Dealing with “Therapy Doesn’t Work”
Curt and Katie chat how to engage with people who doubt the efficacy of therapy. We look at how to address general skeptics, mandated clients, hesitant prospective clients, and uncertain longer-standing clients. Spoiler alert: validation, understanding, and coming back to the relationship go far.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we explore how to talk with folks who don’t believe in therapy
In response to a Reddit thread asking how therapists can respond when someone says they don’t believe in therapy or that therapy doesn’t work.
How can therapists respond when someone says, “therapy doesn’t work?”
“Not every single therapy session is a winner.” – Curt Widhalm, LMFT
- Therapy is not for everyone
- Validating concerns
- Work to understand their previous experiences in therapy
- Acknowledge problematic elements in therapy
How do you approach clients who are mandated or forced into treatment?
- Working with resistance
- Going back to the relationship and shared goals
- Meeting client where they are
What can therapists do when parents don’t believe in therapy for their kid?
“I think if you can make jokes about [what therapy is and what it isn’t] I think it’s something where it helps because you’re humanizing the person, you’re showing a little bit of humility around what therapy is, and you’re not treating them as a problem to be solved, or their kid or them as damaged.” – Katie Vernoy, LMFT
- Understanding fear or concerns
- Joining and building rapport
- Exploring their goals for their child
- Seeking engagement and involvement
- Don’t throw evidence-base at them
- Explaining how therapy works for kids
- Avoiding defensiveness on the part of the therapist
How can you explain therapy to a hesitant client considering therapy for the first time?
- Validation of fears and concerns
- Acknowledging challenges in coming into therapy
- Identifying what would be most helpful to address in therapy
- Trying to break through preconceived worries about it not working
- Exploring how to find a good match
- Describing what therapy can look like
- Explain that therapy might not be the only answer (e.g., coaching, social work, meds, etc.)
The importance of being able to describe what therapy is like with you
- Curt’s suggestion of having a casual conversation with a colleague to describe what your therapy look like
- Know how to describe your approach to people who don’t know what therapy is
- Not every client is best for you
- Focusing on the relationship you will provide to the client
What are the options for talking with long term clients who are doubting therapy?
- Use the concerns clinically
- Validating concerns
- Coming together related to expectations and goals
- Acknowledging when therapy isn’t working
- Reframing incremental progress
- Therapists seeking consultation and supervision, so these conversations don’t feel painful
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Our Linktree: https://linktr.ee/therapyreimagined
Reddit feeds about people’s response to therapy:
r/therapists – What is your response to “I don’t believe in therapy/therapy is bs?”
r/askreddit – People who think that therapy doesn’t work, why do you think that it doesn’t work?
Relevant Episodes of MTSG Podcast:
Why Is Therapy Taking So Long? The causes and solutions for therapeutic drift
What to do When Clients Get in Their Own Way
Why You Should Stop Trying to Convince Clients to Change, An Interview with Hillary Bolter, LCSW
Has Therapy Become the New Religion?
What Can Therapists Do When Clients Don’t Get Better?
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe, and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm, and Katie Vernoy.
Curt Widhalm 0:15
Welcome back modern therapists, this is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists about the things that happen in our field, the ways that therapists respond to the world around them. And we dive into all kinds of topics here. And we are talking today about something that was inspired by a Reddit thread in the subreddit, r/therapists by user throwrowrowurboattt.
Katie Vernoy 0:44
Oh, that’s a great one. I love that.
Curt Widhalm 0:47
Yes. So the question, the user identifies as a trainee, and they have the question, What is your response to, “I don’t believe in therapy or therapy is BS.” And they say that they have heard it all the time, and haven’t had anyone directly say it to their face, but they want some response. So I think a lot of the commentary around this is going to be different depending on what your experience is with this kind of stuff. But Katie and I are talking about different points in your career, this is going to show up in different ways. You’re going to hear it in different walks of life. So Katie, what is your kind of general initial response to therapy is BS or therapy doesn’t work?
Katie Vernoy 1:37
It certainly depends on where I’m hearing it, right? If I’m hearing it out in the world, and it’s just some random person telling me “Oh, you’re a therapist? Well, I don’t believe in therapy” or “therapy doesn’t work.” I, you know, I don’t know that I engage too dramatically in those situations. But if it’s someone that I actually care what they think, and I want to have a conversation with them, I’ll say, Yeah, therapy is not for everyone. Sometimes people get a lot out of therapy, and some people don’t. And there’s so many factors in whether therapy works or not. I think there have been times in sessions or with clients that I’ve experienced that and I’m sure we’ll go through all the different types of clients where this might happen. But I have, I think, a subset of clients who are caretakers, and oftentimes they will say “therapy is not working, because I’m doing something wrong,” which I think is a fairly unique situation for my client type. I think a lot of times people will blame the therapist if therapy isn’t working. But that’s a whole other way to approach it, right. So I think, to me, I think it really, it depends, is my answer.
Curt Widhalm 2:47
That’s an interesting point. Because I guess I was reading this question more in the sense that therapy in general doesn’t work. And that’s where people’s resistance to it is. Well, there’s a part of me that wants to be like, hey, that’s like me saying that, I don’t believe in the sun, or I don’t believe in the designated hitter in baseball. Those things exist, just because I may or may not like them doesn’t mean that it doesn’t work. Now, I would win approximately 0% of people over if I did take that approach.
Katie Vernoy 3:25
Sure.
Curt Widhalm 3:26
And I think a lot of the advice and credit to a lot of the therapists who responded on this thread, I think that a lot of it just comes down to validation.
Katie Vernoy 3:36
Sure.
Curt Widhalm 3:37
And, you know, in general, just kind of how did you come to that conclusion? And, you know, being able to use some of those therapy skills that we have that is just kind of like, tell me more about that. Tell me, you know, what your experience with therapy has been. And I think when I have done this with people in the past, a lot of times it comes down to: I had a bad experience with therapy, I didn’t get what I wanted out of therapy, somebody in my life went to therapy, and they made changes that I did not like. And I am going to blame the entire profession on those changes rather than somebody getting some benefits for themselves out of therapy. But I think that oftentimes, the best thing to do is validate and be able to say, oh, yeah, sounds like you did have a bad experience with therapy. And really being able to go on and acknowledge, you know, hey, there’s bad therapy out there. There’s therapists who are, you know, mismatched with some of their clients, sometimes. There’s bad therapists out there in general, like is much as we try, Not everybody is great and even you know, sometimes I hear this from just about every therapist, not every single therapy session is a winner, you know that there’s some times where, admittedly, sometimes we have lackluster sessions. And that means that, you know, okay, that was a bad session, not that therapy in general is bad.
Katie Vernoy 5:20
So it’s validating and clarifying that not all therapists, not all therapy.
Curt Widhalm 5:27
And not even all the time with good therapists,
Katie Vernoy 5:30
Not not all the time with good therapists. So I think it’s, it’s something where the validation, I think, is disarming, I think it also is connecting, I think it’s a great way to start. To me, I feel like there’s, there’s additional elements that go into deeper conversations, looking at the expectations people have for therapy, or why people are coming to therapy. I think there’s a lot that impacts how someone views therapy, and what they get out of it. And so I know before, we you know, kind of in our pre-record for our Patreon folks, we talked about some of the different types of clients who may have bad experiences or have ineffective experiences with therapy. I’d like to talk about first, because I think this is, these are the people that I think oftentimes are the most hesitant, skeptical of therapy, are folks who are forced into treatment. Which can be partners, it can be kids, it can be court ordered, it can be a lot of things. And so I’ve worked with a lot of those folks. I know you currently work with a lot of these types of folks. How do you approach them saying, “well, it doesn’t matter, I have to be here, therapy doesn’t work, therapy’s BS.”
Curt Widhalm 6:45
I think it’s the same approach to start with, which is, let’s talk about that. How did you arrive at that conclusion?
Katie Vernoy 6:54
Sure.
Curt Widhalm 6:55
And, you know, so this is kind of that working with resistance piece when clients are already in the office. Of like, hey, you know, let’s talk about what your your perceptions about therapy are. Let’s see if some of this stuff is things that we can just be able to kind of talk through and work through. Maybe one or both of us has misconceptions about what it is that we’re here to do. You know, sometimes I’ll hear from clients, and I work with a lot of teenagers, so I was here just like you’re, you’re here to change my mind about things. Well, let’s talk about what your goals are. And then let’s work towards your goals. And what I’m here to do is to help you be able to get to those goals. I don’t need therapy, my parents are making me do something. Okay. So your goals are get your parents off your back.
Katie Vernoy 7:52
Or to get out of therapy.
Curt Widhalm 7:53
You’re right. Yeah.
Katie Vernoy 7:54
Like graduate quicker.
Curt Widhalm 7:55
Yeah.
Katie Vernoy 7:55
That was definitely the mechanism for me. It’s like, okay, well, your parents want you to be here. What do you need to do to be able to get out of therapy? You don’t want to be here, what are the goals that they’re setting? How do we nod to those? What are goals that you have? How do we get you to a place where, like you said, you get your parents off your back?
Curt Widhalm 8:15
Yeah. Number one goal, what are they seeing that’s me? So yeah, it’s being…
Katie Vernoy 8:21
Meeting them where they are.
Curt Widhalm 8:22
Exactly. And that’s, that’s a lot of, you know, once clients are in the office, but the ones that I hear that make things the most challenging is two households, families, where…
Katie Vernoy 8:37
Families of divorce.
Curt Widhalm 8:38
Yes, yeah. Where a parent called the the non custodial parent or the parent who doesn’t have the, I’ve identified a problem with my child, and I would like them to go into therapy, but you reach out for the consent and make yourself known and you get met with, I don’t believe therapy is gonna work and blah, blah, blah, and all this kind of stuff. And usually, it’s a very short conversation where there’s not a lot of opportunity to be able to say, Well, hey, you know, tell me about that. Tell me what you think it is that you’re afraid that I’m going to do with your child that I can help answer any questions on, because sounds like we might not have the same idea of what we’re here to do.
Katie Vernoy 9:28
Sure. I think in those situations, I think there’s this other element of trying to get to their concerns.
Curt Widhalm 9:35
Yes.
Katie Vernoy 9:36
Because if they don’t have the ability to force their kid out of therapy, it’s more what is the fear around your kid being in therapy? And so obviously, there’s a lot of joining that has to happen there to be able to get to a place that you can actually ask that question. And that may not be possible if you’ve already got kind of a hostile parent to begin with. They’re they’re being forced into the situation, they don’t think it’s going to work. And so trying to join with them can be very challenging.
Curt Widhalm 10:08
Yes.
Katie Vernoy 10:12
And so sometimes you just can’t I guess I’m getting to that sometimes you just can’t get there. But when you can, it can be pretty powerful to be able to talk with them about their fears, allay their fears, talk about ways they might be able to be involved, so they can see what’s going on, being able to talk through what goals they may have for their kid, for their family, whatever it is. I mean, to me, it seems like there’s there’s a lot of benefit to trying. But I think there are a lot of clinicians who get afraid and won’t step forward. And so I just wanted to acknowledge it’s hard, but it’s worth it.
Curt Widhalm 10:43
Yeah. And one of the things that I hope our beloved listeners are catching on here is, we don’t jump to trying to convince people that therapy works. There’s not like, hey, studies show that this helps people with these, you know…
Katie Vernoy 11:02
You’re not throwing evidence base at them.
Curt Widhalm 11:05
No, because you’re you’re not bringing logic to an emotional argument here. And you’re not going to get anywhere with that. So while all of that logic is true, know your audience and know how to apply that there. And a lot of what makes early resistance in therapy work, whether it’s somebody can, you know, considering entering therapy, or trying to fight against it, if somebody’s trying to force them to come in is: help, you know, talk about like, what therapy is. Hey, this is where we set some goals. I can help you put some words to it, but, you know, you sometimes hear like, um, you know, I don’t understand how talking about something is going to help me get past it. So might be breaking down some of the process that goes alongside that like, Okay, well, we do more than just talk about things. We do more than just me sitting here and being like, and how do you feel about that?
Katie Vernoy 12:04
I think if you can make jokes about those things, I think it’s something where it helps because you’re humanizing the person, you’re showing a little bit of humility around what therapy is, and you’re not treating them as a problem to be solved, or their kid or them as damaged.
Curt Widhalm 12:26
Yeah. And I think it also goes against one of those therapy jokes, that’s, you know, how many therapists does it take to change a light bulb, just one, but the light bulb has to want to change. There’s some truth to that. But I think in being flexible in kind of your approach to things helps to work through some of the resistance about therapy. But a lot of it just comes down to not being defensive ourselves in response to however people may perceive of our career.
Katie Vernoy 12:58
And I think that defensiveness can be very, I don’t know, tempting, I don’t know that that’s the right word. But it can be easy to go to defensiveness, especially early in your career, because you’ve invested in this, you feel like you’re being put on the spot, you have to prove yourself, you have to prove that what you’re doing is going to be helpful. And honestly, that’s probably the the least effective way to address some of these questions and concerns.
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Curt Widhalm 13:26
With people who might be considering therapy for themselves, I think that this is where you might also feel, you know, to the well, Have you tried therapy? Have you tried therapy with me? sort of things, you know, let’s work towards finding somebody that might know more about your experience, has some lived experience with these kinds of things, then you’ll see maybe some other kinds of resistance or some misconceptions about things and that might show up as like, well, you know, it’s just super expensive to get into therapy, or how many times have people legitimately brought up especially here in the last couple of years of like, it’s so hard to find a therapist. It’s so difficult, people aren’t calling me back, or they have really, you know, limited availability, that doesn’t match with my schedule sorts of things. That does show at least some progression through like, Hey, I might be in a little bit of a pre contemplative stage here to maybe try some things out. But there’s other things that are coming up. And that’s also where you don’t want to start problem solving for them. This is still kind of a, you know, validation sort of thing. You’re not going to turn to that logic and be like, ah, but now that you are in thinking about therapy, have you tried it? So don’t get to that sales point yet continue to show those are also really valid concerns that get in the way of not having things get better fast enough. You know, this is really then where you can kind of turn it into: Alright, what are you looking for that could actually be helped? You know, this is getting somebody else’s perspective here, this is something that is not just kind of like, Alright, you’re gonna get answers on everything. It’s something where it’s like, alright, really understanding where you’re coming from, is kind of the first part of therapy. And I think that sometimes people come in with the expectations or have this idea that therapy is just like, I’m gonna get told what to do. And if I don’t like it, then it’s obviously not going to work. And I’ve already made my mind up that that’s going to happen. But really being able to not take on, you know, random strangers on the street or at dinner parties, or that kind of stuff. Oh, therapy doesn’t work. Well. Let me stand here in therapize you. Well. But this is really, you know, kind of showing like, Oh, here’s some very soft skills that can be done in three or four sentences, like, yeah, those do sound like barriers that would make it to where therapy potentially couldn’t work in this situation.
Katie Vernoy 16:10
So in in talking about the kind of the resistant folks, the people who are like, I’m being forced here, or I’m being forced to accept this, because my kid was brought to therapy, and I think therapy doesn’t work, there’s a little bit more energy behind it, right? There’s this element of this is threatening in some way, and I’m forced to deal with it. But it also means that there’s that element of I’ve got to come to terms with it. When we’re talking about folks who are thinking about therapy and coming up against all these barriers: it cost too much, I can’t get a therapist or I don’t even know that therapy is going to work anyway. I think, to me, yeah, I think you validate those, validate those things. But I don’t know that there’s great solutions right now. Because it is hard to get a therapist. It is expensive for most therapy. It is something where there are people who are going to get all the way to a therapist after a long search and have bad therapy. And so where I go in that situation, is there’s a lot of different types of therapists, there’s a lot of different ways therapy can work, let’s talk about what that what therapy can be, and see if that’s something that’s of interest to you. Because yeah, if it’s if it’s something where you’re, you’re going through this thing, because that’s the only mechanism of change that people are suggesting to you, or, you know, we had our kind of the “is therapy, the new, you know, religion,” the you know, like, you have to be in therapy to be dateable, or you have to kind of go to do, do your work to be safe to be around other people. If you’re in this place where it’s not a good match, I think people are going to have more and more of these experiences that therapy is BS, because it’s not for that. It’s not for a badge saying, I did therapy, I’m safe. It’s it’s for actually doing some of this other work. But there’s folks who do very intense treatments or folks who do more of a, you know, kind of relationship based, I’m much more relationship based. But there’s also folks who will give advice, therapists who won’t give advice. And there’s, there’s so many different ways that therapy can work that I think being able to talk to someone who’s going to like therapy is BS, because of these barriers, and actually doing a little bit of education on what therapy is or could be, I think can be helpful. I don’t think it’s like, da da da, da da, da “Here’s therapy” and like doing a hard pitch. I agree. I don’t think that’s appropriate. But I think that there are so many misconceptions for people who have not been in therapy, or who have only been in therapy with like one therapist about what therapy is, that I think that there’s that element of being able to, you know, kind of get to the place of What is it they’re actually seeking? Because it could be and I will await the pitchforks, but it could be that they need coaching instead of therapy. It could be that they need to go to a psychiatrist and think about meds management first, or it could be that they need to increase their social support network, you know, it may not be solely therapy as the answer. And if they’re hitting barriers, and they’re getting less and less convinced that therapy is going to work for them or they’re that defensive, like, well, I didn’t want therapy anyway. I think it becomes hard if we see ourselves as the only answer. And we don’t really go through the explanation of therapy can look very different with different therapists.
Curt Widhalm 19:22
I have two ideas that go in two very different directions here, but I love a lot of what you’re saying.
Katie Vernoy 19:28
Okay.
Curt Widhalm 19:28
So I’m gonna start kind of latest first on this out of what you’ve said. Some of what people might need is they might need social work, they might need to, for especially more systemic problem type of things.
Katie Vernoy 19:44
Yeah.
Curt Widhalm 19:45
If I go to therapy, and I just talk about, you know, poverty and you know, not having access to things in my life, how is talking to somebody going to address those kinds of things? I agree.
Katie Vernoy 19:57
Yeah.
Curt Widhalm 19:57
You know, dealing with things that systemicly cause problems. Yeah, therapy might not be the part of it. But that’s where I really appreciate more holistic looks at being able to treat people. And if that’s something that can be incorporated, do it. But the other thing…
Katie Vernoy 20:15
And, well, let me let me respond to that before you go to the other idea. I think the thing I like about that is that it it speaks to what we’ve said a number of times is that sometimes therapy can be individual responsibility for systemic problems, and that that’s not helpful. And so either therapists who think more holistically or have access to resources that can help folks to actually address their systems, I think it’s something where individual therapy with somebody that’s going to look at you as the problem when the problem is actually the system, it’s absolutely harmful. So I think, to me being able to get to a place of honoring that sometimes therapy is potentially even an avenue to other services, because it’s real life things that are stressing people out, not mental health concerns.
Curt Widhalm 21:02
Right. And I think what you’re talking about also bridges to the other point that I was gonna make, which is, I tell people, here’s what therapy is like with me. I learned this from you know, one of my co instructors at Cal State University, Northridge, we’ve referred to him a lot. But Ben Caldwell, he teaches the other half of a class that I teach there, but one of the assignments that we make for this class, for first semester therapists is: have a casual conversation with somebody. We make people video it for our class, but having, that that way we can grade them on it. But…
Katie Vernoy 21:43
It seems like that becomes less casual once you’re videoing it. But that’s, that’s a whole other…
Curt Widhalm 21:48
Don’t, don’t have a formal conversation, have a casual conversation with somebody about what therapy is like with you. And because I think that rather than it being kind of this monolithic sort of treatment, where everybody is exactly the same, and something that from the very beginning of our podcasts, and all of the work that Katie and I do is embracing what the individual aspects of things are. And so when you were talking about like, you know, some people do really intense deep work, some people do cookie cutter approaches, that’s just kind of some people, you know, bring out Nerf guns and shoot their clients with Nerf guns. You know, I don’t always approach every single client in the exact same way. But when I talk about kids in my office, we’re going to do a lot of experiential stuff. So that way, they’ve got the skills to deal with it. And it’s going to be goofy, it’s going to bring up big emotions, it might even be frustrating at times, and then we take pauses to be able to be like, Alright, what’s the skill that we need to use right here. And so I think that part of, you know, trying to address the therapy is bad is not necessarily taking on that every client is necessarily for you, but also that you don’t have to be in defense of every single therapist out there. I think one of the things that I see this on sometimes it’s kind of the reverse end, in some of the therapists Facebook groups, when we’re, we’re so quick to judge, Well, I would never do that in therapy, you know, you get kind of a snippet out of a description of a client session or something like that. And just, that’s three sentences. There’s no context to that.There’s no context to the relationship that happens. You know, when we did our CE episode on Humor in Therapy, there’s definitely clients that I have banter with that it makes sense in our relationship that, all right, it’s gonna start with an insults. And it might be the client to me, it might be me to the client, but it’s within such a deep context of the relationship that does not get translated out. My general advice people don’t start your sessions with clients with insults.
Katie Vernoy 24:05
Sure.
Curt Widhalm 24:06
But it might sometimes be something that relates to a client and the way that they are best able to access what they need out of that session. Bringing us back to…
Katie Vernoy 24:21
Well, I was just going to the thing that mostly people say work is the relationship right. And so I think it’s relevant to our conversation. I think that’s a hard a hard thing to sell from like a website. It’s a hard thing potentially even to sell from an initial phone call, right? Is that it coming to therapy with me is adding this person to your life and this is who I am, and this is how I relate with you and these are the things that are going to happen. And this is the type of healing relationship that we’ll have. I think those things become very hard and oftentimes those things, even though there is evidence about that how effective the relationship is, I think it’s hard to explain that to folks who are going, well, I want, you know, I want, quote unquote, medical care that’s going to address this efficiently. I don’t necessarily want to spend years creating a relationship with you. So that three years from now, you insult me in just the right way, and it turns your life around. Like I don’t, I think people signing up for some of this stuff, I think it’s hard to do. And so I can see why folks would be like, therapy is BS, and like, you’re keeping people in therapy forever, because they pay you and it’s a good business model. Like I can see people seeing that as problematic. And it’s something that I feel like is the, the way I’m most effective in my therapy practice is in the relationships. I don’t know that I’m necessarily insulting my clients very often. But it is something where I know them so well, that this one, I make a joke, this one, I say something a little bit sharper than anybody else says in their life. The relationship gives me permission to do stuff. And like I said before, it’s hard to sell that as you’re signing up for a relationship with somebody that’s healing.
Curt Widhalm 26:11
So, in kind of maybe adding to this a little bit: short term can be my kid needs help with dealing with bullies.
Katie Vernoy 26:20
Sure.
Curt Widhalm 26:21
All right, part of the experiential part of that is I’m going to make fun of your child. And over the course, over the course of a few sessions, if they get really good at dealing with me, then they’re going to be able to deal with kids at their school.
Katie Vernoy 26:36
Sure.
Curt Widhalm 26:37
But I think that part of this really comes down to what we talked about in an episode long ago about what the therapeutic alliance really is. And you go listen to the whole episode, but it basically boils down to you and the client identify what what it is that you’re going to work on, you identify on how you’re going to do that, and you identify on how well you’re doing that.
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Curt Widhalm 27:01
And I think that this leads to kind of the last group of people that talk about therapy doesn’t work is those clients that you’ve been working with for a while, that end up having a struggle, and, or are starting to drop out of therapy, not showing up for sessions, those kinds of things. And you hear some version of the phrase, you don’t really care for me, you’re just in it for the money. And there’s, you know, already kind of an established relationship in there. I assume, Katie, that you never hear this with your clients. So, before I give my answer on this, what advice would you give to hypothetical therapists who are like, I’m hearing this from clients?
Katie Vernoy 27:48
I have gotten that, of course, everyone has. Even even when I was making very little at an agency, I’d had clients say like, oh, well, you’re just in it for the money. It’s it’s a hard response. Because there’s so much of it depends that goes into it. Because client by client, there is different ways the relationships show up. So for my clients who I have very deep relationships with, there’s a lot of attachment work that’s been done. I will just look at them and give them an expression like, Uh-huh, really. And we talked about it like, what’s, why is this coming up now? What’s going on and just deal with it clinically. I think for newer folks, or folks who are starting to fall out, or it feels more transactional to them or whatever, I explore where, I mean, I still go, why is this coming up? But I think it’s that element or for what reasons do you feel this, you know, trying to get the why out of there. But it goes to what are you experiencing from me that it’s feeling more like this is transactional versus the relationship that we’ve developed? Or what’s going on here that that’s, that’s what’s brought up because yeah, I’m getting paid to do this. And it could be I’m getting paid very well, or I’m not whatever, like I, you know, I don’t know that how much of that information is relevant to the conversation. But feels like it’s an opportunity to double down on the relationship building. And the way in which that I care for my clients and the way in which I care for that client in particular, without crossing boundaries, of course, so that there’s an understanding of, of why I’m showing up for this client in this way.
Curt Widhalm 29:20
A lot of times, for me, when I hear that, it’s coming back to the idea of what is it that you’re expecting out of our work together? You know, it’s, again, it’s validating to the concern, and depending on, you know, the kind of setting that you’re working on, like Katie described here, there may be some accuracy, there may be some whole lot of projection on to, you know, if you’re working at a free place that you’re not getting paid either, like doesn’t have any meaning to it.
Katie Vernoy 29:58
Yeah. And to pay I think on the client, you can sometimes make a joke about it. I’m like, Well, I’m not making enough to make a difference. So let’s talk about why you why you’re feeling this way.
Curt Widhalm 30:10
But it does come back to that validating the concern.
Katie Vernoy 30:13
Yeah.
Curt Widhalm 30:13
And reestablishing what it is that you’re hoping to work on with the client and what the client is actually wanting out of therapy. And, you know, not everybody at that point is going to be convinced to come back in for more sessions. But a lot of it’s just kind of ending up being able to respond with like, sounds like you have some very serious concerns here. You know, I’ve, you know, been able to, especially with, you know, some of the clients that I’ve seen for more than a handful of sessions and say, you know, my care is free. My education and experience is what is being paid for. But really, this is not a question about care, this is a question about what is it that you need right now?
Katie Vernoy 30:59
Yeah. And I think in some ways, this, this goes to the folks who are feeling like it’s not working, and you just are doing it because you’re mercenary, or or even some of the clients I talked about at the very beginning, who feel like they’re not making progress, and they’re blaming themselves. At times, when it’s appropriate, when this initial kind of exploration of why it’s coming up is completed. If it if it truly is their perception that there’s a lack of progress, I feel like there’s a few ways to go from there. One is, if there truly is a lack of progress, I think there can go to Am I a fit for your needs? What are your expectations? What can we do? Is there a better fit? Like how do we get to a place of you making progress in treatment? Or are there augments to treatment that might be helpful. And so I want to honor that sometimes therapy with you is not working, it is BS, and you need to refer somebody out. But I think in the other regard, and this, this is something that I think is much more typical, at least for me, is they’re not seeing progress, because they still are struggling. And so at that point, I go into really being able to reframe and identify the incremental progress. And I think that can be very, very helpful for folks who are especially, you know, low self esteem, depressed, the folks that their, their mental health concerns are going to amplify their lack of hope that they can get better. And so being able to compare, and I think this is, this is something that I think community mental health helped me with is, we always had to justify medical necessity, even with clients that had such tiny bits of progress, that I’m always looking at, let’s look at where you were, where you were, in the beginning, where you are now and what is different? You know, it’s like one of those pictures of like, can you identify what’s different in picture A and picture B? It’s like, sometimes it’s the tiniest little thing. But being able to see those things was part of my documentation for Medicaid. And being able to say, you being able to tell this to me right now, is progress because of X, Y and Z or…
Curt Widhalm 33:12
Yes.
Katie Vernoy 33:13
…Let’s think about where you started and what you were dealing with, then. And let’s look at what you’re dealing with now and being able to really see and explain very explicitly what progress is made. And I think the reason I say community mental health help with it is because that was we had to do that to be able to keep these clients longer term. It also helped with hopefulness, because it’s like, you know, these tiny, little incremental progressions, they still had so many huge things they were dealing with, but being able to see that tiny little progress is, is magical in a lot of ways. And so I think being able to see it, being able to talk about it and being able to do it with a straight face, meaning that you believe it, and it’s real, and it’s not, you’re just trying to scramble to say like, oh, progress has been made, I think is hugely impactful for the therapeutic relationship and can oftentimes be the jumping off point to additional goal setting or strengthening of the relationship or the things that you were talking about. I think the only other point I wanted to make about this last point is if therapists are brand new and defensive, or if therapists are burned out and feel like therapy doesn’t work either, I think both of those conditions, and obviously not every new therapist is going to get defensive and not all experienced therapists are going to be burned out I’m, I’m just saying when that is the case, it can be very hard to hear that: therapy is BS, you’re just in it for the money. Therapy doesn’t work. You’re a bad therapist, whatever it is. Those things can be very hard to hear. And it’s hard to then have the resources to be able to think through how do I address this clinically, how do I validate validate their point of view and how do I find their path towards healing? Whether it’s, you know, like, Yeah, let’s find a better match. Or let’s look at the progress that’s actually been made. Or let’s look at the possibilities of what we can do in our work together. If you don’t have resources, or if you feel so hurt that someone said this to you, it’s going to be very hard to get to those places. And, and so it’s getting the consultation or supervision that you need. And seeking the resources that are in whatever that community is, whether it’s a group, supervision group or consultation group or friends, colleagues, whatever to get, get to a place of, of groundedness and wise mind, whatever the right word is for you, so that you can actually engage in these conversations without them feeling painful.
Curt Widhalm 35:43
We would love to hear your thoughts on this. And you can do that, share it with us on our social media, join us in our Facebook group, the Modern Therapist Group, or reach out to us and any of the other ways that we respond to our wonderful listeners. If you like our content and want to find other ways to support us, please consider supporting us on Patreon or Buy Me a Coffee. You can find our show notes over at mtsgpodcast.com and until next time, I’m Curt Widhalm with Katie Vernoy.
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