Why I love this work...

[Vasa Lisa]

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I have been in my present job for about a year so there are clients that I have now seen for many sessions. This differs from my prior placements that required artificial terminations because I was moving on. I haven't had the luxury of pacing tx to match the needs of the client until this job.

Because we are not an agency, my case load is pretty small - I see 10 - 15 clients per week - all private pay. Some of the clients I see have complex trauma hx and different expressions of Axis II - particularly, BPD, and so sometimes the work is difficult and slow.

There are weeks where several clients have shifts, changes, improvements, successes, and all the slow steady work of the relationship and emotional regulation through my own "presence" is mirrored back to me.

This was one of those weeks, and I am so grateful to do this work.

How about you - how was your work week this week?

Vasa Lisa

 

[existential79]

I wish I had such an eventful week as yourself, VL... I am still very much in the military and still identifying practicum sites. I have however decided to come back to this site to re-immerse myself in the world of counseling issues. I've almost finished the ACT manual for therapists which has been an incredible read, and I'm really looking forward to applying some of this stuff. Have you encountered any ACT out in your neck of the woods? I'd love to hear about your experience with it...

 

[zensouth]

I have been in my present job for about a year so there are clients that I have now seen for many sessions. This differs from my prior placements that required artificial terminations because I was moving on. I haven't had the luxury of pacing tx to match the needs of the client until this job.

Because we are not an agency, my case load is pretty small - I see 10 - 15 clients per week - all private pay. Some of the clients I see have complex trauma hx and different expressions of Axis II - particularly, BPD, and so sometimes the work is difficult and slow.

There are weeks where several clients have shifts, changes, improvements, successes, and all the slow steady work of the relationship and emotional regulation through my own "presence" is mirrored back to me.

This was one of those weeks, and I am so grateful to do this work.

How about you - how was your work week this week?

Vasa Lisa

I actually had quite a break through with a somewhat avoidant client. At my agency CBT is pushed hard but I took a session and did only interpersonal processing (see Interpersonal Process Therapy by Teyber) and had quite a shift in our therapeutic relationship in just that session. It revitalized me after a particularly rough week.

 

[zensouth]

Y'know . . . amidst all the negativity that can appear on these boards . . . we should have some sort of sticky note at the top for positive things that have recently happened, like a "positive reflections", "small successes" or "something good that happened this week" thread. This goes for the PhD/PsyD section as well. Sometimes stuff gets pretty negative on here. A little positivity would do us all some good.

Thanks for starting this thread Vasa Lisa

 

[Vasa Lisa]

Existential79 - I don't use ACT - but it sounds like it combines a lot of the techniques and interventions that many of us use in our daily work.

I tend more toward depth work (Jung), expressive arts, existential (Yalom), internal family systems, supportive psychotherapy, and just plain "presence." I have done a lot of my own work as a client and my clients can sense my groundedness.

Zensouth - yay you! and thanks for celebrating with me. I too use IPP. Funny you should mention that. I had a client recently who was cancelling at the last minute and coming sporadically. She had been at a plateau for weeks and I had been nudging her to go to every other week, or to stop for now, go out and live a little, and then come back. (This is a private pay client who is a weekly part of my paycheck). She was offended and felt rejected and we processed that in an IPP way, then she fired me! Often an empowering moment for a client 🙂

She recently returned to tx and in her first session back, she began in her usual way, I interrupted, made another IPP observation, made sure to hold her closely in rapport, and gently challenged her that to move past her plateau and to shift her misery would require her taking a risk and doing some scary work in tx. She agreed to try, and we did some gestalt work that rocked her world. She shifted, I shifted, her innerworld shifted and I came out of that session energized.

And yes! I would love a sticky at the top of good news of the week.

I sometimes ask my clients if 99.999999999999999999 % of your life sucks.... what would happen if you could name the 0.000000000000001% that is working? and expend some of your focus, attention, and energy on that small part that is working? I also use gratitude journals for HW. I am not a fan of "positive psychology" per se - but I have seen the power of neural plasticity when we get off the rutted neural pathways and go cross country.

I also use the metaphor of reflexive reactions as being the rutted path - and that we need to grab a machete and find a new trail through the jungle to lay down a new path - one that is more likely to create the life and relationships that they long for.

I LOVE this work. Sounds like you do also... and it is tough at times.

VL

 

[Vasa Lisa]

Because we are not an agency, my case load is pretty small - I see 10 - 15 clients per week - all private pay.

Someone asked me how long it took for me to build up my case load and what my training/qualifications are.

I graduated in 2010. During my grad school years, I did two practicums - only one semester was required - but I chose to do a full year in one placement and a semester in another placement. I was not paid during my practicum. I chose an internship site that would prepare me for private practice. I commuted over an hour each way for two semesters, worked well over 900 hours. I was not paid during my internship. To gain additional experience, I added a second internship site my final semester of grad school. I cut back to three days at my main site, and worked one day a week at a second site. Again - I was not paid for my internship.

Along the way, I had field placements and did volunteer work in my community - working with the homeless population, vulnerable women, drug and alcohol treatment, troubled teens, and anywhere I could get hands on experience with mentoring.

All through grad school I went to conferences and sought out additional training in creative and expressive arts, Motivational Interviewing, PTSD tx, mindfulness therapies, art therapy, music therapy, working with personality disorders, and so on.

I am a voracious reader and while I was a student, I spent a lot of time at psychiatryonline studying the DSM cases and learning about the continuum of mental health and mental wellness. I read books, studied, journal articles, did research on things that interested me and watched hours and hours of videos of master therapists doing what they do best.

I also was a client for several years with one of the established therapists in my area. Most of what I learned about being a therapist came from being a client, and from my clients. The books, videos, coursework, etc. were icing on the cake.

So how long did it take to get where I am? One answer is a lifetime - and the other is about a year after graduation. I didn't do it alone though - I had an entire network and community of support that helped me get launched.

The other question is what are my qualifications:
I am a graduate of a 60 credit CACREP program.
I am in my sixth decade with a lifetime of experience.
I am a resident in counseling which means I am working toward my 4000 hours - 2000 direct and 2000 indirect and my 200 hours of supervision.

When I complete my hours, I will take the NCMHCE and be licensed as an LPC - Licensed Professional Counselor.

I am a few sigmas out in comparison to my fellow graduates🙂 - but none of them are terribly surprised after spending three years with me in grad school!

VL

 

[thirddegree]

Someone asked me how long it took for me to build up my case load and what my training/qualifications are.

I graduated in 2010. During my grad school years, I did two practicums - only one semester was required - but I chose to do a full year in one placement and a semester in another placement. I was not paid during my practicum. I chose an internship site that would prepare me for private practice. I commuted over an hour each way for two semesters, worked well over 900 hours. I was not paid during my internship. To gain additional experience, I added a second internship site my final semester of grad school. I cut back to three days at my main site, and worked one day a week at a second site. Again - I was not paid for my internship.

Along the way, I had field placements and did volunteer work in my community - working with the homeless population, vulnerable women, drug and alcohol treatment, troubled teens, and anywhere I could get hands on experience with mentoring.

All through grad school I went to conferences and sought out additional training in creative and expressive arts, Motivational Interviewing, PTSD tx, mindfulness therapies, art therapy, music therapy, working with personality disorders, and so on.

I am a voracious reader and while I was a student, I spent a lot of time at psychiatryonline studying the DSM cases and learning about the continuum of mental health and mental wellness. I read books, studied, journal articles, did research on things that interested me and watched hours and hours of videos of master therapists doing what they do best.

I also was a client for several years with one of the established therapists in my area. Most of what I learned about being a therapist came from being a client, and from my clients. The books, videos, coursework, etc. were icing on the cake.

So how long did it take to get where I am? One answer is a lifetime - and the other is about a year after graduation. I didn't do it alone though - I had an entire network and community of support that helped me get launched.

The other question is what are my qualifications:
I am a graduate of a 60 credit CACREP program.
I am in my sixth decade with a lifetime of experience.
I am a resident in counseling which means I am working toward my 4000 hours - 2000 direct and 2000 indirect and my 200 hours of supervision.

When I complete my hours, I will take the NCMHCE and be licensed as an LPC - Licensed Professional Counselor.

I am a few sigmas out in comparison to my fellow graduates🙂 - but none of them are terribly surprised after spending three years with me in grad school!

VL

Fantastic, inspirational post. As I await interviews for grad school programs, I must admit, I've been hesitant about pursuing this profession based on all the negative stuff I hear on message boards. But you are an example of what can be done to put oneself in a position of success. Thanks for taking the time to write that all out!

 

[titanz7]

I have been in my present job for about a year so there are clients that I have now seen for many sessions. This differs from my prior placements that required artificial terminations because I was moving on. I haven't had the luxury of pacing tx to match the needs of the client until this job.

Because we are not an agency, my case load is pretty small - I see 10 - 15 clients per week - all private pay. Some of the clients I see have complex trauma hx and different expressions of Axis II - particularly, BPD, and so sometimes the work is difficult and slow.

There are weeks where several clients have shifts, changes, improvements, successes, and all the slow steady work of the relationship and emotional regulation through my own "presence" is mirrored back to me.

This was one of those weeks, and I am so grateful to do this work.

How about you - how was your work week this week?

Vasa Lisa

I'm so glad to hear about your success at your work! I'm an undergraduate student and I'm in the middle of a serious dilemma about my future prospects of school/career. But whatever you are doing right now is something that I am pretty interested in doing myself, but I don't know if you explicitly stated your job title. I want to guess LCSW?

edit: also, I agree with zensouth that this forum does have lot of negativity going around... I've been on this forum for only few days to ask some questions about graduate schools but most of the answers were demotivating, denouncing/negative talk about certain programs, etc... I also think there should be a sticky for "Positive experiences" or something along the line.

 

[Vasa Lisa]

When I complete my hours, I will take the NCMHCE and be licensed as an LPC - Licensed Professional Counselor.

Titanz - not going for LCSW - going for LPC/LCMHC (licensed professional counselor/licensed clinical mental health counselor). Various states call counselors various names.

VL

 

[titanz7]

Titanz - not going for LCSW - going for LPC/LCMHC (licensed professional counselor/licensed clinical mental health counselor). Various states call counselors various names.

VL

May I ask what kind of school/degree is required for that? If it's a Master's in clinical/counseling psychology, wouldn't you need a supervision during your practice?

 

[Vasa Lisa]

May I ask what kind of school/degree is required for that? If it's a Master's in clinical/counseling psychology, wouldn't you need a supervision during your practice?

Titanz - I have a MA and EdS in Clinical Mental Health Counseling. And yes - I do need supervision. You can click on my name on the left and see all my prior posts, and read all about it.🙂

I have an administrative supervisor AND a clinical supervisor. In my state, it is against the law and also unethical for me to practice without supervision until I am licensed. All residents in my state practice under supervision and are required to have a minimum of 200 hours of supervision. At least 100 hours must be from an LPC-S.

Even after licensure, I plan to continue to use both supervision (paid) and peer consultation (unpaid) for at least 10,000 hours or five years. For me it is my commitment to the profession and for me it is part of the process of becoming a master therapist. The best therapists I know - the ones with decades of experience who are still growing, use weekly peer consultation groups. I would be wary of any therapist/teacher/supervisor who had not had their own therapy and did not continue to engage in peer consultation.

This is a whole 'nother thread - for a whole 'nother time - but if you are in grad school - how many of your faculty are actively practicing therapy and how many of your faculty have had a long term experience as a client?

Is it possible to "teach" someone how to be a therapist if you are not a practicing therapist and have never experienced therapy? Is it "best practices?"

Being a therapist can be lonely work at times. We don't have anyone other than ourselves directly evaluating our work. Of course our clients are giving us feedback - sometimes directly - and often indirectly.

Audio and videotaping are ways to have another person objectively evaluate my work and to assess transference/counter-transference and other issues. Taping is always done with the client's written consent. Clients are free to opt out - no pressure. Most of my clients like to know that a second set of eyes/ears are reviewing their issues - and some refuse taping - and I of course respect that since there is no way I have time to listen to or watch all my tapes! I explain that my supervisor isn't listening to their stuff - but is listening to me - to help me develop into a more skilled therapist.

When I was in grad school, practicum, and internship, we videotaped everything! It ranged from nerve wracking to useful - and everything in between. I often felt defensive - depending on the skill of my supervisor, my skills being evaluated, and what I was asking for in supervision. It was a process of growth for me to be able to see myself through the eyes of another therapist without feeling self-conscious. I think it is natural to feel some discomfort when we show our work, but I rarely feel feel defensive anymore. I know I am doing good work, and I don't bring that good work to supervision very often. I bring the stuck places, plateaus, misses, and missteps to supervision where I can learn more about myself and improve my skills.

Often, the missteps, when handled with skill, can lead to a therapeutic breakthrough. For many of our clients - when there is a conflict with someone in their lives, there isn't always the skill needed to resolve the conflict. To have conflict, or hurt feelings with the therapist, and have the therapist respond differently (corrective emotional experience) can be healing. This is the process of clients bringing the "there and then" into the "here and now." Part of our work is to be curious about the there and then, evaluate it through the lens our "self as therapist", and then intervene in the here and now in service to the client's growth.

Might be more than you wanted to know Titanz - but I sure love this work. Can you tell?😍

VL

 

[Irene1504]

Hi,

I am an LMSW professional currently working at an addiction treatment center.
Many of my clients are challenged with mental illness of some sort, for the most part personality disorders. Few of them are challenged with some psychotic disorder. My case load currently includes 54 clients, I see 50% of them regularly and some of them they come for a check in session every 2 or 3 weeks.
I have been 6 months in this job and what I am really missing is a proper professional supervision. My boss is always busy, never have time to sit down and discuss any issue that relates to my clients. The only exception to that would be if there is an emergency situation that erupts, only then I can have his attention for some brief moment and even then the handling of the situation aims to solve a specific issue, e.g. a client attempted a suicide, so only then the director would be willing to hear about the case, just because it became a life threatening issue.
There are also no regular staff meetings. I have already mentioned that to my boss on two separate occasions. The answer that I've received is that there will be regular staff meetings, just after the opening of the new department.
I am feeling frustrated and lonely at m work. There is a mentor who comes on a bi-weekly basis to meet with us the clinicians but it is not enough. I don't feel that I learn anything from her. Her style seems to be more appropriate for students and I am a licensed Master Social Worker and has been in the field for more than 5 years.

I have talked to my colleagues about this and they feel the same way about the situation, and now I am not sure what to do. Right now I am working part time, but my boss offered me a full time starting of next month but he wants me to work 6 days a week. I thought to look for another job and went to a job interview, but I am plannig on leaving the city where I am right now within the next 6 months. I am hesitant about accepting the full time job offer from my current boss, but at the same time I love my clients and I enjoy working with them. I am feeling dissatisfied about the situation of working alone, and that my boss have no idea whats happening at work until something bad happens.

This forum is an excellent way to vent away and to share what happens with me at work because I have been feeling increasingly frustrated lately.


Any suggestions on how to handle this situation?

Thank you!

 

[Vasa Lisa]

Six days a week - red flag!
No consultation/supervision - red flag!
Feeling attached to clients, but unsupported by agency - red flag!

This sounds like a rough situation - I hope you are able to find some local consultation and support - it doesn't have to be like that.

VL