IAmA therapist. Turn the tables and ask away!

Rough estimation, how many people cry during their sessions?

I would say most women - 70% or so - cry in a session at some point, though that doesn't mean they cry every session.

With men, that number is probably closer to 40-50%.

I'm a female and see a MFT on on how to parent my son who has ADHD/ pdd/ anxiety. I feel like she is trying to push me to cry and wants me to cry but I never have and really don't want to

Have you talked to her about it? How long have you been seeing her?

A year . Mainly my son would see her and I would go with him since he stared at 6 ( now 7) but about 6 months ago I started seeing her alone. No I've never told her it seems like she is trying to force more emotions out of me. I am really really upset that my son is having so many problems and I cry about it all time time alone.... I just don't want to cry in front of her.

Sounds like maybe you need to communicate that to her!

That'll be $100, thank you

You think I'm making $100 a session? Ha!! That is NOT the world I live in. And a good therapist knows when not to be a therapist.

Have you ever been to therapy yourself?

Absolutely! I actually get really annoyed when I hear of therapists who've never been in therapy. In fact, I am currently in therapy, and I think it's good practice for therapists to be in therapy.

I-It's a never ending paradox of therapists giving therapy to other therapists... It's like that episode of Spongebob where he asks the mailman about who delivers other mailmen's mail.

Oh god...

LOL You just have to make sure that you see a therapist who is trained and comfortable seeing other therapists.

What is your personality type?

Are we Meyers-Briggs-ing it? If so, INFJ. :-)

and how does that make you feel?

Proud of how much I've come to embrace my personality! Nice question. LOL

SAME! Hello, friend. I have literally never met another one. chest bump

INFJs are gentle, caring, complex and highly intuitive individuals. Artistic and creative, they live in a world of hidden meanings and possibilities. Only one percent of the population has an INFJ Personality Type, making it the most rare of all the types.

Weirdos.

We will come for you. And we will stand around and not say a single word . And you will feel so awkward. SO. AWKWARD.

This thread is cracking me up!!

wOOt!!! We're very rare. Though, most therapists are introverts, and I work with a few other INFJ's. I feel MUCH less like a fish out of water when surrounded by other introverted therapists! ;-p I'm also an HSP, if you're familiar with that.

Why do all of these penises remind me of cigars?

Sometimes a penis is just a penis.

Isn't therapist a general term? Like are you a Clinical Psychologist, MS in Social Work, etc?

What kinds of therapy do you conduct?

Do you feel you've become more sympathetic or less to others' issues?

Do you think current treatments are sufficient, or need to be improved?

Yes, it is! I'm a clinical social worker. I work with psychologists, counselors, and psychiatrists. It has helped me to become more empathic. I don't find sympathy to be very congruent with who I am as a person or as a clinician, but empathy can be transformative. I think that there is always room for improvement.

Do you ever play mind games with your clients? Like reverse psychology? Or trying to provoke a particular response? For example, try to make a client angry who has difficulty expressing their anger?

No. If I have a client who is avoiding conflict in the therapeutic relationship, I won't collude with that, but that's because conflict in relationships is necessary, not because I am playing mind games. And I will openly discuss the need for conflict with them. As much as possible, I try to be open and authentic with my clients about what I am doing and why.

Many questions :D

What do you think about the ever increasing size of the DSVM.

What is the difference between ADD/ADHD?

What do you think about Adderall?

What do you think about this dude

http://www.ted.com/talks/ben_goldacre_battling_bad_science.html

1) Oh, the DSM. deep sigh I know that there is a lot of fatalism about it. I don't think that the new one is objectively worse than the DSM IV-TR, but it's certainly NOT better overall. I think that the APA needs to talk to specialists in each disorder/diagnostic category from across the spectrum of mental health professionals if they want to come up with a productive, useful manual that actually speaks to clients' experiences and symptom presentations.

2) ADD is not an actual diagnosis. The diagnosis is always ADHD, though there are different subtypes based on a client's predominant symptoms - predominantly inattentive type, predominantly hyperactive-impulsive type, combined type, and NOS (not otherwise specified).

3) Can you be a bit more specific with this question? Like with psychiatric medications in general, I think that it can be very effective when it is prescribed appropriately and used in conjunction with therapy.

4) I'll watch it and get back to you!

As a follow up, how do you feel about the debates surrounding the DSM currently? I know that some professionals are turning away from it and its former bible-like status.

Well, we can't actually turn away from it because it's the only diagnostic manual that we have. That said, I have never been one who sees the DSM as Truth. It is an imperfect tool that comes with the trade.

Do you really just wish they'd all shut the fuck up already?
Do their problems make all problems in general melt together into a meaningless puddle of tears, or do you rank people's problems in order of severity? What percent of people are crazy by your standards?
Have you ever felt you've actually helped someone in a long lasting way? How many?

LOL Oh my. Lots of questions!

Sometimes when a client is avoiding a topic by talking around it, I wish they would get to it. But, it's the client's hour to fill!

I try very hard to avoid "ranking" people's problems, though there are clients and situations that are more severe than others.

"Crazy" is a really ambiguous term. How would you define it? I'm just not sure how to answer that question, since I am not clear on what you mean when you say crazy."

Not all of my clients keep in touch after we work together, so often don't get an idea of how many I have helped in a lasting way. It's one of the hard things about being a therapist. And some clients, depending on their life circumstances and/or mental illness, are always going to struggle at times. I will say that there is general a noticeable and significant positive difference after I've worked with a client for a while - and that is my client's feedback, not just mine.

Have you ever encountered a situation where you meet with someone who clearly needs psychological support but cannot afford to pay for therapy? How did you react emotionally and what steps did you take professionally?

Yes, I have and it's very hard. Luckily, most areas have at least some agencies that offer pro bono or sliding feel services, so I would refer those clients there.

pro bono or sliding feel services

Sometimes a pro boner is just a pro boner..?

Well played, friend. Well played.

Some people in here seem to think therapist automatically means psychoanalyst.

Yes, that happens!

How would you deal with a pedophile?

That's a population that I'm not sure I would work with.

What's the reasoning behind that? Do you think you wouldn't be able to help them, or would you find it too difficult to be non-judgmental? I'm curious/excited to hear your answer!

It's one of the areas where I think it would be too difficult to separate my own "stuff" from my work. I'm an abuse survivor, so I would worry that my fear/anger might get in the way of me truly helping and connecting to those clients. I do have colleagues who work with people with pedophilia, though, and I have worked with clients with sexual addiction.

How to forget a girl one loves, since a year, thinks about her everyday (even though I try not to) ?. I'll buy you a spaceship, if you could help me Shift+Delete that girl from my memory. Thanks.

Ah - if it were as easy as pushing a button, therapists wouldn't exist! Have you spoken with a therapist about this?

Nope. Not Yet. I'm 16 (Yes, you can laugh) & I ofcourse can't go to therapist without my parents knowing.

Why would I laugh at you being 16? Do you have a school counselor that you can talk to about this?

Nope, no counselor. Well, reddit for some reason finds it amusing for a 16 yo to have any problems.

That's too bad that your school doesn't have a counselor! Would your parents be open to you seeing someone! I love working with adolescents, and I also know that it can be one of the most difficult and challenging faces of life. And I think it's made harder because so many people stigmatize or belittle teenagers!

Yup, you're absolutely right. Unfortunately, if I let my parents knew about such a thing I would be embarrassed for the rest of my life. They're not so open about stuff like love (by love, I meant the male-female love). Anyways, thanks a lot for understanding my concern. I really appreciate it.

Regards, Netizen

One thing to keep in mind is that it's up to you if you tell your parents why! Maybe you could even say something like, "I just want to talk through some stuff with someone." Glad I could be of help! You will get through this - I promise.

Tell me about your father.

He's great.

this is going to be lovely! a few questions:

(1) do you feel that therapy and therapists are appropriately displayed in pop culture? For example, Good Will Hunting, It's Kind of a Funny Story, America etc

(2) who are your favourite clients and why?

(3) does everyone have some sort of disorder? or do "normal" people actually exist?

(4) what advice would you give to someone who feels uninspired, unmotivated, apathetic? hypothetically, this person is waiting for something to happen but there lies a good deal of 700 hours between now and the potential new.

1) I think that Good Will Hunting is one of the better portrayals of a therapist in popular culture. I think that there are some really great portrayals, some complex portrayals (e.g. In Treatment), and a lot of portrayals that are inaccurate and/or unflattering (e.g. 50/50).

2) My favorite clients are the clients with good insight - it allows us to really get down to work and begin digging deeply together. I also really love working with trauma survivors - they are generally so much stronger and more resilient than they know, and it is so incredibly powerful to be part of the process of healing from trauma.

3) There certainly are people who do not warrant a clinical diagnosis - I have a number of current clients whom I refuse to diagnose because they don't really warrant. However, with the new DSM 5, I think more people are going to be diagnosable.

4) Hmmmm . . . that's a hard question because it really depends on what is causing the person to feel unmotivated, apathetic, etc. One thing I might suggest is to start a gratitude journal. I might ask the client to take some time with me in session to write down 5-10 things that she is grateful for in her current life, then I would encourage her to mindfully incorporate those things into her daily life while awaiting her new adventure. I might also suggest visualization exercises both of how she wants the potential new to be and also how she can get the most out of the present. Finally, I would possibly suggest radically accepting that she feels unmotivated right now and not trying to fight it, but trust that it is temporary.

Every psychiatrist I have ever met is bat shit crazy. Are therapists, too? (edit: and not bat shit crazy in a bad way, just very eccentric. Super smart, too... just nuts)

LOL Many of us are "quirky." I think part of it is that we tend to have personality types that are not super common in society, so we might seem a bit different. Also, a lot of therapists tend to express ourselves in ways that are atypical for many people, and we get so used to talking about things that can be pretty taboo that we sometimes lose our filter!

Thanks for the answer. Quirky was the more appropriate word I was looking for but couldn't come up with.

Therapists tend to have a sizeable battery of descriptive terms. ;-)

Hi, I want to go to grad school and become a therapist.

Tell me, what's grad school like? Oh, and one more thing. Have you heard of the book Letters to a Young Therapist by Mary Pipher?

Grad school varies enormously based on what therapeutic field you go into - e.g. social work, psychology, counseling, etc. I have heard of the book and I've heard a lot of good reviews! It's on my to-read list for the summer.

How can you remain interested in other people's problems? I can't talk to therapists because it feels like they don't really care, because it's not their life that they're listening to. I wonder if this is just how I interpret the situation, or not.

Hmmm . . . I guess that what I would say is that I'm interested in other people, problems or not. I have worked with clients with very severe mental illness and/or life circumstances, and I have worked with clients who just need someone to talk to or might need an objective opinion on the situation. I guess what I would say is that it's not so much the client's problems that draw me in, as it is the connection and relationship that I form with each client. Like anyone, there are days that I feel particularly present with clients or days that I have to work a little harder to be fully present with clients (like if I have something difficult going on in my own life), but it's the power of the connection that keeps me present and interested. I also feel so incredibly honored and fulfilled by the fact that I am able to create a space that feels safe enough for clients to talk freely. I care very deeply about my clients. Have you tried going to therapy before?

Do you ever get frustrated when clients don't take your advice? Do you ever want to yell at them?

I'm not much of a yeller in general, but yes, I'm human and do get frustrated. There are definitely times I want to say, "Just try ____!!!! I know it will work, gah!!" When I feel that way, though, it means I might have some countertransference going on or I am missing a piece of the puzzle, so it's time to seek consultation to process my reaction.

Countertransference? Thanks for teaching me a new word!

Yep! It's the same thing as transference, basically, except that it goes from therapist to client, instead of client to therapist.

is it true what people say about people who specialize in the psychological field? does the majority really get into the job to find out what may be wrong with themselves?

Yes and no. In every graduate class that I well (well, this was true in undergrad psych courses as well), there were people who seemed to be becoming therapists because they had unresolved stuff. That said, it was nowhere near the majority of people going into the field. I do think that A LOT of therapists go into the field because we have been helped by therapy or have been close to people who have been helped by therapy.

What is your specialty in therapy?

women/women's issues, trauma, eating disorders, LGBTQIA/sexuality issues, grief/loss

you're a good person

I truly believe that people in general are good. :-)

Best way to manage anxiety?

First of all, deep diaphragmatic breaths (your belly should move in and out, not your chest). Mindfulness techniques and cognitive-behavioral therapy can also be very helpful with anxiety. And some people need medication to help manage it as well.

Every time I try and do breathing exercises like this I get very light headed and nearly black out.

And what do you mean by Mindfulness techniques?

You might not be taking diaphragmatic breaths - that's what happens if you do breathing exercises but breath into your chest and not your belly. But it's best to start small. Take five deep, slow breaths, don't overdo it while your body is adjusting!

One of my favorite definitions of mindfulness is by Jon Kabat-Zinn: "“Mindfulness means paying attention in a particular way; On purpose, in the present moment, and nonjudgmentally." Here are a couple of links about mindfulness: http://www.livingwell.org.au/mindfulness-exercises/ http://www.wildmind.org/applied/daily-life/what-is-mindfulness

What do you write on the clip board?!

Ha! I actually use a small notepad because it's not as obtrusive. Some therapists don't take notes at all. It's really just very basic key terms to jog my memory when I put the formal notes into a client's file.

My old math teacher said "The best thing about being a teacher is seeing the spark go off in a student's mind and hearing them say Oh my god, I get it now!"

Does something similar happen with your clients? If yes, how common is this and what's your reaction to it?

It does, and it's SO awesome when it happens!! And sometimes that happens for me as a therapist, too. I can suddenly see connections in what a client is dealing with, when I couldn't see them before. It depends on the client. With some clients, they seem to have those moments every session. Other clients have to work really hard to develop that insight. Depending on what the revelation is, I typically compliment their insight, reinforce it, and often ask a question to deepen it.

How much is confidentiality really respected in your profession? For example, if your best friend met one of your clients (not through your work, just out in the world) would you ever tell your best friend "don't be friends with him/her, she's nuts?" What about if it was your family member who met the client?

(My best friend was seeing a therapist and mentioned her new daughter's roommate was causing some drama, and the therapist said to her, "just between us, I used to be (roommate's) therapist, she is bad news, get her away from your daughter. Does this sort of thing happen often?)

I absolutely would not tell a friend/family member that. It would be a HIPAA breach for which I could (and should) be reported to the state board. I'm appalled that the therapist said that to your best friend!! That is definitely something that should be reported to the board. No, things like that do not happen often (as far as I'm aware), because a therapist could lose her license for that.

Do you believe in the borderline personality disorder diagnosis? If so, have you treated people with it? I have heard friends in the field say that they are very difficult to treat.

I think that there are probably people out there who have BPD, though I think they are FAR fewer than many believe. I think that, unfortunately, it's very, very common that people with severe and/or complex PTSD are misdiagnosed as having BPD. I have worked with a client who was in that situation. I have not worked with any clients with true BPD. I do use a lot of dialectical behavior therapy in my practice, which is the treatment of choice for people with BPD.

Do you have one of those awesome couches? You know the type.

Ha! The chaise-lounge? No, I can't say that I do.

and you call yourself a therapist...

if i was a millionaire i would buy you one.

I appreciate the thought!

I am an Addictions Therapist, any advice to counteract counselor burnout? Any general tips going into the field? How long have you been practicing? What state do you practice in? How many clients are dual-diagnosis MH/CD?

I'm still pretty new to the field - at least in terms of doing true therapy. I don't want to disclose what state I'm in, though I'm about to move to a different state anyway. My general tip would be support, support, support!!! And I think that, for those who really specialize, trying to make sure that you get some variety in your caseload (if at all possible) can help a lot. I think that most clients with CD have a co-occuring mental illness. I think it varies the other way around.

What was the most mentally disturbed person you have ever treated?

Have you ever been physically assaulted by one of your patients? If so how did you deal with the situation?

"Mentally disturbed" isn't a term I would use, personally. I have worked with clients with severe psychosis, which is as severe as I have gotten. I have also had to hospitalize suicidal clients.

I have been grabbed once, and luckily it was in a common space of a treatment facility. I'm physically pretty small, so I just stayed calm and a bigger nurse intervened.

I know this is an obvious one, but how do you help people deal with death of a parent?

Actually my favorite model of grief is called "companioning," which means that I am willing to be with a person in her/his grief, instead of avoiding it or trying to fix it. One thing that I think is very important in dealing with death is to get comfortable talking about it. When I am talking about death with a client, I do not use euphemisms. We are a society that is almost phobic about talking about death, which keeps us from really being present with people who are grieving a death or facing the prospect of their own death. More on the companioning model here: http://www.centerforloss.com/ and http://www.centerforloss.com/companioning-philosophy/

Have you had any patients who challenged you / were critical of you to the point where you felt yourself getting defensive, and if so how did you deal?

I have had clients who challenge me. I have not had ones that have stayed critical, but I have had ones who have been very skeptical of me at first. When I find myself getting defensive or frustrated, that's when I seek consultation to sort through my emotional reaction.

Sounds like you're doing it right!

What do you think is your "Achilles heel" where if a client were to behave in a certain way towards you, you think you wouldn't be able to handle it emotionally? I'm not talking about a client being threatening or something else that would be obvious cause for termination, but something that is within the bounds of the therapeutic setting and that another therapist might conceivably be able to handle, but that you would have difficulty with because of your own baggage, biases and blind spots.

I think it would be really difficult for me to have a client who openly expresses misogynist, racist, and/or homophobic viewpoints.

You say above you've already had such clients. How did that go?

I did, though they were group clients, not individual clients. And, they were minority clients who were mostly racist against me (I'm white), and that was actually a lot easier to tolerate than racism against minorities. lol I also have had a group client who would express misogynist views (in joke form) when he was mad at me (I was a facilitator and it otherwise was a group for me), so that was fine because I knew it was connected to the work I was asking him to do.

Thanks for answering!

For the group therapy you did, were you the only therapist involved or did you collaborate with a colleague? If the latter, can you share some things you and your colleague might say to each other in confidence about how things were going that you would not say to the clients?

I've done group therapy solo and with a colleague. If there was a client that we had clinical concerns about, we would talk about that with each other. Or we might talk about dynamics/themes that are emerging in the group that warrant exploration and talk about ways we could collaborate to facilitate that work. But then we share that with clients - why we are doing what we doing, etc.

Do you analyze dreams?

I don't do the full-on Jungian type analysis, but I absolutely talk about significant and meaningful dreams with clients.

When you're working with a patient, how do you draw the line between professional judgment and making moral/political judgments about them? I'm thinking for example of when Fanon was a therapist in Algeria: part of his work was giving counseling to police who'd developed psychological problems torturing native Algerians, and he concluded society would have to change for therapy to have any meaning in that case.

Good question! I think the most important thing here is that it's important for me to be very aware of my own values and biases, so I know what to be on the look for. This is also where consultation and supervision come into play. If I am feeling things about a client that are not clearly within the bounds of productive and appropriate therapeutic work, then I seek consultation from a colleague, or supervision from a therapist with more experience.

What degree do you hold?

I have a clinical MSW. I also have an M.A. in Women's Studies, and I am a Ph.D. candidate in Women's, Gender, and Sexuality Studies.

Have you ever lost a client to suicide? If so, did you feel responsible for their death? If this is too touchy, you don't have to answer.

I haven't yet, and I know that it will likely happen someday. There's a saying about it - "There are two kinds of therapists in the world - those who have lost a client to suicide, and those who haven't yet." I did have a classmate commit suicide a few years ago, and I definitely had to work through some survivor's guilt for not picking up on it.

I am thinking about going into psychology/therapy, would you suggest it?

I'm very happy with it so far. And, it is a challenging career path. What are your reasons for going into it? Do you definitely want to do psychology, or are you open to other mental health fields as well?

What is your certification

Have you treated victims of sexual abuse? What is that like?

I'm a clinical social worker. Survivors of sexual abuse are actually some of my favorite clients to work with. It can be very difficult work because it is difficult to hear stories of abuse and to see what it does to people. That said, i also find it so incredibly powerful to see survivors of sexual abuse heal from that trauma.

how do you foster a persons development from a victim to a survivor?

I typically use the term survivor from the get-go, unless the client asks me to use the term victim. If someone has been abused or assaulted and she/he is in my office, she/he is a survivor. However, I think that as clients begin to feel more able to talk about what happened to them, own it as part of their story (but not their whole story), and start feeling more in control of symptoms of ptsd, they start to feel more like survivors and less like victims.

Bit late to the party. Curious, what's a personality type/mental disorder (if you deal with those?) that you see a lot?

I see anxiety disorders A LOT, and depression is pretty common too. Many of my clients seem to be introverts (more than is proportional to the general population).

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Not per se. I did have one client ask to have sex with me, though.

How did you know that you wanted to be a clinical therapist? Have you ever considered switching to research? Is that an option for you in the future or do you kind of have to stick with what you choose initially?

Hmmmm . . . I've known for a long time that I wanted to be a therapist, but I think it was really my own transformative experience in therapy that made me want to go the route of clinical practice. It also suits my personality-style well, and I feel very competent at it.

As for research, I appreciate the research that others do, and I don't feel the need to conduct it myself! The ability to switch between research and clinical practice varies by one's degree.

What advice would you give a current psychology undergraduate interested in becoming a therapist?

Explore your options for graduate school. Remember that psychology is only one route to becoming a therapist, and each mental health field has its own guiding values. I'd explore how long you want to be in school, what you want to be able to do with your degree, and, most importantly, what values/practices you want your graduate program to emphasize.

Thanks for replying! I'm actually thinking about applying for my masters in social work next year. What would you say makes a strong applicant? Where I live the social work programs are very competitive. I was just wondering if there is anything that would make an application stand out against the rest.

I would say having strong volunteering/community mental health/advocacy involvement could give you an edge. And emphasize diversity and cultural competence! And I'd be ready to articulate why you want to do social work as opposed to other fields.

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Hmmm . . . There are multiple kinds of school counselors. There are guidance counselors, school social workers, professional counselors, and school psychologists. Which are you referring to?

Any advice for choosing a therapist? How do I know I've found the right one?

I'd do some internet searching and see if there are any therapists who have bios that you particularly like. Like with any relationship, sometimes you'll "click" with a therapist and sometimes you won't. That's okay. Sometimes it takes some shopping around. One good place to start is by asking friends/family or another trusted professional (e.g. a doctor, mentor) if they have an recommendations.

I am curious about your opinion on human euthanasia rights. Death seems to be (at least more and more as of late) a legitimate option for people suffering from painful and terminal physical conditions. Do you think there could (or does) ever exists a situation in which a person suffering from painful or terminal psychological condition decision to end their life would be taken seriously? Is there just never enough guarantee that their psychological affliction isn't getting in the way of their "best judgement"? Opinions, thoughts? Thanks!

I believe in the right to die when one is facing a terminal, chronic illness where it is clear that she/he will never return to the quality of life that she/he needs in order to feel that life is worth living. I do think that pre-death counseling should be required, however. I do think that it is possible that the right to die might apply to certain psychological conditions, and I think we need to be very, very careful about that.

I hope you are still answering questions!

But I really was wondering if you analyze people you meet in your everyday life?

I used to work for a psychiatrist and I was always paranoid that he might be analyzing me. I was always wondering- Can he tell what I'm thinking? Is he studying my behavior now? Are my responses giving him clues about who I am?

In general, I do not. If I see an obvious connection or know of a coping technique that might help, I'll share that with someone in my life, but I don't analyze them. Frankly, I do that all day with my clients - I don't feel the need to do it with non-clients too! And, keep in mind, therapists can't actually read minds. I promise. ;-)

Question: Why do I feel more offended when somebody insults something I like, as opposed to when somebody insults me personally?

That could be for any number of reasons, honestly. It might be a good thing for you to see a therapist about!

I want to work in a rehabilitation center for people who have been trafficked. What advice do you have for an ENFP who is wanting to work with PTSD of many different sorts?

I'm really not an expert on the MBTI types. lol I can give some general advice for working with trauma survivors, though.

Why is it so insanely difficult to find therapists who work with kids? We've been on waiting lists for MONTHS trying to get our son in to see an occupational therapist... is the job market really that understaffed?

Occupational therapy is a bit different than seeing a child therapist. But yes, in general there is ALWAYS more demand than supply when it comes to mental health care.

be honest with me, what the fuck are you writing down? flaws, perks, notes, just how crazy this person actually is?

LOL I take minimal notes. Usually it's just stuff to help me make sure that I get everything in the notes that go in the client's record. It's usually basic observations/content from the session, interventions that I use, and any risks that warrant further assessment.

What's wrong with me?

My guess would be that nothing is inherently wrong with you.

Thanks very much for doing this AMA. I really appreciate you taking your time to do it. Spreading awareness is so important. Reddit is finicky about which posts really take off. I think it has a lot to do with timing. This was one of the best AMAs I've seen. I think you're awesome and hope you'll consider maybe doing a part II sometime.

Good idea! It's so interesting to me that this has taken off like this! I'm glad that it has, and I'm definitely open for doing a part II. I'm still new to this whole reddit thing; any tips on when it might be good to do a part II?

1. I hear some say that things such as ADD/ADHD are too commonly diagnosed, what is your opinion on this?

2. How will Obamacare effect you and the patients you see? what is your opinion of it?

1. I have heard that too, and that has not been my experience. It can actually be quite challenging to get a full ADHD diagnosis because it can really involve a battery of expensive tests.

2. I think it will make mental healthcare in general, and long-term therapy specifically, reachable for more people. I'm a huge fan of the ACA.

I go to some kind of therapist pretty much every week (they're still trying to find out what's "wrong" with me), and the woman I talk to make jokes about my lack of self esteem and told me to stop self harming because it, and I quote, "leaves ugly scars". I feel bad if I talk to her about it, and she starts making jokes. Any ideas on what I can do to make her take me more seriously? I mean, I am there for a reason, I don't need her to make me feel even worse.

I would either communicate to her how you're feeling or find another therapist. She doesn't sound very professional! Or, she just may not be equipped to provide you with the therapy that you deserve.

Any tips for a parent of a kid with selective mutism?

I'm not a child therapist. Are you working with qualified professionals?

How do you feel about MDMA therapy and it's potential uses as an empathogenic therapeutic drug?

While I know a bit about this, I don't really know enough to have a solid opinion.

I just started seeing a therapist about a lifetime of gender identity issues and depression. He keeps trying to tell me that transitioning is the only way to be happy, but it scares the crap out of me. Do you think trying to find ways to just push down those feelings is feasible/healthy or would you agree with my therapist?

I think that you're the only one who can make that decision. I guess my question would be - do you feel happy and healthy now?

How do you know when a client is "done" with therapy? I've been in and out of therapy since I was ~13 and I'm turning 22 this year, I feel like I had a hard time knowing what's normal and what's something I need to go to therapy for.

That's really something that clients and I decide together. I don't think that people need to be diagnosable or in severe distress to be benefited from therapy. And, if a client is holding on because she/he just does not want to say goodbye but is no longer benefiting from therapy, then that is something I will discuss with the client.

A few questions for you:

• What do you think about hypnosis? Have you used it with your clients, and what is your opinion of hypnotists in general?

• I've read that you are employed at an agency but will be moving soon. If you were to start a private practice what are some of the things you would do build up a referral base?

• Is seeing clients what you hoped/imagined it would be like?

• What is your favorite tool or piece of advice you use to help someone who is dealing with grief (specifically grief stemming from a romantic relationship that has ended)

Thanks!

I'm not a hypotherapist, but I have heard of it being successful.

I would get connected with other therapists and treatment centers in the area. And I would create a website and probably pay to list myself on psychologytoday.com.

It's even better!

That it's okay to grieve. Trying to fight it often makes it more intolerable. Grief is a sign of how much we have loved. I think it is one of the hardest human experiences that we can go through, and I also think it has the power to be one of the most transformative.

... Can I pm you with a problem I am having?

You can if you want, but I cannot act as your therapist. I can perhaps give you guidance on how you might find the right professional support.

If I could afford it, I'd go to a therapist... thanks though...

There are therapists who will seek clients on sliding fee or even pro bono! Try googling community counseling centers in your area.

Is it true that some therapists take advantage of their patients' emotions and make them dependent on coming back to therapy for the sake of making money?

My guess is that, unfortunately, there may be therapists out there who do that. I do not know any personally, and I think the vast majority of therapists have good intentions and ethical reasons for being in the field.

When it comes to various methods of psychology (behavioral-cognitive, gestalt, humanistic etc) is there a particular method to which you generally ascribe? If so, which one and why? Also, do you think particular schools of thought are better suited for particular issues? If so, which ones and why? Thank you :)

I am a DBT-informed, feminist, person-centered therapist. I also incorporate a lot of interpersonal techniques and some CBT into my practice. I subscribe to those because they feel congruent with who I am both as a person and as a clinician, and I really value a collaborative, egalitarian relationship between client and therapist. I do think that there are some techniques that can be more or less useful for certain issues, but it also really depends on the client and the presentation of symptoms.

What is your degree exactly? PhD? PsyD? Also, what do you think of psychologists getting the right to prescribe in Illinois (and I think New Jersey?) Finally, where do you see psychology heading in the next 10-20 years? More drug-based therapy?

I have a clinical MSW. I also have an M.A. in Women's Studies, and I am a Ph.D. candidate in Women's, Gender, and Sexuality Studies.

I used to be for the idea of psychologists prescribing, but I have changed my mind. I think it should be kept for people with medical degrees. I'm interested to see what the Affordable Care Act does for mental health - I'm hoping that it will re-open the possibility of long-term therapy.

Have you ever had a patient whose life you turned around or helped turn around significantly?

Yes, more than once. Though, really, the clients do the work. I get to be along for the process and I may navigate us a bit, but the clients are the ones who are living the work that we do in session.

What has been your experience with community mental health? Do you have a private practice? Are you an LPC?

I'm a social worker. I am not in private practice, nor am I in community mental health. I have worked in community mental health previously, and may return to it temporarily. I think that it is one of the most challenging settings to work in because there is often a lot of burn-out. I also think that it is some of the most necessary work that we can do as therapists.

How do you handle knowing all these sad things? To me, it seems like it would just be terrible to know about all the bad things people can do and have done to others.

One phrase that I love that I stole from a therapist of mine is that, "It's my job to make sure that my needs are met outside of work so that the therapy office can be about what my client needs." In order to be a healthy therapist, self-care is very, very important, so I make sure that I am listening to what I need and attending to it. I also have a therapist of my own, and therapist friends and colleagues who are wonderful supports. That said, I also get to see people heal from sadness. I get to see them grow and change and bloom right before my eyes - it's pretty rewarding!!

OK so who's the grand poohbah of therapy now? Hillman? Still Jung?

In other words, who would I read to understand the state of art regarding psychotherapy?

There isn't one. I would say that therapy has become split into so very many styles and types that it's impossible to say. Rogers is constantly being proved right, so he's coming back around! Marsha Linehan and DBT are becoming increasingly well-known. And CBT is still one of the most widely used treatment modalities.

What's it like dealing with clients from the same family? I bet knowing each persons take on each other and different events but not being able to share due to confidentiality purposes.

I would probably only see clients from the same family if I was actually doing family therapy. Otherwise, it's a conflict of interest.

What is your opinion on women using the term "abuse" to justify leaving a relationship? I am not insinuating that abuse does not occur. But, I believe that some people use the term to commonly to persecute the other partner.

Actually, statistic show that false accusations of abuse/assault are no more common than any other crime. If anything, I think the term "abuse" is underused.

Is it ever difficult for you to say goodbye to a patient? Like if one of them particularly touches your heart in some way?

YES. I am currently getting ready to move and am having to say goodbye to all of my clients, and it is ROUGH.. It varies from client to client, but there have been numerous times I have cried because I am so sad to say goodbye to a client - especially those that I've been working with for a long time, or those with whom I've done particularly emotional or vulnerable work.

That said, it is also my ethical duty to let a client go when she/he feels ready.

I'm sure you are aware that suicide rates are climbing at a rate which outweighs the amount which could be attributed to population growth.

What do you attribute this to?

And is there anything that you think can realistically be done about the problem?

I attribute this to living in a society that is increasingly disconnected. Even as we have more technological ways to stay in touch, we have so much less deep, authentic, interpersonal connection than we used to. I feel incredibly privileged to be in a field where I get to have deep, connected conversations with people all day, and neither of us has our cell phone or computer out. I think that we need to foster interconnectedness, authenticity, and vulnerability (rather than individuated, performative disconnection) if we want to see the suicide rates decrease. I think we would see mental illness decrease in general, in fact.

DO you find that therapy overtime works betetr for treating certain conditions, for example psychosis, then taking anti psychotic pills? if someone could only take the meds or go to therapy, which one would be more effective?

I think that it really depends on the person and the diagnosis. I think that if someone is on a psychiatric medication, she/he should at least be checking in with a therapist or good psychiatrist from time to time. That said, I certainly do not think that everyone who seeks therapy needs to be on meds.

Would you say that everyone could benefit from therapy?

Presuming they find the right therapist, yes.

can you analyze me please?

I don't do web-based therapy. ;-)

No therapist enjoys every patient throughout the course of therapy. Which patients have you dreaded seeing and why?

I think my biggest struggle is with clients who willfully lack insight. Of course, we all lack insight at times, but my struggle is with the clients who want to be in therapy but don't want to dig deep or engage with what's going on with the internally.

Hi.

How much do you earn?

How much do you charge per hour?

Has the recession hurt your job/practice?

How much does the richest therapist you know earn?

:)

I am actually still working toward my independent license, so not much! I currently work at an agency where I am on a stipend, and I won't be charging hourly unless I move into private practice. I do know therapists who are in private practice who have had to see more clients on sliding fee scale because of the recession, though that's not as common as a few years ago. It's possible for therapists to earn six digits, but I can't say I know any of them personally! Probably the richest therapist I know earns about $80,000 - $90,000.

How do you deal with a client who you feel is becoming too reliant upon you? Reliant in terms of support and socialization.

I would talk with that client and express my concerns and then we would work together to address it. That is, if they were too reliant for support. Can you tell me a bit about what you mean by too reliant for socialization?

How many professional therapists you know have a history of mental illness?

It would be hard to say, as not all therapists discuss that. My guess is that most therapists have been touched personally by mental illness - whether that was themselves or someone close to them.

Have you ever felt burned out from your job?

Not yet, and I know it's a big risk. It's something that I watch for very carefully. And it's also something that I am wary of in agencies as I am looking to move and get a new job.

Do you have a specific theoretical approach you utilize?

I take an integrative approach. I am a feminist, client-centered therapist. I am a dialectical behavior therapy informed therapist, and I also incorporate a lot of interpersonal techniques.

Hi! I want to be a therapist when I grow up. I'm starting university in September and am planning on transfering into the department of psychology in the second semester. My questions are; How did you get your first job(s) after having graduated with said degree?

Also, how well are you paid? How do you feel about your career in general? Yes I did just ask how you feel lol

Thank you in advance for any reply :)

EDIT: deleted a question s/he answered twice already

Congrats on starting university! The degree that I have that allows me to do therapy is a Master's in Social Work. I'm still employed in the position that I had when I graduated, though I'll be moving soon and therefore leaving this position. Social workers are highly employable. I'm still working toward my independent license, so I'm still waiting to see what my full earning potential is. I love my work as a therapist! I actually kind of have dual careers (I'm also completing a Ph.d. and teach college), so that gives me some variety. I think I'd like to end up to doing primarily therapy with a big of university teaching on the side.

What do you recommend to a disabled teenager with slight depression and social anxiety?

I recommend therapy. ;-) Are you seeing anyone?

Oh, another question. Do you reject people based purely on religious or other issues? (Homosexual couples, PTSD?)

I do not reject people based purely on identity, culture, or diagnosis. There are some groups I prefer not to work with, though.

What causes DP/DR ?

It can be a number of things, but trauma is probably the most common cause.

Have you ever worked with anyone (or do you know of anyone) with GAD/panic disorder who has gotten off medication and stayed off successfully? I had to stop my antidepressant due to medical issues a month ago, and I feel better than I did, but I'm losing hope that I can be OK without meds. I am seeing a therapist, but she doesn't seem to think that my being off medication is a good idea.

I have worked with clients with anxiety and/or depression who are able to taper off of meds eventually. That said, I have also worked with clients who clearly have biologically-based anxiety/depression who need to stay on meds indefinitely.

In general, what do you do with a person who is depressed? Is there a certain procedure you follow? Like 1) history 2) problems 3) solutions. That kind of thing?

The first session is always gathering information - personal history, family history, history of mental illness, interpersonal relationships, trauma history, etc. Then, based on that, I tailor my treatment to each client.

why cant you just tell people what they need to do, instead of all the mind games of making the patient figure it out?

I try very hard not to play mind games with my clients. I try to be as transparent as possible in my practice. We can't tell people what they need to do because we're therapists, not psychics. We can't predict the future or say definitively what is right for someone.