![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
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
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
From:
no subject
*Poke*
Anything else I should know? It could be totally random.
PS. What do you do with delusional clients?
From:
no subject
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.
From:
no subject
My Kindle will be my constant companion, once I start.