Being a good therapist is high praise.

I never understood this until recently.

I recall being in my first internship one day, and the client looks at me – and we’re about six sessions in – and he goes, “You’re a good therapist.”

I was shocked.

Me, whose “experience” up until that point was being kicked out of an addictions clinic because her supervisors told her she wasn’t qualified? What was he seeing in me?

This client, who had been through multiple therapists and clinics, was completely floored at my “technique”. I don’t think it was because I was particularly perfect, but rather because I do look like a kindergarden teacher. And I am boldly autistic, to the point where anyone who has any functional observational skills can tell. And yet, my “style” worked.

My “style”? This mystery “technique”?

It’s letting the client set all the boundaries of what is and isn’t allowed. It’s ensuring that the only part of you who shows up as yourself is the part the client asks for and gives permission to participate in the session with them, first.

Good therapy isn’t about a technique or style working for everyone.

Good therapy is about being able to allow the client’s story to be primary in formulating session goals, and allowing the client to modify treatment plans alongside you.

When you have good therapy, it feels like you are seen.

When you are a good, ethical therapist, you also learn to listen to the client – not your paycheck! It is about learning to set, delineate, and define your own skills as a therapist as a means to value the client’s experience, as well.

I wanted to share a story of the client I learned the most from.

We’ll call her “Quinn” (which, to be clear, dear reader, is nowhere near the real name).

Quinn was perhaps the third client I ever had the honor of learning how to develop an individual therapeutic relationship with. She and I got along well – I could field many of her issues and was there to listen to what she needed from me.

My agency was flabbergasted – this client immediately begins taking the full hour of sessions with me. The agency loved that my billable hours were presenting really well with some clients – namely those who could tell I was geninune in wanting them to show up for themselves rather than perform to my agenda.

I’m not an expert – that’s for sure.

Quinn knew this – she gave me a fair shot of six months anyway.

When I discussed her case in supervision, it was always very clearly stated as, “Quinn states she has more going on, and when I ask, will not tell me, and yet, I don’t know what to do. What’s the proper clinical method to proceed when the client is not opening up?”

My supervisor – stated as the agency’s best – seemed frustrated.

I eventually gave up discussing many of my pressing dilemmas in supervision, and instead sought out CEU trainings, and specialized seminars. I filled out all the proper internal documents to demonstrate my commitment to obtaining trainings to achieve the knowledge of clinical experts whose teaching was client-focused and not client-confused.

Quinn and I were mismatched.

It was not so much my skills were unable to help her, or that my trainings were inappropriate for her diagnosis profile. Rather, it was that my discovered area of clinical expertise and prowess ended up not being with her profile. While I admit that is part of internships, and is not an unethical component of interning, I do wonder about her.

My expertise is highly niche, and that’s OK.

I have the ability to help a wide range of diagnostic profiles, presentations, and treatment goals. That’s fine. It’s actually due to a stylistic nature of therapy I am a mismatch for many clientele and say I’m highly niche and unconventional.

See, most of us who hold high ethics within therapy hold that continuity of care is an ethical thing we impress upon clients. I’m not one of those. It makes me niche. I work with many people who prefer to choose when, how, and if to attend therapy.

This works for my chosen niche. For generalized therapy, it really doesn’t.

I work with symptom and pathology profiles that most differential diagnostic trainings are egregiously wrong about. That’s my skill set – fixing the misdiagnoses based on poor training stemming from overgeneralized data science.

I find I do expressive therapy very well, narrative therapy very well, as well as therapy modalities that are cross sectional in that the skills are atypical in order or type.

I am a quirky human whose training allows for people to want me to prove myself; I don’t care. If that’s where you’re at with mental health providers, cool deal. I don’t need to be the ultimate authority in the room. Not my point of contention, one bit.

Quinn taught me my ethics are that, if the client wants to end therapy, we let them.

We do not impress upon the client that they must continue.

It does not matter if we could help, want to help, or are equipped to help. I have strong ethics that begin and end with: the client has ultimate logical autonomy in knowing who is the proper and safe therapist and clinical team for them.

If that is not me, or now is not the time, that’s cool.

I don’t ever want to impress upon a client that they cannot terminate therapy due to discomfort. They owe me no explanation. I may want one. But it is not the client’s job to provide me a defense – especially if they are feeling I am not the right person to hear it.

I have been a Quinn – having a therapist who was mismatched.

I have been in siutations where I had a therapist who was like me, getting poor supervision but doing their best to make it through until better guidance could be obtained and sought out. Mismatches are really hard to come to terms with.

I have been in situations where it took me until I found “the professor everyone adores” to get the honest answer of “you need (deserve) a different program”. People doing their best to help specific people doesn’t mean they know how to respond to a mismatch.

I have been in scenarios where I was chosen to scope out if the clinical director was ethical or not, and because I called him out so thoroughly, he demoted me, while a longstanding member/consultant of/to the company pulled me aside and said, “No, you’re highly qualified, the CEO is just concerned about the financials, and you are going to be great in this field; I look forward to seeing where you go.”

Ethics aren’t clearly defined.

The code of ethics doesn’t state: “Here’s what to do when you and a client are a clear mismatch for one another.”

The code of ethics doesn’t state: “Here’s how an agency needs to allow clients to state their need for a new therapist.”

The code of ethics doesn’t state: “Here’s how to lead your supervisee in a conversation with their client around your specific stance on grey areas.”

Those are huge grey areas. Huge points of contention in clinical work.

Good clinicans, and great clinicans handle those first two very differently.

Great supervisors train supervisees how to proceed in the third one.

I’ve had great clincians with horrible supervisors whose skills in having the hard conversations made them pull what I had to stop myself from pulling on Quinn – using our “non-clinical” voice in session, as we’re poorly supervised in how to proceed.

I know how to fight against bad supervision, yes.

I had a therapist once give me all the skills in that. I still remember her. I am lucky to have had her and learned from her how to stand up against bad therapy and practices, as well as stand firm that my ethics and morals are OK to be non-negotiables both professionally and in community spaces. She was lovely in that regard.

I stopped myself from getting the full speech I got from a clinican on it. I never did know what a mediocre reponse to “here’s how to terminate a mismatch” is. Quinn saved herself a headache from a supervisor on it. My response was halfway decent – not perfect, admittedly, though. It was still highly ethical, at the end, and the client was valued.

My one therapist didn’t know how to. Especially when the supervisor was giving the feedback I was unethical for my grey area stances. This therapist used her “non-clinical” voice to repeat back the words of the supervisor at me.

I spoke up and called out the supervisor. She goes, “Well, I’m sorry you feel that way,” and I launched into my speech that it was not a feeling, but rather a statement of fact on what he was doing and my proper response to it. I would accept nothing less.

I have done similar things from bad supervision.

With Quinn, when she was non-verbally aghast at my “non-clinical” voice coming out, I not only immediately apologized, going, “Oh my gosh, I should not have said that, I am so sorry,” but I told her later that session nearing the end, “You are welcome of course to continue, but do know I welcome you to switch therapists, and respect that.”

I called her up and we were able to do that.

Was it perfect? No.

But was it ethical? Of course.

And was I mortified when I followed up? Damn straight I was.

She laughed at my embarrassment, and goes, “No, it’s fine, I’ll wait for someone else, thank you for allowing me to switch and following up with me.”

Am I perfect? No?

Was I learning? Also, yes.

I learned from Quinn how to spot when a client is ready to terminate, and how to listen to them above the desire to help. I am sorry to Quinn for being the one to teach me that, and am forever grateful to her for not giving up on therapy after I accidentally burned a bridge by showing my niche was not with her symptomology.

I learned how to figure out when supervision is bad, as well. I am forever sorry to Quinn for teaching me this, and hope to be a better supervisor than the one I got. I hope to change the way we train supervisors in the future. It’s hard to mentor new therapists.

I am forever grateful to the agency for understanding the difference between an intern learning and a clinican being downright unethical and not owning up to it in any regard. I know I was not perfect, and I know I needed someone different, someone who understood my training was not lesser for being non-clinical, but was different for that.

To the clients who showed us how to be better.

To the mistakes that shaped our ethics.

To supervisors, for being human and still making mistakes, too.

To doing our best and still getting it wrong.

To life, therapy, and grey areas being disastrous.

May you all be blessed in finding your mentors.

XOXO,

Dorothy B