Becoming a Therapist

On the Path to Mastery

Thomas M. Skovholt

• Publisher: Wiley
• Year: 2012
• Print ISBN: 9780470403747
• eBook ISBN: 9781118178195
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Praise for Becoming a Therapist

"This resource is filled with practical and personal advice, relevant stories, and examples, and reads more like help from a friend than a typical textbook."
—Roberta L. Nutt, PhD, ABPP, Visiting Professor and Training Director, Counseling Psychology Program, University of Houston

"Ah, now this is the book I wish had been available when I entered the field. Tom Skovholt has defined the initial experiences and followed the process through to the culmination of the therapeutic experience in a truly great book. Becoming a Therapist is a major contribution to our field."
—Arthur (Andy) M. Horne, Dean and Distinguished Research Professor, College of Education, The University of Georgia; President-Elect, Society of Counseling Psychology

" Becoming a Therapist 's informal style is accessible and engaging and yet soundly grounded in evidence and in the wisdom Skovholt has developed through his career-long research on psychotherapists and their development."
—Rodney K. Goodyear, PhD, Professor, School of Education, University of Redlands; Emeritus Professor of Education (Counseling Psychology), University of Southern California

Essential guidance for mental health professionals navigating the start of their helping careers

Written for those entering a career in the helping professions, Becoming a Therapist: On the Path to Mastery explores the therapeutic career path for new practitioners, painting a vivid portrait of the novice therapist's journey.

This practical book guides you in using the helping relationship to improve the lives of others, whether your chosen profession is in counseling, clinical psychology, social work, school counseling, addictions counseling, family therapy, medicine, community counseling, pastoral counseling, or academic advising.

Destined to become the resource every new practitioner turns to again and again, Becoming a Therapist prepares you for the reality of what it means to be a beginning therapist, with relevant discussion of:

• The fifteen indispensable qualities of every mental health professional
• The unfolding practitioner self
• Self-care for burnout prevention and resiliency development
• The importance of culturally competent practice to practitioner expertise
• Practice, research/theory, and personal life: the practitioner's learning triangle
• The significance of peer relationships in the novice experience

Steeped in author Thomas Skovholt's years of experience, Becoming a Therapist thoroughly and clearly illustrates the excitement, intensity, anxiety—and, ultimately, the satisfaction—you can expect as a helping professional.

1

Opening Up Your Life to the Excitement of the Therapy and Counseling Professions

15 QUALITIES FOR THE THERAPIST/COUNSELOR

All career fields have key qualities, attitudes, and skills that are needed for success. For the architect, it includes proper spatial calculations; for the tree trimmer, obsession with safety is valuable; the psychometric psychologist hates measurement error; the chef seeks a well-timed mix of ingredients; for the baseball player, it is seeing the ball and its secrets when coming out of the pitcher’s hand. In order to excel at the work, each of these occupations calls for the mastery of specific attitudes and skills. What are therapists’ difficult-to-master attitudes and skills? What key qualities do we need? These are important questions for emerging practitioners.

Key Quality 1: Enthusiasm Within Insecurity

Helge Rønnestad and I wrote years ago about the emotional reactions of the beginner in our field. These emotions seem to be timeless and are part of the rite of passage into the work whether one begins in the early decades of the 21st century or decades earlier.

Enthusiasm and insecurity are predominant affective expressions. The beginning graduate student feels very excited about learning how to help others yet very insecure about her/his knowledge of therapy/counseling procedures and one’s own ability to succeed.

—Skovholt & Rønnestad, 1995, p. 24

The excitement and the fear, the known and the unknown, the certain and the uncertain. These are the conditions for novices entering the therapy and counseling professions. Like other explorers, such as Lewis and Clark in North America and Jane Goodall in Africa, novices enter a personally unexplored wilderness.

A bounty of unknown sensations, stretching experiences, new perspectives, and skills await them. Our profession, wherein we commit ourselves to being helpful to others, is at the center of this world. There is a thrill about the novice practitioner voyage into this world, about the steps taken to be a practitioner of helping and human development. To get there, novices must enter the vast unknown. Explorers are to be applauded for their risk taking. The joy when entering the helping professions is the anticipation of an effective professional career of service to others. Professional development is about cultivating a style and skill level that optimizes the human development of those clients who invite us into their lives. If done right—with respect, caution, and skill—the counseling process can be of benefit to others.

Key Quality 2: Courage

If you pay attention to the world you see a lot of pain. . . . Francesca was in therapy after a brutal date rape. Sue Anne came because her husband had just killed himself.

—Pipher, 2003, p. 53

Therapists/counselors must possess immense courage. Our enemies are the distress trilogy of anger, anxiety, and depression that invade the lives of our clients. We must stand up to these crippling emotions and not be afraid. How can we help our clients if we are afraid of their distress?

We must wade into the anxiety and fear, despair and hopelessness, anger and rage, and stand in the pool of the client’s distress with fortitude, patience, and serenity. We must show the client that we are not afraid; if they see that we are not afraid, they need not be afraid. We stand up to fear, we do not give in to despair, and we are relentless in understanding the sources of rage while helping the other to heal. Courage must envelop us as we attack the limits that these emotions put on our clients as they try to live, grow, and extend themselves into full lives. It is easy to back down from life, from the existential realities that are in front of us as human beings, to shrivel into the routines that give us comfort and security. Just as muscles become less flexible when not stretched, the human will is more susceptible to ongoing emotional distress when it is not engaged.

Courage also involves not being intimidated by our clients. One of the reasons to get more education and have more degrees is to be immunized from being afraid of accomplished people who come to us as clients. Our clients do not need us to be intimidated by them or be jealous of them. These things get in the way of what they need—our intense focus on helping them. So, if your client is a lawyer, a doctor, a chief executive, a professor, a wealthy person, a beautiful person, a wonderful artist, or has one or another admired trait, it does not matter. Or if your client seems so different from you, lives differently from you, has made choices different from yours, it is the same. All our clients need the same thing, no more or less: our best efforts at being a helpful practitioner in their lives.

Having courage when working as therapists and counselors, as guests in the lives of our clients, can be difficult. Meeting this challenge is helping to head off the client’s ontological anxiety, a term used by theologian Paul Tillich (1952) to describe that life is not on track. This courage of practitioners, a more subtle kind than that of the boxer and firefighter, is still courage. It is an occupational essential for effective counselors and therapists. During education and training, emerging practitioners learn how to have and show this courage.

There is also the courage of novices when entering practice as students in training. Novices enter practice as a new canoeist enters white water—with anxiety, some instruction, a crude map, and some previous life experience. However, all of a sudden, the client is in front of student practitioners, telling a very personal, real story. The story often comes in a form and structure that is unique. The student experience is like the sudden rush of water, rocks, and rapids demanding instant understanding and reaction. Novices often have the urge to both call the emergency phone number 911 and appear calm, collected, and professional—whatever that is. In a study of novices in the related field of medicine, the most stressful situation was the white-water experience—having to make clinical decisions while very confused (Zeigler, Kanas, Strull, & Bennet, 1984).

Key Quality 3: Profound Empathy and Cultural Competence

We tend to forget the complexity of the process [of being empathetic]. It is extraordinarily difficult to know really what the other feels; far too often we project our own feelings onto the other.

—Yalom, 2002, p. 21

The work of therapists/counselors is also difficult because it demands that we gather information and understand the other in a way that goes against our basic nature. The human senses of touch, sight, hearing, smell, and feel are all designed to give each of us information to be safe as an individual. The information is to help each of us in our own personal survival and well-being.

We process data in our brains to understand the situation we are in and to make judgments. We do this to increase our own safety in many areas, such as physical, emotional, spiritual, financial, interpersonal, and intellectual. This constant sensory perception and processing is an amazing way that we, as a species, have developed to live and thrive. It has given us the capacity to grow, multiply, and dominate all living things.

Opposed to this ingrained natural response, therapists/counselors are required to use their hearing, smelling, feeling, seeing, and touching to sense the world and life of the other, to experience the movie of the other’s life. It is not natural. It a difficult and potentially exhausting request. And it is an enormous gift to the other. This gift propels much of the positive power of our work.

In my classes, I often ask students to describe their reactions to a common experience, such as the view outside the classroom window. During this exercise, all students look at the same view yet their descriptions differ dramatically: One student says she sees the far, large white building; another, the close oak trees; a third, the people on the sidewalk, a fourth brings up the pale blue sky as that which got his attention. Most often we dismiss such differences as cute, interesting, and funny and then move on. Yet thinking deeply about these instant perceptual differences can shake us as we realize that we actually live in a world that appears the same but can be experienced very differently.

Years ago, in an interviewing class, I asked a Jewish Israeli woman and Palestine Muslim man to talk about their common world. They could not do it. Although they were both English speakers, they had no shared language. Neither had the ability to see and feel the other’s perspective. Each had a worldview that was too ingrained. I remember a similar experience in the prime days of the nuclear showdown of the Cold War. On a television show, Soviet and American citizens were asked to have a dialog. I recall feeling frightened when they could not do it. They had so little understanding of each other. I thought, at a time when each has scores of missles directed at the people of the other country, how could USA-USSR differences ever be bridged?

Cultural competence is a central skill here. It consists of having awareness, knowledge, and skills that can connect the practitioner to the client regardless of diversity differences such as ethnicity and social class (Goh, 2005; Sue, Arredondo, & McDavis, 1992; Vasquez & Vasquez, 2003; also see Chapter 5 in this book).

The job of therapists/counselors is to excel at seeing and feeling the world of the other. It is hard work. It is not natural; it is like swimming not with the current but instead voluntarily going upstream against the current. It is an occupation that stretches the natural self like yoga or as the physical therapist stretches us. We must understand the world through the eyes of the other in order to be highly effective in helping. It is not natural to swim upstream, to put ourselves in such a challenging empathy situation, but it is an occupational essential.

Practitioners must also maintain the self while perceiving the world through the eyes and ears of the other. The task of counselors/therapists is to maintain their human perceptual system while taking on the client’s at the same time.

This is a way that counseling and therapy work is different from the interpersonal help offered by family and friends. Practitioners must maintain a dual reality: a strong sense of one’s self while at the same time accurately perceiving the world through the senses of the other. Some naturally skilled helpers, early on in life, develop the capacity to easily and accurately feel another’s distress; they have the perceptual maturity and empathy to hold onto multiple perspectives and gather data through multiple channels at the same time.

Key Quality 4: One-Way Helping Relationship Embedded in the Cycle of Caring

Therapists must be experts in fostering relationships with individuals who have difficulty doing so.

—Clarkin & Levy, 2004, p. 211

The one-way helping relationship gives the work its power. Clients’ lives, and all their nuances, command center stage. Their hopes, their joys, their fears, their needs draw therapist energy and focus. It is like the parent’s focus on the young child—the focus is on the needs of the child. So too, the teacher, the nurse, the family law attorney, the physical therapist, and many other helping fields focus on the needs of the other as part of the power of the occupation. My life might be about me, but the work is about the client.

This focus on the other is not easy. One study of physician–patient relationships, for example, found that physicians focused on themselves to a surprising amount; physician self-disclosure occurred in 34% of first-patient visits. The article title shows the problem: “Physician Self-Disclosure in Primary Care Visits: Enough about You, What about Me?” (McDaniel et al., 2007).

It can be especially hard to focus on the client when the client is not able to be positive and engaging. For example, Strupp and Hadley (1977) found an appallingly poor pattern of reaction by trained therapists to challenging client behavior. When clients expressed negativity, the therapists responded with negativity, often in a subtle way unrecognized by the therapists themselves. And these were trained therapists. It is important to be able to respond to client negativity in more therapeutic ways than just with more negativity. Anybody can respond negatively to negativity. Doing so is just basic human 101.

Those in the helping professions offer a one-way caring relationship—that is the meaning of the helping professions, the caring professions, the helping/healing/teaching professions, whatever term we use. But it is difficult because we too are human. We too have needs. We t...

Table of contents

• Cover Page
• Title Page
• Copyright
• Dedication
• Preface
• Acknowledgments
• Chapter 1: Opening Up Your Life to the Excitement of the Therapy and Counseling Professions
• Chapter 2: Novice Advantages
• Chapter 3: The Curse of Ambiguity and Other Ills and What to Do About Them
• Chapter 4: Who Am I Becoming
• Chapter 5: Developing Habits of Culturally Competent Practice
• Chapter 6: Issues, Concerns, and Tips as Antidotes to Novice Stress
• Chapter 7: Becoming a Resilient Practitioner
• Chapter 8: The Cycle of Caring
• Chapter 9: The Practitioner’s Learning Triangle
• Chapter 10: Path Toward Mastery
• Chapter 11: Practitioner Mastery and Expertise
• Chapter 12: Vertical and Horizontal Nurturance for the Novice
• Chapter 13: Worlds Apart
• Chapter 14: Epilogue
• Index