And to whoever is remotely interested in mental health…
Dear Aspiring Psychologists/Mental Health Professionals everywhere,
I write to you today because the last 4+ years that I have spent in the field of mental health and therapy have taught me a great deal about what’s on offer and what it takes to do justice to the offer. But mostly, I write to you out of concern for the realities of this domain and the need of the hour.
Maybe you are venturing into psychology out of interest; maybe you’re doing so because you believe (or have been told to believe) that mental health is the next big thing; maybe you’re doing it because of yourown experiences with mental health and therapy; maybe you’re doing it out the of the need to serve others and to make the world a better place, or maybe you’re doing it because you believe it’s easy talking to people and giving advice (two gross misconceptions, but okay, whatever works for you). Regardless of what got you into it, now that you’re here, there are some important “Points to Remember” that you may need going forward. This is, by no means a list or an exhaustive collection of lessons. It is, at best, a recollection and reflection of my experiences that may prove useful to others. So, spare some time (’cause this is a wee bit too long) and read on…
There are as many definitions of mental health as there are faces on this planet
Understanding a case is a lot like trying to figure out a colour from a palatte — from the distance every blue seems blue, but when you look closely and in comparison to what you already know, you’ll see how this particular blue is not like other blues. Pun un-intended.
Yep, you read that right. While we may generalise all stars as stars, all planets as planets, all flowers as flowers, all… You get the point. But inherently each one of them is different from the other. There may be many similarities, but there will also be some differences, simply because no two people are the same and hence, owing to a difference of perception, the same stimulus would generate a different response.
The books you study will prepare you just enough to develop a minuscule know-how of what lies out there in the world. You will be taught, for instance, that Clinical Depression is known to exhibit eight symptoms of which at least five must be present for a period of two weeks or more, to make a diagnosis. But what you won’t be taught in a classroom is how many people wouldn’t even know how to describe their symptoms correctly, making the presenting problem grossly different from the underlying issue (which may not be anywhere close to Depression at all). When you venture into the domain of mental health, you will realise from the very first day, that your experience on-ground is going to teach you over seventy percent of what you need to know to be able to do anything of substance in the field. As such, to make the best of your tryst with Psychology or mental health, venture into it with an open mind and an eagerness to learn every single day. If you’re looking to become a therapist (of any kind), make sure you have your theoretical knowledge at your fingertips because that remaining thirty percent is the essential groundwork you will need to build your repertoire. Additionally, make sure you allow yourself to be guided by the flow of your work.
Don’t get into it for the money: Set better intentions and lower expectations
To be honest, envisioning a career path for yourself will involve a great deal of expecting yourself to be rich, or maybe being able to afford a trip around the world… Whatever the plan may be. Even if you don’t start out with such ideas, at some point you may feel tempted to give in to believing the misconception that Mental Health is a money tree because you’ve seen how plenty of therapists and doctors charge exorbitant per-hour fees and the number of clients/patients lining up outside their doors. While there’s nothing wrong in thinking that way, money should never be the motivating factor for you to venture into mental health services, or any career path for that matter. The more materialistic your ambitions are, especially in this field, the less successful you will be. Mental health services are about compassion, empathy, and an open-minded outlook. Besides, the industry doesn’t readily offer you the big bucks or even a job right after you complete your degree. It’s a struggle to find your footing initially, and the key to success is trusting yourself and the process, to help prepare you for the rest of your journey. Don’t be in a hurry to succeed.
Learning never ends
Once you do get started (whether as a freelancer taking independent clients or through a steady job), to find success in this industry, you need to constantly adapt, improvise, and innovate. You need to keep reinventing your approach to therapy. That may involve reading journals, acquiring certifications and licences, reading articles or case studies, and learning different types of therapies. The broader your horizons are, the quicker your in-session responses become. For instance, in the beginning you may struggle to find the right approach to a client who seems unresponsive to CBT, and you may feel like you need more time to figure out what the next step would be. But, with experience and constant learning, you will be able to tweak the treatment quickly by adding elements of other therapies such as ACT or Hypnosis, to name a few, without keeping the client waiting till the next session. You have to soldier on and the rewards will start pouring in when you least expect them to.
However, the real test of your resilience comes after you’ve started achieving some success in your initial years as it tends to stagnate your learning curve. Often, therapists become fixated on catering to their clients that they lose sight of the need to learn and reinvent. In which case, every session and every case begins to look more and more alike, giving rise to monotony and increasing the chances of an early burnout. Remember, your learning curve is the biggest adventure in this field. Don’t hop off it.
Client History is Important
Client history taking is always an important part of therapy — not just an initiation formality. When done right, it gives you the picture of the client and their mindset, the experiences that have shaped them into the person in front of you now, and gives you clues to what therapy or strategies they will best respond to. Many a times novice therapists make the mistake of either taking too many notes or not paying attention to the client history after the second session — only going back to it when nothing seems to be working. The client history is a handy document that you must refer to at some point in each session to build trust with the client, keep track of the goals accomplished and the goals that remain still, and to better understand the underlying causes and meaning behind the symptoms initially mentioned by the client. Even a regular follow-up on the severity of symptoms or issues mentioned by the client during history taking can help both you and the client have a tangible record of progress and recovery. Paying attention to and putting in equal effort in history taking as in treatment can help you establish a healthy and successful work ethic.
Client: Therapist:: Lock: Key
Achieving success in the mental health industry also means acknowledging the fact that you won’t always be the right fit for a client, and knowing when to let go.
The lock and key concept is simple — there is a key to every lock and only the right key, used in the right way can help open the lock. You can try opening the lock by fidgeting with a hairpin, but it won’t get you anywhere and may render the lock dysfunctional. When you don’t have the key, it is okay to call in a locksmith. The quality of the therapeutic relationship between a client and therapist is a therapy in itself. When a client can trust you and your own attitude towards a case is optimistic, it can go a long way in initiating and maintaining healing for the client. There will always be cases which are out of your area of expertise, or cases where you reach a deadlock and nothing seems to be working. In such cases, it is always better to talk to your client clearly explaining to them why it’s time for them to seek help from someone else. Turning down a client without closure will always add a dent in your répertoire, but closing a case by supporting the client and helping them transition to a different professional will always garner more respect and better feedback. So, take your time to understand where your expertise lies, and always be transparent with your clients about their progress with you. It is okay to not know everything about everything.
Counter-transference is as Real as Transference
It is common in therapy for the client to develop familial feelings or infatuation towards the therapist, we call that transference, and your training will certainly teach you how to establish and maintain boundaries with your clients. However, an important yet often overlooked phenomenon in therapy is counter-transference. You may end up taking a parent-like approach towards your clients or develop a soft corner for them. While it is human to develop such emotions, it can be highly unprofessional and unproductive for therapy. The best way to overcome this is mindful awareness of your own behaviour as well as regularly reviewing and reflecting on your conduct during sessions. This helps you keep a clear picture of where your professional boundaries lie and when you may have crossed them. When you realise you may have experienced signs of counter-transference, it is always easier to step back and course-correct.
Prejudice and Bias are Human Emotions that you will be prone to
It is incorrect to think that being a therapist, you will be immune to experiencing bias or prejudice against your client(s). You’re as human as they are and at some point you will experience these emotions as well, regardless of your willingness to do so. Here again, mindful awareness of your own thoughts, feelings, and behaviour will go a long way in helping you bring your focus back to work.
There will also be times when you won’t feel like taking a session for a certain client due to exhaustion or saturation. In such situations it is always advisable to take a break from work and focus on grounding your own self and realigning your values, ethics, and professional responsibility. In case you find it difficult to continue with a client (which may happen for a variety of reasons), always remember that it’s okay to transfer the case to someone else. Allow yourself to be human.
This is, by no means, an exhaustive list of lessons that I’ve learnt or lessons that I believe you need to learn. There is so much to therapy that a concise letter cannot do justice to. My hope is that these few words will help you get started and keep you in-sync with your profession and the responsibilities that come with it. I will end this letter here by reiterating that above everything else, you need an open mind and faith in yourself.
Wishing you great success in your endeavours,