Tag Archives: Clinician

Intersections of Spirituality and Psychotherapy

An important aspect of my life has been my interest and growth in spirituality.  I was raised in a sunrise_vert_1fundamentalist Protestant church, which I left as an adolescent, and I have continued to explore my spiritual experience, beliefs, and values for most of my adult life.  Currently, I am an active member of a progressive Protestant church, and I have read and studied aspects of Buddhist philosophy as well as meditation from a variety of spiritual perspectives over a number of years.  I don’t bring my spiritual beliefs or practices into my work as a psychotherapist directly, although I have answered “yes, I’m part of a spiritual community” when clients have asked about my spiritual or religious affiliation.  I have become aware of using some of the insights I have gained on my personal spiritual journey, and I have encouraged clients who have an active spiritual practice or affiliation to incorporate the strengths of that practice as an aid to their therapeutic progress.  This blog contains some of my thoughts and experiences related to the intersection of spirituality and psychotherapy.

Compassion for self and others is an aspect of therapeutic work for almost all clients.  Whatever the presenting issue or symptoms, clients are usually struggling with negative judgments about themselves and/or other people in their families, social network, or work setting.  My own experience of developing compassion within myself has taught me how complex this process can be.  At times I find acceptance of others easier than acceptance of myself, and at other times I may find myself being judgmental of others while viewing my perspective with compassion.  In general, though, I find that greater openness and acceptance of myself and others develop in tandem.  It is hard to hold on to judgment in one area of my life without it showing up somewhere else.  I have also found that there isn’t an end point to developing compassion, but instead a more gradual growing awareness of the absence of compassion in some circumstances and a growing ability to become more accepting.

Since my understanding and experience of compassion are rooted in my spiritual journey, I draw on this when I work with clients to help them expand their acceptance of themselves and others.  However, I don’t assume that my clients share my value of spiritual paths.  There are many therapeutic practices that can assist clients in developing compassion, and there are some religious communities in which compassion is less present than judgment.  This means that I join each client in looking for the path that is most congruent with her/his values and experience.  When clients have their own spiritual or meditation practice, I assist them in integrating this in their daily lives.  When clients don’t have an interest in any type of spiritual practice, I introduce the idea of mindfulness as a therapeutic tool and follow the client’s interest.  I also talk about ways of noticing present experience and slowing emotional reactivity as a path to developing greater compassion especially for oneself.  Expanding compassion is a slow process, so compassion for the slow nature of progress is often part of the therapeutic process.

Community is another issue that arises in most therapeutic work, since clients often enter therapy feeling isolated.  Many of their relationships are characterized by feelings of blame, burden, and judgment rather than mutual care and support.  I have experienced many benefits from being part of a spiritual community as an adult, though any human community contains the potential disappointments and conflicts that occur in all human relationships.  At best, I have been part of a spiritual community that is bonded by implicit and explicit agreements to treat all members with respect and to see the value that each member contributes to the greater whole.  The ritual of coming together as a group and being reminded of our shared values and practices is comforting to me, and it often puts the irritations and annoyances of my daily life into a larger perspective.

It is challenging to encourage clients to become part of a community when they don’t have a natural group in which they already participate.  Some clients find solace in a formal religious or spiritual organization, others benefit from a group practice of meditation or other mindfulness practice, and others value attendance in a 12-step group.  When talking with clients about isolation, I generally start by asking about their social relationships to identify any communities that already exist in the client’s life.  Sometimes the client is part of a naturally occurring group that they don’t identify as a source of support, such as a parent group at their children’s school, a book group, or an exercise or yoga class.  Even though these groups don’t have an explicit purpose of mutual support, they can provide clients with a place to start to reach out to others and to notice their thoughts and feelings in interactions with others.  Often the dissatisfactions that clients experience in these communities are related to the therapeutic issues we’re addressing including self-blame and judgment, experiences of rejection and exclusion that are reminiscent of childhood and adolescence, and a lack of self-assertion and other interpersonal skills.

If you have been thinking of ways that your own spiritual practices intersect with your work as a therapist, I hope these examples contribute to your work with your clients.  I’m interested in your feedback or additional thoughts and comments you have on this topic.

Having Difficult Conversations with Colleagues

I’m seeing a heterosexual couple in couples therapy, and a colleague at my agency is seeing the wife individually. Last week my colleague made a critical comment about the husband and questioned how helpful couples therapy could be. She said this in front of several of our peers, and I didn’t respond because I was shocked and hurt. I think I need to say something to her, because her negative view of the couples therapy will undermine the wife’s participation. There is a lot of conflict in the relationship but they have both expressed a commitment to work it out and stay together.

This is my second blog on the topic of having difficult conversations. It may be helpful to read the prior blog about client conversations if you didn’t do so already. This situation with your colleague is an example of difficult conversations that can arise when we share cases or consult with colleagues about our work. Growing into the role of clinician means developing skills to talk with colleagues as well as clients about uncomfortable issues and areas of conflict. You’ve already made an important first step in deciding that you need to talk with your colleague rather than avoiding a challenging interaction. I would agree that having a disagreement between the individual and couples therapists can be harmful to the client, and I would add that it can also be informative to both the individual and the couple therapy.

I would suggest that you engage in personal reflection before you approach your colleague. It is important to identify 1) the nature of the conflict or difficulty you are experiencing with your colleague, 2) assumptions you may be making about the reasons for the conflict, and 3) the desired outcome of a conversation. During this process, it may be helpful to consult with another trusted colleague or your supervisor to sort through your feelings and hear some alternative explanations or outcomes you may not have considered.

When you reflect on the nature of the conflict, identify the content or issues of disagreement as well as the emotions associated with the conflict. In this instance, you mention shock and hurt, but you may notice other emotions that have arisen since then. If you find that the issue and associated emotions are similar to interactions that have been a struggle in your personal life, it may be helpful to take this to your own therapy as well as getting supervision and consultation.

After you feel clear about the conflict itself, reflect on the assumptions you have about why your colleague made this remark. Usually an emotionally charged interaction leads us to develop explanations for our hurt or angry feelings, and these explanations often include criticism and judgment of yourself or the other person. For example, you may wonder whether your colleague doubts your skill as a couples therapist or whether she has a bias in favor of separation for couples in conflict. Consider other explanations as well, possibly with the help of your supervisor, therapist, or colleagues. One possibility is that the wife is describing her view of and feelings about her husband and marriage differently in her individual therapy than in the couples therapy. This would mean that you and your colleague are holding two disparate parts of the wife’s experience that she hasn’t reconciled.

Third, identify the outcome you desire for your conversation. There are a number of possible outcomes when approaching a colleague about a difficult interaction: expressing your point of view, engaging your colleague in understanding your difference of opinion, and sharing your view of possible reasons for your differences in perspectives are a few. Make sure that the outcome you identify is something that is focused on your communication and is collaborative in nature. A desired outcome of changing your colleague’s point of view establishes a more adversarial tone and is likely to lead to a deterioration of your collaboration rather than strengthening it. If you have difficulty identifying your desired outcome, check with your supervisor, therapist, or another trusted colleague who can maintain neutrality.

Once you have moved through these steps in understanding the interaction with your colleague, you are ready to plan a conversation with her. I would recommend letting her know you’d like to talk and planning a specific time and plan for the conversation. You’re more likely to achieve your desired outcome if both of you have set time aside and if your colleague knows what you want to talk about. Make sure you describe the purpose of the conversation in neutral terms by saying something like “I’d like to talk further about our work with X and the questions you raised last week about the couples therapy.” Follow that statement with some suggested times and a private location where you can talk without disturbance. When you come to the designated time and place, you may benefit from having a clear opening statement about your reason for wanting to have the conversation, setting the tone as positive, curious, and collaborative. An example of an opening statement in your situation might be “I was surprised to hear what you said last week about X’s husband and the couple therapy. I’d like to compare our perspectives to see if we can make sure the two therapies are beneficial to her.” The preparation you have done will enable you to listen to your colleague’s point of view, express yours, and work to establish common ground in understanding your client.

I hope you find these suggestions helpful in addressing difficult conversations with colleagues in your clinical work. Please email me with comments, questions, or suggestions for future blog topics.

Self Care in Work Habits

Iimg-article-are-you-too-stressed-out’m in my second year of practicum placement and I feel really burned out. What can I do to keep going in this career without constantly feeling depleted by my work with clients?

Your concern is a universal one for clinicians. We tend to enter this field with a predisposition for caregiving others and neglecting ourselves. The emotional demands of doing psychotherapy with highly distressed individuals and families are intense and most of us reach the limits of our previously developed coping strategies during our training. This is a good time to create new routines and habits that will serve you throughout your career.

In this blog, I will suggest some general strategies that will help to build your emotional reserves and detach in a healthy way from the intensity of clinical work. The next blog will address more specific ways to attend to your physical, mental and emotional health. I recommend that you choose one or two small steps to try out first, see if they are helpful, modify them if necessary, then build on those after you have had some success. You will probably find it hard in the beginning to give attention to yourself, as you go against longstanding patterns. Be gentle with your expectations and remember that you can always start again if you slip back into old habits.

It will be easier to sustain your physical and emotional energy if you build in breaks for yourself, both on a daily basis and throughout the training year. Look at your daily routine and schedule one or two breaks if you have a full day at your placement. Use your break to eat a meal or snack, take a walk, read or watch something unrelated to your work, or talk to a colleague. Turning your attention away from your work for a period of 15 minutes to an hour will enable you to be more engaged when you return to it. If you have classes and clinical work in the same day, give yourself some transition time in addition to your commute.

Another aspect of your routine to examine is the structure of your day. It is helpful to alternate more and less demanding tasks throughout the day. Consider taking an hour to work on paperwork or do some research into resources for a particular client to break up your client hours. If you have several particularly complex or challenging clients, schedule them on different days or at different times of the day so you have other work or less challenging clients between them.

Clinicians often have a very hard time taking a vacation from clinical work. Because of our pattern of caregiving, we often feel as though we must be available at all times. We don’t feel comfortable having someone else provide coverage. However, we cannot maintain our own equilibrium if we never take a break to restore ourselves. Throughout the training year, take vacation time as it is permitted at your agency and have a colleague provide coverage for your clients so you can be free of responsibility and preoccupation. It is tempting to check voice mail or email when you’re away from the office but you will benefit more from your time off if you fully detach. Keep in mind that taking a vacation means being away from the office and not having any client contact for at least a week. Taking short periods of a few long weekends will not allow you to truly rebuild your reserves and return feeling restored.

I hope you can use these tips for developing some work habits that counter your feelings of depletion. The next blog will continue on this topic, addressing specific ways to care for your physical, mental and emotional well-being. Please email me with comments, questions or suggestions for future blog topics.