Therapist bad habits

Ah, yes, I have to be fair.

Having raised the issue of the 'Last Minute Bomb', thanks to a reader who kindly *grin* directed me to an article by John Grohol over at PsychCentral - The 12 most annoying bad habits of therapists.

Only 12 you say?

Read the article for more depth but basically the list of therapeutic crimes reads as follows:

Showing up late for appointments Sometimes a delay can't be helped if an earlier scheduled client is experiencing a crisis situation. Having a buffer time between clients helps minimise that likelihood.

Eating in front of a client You really don't need to see me eating my lunch. However, I do have a drink of water to hand and I always offer clients tea/water to drink before starting.

Excessive yawning/sleeping during session zZzzzZzz. If I did this to a client, I'd expect them to be looking for a new therapist.

Inappropriate disclosure Therapist disclosure has to be kept to a minimum and used with excessive care. I could spend hours sharing my snake phobia with you and explore why I moved to a country with so many venemous snakes but shouldn't the session really be about you, not me?

Being impossible to reach by phone or email This is where I usually err but in the opposite direction. I believe it is important to be available but boundary setting is critical (and a work in progress on my part!).

Disturbed by phone/cell phone/computer Guilty on occasions. The practice where I work has no land line and I leave my mobile phone on mute for ease of use in an emergency. I don't want to wait minutes to get network (ah, Optus). I always explain this to new clients and everyone is fine with that. Occasionally, either because of my technical ignorance or the pecularities of the iPhone, the mute doesn't work. It's unfortunate and I apologise and reject the call/silence the phone.

Expressing racial/sexual/musical/lifestyle/religious preferences Ha. Might freak clients out totally if only they knew of my musical tastes! An 80s tragic (but, I hasten to add, no MC Hammer harem pants even if they are back in fashion).

Bringing your pet to therapy sessions What all six? That would be a madhouse indeed.

Hugging and physical contact Guilty in part. I have never initiated hugging but clients have hugged me. They have usually asked first and as this has typically happened at the end of therapy, I haven't minded. The most poignant time was for a client who had terminal cancer where we knew this would be our last meeting ever.

Inappropriate displays of wealth/dress I don't think I'll ever have to worry about the first. I'm way too much of a Brit for the second.

Clock watching Wonder why the clock sits directly behind you? When I'm running clients without a break inbetween, I must keep an eye on time and while I usually have a rough idea of how long the session has been running, it's helpful to check out time on occasions. This way I can keep track without explicitly diverting my attention from the client.

Excessive note-taking I used to be guilty of this when I first started out. I think that's possibly true for most therapists. Now I just note keywords to jog my memory later. Sorry, but I'm aging!

Years ago, I had a therapist who used to crack his knuckles incessantly which drove me insane. A good therapist, I managed my reaction to that. What wasn't managable was his insistence on smoking in sessson (obviously in more smoker-friendly times) and that was enough cause to change therapist for me. Those 'crimes' didn't make the list though.

So...anything else missing?

The LMB

Or the Last Minute Bomb.

Something most therapists experience from time to time, something most of us who have been through any kind of therapy have unleashed ourselves.

What is it? A Last Minute Bomb describes that situation where session time is almost out and the client suddenly raises a critical issue, something requiring far more than the last remaining five minutes of a session. What happens next really depends on the nature of the disclosure - if a risk of self-harm or potential danger to others exists, action must be taken, otherwise the issue usually has to be deferred to the next session, which may leave the client feeling a little disgruntled or that their issues are dismissed.

There's a number of reasons why the Last Minute Bomb happens as detailed in this excellent brief article by Dr. Ryan Howes about the Last Minute Bomb in therapy.

What do you think about the Last Minute Bomb? What are your experiences? Client-side, therapist-side - do you have other views of why this happens?

Asking the questions

It always surprises me that people rarely ask questions when they start therapy. I cover all the legal and administrative issues as you'd expect. I also like to get an idea of what people's expectations are. People seem comfortable with that. It's expected that I ask the questions.

Yet embarking on a therapeutic relationship is not an insignificant matter. I wouldn't allow a surgeon to operate without asking about his or her experience with my particular situation and outcomes achieved. Why should a therapist be any different? A good therapist-patient fit is essential. Therapists are not 'one size fits all' and sometimes it may be necessary to 'trial' a couple before finding one that feels right. Asking some of these questions (as appropriate) at your initial session may be all you need to gauge suitability.

What are your qualifications?

You wouldn't hire an electrician to plumb your bathroom, would you?

What professional body do you belong to?

Membership of a professional body usually requires attainment of a certain level of proficiency/ training.

How long have you been practicing?

Can demonstrate both experience and stability in the profession.

Do you have regular supervision?

Deminstrates ongoing commitment to personal development.

What kind of therapy do you practice?

Important to have some understanding of what to expect or to know if the therapist practices a modality that you personally do not feel comfortable with.

What experience do you have with my particular presentation?

What outcomes have you experienced?

You need to know you're getting someone experienced for your particular issue.

Have you ever been in therapy yourself?

It can be beneficial to know that your therapist has experienced being a patient. A good therapist will be happy to be open (to a certain degree) about personal experience in therapy.

What do you think? As a client, any questions you'd like to ask but don't? Why? As a therapist, what do you feel about these questions?

Making changes

I'd again like to highlight the site making changes from Dr. Timothy Sharp, a leading Sydney clinical psychologist. Dr. Sharp makes available free weekly tips (current available here) and you can also register to receive them by email. I enjoy the arrival of the latest tip every Monday morning and find it often helps me to start the week on a positive note. People that I've told about these tips have found also them to be quite helpful.

Dr. Sharp also has a number of help sheets covering topics including insomnia, depression, chronic pain, anxiety and more available here.

Dr. Sharp also offers online therapy, making changes being the first organisation in Australia to have done so, in addition to regular office consultations.

makingchanges, an excellent resource, be sure to check it out.

Movies as Therapy

Looking for that good reason to watch a movie?

We can all name at least one movie that has affected us in some way. One image that has stayed with me, and still evokes considerable emotion, has been the little girl in the red coat from the movie Schindler's List.

What movies have impacted on you? In what way?

Whether a movie has made us reflect on our own life situation, inspired us in some way, given us a greater understanding of others or simply made us roar with laughter, there's no doubt that movies can be a powerful influence.

Recognising such experiences, movies are increasingly being used as an adjunct to therapy.

Cinema Therapy involves the use of films to help individuals learn about themselves by examining how they respond to the different characters and situations portrayed.

Cinema therapy is claimed to be beneficial in several ways.

Ruth Rosalion, a Melbourne-based clinical psychologist, says the use of movies can be useful in building the rapport that underlies a good therapeutic relationship. "Movies establish a common ground … a platform of commonality that the therapist and the individual can work through."

Movies can also be used to facilitate discussion about areas that people might find difficult. “Because cinemagoers watch films from a third person perspective, their defences are often down and the film acts as a springboard to self-discovery,” says Barry Wooder, a UK based psychotherapist and pioneer of film therapy.

In the same way, films can often generate an emotional release that people might find impossible in real life. This may then allow further exploration of those feelings to begin in earnest.

Cinema therapists also claim that movies provide role models, giving inspiration and hope and suggest potential solutions to problems. “If you can identify with characters trapped in their circumstances, and share their disappointments as well as their unsteady steps towards liberation, you may find optimism in your own situation,” says Birgit Wolz, an American cinema therapist.

Movies can also be useful to educate others about an individual's difficult life experiences.

So what movies to watch?

Cinema therapists advocate the selection of movies with underlying themes that match the the individual's current problem or situation.

Cinematherapy.com offers some helpful guidelines and movie recommendations for choosing films.

But...

Cinema therapy may not be for everyone. Melbourne psychologist Dr Peter Cotton says that before using additional tools in therapy, which may include both movies and books (termed bibliotherapy), it is important to assess a client’s therapeutic status. "It’s about ascertaining what’s most relevant to the person you’re working with."

It's also critical to bear in mnd that not all movies feature healthy role models or realistic scenarios. This is particularly true in respect to the portrayal of mental disorders.

And a Further Precautionary Note

While using the guidelines for choosing and watching films on an individual basis can support personal growth, cinema therapists recommend that where long-standing psychological problems are in existence, the use of movies as therapy is only recommended within the context of a therapeutic relationship.

Additional Sources

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Movie Therapy: Using Movies for Mental Health