What No One Tells You About Being a Therapist

A therapist’s office is intended to be a safe, warm space that allows for others to express and process patterns of thoughts, feelings, and behaviors. It’s a place where people go to feel better. As a helping professional, I have the privilege of being part of the personal development and growth of my clients. I am deeply passionate about what I do, and I’ll be the first one to admit that I still get goosebumps whenever a client experiences an “Aha” moment. That being said, the mental health profession is not one without challenges.

According to the Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), it’s estimated that about 22% of adults in the city are diagnosed with Depressive Disorder, 16% of adult Philadelphians experience frequent mental stress, and 13.8% of teens experience suicidal ideation.

To paint a clearer picture, these statistics mean that in Philadelphia 1 in 5 adults are diagnosed with depressive disorder, and 1 in 7 high school students have reported seriously considering suicide. These startling numbers are not counting the undiagnosed or unreported cases. These rates have remained consistent within recent years, with the exception of a wild increase of opioid-related deaths and ER visits for drug overdoses. With the growing severity of the opioid epidemic in the United States, an already overwhelmed system seemingly only has so much wiggle room before it breaks.

Community Behavioral Health (CBH) is a non-profit corporation contracted by the City of Philadelphia to provide mental health and substance use services to Medicaid recipients in Philadelphia County. There are about 144 Community Behavioral Health organizations in Philadelphia, and I have worked for and with many of them. Although I love the work that I do with clients, working in community agencies has created an entirely new perspective on how therapists and participants are treated among the Community Behavioral Health system….. and I think we all deserve better.

I remember learning about proper ethics and counseling techniques in my graduate program, bright eyed as I geared myself up for a future as a helper. Looking back, it seems so naive for me to have thought that it would be easy. Admittedly, I often wish I could go back to school and pay closer attention to discussions on how to avoid burnout, but sometimes it seems that in the community behavioral health field, burnout is inevitable. Although it would not have changed my choice of profession, I wish I had been more prepared for the community mental health world.

Here’s what I wish I had known:

  1. There are not enough mental health therapists in the community behavioral health system. It seems as though a major theme within the therapist community is the feeling of being overwhelmed by a bogged down system. Community Behavioral Health has an incredible amount of participants in need of mental health care and not enough wo/manpower to provide the quality of care necessary to treat severe mental health symptoms. This means that the large number of participants receiving services are divided among the limited mental health professionals that exist, meaning higher burnout rates for therapists.
  2. There is a major focus on productivity. Full time therapists are given a certain number of clinical hours that they must provide per month, typically called productivity. For example, in my organization, the month of October held 160.63 available treatment hours. I need to achieve 66% of that, meaning I needed to provide at least 106 hours of therapy to meet productivity expectations. If I don’t, I risk being written up. So when we get into the nitty-gritty of things, my work performance is not determined by the quality of therapy I provide, but by the quantity of services I provide. Where I try to validate myself, it is sometimes hard to focus on my successes with clients when I am consistently reminded of “my numbers.” It also makes it more difficult to be understanding when clients cancel, which is often framed as one less hour toward productivity.
  3. Many organizations are turning to fee-for-service. Fee-for-service is pretty self-explanatory. In fee-for-service positions, therapists only get paid for the sessions they complete. This means that if a client does not show up, the therapist will either not get paid, or will get paid a small percentage of what they would have received. Oh, and fee-for-service therapists don’t get paid for the paperwork or outreach they do…. and let me tell you, in this field there is always a lot of paperwork and outreach to do.
  4. Community behavioral health is behind. Think about all of the ethical guidelines, evidence-based practices, and sensitivity training we learned about in school. Now, try to imagine trying to implement those practices in an organization that always seems 20 years behind the present status quo. This isn’t necessarily community behavioral health’s fault. It simply takes time to roll out new methods given the amount of education and training they require.
  5. Sometimes people don’t listen. I feel like I can talk about ethical treatment and appropriate care until I’m blue in the face, and it still doesn’t feel like I am heard. I often find myself thinking of therapists as the nurses of the mental health field– we have an incredible amount of knowledge, have spent years studying the subject, and care deeply about making sure our clients are receiving proper care… and it still feels like we are spinning our wheels just to be heard and respected.

And finally, none of this would matter if we didn’t care. Professionals typically don’t join the mental health field if they don’t care about the well being of others. This makes it even more frustrating when we can see that the overall focus is not on the quality of care we provide, but instead, on the success of the business. Although I can recognize that the business aspect is important, it just does not feel right to put the needs of the business before the needs of people. Helpers feel passionately about the injustices within social systems, because we care about the outcomes of the people we work with. It can be incredibly frustrating to see the above factors as barriers to doing what we love most– helping people.

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How to Stay Motivated

My dad always says, “Find something that puts a fire in your belly.” Teenage Me would often roll my eyes, turn up the volume on my latest self-burned punk/emo mix CD and let Travis Barker’s drum beats muffle the unappreciated wise words of my father. As an adult, I can finally understand the sentiment of embracing motivation and passion while pursuing goals. I can also recognize a possibly unintentional deeper meaning here- if left without fuel, fires burn out.

Establishing a goal is the easy part. Hard work comes with actually following through with the steps required to achieve that goal. Maintaining motivation can be difficult, and I always say that building motivation is somewhat of a catch-22. The best way to increase motivation is to just do it (insert Nike symbol here). We feed motivation by reflecting on how we feel as we complete steps toward a goal. Even if the motivation begins as a small flame, we can turn it into a bonfire. Here are some tips for building and maintaining motivation while working toward goals:

  1. Remind yourself of your goals.
    • Write your goals down and display them in a place you look at often. Make sure they are specific and detailed to better organize steps necessary. Take away the “Oh, right, I forgot I wanted to do that” moment and shoot directly for goal achievement. Goals can be easily pushed to the side and forgotten about if we don’t make a point to keep them in our focus.
  2. Discover the WHY.
    • Any task has a number of good reasons behind it. Even small things can be analyzed to find something good. Consider washing dishes. We don’t complete the task for no reason- we complete the dishes in order to have a greater sense of cleanliness and organization (and it helps keep little pestering pests away, but that’s a different blog post). It’s all helpful in creating an image of the bigger picture we are striving for.
  3. Partialize your goals.
    • If we view our goals as one large chunk, it can become overwhelming and cause a person to shut down or give up. By breaking goals down into smaller pieces, we can more easily set targets and obtain a greater sense of achievement. Additionally, developing a deadline for each step can be crucial in maintaining momentum.
  4. Acknowledge your achievements.
    • Track your progress and celebrate benchmarks along the way. Congratulate yourself when you have completing a smaller chunk of the overall goal. Acknowledging progress made toward your goal can propel you forward to the next step.
  5. Be flexible.
    • I have said this so many times that I feel like it should be my new tag line, but: BE GENTLE WITH YOURSELF. If something is not working, be flexible and try it a different way. If you find yourself frustrated, stressed, or overwhelmed, be flexible enough with your deadlines that you can allow yourself a moment to step away and regroup. Achieving a goal looks differently for every person. Don’t just find a process, find YOUR process.

What helps you stay motivated?

Do You Even Gram?

Follow me on Instagram at @the.wellnesswarrior to get a little snapshot of my day-to-day life.

Here are some examples of what you’ll see:

My food experimentation

Me being active

My travels

My feelings turned into cartoons

My face

Urban exploration

My DIY projects

Positivity