The ethics of becoming a therapist
August 7, 2021 8:00 PM Subscribe
I've been strongly considering going back to school and studying to become a therapist. However, between reflecting on my own harmful experiences with therapists in the past, and the lit I've read on the field's systematic problems in terms of race, class, captialism; the moral issues with the power imbalance; and a worry that therapy doesn't actually help anyone in a meaningful way—I'm not so sure I want to pursue it. Are my concerns legitimate? How do therapists navigate them?
For starters, let me just say that I'm not trying to be insensitive to anyone within the field of therapy or clinical psych, and if I say something that’s hurtful or ignorant, my apologies. Most of this question is probably linked to uncertainty and a little anxiety since I don't know much about the experience of being a therapist and it feels very unknown and foreign, hence the question on askmefi.
That out of the way, some context: I'm in my early 20's, and I feel like I have a calling to be a therapist; that it's something that I'd love to do as a career. I've always been infinitely fascinated by the human mind and how it works; and how the past, trauma, the body, environment affect it; and I really love the concept of spending my time assisting others in meaningful, tangible ways that help them deeply understand themselves better and supports them in making their daily lives more livable. I'm aware it has its intense challenges of boundaries, responsibility, insurance, burnout, barriers to entrance, compassion fatigue, etc, but that hasn't deterred me so far—I felt like I could probably handle it, or learn to.
The thing that's deterring me now, though, is that I'm filled with doubt around the actual...Usefulness of therapy, and a fear that maybe I'd be doing more harm than good. I know that therapy is not for everyone, and I've also lived firsthand how horrible it feels to have a crappy therapist—to have the mental health care system fail you so catastrophically when you're already in distress can be traumatic, and the idea of potentially doing that to someone else is awful to me. I finally found a good, non-harmful therapist but it took years, and the damage of the therapists before her still lingers. The idea of perpetuating and upholding a system that does that to people, well. Feels pretty unethical, pretty bad, though rationally I know situations of harm are not always the case.
Otherwise, a lot of my doubt is stemming from concerns around participating in a system that's inherently racist, classist, and rooted in capitalism (even though everything is, I know)—am I perpetuating and reinforcing a paternalistic medical system that has violently hurt marginalized people? Is it not better to stay out of it and go into a career that is less problematic, or more helpful to vulnerable people in other ways? Does a career that's less problematic even exist? (Cue existential crisis of living in a nightmare of capitalism and inherent harm.)
I'm also worried about the inherent power imbalance: therapist/patient, “expert”/vulnerable person. The ethical ickiness of being in a position of power over someone like that, the potentially paternatlistic feeling—I don't know. I don't like it, though I'm assuming (?) there's ways to mitigate it a little, though I imagine it can't be erased entirely.
There's also general concerns around the actual effectiveness of therapy in all its forms—is it actually helpful to get this type of care when we live in such a crushing, traumatizing society daily? In the middle of a climate collapse? Is it helping anyone to visit a therapist weekly even though they're stuck in a terrible job, or have unstable housing, or are trapped in an abusive environment? Would I actually help, or would I just gaslight my clients into tolerating something that shouldn't be happening at all? Is that ethical? Is it enough? (No, obviously, they need more support beyond therapy, but I wouldn't be able to provide that, so... What's the point? What would I be doing to help them?)
To summarize: I truly, seriously want to pursue being a therapist but I'm concerned about perpetuating a harmful system, playing into a bad power imbalance, and not being effective in actually helping others. Are these concerns legitimate? Is there a way to keep them in mind and still pursue a career in clinical therapy, or should I study something else that's more tangibally helpful? How do other therapists balance social justice concerns and their profession? Sorry if this ask is all over the place; I hope it's not too many questions. Any insights are welcome. Thank you so much!
For starters, let me just say that I'm not trying to be insensitive to anyone within the field of therapy or clinical psych, and if I say something that’s hurtful or ignorant, my apologies. Most of this question is probably linked to uncertainty and a little anxiety since I don't know much about the experience of being a therapist and it feels very unknown and foreign, hence the question on askmefi.
That out of the way, some context: I'm in my early 20's, and I feel like I have a calling to be a therapist; that it's something that I'd love to do as a career. I've always been infinitely fascinated by the human mind and how it works; and how the past, trauma, the body, environment affect it; and I really love the concept of spending my time assisting others in meaningful, tangible ways that help them deeply understand themselves better and supports them in making their daily lives more livable. I'm aware it has its intense challenges of boundaries, responsibility, insurance, burnout, barriers to entrance, compassion fatigue, etc, but that hasn't deterred me so far—I felt like I could probably handle it, or learn to.
The thing that's deterring me now, though, is that I'm filled with doubt around the actual...Usefulness of therapy, and a fear that maybe I'd be doing more harm than good. I know that therapy is not for everyone, and I've also lived firsthand how horrible it feels to have a crappy therapist—to have the mental health care system fail you so catastrophically when you're already in distress can be traumatic, and the idea of potentially doing that to someone else is awful to me. I finally found a good, non-harmful therapist but it took years, and the damage of the therapists before her still lingers. The idea of perpetuating and upholding a system that does that to people, well. Feels pretty unethical, pretty bad, though rationally I know situations of harm are not always the case.
Otherwise, a lot of my doubt is stemming from concerns around participating in a system that's inherently racist, classist, and rooted in capitalism (even though everything is, I know)—am I perpetuating and reinforcing a paternalistic medical system that has violently hurt marginalized people? Is it not better to stay out of it and go into a career that is less problematic, or more helpful to vulnerable people in other ways? Does a career that's less problematic even exist? (Cue existential crisis of living in a nightmare of capitalism and inherent harm.)
I'm also worried about the inherent power imbalance: therapist/patient, “expert”/vulnerable person. The ethical ickiness of being in a position of power over someone like that, the potentially paternatlistic feeling—I don't know. I don't like it, though I'm assuming (?) there's ways to mitigate it a little, though I imagine it can't be erased entirely.
There's also general concerns around the actual effectiveness of therapy in all its forms—is it actually helpful to get this type of care when we live in such a crushing, traumatizing society daily? In the middle of a climate collapse? Is it helping anyone to visit a therapist weekly even though they're stuck in a terrible job, or have unstable housing, or are trapped in an abusive environment? Would I actually help, or would I just gaslight my clients into tolerating something that shouldn't be happening at all? Is that ethical? Is it enough? (No, obviously, they need more support beyond therapy, but I wouldn't be able to provide that, so... What's the point? What would I be doing to help them?)
To summarize: I truly, seriously want to pursue being a therapist but I'm concerned about perpetuating a harmful system, playing into a bad power imbalance, and not being effective in actually helping others. Are these concerns legitimate? Is there a way to keep them in mind and still pursue a career in clinical therapy, or should I study something else that's more tangibally helpful? How do other therapists balance social justice concerns and their profession? Sorry if this ask is all over the place; I hope it's not too many questions. Any insights are welcome. Thank you so much!
For the underlying question of how to plan your work and life in accordance with your values and ethics, and how to "determine your authentic path and not act out of guilt, shame or obligation," take a look Hilary Rettig's Lifelong Activist book/website.
Why do I trust in her sincerity? For starters, she donated a kidney to a stranger.
posted by dum spiro spero at 8:31 PM on August 7, 2021 [2 favorites]
Why do I trust in her sincerity? For starters, she donated a kidney to a stranger.
posted by dum spiro spero at 8:31 PM on August 7, 2021 [2 favorites]
This is a very philosophical post. It's relatively detached with an outside-in perspective. Systems-focused.
Reading the question, I wonder what benefit you'd really stand to gain from treating others, as opposed to the possible energetic benefits from writing examinations like this one.
Because we could say you're looking for answers and so you're posting to AskMe.
But we could also say you're narrating your own journey and answering your own question as you wind through it. After all, this is a question of what you like, not us.
So you're really working through something here on your own.
Some would also call it criticism or meta-criticism. You have a critic's gift for examination, anyway.
It's also an exploration of likes & dislikes at a fundamental level.
I would wonder--why not zoom out of psychiatry a bit and look at these other aspects of what you're doing here, this process that causes paragraphs of interested-sounding words to come out. Is that also a job-thing that might be interesting?
Good luck & wishing you the best with this process.
posted by circular at 8:35 PM on August 7, 2021 [5 favorites]
Reading the question, I wonder what benefit you'd really stand to gain from treating others, as opposed to the possible energetic benefits from writing examinations like this one.
Because we could say you're looking for answers and so you're posting to AskMe.
But we could also say you're narrating your own journey and answering your own question as you wind through it. After all, this is a question of what you like, not us.
So you're really working through something here on your own.
Some would also call it criticism or meta-criticism. You have a critic's gift for examination, anyway.
It's also an exploration of likes & dislikes at a fundamental level.
I would wonder--why not zoom out of psychiatry a bit and look at these other aspects of what you're doing here, this process that causes paragraphs of interested-sounding words to come out. Is that also a job-thing that might be interesting?
Good luck & wishing you the best with this process.
posted by circular at 8:35 PM on August 7, 2021 [5 favorites]
Have you considered trying to get some relevant experience to feel things out? I have had a couple of acquaintances who have gotten jobs that had a sort of clinical aspect to them, think lower level social worker. I think these people just had bachelor's degrees.
Generally, in personal experience the therapists I've seen have been a part of a needed support system. They didn't necessarily fix my life or what have you but they did provide an outlet and a sounding board during periods that I needed it and introduced concepts about things like self-acceptance that I wasn't really getting anywhere else at the time.
I feel like you seem to be envisioning some kind of therapy or therapist that is not the way it has to be. Sure maybe there is a power imbalance, but an empathetic and caring/good therapist should know how to skirt that and provide support in a way that doesn't perpetuate some sort of unhealthy dynamic. I would encourage you not to think about these things in a black and white way but to get curious about what being a good therapist would mean to you.
posted by knownfossils at 8:39 PM on August 7, 2021 [1 favorite]
Generally, in personal experience the therapists I've seen have been a part of a needed support system. They didn't necessarily fix my life or what have you but they did provide an outlet and a sounding board during periods that I needed it and introduced concepts about things like self-acceptance that I wasn't really getting anywhere else at the time.
I feel like you seem to be envisioning some kind of therapy or therapist that is not the way it has to be. Sure maybe there is a power imbalance, but an empathetic and caring/good therapist should know how to skirt that and provide support in a way that doesn't perpetuate some sort of unhealthy dynamic. I would encourage you not to think about these things in a black and white way but to get curious about what being a good therapist would mean to you.
posted by knownfossils at 8:39 PM on August 7, 2021 [1 favorite]
Is it helping anyone to visit a therapist weekly even though they're stuck in a terrible job, or have unstable housing, or are trapped in an abusive environment?Short answer: Yes.
Longer answer: yes, it’s helpful for people to obtain even small assistance in the face of the kind of totalising oppressive society you’re describing, because even if coping strategies might be less than fundamental alteration of conditions—having a coping strategy beats the hell out of not having a coping strategy at all.posted by Fiasco da Gama at 8:41 PM on August 7, 2021 [24 favorites]
I'm don't know whether or not therapy is your calling. But being aware of the negative aspects of therapy is the only way you could be a good therapist. The fact that you are aware of the potential problems could make you a better therapist, than if you blindly believe in the benefits.
posted by Zumbador at 8:50 PM on August 7, 2021 [15 favorites]
posted by Zumbador at 8:50 PM on August 7, 2021 [15 favorites]
Therapists can help with all of the stuff you list. I specifically went to therapy the first time to deal with the fallout of an abusive relationship, and as I healed from that we moved more towards helping me figure out things about my job & what I really wanted to be doing. My partner's therapist has recently literally helped her work on job applications & sat with her while she's made calls to insurance providers & the healthcare.gov hotline. There's no rule that therapists have to operate only in the abstract for their clients.
posted by augustimagination at 8:56 PM on August 7, 2021 [6 favorites]
posted by augustimagination at 8:56 PM on August 7, 2021 [6 favorites]
My mother is a therapist who used to treat people ordered into therapy by the court system, people who had the sort of problems you list, who often also did not want to be in therapy. For years while she did this, and for many after, her former clients would see her in public and race over to thank her, to tell her how much she had helped them, show her photos of their kids or their spouses or just thank her again and again. It happened so many times when we’d be out together I learned to quietly step away and give them space.
She’s absolutely not the right therapist for everyone but when she found the people she could help the most she did an amazing job and the ripples of each person she helped are so far reaching. There’s a lot of good you can do out there.
posted by lepus at 9:06 PM on August 7, 2021 [18 favorites]
She’s absolutely not the right therapist for everyone but when she found the people she could help the most she did an amazing job and the ripples of each person she helped are so far reaching. There’s a lot of good you can do out there.
posted by lepus at 9:06 PM on August 7, 2021 [18 favorites]
I really appreciate your question and the thinking behind it. Those questions really matter.
In my family, it’s been hard to get people to consider therapy for all the reasons you mentioned, plus the fact of the huge gap between the world of the therapist’s experience and that of the prospective patient. If you’ve lived, or still live, in a world of incredible violence, you can’t even trust that you can talk about it safely without endangering your family. Not that every therapist has to be a retired banger or whatev, but it can be really hard to talk to sheltered middle class ppl bc everything shocks them and you don’t know how they’ll react to you. Will they call the cops? Will they commit you?
But with all that, if you’re willing and able to get into it, and you can find a fit, it can help so much. It can help you get yourself together to make better decisions for yourself and your family, and slow the world down a bit.
TL;DR there’s not enough ppl from the oppressed classes serving really compassionate, helpful therapy TO the oppressed classes (obvs the gate keeping of higher ed), and many of those who are, are mainly serving tough love, like that’s all poor people want/need/can understand. Believe me — good therapy works, it helps, and it’s needed. We need the numbers.
Idk if that’s you, but if you can, you’d be needed and welcome.
(FWIW we go to a therapist who is Black and Caribbean, from a marginalized population, and their personal experience of violence and trauma, while not as extensive as some, has given them the perspective to not find us strange or frightening, which, IMO, drives a lot of bad, class-and race-based therapeutic experiences)
posted by toodleydoodley at 9:15 PM on August 7, 2021 [9 favorites]
In my family, it’s been hard to get people to consider therapy for all the reasons you mentioned, plus the fact of the huge gap between the world of the therapist’s experience and that of the prospective patient. If you’ve lived, or still live, in a world of incredible violence, you can’t even trust that you can talk about it safely without endangering your family. Not that every therapist has to be a retired banger or whatev, but it can be really hard to talk to sheltered middle class ppl bc everything shocks them and you don’t know how they’ll react to you. Will they call the cops? Will they commit you?
But with all that, if you’re willing and able to get into it, and you can find a fit, it can help so much. It can help you get yourself together to make better decisions for yourself and your family, and slow the world down a bit.
TL;DR there’s not enough ppl from the oppressed classes serving really compassionate, helpful therapy TO the oppressed classes (obvs the gate keeping of higher ed), and many of those who are, are mainly serving tough love, like that’s all poor people want/need/can understand. Believe me — good therapy works, it helps, and it’s needed. We need the numbers.
Idk if that’s you, but if you can, you’d be needed and welcome.
(FWIW we go to a therapist who is Black and Caribbean, from a marginalized population, and their personal experience of violence and trauma, while not as extensive as some, has given them the perspective to not find us strange or frightening, which, IMO, drives a lot of bad, class-and race-based therapeutic experiences)
posted by toodleydoodley at 9:15 PM on August 7, 2021 [9 favorites]
There are definitely good therapists out there helping people who want to be helped, but lack [something] to reach their goal on their own. I'm one of them. I'd done a lot of the work on my own, but hit a stumbling block that I was well aware was myself getting in my own way, but I still couldn't find my way past it.
One thing I would say: be aware of what your personal blind spots are. I've contemplated becoming a therapist myself, and over the years, I've realized that while I do ok with people who are in later stages of recovery due to personal experience with friends and family members, I don't think I'd be effective during the earlier stages, because I have zero history of drug or alcohol use myself. Caffeine is pretty much my limit, because even alcohol does not react reliably for me, and despite a lifetime around smokers, I have zero interest myself. I'm also someone who very easily stops literally anything cold turkey. And I realize I'm very much not the norm, being like that. Don't know what triggered that particular effect, but I don't really mind - it's made life easier, with the exception of truly understanding anything about addiction beyond a habit to just... stop.
On the other hand, I understand from talking with a lot of other people that it can be extremely difficult to find therapists who have a good understanding of things like being raised by a narcissist or other toxic parental figures, especially those that did not commit physical or sexual abuse. Various forms of mental and emotional abuse can be as much or more damaging, but regardless of race or culture, it's very much the norm to assume that a child that runs away as a minor, or leaves and goes low or no contact with their parents as an adult, is in the wrong and somehow being rebellious. Often, though, it's a sign that something is seriously wrong in that household. It might be as simple as a lack of supervision or too much permissiveness that led the child down a path into drugs or alcohol or simply a cruddy group of friends, but there's a reason the child went looking for something outside the home. Even, or especially, if the home and adult(s) seem perfect on the outside, there's something wrong there. People don't vanish and go no contact for no reason, despite what their estranged parents say - and it's very common for the world at large, let alone therapists, to pressure them into returning home and allowing contact and permitting whatever negative situation to continue.
So... not everybody has a happy family. And if you go into therapy, don't be afraid to support a client who has chosen no or low contact. Don't ever assume that restoring a family to wholeness is a good thing.
And be well aware that a narcissist or abuser in couples or family therapy will attempt to use you against their victim(s). Attending alone, they will twist what you tell them to their victim. A narcissist will not be there to be helped; there is, of course, nothing wrong with them. [sigh] (I had to be very careful choosing my therapist; I knew darn well what things would NOT help me, and restoring contact would have been the worst possible thing for my mental help.)
posted by stormyteal at 9:23 PM on August 7, 2021
One thing I would say: be aware of what your personal blind spots are. I've contemplated becoming a therapist myself, and over the years, I've realized that while I do ok with people who are in later stages of recovery due to personal experience with friends and family members, I don't think I'd be effective during the earlier stages, because I have zero history of drug or alcohol use myself. Caffeine is pretty much my limit, because even alcohol does not react reliably for me, and despite a lifetime around smokers, I have zero interest myself. I'm also someone who very easily stops literally anything cold turkey. And I realize I'm very much not the norm, being like that. Don't know what triggered that particular effect, but I don't really mind - it's made life easier, with the exception of truly understanding anything about addiction beyond a habit to just... stop.
On the other hand, I understand from talking with a lot of other people that it can be extremely difficult to find therapists who have a good understanding of things like being raised by a narcissist or other toxic parental figures, especially those that did not commit physical or sexual abuse. Various forms of mental and emotional abuse can be as much or more damaging, but regardless of race or culture, it's very much the norm to assume that a child that runs away as a minor, or leaves and goes low or no contact with their parents as an adult, is in the wrong and somehow being rebellious. Often, though, it's a sign that something is seriously wrong in that household. It might be as simple as a lack of supervision or too much permissiveness that led the child down a path into drugs or alcohol or simply a cruddy group of friends, but there's a reason the child went looking for something outside the home. Even, or especially, if the home and adult(s) seem perfect on the outside, there's something wrong there. People don't vanish and go no contact for no reason, despite what their estranged parents say - and it's very common for the world at large, let alone therapists, to pressure them into returning home and allowing contact and permitting whatever negative situation to continue.
So... not everybody has a happy family. And if you go into therapy, don't be afraid to support a client who has chosen no or low contact. Don't ever assume that restoring a family to wholeness is a good thing.
And be well aware that a narcissist or abuser in couples or family therapy will attempt to use you against their victim(s). Attending alone, they will twist what you tell them to their victim. A narcissist will not be there to be helped; there is, of course, nothing wrong with them. [sigh] (I had to be very careful choosing my therapist; I knew darn well what things would NOT help me, and restoring contact would have been the worst possible thing for my mental help.)
posted by stormyteal at 9:23 PM on August 7, 2021
All of your concerns are legitimate, but could really be applied to…most labor performed under capitalism. Opting out of that is exceedingly difficult.
You can do some good, even within the limitations of capitalism and the industry of therapy. You could also do some bad. It is exceedingly rare to be able to do no bad. It’s good that you’re aware of that, and that will make you a better therapist for folks like me who have a hard time with those aspects of the industry.
It is also possible to be a therapist that is more collaborative and egalitarian than not. I don’t feel much of a power differential between my current therapist and myself. We have discussions about this kind of stuff from time to time. This is front of mind for me, so it’s important. It is not necessarily important to others.
posted by furnace.heart at 9:35 PM on August 7, 2021 [14 favorites]
You can do some good, even within the limitations of capitalism and the industry of therapy. You could also do some bad. It is exceedingly rare to be able to do no bad. It’s good that you’re aware of that, and that will make you a better therapist for folks like me who have a hard time with those aspects of the industry.
It is also possible to be a therapist that is more collaborative and egalitarian than not. I don’t feel much of a power differential between my current therapist and myself. We have discussions about this kind of stuff from time to time. This is front of mind for me, so it’s important. It is not necessarily important to others.
posted by furnace.heart at 9:35 PM on August 7, 2021 [14 favorites]
There is a deep end to clinical psychology: it is crisis work or community mental health or the VA for veterans with PTSD and everything that follows from it or in shitty public inpatient facilities or the prison system or care homes. The deep end is people in the worst internal places. It is people who are in places that they are not allowed to leave. If you do something like a Psy. D. or even a terminal masters you will most likely be thrown in at the deep end at some point, and you will start thinking about therapy as something more than private practice work in a pleasantish room.
A career as a therapist requires an ongoing engagement with how the ethics component of professional licensing works out in real life. A lot of therapists have very strong opinions about other therapists who seem to take lucrative shortcuts in putting together their caseload, who seem to string clients along instead of having a treatment plan, who aren't really interested in CE as anything other than going through the motions for license renewal, who refer out whenever a client stops being easy money.
Given your concerns, "going back to school" is probably too broad a way to think about things. You'll want to find a program that explicitly engages with those concerns. This may make it an expensive journey, which is why the ethics of "how to pay the bills and also the student loans" is a big issue. But if you want to do this you'll need to work out where you should do this, where you should do practicum and internship work -- on an absolute pittance -- and whether you are willing to take on a career that might involve being woken at 3am and then showing up with the police to try to help someone in mental distress who also has access to firearms. Or whether you are willing to sit in a room with someone who has killed people, when sometimes the room has a panic button and armed guards outside, and sometimes there are no guards and there is no panic button. Being a clinical psychologist can mean talking to teenagers who've known nothing but gangs, or to people who are going to spend all of their twenties in a cell two hundred miles away from their family.
Think about the deep end. The deep end is where it actually matters.
posted by holgate at 9:46 PM on August 7, 2021 [6 favorites]
A career as a therapist requires an ongoing engagement with how the ethics component of professional licensing works out in real life. A lot of therapists have very strong opinions about other therapists who seem to take lucrative shortcuts in putting together their caseload, who seem to string clients along instead of having a treatment plan, who aren't really interested in CE as anything other than going through the motions for license renewal, who refer out whenever a client stops being easy money.
Given your concerns, "going back to school" is probably too broad a way to think about things. You'll want to find a program that explicitly engages with those concerns. This may make it an expensive journey, which is why the ethics of "how to pay the bills and also the student loans" is a big issue. But if you want to do this you'll need to work out where you should do this, where you should do practicum and internship work -- on an absolute pittance -- and whether you are willing to take on a career that might involve being woken at 3am and then showing up with the police to try to help someone in mental distress who also has access to firearms. Or whether you are willing to sit in a room with someone who has killed people, when sometimes the room has a panic button and armed guards outside, and sometimes there are no guards and there is no panic button. Being a clinical psychologist can mean talking to teenagers who've known nothing but gangs, or to people who are going to spend all of their twenties in a cell two hundred miles away from their family.
Think about the deep end. The deep end is where it actually matters.
posted by holgate at 9:46 PM on August 7, 2021 [6 favorites]
All of which is to say: the tip of the iceberg of therapy is nice and middle-class and talking about feelings, but the iceberg of therapy contains a large amount of social justice work for shitty money. If you're worried about the racist / classist aspect of therapy, aim to become a prison therapist or an inpatient therapist at a state hospital or a VA therapist. It will be a job that will leave you needing your own therapist -- or at very least a very good supervisor and peer group -- and it is a job that will eventually give you the expertise to do private practice work, but it will strip away all of your preconceptions.
posted by holgate at 9:57 PM on August 7, 2021 [5 favorites]
posted by holgate at 9:57 PM on August 7, 2021 [5 favorites]
Echoing toodleydoodley. Therapists who are even remotely conscious of the issues of non-white, non-wealthy and non-male people, are vital. If you are able to bring this to your practice then it will encourage people from those groups to go to therapy.
I also agree that trust is a massive issue and with good reason. All cultures, genders, races, everything, need their own therapists - people who are sensitive to and understanding of their issues. I went to a therapist (atheist) and briefly mentioned my mother (religious). The condescending way the therapist spoke about my mum being religious made me want to knock her front teeth out. The therapist, that is. Completely off-putting.
I can't tell you what to do but I encourage you to be a presence and to spearhead change.
posted by ihaveyourfoot at 1:25 AM on August 8, 2021 [4 favorites]
I also agree that trust is a massive issue and with good reason. All cultures, genders, races, everything, need their own therapists - people who are sensitive to and understanding of their issues. I went to a therapist (atheist) and briefly mentioned my mother (religious). The condescending way the therapist spoke about my mum being religious made me want to knock her front teeth out. The therapist, that is. Completely off-putting.
I can't tell you what to do but I encourage you to be a presence and to spearhead change.
posted by ihaveyourfoot at 1:25 AM on August 8, 2021 [4 favorites]
This might be off-topic, or it might be relevant to some of your worries about therapy.
For me, one of the things that attracted me to studying therapy is that it can be relatively carbon-neutral, or that it can have a very small harmful impact on the environment. Therapy can happen without electricity, without wifi, without plastic, which makes it a suitable occupation for a low-carbon economy. Even when the lights are off, or maybe especially then, therapy can still take place.
Regarding its usefulness, on a fundamental level, therapists are storytellers, they help clients to tell their stories. Whether this is useful or not will depend on the way you view human life. If you have existentialist leanings this might be one of the best things you could be doing.
posted by slimeline at 2:57 AM on August 8, 2021 [4 favorites]
For me, one of the things that attracted me to studying therapy is that it can be relatively carbon-neutral, or that it can have a very small harmful impact on the environment. Therapy can happen without electricity, without wifi, without plastic, which makes it a suitable occupation for a low-carbon economy. Even when the lights are off, or maybe especially then, therapy can still take place.
Regarding its usefulness, on a fundamental level, therapists are storytellers, they help clients to tell their stories. Whether this is useful or not will depend on the way you view human life. If you have existentialist leanings this might be one of the best things you could be doing.
posted by slimeline at 2:57 AM on August 8, 2021 [4 favorites]
As a non-therapist just to note that you being aware of these issues at this point in your life puts you on the "good" side of the equation. Go help folks.
posted by sammyo at 5:10 AM on August 8, 2021 [1 favorite]
posted by sammyo at 5:10 AM on August 8, 2021 [1 favorite]
The world needs therapists who value the decolonization of therapy. The world also needs therapists who recognize the trauma of otherness and marginalization. I'm a trauma therapist and continue to be amazed at how many people have seen trauma therapists who don't recognize how growing up BIPOC in a predominantly white neighborhood, being disabled, being female presenting in a male dominated field, etc can all cause trauma. I don't market myself as a therapist specifically for LGBTQIA but I mention it in my marketing materials and continue to get a stream of clients who identify that way because most providers in the area either don't mention it or market themselves as Christian therapists so the fact that I mention I am affirming and affiliated at all gives them safety that they struggle to find elsewhere. In 2021. Blows my mind.
There's a lot of socal justice work being done in this field and we need more voices that want to see the dark underbelly.
I also agree with holgate that there are places to practice where you have a chance to help disenfranchised populations and confront systemic oppression, while probably being oppressed yourself (i.e. community mental health where you work for laughably low wages, have a caseload of 100, are expected to take call after hours, and are traumatized by toxic expectations while serving a population that has been oppressed so that they cannot afford the fancier therapy places, lack good health insurance, etc.). Whether you can afford to work at those places, and whether you can work there without burning out and leaving the field, is a separate question. (Most work in these places at least some of the time, and most do so without burning out entirely. But I mention it because the kushy private practice world is just one face of things.)
And then there's the obvious choice of going with social work vs psychology. Social workers with a Master's can get a license that allows for the practice of psychotherapy and the social justice piece is baked into the education in a way that it is not for psychology, unless you pick a school or program that specifically makes it a focus.
posted by crunchy potato at 7:50 AM on August 8, 2021 [5 favorites]
There's a lot of socal justice work being done in this field and we need more voices that want to see the dark underbelly.
I also agree with holgate that there are places to practice where you have a chance to help disenfranchised populations and confront systemic oppression, while probably being oppressed yourself (i.e. community mental health where you work for laughably low wages, have a caseload of 100, are expected to take call after hours, and are traumatized by toxic expectations while serving a population that has been oppressed so that they cannot afford the fancier therapy places, lack good health insurance, etc.). Whether you can afford to work at those places, and whether you can work there without burning out and leaving the field, is a separate question. (Most work in these places at least some of the time, and most do so without burning out entirely. But I mention it because the kushy private practice world is just one face of things.)
And then there's the obvious choice of going with social work vs psychology. Social workers with a Master's can get a license that allows for the practice of psychotherapy and the social justice piece is baked into the education in a way that it is not for psychology, unless you pick a school or program that specifically makes it a focus.
posted by crunchy potato at 7:50 AM on August 8, 2021 [5 favorites]
You need to meet some real people who are doing the work you want to do and in the way you would want to do it. Think of it as information interviewing for your new career. Therapists tend to be pretty helpful (if busy). Find people in your area who seem to doing what you imagine for yourself and reach out them and ask for little of their time to answer questions from someone who thinking about joining the profession. Ask them what is it like and see what kind of advice they can give you. I bet if you reached out to 50 people you would get 5-10 interviews that would change your sense of what is possible.
posted by metahawk at 1:15 PM on August 8, 2021 [1 favorite]
posted by metahawk at 1:15 PM on August 8, 2021 [1 favorite]
"Therapists" can have quite few different qualifications - Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW) or Psychologist (PsyD). An LCSW (Licensed Clinical Social Worker) can do individual counseling just like any other therapist but they are also trained for more community oriented work. It might be a good fit for you.
posted by metahawk at 1:18 PM on August 8, 2021
posted by metahawk at 1:18 PM on August 8, 2021
There are lots of perspectives from above posters so I’ll focus on the aspect of therapy ethics that I’ve had the most issue with. My partner and I are both trans and have needed to seek out therapists for gender affirming surgery letters. I wanted therapy anyways, she didn’t, she just wanted a letter saying she was indeed a woman and should be allowed to get surgeries to make her feel like a woman. She had to repeatedly pay therapists $300-500 to write letter that were necessary for her health, while working a minimum wage job.
Some of her therapists wanted to discuss with her the “power dynamics” and “gatekeeping” of her paying them for those letters. Don’t be that guy. If you’re interested in being a therapist for marginalized people, find a way to make your work sliding scale, accept as many insurances as possible, and cut people a break. Figure out how you feel about all of this now, make ethical decisions, and don’t offer to “explore” it in therapy with clients. I think you’re on a good path questioning the utility of therapy. Some people don’t want or need therapy, they just need to get through some kind of bureaucracy, so you should be aware and accommodating of that in your practice. Everyone won’t be there to have their emotional life changed through talk therapy. (I did get a lot of help from talk therapy while trying to get surgery! Not everyone does though)
posted by Summers at 3:29 PM on August 8, 2021 [1 favorite]
Some of her therapists wanted to discuss with her the “power dynamics” and “gatekeeping” of her paying them for those letters. Don’t be that guy. If you’re interested in being a therapist for marginalized people, find a way to make your work sliding scale, accept as many insurances as possible, and cut people a break. Figure out how you feel about all of this now, make ethical decisions, and don’t offer to “explore” it in therapy with clients. I think you’re on a good path questioning the utility of therapy. Some people don’t want or need therapy, they just need to get through some kind of bureaucracy, so you should be aware and accommodating of that in your practice. Everyone won’t be there to have their emotional life changed through talk therapy. (I did get a lot of help from talk therapy while trying to get surgery! Not everyone does though)
posted by Summers at 3:29 PM on August 8, 2021 [1 favorite]
Transgender person living in the USA here, and has US-based healthcare:
When I wanted to get gender affirming care, such as hormones and surgery, I was required get a "letter of referral from a qualified mental health professional" before insurance would consider paying for it. For mine, I want to a Therapist who specialized in treating gender-diverse clientele. They were also a member of WPATH, which sets the standards for Transgender Care that a lot of insurance companies use.
I was extremely fortunate in that I found a therapist who was both competent and understanding, and also worked on Sliding Scale when I was unemployed. They not only wrote my letters for health care, but they helped me in many facets in my life. Many, many, many, many other Transpeople don't have access to these resources in the USA.
Now - as a Trans person? I don't believe that this gatekeeping is necessary, and I resent that it's there. But, as long as it's there, there's a need for high quality Gender Therapists to help us navigate these complicated and hostile bureaucratic systems, and to help us get the gender-affirming treatments that are necessary for us to live.
posted by spinifex23 at 3:58 PM on August 8, 2021 [1 favorite]
When I wanted to get gender affirming care, such as hormones and surgery, I was required get a "letter of referral from a qualified mental health professional" before insurance would consider paying for it. For mine, I want to a Therapist who specialized in treating gender-diverse clientele. They were also a member of WPATH, which sets the standards for Transgender Care that a lot of insurance companies use.
I was extremely fortunate in that I found a therapist who was both competent and understanding, and also worked on Sliding Scale when I was unemployed. They not only wrote my letters for health care, but they helped me in many facets in my life. Many, many, many, many other Transpeople don't have access to these resources in the USA.
Now - as a Trans person? I don't believe that this gatekeeping is necessary, and I resent that it's there. But, as long as it's there, there's a need for high quality Gender Therapists to help us navigate these complicated and hostile bureaucratic systems, and to help us get the gender-affirming treatments that are necessary for us to live.
posted by spinifex23 at 3:58 PM on August 8, 2021 [1 favorite]
As an addition: Some doctors will also require letters for gender-affirming surgery, even if they are using an Informed Consent model, from a Gender Therapist.
posted by spinifex23 at 4:04 PM on August 8, 2021
posted by spinifex23 at 4:04 PM on August 8, 2021
CBT legitimately does help people. If you stay up with the science I think you can do it ethically.
posted by Jacqueline at 4:15 PM on August 8, 2021
posted by Jacqueline at 4:15 PM on August 8, 2021
Therapy has helped me immensely.
The work I've done in therapy has literally saved my life. At least twice.
posted by Archipelago at 7:50 PM on August 8, 2021
The work I've done in therapy has literally saved my life. At least twice.
posted by Archipelago at 7:50 PM on August 8, 2021
The bird's eye view critiques/concerns that you mention are very valid when thinking about the practice of therapy writ large. But—and I'm just speaking from a very positive experience with a specific therapist over the last few years—none of them strike me as impossible to counter as long as you find an approach and training with space for you to do so. It's such a hugely broad field. Almost as broad as teaching as a practice. Teaching what? Teaching how? There are more critical approaches, and less critical approaches. Approaches more attuned to social factors, approaches less so. The same is true with therapy.
posted by umbú at 10:45 AM on August 9, 2021
posted by umbú at 10:45 AM on August 9, 2021
hey, fyi, there are therapist frameworks that operate outside of capitalist/racist perspectives -- my therapist uses this framework (and she's been a blessing) - a lot of it is framed around letting the client/patient guide the conversation, framing it more as a collaboration/community rather than expert/treatment. the format she uses is called narrative initiatives -- might be something worth looking into.
i really emphasis with and appreciate your concerns about the broken system -- and also, i think there are ways to work from within the system to change it. having an anti capitalist/anti racist therapist can be especially heartening when so much of it *is* broken.
posted by lightgray at 4:26 PM on August 9, 2021
i really emphasis with and appreciate your concerns about the broken system -- and also, i think there are ways to work from within the system to change it. having an anti capitalist/anti racist therapist can be especially heartening when so much of it *is* broken.
posted by lightgray at 4:26 PM on August 9, 2021
CBT legitimately does help people. If you stay up with the science I think you can do it ethically.
And something like EMDR legitimately does help people.
But I'll emphasize something else: if you want to do this as a career you will likely be dealing with some people who have belief systems that you find to be fucked up or even abhorrent, and the "this is a no judgment zone" sign that some therapists put up in their offices applies equally to them as to their clients. The instinct to judge is trained out of you to a large degree and has to be trained out of you for you to do the job effectively. You have to be okay with letting clients terminate when they feel like they're in a better place even if it's not a place you would prefer them to be in. Ethical therapy is not about conversion.
posted by holgate at 12:25 AM on August 10, 2021 [1 favorite]
And something like EMDR legitimately does help people.
But I'll emphasize something else: if you want to do this as a career you will likely be dealing with some people who have belief systems that you find to be fucked up or even abhorrent, and the "this is a no judgment zone" sign that some therapists put up in their offices applies equally to them as to their clients. The instinct to judge is trained out of you to a large degree and has to be trained out of you for you to do the job effectively. You have to be okay with letting clients terminate when they feel like they're in a better place even if it's not a place you would prefer them to be in. Ethical therapy is not about conversion.
posted by holgate at 12:25 AM on August 10, 2021 [1 favorite]
I'm very critical of therapy and aware of how it feeds and is fed by white supremacist Enlightenment ideals but even so I would never tell someone they shouldn't become a therapist. There are so many bad therapists out there. My Christian ex-roommate who tried to convert me out of my homosexuality studied to become a therapist. (She did not go through with it, thank god.) Think of yourself as a counterweight to those people.
posted by coffeeand at 5:00 PM on October 10, 2021
posted by coffeeand at 5:00 PM on October 10, 2021
This thread is closed to new comments.
posted by rikschell at 8:28 PM on August 7, 2021 [9 favorites]