1) Kottler’s (2003) chapters underscore the importance of therapist self awareness. The therapist’s ability to be self reflective, open and honest with him or herself about feelings and life stresses appears to be critical to therapist health and effectiveness. Kottler provides lists of questions therapists can ask themselves to assess issues such as countertransference, dealing with problem clients, fantasy life and burnout. When circumstances and situations arise that a therapist cannot handle independently however, the ability to seek assistance from others is also necessary.
2) Kottler (2003) discusses a number of ‘cures’ for burnout. What are some spiritual resources you have used or could use as a therapist to prevent/address burnout?
References
Kottler, J. (2003). On being a therapist. San Francisco: Jossey Bass
1) In chapter sevens section on spirituality, Kottler explores the idea that therapists have exchanged their pure spiritual insight and soul healing abilities for monetary compensation. “Historically, therapists were always poor. They were Buddhist monks, Socratic scholars, priests, wanderers, healers. What they lacked in material affluence, they made up for in wisdom and purity of soul” (Kottler, 204). I think in some cases this may be true but I don’t think this can be generalized to all therapists. Do you think therapists have exchanged the “gift” for material gain?
2) In chapter six, Kottler discusses some issues that therapists have to deal with on a personally. One emotional issue he mentions is lack of family support (Pg. 171). Although I am presently single, I have thought about this topic quite a bit. It seems like a therapists family is in a way similar to a military family in that one member of the family may be serving but the dynamics of the whole family is affected. In the future I am definitely going to have to make sure the woman I am with is both empathic and sympathetic toward my vocation and the demand it places on me. But I don’t know, maybe that’s too much to ask. What do you think?
In response to Melissa’s 2nd post,
Some spiritual resources for me would be my prayer life and my faith community; which includes my church but it is really the intimate circle of friends there that I am referring to. Also, my family is a big spiritual resource for me, especially my younger brother and mother.
1. “Some therapists consider intense therapist reactions, when recognized, to be crucial in diagnosing how others probably respond to the client,” (p. 125). I found this quote to be not only insightful but also illuminating on therapeutic application. How a client makes the therapist feel is a good indicator of how others feel when they are around the client. I think that this would change the therapeutic techniques as well as provide invaluable insight to understanding the client’s perspective. If a therapist is able to understand not only the clients perspective (what they are telling in the session) but also have the added insight into why others might be responding to the client the way they do, the therapist is able to offer more constructive and holistically guided therapy techniques.
2. After reading the chapter on therapeutic lies and assumptions, I was a bit confused, is he advocating therapeutic lies or not? “Perhaps these games are necessary to increase the stature, omnipotence and influencing capabilities of the therapist – but it is at the expense of the genuineness, humanness, and presence that are so crucial in being with a client,” (p. 187). He seems to imply that it is less than desirable to have lies that imply perfection in the therapist, however, he also states that these beliefs inspire “faith” and confidence (p. 189). So is he saying that one is more desirable than the other or is he implying that there should be a balance between the two? In response to Stephan’s first response, I do not believe that all therapists have exchanged the “gift” for monetary gain. I think it is important not to make generalizations because inevitably there is someone or some situation that will not comply. In a highly specialized society all people exchange their “gift” for monetary gain…it is called “making a living.” I think that Kottler did sound a bit judgmental but that it is important to keep things in the perspective of reality. The reality is that in order to survive, we must make a living. And even if monks and other self-sacrificing individuals were the original holders of the “gift”, it is important to remember that they often received large monetary endowments (to the monastery or church) that enabled them to continue living with the “gift.”
1. One point that Kottler (2003) discusses regarding boredom is that the therapist will just do what they have done before and not try new things. Therapists might also not try new or unique interventions because they know that the client will just eventually get better on their own regardless of the therapists help (p. 156). To be honest I think that this cannot be beneficial for the client if we are not considering what is best for the client. Our clients deserve the best treatments and interventions. What are ways that we can do this without always repeating what we know and what we are comfortable with?
2. Kottler (2003)discusses how it requires honesty and can be a challenge to deal with our countertransference (p. 129). I would have to agree with this in that we have to be very aware of our feelings and very honest with ourselves. I am curious to know what other ways we can deal with this apart from discussing it with our supervisor or seeing our own psychotherapist.
Response to Steven’s second comment: I find it somewhat amusing that you are discussing the personality traits you want in your future wife on this blog. But, I think it is awesome that you are considering this now. No, I don’t think it is too much to ask. I think that it is a realistic and honest approach. I think that it is a good thing that you are aware of these issues now before you actually get married. And, I think these issues in the family dynamics are something that you are going to have to be aware even after you get married.
1.) Kottler speaks of the difficulties of dealing with a suicidal client. Though I have heard some jokes about what Rogers would do with someone in that situation (“Hmm, it sounds like dying is important to you,”), I do wonder what good these Rogerian techniques we are learning could do in such a situation. Empathy and unconditional positive regard do not seem sufficient. And, of course, suicide is as far from any self-actualizing organismic principle as one could get. Do you think that this, like psychosis, is an area that Client-Centered Therapy just does not work very well, or could mirroring, reflecting, positive regard in the hands of a truly gifted CCT therapist save a life? (Kottler, pp. 134-135)
2.) At first I just skimmed over Kottler’s burnout questions on page 173. I figured they weren’t applicable to me since I certainly am not burned out right now as I’ve only had one client hour so far. But as I skimmed I realized they are important for us, for me, to take seriously before we even begin. Answering these questions and getting our own therapy and prayer to deal with the answers is important to help us avoid burnout before it even begins. (Kottler, p. 173).
Jonathan Wellman, November 15, 2009
Reply to Stephen question 1:
I think the fact that Kottler’s blurb on spirituality is just over a page in a 250 page book demonstrates part of his point. One of our readings in integration had a stat that something like half of psychologists consider themselves atheists. Despite the fact that we are as Kottler says, “spiritual healers” (p. 205), our colleagues do not want to admit that. However, I do not think that mental health professionals have all, or even mostly, given up the gift for materialism. Most of us don’t make six figures, and when you consider master’s level therapists as well, many make very little money compared to the work they do. Most of us mainly just want to help. But when you combine that with the anti-spiritual bias prevalent in the field, I think what psychologists have done is to set themselves up much like a new, secular, priesthood.
1)Kottler (1993) tells of a client who confronted him about the "success" of therapy with him and I found his response to be important for us as we will be faced with this in our near futures (pp.133-134). Kottler describes how the client was waiting to make sure she could trust him; was waiting until she was ready to truly begin therapy (pp. 133-134). From this and many other examples, I feel that one of the most important things we can do for our clients is to wait it out. We must be patient and commit ourselves to the relationship. In a sense, we must prove that we're not going to give up as others may have done in our clients' lives.
2) In talking of the games therapists play, Kottler states that "to err may be human, but it is not all that noble for therapists whose power may be undermined by mistakes," (pg. 184). I completely disagree with what this statement implies. I believe it is profoundly healing for all human beings to know that they are not alone in their mistakes and in their fears. Often it isn't appropriate to disclose our many failures, but I believe going in with the heart attitude that we have all fallen will be evident for our clients. The way we treat them, the way we listen, and the power of the Holy Spirit can speak more powerfully if we first admit that we are not perfect and we are not powerful, yet we have hope. I believe that, on some level, every client we see needs to know that we can relate to the many temptations and pain they've experienced and that we have survived and grown from them.
Nikki Frederick 11/16/09
In response to Stephen's second comment: I think it goes both ways. I believe marriage tests your ability to sacrifice, yet so does therapy. Yes, your family is going to have to be understanding when you come home and need time to just be alone or to take a shower or listen to music, etc. However, your family is also going to need you to disengage from the many clients you'll see , and instead focus on them and their needs. I think it will also be helpful to allow yourself to be vulnerable in the marriage, and to "break down" in a sense. Being honest and having that open communication about whay you're struggling with because of work is vitally important.
1) In chapter 5, Kottler hit on an interesting issue that made me think about going at the client's pace. He describes that one of his clients was waiting to express her true feelings until she knew she could trust him (p. 134). This happened in the ninetieth session! It struck me as very interesting to think that we may connect some dots or observe some things about our clients, but we need to wait until they are ready to see it themselves. This brings to light how as a therapist, your job may go long periods of time without feeling like you are "helping." Any ideas on how we might stay motivated if, say, our entire caseload is full of clients who are not immediately experiencing growth?
2) Kottler tells the story of teaching in Peru and having students walk in late to class (p. 148). The lesson learned was to never interrupt a time of learning on account of adhering to time or being on time. I wonder how this may play into our sessions with clients. If a client is in the middle of some deep soul searching and the hour is up, do we let them continue or do we interject softly with, "well, we are out of time for this week?" If we let them go, for how long? Do we do this for all of our clients across the board? Interesting stuff to wrestle with.
Response to Jay's #2
Jay, I like how you mentioned seeking counseling and/or prayer before the burnout actually begins. This is something important and I am glad you pointed it out. A lot of times, therapy and prayer comes as a result of an immediate need or "emergency situation" of sorts. But, really prayer and therapy can be most effective when they are infused into our tradition and habits so that the burnout has less chance of ever really appearing.
1) One focus in Kottler's (2003) book is the issue of boredom in the therapist's practice. As a triathlete, the comparison to long distance swimming, ultramarathons and cycling for miles helped me understand the type of grueling daily commitment to which therapists' subscribe. It seems the best way to manage this boredom is to keep attention focused on the exchange and genuine interest in the human story and condition (p. 149-152).
2) The symptoms of burnout mentioned by Kottler reminded me of a movie I recently watched called “Getting Played” featuring Vivica A. Fox. In the film, three women are engaging in risky sexual behavior trying to win a bet. One of the women is in therapy and her therapist who is unhappy in her own personal life, encourages her client to participate in the sexual gamble even though her client is very uncomfortable with the idea. Interestingly, Kottler mentions a variety of sexual improprieties including this exact scenario, when burnout is present and ethical conduct is compromised (p. 160).
In response to Steven’s #1: I think the question Steven poses is a good one. Perhaps many therapists exchange the “gift” for material gain in Western culture due to the significant monetary compensation offered in the field. Such compensation may also attract those who would otherwise not choose the helping professions and increase the interest in what has become a highly lucrative career field.
1. Kottler hits quite a few key points in Chapter 7 as he discusses the ways that therapists often try to become superhuman. The aura of mystery, the perfectionism, the attempt at being objective, the desire to be indispensable, all of these point toward a desire to not give in the the limitations that make us human. We make mistakes, have off days, have a point of view, and it seems that in trying to make sure the client does not find those human elements in their therapist, a handicap is created.
2. It is generally alarming that the more burnt out a therapist is, the more likely they will breach ethical code (160). It makes sense in that a general sense of not caring seems to accompany burnout, as does a lack of willingness to think through the ramifications of action or inaction. That so many people do breach ethics in areas like sexuality may then not only be attributed to a lack of unifying moral structure in culture, but also to the culture of the work - one where therapists are burnout enough to only want something they perceive as pleasurable.
Response to Stephen:
I think in many ways therapists have exchanged the gift for that material gain. Even looking at the people in other healing professions, I think it can be seen. As children and young students, people generally enter healing professions because they want to help people, and end up wanting to repay their loans and get something that is worth their time. Not that I know how to cure that, but it is a problem.
1) In writing about dealing with problem patients, Kottler says “when all else fails, allow the clients to keep their dysfunctional behavior” (p. 145). I imagine that would be a very difficult thing for me to do. I know that we are not ultimately the ones changing people, and that we need to honor the client's schedule for change. However, I feel we are also charged with expediting and facilitating that schedule as well.
2) Kottler says that referring clients who are beyond our expertise is not really an absolute rule (p. 195). He says that if we did, we wouldn't grow have not have many clients. I wonder how much Kottler is exaggerating when he says this. I suppose he is pointing out that there are times when it is more gray than black and white. Still, I would love to hear how Dr. Bjorck would respond to this.
David Choi, November 16, 2009.
In response to Jay's first comment:
I would guess that it would probably take a more directive approach to show a suicidal client that there are reasons to live. At that point, the client's only contribution of content would be dark and pessimistic. Having said that, Roger's concept of unconditional positive regard may still help. It just probably has to be a bit more explicit.
1) It's very interesting to read Kottler's descriptions in Ch. 5 of patients that evoke strong, often negative countertransference reactions from their therapists. For me this kind of underscores the therapist's humanity (which we touched on today in integration), which can be both comforting, as an aspiring therapist, and unsettling as a client myself. Having this kind of "insider's perspective" makes me view my own therapy differently. I'm curious, perhaps more so than the typical client, about my therapist's inner world and reactions to me.
2) On a slightly different note, it was incredibly refreshing to see Kottler remark on the joy that comes with the gradual progress of such difficult cases, those little nuggets of success that make it all worth it. (This book does a good job of laying out the sometimes-painful reality of the therapist's world, and then bringing it back to the reason we do it all in the first place, the source of therapy's joy: helping others grow!) This gives me a sense of the great value of patience and perseverance in this work.
Response to Melissa's 2nd question: I think having your own therapy or supervision, some source of personal and professional nurture, is very important in preventing or dealing with burnout. Having a kind of escape also comes to mind - something to focus on outside of the realm of psychology - hobbies! For me journaling would be a great way to process, unwind, and get back to normal when I'm having difficulty with a client or my caseload in general. Family...nature...making time for and taking advantage of those things that can be easily neglected but that are so enriching.
1)In his discussion on burnout, Kottler shared the story of one professional who intentionally used his cancelled sessions unproductively (Kottler, p. 175). I thought that this was incredibly insightful. Not only does it kick against modernistic ideals of productivity but it also allows for breathing space. As we learned, Winnecott calls this "transitional space" (Grolnick, 1990). It is way to easy to get into the habit of scheduling or arranging every hour of every day.
2) Kottler explains the very human phenomenon where we "disguise our imperfections and lapses" (p. 183). It is very sad statement, but also very difficult to avoid fact, that therapists put on masks--even to themselves. How can we gaurd agianst this as Christian psychologists in order to not be alienated from loved ones and ourselves?
In response to Rebecca and Nikki's comments...I agree that the section on lies was initially confusing. I realized as I read that the lies he was talking about were lies that many therapists tell themselves whether they see them as lies or not. I suspect we will fall into this trap as well. We don't like to think of ourselves as lieing to ourselves but in all actuallity we commonly are. I think a mix between being aware of our humanity and imperfections, accepting that we do lie (and working to not), and then relying on the power of the Holy Spirit would be a good way to approach the topic. What do you think?
While there are many strategies to improve self awareness, one protective factor is creating a support network of people around us (friends, professional colleagues and supervisors, spiritual mentors, etc) that know us well and are willing to be honest with us. For example, people who love us enough to “check-in” and point out potentially concerning behaviors or trends they observe we may be unaware of (e.g. workaholism and increased irritability). For effective accountability, a commitment to trust, respect, listen to and receive feedback from these individuals is helpful.
1.I loved the quote from chapter five in which Kottler states “The key to preventing boredom and burnout, to surviving in the field with the minimum of negative personal consequences, is to do only what we can – no more, no less” (Kottler, 141). This concept ties into what Dr. Bjorck is always saying about embracing your limits. However, while I understand this general concept, I am curious as to how one finds the balance between embracing and acknowledging one’s limitations, but not becoming apathetic, and content not to grow?
2. In chapter 6 Kottler states “Helping professionals require much nurturance, understanding, and demonstrations of affection” (Kottler, 168). Consequently, how does one avoid being a therapist in all their relationships and help others understand that when we are off the clock we need to be cared for too? Additionally, how can one prevent going to the opposite extreme and becoming needy in their relationships because they are giving so much emotionally to their clients?
3. In response to Stephen’s 2nd comment: I loved your military analogy, and have too been concerned about how to balance things with my significant other/spouse. What is reasonable to expect from them? And how do I insure that I’m giving them what they need as well as getting the support that I need? Unfortunately, I do not have an answer for this yet, and my own situation is slightly more complicated because my significant other is a practicing MFT and thus will need more support as well. However, I think that by taking some of Kottler’s advice regarding avoiding burn out, we can function more appropriately in our intimate relationships and not be overly selfish because we are not overextending ourselves.
1. Kottler states that therapists should expect some form of “intrusion” or experience some smothering by their clients (144). Depending on the modality of therapy, I wonder if it is ever appropriate for the therapist to directly confront this issue if it were ever to occur. I do not mean that therapists should retaliate by addressing this issue, but do they have a right to expect clients to not smother them? I think this would be one concern of mine when thinking about my future as a therapist.
2. I have little experience doing therapy, but I have had the opportunity to be in a position where I had weekly supervision when doing floortime therapy with children with autism. This job is extremely draining, and supervision is required because of the nature of the work. I have found supervision to help with a lot of issues, especially burnout. Kottler calls supervisions a “cure” for burnout (172), and I completely agree. I have been able to process what is happening in my work and how that affects me. I also receive professional perspective. This is extremely important for successful therapists.
3. In response to Bobby’s second comment: The idea of interjecting during a session when clients are processing in depth is a difficult issue. I think when the therapist-client relationship develops, it will become more clear about what to do. Do we allow the client to have more time than allotted? Or do we get in the habit of ending on time, and making sure that we come back to the issue in later sessions? I think this is something that we should always be weighing with each client in the future. It is definitely important.
1) On page 171 Kottler talks about the therapists need for a supportive family. He says "After giving and giving all day long, a therapist can come home with a short fuse and a long list of demands. Tender loving care is indicated until he or she returns to the land of the living" (171). I'm wondering if this maybe more of a luxury than a necessity. Can stay at home mothers who have been struggling with taking care of children all day really afford for their therapist husband to find himself before helping out around the house?
2. In chapter 5, Kottler (2003) talks about the therapists reactions to clients. I'm wondering at what point we need to seek supervision for dealing with our feelings toward our clients. Obviously, if we are having sexual longings for a client that would be an indicator. However, what about when we are experiencing feelings of boredom, annoyance, or attraction? It seems like if we sought supervision anytime we experienced these feelings we would be need it a lot. So at what point?
Response to Stephen's first question: I think it probably varies. There are probably some who's primary motivation is monetary gain but I doubt that is the case for most. Indeed, I would imagine that those who do it primarily for that reason would be more susceptible to burn out and, frankly, not being a good therapist.
1. As therapists, we not only have to be aware of how our clients are doing, how they are processing, what perspectives they are taking, and how they are progressing in therapy, but we also have to be very aware of our own feelings, thoughts, reactions, and emotions (Kottler, 128). As I process through how my own thoughts about the client, or the client’s situation affects me, I am finding it increasingly important to have my own therapist and a great support system around me. To have a healthy life as a psychologist, it’s not only about how I am able to deal with difficult situations. It’s also about how well my family supports me, how well I work with other psychologists when seeking consultation, and how much I go to God for strength, patience, and peace. I have to remember that I cannot do this alone.
2. I had my first session with my live team client last week, and my goal was to stay focused for the entire fifty minutes and to really take on the perspective of the client. Once the client started talking, I forgot that she was an actor and really felt myself empathizing with her problems. After the session, I asked myself how far I should be feeling with the client. As the client expressed her frustration and loneliness during the session, I felt my emotions drop along with her. I am not quite sure yet if this is okay, or how to keep my emotions and feelings in check. I know that I do not want it to affect the quality of the therapy, and certainly do not want the session to be about me. Kottler says that burnout could be attributed to overidentifying with the client’s situation or the fact that the therapist is just trying too hard (Kottler, 170). Where do we draw the line and when are we crossing from healthy emotions over to the unhealthy, dangerous side of empathy that may lead to burnout?
Sarah Moon, November 17, 2009
In Response to Bobby’s first comment:
I also was impressed by Kottler’s patience with the woman. It’s so crucial to go at the pace that the client sets, even if we think it’s too slow. To answer your question about how we might stay motivated when it feels like we aren’t helping, it reminds me of Dr. Dueck’s chapter on narratives. When we see clients’ lives as stories and narratives, it helps us engage with them on a deeper level. Kottler mentions also that our role is to “focus on the uniqueness of each case, the individuality of each client, and the opportunity for growth in every encounter” (Kottler, 157). As therapists we need to continually look to the potential rather than being stuck on where the client is at currently, especially if they are stuck for 90 sessions!
1) Asking the therapist what they think of me (p. 130) is something that I have asked my therapist before. I wonder if this is not an ok questions to ask or be asked. Obviously, the therapist needs to understand the why of the question, but it can be helpful. I asked it because I wanted to test reality, to understand what it was that he saw, and how thought about me therapeutically. That was helpful for me.
2) Kottler's discussion of "experiencing the flow" (p. 149) is one that I have experienced before. I know that it is something that makes me feel like what I am doing is right. Being able to do that in therapy seems to be what "being in the room, and leaving your life outside" is all about.
At Nikki's first comment. I agree that it is important to wait with our client. I know that personally, I have many issues with trusting people, and to know that going into therapy with others, I think it is important to expect that clients will have trust issues as well. Not that they will have my issues, but I need to be sensitive to client's needing to know that the space is safe.
1. Kottler discusses patients who test our patience and gave an example of significant progress that was made on a difficult case (p 148). I was very encouraged to read this success story because I frequently wonder about the measure of success on difficult cases. It took years for the therapist and the client to see progress, but they were able to make progress together. The therapeutic relationship really is a partnership.
2. “A therapist should be, beyond all else, a fully functioning model for others to emulate, a personally and professionally masterful human” (Kottler, 2003, p. 200). This sounds really close to perfection. Would this be a description of a therapist that is doing their own work with a therapist or would this be a description of a therapist that does not need to do their own work in therapy?
Response to Bobby’s 2nd Comment: I think about this issue often. What if there isn’t a good transition point at the end of the hour to interject “we are out of time, let’s pick this up next week.” I suppose with time, we will learn effective ways to end the session at the scheduled time; in a manner that is sensitive to what is happening in the room at that point in time.
1) The author mentions seeing the "absolute worse" (Kottler, p. 131) part of humans in clients. He talks in a way that may be depressing for the therapist. On the contrary, I think everyone possess some quality of darkness that one would not wish to have it revealed. But as a therapist, unable to work in such depth may become frustrating.
2) The author mentions the prominence of boredom for therapists and how it could effect therapy. (Kottler, p. 147-149). It is interesting to note that having interest in the client and not seeing them as a symptom is important for the therapist to maintain their role. In numerous occupations, it seems that it is common to not see their clients as a whole person, or objectify them (e.g. surgeons, soldiers, undertakers, etc.).
Response to Takisha: It is vital that a therapist portrays mature characteristics as a human. However, it may be as important to do so outside of therapy as well. Not to mention the congruence, but there is also a potential for the client to find out about the therapist's personal life style and find inconsistency, which may interfere with the therapeutic process.
1. One thing Kottler discusses is the tendency for therapists to sometimes take too much responsibility for therapeutic successes and failures (p. 170). I think it is clear that the therapist needs to leave room for the client to grow and direct therapy, as well as leave space for God to use the therapist in therapy. It is crucial that the therapist not develop a sense of over-importance or attach their own sense of self or meaning on the clients success. This would be problematic on many levels. However, in light of the fact that we live in a culture where we are often measured in terms of successes and failures, and in a culture where we are largely defined by what we do (i.e. our careers), how does a therapist balance these cultural values and assumptions with not doing these things? 2. When reading about how to avoid burnout, I was struck by the advice to “assume as much responsibility for your own growth as you try to with your clients” (p. 177). After reading this, I think to myself, of course! That makes sense. However I find it a great reminder that as we seek to become therapists, we would not get so caught up in our training and someday, our practice that we would neglect our own personal growth, especially, as our growth is directly related to who we are when we do therapy. I am also encouraged that as I grow and do things outside of my studies for personal development, it contributes a valuable piece to who I will be as a therapist. 3. In response to Stephen’s Number 1: Stephen, I think that you raise an excellent question. I think that perhaps something is lost as therapist’s give their “services” for payment, however I think it is important to consider our culture today. Is possible that this view of therapists is different than our own? I think that the therapist definitely has some wisdom to impart, however I’m not so sure of “purity of the soul”? I think that this is perhaps describing a different role, rather than therapist. I also wonder, if there was no means for trading service for payment, would there even be any therapists? I still think that the question you raised is valid, but for me personally, I struggle with it more in terms of- how much do I charge for services? I think that we are blessed to be here at Fuller as we are trained, and that our professors raise these issues for us to think about daily.
1. The author states, “Only when we are willing to identify and explore how we feel about our clients and how it affects our clinical judgment can we ever hope to harness this energy constructively” (Kottler, 128). Self-awareness and the ability to self-critique is so important for a therapist. Therapists are humans and therefore they have reactions to certain people that are due to judgment, prejudice, or intolerance. But unlike other people, therapists have the responsibility to be aware of their reactions and have self-control. Otherwise, therapy can be ineffective and unethical.
2. After reading about difficult clients, I can see how it is tempting for a therapist to pick and choose the clients he or she wants to work with. The most important thing to remember when working with a difficult client is to have empathy. If the therapist finds the client frustrating or annoying, it will inhibit the therapist from showing unconditional positive regard. Perhaps the therapist is frustrated or annoyed not despite their empathy but because of their lack of it. If they really attempt to empathize with the client they will have a better perspective of his or her worldview and perhaps will not feel as frustrated or annoyed with them.
In response to Nikki’s first comment …
I was also amazed by Kottlers story of this client. She was so afraid of trusting the therapist that it took her 90 sessions to finally come around. Most therapists may have given up by then but he stuck it out and I’m sure that meant a lot to the client. Therapists cannot force their clients to trust them, or to feel anything else for that matter. It is so important for therapists to be patient with their clients so the work can be done effectively on their timing.
1) In Chapter 6, Kottler talks about cures for burnout, such as seeking supervision or your own therapy, and change your attitude, and do therapy differently, and teach others how to do therapy (p. 171-175). Most of these things seem like they take more time and energy. When you’re burned out, don’t you need to take some time off, recharge, lower your client load for a while, and re-examine to see if you are over committed? Once you’ve had the chance to rest, rejuvenate, and change your attitude, you can gradually work your way back up to full capacity or decide that you need to operate with less capacity.
2) In Chapter 7, Kottler discusses various areas where therapists have trouble doing at home what they do in the therapy room, such as focus, compassion, respect, patience, and self-control (p. 197-204). That is a problem with our work, that these great relationship skills are so needed in the therapy room but are exhausting to do all the time so we neglect them at home. How do you guard against this if it is so common with therapists? Is recognizing the propensity enough, or is there more we can do?
Response to Rebecca Rouse’s comment #2: I see too how it would be hard not to choose clients that would be easier to work with instead of difficult ones. You mention empathy as a way of dealing with difficult clients. One way I can see that would help us to have empathy is to try to see the client through God’s eyes, see what in them that God loves, and pray for them and for our interactions with them.
1)Well, I'm scared to be a therapist. Although I think that Kottler has some very valuable insight, often his writing feels as if he is using this opportunity for an extreme catharsis in which he complains about human nature- his and his clients- in general. I suppose reading this is good training, in that I can imagine what it would be like to have Kottler as a client. I know what he means when he points out, " we are friendlier with some clients than with others....some are greeted cordially with an open smile and an offer of a beverage, where others are coolly directed to their place with a reminder of their delinquent bills". (pg 119). Can a therapist escape this fate of "conditional" treatment, or was Carl Rogers just better at what he did than Kottler?
2) I'm struck by the discussion of boredom in chapter 6. While it is characteristic of every profession, it seems especially dangerous in the therapeutic context. If we are bored, how will this affect our clients? Kottler (2003) speaks of boredom as "less of a condition, and more of a way of seeing the world". It seems that our boredom will be dependent upon if we can continue to "see" our clients. Once we fail to see them, we will become overly conscious of time, and begin to see the world as one slow ticking litany of sameness. What, realistically, would a therapist do if they realized that they were bored and it was coming into the room with all their clients...ethically they could take time off, but is it practical? Or, is it really ethical to leave clients with no therapist as an improvement from "bored" therapist?
References Kottler, J. (2003) On being a therapist. San Francisco: Jossey Bass.
In response to Melissa's question: What are some spiritual resources you have used or could use as a therapist to prevent/address burnout:
We discussed lack of imagination as a spiritual and psychological issue today in Integration. Dr. Dueck made the point that the psychological could not be distinguished from the spiritual, especially in seeking healing. In chapter 6, Kottler discusses the ability of long distance runners and swimmers to eliminate boredom through repetition. (pg 146) "They excel because they are willing to put themselves in that place where there is nowhere else to escape to". They become in a trance like state where they become more aware of images flashing through their heads, fleeting thoughts. This description reminds me of our discussion of spiritual disciplines as we discussed them in Integration today. Although writing in a journal, or consistently going to scripture is the definition of boredom for some, there is something to be said about repetition, rythm, and consistency. Writing in a journal everyday is boring in the short term, but rewarding in the long run and gives your mind a place to go to when you are not writing. It is as if the human psyche is programmed to counteract repetition with creativity--this is what I imagine when I think of the daydreaming runner. Perhaps boredom is just discomfort with consistency, and the secret to breaking it is by practicing consistency in our spiritual disciplines.
1) As discussed in several current and previous readings and group settings, I am still caught in the continual tension of finding the balance between sharing a common ground (understanding, similar circumstances, etc.) with a client while maintaining that sense of authority that is essential to the therapist-client relationship. “The therapeutic relationship is a unique and asymmetrical contractual arrangement in which the therapist retains complete control to reveal about himself only what he likes…the therapeutic transaction provides intimacy and close personal familiarity without, at the same time, involving the risks entailed in revealing one’s inner thoughts and feelings to one another” (Kottler, 132). What is the balance between providing commonality and retaining authority in the relationship? For some clients it might be beneficial to know that their therapist experienced something similar (and therefore better understands the situation), which inherently gives more of an authority to speak to the issue, and gives a grace that no one is perfect and that everyone struggles. On the other hand, it might be frustrating to a client if he or she perceives the therapist as writing off his or her experience as common when it has deeply affected them in a personal way, understanding that no matter how similar the circumstances were, no one person can completely understand the experience (and therefore the pain) of any other individual. I know it will be different depending on the circumstances and the client themselves, and that this is where wise discernment comes in. (Kottler, 132).
2) I really appreciate Kottler’s sense of honesty, transparency, vulnerability, and grace that he conveys in chapter 5. It takes a lot of strength and humility to admit certain aspects of counter-transference, as this still can be a taboo topic (or seems to be to me sometimes). I appreciate the balance between the warning that this can be harmful in many ways but that there is “the possibility that such feelings can have beneficial…effects” and that these experiences can be “real assets in the promotion of a true human encounter” (Kottler, 116-117). Kottler puts as much emphasis on the way that countertransference can be a tool and that the key is to have the therapist go through continual intense self-examination in his or her own analysis and supervision to be held accountable for these things. Kottler warns against ignoring or denying these countertransference feelings, arguing that “only when we are willing to identify and explore how we feel about our clients and how it affects our clinical judgments can we ever hope to harness this energy constructively” (Kottler, 122). The main themes in his section for dealing with problem patients are honesty, self-reflection, patience, and grace. (Kottler, 140).
Kim Richardson, November 18, 2009
Response to Lauren’s 1st Comment:
I agree that not making an attempt to try new interventions with a client because of the belief that they will eventually get better no matter what we do is not in the best interest of the client, and therefore is not what a therapist should do. If the therapists role is really that passive, it would be unethical to continue that therapeutic relationship (to continue to charge the client). Even though people do tend towards their own healing, there is a dynamic that happens through the therapist-client relationship that should not be taken for granted. I think that every situation will be different based on the individual client, but I think it is important to work within their framework and within their creative expression. To get to know a client is to understand how they express themselves and try to work that into the therapy session and the therapeutic interventions for them (art, music, literature, nature, etc.).
1. Kottler (2003) quotes Freud as stating that "the therapist's personal feelings toward the client are both the greatest tool in treatment and the greatest obstacle" (p. 122). I almost find that to be a double-edged sword in that for one client it my work in their favor, it may work against another client, and in some situations, it may both help and harm the client. Of course, it's natural to form opinions about our clients, to like or dislike them. However, when do those personal feelings become counter-transference and potentially harm the therapeutic relationship? I feel like it could be a fine line.
2. Kottler (2003) writes that while we are bored, "it is a time to stand naked and confront one's pain without distractions or diversions" (p. 149). Could our boredom with certain clients be more about ourselves then and less about the client, the therapeutic relationship or what is happening in the room?
In response to Melissa's second question: I have found that the spiritual disciplines of silence and solitude to be very healing and nurturing to my soul. When I worked with InterVarsity Christian Fellowship, we were allowed one day per month as a spiritual retreat day to be used to decompress from seemingly-endless meetings with students and campus events. I feel like working with clients is a similar drain. For me, as an extrovert, practicing silence and solitude is a difficult task but worth every moment for the refreshment it brings to my soul.
1) I like how Kottler discusses the issue of time and lateness in Chapter 6 (pp. 147-8). Perhaps this is because of my own experience in Latin America, but I feel that we in the United States tend to work towards efficiency and compromise quality. Like Kottler describes, in Latin America the people are much more focused on relationships as opposed to the issue of time. I know as therapists we will need to set time boundaries, but should this override the quality of our work? I believe there is a balance to making people feel loved and not overrun by the clock, but how does a therapist establish this without compromising boundaries?
2)On page 160, Kottler describes some symptoms of burnout. When I was working as a case manager I definitely experienced a few of these. The one that resonated most with me was about celebrating when a client canceled their appointment. I used to do this at times when either the client was difficult or I had too many clients scheduled in a day. I wonder, if it will be the same when I am a therapist, and if so, how do I change that sentiment?
In Response to Bobby's first question:
I wonder about the same thing. Though I think, if we are somehow truly able to feel what the clients are experiencing, then we will feel more connected and engaged as opposed to burnt out. However, I am sure this will happen from time to time, and it happened when I was a case manager. I would suggest placing a goal for yourself in your personal life, and start making progress towards that goal. After all, we can't control the lives of others, and we most definitely are not their saviors.
1. Kottler addresses the fact that we, the therapists, are not infallible to unconscious self-preservation ourselves. Maybe because of our inherent human desire to be accepted and loved, we sometimes avoid our weak spots or cover our mistakes (183). This reminder seems obvious at first look. However, I want to take it very seriously. Admitting that we are not above trying to cover our own butts when we mess up is the first step toward transparency, true criticism, and real growth. I want to make a commitment now to continually confront my weaknesses or screw ups and humbly share them with trusted and wise colleagues.
2. Boredom is something Kottler discusses and warns us about (150), but I honestly can’t foresee myself getting bored with a client. I just don’t know what that would really look like? Maybe if the client refused to speak at all, after fifty straight minutes, my mind might wander. But even that would be intriguing clinically. Does anyone have a description of what would bore you in the therapy room? Or what would make a client boring?
3. In response to Stephen’s thoughts on monetary compensation, I’m not sure I would say that psychologists are sell-outs. However, I think there indeed are some more genuine and caring counselors versus some more lazy and greedy ones. I went to a MFT once who I generally liked, but was bummed that she could never remember anything I had told her previously. Then my schedule was shifting, so I let her know well in advance and told her to cancel my standing appointment. She continued to charge my insurance company and call me on some Thursdays saying I was late for two months! When I would call back (every week) to tell her I no longer had a standing appointment, she repeatedly played dumb.
1. I found Kottler's advice for dealing with difficult clients both helpful and concerning. Although having clients that a therapist does not look forward to seeing is a reality, I am concerned with how Kottler lumps all difficult clients into one category that he can give general advice about as if all difficult clients are the same. However, I think our reactions to client are often an important aspect of clinical assessment and keeping Kottler's 8 priniciples (pg 144) in mind could facilitate a better working alliance. 2. On pg 122, he lists different distortions that can happen to the therapist, one of which is, "Impaired empathy in which the therapist finds it difficult to feel loving and respectful toward the client." What are some ways to stay empathetic when you feel yourself becoming cold or indifferent?
Response to Melissa's #2: One thing that I have found to be a spiritual resource for me in times of burnout is running. Running? That doesn't sound spiritual, but it is for me. Putting myself in a physically demanding position offers me up to God in a humble state. When I'm running, I'm reminded of how much I rely on God, physically, mentally and spiritually. I become grateful for his presence in my weakness and then I am better able to approach my tasks with joy instead of being overwhelmed. How many times have I practiced what I'm say this quarter? None... I need to go running.
1)I have been encouraged by Kottler's honesty at least to know my fears are not just my fears, but a professional's fears too (even though the book touches on negative aspects of therapy). But finally I was encouraged by a positive aspect of where I currently am! He suggests a solution to boredom is to go back to the basics, go back to the training of empathy, engaging the client--all skills we are learning right now. I was encouraged to know that what we are learning is actually something that lon time therapists NEED to be reminded of when they get in a rut.
2) The dooming silence. . . Kottler describes the dialogue that happens when a quiet person come to therapy. I read the dialogue and i felt so uncomfortable. I have watched this role played and I started to squirm. How do you engage a person who will not give anything but one word answers?
In response to Amber 1: I like how you compared it to your triathlon. You have to intentionally focus on they purpose and reason you are doing this grueling process. But on the otherhand, i think it is important that we recognize the boredom, not just refocus, maybe the boredom can key us into some of our own issues we need to deal with.
I'm the author of Assaulted by Joy: The Redemption of a Cynic, What Women Wish You Knew about Dating, and co-author of What Wives Wish Their Husbands Knew about Sex.
34 comments:
1) Kottler’s (2003) chapters underscore the importance of therapist self awareness. The therapist’s ability to be self reflective, open and honest with him or herself about feelings and life stresses appears to be critical to therapist health and effectiveness. Kottler provides lists of questions therapists can ask themselves to assess issues such as countertransference, dealing with problem clients, fantasy life and burnout. When circumstances and situations arise that a therapist cannot handle independently however, the ability to seek assistance from others is also necessary.
2) Kottler (2003) discusses a number of ‘cures’ for burnout. What are some spiritual resources you have used or could use as a therapist to prevent/address burnout?
References
Kottler, J. (2003). On being a therapist. San Francisco: Jossey Bass
Melissa Gardner Curri, November 14, 2009.
1) In chapter sevens section on spirituality, Kottler explores the idea that therapists have exchanged their pure spiritual insight and soul healing abilities for monetary compensation. “Historically, therapists were always poor. They were Buddhist monks, Socratic scholars, priests, wanderers, healers. What they lacked in material affluence, they made up for in wisdom and purity of soul” (Kottler, 204). I think in some cases this may be true but I don’t think this can be generalized to all therapists. Do you think therapists have exchanged the “gift” for material gain?
2) In chapter six, Kottler discusses some issues that therapists have to deal with on a personally. One emotional issue he mentions is lack of family support (Pg. 171). Although I am presently single, I have thought about this topic quite a bit. It seems like a therapists family is in a way similar to a military family in that one member of the family may be serving but the dynamics of the whole family is affected. In the future I am definitely going to have to make sure the woman I am with is both empathic and sympathetic toward my vocation and the demand it places on me. But I don’t know, maybe that’s too much to ask. What do you think?
In response to Melissa’s 2nd post,
Some spiritual resources for me would be my prayer life and my faith community; which includes my church but it is really the intimate circle of friends there that I am referring to. Also, my family is a big spiritual resource for me, especially my younger brother and mother.
Stephen McGee,November 14, 2009.
1. “Some therapists consider intense therapist reactions, when recognized, to be crucial in diagnosing how others probably respond to the client,” (p. 125). I found this quote to be not only insightful but also illuminating on therapeutic application. How a client makes the therapist feel is a good indicator of how others feel when they are around the client. I think that this would change the therapeutic techniques as well as provide invaluable insight to understanding the client’s perspective. If a therapist is able to understand not only the clients perspective (what they are telling in the session) but also have the added insight into why others might be responding to the client the way they do, the therapist is able to offer more constructive and holistically guided therapy techniques.
2. After reading the chapter on therapeutic lies and assumptions, I was a bit confused, is he advocating therapeutic lies or not? “Perhaps these games are necessary to increase the stature, omnipotence and influencing capabilities of the therapist – but it is at the expense of the genuineness, humanness, and presence that are so crucial in being with a client,” (p. 187). He seems to imply that it is less than desirable to have lies that imply perfection in the therapist, however, he also states that these beliefs inspire “faith” and confidence (p. 189). So is he saying that one is more desirable than the other or is he implying that there should be a balance between the two?
In response to Stephan’s first response,
I do not believe that all therapists have exchanged the “gift” for monetary gain. I think it is important not to make generalizations because inevitably there is someone or some situation that will not comply. In a highly specialized society all people exchange their “gift” for monetary gain…it is called “making a living.” I think that Kottler did sound a bit judgmental but that it is important to keep things in the perspective of reality. The reality is that in order to survive, we must make a living. And even if monks and other self-sacrificing individuals were the original holders of the “gift”, it is important to remember that they often received large monetary endowments (to the monastery or church) that enabled them to continue living with the “gift.”
Rebecca Kulzer, November 15, 2009
1. One point that Kottler (2003) discusses regarding boredom is that the therapist will just do what they have done before and not try new things. Therapists might also not try new or unique interventions because they know that the client will just eventually get better on their own regardless of the therapists help (p. 156). To be honest I think that this cannot be beneficial for the client if we are not considering what is best for the client. Our clients deserve the best treatments and interventions. What are ways that we can do this without always repeating what we know and what we are comfortable with?
2. Kottler (2003)discusses how it requires honesty and can be a challenge to deal with our countertransference (p. 129). I would have to agree with this in that we have to be very aware of our feelings and very honest with ourselves. I am curious to know what other ways we can deal with this apart from discussing it with our supervisor or seeing our own psychotherapist.
Response to Steven’s second comment:
I find it somewhat amusing that you are discussing the personality traits you want in your future wife on this blog. But, I think it is awesome that you are considering this now. No, I don’t think it is too much to ask. I think that it is a realistic and honest approach. I think that it is a good thing that you are aware of these issues now before you actually get married. And, I think these issues in the family dynamics are something that you are going to have to be aware even after you get married.
Lauren Brighton November 15, 2009
1.) Kottler speaks of the difficulties of dealing with a suicidal client. Though I have heard some jokes about what Rogers would do with someone in that situation (“Hmm, it sounds like dying is important to you,”), I do wonder what good these Rogerian techniques we are learning could do in such a situation. Empathy and unconditional positive regard do not seem sufficient. And, of course, suicide is as far from any self-actualizing organismic principle as one could get. Do you think that this, like psychosis, is an area that Client-Centered Therapy just does not work very well, or could mirroring, reflecting, positive regard in the hands of a truly gifted CCT therapist save a life? (Kottler, pp. 134-135)
2.) At first I just skimmed over Kottler’s burnout questions on page 173. I figured they weren’t applicable to me since I certainly am not burned out right now as I’ve only had one client hour so far. But as I skimmed I realized they are important for us, for me, to take seriously before we even begin. Answering these questions and getting our own therapy and prayer to deal with the answers is important to help us avoid burnout before it even begins. (Kottler, p. 173).
Jonathan Wellman, November 15, 2009
Reply to Stephen question 1:
I think the fact that Kottler’s blurb on spirituality is just over a page in a 250 page book demonstrates part of his point. One of our readings in integration had a stat that something like half of psychologists consider themselves atheists. Despite the fact that we are as Kottler says, “spiritual healers” (p. 205), our colleagues do not want to admit that. However, I do not think that mental health professionals have all, or even mostly, given up the gift for materialism. Most of us don’t make six figures, and when you consider master’s level therapists as well, many make very little money compared to the work they do. Most of us mainly just want to help. But when you combine that with the anti-spiritual bias prevalent in the field, I think what psychologists have done is to set themselves up much like a new, secular, priesthood.
1)Kottler (1993) tells of a client who confronted him about the "success" of therapy with him and I found his response to be important for us as we will be faced with this in our near futures (pp.133-134). Kottler describes how the client was waiting to make sure she could trust him; was waiting until she was ready to truly begin therapy (pp. 133-134). From this and many other examples, I feel that one of the most important things we can do for our clients is to wait it out. We must be patient and commit ourselves to the relationship. In a sense, we must prove that we're not going to give up as others may have done in our clients' lives.
2) In talking of the games therapists play, Kottler states that "to err may be human, but it is not all that noble for therapists whose power may be undermined by mistakes," (pg. 184). I completely disagree with what this statement implies. I believe it is profoundly healing for all human beings to know that they are not alone in their mistakes and in their fears. Often it isn't appropriate to disclose our many failures, but I believe going in with the heart attitude that we have all fallen will be evident for our clients. The way we treat them, the way we listen, and the power of the Holy Spirit can speak more powerfully if we first admit that we are not perfect and we are not powerful, yet we have hope. I believe that, on some level, every client we see needs to know that we can relate to the many temptations and pain they've experienced and that we have survived and grown from them.
Nikki Frederick 11/16/09
In response to Stephen's second comment: I think it goes both ways. I believe marriage tests your ability to sacrifice, yet so does therapy. Yes, your family is going to have to be understanding when you come home and need time to just be alone or to take a shower or listen to music, etc. However, your family is also going to need you to disengage from the many clients you'll see , and instead focus on them and their needs. I think it will also be helpful to allow yourself to be vulnerable in the marriage, and to "break down" in a sense. Being honest and having that open communication about whay you're struggling with because of work is vitally important.
1) In chapter 5, Kottler hit on an interesting issue that made me think about going at the client's pace. He describes that one of his clients was waiting to express her true feelings until she knew she could trust him (p. 134). This happened in the ninetieth session! It struck me as very interesting to think that we may connect some dots or observe some things about our clients, but we need to wait until they are ready to see it themselves. This brings to light how as a therapist, your job may go long periods of time without feeling like you are "helping." Any ideas on how we might stay motivated if, say, our entire caseload is full of clients who are not immediately experiencing growth?
2) Kottler tells the story of teaching in Peru and having students walk in late to class (p. 148). The lesson learned was to never interrupt a time of learning on account of adhering to time or being on time. I wonder how this may play into our sessions with clients. If a client is in the middle of some deep soul searching and the hour is up, do we let them continue or do we interject softly with, "well, we are out of time for this week?" If we let them go, for how long? Do we do this for all of our clients across the board? Interesting stuff to wrestle with.
Response to Jay's #2
Jay, I like how you mentioned seeking counseling and/or prayer before the burnout actually begins. This is something important and I am glad you pointed it out. A lot of times, therapy and prayer comes as a result of an immediate need or "emergency situation" of sorts. But, really prayer and therapy can be most effective when they are infused into our tradition and habits so that the burnout has less chance of ever really appearing.
1) One focus in Kottler's (2003) book is the issue of boredom in the therapist's practice. As a triathlete, the comparison to long distance swimming, ultramarathons and cycling for miles helped me understand the type of grueling daily commitment to which therapists' subscribe. It seems the best way to manage this boredom is to keep attention focused on the exchange and genuine interest in the human story and condition (p. 149-152).
2) The symptoms of burnout mentioned by Kottler reminded me of a movie I recently watched called “Getting Played” featuring Vivica A. Fox. In the film, three women are engaging in risky sexual behavior trying to win a bet. One of the women is in therapy and her therapist who is unhappy in her own personal life, encourages her client to participate in the sexual gamble even though her client is very uncomfortable with the idea. Interestingly, Kottler mentions a variety of sexual improprieties including this exact scenario, when burnout is present and ethical conduct is compromised (p. 160).
In response to Steven’s #1:
I think the question Steven poses is a good one. Perhaps many therapists exchange the “gift” for material gain in Western culture due to the significant monetary compensation offered in the field. Such compensation may also attract those who would otherwise not choose the helping professions and increase the interest in what has become a highly lucrative career field.
Amber Blews, November 16, 2009
1. Kottler hits quite a few key points in Chapter 7 as he discusses the ways that therapists often try to become superhuman. The aura of mystery, the perfectionism, the attempt at being objective, the desire to be indispensable, all of these point toward a desire to not give in the the limitations that make us human. We make mistakes, have off days, have a point of view, and it seems that in trying to make sure the client does not find those human elements in their therapist, a handicap is created.
2. It is generally alarming that the more burnt out a therapist is, the more likely they will breach ethical code (160). It makes sense in that a general sense of not caring seems to accompany burnout, as does a lack of willingness to think through the ramifications of action or inaction. That so many people do breach ethics in areas like sexuality may then not only be attributed to a lack of unifying moral structure in culture, but also to the culture of the work - one where therapists are burnout enough to only want something they perceive as pleasurable.
Response to Stephen:
I think in many ways therapists have exchanged the gift for that material gain. Even looking at the people in other healing professions, I think it can be seen. As children and young students, people generally enter healing professions because they want to help people, and end up wanting to repay their loans and get something that is worth their time. Not that I know how to cure that, but it is a problem.
This week is one of my freebies. :)
Rachael Wittern
1) In writing about dealing with problem patients, Kottler says “when all else fails, allow the clients to keep their dysfunctional behavior” (p. 145). I imagine that would be a very difficult thing for me to do. I know that we are not ultimately the ones changing people, and that we need to honor the client's schedule for change. However, I feel we are also charged with expediting and facilitating that schedule as well.
2) Kottler says that referring clients who are beyond our expertise is not really an absolute rule (p. 195). He says that if we did, we wouldn't grow have not have many clients. I wonder how much Kottler is exaggerating when he says this. I suppose he is pointing out that there are times when it is more gray than black and white. Still, I would love to hear how Dr. Bjorck would respond to this.
David Choi, November 16, 2009.
In response to Jay's first comment:
I would guess that it would probably take a more directive approach to show a suicidal client that there are reasons to live. At that point, the client's only contribution of content would be dark and pessimistic. Having said that, Roger's concept of unconditional positive regard may still help. It just probably has to be a bit more explicit.
1) It's very interesting to read Kottler's descriptions in Ch. 5 of patients that evoke strong, often negative countertransference reactions from their therapists. For me this kind of underscores the therapist's humanity (which we touched on today in integration), which can be both comforting, as an aspiring therapist, and unsettling as a client myself. Having this kind of "insider's perspective" makes me view my own therapy differently. I'm curious, perhaps more so than the typical client, about my therapist's inner world and reactions to me.
2) On a slightly different note, it was incredibly refreshing to see Kottler remark on the joy that comes with the gradual progress of such difficult cases, those little nuggets of success that make it all worth it. (This book does a good job of laying out the sometimes-painful reality of the therapist's world, and then bringing it back to the reason we do it all in the first place, the source of therapy's joy: helping others grow!) This gives me a sense of the great value of patience and perseverance in this work.
Response to Melissa's 2nd question:
I think having your own therapy or supervision, some source of personal and professional nurture, is very important in preventing or dealing with burnout. Having a kind of escape also comes to mind - something to focus on outside of the realm of psychology - hobbies! For me journaling would be a great way to process, unwind, and get back to normal when I'm having difficulty with a client or my caseload in general. Family...nature...making time for and taking advantage of those things that can be easily neglected but that are so enriching.
1)In his discussion on burnout, Kottler shared the story of one professional who intentionally used his cancelled sessions unproductively (Kottler, p. 175). I thought that this was incredibly insightful. Not only does it kick against modernistic ideals of productivity but it also allows for breathing space. As we learned, Winnecott calls this "transitional space" (Grolnick, 1990). It is way to easy to get into the habit of scheduling or arranging every hour of every day.
2) Kottler explains the very human phenomenon where we "disguise our imperfections and lapses" (p. 183). It is very sad statement, but also very difficult to avoid fact, that therapists put on masks--even to themselves. How can we gaurd agianst this as Christian psychologists in order to not be alienated from loved ones and ourselves?
In response to Rebecca and Nikki's comments...I agree that the section on lies was initially confusing. I realized as I read that the lies he was talking about were lies that many therapists tell themselves whether they see them as lies or not. I suspect we will fall into this trap as well. We don't like to think of ourselves as lieing to ourselves but in all actuallity we commonly are. I think a mix between being aware of our humanity and imperfections, accepting that we do lie (and working to not), and then relying on the power of the Holy Spirit would be a good way to approach the topic. What do you think?
Response to Hannah’s second comment:
While there are many strategies to improve self awareness, one protective factor is creating a support network of people around us (friends, professional colleagues and supervisors, spiritual mentors, etc) that know us well and are willing to be honest with us. For example, people who love us enough to “check-in” and point out potentially concerning behaviors or trends they observe we may be unaware of (e.g. workaholism and increased irritability). For effective accountability, a commitment to trust, respect, listen to and receive feedback from these individuals is helpful.
1.I loved the quote from chapter five in which Kottler states “The key to preventing boredom and burnout, to surviving in the field with the minimum of negative personal consequences, is to do only what we can – no more, no less” (Kottler, 141). This concept ties into what Dr. Bjorck is always saying about embracing your limits. However, while I understand this general concept, I am curious as to how one finds the balance between embracing and acknowledging one’s limitations, but not becoming apathetic, and content not to grow?
2. In chapter 6 Kottler states “Helping professionals require much nurturance, understanding, and demonstrations of affection” (Kottler, 168). Consequently, how does one avoid being a therapist in all their relationships and help others understand that when we are off the clock we need to be cared for too? Additionally, how can one prevent going to the opposite extreme and becoming needy in their relationships because they are giving so much emotionally to their clients?
3. In response to Stephen’s 2nd comment:
I loved your military analogy, and have too been concerned about how to balance things with my significant other/spouse. What is reasonable to expect from them? And how do I insure that I’m giving them what they need as well as getting the support that I need? Unfortunately, I do not have an answer for this yet, and my own situation is slightly more complicated because my significant other is a practicing MFT and thus will need more support as well. However, I think that by taking some of Kottler’s advice regarding avoiding burn out, we can function more appropriately in our intimate relationships and not be overly selfish because we are not overextending ourselves.
1. Kottler states that therapists should expect some form of “intrusion” or experience some smothering by their clients (144). Depending on the modality of therapy, I wonder if it is ever appropriate for the therapist to directly confront this issue if it were ever to occur. I do not mean that therapists should retaliate by addressing this issue, but do they have a right to expect clients to not smother them? I think this would be one concern of mine when thinking about my future as a therapist.
2. I have little experience doing therapy, but I have had the opportunity to be in a position where I had weekly supervision when doing floortime therapy with children with autism. This job is extremely draining, and supervision is required because of the nature of the work. I have found supervision to help with a lot of issues, especially burnout. Kottler calls supervisions a “cure” for burnout (172), and I completely agree. I have been able to process what is happening in my work and how that affects me. I also receive professional perspective. This is extremely important for successful therapists.
3. In response to Bobby’s second comment: The idea of interjecting during a session when clients are processing in depth is a difficult issue. I think when the therapist-client relationship develops, it will become more clear about what to do. Do we allow the client to have more time than allotted? Or do we get in the habit of ending on time, and making sure that we come back to the issue in later sessions? I think this is something that we should always be weighing with each client in the future. It is definitely important.
1) On page 171 Kottler talks about the therapists need for a supportive family. He says "After giving and giving all day long, a therapist can come home with a short fuse and a long list of demands. Tender loving care is indicated until he or she returns to the land of the living" (171). I'm wondering if this maybe more of a luxury than a necessity. Can stay at home mothers who have been struggling with taking care of children all day really afford for their therapist husband to find himself before helping out around the house?
2. In chapter 5, Kottler (2003) talks about the therapists reactions to clients. I'm wondering at what point we need to seek supervision for dealing with our feelings toward our clients. Obviously, if we are having sexual longings for a client that would be an indicator. However, what about when we are experiencing feelings of boredom, annoyance, or attraction? It seems like if we sought supervision anytime we experienced these feelings we would be need it a lot. So at what point?
Response to Stephen's first question:
I think it probably varies. There are probably some who's primary motivation is monetary gain but I doubt that is the case for most. Indeed, I would imagine that those who do it primarily for that reason would be more susceptible to burn out and, frankly, not being a good therapist.
1. As therapists, we not only have to be aware of how our clients are doing, how they are processing, what perspectives they are taking, and how they are progressing in therapy, but we also have to be very aware of our own feelings, thoughts, reactions, and emotions (Kottler, 128). As I process through how my own thoughts about the client, or the client’s situation affects me, I am finding it increasingly important to have my own therapist and a great support system around me. To have a healthy life as a psychologist, it’s not only about how I am able to deal with difficult situations. It’s also about how well my family supports me, how well I work with other psychologists when seeking consultation, and how much I go to God for strength, patience, and peace. I have to remember that I cannot do this alone.
2. I had my first session with my live team client last week, and my goal was to stay focused for the entire fifty minutes and to really take on the perspective of the client. Once the client started talking, I forgot that she was an actor and really felt myself empathizing with her problems. After the session, I asked myself how far I should be feeling with the client. As the client expressed her frustration and loneliness during the session, I felt my emotions drop along with her. I am not quite sure yet if this is okay, or how to keep my emotions and feelings in check. I know that I do not want it to affect the quality of the therapy, and certainly do not want the session to be about me. Kottler says that burnout could be attributed to overidentifying with the client’s situation or the fact that the therapist is just trying too hard (Kottler, 170). Where do we draw the line and when are we crossing from healthy emotions over to the unhealthy, dangerous side of empathy that may lead to burnout?
Sarah Moon, November 17, 2009
In Response to Bobby’s first comment:
I also was impressed by Kottler’s patience with the woman. It’s so crucial to go at the pace that the client sets, even if we think it’s too slow. To answer your question about how we might stay motivated when it feels like we aren’t helping, it reminds me of Dr. Dueck’s chapter on narratives. When we see clients’ lives as stories and narratives, it helps us engage with them on a deeper level. Kottler mentions also that our role is to “focus on the uniqueness of each case, the individuality of each client, and the opportunity for growth in every encounter” (Kottler, 157). As therapists we need to continually look to the potential rather than being stuck on where the client is at currently, especially if they are stuck for 90 sessions!
1) Asking the therapist what they think of me (p. 130) is something that I have asked my therapist before. I wonder if this is not an ok questions to ask or be asked. Obviously, the therapist needs to understand the why of the question, but it can be helpful. I asked it because I wanted to test reality, to understand what it was that he saw, and how thought about me therapeutically. That was helpful for me.
2) Kottler's discussion of "experiencing the flow" (p. 149) is one that I have experienced before. I know that it is something that makes me feel like what I am doing is right. Being able to do that in therapy seems to be what "being in the room, and leaving your life outside" is all about.
At Nikki's first comment. I agree that it is important to wait with our client. I know that personally, I have many issues with trusting people, and to know that going into therapy with others, I think it is important to expect that clients will have trust issues as well. Not that they will have my issues, but I need to be sensitive to client's needing to know that the space is safe.
1. Kottler discusses patients who test our patience and gave an example of significant progress that was made on a difficult case (p 148). I was very encouraged to read this success story because I frequently wonder about the measure of success on difficult cases. It took years for the therapist and the client to see progress, but they were able to make progress together. The therapeutic relationship really is a partnership.
2. “A therapist should be, beyond all else, a fully functioning model for others to emulate, a personally and professionally masterful human” (Kottler, 2003, p. 200). This sounds really close to perfection. Would this be a description of a therapist that is doing their own work with a therapist or would this be a description of a therapist that does not need to do their own work in therapy?
Response to Bobby’s 2nd Comment: I think about this issue often. What if there isn’t a good transition point at the end of the hour to interject “we are out of time, let’s pick this up next week.” I suppose with time, we will learn effective ways to end the session at the scheduled time; in a manner that is sensitive to what is happening in the room at that point in time.
1) The author mentions seeing the "absolute worse" (Kottler, p. 131) part of humans in clients. He talks in a way that may be depressing for the therapist. On the contrary, I think everyone possess some quality of darkness that one would not wish to have it revealed. But as a therapist, unable to work in such depth may become frustrating.
2) The author mentions the prominence of boredom for therapists and how it could effect therapy. (Kottler, p. 147-149). It is interesting to note that having interest in the client and not seeing them as a symptom is important for the therapist to maintain their role. In numerous occupations, it seems that it is common to not see their clients as a whole person, or objectify them (e.g. surgeons, soldiers, undertakers, etc.).
Response to Takisha:
It is vital that a therapist portrays mature characteristics as a human. However, it may be as important to do so outside of therapy as well. Not to mention the congruence, but there is also a potential for the client to find out about the therapist's personal life style and find inconsistency, which may interfere with the therapeutic process.
1. One thing Kottler discusses is the tendency for therapists to sometimes take too much responsibility for therapeutic successes and failures (p. 170). I think it is clear that the therapist needs to leave room for the client to grow and direct therapy, as well as leave space for God to use the therapist in therapy. It is crucial that the therapist not develop a sense of over-importance or attach their own sense of self or meaning on the clients success. This would be problematic on many levels. However, in light of the fact that we live in a culture where we are often measured in terms of successes and failures, and in a culture where we are largely defined by what we do (i.e. our careers), how does a therapist balance these cultural values and assumptions with not doing these things?
2. When reading about how to avoid burnout, I was struck by the advice to “assume as much responsibility for your own growth as you try to with your clients” (p. 177). After reading this, I think to myself, of course! That makes sense. However I find it a great reminder that as we seek to become therapists, we would not get so caught up in our training and someday, our practice that we would neglect our own personal growth, especially, as our growth is directly related to who we are when we do therapy. I am also encouraged that as I grow and do things outside of my studies for personal development, it contributes a valuable piece to who I will be as a therapist.
3. In response to Stephen’s Number 1: Stephen, I think that you raise an excellent question. I think that perhaps something is lost as therapist’s give their “services” for payment, however I think it is important to consider our culture today. Is possible that this view of therapists is different than our own? I think that the therapist definitely has some wisdom to impart, however I’m not so sure of “purity of the soul”? I think that this is perhaps describing a different role, rather than therapist. I also wonder, if there was no means for trading service for payment, would there even be any therapists? I still think that the question you raised is valid, but for me personally, I struggle with it more in terms of- how much do I charge for services? I think that we are blessed to be here at Fuller as we are trained, and that our professors raise these issues for us to think about daily.
Brittany Rice November 18, 2009
1. The author states, “Only when we are willing to identify and explore how we feel about our clients and how it affects our clinical judgment can we ever hope to harness this energy constructively” (Kottler, 128). Self-awareness and the ability to self-critique is so important for a therapist. Therapists are humans and therefore they have reactions to certain people that are due to judgment, prejudice, or intolerance. But unlike other people, therapists have the responsibility to be aware of their reactions and have self-control. Otherwise, therapy can be ineffective and unethical.
2. After reading about difficult clients, I can see how it is tempting for a therapist to pick and choose the clients he or she wants to work with. The most important thing to remember when working with a difficult client is to have empathy. If the therapist finds the client frustrating or annoying, it will inhibit the therapist from showing unconditional positive regard. Perhaps the therapist is frustrated or annoyed not despite their empathy but because of their lack of it. If they really attempt to empathize with the client they will have a better perspective of his or her worldview and perhaps will not feel as frustrated or annoyed with them.
In response to Nikki’s first comment …
I was also amazed by Kottlers story of this client. She was so afraid of trusting the therapist that it took her 90 sessions to finally come around. Most therapists may have given up by then but he stuck it out and I’m sure that meant a lot to the client. Therapists cannot force their clients to trust them, or to feel anything else for that matter. It is so important for therapists to be patient with their clients so the work can be done effectively on their timing.
1) In Chapter 6, Kottler talks about cures for burnout, such as seeking supervision or your own therapy, and change your attitude, and do therapy differently, and teach others how to do therapy (p. 171-175). Most of these things seem like they take more time and energy. When you’re burned out, don’t you need to take some time off, recharge, lower your client load for a while, and re-examine to see if you are over committed? Once you’ve had the chance to rest, rejuvenate, and change your attitude, you can gradually work your way back up to full capacity or decide that you need to operate with less capacity.
2) In Chapter 7, Kottler discusses various areas where therapists have trouble doing at home what they do in the therapy room, such as focus, compassion, respect, patience, and self-control (p. 197-204). That is a problem with our work, that these great relationship skills are so needed in the therapy room but are exhausting to do all the time so we neglect them at home. How do you guard against this if it is so common with therapists? Is recognizing the propensity enough, or is there more we can do?
Response to Rebecca Rouse’s comment #2: I see too how it would be hard not to choose clients that would be easier to work with instead of difficult ones. You mention empathy as a way of dealing with difficult clients. One way I can see that would help us to have empathy is to try to see the client through God’s eyes, see what in them that God loves, and pray for them and for our interactions with them.
Jenn Greiner 11/18/09
I would like to use one of my freebies for this week. (2/3) Thank you.
1)Well, I'm scared to be a therapist. Although I think that Kottler has some very valuable insight, often his writing feels as if he is using this opportunity for an extreme catharsis in which he complains about human nature- his and his clients- in general. I suppose reading this is good training, in that I can imagine what it would be like to have Kottler as a client. I know what he means when he points out, " we are friendlier with some clients than with others....some are greeted cordially with an open smile and an offer of a beverage, where others are coolly directed to their place with a reminder of their delinquent bills". (pg 119). Can a therapist escape this fate of "conditional" treatment, or was Carl Rogers just better at what he did than Kottler?
2) I'm struck by the discussion of boredom in chapter 6. While it is characteristic of every profession, it seems especially dangerous in the therapeutic context. If we are bored, how will this affect our clients? Kottler (2003) speaks of boredom as "less of a condition, and more of a way of seeing the world". It seems that our boredom will be dependent upon if we can continue to "see" our clients. Once we fail to see them, we will become overly conscious of time, and begin to see the world as one slow ticking litany of sameness. What, realistically, would a therapist do if they realized that they were bored and it was coming into the room with all their clients...ethically they could take time off, but is it practical? Or, is it really ethical to leave clients with no therapist as an improvement from "bored" therapist?
References
Kottler, J. (2003) On being a therapist. San Francisco: Jossey Bass.
In response to Melissa's question: What are some spiritual resources you have used or could use as a therapist to prevent/address burnout:
We discussed lack of imagination as a spiritual and psychological issue today in Integration. Dr. Dueck made the point that the psychological could not be distinguished from the spiritual, especially in seeking healing. In chapter 6, Kottler discusses the ability of long distance runners and swimmers to eliminate boredom through repetition. (pg 146) "They excel because they are willing to put themselves in that place where there is nowhere else to escape to". They become in a trance like state where they become more aware of images flashing through their heads, fleeting thoughts. This description reminds me of our discussion of spiritual disciplines as we discussed them in Integration today. Although writing in a journal, or consistently going to scripture is the definition of boredom for some, there is something to be said about repetition, rythm, and consistency. Writing in a journal everyday is boring in the short term, but rewarding in the long run and gives your mind a place to go to when you are not writing. It is as if the human psyche is programmed to counteract repetition with creativity--this is what I imagine when I think of the daydreaming runner. Perhaps boredom is just discomfort with consistency, and the secret to breaking it is by practicing consistency in our spiritual disciplines.
1) As discussed in several current and previous readings and group settings, I am still caught in the continual tension of finding the balance between sharing a common ground (understanding, similar circumstances, etc.) with a client while maintaining that sense of authority that is essential to the therapist-client relationship. “The therapeutic relationship is a unique and asymmetrical contractual arrangement in which the therapist retains complete control to reveal about himself only what he likes…the therapeutic transaction provides intimacy and close personal familiarity without, at the same time, involving the risks entailed in revealing one’s inner thoughts and feelings to one another” (Kottler, 132). What is the balance between providing commonality and retaining authority in the relationship? For some clients it might be beneficial to know that their therapist experienced something similar (and therefore better understands the situation), which inherently gives more of an authority to speak to the issue, and gives a grace that no one is perfect and that everyone struggles. On the other hand, it might be frustrating to a client if he or she perceives the therapist as writing off his or her experience as common when it has deeply affected them in a personal way, understanding that no matter how similar the circumstances were, no one person can completely understand the experience (and therefore the pain) of any other individual. I know it will be different depending on the circumstances and the client themselves, and that this is where wise discernment comes in. (Kottler, 132).
2) I really appreciate Kottler’s sense of honesty, transparency, vulnerability, and grace that he conveys in chapter 5. It takes a lot of strength and humility to admit certain aspects of counter-transference, as this still can be a taboo topic (or seems to be to me sometimes). I appreciate the balance between the warning that this can be harmful in many ways but that there is “the possibility that such feelings can have beneficial…effects” and that these experiences can be “real assets in the promotion of a true human encounter” (Kottler, 116-117). Kottler puts as much emphasis on the way that countertransference can be a tool and that the key is to have the therapist go through continual intense self-examination in his or her own analysis and supervision to be held accountable for these things. Kottler warns against ignoring or denying these countertransference feelings, arguing that “only when we are willing to identify and explore how we feel about our clients and how it affects our clinical judgments can we ever hope to harness this energy constructively” (Kottler, 122). The main themes in his section for dealing with problem patients are honesty, self-reflection, patience, and grace. (Kottler, 140).
Kim Richardson, November 18, 2009
Response to Lauren’s 1st Comment:
I agree that not making an attempt to try new interventions with a client because of the belief that they will eventually get better no matter what we do is not in the best interest of the client, and therefore is not what a therapist should do. If the therapists role is really that passive, it would be unethical to continue that therapeutic relationship (to continue to charge the client). Even though people do tend towards their own healing, there is a dynamic that happens through the therapist-client relationship that should not be taken for granted. I think that every situation will be different based on the individual client, but I think it is important to work within their framework and within their creative expression. To get to know a client is to understand how they express themselves and try to work that into the therapy session and the therapeutic interventions for them (art, music, literature, nature, etc.).
Kim Richardson, November 18, 2009
1. Kottler (2003) quotes Freud as stating that "the therapist's personal feelings toward the client are both the greatest tool in treatment and the greatest obstacle" (p. 122). I almost find that to be a double-edged sword in that for one client it my work in their favor, it may work against another client, and in some situations, it may both help and harm the client. Of course, it's natural to form opinions about our clients, to like or dislike them. However, when do those personal feelings become counter-transference and potentially harm the therapeutic relationship? I feel like it could be a fine line.
2. Kottler (2003) writes that while we are bored, "it is a time to stand naked and confront one's pain without distractions or diversions" (p. 149). Could our boredom with certain clients be more about ourselves then and less about the client, the therapeutic relationship or what is happening in the room?
In response to Melissa's second question:
I have found that the spiritual disciplines of silence and solitude to be very healing and nurturing to my soul. When I worked with InterVarsity Christian Fellowship, we were allowed one day per month as a spiritual retreat day to be used to decompress from seemingly-endless meetings with students and campus events. I feel like working with clients is a similar drain. For me, as an extrovert, practicing silence and solitude is a difficult task but worth every moment for the refreshment it brings to my soul.
Posted by Heather Patterson Meyer
1) I like how Kottler discusses the issue of time and lateness in Chapter 6 (pp. 147-8). Perhaps this is because of my own experience in Latin America, but I feel that we in the United States tend to work towards efficiency and compromise quality. Like Kottler describes, in Latin America the people are much more focused on relationships as opposed to the issue of time. I know as therapists we will need to set time boundaries, but should this override the quality of our work? I believe there is a balance to making people feel loved and not overrun by the clock, but how does a therapist establish this without compromising boundaries?
2)On page 160, Kottler describes some symptoms of burnout. When I was working as a case manager I definitely experienced a few of these. The one that resonated most with me was about celebrating when a client canceled their appointment. I used to do this at times when either the client was difficult or I had too many clients scheduled in a day. I wonder, if it will be the same when I am a therapist, and if so, how do I change that sentiment?
In Response to Bobby's first question:
I wonder about the same thing. Though I think, if we are somehow truly able to feel what the clients are experiencing, then we will feel more connected and engaged as opposed to burnt out. However, I am sure this will happen from time to time, and it happened when I was a case manager. I would suggest placing a goal for yourself in your personal life, and start making progress towards that goal. After all, we can't control the lives of others, and we most definitely are not their saviors.
-Candace Coppinger
November 18, 2009 11:17 PM
1. Kottler addresses the fact that we, the therapists, are not infallible to unconscious self-preservation ourselves. Maybe because of our inherent human desire to be accepted and loved, we sometimes avoid our weak spots or cover our mistakes (183). This reminder seems obvious at first look. However, I want to take it very seriously. Admitting that we are not above trying to cover our own butts when we mess up is the first step toward transparency, true criticism, and real growth. I want to make a commitment now to continually confront my weaknesses or screw ups and humbly share them with trusted and wise colleagues.
2. Boredom is something Kottler discusses and warns us about (150), but I honestly can’t foresee myself getting bored with a client. I just don’t know what that would really look like? Maybe if the client refused to speak at all, after fifty straight minutes, my mind might wander. But even that would be intriguing clinically. Does anyone have a description of what would bore you in the therapy room? Or what would make a client boring?
3. In response to Stephen’s thoughts on monetary compensation, I’m not sure I would say that psychologists are sell-outs. However, I think there indeed are some more genuine and caring counselors versus some more lazy and greedy ones. I went to a MFT once who I generally liked, but was bummed that she could never remember anything I had told her previously. Then my schedule was shifting, so I let her know well in advance and told her to cancel my standing appointment. She continued to charge my insurance company and call me on some Thursdays saying I was late for two months! When I would call back (every week) to tell her I no longer had a standing appointment, she repeatedly played dumb.
Mary Jacobs November 19
1. I found Kottler's advice for dealing with difficult clients both helpful and concerning. Although having clients that a therapist does not look forward to seeing is a reality, I am concerned with how Kottler lumps all difficult clients into one category that he can give general advice about as if all difficult clients are the same. However, I think our reactions to client are often an important aspect of clinical assessment and keeping Kottler's 8 priniciples (pg 144) in mind could facilitate a better working alliance.
2. On pg 122, he lists different distortions that can happen to the therapist, one of which is, "Impaired empathy in which the therapist finds it difficult to feel loving and respectful toward the client." What are some ways to stay empathetic when you feel yourself becoming cold or indifferent?
Response to Melissa's #2:
One thing that I have found to be a spiritual resource for me in times of burnout is running. Running? That doesn't sound spiritual, but it is for me. Putting myself in a physically demanding position offers me up to God in a humble state. When I'm running, I'm reminded of how much I rely on God, physically, mentally and spiritually. I become grateful for his presence in my weakness and then I am better able to approach my tasks with joy instead of being overwhelmed. How many times have I practiced what I'm say this quarter? None... I need to go running.
1)I have been encouraged by Kottler's honesty at least to know my fears are not just my fears, but a professional's fears too (even though the book touches on negative aspects of therapy). But finally I was encouraged by a positive aspect of where I currently am! He suggests a solution to boredom is to go back to the basics, go back to the training of empathy, engaging the client--all skills we are learning right now. I was encouraged to know that what we are learning is actually something that lon time therapists NEED to be reminded of when they get in a rut.
2) The dooming silence. . . Kottler describes the dialogue that happens when a quiet person come to therapy. I read the dialogue and i felt so uncomfortable. I have watched this role played and I started to squirm. How do you engage a person who will not give anything but one word answers?
In response to Amber 1:
I like how you compared it to your triathlon. You have to intentionally focus on they purpose and reason you are doing this grueling process. But on the otherhand, i think it is important that we recognize the boredom, not just refocus, maybe the boredom can key us into some of our own issues we need to deal with.
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