November 21, 2024 • 46 mins
Post-US-election season and approaching the New Year and NY resolutions, there is natural upward trend in people looking for therapy. Depending on who you ask, which directions your algorithms follow, and what the latest TikTok and IG trends are, potential clients have all kinds of ways of approaching this, many of which lead those of us in the know to exclaim, "OMG, that's not it!" Conventional wisdom surrounding finding therapists, including that which is accidentally or intentionally propagated by the mental health industry and that necessarily has a certain logic, still often fails to consider or reveal what research suggests is the single biggest predictor of therapeutic success. Nicole and Ryan deconstruct the conventional wisdom with incisive mental health veteran insider knowledge, and then turn the tables to pose the questions they ask in searching for a therapist.
Discussed: good therapist vs. therapist fit, on being a therapist, Dr. Jeffrey Kottler, understanding mental health specialization, mental health vs. organic-medical terminology, the role of social media in developing ego props, questions to ask to find a therapist, single-modality therapists, personality fit with therapists, therapeutic bond/alliance/rapport as the single biggest predictor of success in counseling, and more.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
This is Ryan Thomas Neace.
(00:03):
And this is Nicole Neace.
This is the Closer Podcast.
How are you doing?
I actually, I feel good.
I feel good.
I just got out of yoga and when I was laying in Shavasana, I was thinking to myself, if
(00:28):
someone asked me right now, it's so weird that you asked me this question.
I was like, if someone asked me right now how I feel, I would say, this sounds so stupid,
I was like, I'm going to say I'm with peace.
You're with peace?
Yes, I'm with it.
Like, not I am peaceful or there's peace, but I'm with it.
Like there's peace and I'm with the peace.
(00:49):
Because not all things are great.
I'm not like, normally people are like, oh I'm fine, I'm good, da da.
Like, oh no.
I'm just, I'm with peace.
There's peace within and around and I'm with it.
It's an interesting thought.
I've never had that before.
Yeah, it's an interesting way to word it.
(01:10):
Yeah.
I was thinking about how when I used to say to you, have a good yoga, because today our
instructor let us, I wish I already knew this, but yoga means union.
Yeah.
And I was like, oh, have a good union.
I'm glad that's how I used to say that to him.
And then that got me on the train of thought of someone asked me how I was doing.
(01:31):
How would I word it?
And I intentionally went with, I am with peace.
I like it.
Thanks.
How are you doing?
How are you feeling?
I don't have an answer to that question.
One of the weird things that's happened for me over the last couple of years is that in
(01:53):
spite of the fact that I still regularly use and answer that question for people, it has
become an increasingly irrelevant question to me.
It feels like, obviously we know in our culture, we use it as like a, you know.
Greeting.
Yeah.
It's just a way to get in the door, to get in the room.
(02:15):
Sort of as like a little light surface talk while we sit down in the room together.
But you know, a lot of times we also try to answer it meaningfully when we can as well.
And I just find that I am variable throughout the day.
I feel one way when I wake up, which is why I get up and go to yoga and cold plunge and
(02:41):
contrast therapy, infrared sauna.
And then by the time I'm finished with that, I feel a different way.
And then by the end of the day, I feel another way, by the time I'm ready to go to bed, I
feel another way.
And so, you know, I'm with a lot of things.
Peace is one of them.
(03:01):
Definitely not the only one.
Yeah.
And there is a lot of that maybe in the world right now.
Yeah, certainly.
There's, you know, we're, as this is being recorded, we're just very shortly outside
the 2024 US presidential election.
So people are feeling a lot of ways about that.
(03:23):
And I think we feel a lot of ways about it ourselves.
And you know, we're looking at the New Year is not far away in light of the distress that's
sort of in the world right now.
And in light of the New Year coming, New Year's resolutions, etc.
This is the time of year when people start looking for therapy.
(03:48):
Yeah.
I mean, the holidays alone, let alone the election time is, so it's going to be a double
doozy I think for a lot of people.
Yeah, right.
Holidays, you know, increase in time with family for a lot of people just seems to drive
the therapy, oh God, I should look for therapy, oh meter.
(04:09):
And so today we kind of wanted to talk about our experiences of what clients tend to sort
of come in, like asking in an effort to determine what kind of therapists they're going to be
seeing.
And then our experience of maybe what we would ask on the basis of our own experience and
(04:32):
mental health.
I mean, between you and me, we have a combined, you know, 35-ish years or so of mental health
experience.
And we have learned a thing or two and it is the kinds of questions that clients tend
to ask are not bad, per se.
(04:54):
And there definitely is a certain logic to them.
Yeah.
But again, they're just like not the ones we would ask and maybe that's important.
They're not the only ones we would ask.
Yeah.
Yeah.
I don't think I would ask them, but...
These particular, I don't know that I would ask them or not quite this way, but it doesn't,
(05:15):
it wouldn't be wrong to ask them per se, but I don't know if it gets to the point of finding
fit.
Yeah.
So when she says these particular, we have seen a few that are passed around sort of
as memes on the internet, at our counseling practice, our group counseling practice, and
then in our own individual practice, we've seen clients come in asking questions like
(05:39):
this.
And so we'll just maybe kind of talk about those for a second and then do a sort of a
compare contrast and go from there.
Yeah, that sounds like a plan.
All right.
So the first one that clients come in asking a lot is a pet peeve of mine.
So it's a good place to start.
It is.
(06:01):
What do you specialize in?
And the problem with this, to the degree that there is one, I understand what it is driving
that.
Yes.
But the difficulty is asking it as such does not probably actually reveal what you think
it reveals, or at least it potentially does not reveal what you think it reveals.
(06:25):
So imagine that you've asked me, what do I specialize in?
And let's say that, for example, I say, you know, anxiety.
The question that I want to ask you as a client searching for a therapist is, do you know
anything about what it means when I say that I specialize in anxiety?
(06:48):
Do you know like what you've just asked me?
And the difficulty is that in our field, the term specialize is not regulated, meaning
you can kind of say you specialize in whatever you want.
And unless somebody finds that to be inaccurate, is really motivated, feels that somehow, let's
(07:10):
say they go and see you and that that's not the case and that somehow you're guilty of
misconduct and then they report you.
And then somebody else, then the board says, does an investigation and your licensure board
and then you end up being penalized or your licensure is in jeopardy or something.
You can more or less say that you specialize in whatever you want.
(07:33):
And you know, that's it.
No, it doesn't mean much.
It's not like going to a doctor.
Right.
Right.
So when you go to it, and this is, I think, part of the genesis of this question.
When you go to a doctor and you have a foot problem, well, you want to see a podiatrist.
You know, if you have an eye problem, what is it?
(07:54):
What is it?
Optometrist?
No, I think that's the people who do glasses.
I think ophthalmologist maybe.
Yeah, see, don't even know.
No, don't know.
But the point is, and you understand that there is at least some specialty training
there and typically quite a lot.
In therapy, necessarily, that could be true.
(08:18):
Somebody who says, I specialize in anxiety may in fact have advanced training in anxiety.
They may have advanced experience in anxiety.
But here's the thing, particularly as a person who has tended to employ younger budding
therapists with a desire to help them and sort of navigate the therapy world, what it
often means is, I have a lot of anxiety.
(08:44):
I've had a lot of anxiety my whole life.
And for the vast majority of the people that we've intersected with, that often means I
have not resolved a lot of my own anxiety.
I have not figured it out.
And so I think I should help other people who have the same.
And I want to be honest, like I, when I started out in mental health, I thought to myself,
(09:07):
well, I have really struggled.
And so maybe my sort of like calling in life is to help other people who've struggled.
And there's nothing principally wrong with that.
As a matter of fact, all of our research says that that's why we go in the field.
There's a bunch of therapists that don't know that apparently, but all of our research says,
I don't mean our, Nikki and I's, all the research in our field says that most therapists
(09:30):
go into therapy not so much for a desire to save the world, but something about saving
themselves.
There's nothing principally wrong with that as long as you figure it out.
And here's the thing, if the therapist doesn't know any of this, then a lot of times what
that means is they're going to be working out their anxiety issues with you.
Yes.
(09:50):
Yeah.
And I think also sort of similarly, as we're talking about, if you go see a specific type
of doctor for a specific type of thing, they've had a lot of education in that specific field
and it's less about an emotive state and just sort of like factual things that they're dealing
with.
So it's kind of something that's more concrete.
(10:10):
Yes.
Anxiety has many forms.
It shows up in a variety of ways.
So just because I've had anxiety myself the whole time and I want to help somebody who's
had anxiety, that doesn't mean I'm going to be a good fit with every person who has anxiety.
It's beyond just the thing that they quote unquote specialize in.
It is.
(10:31):
And maybe people don't know that for licensed professional clinical counselors, as they
call them in California, or licensed professional counselors or licensed mental health counselors
or switching disciplines a little bit, licensed clinical social workers or licensed marriage
and family therapists.
Any of these degree types, our training does not actually include specialization.
(10:55):
It is a very, very, very broad overview, enough to kind of get your foot in the door.
And that it is thought that specialization to the degree that it exists comes with time
and funneling of continued education post your graduate degree.
So again, when you ask someone, what do you specialize in?
(11:18):
You need to understand that in our field that may or may not reveal much about their actual
ability, acuity or skill in that area.
It could be you specialize in depression.
It means you've been depressed your whole life and that may or may not be worked out
just yet.
(11:38):
On this front that we go into the field sort of on the basis of our own struggle, there's
a book that's now I believe in its sixth edition by a guy named Dr. Jeffrey Kotler.
He is a friend of mine and has been, at least in the past, was a mentor of mine.
(12:01):
And this book has been a bestseller for over 30 years, hence it being on its late edition
here.
And the very first chapter of that book on being a therapist, at least in its previous
edition was called The Therapist's Journey.
And one of the subheadings is personal motives for being a therapist.
(12:22):
And I just want to read to you what he says.
He says, Our journey to become therapists began for most of us, here it is, not with the urge
to save the world or to help people, but rather to save ourselves.
Many of the motives for becoming a therapist are unconscious and even beyond the reach
of clinical supervision or personal therapy that skirts over such unresolved or disguised
(12:43):
issues.
And by the way, he is citing research in each of these sentences.
Frequently, they involve lingering struggles with early loss or unfulfilled narcissistic
needs for recognition and approval.
Half a therapist polled in a large-scale survey confessed that their choice to become a therapist,
as well as their subsequent professional development, was motivated largely by their resolution
(13:04):
to work through their own problems.
One area frequently mentioned is the desire to understand oneself more fully and to feel
more understood by others.
So again, when we really look at our motives for going into this field and then that intersects
with what we say we specialize in, knowing that specialization does not actually constitute
(13:28):
something that's regulated, that you have to do 10 trainings in anxiety to say you're
an anxiety specialist.
We just want to really encourage people to think, maybe this isn't the best way to frame
this question.
Right.
And I think I get it, yes, I specialize in anxiety, and unless I ask some really good
follow-up questions, I haven't actually, there's not been much revealed to me yet.
(13:50):
Right.
And a lot of those, I mean, nowadays with websites and different things like that, it
says on their bios what they, quote unquote, specialize in.
It does.
So you don't even really need to ask that question because most people are talking about
that in their bio as a snapshot of the types of clients that they are willing or wanting
to work with.
(14:10):
And so that question almost doesn't do much for you.
Okay, great, you worked with anxiety, now what?
Right.
And if, in other words, if you're going to ask that question, it's probably already been
answered on their website.
Interestingly, you and I don't say we specialize, we say we have a good bit of experience working
with, which tells you something.
(14:31):
Again, I could say I specialize in anxiety and I just got out of grad school and it means
all these other things, but I haven't actually, I don't have much experience, period, let
alone much experience with people with anxiety.
We try to talk about a little bit more as what we have experience with.
But this does highlight, you talk about websites and social media and so forth, another facet
of this.
Asking what you specialize in is like asking someone to give you all of their ego props.
(14:58):
Here's what I mean by that.
Our culture, perhaps more than any time in my own lifetime because of the advent of not
only the internet, but social media and this idea that everybody has their own personal
megaphone or their own personal place on the worldwide web that they can showcase who they
(15:18):
are.
The difficulty is, of course, often you are not really meeting them, you are meeting their
agent.
Chris Rock had a comedy special years and years and years ago and he was talking about
it in the context of dating, how oftentimes when you're meeting someone, you're not meeting
them, you're meeting their agent.
Your agent is somebody who looks like you and dresses like you but isn't really like
(15:41):
you at all once you get to know you.
Of course, this is what happens a lot of times in relationships.
Some of it is the inevitable course of a relationship.
How much can you really know about someone at the outset?
The difficulty with social media in particular is that it takes your agent and puts that
on display for the world to see.
It isn't that there isn't anything in there that's really you.
(16:04):
And of course, there usually is, but it isn't you.
In this same sense that you've heard me talk about this before, words are metaphors.
And so once you can kind of accept that, that when I am describing something to you as I
am doing right now, I'm carving at an idea, but I'm using words to carve at that idea.
(16:25):
And so words aren't the thing.
If I'm describing a cheeseburger to you, and even if that's a really accurate, precise
description to your experience, and it makes your mouth water and you think, oh, wow, this
is something, it's still not a cheeseburger.
Right.
Similarly, with social media, no matter how accurately I am trying to authentically display
(16:48):
who I really am, it's still not really me.
You won't really know that until you spend a bunch of time directly experiencing me.
And so my biggest beef with the specialty question, given that it's not regulated, and
you can kind of say whatever you want, and that it may actually be an outgrowth of your
dysfunction, and let alone, in our experience, a bunch of therapists aren't even aware of
(17:11):
why they got into the field beyond the, I want to help people, I swear, you know, statement.
You're like asking them to give you all of their ego projections about themselves.
That's just not a good approach.
But it's definitely from the organic medical paradigm, the doctor paradigm.
(17:34):
There's something to it.
It just may not actually be giving you the information that you're actually looking for.
Right.
Well, it's like, you know, for years at our practice when I would help onboard clients
and try and figure out fit, and these were the kinds of questions that people would ask,
I used to say, you can go to a car dealership with a laundry list of things that you want
(17:56):
your car to look like have all the amenities, what so have you, then you get behind the
wheel and you drive it and you're like, oh, this is saying that this is not it.
There's nothing wrong with this, but this is not the thing.
So then you continue your search.
And that is sort of how I feel like the specialization question is.
You asking me what I specialize in is just something on a paper that might be a good
(18:20):
fit, but there's more to it than just that.
Yeah.
Maybe that's a good point you're bringing up when you use the word fit.
If the question is sort of like, how do I find a good therapist?
Gosh, man, you can ask these questions.
They may or may not get you there.
But I think the thing that we're always wanting to do with people is as much or more as like,
(18:41):
how do I find a good therapist where good therapist equals somebody who specializes
in anxiety?
Because that's what I think I have.
And oh, by the way, I'm self-diagnosed because I read on Google that I have these three things.
And that sounds a lot like anxiety.
What we're saying is, well, how about we try to help you assess fit, which is different
than are you a good therapist?
(19:01):
Or what do you specialize in, which I then stack up as reasons to or to not call you
a good therapist.
Right?
Yes.
So also just to piggyback on here, a similar related question that is sort of driving at
the same types of things is what types of therapy do you use and how you how would you
(19:23):
describe your approach?
I am now a 22 year veteran of the mental health industry and I have been practicing counseling
proper since roughly 2005, post-master's since 2006, post-licensure since 2011.
(19:49):
So I'm even post-licensure.
I'm 13 years in and I'm 22 years into the field.
I am just now in some senses really able to articulate a coherent answer to that.
And so the difficulty in asking people with even my degree of experience or less is again,
(20:12):
you're sort of asking them to sort of sell you a bill of goods, which that bill of goods
may or may not actually correspond to reality.
Again, like with my experience of onboarding clients, we noticed this trend with social
media where there's a particular type of modality that is really being heavily pushed for a
(20:37):
long time.
Like all of a sudden 70,000 people are on TikTok talking about whatever, CBT or narrative
therapy or...
Correct.
And then all of a sudden everyone who's calling, everyone who's writing is like, are you a
CBT therapist?
Do you do EMDR?
And then if you don't, I'm not open to talking about talking with anybody else because they
(20:58):
don't go back to the first question, specialize, right?
Or have that as their particular approach.
What we would find a lot of times is I can pair you with somebody who has CBT training.
Most of us get some of that on the front end of schooling, go on to do a little bit post
(21:19):
graduate work.
Doesn't mean that I'm necessarily going to be a good fit for you because there could
be a variety of other things that are being presented that would be good for this therapist
and maybe not so much for this one.
In terms of what the client is presenting, is there issues?
Yeah, exactly.
Let me give you an example.
(21:40):
Someone calls in and says, do you have CBT training?
I'm like, I have three therapists who have CBT training.
Okay.
Okay.
Do any of them specialize in anxiety?
So now we've got both questions.
Right.
Oh my gosh.
So you specialize in anxiety if you want to use that language.
Which is like, oh my God, this is not it.
This is not how you do this.
(22:00):
So then my approach would be somewhat different.
There are other things that I implement at this point to say, how do I find a good fit
for you?
Right.
There it is again.
So it's like there is something to this idea of you asking me sort of generic questions
and hoping that that is going to get to the source of the thing that you've been saying.
(22:22):
Right.
So you're asking me questions that because naturally no fault, not a criticism, you don't
know that they're generic because they sound really insightful.
Right.
But in fact, again, and here's the piece that highlights training again.
You may not know this, people who are listening, but we do.
When you go through training to be a therapist, again, you are given a general broad overview.
(22:47):
And when you come out, you are encouraged to elect a particular school of thought that
you want to operate from.
Right.
And to learn as much as you can about that.
But check it out.
All of that occurs post-graduation.
Right.
And so you may be meeting someone anywhere along that road of their journey.
And again, saying that I use a particular modality is not regulated.
(23:11):
Right.
I can say I use CBT.
And actually, this is a very frequent occurrence in my experience of therapy.
People say, oh, what are we doing?
And I will name some thing that we've just done.
And they'd be like, oh, I went to a therapist who said they, and it is very clear from the
client's description of their previous therapy experience, that in fact, although the person
(23:32):
had it on their website and they say they're trained in it and they might even say, oh
God, they specialize in your particular issue using narrative therapy to treat anxiety,
they don't.
Right.
And if, again, if this contextualizes your experience of therapy, if you're listening
(23:53):
to this and you're like, oh my gosh, this kind of describes what I've experienced.
I mean, wouldn't you say that that's one of the most common things that we hear?
People coming to our practice, one of the most common refrains that I have heard, you
could tell me if it's the same on the phone, is I've been to like four therapists and they're
all shit.
Yes.
Yes.
(24:13):
It's not a very nice thing to say, but I'm just like, oh my gosh, if I have to hear,
I mean, so many clients say it.
This is not it.
This is not what they were doing.
One of the unique approaches that we take to pairing clients with clinicians around
the concept of fit is going beyond these sorts of generic questions.
(24:34):
And after I spend 15 minutes on the phone with them talking to them about these sorts
of things, they feel very hopeful because they're like, wow, before I just clicked on
a button because this person said anxiety and said CBT and those were the two things
that I think I need.
And so I signed up and then I got there and I sat across from this person who, you know,
clearly we were not vibing.
(24:55):
Yes.
And also they didn't actually do the thing that they said they were going to do anyways.
No.
I don't feel great like saying these things about our industry because it's critical
in a way and it is sort of feels like we're trotting out our dirty laundry for everyone
to see that the industry.
But on the other hand, I do feel great about it because it adds context to so many people's
(25:20):
experiences of therapy that seemingly went nowhere.
You know, when you, there's only so many times in a row you can hear a client say, I have
been in therapy for two years prior to coming to you.
And in the first two months with you, I've had more movement than I did in the entire
two years previously before you finally are saying, well, gosh, I guess this must really
(25:42):
be true about our industry.
And certainly again, as people who have employed therapists, this is very true to our experience.
And we don't even mean these as criticisms per se.
They are just, let's get real about what this industry really looks like from the inside
and then let's try to help people navigate their way to something that's actually going
(26:03):
to help them.
So I think I mentioned this earlier, one of the fun things that Nikki and I did in advance
of having this little discussion was say, what if we both kind of thought about like,
what are the questions we would ask when looking for therapists?
What would we say?
And again, you can hear that however you want.
(26:25):
You can pair it alongside the questions that if you still like the specialty question and
the what therapy style do you use question, or you can hear them as alternates and they
can go with them or alternate to them.
But what would we ask?
And then we didn't talk about it so that we could kind of see, ooh, do we have overlap?
Do we agree?
(26:45):
Do we disagree?
Is there something that...
So you want to try it out maybe.
I just came up with a couple and I think cut at it.
So maybe I'll let you go first and why don't you hit us with it?
What would you ask?
Right.
Well, okay.
So maybe piggy, one of mine actually kind of piggybacks off of this last question.
(27:06):
When I said...
Which question?
The last one about what kind of therapy do you use, like modalities, right?
And I said, hey, when I used to talk to clients, they would say CBT anxiety and then that would
be it.
One of the things that I would often say to clients is like, okay, talk to me just a little
bit about you.
Tell me about who you are.
Like outside of your presenting concern, right?
(27:30):
You're calling in because you're feeling very anxious and you want to tend to that.
Can you talk to me just a little bit about your life?
Things that you're into, like what interests you?
Have you had experience in therapy before?
What was that like for you?
What went well?
What didn't go well?
And just getting to know the person on the phone and saying, oh wow, and I use the same
approach even with my own clients.
(27:52):
Talk to me a little bit about you because while I could use CBT or narrative or any
kind of other modality, I am not going to limit myself to that modality.
So one of the things that happens a lot of times is as I get to know you and what's going
on, I might use pieces of those modalities, but because you're a human and you're complex
(28:19):
and there's lots of parts of you, I need to be able to move and shift in and around those
things.
Yes.
And so one of my questions when I am looking for a therapist and trying to determine who
is a good fit is sort of like, who am I in relation to my affect and reality and who
(28:39):
do I tend to get along with?
So that's a question you're actually asking yourself.
I'm asking myself that.
And so while I'm interacting with the potential clinician I'm going to see, I'm saying, is
this that kind of fit?
Because if I'm going to sit here and open up the depths of me and try and talk to someone
for an hour once a week about things that I don't talk to most people about, I can't
(29:01):
realistically think I'm going to do that with somebody that we're just not clicking.
We're not seeing the world in the same way.
And some of that is sort of an unspoken experience.
So the only way I know how to get to that is kind of just being with them on the phone
and talking to them.
So I think what you're saying is part of finding a good fit, which is different than is this
(29:28):
person a good therapist where a good therapist equals all the things we've said, which we're
saying may or may not correspond to reality on any number of levels.
You're saying first I should ask myself, what kinds of people do I really find that I gel
with?
And then there's something about carrying the answer to that question with you into
(29:51):
either an initial phone call with the therapist or to being in the room with the therapist.
That's an important caveat.
You may have to test drive a therapist or two and check it out.
Yeah.
You may have to shell out some money either through insurance or through your regular
old bank account to make this happen.
(30:12):
And we can talk about that at another time, but I realize a lot of people, they don't
want to spend any money on this.
They want the therapist to give them an initial consult where the initial consult is 20 minutes
and they want to be able to figure it all out there.
My experience is that's not realistic that you really have to spend at least an hour
or two or three with them before you may have the sense.
(30:33):
Although you may also develop it much more quickly.
But the point is, what does my intuitive reading of myself say about the types of people I
gel well with on the basis of personality?
It may not matter if they check the specialty and therapy type box.
If you sit down in front of them and you're like, oh my gosh, I would never talk to this
(30:53):
person outside this therapy room ever.
Yeah, 100%.
What about you?
Do you have a...
Do you want me to trot one of mine now?
I want you to go one time.
Yeah.
Well, I don't...
The difficulty with what I'm about to say is I don't know if therapists will answer
this.
Okay.
Which should tell you something if they won't.
(31:15):
Yeah, I'm really...
I'm so excited for that.
Well, it's not...
I'm making it...
Now it's going to be anticlimactic.
I would ask the therapist, because it's very important to me as a therapist who understands
that therapists go into therapy because we are motivated to do so out of our own struggle.
(31:37):
And as a therapist who has spent most of his professional career and a little bit before
in therapy, I would ask, how much therapy have you been in across your lifetime?
I'm not necessarily needing to know the contents of your therapy or anything sort of invasive
like that.
(31:57):
I'm just wanting to know how much therapy have you been in?
Can you give me like a sort of an aggregate ballpark number of days, weeks, months, years?
And so part of the deal in asking this question is also informed by us as employers, the amount
of times...
And guys, I don't like saying this.
(32:18):
This is a problem.
Yeah.
But how many therapists we meet who have never done any therapy outside of what was required
by their graduate programs, which by the way is typically 10 to 12 sessions.
It used to be like a sine qua non, a quintessential part of therapeutic training back in the olden
(32:40):
days when the psychoanalysis...
You're talking about the post Freudian where everybody was a psychoanalyst or everybody...
Then Jung came along and everybody...
Where you had to go through your own analysis.
And psychoanalysis takes years.
And so it was just sort of a given that you've had these gobs and gobs and gobs of therapeutic
(33:00):
experiences.
Now that's not it at all.
It's 10 to 12.
Some programs don't require any.
Some people have tried to argue that somehow it's not ethical to require students to do
that.
But I have learned so much being a client in at least a few ways.
One is I've learned so much about myself, which is entirely relevant to my understanding
(33:21):
of you.
100%.
I don't understand something within me.
I don't understand it very well in you at all.
I certainly don't think you have to have gone through everything that your clients have
gone through.
If that's the kind of match that's required, you're going to only...
It's going to be a charter.
Yeah.
Essentially nobody has all of your experiences or you they.
But the point is I need to know a lot of things about myself.
(33:43):
Secondly, I learned a lot in the client chair about what does and does not feel good coming
from the other chair.
100%.
Yeah.
And so if you don't think about it for yourself, just trust me on my experience of being an
employer.
Oh my gosh, you haven't done any...
And then think about it like this.
Let me get this straight.
(34:05):
Therapy is for everyone but you.
That is a special kind of...
I don't have any good words to describe it.
There's a special kind of streak in you that looks an awful lot like a buzzword that's
in our culture right now.
I'm going to use it anyways, which is narcissism.
And really it's about not wanting to be known.
(34:26):
A lot of therapists end up hiding.
Maybe if I can focus on everyone else's problems, I won't have to really worry about mine.
So the difficulty is I don't know how many therapists will answer that question.
Because a lot of therapists are so anti-disclosure, they're so anti-mutual vulnerability that
(34:46):
they wouldn't answer that with any level of specificity.
And for me, if they refuse to answer, that would be all I need.
I'd be like, thank you for your time.
All right.
Have a nice day.
This has been great for the 30 minutes that I've been sitting here.
That was one of my questions.
Oh, was it really?
Yes.
We had the same question and I was going to say the same thing.
(35:07):
Talk about what is it for you?
Or is it the same?
It is the same.
One of the things that I'll say, and I think I have a fair amount of disclosure with my
clients, but I will talk about, I'm in therapy.
You want me to be in therapy.
I'm like, would you go to a personal trainer who couldn't lift a weight?
You would be like, oh, I don't know that I can take you seriously about what I should
(35:29):
be doing for my body if you can't even lift a five pound dumbbell.
So the same concept sort of applies here.
And even if you want to say I had a blissful life until I was a therapist and I had nothing
that I had to process, the things we hear in the office alone between us and our clients
is enough to process in therapy, to hold space for people.
(35:51):
It has enough of an impact on us.
Yeah, to hold that kind of space for people.
You need to be able to have an outlet there that you can process the emotions and the
feelings that come up.
Because gosh, to speak to sort of what you were saying before, being a client gives me
an idea of what it's like for my clients.
No, we're not going to have the exact same stories.
(36:12):
And listen, a lot of my clients have gone through a lot of things that I have never
gone through, and it's heartbreaking to hear it.
And if I didn't have somewhere to process that, I can't show back up in the room and
really be beneficial because I'm going to start getting in my feels and getting distracted
by the things that don't help.
So that absolutely is a question.
(36:34):
I said the same thing.
In my notes, I said ask them have they been in any personal therapy, and if they're not
willing to answer the question, then that's all I need to know.
Was that both of your questions that you just had two?
Did you already have more?
I have one other one.
It was a semi question.
It was kind of like an outgrowth of my first one.
Can I hear that one?
You can.
(36:54):
So what if I find a great clinician, I like them, but they have a specific modality that
they use?
And I'm going to use a personal example.
I had a therapist who I went to.
She was great.
I was with her for a very long time.
Her modality was ACT, acceptance and commitment therapy.
(37:16):
And this is somebody that you, she did successfully answer your first question.
She was a good fit.
You enjoyed her company.
She's been in therapy herself.
She disclosed that she'd been in it for 20 years and was still in it.
So there was a fair amount of like decent disclosure there that I appreciated.
I saw her for two years.
(37:37):
We did great work together.
But one of the things that I didn't think to ask on the front end and was an outgrowth
of this experience that I then used going on to find new therapists was what happens
if your specific modality that you've done all this training in and that that's how you
brand yourself becomes a limit for me in terms of being able to go deeper or do other types
(38:00):
of work.
So they only sort of see the world and at least in therapy through that lens.
Yes.
And you know, with her, we came to an end and it was a mutual ending because she really
wanted to continue to only use that modality.
And it kept getting us stuck around things because I would say I want to express this
(38:22):
and learn about this in a different way.
And she just was really laser focused.
That is a great thing in a lot of ways, but it does have a hindrance later on, or at least
it did for me.
So one of my questions is going to be what happens if your modality becomes a sticking
point?
(38:42):
What do we do then?
Yeah.
Yeah.
And a good way to frame that maybe too is that because you're asking a question that's
a hypothetical for a future point that may or may not come, that this maybe isn't, you
can tell me if you agree with me, maybe this isn't a question that's necessarily a rule
out.
Right.
But there are a lot of good therapists who really do it just from this angle.
(39:08):
And maybe even ones that use multiple schools of thought might hear the question that you're
asking is like, what happens when we come to an impasse?
And the truth is that sometimes the work is just done and it is time to move on, which
is kind of what you said.
It was somewhat mutual on the basis of her being like, well, this is kind of like what
I do.
So part of the deal is knowing that this question is ultimately in service of you being able
(39:32):
to identify when you reach an impasse with your therapist and that it's time to move
on.
Because that is another thing.
We didn't even think about this ahead of time, but that a lot of people come in and you hear
that they were confused at some point because they really like their therapist and you really
have done good work.
And don't get me wrong, also in therapy, there are plateaus and then you scale another peak
(39:54):
together.
Sometimes the plateau just keeps plateauing and I've experienced this on the therapist
end as well.
And sometimes therapists are not skilled at saying, hey, it may be time for us to be done.
So maybe on the basis of asking this question, you will be skilled that this is a time to
hang it up if they aren't able to do anything fresh and you really think that that's what's
(40:18):
called for.
The difficulty being, of course, that sometimes, again, plateaus are just that and you will
scale a new one.
Yeah, that's really great.
I hadn't thought about questions that you ask at the beginning that could become relevant
later on, but I really appreciate that framework.
I kind of only have one more myself and it's interesting how much overlap there actually
(40:39):
is.
Not that that's really shocking for us, but I also am concerned about who the therapist
is besides their therapist identity.
And again, this is another thing that maybe some therapists...
Remember the whole point of this podcast is that we want to allow you a step closer, that
the therapists are opaque and a lot of therapists will not cede their opaqueness.
(41:03):
And to be clear, there are potentially some good clinical reasons why that is important.
I just don't think this type of question, who are you besides a therapist?
As much as I am interested in what they say, I am also interested in all the rest of what
they do with that.
(41:24):
Do they get squirmy?
Do they get shifty?
Are they like, I don't like this?
So for me, part of it is, again, speaking to your question about the sort of intuitive
read on is this a good fit or not in terms of personality and so forth, which I think
is also mission critical.
I'm interested in asking them things, appraising them intuitively, hey, who are you?
(41:49):
What if I was to ask you, who are you outside of being a therapist?
And again, I'm not really looking for contents.
I'm more like, give me a description of who you are.
And I'm interested to see what they can do with that question.
And in the same way, like you, I am one of my other things was also what you've already
said, which is who are we on a personality basis and is this a good match while remaining
(42:12):
open to the idea that personality isn't everything.
Sometimes it is way, way, way, way more than you think.
And on the basis of personality, a lot of times I come up with a final thought that
I had, which is like, do I like this person?
Like as a person and do they seem to like me?
(42:36):
Translating to a sort of inexperience mutually of feeling seen.
When I feel seen by someone for me, that means I feel liked by them up to and including disclosures
I have made about myself that may reveal darker themes, stuff that I'm not proud of, stuff
(43:02):
that I feel shame about, and I still feel regarded by them and really well liked by
them.
And then also I'm a person that like my thinking moves fast, my mouth can move fast.
I can say a lot in a very small timeframe.
I don't wish to have to like slow down for you unless you were asking me to like not
(43:22):
on the basis of if I don't slow down, you're not going to understand me.
More like I need you to slow down for a purpose, for a device and something I want to do here
with some of the content that you're saying.
So all of these are things that like, again, the question I would ask is, do I feel seen?
Do I like this person?
Which really corresponds to what you said at the outset, like, can I kind of be in the
(43:44):
room with you?
And the difficulty about this, when you compare this to what do you specialize in and what
types of therapy do you use, it almost feels sort of like unscientific.
And here's why it ain't.
In addition to you and I saying anecdotally that we have found these things to be helpful,
(44:06):
going back to this idea about the research in our field, research indicates that the
single biggest predictor of success in therapy is not modality.
Not whatever school of thought you use.
It is not what do you specialize in.
It is not age of the therapist.
(44:28):
It is not experience level even, but it is something that is referred to in a variety
of ways, but it would be like something called therapeutic alliance or therapeutic bond,
which is generally speaking, do I want to be in the room with this person?
Do I feel seen?
Do I feel understood?
(44:49):
Do they allow me close enough to be able to actually know the answer to those things,
to actually be able to evaluate these things?
And if they don't and I can't figure them out, then that's why it won't work.
Because not only have I not experienced that, I'm not even able to ask questions that allow
me to assess it.
(45:10):
And so if you're curious about this concept called therapeutic alliance or therapeutic
bond, please Google something like this, single biggest predictor of success in therapy.
And if you're really sharp and you want to go to scholarly research, go to scholar.google.com
and search for indicators of therapeutic success and over and over and over again, you will
(45:34):
see therapeutic bond rapport.
That's another way of saying it.
That's great.
I'm glad you said that.
Therapeutic rapport.
That's another one.
And you will notice, however, that again, these are not the types of things that are
emphasized by therapists.
Is that trust us, when you sit down with us, you're going to feel seen and you're going
to like us and we're going to like you.
(45:54):
Why?
Because it doesn't sound very scientific.
And the truth is in the school of human relationships, we come to find out that there are a whole
bunch of things that make sense and that have been validated by scholarly research and that
somehow still don't pass muster at the level of pop culture, what you saw on TikTok.
(46:16):
Why?
Because, I don't know, truth is stranger than fiction.
Sometimes the stuff that's real is actually a lot harder to believe than the stuff that
ain't and if that isn't a thing in our culture right now, I don't know what is.
Yep.
Stranger than fiction.
Real strange.
Little did you know.
Little did you know.
This is Ryan Thomas Neace.
(00:03):
And this is Nicole Neace.
This is the Closer Podcast.
How are you doing?
I actually, I feel good.
I feel good.
I just got out of yoga and when I was laying in Shavasana, I was thinking to myself, if
(00:28):
someone asked me right now, it's so weird that you asked me this question.
I was like, if someone asked me right now how I feel, I would say, this sounds so stupid,
I was like, I'm going to say I'm with peace.
You're with peace?
Yes, I'm with it.
Like, not I am peaceful or there's peace, but I'm with it.
Like there's peace and I'm with the peace.
(00:49):
Because not all things are great.
I'm not like, normally people are like, oh I'm fine, I'm good, da da.
Like, oh no.
I'm just, I'm with peace.
There's peace within and around and I'm with it.
It's an interesting thought.
I've never had that before.
Yeah, it's an interesting way to word it.
(01:10):
Yeah.
I was thinking about how when I used to say to you, have a good yoga, because today our
instructor let us, I wish I already knew this, but yoga means union.
Yeah.
And I was like, oh, have a good union.
I'm glad that's how I used to say that to him.
And then that got me on the train of thought of someone asked me how I was doing.
(01:31):
How would I word it?
And I intentionally went with, I am with peace.
I like it.
Thanks.
How are you doing?
How are you feeling?
I don't have an answer to that question.
One of the weird things that's happened for me over the last couple of years is that in
(01:53):
spite of the fact that I still regularly use and answer that question for people, it has
become an increasingly irrelevant question to me.
It feels like, obviously we know in our culture, we use it as like a, you know.
Greeting.
Yeah.
It's just a way to get in the door, to get in the room.
(02:15):
Sort of as like a little light surface talk while we sit down in the room together.
But you know, a lot of times we also try to answer it meaningfully when we can as well.
And I just find that I am variable throughout the day.
I feel one way when I wake up, which is why I get up and go to yoga and cold plunge and
(02:41):
contrast therapy, infrared sauna.
And then by the time I'm finished with that, I feel a different way.
And then by the end of the day, I feel another way, by the time I'm ready to go to bed, I
feel another way.
And so, you know, I'm with a lot of things.
Peace is one of them.
(03:01):
Definitely not the only one.
Yeah.
And there is a lot of that maybe in the world right now.
Yeah, certainly.
There's, you know, we're, as this is being recorded, we're just very shortly outside
the 2024 US presidential election.
So people are feeling a lot of ways about that.
(03:23):
And I think we feel a lot of ways about it ourselves.
And you know, we're looking at the New Year is not far away in light of the distress that's
sort of in the world right now.
And in light of the New Year coming, New Year's resolutions, etc.
This is the time of year when people start looking for therapy.
(03:48):
Yeah.
I mean, the holidays alone, let alone the election time is, so it's going to be a double
doozy I think for a lot of people.
Yeah, right.
Holidays, you know, increase in time with family for a lot of people just seems to drive
the therapy, oh God, I should look for therapy, oh meter.
(04:09):
And so today we kind of wanted to talk about our experiences of what clients tend to sort
of come in, like asking in an effort to determine what kind of therapists they're going to be
seeing.
And then our experience of maybe what we would ask on the basis of our own experience and
(04:32):
mental health.
I mean, between you and me, we have a combined, you know, 35-ish years or so of mental health
experience.
And we have learned a thing or two and it is the kinds of questions that clients tend
to ask are not bad, per se.
(04:54):
And there definitely is a certain logic to them.
Yeah.
But again, they're just like not the ones we would ask and maybe that's important.
They're not the only ones we would ask.
Yeah.
Yeah.
I don't think I would ask them, but...
These particular, I don't know that I would ask them or not quite this way, but it doesn't,
(05:15):
it wouldn't be wrong to ask them per se, but I don't know if it gets to the point of finding
fit.
Yeah.
So when she says these particular, we have seen a few that are passed around sort of
as memes on the internet, at our counseling practice, our group counseling practice, and
then in our own individual practice, we've seen clients come in asking questions like
(05:39):
this.
And so we'll just maybe kind of talk about those for a second and then do a sort of a
compare contrast and go from there.
Yeah, that sounds like a plan.
All right.
So the first one that clients come in asking a lot is a pet peeve of mine.
So it's a good place to start.
It is.
(06:01):
What do you specialize in?
And the problem with this, to the degree that there is one, I understand what it is driving
that.
Yes.
But the difficulty is asking it as such does not probably actually reveal what you think
it reveals, or at least it potentially does not reveal what you think it reveals.
(06:25):
So imagine that you've asked me, what do I specialize in?
And let's say that, for example, I say, you know, anxiety.
The question that I want to ask you as a client searching for a therapist is, do you know
anything about what it means when I say that I specialize in anxiety?
(06:48):
Do you know like what you've just asked me?
And the difficulty is that in our field, the term specialize is not regulated, meaning
you can kind of say you specialize in whatever you want.
And unless somebody finds that to be inaccurate, is really motivated, feels that somehow, let's
(07:10):
say they go and see you and that that's not the case and that somehow you're guilty of
misconduct and then they report you.
And then somebody else, then the board says, does an investigation and your licensure board
and then you end up being penalized or your licensure is in jeopardy or something.
You can more or less say that you specialize in whatever you want.
(07:33):
And you know, that's it.
No, it doesn't mean much.
It's not like going to a doctor.
Right.
Right.
So when you go to it, and this is, I think, part of the genesis of this question.
When you go to a doctor and you have a foot problem, well, you want to see a podiatrist.
You know, if you have an eye problem, what is it?
(07:54):
What is it?
Optometrist?
No, I think that's the people who do glasses.
I think ophthalmologist maybe.
Yeah, see, don't even know.
No, don't know.
But the point is, and you understand that there is at least some specialty training
there and typically quite a lot.
In therapy, necessarily, that could be true.
(08:18):
Somebody who says, I specialize in anxiety may in fact have advanced training in anxiety.
They may have advanced experience in anxiety.
But here's the thing, particularly as a person who has tended to employ younger budding
therapists with a desire to help them and sort of navigate the therapy world, what it
often means is, I have a lot of anxiety.
(08:44):
I've had a lot of anxiety my whole life.
And for the vast majority of the people that we've intersected with, that often means I
have not resolved a lot of my own anxiety.
I have not figured it out.
And so I think I should help other people who have the same.
And I want to be honest, like I, when I started out in mental health, I thought to myself,
(09:07):
well, I have really struggled.
And so maybe my sort of like calling in life is to help other people who've struggled.
And there's nothing principally wrong with that.
As a matter of fact, all of our research says that that's why we go in the field.
There's a bunch of therapists that don't know that apparently, but all of our research says,
I don't mean our, Nikki and I's, all the research in our field says that most therapists
(09:30):
go into therapy not so much for a desire to save the world, but something about saving
themselves.
There's nothing principally wrong with that as long as you figure it out.
And here's the thing, if the therapist doesn't know any of this, then a lot of times what
that means is they're going to be working out their anxiety issues with you.
Yes.
(09:50):
Yeah.
And I think also sort of similarly, as we're talking about, if you go see a specific type
of doctor for a specific type of thing, they've had a lot of education in that specific field
and it's less about an emotive state and just sort of like factual things that they're dealing
with.
So it's kind of something that's more concrete.
(10:10):
Yes.
Anxiety has many forms.
It shows up in a variety of ways.
So just because I've had anxiety myself the whole time and I want to help somebody who's
had anxiety, that doesn't mean I'm going to be a good fit with every person who has anxiety.
It's beyond just the thing that they quote unquote specialize in.
It is.
(10:31):
And maybe people don't know that for licensed professional clinical counselors, as they
call them in California, or licensed professional counselors or licensed mental health counselors
or switching disciplines a little bit, licensed clinical social workers or licensed marriage
and family therapists.
Any of these degree types, our training does not actually include specialization.
(10:55):
It is a very, very, very broad overview, enough to kind of get your foot in the door.
And that it is thought that specialization to the degree that it exists comes with time
and funneling of continued education post your graduate degree.
So again, when you ask someone, what do you specialize in?
(11:18):
You need to understand that in our field that may or may not reveal much about their actual
ability, acuity or skill in that area.
It could be you specialize in depression.
It means you've been depressed your whole life and that may or may not be worked out
just yet.
(11:38):
On this front that we go into the field sort of on the basis of our own struggle, there's
a book that's now I believe in its sixth edition by a guy named Dr. Jeffrey Kotler.
He is a friend of mine and has been, at least in the past, was a mentor of mine.
(12:01):
And this book has been a bestseller for over 30 years, hence it being on its late edition
here.
And the very first chapter of that book on being a therapist, at least in its previous
edition was called The Therapist's Journey.
And one of the subheadings is personal motives for being a therapist.
(12:22):
And I just want to read to you what he says.
He says, Our journey to become therapists began for most of us, here it is, not with the urge
to save the world or to help people, but rather to save ourselves.
Many of the motives for becoming a therapist are unconscious and even beyond the reach
of clinical supervision or personal therapy that skirts over such unresolved or disguised
(12:43):
issues.
And by the way, he is citing research in each of these sentences.
Frequently, they involve lingering struggles with early loss or unfulfilled narcissistic
needs for recognition and approval.
Half a therapist polled in a large-scale survey confessed that their choice to become a therapist,
as well as their subsequent professional development, was motivated largely by their resolution
(13:04):
to work through their own problems.
One area frequently mentioned is the desire to understand oneself more fully and to feel
more understood by others.
So again, when we really look at our motives for going into this field and then that intersects
with what we say we specialize in, knowing that specialization does not actually constitute
(13:28):
something that's regulated, that you have to do 10 trainings in anxiety to say you're
an anxiety specialist.
We just want to really encourage people to think, maybe this isn't the best way to frame
this question.
Right.
And I think I get it, yes, I specialize in anxiety, and unless I ask some really good
follow-up questions, I haven't actually, there's not been much revealed to me yet.
(13:50):
Right.
And a lot of those, I mean, nowadays with websites and different things like that, it
says on their bios what they, quote unquote, specialize in.
It does.
So you don't even really need to ask that question because most people are talking about
that in their bio as a snapshot of the types of clients that they are willing or wanting
to work with.
(14:10):
And so that question almost doesn't do much for you.
Okay, great, you worked with anxiety, now what?
Right.
And if, in other words, if you're going to ask that question, it's probably already been
answered on their website.
Interestingly, you and I don't say we specialize, we say we have a good bit of experience working
with, which tells you something.
(14:31):
Again, I could say I specialize in anxiety and I just got out of grad school and it means
all these other things, but I haven't actually, I don't have much experience, period, let
alone much experience with people with anxiety.
We try to talk about a little bit more as what we have experience with.
But this does highlight, you talk about websites and social media and so forth, another facet
of this.
Asking what you specialize in is like asking someone to give you all of their ego props.
(14:58):
Here's what I mean by that.
Our culture, perhaps more than any time in my own lifetime because of the advent of not
only the internet, but social media and this idea that everybody has their own personal
megaphone or their own personal place on the worldwide web that they can showcase who they
(15:18):
are.
The difficulty is, of course, often you are not really meeting them, you are meeting their
agent.
Chris Rock had a comedy special years and years and years ago and he was talking about
it in the context of dating, how oftentimes when you're meeting someone, you're not meeting
them, you're meeting their agent.
Your agent is somebody who looks like you and dresses like you but isn't really like
(15:41):
you at all once you get to know you.
Of course, this is what happens a lot of times in relationships.
Some of it is the inevitable course of a relationship.
How much can you really know about someone at the outset?
The difficulty with social media in particular is that it takes your agent and puts that
on display for the world to see.
It isn't that there isn't anything in there that's really you.
(16:04):
And of course, there usually is, but it isn't you.
In this same sense that you've heard me talk about this before, words are metaphors.
And so once you can kind of accept that, that when I am describing something to you as I
am doing right now, I'm carving at an idea, but I'm using words to carve at that idea.
(16:25):
And so words aren't the thing.
If I'm describing a cheeseburger to you, and even if that's a really accurate, precise
description to your experience, and it makes your mouth water and you think, oh, wow, this
is something, it's still not a cheeseburger.
Right.
Similarly, with social media, no matter how accurately I am trying to authentically display
(16:48):
who I really am, it's still not really me.
You won't really know that until you spend a bunch of time directly experiencing me.
And so my biggest beef with the specialty question, given that it's not regulated, and
you can kind of say whatever you want, and that it may actually be an outgrowth of your
dysfunction, and let alone, in our experience, a bunch of therapists aren't even aware of
(17:11):
why they got into the field beyond the, I want to help people, I swear, you know, statement.
You're like asking them to give you all of their ego projections about themselves.
That's just not a good approach.
But it's definitely from the organic medical paradigm, the doctor paradigm.
(17:34):
There's something to it.
It just may not actually be giving you the information that you're actually looking for.
Right.
Well, it's like, you know, for years at our practice when I would help onboard clients
and try and figure out fit, and these were the kinds of questions that people would ask,
I used to say, you can go to a car dealership with a laundry list of things that you want
(17:56):
your car to look like have all the amenities, what so have you, then you get behind the
wheel and you drive it and you're like, oh, this is saying that this is not it.
There's nothing wrong with this, but this is not the thing.
So then you continue your search.
And that is sort of how I feel like the specialization question is.
You asking me what I specialize in is just something on a paper that might be a good
(18:20):
fit, but there's more to it than just that.
Yeah.
Maybe that's a good point you're bringing up when you use the word fit.
If the question is sort of like, how do I find a good therapist?
Gosh, man, you can ask these questions.
They may or may not get you there.
But I think the thing that we're always wanting to do with people is as much or more as like,
(18:41):
how do I find a good therapist where good therapist equals somebody who specializes
in anxiety?
Because that's what I think I have.
And oh, by the way, I'm self-diagnosed because I read on Google that I have these three things.
And that sounds a lot like anxiety.
What we're saying is, well, how about we try to help you assess fit, which is different
than are you a good therapist?
(19:01):
Or what do you specialize in, which I then stack up as reasons to or to not call you
a good therapist.
Right?
Yes.
So also just to piggyback on here, a similar related question that is sort of driving at
the same types of things is what types of therapy do you use and how you how would you
(19:23):
describe your approach?
I am now a 22 year veteran of the mental health industry and I have been practicing counseling
proper since roughly 2005, post-master's since 2006, post-licensure since 2011.
(19:49):
So I'm even post-licensure.
I'm 13 years in and I'm 22 years into the field.
I am just now in some senses really able to articulate a coherent answer to that.
And so the difficulty in asking people with even my degree of experience or less is again,
(20:12):
you're sort of asking them to sort of sell you a bill of goods, which that bill of goods
may or may not actually correspond to reality.
Again, like with my experience of onboarding clients, we noticed this trend with social
media where there's a particular type of modality that is really being heavily pushed for a
(20:37):
long time.
Like all of a sudden 70,000 people are on TikTok talking about whatever, CBT or narrative
therapy or...
Correct.
And then all of a sudden everyone who's calling, everyone who's writing is like, are you a
CBT therapist?
Do you do EMDR?
And then if you don't, I'm not open to talking about talking with anybody else because they
(20:58):
don't go back to the first question, specialize, right?
Or have that as their particular approach.
What we would find a lot of times is I can pair you with somebody who has CBT training.
Most of us get some of that on the front end of schooling, go on to do a little bit post
(21:19):
graduate work.
Doesn't mean that I'm necessarily going to be a good fit for you because there could
be a variety of other things that are being presented that would be good for this therapist
and maybe not so much for this one.
In terms of what the client is presenting, is there issues?
Yeah, exactly.
Let me give you an example.
(21:40):
Someone calls in and says, do you have CBT training?
I'm like, I have three therapists who have CBT training.
Okay.
Okay.
Do any of them specialize in anxiety?
So now we've got both questions.
Right.
Oh my gosh.
So you specialize in anxiety if you want to use that language.
Which is like, oh my God, this is not it.
This is not how you do this.
(22:00):
So then my approach would be somewhat different.
There are other things that I implement at this point to say, how do I find a good fit
for you?
Right.
There it is again.
So it's like there is something to this idea of you asking me sort of generic questions
and hoping that that is going to get to the source of the thing that you've been saying.
(22:22):
Right.
So you're asking me questions that because naturally no fault, not a criticism, you don't
know that they're generic because they sound really insightful.
Right.
But in fact, again, and here's the piece that highlights training again.
You may not know this, people who are listening, but we do.
When you go through training to be a therapist, again, you are given a general broad overview.
(22:47):
And when you come out, you are encouraged to elect a particular school of thought that
you want to operate from.
Right.
And to learn as much as you can about that.
But check it out.
All of that occurs post-graduation.
Right.
And so you may be meeting someone anywhere along that road of their journey.
And again, saying that I use a particular modality is not regulated.
(23:11):
Right.
I can say I use CBT.
And actually, this is a very frequent occurrence in my experience of therapy.
People say, oh, what are we doing?
And I will name some thing that we've just done.
And they'd be like, oh, I went to a therapist who said they, and it is very clear from the
client's description of their previous therapy experience, that in fact, although the person
(23:32):
had it on their website and they say they're trained in it and they might even say, oh
God, they specialize in your particular issue using narrative therapy to treat anxiety,
they don't.
Right.
And if, again, if this contextualizes your experience of therapy, if you're listening
(23:53):
to this and you're like, oh my gosh, this kind of describes what I've experienced.
I mean, wouldn't you say that that's one of the most common things that we hear?
People coming to our practice, one of the most common refrains that I have heard, you
could tell me if it's the same on the phone, is I've been to like four therapists and they're
all shit.
Yes.
Yes.
(24:13):
It's not a very nice thing to say, but I'm just like, oh my gosh, if I have to hear,
I mean, so many clients say it.
This is not it.
This is not what they were doing.
One of the unique approaches that we take to pairing clients with clinicians around
the concept of fit is going beyond these sorts of generic questions.
(24:34):
And after I spend 15 minutes on the phone with them talking to them about these sorts
of things, they feel very hopeful because they're like, wow, before I just clicked on
a button because this person said anxiety and said CBT and those were the two things
that I think I need.
And so I signed up and then I got there and I sat across from this person who, you know,
clearly we were not vibing.
(24:55):
Yes.
And also they didn't actually do the thing that they said they were going to do anyways.
No.
I don't feel great like saying these things about our industry because it's critical
in a way and it is sort of feels like we're trotting out our dirty laundry for everyone
to see that the industry.
But on the other hand, I do feel great about it because it adds context to so many people's
(25:20):
experiences of therapy that seemingly went nowhere.
You know, when you, there's only so many times in a row you can hear a client say, I have
been in therapy for two years prior to coming to you.
And in the first two months with you, I've had more movement than I did in the entire
two years previously before you finally are saying, well, gosh, I guess this must really
(25:42):
be true about our industry.
And certainly again, as people who have employed therapists, this is very true to our experience.
And we don't even mean these as criticisms per se.
They are just, let's get real about what this industry really looks like from the inside
and then let's try to help people navigate their way to something that's actually going
(26:03):
to help them.
So I think I mentioned this earlier, one of the fun things that Nikki and I did in advance
of having this little discussion was say, what if we both kind of thought about like,
what are the questions we would ask when looking for therapists?
What would we say?
And again, you can hear that however you want.
(26:25):
You can pair it alongside the questions that if you still like the specialty question and
the what therapy style do you use question, or you can hear them as alternates and they
can go with them or alternate to them.
But what would we ask?
And then we didn't talk about it so that we could kind of see, ooh, do we have overlap?
Do we agree?
(26:45):
Do we disagree?
Is there something that...
So you want to try it out maybe.
I just came up with a couple and I think cut at it.
So maybe I'll let you go first and why don't you hit us with it?
What would you ask?
Right.
Well, okay.
So maybe piggy, one of mine actually kind of piggybacks off of this last question.
(27:06):
When I said...
Which question?
The last one about what kind of therapy do you use, like modalities, right?
And I said, hey, when I used to talk to clients, they would say CBT anxiety and then that would
be it.
One of the things that I would often say to clients is like, okay, talk to me just a little
bit about you.
Tell me about who you are.
Like outside of your presenting concern, right?
(27:30):
You're calling in because you're feeling very anxious and you want to tend to that.
Can you talk to me just a little bit about your life?
Things that you're into, like what interests you?
Have you had experience in therapy before?
What was that like for you?
What went well?
What didn't go well?
And just getting to know the person on the phone and saying, oh wow, and I use the same
approach even with my own clients.
(27:52):
Talk to me a little bit about you because while I could use CBT or narrative or any
kind of other modality, I am not going to limit myself to that modality.
So one of the things that happens a lot of times is as I get to know you and what's going
on, I might use pieces of those modalities, but because you're a human and you're complex
(28:19):
and there's lots of parts of you, I need to be able to move and shift in and around those
things.
Yes.
And so one of my questions when I am looking for a therapist and trying to determine who
is a good fit is sort of like, who am I in relation to my affect and reality and who
(28:39):
do I tend to get along with?
So that's a question you're actually asking yourself.
I'm asking myself that.
And so while I'm interacting with the potential clinician I'm going to see, I'm saying, is
this that kind of fit?
Because if I'm going to sit here and open up the depths of me and try and talk to someone
for an hour once a week about things that I don't talk to most people about, I can't
(29:01):
realistically think I'm going to do that with somebody that we're just not clicking.
We're not seeing the world in the same way.
And some of that is sort of an unspoken experience.
So the only way I know how to get to that is kind of just being with them on the phone
and talking to them.
So I think what you're saying is part of finding a good fit, which is different than is this
(29:28):
person a good therapist where a good therapist equals all the things we've said, which we're
saying may or may not correspond to reality on any number of levels.
You're saying first I should ask myself, what kinds of people do I really find that I gel
with?
And then there's something about carrying the answer to that question with you into
(29:51):
either an initial phone call with the therapist or to being in the room with the therapist.
That's an important caveat.
You may have to test drive a therapist or two and check it out.
Yeah.
You may have to shell out some money either through insurance or through your regular
old bank account to make this happen.
(30:12):
And we can talk about that at another time, but I realize a lot of people, they don't
want to spend any money on this.
They want the therapist to give them an initial consult where the initial consult is 20 minutes
and they want to be able to figure it all out there.
My experience is that's not realistic that you really have to spend at least an hour
or two or three with them before you may have the sense.
(30:33):
Although you may also develop it much more quickly.
But the point is, what does my intuitive reading of myself say about the types of people I
gel well with on the basis of personality?
It may not matter if they check the specialty and therapy type box.
If you sit down in front of them and you're like, oh my gosh, I would never talk to this
(30:53):
person outside this therapy room ever.
Yeah, 100%.
What about you?
Do you have a...
Do you want me to trot one of mine now?
I want you to go one time.
Yeah.
Well, I don't...
The difficulty with what I'm about to say is I don't know if therapists will answer
this.
Okay.
Which should tell you something if they won't.
(31:15):
Yeah, I'm really...
I'm so excited for that.
Well, it's not...
I'm making it...
Now it's going to be anticlimactic.
I would ask the therapist, because it's very important to me as a therapist who understands
that therapists go into therapy because we are motivated to do so out of our own struggle.
(31:37):
And as a therapist who has spent most of his professional career and a little bit before
in therapy, I would ask, how much therapy have you been in across your lifetime?
I'm not necessarily needing to know the contents of your therapy or anything sort of invasive
like that.
(31:57):
I'm just wanting to know how much therapy have you been in?
Can you give me like a sort of an aggregate ballpark number of days, weeks, months, years?
And so part of the deal in asking this question is also informed by us as employers, the amount
of times...
And guys, I don't like saying this.
(32:18):
This is a problem.
Yeah.
But how many therapists we meet who have never done any therapy outside of what was required
by their graduate programs, which by the way is typically 10 to 12 sessions.
It used to be like a sine qua non, a quintessential part of therapeutic training back in the olden
(32:40):
days when the psychoanalysis...
You're talking about the post Freudian where everybody was a psychoanalyst or everybody...
Then Jung came along and everybody...
Where you had to go through your own analysis.
And psychoanalysis takes years.
And so it was just sort of a given that you've had these gobs and gobs and gobs of therapeutic
(33:00):
experiences.
Now that's not it at all.
It's 10 to 12.
Some programs don't require any.
Some people have tried to argue that somehow it's not ethical to require students to do
that.
But I have learned so much being a client in at least a few ways.
One is I've learned so much about myself, which is entirely relevant to my understanding
(33:21):
of you.
100%.
I don't understand something within me.
I don't understand it very well in you at all.
I certainly don't think you have to have gone through everything that your clients have
gone through.
If that's the kind of match that's required, you're going to only...
It's going to be a charter.
Yeah.
Essentially nobody has all of your experiences or you they.
But the point is I need to know a lot of things about myself.
(33:43):
Secondly, I learned a lot in the client chair about what does and does not feel good coming
from the other chair.
100%.
Yeah.
And so if you don't think about it for yourself, just trust me on my experience of being an
employer.
Oh my gosh, you haven't done any...
And then think about it like this.
Let me get this straight.
(34:05):
Therapy is for everyone but you.
That is a special kind of...
I don't have any good words to describe it.
There's a special kind of streak in you that looks an awful lot like a buzzword that's
in our culture right now.
I'm going to use it anyways, which is narcissism.
And really it's about not wanting to be known.
(34:26):
A lot of therapists end up hiding.
Maybe if I can focus on everyone else's problems, I won't have to really worry about mine.
So the difficulty is I don't know how many therapists will answer that question.
Because a lot of therapists are so anti-disclosure, they're so anti-mutual vulnerability that
(34:46):
they wouldn't answer that with any level of specificity.
And for me, if they refuse to answer, that would be all I need.
I'd be like, thank you for your time.
All right.
Have a nice day.
This has been great for the 30 minutes that I've been sitting here.
That was one of my questions.
Oh, was it really?
Yes.
We had the same question and I was going to say the same thing.
(35:07):
Talk about what is it for you?
Or is it the same?
It is the same.
One of the things that I'll say, and I think I have a fair amount of disclosure with my
clients, but I will talk about, I'm in therapy.
You want me to be in therapy.
I'm like, would you go to a personal trainer who couldn't lift a weight?
You would be like, oh, I don't know that I can take you seriously about what I should
(35:29):
be doing for my body if you can't even lift a five pound dumbbell.
So the same concept sort of applies here.
And even if you want to say I had a blissful life until I was a therapist and I had nothing
that I had to process, the things we hear in the office alone between us and our clients
is enough to process in therapy, to hold space for people.
(35:51):
It has enough of an impact on us.
Yeah, to hold that kind of space for people.
You need to be able to have an outlet there that you can process the emotions and the
feelings that come up.
Because gosh, to speak to sort of what you were saying before, being a client gives me
an idea of what it's like for my clients.
No, we're not going to have the exact same stories.
(36:12):
And listen, a lot of my clients have gone through a lot of things that I have never
gone through, and it's heartbreaking to hear it.
And if I didn't have somewhere to process that, I can't show back up in the room and
really be beneficial because I'm going to start getting in my feels and getting distracted
by the things that don't help.
So that absolutely is a question.
(36:34):
I said the same thing.
In my notes, I said ask them have they been in any personal therapy, and if they're not
willing to answer the question, then that's all I need to know.
Was that both of your questions that you just had two?
Did you already have more?
I have one other one.
It was a semi question.
It was kind of like an outgrowth of my first one.
Can I hear that one?
You can.
(36:54):
So what if I find a great clinician, I like them, but they have a specific modality that
they use?
And I'm going to use a personal example.
I had a therapist who I went to.
She was great.
I was with her for a very long time.
Her modality was ACT, acceptance and commitment therapy.
(37:16):
And this is somebody that you, she did successfully answer your first question.
She was a good fit.
You enjoyed her company.
She's been in therapy herself.
She disclosed that she'd been in it for 20 years and was still in it.
So there was a fair amount of like decent disclosure there that I appreciated.
I saw her for two years.
(37:37):
We did great work together.
But one of the things that I didn't think to ask on the front end and was an outgrowth
of this experience that I then used going on to find new therapists was what happens
if your specific modality that you've done all this training in and that that's how you
brand yourself becomes a limit for me in terms of being able to go deeper or do other types
(38:00):
of work.
So they only sort of see the world and at least in therapy through that lens.
Yes.
And you know, with her, we came to an end and it was a mutual ending because she really
wanted to continue to only use that modality.
And it kept getting us stuck around things because I would say I want to express this
(38:22):
and learn about this in a different way.
And she just was really laser focused.
That is a great thing in a lot of ways, but it does have a hindrance later on, or at least
it did for me.
So one of my questions is going to be what happens if your modality becomes a sticking
point?
(38:42):
What do we do then?
Yeah.
Yeah.
And a good way to frame that maybe too is that because you're asking a question that's
a hypothetical for a future point that may or may not come, that this maybe isn't, you
can tell me if you agree with me, maybe this isn't a question that's necessarily a rule
out.
Right.
But there are a lot of good therapists who really do it just from this angle.
(39:08):
And maybe even ones that use multiple schools of thought might hear the question that you're
asking is like, what happens when we come to an impasse?
And the truth is that sometimes the work is just done and it is time to move on, which
is kind of what you said.
It was somewhat mutual on the basis of her being like, well, this is kind of like what
I do.
So part of the deal is knowing that this question is ultimately in service of you being able
(39:32):
to identify when you reach an impasse with your therapist and that it's time to move
on.
Because that is another thing.
We didn't even think about this ahead of time, but that a lot of people come in and you hear
that they were confused at some point because they really like their therapist and you really
have done good work.
And don't get me wrong, also in therapy, there are plateaus and then you scale another peak
(39:54):
together.
Sometimes the plateau just keeps plateauing and I've experienced this on the therapist
end as well.
And sometimes therapists are not skilled at saying, hey, it may be time for us to be done.
So maybe on the basis of asking this question, you will be skilled that this is a time to
hang it up if they aren't able to do anything fresh and you really think that that's what's
(40:18):
called for.
The difficulty being, of course, that sometimes, again, plateaus are just that and you will
scale a new one.
Yeah, that's really great.
I hadn't thought about questions that you ask at the beginning that could become relevant
later on, but I really appreciate that framework.
I kind of only have one more myself and it's interesting how much overlap there actually
(40:39):
is.
Not that that's really shocking for us, but I also am concerned about who the therapist
is besides their therapist identity.
And again, this is another thing that maybe some therapists...
Remember the whole point of this podcast is that we want to allow you a step closer, that
the therapists are opaque and a lot of therapists will not cede their opaqueness.
(41:03):
And to be clear, there are potentially some good clinical reasons why that is important.
I just don't think this type of question, who are you besides a therapist?
As much as I am interested in what they say, I am also interested in all the rest of what
they do with that.
(41:24):
Do they get squirmy?
Do they get shifty?
Are they like, I don't like this?
So for me, part of it is, again, speaking to your question about the sort of intuitive
read on is this a good fit or not in terms of personality and so forth, which I think
is also mission critical.
I'm interested in asking them things, appraising them intuitively, hey, who are you?
(41:49):
What if I was to ask you, who are you outside of being a therapist?
And again, I'm not really looking for contents.
I'm more like, give me a description of who you are.
And I'm interested to see what they can do with that question.
And in the same way, like you, I am one of my other things was also what you've already
said, which is who are we on a personality basis and is this a good match while remaining
(42:12):
open to the idea that personality isn't everything.
Sometimes it is way, way, way, way more than you think.
And on the basis of personality, a lot of times I come up with a final thought that
I had, which is like, do I like this person?
Like as a person and do they seem to like me?
(42:36):
Translating to a sort of inexperience mutually of feeling seen.
When I feel seen by someone for me, that means I feel liked by them up to and including disclosures
I have made about myself that may reveal darker themes, stuff that I'm not proud of, stuff
(43:02):
that I feel shame about, and I still feel regarded by them and really well liked by
them.
And then also I'm a person that like my thinking moves fast, my mouth can move fast.
I can say a lot in a very small timeframe.
I don't wish to have to like slow down for you unless you were asking me to like not
(43:22):
on the basis of if I don't slow down, you're not going to understand me.
More like I need you to slow down for a purpose, for a device and something I want to do here
with some of the content that you're saying.
So all of these are things that like, again, the question I would ask is, do I feel seen?
Do I like this person?
Which really corresponds to what you said at the outset, like, can I kind of be in the
(43:44):
room with you?
And the difficulty about this, when you compare this to what do you specialize in and what
types of therapy do you use, it almost feels sort of like unscientific.
And here's why it ain't.
In addition to you and I saying anecdotally that we have found these things to be helpful,
(44:06):
going back to this idea about the research in our field, research indicates that the
single biggest predictor of success in therapy is not modality.
Not whatever school of thought you use.
It is not what do you specialize in.
It is not age of the therapist.
(44:28):
It is not experience level even, but it is something that is referred to in a variety
of ways, but it would be like something called therapeutic alliance or therapeutic bond,
which is generally speaking, do I want to be in the room with this person?
Do I feel seen?
Do I feel understood?
(44:49):
Do they allow me close enough to be able to actually know the answer to those things,
to actually be able to evaluate these things?
And if they don't and I can't figure them out, then that's why it won't work.
Because not only have I not experienced that, I'm not even able to ask questions that allow
me to assess it.
(45:10):
And so if you're curious about this concept called therapeutic alliance or therapeutic
bond, please Google something like this, single biggest predictor of success in therapy.
And if you're really sharp and you want to go to scholarly research, go to scholar.google.com
and search for indicators of therapeutic success and over and over and over again, you will
(45:34):
see therapeutic bond rapport.
That's another way of saying it.
That's great.
I'm glad you said that.
Therapeutic rapport.
That's another one.
And you will notice, however, that again, these are not the types of things that are
emphasized by therapists.
Is that trust us, when you sit down with us, you're going to feel seen and you're going
to like us and we're going to like you.
(45:54):
Why?
Because it doesn't sound very scientific.
And the truth is in the school of human relationships, we come to find out that there are a whole
bunch of things that make sense and that have been validated by scholarly research and that
somehow still don't pass muster at the level of pop culture, what you saw on TikTok.
(46:16):
Why?
Because, I don't know, truth is stranger than fiction.
Sometimes the stuff that's real is actually a lot harder to believe than the stuff that
ain't and if that isn't a thing in our culture right now, I don't know what is.
Yep.
Stranger than fiction.
Real strange.
Little did you know.
Little did you know.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
NFL Daily with Gregg Rosenthal
Gregg Rosenthal and a rotating crew of elite NFL Media co-hosts, including Patrick Claybon, Colleen Wolfe, Steve Wyche, Nick Shook and Jourdan Rodrigue of The Athletic get you caught up daily on all the NFL news and analysis you need to be smarter and funnier than your friends.