org updated their layout they made some things harder to find. I don't know how easy it is to find that brief now. The long short of it is...

Get supervision, often. Too much self-reliance can be a bad thing both emotionally and ethically.

Maybe look into personal therapy.

Practice mindfulness.

Have a life outside of therapy! Do things that you enjoy in your off time, and do them often. Though for my fellow mindfulness practitioners this suggestion falls in with the concept of value activities.

Stay educated.

Here are some more resources...

http://pegasus.cc.ucf.edu/~drbryce/Preventing Counselor Impairment.pdf

Faculty Experiences Working with Impaired Counseling Students: A Grounded Theory By Jennifer E. Capps

Empathy Fatigue: Healing the Mind, Body, and Spirit of Professional Counselors By Mark A. Stebnicki

Beyond Burnout: Helping Teachers, Nurses, Therapists, and Lawyers Recover from Stress and Disillusionment By Cary Cherniss

 

[PHD12]

Get supervision, often. Too much self-reliance can be a bad thing both emotionally and ethically.

Maybe look into personal therapy.

Practice mindfulness.

Have a life outside of therapy! Do things that you enjoy in your off time, and do them often. Though for my fellow mindfulness practitioners this suggestion falls in with the concept of value activities.

Stay educated.

/QUOTE]

All great suggestions. I find it incredibly helpful to have friends outside of psychology so that I don't talk about my job/patients 24/7 and am clued into the outside world.

 

[MBellows]

All great suggestions. I find it incredibly helpful to have friends outside of psychology so that I don't talk about my job/patients 24/7 and am clued into the outside world.

Introverts can have problem with this at times. Often our friends come from the people who we have to be around enough to form bonds with and who are used to knowing how to interact with us. A good way to bypass that is by finding a hobby that you like and making yourself join a group that focuses on that hobby.

 

[paramour]

Introverts can have problem with this at times. Often our friends come from the people who we have to be around enough to form bonds with and who are used to knowing how to interact with us. A good way to bypass that is by finding a hobby that you like and making yourself join a group that focuses on that hobby.

Great advice. 👍

 

[LPPSYD]

Ok, let me put some of my inarticulated questions another way.

- How important is personal warmth in establishing a rapport, with every client? How does that quality, of warmth, or what in I guess social work programs is called 'use of self' (I imagine this means: use of one's physicality, bearing, mien, nonverbal communication, empathetic attention) bear on outcomes?

- How much can you rely on professional skills to help you assist a client you might not personally like? What about populations that aren't really your bag?

- Outcomes are often long-term or uncertain; you probably don't see them, often. How does this affect your belief in the value of clinical work? How do clinicians retain a sense of professional efficacy, given this?

- I know every setting is different, but typically, how often does conflict come up? Every day, every other hour? How tough is it, really, to manage this, given professional skills, supervision, personal coping methods?

- Can burnout be avoided?

I feel compelled to comment on the issue of warmth. I don't think warmth is as essential as things like empathy and compassion. I personally don't consider myself an especially warm person (and I doubt anyone close to me would use that adjective either), but I am both very passionate and also very honest and blunt at times. Interestingly, the feedback that I consistently get from clients (from college students to inmates) is that I am honest and genuine and that they feel truly cared about, which helps get them motivated to make changes. Thinking of the Rogerian triad, warmth as far as a therapist's personality isn't what's important, it's more about the approach or attitude towards the client. This is also related to your other question about establishing rapport and seeing a client you just don't like all that much. In my opinion, if your approach is to suspend judgment while also being comfortable enough to be honest and to be able to confront clients empathically, you can be really effective. Also, I could really relate to what you said about being a good listener and I believe that's an asset in this field. I'm honestly not sure why people get that from me personally (I'm a chatterbox and my attention span is less than wonderful), but friends/acquaintances and clients frequently tell me how easy I am to talk to. I assume that it's less listening skills as much as genuine interest in others and being able to be present with another person.

I find that the interesting thing about working with negative/unmotivated individuals (again, inmates) is that small amounts of progress are really rewarding. It can be very frustrating and discouraging at first to work with someone who fits in either of those categories. Theoretical orientation will also influence one's responses to some of these questions. I'm partial to interpersonal techniques, especially processing in the moment, so when it comes to any type of difficult client I find that discussing the issue directly (confronting something like maladaptive relationship patterns, for example), brings it all out in the open in a really productive way.

I agree with others' comments on the importance of supervision, and I think this relates to several of your questions. Also, I am just heading off to internship this year, so my advice is based on relatively little experience compared to others here.

I hope at least some of that made sense for you and didn't come off as arrogant or anything. I'm running on very little sleep and avoiding finishing the last paper of my doctoral education, haha 😴