rachelmanija (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
rachelmanija) wrote2012-01-11 04:26 pm
rachelmanija) wrote2012-01-11 04:26 pm
The Making of a Therapist, by Louis Cozolino
A practical, easy-reading guide to some common issues and obstacles faced by a beginning therapist. This makes a good companion to Yalom’s The Gift of Therapy, which could be described the same way but which has little overlap in content.
What I liked best about Cozolino’s book is his emphasis on the idea that no one is perfect when they start out, everyone feels like an imposter, and that mistakes are inevitable but not the end of the world. While Yalom discusses his own mistakes, they tend not to be embarrassing or stupid ones. Cozolino, to my relief, recounts some truly ridiculous errors of his own. My favorite was how when he was just beginning private practice, an earthquake hit in the middle of a session. Cozolino was so locked into his role as the “unflappable analyst” that he didn’t react at all.
Finally, his client said, “Um… Isn’t that an earthquake?”
Cozolino replied, “How does that make you feel?”
In retrospect, of course, he realized that he had acted like a robot, and also that he might have made his client feel that his own completely normal reaction was wrong.
The book has a nice balance between emphasizing being yourself and not getting so anxious that you become a robot, and pointing out ways to avoid making common errors. A few suggestions:
- Keep what you say as concise as possible. Clients tune out long monologues. Try to get to the heart of what you’re trying to say.
- Put emergency numbers on speed dial. Schedule any potentially dangerous (to self or others) clients for when your supervisor or other backup is present. Discuss emergency procedures with your supervisors before there’s an emergency.
- Stay calm. You don’t have to feel your client’s emotions. Provide hope, and provide structure. It can be helpful to boil down multiple problems into some central core issue, to make them feel less overwhelming and hopeless.
- Don’t try to reason people out of delusions. Cozolino has a great story here in which he tries to prove to a psychotic client that she is not pregnant with a kitten. When he attempts to enlist the other members of her group in this effort, he instead inspires her to persuade them of the truth of her delusion. They end up planning a kitten shower, to which Cozolino is browbeaten into contributing a litter box.
- Always get specifics, especially in the areas of child discipline, sexual behavior, alcohol and drug use, past diagnoses, and cultural and religious beliefs. “One drink” may mean “one glass of wine.” It may also mean “one liter of vodka.” “Spanking” may mean one swat across the butt. It may also mean “a blow to the head with a piece of wood.”
- If something tragic or traumatic happens to you, it’s better to cancel than to come in distracted and upset.
- Don’t voice an interpretation the first time it occurs to you. Sit with it and see if more supporting evidence turns up. Also, don’t get too attached to interpretations. It’s OK if clients reject them.
- Be aware that much of your fees in private practice will be eaten by office rent.
Incidentally, there’s a meme going around: “Pick up the nearest book to you. Turn to page 45. The first sentence describes your sex life in 2012.”
Using this book, I got: "In addition to a growing sense of confidence, it also helps to have crisis-situation action plans prepared in advance." Actually, this describes my sex life to date.
The Making of a Therapist: A Practical Guide for the Inner Journey
What I liked best about Cozolino’s book is his emphasis on the idea that no one is perfect when they start out, everyone feels like an imposter, and that mistakes are inevitable but not the end of the world. While Yalom discusses his own mistakes, they tend not to be embarrassing or stupid ones. Cozolino, to my relief, recounts some truly ridiculous errors of his own. My favorite was how when he was just beginning private practice, an earthquake hit in the middle of a session. Cozolino was so locked into his role as the “unflappable analyst” that he didn’t react at all.
Finally, his client said, “Um… Isn’t that an earthquake?”
Cozolino replied, “How does that make you feel?”
In retrospect, of course, he realized that he had acted like a robot, and also that he might have made his client feel that his own completely normal reaction was wrong.
The book has a nice balance between emphasizing being yourself and not getting so anxious that you become a robot, and pointing out ways to avoid making common errors. A few suggestions:
- Keep what you say as concise as possible. Clients tune out long monologues. Try to get to the heart of what you’re trying to say.
- Put emergency numbers on speed dial. Schedule any potentially dangerous (to self or others) clients for when your supervisor or other backup is present. Discuss emergency procedures with your supervisors before there’s an emergency.
- Stay calm. You don’t have to feel your client’s emotions. Provide hope, and provide structure. It can be helpful to boil down multiple problems into some central core issue, to make them feel less overwhelming and hopeless.
- Don’t try to reason people out of delusions. Cozolino has a great story here in which he tries to prove to a psychotic client that she is not pregnant with a kitten. When he attempts to enlist the other members of her group in this effort, he instead inspires her to persuade them of the truth of her delusion. They end up planning a kitten shower, to which Cozolino is browbeaten into contributing a litter box.
- Always get specifics, especially in the areas of child discipline, sexual behavior, alcohol and drug use, past diagnoses, and cultural and religious beliefs. “One drink” may mean “one glass of wine.” It may also mean “one liter of vodka.” “Spanking” may mean one swat across the butt. It may also mean “a blow to the head with a piece of wood.”
- If something tragic or traumatic happens to you, it’s better to cancel than to come in distracted and upset.
- Don’t voice an interpretation the first time it occurs to you. Sit with it and see if more supporting evidence turns up. Also, don’t get too attached to interpretations. It’s OK if clients reject them.
- Be aware that much of your fees in private practice will be eaten by office rent.
Incidentally, there’s a meme going around: “Pick up the nearest book to you. Turn to page 45. The first sentence describes your sex life in 2012.”
Using this book, I got: "In addition to a growing sense of confidence, it also helps to have crisis-situation action plans prepared in advance." Actually, this describes my sex life to date.
The Making of a Therapist: A Practical Guide for the Inner Journey
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the other thing she helped me do was not escalate the drama. she got my number and sometimes i think she deliberately underplayed things in order to help me learn to have a bit of detachment too.
really enjoying these posts; thank you.
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Finally, his client said, “Um… Isn’t that an earthquake?”
Cozolino replied, “How does make you feel?”
*dies*
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Finally, his client said, “Um… Isn’t that an earthquake?”
Cozolino replied, “How does make you feel?”
//shrieks
Cozolino has a great story here in which he tries to prove to a psychotic client that she is not pregnant with a kitten. When he attempts to enlist the other members of her group in this effort, he instead inspires her to persuade them of the truth of her delusion. They end up planning a kitten shower, to which Cozolino is browbeaten into contributing a litter box.
OK, I love this guy.
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I had spent 60 intense hours learning about crisis and trauma and how to listen actively.
At 11:30 at night the pager went off. Adrenaline rush!
The "client" was somebody who wanted to know if we were hiring.
I think I spent at least two minutes using active listening techniques on her.
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(meme: ""We'll get some," said Milda." Definitive and confident, if also enthusiastically plural :-) )
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As for the meme: the nearest book to me, because I was at work, was a King James Bible, and what I got was, "God hath found out the iniquity of thy servants: behold, we are my lord's servants, both we, and he also with whom the cup is found." Ummm ....
(Unfortunately the Song of Songs, which is the only part you'd get anything really good from, is way more than 45 pages in).
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I've been thinking that too - not just re this book, but in general.
The King James quote sounds like the sort of sex life that is going to land you in the papers.
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I got: Spoils of the Desert. Desert hares are often shown in Egyptian hunting scenes.
At least it wasn't a beaver?
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As for me, the first full sentence of page 45 in Late Antiquity: A Guide to the Postclassical World is "In Arabia, the Prophet Muhammad treated the pagans, Jews, and Christians he encountered differently."
You're the therapist-in-training, you got any creative interpretations of that? ;)
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I'm sure you've heard the story about how Marshal Blücher thought he was pregnant with an elephant.
Using this book, I got: "In addition to a growing sense of confidence, it also helps to have crisis-situation action plans prepared in advance." Actually, this describes my sex life to date.
Heh.
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Doing this I get "He saw gangs of old men with linked arms, proceeding majestically along the thoroughfares of the city, carrying all before them, their naked, bony feet kicking up the dust as they moved." I am unsettled.
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Hm...
The expression "Shiver me timbers!" comes from the society of pirates, who enjoy using interesting expressions almost as much as jumping aboard other people's ships and stealing their valuables.
I have always said everything's better with rum and pirates. ;)
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I love this! :)
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Nine
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You just won this meme. Well done.
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The kitten shower is excellent. I think mental health could be much improved if people who think they're pregnant with kittens got to have kitten showers.
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My favorite piece of advice for new therapists was the result of a friend's dissertation: "It will take ten to fifteen years before you feel like you actually know what you're doing. Don't worry about this too much."
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*Poke*
Anything else I should know? It could be totally random.
PS. What do you do with delusional clients?
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a) try to make sure they're being properly medicated
b) talk about the feelings, not the facts.
Client: I was kidnapped by aliens.
Therapist: Gah, that sounds terrifying.
Doesn't always work, but it neatly sidesteps either having to either lie about your beliefs or argue with the client. Also: don't lie to the client about believing them. Don't bring this up, but if they ask, acknowledge that it doesn't sound like the way you think things are, and you haven't personally seen any aliens (or whatever). Then bring it back to the fact that the main point is not whether you believe it or not, but how it's affecting the client's life, and what the two of you can do together to make it better.
Because from what I've seen, delusions are rarely random-- they're often very good metaphors for what actually happened. "I was sexually abused" may just not have quite the right emotional resonance for what the experience felt like-- "I was kidnapped by aliens" may be a better way of describing how it felt. So if you talk about how it feels to be kidnapped by aliens, that's sometimes what the client actually needs you to know.
There's a theory about trauma that says what heals is not necessarily having all the facts of what happened-- it's being in touch with and able to deal with all the feelings that the trauma caused. So, like that.
And, hm, a random thing you should know. I feel like you already know lots of stuff. Um... not everyone can use therapy? Don't trust that other people's experiences/ids/minds work like yours? Always bring a book to sessions, so that if your client no-shows or is late, you're not sitting there being frustrated and bored and worried/annoyed at them? Try to use the vocabulary your clients use to describe things (unless you're deliberately doing psychoeducation)?
"Write up your notes right after sessions or you'll forget everything," that's a good one.
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My Kindle will be my constant companion, once I start.
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- Refer to a really good psychiatrist for a medication consultation.
- Don't ignore the content of the delusions. Yes, they're not real, but they are probably very psychologically important to the client, and may contain clues to the client's psyche.
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This made my whole day, thank you.
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Another 14 accused witches were daughters or granddaughters of witches who did not have brothers or sons to inherit their property.
(From a discussion of the Salem Witch Trials as pertains to mapped data in a historiography textbook.)
...I'm not sure what to make of that. I'm not sure I want to know!
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... thank God I'm assexual.
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Using this book, I got: "In addition to a growing sense of confidence, it also helps to have crisis-situation action plans prepared in advance." Actually, this describes my sex life to date.
....
lololololololol