Let’s Break Some Rules

A lot of our focus over at Therapy Reimagined seems to hit on growing therapists and early career professionals. However, this isn’t the entirety of our profession. Not by a long shot. There are those who advance and mature; those who become established and senior in our world. Ultimately, those who set the path for the next generation of therapists. When we look at the feedback that we get from our podcast and our conference, we see the inspiration, permission, and acceptance of what really defines the established and establishing therapist: the rules don’t always apply.

Ronnestad and Skovholt (2003) describe the work of these mid and later career professionals:

… A central developmental task for most experienced professionals is to create a counseling/therapy role which is highly congruent with the individuals’ self-perceptions (including values, interests, attitudes), and which makes it possible for the practitioner to apply his/her professional competence in an authentic way.

It’s at this point that we’ll admit…we here at Therapy Reimagined are not really proposing anything new. It just seems that what is known – about how therapists work and succeed – gets buried under an emphasis to follow the next evidence-based practice, or how to make a managed care company happy. Unfortunately, this avalanche of bureaucracy pushes us away from what makes therapy actually work.

In their article, Ronnestad and Skovholt give several examples of therapists who learn the rules well enough that they know when and how to break them. They describe that therapists eventually reach a point where the rules, once understood and followed, are now recognized as not universally applicable. At this time, new rules are developed to match the person delivering them, and are then honed and evaluated on their own merits. This is a stage where self-reflection is at its most effective because the wide variety of clients seen in, presumably, a wide variety of settings, allows for therapists to see how the relationships of therapy are the most widely useful tool.

In teachings and supervision, we attempt to push the idea that therapists have their own ideas and impacts on the clients that we treat. In hearing novice therapists try to describe these same ideas, it becomes obvious very quickly to a trained ear that the novice therapists don’t know what they don’t know. But does that have to be the way? In training and supervision, self-reflection can be taught and utilized to best help develop this sense of self in the therapy room. Going through the list of questions: “What happened? What should have happened? Why didn’t it happen? What makes sense for you to help it happen?”

In this sense, therapists become empowered when they have the option to influence a session. We can teach therapists to use themselves in the room, but established and senior therapists are afraid that beginning therapists are going to make mistakes that harm clients and we should prevent beginning therapists from making mistakes. Unfortunately, our field has become so cautious about avoiding mistakes and now we are training people to have almost no influence on clients. We see this in the responses that clients are giving to us about therapy and the emphasis by researchers like our hero Scott Miller on the role of listening to what clients actually want to improve how clients respond to therapy.

Along with the utility of being able to understand when the rules don’t need to be followed, therapists at this point in their career are also better able to leave work at work and avoid burnout by turning off at the end of the day.

In working with students, we hear that question all of the time: “How do you turn it off at the end of the day?”. Ronnestad and Skovholt describe that the skill is best learned and utilized in the continuum of how the professional and personal lives interplay with each other. In the beginning stages of this profession, therapists often see how their professional lives influence their personal lives. When you are off the clock, you worry about things on the clock…the patient, the paperwork, the productivity. However, more experienced clinicians begin to implement how their personal lives impact their professional lives. The acceptance of the pain in your life connects you more with the pain that others experience.

While these are skills that cannot be faked, at least not in a convincing matter, it does impact how we should view our therapist education. We hear all of the time that personal therapy should be mandated for therapists in training, but the goal of that cry is to achieve these things. Own your experience. See how that experience affects you. Use that insight to be the best human who connects with other humans that you can be. But bringing this process up earlier in therapist development will help every therapeutic relationship.

Ronnestad, M. H. & Skovholt, T. M. (2003). The Journey of the Counselor and Therapist: Research findings and Perspectives on Professional Development. Journal of Career Development, 30(1), 5-44.