How do I become an effective therapist?

In entering the field of therapy I feel a sense of smallness.

Around me I am surrounded by people who have years of experience, mountains of knowledge, and more training than I. 

I look on internet sites for counsellors advertising their services and I see that they are trained in a dozen different methods and treat clients with a myriad of problems and issues.

I could spend a fortune attending training after training, but should I?

Maybe, maybe not.

I want to become an effective therapist. What does that mean?  I want to be as skillful as possible in doing what therapists do.  As one of practicum supervisors says, what little we do.  In the right time and place I want to be ready to assist someone in making the changes in their life they need, or gaining the perspective that they are seeking.

People say that therapy is part science and part art- many argue for more or less of one or the other.  I tend to agree with the mixture theory.  I do not just want to do what feels like the right thing to do but what has worked positively in the past for others in similar circumstances.  However, I do not believe in a cookie cutter approach and believe in miracles, and intuition and want to think outside of the box with imagination. 

My first obstacle in becoming a therapist is simply experience and supervision.  In my practicums I have had the chance to do general counselling but am only beginning to feel more confident or even versed in few therapeutic approaches (e.g. CBT). 

I originally felt trepidation in pursuing a counselling practicum as i did not feel wise enough; or that I was ready to take on the intimate details of people’s painful lives at this point in my life.  Knowing myself I know I always pull towards working with the most marginalize but realize this must come from a firm place of readiness.

So instead I have had practicums specializing in mental health and addictions, but without intensely supervised counselling experience.  In some ways I regret this, but I also trust that God will open up doors if this is to be a path that I am to pursue and that it will happen at the right time in the right place with the right supervisor.

Now I am beginning to develop the curiosity and passion for therapy that makes me want to learn everything I can.  I take this as a good sign.  I still have my doubts about pursuing this vocation, but I am grateful for my times of self-doubt as they show me my weaknesses.

There are many different roads I could take to become a therapist, currently my road is finishing my masters of social work, continuing to learn and process on my own, and to keep my eyes open for opportunities to apply this learning, and look out for good mentors and supervisors.  I would love to take a bazillion courses, but I just don’t have the money right now.  Also the idea of taking course after course makes me feel increasingly confused.  I think I need to digest what I learn fully before going to the next course.  I cannot expect myself to take lots of training and then magically practice all that I have learned.  I want to carefully learn and ruminate on what approaches are not only supported by evidence, but would jive with my personal style, and fit with the type of problems that are coming up with clients I see.

For example, after taking a theory course in counselling I developed an overview of different theories but I’m still on the fence as to what I think of them and how I could apply them.

Ultimately I want to use this vocation to serve God- if it becomes an idol, a way to self-agrandize, or a pure pursuit of money- that I don’t want it, I’m better off-putting my energies into being a true friend to ll those around me  instead.  Ultimately love has to be the centre of this practice, otherwise I’m just a clanging gong (1 Corinthians 13).

This is supported by research in literature that shows more effective counsellors and more affirming and nurturing. However this is not the only element cited, but as well offering a new schema or rationale offered with confidence by the therapist as well as techniques that match the client’s expectations.  Techniques account for only 12-15% of success, more can be attributable to counsellor characteristics than a particular approach. Techniques really rest on the sense of positive alliance with a counsellor. 

In many ways this puts me somewhat at ease as these are aspects I’ve been working at for some time.  Now it is time to learn the details of techniques and theoretical orientations and figure out where I fit in and what I agree with.

Will I learn to be an effective counsellors? With perseverance, I believe and hope.  However, more importantly will God be able to use me as a counsellor through my strengths and weaknesses that I have?  That I am truly hoping and praying for.

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Dialectical Behavioral Therapy (DBT) Musings Part One

Dialectical Behavioral Therapy was created by Marsha Linehan, a psychologist based in Washington. It combines cognitive behavioral therapy and mindfulness principles in a highly structured program to treat individuals with emotional regulation problems, most notably those with Borderline Personality Disorders.

It has undergone a lot of scientific review and now is considered one of the most successful therapies for this diagnosis, as Borderline personality disorder (BPD) is not treatable by pharmaceuticals (although medication can be used to address symptoms of depression, anxiety, and sleep issues).

I was eager to receive training in DBT at my practicum and jumped at the chance as I knew it was one of those therapies that is very valuable to have under your belt as an up and coming therapist. However, I was wary of how much I would be comfortable with it as it relies heavily on Zen Buddhist principles, and I am a Christian.

I have never myself gotten into practicing meditation. In an Anglican church I was part of I tried to engage in centring prayer but did not persist in it nor did attend any training.  I have done meditation on verses or words in the Bible, as there are verses in the Bible that tell us to meditate on God’s nature, his creation, and his word.  However, I was wary of meditation that aims to empty the mind or to be rid of all thoughts.

Why is that, you may ask? I wondered the purpose of emptying the mind, and what you fill it with after it is empty? I experiences of meditation alone form one’s basis for who they are then I would object, because I think we discover that in discovering God’s love for us, not in entering a state of nothingness.  However, it is true that emptying our mind can be good for getting rid of anxious, depressing, or disturbing thoughts which most people struggle with, especially those with Borderline Personality Disorder.

A scripture came to mind when I was thinking of the idea of emptying the mind: Luke 11: 24-36

24 “When an impure spirit comes out of a person, it goes through arid places seeking rest and does not find it. Then it says, ‘I will return to the house I left.’ 25 When it arrives, it finds the house swept clean and put in order. 26 Then it goes and takes seven other spirits more wicked than itself, and they go in and live there. And the final condition of that person is worse than the first.”

So the message I get from this verse is to be mindful that after you cleanse or heal the soul/mind that you do not leave it unoccupied, which can be the case with meditation.  But this verse is not primarily directed at those whose lives are cleansed by God but then do not fill it with anything from God afterward.

Needless to say I had my reservations about whether I could teach this therapy given that I have not previously practiced meditation and I wondered if my faith would be in conflict.

What I have discovered to date (within the context of the DBT group that I have been observing) have been very useful concepts, many for which I can see a clear biblical basis which I will outline in my next post.

What is this blog about?

This blog is an attempt to synthesize all the thoughts that I’ve been collecting in my head around social work, faith, therapy, psychology, and the like.

I’m at the tail end of a masters in social work in Canada.  I have had two placements in the area of mental health and addictions.  I also live in a poor neighborhood in our city, and am part of a network of Christians who are wanting to support people around here, creating a new kind of family, and a renewed expression of church.