Trauma has become a huge buzzword over the past several years. In fact, I would say that trauma is having a moment.

And because trauma is having a moment, there is a glut of people out there who are chomping at the bit to tell you what the best kind of treatment for your trauma is and what you should be looking for in a trauma therapist. And this has become a prime opportunity for people to sell their own theoretical orientation or opinion on trauma therapy, not as if it's an opinion or a theoretical viewpoint, but as if it's simply a statement of fact about trauma treatment in general.

That theoretical difference being the schism between trauma therapists who believe that exposure, meaning a direct confrontation with the content of a traumatic memory, is a crucial part of trauma treatment and those who believe that it's not only not necessary, but that it is dangerous or potentially harmful.

There is a shift towards the viewpoint that exposure is harmful in the context of trauma, when in fact it can be, and very often is, a powerful and life changing intervention and the backbone of the work that many of us do in treating trauma. 

And I'm concerned that clients may be being dissuaded from accessing kinds of treatment that could make a massive positive difference in their lives. 

Today, I'm talking with Allison Aosved, a clinical psychologist who specializes in prolonged exposure therapy for PTSD and does a lot of supervision and training in that modality.

I wanted to talk with her about the importance of trauma exposure and some of the factors that may be contributing to increasing anti-exposure bias in this field.

• How the research on exposure therapy is affirming it as an effective treatment for PTSD and a range of other disorders
• How the fear of exposure therapy causing destabilization or retraumatization for clients isn’t borne out in the research
• Why the isolation of private practice can make therapists risk-averse in their treatment
• Why distress and discomfort shouldn’t be confused with danger
• How exposure helps uproot shame around traumatic experiences
• The role of informed consent in exposure therapy

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Why do we become therapists?

You wouldn’t necessarily think this is a spicy topic, but it is.

Some therapists would say that we as therapists are just people who are unusually compassionate, empathetic, and giving, even selfless or altruistic. 

I don’t agree.

I don't think we're more inherently compassionate or giving people than anybody else. Often, we're people who took on caregiver roles in our families of origin and we learned to give in order to get, and ultimately, we’re no less selfish than anyone else.

But if you say that out loud in a group of therapists, as I have, they will bristle. Unless it’s on Facebook or Twitter, and then it will be a flame war.

The first answer is obviously the more flattering version - the version that’s been run through Instagram filters. The second answer might not be as flattering, but it might be more real.

Why does it matter what we think our reasons are for becoming therapists? Why do we need to accept the less flattering portrait of ourselves?

Because whether we acknowledge it or not, it’s in the room with our clients.

• Why the grandiosity of thinking we’re more compassionate or altruistic is a problem for our work as clinicians
• How attachment to the self-belief that we are especially compassionate is connected to moral injury, burnout, and shame
• Why we have to acknowledge that making sense of people often motivates us at therapists
• ​Why it’s necessary to interrogate our relationship to power and influence in our roles as therapists

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• Episode 06: Carrying the Weight of Moral Injury with Dr. K Hixson
  
• Episode 07: The Poison and the Cure: Expanding Our Understanding of the Wounded Healer
  
• Episode 08: Why We Become Therapists with Ben Fineman and Carrie Wiita

​There are so many ways, so many careers we can choose where helping people is the central thing.

And the type of helping that we are interested in and pursue says at least as much about us, if not more, than the fact that we want to help in general.

Yet, if you ask a therapist why we decided to get into this field, the answer you're most likely to get is to help people.

But what are some of the other deeper, more complicated, maybe less flattering answers to why we became therapists? And why is it important to look at those reasons up close?

Today I’m joined by Ben Fineman and Carrie Wiita, co-hosts of the Very Bad Therapy podcast, where they not only feature client stories about negative experiences with therapy, but they also call into question a lot of the conventional wisdom about what makes therapy effective and what makes therapists skillful.

We’re discussing the reasons we become therapists, consciously and unconsciously, and how that shows up in the therapy room for us and for our clients.

Ben Fineman is the co-host of the Very Bad Therapy podcast. He works as the Clinic Director of Sentio Counseling Center and the Chief Operating Officer of Sentio University, two new nonprofit organizations which use the emerging science of Deliberate Practice to improve the quality of therapist training and education. Ben is also an Associate Marriage and Family Therapist in the state of California.
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Caroline Wiita is a marriage and family therapist trainee in Los Angeles, California. Her interests include the professional development of therapists, postmodern approaches to psychotherapy, and the finer points of cheap wine. She also runs MFT California, an online catalog of marriage and family therapy (MFT) programs in California, and offers personal coaching for anyone thinking about becoming an MFT.

• Why we need to interrogate our reasons for becoming therapists beyond altruism
  
• The cultural assumptions and scripts we interact with when we tell people we’re therapists
  
• How our self-presentation impacts our relationships with our clients and how we can use that to generate positive outcomes
  
• How our conscious and unconscious motivations for doing this work show up in the therapy room
  

• Very Bad Therapy
  
• Facebook: @VeryBadTherapy
  

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Therapists are tasked with being secret keepers.

The first layer of secrecy seems easy and simple. Maintaining client confidentiality. You can probably recite the limits of confidentiality off the top of your head, and you probably do it regularly during intake sessions.

Everything else goes in the vault. But the vault isn’t a what, it’s a who. The vault is us.
We mostly talk about confidentiality from the client’s perspective. The absolutely crucial nature of it, the ethical dilemmas that come up when we have to breach it, how the client’s understanding of confidentiality impacts the therapeutic process… All very important things.
But we rarely talk about what confidentiality means for therapists beyond a set of rules or ethical puzzles to navigate.
What does it really mean for us as therapists to be the bearers of all of this confidential information about other human beings? 
Content note: References to interpersonal traumas

• How bearing witness to the capacity for human beings to cause harm challenges our illusions and contributes to moral injury
  
• Why the disruption of our expectations of human beings as moral agents has the possibility of being generative, for ourselves and for our clients
  
• Why our institutions need to support the passage of intergenerational knowledge among therapists
  
• How therapists experience traumas intrinsic the work and as a result of the systems we work in
  

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• A Therapist Can’t Say That Ep. 6: Carrying the Weight of Moral Injury with Dr. K Hixson
  
• A Therapist Can’t Say That Ep. 4: Doing Our Own Work: Mental Health and Workplace Culture with Rebecca Ching, LMFT, PCC, Certified IFS Therapist

Moral injury.

It’s a term that often evokes images of soldiers deep in the fog of war or perhaps of a surgeon in scrubs holding their head in their hands in the hallway of a hospital emergency department. 

A therapist sitting quietly in their office or in the cubicle of a community mental health agency’s open office plan isn’t really what pops into most people’s heads when someone says the words “moral  injury.” But maybe sometimes it should be.
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As therapists, we are in daily intimate contact with the moral complexity of human beings. And we also have front row seats to the profound moral failings of the large systems that we and our clients regularly have to  navigate.

Today, I'm talking with Dr. K Hixson, a dear friend, colleague, and mentor of mine, as well as a community treasure in our therapist community here in Portland. 

Dr. Hixson and I get into some of the big factors that contribute to moral injury among therapists like individualism and the burdens of excessive responsibility that we place onto individual clinicians, and how the larger systems that we operate within prevent us from living out our own values, both as clinicians and as regular humans.
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• How the concept of burnout can turn systemic failures into individual problems
• How the shortage of therapists contributes to moral injury in the field
• Why therapy can’t be divorced from the context of politics, capitalism, climate change, etc.
• ​How the individualized medical and insurance model of care fails clinicians and patients

• Website

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• What is Moral Injury - Syracuse University Moral Injury Project

As therapists, we know about the power of silence and how much someone is saying when they aren’t saying anything at all. 
And we know how silence around something big, like a client’s suicide attempt, sends the message that this is too big or too scary to talk about.
But if we mostly all agree that therapists are responsible for doing their own self-work, it’s necessary to facilitate conversations around the decision-making that precedes a serious event or to simply check in on a clinician.
Because we know that in the aftermath of a crisis event, when a therapist says they’re fine, there’s some work to be done.
Yet there is a culture of silence from supervisors that contributes to the dysfunctional workplaces in mental health. Silence imbues the event with shame and inhibits the capacity to do self-work.
So what stops supervisors from supporting their clinicians after a crisis?
Content warning: This episode contains frank discussion of suicide.

• How supervisors fail their clinicians when they respond to crises with silence
• How silence is tied to the precarity of funding in community mental health
• Why the conflicting agendas of the multiple stakeholders in mental healthcare make clinician professional development and self-work an uphill battle
• ​Why systemic overhaul of the mental health field is necessary, and maybe inevitable

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It’s something of a cliché that being a therapist comes with the obligation to do your own work. 

And it happens to be a cliché I agree with. And if you’re listening to this podcast, I’m guessing you do too.

But what happens when the institutions and systems that train us, employ us, and regulate us act as barriers to actually doing that self-work?

Today I’m talking with psychotherapist and certified leadership coach, Rebecca Ching. In addition to therapy and coaching, Rebecca also has extensive experience with supervision, teaching, and advocacy in the mental health field and we’re going to dig into dysfunctional mental health workplace culture, how we got here, and why it’s so hard to change it.

Rebecca Ching is a psychotherapist, leadership developer, writer, speaker, and host of The Unburdened Leader podcast, where she goes deep with leaders on how the burdens they carry inspire their life’s work, how they still threaten to take them out, and how they rise from them.

Unburdened Leadership™ is the work Rebecca has honed to take leaders and entrepreneurs through so that they can have greater impact and legacy.

She is also the CEO and founder of Potentia Family Therapy, Inc. and is a Certified Daring Way™ Facilitator and Consultant and Certified Internal Family Systems Therapist and IFS Approved Supervisor.
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Rebecca also leads, Rebecca Ching Leadership Coaching and Consulting, and is where she develops leaders through coaching and workshop experiences.

• How grad school, licensure requirements, and low wages pave the way for early-career burnout 
• ​Why the professional culture of mental health needs to acknowledge the wounds that lead people into the field
• How the current educational and licensing systems create barriers to clinicians without financial privilege
• Why the emphasis on efficiency from leadership, funders, and the culture leads to therapists who can’t or won’t do self work

• RebeccaChing.com
  
• The Unburdened Leader
  
• Instagram: @rebeccachingmft
  
• Facebook: @rebeccachingmft

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The “good therapist” isn't necessarily the type of therapist you want to be.

It's not the most actualized version of you as a therapist. It's not even necessarily a particularly effective therapist.

The good therapist is about being seen as good and about being able to reassure ourselves that we are good when maybe we don't feel so sure.

Maybe we bump up against the specter of the good therapist when we have difficult clients and we genuinely feel at a loss for what to do.

Maybe it's when we have something heavy going on in our personal lives and find our minds repeatedly drifting away from a client in session and back to our own problem of the week, because a good therapist wouldn't do that.

Maybe the good therapist peeks through the office window judging us when we go against established norms, like when we use self-disclosure more than other therapists might think we should, or talk more in session than we think we're supposed to, or whatever else gives us the sense that we're stepping outside of bounds.

And the specter of the good therapist has definitely been much more activated for almost all of us during the past two years of the pandemic.

The pandemic has made the gap between who we believe we should be as therapists and who we actually are much, much harder to bridge.

• How the good therapist archetype creates dishonesty in the name of professionalism
  
• Why therapists aren’t any more equipped than most people to address collective trauma
  
• Why we need to think beyond the good therapist archetype to meet the increasing uncertainty of the future
  

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If you’re a therapist, even if you’re far from your practicum days, you can probably relate to the feeling of sitting in a session and being distracted by the thought of whether you’re living up to the standard of a good therapist.

And you’ve probably had a moment where you’re sitting with a client or group and you heard something come out of your mouth and immediately thought, “That doesn’t sound like something a good therapist would say.”

Who is this mythical good therapist? What are their qualities and where do those ideas come from? When you think about that archetypal good therapist that you compare yourself to, is that therapist a blank slate?

Does a good therapist take all the most challenging cases? Do they self-disclose? Do they diagnose and write treatment plans? Are they a quiet introvert? Do they have it all together?

Nancy Jane Smith and I are talking through some of these questions today and how uncomfortable it can be when we sense we’re going out of the “good therapist” box.
Nancy Jane Smith, MSEd., LPC is a Licensed Professional Counselor trainer, and author specializing in high-functioning anxiety. Nancy completed her postgraduate training in Gestalt Therapy at the Gestalt Institute of Central Ohio and is a Certified Daring Way™ Facilitator, based on the research of Dr. Brené Brown.

She has over 20 years of working as a counselor and coach and most recently created Self Loyalty Schoo,l an audio-based program to help quiet high-functioning anxiety.

Nancy has written 3 books with tips, lessons, and stories on reducing anxiety, most recently, The Happier Approach: Be Kind to Yourself, Feel Happier and Still Accomplish Your Goals.

​Listen to the full episode to hear:

• Why Nancy struggled to feel like a legit therapist
• How norms around self-disclosure are shifting and why Nancy is open about her own anxiety
• How different therapist subcultures influence the image of the good therapist and create new pressures
• Why Nancy regrets being too passive with early clients and why some therapists don’t talk enough
• Why the good therapist isn’t an effective therapist

​Learn more about Nancy Jane Smith:

• NancyJaneSmith.com
• The Happier Approach: Be Kind to Yourself, Feel Happier, and Still Accomplish Your Goals

Learn more about Riva Stoudt:

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I got the idea for this podcast in late 2019.

I had been in the field for several years at that point. Long enough to work through the first wave of impostor syndrome, experience my first episode of burnout, bounce back from burnout, get high on the grandiosity when I realized I really was helping people and changing their lives, go through the second wave of impostor syndrome when I realized there were some people I really WASN’T helping, and then settle somewhere relatively comfortable between confidence and humility.

When you’ve been in a field for a while, you start to get a sense of its parameters–the things you’re allowed to say, and allowed to think, the things regarded as self-evident truths that are off-limits for questioning.

And if you’re like me, after a while, you start to feel really constricted. Because outside those parameters a lot of things are happening, but aren’t being talked about, and there are unallowable ideas and perspectives that might contain pieces of the truth.

Truths that, if we confronted them, might actually make our work better.

​Listen to the full episode to hear:

• The first time I said something a therapist can’t say
• Why therapists aren’t supposed to admit that they have unmet needs–or that their clients might meet some of them
• Why breaking down clichés and archetypes of the good therapist needs more nuance than Instagram can handle
• What’s coming up on the podcast

​Learn more about Riva Stoudt:

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