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Sunday, April 7, 2013

Appearances Can Be Deceiving

It isn't often that anyone thinks about what it took for someone else to achieve what they have

Sometimes I get the impression, from clients or from others, that they think that becoming a therapist is easier than it actually is.   Once a client said to me:  "You must have an easy life!"  The opposite is the case; I've worked very hard, all my life.  The only help I had was from my Dad with paying for my college education, although I also worked part time and contributed that way myself. After that I did everything on my own steam! Clearly, I can't make that kind of response in a therapy session; I include here as an example of comments that have led me to this impression.

To become a licensed professional, the first requirement is a graduate degree.  So, first you must graduate from college, then apply and get accepted to a graduate school (no small task:  got to get good enough grades in college to be considered, usually have to go through an application interview and, depending on the institution, fulfill some other requirements), then follows anywhere from 1 to 3 additional years of education, including a practicum.  To graduate at my institution, there was a choice of a 4 hour comprehensive written exam and, once having passed that, a one-on-one interview with the dean or, writing a thesis (25% of graduate students finish the program and then cannot graduate; either they can't pass the exam or they can't finish their thesis).   The training is slightly different for each license but for my license, in addition to the master's degree, this is required:  3000 hours of supervised (unpaid) internship hours, and an oral and written exam from the state.  It's one thing to read through this but, just imagine doing it.  It takes fortitude! Once the license is awarded, it has to be renewed every 2 years.  To do this,  36 hours of continuing education must be completed by the therapist every time.

To be fair, we all don't know what is required for every profession.  Sometimes we assume that to do any particular job, it may take the same approximate qualifications as for whatever job we do ourselves does.   This is natural.  I know, for example, sort of what it takes to earn a medical license, but not exactly.  I do have a sense of how it is to do the work for a PhD, the next degree up from mine.  A high school graduate may not really have a sense of what has to go into graduating from college.  Most college graduates will probably have some appreciation for what graduate school entails.  And, of course each profession has other requirements, such as those I wrote about above, that will be unique.  Most people won't know about them.

We may also, on the other hand, give more credibility to a particular title than warranted.  Sometimes we make assumptions that a medical technician, because he has on a white coat, has more knowledge about medical matters than he really does.  So this can work the other way too.

Perhaps because we therapists don't, in fact, wear a white coat, we are thought of as knowing less than we do.  We dress in professional style work clothes.  We are in an office with no special equipment.  In fact, most of us have an office that looks more like a living room.  They are designed to be comfortable and inviting, not intimidating.  But sometimes I wonder if these cues are misinterpreted---if some patients think that a session is just a visit almost like what one does with a friend.

Obviously , everyone is going to be different about the assumptions they make---about any of us in any job.  But, over the years, I have had enough comments and indicators to know that the level of training and expertise that I and my colleagues must have is often not understood by the very patients who seek our help.  Sometimes when we work with a patient, we seem to be simply engaging in a conversation, sometimes we sit in silence; these are times when it is easy to see how someone new to therapy, (or, even an on-going client), may have no idea what the therapist is thinking, much less what  has gone into putting that therapist in that position.

I don't mean to imply that I feel unappreciated. Not at all.  I feel very valued by my patients.  I have a unique relationship with each one.  Trust has developed.  They recognize the benefit of their therapy.  Nonetheless, I find that the other part, the huge amount of work and determination that goes into becoming a therapist and maintaining that license is  not always recognized.                                                           
We all know that we each have areas of more fragile self-esteem.  But, after all my training and experience, I do have a sense of self value in my work.  So, sometimes I have had the odd experience of being treated, by a patient, with less respect than I have for myself.

I have seen some therapists become irate at paraprofessionals and at practitioners whose title is "coach"(some certified, some not) because they see them wandering into counseling areas that really require the professional expertise of a licensed therapist.  Not only do they feel that it is an incursion but they also worry about the welfare of the clients.  However, despite some apparent lack of information on the part of consumers, most states do have a state board that licenses many professions and business people.  Those boards are in place to protect people.

Part of the reason I wrote this post is because you, the readers, have indicated that you want to know about the behind-the-scenes aspect of a therapist's practice.  I do have some readers who are studying to become therapists so they and, of course the other therapists who are also readers, know all about this.  But those readers who are in therapy themselves or considering therapy or are just interested in this subject may not know.

Was this information you found interesting?


  1. What you've said parallels what my therapist has said, simply because I've asked a thousand and one questions (as it's the profession in which I hope to reside).

    I agree, that many folks don't know how much work it takes to complete this degree (although I'm at the beginning). I'm half exhausted already!

    Thanks for sharing a "behind the scenes" look at your profession!

  2. Amanda. I'm glad you liked this post. One good thing about where you are in the process is that, if you have good professors, the educational experience itself will be interesting and engaging. In graduate school, nearly all of your seminars will be in your field of interest. I found that time period, while difficult financially and plenty of work, still so exciting. Paula

  3. Paula, thank you for a most interesting article that lets us "peep behind the therapist's couch." We all have curiosity about the professions that we interact with. Surely the greatest curiosity is about therapists and psychiatrists.

    As I CPA, I have found the following to be true time and time again, and I believe that it applies to all professions. We think that our clients, patients, etc. know what we do and how we were trained and educated to do it, but they do not know! Over the years, I have had every type of mental health professionals as my clients, but I did not really understand and appreciate what therapists do until seven years ago when I sat with a therapist in HIS office as HIS client.

    Thank you for a good, most insightful article!


  4. Hi Robert-Good to hear from you! I see that you know whereof I speak.

  5. I am guilty of thinking others have it easier than me - but I do not think that of therapists! One really simple skill that therapists have is keeping story lines straight. You can't be like, "Wait, so was it you who was telling me about your weird cousin or was that my other client? You two look alike so I get you mixed up."

    Thanks for all of the insight on your extensive education!

    1. PJ-Thanks for the funny story---sort of a therapist's nightmare...! Indeed we do have to pay enough attention to remember who's who. Paula

  6. Ooh I'd love to know what you do during your 36 hours of continuing ed. Is there something that's hot? Does it go in trends? Can you pick whatever you like? Where do you go? Do you have to meet with a superviser? --PJ

  7. Hi PJ. Therapists are constantly plied with advertisements for continuing ed offers-it's a great money maker for those who put together a course (which has to be approved by the state licensing board). The offerings range from wonderful, high quality, inspiring seminars to online, very simple topics you test on. An exciting example, I have a pamphlet here from the New York Center for Jungian Studies that offers 2 weeks of seminars with intriguing seminar titles like The Alchemy of Individuation. One of the things that I do a lot, which is in evidence here on the blog, is attend presentations at the Herrick Psychiatric Hospital Grand Rounds. Cutting edge researchers present there-it's always interesting. I've written many posts on those.

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  9. I have a question: sometimes it feels like my therapist is just working on me DURING our sessions. There was one session in particular where she spent 15 minnutes of therapy time looking at her RA to find out if i had overpaid her (which turns out i did), and i felt that was not right because that was 15 minutes of true therapy time and i felt she should have done that business at another time. So My question is: after therpay is over, how much time is devoted to doing "homework" on the clients, thinking about them, trying to figure them out? After our session ends, she goes straight to her laptop and starts typing stuff out, i dont know if shes just catching up on emails or recapping to herself what the next course of action is. To me, i think she's flying by the seat of her pants. thanks!