#mft intern

Hi anon! 

Yay! I looooove asks from therapists or from those trainings to do so. I wrote about this here so this is a more expanded answer but will be similar.  @othersideofthecouch answered this here. My answer isn’t going to be perfect and it’s coming from my experience so it’s just as flawed as everyone else. Also I know a lot of folks in therapy who aren’t therapists read this so a heads up - this may be okay for you but it may not. If it feels like too much, bounce out! Take care of you! {This is also like the world’s longest post so just fyi}

Take some breaths - all the shit you are going to be passing along regarding anxiety management, you are passing it on cause it works. So use it. Use the mindfulness and DBT techniques you know. Laugh with your peers, use your supervision and if you have it, use your field placement class if you are still in graduate school. Remember that you are the therapist and they are the client - when you the person is showing up with the room, it needs to be for a reason. I’ve seen therapists who have used sessions to spend the whole thing talking about themselves and it sucks. Remember that your clients don’t owe you trust - you have to earn that. OH and please for love of everything read this post by @cps-oteric if you are going to do any work with social worker “in the system.” You also may want to take a look at your social media accounts prior to starting.

The best advice I got in grad school was a professor (who continues to be one of my mentors and leads my consult group). They laid it out: “You guys are going to fuck up. Every. Single. One. Of. You. Will. Mess. Up. It’s going to happen. Because you are human and your clients are human and there is room for mistakes. Now, I’m not talking about the mistakes you have a choice over - the stuff you guys covered in Law and Ethics. That you should always be aware of and strive to prevent. But the accidental mistakes? The mistakes of inexperience? Those can be incredibly valuable for your client too. Part of our job is give people a different experience - to own up when we fuck up and do the repair work with the client.” 

Why was this the most helpful for me? Because it gave me the space to feel like it’s okay to make mistakes. It wasn’t okay to ignore those things or be intentionally fucked up but that I didn’t have to be perfect. I “fucked up” early in my first field placement - I had to call out unexpectedly. I did the right thing and called my supervisor, let them know and called the location I was supposed to be at that day. The site was supposed to let my client know and they didn’t. For the client, this is was major thing and we ended up doing a lot of repair work around but in owning up to the experiencing be shit for the client, even though that wasn’t my intention, was a huge deposit in the proverbial trust bank and was new experience for the client. I didn’t apologize for taking the time - I needed it full stop - but I did apologize that it wasn’t communicated effectively to this client and validated/normalized the feelings that came up. It’s also important not to let your anxiety/discomfort/fear etc. around messing up, compound the mistake - which is why I am pretty into therapist’s knowing their own shit. tldr; You are going to mess up but explore it with your supervisor, your mentors, your cohort. You won’t be a perfect therapy robot. 

As to the second fear - look at what you mean by attached. What’s the fear there for you? Often, it’s around not being able to keep your clinical hat on because you will be too close and/or that it will hurt when you leave. There will be probably clients it hurts to leave. Leaving my last job, I had a couple of clients - man. I still think about them and hope they are doing well. There are a couple of clients right now, who if I left my agency, it would hurt to leave. And I’m not talking about being devastated or anything would indicate an over attachment where you don’t keep that clinical hat on but when relationships end - it can be sad. Relationships have two sides, that connection develops no matter your modality - I can’t speak of all therapists here for sure. But all of the therapists I know personally and many of the therapists I’ve take courses from have experienced attachment in some way. Often, your clients will leave their fingerprints on you. Some in dust and some tattooed. Process your countertransference around this. Sometimes, in grad school, you get the idea that countertransference is all about the start of an ethical breach (or my Law and Ethics professor was just a royal asshole which is a distinct possibility). You will have feelings about your clients - positive, negative and in between - and sometimes - right at the beginning especially for me - I thought grownup therapists had all their shit together and they didn’t have feelings about this shit which like WHAT?! No. You get better at riding those waves that’s all. It’s more like “oh yup, this client’s mom is making me feel X” or “this client is bringing up frustration because of x and I know that and that’s just me. Gotta bring that to supervision/consult group/therapy”

It will depend on your placement and other factors. If you are working on a MRT or in a hospital, then you are will be affected by your clients, for sure, but your attachment may be different than it is for others with more long term placements. One of my really good friends from graduate school loves working on mobile response because she likes engaging with folks for a short period of time and has never had a desire to do the more long term work. I ended up being hired by my first placement so I had the opportunity to work with some clients for multiple years. And sometimes the length of time doesn’t matter. I saw a client for I think 2-3 times? Somewhere in there but no more than 4. But there was something about that client and those sessions that will stay with me forever. (I talked about this case in therapy when it was happening and I have a decent idea why). So your mileage will vary. 

Do your best to take care of yourself. Put your cases and clients, lovingly away at the end of the day. Set good boundaries with your agency and placement. Yes, you signed up to do a job but they don’t own you 24/7. Hang out with your friends, your family, your partner, your cat - whatever you love. Grab a coffee or a dinner with a friend or a cohort member. Have good boundaries with your friends. If you aren’t sober/working on sobriety, go to team happy hour and if you are, advocate to have a team activity that’s not a bar. Use your supervision. Reach out to mentors if you don’t think the placement is a good fit. Don’t forget to eat. Move your body. Watch TV or read a good book or garden or run or goof off on the internet but do something for you. SLEEP. If you are on meds, take them. If you can make it work (I couldn’t most of my traineeship and regret it), find a therapist. Tell ‘em you are starting your placement and some will dip low on the sliding scale cause we’ve been there. 

Yeah, it’s frowned upon to be a therapist and never been in therapy. You can wait til you are in graduate school but many programs’ applications want you to be able to speak to your experiences in therapy. It’s fine to have the desire and not have had therapy but if you really want to pursue it - it’s important to go for at least a bit. You need a lot of good self-knowledge to be a good therapist. Counter-transference and your own shit is going to come up for you, even if you think it won’t (I saw this in grad school for sure with the one person without any therapist experience). If you get all the way through graduate school and still haven’t ever been in therapy, you will get some side eye from other therapists for sure. 

If you haven’t ever been if therapy, you don’t know what’s it’s like to be on the other side: to know how much power and influence a therapist can wield; how hard it is to trust this random stranger with a degree to whom you pay money; what it feels like when questions are asked too hard or too quickly or just right; what it feels like when you are in a good grove and it’s shitty and hard and wonderful all the time; or what it’s like to feel like you might be dependant on a therapist and it scaring the fuck out of you; what good attunement in therapy feels like; what bad attunement in therapy feels like; what makes you feel safe in therapy and why that is; what happens when you are really fucking pissed at your therapist and how a good therapist handles it, or what a bad therapist does to not handle it; what a bad fit feels like with a good therapist; what a shit therapist feels like; what feels like support and what feels like dismissal, how it is to tolerate when someone else is dragging you through your own emotions. 

All that stuff is in addition to the self-knowledge you need to be good at this - what pisses you off and what to do about it - and not even the big things! I fucking hate spit and didn’t know it until I started but I knew how to tolerate other stuff so I was able to apply that to a spitting situation. What shit you are carrying from your own trauma(s) or Trauma(s). What stuff you are carrying from your family of origin. Having a defined sense of self so that you don’t get wrapped up in your clients. Because some clients won’t get better and some don’t need your help; some will but that’s not up to us. What triggers you? A client who liked very much casually referred to me as a dyke in a joking way when the client was not any flavor of lbgtq and I had an enormous reaction to it but I knew why, I could process that if I expressed this to the client it would be harmful, was able to set a boundary around language in session and then cry in my car with on the phone with another queer therapist. It wasn’t about the client at all. It was my shit. But because of therapy - I knew it. I safely set a good, non-shaming boundary and we moved on to some amazing work. But without doing my own work - that wouldn’t have been the outcome. Or it would have taken a lot of mess to get there. You need choice around your actions in the room and unless you really look at it and have someone from the outside look at with it - those issues can be hard to see. Looking at why you want to do this. Looking at what this means to you.  Where are your boundaries? What’s flexible and what’s not? Can you tolerate others being dependant on you. Can you tolerate people getting mad or being attracted to you? What happens if you race/disability/gender/religion/fatness come into the room in a mean or an aggressive way? Because it might. It probably will. What your culture, racial, class-based, gender based, religious and familial biases are. It’s frustrating to see clinicians who don’t do their own work to expect marginalized populations to do their work for them or to make them “feel okay” about issues around race, class, disability, gender or sexuality. And this happens a lot. You will have feelings about all these things and dealing with them in the room with client can be extremely harmful. 

I’ve done therapy in a residential setting, in a school setting and some in private practice. Right now, I’m primarily in a school setting. It’s very different than private practice. Private practice - it’s all on you administratively. You are marketing yourself to get referrals, billing insurance if you take it, finding, renting and maintaining your own space, your own health insurance etc. It also means that most of the time, you set your own schedule, which days you work and the times, how many clients you see. Clients also come to you. You still have to write some notes but from my experience - private practice folks vary *widely* in how extensive they are. Cost can be issue (i.e. if you think a client needs supplemental sessions or more than once a week, that’s coming out of the client’s pocket or you are justifying that to the insurance panel). When a client misses sessions, man it’s a thing you have to deal with. Depending on your policy, you have to charge them because that is time reserved for them. Income can be decent if you are seeing a fair number of clients.

 In a school setting, most of the time you aren’t dealing with most of the stuff above. You are an employee for a district or an agency. They do the business taxes, the health insurance, the physical space stuff. When you are seeing clients in school, you get a lot more flexibility - especially if you are at placement all week. Client absent? No worries. Try and catch the client tomorrow. Major dissociation in session? Again no worries. The client just stays through the next period. Something major just happen? Cool, twice a week this week. And your clients have to be at school so it’s easy to find them, even if they are choosing not to come to session. It’s not my therapy and it doesn’t affect my livelihood if they don’t show. I can be way more patient with school based than in private practice because I get paid whether or not they come. It gives slow to warm clients more flexibility - I have no problem holding a slot for them and them not taking it because I do have the flexibility. I can fill that time a lot of ways - including seeing other clients because of the environment. It can also be really fucking frustrating to deal with everything not client related. It’s formal assessments and treatment plans every 6 to 12 months for every client. It’s not being able to control your caseload. I’m not good with psychotic disorders. But I’m expected to take what come down the line. They also control my caseload. I can (and do) push back against this aggressively but unless I can make an ethical argument or my individual supervisor backs me up I don’t have a lot of choice. Medi-Cal or district note writing can die in the fire. Having to get notes in within 24, 48, or 72 hours is a exercise in both futility and aggravation. (My notes? Basically only on time if I’m writing about a no show. If I have to choose between clinical care and paperwork - clients come first and I can’t maintain 10-12 hour days.). I also have to step carefully around teachers and school staff as well as all the office drama. To me, it’s worth it because I do get to do such cool work and get this much flexibility. But most agency therapists eventually get burnt out and leave or just make the choice to leave because the pay isn’t very good, you are expected to work long hours, to meet impossible productivity requirement and you are often dealing with intense trauma. And all of that is happening in addition to the systemic racism and oppression inherent in the systems that you and your client are trying to navigate. And most of the time the district doesn’t want to hear, “Hey this long term teacher is a racist asshat who is using racial slurs in class” especially if they are teaching the difficult to fill classes (like special education). I wish that I could say I have done this. I'm done it multiple times. I mean I do it. Everytime. It’s important that my clients know that I believe them and will fight with them and for them. But I know it will cause me a mountain of shit. I know it and do it anyway. But some people can’t.  And that’s okay because hopefully they’ll move onto something that suits them better. For me, this is worth it and I love, love my job. 

{Sidebar to the therapists and social workers reading this: We are going to real for a second. if you are a therapist in a school, public health or a community setting and you are feeling like, “Fuck me. I can’t do this work anymore” - get out. Secondary trauma is a serious occupational hazard. Take care of yourself. Try a new job in the same setting if you think it’s the agency. Try a new job is a different type of therapy. You have to make the best choice for you and your family. You won’t be helping anyone if you are burnt out. You’ll miss stuff and beat yourself up. You have to put your oxygen mask on first. Anyone who judges you for knowing your limits is fucking jerk and should be mentally classed as such. Love to all y’all}

Have you ever been? I couldn’t afford therapy while I was in graduate school most of the time but I had been through a *ton* of therapy in my life so it kinda held me over til I could. It is important. Until I went back, I had forgotten some of the visceral, physical feelings of being in the room with a therapist and it’s definitely made my therapy as therapist better. Until you can, try and make sure that you are connected to your supports, get some sleep, move, eat. Ask your professors for suggestions. Get together with your classmates and have a beer, a meal or coffee. Find the local intern/trainee support group (often run by the therapist group in the area) - they are often once a month and free.