A Therapist Can't Say That

Here in 2022, therapists have largely resigned ourselves to the fact that we need to do some kind of marketing. We have been dragged into the world of social media, user generated content, and the imperative of the personal brand. And the necessity of marketing ourselves comes with a lot of uncertainty, discomfort, and unease.

How do we market ethically? What does it actually mean to be authentic in our marketing? Is there any way to do this without feeling icky or like we’re selling ourselves?

And our discomfort with the idea of marketing in and of itself makes us easy marks for people selling certainty, selling relief from our anxiety about marketing, and we can end up buying into cookie cutter strategies that don’t work.

Which isn’t to say all standard marketing advice is bad–it helped me grow a thriving practice–but there is something deeper to consider about how and why therapists struggle with this process, and how we contend with it.

Which is why I’m talking to Racheal Kay Albers, Creative Director and Brand Strategist at RKA Ink. 

I wanted to talk to Rachael specifically, because she puts the experience of marketing in 2022 into a much-needed historical and sociological context that gives voice to the way marketing grinds up against our values and our senses of ourselves.

Rachael Kay Albers is a creative director and brand strategist for businesses that burn the rulebook. When she's not helping brands set fire to the box instead of thinking inside it, she writes about the intersection of branding, pop culture, tech, and identity. She also hosts the podcast, Marketing Muckraking, where she explores what brand culture is doing to us — and what to do about it. 

Listen to the full episode to hear:

• How social media skews our concept of how long marketing–or therapy–should take before we see results
• Why your brand is about how your audience perceives and remembers you, not your logo
• Why we have to go deeper than fill-in-the-blank “about me” and “who I treat” to make potential clients feel seen and safe
• Why marketing can be surprisingly emotional
• A way to think about niche that goes beyond ideal client profiles
• Why the pursuit of ethical marketing means leaving money on the table

Learn more about Rachael Kay Albers:

• RachaelKayAlbers.com 
• RKA Ink 
• Marketing Muckraking Podcast
• Instagram: @rachael.kay.albers
• YouTube: @RKAInk
• TikTok: @rachaelkayalbers
• Twitter: @rkaink
• Facebook: @rachaelkayalbers
• Connect with Rachael on LinkedIn

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Two years ago, on October 8, 2020, my teacher, David Schnarch died suddenly.

Anyone who knew Dave even for a few moments, could see that he had an arresting presence. Tall and broad-shouldered with high contrast, salt and pepper hair, strong features, and an electric gaze that, when focused on you, elicited the distinct and disarming feeling that he was looking into some dusty and hidden back corner of your soul.

I have tried and failed to pay tribute to Dave before, but in this episode, I will attempt it again through my personal recollections of his work, and how his training and methodology impacted me and my practice.

Content note: This episode contains somewhat detailed references to sexuality and mention of fertility treatment.

Listen to the full episode to hear:

• How I first encountered Dave’s work in the self-help section of a new age store
• Why I booked a flight to Germany for a training before even reading the book it would be based on
• The vulnerable, though anonymous, share that made me feel profoundly seen

Learn more about Riva Stoudt:

• Into the Woods Counseling
• About Riva
• Instagram

Resources:

• Passionate Marriage: Love, Sex, and Intimacy in Emotionally Committed Relationships, David Schnarch
• Brain Talk: How Mind Mapping Brain Science Can Change Your Life & Everyone In It, David Schnarch

In the last episode, Dr. Ofer Zur stated that he estimates at least 50% of board complaints in some way involve the subsequent therapist encouraging a client to initiate a complaint against a prior therapist.

And most of these cases do not involve egregious misconduct or predatory behavior.

Many of these cases result from misunderstandings, clients who are unreliable reporters, gray areas, differences in theoretical orientation that result in disagreement about the use of therapeutic practices, or poorly handled therapeutic ruptures of the sort that all of us have been, or will be guilty of, at some point in our careers.

So of course, I keep asking myself why.

Why is this phenomenon so common in our field? Why are therapists so frequently getting involved in the complaint process against other therapists? And what is it about our field that makes this more likely compared to other professional fields with board complaint processes?

Today, I’m digging into the contributing and converging factors that may explain just what it is about therapists that makes this phenomenon possible.

Listen to the full episode to hear:

• How the savior complex that drives many of us into this field may motivate therapists to encourage clients to initiate board complaints
• How risk management mentality and differences in theoretical orientation converge in our perceptions of harm
• How professional isolation and the uncertainty inherent in this work contribute to subsequent therapist syndrome
• Why curiosity and building real community may be the antidote to our unhealthy professional culture

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Resources:

• Episode 08: Why We Become Therapists with Ben Fineman and Carrie Wiita
• Episode 12: Subsequent Therapist Syndrome with Dr. Ofer Zur

Imagine you’re sitting in your office with a new client and the intake conversation turns to their previous therapist and they toss off a piece of information or a comment about something that their previous therapist did or said that really concerns you, maybe even alarms or disturbs you.

How would you react? What would you do?

If it occurred to you that might encourage your client to report their former therapist to the licensing board, you are far from alone.

Today, I’m talking with Dr. Ofer Zur about what he calls subsequent therapist syndrome, a surprisingly common phenomenon where a client makes a licensing board complaint against a prior therapist based on the advice or encouragement of their new therapist.

Dr. Ofer Zur is a psychologist, ethics professor, and consultant on ethical, clinical, and forensic matters in psychotherapy. He has a great deal of experience with the board complaint process and all of the reasons why therapists get embroiled in it, and the various outcomes of the process.

We’ll discuss a variety of factors that influence our perceptions of prior therapists, the interprofessional dynamics at play that make it so hard for therapists to simply say to each other, “I disagree,” and how context complicates our perceptions of ethicality.

Listen to the full episode to hear:

• Why context and relationship are vital to understanding the actions of a prior therapist
• The enormous influence of risk management on perceptions of clinical standards and minimizing harm
• How the wide spectrum of theoretical orientation makes therapists more likely to see each other as negligent or unethical
• Why it’s worth it to connect with your clients’ prior or next therapists

Learn more about Dr. Ofer Zur:

• DrZur.com

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

In episode 10, Allison Aosved and I discussed exposure therapy for trauma, and the anti-exposure bias that we are seeing in the field.

Today, I want to dig a little deeper into the context of that conversation, the factors that are contributing to anti-exposure bias, and how opinion on theoretical orientation inevitably shifts and swings over time, and how concerns about retraumatization and vicarious trauma may be impacting therapists’ ability to truly help their clients heal.

Because my concern in the context of anti-exposure bias is that many people may be missing out on some of the potential transformative impact of trauma therapy when they don't have access to exposure-based methods that do utilize the narrative, and that access to these modalities is becoming increasingly limited.

Listen to the full episode to hear:

• How differences in generational cohorts may be influencing view on exposure-based modalities
• Why our field is so prone with pendulum swings of prevailing opinion on treatment and best practices
• Why therapeutic rupture and client buy-in may be major contributing factors to adverse experiences with exposure therapy
• How anti-exposure bias increases opportunities for avoidance and therapist-client collusion
• How clients’ positive outcomes influence the impact of vicarious trauma

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Resources:

• A Therapist Can’t Say That Ep 10: Leave No Stone Unturned: The Healing Opportunity of Exposure Therapy with Allison Aosved
• Revolutionizing Trauma Treatment: Stabilization, Safety, & Nervous System Balance, Babette Rothschild

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.

Listen to the full episode to hear:

• 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

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

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.

Listen to the full episode to hear:

• 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

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Resources:

• 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.

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.

Listen to the full episode to hear:

• 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

Learn more about Very Bad Therapy:

• Very Bad Therapy
• Facebook: @VeryBadTherapy

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

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

Listen to the full episode to hear:

• 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

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Resources:

• 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.

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. 

Listen to the full episode to hear:

• 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

Learn more about Dr. K Hixson:

• Website

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Resources:

What is Moral Injury - Syracuse University Moral Injury Project