Monday, July 25, 2016

Therapist or Coach?

Recently I was asked to see some kids whose parents are worried about them. They don’t talk much, they mope around the house, and other vague complaints. Engaging kids who don’t want to be “in therapy” is a unique challenge. I have to sell it to them and often I end up going the route of coaching for a time, instead of therapy. This is especially helpful with teens, who often are blowing through their adolescence with no understanding that their childhoods are coming to an end. So what should we do? We make a plan. We start imagining life in the future, where will you live? Will you have a job? Will you go to college? How will you get into a college? Suddenly, reality sets in and they start engaging a little in the work of therapy because they don’t want to live with mom and dad forever. And that is a good thing.
I wanted to write this entry about the difference between coaching and therapy – so I Googled it, of course, and read a few REALLY dry, matter of fact explanations, and yes, other blog entries. I don’t want my blog to be one of the boring ones.  Coaching is much more directive, and it’s not for people whose mental health is not stable enough. I see people for therapy because their symptoms are such that they cannot cope with the life they are currently living. They are depressed, or debilitated by anxiety, or their traumatic experiences are overwhelming them. These people need solid interventions and relief first.
A good coaching candidate is someone who is blowing through life. Or stuck in a rut but not meeting DSM V criteria. People who just don’t know where to go next or how to identify that next step. I have a friend who wants to move to my State but knows the salary won’t be comparable. I suggested taking some courses in business/non profit management or become a certified project manager because I know those are skills that are sought after. Plus I know that this friend has tuition reimbursement through his employment. While I don’t yet know if he took my guidance, it gave him some ideas and options that he had not thought of before. As a clinical supervisor, I learned in a post graduate class that “supervisors don’t know better, they know different.” The same is true for a coach. Now you want to be careful to not overwhelm someone with all of your ideas for their life. I have had that experience as well, with someone who threw out so many possibilities in one breath I completely zoned out. A coach should listen to where your particular passion lies. She was well meaning but the advice was all over the map.

Keep in mind that I have years of education and experience as a clinical social worker, while a coach can wake up one day and say, “I’m a coach” and charge you $100/hour to coach you. Many of them don’t have specific training or credentials, and there really aren’t any real credentials at this time, not in the way there are for mental health professionals. Someone who is a coach should not be trying to treat your panic attacks or your teen’s cutting behaviors. Be sure you are finding that you are benefiting. Just like a good therapist, a good coach is worth every penny. 

Wednesday, July 13, 2016

Countertransference

If there is one thing I stress to students and anyone I supervise... it's "get a handle on your own stuff." What does this really mean? I see a lot of posts about behaviors people need to stop doing, for example, complaining or worrying, nail biting.

But first you must be aware that you do these things at all. And most people are NOT because they can be very unconscious. Long before I knew this is what I wanted to do, I went to therapy for a year. I was 17 and I had issues, suffice it to say. I didn't think this therapist was any kind of guru but I learned what I needed to learn and threw away some of his sexist, assuming and occasionally belittling crap about me. I can laugh about it now! I also went to therapy in my 20s because my father was terminally ill but I went for ten years anyway. After I got married and had a baby, I was in marital therapy *surprise!* So I have done some time on the couch, and I think ALL therapists should. Why? Because you need to be aware of your own stuff! I cannot say this enough!

Counter-transference is the therapist's reaction to the client's reaction to them. Or to their story. Last week I saw a couple - only for two sessions. One wanted to work on the marriage, and the other was done with her spouse. I don't really want to see couples, and I was glad when they decided to stop coming. Why? Because I have gotten divorced, and clearly not long ago enough. My mind wandered and I struggled with staying focused on them because I could see all the similar issues. I also have a client who is getting divorced but it's a little easier to manage my feelings with just one person - I tend to align myself with one person vs staying in the middle - I am not a good mediator. Well, it is something I can work on. I have my areas of expertise and I do not have to be an expert in all things.

During my marital counseling time, I found a therapist whom I adored. She was an older lady (we both thought she resembled my mother but she was nothing like my mother as we found out!), French speaking Swiss ex-pat, elegant, and had this uncanny way of using her own counter-transference to work with us (I am sure this was her Institute training but she was gifted). She allowed her feelings to surface based on what each of us said. She used those feelings to respond to the person who was talking and not talking. I loved her and eventually went to see her on my own from time to time.

I once went to a training on counter-transference where we watched some film clips - Ordinary People, and Dead Man Walking are the two I recall the most. Any film with therapy scenes or
difficult issues are good opportunities for therapists to think. If you were sitting across from a sociopath on death row and he started making sexual innuendos - how would you handle that? Watch the movie - she did great. Granted - you'd feel pretty uncomfortable. Angry even - how dare he? Be aware of those things. Narcissistic people will piss you off constantly, be aware of that. Those feelings are telling you something not just about you but about your client.

The California psychiatrist Irving Yalom MD writes great books about therapy - I recommend them. The book "Love's Executioner" is specifically about counter-transference and is a must read on the topic. I have learned more from his books than any class or supervisor. While I was reading his book, "The Gift of Therapy" I got stuck on a chapter and stopped reading it. I mentioned this to a colleague and he asked what the chapter was about because it had triggered something in me... well of course it was something I was having a reaction to - I don't recall at this moment what it was. My point is that these things are all signs that point to our issues and we must listen.

Therapy is a GIFT. Managed care has made it all about billing hours and time limits, sadly, but if you really want to be a good therapist, dig deep into yourself and not only learn about yourself, but learn from your therapist. If you are not learning - find someone else who can be your guru.

Tuesday, July 12, 2016

Welcome

I recently quit my day job. I have worked full time since 1993, fresh out of college and trying to save the world. Well, not really. I wanted to make a difference, even if it was for one person. I think I managed that. I was a caseworker in Brooklyn for kids in foster care, I was a hospital social worker for the pediatric crime victims unit at Bellevue, I was a therapist for Catholic Charities, I worked in cardiac surgery for a stint at Columbia. When I moved to Denver I knew I wanted to supervise and I loved doing that for 8 years. And then I was done.

I had a make a plan over several months how to transition from "working for the man" to working for myself. My father was self employed for most of my life - what I remember. I thought I could never live like that - not knowing how I was going to pay the bills. But once I started digging around, I realized I had the key already. I worked in Child Welfare, I am a subject matter expert in child welfare, trauma, and therapy. I am also a painter and studied art in a specialized High school and in college as well as going to classes at the Art Student's League of NY. Everyone said, "you should be an art therapist." I thought I needed to go back to school. I was wrong!

I am already a Licensed Clinical Social Worker, and an artist. I had joined a mobile painting party company in the fall for fun - to get out and meet people and "teach" them painting by showing the group how to do a painting from start to finish. Easy right? You'd be amazed at how anxious people would get. They think it's funny when they say "I suck at this," but I was stunned by these reactions. It felt like part of my work was helping people overcome psychological barriers to be able to say, "I am making something nice," instead of being self deprecating. So I started some groups at work, with caseworkers, making mixed media paintings that were meant to reflect who they are and how they cope with their difficult jobs. Amazing art was created!

So I began applying for contracts and to serve Medicaid clients (for child welfare). In talking to people I found that there are few child therapists who really know this population and fewer still who do art therapy, let alone directive, trauma informed play therapy. I am not a playmate, I am a therapist.

While I am still advertising myself as a clinical supervisor (for those who want to consult or get license hours), I still feel the need to make a wider impression, to make that difference for children, for their parents, for people who have been harmed and want to heal. So the blog was born. I don't write it for money or fame, but I am never opposed to money... let's just be honest. Starting out is scary - there's no weekly check that gets mailed out automatically unless I have CLIENTS.

Be sure to check out my website: www.aliceriley.net

thanks for reading!  Comments are welcome - next topic: COUNTERTRANSFERENCE!