CHARACTERISTICS OF PSYCHOTHERAPISTS WHO ARE
PASSIONATELY COMMITTED TO PUBLIC MENTAL HEALTH
By
Brian Miller
A Dissertation
Submitted to Case Western Reserve University
In Partial Fulfillment of
The Requirements for the Degree of
Doctor of Philosophy
Mandel School of Applied Social Sciences
August, 2005 CASE WESTERN RESERVE UNIVERSITY
SCHOOL OF GRADUATE STUDIES
We hereby approve the dissertation of
Brian Miller
Candidate for the Ph.D. degree*.
(signed) Wally Gingerich, Ph.D. (chair of the committee)
Jerry Floersch, Ph.D.
Kathy Farkas, Ph.D.
Mary Anthony, Ph.D.
(date) May 26, 2005
*We also certify that written approval has been obtained for any proprietary material contained therein.
1 Table of Contents
Acknowledgments………………………………………………………………………… 5
Abstract……………………………………………………………………………………7
Chapter I: Introduction…………………………………………………………………….9
Chapter II: Review of the Literature………………………………………………………18
The Definition and Nature of Burnout·············································································19
Associations of Work/Environmental Characteristics and Burnout in Mental Health
Professionals··························································································································22
Associations of Personal Characteristics and Burnout in Social Service Workers/
Therapists································································································································23
Moderating Variables············································································································24
Burnout in Mental Health Workers in the Public Sector················································27
Burnout in Mental Health Therapists·················································································28
Critique of the Literature on Professional Burnout·························································30
Dlugos Study: Psychotherapists Who are Passionately Committed to their Work:
A Qualitative Study of Their Experiences·········································································32
Critique of Dlugos·················································································································33
Chapter III: Method···························································································································34
Participants·····························································································································37
Identifying the Study Group·······························································································38
Design·····································································································································39
Interview Format···················································································································39
Procedures······························································································································42
Analysis···································································································································44
2 Coding·····································································································································45
Criteria for Evaluation··········································································································47
Chapter IV: Results·····························································································································48
Demographic Description of Nominated Participants···················································49
Participants’ Response to Their Nomination as Passionately Committed
Psychotherapists····················································································································51
Participants’ Rating of Current Level of Burnout····························································52
Common Characteristics of Passionately Committed Psychotherapists:
Categories and Coding··········································································································56
General Theme 1: Balance······················································································57
Table: General Categories of Findings, Percentage of Participants
Identifying, Number of Data Points·····································································58
General Theme 2: Adaptiveness/Openness·······················································65
General Theme 3: Transcendence·······································································69
General Theme 4: Intentional Learning······························································73
General Theme 5: Personal Fit with Role···························································77
General Theme 6: Passion-Supporting Beliefs··················································94
Validation of Findings········································································································101
Chapter V: Discussion······················································································································104
Summary of Findings··········································································································105
Passionate Commitment and Burnout·············································································112
Implications of Study··········································································································114
Strengths of Study···············································································································117
Limitations of Study············································································································120
3 Recommendations for Further Study···············································································122
References··········································································································································125
Appendix A: Interview Protocol····································································································133
Appendix B: Nomination Form·····································································································135
Appendix C: Letter of Invitation····································································································136
Appendix D: Informed Consent Document················································································137
Appendix E: Codebook···················································································································140
4 Acknowledgments
Five years ago, I imagined writing these acknowledgments as the crowning moment
of the Ph.D. process, and I looked forward to it. Now, I find that words fail.
Thank you, Mark Singer, for envisioning the Mandel Leadership Fellow program.
Through this fellowship, I was tapped on the shoulder in the middle of my career and
awakened. I wouldn’t have even started without you.
My dissertation committee has failed in the reputation of such committees—they
never made me jump through hoops, or added unnecessary difficulty into the process-- They
have maintained the highest level of academic integrity while truly serving as consultants and partners. Jerry Floersch has taught me volumes about qualitative research—I hope this isn’t the end of our professional partnership. Wally Gingerich is the chair that everyone aspires to: Endlessly supportive, academically wise, and—that rarest of qualities-- always timely with
his reviews of my chapters.
My eight year old and twelve year old sons were, respectively, three and seven when I
started this. Dad is home now, and I’m going to make up for every lost minute. Lori:
Doctoral students typically tell their partners that it is they who have earned the Ph.D., and I
know you understand this in a special way. It is you to whom I am passionately committed.
Dad: You were supposed to be here for this. My sun has shifted, but I walk in your light.
Thank you to the mental health managers who partnered with me to gather the
nominations. You joined me unhesitatingly without anything to gain personally, and made
the whole thing possible. On more than one occasion, you went so far as to seek me
out to return any unused stamps on the nomination envelopes. Thanks for rooting for me.
5 Finally, my deepest thanks and personal respect go to the passionately committed psychotherapists who allowed me to interview them, and who gave generously of their time and ideas. My own faith in psychotherapy is renewed—not only by what you told me-- but even more, by the fact that people like you are out there. What my analysis can never really convey is your abundant goodness. I am certain that people are made well by your ministrations.
6 Abstract
Many psychotherapists believe that the demands of managed care, performance
pressures of hiring organizations, and an increasingly complex clientele have made the
practice of psychotherapy difficult and unrewarding. Yet in this same environment, some
psychotherapists flourish and remain enthusiastic about their work. The purpose of this
study is to learn what distinctive attributes are shared by these individuals who are
“passionately committed” to the practice of psychotherapy.
Modifying the definition of Dlugos (1999), passionately committed psychotherapists
are defined as those who maintain an enthusiasm for their work regardless of time in the job,
and for whom work produces more energy than it demands. Understanding the salient
characteristics of these extraordinary individuals may have implications to practicing
psychotherapists, graduate training programs, and organizations that hire psychotherapists.
Fifteen psychotherapists practicing in the public mental health system in Utah were
nominated by two or more of their peers as passionately committed psychotherapists. These individuals were interviewed using a semi-structured interview protocol. The data from
these interviews were analyzed, compared, and contrasted in a manner consistent with
grounded theory research. Based on this analysis, common characteristics were identified
that may distinguish “passionately committed psychotherapists” from practitioners who become disillusioned or burned out in their work.
The results supported the four categories identified in Dlugos’ seminal work, as
dense data supported the general themes that he identified: 1) Balance, 2) Adaptiveness/
Openness, 3) Transcendence, and 4) Intentional Learning. Additionally, strong themes
7 within the data led to the development of two further categories: 5) Personal Fit with Role, and 6) Passion-Supporting Beliefs.
Examples of the sub-themes within these general categories are: Having passions about at least one non-work activity, hunger for feedback from supervision, locating the significance of psychotherapy within communal/social responsibility, continual fascination with human development and change, will to intimacy, and equality in relationship with clients.
Support for the findings comes in the form of concurrence with the Dlugos data, support from a consensual external rater activity, and most importantly, in the robustness of the data.
The strengths and limitations of the study, considerations for further research, and implications to practitioners, researchers, graduate programs, and hiring organizations are discussed.
8 Chapter 1: Introduction to the Study
Irvin Yalom, in The Gift of Therapy (2002), his book of reflections on his more than
forty years of practice as a psychotherapist, writes about the importance of cherishing the
occupational privilege of performing psychotherapy:
"…it has always struck me as an extraordinary privilege to belong to the venerable and honorable guild of healers. We therapists are part of tradition reaching back not only to our immediate psychotherapy ancestors, beginning with Freud and Jung and all their ancestors-- Nietzche, Schopenhauer, Kierkegaard-- but also to Jesus, the Buddha, Plato, Socrates, Galen, Hippocrates, and all the other great religious leaders, philosophers, and physicians who have, since the beginning of time, ministered to human despair. "
"Passionate commitment" to the profession of psychotherapy is exemplified by such a psychotherapist: One who has labored in the occupation for many years--and in full awareness of the perils and challenges of this occupation-- and yet continues to feel honored to be allowed to do this work. What are the personal characteristics of such a person, and what qualities distinguish him or her from those psychotherapists who become disaffected and either change professions or continue on in a career of "quiet desperation"? These are the questions of interest to this study.
It is the extraordinary psychotherapist who would fit this description of "passionate
commitment" to their chosen profession. The fact that professional burnout in the social services has held the interest of researchers and practitioners for nearly thirty years is testament to the fact that there are intense hazards associated with this type of work. These hazards may be unique to occupations that involve intense interpersonal interactions and a continual focus upon trauma, crisis, and personal problems. Many practitioners do not thrive in such work environments.
9 Evidence for this widespread failure to thrive amongst psychotherapists is provided
by Berger, (1995) who cited findings that psychotherapists report that there is broad
dissatisfaction with their work, and unusually high levels of feelings of depletion and
isolation (Kelly, Goldberg, Fiske, & Kilkowski, 1978; Norcross & Proschaska, 1982;
Deutsch, 1984; Hellman, Morrison, & Abromowitz, 1986). Ackerly et al. (1988) found that
nearly 40% of licensed psychologists were in the high burnout range as measured by the
Maslach Burnout Inventory.
The concept of "passionately committed psychotherapists" first appears in the
literature in Raymond Dlugos' (1999) dissertation and later journal article (Dlugos and
Friedlander, 2001.) Because the use of the term passionate commitment was unique to
Dlugos, the relationship of this constellation of characteristics to burnout, hardiness, emotional intelligence, or other established concepts is not known.
Certainly, as Dlugos intends the concept, passionate commitment is more than a
mere absence of burnout. Rather, this concept is directed towards those who have found a
true "vocation" in psychotherapy to which they feel called-- not just that they aren't suffering
from burnout, but that they believe that they are in the occupation that fits their personality better than would any other.
In the Dlugos study, a passionately committed psychotherapist is defined as one who:
• Is energized and invigorated by his or her work rather than drained and
exhausted by it;
• Clearly enjoys and finds significant meaning in his or her work;
• Continues to love his or her work in spite of personal and environmental
demands that are imposed on all psychotherapists;
10 • Demonstrates a harmony and balance among the various aspects of life; and
• Energizes and invigorates those with whom he or she works.
There is potentially great significance to understanding the characteristics of
someone who possesses such qualities. Agencies who hire psychotherapists clearly would
like to select those who, even after ten years of practice, continue to possess such energy and
love of their work.
Graduate level training programs would greatly benefit from understanding the
characteristics of those who will thrive in the occupation of psychotherapy. Understanding the characteristics of those who flourish as psychotherapists may have implications to the screening and admission practices of those programs. If it can be demonstrated that passionately committed psychotherapists engage in certain self-maintaining strategies, those strategies can be incorporated into the training curricula of mental health and counseling programs.
Likewise, knowing what strategies may help preserve the energy and commitment of
psychotherapists would be of immense interest to those who are currently practicing in the field. Knowing the personal characteristics profile of those who are the most satisfied in the practice of psychotherapy would be of assistance to those who are contemplating choosing psychotherapy as an occupation.
By almost anyone's reckoning, the current time is a difficult one in which to be a
psychotherapist. Managed healthcare has placed financial pressures upon psychotherapists, limiting the number of sessions that are authorized for payment, and increasing the paperwork demands in order to justify payment. Because most psychotherapy is paid for by third parties, there has been a narrowing of focus in psychotherapy to short-term, symptom- targeting approaches that depend less upon establishing long-term relationships.
11 Current pressures resulting from managed care only exacerbate the difficulties
inherent in the practice of psychotherapy-- practitioners labor in relative isolation, attending
to the often-intense problems of their clients. Adding to this isolation is the fact that
psychotherapists cannot ever relax into the relationship with their clients, as they must
remain always vigilant to the transferences and dynamics of the therapeutic transaction.
Many psychotherapists work with clients who are contending with profound trauma, are
chronically suicidal, or who may be angry, uncooperative, and likely to blame the therapist
for their unsatisfactory lives.
The pressures of the work in the human services, and specifically in psychotherapy,
have been long recognized. For nearly thirty years, the emphasis of study has been in the
form of understanding the conditions that correlate with "burnout". Perhaps in keeping
with the traditional mental health focus upon pathology, this research has focused on
negative styles of work adjustment. Very little attention has been given to the study of
career-sustaining behaviors, or factors that correlate with high job satisfaction.
As will be demonstrated in the literature review in Chapter 2, the burnout literature
demonstrates conclusively that burnout may have a great deal to do with the personal factors
of the therapist, and the degree of compatibility between the therapist and the job.
The popular wisdom about burnout is that it is a downward course in which highly
energized psychotherapists are worn down by the pressures of the job until they reach total
depletion. As will be demonstrated, the reality of burnout is that it tends to remain stable over the course of the career and, surprisingly, is often highest in the early stages of one's career.
There are well-established correlations between burnout and psychotherapists' reports of certain stress-producing job conditions. There is, however, no clear evidence that
12 clarifies the direction of causality between stressful job conditions and burnout. Job
dissatisfaction that originates as a poor fit between the personality characteristics of the worker and the job may lead to high burnout scores. In most correlational studies relating job stressors to burnout scores, it is impossible to discriminate that the burnout scores are
high in a given worker because of the self-reported stressful job conditions, or if
dissatisfaction with the job results in him or her experiencing more stress. Surely,
dissatisfied workers will interpret job conditions more negatively. And regardless of the
direction of this relationship, it is clear that even when work conditions are less than optimal, some psychotherapists seem to flourish--and it is these individuals whom this study focuses upon.
Understanding burnout in light of the evidence, as will be reported in chapter two,
suggests that much of what is commonly referred to as burnout could be attributable to a
"poorness-of-fit" between the psychotherapist and the job. And if this is true, it becomes
important that those in the field (or contemplating entering the field) understand what
comprises "goodness-of-fit" between psychotherapist and the vocation of psychotherapy.
Perhaps psychotherapy is a profession that is especially likely to be attractive to
prospective workers in concept, but also likely to disappoint in the reality of practice. Some
may be attracted to the practice of psychotherapy in an effort, conscious or unconscious, to
find healing for their own distress or neurosis. Some may choose this career in the belief
that the constant, intense personal interaction with clients will stave off loneliness or
boredom. Some may have a preconception that their clients will be warmly grateful for their
ministrations, and will grow steadily better under their psychotherapeutic care. Some may
believe that psychotherapy offers a career of independence and work freedom.
13 Careers chosen based on such prejudgments are likely to lead to disappointment.
There is no credible evidence that practicing as a psychotherapist can alleviate the personal
problems of the therapist. Many believe that, in fact, practicing psychotherapy is hazardous to the well being of the practitioner.
Because the nature of psychotherapy requires the therapist to constantly hold his or
her self out of the relationship in order to retain a "third eye" on the dynamics of the
transactions, the therapist's desire for relationship cannot be appropriately fulfilled during
treatment.
While it is certainly true that some clients respond to the psychotherapist with
gratitude and work diligently towards change, by no means does this describe all clients.
Real therapeutic change requires that the client face long-standing behavioral patterns, deal with grief or other painful emotions, and adopt unfamiliar ways of being and thinking. The magnitude of such change may lead many to discontinue therapy, or even blame the psychotherapist for not giving them an easier way out of their life difficulties.
Many psychotherapy clients seek help for problems resulting from interpersonal conflict that may result significantly from the client's ineffective way of relating to others.
They may, accordingly, relate to their psychotherapist in dishonest, ineffective, or even hostile ways. They may project issues of abuse, abandonment, or distrust onto the therapist.
The psychotherapist is charged with maintaining a stance of unconditional positive regard even in the face of such challenges.
Psychotherapists who practice in the public sector are often confronted with
institutional challenges to their independence as practitioners. The public sector employer is
likely to require certain productivity minimums, which may exceed the caseload that the
practitioner would independently choose. Specific practice patterns, such as brief symptom-
14 focused treatment, may be required by the institutional demands of the employing agency.
Organizational decisions may be made without the involvement or consent of the practitioner. Even psychotherapists in private practice are likely to report that the demands of third-party payers limit how they practice, and that they require an odious amount of documentation and non-client activities.
In brief, many of the notions about psychotherapy that would attract a potential trainee to the field are not founded in the reality of practice. And it is extremely likely that the disjuncture between these preconceptions and the reality of actual practice will be realized only after the completion of many years of training, and considerable investment of time and money. The "sunk costs" may be so high at this point that few are willing to reconsider the career choice that they have made.
When Berger (1995) faced disillusionment as a psychotherapist during the middle of
his career, he interviewed ten senior psychotherapists to determine what wisdom they had to
offer. The psychotherapists he interviewed had practiced an average of almost 30 years.
Among the observations that impressed this author was the fact that every one of the
therapists emphasized how much they got from the work, not how much they were giving to
the work. Passionately committed psychotherapists derive as much or more energy from the
work as they lose to the work. Of interest to this study is why they appear to get the rewards
that they expected from the practice of psychotherapy when other therapists become
disappointed, disillusioned, or burned out.
What, exactly, makes a psychotherapist passionately committed? How much of
passionate commitment to the practice of psychotherapy is attributable to the fact that the
personality of the psychotherapist is a naturally good fit for that job? Do passionately
committed psychotherapists have particular ways of thinking about psychotherapy that
15 contributes to their passion about it? Do these extraordinary individuals have to work hard to maintain their passion, or does psychotherapy naturally provide stimulation and energy?
Is passionate commitment a stable trait, or have these individuals weathered periods of disillusionment? The present study seeks to address these questions.
Because the concept of passionately committed psychotherapists is new, and has to date only been investigated by Dlugos, this exploratory study casts a "broad net" to see if the characteristics that emerge have to do with lifestyle, personality traits, cognitive styles, or the beliefs of the practitioner. By design, no a priori assumptions will be made regarding which category of factors will be emphasized by the passionately committed psychotherapists.
Because this study will identify the traits of the passionately committed psychotherapists that include internal processes, narrative data will be the focus of analysis.
This focus indicates the use of qualitative research methods. This study will employ the analysis of data derived from semi-structured interviews of passionately committed psychotherapists. These interviews will be flexible enough to allow these individuals to tell their own stories according to how they have experienced them.
Because this is a relatively new area of research, the present study is defined as an exploratory, grounded theory study. This definition indicates that rather that rather than defining a theoretical orientation prior to the study, theory will emerge from the data as it is analyzed. In this kind of research, theory is the product of the study rather than the basis of the investigation.
The nature of psychotherapy is to attend to the human condition. Doing so may accurately be described as both an extraordinary privilege and hazard. Passionately committed psychotherapists feel honored to be allowed to contribute to this demanding but important endeavor. Understanding the ways in which they have learned to honor the
16 privilege while attending to their own well being-- emerging enriched rather than depleted may provide assistance to others who have made the decision to attempt this venerable occupation.
17 Chapter II: Review of the Literature
What factors improve the likelihood that a mental health worker will become, and will remain, energetically committed to his/her chosen profession? The social work and mental health literature is virtually silent on the question. By contrast, there is a sizable body
of research related to the job factors that correlate with low energy, low job satisfaction, and mental morbidity in mental health workers. Thus, the body of literature most germane to this study is the research pertaining to professional burnout in human service workers and especially, mental health workers. This professional burnout literature represents a pathology-focused approach to the converse question, studying the factors that diminish energy, health, and job satisfaction.
This emphasis on the pathological intrinsically presupposes that high energy and
career commitment is the natural course of a career. When such is found to be absent, some
pathological condition is assumed to exist in the job environment, in the personality, support
system, or the coping strategies of the worker.
Because passionate commitment is a state of high energy and engagement in one's
vocation, there is much to be learned from the literature about professional burnout, which
is characterized by a state of lowered energy and disengagement from one's work. Although
passionate commitment is more than merely an absence of burnout, this literature provides
the evidence base that is the most relevant, at least in the negative sense, to the proposed
study.
18 The Professional Burnout Literature: What is Known About Factors Diminishing Job
Satisfaction
Herbert Freudenberger (1974, 1975) is given credit for coining the term "burnout" and identifying the physical and behavioral manifestations of the phenomenon.
Freudenberger compared "burn-out" to the same process that drug-users experience over a career of drug use. He identified a certain personality type that is prone to burnout: those who were dedicated to the job, but who were also torn between their own needs and those of their clients and organization; those who were over-committed; who were authoritarian; who were overworked, and who lend their services to alternative institutions.
Christina Maslach (1981, 1982, 1987) has contributed a significant amount of research in the area of professional burnout in the social services. She developed the standardized burnout instrument, The Maslach Burnout Inventory (MBI), which now substantially defines burnout in the published literature. Maslach takes an approach that contrasts with Freudenberger's in her emphasis upon the relationship between job conditions and the personal factors that produce burnout, rather than solely upon the personality factors of the workers.
Sowers-Hoag & Thyer (1987) quote Maslach, "We have reached the point at which the number of rotten apples in the barrel warrants examination of the barrel itself." Thus
Maslach, who possesses emeritus status among burnout researchers, clearly suggests that: 1) burnout is ubiquitous among social service workers, and 2) because of the ubiquity of burnout, the source is not in the worker, but in the workplace. In the whole of her work, however, there is considerable reference to the personality factors that predispose a professional helper to burnout, and not an exclusive emphasis upon work conditions.
19 Literature on the definition and nature of burnout
Many authors and researchers have defined "burnout" variously and imprecisely.
According to Maslach (1982) there are at least 30 different definitions and descriptions of
the concept. Soderfeldt and Soderfeldt (1995) give examples of definitions ranging from
Freudenberger's original definition of burnout as "a state of fatigue or frustration brought
about by devotion to a cause…" to Ernest Johnson's (1988) definition of burnout as "a
socially accepted word for fatigue, laziness, or change of heart."
Because of the near-universality of use of the Maslach Burnout Inventory or MBI
(1981) as the measure in empirical studies, these arguments about definitions are virtually
moot. In most burnout research, burnout is operationally defined according to the derived
scores of the MBI. There are three subscales on the MBI: Emotional exhaustion,
depersonalization, and reduced personal accomplishment. As the preponderance of
empirical research on burnout employs one or more of these measures as the indicator of
the presence of burnout, these characteristics have become the de facto definition of burnout.
The problem created by the lack of a validated definition of burnout will be commented
upon later.
Emotional exhaustion is characterized by a feeling of emotional depletion with no
source of replenishment. Depersonalization refers to the development of a callous, detached
and even dehumanized response to others. Reduced personal accomplishment refers to the belief
on the part of the provider that he/she is inadequate to relate to and help his/her clients
(Maslach, 1982). Important to a critical understanding of the burnout literature is that, in most published studies, the subjects' self-report score of these characteristics on the MBI defines the aspect of burnout under study. Thus, burnout has come to be largely defined by subjects' self-reports on the three measures of the MBI.
20 Early conceptualizations such as those of Freudenberger and Maslach describe a developmental phenomenon in which highly committed providers become increasingly depleted and demoralized. Such a framework suggests burnout as an unstable phenomenon that increases over time as the stressors accumulate and the resiliency of the practitioner degrades. Maslach (1982) uses several metaphors for this in her popular book, describing the burnout process variously as a once boiling teapot that had now boiled its water away but remains on the hot stove; a battery that is worn down and depleted of energy; and an electrical circuit that has become overloaded.
Contrariwise, the body of empirical research since early formulations of burnout is
clearly describing a phenomenon that is stable over time, in which years of experience is
either unrelated to the development of burnout, or is negatively correlated (Sullivan
&Nashman, 1999, Fagin et al., 1996, Soderfeldt & Soderfeldt, 1995). Maslach herself has
since described the chronic and stable course of burnout (Maslach & Schaufeli, 1993). Leiter
& Harvie (1996) and Soderfeldt & Soderfeldt (1995) have conducted literature reviews and
conclude that there is no positive association between years of experience and the presence
of burnout.
In fact, there is an established negative correlation between years of experience and the presence of burnout-- at least as measured by the subscales of the MBI. As cited in Lieter and Harvie (1996), Ross et al. (1989) demonstrated that experience had a negative correlation
with the emotional exhaustion subscale. They also cite evidence that years of experience has
a negative correlation with emotional exhaustion and depersonalization, and a positive
association with personal accomplishment (Carney et al., 1993, Van der Ploeg et al. 1990,
Ackerly et al., 1993, and Tamura et al., 1994.) Furthermore, Farber (1985) reports that this effect holds even if age is partialled out. As Pottage & Huxley cite, it is the training period
21 for social workers that is the most stressful part of the provider's career (Tobin & Carson,
1994, Kramer, 1987).
In the twenty-nine years since Freudenberger published the concept of burnout in
social service professionals, there are surprising gaps in the knowledge base about the
phenomenon. As identified in Soderfeldt and Soderfeldt's (1995) review of the burnout
literature, there are weak indications (and little replication) of any patterns of association
between specific components of the job or the worker and burnout. They cite Maslach's
criticism in 1987 that the empirical studies are "fishing expeditions" in which the researcher
throws out a questionnaire to see what associations they can find.
Certainly, after nearly 30 years and hundreds of published research articles, some
associations have been found-- but the direction of the relationships between job factors,
environmental factors, and personal factors is not at all clear. Thus, there is no articulated
understanding of what personality or job factors would predict a career trajectory of
continuing "passionate commitment".
Although little is known about the patterns of relationships between factors, this is
not to diminish the fact that much is known about job, personal, and environmental
conditions that correlate with burnout.
Associations of work/environmental characteristics and burnout in mental health
professionals
There is a sizable literature that establishes that there are characteristics in the work
environment of mental health workers that correlate with elevated burnout scores on one or more of the subscales of the MBI. Pines and Malasch (1978) found that the more schizophrenics that were on the caseload of the mental health worker, the lower their job
satisfaction. This finding may have particular relevance to the present study, as public
22 mental health workers are especially likely to be working with a number of clients with
diagnoses of schizophrenia.
Tennant (2001) cites the large Whitehall II study (Stansfeldt et al. 1997) in evidence that psychological morbidity, as measured by the General Health Questionnaire, was predicted both by poor working social supports, and by high job demands. Prosser et al.
(1997) employed the MBI to assess level of burnout in a group of mental health workers, and then conducted a principal components analysis to identify the greatest sources of stress and burnout. The results were that home stressors were not a significant source of stress, but work factors such as "role", "poor support" "clients" and "overload" were perceived as major causes of stress and subsequent elevation on the MBI. In this study, the authors also identified the sources of job satisfaction, such as "working at a famous hospital," "training opportunities," and "career prospects." These sources of career satisfaction exhibited a
negative correlation with burnout scores on the MBI. Prosser also refers to a national survey
of community mental health teams in the UK, (Onyett, Pillenger, & Muijen, 1995) which
found that the chief sources of stress identified by workers are "lack of resources…followed
by work overload, bureaucracy and management."
Soderfeldt and Soderfeldt (1995), in their review of studies on burnout in social
workers, reported that in two of three reviewed articles, burnout was found to correlate with
caseloads. In the third, no correlation was found to exist between number of clients and
level of burnout.
Associations of personal characteristics and burnout in social service
workers/therapists
Since Freudenberger's initial conceptualization of the over-involved helper who is
susceptible to burnout, there is considerable research and literature supporting the view that
23 the personal characteristics of helpers correlate with an increased risk of burnout. As the
present study focuses on the personal characteristics of those who remain passionately
committed to psychotherapy over the course of a career, this literature is especially pertinent.
Tennant (2001) cites several studies (Mills & Huebner, 1998, Wade et al., 1986,
Cherry, 1978) that show the independent effect that personality has upon psychological
morbidity and burnout. These studies show that personality factors such as neuroticism or a
"nervous strain variable" are significant predictors of burnout, accounting for as much as
18% of the variance (Mills & Hueber, 1998).
Dreary, Agius, and Sadler (1996) identified an even stronger association between personality and burnout, finding in their sample of consult psychiatrists that 48% of the total variance was attributable to trait anxiety. They cite Naisberg-Fennig (1991) who found that psychiatrists who are troubled by conflict and who do not use repression, and who have not learned to be resourceful, were more likely to report high burnout scores. Others have found associations between neuroticism and job pressure (Kirkcaldy et al. 1989), Type A behavior pattern and burnout (Rees &Cooper, 1992, Johnson & Stone, 1987), Stress resistance and "hardiness" personality characteristics (Kobasa, 1979), pessimism about effects of work and detachment (Pines and Maslach, 1978), psychological morbidity and workplace fatigue (Hardy et al., 1997), and passive coping styles and distress (Cushway and
Tyler, 1996, Norcross & Prochaska, 1986).
In the Leiter and Harvie (1996) review of burnout and mental health workers, they
identify multiple research projects that identified personality or individual correlates of
burnout: Satisfaction with leisure activity--negative correlation (Hoeksma, et al. 1993), a
sense of purpose in life--negative correlation (Yiu-Kwee & Tang, 1995), perspective taking,
24 empathic concern, and personal distress--positive correlation (Day & Chambers, 1991),
outward directing of anger--positive correlation (Firth et al. 1987), use of talking to a friend
as an active coping strategy--negative correlation-- use of alcohol as a passive strategy coping
strategy--positive correlation (Kandolin, 1993), and use of escape-avoidance strategies--
positive correlation (Thornton, 1992).
Research on moderating variables
Relative to the abundance of literature on the factors that correlate with stress and burnout in the mental health workplace, there is little published research relating to the
conditions that moderate the stress effect. Duquette et al. (1994) concluded in their review
of the literature on nursing burnout that there are three moderators of burnout: social
support, hardiness, and coping skills.
Cushway and Tyler (1996) synthesized burnout research into a model of factors that
mediate distress in psychologists in mental health practice. These authors suggest that the
evidence reveals seven mediating variables: 1) high job satisfaction, 2) wide range of active
coping strategies, 3) ability to externalize and objectify stressors, 4) job stressors that do not
threaten other roles/relationships, 5) high experience in job, 6) quality relationship with
partner, and 7) male gender.
Research in the relatively new area of "emotional intelligence" may also provide
understanding of the personal characteristics that enhance job satisfaction (which, as shown
above, correlates with reduced burnout scores). Some evidence exists that emotional intelligence may increase career commitment. Emotional intelligence has been shown to moderate employee's emotional reactions to job insecurity and their ability to cope with associated stress (Jordon, Ashkanasy, and Hartel, 2002.) Emotional intelligence, as defined by empathy, utilization of feelings, and self-control (Brown, George-Curran, & Smith, 2003)
25 and emotional resilence, optimism, and work drive (Lounsbury, Loveland, Sundstrom et. al,
2003) correlate with career decision-making self-efficacy and career satisfaction. Carson and
Carson (2002) found that emotional intelligence correlated with career commitment, but that it did not correlate with organizational commitment.
These studies appear to produce different results about the relationship between job commitment and emotional intelligence for different careers. Hendee (2002) found no correlation between emotional intelligence and job satisfaction among practicing chefs and culinary educators. Certified chefs had higher job satisfaction and lower emotional intelligence compared to other sub groups. The variability of the link between emotional intelligence and career commitment was also demonstrated by Bar-On (1997), who found that there was a very modest relationship between these variables, but that the relationship varied from occupation to occupation (cited in Mattews, Zeidner, and Roberts, 2002).
The concept of emotional intelligence is multifaceted, and the research literature related to this trait often uses varying aspects of the attribute as measures in the studies.
Representative are the studies just cited above, one of which employs "empathy, utilization of feelings and self control" as proxies for emotional intelligence. The other cited study uses
"resilience, optimism, and work drive" as the measures of emotional intelligence. In the research used to support the relationship of emotional intelligence to occupational success, there are scores of different attributes used as variables, some of which are trait variables and some of which are state variables. This makes the relationship between emotional intelligence and the concept of passionate commitment difficult to determine.
Matthews, Zeidner, and Roberts (2002), in their exhaustive review of the emotional intelligence literature, also discuss the inconsistency in the EI research definitions of the concept. These researchers argue that prior to any widespread use of EI for occupational
26 assessment, the concept of emotional intelligence needs to be systematically constructed and standardized, and validated for specific occupations. Up to this point in time, they advocate,
"we do not believe that this has been achieved by anyone espousing the utility of measuring, training, or otherwise modifying EI in occupational settings."
The research on the relationship between emotional intelligence and career commitment is scant. Most of the research in this area focuses upon the characteristics of workers who are deemed to be exceptionally successful and the characteristics of managers who lead successful groups or organizations. Although "passionately committed employees" and "highly successful employees" may be related concepts, they are also different concepts.
Future research may focus upon the question of whether or not psychotherapists who are passionately committed are also exceptionally successful, or "emotionally intelligent", but in this exploratory study this relationship is not known.
Burnout in mental health workers in the public sector
Because the present study focuses upon passionately committed psychotherapists in the public sector, a key question is whether burnout is more likely for those practicing in a public setting as compared to those in private practice. There is evidence that such is the case.
As early as 1978, Pines and Maslach found that the higher the number of schizophrenics that a therapist has on their caseload, the higher the rate of burnout. These authors express that the less seriously ill the clientele is, the more likely the worker is to express positive attitudes about their work. Prosser et al. (1997) also established that client variables had a significant effect upon the burnout of the worker.
To the extent that the clients in public settings exhibit a more complex treatment profile, the workers will be expected to be at greater risk of burnout. There is further
27 evidence of this when the worker expressed dissatisfaction with the clients (Poulin & Walter,
1993). This finding is also replicated in the education field, as lower job satisfaction is experienced by teachers who have a higher number of disruptive students (Burke et al.1995).
Beck (1987) also reports that workers experience more burnout when they have more uncooperative clients, a greater incidence of clients with chemical abuse, depression or other mental illnesses, and when they must contend with greater administrative constraints.
Negative client behavior has positive associations with burnout (Ackerly et al., 1988), as does client aggressive behavior (Kandolin, 1993), and the number of clients on a caseload exhibiting stressful behaviors (Skorupa & Agresti, 1993).
As reported in Leiter et al. (1996), Farber (1985) directly studied the question of the relative burnout susceptibility of public versus private mental health workers. As assessed by the emotional exhaustion and personal accomplishment subscales of the MBI, those in private practice experienced significantly less burnout. Van der Ploeg et al. (1990) reported similar findings when they compared Dutch psychotherapists who were employed by regional mental health centers compared to those who practiced privately. Hoeksma et al.
(1993) identified that the only work activities significantly related to burnout in private practitioners were psychological testing and report writing. Research reported by Ackerly et al. (1988) is notable for its finding that public versus private work did not make a significant contribution to the reported MBI measures of burnout in psychologists.
Burnout in Mental Health Therapists
Burnout, as originally described by Freudenberger, was conceived as a phenomenon induced by intensive work in the human services. Indeed, as described by most researchers, burnout is an occupational hazard specific to the human services. Accordingly, psychotherapists would appear to be at substantial risk of burnout. A question of the
28 research literature is whether it is true that psychotherapists are more inclined to burnout
than are other professionals. Similarly, it is relevant to this study whether or not
psychotherapists more likely to be dissatisfied, e.g., not passionately committed to their
careers, than are other professionals.
Although no research was identified that compared the job satisfaction rates of
psychotherapists to other professionals, there is evidence that there are a high number of
psychotherapists who report dissatisfaction with their career choice (Kelly et al., 1978,
Norcross and Prochaska, 1982). Similarly, several surveys have revealed high levels of
reported emotional depletion and isolation in psychotherapists (Deutsch, 1984, Hellman,
Morrison, & Abramowitz, 1986). Leiter (1996) concludes that after review of a decade of
evidence, that burnout in mental health workers "is consistent with the state in teachers, health care workers, and social service workers". Ackerly et al. (1988) found that nearly 40%
of licensed psychologists were in the high burnout range as measure by the MBI.
Certainly, there is face validity to the assumption that psychotherapists deal with
unique stressors. From Freudenberger's (1974) original coining of the term, burnout has been viewed as a phenomenon especially likely to be produced in the context of intense interpersonal interaction. Dealing with client's often-intense problems in the isolation of one's professional office poses singular challenges in maintaining energy and optimism.
One of the most intense stressors to psychotherapists is dealing with the threat, and
occasional reality, of client suicide. Survey data suggests that one in five psychologists and one of two psychiatrists will lose at least one patient to suicide over the course of their
careers (Chemtob et al. 1988). As cited earlier, dealing with clients who manifest difficult
behaviors such as aggressive and suicidal impulses is one established correlate of burnout.
29 Although the relationship between personal distress and job stress is far from clear,
Cushway and Tyler (1996) cite evidence that there is a relatively high incidence of mental
illness, drug and alcohol abuse, sexual acting out, and suicide among psychotherapists in the
USA (Guy, 1987; Kilburg et al., 1986; Sussman, 1995).
Critique of the Literature on Professional Burnout
In surveying the literature on burnout in mental health workers, it is notable that the
overwhelming preponderance of that research uses similar methodology. The typical study
is one in which: Cross-sectional sampling of some subgroup of mental health professionals
is used, the providers are surveyed as to various work conditions or other factors, and are
then are scored on one or more of the subscales of the MBI. Correlational techniques are
then applied with the work/environmental conditions as the independent variables, and MBI
scores as the dependent variables. Thus are correlations discovered between certain factors,
e.g., caseloads, and burnout scores on the MBI.
As previously quoted, Maslach has described such studies as "fishing expeditions".
Although some of the studies reviewed have an impressive number of subjects and sound
sampling methods, it is difficult to know what to make of the obtained results. Because of the dominant reliance upon self-report of job conditions, there is a likely contamination of
the reports of job conditions by the perceptual state of the subject. Subjective reports of job
factors will be influenced heavily by the presence or absence of burnout, depression,
neuroticism, or other personal characteristics. Viewed this way, it is unsurprising that
persons who are experiencing high levels of burnout report dissatisfaction with caseloads,
the quality of supervision, level of social support, etc. That this relationship exists says little
about the directionality of causation, or if these two variables are covariates of other
conditions.
30 The few studies that have compared objective measures to the subjective reports add
evidence that the self-reports of work condition are colored by the presence of burnout. At
least two studies have found that self-reports of job stress correlate more with self-reports of
depression than do objective work conditions (Stanfeld et al., 1995; Goldberg et al., 1996).
Leiter and Harvie (1996) cite evidence that there is actually a positive correlation between
hours of patient contact per week and MBI measure of personal accomplishment. The
perception, however, of having too many clients was associated with burnout (Raquepaw &
Miller, 1989).
A reasonable summation of the literature on burnout in mental health professionals
is that there is evidence that psychotherapists are at risk of experiencing symptoms of
burnout. "Burnout", however, is not a validated concept that can be given a precise
definition. In the research, burnout has been operationalized most frequently employing
scores on the three subscales of the MBI. Although these subscales have been consistently
demonstrated to possess factorial validity, the discriminant validity overlaps with somatic
complaints and psychological strain (Koeske and Koeske, 1989; Schaufeli and Van
Dierendonk, 1993). Thus, burnout may not be a conceptual entity that is distinct from job
dissatisfaction, stress, or depressed mood.
Most of the conclusions commonly made in this body of literature are confounded
by reliance on self-report. In other words, what we know with the most confidence is that
psychotherapists who report that they are burned out (as measured by the MBI), also report
that they feel overworked, and that they are stressed by factors in their jobs. It is not at all
clear to what extent job factors contribute to burnout, and to what extent burnout produces dissatisfaction with the same job factors.
31 There is good evidence that burnout is a stable phenomenon, as opposed to the
popular view that it is a condition which accrues as stressors accumulate. This means that some workers cite high burnout early in their career, while others report low burnout even
late in their career. As these workers have a stable level of burnout over their career, this
suggests that burnout is, at least to some measure, a product of the goodness-of-fit between
the worker and the job. This possibility is further bolstered by the fact that personality and
personal factors have a significant correlation to the burnout levels reported by workers.
What has been little researched is what constitutes "good fit." What personal
factors, or personality characteristics, correlate with an ongoing sense of loving the practice
of psychotherapy? The current study moves beyond the concept of "burnout" and begins to
address this question.
Raymond Dlugos: Psychotherapists Who are Passionately Committed to Their Work: A
Qualitative Study of Their Experiences
In 1999, Raymond Dlugos completed a dissertation, and subsequent journal article
(Dlugos and Friedlander, 2001), in which he coined the term "passionately committed
psychotherapists". Employing methodology that influenced the present study, Dlugos
identified twelve peer-nominated psychotherapists who were described as having "sustained
high levels of commitment" to the practice of psychotherapy. These passionately committed
psychotherapists were nominated from a bank of 548 practicing psychotherapists identified
from phone books and lists of licensed psychotherapists.
Once identified, Dlugos, who employed a semi-structured interview protocol,
interviewed the passionately committed psychotherapists. Examples of prompts in the
protocol are " Can you describe what makes you hate or dislike your work as a
psychotherapist?" and "Can you describe an example of how your commitment to being a
32 psychotherapist has changed over the course of your career?" Transcriptions of the
interviews were used to develop common themes by having a panel of trained judges who
employed methods of Consensual Qualitative Research, or CQR.
In order to attempt to triangulate the qualitative data, Dlugos also administered a
series of scales to the passionately committed psychotherapists. Based on a priori theoretical
assumptions about significant areas, four self-report measures were administered: The
openness scale of the NEO Personality Inventory, the Salience Inventory, the Job in General
Scale, and the Maslach Burnout Inventory.
Dlugos identified four major characteristics of passionately committed
psychotherapists from the themes classified from the qualitative interviews: 1) Balance
(boundaries between work and non-work and engagement in non-work activities), 2)
Adaptiveness/Openness (meeting obstacles as challenges and hunger for feedback through
supervision), 3) Transcendence/Humility (Acknowledgment of the spiritual nature of
psychotherapy, locating the significance of therapy within the communal and social
responsibility), and 4) Intentional learning (recognizing complementarity of personal and
professional development).
The quantitative findings resulting from the administered scales were that these passionately committed psychotherapists were, as a group: 1) High in seeking new knowledge and experiences (Openness Scale), 2) Not more likely to make work the primary
commitment in their life (Salience Scale), 3) Above the median, but not in the exceptional range in job satisfaction scores (Job in General Scale), and 4) Very high in the "personal accomplishment" subscale of the Maslach Burnout Inventory-- but scored at the moderate or high range of "emotional exhaustion" and "depersonalization" subscales.
Critique of the Dlugos study
33 The present study seeks to extend the Dlugos study in two key areas: First, although
the author describes his methodology as a grounded theory approach, he clearly violated the
atheoretical nature of grounded theory research by founding his research upon
Csikzentmihaly's theory of optimal states (1990) and Mark's theory of energy exchange
(1979). Other a priori assumptions about characteristics of passionately committed
psychotherapists also are evident, and are also a departure from pure grounded theory
research. These assumptions are evident in the definition sent to the potential nominators to
describe passionately committed psychotherapists, e.g., "demonstrates a harmony and balance in all areas of life". That Dlugos asks for nominations of passionately committed psychotherapists based on this criterion, and then concludes in his findings that one of the characteristics of passionately committed psychotherapists is "balance" represents a tautology.
Similarly, the selection of scales, which Dlugos uses to triangulate the qualitative
data, also required some a priori assumptions that would guide the study in specific areas.
Because the scales were selected prior to the study, certain decisions had to be made in anticipation of the qualitative data. Use of the "openness" subscale of the NEO Personality
Scale would only serve to support the qualitative data if, in fact, the subjects did speak of openness as one of their key characteristics. In this way, Dlugos seems to have predetermined the data he would be seeking to triangulate. This approach is not consistent with the grounded theory approach. The present study will approach the question without such a priori bias in an effort to develop theory consistent with the derived results. A
comparison to the Dlugos findings will be made at the conclusion of the study in an effort
to add replication or a competing theory.
34 The second area in which the current study seeks to extend Dlugos' work is in criterion sampling with psychotherapists who practice in the public sector. This focus compares to Dlugos' subjects, nearly all of whom practiced privately. To the extent that publicly employed psychotherapists work with a more difficult clientele and contend with increased institutional barriers, there is added significance to learning about those who continue to flourish in this work environment.
The effort made by Dlugos to define key characteristics of passionately committed
psychotherapists is justified by the fact that a large body of previously cited literature
substantiates that a significant part of the burnout phenomenon is the "goodness of fit" between the worker and the job role. Thus, the present study will seek to extend this work to bring a better theory of who is likely to become, and remain, passionately committed to
the practice of psychotherapy.
Lastly, the current study seeks to investigate an interesting, though little commented
upon, anomaly of the Dlugos work. Although the twelve subjects were selected for being
high in energy and commitment to the practice of psychotherapy, they scored in the
moderate to high ranges on two of the MBI subscales. This interesting finding is that,
though they were identified both by themselves and their peers as "passionately committed",
and in spite of high scores on measures of personal accomplishment, they were
simultaneously moderate to high on measures of emotional exhaustion and
depersonalization. Extension of this work may shed light on whether this is because
"passionately commitment" is a concept distinct from mere "absence of burnout", or
perhaps this finding is simply evidence of the poorly validated, imprecise nature of the
definition of "burnout".
35 Or perhaps, finding that passionate commitment to the practice of psychotherapy persists even in the face of emotional exhaustion further elevates the stature of those who fit such a description.
36 Chapter III: Method
In this qualitative study, the researcher sought to identify the key characteristics that
define passionately committed psychotherapists. Passionately committed psychotherapists
are those who find the practice of psychotherapy to be highly enjoyable, whose energy in the job hasn't diminished irrespective of how many years they have practiced, and who are highly satisfied with their career choice. Characteristics to be examined include attitudes, beliefs/values, non-work activities, and cognitive strategies as they relate to the self- maintaining characteristics of the passionately committed psychotherapists.
The results from this grounded theory study will be used to fashion a theory that
describes the key individual characteristics and strategies that may determine whether or not
a therapist will become passionately committed to the practice of psychotherapy.
The implicit study problem, "How are psychotherapists who remain energized and
committed to the practice of psychotherapy different from those who become dissatisfied,
burnout, or languish?" is not one that has been well studied. The study is defined as an
exploratory study because of the near absence of research in the social work/mental health
literature on this topic. As Artinian states, "If prior descriptive research has not been done
for a particular problem area, this (grounded theory) is the type of research to use" (Chenitz
and Swanson, 1986).
Glaser and Strauss (1967), in The Discovery of Grounded Theory, describe the process of joint coding and analysis of data in which observations are systematically placed into conceptual elements. These elements are used to build a tentative theory explaining a phenomenon. This process of comparing and contrasting observations, integrating categories and their properties, delimiting and writing the theory, will be used as the method of choice in this study.
37 This chapter describes how a sample of passionately committed psychotherapists will be selected for the study, how the qualitative data is to be generated through a semi- structured interview protocol, and how the data will be coded and analyzed by the researcher.
Participants
For the purpose of this study, "psychotherapists" are defined as any individual who meets the Utah State Department of Professional and Occupational Licensing requirements as an independently licensed mental health therapist, and who in fact practices psychotherapy. This may include psychiatrists, psychologists, social workers, marriage and family therapists, and licensed professional counselors. Because the aims of the study are not exclusive to any one of these professional groups, and because there is more commonality than difference in their job roles, the decision has been made to allow psychotherapists of any of these disciplines to be sampled. There is, for instance, no reason to believe that the self-maintaining strategies of social workers who are passionately committed psychotherapists would differ from psychologists who are passionately committed psychotherapists. Confining the sampling to the state of Utah is being done for reasons of feasibility and convenience.
The inaugural use of the term "passionately committed psychotherapists" in the literature was Dlugo's use of the term in his dissertation paper (Dlugos, 1999). Dlugos coined the term to refer to those psychotherapists who are "continually energized, renewed, and reinvigorated by his or her work and for the rest of life's experiences". Because
"passionately committed psychotherapists" is an original term, no standardized measurement of the concept is available. Therefore, as in Dlugos' study, this study will employ peer nomination in order to identify the study group "passionately committed psychotherapists".
38 Identifying the Study Group
This study seeks to identify as many therapists as possible in the Utah Public Mental
Health System who could be defined as passionately committed psychotherapists. The
public mental health system is selected for study in order to extend Dlugos' work, and to
determine if the results are similar for psychotherapists in the public sector. In Dlugos
study, nearly all of the identified passionately committed psychotherapists were found in
private practice. As therapists in publicly funded mental health settings typically work with a
more difficult clientele, there is value in learning more about those psychotherapists who
remain energetically involved in their work.
In the Dlugos study, therapists must have been practicing for at least ten years to
qualify for nomination as a passionately committed psychotherapist. This decision was made
based upon the assumption that there is something distinctive about someone who remains
passionately committed after many years of practice. As demonstrated in chapter 2,
however, the burnout literature demonstrates that burnout does not become greater over the
course of a career. Most research shows that burnout is a stable phenomenon, or event that
it is higher during the initial training period. Therefore, time in practice was not used to
determine eligibility for nomination in this study.
The requirements for participation in this study were: 1) Nomination as a
"passionately committed psychotherapist" by two or more peers; 2) the therapist must
continue to work in providing psychotherapy for at least 50% of their workweek, and 3)
continue to conduct psychotherapy in the community mental health system.
Once nominated by two or more peers, a letter of invitation (Appendix C) was sent
to the potential interviewee. This was accompanied by the informed consent document
(Appendix D.) The mailed material was followed by a telephone contact from the
39 investigator. During the phone call, the investigator reviewed the goals of the study and the
informed consent process, and requested an interview appointment with the nominee. The
informed consent document and orientation provided a description of the purpose of the
study, requested permission to audiotape the interview, and described the protections and
limits under the confidentiality agreement.
Design
The aim of this study, understanding the self-maintaining strategies used by
passionately committed psychotherapists, requires use of qualitative methods.
Understanding how the passionately committed psychotherapists think about their work,
how they describe the internal rewards and risks of doing psychotherapy and other related concepts, requires data collection in a narrative form. This consideration suggests the use of
an interview format. Therefore, a semi-structured interview protocol is developed for use in
this study (Appendix A.)
Interview Format
Because the investigation is a grounded theory study, prompts in the interview
protocol are not organized around any theory. Rather, the questions are open-ended and
intended to elicit data deriving from the original descriptions of the study subject. Most of
the guiding questions are crafted to be consistent with the discovery mode of the study., e.g.,
"What, in your opinion, makes the difference between a therapist who flourishes in the job and one who burns out and becomes disaffected?" Some of the questions, however, derive from the Dlugos study, i.e., "Have you had any experiences that made you doubt the appropriateness of psychotherapy as a career for you? How did you manage that situation?"
The questions are asked within the emergent fit model, with the intent both to replicate the
40 Dlugos questions, and to extend his findings into a formal grounded theory (Artinian in
Chenitz, 1986.)
Charmaz (1990) discussed the importance of directing the conversation during the
qualitative interview without being too directive. She cites Lofland and Lofland (1983)
describing the interview as a "directed conversation." The goal is to be directive enough to
structure the interview in a way consistent with the respondent's psychological and physical
status, the relationship between researcher and respondent, the researcher's theoretical perspective, and the topic. On the other hand, Charmaz states, "the overly-directive researcher can cut off the most interesting leads and rich data."
Reissman (1990) describes how, in her research, some subjects reported being depleted and demoralized because the fixed protocol to which she was adhering left them feeling unable to discuss what mattered to them. It is especially important that, in a
grounded theory study, the interview protocol not intrude upon the subject's reports of their own lived experience. Riessman made a mid-stream correction and her interview schedule became more flexible. She began employing a combination of a structured protocol so that variations could be analyzed, but added open-ended interpersonal questions.
The present study employed an interview protocol consistent with Charmaz' (1990)
ordering of questions in a grounded theory study. She proposes that the interview questions
should be ordered by beginning with short "face-sheet" type questions, then moving toward
questions that are purely informational, progressing toward reflective questions, then feeling
questions, and ending questions which terminate the interview on a positive note.
Similarly, the interview protocol for the present study began with brief informational
questions that serve both to generate data and to establish rapport with the interviewee. As
the interview progressed, the researcher asked the "reflective" questions that in the
41 beginning are intentionally global, e.g., "What, in your opinion, makes the difference between a therapist who flourishes in the job and one who burns out and becomes disaffected?" Consistent with a grounded theory approach, such non-directive questions are designed to avoid biasing the subject towards any particular factor or theory.
Questions later in the protocol queried specific areas, e.g., "Do you consciously involve yourself in activities that are restorative?" but only after the subject has had opportunity to offer their views concerning the relevant factors in achieving/maintaining a passionate commitment to the practice of psychotherapy.
It is stressed that the questions in the initial protocol (appendix A) are defined as guiding questions. The main focus of the interview was to provide an opportunity for the subject to provide a description of his or her own lived experience as a psychotherapist or former psychotherapist. Furthermore, the interview protocol varied somewhat between interviews, allowing the researcher to ask theoretical questions as provisional hypotheses begin to emerge (Strauss and Corbin, 1998.)
After asking the reflective questions, the queries began focusing upon the most personal area of inquiry, the feelings of the psychotherapist related to key areas of interest, e.g., " Can you tell a story that describes how you feel about being a psychotherapist?"
At the conclusion of this discussion, ending questions helped complete the interview on a positive note.
The interviews were conducted in the subject's professional office, and were facilitated by this author. Swanson proposed that the interviewer be fresh to the clinical area in order to have less biasing tendencies during the interview (in Chenitz, 1986.) As this researcher is experienced in the clinical area, efforts were made, consistent with Glaser and
Strauss, to deliberately hold the biases in abeyance (1967.) This was accomplished through
42 the process of bracketing, which Rennie maintains Glaser and Strauss incorporated implicitly
(2000.)
The interviews were recorded and transcribed verbatim. The interviews each lasted
approximately one hour.
Procedures
Identifying the Study Group
A nomination letter was given to psychotherapists practicing in public mental health
throughout Utah. The letter requested that the mental health professionals nominate any passionately committed psychotherapists of which they are aware, as defined by the included criteria. The investigator disseminated the nomination requests through personal contact with managers of the public mental health agencies in the state. Because personal requests were be made for nomination, the return rate was expected to be higher than for mail-out requests.
Dlugos' definition deemed a therapist passionately committed if he/she: 1) is
energized and invigorated by his or her work rather than drained and exhausted by it; 2)
clearly enjoys and finds significant meaning in his or her work; 3) continues to love his or
her work in spite of personal and environmental demands that are imposed on all
psychotherapists; 4) demonstrates a harmony and balance among the various aspects of life; and 5) energizes and invigorates those with whom he or she works.
A potential flaw in that definition is the somewhat self-sealing quality of
characteristic #4: Dlugos' study was an exploratory study, but seems to pre-define that a
characteristic of passionately committed psychotherapists is that they “demonstrate a
harmony and balance among the various aspects of life". The current study, in contrast,
deems it preferable to determine the attributes that emerge from the data, rather than
43 defining the study group by assumed characteristics. Therefore, this criterion was deleted
from the definition used in this study.
Because "passionate commitment" is an exploratory concept, no defined criteria exist. Therefore, a parsimonious description that excludes investigator bias was developed as follows:
"In the spaces below, please list passionately committed psychotherapists with which you are
acquainted. A passionately committed psychotherapist is one who:
1. Is licensed in any of the psychotherapy professions (Psychology, Psychiatry, Social Work,
Professional Counseling, Marriage/Family Counseling, or Advanced Practice Nursing),
and who
2. Has an extraordinary amount of energy for, and commitment to his or her work, and
3. Is invigorated by, rather than depleted by, doing psychotherapy.
The Dlugos study, of which this investigation is an extension, studied thirteen
passionately committed psychotherapists. This was the product of over 500 nomination
requests for nominations. Because this study focused on public mental health workers in a
small rural state, fewer requests for nominations were made. The goal of a grounded theory
study is to continue sampling until saturation of the data is observed. Initially, it was
uncertain if saturation would occur before all available passionately committed
psychotherapists were interviewed. As will be reported in Chapter 4, however, sufficient
saturation of the data occurred prior to interviewing all potential subjects.
As the subjects were identified, the investigator made personal contact to describe
the study and to inquire concerning the subject's willingness to participate. A one-page
study description, and consent form followed this phone contact. Upon receipt of this
information, an appointment time was made for the interview.
44 Analysis
Recording expectations and biases
The first step in the analysis is for this researcher to bracket his preconceptions and
theoretical biases towards the study question. As this investigator has nearly twenty years in
the mental health field, a substantial amount of preconception exists, which should be
recorded before the research in order to bracket the biases from the emerging data.
The investigator has practiced as a psychotherapist and mental health administrator
in private practice and in the public sector in inpatient, outpatient, and intermediate levels of
care. His experience includes collegial and supervisory relationships with psychotherapists
whom he considers to be passionately committed, and with more therapists whom he
considers to be practicing psychotherapy only because the "sunk costs" are too great to allow
them to consider a professional change. His thinking and preconceptions are considerably
influenced by the Dlugos study findings, with which he concurs, but believes may not be
representative of psychotherapists working in the public sector.
This author's theoretical orientation is prominently existential, though his own clinical work employs specific practice models, e.g., dialectical behavior therapy and behavioral strategies for anxiety disorders, to provide structure to the therapy.
This researcher describes a passionately committed psychotherapist as one who,
above all else, is passionate in life in general. The finding in the Dlugos study that
passionately committed psychotherapists engaged in non-professional activities with as much
passion as they did their work is probably not causal. Rather, both passionate commitment
to psychotherapy and passion about a hobby are probably covariates of the personality
factor that produces "passion".
45 The investigator would expect that passionately committed psychotherapists are
people who are stimulus augmenters, who tend to want more stimulation than is normative.
They are, therefore, less likely to want to go home a day practicing psychotherapy and watch television and become lethargic. Because psychotherapists are in a sedentary profession, however, the author expects that this stimulation-seeking is specifically of the intellectual variety, and may or may not include physical "thrill-seeking".
The investigator believes that passionately committed psychotherapists in the public
sector have necessarily emerged from a process of redefining their inceptive notions of the
practice of psychotherapy. The belief that the clinical hour would involve a pleasant and
nurturing conversation with a motivated client, must evolve to the requirement of the
therapist that he or she be willing to "give grace" to clients who may be non-compliant, who
may seem unmotivated, who may engage in socially unacceptable behaviors, who may be
noxious and even abusive to the therapist. This transcendent view of psychotherapy is that joy can be found in making the desires of the self subordinate to the needs of the client.
Finally, because working with difficult clients requires something of a "mortification
of self", the investigator believes that passionately committed psychotherapists have experienced some close personal experience with personal wounds or mental illness, either in him or herself, or in relationship to some loved person, that transforms the occupation of psychotherapy into a vocation.
Coding
This grounded theory investigation proceeded with fidelity to the Strauss and Corbin
(1998) descriptions of the analysis and coding of qualitative data. This means that analysis
began immediately upon completion of the first interview. The transcript of that dialogue
was reviewed in a microanalysis (line by line) that started the process of open coding. In the
46 open coding process, the analysis is an effort to discover the concepts, and to break down
the data into parts and examine for similarities and differences (Strauss and Corbin, 1998).
Upon completion of the second interview, a comparative analysis began in an initial
effort to develop provisional categories. Thus, analysis and data collecting proceeded
simultaneously and influenced each other in transaction.
After completion of the open coding process, which resulted in the initial
categorization of the concepts into phenomenon, the analysis moved to the axial coding
process. During axial coding, the researcher spends less time comparing and contrasting
incidents to each other, and more time comparing the data to the categories. During this coding process, the dimensions and properties of the category are discovered (Locke, 2001).
In axial coding, the investigator will begin to reassemble the data that was broken down
during the open coding analysis. This process involves an analysis of how the categories
relate comparatively and differentially, and relating the categories to subcategories along the
lines of properties and dimensions (Corbin and Strauss, 1998). By the completion of
interview number 12, the analysis had evolved to almost exclusively axial coding.
Throughout the coding process, the researcher made use of memoing of personal
responses to the data, and the reasoning behind choices about the meaning of the data and
why decisions were made about categorization of data. Memoing is deemed to be important in qualitative data analysis in order to "articulate and conserve their (the researchers) sense- making about what is going on with the data (Locke, 2001)."
In addition to memoing, a codebook was developed that listed all highlighted
quotations used to support each category and sub-theme. The codebook was employed to
assess the consistency of the coding, and the level of support the data provided to each
47 category. Additionally, the codebook (Appendix E) provides transparency in method that
can be used by other researchers wishing to examine the coding method in detail.
The product of the coding process will be a substantive level theory, constructed by
the investigator, which tentatively explains the relationship between the independent
variables (the phenomena discovered in the investigation) and the dependent variables
(presence or absence of passionate commitment). This theory is written in narrative form,
and describes the categories, the relationship between them, and the properties and
dimensions of each of the categories. One measure of success of this theory building will be
the degree to which the resulting theory could be used to extend the research from the
discovery phase to some form of empirical testing.
Criteria for Evaluation
Because the concept of validity is largely associated with its positivist origins, it is
controversial in qualitative research. Some qualitative researchers do not accept that validity is a relevant concept in this type of research; others do. Corbin and Strauss (1998) do not discuss "validity" in the traditional, quantitative sense, but they do discuss "criteria for evaluation" of a grounded theory. They list eight criteria, with the proviso that these criteria are only guidelines, and should not be taken as "rules". Seven of these criteria seem relevant for assessment criteria for this project (the eighth, "Does the theory stand the test of time…" can only be assessed with the passage of time.) These are the criteria:
1) Are concepts generated?
2) Are the concepts systematically related?
3) Are there many conceptual linkages, and are the categories well developed?
4) Is variation built into the theory?
5) Are the conditions under which there are variation explained?
48 6) Has process been taken into account?
7) Do the theoretical findings seem significant, and to what extent?
These criteria become both the map for the development of the theory in this study, and
the gold-standard by which the resulting theory will be assessed.
In addition to the assessment of the theory according to these criteria, a consensual
validity exercise was conducted with two external raters. This exercise was developed when the researcher had analyzed the data from six interviews and had established some initial code categories.
Two raters volunteered for participation in the validation exercise. One was a senior
manager at a community mental health center, and one was a graduate student currently
doing an internship in a community mental health center. Both participated in a one-hour
individual meeting with the investigator during which they were instructed as to the goals of
the study, the confidentiality agreements, and the structure of the validation exercise.
During this meeting, each was briefly oriented to grounded theory research and the open
coding process.
The external raters were asked to independently code two transcripts and to assign agreement ratings with the coding assigned by the primary investigator. The coding was compared at the levels of the microanalysis, major concepts, and finally, at the level of the initial code categories. The result of this exercise is reported in Chapter IV.
49 Chapter IV: Results
The purpose of this study was to identify the attitudes, beliefs, values, personality
traits, non-work activities, and cognitive strategies that are common to, and which may
distinguish passionately committed psychotherapists. Consistent with grounded theory
research, data derived from interviews with peer-nominated passionately committed
psychotherapists were coded, analyzed, and organized into thematic categories. These
categories were then synthesized into a substantive level theory that describes those
common characteristics.
This chapter will describe the demographic profile of the practicing psychotherapists
who were nominated by their peers as "passionately committed psychotherapists". Their reactions to the term "passionately committed psychotherapist" and their nomination as such will be reported. Then the common characteristics of passionately committed psychotherapists will be identified and described as derived from the interview data. The chapter will conclude with a description of the validation of the findings.
Demographic Description of Nominated Participants
Practice sites within the Utah community mental health system were contacted to request that their psychotherapy staff be invited to submit nominations of passionately committed psychotherapists. These sites were all outpatient clinics that serve public clients, the majority of whom are on Medicaid insurance. The sites represented geographic areas that included frontier, rural, and urban population regions. One-hundred and thirty-five nomination forms were distributed to office program managers who agreed to distribute the nomination letters and forms to their independently licensed psychotherapy staff. These nomination forms resulted in 32 returned nomination forms, which contained a total of 48
50 unduplicated individuals receiving nominations. Of these, 16 psychotherapists were
nominated by two or more of their peers, making them eligible for participation in the study.
Saturation of key data categories occurred prior to solicitation of nominations at all practice
sites in the state, suggesting that a significantly greater number of passionately committed
psychotherapists could have been identified had the study continued.
All of the psychotherapists who qualified for participation in the study agreed to be
interviewed, although one was unavailable during the time period of the study. Therefore,
15 of the qualified 16 passionately committed psychotherapists participated in the interviews.
Some of the passionately committed psychotherapists were nominated by many
more than two of their co-workers, as several nominated passionately committed
psychotherapists were nominated 6 or 7 times. Because the number of times an individual
therapist was nominated was undoubtedly influenced by the size of the office, it is not
assumed that the number of nominations is necessarily indicative of the level of passion or
commitment.
Eight of the nominees were male, and 7 were female. The age of the subjects ranged
from age 31 to age 61. The average age of the study group was 46.5. All of the participants
except one reported that they were married or in some form of a long-term, committed
relationship. 14 of the subjects were full-time therapists, who reported that more than 50%
of their forty hour work week was spent doing psychotherapy. One worked in a 75% (30
hours/week) position.
All but one of the subjects reported that they received clinical supervision, which in
all cases consisted of organizational supervision from a supervisor or group supervision in team case staffings. None of the interviewees reported having sought external supervision.
All but one of the participants described their practice as some form of an integrated, or
51 eclectic practice, usually with a particular emphasis (most commonly cognitive-behavioral.)
Only one described her practice in the form of a singular theoretical model, feminist.
In Utah, a significant majority of psychotherapists in the public mental health system
are social workers. It is not surprising, therefore, that 11 of the nominated participants were
licensed social workers, 9 of whom had an independent clinical license, with two working
toward that goal. 2 were psychologists, and one each who held a marriage and family
therapy or licensed professional counseling license. Because the role of psychiatrists in
Utah's public mental health system emphasizes psychiatric assessment and medication
management as opposed to psychotherapy, it is not surprising that none of the nominees
were psychiatrists.
The time in practice varied greatly, from as little as 3 years, to more than thirty years
for five of the PCPs. The numbers of years in practice did not appear to be a factor in the
responses of the participants, as the subjects universally described a stable course of passion
and commitment over the course of their career. This finding will be elaborated upon later
in this chapter.
Participants' Response to Their Nominations as "Passionately Committed Psychotherapists"
All but one of the interviewees endorsed the concept of passionate commitment, and
stated that this term was consistent with their view of themselves as psychotherapists. Some of the nominees, however, needed clarification before accepting this as a description of them. Only one participant was hesitant to embrace the concept of "passionate" commitment, stating that the term connoted ambitiousness, which she didn't endorse:
I am really honored. Passionately committed…well the term committed, means something different in
mental health…No, because to me “passion” means you are sort of driven and I’m a bit of a rebel.
Driven to succeed in ways up the ladder, and that is what I fear.
52 This subject, passionately committed therapist PCP 7, preferred the term "dedicated
psychotherapist", which to her did not suggest the same level of ambitiousness.
One of the subjects, PCP 12, demonstrated some reluctance to embrace this term:
I think I am committed to my clients, but I probably wouldn't have said that. I'm just surprised.
I guess because it sounds like something more than I am, more of an honor than I really deserve.
I was nominated as the clinician of the year for (names employer) and I was really surprised by that.
I don't see myself as this person who really does that much. I mean, I do my work, and I really love
my job. I really enjoy what I do, but I don't see it as that outstanding. For anybody to recognize me
as extremely good, or extremely committed, surprises me regularly.
The interviewer clarifies that this term seeks to identify those psychotherapists who
derive energy from the doing of psychotherapy. After this clarification, he accepts this as a
description of himself:
That would fit--it fits. I may come to work and not want to be here, but by the time I engage with
working with a family or with a group, I seldom fall asleep or wonder why we are not going
somewhere, it just feels energizing.
Another of the subjects hesitated to identify herself as "passionately committed"
because psychotherapy wasn't her only passion, which is actually a typical description of passionately committed psychotherapists:
I've been thinking about that. I love what I do, most of the time, not all of the time. I look forward
to coming to work. I like what I do, I like the diversity of kids. It's always kind of fun… what
am I going to do with this kid? I like all that. I can't imagine having another job. I can't think of
another job I would enjoy more. In terms of "passionately committed", if that's passionately
committed, then yeah. If that is my whole life, then absolutely not. I'm real clear that my work is
my work and the rest of my life is lots more fun, well not lots more, but sometimes.
53 All of the remaining interviewees stated that they liked the term "passionately committed psychotherapist", and often that it described a quality with which they resonated.
PCP 2 stated:
It was good wording, did you come up with that? I loved it when I opened up that letter. I
thought, this is exactly the words that I would use, which I hadn’t used. But what it means to
me is that I’m pretty energized by my job. There’s passion and energy, and something that is
meaningful for me, so there’s a commitment. It’s not like, I just put my time card in, it’s
something I care about very much, and I think matters, and there’s a commitment, and it’s just
fun.
The participants endorsed not only the label "passionately committed psychotherapist", but also tended to enthusiastically embrace that this description was resonant with their own views of themselves. Examples from PCPs 9, 10, and 11:
I'm kind of a passionate person. I really love my work, it's almost like a hobby for me, it's so much
fun and so fascinating to me. I get excited about things. I never ask anybody to do anything in
therapy that I'm not willing to do. I use myself as a test case. A lot of times, I do DBT skills and
the skills that we teach our clients, they're really hard, and I feel like I have to see what this is like
in a particularly difficult time. So when I do it, and I see that it works, I get so excited. I just love
it.
I like it. I like the term. I guess it is just, well, ever since the '70's I've had this intense interest in
people, behavior, curiosity about people and how people work, and all that. I'll get passionate about
whatever I do, but there's just something about this that's just absolutely mind-boggling to me. I just
wake up in the morning really excited to do it, and often, usually, go home at night with a sort of
buzzing, almost a kind of high from the interactions, the things I see people do.
54 Yeah, I do. I agree with the idea of "passionate commitment" in any venue of human endeavor. I do
this, not for the money, I do this because I love it. I am never, at least so far, in that place where I
have been many times in my life, of wondering A) what was I doing with my life, or B) how long
this had to go before I could do something more interesting. I've never had that before, not at all.
PCP 1 expressed a little more hesitation, and stated the same reservation that some
of the other interviewees did: That there were some days that they didn't feel passionate, and
that they wanted to do something besides come to work:
I had to think about that for awhile. On the whole, yeah. The word passionate-- I think of Jeffrey
Young, I think it’s his term “unrelenting standards” and that the word passionate almost suggests
someone who’s just got the fever every day, and in public mental health, there may… I hope you find
some people that attain that level, but I think that’s a challenge, but on the whole I would say, yeah,
I do a good job of having a real desire to help people, and wanting to be a front line worker and
being committed and dedicated to that.
Participant's Rating of Current Level of Burnout
None of the participants reported that they were burned out, or that they had ever
experienced burnout in their career. PCP 11 stated it simply and categorically when asked to rate his current level of burnout:
Zero. I'm not burned out.
Many of the subjects added what was, to them, a necessary distinction: That they
had periods of fatigue, and may have even had a period in their career where they had some
kind of crisis, such as a health condition or client suicide, which had served as a signal that
they had lost balance. These periods were viewed as transient, however, and were
distinguished from the concept of burnout as a steady downward course:
55 If I find I’m feeling worn-down, I don’t like to put up with that. I’ll do something in the next 5
minutes or the next hour, or over the weekend. I don’t like feeling that way. So I guess, yeah, I
mentioned that hardiness. Maybe it’s my upbringing, maybe a little bit of genetics, I don’t tolerate
feeling burned out. I tend to want to steer away from that as best as I can (PCP 1).
I don’t feel burned out. I’m tired. It’s been tiring since (names client) killed himself. And then you
know when I was called to the scene of the other suicide… umm, I was tired. I don’t know if I was
burned out, and I feel like I’ve learned enough about how to take care of myself so I feel like it’s OK
to say I’m a fucking mess and I cannot come in, and to tell my clients that (PCP 2).
I'm not burned out, I haven't had a problem with burnout since I left administration. I made a
really good decision. I've retired, I don't have to do this financially. I'm to that point. I do it
because I love it. I could quit any day of the week I want (PCP 3).
I'm sure that I've been burned out at times, but I've never found myself thinking, you know, "this is
it, I can't handle anymore." There have been days or even weeks where I've gone home and thought
"this is tough, I'm really worn out". My current level of burnout is not very high. My morale is
kind of fluctuating depending on what's going on with clients and situations that they are going
through (PCP 5).
PCP 8, after 32 years of practice, even describes a reduction in his burnout level over the course of his career:
It (doing psychotherapy) seems to be getting more and more joyful.
56 Common Characteristics of Passionately Committed Psychotherapists: Categories and
Coding
In keeping with the principles of grounded theory research identified in chapter
three, a microanalysis of the transcripts was conducted until initial categories began to
emerge from the data. After the development of the initial categories, the data was
reanalyzed as the categories began to evolve. At this point, the data developed by Dlugos in
his similar study with private practice psychotherapists was added for comparison and
contrast.
Dlugos (1999) identified four general themes that resulted from his study of
passionately committed psychotherapists. Dlugos' subjects were, for the most part, in
private practice as compared to the community mental health practitioners interviewed in this study. Although differences will be commented upon, the four categories identified by
Dlugos were supported for public practitioners in this research: 1) Balance, 2)
Adaptiveness/Openness, 3) Transcendence/Humility, and 4) Intentional Learning. Two new categories are added because of their dense groundedness in these data: 1) Personal Fit with Role, and 2) Passion-Supporting Beliefs.
Combined, these six major themes emerged from the data analysis and capture the
most salient aspects observed as demonstrated by the participants. These general themes
were spoken to by all of the interviewed passionately committed psychotherapists. Within
each of these general themes are categories of codes that are supported by the data. Some of
the categories within the themes were grounded in the data from all observed cases, and
some are sub-categories that may identify differences in subtypes of passionately committed
psychotherapists.
57 General Theme 1: Balance
Strongly supporting Dlugos' finding, all of the interviewed passionately committed
psychotherapists identified in some way the importance of balance in their lives. These
passionately committed psychotherapists often expressed strong sentiment about the
importance of balance. The term "balance" was not used in the questioning protocol, yet
emerged spontaneously in every one of the interviews.
Dlugos identified four sub-themes within the category of balance: 1) boundaries
between work and non-work, 2) Passionate engagement in at least one non-work activity,
3) Deliberately seeking diversity within work activities, and 4) the recognition of economic
motivation to diminish passion for work as a psychotherapist.
Sub-category #1: Boundaries between work and non-work
The first sub-theme was strongly supported in the sense that these psychotherapists
emphasized the importance of their non-work activities. The description of "physical and
emotional boundaries between work and non-work activities" is not supported in these data,
however. The interviewees typically stated specifically that they did not engage in their non-
work activities for the sake of balancing the stressors of work; rather, they did so for the
intrinsic pleasure of those activities. Only two interviewees (PCP 5 and PCP 6) made reference to establishing an emotional boundary between work and non-work:
Knowing how to pull up the drawbridge and not take it home with you is what allows you to survive.
Which is why crisis work is difficult, because it intrudes in that time where you are away from work.
It used to be horrendous, you would go to the hospital at 2:00 and get home and the jail would call
at 3:00 and you had to be at work at 8:00 and that makes it hard to find balance (PCP 6.)
58 For the other passionately committed psychotherapists, balance is of central importance, but they do not describe having to define discrete boundaries between work and
Table
General Categories of Findings, Percentage of Participants Identifying, Number of Data Points
1. Balance (100%, 180 data points)
A. Importance of non-work activities (80%, 41 data points)
B. Passionate about other activities (87%, 25 data points)
C. Noticing Diversity within work activities (100%, 93 data points)
D. Significant sub-theme: Difficulty in finding balance (60%, 21 data points)
2. Adaptiveness/Openness (100%, 42 data points)
A. Meeting obstacles as challenges (67%, 29 data points)
B. Hunger for feedback from supervision (67%, 24 data points)
C. Confidence in core therapy skills (47%, 18 data points)
3. Transcendence (93%, 56 data points)
A. Recognition of the spiritual nature of psychotherapy (53%, 15 data points)
B. Locating the significance of psychotherapy within communal/social responsibility (67%, 41 data
points)
4. Intentional Learning (87%, 47 data points)
A. Recognizing the complementarity of personal and professional development (80%, 33 data points)
B. Continual fascination with human development and change (47%, 14 data points)
5. Personal Fit With Role (100%, 229 data points)
A. Will to intimacy (93%, 61 data points)
B. Drive for personal purpose/meaning (80%, 26 data points)
C. Stimulus Seeking (100%, 142 data points)
59 6. Passion-Supporting Beliefs (93%, 75 data points)
A. Strength-based orientation (67%, 21 data points)
B. Equality in relationship with clients (93%, 54 data points)
non-work. As will be explicated later, a central finding of this research is that passionately
committed psychotherapists do not find the practice of psychotherapy to be stressful most
of the time. There is, therefore, no stated need to develop "physical and emotional
boundaries" between work and non-work. PCP 13 makes this point when asked if it is hard
to leave the concerns of work at work:
No, not really. It's about everything here--the ambiance. They are good people here. And for the
most part, my families are pleasant people. I mean, there are times where it gets kind of up in arms,
but with the exception of one family, I like my families, and I like to see them, and have them come
in and say, "Johnny did this today'" and I say, "Okay, we've been working on it for two months."
But, yeah, I like to come to work. Not everyday, like when my son gets up at 5:00, but for the
most part I miss work if I'm gone for too long. For the most part, I am able to leave the stories that
I hear and the work that I do here. What I miss is the camaraderie, and just being around the
people that I love to be around, because they are good people.
So, while balance is extremely valued by these clinicians, their description of their
non-work activities is typically one of a fairly effortless flowing from one passion, psychotherapy, to another outside work.
Not necessarily because I know this will be rejuvenating and give me more energy for therapy, but
because in and of themselves it’s good to be energized. But the things that I’ve identified that I don’t
take on a lot as far as complications, I lead sort of a low-stress lifestyle. And the things that I do I
enjoy doing. I have the avocations that are motivating and fulfilling. (PCP 1.)
60 Sub-category #2: Passion about non-work activity
Consistent with Dlugos is that most of the subjects describe feeling very passionate about at least one non-work pursuit:
I jog every morning; I hate to miss that. That’s a very special thing. I ski avidly, I have my
schedule here, and I’ve been pretty open about it, I like to ski every morning that there is new snow,
what can you do to help me pull that off? (PCP 8.)
I love building - and construction and woodworking. I have a shop and I do that. Garden - you
know when the time is right - a huge garden with a hundred and something roses in it I take care of.
But building is my main source of creative outlet - you know where I can actually make something,
and I do it. In fact I'm kind of compulsive about it. I'm always making something. And it's fine.
You know I just let that happen. (PCP 9.)
I have other passions. My current one, that has been at the top the last year or so is photography.
That takes me outdoors a lot, so nature and photography are, and friends, I have a good set of
friends. I'm also passionate about cooking; I'm passionate about a lot of things. (PCP 11.)
Sub-category #3: Seeking diversity within work activities (Noticing diversity within work activities)
While this sub-category is supported by the present data, the label "seeking diversity within work activities" is a misnomer. In the current study, none of the interviewees mentioned that they sought out diversity within work activities. Review of the quotes cited by Dlugos also do not seem to support "seeking diversity." Many of them made it apparent
61 that such diversity happened naturally in the way they view their work. A more accurate
label for this category might be "noticing diversity within work activities":
I think… see what’s so beautiful about people every day, you know, getting to see that vulnerability,
and unique characteristics, it ‘s just really exciting. So I think that, you know nothing’s ever the
same, I may see the same client week after week, but things are different every time, so I think the
variety is exciting, and watching progress over the long term is exciting (PCP 2.)
For me, it's the hope of the possibility that each interaction with the client might be one more little
brick in their progression. If you look at it as mundane, kind of ho-hum, here comes another client,
then that's the kind of treatment that is going to take place. But if you look at it like each
interaction is a chance for growth or progress, it helps you stay a little more passionate about things.
(PCP 5.)
Every person I see is somebody I can brighten, and it brightens me, and I look forward to that.
This is a pretty nourishing job. (PCP 8.)
As will be elaborated under the category "intentional learning", a very strong theme was that the diversity in their jobs came in the form of growth and learning within the job.
Perhaps this could be expressed that the passionately committed psychotherapist seeks growth in him or herself, rather than needing a change in the functions of the job role.
Not supported: Sub-category #4: Recognition of the power of economic motivation
to diminish passion
Another difference in the category of balance compared to Dlugos, is that the sub-
category "recognition of economic motivations to diminish passion" simply did not develop
in this data. Almost certainly this is attributable to the fact that none of these interviewees
62 were solely in private practice and were, therefore, salaried employees of a community
mental health center. They did not, therefore, have to expend energy with the economic
concerns of running one's own practice.
Perhaps a parallel finding for public mental health practitioners, however, is the
abundant, if implicit, finding in the data that these clinicians have focused upon the
enjoyment and meaning in their work and de-emphasized attaining a high income. PCP 2 makes this point:
I think, first of all, they have to find out if they really are committed and passionate and I think if
they’re not, it might not be the right field 'cause you can really get burned out. So if it’s for …I
mean I can’t imagine why someone else would do this because there’s no money in it.
PCP 3 states similarly:
The best clinicians that I have known are introspective. That doesn't mean they have a whole lot of
problems they are working through, it means they are, you know, "the unlived life is not worth
living," they have a curiosity about themselves. The ones who don't have that, I would question why
you are going into this field. Because it isn't the best moneymaking gig in the world.
The interviewees did not specifically mention either satisfaction or dissatisfaction
with their income. They did, however, mention abundantly the implicit joy and satisfaction
that they took from their vocation.
Passion and commitment to the practice of psychotherapy does not preclude
interests outside of work. In fact, it may be that balance of work and outside interests,
especially including family, may be a facilitating factor of passion, if not a precondition.
If anything has served me well, I have some other things in my life that give me balance; this isn't my
one and only passion. If you look behind you, there is a strange piece of furniture, I make strange
furniture and I go home and whittle away…My other interests are a big part of my life (PCP 6.)
63 Another interviewee gives advice to beginning psychotherapists:
Make sure they do things and have things in place in their own life to take care of themselves. To
enjoy life, whether it's with a spouse or partner or family or friends or on their own. Having things--
realize all of life isn't work. There is a time and place for work, and a time to let it be. Let it sit
and stay at work. I don't know the skills for doing that, but I feel I have been lucky and have been
able to do that well. I think the biggest one for beginning therapists is to make sure they keep their
own personal life a healthy one and going well, keep refreshed (PCP 5.)
I think that in the beginning, people would have said that I was passionate in my work. I think
they would have said that in graduate school, and at different points in my life; but I think that in
this role, with comprehensive, real difficult cases, I don't think I could sustain my passion if I didn't
have a balanced personal life. Because I think this job-- and it has, a couple of years ago-- kind of
can take over, and so I've learned that even with passion, the job kind of can take over, and without
balance I will burn out (PCP 4.)
It is noteworthy that, although balance was mentioned by all of the interviewees,
clear differences are noted between one subgroup of passionately committed
psychotherapists who have a relatively easy time maintaining balance, and the other group who struggle to maintain such proportion.
Typical of the first group (PCP 14):
There are therapists here who will come in on the weekend and do their paper work. I'm not going
to do that. My weekends are my weekends. I try to keep everything in perspective.
Significant sub-theme: Difficulty in finding balance
In spite of its universally acknowledged importance, some subjects describe a
decidedly difficult time finding or maintaining that balance.
64 I've had a few set backs with my health problems, but even that has been pretty beautiful once you
are on the other side of that, and have time to really reflect on that. That's the thing about
community mental health, you're always so busy you don't have any time to reflect or maybe read the
literature, to see what's the latest, because you just see one person then the next person. It's been
good for me to pull back, like I haven't done an intensive group for four months, and it's been good
to pull back and see what I value and so I want to make sure I keep that, so I know where I am
going. (PCP 4)
For at least some passionately committed psychotherapists, their passion for the work makes it difficult for them to honor the goal of balancing their other interests, and even self-care. In fact, eight of the subjects describe being confronted with some type of crisis before they realized that they needed more balance in their life:
I think a couple of years ago I ended up with some health problems because I worked too much. I
ended up with Bell's Palsy, and so those are wake up calls for me --that's why I am working on
being balanced. I think even then, people would have said I was passionate, but I know I didn't
have much in the tank. It's me just learning how to balance out, because it's really easy in this kind
of job to be taken advantage of, not because people mean to, but the cases never end, there's never an
end to intakes. So it's really me that has to learn how to set those boundaries, and not to think it
needs to be me to see all the women of trauma, because there's so many, I can't see all of them.
(PCP 4.)
I said, "One of my clients killed himself and I don’t think I can work tomorrow." So I stayed
home. And they just went, 'oh you poor thing. OK, stay home.' Nothing that's going on with me
is life and death, you know and we talked about a safety plan. If something is life and death, this is
65 what we need to do. I mean this is 12 years in the field and I’m just now figuring this out. But
again, it’s the response to a pretty serious crisis. That’s the worst I’ve ever been. (PCP 3.)
I’ve got my DBT people calling me at home, so you know, you have to have kind of rules, like, you
know don’t sit at the kitchen table to take a phone call, don’t sit on the couch, don’t talk about
work in bed, if we start to, we have to stop, but we can sometimes feel like it’s 24 /7 so we both
have to be really, you know, disciplined at home, because we work with some of the same people. I
do groups with some of the people that (husband) case manages, so we have to really be like, no,
come into my office at 4:00 and we’ll talk about it then, we’re not going to talk about it on the way
home. We screw it up all the time. Definitely, like a half-hour will go by and we’ll say ‘Oh, shit,
we’ve got to quit talking about this’. So we try, we have to make an effort at it, that’s for sure.
(PCP 2.)
Adaptiveness/Openness
Dlugos describes two sub-categories to this general theme: 1) Viewing obstacles as challenges, and 2) Hunger for feedback from supervision. Both of these sub-categories were supported in this study, and an important third sub-theme of adaptiveness emerged which had not been observed in the Dlugos study: 3) Confidence in core psychotherapy skills.
Sub-category #1: Meeting obstacles as challenges
Nine of the interviewed passionately committed psychotherapists (60%) described the fact that they thrive on challenges, or that they take difficult assignments and turn them into challenges:
It’s a challenge I think with working with the seriously mentally ill. The thing I enjoy most about
psychotherapy is getting people to change and getting them to change their lives and with the seriously
66 mentally ill you have to change your expectations. So I don’t find it revitalizing to work just with
people who need a friend and a social support (PCP 1.)
I didn’t think borderline women would be a good fit for me. I thought they’d be a nightmare for me.
Really bad. I had a big temper tantrum when I thought they were ‘dumping’ (names co-worker's)
caseload on me. But you know, what are you doing to me? I work with teenagers. These are
personality disorders. I know nothing about personality disorders. I had a fit for about 10 minutes,
and then I went oh, this really might be kind of interesting. You know, sometimes I have a little
hissy fit, and then I realize this could be a great opportunity. (PCP 2.)
It’s challenging--it’s using that creative process. You kind of have to out-maneuver them. And they
know when they’ve got someone that they can just steer all over, and they have a fun time doing that.
They also know when they have met their match. And I think they have respect for someone that
will say, 'Let’s not go there.' …Oh, I think the most difficult things in life are also immensely
rewarding. (PCP 7.)
Sub-category #2: Hunger for feedback through supervision
Eight of the interviewees (53%) discussed the importance of supervision, including peer supervision. All but one of the subjects reported that they received supervision, but this usually took the form of organizational supervision, which some valued highly, or, more commonly, weekly peer supervision in the form of case staffings, or informal "hallway supervision." These individuals valued the importance of this chance to discuss difficult cases or merely to talk about what they had done:
I really think that collaborating with colleagues and making sure you get a good supervisor. I mean
I really lucked out. I really lucked out, and…um… I know, well, as a graduate student I looked
67 at the clinical, and did my internship here and my supervision, not as a graduate student. It was
not good and so I took it upon myself to go out and find supervision from everybody else in the clinic
- just ask lots and lots and lots of questions, you know, and um… that kind of thing. And then I
would… I'm really a big believer that after going into it as an expert, that's a pretty tall order to
fill. And I don't know that you can ever fill it. (PCP 10.)
Probably not taking extra time to just talk. To talk about countertransference, to talk about how
life in general is going, (my supervisor) will ask, "how are things in your life?" and he's not asking
how I am as a therapist, he's talking about it in general. I think if the supervisors didn't care, or if
they were all just Type As and interested in how things were business oriented, that would probably
drive me insane, if there were no feelings or emotions about it, just "get everything done and don't
come to me." I've worked in different fields like that, and it is really bothersome. You want that
support, people in (names organization) have said children's outpatient is the best place to work,
because it's not like that throughout (organization.) (PCP 13.)
Sub-category 3: Confidence in core therapy skills
A third sub-category emerged from the data that also fits with the theme adaptiveness/openness. This sub-category is "confidence in core therapy skills" and connotes willingness to accept new assignments or challenges without preconditions of expertness or confidence in mastery of a specific knowledge base. What is suggested by this confidence is not a willingness to practice sloppily or negligently; but rather, suggests an acquired confidence that they possess the core skills of psychotherapy, and that the more diagnosis-specific or model-specific skills can be acquired "on the job." Several of the interviewees described being anxious and feeling insufficient for their jobs early in their careers, but later developing a confidence in their core set of therapy skills.
68 Pretty much everything, like for example when (names co-worker) left, she had this whole DBT
caseload, and I got it, no training, had no idea what DBT was, all I was told was you’re kind of a
Zen Buddhisty kind of person, you’ll like it, just read the textbook. I don’t know if you’ve read the
book, but ‘like hell I’m going to read it’. When would I have time - with my 50 other clients, and
now my 20 new DBT clients. I’m sorry, I’m trying to read that thing. So I just read the manual,
got the gist of it, and got this group of 5 women together and said “I don’t know what I’m doing,
this is totally me winging it, and the only reason this isn’t going to be a waste of your time is because
I do have an education and some experience in the field, but I’ve never worked with the diagnosis
before and you guys have all been through this group once before, so you need to let me know when
I’m insanely off-base and let’s just do this together” and it worked out great. (PCP 2.)
I remember back then, that I used to think there was so much I needed to know, and there just isn't. To give themselves permission to not know everything, and to learn to say no, and also to have interests outside of work. I don't think work can be the only thing that brings you joy, you've got to do that on your own. With the students I've worked with, we've really talked about that, and I've given them the understanding that it's okay in the beginning to take very few clients and to build their confidence. I didn't know those things, and didn't know to ask those things, so in the beginning I got in way over my head, way fast, so you have to learn by experience. (PCP 4.)
Overtime it has evolved. Initially, it was more of an anxiety state, "Oh my gosh, they're going to
want something, and I don't get it, I'm just so confused." Now it has become much more centered, I
can be okay with not knowing. So at times, it's not knowing what do I need to know, what do I
need to get out of this, what am I missing? So it is much more of a meditative, centered state when
I'm working. (PCP 13.)
69 I'm okay with failure, I wasn't at one time, but I'm okay with failure because I see that failure is
about learning from that failure. I'm determined to learn as much as I can, so that's another
balance. And the other piece is spiritually, I'm a very spiritual person, so I recognize for my clients
to have success, they have to have balance as well, so I bring that aspect into my treatment. (PCP
15.)
It is important to note that this lack of perfectionism does not indicate that these
individuals have slowed in their quest for learning and growth as clinicians. As will be
elaborated upon, this trait of confidence in core psychotherapy skills co-exists with a very pronounced hunger for supervision, growth, and learning.
Category #3: Transcendence (supported)/Humility(not supported)
Dlugos' third category, Transcendence/humility, was defined by its two sub-
categories: 1) Recognition of the spiritual nature of psychotherapy; and 2) Locating the
significance of psychotherapy within communal and social responsibility. These sub-
categories were confirmed within the data of this investigation, although the label selected
for this category is somewhat misleading. Although themes of the spiritual nature of
psychotherapy and the significance of this role were prominent in the interview data, none
of the subjects discussed this in such frankly religious terms as would be connoted by the
term "transcendence."
The "humility" aspect of this label was neither supported in this research, nor in
Dlugos' original data. In fact, many of the passionately committed psychotherapists describe
more hubris concerning their abilities than they do humility. One of the subjects in the
Dlugos study makes this point:
70 I'm using that talent. Because I know it's a talent. Sometimes you look at people who are ice
skaters…and you watch them and say, "Oh, that looks really easy," and then you put on a pair of
skates and get on the ice and you can barely stand up…I've had people who have supervised my
work…and they'll come out of a session with me and they'll say, "I can't believe you reached that
person in that way, you know, how did you do it? …" (Dlugos, 1999.)
Similar to this subject of Dlugos, many of the psychotherapists in the present study demonstrate an unswerving confidence in their ability as a psychotherapist. Most passionately committed psychotherapists take some pride in the fact that their commitment is exceptional, and demonstrate an understanding that this is not true for many of their colleagues. PCP 1 makes this point:
I feel like if they had seen another therapist, and this may be justified or not, but I feel like if they
had seen my good colleague, or your garden variety of therapist, this might not have happened for
them. And again, maybe a little of hubris is to overestimate one’s ability and to assume maybe that
my approach was what made a bit of a difference. If someone has changed and grown, you might
think that’s probably because of some of my above-average abilities as therapist…especially if
someone comes back and says, 'I’ve worked with so and so or I’ve been in crisis at 2 in the morning
and kind of got blown off by Jim, and that was not what I was accustomed to'.
Sub-category #1: Acknowledgment of the spiritual nature of psychotherapy
Many of the nominated therapists did speak to their own spiritual natures or the spiritual, trans-personal nature of the psychotherapeutic process, as in this conversation from an interview with PCP 15:
I look at, I have a belief that I have to do the footwork in life, but at the same time I come into
connection with people for reasons that can't be answered. And knowing, recognizing, I feel like I
have the ability to recognize when that very positive energy is going on in my session.
71 You see that connection as meant to be?
I do, yes.
Doesn't happen all the time?
A good part of the time. I wouldn't say always, but a good part of the time I can recognize that and
feel it. Without guiding my clients there have been many times when they have actually
acknowledged the positive energy that is going on within the session.
PCP 6 makes clear that he distinguished his spirituality from religion:
I'm not dogmatically evangelical in any religious belief, but I draw a big distinction between
religiosity and spirituality, and I consider myself highly spiritual and not religious.
Although PCP 8 talked openly about using Jesus as a role model, he also makes clear
that he distinguishes this goal from any kind of religious belief:
Shortly after that I went to college and studied biology and all this stuff, and I realized that the
theology of religion is insane, as best I could see, I couldn’t see any sense in it. But being like Jesus -
I quit praying, quit going to church, and so forth, but there’s something about this message of
salvation, and if you believe you go to heaven when you die, and if you don’t, you go to hell, I
thought, I don’t even want to have anything to do with that God. Being like what Jesus was like,
being in an interpersonal situation and thinking, what would Jesus do here; it wouldn’t be unusual
to try to go in that direction.
The most common way for passionately committed psychotherapists to describe the
spiritual nature of psychotherapy is to make some reference to the almost magical things that happen during a psychotherapy session. PCP 9 makes this point:
I still am amazed at the very un-namable things that happen in psychotherapy and the power that
that relationship holds, and the very real almost trans-personal events that take place, I can't
describe it better than that.
72 Sub-category #2: Locating the significance of psychotherapy in communal or social
responsibility
Consistent with the sub-category of "locating the significance of psychotherapy in
communal or social responsibility," ten of the interviewees (67%) emphasized the
importance of the role of psychotherapy in helping others, or contributing to the
community.
And promote change and in public mental health sometimes our clients are not motivated to do that
so I also find that very energizing. Helping them change and improve, but even just being there and
having that closeness and connection to people that may not get that. So that idea that sort of
humanistic ethic. I find that very vitalizing. There are few professions I think where you can help
people in as substantive a way (PCP 1.)
Again, one thing that comes to mind is that I just feel that I've always had a care, a concern, about
people. I think that is mandatory for someone to be a passionately committed psychotherapist, is just
a general care for your fellow man, for people that are uncomfortable. (PCP 5.)
PCP 9 describes having selected public mental health precisely because of his sense of responsibility to the community:
Private practice doesn't appeal to me. It never had when I got into this. Personally I consider it
corrupt. There's a huge incentive to keep somebody sick. Here there is none of that. I feel very
wanted by this group of people. I feel very, very necessary to the group effort. I've never had the
feeling that what I do is superfluous or we're just here because of the Medicaid role, you know.
People bring clients to me and say "Can you help this person?" and so that helps me understand
that I've got a role here.
73 PCP 11 describes that one of the unique aspects of community mental health is that
the role of the psychotherapist may go beyond interacting with the client in the office
setting:
Yeah, I think to work somewhere like this, you have to be able to see well beyond the realm of the
therapy room to help people. You have to understand Maslow's hierarchy of needs. You've got to
understand the kids are embedded in families and communities and you have to be able to see all of
that to really be able to help them. To take a child into your room week after week and work with
them without this understanding has limited value, I think. I would more often be here with the
family, talk to the school, change something in the community about how they react to this kid. So
you have to have a social worker's view of things. We have psychologists here, but they are basically
acting like social workers, maybe do a little bit of testing, but really act in a social worker role.
PCP 9 notes, perhaps with apology, that he is motivated by his sense of
responsibility to the larger community:
I do believe that part of what clicks for me is the sense of helping them, that I'm making the world a
better place. It sounds corny, but it really does feel like that. Like I'm not just out there trying to
market something that won't better someone's life, you know, the latest VCR or DVD or
whatever, it's not like a marketing technology.
Category # 4: Intentional Learning
Very prominent in the data resulting from these interviews is the fact that these
passionately committed psychotherapists value personal growth and learning. As previously
described, little mention was made by any of the interviewees about feeling stale on the job
or needing to add diversity to the job role. Instead, they emphasized that they felt like they were continually growing in the job.
74 Within the category of intentional learning, Dlugos identified three sub-categories: 1)
recognition of the complementarity of personal and professional development, 2) understanding that work as a psychotherapist allows for congruent self-expression, and 3)
continual fascination with human development and change.
This general category of intentional learning was strongly supported in the data from
this research. The second sub-category, "understanding that work as a psychotherapist
allows for congruent self-expression", can be stated much more parsimoniously: fit. The
amount of data that supports the concept that much of what makes a passionately
committed psychotherapist is a goodness-of-fit between that person's values and personality
and the job role, suggests that "personal fit with role" warrants its own, general category.
Furthermore, this concept of fit transcends the concept of intentional learning. These data
will, therefore, be described as a discrete general category rather than here as a sub-category
of "intentional learning."
Sub-category #1: Complementarity of personal and professional development
PCP 10 clearly exemplifies her belief that there is a complementarity of personal and
professional development, and that she internalizes the therapeutic concepts with which she
is working. She is discussing why it is that non-passionately committed psychotherapists
burn out:
They keep it at the intellectual level. And they may get to the personal level, but then they feel like -
if I have to use these skills then there's something wrong with me. Or what kind of therapist am I?
I should have everything all together. Well I don't! And I use what I teach other people to use and
I'm not ashamed of it. I'm just a human being trying to get through life like everyone else. I guess I
don't see myself as that much different than all of my clients - well, all people, and I think to the
level where you feel like you have to keep it intellectual and you have to be an expert, and you have
75 to have all of the answers and then like some wise sage you can impart all of your wisdom on to
somebody…
PCP 14 also illustrates how his thinking about how and why people change affects his own personal life, with something as common as commitment to an exercise program:
Sometimes we are unhappy, and we don't know why, and so our next step is to find out about that
unhappiness that is there, so that is that beginning recognition that something has to change, and
then sort of searching for the pieces of that, what is making me unhappy right now, what can I
change and then moving through that to making a commitment to actually making some investment
in changing my own life. Even my wife and I were talking about a commitment to an exercise
program this year, I think we all do that, we all look for something that is not quite right in my life,
and once we become aware of the specifics of that, it all becomes easier, and then the next step is
looking for how can I implement that on a daily basis, and how can I keep committed to making
that change. I really do like their model.
PCP 8 makes describes the synergy that he believes exists between his own
"enlightenment" and that of his clients:
My own ability to experience this is linked to my willingness to share and teach it to others, which
make it more available to me. Yacinski says to work on three lines to achieve anything, because
otherwise you always get deviated. Nothing ever goes to completion, so if it was just me trying to
become enlightened, I wouldn’t make it, but if it’s me trying to help others have it…
Another passionately committed psychotherapists talks about not only helping
others but also yourself:
It's good to have that "Let's go change the world" but how you promote that in your own
life is your capability of forming relationships, and enjoying those relationships. (PCP 13).
76 Subcategory #2: Continual fascination with human development and change
Many passionately committed psychotherapists in this study describe an unending fascination with people, and curiosity about them that is both intellectual and personal. This curiosity serves as a source of energy in their job roles. PCP 6 observed of himself:
I think I've always had an intuitive sense of what is going on with folks, I've told you I
contemplated going into different areas, I was going to be an English professor, and artist, but I
probably would have been it for a week or two. I think there's a common thread through all of that,
it's a fascination with the human drama. My mom used to read tea leaves and used to see herself as
psychic, not that I see myself as psychic, but I think I have been able to see what is subterranean, or
what was hidden, and that has sort of fascinated me.
PCP 8 describes this interest in a way that suggests both an intellectual interest, and also a spiritual component:
I really love this study of what it means to be human, and this process of transformation and the
possibility of joy, and love, and invulnerability.
PCP 9 describes what he is like during a psychotherapy session in a way that indicates the curiosity that he maintains in going about his work:
I think you'd see what you are seeing now. I think it would be reversed, I would sometimes be
interviewing you, because I would be curious. I would really want to know what is going on, and
what you are thinking about and where those thoughts are coming from.
PCP 11 makes clear that this curiosity is a significant part of what motivates him as a psychotherapist, and also how it is a curiosity that is very personal to him:
It's interesting--when I was fifteen or sixteen years old, I used to go into the old part of town to look
at the interesting architecture. I would walk down the streets, and for some reason I had this real
77 curiosity about what was happening in those homes behind those doors and windows. I just had this
sense of curiosity, and wondered what kind of lives were going on there. I think it's because my life
had been so hard for a while there, so I was curious what other people's lives were like and what was
happening, I had this intense curiosity about it. That's almost what I am like when I meet new
people in therapy. I just have this real curiosity about who they are and how they got to be the way
that they are, how they function, and in a larger sense, families just fascinate me, the system does,
and in the larger sense, how they are embedded in the community. It's the same kind of thing; it's
this intense curiosity. I think that people are so interesting, and really wonderful, they're just great.
Category #5: Personal Fit with Role
Perhaps the most prominent data in the study supports that these psychotherapists are passionately committed to their jobs as vocations because they experienced a superior fit in their job role. This fit represents ease between their own personal values/personal characteristics and what they do each day in their job.
Most simply defined, this fit means that they love doing psychotherapy. These individuals do not report burnout because of active strategies to preserve themselves.
They don't burnout because doing psychotherapy is not stressful to them; it is pleasurable most of the time. With the exception of some initial insecurity about their lack of experience, most passionately committed psychotherapists report an instant sense of being at home in the psychotherapist's chair. This belief that they were "made for this job" does not change over their careers, but remains part of their sense. They are intrinsically motivated to do this job because it is intrinsically reinforcing to them: they like doing psychotherapy.
Some of the densest data in the study occurred in answer to the question, "What are your energizers at work?" A robust finding was that these psychotherapists are energized by
"getting to spend time with clients."
78 I love it because it's life and there are other people, and however they show up in life is how they show
up in this group, because they can't do anything else, whereas in here this is such a sterile
environment in my office, so I think this is what keeps me energized. Right in the moment I get to
see how they show up and we get to work on it right in the moment, kind of like a piano lesson they
are playing and I'm right there, and so the kind of work, and the style, its just a good fit for me.
It's energizing, it just is. And they love it because they can feel a difference, so they are making
progress, but I'm also being richly fed, because therapeutically it's just invigorating. (PCP 4.)
If "fit" is a significant part of what makes a passionately committed psychotherapist,
the real challenge from this data is to determine what constitutes this good fit. If these
individuals are passionately committed because who they are naturally fits the role of
psychotherapist, what are the personal characteristics that make this so? What are the
characteristics of someone who is energized by doing psychotherapy? Emerging from the
data are the three sub-categories that comprise the general theme "personal fit with role."
These sub-categories are: 1) Will to intimacy; 2) Drive for personal purpose/meaning, and
3) Stimulus seeking.
Sub-category #1: Will to intimacy
A thematic thread that connects all interviewed subjects in this study is that they
derive pleasure from the intimate connection that develops during psychotherapy. This finding emerged spontaneously during the interviews, and themes of "intimacy" and
"connectedness" became prominent in the conversations. All of the interviewees demonstrated a sound sense of professional boundaries with their clients, and many made clear that they not only understood that their role was not to be the "friend" of the client, but also that they did not desire to do so.
79 I don’t find it revitalizing to work just with people who need a friend and a social support as far as
a low point, it’s difficult not to get a little bored, to get bored with some of the clients that are…kind
of like you’re in a rut with those clients. So that can be a little enervating I suppose but those are
sort of transient moments. (PCP 1.)
Although the professional boundaries are respected and intact, many of the
psychotherapists talk about the relationship in sometimes frankly personal ways.
Descriptions of the importance of this intimacy, and even "loving" their clients were common. Their description of the relationship that they seek with clients is materially different than that which might be found in formal training programs. PCP 2 talks poignantly about a client of hers who had suicided:
I think it was a personal loss more than anything. I really loved this kid. He was the kind of kid
that I really saw myself, you know getting a wedding invitation in the mail, 15 years from now
saying I’m in New York, and I’ve found the perfect woman. This was a kid I kind of knew would
be around. For me it was more than professional, way more than professional. It was just more
that I really, really liked him.
PCP 5 discusses that one of the ways he "keeps the juices flowing" is treating his
therapy relationships in ways similar to his other relationships:
The biggest one is trying to interact with people the same way, no matter where I am. Whether it's
at home, or church, or in therapy, I just try to be the same person wherever I am at, that takes some
of the load off.
PCP 7 discusses what is energizing about the practice of psychotherapy:
Making that connection with clients, not as a patient and therapist, but on a very personal level, I
look for that all the time. That is my joy.
80 None of the interviewed passionately committed psychotherapists describe a therapeutic relationship that even remotely resembles the "as if relationship" proposed by some psychoanalytic schools of thought (Casement, 1985.) Although they establish that they respect the significance of professional boundaries, and often emphasize their role as healer, they were unabashed in their descriptions of their own will to intimacy:
PCP 8 describes succinctly how he interacts with his clients that maintains his
passion and commitment to the work:
Just loving them.
Another psychotherapist describes how he relates to his clients during a session, and
how it differs from an "as if" relationship:
I try to be me. It's the information that I share, that I hope is about them, and not about me. I
don't try to pose or act in a certain way, or pretend that I'm not feeling something when I really am.
I usually tell them that I am, or try to reflect back to them in that very annoying way that some
therapists do as if I never had an opinion about anything. If I have an opinion about things, I'll let
them know right off the bat. One client I-- well, I didn't kick her out, but I was on the verge of it.
She stomped out of my office when I refused to let her use the word "nigger". I just didn't want to
hear it, it's ugly and not in my office. I'll take the therapeutic hit in that one and I did. She
walked out and said I wouldn't let her express herself, which was true. And I won't, I'd reached
my own line with that. But that's very, very… I don't think it's happened again. But no, I don't
try to hide behind any analytic façade. Where you are is where the client sits and I sit where I am.
I like to sit facing them, I don't like an off-angle so eye contact can be avoided, and I like to see if we
can relate for even fifty minutes. (PCP 9.)
He elaborates upon this later in the interview:
81 What I have learned in my little time doing this is that people want to be related to and taken
seriously as human beings. They don't want--I wouldn't want-- my feeling in my training years, and
here in my work, is they don't want a machine and they don't want someone who is going to
"scrutinize" them. I don't want to ever be viewed as someone who scrutinizes. I want to be viewed
as someone who joins and listens to them, and takes them seriously. Because what they say is
serious, and if they are bullshitting you, it doesn't matter, because the fantasy is just as valuable.
PCP 11 infers that the intimacy that feeds him during a psychotherapy session is not necessarily accepted as a standard practice:
I had a friend who was a therapist for years and he was retiring, he had been a therapist for thirty
years. I talked about therapy being an intimate experience for me, and he just about bristled. I
don't know what he was thinking, but to me it is a very intimate very engaging relationship. To me,
that's what makes it work. The other person, so many people we are working with have never had
that, never had that foundation, never had that other person appreciate them. A woman I am
working with right now, and I find it appropriate, at the end of the session she gives me a hug, and I
think it is appropriate in the situation, but I don't think that has happened in ten years, three
times. I don't do that, I keep that boundary clear, but for some reason this woman, and it seems
appropriate to me, she said "Am I violating your boundaries?" and I said "no, I'm fine with it."
But it's a very engaged…I don't sit back and be real clinical about it or…
The passionately committed psychotherapists who were child therapists also emphasized the importance of intimacy, and the genuineness of the relationship
It is a genuine emotion. I play with the kids, I get down on the floor, I use humor a lot,
joke around with the kids, and joke around with the family. (Names supervisor) once told me it is
about the relationship; it's not about the knowledge that you have, so I really took that to heart. So
I have fun with my families. When it comes to business, we get down to it and we do what we need
82 to do. Sometimes we are just talking, and it has nothing to do with therapy, which is about getting to know them. Not that I divulge a great deal of personal information, but it is just, what do they like, what do they not like, what do they do, and try to work on that. I'm a kid myself, in so many ways; I'm an adult with a kid's frame of mind. I know the latest music; I can talk to them about things on their own level. Parents and I will laugh about how we feel, because they don't even know what Gilligan's Island is, but we have a good time that way. There is this one mother, and we do that a lot, and we will start laughing, and that is an icebreaker, just to have fun. Even when we are having fun, I can ask them questions and they will talk to me. My supervisor would probably say,
and I think he's probably right, that sometimes my engagement, although it works, may be too fast
paced. He is going to work with me on that. (PCP 11.)
Perhaps another thing that I do, and I don't know where I picked that up, but I have a really
strong ability to remember what they have talked about. So somebody says, "you remember so-and-
so, and remember how I was having…" and I can recount some of that situation. I think it says,
"yeah, you really are paying attention." Because it is almost like I can replay their life. Very often
I get feedback, "how do you remember that stuff about me?" I think that is one of those natural fits, one of those things that makes it work for them and more enjoyable for them, in that I really do enjoy that connection. (PCP 12.)
PCP 15 discusses the importance of this attachment as a specific therapeutic strategy:
Especially when I work with such a continuum of reactive attachment disordered children to kind of
the budding borderline adolescent to the full blown borderline personality disorder, and attachment is
such an issue when it comes to treatment and successful treatment that if I'm going to expect them to
trust me, I have to show them that I trust them as well.
83 Among the most commonly recurring themes in this investigation is the expression that, not only is the intimacy in relationship necessary for therapeutic change to occur, but that attaining this connection is what motivates the psychotherapist in their work:
So I think the interconnectedness is… you know I’ve spent half my career here in a small town, and
I really get attached in a way you don’t in the city. I see these people at City Market, I see them at
the library. I see these people at the movies. It’s not that my clients live in one part of town and I
live in another. It’s not that I see them once a week and it’s very isolated. I know their
grandmothers, and I see their aunts and uncles passed out on the lawn drunk on the weekend. I see
the living/walking genogram everyday. There’s an intimacy. (PCP 2.)
I think it's the relationship that gives energy to me, being able to connect up with another human
being and to share of their world and to… I think that's what provides energy. I think that the
relationship that you develop with somebody in therapy is most of the time, just incredible. It does, it
produces your energy for the day and for the moment of the session, I think that is where the energy
comes from. (PCP 11.)
This will to intimacy may be a defining characteristic for personal traits that will "fit" in the role of psychotherapist. PCP 14 describes how this desire for connectedness may be what determines whether one will, or will not, become a passionately committed psychotherapist. She contrasts the desire for connectedness with clients with an intellectual interest in analyzing them:
I think it's all about fit. I think that developing skills, learning new techniques, and training helps
as you go along, but if the fit isn't there, you won't be happy. I really do think that good therapists,
or happy therapists, whatever, are born and not made. You have to have the instinct, you can learn
the skills, you can learn what to say and kind of what to do, but I think you learn those things
84 based on your own style. I think my style isn't the only way, it just kind of works with my
personality. I encourage my students to hang with lots of therapists to try to pick up things from
them in a way that works with their personality. But I think unless you have that instinctual
feeling about things, or something, just learning the skills or the rote stuff isn't going to make a lot of
difference. You kind of learn what to say and what to do, but unless you feel it, I don't know if you
can learn to get that feeling, or if it is just there. I think it is just there. I think you get inspired.
You may not realize it's there, but then something happens to light the fire, but I don't think that--
I don't know, I sort of worry about people who come in-- not so much with kids therapists, kids
therapists tend to come in with this energy, but with adults, "I'm really interested in understanding
people, and figuring out what makes people tick," and it's (makes snoring sound.) I don't know
that that is it.
Sub-category #2: Drive for personal purpose/meaning
This sub-category overlaps the sub-category of "Transcendence" labeled by Dlugos
"locating the significance of psychotherapy in social/communal responsibility." But the
drive for meaning is such a salient characteristic of the personal fit of the individual in the
psychotherapist role, however, that it also moves beyond a general sense of communal
responsibility. For these passionately committed psychotherapists, the drive for significance
in their work is deeply personal. The interviewees' discussions of why they chose
psychotherapy as a career, and what energizes them while doing psychotherapy, are replete
with personal stories of how they came to believe in the importance of doing work which
helps others, either individually or in the communal sense.
Although it is likely that any psychotherapist will mention "desire to help others" as a motivating factor, there is ample evidence in the experience of these passionately committed
85 psychotherapists that they have internalized this goal. The drive for purpose in their work is very personally held, and it makes psychotherapy a vocation for them as well as a career.
I never had that as a goal (becoming a psychotherapist)-- I've been thinking about that this
week, anticipating that you would ask that question. We have a history of mental illness in my
family. As a child, we dealt with a grandmother who was in and out of the state hospital, and that
was a shameful thing, something you don't talk about. I had no idea what was wrong with her,
other than she was "crazy". And I got as many records as I could and interviewed people, and she
was just a very depressed woman who had a strong desire not to be here anymore, and that was her
illness. I have a sister who has struggled with major depression, has been hospitalized, had ECT,
and I realized that's what triggered me-- I went to Social Services-- I had intended to be a sculptor.
I had a scholarship to go to Denmark to work on a Masters Degree, and didn't have any money.
Found a job here as a social worker. All you had to have was a bachelor's degree back then to do
that. And somewhere, in that whole process, I became aware of the whole area of mental health.
And I remember one night seeing something on television that made it clear for the first time that
there was some connection between mental illness and biology. That was just a revelation to me, and
that fascinated me. Probably because of the family connection, but more than that, that just
resonated with me. Somehow, that got me interested in the whole area of depression. (PCP 3.)
PCPs 9, 11,12, and 13 also describes how personal experiences served as a basis for
them to dedicate themselves to a career in mental health:
Witnessing the process when I went for psychotherapy when I was about 24 years old. Recognizing
that psychotherapy had a profound effect on the direction in my own life and my own conception of
myself, and improving how I felt and what I did in my life. I was astonished at that improvement,
it was so much so that I wanted to learn how it worked and how that happened, and then in that
process I learned that I wanted to do that myself, you know. Could I be part of that? Could I be
86 on the other side of the fence in that equation? Because I see it as endlessly fascinating, how that
happens.
I think it's because my life had been so hard for a while there, so I was curious what other people's
lives were like and what was happening, I had this intense curiosity about it.
On a personal note, I had been married very early, she (his wife) had a son, and I think one of the
things that spurred that, I want to be a decent parent, and began studying more about kids, and it
just sort of evolved to a profession rather than a family.
Well, it was a long time ago. Way back. I've always liked kids. I was always the neighborhood
baby sitter. I was the oldest of five, always really liked my younger brothers and sisters and loved
taking them places. And at some point in high school when you were trying to figure out what you
wanted to be when you grew up, I decided that I wanted to work with emotionally disturbed children.
I don't know why, that just sort of came to me. I had a cousin, who was mentally retarded, and so I
was sort of interested in special kids, but I didn't know if I wanted to work with the intellectually
handicapped. But the emotionally disturbed just sort of intrigued me. And I think, looking back,
my high school counselor said, "Oh, so you want to be a special education teacher" and I said
"Okay." I was from a blue-collar family so I wasn't really-- I didn't know about therapists or
psychologists, it just wasn't part of my experience, so that is what I went into.
Regardless of whether or not the interviewees had personal experiences with psychotherapy or mental health, they emphasized the profound importance of a career that helps humanity:
87 For me, I grew up Christian, a Christian household in the LDS church--very devout Mormon-- not
the kind that you might live around up in Alpine. I think I’m more of a liberal. The humanistic
ethic, if a person--the church whether it can be criticized in some ways or not they’ve done a good job
as do most religions in general whether it be eastern religions… they promote a humanistic ethic
which says to help other people is good, to serve other people is noble, it is a substantive pursuit. So
I grew up in a good household where you kind of learned that--if you’re too much into yourself, too
hedonistic, just even focused on your own needs is fine, but you should be interested in serving other
people. And that’s values, and I find that there may be days where I look at my caseload and look
at who I’m seeing and say “Oh, man” but I think "I'm a therapist. I’m in a helping profession."
So many professions are about making money for your family, and getting people to buy your
products and that’s their profession… (PCP 1.)
Significant is the way PCP 2 talks about the meaning in her work:
My life is not hard work. But I think you still need to believe, and feel like you’re doing
something meaningful.
Although the need for meaning in her work permeates her interview, she makes a
distinction here that is implicit in most of the other interviews: doing psychotherapy is significant, but also pleasurable. Passionately committed psychotherapists talk about how important they believe their work to be, but they do not stay in the field because they are duty bound-- they stay in the field because they love it.
Passionately committed psychotherapists do talk about their careers as vocations,
and some describe a sense of being called to it. PCP 2 describes her career in exactly that
term:
88 So I know that this is my calling, and I love it and it’s …I would do this….I always tease (names
supervisor) I tell him "you pay me shit, cause you know I’d do this for free" you know, and it’s true,
I would. If I won the lottery, I’d be right back at work on Monday Morning.
Many of the interviewees however, do not describe having a sense of a calling prior to their careers. They describe a very ordinary process of trying different pursuits, having difficulty in deciding majors, and having first careers that didn't fit for them. What they have in common, however, is that they found their way to the practice of psychotherapy, once they began practicing, they felt that they had arrived to exactly where they were supposed to be.
About 20 years ago, I was living in (names city in Utah), I was a pre-law major, and my
roommate at the time was working with autistic kids, and I thought there is no way I could do that.
I didn't have, I didn't think, that kind of personality. But then she said, "Why don't you just come
over and volunteer?" So I started doing that, fell in love with the kids, and didn't look back. I
guess I was more of a type A personality, and focused on what I was going to do. It wasn't until I
did my internship in Washington that I found out I absolutely hated what I was doing. Then when
I started volunteering, it was like okay, and I seemed to bond, and very quickly, with the kids. So
when a position came open, I changed my major and moved to (names city in Utah.).
PCP 12 also talks about the evolution that brought him to the practice of psychotherapy:
I started as a math major and taking a lot of philosophy classes and ran into (names a psychologist)
who convinced me that psychology was this beautiful blend of math and philosophy, and that began
my study academically. I did an internship with our children's day treatment program and just
89 really got hooked into that, and pretty much practiced in working with kids, either as a teacher or as
a clinician since then. It was an evolution.
PCP 15 expresses how, regardless of what brought them to the profession, a
passionately committed psychotherapists is defined when they "try on" the role, and find
that it fits them perfectly:
You know, I was incredibly nervous the first time. It took me a couple of weeks, but I felt more
comfortable in a therapist's chair than I had ever felt.
Sub-category #3: Stimulus seeking
A third personal characteristic that leads to fit with the psychotherapist role is stimulus-seeking. Clearly, if a psychotherapist is to consistently enjoy doing psychotherapy, he or she cannot be bored with that process. Passionately committed psychotherapists describe being almost constantly stimulated by the process of psychotherapy, and make reference to the fact that they are rarely bored by it. This stimulus seeking comes in two distinct forms: 1) Appreciation of the aesthetic form or process of psychotherapy, and 2)
Filtering for uniqueness.
It was noted that a high percentage of the therapists described one of their external-
to-work passions as some art or creative form. It was also noted that these artists, as well as
some of the non-artist passionately committed psychotherapists, described how they derived
stimulation from the aesthetic form or process of the therapeutic hour:
Well I offend people sometimes when I say this, but to be a good therapist, there has to be kind of an
artistic nature to the person. People who want to learn the formula, and can't get past the steps of
therapy, and can't turn it into an art form, lose interest. Because I think it really is an art form.
People who can't get excited about the flow that happens-- and can't get past which of the 12 steps
90 we are on-- people who can't do that don't seem to stay interested very long or aren't very productive.
That's what I think makes the difference. (PCP 3.)
It was common, especially for the artists, to make an intentional connection between their aesthetic and the process of treatment:
There are principles that guide psychotherapy, it is to a degree a science, but it is also an art. When
I talk about those moments of euphoria when you trust in your science and free yourself for your art
and the art directs you as to what the right intervention should be and you trust this intuitive sense of
what is underneath something and you move that rock and find what you are looking for. I f
somehow I could hook myself up to some kind of machine that could beep whenever I had a certain
emotion, that state is probably accessible to me in doing psychotherapy, or when I'm working in my
shop and thinking, "what is this thing going to look like?" and I have absolutely no idea
When you're hooked into that process, and again, it's that process, when you are connected to
something larger, and you are just doing your part in that and it's carrying you, that affective state is
very similar in both arenas (PCP 6.)
PCP 9 attempts to understand why there is this connection between the desire to
produce art and the desire to do psychotherapy:
But you're making an association in your interest in the arts - literally in art - and your interest in psychotherapy.
Absolutely, oh, absolutely.
Say more about that.
That's what these things are - these things are concretizations of what thought and perception and
interpretation end up being. One way we concretize it is behavior. But another way is in these
records of that.
91 He later makes the revelation that, because the need to paint and the need to do psychotherapy have their genesis in the same part of his psyche, he has lost the incentive to paint since beginning his work as a psychotherapist:
I think that it's because this (psychotherapy) is replacing that (painting) in a way that was very
similar. Something happens in this that happened when I was painting. I take pictures which is
like instant art - you know I'll just go out and just kind of in a sense draw a line around something
that I like. You know, and that's satisfying and I bring the pictures here. I change those, just kind
of as I think of it. But that does it in terms of getting that art ya-ya out. Now before, when I was
in school or when I supported myself for quite awhile building houses and when I was doing that I
would always need to be painting. If I didn't paint, it would build up inside me - it would be like a
compulsion inside me - it had to happen and I would go paint and I'd feel better again, you know.
That's just vanished since I've done this. So something about this and that are the same in me.
PCP 10 is also an artist, and she also describes the similar way in which she views her work as a psychotherapist and as an artist:
I'm always making artistic analogies in my therapy. I'm a very visual person, I always have my
board out that I'm, you know, writing on, helping people to see visually. Because of the particular
kind of work I do, as a fiber artist, it's very specific patterns that create beautiful pieces of fabric. I
can see, I can see patterns in a lot of things I do, and I can see patterns in behavior. I think it helps
me to see the patterns quicker. I'm always drawing. And my latest thing is that people are like a
kaleidoscope. All of the little pieces of glass are all there - the environment turns it and it looks like
a completely different picture, but it's all the same thing.
Other passionately committed psychotherapists who are not part of the visual arts also emphasize the importance of the process of psychotherapy. Their appreciation of the
92 process differs from those who describe it aesthetically. PCP 2 gives an example of how the process is, for her, a meditative one:
So that’s good for me, and it’s really meditative because I get to be present for 50 minute cycles, 6
times a day or whatever, and I’m just present and there, so I don’t know, it just kind of seems to
be…it doesn’t drain my energy, and I feel like I can lend my energy. I don’t know if that makes
sense, or if it’s too flaky, it’s not draining.
A second way in which this stimulus seeking is experienced by some passionately
committed psychotherapists is through filtering for uniqueness and growth. As was
previously mentioned, a difference was found in this data compared to Dlugos. Dlugos
observed that the subjects in his study sought to actively create diversity in their job roles by
seeking new types of clients, or adding non-psychotherapy tasks.
By contrast, the passionately committed psychotherapists in the current study
frequently reported that they naturally found variety in their job in a way that keeps them
stimulated. This variety is found by emphasizing the variety in individual clients, or focusing
upon individual uniqueness rather than sameness across individuals. These psychotherapists
expect change in their clients, and engage in a filtering process to note even small,
incremental change in their clients. This accomplishes the result of feeling that their clients
are evolving, which serves as a hedge against staleness.
Variety is also found, as previously discussed, by emphasizing growth and learning.
The job continues to feel new to them because they see themselves as constantly evolving.
The activities that they pursued to provide variety sometimes included non-psychotherapy
pursuits, such as supervision of students, but was more likely to involve learning new
therapeutic approaches to treating their current clientele. PCP 2 gives an example of how
variety is found naturally in her work:
93 I think it’s my clients, it’s getting to sit in front of people every day, and have… see what’s so
beautiful about people every day, you know getting to see that vulnerability, and unique
characteristics, it ‘s just really exciting. So I think that, you know nothing’s ever the same, I may
see the same client week after week, but things are different every time, so I think the variety is
exciting, and watching progress over the long term is exciting.
PCP 1 works in a rural setting, and feels that his role as a generalist provides a
natural variety in clientele that he values:
Practically speaking, we’re a small clinic. Most therapists here have to be generalists. I'm the only
full time therapist that works primarily with adults, so I have to work with whatever comes through
the door. And so I like that. I like that I’m not forced to work with these kinds of clients. And
so where there might be restrictions in a larger agency, I don’t get that here.
Most of the interviewees do not explicitly describe the ways that they seek variety.
For them, this filtering is expressed in the various ways that they discuss the expectation of change that they have for nearly all of their clients:
Probably the most exciting thing is that I don't think it takes a lifetime to undo a lot of this stuff. I
mean, we are always progressing as humans, but I think a lot of people think it took forty years to
get here, it's going to take forty years to get out, and I just don't believe that. So that's probably the
most exciting. (PCP 4.)
A common way for the participants to express their need for variety is to describe
how they lose energy with clients when their change expectations are not met. When every
session feels the same, even these hardy psychotherapists become enervated:
(The most difficult to maintain energy with are) the folks who are depressed and
who don't want to let go of their depression, depression has become their best friend, because the affect
produces secondary gain, or whatever, they just don't seem to be able to let go of that. (PCP 6.)
94 Where I find myself getting sleepy is when it is the same story over and over. Eventually I'll say
something, maybe not in two or three sessions of that, but eventually I'll say, "You know what, I'm
getting sleepy, and I think it's because I've heard this story so many times I can almost tell it to
you." They will look at me, like "I'm boring you?", and a few times I've said, "Yea, what else is
new?" or "Let's talk about why you are stuck right here. Let's find what this means right here,
and dig down a little deeper and find why it's such a sticking place. (PCP 9.)
While having difficulty working with clients who are not motivated to change is
unlikely to be a distinctive characteristic of passionately committed psychotherapists, what is unique is how rarely they experience their clients as being difficult or unchanging.
General Theme # 6: Passion-Supporting Beliefs
Passionately committed psychotherapists do not view psychotherapy as difficult.
This is a key and distinctive characteristic of these individuals. The data resulting from these
interviews reveals that they have implicit ways of thinking about psychotherapy that eases
the burden of the psychotherapist. None of the interviewees describe involving themselves
in a conscious effort to develop these cognitions or beliefs, yet there is dense data to suggest
that they have certain ways of thinking about their role that facilitates the ease with which they engage in the psychotherapy process. These passion supporting beliefs fall into two sub-categories: 1) Strength-based orientation, and 2) Equality of relationship with client.
Sub-category #1: Strength-based orientation
Passionately committed psychotherapists are optimistic about their clients. They are
hopeful about the change that can occur from the psychotherapy process. They also have
the ability to focus on the strengths of the client rather than upon the symptoms or
95 problems. They seem to engage in positive filtering that focuses upon the enjoyment of the personal connection that develops during the therapy session; and the potential for growth in the client, rather than focusing upon barriers and suffering. They experience less distress from organizational barriers and demands because they are singularly focused upon their work with clients.
PCPs 1, 12, and 14 discuss how they filter out the organizational depleters:
I just kind of try to find my way through the procedures and the agencies, you know the do’s and
don’ts. I enjoy being with clients. I love that I can put it aside. If I have a boss with whom I have
problems or a coworker, all of that stuff is separate from the process of closing the door and being
with a client. And that’s actually soothing. The therapy is something I have control over in a sense.
I don’t control the client, but as a partner in that therapy process I do have control over, much more
over that than other things that may happen in the workplace, and so I think that’s actually a relief
and a release and you know they don’t have a microphone set up, they don’t monitor what I do and
so I agree that I don’t have to worry about office politics and those sorts of things. So I would say
that’s what helps energize. I prioritize.
I was in a high burnout job, so I don't think it is about longevity-- I think it is about enjoying what
you do, and enjoying the people you are around, and not getting into the "he-said she-said" kind of
stuff. Not worrying so much about the bureaucracy, kind of rolling with the punches, with yeah, you
know, you may not like it, but there's not a lot you can do to change that kind of stuff, that's just
par for the course. I think too, they don't like who they work with, sometimes there is some
negativity about how people talk about their clients. With very few exceptions, I can honestly say I
like all my clients--all the kids, all my families, you know, there are frustrating moments, but for the
most part I like who I work with.
96 I suppose there would be things that would threaten my passion if I let it bug me, but I guess it's just
the reality, you know, it's an agency, there isn't endless money. Everybody has stupid policies; it
wouldn't be any better if I went someplace else that's just the way it is, so you just shrug it off and go
on. So, overall, it doesn't bother me.
Many of the interviewees describe a high level of hopefulness for their clients, even though these clients may suffer from profound mental illnesses or emotional disturbances.
It is apparent that they believe that this potential for growth is true of most of their clients.
PCP 4 is talking about women with borderline personality disorder:
They do burn everyone out; but the reality is they can turn a corner and lead a healthy lifestyle, and
I really believe it. We’ve done a study--we've got this intensive group that we do, and we've had some
pretty remarkable results, not just with this, but with trauma. We've got a pretty full gamut, and I
think that is pretty rewarding, that I think my boss gives me autonomy to create and to try new
things, and if I did not have that, it wouldn't work for me.
Others also reveal the positive expectancies that they have for their clients:
I guess being able to work with people and gain some sense of hope for the future in situations that
are pretty bleak and discouraging, that's a pretty lonely, dark place to be in, so to give somebody
some hope, something to work towards, is enjoyable. (PCP 5.)
There’s not one condition that doesn’t get experienced in the mind, so healing is universal. All of
healing is equally simple for all people because it’s always involving a change in the way that they are
seeing something that they think is it, but they have made it what it is for them, and they don’t
know it yet. And I’m trying to create a climate in which they can wake up and see it and make a
choice and it is gone that quick, it doesn’t take time to heal. It happens the minute you change the
97 way you see it. And now instead of a judgment that terrifies, is a creative, loving idea. It just feels
wonderful. (PCP 8.)
So I look for, I've hired people for years, and I look for that, there's an energy to it, and the other
people I don't think are optimistic, I think optimism is part of it. (PCP 11.)
A pronounced theme amongst the interviewees was their focus upon strengths in their clients rather than upon deficits or symptoms:
There are, well, I think what is consistent with all of my therapy is that I'm a very strength based
therapist. I really focus on strengths rather than everything that's wrong. I start there and kind of
build a person up. And then we apply their strengths to the problem areas of their lives. (PCP 10.)
And the other thing is work from a solution-focus, use a strength-based view. If you can see the
strengths and believe in people, then this will be a lot easier for you, because that is just the opposite
of burnout. Study Milton Erickson and people like that. He had this total belief in people's
resources. Find something in every client that you really like, just find that, and if you can't then
send them on to someone who can. But stay in a solution-focus, and get plenty of support (PCP
11.)
Actually, I have thought about that a lot over that last nine months of my life, having seen that in
some regards. I think the biggest thing is not focusing on the problem, but focusing on the solutions.
As therapists, we have to help the clients; okay, what is the problem, but not fully focus on the
problem, but what can you do to create a better life, a better situation, a more purposeful life. I am
a very solution-focused type person, I don't necessarily use solution-focused therapy. (PCP15.)
Sub-category #2: Equality in relationship with clients
98 The interviewed passionately committed psychotherapists describe a relationship with clients in which they view themselves as equals with the client. It is noted that this is more than a personal value of these psychotherapists, but may also serve an important function in preserving their energy and passion for the work. As equals of the client, the psychotherapist does not feel responsible for knowing how to "fix" the problems with which the client presents. It is likely that this reduces the pressure that the psychotherapist feels and therefore allows for them to focus more upon the relationship with the client, which is one of the pleasure-bringing aspects of the work. A very common discussion point related to this internalized boundary about what the therapist has responsibility for, and what the client is responsible for:
One area that I am recognized for and that is being able to distinguish what you have control over
and what you don’t. You kind of stay focused on what you do have influence over. Instead, I think
most therapists may be surprised by clients that don’t heed their advice. Clients especially in public
mental health struggle to want to change. I’ve learned that that’s sort of human nature. That it’s
difficult to change. (PCP 1.)
If I felt responsible for their growth, I think you take their trauma on a little bit, because it is heavy,
but if I took it on and thought I had to make them better, if I had the illusion that that was my job
as a therapist, that would burn you out. (PCP 4.)
But what it did do, though, was help me understand that my role as a therapist has very little to do
with somebody else's direct, material involvement in their life. I perhaps at best provide a tap, or a
slight encouragement or some kind of redirection that helps them complete a life path to themselves
99 that makes sense to them from their point of view and often none from mine. I didn't understand
that at the time, this process seemed very mystical. (PCP 9.)
The longest client I have has been here all the three years I have been here. And she says, "You
know me too well." But she is moving on; she is ready to do her own thing. And that was about the
relationship, not skills that I had; because it wasn't anything that I did. It was her ability to see,
and her Mom's ability to see what she needed. That's the skill-- I'm the eyes that see it, now you
have to see it. I think skill has very little to do with it. (PCP 13.)
A related finding within the data is that passionately committed psychotherapists, in keeping with an egalitarian relationship, do not seek to hold control or power over their clients. This preservation of equality in the relationship may also have an energy maintenance function, in that it allows for acceptance of the relationship as it is, and preserves the effort that would be required to attempt to control the client. PCP 8 illustrates how this furthers the enjoyment he can derive from the therapeutic relationship:
Just loving them…and listening. It’s not like I’m non-judgmental, I’m judgmental, in that I know
they’re beautiful, and I’m not fooled by one illusion or another. There is one judgment: they’re
fabulous, but otherwise, all judgments are horseshit.
PCP 2 talks about her active strategies to avoid taking power over her clients:
It was good because I think that knowledge is power, so helping people…I always joke that…I did
have a private practice in Canada, before I moved out west, but I always joked that I would not do
therapy, but say more like a guide. It’s just where do you want to go and can I help you get there;
not this is where I think you should be, and this is what we’re doing. So I think that because
100 knowledge is power, helping people get knowledge about themselves is wonderful. It gives them
power. It’s meeting the needs that I have.
Many of the passionately committed psychotherapists describe their realization that
there is no "magic" to psychotherapy, and that they don't want their clients to believe that
they possess a power, or knowledge, that they do not. In fact, one of the sources of
satisfaction in doing psychotherapy is sharing the knowledge, or power, with the client. PCP
8 makes a related point:
I have a core belief that everyone has within themselves the answers. Always have, and kind of
resent people making a mystery out of anything and really believe that people have all the answers.
It 's just part of my personality-- I remember when I first learned to bake bread, I thought, "this
isn't that hard-- why does everybody think it is so hard, I've got to tell everybody how easy it is!"
That's the way I am, I just like people, I believe in them, and I always have.
PCPs 10 and 12 speak similarly:
I never see myself as the expert. I don't take that approach with my clients. I am not the expert.
You know, you're the expert. You're inside your own skin. You know your own answers. We're
going to work together and I'm going to help you find those answers, but they're your answers.
That's a very hard question. I like that question. One of my clients at one point gave me a book.
There are so many good books out there about doing therapy, but this one happened to be a little
picture book. It's called 'The Missing Piece Meets Big O', it’s a Shel Silverstein book, and one of
the things that really intrigued me about that is about how this unhappy piece goes looking for
someone to fulfill them, and they finally find this perfect match, and then they feel swallowed up by
it. The story became sort of an ideal for me, in that there is almost a Winnicot kind of model, that
I want to be a "Good Enough" kind of therapist because if not, I become like the Missing Piece
101 and the Big O, in that I begin to impose on the other person that you can only be complete if you are
working what I want you to do, and that's not going to work. It's something that we all go along,
and find our own way.
In summary, passionately committed psychotherapists have found a vocation in
which they not only enjoy their work, they also believe it is of extraordinary significance.
Because of this complementary fit between personal characteristics and personal values, they
do not experience a sense of tiring over the course of their career. Rather, they have an
unending source of energy in the pleasures and satisfaction of the work itself.
Validation of Findings
As grounded theory research, the chief method of "validation" of results from this
study is found in an analysis of the extent to which the theory posited is grounded in the data. As an aid to readers of this study, a complete codebook, including quotations attributed to each respective category, is reproduced in Appendix E.
As an additional validation check, two external raters were recruited to engage in a
consensual validation exercise. One of the raters is a senior manager of adult mental health programs at a medium-sized urban community mental health center. The other rater was a graduate student completing her internship in social work.
The two raters read two transcripts each from interviews conducted as part of this
research. The raters were blind to the coding that had been assigned by the principal
investigator. Before the consensus exercise, they were asked to code both of the transcripts on two levels: 1) To assign a code in the margin of each meaning unit; and 2) To describe
102 for each key concept "What is going on in their description of themselves as a passionately
committed psychotherapist, what major themes do you identify?"
The three raters (principle investigator and two external raters) then convened for
consensus development. This activity consisted of three consensus-building exercises: 1)
Comparison of the coding of the external raters and the principle investigator for the individual meaning units of the two transcripts; 2) Open discussion of each rater's view of the most significant themes in critical parts of the transcripts; and 3) Assigning a Likert rating signifying the degree of agreement with the primary investigator's initial theoretical categories.
Full consensus was achieved amongst the three raters on all three rating levels.
Comparisons of the coding of individual meaning units resulted in substantial independent
agreement. Areas of difference were discussed, and terminology agreed upon to the
satisfaction of all raters. An example of a coding change was to add "connectedness" to the code "intimacy" when it was agreed that this concept was discussed in both transcripts.
The second level coding, in which the raters had an open discussion of the most
significant themes in critical areas of the transcript, also resulted in full consensus. Themes
discussed during this part of the exercise were "absence of burnout", "high need for meaning
in work", "balance", "Perfect fit with job," and "Intimacy seeking during psychotherapy."
Terminology for labeling the categories was discussed until there was consensus amongst the
raters.
During the third portion of the consensus exercise, the primary investigator gave the
external raters the initial categories that had emerged from his review of the transcripts. The
raters were asked to assign a rating according to these instructions: "Assign a rating from 0-
10 according to how strongly you agree that the named category is consistent with the two
103 transcripts that you have reviewed. You are not being asked if the category has been
"proven", only to rate how strongly you agree that it is consistent with the data you have
seen. "0" indicates that you feel strongly that the category is not representative of the transcript you have reviewed, "10" means that the category is perfectly represented in the transcripts."
Of the five initial categories, the raters both assigned "10" to four categories,
indicating perfect agreement. The fifth category resulted in one rating of "10" and one "9".
When the description was changed from "balance of work and other passions" to "valuing
balance", perfect agreement was attained on round two. All raters agreed to the distinction between "balance" and "valuing balance", as there was evidence in transcript 2 that the passionately committed psychotherapist had some difficulty maintaining balance, even though she valued it.
104 Chapter V: Discussion
The purpose of this study was to identify the characteristics of psychotherapists who
are, to an exceptional degree, flourishing in their jobs. The study was designed to discover
what traits, practices, or beliefs these exceptional individuals have in common. As an exploratory, grounded-theory study, the intent was not to support or invalidate a theory; but rather, to develop a substantive-level theory that is grounded in the data.
The concept "passionately committed psychotherapist" is not a validated concept,
nor does it have an established definition in the field. One of the functions of this
exploratory study was to begin defining the attributes contained within this concept.
Identification of the psychotherapists who are "passionately committed" employed a peer
nomination process. Supporting the effectiveness of this method of identifying subjects for
the study is that all of the nominated psychotherapists endorsed this description as
consistent with their view of themselves, at least with some clarification of terminology. All
but one nominee described that, in fact, they derived more energy from doing psychotherapy
than they expended. Gaining energy from one's work is one of the defining characteristics
of "passionately committed psychotherapists," suggesting that the peer identification process
had succeeded in identifying subjects meeting the intended study criteria.
The primary source of data for the study derived from the semi-structured interviews
with these nominated individuals. During the subsequent analysis, common themes began
to emerge that were shared by all of the passionately committed psychotherapists. Within
the common themes were sub-categories that were shared by many, but not all of the interviewees. These general themes and sub-categories represent the theory that results from the investigation.
105 The common elements, considered to be characteristic of this group, were validated
in several ways. The primary support for these findings is in the robustness of the data.
Once categories were initially identified, subsequent interviews were used to test and refine
the concepts. After twelve interviews, it was found that the categories could be used to
substantially predict the responses that would be given during the interviews. After the fifteenth interview, the decision was made that saturation of the data categories had been
obtained. Data supporting the conclusions were dense and well grounded in the data.
Two raters external to the project participated in a consensual validation exercise and
lent further support to the coding and categorization of data.
Summary of Findings
The level of consistency in the data allowed for a theory to emerge about the
characteristics of passionately committed psychotherapists. After these categories were
identified and labeled, they were compared and contrasted with the findings of the Dlugos
study (1999.) The categories identified by Dlugos: Balance, adaptiveness/openness,
transcendence, and intentional learning; were also strongly represented in this data. Not only
does this finding add increased support to the Dlugos findings, it also suggests
generalizability of those discoveries. This sample differed from the Dlugos sample in the
composition of the study group. The present study represented clinicians from Utah rather
than upstate New York, public sector employees instead of private practitioners, and a wider
range of years of practice. Nonetheless, the characteristics of the passionately committed psychotherapists were consistent with the Dlugos sample.
In addition to adding support to the Dlugos investigation, these data also extend his findings. Two new general themes were identified that emerged strongly from the interview
106 data. These themes were implicit in the Dlugos categories, but were so robust that they
warrant discrete categories: Personal fit with role, and passion-supporting beliefs.
Passionately committed psychotherapists have a natural and complementary
personality fit with their job as psychotherapists. They also have characteristic beliefs about
their clients and about psychotherapy that maintain their passion for doing the work.
Balance
Passionately committed psychotherapists are devoted to their work as
psychotherapists. This devotion is not limited, however, to their job role. They express
passions in other areas of their non-work life as well. Family, artistic pursuits, and
recreational outlets are described as very important to their life satisfaction. It is, perhaps,
reassuring to discover that passionate commitment is not synonymous with workaholism,
and in fact, may be an opposite construct. Many of these individuals describe a very natural
interest in multiple passions, and find pleasure in a variety of activities. Unlike the
workaholic, they do not work hard because of any compulsion to do so, but because they
find it enjoyable.
Because the passion of the passionately committed psychotherapist is not limited to
the practice of psychotherapy, it might be tempting to think of "passion" as a general factor;
that these individuals would be passionately committed to whatever they chose to do. There is some evidence that this is not so, however. To be sure, these individuals are passionate people, but many describe other work they have done, sometimes in the human services, and sometimes in other fields, where they were not comfortable and did not enjoy the work.
Several of the child psychotherapists specifically mentioned, for example, that they had no interest in working with adult clients. This suggests that their passion and commitment is specific to certain activities that seem meaningful or that accord with their personal interests.
107 Although 100% of the subjects emphasized the importance of balance in maintaining
their passion and commitment, 60% of them also describe that they have had difficulty
finding such balance. Many of them describe that they had confronted a serious crisis, such
as a significant health problem, before they emphasized balance in their life. They report
that they are increasingly successful in finding balance as their career proceeds.
Adaptiveness/Openness
Passionately committed psychotherapists demonstrate adaptiveness to new demands
in their work roles or environment, and are open to new experiences. Perhaps most
illustrative of this adaptiveness is the fact that most of the interviewees do not describe the current time as a difficult one in which to be practicing in mental health In fact, some of the interviewees asked for a clarification of the question about whether or not they think the current time is a difficult one to be practicing as a psychotherapist. They seem surprised that some think this is a hard time to be a psychotherapist. Managed care, redefined service populations, increased documentation, risk management, and productivity demands have been accommodated without rendered their jobs undesirable.
This general characteristic, adaptiveness and openness, is distinguished by two
attributes that would perhaps not logically be expected to co-exist: One is an openness to
learning and experience, the other is a sense of confidence in their core skills as a psychotherapist. On closer examination, however, there is a synergy between these two
characteristics: If one has confidence that one understands the fundamental basics of what
makes a change relationship effective, it is less threatening to take new challenges with
different populations. If one has a sense of basic competence and ability, then one can open
one's self to learn the situation-specific skills on the job.
108 Similarly, a therapist may be more open to receiving supervision if there is
confidence about fundamental skills, and therefore, less self-consciousness about being
found to be deficient by the clinical supervisor. The unfortunate corollary suggested by this
finding is that perhaps for some therapists, the more they may need supervision, the less
likely they may be to request it or be truly open to it.
Transcendence
The passionately committed psychotherapists that were interviewed for this study believe that something happens in psychotherapy that is bigger than they are. They talk abundantly about being driven to contribute to the good of humanity, and that they believe that psychotherapy contributes significantly to the good of their clients. They believe that psychotherapy is effective, and that it changes the lives of their clients. Often, they will describe some kind of force, even an ineffable power, that occurs in the interpersonal relationship between the therapist and the client.
The interviewees often describe themselves as spiritual, though they typically take
care to distinguish their spirituality from being "religious." The esthetic of therapy, the belief
in the power of the interpersonal relationship, and the sense of contributing to the
communal good is, to a large degree, what defines the spirituality of the passionately
committed psychotherapist.
Intentional Learning
Learning continually about the human condition is part of the unending energy
source for the passionately committed psychotherapist. They are intensely curious about their clients, and it is this interest that provides motivation to see new clients, to try to learn more about the clients they are serving. They see their professional growth as complementary with their personal growth in two ways: As they develop improved
109 relationship skills, and learn more about the human condition, they become more competent
in their own lives. And the more effectively they help others, the more fulfilled they feel
personally.
Personal Fit with Role
Although the passionately committed psychotherapists interviewed in this study took
different routes into the profession, what they have in common is that, with the exception of
some initial insecurity, once they sat in the therapist's chair, they felt that they had found
their true calling. They describe that the job duties of a psychotherapist perfectly matches
their interests and desires-- they believe that they were "born to be a psychotherapist". This
study begins to define some of the personal characteristics that comprise this goodness-of- fit.
Chief among these personal traits is a robust "will to intimacy." This desire for
personal connectedness creates a "toward energy" that drives the practitioner into the
relationship with his or her clients. This energy can be contrasted with an aloof, observing
presence in the therapeutic setting that may be prescribed by some psychotherapeutic
schools. It is theorized, consistent with this finding, that psychotherapists with a detached,
intellectual approach to the therapeutic relationship will find psychotherapy to be energy-
depleting, whereas those with this "toward energy" will find psychotherapy to be energy-
producing.
Another personal characteristic of passionately committed psychotherapists is a
pronounced drive for personal purpose and meaning. The source of this drive may vary--a
family member with mental illness, feeling lonely and isolated as a child, or believing that
one's relative good fortune requires giving back to the world-- but in all cases results in a
very personal need that is fulfilled by the helping relationship of psychotherapy.
110 These therapists have a high need for stimulation from the therapy session, and they
have a wide variety of approaches to meeting this need. Several of the interviewees even commented upon their own short attention span, two self-described as "attention deficit
disordered". Yet they find therapy to be very stimulating because of the particular type of
stimulation that they find desirable and in abundance during a session. For a significant sub-
group, this came in the form of an esthetic appreciation for the form of therapy, and were, in fact, artists. Enjoying this process in an almost visual sense provides stimulation that the therapist finds pleasurable, and this seems to sustain these practitioners.
Others describe an ability to note even very incremental changes that a client is
making. This filtering process focuses the attention of the therapist away from the areas in
which the client is "stuck", and directs attention towards areas of progress. Whereas another
psychotherapist might feel bored by the lack of progress in the client, the passionately committed psychotherapist experiences a sense of constant change, albeit in small ways.
This selection process makes the therapy sessions seem fresh and productive.
Because of the various ways that a passionately committed psychotherapist keeps his
or her stimulation high, the experience of doing psychotherapy is a pleasurable one. The
mental state that they are in during a therapeutic session is, at least during the best moments, a flow state. And this state is effortless, pleasurable, and produces rather than depletes energy.
Passion-supporting beliefs
In addition to distinctive personal characteristics, the passionately committed
psychotherapist also has certain ways of thinking about psychotherapy and their clients that
supports passion and commitment. These characteristic ways of thinking are both beliefs
and values.
111 The first of these involves another type of positive filtering that directs their
attention toward the strengths of a client and away from the deficits or problems. The result
of this filtering is another one of the sources of the continuing passion that the therapist has
for their work. They do not become depleted by the profundity of their client's problems, or
experience secondary trauma from some of the personal catastrophes that their clients have
experienced. Rather, the focus upon strengths promotes optimism and hopefulness for both
client and practitioner. This cognitive strategy also promotes more affection for the client--
the therapist will experience more positive feelings towards a client whom they see
possessing positive attributes than if they are perceived as an amalgam of problems and
symptoms. And a positive affection for the clients with whom one works is a precondition to job satisfaction.
These passionately committed psychotherapists describe unequivocally that they see
themselves as equal to the clients with whom they work. They do not wish for the client to view them as having more power than the client does, or that they have the answer to any
problem. Rather, they wish to convey to the client a willingness to provide them with
genuine caring, and a willingness to join them in the search for solutions to difficult
problems. The boundary of responsibility for life decisions is a bright line to the
passionately committed psychotherapist, and the client is responsible for his or her own life.
The belief in the equality between therapist and client is more than a personal value.
Accepting this belief has the added benefit of relieving the psychotherapist of the burden of
responsibility for always knowing the answer to very complex problems. By joining the
client as an equal, albeit a caring other, neither the client nor the therapist is left feeling that
they are trying to solve the problem alone. This also has the potential to make the practice
of psychotherapy less burdensome, and more enjoyable.
112 Passionate Commitment and Burnout
A very prominent finding in this investigation is that passionately committed
psychotherapists do not seem to "run down" as their career progresses. The data was very
consistent in the finding that, although these psychotherapists have ups and downs and
occasional crises, the passion that they have for their work is constant and self-sustaining.
Many of them report that they experienced the most job stress during their early apprenticeship, but have become increasingly confident and satisfied with their jobs over time. None of the interviewees report a sense of feeling drained as their career progressed.
That these individuals find intrinsic energizers within the practice of psychotherapy
is of central significance in the findings. Simply put, these psychotherapists simply love the
actually doing of psychotherapy. These therapists do not maintain high job satisfaction
because they have an extraordinary resistance to stress-- they maintain their passion for their
job because, for them, doing psychotherapy is not stressful. Even with a very difficult, often
suicidal, combative, or uncooperative clientele, they find continual satisfaction. This
satisfaction derives from learning new skills to do a difficult job; from working in a career
that contributes materially to the good of the community; from being allowed to experience
the personal struggles of another human being; and, above all, from having frequent
opportunities for very intimate, personal connections with people who need their help.
The findings from this research significantly challenge the notion of burnout being
caused by "caring too much," high workload, or other job conditions. There is evidence in
this research that passionately committed psychotherapists are those who have a natural fit
with their job role, and who are able to extract intrinsic rewards from doing psychotherapy.
Freudenberger's (1974) seminal descriptions of those prone to burnout would, in large measure describe these same passionately committed psychotherapists. They are highly
113 involved with their clients on a personal level, and often exceed the productivity
requirements of their employer. But in contrast to Freudenberger, the job satisfaction of
these individuals remains high and stable over the course of their career, or may even
increase over time.
All of these findings are consistent with the possibility that much of what we term
"burnout" is a poorness-of-fit between the person and their job role. This conclusion
accords with the review of the burnout literature, in which there is compelling evidence that
levels of burnout-- whether high or low-- tend to remain stable over the course of a career;
and that in fact, measures of burnout are often highest early in a career. It is entirely
plausible that a psychotherapist who is experiencing a poor fit with their role-- who does not
enjoy their interactions with their clients-- would also be likely to believe that the workload
requirements are too high, that the clients are too stressful, and the workplace is undesirable.
Thus, we describe him or her as "burned out", when in fact they were never "on fire" about their job from the beginning.
These passionately committed psychotherapists, by comparison, do not experience
stress or fatigue from doing psychotherapy. The sense of intimacy and connectedness that
they experience during the psychotherapy hour energizes them, and they find this experience
pleasurable rather than draining. For many of these individuals, balance is of critical
importance to them not because they have a sense of needing to get away from the stress of
doing psychotherapy; but rather, because they are tempted to spend too much time and
energy on it. Most of them report that they are similarly passionate about their other
interests.
114 Implications of the Study
Because this was an exploratory investigation, any conclusions drawn from the
results must be viewed as theoretical. Findings from this study could be tested in
subsequent research that could be designed to test an a priori hypothesis developed from
these theories. To the extent that these findings are supported, there are implications to
practitioners, agencies that hire psychotherapists, clinical supervisors, and clinical training programs.
Trainees may look at the characteristics of passionately committed psychotherapists and conduct a self-assessment of the extent to which they personally have the traits, beliefs, lifestyle attributes, and values that constitute goodness-of-fit in the role of psychotherapist.
This would be a particularly valuable activity when contemplating a career as a psychotherapist.
Practicing psychotherapists can also apply these findings. Many of the findings relate
to lifestyle characteristics and therapeutic beliefs, or thinking styles. Psychotherapists who
find themselves depleted in their work may be able to make adaptations to place their
lifestyle and thinking style more in accord with these passionately committed
psychotherapists. The passionately committed psychotherapists interviewed in this study seem to describe characteristics that they had prior to their career as mental health professionals. It is plausible, however, that what distinguished these individuals is not the ability to possess these traits, but rather, that they have them intrinsically. The characteristics describe here could be learned and developed. Although untested, the results of this study suggest the possibility that, to the extent that less passionate practitioners are successful in making these adjustments, they may find a renewed passion for their work.
115 Employers who hire psychotherapists can find utility in these findings. Certainly, the
description of passionately committed psychotherapists would be consistent with attributes that employers would find highly desirable: Someone who has a passion for their work, and who is not prone to disillusionment or burnout. To the extent that these characteristics can be identified during the selection process, this could represent a significant benefit to the employer.
Continuing supervision provided by these employing agencies should be delivered in
a manner consistent with these findings. A clear finding in the investigation is that
passionately committed psychotherapists value highly the role of supervision for their on-
going career satisfaction. Clinical supervisors could better support their passionately
committed psychotherapists by understanding these characteristics and adjusting their
supervision accordingly. Most importantly, continuing supervision, including team-based
peer supervision, should be viewed as part of an on-going practice and not merely necessary
based on licensure requirements early in a practitioner's career.
The findings of this study have significant implications to the graduate programs that
prepare future psychotherapists. By better understanding the attributes that correlate with
long-term career satisfaction, and presumptive career success, these programs could improve
the methods of selecting, training, and counseling students. Full acceptance of the results of
this study would result in significant overhaul in the procedures used to weight candidate's
success potential in the graduate program. Conceivably, this could even result in a relative
de-emphasis of academic achievement priorities, and increased emphasis on screening for
the personal characteristics identified in this study. Of course, this would be feasible only if
reliable methods, e.g., assessment scales or interview techniques, were available for
identifying these traits.
116 Curriculum design for programs preparing psychotherapists could also employ the findings from this study. Curricula that are consistent with this data would: 1) Emphasize competence in a core set of psychotherapy skills. 2) Develop skills and supervision for managing psychotherapy as both a personal, genuine relationship, and as a professional relationship in which transference and countertransference must be recognized and managed. 3) Develop psychotherapists who interact with clients as equals and from a strength-based, as opposed to pathology-focused, approach.
The core skills in psychotherapy relate to the ability of the therapist to create a
feeling of connectedness, for the client and for the therapist him/herself. This skill category
contains basic interpersonal effectiveness, engagement skills, empathic communication, and
joining skills. The implications of this study are that these skills should be viewed as primary
to specific treatment models, which are viewed as additive instrumental skills. This study
concluded that passionately committed psychotherapists' confidence in their own core
therapy skills reduced performance pressure and enhanced their willingness to continually add to their skills in specific areas. This finding suggests that by defining these skills as primary to specific model-driven interventions-- and making certain that future therapists possess competencies in them-- the therapists can engage clients confidently, and with less job stress, while they acquire target-specific intervention skills.
The further implication of this suggestion is that the core skills also should include
the ability of the therapist to enjoy these interactions, and to positively engage with the client
in the same manner as the therapist hopes that the client engages with the therapist.
Current training programs differ in their definitions of the characteristics of the optimal therapy relationship. These differences are largely based on the school of thought that serves as the basis for the curriculum. This study suggests that psychotherapists who
117 work to attain an "as if" relationship in the treatment environment, that by definition is not a personal, genuine relationship, will be more prone to career dissatisfaction. The satisfaction of the passionately committed psychotherapists in this study derived from the intimate personal connections that they made with their clientele.
Yet the hazard suggested by this conclusion is apparent: Personal relationships are
not governed by the protections and ethical codes that are required by the professional
helping relationship. Due to the very realistic concern that a personal relationship can result
in untoward boundary crossing, training curricula tend to emphasis a detached, observing
relationship. The passionately committed psychotherapists in this study, however, thrive
within a different kind of relationship. Therefore, the indication from this study is that this
dilemma should be resolved in training programs in a dialectical fashion that synthesizes
both the genuineness of the personal relationship, and the importance of professional self-
monitoring to observe the effectiveness of the treatment (transference and
countertransference.)
Finally, these findings suggest a problem in training curricula that emphasize
pathology-focused assessment, diagnosis, and treatment. Although diagnosis and
identification of problem areas is necessary in virtually any mental health setting, it is evident in these interviews that it is also important to focus on patient's strengths and attributes.
The participants in this study did not report formal training in this approach, and they stated explicitly that they do not practice "solution focused therapy" as a model. Rather, they have independently progressed over time to focus upon client's abilities and positive attributes. It is apparent this approach becomes a strategy for maintaining hopefulness and affection for their clients. Training programs should give recognition to this strategy and make it part of the curricula.
118 Strengths of Study
The peer nomination method employed by this study to identify passionately
committed psychotherapists appears to have successfully identified therapists who: Are very
committed to their work, have a high amount of energy for conducting psychotherapy
irrespective of how long they have been in the profession, and who derive more energy from
doing psychotherapy than they invest into it. These defining characteristics of "passionately
committed psychotherapists" were richly evident in the data that emerged from the
interviews with the nominees. All but one of the interviewees spontaneously described the
fact that they found energy in doing psychotherapy, and that it rarely depleted or stressed
them, even though they were not specifically asked about this.
Limiting the study group to those nominated by two or more times limited how
many nominees became eligible for the study, but is likely to have improved the reliability of
the method. Because some of the offices that were asked to provide nominations were very small, setting the number of nominations necessary to eligibilize a candidate higher than two
would have risked eliminating passionately committed psychotherapists from study merely
because they have fewer colleagues in their office.
The semi-structured interview format proved successful in guiding the interview
without constraining the conversation with the interviewee. Leading questions, e.g., "Does conducting psychotherapy energize you?" were avoided assiduously. Instead, open-ended
questions, e.g., "What do you like and dislike about doing psychotherapy?" were favored, and
resulted in freedom for the interviewee to respond without a sense of being directed by the
interviewer.
The general themes that emerged from the data could not have been predicted by
the form of the questions in the semi-structured interview protocol, suggesting that they
119 arose spontaneously. The most leading question in the protocol, "Many practicing
psychotherapists consider the present time to be a difficult one to be a psychotherapist. Do
you agree?" actually led the interviewee in a direction opposite from the obtained result. In
spite of normalizing a response that, yes, the present is a difficult time for psychotherapists,
the common response was no-- and often, a seeming sense of surprise that some
psychotherapists feel this way.
Another strength of the study was the bracketing exercise that the primary investigator engaged in prior to the nomination process. Bracketing the preexisting biases of the researcher is an important part of qualitative studies. Review of the bracketing narrative produced by this investigator prior to the study reveals that the findings are substantially free
from bias from pre-exiting expectancies. Many of the categories arising from the research
were not identified prior to the study, and many of the predicted responses did not develop.
This research is strengthened by the fact that the general categories were saturated by
the data prior to the decision to conclude the nomination process. Before terminating the study, it was concluded that the general categories could accurately predict the responses of the nominated passionately committed psychotherapists. Rather than concluding the study
merely because the number of potential subjects had been exhausted, the study proceeded
until there was substantial saturation of the categories and many of the sub-dimensions of
the general characteristics.
The most significant strength of the study is found in the robustness of the data.
Each general characteristic is strongly supported by the interview data, which was consistent
and supported across the interviews. Once identified, the categories were of sufficient
density to support the study of dimensions within the category, represented by sub-
120 categories. These dimensions of the categories both enrich the findings in the present study,
and offer possibilities for elaboration in subsequent research.
Limitations of Study
The concept "passionately committed psychotherapists" is not a recognized nor
validated term in the field. Nor is it easily defined in empirical terms. It does, however,
seem to have some resonance to the individuals identified as such in this study, and seems to
communicate something to practicing psychotherapists. This lack of a standardized
definition clearly suggests the possibility of reliability problems. The reliance upon peer-
nominations in this study allows for broad disparity in who is nominated, or the
characteristics that are deemed salient by the nominating psychotherapists.
The psychotherapists who submitted nominations were not interviewed to determine
which of the "passionately committed psychotherapist'" characteristics were considered in
making the decision to submit the nomination. Nominating a co-worker as a passionately
committed psychotherapists could, conceivably, be a way of giving them recognition because
the nominator has positive regard for them, or finds them to be pleasant co-workers, or any
other purpose that may have little to do with the specific characteristics of passionately
committed psychotherapists.
Because the concept "passionately committed psychotherapists" is a novel one, it
became apparent that the extant research could not provide a basis for formulation of any
hypotheses prior to the advent of the study. Therefore, this study was defined as an
exploratory investigation. A weakness in this approach is the lack of a comparison group.
The findings of the present study could be substantially strengthened by the addition of a comparison group to assist in determining which of the identified characteristics are distinctive to this group of passionately committed psychotherapists. Without this
121 comparison, it cannot be determined if the common elements discovered here are distinctive
or unique to this group. Comparison groups for future research could include disillusioned
psychotherapists who have changed careers, psychotherapists who are burned out, or
persons who are passionately committed to professions outside the field of psychotherapy.
A potential weakness of this study is the fact that the subjects included both adult psychotherapists and child/youth psychotherapists. Although the characteristics identified were common to both, there is reason to believe that there may be substantial differences between the factors that energize the adult therapists compared to the child/youth therapists. Several of the child/youth therapists commented that they had no interest in doing psychotherapy with adult clients. Presumably, some of the adult psychotherapists also would not be passionately committed child therapists. This suggests that certain characteristics may differ between these groups.
This weakness could have been overcome with a substantially larger study group that
would have allowed data saturation of the commonalties and differences identified found
within each of these groups. Given the current sample size, this comparison could not be
adequately accomplished. Subsequent research should either focus specifically upon one of these groups, or should identify a sample size sufficient to develop comparisons of common and distinctive characteristics between the adult and child/youth therapists.
A final limitation of the study is found in the fact that all of the subjects were
identified within a one-state area. Utah is a very homogenous state in ethnicity and religious
belief. Inclusion of psychotherapists from a wider area and more diverse population would
have strengthened the design. This limitation is mitigated somewhat by the comparison
conducted with the Dlugos study, which was conducted in New York state.
122 Recommendations for Further Study
The implicit theory that results from the present study is that the identified
characteristics are common to passionately committed psychotherapists, and that these same
characteristics distinguish them from psychotherapists who will become disaffected or
burned out. Because the characteristics are defined in this exploratory work, this theory can
be tested in subsequent research.
Future research can compare passionately committed psychotherapists to disaffected
psychotherapists to determine whether or not these characteristics accurately distinguish this
group. If a similar study resulted in a definition of the characteristics of "disillusioned
psychotherapists," a good basis would exist for persons self-assessing their own suitability to
the role of psychotherapist. Similarly, potential employers would have a basis for selecting
persons with the characteristic profile of "passionately committed psychotherapists."
Exciting research could be developed for assessing the presence of these traits in
individuals beginning a career in psychotherapy to determine whether or not they predict
success and satisfaction in that role. The participants in this study described careers of
stable, high job satisfaction. Therefore, prediction that the presence of these characteristics
will correlate with long-term job happiness could be developed and tested. Through
identification of individuals high in these traits and low in these traits, therapists could be compared on measures of job satisfaction at different points in a career.
Other interesting research could involve a comparison group of similarly identified
passionately committed workers in fields unrelated to psychotherapy, i.e., executive
management or architecture, to determine what passionately committed psychotherapists
have in common, and in distinction to, other passionate professionals.
123 A question that lingers after the completion of this study is to what extent the
characteristics of passionately committed psychotherapists are inherent to the personalities
of these individuals and to what extent that have been, or could be, developed. An idea for
researching this question would be to identify a group of mid-career psychotherapists who
are experiencing career burnout by some standardized measure, e.g., the Maslach Burnout
Inventory. After identification of these psychotherapists who are in mid-career crisis, or
mid-career doldrums, an intervention could be applied based on the distinctive lifestyle
characteristics and passion-supporting beliefs of the passionately committed
psychotherapists. Following the intervention, assessment could determine whether or not
the intervention effectively improved the job satisfaction and career energy of the subjects.
In this way, data could be gathered to answer the question whether these characteristics can
be acquired by psychotherapists who would not currently describe themselves as
passionately committed psychotherapists.
Conclusion
This exploratory, grounded-theory study employed data analysis of the transcripts of
semi-structured interviews with passionately committed psychotherapists in the community
mental health system in Utah. The purpose of the analysis was to develop a theory of the
common and distinctive characteristics of persons who are passionately committed to the
practice of psychotherapy.
The data analysis yielded six general characteristics of passionately committed
psychotherapists. First, passionately committed psychotherapists emphasize the importance
of balancing career demands and finding passions in other, non-work, aspects of their life.
They are open to learning and supervision and adapt to career demands with flexibility.
They have a deeply held value in the importance of contributing to the communal good
124 through their work. Learning continuously throughout their career is important to the passionately committed psychotherapists. These therapists consider their personality a perfect fit with the practice of psychotherapy, and they have a strong "will to intimacy" that is satisfied with the intense interactions that doing treatment requires. Lastly, they maintain strong beliefs in the equality of the relationship between therapist and client, and they take a strength-based focus to their clients that adds a sense of continual hopefulness.
Given these results, further research can be developed that surpasses the limited nature of this exploratory study. Addition of comparison groups and hypothesis testing can lend support to these theoretical results. Students, practicing psychotherapists, human service employers, and graduate training programs can all benefit from an increased understanding of the characteristics of those who flourish while doing the important and difficult work of psychotherapy.
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133 Appendix A: Interview Protocol: Study Group
1. What would you describe as your psychotherapeutic theoretical orientation?
2. What is your primary work setting? In what other settings do you work?
3. How many hours, on the average, do you work per week? What percentage of your workweek is spent providing clinical services?
4. What other kinds of activities are included in your usual workweek?
5. Do you participate in supervision or a professional support group?
6. What initially motivated you to choose psychotherapy as a career? (Dlugos, 1999)
7. Your peers have nominated you as a "passionately committed psychotherapist". Do you agree? If not, why not? If so, what are the factors that that keep you passionate about doing psychotherapy?
8. What, in your opinion, makes the difference between a therapist who flourishes in the job and one who burns out and becomes disaffected?
9. For yourself, what are the energy-producers in your work? What are the energy- depleters?
10. When you are not at work, what helps you to renew yourself? Do you consciously involve yourself in activities that are restorative?
11. Can you tell a story that describes how you feel about being a psychotherapist? Can you describe what you hate or dislike about your work as a psychotherapist? Can you describe what you love about your work as a psychotherapist? (Dlugos, 1999).
12. Have you had any experiences that made you doubt the appropriateness of psychotherapy as a career for you? How did you manage that situation? (Dlugos, 1999).
13. (If the subject has endorsed that they consider themselves a passionately committed psychotherapist): Have you been passionately committed to psychotherapy throughout your career? How would you describe what the ups and downs of your career? Talk about one of the lowest moments in your career. Talk about one of the highest moments of your career.
14. With what type of clients do you find the most difficulty? How do you maintain your commitment to psychotherapy with these clients? Are there certain ways you have of thinking about the practice of psychotherapy that helps you enjoy it?
134 15. Some practicing psychotherapists describe the current time as a trying time in which to be a psychotherapist. Do you agree? What strategies have you found that help you cope with some of these externally-produced barriers to job satisfaction as a psychotherapist?
16. In what way(s) has(have) your employing organization(s) added to your commitment and passion as a psychotherapist? In what way(s) has(have) your employing organization(s) detracted from your commitment to the practice of psychotherapy? In your opinion, what can employing organizations do to enhance the passion and commitment of their psychotherapists?
17. Have you ever come close to choosing to change careers from the practice of psychotherapy? If so, why did you choose to remain as a therapist? Have ever been "burned out" as a psychotherapist? Did you find ways of restoring your passion for doing therapy? How would you rate your current level of burnout?
18. What advice would you have for beginning therapists for maintaining their passionate commitment to the work of psychotherapy? (Dlugos, 1999).
135 Appendix B: Nomination Form
In the space below, please list the psychotherapist(s) that you are nominating as "passionately committed psychotherapists". A passionately committed psychotherapist is one who: 1) Is licensed in any of the psychotherapy professions (Psychiatry, Psychology, Professional Counseling, Marriage/Family Therapy, Social Work, or Advanced Practice Nursing.), and who 2) Has an extraordinary amount of energy for, and commitment to, his or her work, and 3) Is invigorated by, rather than depleted by, doing psychotherapy.
Please list any professional psychotherapist who you believe fits the description as a "passionately committed psychotherapist":
1. Name:______
Work Location: ______
Telephone: ______
2. Name:______
Work Location: ______
Telephone: ______
3. Name:______
Work Location: ______
Telephone: ______
136 Appendix C: Letter of Invitation
DATE
Name Address
Dear ______,
Recently, I asked psychotherapists practicing in the public mental health system in Utah to nominate their professional colleagues whom they consider passionately committed to their work. It is my pleasure to inform you that your name has been submitted by one or more of your peers as such a uniquely dedicated professional.
I am writing to you at this time to invite you to participate further in this study. Further participation is, of course, voluntary. If you choose to participate further, I am asking that you: 1. Complete the enclosed consent form. This form will explain the voluntary nature of your participation, will discuss the confidential nature of all information derived in the study, and will discuss the risks and benefits of participation in the study.
2. Participate in a one-hour long personal interview with me during which I will ask you about your career as a psychotherapist, experiences you have had during your professional career, and strategies that you use to remain "passionately committed".
I can assure you that your identity will be kept strictly confidential. I am asking permission to audiotape the interview so that it can be transcribed and analyzed by a small team of researchers. I will offer the completed transcript for your review so you can make any changes that you deem necessary. I will request your informed consent once again after you have had opportunity to review this transcript.
The purpose of this study is to discover the common and distinctive characteristics of professionals who are passionately committed to the work of psychotherapy. I hope that the results will assist others in increasing and maintaining their own commitment to this important work.
I will contact you by telephone to schedule a time for an interview if you elect to participate in this study. If you choose to not participate, you may contact me at [email protected] , by phone at (801)447-8887 Ext. 304, or you may simply tell me when I phone you.
Congratulations on this recognition from your peers. I appreciate your consideration of this request, and I look forward to speaking with you.
137 Appendix D: Informed Consent Document
INFORMED CONSENT DOCUMENT Characteristics of Public Mental Health Psychotherapists Who are Passionately Committed to Their Work
You are being asked to participate in a research study about the characteristics of persons who are psychotherapists in the public mental health system and who are passionate about and committed to the work of psychotherapy. You were selected as a possible participant because your peers nominated you as a person who is energized and invigorated in your work. Please read this form and ask any questions that you may have before agreeing to be in the research.
Researchers at Case Western Reserve University are conducting this study.
Background Information The purpose of this study is to discover the common and distinctive characteristics of professionals who are passionately committed to the work of psychotherapy. I hope that the results will assist others in increasing and maintaining their own commitment to this important work..
Procedures If you agree to be a participant in this research, we would ask you to do the following things: 3. Sign this consent form. 4. Participate in a one-hour long personal interview with me at your workplace or place of your choosing. During this interview, I will ask you about your career as a psychotherapist, experiences you have had during your professional career, and strategies that you use to remain "passionately committed". 5. Allow me to audiotape the interview so that it can be transcribed and analyzed by a small team of researchers.
Risks and Benefits to Being in the Study This research has the following risks: This study is expected to create minimal risk.
The benefits of participation are: There are no direct benefits to subjects participating in this study. Secondary benefits that are: 1. All participants (and their employing agencies) will be offered a formal report on the findings resulting from the study. 2. Some participants may report a benefit in having opportunity to think about and articulate, for themselves and others, the satisfying and dissatisfying aspects of a career in psychotherapy.
Compensation You will receive no payment/reimbursement for your participation in this study.
138 Confidentiality The records of this research will be kept private. They will be kept in a locked file and any report we publish will not include any information that will make it possible to identify a participant. Access to research records will normally be limited to the researchers. However, the University’s Institutional Review Board (IRB) may review the research records to ensure that the rights of human subjects are being adequately protected. The audiotapes of the transcripts will be maintained in the same manner as the records, with the same restricted access. These tapes will be destroyed three years after completion of the study.
Voluntary Nature of the Study Your participation is voluntary. If you choose not to participate, it will not affect your current or future relations with the University. There is no penalty or loss of benefits for not participating or for discontinuing your participation.
Contacts and Questions The researchers conducting this study are Wally Gingeritch, Ph.D., and Brian Miller, L.C.S.W.. You may ask any questions you have now. If you have any questions later, you may contact them at: Wallace Gingerich, Ph.D., Case Western Reserve University Phone: (216) 368-0313 e-mail: [email protected]
Brian Miller, Davis Behavioral Health Phone: (801) 447-8887 X 304 e-mail: [email protected]
If you would like to talk to someone other than the researcher(s) about; (1) concerns regarding this study, (2) research participant rights, (3) research-related injuries, or (4) other human subjects issues, please contact Case Western Reserve University’s Institutional Review Board at (216) 368-6925 or write: Case Western Reserve University; Institutional Review Board; 10900 Euclid Ave.; Cleveland, OH 44106-7230.
You will be given a copy of this form for your records.
139 Statement of Consent I have read the above information. I have received answers to the questions I have asked. I consent to participate in this research. I am at least 18 years of age.
Print Name of Participant:
□ Yes, I agree to being audiotaped, but I can change my mind at any time during the course of my interview and participation with the study.
□ No, I do not wish to have my interview audiotaped.
Signature of Participant: Date:
Signature of Person Obtaining Consent:
140 Appendix E: Codebook
Code Family: Adaptiveness/Openness: Confidence in Core Therapy Skills
Codes (2): [Personal characteristics, failure, learned not to fear] [Therapy attitudes, core tx skills] Quotations: 18
P 2: Transcript 2.doc - 2:29 Codes: [Personal characteristics, failure, learned not to fear] it’s kind of fun to really suck at something, and it’s like “Oh great you did 15 kilometers, I did 4” and that’s half more than yesterday, so a lot of athletic stuff. I like way out of town, I like 15 miles out of town at the top of a mountain with only 2 other houses and it’s like a retreat, so we can just get away. That’s great.
P 2: Transcript 2.doc - 2:30 Codes: [Personal characteristics, failure, learned not to fear]
Pretty much everything, like for example when Martha left, she had this whole DBT caseload, and I got it, no training, had no idea what DBT was, all I was told was you’re kind of a Zen, Buddha-isty kind of person, you’ll like it just read the textbook. I don’t know if you’ve read the book, but ‘like hell I’m going to read it’. When would I have time - with my 50 other clients, and now my 20 new DBT clients, I’m sorry, I’m trying to read that thing, so I just read the manual, got the gist of it, and got this group of 5 women together and said “I don’t know what I’m doing, this is totally me winging it, and the only reason this isn’t going to be a waste of your time it because I do have an education and some experience in the field, but I’ve never worked with the diagnosis before and you guys have all been through this group once before, so you need to let me know when I’m insanely off- base and let’s just do this together” and it worked out great
P 2: Transcript 2.doc - 2:31 Codes: [Personal characteristics, failure, learned not to fear] Yeah, because she really influenced me, it was really this My initial feeling was, “Oh, shit, don’t give me this caseload, all I’ve heard is horror stories about these ladies” Why are you doing this to me, I enjoy working with teenagers and the more I looked at it when you look at the criteria for borderline personality disorder, and to me it looks like most 16 year olds I know. And I thought, Oh, I can probably do this. So it’s been great, they have not been a problem at all, and it’s been a year and maybe a year and a half now, that I’ve had that caseload, You know I do the DBT thing, where they can call me at home, and a couple of them do, more than I would like, which I let them know, but they’re nice, I mean they’re nicer than my friends, because they’ll ask if now’s a good time and I can say, is this like a total emergency, are you going to cut yourself? And they’ll say it ‘s not totally, but getting there, and I’ll say “could you just use some skills for half an hour and I’ll call you back. So it’s not… I don’t feel like I have to rescue them, and they’re great - they’re just really wonderful. I definitely was in that situation, so I feel that I don’t have to be perfect, because
141 I’m not. And I screw up daily. And you can’t pretend that I don’t, so I try my best and I did get the training for DBT after I started the group, so I wasn’t totally winging it, but
P 2: Transcript 2.doc - 2:73 Codes: [Therapy attitudes, core tx skills] “I don’t know what I’m doing, this is totally me winging it, and the only reason this isn’t going to be a waste of your time it because I do have an education and some experience in the field, but I’ve never worked with the diagnosis before and you guys have all been through this group once before, so you need to let me know when I’m insanely off-base and let’s just do this together” and it worked out great
P 2: Transcript 2.doc - 2:74 Codes: [Personal characteristics, failure, learned not to fear] I don’t feel like I have to rescue them, and they’re great - they’re just really wonderful. I definitely was in that situation, so I feel that I don’t have to be perfect, because I’m not. And I screw up daily. And you can’t pretend that I don’t, so I try my best and I did get the training for DBT after I started the group, so I wasn’t totally winging it, but
I: You did it the right way. That’s the best way to learn DBT is to do it first and then get the training, the training doesn’t mean much if you start there.
T2: Just do it. OK I’ll try it but I couldn’t pretend to these women like I knew what I was doing cause I didn’t.
P 4: transcript 4.doc - 4:8 Codes: [Personal characteristics, failure, learned not to fear] I certainly don't feel I have all the answers, I'm always learning, and that also excite me,
P 4: transcript 4.doc - 4:58 Codes: [Personal characteristics, failure, learned not to fear] To give themselves permission to not know everything,
P 4: transcript 4.doc - 4:64 Codes: [Active strategies, growth and learning] [Personal characteristics, failure, learned not to fear] [Personal characteristics, openness] but I'm also willing to try new things, and I don't have to have it perfect. I think you need to grow and learn and develop competence, but I think if I waited I won't do very much. I think you have to be willing to just go for it. Not to be too zealous without being grounded, but I think it's okay, even outside of here, I agreed to do this DVD project with a group going on a trek and I didn't have a clue what I was saying yes to, but I certainly get to ask a lot of questions and learn a lot, and that's kind of what I do too. I don't always know what I'm getting into, but once I do commit to do something, I jump in and am going to do what I can to do a good job
P 4: transcript 4.doc - 4:76 Codes: [Personal characteristics, failure, learned not to fear]
142 I remember back then, that I used to think there was so much I needed to know, and there just isn't. To give themselves permission to not know everything, and to learn to say no, and also to have interests outside of work.
P 8: transcript 8.doc - 8:30 Codes: [Therapy attitudes, core tx skills] When you take that broad sweep that you talk about, which for you is clearly a world view, and I’m looking at your DBT book over there, or any other technique that they ask you to employ, is there difficulty integrating that?
Truth is in it. It just gives me a perspective that as I am applying the particulars, I can see where they fit.
P 8: transcript 8.doc - 8:31 Codes: [Therapy attitudes, core tx skills] Yes, and just, I’m drawing from a lot of different areas. Like the mindfulness exercises of DBT are quite useful, as well as the inquiry is it really true, the thought, is the thought of separateness, you can get…but I work with very difficult and resistive, and even low functioning clients, and I’m amazed at how quickly they can say, “Oh, that was just my story, that didn’t happen.” So it’s user-friendly. Even though it can seem pretty abstract.
P 8: transcript 8.doc - 8:45 Codes: [Therapy attitudes, core tx skills] [Therapy attitudes, equality in relationship/mutual goal setting] I was always good at being patient with them, or being kind, but I eventually discovered the core of healing, which is joining with others in a common venture.
P11: Transcript 11.doc - 11:43 Codes: [Therapy attitudes, core tx skills] I read voraciously, I read 72 books in graduate school, none of them textbooks. I had all this foundation of knowledge that I had to sort through. So when I started out, like anyone else, I had too much knowledge and too much technique and had to toss some of it away.
P13: Transcript 13.doc - 13:22 Codes: [Personal characteristics, failure, learned not to fear] No, not really. It's about everything here--the ambiance. They are good people here. And for the most part, my families are pleasant people. I mean, there are times where it gets kind of up in arms, but with exception of one family, I like my families, and I like to see them, and have them come in and say, "Johnny did this today'" and I say, "Okay, we've been working on it for two months. But, yea, I like to come to work. Not everyday, like when my son gets up at 5:00, but for the most part I miss work if I'm gone for too long. For the most part I am able to leave the stories that I hear and the work that I do here. What I miss is the camaraderie, and just being around the people that I love to be around, because they are good people.
P14: Transcript 12.doc - 14:26 Codes: [Personal characteristics, failure, learned not to fear]
143 Overtime it has evolved. Initially, it was more of an anxiety state, "Oh my gosh, they're going to want something, and I don't get it, I'm just so confused." Now it has become much more centered, I can be okay with not knowing. So at times, it's not knowing what do I need to know, what do I need to get out of this, what am I missing? So it is much more of a meditative, centered state when I'm working.
P14: Transcript 12.doc - 14:27 Codes: [Therapy attitudes, core tx skills] Overtime it has evolved. Initially, it was more of an anxiety state, "Oh my gosh, they're going to want something, and I don't get it, I'm just so confused." Now it has become much more centered, I can be okay with not knowing. So at times, it's not knowing what do I need to know, what do I need to get out of this, what am I missing? So it is much more of a meditative, centered state when I'm working. Sometimes, I will do what I was just talking about, when I'm really confused, and I see this and this and this, and I really can't see a solution that can encompass all this, and if I talk about it like that, it is easier for me to get relaxed and them to get relaxed, and it's a little "let's start toying with options" and that's when I get thinking again. I do think it is a matter of coming to a centered position, almost a meditative position, in order to get creative. That's the important thing, is getting creative. How do you get them to get creative?
P16: Transcript 15.doc - 16:7 Codes: [Personal characteristics, failure, learned not to fear] I'm okay with failure, I wasn't at one time, but I'm okay with failure because I see that failure is about learning from that failure.
P16: Transcript 15.doc - 16:39 Codes: [Personal characteristics, failure, learned not to fear] Then the last one is more important, and thank God for (names clinical supervisor) he recognized that I was an overachiever, and he helped me stay grounded, and that I don't have to be right all the time, I'm going to make mistakes, and that's okay. You learn to learn from your mistakes. I was so concerned about messing up, I was so worried about saying the wrong thing or doing the wrong thing or looking at something the wrong way, that was very draining at first. But that is part of the learning process. I think if a young therapist can accept that, they are going to be more likely to be successful in the long run.
Code Family: Adaptiveness/Openness: Hunger for Feedback Through Supervision
Codes (3): [Employer factors, supervision] [Employer factors, talking about cases] [Employer factors,, desires feedback on performance] Quotation(s): 23
P 1: Transcript 1.doc - 1:52 Codes: [Employer factors,, desires feedback on performance] Remove encumbrances. Make their job as hassle free as possible. I don’t want to get into that whining mode, boy I wish they would do this, or do that better. I suppose if from a factual standpoint, if there was a way of measuring the quality of the therapy I do. The
144 essence of what I do is psychotherapy and my performance appraisal is based less on that than anything else. There are instruments by which outcome surveys that measure clients improvement in their functioning and also satisfaction surveys...I don’t know if people do a lot of that cutting edge by which my employers could measure the degree to which my clients are satisfied with the service I provide and the degree to which they improve their functioning. So there are way to do that, and we don’t do any of that here I tend to think that they could so It’s a little discomfiting to think that my most important job is something they don’t get any information on.
P 2: Transcript 2.doc - 2:26 Codes: [Employer factors, supervision] Part of what’s nice about not working in private practice is having support, and for me I can definitely get so excited about my job that I feel that I can take on anything, and I tend to need a supervisor, who will say, so what is it going to be? 80 hours a week now? You know, how are you going to do this? And I feel like what happens is , Oh, you want to take this on, great, OK, you figure out how to deal with it. So I need to learn as I grow up
P 2: Transcript 2.doc - 2:56 Codes: [Employer factors, supervision] I did put the staff meeting on Tuesday. I didn’t go to work Monday, and didn’t go to staff meeting on Tuesday, and one of the case managers said what’s happening? Why is Misha still on call. Why haven’t one of you offered to relieve her? This is not OK. How can she be doing this and being on call. And that was great, and somebody took away. But I didn’t think to ask for that. I didn’t think I was allowed to ask for that - plus I wasn’t thinking.
P 4: transcript 4.doc - 4:71 Codes: [Employer factors, supervision] If I ever go into private practice, I want to go in with somebody, because I don't want to get off and not have anybody question why I'm doing something. I want to always get that kind of feedback I think that's really healthy.
P 6: transcript 6.doc - 6:33 Codes: [Employer factors, talking about cases] part of what used to be good about this profession is that there was an encouragement for contemplation, for reflection, for getting together with other people and soliciting ideas about how you were doing.
P 9: Transcript 9.doc - 9:52 Codes: [Employer factors, supervision] Um hum. I can in supervision and do, and you know I talk both about clients or cases that are vexing to me and hope to get input on, and we have - I'm involved in the DBT program for borderline personality disorder and we have a staff meeting every week for an hour that's devoted just to that - which is for us so that we don't burn out - so that we can get it all out about some clients that are generally pretty difficult to work with.
P 9: Transcript 9.doc - 9:53 Codes: [Employer factors, talking about cases]
145 Yeah, I feel I have ample opportunity and then if I've got an hour with nothing to do, or if somebody cancels on me or something I could just roam the halls and just buttonhole anybody. I've never run into anybody in this agency who is unwilling to talk about something or to sit down and help me understand what I'm seeing, so yeah, I've got plenty of that.
P 9: Transcript 9.doc - 9:56 Codes: [Employer factors, supervision] He is someone that I have passionately disagreed with, who I've called a proselytizer, who I have denounced, but he is the first person whose door I knock on if I'm stuck. He is just a lifeline, and I depend on that.
P10: Transcript 10.doc - 10:11 Codes: [Employer factors,, desires feedback on performance] [Energy, energizer, team of colleagues] I really enjoy working with the team, that is one of the reasons that I'm not in private practice. I really enjoy working with a group of people who have the best interest of one individual. I really like that. Of course I always respond to approval from my peers and supervisors. I'm interested in the theory and seeing it work.
P10: Transcript 10.doc - 10:28 Codes: [Employer factors, supervision] I had a really excellent supervisor that supported me through all of that and I really think that made a big difference.
P10: Transcript 10.doc - 10:32 Codes: [Employer factors, supervision] Right. I really think that collaborating with colleagues and making sure you get a good supervisor. I mean I really lucked out. I really lucked out, and um I know, well as a graduate student I looked at the clinical, and did my internship here and my supervision, not, as a graduate student it was not good and so I took it upon myself to go out and find supervision from everybody else in the clinic - just ask lots and lots and lots of questions, you know, and um… that kind of thing. And then I would, I'm really a big believer that after going into it as an expert, that's a pretty tall order to fill. And I don't know that you can ever feel it.
P11: Transcript 11.doc - 11:27 Codes: [Employer factors, desires feedback on performance] Yea, I get this wonderful feedback from people, and they support me, give me nice feedback, every so often I will get something extra in my paycheck just for my overall job, I've always felt very supported, and I'm thinking of both places that I work, very well respected and supported, very much so.
P11: Transcript 11.doc - 11:29 Codes: [Employer factors, talking about cases] [Energy, energizer, team of colleagues] There would be a lot of getting together to staff cases, I have a lot of good people, and they all like getting their work and their jobs, and one of the ways that we keep that going is we
146 have a once-a-week clinical staffing, the meetings are a blend of getting the work done, and just laughing. A lot of humor, you could look at parts of the meeting and thing, "that's a waste of time", but the business gets done, but also the people connect and let off some steam.
P13: Transcript 13.doc - 13:18 Codes: [Active strategies, avoids colleagues who aren't PCP] [Active strategies, PCPs, being around others facilitates passion] [Employer factors, supervision] [Energy, energizer, team of colleagues] the entire team here, they have been great. They have been supportive, they are professional, they let us know what is going on, I know I can go to any of three of them with a question or concern. Because I came from out of state, I worked for two years at the (names day treatment program), and every bit of that was great too. I think the frustrating part is when you get around people that aren't passionate, and we don't have that here. I'd say that passion is probably different with each of use, but you know, I don't have any complaints about anybody here. I could go to anybody here and say "This is what's going on, can you help me?" and that's what I truly believe. I think that everybody is committed to what they do. They may not like it some days, but…Everybody here is great-- we all get along, we have a lot of fun, some of us do things after work, we're friends. Although, when we are here, we know some things have to remain out there, our kids play together. But I would say my team--we have the best team in the world here.
P13: Transcript 13.doc - 13:19 Codes: [Employer factors, mission driven] [Employer factors, supervision] [Employer factors, talking about cases] Probably not taking extra time to just talk. To talk about countertransference, to talk about how life in general is going, (my supervisor) will ask, "how are things in your life?", and he's not asking how I am as a therapist, he's talking about it in general. I think if the supervisors didn't care, or if they were all just Type As and interested in how things were business oriented, that would probably drive me insane, if there were no feelings or emotions about it, just "get everything done and don't come to me." I've worked in different fields like that, and it is really bothersome. You want that support, people in (names company) have said children's outpatient is the best place to work, because it's not like that throughout (company.) You hear a lot of complaints about other parts of (company).
P14: Transcript 12.doc - 14:31 Codes: [Employer factors, supervision] I think that supervision is paramount.
P14: Transcript 12.doc - 14:32 Codes: [Employer factors, talking about cases] I love working as a team here. We will get together here and just chat, and it's not something that you could rearrange, but it's not precluded by a) they way we are situated, or b) how we our schedules overlap. The more time that I find that I am able to sit and talk with my colleagues, certainly there is a downside to that in terms of you're doing too much of it, it's detracting from doing work, per se. But I do think that kind of group discussion really keeps me motivated, I find that helpful.
147 P14: Transcript 12.doc - 14:35 Codes: [Active strategies, growth and learning] [Employer factors, supervision] I do believe the more you continue to grow, the more you'll stay invested in it, because I think it is about personal growth as well. If there were a way to make it more of an apprenticeship the next two or three years, where they are not seeing as "supervision" like they had during their internship, but apprenticeship, how can I become more skilled in this, and gain from other people around me and see what I want to be. I think that would do it--it would open their eyes.
P15: Transcript 14.doc - 15:24 Codes: [Employer factors, supervision] Just being available… I think the agency on the whole, I know (names supervisors) do a good job of supporting their therapists if they get a complaint, or if there is a problem, they don't automatically assume that you screwed up. They listen very well to clients, but they also listen to therapists, so I feel supported that way.
P15: Transcript 14.doc - 15:32 Codes: [Employer factors, supervision] Get good supervision,
P16: Transcript 15.doc - 16:35 Codes: [Employer factors, supervision] Having a supervisor or administrator that understands, that if they want to keep passionately committed psychotherapists, they will be supportive of those experiences.
P16: Transcript 15.doc - 16:37 Codes: [Employer factors, supervision] First of all, find a very good clinical supervisor. Being a new psychotherapist, you are so nervous, and so unsure about what you are doing, and that takes so much energy anyway, and so having someone that you can staff cases with and talk to and get ideas from is huge.
P16: Transcript 15.doc - 16:40 Codes: [Employer factors,, desires feedback on performance] one of the things that was encouraging to me, and helped me feel I was capable of doing what I was doing, was having supervisors and administrators give me feedback and those pats on the back of, you're doing a great job, we appreciate what you are doing, I love that kind of stuff. I thrive on that.
Code Family: Adaptiveness/Openness: View Obstacles as Challenges
Codes (2): [Personal Characteristics, challenges] [Personal characteristics, hardiness] Quotation(s): 29 P 1: Transcript 1.doc - 1:11 Codes: [Personal characteristics, hardiness]
148 I haven’t taken a sick day
P 1: Transcript 1.doc - 1:12 Codes: [Personal characteristics, hardiness] One of the other things for which I have a reputation is that I don’t let stuff get to me.
P 1: Transcript 1.doc - 1:31 Codes: [Personal characteristics, hardiness] I don’t get easily frustrated.
P 1: Transcript 1.doc - 1:56 Codes: [Personal characteristics, hardiness] I’m sort of unflappable, stuff doesn’t get to me that much. I w up in a household where I had seven, I had six brothers, and a sister, so we were , we, being tough and being strong, and not being complainers, those things were all being reinforced, so I think it’s kind of curious that… I don’t think I would ever have been a therapist if I hadn’t been,
P 1: Transcript 1.doc - 1:59 Codes: [Personal characteristics, hardiness] So I guess yeah I mentioned that hardiness. Maybe it’s my upbringing, maybe a little bit of genetics, uh; I don’t tolerate feeling burned out. I tend to want to steer away from that as best as I can.
P 1: Transcript 1.doc - 1:71 Codes: [Personal characteristics, hardiness] I haven’t had a lot of low moments. I’m sort of known for being psychologically hardy and I. P 1: Transcript 1.doc - 1:72 Codes: [Personal Characteristics, challenges] It’s a challenge I think with working with the seriously mentally ill. The thing I enjoy most about psychotherapy is getting people to change and getting them to change their lives and with the seriously mentally ill you have to change your expectations. So I don’t find it revitalizing to work just with people who need a friend and a social support
P 2: Transcript 2.doc - 2:77 Codes: [Personal Characteristics, challenges] I didn’t think borderline women would be a good fit for me. I thought they’d be a nightmare for me. Really bad. I had a big temper tantrum when I thought they were ‘dumping’ Martha’s caseload on me. But you know, what are you doing to me? I work with teenagers. These are personality disorders, I know nothing about personality disorders. I don’t fit for about 10 minutes, and then I went oh, this really might be kind of interesting. You know, sometimes I have a little hissy fit, and then I realize this could be a great opportunity.
P 2: Transcript 2.doc - 2:78 Codes: [Personal characteristics, hardiness] It’s been a trip. You know, this is a good fit. But there’s going to be something come along, and they’re going to want to stick me in some other thing that’s not going to be a good fit.
149 And I’ll just try to figure out how to balance that. And Maybe I can make it a good fit. I didn’t think borderline women would be a good fit for me. I thought they’d be a nightmare for me. Really bad. I had a big temper tantrum when I thought they were ‘dumping’ Martha’s caseload on me. But you know, what are you doing to me? I work with teenagers. These are personality disorders, I know nothing about personality disorders. I don’t fit for about 10 minutes, and then I went oh, this really might be kind of interesting. You know, sometimes I have a little hissy fit, and then I realize this could be a great opportunity. And you know if it was a horrible fit I would have gotten myself out of it. Which I just did.
P 3: transcript 3.doc - 3:12 Codes: [Personal Characteristics, challenges] having clients that want to come back,
P 3: transcript 3.doc - 3:14 Codes: [Personal Characteristics, challenges] Trying a new technique
P 4: transcript 4.doc - 4:16 Codes: [Personal Characteristics, challenges] Just because there wasn't another female therapist, and we are even privately lacking in this area, so it's just naturally evolved because it is what was needed. But I've grown to love it, even those with borderline personality disorder, just to put it in a healthy context, because I don't come at it thinking, oh, my gosh, because some of them are so difficult, I can have more compassion. It's a better way to present that, and we can get a lot further, because they know I'm not afraid of them, and understand kind of where they are coming from, but also can hold them accountable.
P 4: transcript 4.doc - 4:17 Codes: [Personal Characteristics, challenges] I'm not afraid of them, and understand kind of where they are coming from, but also can hold them accountable.
P 4: transcript 4.doc - 4:46 Codes: [Personal Characteristics, challenges] Probably, even though I love them, the borderlines. One I'm just now getting back, was doing great, and then awful, and now I'm getting her back. They just don't stay around long enough to get good, solid treatment, but they keep popping up, so I just hope one of these times they'll settle down.
P 4: transcript 4.doc - 4:67 Codes: [Personal characteristics, hardiness] I don't think that's what I enjoy, but when they do things that aren't appropriate, because I'm okay with me even when they are real "naughty"--I know that sounded bad-- when they are inappropriate, it doesn't rock my boat too much, and I think that is important, because if I reacted that's the same message they get everywhere. I don't know that I enjoy that so much, but when it comes, I feel pretty steady.
P 4: transcript 4.doc - 4:82
150 Codes: [Personal Characteristics, challenges] It used to be scary, because they can be scary sometimes. I don't think that's what I enjoy, but when they do things that aren't appropriate, because I'm okay with me even when they are real "naughty"--I know that sounded bad-- when they are inappropriate, it doesn't rock my boat too much, and I think that is important, because if I reacted that's the same message they get everywhere. I don't know that I enjoy that so much, but when it comes, I feel pretty steady.
P 5: Transcript 5.doc - 5:36 Codes: [Personal Characteristics, challenges] where I interact with families and adolescent, and there's lots of emotion and fighting and yelling and people who are really worked up-- so for me, that's something that has helped. I apologize that I don't have a word to put on it, to describe it.
P 6: transcript 6.doc - 6:26 Codes: [Personal characteristics, hardiness] I think I've improved at dealing with intense affect over the years, otherwise I don't think I would have lasted. Yea, I'm much better at being able to detach from that, and to look at it, and even to elicit it from people I work with. Sometimes that's powerful to work with, so I'm comfortable with that most of the time.
P 6: transcript 6.doc - 6:48 Codes: [Personal Characteristics, challenges] It isn't that I'm immune to stress, because I wouldn't have all this gray hair, if I were. I think I've improved at dealing with intense affect over the years, otherwise I don't think I would have lasted. Yea, I'm much better at being able to detach from that, and to look at it, and even to elicit it from people I work with. Sometimes that's powerful to work with, so I'm comfortable with that most of the time.
P 7: Transcript 7.doc - 7:13 Codes: [Personal Characteristics, challenges] But I don’t mean creative in that sense when it comes to this. I mean creative in the sense that you don’t have to do what you’ve always been doing that doesn’t work. Think of a different solution to meet the needs of these people that will meet that deficit. For example, when we were dealing with the borderline population before, and we really had kind of a stomp out fires approach because so many fires were being created and we were caught in that web of them telling one person one thing and one person something else, and being pitted against one another. I said we really need a unified approach, there’s a better way to treating these people than just putting out fires---this is also a good example of how I set myself up. So how about if we just consolidate that, have one person in charge of it, one person to refer to, and an avenue where that person's needs can be met. So then, guess what? I’m the designated person, and everyone is ready to take every borderline person they have into that arena. What I really had in mind was something different, I had in mind the designated person would support, they missed the support part. But it worked; it cut down on problems in lots of arena. We were having problems in our crisis calls, they would wait until after hours, that is when they would go into crisis, then set up the crisis person to call a bunch of people and get them all involved. So they don’t do that now, they are referred to
151 the group to deal with their problems and we’ve created specific treatment plans for them and they like that. So they have an avenue to meet their needs and our needs as a center, we weren’t being taken advantage of, we were cutting down the amount of time we were investing.
P 7: Transcript 7.doc - 7:20 Codes: [Personal Characteristics, challenges] And yet you talked about wanting to go back to adult services and run a group for persons with borderline personality disorders.
It’s challenging-it’s using that creative process. You kind of have to out-maneuver them. And they know when they’ve got someone that they can just steer all over, and they have a fun time doing that. They also know when they have met their match. And I think they have respect for someone that will say, “Let’s not go there.”
P 7: Transcript 7.doc - 7:21 Codes: [Personal Characteristics, challenges] Oh, I think the most difficult things in life are also immensely rewarding.
P 8: transcript 8.doc - 8:19 Codes: [Personal characteristics, hardiness] I love the physiological experience…and the healthiness, you know, I rarely get colds or flu
P 8: transcript 8.doc - 8:25 Codes: [Personal Characteristics, challenges] Are the clients that you are describing that might be malingering or have secondary gains difficult for you?
No, they are the kind that no one likes. And they are the kind that I sort of enjoy. Because it’s a challenge. It’s satisfying to take the impossibles. I don’t have enough time in the day in a way to sometimes manage all that could be managed.
P 8: transcript 8.doc - 8:49 Codes: [Personal Characteristics, challenges] No, they are the kind that no one likes. And they are the kind that I sort of enjoy. Because it’s a challenge. It’s satisfying to take the impossibles. I don’t have enough time in the day in a way to sometimes manage all that could be managed.
P 9: Transcript 9.doc - 9:8 Codes: [Personal Characteristics, challenges] Perhaps from that standpoint, I end up being energized by the interaction because it is more of an investigation.
P 9: Transcript 9.doc - 9:9 Codes: [Personal Characteristics, challenges] I think I understand that, and when you talk about the discipline of it, is it actually part of the challenge for you to maintain the discipline?
152 Code Family: Balance: Boundaries Between Work and Non-Work Codes (4): [lifestyle, balance] [Lifestyle, balance, family] [Lifestyle, renewal, reading/meditation] [Lifestyle, work is lesser priority] Quotation(s): 39
P 1: Transcript 1.doc - 1:6 Codes: [lifestyle, balance] healthy lifestyle
P 2: Transcript 2.doc - 2:22 Codes: [Lifestyle, balance, family] my husband is a social worker
P 2: Transcript 2.doc - 2:65 Codes: [Lifestyle, work is lesser priority] But, it’s not my life. My marriage is the most important thing to me. My health, and my family. That’s what’s the most important thing. Work is almost that important to me, but enough that there’s no question where my priorities lie.
P 3: transcript 3.doc - 3:17 Codes: [Lifestyle, renewal, reading/meditation] I read a lot.
In the field, or for pleasure?
Both-- I read a lot of both.
P 3: transcript 3.doc - 3:19 Codes: [Lifestyle, renewal, reading/meditation] I've been meditating for a number of years. When I was talking about new things I've tried, I did a meditation class here in town for years, and that's something I've stayed with that helps.
P 4: transcript 4.doc - 4:11 Codes: [lifestyle, balance] I just do what I can to just try to be balanced
P 4: transcript 4.doc - 4:21 Codes: [lifestyle, balance] I think that in the beginning, people would have said that I was passionate in my work, I think they would have said that in graduate school, and at different points in my life, but I think this in this role, with comprehensive, real difficult cases, I don't think I could sustain my passion if I didn't have a balanced personal life. Because I think this job-- and it has, a couple of years ago-- kind of can take over, and so I've learned that even with passion, the job kind of can take over, and without balance I will burn out.
P 4: transcript 4.doc - 4:33 Codes: [Lifestyle, balance, family]
153 I love to exercise, I have really good friends, I have children in my life, my brother's friend's children, I think they are instant renewal. I just, spiritually, do what I can to stay grounded that way.
P 4: transcript 4.doc - 4:34 Codes: [lifestyle, balance] And that's just been a process, and it's really just been about the last year and a half that I've understood the need for that level of balance, and I do believe my work is a lot better now.
P 4: transcript 4.doc - 4:36 Codes: [lifestyle, balance] I feel better if I do something in the way of self-care each day, I don't get too far off, I mean sometimes you do, but not too far.
P 4: transcript 4.doc - 4:57 Codes: [lifestyle, balance] [lifestyle, balance is a struggle] Yes. I've had a few set backs with my health problems, but even that has been pretty beautiful once you are on the other side of that, and have time to really reflect on that. That's the thing about community mental health, you're always so busy you don't have any time to reflect or maybe read the literature, to see what's the latest, because you just see one person then the next person, it's been good for me to pull back, like I haven't done an intensive group for four months, and it's been good to pull back and see what I value and so I want to make sure I keep that it, so I know where I am going.
P 4: transcript 4.doc - 4:59 Codes: [lifestyle, balance] [lifestyle, balance is a struggle] learn to say no, and also to have interests outside of work. I don't think work can be the only thing that brings you joy, you've got to do that on your own. With the students I've worked with, we've really talked about that, and I've given them the understanding that it's okay in the beginning to take very few clients and to build their confidence. I didn't know those things, and didn't know to ask those things, so in the beginning I got in way over my head way fast, so you have to learn by experience.
P 5: Transcript 5.doc - 5:6 Codes: [lifestyle, balance] People might say that I am too silly or immature, we goof around a little bit as co-workers, so I would say a sense of humor, keeping light-hearted, not letting yourself get too bogged down from all the woes that we deal with. Also, not trying to overload myself, that can weigh me down.
P 5: Transcript 5.doc - 5:8 Codes: [Lifestyle, balance, family] and then my family. I enjoy spending time with my wife and kids.
P 5: Transcript 5.doc - 5:32 Codes: [lifestyle, balance]
154 I guess that's when you go to some of the things I've talked about to rejuvenate yourself, or sometimes I'll take a mental health day. Looking at my schedule, next Friday is thin, I'm moving the clients and taking the day. Either spend the day with my family, or do nothing or whatever. You've got to take care of yourself, be aware of your own needs, and be aware of that.
P 5: Transcript 5.doc - 5:33 Codes: [lifestyle, balance] Make sure they do things and have things in place in their own life to take care of themselves. To enjoy life, whether it's with a spouse or partner or family or friends or on there on. Having things…realize all of life isn't work. There is a time and place for work, and a time to let it be. Let it sit and stay at work. I don't know the skills for doing that, but I feel I have been lucky and have been able to do that well. I think the biggest one for beginning therapists is to make sure they keep their own personal life a health one and going well, keep refreshed.
P 6: transcript 6.doc - 6:5 Codes: [lifestyle, balance] IF anything has served me well, I have some other things in my life that give me balance; this isn't my one and only passion. If you look behind you, there is a strange piece of furniture, I make strange furniture and I go home and whittle away. Knowing how to pull up the drawbridge and not take it home with you is what allows you to survive. Which is why crisis work is difficult, because it intrudes in that time where you are away from work. It used to be horrendous, you would go to the hospital at 2:00 and get home and the jail would call at 3:00 and you had to be at work at 8:00 and that makes it hard to find balance. I think my job is one aspect of my life, but quite frankly I'm one of these dads that is just totally close to my kids and that's a big aspect of my life, my wife and my kids. My other interests are a big part of my life.
P 6: transcript 6.doc - 6:6 Codes: [Lifestyle, balance, family] I'm one of these dads that is just totally close to my kids and that's a big aspect of my life, my wife and my kids. My other interests are a big part of my life.
P 6: transcript 6.doc - 6:16 Codes: [Lifestyle, balance, family] the first thing my kids would do if they walked in right now is give me a big hug. If they take vacations, they want me to go with them. I would rather have the things I have in my life than more material things.
P 6: transcript 6.doc - 6:37 Codes: [lifestyle, balance] What advice would you have for beginning psychotherapists about maintaining their passion and commitment to the work?
Let me go back to what I said, about balance.
155 P 6: transcript 6.doc - 6:39 Codes: [lifestyle, balance] To keep balancing, this is one exciting aspect of your life, but don't expect it to sustain your whole life.
P 6: transcript 6.doc - 6:43 Codes: [lifestyle, balance] [Quotes] This something that I love, but I am a polygamist in that I have a variety of passions, and spread my loyalties amongst those. I'm not just married to one aspect of who I am.
P 7: Transcript 7.doc - 7:30 Codes: [lifestyle, balance] I need something in my life that is a creative outlet; I mean an artistic creative outlet. Something that I make and do. My undergraduate degree is in art and painting was my specialty, a number of my paintings are here on the wall. I hadn’t done that for years, on occasions if I had some burning psychological need I would do a painting, but I haven’t done it regularly. I said I needed something to feed myself, to balance the energy-taking part, and to renew myself, and it was really delightful. I just stumbled upon that one day, I was at an art fair, because I love seeing what other people do and I found a bracelet one day that was really unique. I asked the lady that sold the bracelet what the beads were, and she said, “They’re glass”, and I said “do you make them,” and she said “No, I get them off E-bay.” She and I since then have become great friends. I now have a glass studio where I probably spend the majority of time when I’m not here.
P 7: Transcript 7.doc - 7:31 Codes: [lifestyle, balance] Ever since I found that I do something rewarding for me that isn’t related to social work, I don’t feel burned out. I’m a whole lot more tolerant-I knew I was headed there, if I hadn’t looked for something to bring me balance, it definitely would have arrived there. I would have failed in my profession. But now, I come to work, I can tolerate it most of the time-I have these moments when I have to go out in the hall and go “Ahhh!” and then I’m fine-but I have these bead ideas going in my head, I’m a little OCD, and I look forward to a time when I can go to my glass studio and see if it actually works.
P 7: Transcript 7.doc - 7:32 Codes: [lifestyle, balance] Balance-I think you can give too much of yourself. I think for everybody how they nurture themselves and keep themselves in an okay place-two different things. Whatever activities they need to do to keep it in balance, then they’ll be okay. But then, I’m a Gemini, so balance makes sense to me. My tendency is to become too consumed in things. And I’ve had to become aware of that myself. I don’t know if for non-Gemini’s maybe that won’t strike a chord, I don’t know. But I personally think that there are things that feed yourself, and things that take. Social Work is definitely one of those things that take, and I have to feed myself. That’s just enormously rewarding for me to do that. In the quietness of my own little studio, with my own little music and my cuts of glass, I’m just happy as hell.
P 7: Transcript 7.doc - 7:33 Codes: [Lifestyle, balance, family]
156 Another thing that really feeds my soul is I’m really connected to my kids. I just love it, you know… they’re not really what I expected them to be. But I’m delighted at the people that they’ve become and so, for me, I’m just a curious watcher. I’m like wow, you’re really cool, and you’re awfully hunky, too. I mean, I have these huge, hulking sons who are incredibly handsome and daughters that are beautiful and they’re just full of life…
P10: Transcript 10.doc - 10:15 Codes: [lifestyle, balance] I spend a lot of time with my family. I have a group of friends that I meet with every Wednesday night, a group of girl friends
P11: Transcript 11.doc - 11:36 Codes: [lifestyle, balance] get plenty of support, and don't work more that, with my staff I never wanted them to give us more than forty hours a week. I never lived that way; I put in more, but have a balance in your life, besides this. Figure out some way when you walk out the door to leave all the stuff you collected during the day…
P11: Transcript 11.doc - 11:40 Codes: [lifestyle, balance] I have other passions. My current one, that has been at the top the last year or so is photography. That takes me outdoors a lot, so nature and photography are, and friends, I have a good set of friends. I'm also passionate about cooking; I'm passionate about a lot of things.
P13: Transcript 13.doc - 13:5 Codes: [lifestyle, avocations.] [lifestyle, balance] My son and my partner, we go hiking, we love to go snow shoeing, go to movies, and even sometimes we do absolutely nothing, we just sit around the house. Love to shop-- well, money is always an issue-- but just get out and do things.
P13: Transcript 13.doc - 13:6 Codes: [lifestyle, balance] I think the passion is different-- I think my passion to be a good mom, and to be a good partner, and to be a good human all the way around, I wouldn't say I have the same kind of passion for anything else, because it is different. Working with people is a different kind of passion than snow shoeing, I love to be outside, and looking at the beauty of nature, but I wouldn't say it's the same passion, it's different levels of passion. I wouldn't say this is the only passion I have, just that there are varying degrees of it.
P14: Transcript 12.doc - 14:12 Codes: [lifestyle, avocations.] [lifestyle, balance] [Lifestyle, balance, family] [Lifestyle, renewal, reading/meditation] I think it has changed over time, interestingly enough. I do less physical activity, I used to do a lot of hiking and camping and skiing, and unfortunately I've let that go and that's been one of the things that has been a loss, so I'm trying to change that. I have been doing a lot more intellectual stuff, I read, not only more psychology kinds of things, but fun stuff, science fiction, or… I'm involved in a number of activities tangentially related to my
157 profession, being on the licensing board of my profession, being in my professional organization, so I do some of that, that's renewing. I do spend, I'd say most of my "renewal" comes from spending time with my wife. I think our relationship has been a major boon to me. We've been doing a lot of house projects. Just having that family piece is renewing. I do meditation, that is part of my balance. I used to practice aikido, and I still to a little tai chi.
P15: Transcript 14.doc - 15:5 Codes: [lifestyle, balance] [Passionate commitment, resonates with term] I've been thinking about that. I love what I do, most of the time, not all of the time, I look forward to coming to work. I like what I do, I like the diversity of kids, it's always kind of fun, what am I going to do with this kid, I like all that. I can't imagine having another job. I can't think of another job I would enjoy more. In terms of "passionately committed", if that's passionately committed, than yea. If that is my whole life, then absolutely not. I'm real clear that my work is my work and the rest of my life is lots more fun, well not lots more, but sometimes.
P15: Transcript 14.doc - 15:14 Codes: [lifestyle, balance] There are therapists here who will come in on the weekend and do their paper work. I'm not going to do that. My weekends are my weekends. I try to keep everything in perspective.
P15: Transcript 14.doc - 15:15 Codes: [lifestyle, avocations.] [lifestyle, balance] I have a dog and I'm in agility training with her, so we are doing tunnels and leap poles and dog training. That's an energy producer. I'm a quilter. I belong to a quilt group and I teach quilting. I have friends, and belong to a book club. My husband and I do a lot of outdoor stuff. We like to travel, we like to camp. In the winter we like to snowshoe and cross- country ski, in the summer we bike and hike and canoe. We spend as much time as possible off exploring and doing things. I go as much as possible; lots of things that keep me busy and interested.
P16: Transcript 15.doc - 16:5 Codes: [lifestyle, balance] [Passionate commitment, resonates with term] Do you see yourself as a passionately committed psychotherapist?
I do. I mean, I was very honored to be nominated, but at the same time I feel very passionate about my work. I was late today because I was passionately committed to a client. But I also have a balance in life, so that helps me to be passionate about my work.
P16: Transcript 15.doc - 16:6 Codes: [Lifestyle, balance, family] One, support of my family, my children and husband. Dealing with a tremendous amount of emotion during the day, and being drained after the day is over with, being able to go home and have the support of my husband and children, is huge.
P16: Transcript 15.doc - 16:17 Codes: [lifestyle, avocations.] [lifestyle, balance]
158 I love spending time with my family. I love spending time with my children and my husband. We are a very active family. During the wintertime we ski and snowboard so we take a lot of weekends and do that. Just having a balance outside of work, being active. I also do volunteer work at my children's school, and that gives me a lot of energy. Coffee. Lots of coffee.
P16: Transcript 15.doc - 16:36 Codes: [Energy, Burnout, not burned out] [lifestyle, balance] I fully believe that I am not even close to burnout now. I love getting up in the morning, I love going to work, I love working all day, and I love going home and letting it all go. That's probably why I'm not in burnout mode.
P 9: Transcript 9.doc - 9:48 Codes: [Active strategies, growth and learning] [Personal Characteristics, challenges] Yes, yes, absolutely. I'd like to get better, and to get better is to practice keep that line distinct. A lot of times, that line is blurred or nonexistent anyway, and they don't know where they leave off and another person begins.
P11: Transcript 11.doc - 11:21 Codes: [Personal Characteristics, challenges] So you probably deal with a fair share of angry clients.
Yea.
Are you able to tolerate that?
I worked for about a year on that, because I wasn't very good at it. I tended to get defensive, and not be very effective. But now I tell the front desk if you're having problems with angry clients, send them to me because I enjoy working with them, they're very, very challenging. I got a formula in training that angry people just want to be validated, and that makes it very easy. I'll validate you now instead of trying to reason with you, and it always seems to work. So, I really like to get there.
Code Family: Balance: Difficulty Finding
Codes (2): [lifestyle, balance is a struggle] [Lifestyle, crisis in balance] Quotation(s): 21
Codes: [lifestyle, balance is a struggle] It is, because everything sounds really exciting to me. So, that’s really hard, it is. And I often get in over my head , because like you know, “Oh my God, shit, how am I going to do this” You know have a total breakdown, I took on Green River, two days a week, July 1st, instead of going up to Price with Gen and it’s total breakdown in the car when I realized I thought I was going to keep my 60 clients in Moab and pick up clients here, and I couldn’t possibly see the people in 2 days that I see in 5 days, and I was just like completely flipped when it never occurred to me when I said yes to this commitment
159 That it meant I was going to have to cut down in Moab, I was kind of just adding 2 days, not subtracting 2 days so that’s the kind, I get myself into this kind of thing all the time, but then you know I figure it out. But that’s kind of hard.
P 2: Transcript 2.doc - 2:33 Codes: [lifestyle, balance is a struggle] I’ve got my DBT people calling me at home, so you know, you have to have kind of rules, like, you know don’t sit at the kitchen table to take a phone call, don’t sit on the couch, ( unintelligible….), don’t talk about work in bed, if we start to ,we have to stop, but we can sometimes feel like it’s 24 /7 so we both have to be really, you know, disciplined at home, because we work with some of the same people, I do groups with some of the people that Kevin case manages, so we have to really be like, no, come into my office at 4:00 and we’ll talk about it then, we’re not going to talk about it on the way home. We screw it up all the time. Definitely, like a half hour will go by and we’ll say ‘Oh, shit, we’ve got to quit talking about this’. So we try, we have to make an effort at it, that’s for sure.
P 2: Transcript 2.doc - 2:55 Codes: [lifestyle, balance is a struggle] So I stayed home. And they just went, oh you poor thing. OK, stay home. Nothing that’s going on with me is life and death, you know and we talked about a safety plan. If something is life and death, this is what we need to do. I mean this is 12 years in the field and I’m just now figuring this out. But again, it’s the response to a pretty serious crisis. That’s the worst I’ve ever been.
P 2: Transcript 2.doc - 2:79 Codes: [Lifestyle, crisis in balance] OK, stay home. Nothing that’s going on with me is life and death, you know and we talked about a safety plan. If something is life and death, this is what we need to do. I mean this is 12 years in the field and I’m just now figuring this out. But again, it’s the response to a pretty serious crisis. That’s the worst I’ve ever been.
P 3: transcript 3.doc - 3:26 Codes: [lifestyle, balance is a struggle] I'm not really good at pacing myself, and I've given more than I had to give. There have been some times when I've had to stop and regroup, and get a better balance of how I was living my life.
P 3: transcript 3.doc - 3:27 Codes: [lifestyle, balance is a struggle] Yes. I was at a point where I was trying to be an administrator, a supervisor, and a therapist, and I had taken on more than… at least more than I could handle, more that was satisfying for me. It helped me redefine who I wanted to be, what I wanted to give up. I ended up leaving administration because of that.
P 3: transcript 3.doc - 3:28 Codes: [lifestyle, balance is a struggle]
160 My lowest moments were when I was trying to be the director and supervise several clinicians, see several people at the agency, see people privately, and do presentations for everyone who wanted a presentation. I let myself get way overextended. I had about a two year period where I really wondered …well, I knew I had overextended myself and wondered what I should do about the administration.
P 3: transcript 3.doc - 3:30 Codes: [lifestyle, balance is a struggle] I didn't consider getting out of the therapy business, I just had to figure out how to be better at everything I did. Obviously, it didn't work, and I finally figured out what piece to let go of.
P 4: transcript 4.doc - 4:22 Codes: [lifestyle, balance is a struggle] Yea, I mean when I started here, nobody said , everyone is so glad that a new person is working here, no one tells you how to find balance, or how to structure a case load, or how many people to see, and those kinds of things. I've had to learn that the hard way. Things like Leif's death have been a wake up call. I'm still passionate, but I think I'm wiser now. I still have that passion and that drive to improve as a clinician and as a person, but it's balanced, because without that, I don't know how long people can sustain, even if you're passionate about something, you still have to have balance
P 4: transcript 4.doc - 4:42 Codes: [Lifestyle, crisis in balance] I think a couple of years ago I ended up with some health problems because I worked too much, I ended up with Bell's Palsy, and so those are wake up calls for me, just to really…that's why I am working on being balanced. I think even then, people would have said I was passionate, but I know I didn't have much in the tank. It's me just learning how to balance out, because it's really easy in this kind of job to: 1) be taken advantage of, not because people mean to, but the cases never end, there's never an end to intakes, so it's really me to learn how to set those boundaries, and not to think it needs to be me to see all the women of trauma, because there's so many, I can't see all of them.
P 4: transcript 4.doc - 4:43 Codes: [Employer factors, employers overload PCPs] [lifestyle, balance is a struggle] Yes, it's getting easier, but I think it's easy to assign cases to your go-getters, so it's good for me to learn to say, "thank you, but…"
P 4: transcript 4.doc - 4:57 Codes: [lifestyle, balance] [lifestyle, balance is a struggle] Yes. I've had a few set backs with my health problems, but even that has been pretty beautiful once you are on the other side of that, and have time to really reflect on that. That's the thing about community mental health, you're always so busy you don't have any time to reflect or maybe read the literature, to see what's the latest, because you just see one person then the next person, it's been good for me to pull back, like I haven't done an intensive group for four months, and it's been good to pull back and see what I value and so I want to make sure I keep that it, so I know where I am going.
161 P 4: transcript 4.doc - 4:59 Codes: [lifestyle, balance] [lifestyle, balance is a struggle] learn to say no, and also to have interests outside of work. I don't think work can be the only thing that brings you joy, you've got to do that on your own. With the students I've worked with, we've really talked about that, and I've given them the understanding that it's okay in the beginning to take very few clients and to build their confidence. I didn't know those things, and didn't know to ask those things, so in the beginning I got in way over my head way fast, so you have to learn by experience.
P 7: Transcript 7.doc - 7:10 Codes: [lifestyle, balance is a struggle] Sometimes I’m so willing to help that I get too involved. Sometimes I get to the point that I’m uncomfortable with how much I am doing, and I have to pull back
P 7: Transcript 7.doc - 7:18 Codes: [Lifestyle, crisis in balance] No-I became aware about three years ago that my life was out of balance. I contemplated leaving the agency, I considered changing jobs at the agency as a change, I contemplated leaving the field altogether as a change. I decided, okay, probably the best approach is to scale down how much time you actually spend doing social work, and balance things out first, before you bail out all together. So, I made the change and came down here (to youth services from adult) and that was good, because I think on the second floor they had come to depend on me to manage their most difficult clients and I felt badly for leaving the clients. Not for leaving that floor, but for leaving the clients. I left them with (name of co-worker) who had been the co-therapist for that group. I still kind of feel bad about that-if I could have tweaked it so I could have survived up there, I would have like to have continued to work with that population. In fact, when I left that floor, I wanted to still go up there and do the group, and asked them if I could do that, but they said no. So, what I did is come down here and create a “budding borderline” group, we call it the buds, and I do a group down here now. When I was setting up the group up there and crashing though all those barriers I didn’t have a frame of reference, DBT wasn’t around yet, so I was learning as I left. It was really hard, and I made some mistakes along the way and learned from them.
P 8: transcript 8.doc - 8:29 Codes: [Lifestyle, crisis in balance] For the first seven years, I had heated moments in which I wanted to flee periodically. I enjoyed my work, but maybe once a month I had the feeling I just wanted to disappear, go travel or something.
P10: Transcript 10.doc - 10:19 Codes: [Lifestyle, crisis in balance] Yes, I do. The interesting thing about DBT is you know we use DBT on ourselves and we use that dialectic all the time and so I am always trying to keep balance and being aware, and I have to say that when I needed to work part-time I made the necessary adjustments, rather than losing …
Was that preceded by a crisis? That made you realize something had to change?
162 I had a mother and father who moved out here who were both very ill. I have two young teen-age boys at home. I had a daughter who helped me a lot with them, but she left for China, which left these boys home unsupervised, and you know, I couldn't live with being here helping every bodyelse while my kids were going to hell in a handbasket. So, you know I chose to do that.
P13: Transcript 13.doc - 13:10 Codes: [Lifestyle, crisis in balance] Yea, I had a teenager, who was my client, commit suicide. That was a tough one. I had had her, she had come in on crisis, and I'd had her for a year, and I think that was a moment when I wondered if I was doing the right thing or not.
How did you deal with that?
A lot of support. People here--some of the older therapists who had clients who had commit suicide say if you need to come in and talk. I cried…
Were you impaired for a while?
The first day, when I took the call from Dad, I went home that day, because there was absolutely no way I could get it together. I would say the emotions were pretty strong for about a week. I started to say, "what have I learned from this, what would I have done differently?" Not that I could have prevented it, but how can I help next time I have a highly suicidal teen. I think it went about a month, month and a half before we had to do the psychological autopsy, and that was hard. To have to finally put it aside, and then go through the whole thing again to decide what happened step-by-step. My partner is a psychotherapist also, and she is understanding, so she understood where I was coming from and allowed me to have my space.
P14: Transcript 12.doc - 14:18 Codes: [Employer factors, documentation pressures] [Lifestyle, crisis in balance] Have you ever had any experiences that made you doubt the appropriateness of this profession for you?
Any time I write my notes (laughs.) I sometimes wonder if my ability to keep parts of the work balanced are a problem, I really do at times get to the point that if I'm behind in my notes by this much, then I'm really doing something unethical, I'm doing a disservice, and maybe I shouldn't be practicing.
P16: Transcript 15.doc - 16:18 Codes: [lifestyle, balance is a struggle] It hasn't come easily for me. It has been a struggle. It hasn't been but the last two years, my husband and I separated when I was in graduate school, and a big part of our separation is that either one of us had balance in our lives. A label that he give me was "superwoman", that I had to be superwoman all the time, and being superwoman is not about having balance, because when you are superwoman nothing is enough. That is something that I
163 have really internalized and focused on, and have a better understanding of what balance is, because you can't do it all, we're not capable of that. It's taken me a long time to acknowledge that.
P16: Transcript 15.doc - 16:23 Codes: [Lifestyle, crisis in balance] I will say I have so much greater awareness-- I got sick last spring and had a real serious scare. I didn't really get sick, I had a seizure. That really helped me, because it took about five days for my brain to not be delayed. So for me to sit back and think about that if I really want to be the kind of therapist that I want to be, I can't be a hypocrite. I have to have balance in my life if I want to influence my clients for them to have balance in their lives; I have to have balance in mine. So, sitting for five days and not be able to immediately come up with things, my brain would not allow me to analyze things as quickly as I was used to, and that fear of losing that ability, helped me realize that I have to be firm in those boundaries that I set for myself. I have to be assertive with that.
Code Family: Balance: Passionate Engagement in Non-Work Activity
Codes (2): [lifestyle, avocations serve as end to self] [lifestyle, avocations.] Quotation(s): 25
P 1: Transcript 1.doc - 1:9 Codes: [lifestyle, avocations.] avocations.
P 1: Transcript 1.doc - 1:10 Codes: [lifestyle, avocations.] physical fitness and nutrition
P 1: Transcript 1.doc - 1:36 Codes: [lifestyle, avocations serve as end to self] Not necessarily because I know this will be rejuvenating and give me more energy for therapy, but because in and of themselves it’s good to be energized. ,but the things that I’ve identified that I don’t take on a lot as far as complications, I lead sort of a low-stress lifestyle. And the things that I do I enjoy doing. I have the avocations that are motivating and fulfilling.
P 1: Transcript 1.doc - 1:63 Codes: [lifestyle, avocations.] Have some good pursuits outside of work.
P 1: Transcript 1.doc - 1:64 Codes: [lifestyle, avocations.] And I enjoy that. I play the piano. Just maybe a notch short of advanced. Blurs the line between intermediate and advanced.
P 1: Transcript 1.doc - 1:65 Codes: [lifestyle, avocations.]
164 I enjoy sports on TV; You know I’m sort of a sports fan. I enjoy reading the paper at the end of the day.
P 2: Transcript 2.doc - 2:28 Codes: [lifestyle, avocations.] We have a wonderful community, outdoor swimming pool and the lot, so 5 months a year, I get to swim at lunch every day, what’s cool too, is being in control of my own schedule. So I can, if I want 2 hours off at lunch today, so I can swim and then eat, or come in an hour early, or stay an hour late, and that’s so great to just be able to do that, swimming and eating. , You know in the winter I go cross country skiing. We do that at Grand Mesa and Grand Junction, so on Friday after work, we get a room in Grand Junction and ski for 2 days and come home on Sunday.
P 2: Transcript 2.doc - 2:32 Codes: [lifestyle, avocations.] Yes, I used to do…I did yoga for about 3 years, up until about a year ago and that was really great, and yeah, I have to really, like the swimming thing, I’m pretty lazy, so I have to be , like most people, it has to be a habit, I have to really really force myself, and then after about a month, I get hooked and then I’m really into it. It’s really conscious, I could definitely, work is pretty fun, so you know I could really not relax,
P 2: Transcript 2.doc - 2:62 Codes: [lifestyle, avocations.] having an outlet, and I think definitely having a life outside of work.
P 3: transcript 3.doc - 3:18 Codes: [lifestyle, avocations.] My wife and I walk every morning.
P 3: transcript 3.doc - 3:20 Codes: [lifestyle, avocations.] I still paint-- I don't sculpt anymore, but I still like to paint. I've got a garden that I'm pretty passionate about.
P 4: transcript 4.doc - 4:35 Codes: [lifestyle, avocations.] I pretty much try, at least four times a week to exercise,
P 4: transcript 4.doc - 4:40 Codes: [lifestyle, avocations.] Yea, I'm interested in a lot of things, I don't know if I will do this forever, but I sure love it for right now. But I'm open, I love to write, I like to teach, but I do all of that right now and this too. All the things I thought I was going to do in graduate school, that's still an interest to me, it's just not a driving thing.
P 5: Transcript 5.doc - 5:9 Codes: [lifestyle, avocations.]
165 I try and jog, going home at the end of the day or in the morning getting on the treadmill and running.
P 5: Transcript 5.doc - 5:10 Codes: [lifestyle, avocations.] I'm a sports fan and so that's another one of my releases, reading the sports pages or Sports Illustrated or catching a game on the weekend, playing basketball with they guys in my neighborhood,
P 5: Transcript 5.doc - 5:11 Codes: [lifestyle, avocations serve as end to self] I do them for their own sake. Everyone in awhile I will notice myself saying, "I'm going home tonight and doing nothing, I'm just taking it easy" but most of those things I do just come naturally and they help to keep me feeling fresh.
P 8: transcript 8.doc - 8:17 Codes: [lifestyle, avocations.] I jog every morning; I hate to miss that, that’s a very special thing. I ski avidly, I have my schedule here, and I’ve been pretty open about it, I like to ski every morning that there is new snow, what can you do to help me pull that off?
P 8: transcript 8.doc - 8:20 Codes: [lifestyle, avocations.] Skiing has been my number one passion and sports has been my number one, but enlightenment is now becoming
P 9: Transcript 9.doc - 9:32 Codes: [lifestyle, avocations.] I love building - and construction and woodworking. I have a shop and I do that. Garden - you know when the time is right - a huge garden with a hundred and something roses in it I take care of. But building is my main source of creative outlet - you know where I can actually make something and I do it. In fact I'm kind of compulsive about it. I'm always making something. And it's fine. You know I just let that happen
P11: Transcript 11.doc - 11:12 Codes: [lifestyle, avocations.] I have other passions. My current one, that has been at the top the last year or so is photography. That takes me outdoors a lot, so nature and photography are, and friends, I have a good set of friends. I'm also passionate about cooking; I'm passionate about a lot of things.
Still doing woodwork?
No, no woodwork. All that energy is gone. That's what keeps me moving, and I'm very active when I'm not at work doing stuff. Don't watch the TV much, I am doing photography for two hours a day.
P13: Transcript 13.doc - 13:5
166 Codes: [lifestyle, avocations.] [lifestyle, balance] My son and my partner, we go hiking, we love to go snow shoeing, go to movies, and even sometimes we do absolutely nothing, we just sit around the house. Love to shop-- well, money is always an issue-- but just get out and do things.
P14: Transcript 12.doc - 14:12 Codes: [lifestyle, avocations.] [lifestyle, balance] [Lifestyle, balance, family] [Lifestyle, renewal, reading/meditation] I think it has changed over time, interestingly enough. I do less physical activity, I used to do a lot of hiking and camping and skiing, and unfortunately I've let that go and that's been one of the things that has been a loss, so I'm trying to change that. I have been doing a lot more intellectual stuff, I read, not only more psychology kinds of things, but fun stuff, science fiction, or… I'm involved in a number of activities tangentially related to my profession, being on the licensing board of my profession, being in my professional organization, so I do some of that, that's renewing. I do spend, I'd say most of my "renewal" comes from spending time with my wife. I think our relationship has been a major boon to me. We've been doing a lot of house projects. Just having that family piece is renewing. I do meditation, that is part of my balance. I used to practice aikido, and I still to a little tai chi.
P15: Transcript 14.doc - 15:15 Codes: [lifestyle, avocations.] [lifestyle, balance] I have a dog and I'm in agility training with her, so we are doing tunnels and leap poles and dog training. That's an energy producer. I'm a quilter. I belong to a quilt group and I teach quilting. I have friends, and belong to a book club. My husband and I do a lot of outdoor stuff. We like to travel, we like to camp. In the winter we like to snowshoe and cross- country ski, in the summer we bike and hike and canoe. We spend as much time as possible off exploring and doing things. I go as much as possible; lots of things that keep me busy and interested.
P15: Transcript 14.doc - 15:16 Codes: [lifestyle, avocations serve as end to self] For their own sake, love doing it.
P16: Transcript 15.doc - 16:17 Codes: [lifestyle, avocations.] [lifestyle, balance] I love spending time with my family. I love spending time with my children and my husband. We are a very active family. During the wintertime we ski and snowboard so we take a lot of weekends and do that. Just having a balance outside of work, being active. I also do volunteer work at my children's school, and that gives me a lot of energy. Coffee. Lots of coffee.
Code Family: Balance: Seeking Diversity in Work Activities
Codes (12): [Employer factors, creating new opportunities] [Energy, energizer, interesting clients] [Energy, energizer, seeing clients] [Energy, energizer, seeing growth in clients] [Energy, energizer, variety] [personal characteristics, creative]
167 [Personal characteristics, flow of therapy, enjoying the art form] [Personal characteristics, short attention span] [Therapy attitudes, change expectations with seriously mentally ill] [Therapy attitudes, expectation of change] [Therapy attitudes, process] [Therapy attitudes, uniqueness of clients] Quotation(s): 88
P 1: Transcript 1.doc - 1:42 Codes: [Energy, energizer, seeing clients] The thing I enjoy most about psychotherapy is getting people to change and getting them to change their lives
P 1: Transcript 1.doc - 1:43 Codes: [Therapy attitudes, change expectations with seriously mentally ill] with the seriously mentally ill you have to change your expectations.
P 1: Transcript 1.doc - 1:45 Codes: [Energy, energizer, seeing clients] The highs, again I come back to the idea that if they get soothed and get release maybe they feel good for that hour and may be a little afterward, but when they make changes, when they gain insights, they may come back and they demonstrate that “I’m making changes in the way I go about things, and I’m healthier and I’m happier, in specific ways, those are sort of the highs.
P 1: Transcript 1.doc - 1:51 Codes: [Energy, energizer, variety] Practically speaking, we’re a small clinic. Most therapists here have to be generalists. I'm the only full time therapist that works primarily with adults, so I have to work with whatever comes through the door. And so I like that I like that I’m not forced to work with these kinds of clients. And so where there might be restrictions in a larger agency, I don’t get that here. And as far as how they’ve made it more difficult,
P 1: Transcript 1.doc - 1:75 Codes: [Therapy attitudes, process] He emigrated from some eastern European had a heavy accent, and had been stern, and he had left home Left Cleveland, Ohio, had a schizophrenic problem and he came every week, and I don’t remember much, and I remember I tried to help, and our last session he fancied himself a painter, and put his world on canvas. He wanted me to have it, and that was sort of his way of communicating. I don’t know how he communicated, but that had been important to him and very helpful for him. But I remember thinking, Wow, I didn’t really know, I knew he came every week, but as a picture you know two a male and a female person, and there’s a fountain. His parents were stern and sort of OCD, cold and he had to break free from his parents, and this was where I leaned it can be powerful.
P 2: Transcript 2.doc - 2:11 Codes: [Energy, energizer, variety] variety is exciting
P 2: Transcript 2.doc - 2:13
168 Codes: [Therapy attitudes, process] process
P 2: Transcript 2.doc - 2:15 Codes: [Personal characteristics, short attention span] I’m probably attention deficit in a lot of ways
P 2: Transcript 2.doc - 2:16 Codes: [Therapy attitudes, process] meditative
P 2: Transcript 2.doc - 2:46 Codes: [Energy, energizer, seeing clients] Umm, I have one client, and she’s the only client I can think of, she’s a client right now. She’s more of what I would call the worried well. She’s what I would want in my private practice. The kind that might have a lot of money, enough money to come in once a week and just cratch about their problems. But not who I want to be seeing at a ? center. Oh my God you know, and Actually what was really neat was I was really losing it with her. It was just boring. She wasn’t moving anywhere. It was a year and two months of seeing her bi- weekly, and she’s in my borderline group, but she’s not very borderline. It was more about needing the skills. And there was no movement, and I have to admit it got a little boring. I thought it was boring. You know when the front office would call and say so and so’s here and I would say ‘Oh , shit’. You know, and then I thought the process I was going through with her was she would sit across from me and I would be saying ‘Oh fuck’
P 2: Transcript 2.doc - 2:64 Codes: [Energy, energizer, seeing clients] I always tease (names supervisor) I tell him ‘you pay me shit, cause you know I’d do this for free’ you know, and it’s true, I would. If I won the lottery, I’d be right back at work on Monday morning.
P 2: Transcript 2.doc - 2:72 Codes: [Therapy attitudes, process] I don’t know, I think I like the process, I think it’s really neat when you see the light go on, and something in their eyes, it’s like they really get it, and it’s really fun to be part of that process.
P 2: Transcript 2.doc - 2:76 Codes: [Personal characteristics, optimism/strength based] [Therapy attitudes, uniqueness of clients] To not be around the negative energy of burned out social workers who say mean things about their clients. Hate their clients, and hate everybody who falls under a certain diagnoses, and to really protect yourself from that kind of energy and I believed the hype about these borderline women… I was scared shitless because I was picking up 20 of these crazy women who were all going to kill themselves at the same time. And I’ve been to the hospital with many of them when I was on call and they had huge gashes and words written in their chests and going up to the hospital. I believe the hype. But everyone’s an individual. There’s nothing real in that. These are 20 individual women who are all amazing and who
169 somehow have gotten themselves to 40, 50 or 60. So they don’t fit it, they just need a little validation and support. I think so don’t believe all the negative hype about things
P 2: Transcript 2.doc - 2:80 Codes: [Energy, energizer, variety] Yeah, and I mean again, that’s not frequent, so I think it’ s just I think I’m probably attention deficit in a lot of ways, so this is a job where I can’t really get bored because the variables are changing all the time.
P 3: transcript 3.doc - 3:8 Codes: [Personal characteristics, flow of therapy, enjoying the art form] artistic nature to the person. People who want to learn the formula, and can't get past the steps of therapy, and can't turn it into an art form, lose interest. Because I think it really is an art form. People who can't get excited about the flow that happens-- and can't get past which of the 12 steps we are on-- people who can't do that don't seem to stay interested very long or aren't very productive. That's what I think make's the difference. You see somebody that wants to come in and discuss why people change, and what works and why it works, those are the people who are going to be successful. There are just some folks that get into it probably for the right reasons, but it turns out that they ought to be running a substance abuse twelve step program-- not to put that down, but in many areas of therapy I don't think that works.
P 3: transcript 3.doc - 3:9 Codes: [Personal characteristics, flow of therapy, enjoying the art form] So are you saying it's not irrelevant that you started out as a sculptor, as an artist, and became a passionately committed psychotherapist?
Very much-- I don't know how to put that into words. It's hard to talk about what the art form of therapy is, but it is very much an art form.
P 3: transcript 3.doc - 3:13 Codes: [Energy, energizer, seeing growth in clients] watching people as they grow
P 3: transcript 3.doc - 3:15 Codes: [Energy, energizer, seeing growth in clients] Trying a new technique, seeing it help someone.
P 3: transcript 3.doc - 3:33 Codes: [Therapy attitudes, process] If the process can be exciting, if you can get excited about the whole process, the creation of the change can be exciting, then you are going to enjoy this work. If you are all about the outcome, where are you on the depression scale today, which is where a lot of folks are…
P 3: transcript 3.doc - 3:36 Codes: [Employer factors, creating new opportunities]
170 That's been exciting-- the whole idea about working with sex offenders was-- when that first came along, I didn't think that was something I wanted to do, but that's been exciting--it's been fun. We run an inpatient, and now an outpatient group for the past 12 years, and I've done an adolescent group for the past 5 years, and that's been exciting. That's good stuff to do.
P 3: transcript 3.doc - 3:39 Codes: [Employer factors, creating new opportunities] Keep them doing psychotherapy, and encourage them being curious about new ways to do it. If someone is interested in a new modality, encourage it, rather than seeing it as a drain on the training budget.
P 3: transcript 3.doc - 3:41 Codes: [Therapy attitudes, process] But therapy is an art form, and it can't view it as an art form, and get excited about the steps, the creation of where you're trying to go, it will never be an enjoyable career.
P 3: transcript 3.doc - 3:51 Codes: [Active strategies, growth and learning] [Energy, energizer, variety] I'm still pioneering in different ways. The whole idea of mental health is now acceptable, its got credibility. My latest interest--I think-- I've just spent a week in Vegas, I'm still deciding if this is the way I want to go, is dealing with couples with sexual dysfunction. That's pioneering in this area, its something no one has touched very much. We've all dealt with it to some degree, but not in depth. I've dealt with it with some couples, but didn't know exactly what to do with that piece of it. So, there's still new areas. When I got involved with hypnosis, that was new. But you're right, it's not, its changed. It's not that we are making mental health okay, but making new pieces of it okay.
P 4: transcript 4.doc - 4:14 Codes: [Energy, energizer, seeing clients] [Energy, energizer, seeing growth in clients] [Personal characteristics, fit] To work with, I work with women who have had a lot of trauma, and to me it is pretty energizing for them to go from a shame-based identity to one that is absolutely positive and watch them create the life that they want. To do that is pretty energizing, I don't know that I would want to do anything else. I've had opportunities to go into administration here, and it's not out of fear, it's just that I love what I am doing here. Until that doesn't feel right, or I need a different challenge, I'll move, but for now it feels right.
P 4: transcript 4.doc - 4:28 Codes: [Energy, energizer, seeing clients] The (energy) producers, are just the clients. I enjoy working with them.
P 4: transcript 4.doc - 4:31 Codes: [Therapy attitudes, expectation of change] The analogy I use with them, is if they are fifty, and have trashed their body, and need heart surgery, the surgeons aren't going to sit around the bed for fifty years and say it took you this long. They are going to go in and do the work, and it's up to that person to live a health lifestyle and I just treat emotional trauma pretty much the same. I think that is exciting for
171 them. It's not a quick fix, we're just coming out of that era where you say your therapist two and three times a week for five years at a time like in the eighties and early nineties, and I just love the shift to where people are accountable, and not dependent upon me
P 4: transcript 4.doc - 4:39 Codes: [Energy, energizer, seeing growth in clients] I think any time that someone that someone embraces their true self, and stops living the lies or below what they are capable of, I mean, when they get it, and their shift from a shame- based identify to a positive identity-- before that, it's like they hit the gas, but the brake is on, so once they learn how to take the brake off, and let themselves feel what it's like to be successful without sabotaging themselves, that's incredible-- I mean, that's it for me in a nutshell.
P 4: transcript 4.doc - 4:45 Codes: [Energy, energizer, seeing growth in clients] How about your highest?
I get lots of those. I think it's when they shift--when they are able to shed those layers of trauma, and really embrace that true, healthy self. And the next most incredible is when they learn from that. And when you get to see them six months later, in this small town you run into them, and they are doing wonderful, and still in that good, healthy place. That's pretty incredible. That, to me, is what it's more about, people being able to reclaim who they are and learn how to live from that space
P 4: transcript 4.doc - 4:49 Codes: [Therapy attitudes, expectation of change] I really don't believe that they need to be in therapy year after year, and its those kinds of clients who have been in therapy for fifteen year and are just getting you for the first time that are the hardest to work with. They really just have the expectation that they are going to be around another fifteen years and so they are set.
P 4: transcript 4.doc - 4:50 Codes: [Therapy attitudes, change expectations with seriously mentally ill] Yea, I think so, I don't think it does them any good to be dependent on the mental health center. I mean, we will always have the chronics, people with schizophrenia, and I don't mean them, that's a different group. I mean the trauma group, that kind of grew up in therapy, and that's their second parent.
P 4: transcript 4.doc - 4:70 Codes: [Energy, energizer, seeing clients] [Personal characteristics, engagement, importance of] I love it because it's life and there are other people, and however they show up in life is how they show up in this group, because they can't do anything else, whereas in here this is such a sterile environment in my office, so I think this is what keeps me energized. Right in the moment I get to see how they show up and we get to work on it right in the moment, kind of like a piano lesson they are playing and I'm right there, and so the kind of work, and the style, its just a good fit for me. It's energizing, it just is. And they love it because they can feel
172 a difference, so they are making progress, but I'm also being richly fed, because therapeutically its just invigorating.
P 4: transcript 4.doc - 4:73 Codes: [Energy, energizer, seeing growth in clients] But probably most of it is clients who are ready to work and who turn some pretty significant corners pretty quickly if they are accountable and committed.
P 4: transcript 4.doc - 4:79 Codes: [Personal characteristics, optimism/strength based] [Therapy attitudes, uniqueness of clients] But I've grown to love it, even those with borderline personality disorder, just to put it in a healthy context, because I don't come at it thinking, oh, my gosh, because some of them are so difficult, I can have more compassion. It's a better way to present that, and we can get a lot further, because they know I'm not afraid of them, and understand kind of where they are coming from, but also can hold them accountable.
P 4: transcript 4.doc - 4:80 Codes: [Therapy attitudes, expectation of change] I think with the foundation of both, DBT, (and sexual trauma treatment) they are burned out, and tired, and they have burned out every relationship they have, and they don't understand why they burn every relationship out, so to help them fill their bag with tools, and then get them to a place where they are healthy enough where they can resolve that trauma. They do burn everyone out, but the reality is they can turn a corner and lead a healthy lifestyle, and I really believe it.
P 5: Transcript 5.doc - 5:3 Codes: [Therapy attitudes, patient with slow process of change] [Therapy attitudes, uniqueness of clients] For me, it's the hope of the possibility that each interaction with the client might be one more little brick in their progression. If you look at it as mundane, kind of ho-hum, here comes another client, then that's the kind of treatment that is going to take place. But if you look at it like each interaction is a chance for growth or progress, it helps you stay a little more passionate about things.
P 5: Transcript 5.doc - 5:39 Codes: [Therapy attitudes, expectation of change] I guess that the difference might be that people lose that perspective and forget that it is difficult, but that there are those moments of growth and progress and success that people experience.
P 6: transcript 6.doc - 6:8 Codes: [Personal characteristics, flow of therapy, enjoying the art form] Those moments that I just talked about, when you feel things have come together and just worked.
P 6: transcript 6.doc - 6:9
173 Codes: [Energy, energizer, seeing growth in clients] It's nice to see people take advantage of the opportunities to change and get their life together, that's the biggest paycheck.
P 6: transcript 6.doc - 6:15 Codes: [Energy, energizer, seeing growth in clients] We just got through putting on crisis intervention program training for the police. It turned out really well; it was an excellent experience. We took the officers up to Oasis House, our clubhouse in Cedar City, and had them have lunch with the clubhouse members. It was neat, it was trivial but touching to me, but one of our folks, a young guy, came up to me and said, (Name of therapist!) He was a young man, and had some psychotic symptoms, signs of his schizophrenia coming on, and I had helped him through that. That's always a moment of high concern for me, when people are just becoming aware of their illness and grappling with accepting that, and seeing where it's going to take them. It was like he had remembered me enough, and that I had helped him enough, that even though many years had passed, my name was something that was important to him. That seems small, but it was just a nice feeling.
P 6: transcript 6.doc - 6:17 Codes: [Energy, energizer, seeing clients] Given the person that I am, this seems to be a kind of work, this is going to sound lazy, but this kind of work comes easy to me, so most of the time it isn't depleting. That allows me to attend to the other things in my life that are important to me. I could have a nicer house, but I don't need to have a huge house, I would rather have the things that I have.
P 6: transcript 6.doc - 6:21 Codes: [Therapy attitudes, process] You know what I love? Those moments when you are in a zone, you feel like you are riding a wave, you've joined something kind of beyond you, that intuitive process that psychotherapist muse has landed on your shoulders and you just sort of trust that and go where you want to go. That to me, is probably the most exciting aspect of this.
P 6: transcript 6.doc - 6:41 Codes: [Personal characteristics, art] [Therapy attitudes, process] There are principles that guide psychotherapy, it is to a degree a science, but it is also an art. When I talk about those moments of euphoria when you trust in your science and free yourself for your art and the art directs you as to what the right intervention should be and you trust this intuitive sense of what is underneath something and you move that rock and find what you are looking for. I f somehow I could hook myself up to some kind of machine that could beep whenever I had a certain emotion, that state is probably accessible to me in doing psychotherapy, or when I'm working in my shop and thinking, "what is this thing going to look like?" and I have absolutely no idea. When your hooked into that process, and again, it's that process, when you are connected to something larger, and you are just doing your part in that and its carrying you, that affective state is very similar in both arenas.
P 7: Transcript 7.doc - 7:12 Codes: [personal characteristics, creative]
174 Thinking of creative ways to engage people in the therapeutic process. Not program development on the level… I’m looking at the program needs of the people I am working with, and I’m seeing a deficit-something that we are not doing that we probably could and then finding a way to deliver that. Anything that is in the creative arena, I really enjoy that, something that gives me a little creative license.
P 7: Transcript 7.doc - 7:26 Codes: [Employer factors, creating new opportunities] But for me, it would be using creative ways of meeting the needs of the population you are working with. I would love for administration to think of creative stuff, I don’t think of Profiler as creative. But I have to respect that maybe they know something about how everything operates, and maybe it does meet all of their needs, I don’t know-but it definitely doesn’t meet mine
P 8: transcript 8.doc - 8:7 Codes: [Therapy attitudes, expectation of change] Gradually, as I took all kinds of sources and work with it I think I also developed faster ways of helping people make changes in their life if that’s what they wanted or to begin to see those who don’t even want to make changes they just want to use us to get social security or something else, and how to manage them nicely
P 8: transcript 8.doc - 8:14 Codes: [Energy, energizer, seeing clients] [Therapy attitudes, uniqueness of clients] What are you energy producers here at work, on the job? Every human being I get to interact with.
P 8: transcript 8.doc - 8:15 Codes: [Energy, energizer, seeing clients] After a therapy session, do you have more energy that you did before? Yes, definitely. Is that consistently the case or does it depend? Almost consistently, yea.
P 8: transcript 8.doc - 8:16 Codes: [Energy, energizer, seeing clients] [Therapy attitudes, uniqueness of clients] What are your energy depleters? Isolation. On the job, there aren’t any depleters. Every person I see is somebody I can brighten, and it brightens me, and I look forward to that. This is a pretty nourishing job. On the weekends and evenings I am reading, I have a lot of friends, but there is more…
P 8: transcript 8.doc - 8:21 Codes: [Energy, energizer, seeing clients] [Quotes] I really love this study of what it means to be human, and this process of transformation and the possibility of joy, and love, and invulnerability, kind of. It’s quick to let go of what could feel stressful
175 P 8: transcript 8.doc - 8:27 Codes: [Therapy attitudes, expectation of change] There’s not one condition that doesn’t get experienced in the mind, so healing is universal. All of healing is equally simple for all people because it’s always involving a change in the way that they are seeing something that they think is it, but they have made it what it is for them, and they don’t know it yet. And I’m trying to create a climate in which they can wake up and see it and make a choice and it is gone that quick, it doesn’t take time to heal. It happens the minute you change the way you see it. And now instead of a judgment that terrifies, is a creative, loving idea. It just feels wonderful.
P 8: transcript 8.doc - 8:42 Codes: [Therapy attitudes, expectation of change] When you come and you want it, it can be quick, and when you don’t, that’s okay.
P 9: Transcript 9.doc - 9:5 Codes: [Energy, energizer, seeing clients] I agree with the idea of "passionate commitment" in any venue of human endeavor. I do this, not for the money, I do this because I love it. I am never, at least so far, in that place where I have been many times in my life, of wondering A) what was I doing with my life, or B) how long this had to go before I could do something more interesting. I've never had that before, not at all.
P 9: Transcript 9.doc - 9:14 Codes: [Energy, energizer, interesting clients] An interesting case-- a boring case that gets interesting.
P 9: Transcript 9.doc - 9:15 Codes: [Energy, energizer, seeing growth in clients] Movement in therapy, growth that I can recognize, even if the client doesn't see it. Even if they are weeping and wailing, if everything is miserable and falling apart, if I can see something I hadn't seen before in a client, that gives me energy.
P 9: Transcript 9.doc - 9:22 Codes: [Therapy attitudes, relationhship genuine as well as professional] [Therapy attitudes, uniqueness of clients] You know, I did not want to see people as a lab rat or as a subject, I wanted to see them as human beings living their lives with whatever problems might come up, and what they did with that in the whole, them in the environment, them in their world. Not they as isolated bundles of psychic energy or symptomatology, or anything like that, so I chose social work specifically because I knew it was a route to becoming a therapist but it was a route through a different field, a different lense in looking at human beings.
P 9: Transcript 9.doc - 9:44 Codes: [Energy, energizer, seeing clients] Who derived a very unquantifiable energy from that work. The work didn't debilitate me, it keeps me fresh. It supplies me with energy, in fact. It's almost as if it were another kind of "version" like introversion or extroversion where this "therapist version" was where I got
176 energy. Maybe that is it's own motivator, it's energizing for me, so it maintains my interest always. I don't see any dead spots, or places in me as a therapist where I say "I've got to do something else with my life because I'm feeling stagnant, or this is draining me.
P 9: Transcript 9.doc - 9:47 Codes: [Therapy attitudes, process] In a way, it's kind of detective work, it's not untangling or puzzle-piecing, I don't know who you would put that. But that's the feeling I get when I'm sitting in this chair, and I'm constantly fascinated and it's always interesting, I don't use my own, God forbid, experience or material to help them or use that as an example for them, because that would be debilitating. That would be replacing their psychic contents with my own projections, and then we are both dealing with unreal things. I don't know if that makes sense, but that's what came to mind when you said that.
P 9: Transcript 9.doc - 9:59 Codes: [Therapy attitudes, uniqueness of clients] In a way, it's kind of detective work, it's not untangling or puzzle-piecing, I don't know who you would put that. But that's the feeling I get when I'm sitting in this chair, and I'm constantly fascinated and it's always interesting
P 9: Transcript 9.doc - 9:61 Codes: [Therapy attitudes, uniqueness of clients] It doesn't matter. The most fantastical story a client could tell me would be indicative of they way the world, and that's what's important. And it happens!
P 9: Transcript 9.doc - 9:62 Codes: [Therapy attitudes, uniqueness of clients] If I were given some kind of protocol, and said "you are to follow this, for example, engage in nothing but time-limited therapy, you know, for these disorders we will allow these amount of sessions, and we would like you to cover this material in each session," I'll go work somewhere else. And that doesn't happen here. And I think management here tends to look at outcomes, much more that micromanage day-by-day interactions. Is that client getting better? How long have you seen that client? And what's the symptomatic presentation like now compared to intake? You know, if it's improved or if you can see some kind of symptom relief or the client's goals having been met, you know, do you need to keep meeting with that client anymore?
P10: Transcript 10.doc - 10:8 Codes: [Energy, energizer, seeing clients] I'd say 75% of the time it's easy for me, maybe even 80% of the time. There are times, though, that it kind of drags on and gets a little bit hard.
P10: Transcript 10.doc - 10:9 Codes: [Energy, energizer, seeing clients] [Energy, energizer, seeing growth in clients]
177 That's a good question. I don't know why it's draining for other people, what that burnout thing is all about. I think there are people who just don't enjoy therapy, they enjoy other types of social work, but not therapy. For me, it is really gratifying to me to see the light go on in people's eyes, getting the benefits of their progress, it makes me feel good to see them. I have a, it's very easy for me to see patterns in behavior and to spot where to go next, it just comes to me, and it's just fun. It's kind of like a game to me, and I have fun doing it. I really love it when I see people making progress, and I can usually do that in a session--okay, maybe not progress, but insight. I love it when they have insight.
P10: Transcript 10.doc - 10:10 Codes: [Therapy attitudes, change expectations with seriously mentally ill] I think it depends on the client. You know, the rule of thirds. I have a client that I've had from the very beginning, and some people think, you know they've been coming every week for three years, but for people who are very personality disordered individuals, progress is very slow, but it's happening. I have other clients, usually young women, single moms, who can come in and six sessions, I can do solution-focused therapy with them and get them out of the door really quick. So it just really depends upon how entrenched they are in their problems.
P10: Transcript 10.doc - 10:17 Codes: [Energy, energizer, seeing growth in clients] I have one client who came to me three years ago who was very very very ill. And she was diagnosed schizoaffective but there was a real strong suspicion that she was borderline. And she was very, I mean really high risk, very complicated, difficult client and over three years I've seen her every week. Eventually I did get her into the DBT therapy program and I've watched her, who I think nobody had any faith that she would get better, I watched her get better. And just in the past six months she's made so much progress that she's become…she was a writer and she has been writing poetry. I have her poetry - stacks and stacks of poetry that is.. she could write for the New Yorker… it's just stunning. And she's registered now to go to the University of Utah this spring and she's volunteering at NAMI and I just am so pleased. I'm so pleased with the progress she's made. It's that kind of thing.
P10: Transcript 10.doc - 10:45 Codes: [Therapy attitudes, uniqueness of clients] It's kind of like a game to me, and I have fun doing it.
P10: Transcript 10.doc - 10:47 Codes: [Therapy attitudes, uniqueness of clients] You know I really kind of tailor make each approach to each individual. I mean there are some clients that I take kind of a Doctor Phil approach with and am really kind of in your face, and this is what you need to do - that's pretty rare with me but sometimes I do.
P11: Transcript 11.doc - 11:16 Codes: [Energy, energizer, seeing clients] Is there anything about doing therapy that you just hate? (Long pause.) Not one thing. I can't think of anything I don't like about it.
178 P11: Transcript 11.doc - 11:26 Codes: [Personal characteristics, flow of therapy, enjoying the art form] When I'm at my best, I'm kind of kind of flowing, I have access to my unconscious, and I'm feeling in the present moment, just experiencing… that's when I'm at my best. Is it a pleasant state? It's very pleasant; it's a real Zen thing. That way, you are just so tuned into what is going on, I'm able to connect and respond…
P11: Transcript 11.doc - 11:47 Codes: [Energy, energizer, seeing clients] It's very pleasant; it's a real Zen thing. That way, you are just so tuned into what is going on, I'm able to connect and respond…
P11: Transcript 11.doc - 11:49 Codes: [Therapy attitudes, uniqueness of clients] I'm trying to find something or some way to really fall in love with the client, or like the client or appreciate them. Sometimes I say that therapy is just liking somebody long enough until they get better. Finding a way to really like them, to really engage.
P11: Transcript 11.doc - 11:50 Codes: [Therapy attitudes, uniqueness of clients] Both, it just depends on the individual client, and things that I don't understand. I've seen four or five sessions and that's it, there is major change, and sometimes I've seen clients over two years. I tell my clients, " Usually, if you're working on some aspect of your personality or behavior, you ought to plan on a year--not necessarily come into therapy for a year, but invest in a year-long project. That could include reading, experimenting, coming into therapy.
P11: Transcript 11.doc - 11:51 Codes: [Therapy attitudes, uniqueness of clients] Find something in every client that you really like, just find that, and if you can't then send them on to someone who can.
P13: Transcript 13.doc - 13:9 Codes: [Energy, energizer, seeing growth in clients] I have one boy that I've been working with for two years. His diagnosis is PDD, depression, so he comes off awkward socially. But his father, what is really neat is he wanted his dad, we don't see that a lot. His father took off from work just to take care of his son. He wasn't properly diagnosed until he came here, which was ten years. It was pretty frustrating to go ten years of your life, and have a boy who is not doing well because of a missed diagnosis. The growth that he has, working with him every week, teaching him social skills and getting to know him, and knowing him for who he is, and not judging him for that, has really brought him out of his shell. It allows him to apply it to other environments; this particular kid has grown so much. I think that is why I am here-- it hasn't been an overnight change, I have been working with him almost weekly for over a year and a half, and then with his dad. Seeing the growth in his Dad, it wasn't just him, it was his Dad too, and his sister learning
179 how to help him in a productive way. His Dad would go to parenting support groups and he has done very good work.
Can you articulate what it is in that story that describes what you love so much about being a psychotherapist?
Seeing a boy who didn't smile at all smile. A boy who, when he came in, would barely make eye contact, could barely say two words. Now comes in, tells his dad to leave, and is just engaging-- appropriately engaging. He'll talk to me, and make eye contact, just small changes. I don't think he recognizes them, his dad does, and his grandparents do, but I think that is it- - to see a little boy who is just miserable, be happy.
P13: Transcript 13.doc - 13:35 Codes: [Therapy attitudes, uniqueness of clients] They are good people here. And for the most part, my families are pleasant people. I mean, there are times where it gets kind of up in arms, but with exception of one family, I like my families, and I like to see them, and have them come in and say, "Johnny did this today'" and I say, "Okay, we've been working on it for two months.
P13: Transcript 13.doc - 13:36 Codes: [Therapy attitudes, uniqueness of clients] Regardless of the stories that you hear about people's lives, the narratives that they come in with, to be able to allow them to tell their stories.
P13: Transcript 13.doc - 13:37 Codes: [Therapy attitudes, uniqueness of clients] I think you hit it all in that we are just people who want to make a difference. But a difference in a way that is going to feel helpful to us-- because you build on each relationship, you learn what you can use to help the next family that comes in, "Let's try this."
P14: Transcript 12.doc - 14:15 Codes: [Energy, energizer, seeing clients] No memos
I find that listening to others talk about their therapy is very invigorating. I think we are lucky in this system to get quite a bit of that input. But I would say really just spending people in the doing of therapy. Groups are really invigorating; I really enjoy all the action. Teenagers are really amazing.
P14: Transcript 12.doc - 14:17 [One of the things that happene..] (104:104) (Super) Codes: [Energy, energizer, seeing growth in clients] One of the things that happened to me, just a funny coincidence, when I was working years ago with younger kids in our day treatment program, I have always been pretty invested in working with our clients, but I think I was really a little overly invested then, but was really making some nice relationships with the kids. One of the kids that I had worked with as a second or third grader wrote me a few years ago, and said that he would like to put me and
180 three others in the forward of his textbook. He's teaching in London, and has published his third textbook in his area, and he would really like to thank us for his start. I think that is the epitome of a good teacher, a good therapist, to give that opportunity to develop, not to mold them into this thing that is yourself, but rather, to give them the skills to go on and be whatever they can be. I felt like he was the greatest example in my life of someone who took a very challenging beginning and molded that to someone who is him.
P14: Transcript 12.doc - 14:36 Codes: [Therapy attitudes, uniqueness of clients] Trying to figure out their world view, their values, how all that fits with some pieces that can shift just enough that they will find some greater joy in their relationship together.
P15: Transcript 14.doc - 15:7 Codes: [Energy, energizer, seeing clients] The kids that I see. I just really, really like kids. Just having them come into my office or go out into the office, and it's like (Shouts name!) and they get excited to come in. That's a real big one.
P15: Transcript 14.doc - 15:10 Codes: [Energy, energizer, seeing clients] But it's mostly the kids.
P15: Transcript 14.doc - 15:17 Codes: [Energy, energizer, seeing growth in clients] This is something that happened, way, way back when I was at the Children's Center. (Names director of program) once said "Oftentimes, you have no idea what impact you have on a child, sometimes the most you hope for is you light a little candle that carries them through the rough times later on, even if they don't consciously remember it, there's a little piece of you that you leave with them." This sort of happened one year, there was a little boy, his name was Tony, and we had a pretty conflictual relationship, he was a pretty angry kid. He once threw a Tonka truck through this huge plate glass window. He had these rages, and I'd have to sit on him, so he was a pretty intense kid. He was about four at the time. Some years later, maybe five years later when I was working (here) we were staffing a case with an adult therapist, and he mentioned this woman's name. And I said, "Does she have a kid named Tony?" And he said yea, and I said, "I used to see him at the Children's Center." So one day I was in a children's group, and this therapist knocked on the door and said, "Can you come out for a second, I have someone who wants to see you." And there was this boy, who was ten and the time. And he looked at me and said, "(Therapist's name!) and jumped into my arms, and he said do you remember this person and that person, and do you remember when you used to read me Ferdinand the Bull, and do you remember this… and it was like six years later, and he remembered all this little stuff. He didn't remember me sitting on him or the throwing the truck, he remembered the good stuff. So that's what I think about with these kids, is that they will, hopefully, carry that with them, and that's what keeps you energized. You don't get that very often, but every now and then you do.
P15: Transcript 14.doc - 15:28 Codes: [Energy, energizer, seeing clients]
181 For some children and some families, it's pleasurable, and feels easy and effortless and fun and flowing, and active, and even though it is therapy we are laughing and having a good time together, and mutually energizing. I feel like I am giving to them, and they are giving back to me, and it grows, and that's really fun.
P16: Transcript 15.doc - 16:13 Codes: [Energy, energizer, seeing clients] [Energy, energizer, seeing growth in clients] The positive energy that I receive in the session from the client when we are working on how their perceptions affect their thoughts and when they have that kind of "aha" moment, and have a better awareness of it. That gives me a ton of energy.
P16: Transcript 15.doc - 16:19 Codes: [Energy, energizer, seeing growth in clients] I started working with this young woman who had experienced severe childhood trauma, and had formed DID and borderline personality disorder, and had terribly disregulated mood, and had been in and out of the state hospital and the acute facility. Through perseverance and determination over that past year, and commitment to sort of stepping out of the box, both on her part and my part as well, in separating her from her barriers that were stagnating her progress, this young woman has recently just, she's had her ups and downs, and she will for a while, but she has begun to recognize what has influenced her life and why she interprets things the way that she does and how she has protected herself in really unhealthy ways in the past. She used to come into my office and curl up in a ball and it would be like a dentist trying to pull teeth. But through patience and perseverance, the commitment that we would work through this, this young woman comes to my office, sometimes I can't get her to stop talking. Her ability to recognize and acknowledge what has gone on in her life, and what control and choices she has in her life now, is just amazing. I'm so grateful, because there were a couple of times that I found myself getting sucked into that kind of borderline black hole, and pulling myself out with my colleagues help and supervision and pushing forward instead of getting burned out, and being patient with it, is truly what being a passionately committed psychotherapist is about.
P16: Transcript 15.doc - 16:20 [It's watching a young woman wh..] (93:93) (Super) Codes: [Energy, energizer, seeing growth in clients] No memos
It's watching a young woman who would dissociate and self-mutilate and have her suicidal behaviors every single day of her life, watching her be able to eventually cut back on those coping skills.
P16: Transcript 15.doc - 16:30 Codes: [Energy, energizer, seeing clients] I feel very grounded, and very centered, and focused. Learning how to be focused I gained from, I was into athletics and performance, and competition group all through college, and learning how to focus and be fully, put my full attention into the task that I am doing is very much me. I'm very into my session, I'm not just hearing what my client is saying, I'm watching their body language, I'm looking at the energy, I'm way okay with pausing, silence
182 doesn't bother me I think it's important to just sit in it. I don't have to react immediately to something that a client may say. I'd say my energies are fully focused 95% of the time, you know, everybody has their days.
P16: Transcript 15.doc - 16:43 Codes: [Therapy attitudes, uniqueness of clients] I'm very into my session, I'm not just hearing what my client is saying, I'm watching their body language, I'm looking at the energy, I'm way okay with pausing, silence doesn't bother me I think it's important to just sit in it. I don't have to react immediately to something that a client may say. I'd say my energies are fully focused 95% of the time, you know, everybody has their days.
Code Family: Beliefs, Burnout
Codes (7): [Energy, Burnout, disillusionment temporary moments] [Energy, Burnout, not burned out] [Energy, burnout, private practice, believes would be difficult] [Energy, burnout, stagnation, doesn't feel] [Energy, passion not unrelenting] [Energy, passion, is constant] [Energy, tired, phases of being drained] Quotations: 36
P 1: Transcript 1.doc - 1:5 Codes: [Energy, passion not unrelenting] I think it’s his term “unrelenting standards” and that the word passionate almost suggests someone who’s just got the fever every day, and in public mental health, there may… I hope you find some people that attain that level, but I think that’s a challenge, but on the whole I would say, yeah, I do a good job of having a real desire to help people, and wanting to be a front line worker and being committed and dedicated to that.
P 1: Transcript 1.doc - 1:7 Codes: [Energy, Burnout, not burned out] energized
P 1: Transcript 1.doc - 1:22 Codes: [Energy, passion not unrelenting] there may be days where I look at my caseload and look at who I’m seeing and say “Oh, man” but I think a therapist .
P 1: Transcript 1.doc - 1:40 Codes: [Energy, passion, is constant] No, not on any significant level.
P 1: Transcript 1.doc - 1:53 Codes: [Energy, passion, is constant] No, If I wasn’t a psychotherapist, then being a chef would have been nice, construction would have been nice, but no again I don’t think there are many jobs where you can as directly or substantively help people.
183 P 1: Transcript 1.doc - 1:67 Codes: [Energy, Burnout, not burned out] So there are occasions where I’m worn down, but you mean a more problematic burnout?
P 1: Transcript 1.doc - 1:68 Codes: [Energy, Burnout, not burned out] if I find I’m feeling worn-down, I don’t like to put up with that. I’ll do something in the next 5 minutes or the next hour, or over the weekend, that I don’t like feeling that way. So I guess yeah I mentioned that hardiness. Maybe it’s my upbringing, maybe a little bit of genetics, uh; I don’t tolerate feeling burned out. I tend to want to steer away from that as best as I can.
P 2: Transcript 2.doc - 2:43 Codes: [Energy, passion, is constant] It’s pretty constant, and it was definitely right from the beginning.
P 2: Transcript 2.doc - 2:45 Codes: [Energy, passion, is constant] yeah, I think I’ve always been pretty passionate about it.
P 2: Transcript 2.doc - 2:71 Codes: [Energy, Burnout, not burned out] I don’t feel burned out.
P 3: transcript 3.doc - 3:24 Codes: [Energy, passion, is constant] [Personal characteristics, fit] No, from the time I made the decision, there was never any doubt that this is what I wanted to do, it is what I was going to do, and its never been a question.
P 3: transcript 3.doc - 3:25 Codes: [Energy, tired, phases of being drained] there have been times when I got real tired.
P 3: transcript 3.doc - 3:38 Codes: [Energy, Burnout, not burned out] I'm not burnout out, I haven't had a problem with burnout since I left administration. I made a really good decision, Brian. I've retired, I don't have to do this financially, I'm to that point. I do it because I love it. I could quit any day of the week I want.
P 4: transcript 4.doc - 4:10 Codes: [Energy, burnout, stagnation, doesn't feel] don't ever feel stagnant,
P 4: transcript 4.doc - 4:56 Codes: [Energy, Burnout, not burned out] Right now, I feel pretty good. I don't know what the scale is, but I feel pretty great right now.
184 P 4: transcript 4.doc - 4:69 Codes: [Energy, burnout, private practice, believes would be difficult] I think it would be hard to go private, there are just so many things to work through these days.
P 5: Transcript 5.doc - 5:14 Codes: [Energy, Burnout, disillusionment temporary moments] Trying to put it in perspective, that in every job there are those moments, those ups and downs, and not everything goes perfectly. With some clients, we do the best we can, and it may not turn out, we just have to realize what is in your control and not in your control
P 5: Transcript 5.doc - 5:16 Codes: [Energy, passion, is constant] I'd say I've been that way throughout, but obviously I'm much less experienced, I'm gaining experience. But there are times, I wouldn't say long stretches of time, maybe several days in a row, it makes it harder to feel passionate about work. But for me those stretches have been pretty brief and few and far between.
P 5: Transcript 5.doc - 5:30 Codes: [Energy, Burnout, not burned out] Not a change in careers, different job opportunities have come up, but still as a psychotherapist. I really haven't contemplated changing careers.
P 6: transcript 6.doc - 6:18 Codes: [Energy, passion, is constant] Have you been passionately committed throughout your career?
I think so. I'm thinking about how to answer this in terms of things I've gone through. I've watched this place kind of fall apart and slowly get put back together, I've definitely been through some trying and traumatic times, and some… the hardest part is probably, there are times when you don't necessarily feel that you are supported,
P 6: transcript 6.doc - 6:35 Codes: [Energy, Burnout, not burned out] I've been burned, but never burned out. There came a time in Davis County, where I felt if I continued to be in that kind of a caustic environment where everybody hated coming to work, the negativity was so intense that I knew if I was going to survive, I had to get out of there.
P 6: transcript 6.doc - 6:36 Codes: [Energy, Burnout, not burned out] Yea, I still do, 1 is euphoric, and I'm a 3, so to me that's pretty healthy. If I was to retire from the public sector, I would still probably hook up someplace that had less of the other kind of stress to be able to do what is more significant to me, which is what happens in this space her
P 7: Transcript 7.doc - 7:29
185 Codes: [Energy, Burnout, not burned out] Currently, it’s not. I had come to a big, huge crash when I moved to youth services. Like I told you, that was a time of my life when I was actually considering getting out. I thought, no, I need to try balance first. I came down here, and started something that I hadn’t honored in a long time.
P 8: transcript 8.doc - 8:32 Codes: [Energy, passion not unrelenting] You know the ups and downs…I’ve always done well with my colleagues, with administrators, there have been often times where I…and then other times in the background where I felt uneasy, but on the surface I got pretty high marks and ratings for what I was doing, but I couldn’t even let myself… Ultimately, it was me, and the way I was looking, but for me, there were times that I experienced unnecessary fear and apprehension about administrators, and that were seen as different somehow from clients.
P 8: transcript 8.doc - 8:36 Codes: [Energy, Burnout, not burned out] How would you rate your current level of burnout?
It seems to be getting more and more joyful.
P 9: Transcript 9.doc - 9:34 Codes: [Energy, burnout, private practice, believes would be difficult] Um, it's not a bad time here to be a psychotherapist. Out there in private practice, it probably is. Private practice doesn't appeal to me. It never had when I got into this. Personally I consider it corrupt. There's a huge incentive to keep somebody sick. Here there is none of that.
P10: Transcript 10.doc - 10:27 Codes: [Active strategies, avoids colleagues who aren't PCP] [Energy, Burnout, not burned out] I don't think I'm burned out at all. At least not this week (laughs) You know there are days - there are days that are very difficult, but you know I think there's only been one, and again, you know I’m fairly new to this profession, I don't know how long it takes somebody to burn out. When I first started I had to learn how to adjust. I had to expand my capacity to listen to all of that negative stuff - you know, and now I'm kind of callous to it all and people within my family will say some horrific thing and it's kind of like - you know (laughs) "Oh sorry, I guess I didn't, you know"
P11: Transcript 11.doc - 11:31 Codes: [Energy, Burnout, not burned out] Zero. I'm not burned out.
P11: Transcript 11.doc - 11:32 Codes: [Energy, tired, phases of being drained] Oh, I'll get to a two once in a while. Just the ebbs and flows that come through. I remember a couple of times the last two years when I felt; "I'm just tired,"
186 The kind of tired where you felt you would be able to replenish yourself…?
Yea, once you wake up in the morning and think, "I don't know," and you grind it out for another day.
P13: Transcript 13.doc - 13:11 Codes: [Energy, passion, is constant] I would say that it's been pretty strong, actually. The ebb and flow is the bureaucracy, the changes in, you know, what's frustrating is the legislature, you see cuts here and cuts there and how it really impacts individual. UTA wants to do a fare hike, and I know, people say big deal, 25 cents, but when you are living on a fixed income, that is a big deal. So it's not the people that ebb and flow, it's the bureaucracy that is the ebb and flow, and things you have absolutely no control over. You write the legislature, and all that stuff, you go and try to sit in, you try to make a difference, and when that doesn't do anything, it doesn't produce any results other than they cut here and they cut there. That's the frustrating part, that's like "Why even bother?" But then, you know, you see their faces and say, "This is why I do it, not because some bureaucrat that tells me what I can and can't do because of money". You do the best you can.
P13: Transcript 13.doc - 13:20 Codes: [Energy, Burnout, not burned out] How would you rate your current level of burnout?
On a scale of ten being burned out?
If you wish.
A one. I'm no where near burned out. I've been in a high burnout position for years, and I'm fine. I don't feel, you know there are days when I would rather be a home, just relaxing, but I don't like to go long terms without coming to work. When I was on maternity leave with my son, I really struggled with that. Not that I didn't love my son, but this is part of who I am--This is part of my identity. I realize now that I'm not good as a stay-at-home mom. I have to have this--it is about everything that is here.
P13: Transcript 13.doc - 13:28 Codes: [Energy, Burnout, not burned out] Absolutely, absolutely. I know I've only been on this for three years, and I have a long way to go, but I don't doubt that I will be just like the individual that had 32 years from now, doing just fine. I don't see myself burning out.
P15: Transcript 14.doc - 15:18 Codes: [Energy, tired, phases of being drained] the problem with being in the same public agency for thirty years, is now I am getting to the point where I'm seeing the children of the children I saw when they were children. I mean, it's kind of nice that they will call up and say, "Oh, I used to see (name of therapist) when I was a little girl, and I want my daughter to see her." But on the other hand, it's like, "Oh, things are still awful." So that's sad.
187 Has that been more of a fleeting thought, or has it been more troublesome than that?
I guess more fleeting. It's sad when I think about it, but I don't dwell on it. I guess I figure that probably didn't make things worse. Sometimes I can't make things better, people are going to go where they go, and that's kind of it.
P15: Transcript 14.doc - 15:22 Codes: [Energy, Burnout, disillusionment temporary moments] I think the part that is more difficult is that kids seem to be getting sicker, or families seem to be getting sicker. I see a lot of kids who are being raised by grandparents because of meth use, parents are on meth or in jail. That's just huge. I don't know that it's more difficult, but practice has just changed, a lot. Children are having sex at a much younger age; they're just growing up too fast, so I think it has changed.
P16: Transcript 15.doc - 16:22 Codes: [Energy, tired, phases of being drained] I've had ups and downs. I'd say I've had more ups than downs. I think my downs occur when I allow myself to return to my old patterns of being superwoman. When I started to do that, and use negative coping skills for myself
P16: Transcript 15.doc - 16:36 Codes: [Energy, Burnout, not burned out] [lifestyle, balance] I fully believe that I am not even close to burnout now. I love getting up in the morning, I love going to work, I love working all day, and I love going home and letting it all go. That's probably why I'm not in burnout mode.
Code Family: Intentional Learning: Complimentarity of Personal and Professional Development
Codes (3): [Active strategies, growth and learning] [Employer factors, training/learning opportunities] [Personal characteristics, internalizes therapy] Quotations: 32
P 3: transcript 3.doc - 3:7 Codes: [Active strategies, growth and learning] to keep it interesting, I've tried to "reinvent" myself over the years, to get interested in new areas. I started off with an interest in depression-- I'm sure I've done hundreds of presentations to different groups about depression-- then I got involved in treating survivors of sex abuse, adult survivors. Did groups and individual treatment dealing with that for a number of years. Depression got kind of old, and as new ideas came along, I've tried to jump on those that have a market, and that interested me. I got myself licensed as a hypnotherapist down in Phoenix, and that was interesting. At one time, for about five years, my wife and I ran an experiential program. I went to an experiential program that was a knock-your-socks off experience for me, and we ran that. My wife and I have done marriage retreats over the years, we rent a bed-and-breakfast over in Monticello and do weekend marriage retreats. We did a program called "fully alive" that was bits and pieces of other
188 programs I had seen, we did experiential. We did that for a number of years until I just totally ran out of gas on that. Probably, of everything I've done in my career, I've had more impact there than anything I've done. What else? The Department of Corrections contracted with us to do sex offender treatment-- Monticello contracts where they take fifty beds and we provided the treatment there, and I found that exciting, then we started an outpatient program. I spent a lot of years focused on sex-offender treatment. So just having something new to do, a new focus. Got interested in body work in the early 90's, got licensed as a massage therapist, to see if I could integrate the two. To some extent I have been able to do that, but that hasn't turned out to be a major emphasis of anything that I do. Got interested in trauma work, got licensed as an EMDR therapist, that's been a powerful tool. So just trying to come up with something new to keep me focused, that's kept me interested over the years.
P 3: transcript 3.doc - 3:42 Codes: [Active strategies, growth and learning] Find an area that interests you, get to be the expert in it, know more about it, learn more about it, rather than just trying to deal with every population in an eclectic way.
P 3: transcript 3.doc - 3:51 Codes: [Active strategies, growth and learning] [Energy, energizer, variety] I'm still pioneering in different ways. The whole idea of mental health is now acceptable, its got credibility. My latest interest--I think-- I've just spent a week in Vegas, I'm still deciding if this is the way I want to go, is dealing with couples with sexual dysfunction. That's pioneering in this area, its something no one has touched very much. We've all dealt with it to some degree, but not in depth. I've dealt with it with some couples, but didn't know exactly what to do with that piece of it. So, there's still new areas. When I got involved with hypnosis, that was new. But you're right, it's not, its changed. It's not that we are making mental health okay, but making new pieces of it okay.
P 4: transcript 4.doc - 4:7 Codes: [Active strategies, growth and learning] I'm always learning, and that also excite me, I'm always reading and learning and growing,
P 4: transcript 4.doc - 4:12 Codes: [Active strategies, growth and learning] but I wouldn't still be doing this if I just checked off a box, I would have been bored and burned out, so it's more than that to me.
P 4: transcript 4.doc - 4:61 Codes: [Active strategies, growth and learning] I've also been able to learn, and be introduced to things that are a good fit for me. I think if I was doing therapy still the way I was the first two years, I always joke that everyone should get their money back for the first two years of therapy I did. I did the best I knew at the time
P 4: transcript 4.doc - 4:64 Codes: [Active strategies, growth and learning] [Personal characteristics, failure, learned not to fear] [Personal characteristics, openness]
189 but I'm also willing to try new things, and I don't have to have it perfect. I think you need to grow and learn and develop competence, but I think if I waited I won't do very much. I think you have to be willing to just go for it. Not to be too zealous without being grounded, but I think it's okay, even outside of here, I agreed to do this DVD project with a group going on a trek and I didn't have a clue what I was saying yes to, but I certainly get to ask a lot of questions and learn a lot, and that's kind of what I do too. I don't always know what I'm getting into, but once I do commit to do something, I jump in and am going to do what I can to do a good job
P 6: transcript 6.doc - 6:44 Codes: [Active strategies, growth and learning] But way back when I heard a speaker talking about her goal of being a mature adolescent, and that resonated with me. Like opposite ends of a guitar, you strike one end and the other reverberates, that is what it was like. "That's what I've been trying to do, that's why I wear strange clothes and stuff" I don't want the impulsivity of being a teen-agers, but I want freedom to retool myself, to redefine who I am, to not be stuck. To be a work in progress. I went with two of my kids and we climbed up Machu Pichu two Christmases ago, and I want to be able to feel that I'm still involved, and that if this is who I am right now, If you run into me in two years, some core stuff would be the same, but maybe I would have morphed a little bit. You can only do that if you are able to actively introspect, and you can only do that if you not only can detach and be aware, but then take it to the next step and say I'm going to project into the future a little bit, and this is where I am and where I want to be.
P 8: transcript 8.doc - 8:22 Codes: [Active strategies, growth and learning] but my own ability to experience this is linked to my willingness to share and teach it to others, which make it more available to me. Yacinski says to work on three lines to achieve anything, because otherwise you always get deviated. Nothing ever goes to completion, so if it was just me trying to become enlightened, I wouldn’t make it, but if it’s me trying to help others have it, and another piece is being involved in a school, and that is a place where I’m beginning to have a feeling…of wondering where to go. I have a couple of students, and so forth, but it’s working with an enlightenment school, like Landmark Forum, because Yacinski talks about the seven levels of men, one, two, three, emotional, movement, and intellectual men. Level four you become aware of, you know cognitive therapy, level five, six and seven is Jesus Christ. But level four or five is where you are able to speak in a way that helps others find their freedom. And can give to you, whatever you dream of, you share, and people are able to give to that, and you become a Nelson Mandela or a John Kennedy, that you are able to reach other levels of creation, which is people accepting an idea and passing it on.
P 8: transcript 8.doc - 8:26 Codes: [Active strategies, growth and learning] I love the idea of doing training, I’m doing a seminar now on dealing with stuck clients, doctors, nurses, and I’m just throwing out ideas, and they’ve been begging me not to retire, and to help train others when I go as far as being able to manage some of these people,
P 8: transcript 8.doc - 8:39 Codes: [Active strategies, growth and learning]
190 I think that, one, to be willing to do something like the Landmark Forum, if you’re going to be in this business, watch a first-class organization like them do this with healthy people, but really put people who are well, and everyone has squabbles with their family and moments of depression and fear. But to watch what they do, and a series of procedures, and agreement, you know, Linehan, you can just see reflected in their program. And she does very well because you can see thirty years reflected in her practice. That is a remarkable experience, to be part of school that can help really tackle the fundamentals of what it is to be human and step outside of Western or any kind of thought system, what is the truth? Is this the truth, really? The truth is what is left when you get rid of what isn’t.
P 8: transcript 8.doc - 8:47 Codes: [Personal characteristics, internalizes therapy] I really love this study of what it means to be human, and this process of transformation and the possibility of joy, and love, and invulnerability, kind of. It’s quick to let go of what could feel stressful or fearful, and I could go into, but my own ability to experience this is linked to my willingness to share and teach it to others, which make it more available to me.
P 9: Transcript 9.doc - 9:48 Codes: [Active strategies, growth and learning] [Personal Characteristics, challenges] Yes, yes, absolutely. I'd like to get better, and to get better is to practice keep that line distinct. A lot of times, that line is blurred or nonexistent anyway, and they don't know where they leave off and another person begins.
P10: Transcript 10.doc - 10:29 Codes: [Active strategies, growth and learning] And then look for the opportunities and look for whatever is out there, whether it be workshops, or whether it be associating with colleagues and learning from them, whatever to cultivate that you know, to kind of like to keep the water pouring on the plant. I think it's important to know what it is that you like about it and make sure that that keeps happening. That you're finding new sources to keep that going.
P10: Transcript 10.doc - 10:31 Codes: [Active strategies, growth and learning] I have, and I also I work with some people who are just passionate also and really interested and I associate with those people, and you know they're bringing me articles and I'm taking them articles, and as soon as we find a new book we tell each other about the new book and that kind of thing. But I think it's really important to individually know what it is that you love about it, so that it's not some airy, airy kind of idea about this sort of feeling that's out there why you want to do it, but what exactly it is, so that you can cultivate it. And I think further education is very important. I really think that's very important.
P10: Transcript 10.doc - 10:35 Codes: [Personal characteristics, internalizes therapy] I don't think you've missed anything. I think what the difference is though, what I see, is that you know, I believe that in making any change or in anything really important, there is... I believe that there are like 3 different stages of taking something on. It begins with intellectualizing something, and then it goes into taking it into your heart and personalizing
191 it, but then after that it takes the behavioral leap. And it's really important for me to go through all 3 of those stages in what I do in therapy and I really believe that I have to practice what I preach and when I am asking somebody to do something really difficult, you know, it's important for me to take it to all 3 stages and I think that the difference that I see in kind of the people who are burned out, they won't go to the behavioral level.
P10: Transcript 10.doc - 10:36 Codes: [Personal characteristics, internalizes therapy] They keep it at the intellectual level. And they may get to the personal level, but then they feel like - if I have to use these skills then there's something wrong with me. Or what kind of therapist am I? I should have everything all together. Well I don't! and I use what I teach other people to use and I'm not ashamed of it and I'm just a human being trying to get through life like everyone else. I guess I don't see myself as that much different than all of my clients - well, all people, and I think to the level where you feel like you have to keep it intellectual and you have to be an expert, and you have to have all of the answers and then like some wise sage you can impart all of your wisdom on to somebody, I think that…
P10: Transcript 10.doc - 10:37 Codes: [Active strategies, growth and learning] You know when we did our DBT consultation for new work - changing it from a study group to a consultation group, part of DBT is that the therapists are to use DBT on each other.
Right.
Well, it caused a major rift in the clinic because there were people who felt like they were lowering themselves if somebody were to say "Gee, you know, is that therapy interfering behavior?" You know, they didn't want to be called on anything. They didn't want to work with what they had. Because they wanted everything that they were already perfect.
So, extrapolating - you think that the ones that jumped into that assignment and opened themselves up to it were more likely to be passionately committed?
Oh, absolutely.
And the other group is more likely to be burned out?
Right.
It's a very intriguing thought.
It's like they've got some sort of barrier up where …
Yeah, it's an interesting thought - where I may be able to investigate in some of my future interviews and see if that holds. I'm very intrigued by that.
192 Because there were a number of people who, I mean, and they saw it as a, like there was something wrong with them, and not a "I can grow from this", but there's something, you know, they didn't want any chance that any of their vulnerabilities or anything like that might be exposed.
It was pretty threatening to them?
Very threatening.
And the people that I know that are burned out - they feel like they've learned everything they've had to learn. They don't want to learn any more. They think they've got it all down and aren't open to new perspectives.
P10: Transcript 10.doc - 10:39 Codes: [Personal characteristics, internalizes therapy] I never ask anybody to do anything in therapy that I'm not willing to do, I use myself as a test case. A lot of times, I do DBT skills and the skills that we teach our clients, their really hard, and I feel like I have to see what this is like in a particularly difficult time. So when I do it, and I see that it works, I get so excited. I just love it.
P10: Transcript 10.doc - 10:41 Codes: [Employer factors, training/learning opportunities] but I think that inservices, training, listening to other people who are passionate about what they do can be exciting and rev people up.
P10: Transcript 10.doc - 10:43 Codes: [Active strategies, growth and learning] You know then again I know people who go to workshops and get totally bored and they just dread going to workshops. You know I don't think I've ever been to a workshop that I haven't totally loved.
P10: Transcript 10.doc - 10:49 Codes: [Active strategies, growth and learning] I think that inservices, training, listening to other people who are passionate about what they do can be exciting and rev people up.
P11: Transcript 11.doc - 11:33 Codes: [Active strategies, growth and learning] In terms of burnout, it would be constantly improve your knowledge base, read, go to conferences, staff with other people,
P13: Transcript 13.doc - 13:27 Codes: [Active strategies, growth and learning] You are right, there was. There was one time, where I was "This is the worst story I have ever heard." And these kids talk about it in a frank way. And you think, this fifteen year old kid has been through this for years. And you ask the question about violence, I've come to understand that American's definition of violence is very different than what a refugee's
193 definition of violence is. And learning about other cultures is awesome. I have learned a great deal about Somalia, Croatians, Bosnians, and I think that is really cool.
P14: Transcript 12.doc - 14:10 Codes: [Active strategies, growth and learning] [personal characteristics, curiosity] One thing that really engages me in that is the…I'm trying to not talk in pure abstractions, I'm trying to tie it to some specifics in my head… I guess when I sit with a family and we talk about what is going on in their world, and what they want that world to look like, even subtle changes that will make a difference, there is a certain amount of playing detective with them, that I really enjoy. Trying to figure out their world view, their values, how all that fits with some pieces that can shift just enough that they will find some greater joy in their relationship together. I do believe, at least for me, that part of being in that process of trying to find that shifting point, is what is intriguing. As (names co-worker) told me, I really do think there is a certain amount of philosophy that comes to this and there really is trying to understand what someone's philosophical view is, knowing what mine is, and not discount either of those, and try to figure out how change can be made in either one of those. It's funny, but I think my own philosophical view of life changes as I work with people too. I think my own growth happens as part of this process. Just being able to enjoy that they may be able to enjoy that same goal.
P14: Transcript 12.doc - 14:11 Codes: [Personal characteristics, internalizes therapy] Sometimes we are unhappy, and we don't know why, and so our next step is to find out about that unhappiness that is there, so that is that beginning recognition that something has to change, and then sort of searching for the pieces of that, what is making me unhappy right now, what can I change and then moving through that to making a commitment to actually making some investment in changing my own life. Even my wife and I were talking about a commitment to an exercise program this year, I think we all do that, we all look for something is not quite right in my life, and once we become aware of the specifics of that, it all becomes easier, and then the next step is looking for how can I implement that on a daily basis, and how can I keep committed to making that change. I really do like their model.
P14: Transcript 12.doc - 14:14 Codes: [Active strategies, growth and learning] I find that conferences, I love conferences and workshops. Very often someone will say, we do this, do we have to listen to this again, and yet invariably I will, even hearing something I know pretty well, will hear something and say, that's right, I'd forgotten that, or that's an interesting way to look at it, or that's a great way to describe it. I find that listening to others talk about their therapy is very invigorating. I think we are lucky in this system to get quite a bit of that input.
P14: Transcript 12.doc - 14:30 Codes: [Employer factors, training/learning opportunities] I, for myself, find that part of my being actively committed, seeking new information. Having the opportunity to attend workshops, bringing people in, I think is very helpful.
P14: Transcript 12.doc - 14:35
194 Codes: [Active strategies, growth and learning] [Employer factors, supervision] I do believe the more you continue to grow, the more you'll stay invested in it, because I think it is about personal growth as well. If there were a way to make it more of an apprenticeship the next two or three years, where they are not seeing as "supervision" like they had during their internship, but apprenticeship, how can I become more skilled in this, and gain from other people around me and see what I want to be. I think that would do it--it would open their eyes.
P15: Transcript 14.doc - 15:9 Codes: [Active strategies, growth and learning] I think working with students, I have been supervising students for a long time, I think that is energizing because they get so excited about it, or they make you think about. You listen to a tape of theirs and say, "Oh, I don't think that is quite right, I wouldn't have done it like that." Now I have to think of why I would have done this and not that, so it makes you think about why you do what you do, kind of keeps you going.
P16: Transcript 15.doc - 16:8 Codes: [Active strategies, growth and learning] I'm determined to learn as much as I can, so that's another balance.
P16: Transcript 15.doc - 16:32 Codes: [Employer factors, training/learning opportunities] I would say that something that would be tremendously helpful is, well, I love to learn, I love opportunities for learning.
Code Family: Intentional learning: Continual Fascination With Human Development and Change
Codes (2): [personal characteristics, curiosity] [Therapy attitudes, intellectual component] Quotation(s): 14
P 1: Transcript 1.doc - 1:4 [ntellectual component] (28:28) (Super) Codes: [Therapy attitudes, intellectual component] No memos intellectual component
P 3: transcript 3.doc - 3:50 Codes: [personal characteristics, curiosity] Keep them doing psychotherapy, and encourage them being curious about new ways to do it. If someone is interested in a new modality, encourage it, rather than seeing it as a drain on the training budget
P 6: transcript 6.doc - 6:29 Codes: [personal characteristics, curiosity] [Personal characteristics, fit]
195 I think I've always had an intuitive sense of what is going on with folks, I've told you I contemplated going into different areas, I was going to be an English professor, and artist, but I probably would have been it for a week or two. I think there's a common thread through all of that, it's a fascination with the human drama. My mom used to read tea leaves and used to see herself as psychic, not that I see myself as psychic, but I think I have been able to see what is subterranean, or what was hidden, and that has sort of fascinated me.
P 6: transcript 6.doc - 6:30 Codes: [personal characteristics, curiosity] I tend to see things sooner than my brothers or sisters, I just have that, whether it's some kind of radar, or some kind of capacity for that. I think I've always been fascinated with the human drama, and our field just sort of encapsulates that. It's just sort of a way of theorizing about the human drama, if that makes any sense.
P 6: transcript 6.doc - 6:38 Codes: [personal characteristics, curiosity] The best clinicians that I have known are introspective. That doesn't mean they have a whole lot of problems they are working through, it means they are , you know like Socrates "the unlived live is not worth living," they have a curiosity about themselves. The ones who don't have that, I would question why you are going into this field. Because it isn't the best moneymaking gig in the world.
P 8: transcript 8.doc - 8:46 Codes: [personal characteristics, curiosity] [Therapy attitudes, sprituality] I really love this study of what it means to be human, and this process of transformation and the possibility of joy, and love, and invulnerability
P 9: Transcript 9.doc - 9:11 Codes: [personal characteristics, curiosity] I think you'd see what you are seeing now. I think it would be reversed, I would sometimes be interviewing you, because I would be curious. I would really want to know what is going on, and what you are thinking about and where those thoughts are coming from
P 9: Transcript 9.doc - 9:57 Codes: [personal characteristics, curiosity] Perhaps from that standpoint, I end up being energized by the interaction because it is more of an investigation.
P 9: Transcript 9.doc - 9:60 Codes: [personal characteristics, curiosity] If someone makes up whatever they come in here and tell me about, it's fine, it's all coming from the same place, from their psychic processes, and that's what's fascinating.
P10: Transcript 10.doc - 10:44 Codes: [personal characteristics, curiosity] It's kind of like a game to me, and I have fun doing it. I really love it when I see people making progress, and I can usually do that in a session--okay, maybe not progress, but insight. I love it when they have insight.
196 P11: Transcript 11.doc - 11:5 Codes: [personal characteristics, curiosity] I guess it is just, well ever since the '70's I've had this intense interest in people, behavior, curiosity about people and how people work, and all that.
P11: Transcript 11.doc - 11:15 Codes: [personal characteristics, curiosity] It's interesting--when I was fifteen or sixteen years old, I used to go into the old part of town to look at the interesting architecture. I would walk down the streets, and for some reason I had this real curiosity about what was happening in those homes behind those doors and windows. I just had this sense of curiosity, and wondered what kind of lives were going on there. I think it's because my life had been so hard for a while there, so I was curious what other people's lives were like and what was happening, I had this intense curiosity about it. That's almost what I am like when I meet new people in therapy, I just have this real curiosity about who they are and how they got to be the way that they are, how they function, and in a larger sense, families just fascinate me, the system does, and in the larger sense, how they are embedded in the community. It's the same kind of thing; it's this intense curiosity. I think that people are so interesting, and really wonderful, they're just great.
P11: Transcript 11.doc - 11:48 Codes: [personal characteristics, curiosity] [Personal Characteristics, personal experience led to professional interest] If you rewind the clock to about age 11, my father died, and my mother suicided when I was 13. I'm sure that influenced the direction I took. I think it stimulated my interest in people, my curiosity and compassion.
P14: Transcript 12.doc - 14:10 Codes: [Active strategies, growth and learning] [personal characteristics, curiosity] One thing that really engages me in that is the…I'm trying to not talk in pure abstractions, I'm trying to tie it to some specifics in my head… I guess when I sit with a family and we talk about what is going on in their world, and what they want that world to look like, even subtle changes that will make a difference, there is a certain amount of playing detective with them, that I really enjoy. Trying to figure out their world view, their values, how all that fits with some pieces that can shift just enough that they will find some greater joy in their relationship together. I do believe, at least for me, that part of being in that process of trying to find that shifting point, is what is intriguing. As (names co-worker) told me, I really do think there is a certain amount of philosophy that comes to this and there really is trying to understand what someone's philosophical view is, knowing what mine is, and not discount either of those, and try to figure out how change can be made in either one of those. It's funny, but I think my own philosophical view of life changes as I work with people too. I think my own growth happens as part of this process. Just being able to enjoy that they may be able to enjoy that same goal.
Code Family: Passion-supporting beliefs: Equality in Relationship with Clients
197 Codes (2): [Therapy attitudes, equality in relationship/mutual goal setting] [Therapy attitudes, responsibility-- tx vs. client] Quotations: 51
P 1: Transcript 1.doc - 1:30 Codes: [Therapy attitudes, responsibility-- tx vs. client] One area that I am recognized for and that is being able to distinguish what you have control over and what you don’t. You kind of stay focused on what you do have influence over. Instead, I think most therapists may be surprised by clients that don’t heed their advice. Clients especially in public mental health struggle to want to change. I’ve learned that that’s sort of human nature. That it’s difficult to change.
P 1: Transcript 1.doc - 1:61 Codes: [Therapy attitudes, responsibility-- tx vs. client] To delineate what they can do from life and what they can’t.
P 1: Transcript 1.doc - 1:70 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] There’s really no other venue where the person gets an hour where they are permitted to focus on themselves and they have an attentive, nonjudgmental, supportive audience.
P 1: Transcript 1.doc - 1:73 Codes: [Therapy attitudes, patient with slow process of change] [Therapy attitudes, responsibility-- tx vs. client] It’s kind of human nature to change slowly, or to resist change, so they may not see as many changes as they’d like to. Try to engage with clients, give it a good college effort, but then recognize it’s the client’s effort from that point.
P 2: Transcript 2.doc - 2:4 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] I think I had a lot of privileges, I was white and upper class.
P 2: Transcript 2.doc - 2:5 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] I wanted to give away some of that power to other people . So I thought social work was a good idea.
P 2: Transcript 2.doc - 2:6 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] knowledge is power,
P 2: Transcript 2.doc - 2:7 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] more like a guide, it’s just where do you want to go and can I help you get there, not this is where I think you should be, and this is what we’re doing, so I think that because knowledge is power, helping people get knowledge about themselves is wonderful, it gives them power, it’s meeting the needs that I have.
198 P 2: Transcript 2.doc - 2:20 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] I still lived in Canada, I went to Vancouver, and when I came out to Moab, and was mountain biking, and I picked a really dumb line, and crashed and broke my wrist , and um ended up having to go to the hospital, and having to have a tetanus shot and no one could really explain why, just because, and when I went back home to Vancouver, I went in to see my doctor wasn’t there, so there was this brand new doc, and I wanted to know why, and she said, I don’t know, but she sat next to me on whatever those things, are called those paper covered tables, and she got the book out and flipped through and we found out why, and I remember thinking, this is really cool, I don’t think that she’s not knowledgeable, and I don’t think that she’s an idiot, because she doesn’t know, umm, I feel like she’s sharing information with me, and admitting that she doesn’t know, and that really impacted me, so I feel very comfortable saying to my client, I have no idea, you know I’m not familiar with that diagnosis, let’s get the DSM out, and let’s read it together, so I think I often don’t know a lot of things, and I feel like I’m allowed to say, I don’t know.
P 2: Transcript 2.doc - 2:21 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] It takes a lot of pressure off, Because I don’t have to be the expert, and I have no problem saying, you know, I don’t know if there’s another criteria to get this diagnosis, and I can’t really remember what it is, but you know, I’ve got the book so let’s look it up, so I kind of feel like, I don’t have to pretend to be the expert, the person sitting across from me knows a lot more about their own self than I’ll ever know. And I’m supposed to have some book information that they’re not supposed to have, but there’s no reason we can’t both have it. So yeah, it just takes the pressure off, I don’t feel like I have to be this omniscient person. You know, so I think that that helps, I don’t feel like “Oh, boy” I hope no one asks me what this is, because I have no idea. Do you know what I mean?
P 2: Transcript 2.doc - 2:41 Codes: [Therapy attitudes, fragility of clients] [Therapy attitudes, responsibility-- tx vs. client] When Steven killed himself, absolutely. My first thought really was quitting. How could I have been so wrong. To not… was there something that I had missed? So I basically questioned all of the things I’d been secure about. You are an autonomous being, and you’re only going to tell me what you’re going to tell me. I’m not psychic and I’m not going to know that you’re sitting here telling me that you’re OK but you’re going to go kill yourself tonight. Right? I mean, I work with 9 borderline women who have been hospitalized a million times and who have had very serious suicide attempts. I can’t imagine statistically that one of them isn’t probably at some point going to kill themselves. Martha told me that when I took her caseload. She said ‘this one and this one are probably going to kill themselves on your watch, you need to know that, so just be prepared. And we need to know that. We work with people who are fragile.
P 2: Transcript 2.doc - 2:44 Codes: [Therapy attitudes, equality in relationship/mutual goal setting]
199 I was working at a youth drop in center in downtown Ottawa, which is mostly gang kids. The first intervention I had to do was this teenager came up to me and said I’m worried about that little girl over there. Her dad’s beating the shit out of her, she doesn’t want to tell anybody, she doesn’t want to go to foster care, but I don’t think it’s safe for her to go home. I’d never really been like ‘the therapist’ you know, and I got her to a place in the center where I could talk to her in private and she had a friend, cause she wanted a friend there. We talked about this, and I told her that I was obligated by law that now that I had this information to report it, but that I want…and I do this as a step in my practice, which I do, some families in my practice do things that require that I report them. I do it with them in the room. On the speaker phone, and I let the DCFS worker know that they’re on speaker phone and that my client is sitting here and I make the report. I want my clients to be part of what happens to them. I don’t want anything to hit them from behind. So with this little girl, I said we need to call the version of DCFS in Canada. But I’m not going to make a report without you riht here. So let’s call them and we’re all going to talk together. And they will probably want to talk to you alone, but I’m not going to talk to them alone. Because I don’t want to get anything wrong. If I get anything wrong in my reporting, you need to be here to correct me. The police officer came. That’s how they did it there. The police officer came with the DCFS worker. It went so well, that the DCFS worker called my supervisor the next day and offered me a job working for him, which I did end up doing also, because I was working part time. He was just really pleased with my sensitivity with this. I think that if I was not…It wasn’t something I learned in school, it was just, how would I want to be treated, and how would I want this to play out. I worked for this man off and on for 5 years after that. So I think that I’ve always just committed to it and I’m definitely passionate. I really think I think things through about how things need to play out. And I know that when you get DCFS involved, it’s out of everyone’s hands. You no longer have power andyour client no longer has power. It gets in the system. But I can at least be honest with them about what’s about to happen, and how I can support them as we walk into this abyss together. Because I believe that the system is there for a reason. So we need…I mean I have a mandatory report, so my guess too is so that when my clients tell my . I’m talking so many times about what my obligations are that I feel that you’re asking for help. So, Karen, you know I told you if you took a belt to your son we’d have to call DCFS, so let’s just get it done. Let’s pick up the phone right now and do it. And, it’s a lot easier. I don’t have any one furious with me. They didn’t just tell me something, and then DCFS shows up 10 minutes later. They know what’s going on. We can do the interview at my office. They can do the investigation there.
P 2: Transcript 2.doc - 2:61 [But everyone’s an individual. ..] (159:159) (Super) Codes: [Therapy attitudes, equality in relationship/mutual goal setting] No memos
But everyone’s an individual. There’s nothing real in that. These are 20 individual women who are all amazing and who somehow have gotten themselves to 40, 50 or 60. So they don’t fit it, they just need a little validation and support. I think so don’t believe all the negative hype about things
P 4: transcript 4.doc - 4:23 Codes: [Therapy attitudes, responsibility-- tx vs. client]
200 If I felt responsible for their growth, I think you take their trauma on a little bit, because it is heavy, but if I took it on and thought I had to make them better, if I had the illusion that that was my job as a therapist, that would burn you out.
P 4: transcript 4.doc - 4:32 Codes: [Therapy attitudes, responsibility-- tx vs. client] I'm just a facilitator, I really like that.
P 4: transcript 4.doc - 4:38 Codes: [Energy, energizer, success in treatment] [Therapy attitudes, responsibility-- tx vs. client] I get to create environments that facilitate healing, and I'm really clear that I'm not the healer, I just get to create that environment--but then they get to reclaim themselves and their lives, and that just it in a nutshell.
P 4: transcript 4.doc - 4:78 Codes: [Therapy attitudes, responsibility-- tx vs. client] Well, I don't feel that I do the healing, I think my job is to create the environment where that can happen, just to facilitate that. I think people just need that facilitation, and that the change happens within them.
P 5: Transcript 5.doc - 5:15 Codes: [Therapy attitudes, responsibility-- tx vs. client] With some clients, we do the best we can, and it may not turn out, we just have to realize what is in your control and not in your control.
P 5: Transcript 5.doc - 5:21 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] [Therapy attitudes, relationhship genuine as well as professional] [Therapy attitudes, responsibility-- tx vs. client] The biggest one is trying to interact with people the same way, no matter where I am. Whether it's at home, or church, or in therapy, I just try to be the same person wherever I am at, that takes some of the load off.
P 6: transcript 6.doc - 6:4 Codes: [Therapy attitudes, responsibility-- tx vs. client] I think there's got be a balance between being able to care, and enjoy, and at the same time, recognizing that the power to change rests with the client. I tell clients I'm the head coach, I'm a coach for their head. If there is change that occurs, it isn't because of my magical skills, it's because of their investment in the process. It's what they bring to the table that makes the difference. Being able to accept that and understand the ramifications of that, I mean I see people that are going to crash and burn regardless of what I do, and you have to accept that and move on with that.
P 6: transcript 6.doc - 6:22 Codes: [Therapy attitudes, responsibility-- tx vs. client]
201 If there is change that occurs, it isn't because of my magical skills, it's because of their investment in the process. It's what they bring to the table that makes the difference. Being able to accept that and understand the ramifications of that, I mean I see people that are going to crash and burn regardless of what I do, and you have to accept that and move on with that.
P 6: transcript 6.doc - 6:28 Codes: [Therapy attitudes, responsibility-- tx vs. client] As far as those who aren't motivated to change, my strategy is more to bring that to their level of understanding that they are doing that, and the power to change is with them and if that's what they choose to do, I certainly can't separate them from their best friend. What they should do is own that, and accept their own choice, so what I can do is create a little paradoxical dissonance. You do what you can and you move on.
P 7: Transcript 7.doc - 7:35 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] Linking people up-just grassroots of going out there and seeing her and her three-legged dog and her brew-making husband and being okay with that. She was horribly embarrassed, but she would put out her very best whenever she knew we were coming. And her very best wasn’t very much, they lived in a little plywood shack. And I didn’t care, I really thought that she deserved better-I didn’t care what kind of lifestyle she choose, I thin she deserved to have eyesight and medical care and clothing and to not be psychotic-to have some self- respect.
P 8: transcript 8.doc - 8:8 Codes: [Therapy attitudes, responsibility-- tx vs. client] Not try to make therapy out of someone when that’s not what they want. To know what it took so people could change and have anything that they want if that’s what they are up to, or not if they don’t.
P 8: transcript 8.doc - 8:40 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] If I were able to voyeur on one of you therapy sessions, looking for what is the quality involved defines his passionate commitment, how is it that you interact with clients that makes up this thing I’m calling passionate commitment?
Just loving them.
Which I guess involves non-judgmentalness?
And listening. It’s not like I’m non-judgmental, I’m judgmental, in that I know they’re beautiful, and I’m not fooled by one illusion or another. There is one judgment: they’re fabulous, but otherwise, all judgments are horseshit.
P 8: transcript 8.doc - 8:41 Codes: [Therapy attitudes, responsibility-- tx vs. client]
202 That’s managed very nicely, and when they do have a problem, they call me, and then I can help them get the lights on if that’s what they want. If they don’t, I haven’t wasted my time and I haven’t offended them or gotten into the values of what they should, or shouldn’t ought to do, life is well made. They’re going to suffer until they get it, whether that is now or later, that’s fine. They’re free, but my demonstrating my own joy and vulnerability is the biggest proof that there is something more when you want it, and you’re so precious it cannot be imposed on you, it only comes by your wish and your desire
P 8: transcript 8.doc - 8:45 Codes: [Therapy attitudes, core tx skills] [Therapy attitudes, equality in relationship/mutual goal setting] I was always good at being patient with them, or being kind, but I eventually discovered the core of healing, which is joining with others in a common venture.
P 8: transcript 8.doc - 8:48 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] Well-I’m not a psychotherapist. I am a student, and a teacher, as is everyone. I’m just a few blinks ahead of everyone, but they have everything that I have.
P 8: transcript 8.doc - 8:53 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] And listening. It’s not like I’m non-judgmental, I’m judgmental, in that I know they’re beautiful, and I’m not fooled by one illusion or another. There is one judgment: they’re fabulous, but otherwise, all judgments are horseshit.
P 9: Transcript 9.doc - 9:3 Codes: [Therapy attitudes, responsibility-- tx vs. client] But what it did do, though, was help me understand that my role as a therapist has very little to do with somebody else's direct, material involvement in their life. I perhaps at best provide a tap, or a slight encouragement or some kind of redirection that helps them complete a life path to themselves that makes sense to them from their point of view and often none from mine. I didn't understand that at the time, this process seemed very mystical.
P 9: Transcript 9.doc - 9:7 Codes: [Therapy attitudes, responsibility-- tx vs. client] One comes to mind. I am constantly ever-aware of the idea that I don't provide anything to the client that they don't already have. One of my over-arching goals in any therapeutic relationship with a client, it may be short-term or long-term, is to help the client find in themselves who they really are, and where the source of their own motivation is coming from. It may be, when they come to me, coming from a lot of symptomatic places or conflictual places in them-- I think I differ from a lot of people around here in that I very openly acknowledge an unconscious and recognize that as maybe 99% of our psychic activity, and we are just this little B.B. on the top of what would amount to the face of this earth, in terms of what we are as a total psyche. Our consciousness is this little spot on top of it. Most of what we experience goes on unconsciously. That realization consciously of those experiences can be, for someone, debilitating. Because they are tangled and discordant and out of compensation. But all of that doesn't have anything to do with what I would
203 wish for the client, or what I think the client "should" be doing with their life. I hope I am here simply to facilitate them knowing who they really are and what they could be doing with their life. In that sense, I don't give advice, I don't give counsel, I don't really solve problems for the client. I might help them identify the things on the table, so to speak, the choices before them, and to help them realize that there is a choice even when they think they are a victim and there is no choice, everything is hopeless and everything outside them has caused what they feel. Perhaps from that standpoint, I end up being energized by the interaction because it is more of an investigation. My hunch is that if I started to act in a didactic way, give them advice, problem solve for them, try to untangle real life situations by suggesting certain paths for them, I think I would wear myself down quickly. I think we would both be in the soup, I would be identifying with the client's projection, I would be validating that problem as real and external to the client, when in fact I believe that the problem is internal and anything external is a projection and unreal. So if I give into problem-solving and advice giving, what I am doing is validating their delusion to begin with. It is a trap and I think a lot of people in this line of work fall into that trap, and buy that projected delusional material as real and begin to work with it, and that can be just exhausting, for everybody. It's not real to begin with, and what I try to do--and it's hard, it's a discipline, is to try as much a possible to help the client see what they are revealing about themselves. In a way, it's kind of detective work, it's not untangling or puzzle-piecing, I don't know who you would put that. But that's the feeling I get when I'm sitting in this chair, and I'm constantly fascinated and it's always interesting, I don't use my own, God forbid, experience or material to help them or use that as an example for them, because that would be debilitating. That would be replacing their psychic contents with my own projections, and then we are both dealing with unreal things. I don't know if that makes sense, but that's what came to mind when you said that.
P 9: Transcript 9.doc - 9:24 Codes: [Therapy attitudes, responsibility-- tx vs. client] I think aspects of it can be quantified, you know, but it's mostly a qualitative field, and it has to do with a nuanced kind of a relationship. It's a very artificial relationship. But it's nuanced in such a way that it, in a way it's like a big mirror, that reflects back at the client so the client can have a picture of who they are and what they're doing. And I think me behind the mirror if they see it that way - I doubt it, but if they see it that way - me there as a reference, as a kind of a library you know, in the sense that I've spent a great deal of time looking at human behavior and probably have ways that I can sort of edge the client toward - hoping that they will be experiencing different things because of choices that they've made and I'm dancing around the idea of saying that I'm directive, but occasionally I can be that way, you know, but hopefully it's because I have an idea of what direction might benefit that client's life you know. And not "you should do this" from that standpoint, but from the idea of "could this be a possibility?" "could this be something you may want to consider?" so anyway, that's kind of a long answer to that, but
P 9: Transcript 9.doc - 9:35 Codes: [Therapy attitudes, responsibility-- tx vs. client] OOOh, you know I'd have a big suggestion with a caution. And it doesn't really come from my experience - it comes from people that I knew. However you are going to achieve this - find out whether you're doing this so that you can do your own work on yourself or so you can help somebody else do their own work on themselves. Because if you're really doing this as a way to figure out yourself you're going to burn out like that because it's not going to
204 work - because the only way you can do that is be the client and let a good therapist help you. Because if that needs to happen - it needs to happen before you do this. This cannot be you doing your work on the client's dime. And I firmly believe that. And I've run into people and I still run into people who are in that process of doing their own work on the client's head and not only I think is it unethical it's hopeless - it's not going to help you or the client.
P 9: Transcript 9.doc - 9:36 Codes: [Therapy attitudes, responsibility-- tx vs. client] Yeah, at the base of that I think that's what going on. My field social work tends to attract a lot of hurt puppies and there are a lot of people dragging a lot of baggage behind them that get into this field - and I have an idea it's because they think they can resolve that baggage if they resolve it in somebody else - and from a dynamic point of view which is where my theoretical foundation hails me, all they're doing is trying to, they're lunging at a mirror, they're trying to cure a projection when in fact the reality is behind them and they can't see it - they've split it off and they don't believe they own it. They see it only reflected back to them in the client and (names coworker) actually taught me a great little adage for that is that when we stop trying to cure the disorders in ourselves that we perceive in our patients we'll both be cured and I think after his thirty-something years of this he's finally realized that that's what goes on most of the time. You know, and when that can stop and we both realize that we are distinct individuals but we share a common bond as human beings then we can wake up to what's really going on in the client if we just listen and watch and let the client explain to us what's happening. But when we're busy trying to evade symptoms or do something you know to change what's happening in the client I think what we're doing is we're working on ourselves. And if my anxieties are derived because the client is symptomatic and my anxieties will then be calmed if I can get those symptoms to go away - then who's got the problem? It's me. And I, yeah, I agree with you I think that a lot of burnout begins there and then it's extracted and extracted and extracted and then projected on the clients, on the job, on the agency, on the theories, you know, um, on the hopelessness. You know that all of that is a projection, all of that is just functioning as mirrors to reflect back the fear of the sum problem.
P 9: Transcript 9.doc - 9:37 Codes: [Therapy attitudes, responsibility-- tx vs. client] I suspected that before I did this for a living, but now I know it. It has confirmed for me the idea that we can do nothing more than sit quietly with that patient while the patient agonizes. We can join with that client as a human being in examining the agony, but as soon as we think we can change something, or do something to relieve that agony, exterior to the client, we are in the same agony, the same soup, the same trouble together. It's the client who will do something, it is the client who will find the answer. Sometimes they will find it by reflecting back off from me, seeing themselves as they project it off from me. Most of the time, they'll find it by disavowing me, saying "you'll full of garbage'", and bang, they are cured. Because if they can make that distinction if they can say, you know what, I know what's wrong and you don't, bye, they've done it, they've found that place inside themselves that needs to be untangled. There may be another knot in the future, and they can come back but at that point healing happened. Whether or not I'm a part of that, I have no idea, and I don't know if I ever can know. But I've seen it
205 P 9: Transcript 9.doc - 9:49 Codes: [Therapy attitudes, responsibility-- tx vs. client] you wouldn't see me silent for any length of time unless the client feel silent, then I will wait like a vulture in a tree, I will wait, wait, wait. If that client can't tolerate that silence, that client needs to break it one way or the other. Either talk about it or get up and leave, or whatever they want to do. If the client wants to remain conversant, I will join in a conversation with the client and sometimes in a Socratic kind of what, you know, what did you mean by that
P 9: Transcript 9.doc - 9:58 Codes: [Therapy attitudes, responsibility-- tx vs. client] My hunch is that if I started to act in a didactic way, give them advice, problem solve for them, try to untangle real life situations by suggesting certain paths for them, I think I would wear myself down quickly. I think we would both be in the soup, I would be identifying with the client's projection, I would be validating that problem as real and external to the client, when in fact I believe that the problem is internal and anything external is a projection and unreal. So if I give into problem-solving and advice giving, what I am doing is validating their delusion to begin with. It is a trap and I think a lot of people in this line of work fall into that trap, and buy that projected delusional material as real and begin to work with it, and that can be just exhausting, for everybody. It's not real to begin with, and what I try to do--and it's hard, it's a discipline, is to try as much a possible to help the client see what they are revealing about themselves.
P 9: Transcript 9.doc - 9:63 Codes: [Therapy attitudes, responsibility-- tx vs. client] And, but , it's generally, maybe I can almost say always my stuff. It's my impatience with the client's progress, that gets in my way - it's not anything that comes from the client you know, it's , I'm hoping for an outcome, or I'm looking for the client to go forward or progress or get better, or become less symptomatic, and it's not happening on my timetable. And that's when I need to rekindle that discipline in myself to say "Now wait a minute - it's not your timetable we're talking about here. It happens when it happens for them - not at your convenience, so I've come close to it with individual clients, but as a whole in terms of what I do, no.
P 9: Transcript 9.doc - 9:64 Codes: [Therapy attitudes, responsibility-- tx vs. client] And if my anxieties are derived because the client is symptomatic and my anxieties will then be calmed if I can get those symptoms to go away - then who's got the problem? It's me. And I, yeah, I agree with you I think that a lot of burnout begins there and then it's extracted and extracted and extracted and then projected on the clients, on the job, on the agency, on the theories, you know, um, on the hopelessness. You know that all of that is a projection, all of that is just functioning as mirrors to reflect back the fear of the sum problem.
P10: Transcript 10.doc - 10:23 Codes: [Therapy attitudes, responsibility-- tx vs. client] I am not the expert. You know, you're the expert. You're inside your own skin. You know your own answers. We're going to work together and I'm going to help you find those answers, but they're your answers.
206 I find myself wondering if that isn't part of the answer to one of the questions we were talking about earlier about why it's easier for you. It seems like…
Yeah, I don't have the responsibility. I don't take the responsibility. And I find that when I do start taking the responsibility, that's when I don't like it. And when it really starts to drain me and when I…
P10: Transcript 10.doc - 10:38 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] [Therapy attitudes, responsibility-- tx vs. client] I have a core belief that everyone has within themselves the answers. Always have, and kind of resent people making a mystery out of anything and really believe that people have all the answers. It 's just part of my personality-- I remember when I first learned to bake bread, I thought, "this isn't that hard-- why does everybody think it is so hard, I've got to tell everybody how easy it is!" That's the way I am, I just like people, I believe in them, and I always have.
P10: Transcript 10.doc - 10:40 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] I never see myself as the expert. I don't take that approach with my clients. I am not the expert. You know, you're the expert. You're inside your own skin. You know your own answers. We're going to work together and I'm going to help you find those answers, but they're your answers.
P11: Transcript 11.doc - 11:24 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] The other person, so many people we are working with have never had that, never had that foundation, never had that other person appreciate them.
P13: Transcript 13.doc - 13:25 Codes: [Therapy attitudes, relationship genuine as well as professional] [Therapy attitudes, responsibility-- tx vs. client] Absolutely. The longest client I have has been here all the three years I have been here. And she says, "You know me too well." But she is moving on; she is ready to do her own thing. And that was about the relationship, not skills that I had. Because it wasn't anything that I did. It was her ability to see, and her Mom's ability to see what she needed. That's the skill-- I'm the eyes that see it, now you have to see it. I think skill has very little to do with it.
P13: Transcript 13.doc - 13:31 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] You don't have to like them all the time, you don't have to like all the behaviors kids do all the time, but differentiating between the behavior and who the person is, because I think that is two different things. I may tell the kid, "Your parents are in jail because they made a bad choice, that doesn’t mean that they are bad people."
P14: Transcript 12.doc - 14:7 Codes: [Therapy attitudes, responsibility-- tx vs. client]
207 There are some people that do really good work but burnout, which surprises be because you would think that someone that does well with people would find that invigorating and want to continue. I think that several things contribute to that, one that I think is kind of sad, and I guess it is one of the reasons that I went into therapy looking at my meeting my social needs in this job, is that I do think there is a real importance about boundary setting. I think that some get so caught up in caring about others, and it just carries them over the edge, it drains them. It takes from them because they feel a compelling need to rescue, to pull them back and it's like the other person's feelings are so powerful that it draws almost from them, and yet if you're able to keep this boundary of "I'm involved and I care about you, and I honestly think you are a capable person who is going to be able to handle things on your own, then I don't get as caught up in that. I think it really is a perspective about how to keep from being overly involved, and overly engaged in their feelings, and still empathic and caring. It's a very fine line, I see a lot of people getting burned at that level.
P14: Transcript 12.doc - 14:8 Codes: [Therapy attitudes, responsibility-- tx vs. client] Yea, either getting too withdrawn or too over-invested. I do think there is a piece of what we do when we sit and work with someone that tends to not be reinforcing to some people, they don't enjoy the process, they want to see change, they want to see these people become something that maybe they didn't want to become, or are not capable in this moment of becoming, I think that some people are more product-oriented in that sense. They want change to the point that if it's not happening they can't enjoy the process of moving in a direction with someone and help them move their life.
P14: Transcript 12.doc - 14:16 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] [Therapy attitudes, responsibility-- tx vs. client] That's a very hard question. I like that question. One of my clients at one point gave me a book. There are so many good books out there about doing therapy, but this one happened to be a little picture book, it's called The Missing Piece Meets Big O, it’s a Shel Silverstein book, and one of the things that really intrigued me about that is about how this unhappy piece goes looking for someone to fulfill them, and they finally find this perfect match, and then they feel swallowed up by it. The story became sort of an ideal for me, in that there is almost a Winnicot kind of model, that I want to be a "Good Enough" kind of therapist because if not, I become like the Missing Piece and the Big O, in that I begin to impose on the other person that you can only be complete if you are working what I want you to do, and that's not going to work. It's something that we all go along, and find our own way.
P16: Transcript 15.doc - 16:12 Codes: [Therapy attitudes, responsibility-- tx vs. client] I don't like to focus on what I don't have control over, I like to focus on what I do, and use that as a way to look at the bigger picture.
P16: Transcript 15.doc - 16:25 Codes: [Therapy attitudes, equality in relationship/mutual goal setting]
208 If I expect somebody to trust me enough that they can get to a place that they can eventually work on trauma, then they need to know that I am going to trust them as well. There's got to be that kind of reciprocal relationship.
P16: Transcript 15.doc - 16:27 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] Because attachment happens with trust. I think that is the most difficult job for a therapist, clarifying what that relationship entails, between the two.
Code Family: Passion-Supporting Beliefs: Strength-Based
Codes (1): [Personal characteristics, optimism/strength based] Quotation(s): 21
P 2: Transcript 2.doc - 2:75 Codes: [Personal characteristics, optimism/strength based] And you need to find something that you like about her, at least for the 50 minutes that she’s sitting in front of you. I had to give this to myself every two weeks. So then I would find what I do feel in all honesty for her is that life is really hard for her, and that’s really sad. If this is 50 minutes where she can feel understood and supported…I have to be a pretty cruel person to be thinking evil thoughts about her.
P 2: Transcript 2.doc - 2:76 Codes: [Personal characteristics, optimism/strength based] [Therapy attitudes, uniqueness of clients] To not be around the negative energy of burned out social workers who say mean things about their clients. Hate their clients, and hate everybody who falls under a certain diagnoses, and to really protect yourself from that kind of energy and I believed the hype about these borderline women… I was scared shitless because I was picking up 20 of these crazy women who were all going to kill themselves at the same time. And I’ve been to the hospital with many of them when I was on call and they had huge gashes and words written in their chests and going up to the hospital. I believe the hype. But everyone’s an individual. There’s nothing real in that. These are 20 individual women who are all amazing and who somehow have gotten themselves to 40, 50 or 60. So they don’t fit it, they just need a little validation and support. I think so don’t believe all the negative hype about things
P 4: transcript 4.doc - 4:18 Codes: [Personal characteristics, optimism/strength based] They do burn everyone out, but the reality is they can turn a corner and lead a healthy lifestyle, and I really believe it. We’ve done a study--we've got this intensive group that we do, and we've had some pretty remarkable results, not just with this, but with trauma, we've got a pretty full gamut, and I think that is pretty rewarding, that I think my boss gives me autonomy to create and to try new things, and if I did not have that, it would work for me.
P 4: transcript 4.doc - 4:30 Codes: [Personal characteristics, optimism/strength based] Probably the most exciting thing is that I don't think it takes a lifetime to undo a lot of this stuff. I mean, we are always progressing as humans, but I think a lot of people think it took
209 forty years to get here, it's going to take forty years to get out, and I just don't believe that. So that's probably the most exciting.
P 4: transcript 4.doc - 4:48 Codes: [Personal characteristics, optimism/strength based] I have a belief that people can heal, that they want to heal, and all the reasons they sabotage things and all the things that are in the way can be removed and once that happens, incredible things will happen.
P 4: transcript 4.doc - 4:65 Codes: [Personal characteristics, optimism/strength based] The other thing, Brian, is that I think I have a pretty positive disposition naturally, and when I don't, that's a pretty good sign that I need to take a break or something. Whether it's at work or at home, that's how I would rather…
P 4: transcript 4.doc - 4:79 Codes: [Personal characteristics, optimism/strength based] [Therapy attitudes, uniqueness of clients] But I've grown to love it, even those with borderline personality disorder, just to put it in a healthy context, because I don't come at it thinking, oh, my gosh, because some of them are so difficult, I can have more compassion. It's a better way to present that, and we can get a lot further, because they know I'm not afraid of them, and understand kind of where they are coming from, but also can hold them accountable.
P 5: Transcript 5.doc - 5:13 Codes: [Personal characteristics, optimism/strength based] I guess being able to work with people and gain some sense of hope for the future in situations that are pretty bleak and discouraging, that's a pretty lonely, dark place to be in, so to give somebody some hope, something to work towards, is enjoyable.
P 5: Transcript 5.doc - 5:20 Codes: [Personal characteristics, optimism/strength based] How do you maintain your commitment to those kinds of clients?
That's a tough question. Probably just that hope that you keep chipping away, and maybe something happens outside of therapy that puts them in a different place or different mindset, where they respond a little differently to interventions or things that we are trying to do. The hope that you never know when the situation might change.
P 8: transcript 8.doc - 8:44 Codes: [Personal characteristics, optimism/strength based] If I have a choice, I like to feel pretty joyful and loving, and when I’m not feeling that way I try to exercise that choice, and I know it is up to me. It is what I’ve chosen it to be, and if I’m not really happy with what I’ve chosen, it can be joyful, and I think I’ve stumbled across things that allow it to be that way.
P 8: transcript 8.doc - 8:50
210 Codes: [Personal characteristics, optimism/strength based] There’s not one condition that doesn’t get experienced in the mind, so healing is universal. All of healing is equally simple for all people because it’s always involving a change in the way that they are seeing something that they think is it, but they have made it what it is for them, and they don’t know it yet. And I’m trying to create a climate in which they can wake up and see it and make a choice and it is gone that quick, it doesn’t take time to heal. It happens the minute you change the way you see it. And now instead of a judgment that terrifies, is a creative, loving idea. It just feels wonderful.
P10: Transcript 10.doc - 10:20 Codes: [Personal characteristics, optimism/strength based] There are, well, I think what is consistent with all of my therapy is that I'm a very strength based therapist. I really focus on strengths rather than everything that's wrong. I start there and kind of build a person up. And then we apply their strengths to the problem areas of their lives.
P10: Transcript 10.doc - 10:48 Codes: [Personal characteristics, optimism/strength based] There are, well, I think what is consistent with all of my therapy is that I'm a very strength based therapist. I really focus on strengths rather than everything that's wrong. I start there and kind of build a person up. And then we apply their strengths to the problem areas of their lives.
P11: Transcript 11.doc - 11:7 Codes: [Personal characteristics, optimism/strength based] So I look for, I've hired people for years, and I look for that, there's a energy to it, and the other people I don't think are optimistic, I think optimism is part of it. I don't know that they see strengths, they don't look at a strength basis, or solution-focused. I think that's what keeps the energy flowing. The people that I see that are not, are almost negative toward people sometimes, they just don't have that sense of optimism, belief in people as much. I think that is one of the main differences.
P11: Transcript 11.doc - 11:8 Codes: [Personal characteristics, engagement, importance of] [Personal characteristics, optimism/strength based] There's a detachment, and the burned out ones, usually you'll hear them talking negatively about their clients, I can't even imagine.
P11: Transcript 11.doc - 11:35 Codes: [Personal characteristics, optimism/strength based] and the other thing is work from a solution-focus, use a strength based view. If you can see the strengths and believe in people, then this will be a lot easier for you, because that is just the opposite of burnout. Study Milton Erickson and people like that, he had this total belief in people's resources. Find something in every client that you really like, just find that, and if you can't then send them on to someone who can. But stay in a solution-focus, and get plenty of support,
P13: Transcript 13.doc - 13:13
211 Codes: [Personal characteristics, optimism/strength based] [Therapy attitudes, relationship genuine as well as professional] There are clients I like more than others, and I think it is good to have them longer, I have a relationship. But once I build a relationship, I like them all just the same. Because I see potential in every child who comes here and every family that comes here.
P13: Transcript 13.doc - 13:34 Codes: [Personal characteristics, optimism/strength based] Some of my teens say, what do I have to live for? There's war, I don't want to get in the draft and go somewhere I don't want to go, there is the Tsunami, and the devastating, you look at this country and where it is economically, where it's priorities are, you know, I can understand that. But I think it is a great time to be one, because we give hope.
P14: Transcript 12.doc - 14:22 Codes: [Personal characteristics, optimism/strength based] I think I tend to be really positive, in the sense that I'm always looking for, and that's where the solution-focused part fits for me, is that I'm always looking for what's working, I'm always looking for a positive spin for what is going on.
P15: Transcript 14.doc - 15:35 Codes: [Personal characteristics, optimism/strength based] I'm pretty even tempered, and I'm pretty high energy, optimistic person, so I operate up here more of the time, and when I drop down here, it's never way down.
P16: Transcript 15.doc - 16:11 Codes: [Personal characteristics, optimism/strength based] Actually, I have thought about that a lot over that last none months of my life, having seen that in some regards. I think the biggest thing is not focusing on the problem, but focusing on the solutions. As therapists, we have to help the clients okay, what is the problem, but not fully focus on the problem, but what can you do to create a better life, a better situation, a more purposeful life. I am a very solution-focused type person, I don't necessarily use solution-focused therapy,
Code Family: Personal Fit With Role: Drive For Purpose
Codes (7): [Employer factors, mission driven] [Personal characteristics, calling] [Personal characteristics, childhood role as helper] [Personal characteristics, doing other helping work before therapy] [Personal Characteristics, personal experience led to professional interest] [Personal characteristics, values] [Therapy attitudes, signficance of role] Quotations: 26
P 1: Transcript 1.doc - 1:2 Codes: [Personal characteristics, doing other helping work before therapy] I had been on a mission, and had this sense that I wanted to be in an aiding, helping profession. So my intention was originally to train to be a seminary teacher.
212 P 1: Transcript 1.doc - 1:48 Codes: [Personal characteristics, enhanced feeling for disenfranchised] [Therapy attitudes, significance of role] On the statue of Liberty it says “Bring me your tired, your poor, the huddled masses. And you can sometimes judge a society by how well it deals with its weakest members. And sop usually those that struggle the most to work at improving, are those that struggle the most and are really the most vulnerable psychologically and have the most the most vulnerable and the least capable. It’s not…I’ve tried to encourage a certain pathos, and regard for them that they would probably do more if they could. They have a certain brain capacity and their chemistry, and upbringing that has put them at a disadvantage, so I guess having a compassion and an understanding and having a certain tolerance that this is the best they can do and they don’t get people that listen carefully and they don’t get a lot of support from other that they value at least on my good days I use that to help me
P 2: Transcript 2.doc - 2:34 Codes: [Therapy attitudes, significance of role] especially in a small town is my husband and I got really intimate with the community quickly, you know we’ve only been here almost 7 years, and I have kids come up to me all the time and say, ‘remember when I was in first grade, and I say no I didn’t move her until you were in the 7th grade, and they’re like ‘no, you’ve always been here” parents will do that to me too, they’ll say do you remember coming to my kids kindergarten graduation? And I’ll say no, your child was in the fourth grade. It’s been really nice, there hasn’t been this kind of I know all the people experience, like you’re not locals until you’ve been here for a hundred years, or whatever. It feels like we got embraced really really quickly. And that feels so nice to be in a small town like Moab and to feel like part of the community. In a real way. That’s really nice for us, but I think , I think what you need also, and this is the ego gratifying part is that you can make more of an impact in a small town, or you can feel your impact more
P 2: Transcript 2.doc - 2:40 Codes: [Therapy attitudes, intimacy, enjoys] [Therapy attitudes, significance of role] So I think the interconnectedness is… you know I’ve spent half my career here in a small town, and I really get attached in a way you don’t in the city. I see these people at City Market, I see them at the library I see these people at the movies. It’s not that my clients live in one part of town and I live in another. It’s not that I see them once a week and it’s very isolated. I know their grandmothers, and I see their aunts and uncles passed out on the lawn drunk on the weekend. I see the living/waling genogram every day. There’s an intimacy.
P 2: Transcript 2.doc - 2:50 Codes: [Therapy attitudes, significance of role] I don’t have any people generally die on me. But I take my work really seriously. It’s really important to me.
P 2: Transcript 2.doc - 2:63 Codes: [Personal characteristics, calling] I know that this is my calling,
213 P 3: transcript 3.doc - 3:4 Codes: [Therapy attitudes, significance of role] went on a crusade, went on a mission
P 4: transcript 4.doc - 4:5 Codes: [Personal characteristics, values] values
P 4: transcript 4.doc - 4:25 Codes: [Therapy attitudes, significance of role] this is a profession where we are dealing with human beings and, I just show up different.
P 6: transcript 6.doc - 6:2 Codes: [Personal characteristics, childhood role as helper] As I reflected back on it years later, it was probably indicative of what I had been doing all my life, it always seemed that was the role that I took, being therapist to my family or friends, typical middle child story, middle of six kids.
P 7: Transcript 7.doc - 7:14 Codes: [Therapy attitudes, significance of role] I think one of the most rewarding experiences I’ve ever had is when I was sent to Enterprise and had to meet the needs of that little rural community. That is just such an interesting and diverse place, because the town of Enterprise has about 1400 people, I suppose, so it is small. It’s very closed, they don’t like outsiders. The person up there that recognized that they had mental health needs was a PA (Physician’s assistant) at the clinic, who was an outsider too. He came to us and said, “We really have a lot of people out here that need to be seen.” There’s also an area outside of Enterprise that they call “the Valley” it’s rural, there’s Newcastle, and have you ever been to Modina? It’s a little tiny railroad town that used to be big when the railroad was around. Now it’s a ghost town with four or five occupants, so it’s a funky little place. There are squatters out there; they can buy the land for a very cheap price. But the land has nothing on it, just rocks, a sage brush or two. So people can buy this land very cheap and go out there and literally put up plywood huts with no running water. The way the PA would find the mental health needs is they would come to him because they were sick and then he would call me and say, “I really think we should link you up with this person,”, so I would go out and see them. They are people who would live in these…I had one client who lived in a series of trailers, he had driven his old school bus out there when he was a hippie, parked it, it had all flat tires, and he had these trailers that he had picked up along the way that he used for different things. One was his bedroom, one was his cooking trailer, one was the trailer where he raised rabbits, because that is what he lived on. The one I’m thinking about is the gal that was blatantly psychotic and she was a methamphetamine addict, and she had no teeth. Of course, out there they don’t have the ability to deal with drug and alcohol problems, and she didn’t have Medicaid, ever since she was a small child she had had crossed eyes, and had never known that they could be fixed. She had massive medical needs, and she was psychotic-running around naked on the desert. The police picked her up, wrapped her in a blanket, brought her into the clinic because she had lice and some other medical problems, and then they referred her to me. I hooked her up with Medicaid; she didn’t know anything about that. She was from Texas and some guy from Texas who brewed his own beer that she lived with was out there digging gold mine,
214 literally. He was out there with a bucket and pick and was digging a shaft and was sure he was going to gold. The last time I saw her, I’m not the therapist up there anymore, she was wearing clothes she had just purchased from D.I. She had seen the dentist, and had partials now so that she could smile-she wouldn’t smile before-she was not psychotic anymore, she had made the connection between the methamphetamine abuse and the psychosis. She had had an operation to cut the muscles that made her eyes crossed, so she could actually see. She told me once that she could see out of both eyes, but she saw different things out of each eye. It’s not like us when we look at something and our brain connects those two images, so what she would do is deliberately ignore the one eye and look out the other one, which ever one she wanted to see. And she calls me up whenever she comes to town, “How are you?”
P 8: transcript 8.doc - 8:2 Codes: [Personal characteristics, childhood role as helper] I had always been someone who had tried to befriend others, especially other students who were hurting or a little bit bereft, and I think that is because it felt right to do, as opposed to trying to pursue the finer kids of the class, so I think that was one
P 8: transcript 8.doc - 8:9 Codes: [Personal characteristics, childhood role as helper] I can remember at my junior year in high school, in this religious boarding school, that my brother was becoming pretty prominent and hanging out with popular kids and successes and I tended to be still quite available to anyone who sought me out, and often they were kids who were hurting that I spent time with, trying to help and so forth. I remember at one point trying to figure out, do I try to become famous, or do I try to become like Jesus? And I can remember saying, “What would Jesus do here?”, and try to use that as a cue
P 8: transcript 8.doc - 8:43 Codes: [Personal characteristics, childhood role as helper] [Personal characteristics, fit] I can point to different things like I think I’ve shared a bit with you a certain inclination as a child, I think on some levels the “Jesus model” even though it was outside organized religion. But there was something inside that position that I think was fascinating, or I was so scared I was just saying “I don’t know which way to go, but give my mother’s its so important to us that you know Jesus as your savior, and so forth…” that they never saw what I’m seeing, but I was exposed to that literature, and as far as the Pearl of Precious Price, there is a way of seeing everything where everything gets transformed and I think I have gotten a glimpse of, and look forward to being even more a part of my life and something that can, you know, continue to grow.
P 8: transcript 8.doc - 8:54 Codes: [Therapy attitudes, significance of role] [Therapy attitudes, sprituality] I think on some levels the “Jesus model” even though it was outside organized religion. But there was something inside that position that I think was fascinating, or I was so scared I was just saying “I don’t know which way to go, but give my mother’s its so important to us that you know Jesus as your savior, and so forth…” that they never saw what I’m seeing, but I was exposed to that literature, and as far as the Pearl of Precious Price, there is a way of
215 seeing everything where everything gets transformed and I think I have gotten a glimpse of, and look forward to being even more a part of my life and something that can, you know, continue to grow.
P 9: Transcript 9.doc - 9:25 Codes: [Employer factors, mission driven] That wasn’t the case with my other agency. I didn't feel that they had - there wasn't any genuiness there at all. In fact they made more money when the people stayed sicker. Here it is not the case. Here we have a huge motivation to help them get better and get functional, and that's inspirational to me too. I feel that I've got agency backing for my ideas.
P 9: Transcript 9.doc - 9:27 Codes: [Therapy attitudes, signficance of role] I've never had the feeling that what I do is superfluous or we're just here because of the medicaid role, you know. People bring clients to me and say "Can you help this person?" and so that helps me understand that I"ve got a role here.
P11: Transcript 11.doc - 11:2 Codes: [Personal characteristics, doing other helping work before therapy] [Personal characteristics, helping profession.] Oh, gee… I can tell you the moment, actually. It was in the late sixties or 1970, I was in California. It was the hippie days, I was hanging out with a group of people, and of course there were drugs, and there were a couple of sixteen year old girls there who were in trouble, and I was trying to figure out where I was going to go in my life and it just dawned on me in that moment that that is what I was going to do. It took me quite a journey to get here, but that was actually the moment that I needed to do something.
But there were years in between…
I'd run into… I was a Vista volunteer for a while, so I did my work for four or five years on a bachelor's level, then I went off for a few years on a woodworking odyssey for sixteen years, but I always knew that I'd come back to do this. It was always in my plans to go back and get my Masters. There was just something about that moment that just defined what I wanted to be.
P11: Transcript 11.doc - 11:41 Codes: [Personal Characteristics, personal experience led to professional interest] I think it's because my life had been so hard for a while there, so I was curious what other people's lives were like and what was happening, I had this intense curiosity about it.
P11: Transcript 11.doc - 11:42 Codes: [Therapy attitudes, significance of role] I just have this real curiosity about who they are and how they got to be the way that they are, how they function, and in a larger sense, families just fascinate me, the system does, and in the larger sense, how they are embedded in the community. It's the same kind of thing; it's this intense curiosity. I think that people are so interesting, and really wonderful, they're just great.
216 P11: Transcript 11.doc - 11:45 Codes: [Therapy attitudes, significance of role] You have to understand Maslow's hierarchy of needs, you've got to understand the kids are embedded in families and communities and you have to be able to see all of that to really be able to help them. To take a child into your room week after week and work with them without this understanding has limited value, I think. I would more often be here with the family, talk to the school, change something in the community about how they react to this kid. So you have to have a social worker's view of things. We have psychologists here, but they are basically acting like social workers, maybe do a little bit of testing, but really act in a social worker role.
P11: Transcript 11.doc - 11:48 Codes: [personal characteristics, curiosity] [Personal Characteristics, personal experience led to professional interest] If you rewind the clock to about age 11, my father died, and my mother suicided when I was 13. I'm sure that influenced the direction I took. I think it stimulated my interest in people, my curiosity and compassion.
P13: Transcript 13.doc - 13:19 Codes: [Employer factors, mission driven] [Employer factors, supervision] [Employer factors, talking about cases] Probably not taking extra time to just talk. To talk about countertransference, to talk about how life in general is going, (my supervisor) will ask, "how are things in your life?", and he's not asking how I am as a therapist, he's talking about it in general. I think if the supervisors didn't care, or if they were all just Type As and interested in how things were business oriented, that would probably drive me insane, if there were no feelings or emotions about it, just "get everything done and don't come to me." I've worked in different fields like that, and it is really bothersome. You want that support, people in (names company) have said children's outpatient is the best place to work, because it's not like that throughout (company.) You hear a lot of complaints about other parts of (company).
P14: Transcript 12.doc - 14:3 Codes: [Personal Characteristics, personal experience led to professional interest] On a personal note, I had been married very early, she had a son, and I think one of the things that spurred that, I want to be a decent parent, and began studying more about kids, and it just sort of evolved to a profession rather than a family.
P15: Transcript 14.doc - 15:3 Codes: [Personal Characteristics, personal experience led to professional interest] Well, it was a long time ago. Way back, I've always liked kids, I was always the neighborhood baby sitter, I was the oldest of five, always really liked my younger brothers and sisters and loved taking them places, and at some point in high school when you were trying to figure out what you wanted to be when you grew up, I decided that I wanted to work with emotionally disturbed children, I don't know why, that just sort of came to me. I had a cousin, who was mentally retarded, and so I was sort of interested in special kids, but I didn't
217 know if I wanted to work with the intellectually handicapped, but the emotionally disturbed just sort of intrigued me. And I think, looking back, my high school counselor said, "Oh, so you want to be a special education teacher" and I said "Okay." I was from a blue-collar family so I wasn't really, I didn't know about therapists or psychologists, it just wasn't part of my experience, so that is what I went into.
P16: Transcript 15.doc - 16:2 Codes: [Personal characteristics, doing other helping work before therapy] I started in the field of social work probably about fifteen years ago as a rehabilitation counselor for DSPD clients and eventually worked my way into working with youth in a foster care program and I just felt like what I wanted to do wasn't what I was able to do because of my credentials, and so I felt like I had been told throughout my career that I had a gift of being able to communicate and look at the different perspectives that a person might have, so just at the encouragement of my administrators and colleagues over fifteen years it kind of pursued into therapy. And I love to go to school, so I wanted to finish my masters.
Code Family: Personal Fit With Role: Stimulus Seeking
Codes (20): [Employer factors, creating new opportunities] [Employer factors, talking about cases] [Energy, energizer, interesting clients] [Energy, energizer, seeing clients] [Energy, energizer, seeing growth in clients] [Energy, energizer, variety] [Energy, energizers, esthetics] [Energy, energy depleter, clients who are disengaged] [Personal characteristics, art] [personal characteristics, creative] [Personal characteristics, energy, doesn't drain, can lend energy] [Personal characteristics, flow of therapy, enjoying the art form] [Personal Characteristics, flow state] [Personal characteristics, short attention span] [Therapy attitudes, change expectations with seriously mentally ill] [Therapy attitudes, expectation of change] [Therapy attitudes, patient with slow process of change] [Therapy attitudes, process] [Therapy attitudes, struggle between indulging and boredom] [Therapy attitudes, uniqueness of clients] Quotation(s): 135
P 1: Transcript 1.doc - 1:32 Codes: [Therapy attitudes, patient with slow process of change] So they may struggle. They may change very little. They may change very slowly, and I’m very patient with that process.
P 1: Transcript 1.doc - 1:42 Codes: [Energy, energizer, seeing clients] The thing I enjoy most about psychotherapy is getting people to change and getting them to change their lives
P 1: Transcript 1.doc - 1:43 Codes: [Therapy attitudes, change expectations with seriously mentally ill]
with the seriously mentally ill you have to change your expectations.
218 P 1: Transcript 1.doc - 1:45 Codes: [Energy, energizer, seeing clients] The highs, again I come back to the idea that if they get soothed and get release maybe they feel good for that hour and may be a little afterward, but when they make changes, when they gain insights, they may come back and they demonstrate that “I’m making changes in the way I go about things, and I’m healthier and I’m happier, in specific ways, those are sort of the highs.
P 1: Transcript 1.doc - 1:51 Codes: [Energy, energizer, variety] Practically speaking, we’re a small clinic. Most therapists here have to be generalists. I'm the only full time therapist that works primarily with adults, so I have to work with whatever comes through the door. And so I like that I like that I’m not forced to work with these kinds of clients. And so where there might be restrictions in a larger agency, I don’t get that here. And as far as how they’ve made it more difficult,
P 1: Transcript 1.doc - 1:73 Codes: [Therapy attitudes, patient with slow process of change] [Therapy attitudes, responsibility-- tx vs. client] It’s kind of human nature to change slowly, or to resist change, so they may not see as many changes as they’d like to. Try to engage with clients, give it a good college effort, but then recognize it’s the client’s effort from that point.
P 1: Transcript 1.doc - 1:74 Codes: [Personal characteristics, art] I ‘m involved in music. They have a wind symphony had some community players. So I’m a first chair bassoonist.
I: Oh really?
T1: … And I enjoy that. I play the piano. Just maybe a notch short of advanced. Blurs the line between intermediate and advanced.
P 1: Transcript 1.doc - 1:75 Codes: [Therapy attitudes, process] He emigrated from some eastern European had a heavy accent, and had been stern, and he had left home Left Cleveland, Ohio, had a schizophrenic problem and he came every week, and I don’t remember much, and I remember I tried to help, and our last session he fancied himself a painter, and put his world on canvas. He wanted me to have it, and that was sort of his way of communicating. I don’t know how he communicated, but that had been important to him and very helpful for him. But I remember thinking, Wow, I didn’t really know, I knew he came every week, but as a picture you know two a male and a female person, and there’s a fountain. His parents were stern and sort of OCD, cold and he had to break free from his parents, and this was where I leaned it can be powerful.
P 1: Transcript 1.doc - 1:76 Codes: [Therapy attitudes, patient with slow process of change]
219 The thing I enjoy most about psychotherapy is getting people to change and getting them to change their lives and with the seriously mentally ill you have to change your expectations. So I don’t find it revitalizing to work just with people who need a friend and a social support as far as a low point, it’s difficult not to get a little bored, to get bored with some of the clients that are ,, kind of like you’re in a rut with those clients.
P 2: Transcript 2.doc - 2:11 Codes: [Energy, energizer, variety] variety is exciting
P 2: Transcript 2.doc - 2:13 Codes: [Therapy attitudes, process] process
P 2: Transcript 2.doc - 2:15 Codes: [Personal characteristics, short attention span] I’m probably attention deficit in a lot of ways
P 2: Transcript 2.doc - 2:16 Codes: [Therapy attitudes, process] meditative
P 2: Transcript 2.doc - 2:18 Codes: [Personal characteristics, energy, doesn't drain, can lend energy] it doesn’t drain my energy, and I feel like I can lend my energy.
P 2: Transcript 2.doc - 2:46 Codes: [Energy, energizer, seeing clients] Umm, I have one client, and she’s the only client I can think of, she’s a client right now. She’s more of what I would call the worried well. She’s what I would want in my private practice. The kind that might have a lot of money, enough money to come in once a week and just cratch about their problems. But not who I want to be seeing at a ? center. Oh my God you know, and Actually what was really neat was I was really losing it with her. It was just boring. She wasn’t moving anywhere. It was a year and two months of seeing her bi- weekly, and she’s in my borderline group, but she’s not very borderline. It was more about needing the skills. And there was no movement, and I have to admit it got a little boring. I thought it was boring. You know when the front office would call and say so and so’s here and I would say ‘Oh , shit’. You know, and then I thought the process I was going through with her was she would sit across from me and I would be saying ‘Oh fuck’
P 2: Transcript 2.doc - 2:47 Codes: [Therapy attitudes, struggle between indulging and boredom] Because it’s not like I”d talk myself out of it, but it’s like that’s really and if you sit here thinking that, and you sit across from this person, she’s very vulnerable and sharing this with you, even though you’re bored shitless that’s really mean. And you need to find something that you like about her, at least for the 50 minutes that she’s sitting in front of you. I had to give this to myself every two weeks. So then I would find what I do feel in all honesty for her is that life is really hard for her, and that’s really sad. If this is 50 minutes where she can
220 feel understood and supported…I have to be a pretty cruel person to be thinking evil thoughts about her. So I can always talk myself out of it, but what was funny was …not funny,…I talked to my supervisor about it, and said I can’t do this …it’s just bad and she’s not getting anywhere and I kind of feel like what I say to my clients oftentimes is if you went to a doctor for a sore throat for a year and he couldn’t get rid of it, go somewhere else. If we’re trying to deal with this problem and there’s no progress in a year, go somewhere else. I actually did that with 15 of the borderline clients that I inherited. I said, you get a year, we get a year and that’s it and you know what? They’re off my caseload. They’re fine, they’re OK, they haven’t cut in a year. But I said we can’t do this, you can’t be in therapy for 7 years getting rid of this problem. We can’t do this. So that was… I talked to my supervisor about this feeling that nothing was happening with Charlotte, and he said, ‘tell her, that I’m reviewing progress notes, and if there’s no progress in the next month, she’s out. I mean this was Medicaid, Medicare, we’re obligated to provide services, and he said, she can’t come to group, but you can see her once a month, if there isn’t any progress. That lit a fire under her butt. I didn’t blame it on Rick. I just said I need to tell you that I don’t know that we’re working well together because I know that you are committed, and you can trust me, and that you’re telling me that it’s helpful. She’s actually very funny, she actually called her life the summer reruns. She’d say we’re back in the summer reruns. It’s the same thing all over again. I said ‘I get frustrated with this because I don’t think we have time to indulge in summer reruns’. Life’s short, you’re 60 years old, you’ve got to move here. You know, it’s getting to be indulgent. I think that’s a problem. Private practice can be really indulgent. Right? But when I go into therapy I’m pretty indulgent, very self-indulgent. It’s not that there’s anything big going on and so I said , this is really indulgent, and we’ve got to do something. And also, you know I don’t think that ethically I can be seeing you if we don’t see some progress here. And WOW she started doing her DBT homework for the first time in 6 months. All of the sudden, she started demonstrating insight I hadn’t seen in 18 months. And it’s amazing. She’s just working her butt off. You know, it’s like if someone forgets to do their homework in group, she’s like…you know you need to do your homework. Because you need to get better, you know this is not a self-indulgent exercise. You need to get better. So she has become the greatest cheerleader. So it’s turned into something really nice. But yeah, definitely I was tearing my hair out when I knew she was coming.
P 2: Transcript 2.doc - 2:64 Codes: [Energy, energizer, seeing clients] I always tease (names supervisor) I tell him ‘you pay me shit, cause you know I’d do this for free’ you know, and it’s true, I would. If I won the lottery, I’d be right back at work on Monday Morning.
P 2: Transcript 2.doc - 2:72 Codes: [Therapy attitudes, process] I don’t know, I think I like the process, I think it’s really neat when you see the light go on, and something in their eyes, it’s like they really get it, and it’s really fun to be part of that process.
P 2: Transcript 2.doc - 2:76 Codes: [Personal characteristics, optimism/strength based] [Therapy attitudes, uniqueness of clients]
221 To not be around the negative energy of burned out social workers who say mean things about their clients. Hate their clients, and hate everybody who falls under a certain diagnoses, and to really protect yourself from that kind of energy and I believed the hype about these borderline women… I was scared shitless because I was picking up 20 of these crazy women who were all going to kill themselves at the same time. And I’ve been to the hospital with many of them when I was on call and they had huge gashes and words written in their chests and going up to the hospital. I believe the hype. But everyone’s an individual. There’s nothing real in that. These are 20 individual women who are all amazing and who somehow have gotten themselves to 40, 50 or 60. So they don’t fit it, they just need a little validation and support. I think so don’t believe all the negative hype about things
P 2: Transcript 2.doc - 2:80 Codes: [Energy, energizer, variety] Yeah, and I mean again, that’s not frequent, so I think it’ s just I think I’m probably attention deficit in a lot of ways, so this is a job where I can’t really get bored because the variables are changing all the time.
P 3: transcript 3.doc - 3:8 Codes: [Personal characteristics, flow of therapy, enjoying the art form] artistic nature to the person. People who want to learn the formula, and can't get past the steps of therapy, and can't turn it into an art form, lose interest. Because I think it really is an art form. People who can't get excited about the flow that happens-- and can't get past which of the 12 steps we are on-- people who can't do that don't seem to stay interested very long or aren't very productive. That's what I think make's the difference. You see somebody that wants to come in and discuss why people change, and what works and why it works, those are the people who are going to be successful. There are just some folks that get into it probably for the right reasons, but it turns out that they ought to be running a substance abuse twelve step program-- not to put that down, but in many areas of therapy I don't think that works.
P 3: transcript 3.doc - 3:9 [So are you saying it's not irr..] (53:55) (Super) Codes: [Personal characteristics, flow of therapy, enjoying the art form] No memos
So are you saying it's not irrelevant that you started out as a sculptor, as an artist, and became a passionately committed psychotherapist?
Very much-- I don't know how to put that into words. It's hard to talk about what the art form of therapy is, but it is very much an art form.
P 3: transcript 3.doc - 3:13 Codes: [Energy, energizer, seeing growth in clients] watching people as they grow
P 3: transcript 3.doc - 3:15 Codes: [Energy, energizer, seeing growth in clients] Trying a new technique, seeing it help someone.
222 P 3: transcript 3.doc - 3:16 Codes: [Energy, energy depleter, clients who are disengaged] People who are stuck, people who-- I don't get excited about helping people "maintain"-- I can do that and do that, but it doesn't excite me. Working with chronics who we are just trying to maintain, that doesn't energize me
P 3: transcript 3.doc - 3:31 Codes: [Energy, energy depleter, clients who are disengaged] your folks who aren't amenable to a lot of change, the folks who you know five years from now your still going to be doing something similar with, and just trying to keep out of the state hospital. That doesn't excite me.
P 3: transcript 3.doc - 3:32 Codes: [Energy, energy depleter, clients who are disengaged] Well, I think there is just enough-- there is more of the other, I have total control in my private practice over who I see, so I'll always have those to see. I don't really dread working with those other clients, I just don't get excited about it.
P 3: transcript 3.doc - 3:33 Codes: [Therapy attitudes, process] If the process can be exciting, if you can get excited about the whole process, the creation of the change can be exciting, then you are going to enjoy this work. If you are all about the outcome, where are you on the depression scale today, which is where a lot of folks are…
P 3: transcript 3.doc - 3:36 Codes: [Employer factors, creating new opportunities] That's been exciting-- the whole idea about working with sex offenders was-- when that first came along, I didn't think that was something I wanted to do, but that's been exciting--it's been fun. We run an inpatient, and now an outpatient group for the past 12 years, and I've done an adolescent group for the past 5 years, and that's been exciting. That's good stuff to do.
P 3: transcript 3.doc - 3:39 Codes: [Employer factors, creating new opportunities] Keep them doing psychotherapy, and encourage them being curious about new ways to do it. If someone is interested in a new modality, encourage it, rather than seeing it as a drain on the training budget.
P 3: transcript 3.doc - 3:41 Codes: [Therapy attitudes, process] But therapy is an art form, and it can't view it as an art form, and get excited about the steps, the creation of where you're trying to go, it will never be an enjoyable career.
P 3: transcript 3.doc - 3:46 Codes: [Personal characteristics, art] I had intended to be a sculptor, I had a scholarship to go to Denmark to work on a Masters Degree, and didn't have any money.
223 P 3: transcript 3.doc - 3:47 Codes: [Personal characteristics, art] Well I offend people sometimes when I say this, but to be a good therapist, there has to be kind of an artistic nature to the person. People who want to learn the formula, and can't get past the steps of therapy, and can't turn it into an art form, lose interest. Because I think it really is an art form. People who can't get excited about the flow that happens-- and can't get past which of the 12 steps we are on-- people who can't do that don't seem to stay interested very long or aren't very productive. That's what I think make's the difference.
P 3: transcript 3.doc - 3:48 Codes: [Personal characteristics, art] There are people you can't get to be passionate about anything. But therapy is an art form, and it can't view it as an art form, and get excited about the steps, the creation of where you're trying to go, it will never be an enjoyable career.
P 3: transcript 3.doc - 3:51 Codes: [Active strategies, growth and learning] [Energy, energizer, variety] I'm still pioneering in different ways. The whole idea of mental health is now acceptable, its got credibility. My latest interest--I think-- I've just spent a week in Vegas, I'm still deciding if this is the way I want to go, is dealing with couples with sexual dysfunction. That's pioneering in this area, its something no one has touched very much. We've all dealt with it to some degree, but not in depth. I've dealt with it with some couples, but didn't know exactly what to do with that piece of it. So, there's still new areas. When I got involved with hypnosis, that was new. But you're right, it's not, its changed. It's not that we are making mental health okay, but making new pieces of it okay.
P 4: transcript 4.doc - 4:14 Codes: [Energy, energizer, seeing clients] [Energy, energizer, seeing growth in clients] [Personal characteristics, fit] To work with, I work with women who have had a lot of trauma, and to me it is pretty energizing for them to go from a shame-based identity to one that is absolutely positive and watch them create the life that they want. To do that is pretty energizing, I don't know that I would want to do anything else. I've had opportunities to go into administration here, and it's not out of fear, it's just that I love what I am doing here. Until that doesn't feel right, or I need a different challenge, I'll move, but for now it feels right.
P 4: transcript 4.doc - 4:28 Codes: [Energy, energizer, seeing clients] The producers, are just the clients. I enjoy working with them.
P 4: transcript 4.doc - 4:31 Codes: [Therapy attitudes, expectation of change] The analogy I use with them, is if they are fifty, and have trashed their body, and need heart surgery, the surgeons aren't going to sit around the bed for fifty years and say it took you this long. They are going to go in and do the work, and it's up to that person to live a health lifestyle and I just treat emotional trauma pretty much the same. I think that is exciting for them. It's not a quick fix, we're just coming out of that era where you say your therapist two
224 and three times a week for five years at a time like in the eighties and early nineties, and I just love the shift to where people are accountable, and not dependent upon me
P 4: transcript 4.doc - 4:39 Codes: [Energy, energizer, seeing growth in clients] I think any time that someone that someone embraces their true self, and stops living the lies or below what they are capable of, I mean, when they get it, and their shift from a shame- based identify to a positive identity-- before that, it's like they hit the gas, but the brake is on, so once they learn how to take the brake off, and let themselves feel what it's like to be successful without sabotaging themselves, that's incredible-- I mean, that's it for me in a nutshell.
P 4: transcript 4.doc - 4:45 Codes: [Energy, energizer, seeing growth in clients] How about your highest?
I get lots of those. I think it's when they shift--when they are able to shed those layers of trauma, and really embrace that true, healthy self. And the next most incredible is when they learn from that. And when you get to see them six months later, in this small town you run into them, and they are doing wonderful, and still in that good, healthy place. That's pretty incredible. That, to me, is what it's more about, people being able to reclaim who they are and learn how to live from that space
P 4: transcript 4.doc - 4:49 Codes: [Therapy attitudes, expectation of change] I really don't believe that they need to be in therapy year after year, and its those kinds of clients who have been in therapy for fifteen year and are just getting you for the first time that are the hardest to work with. They really just have the expectation that they are going to be around another fifteen years and so they are set.
P 4: transcript 4.doc - 4:50 Codes: [Therapy attitudes, change expectations with seriously mentally ill] Yea, I think so, I don't think it does them any good to be dependent on the mental health center. I mean, we will always have the chronics, people with schizophrenia, and I don't mean them, that's a different group. I mean the trauma group, that kind of grew up in therapy, and that's their second parent.
P 4: transcript 4.doc - 4:70 Codes: [Energy, energizer, seeing clients] [Personal characteristics, engagement, importance of] I love it because it's life and there are other people, and however they show up in life is how they show up in this group, because they can't do anything else, whereas in here this is such a sterile environment in my office, so I think this is what keeps me energized. Right in the moment I get to see how they show up and we get to work on it right in the moment, kind of like a piano lesson they are playing and I'm right there, and so the kind of work, and the style, its just a good fit for me. It's energizing, it just is. And they love it because they can feel a difference, so they are making progress, but I'm also being richly fed, because therapeutically its just invigorating.
225 P 4: transcript 4.doc - 4:73 Codes: [Energy, energizer, seeing growth in clients] But probably most of it is clients who are ready to work and who turn some pretty significant corners pretty quickly if they are accountable and committed.
P 4: transcript 4.doc - 4:79 Codes: [Personal characteristics, optimism/strength based] [Therapy attitudes, uniqueness of clients] But I've grown to love it, even those with borderline personality disorder, just to put it in a healthy context, because I don't come at it thinking, oh, my gosh, because some of them are so difficult, I can have more compassion. It's a better way to present that, and we can get a lot further, because they know I'm not afraid of them, and understand kind of where they are coming from, but also can hold them accountable.
P 4: transcript 4.doc - 4:80 Codes: [Therapy attitudes, expectation of change] I think with the foundation of both, DBT, (and sexual trauma treatment) they are burned out, and tired, and they have burned out every relationship they have, and they don't understand why they burn every relationship out, so to help them fill their bag with tools, and then get them to a place where they are healthy enough where they can resolve that trauma. They do burn everyone out, but the reality is they can turn a corner and lead a healthy lifestyle, and I really believe it.
P 5: Transcript 5.doc - 5:3 Codes: [Therapy attitudes, patient with slow process of change] [Therapy attitudes, uniqueness of clients] For me, it's the hope of the possibility that each interaction with the client might be one more little brick in their progression. If you look at it as mundane, kind of ho-hum, here comes another client, then that's the kind of treatment that is going to take place. But if you look at it like each interaction is a chance for growth or progress, it helps you stay a little more passionate about things.
P 5: Transcript 5.doc - 5:4 Codes: [Therapy attitudes, patient with slow process of change] I think you used a key word that I think sometimes people just burnout, the work that we do is not easy by any means, there is a lot of potential for frustration and discouragement. I guess it's a matter of keeping it in perspective, that that is the kind of work that we do, and every day isn't going to be fun and excitement and wonderful. I guess that the difference might be that people lose that perspective and forget that it is difficult, but that there are those moments of growth and progress and success that people experience.
P 5: Transcript 5.doc - 5:17 Codes: [Energy, energy depleter, clients who are disengaged] It was pretty early as a therapist, so I'm sure that inexperience tied in with it. There was a family that we worked with that was extremely complex, multi-problem, long, long history of involvement with the system, all kinds of troubles. It just seemed that we tried A-Z, worked
226 with the schools, and family services, all kinds of things, and we just weren't able to come up with that one thing to pull the family out of that history, so that was kind of discouraging.
So, ultimately, you don't feel that you were able to make a difference to them?
They ended up moving, so I'm not sure what's happened or where they are at. We did get bits and pieces of success, but by and large it just felt that the situation stayed the same. On one hand, it was discouraging, on the other it was a learning experience that helped me realize that you can put your best foot forward, try the best interventions in the world, and sometimes it may still not succeed or help the family.
P 5: Transcript 5.doc - 5:19 Codes: [Energy, energy depleter, clients who are disengaged] With those that--don't know the word for it, but they are entrenched in the system, just the systemic nature of their family and the dynamics are such that for years they have been in therapy and services for years, just kind of spinning their wheels. It difficult to know what to do different.
P 5: Transcript 5.doc - 5:23 Codes: [Therapy attitudes, patient with slow process of change] Well, again, not to beat a dead horse, but I keep coming back to that perspective that you have to keep chipping away and working at things, striving to find the ways and techniques that might help a family. Even if it's difficult, keep plugging away, endure with them, and hope for the best. Next session will be a little better, next month will be a little better, if we keep chipping away at it.
P 5: Transcript 5.doc - 5:39 Codes: [Therapy attitudes, expectation of change] I guess that the difference might be that people lose that perspective and forget that it is difficult, but that there are those moments of growth and progress and success that people experience.
P 6: transcript 6.doc - 6:3 Codes: [Personal Characteristics, flow state] You know what I love? Those moments when you are in a zone, you feel like you are riding a wave, you've joined something kind of beyond you, that intuitive process that psychotherapist muse has landed on your shoulders and you just sort of trust that and go where you want to go. That to me, is probably the most exciting aspect of this.
P 6: transcript 6.doc - 6:7 Codes: [Personal characteristics, art] I make strange furniture and I go home and whittle away.
P 6: transcript 6.doc - 6:8 Codes: [Personal characteristics, flow of therapy, enjoying the art form] Those moments that I just talked about, when you feel things have come together and just worked.
227 P 6: transcript 6.doc - 6:9 Codes: [Energy, energizer, seeing growth in clients] It's nice to see people take advantage of the opportunities to change and get their life together, that's the biggest paycheck.
P 6: transcript 6.doc - 6:13 Codes: [Energy, energizers, esthetics] One thing I didn't mention is that I'm fortunate, when we came down here we stumbled onto an area that is architecturally very reminiscent of Santa Fe, all architecturally blended with the landscape, and they keep a lot of the land pristine, so you can't tell there are as many houses as there are. I have these huge, incredibly beautiful cliffs in my back yard. This morning I had my coffee out in my back yard, and watched these waterfalls that were still coming down off these cliffs, and I have coyotes running through my yard. It's like I'm in nature, I'm their visitor. That is my biggest source of serenity and tranquillity. I have a little shop next to my garage, I can go out back and stare at those cliffs, and a wife that's supportive and kids that love me, and that's what makes it work.
P 6: transcript 6.doc - 6:14 Codes: [Energy, energizers, esthetics] [Therapy attitudes, spirituality] Absolutely. I have a little hot tub I can sit in, and its really incredibly beautiful where I live, and you can look up and see more stars that you can imagine and sort of put my own trivial little concerns in perspective, and feel connected-- that is absolutely my spirituality. It's sort of an existential, transcendental blend of things, absolutely.
P 6: transcript 6.doc - 6:15 Codes: [Energy, energizer, seeing growth in clients] We just got through putting on crisis intervention program training for the police. It turned out really well; it was an excellent experience. We took the officers up to Oasis House, our clubhouse in Cedar City, and had them have lunch with the clubhouse members. It was neat, it was trivial but touching to me, but one of our folks, a young guy, came up to me and said, (Name of therapist!) He was a young man, and had some psychotic symptoms, signs of his schizophrenia coming on, and I had helped him through that. That's always a moment of high concern for me, when people are just becoming aware of their illness and grappling with accepting that, and seeing where it's going to take them. It was like he had remembered me enough, and that I had helped him enough, that even though many years had passed, my name was something that was important to him. That seems small, but it was just a nice feeling.
P 6: transcript 6.doc - 6:17 Codes: [Energy, energizer, seeing clients] Given the person that I am, this seems to be a kind of work, this is going to sound lazy, but this kind of work comes easy to me, so most of the time it isn't depleting. That allows me to attend to the other things in my life that are important to me. I could have a nicer house, but I don't need to have a huge house, I would rather have the things that I have.
P 6: transcript 6.doc - 6:21 Codes: [Therapy attitudes, process]
228 You know what I love? Those moments when you are in a zone, you feel like you are riding a wave, you've joined something kind of beyond you, that intuitive process that psychotherapist muse has landed on your shoulders and you just sort of trust that and go where you want to go. That to me, is probably the most exciting aspect of this.
P 6: transcript 6.doc - 6:27 Codes: [Energy, energy depleter, clients who are disengaged] Some folks who are depressed and who don't want to let go of their depression, depression has become their best friend, because the affect produces secondary gain, or whatever, they just don't seem to be able to let go of that.
P 6: transcript 6.doc - 6:33 Codes: [Employer factors, talking about cases] part of what used to be good about this profession is that there was an encouragement for contemplation, for reflection, for getting together with other people and soliciting ideas about how you were doing.
P 6: transcript 6.doc - 6:41 Codes: [Personal characteristics, art] [Therapy attitudes, process] There are principles that guide psychotherapy, it is to a degree a science, but it is also an art. When I talk about those moments of euphoria when you trust in your science and free yourself for your art and the art directs you as to what the right intervention should be and you trust this intuitive sense of what is underneath something and you move that rock and find what you are looking for. I f somehow I could hook myself up to some kind of machine that could beep whenever I had a certain emotion, that state is probably accessible to me in doing psychotherapy, or when I'm working in my shop and thinking, "what is this thing going to look like?" and I have absolutely no idea. When your hooked into that process, and again, it's that process, when you are connected to something larger, and you are just doing your part in that and its carrying you, that affective state is very similar in both arenas.
P 7: Transcript 7.doc - 7:3 Codes: [Personal characteristics, art] I experimented in both realms, and when I discovered I could be either a poor starving artist or a poor starving social worker
P 7: Transcript 7.doc - 7:12 Codes: [personal characteristics, creative] Thinking of creative ways to engage people in the therapeutic process. Not program development on the level… I’m looking at the program needs of the people I am working with, and I’m seeing a deficit-something that we are not doing that we probably could and then finding a way to deliver that. Anything that is in the creative arena, I really enjoy that, something that gives me a little creative license.
P 7: Transcript 7.doc - 7:26 Codes: [Employer factors, creating new opportunities] But for me, it would be using creative ways of meeting the needs of the population you are working with. I would love for administration to think of creative stuff, I don’t think of
229 Profiler as creative. But I have to respect that maybe they know something about how everything operates, and maybe it does meet all of their needs, I don’t know-but it definitely doesn’t meet mine
P 8: transcript 8.doc - 8:7 Codes: [Therapy attitudes, expectation of change] Gradually, as I took all kinds of sources and work with it I think I also developed faster ways of helping people make changes in their life if that’s what they wanted or to begin to see those who don’t even want to make changes they just want to use us to get social security or something else, and how to manage them nicely
P 8: transcript 8.doc - 8:14 Codes: [Energy, energizer, seeing clients] [Therapy attitudes, uniqueness of clients] What are you energy producers here at work, on the job?
Every human being I get to interact with.
P 8: transcript 8.doc - 8:15 Codes: [Energy, energizer, seeing clients] After a therapy session, do you have more energy that you did before?
Yes, definitely.
Is that consistently the case or does it depend?
Almost consistently, yea.
P 8: transcript 8.doc - 8:16 Codes: [Energy, energizer, seeing clients] [Therapy attitudes, uniqueness of clients] What are your energy depleters?
Isolation. On the job, there aren’t any depleters. Every person I see is somebody I can brighten, and it brightens me, and I look forward to that. This is a pretty nourishing job. On the weekends and evenings I am reading, I have a lot of friends, but there is more…
P 8: transcript 8.doc - 8:21 [I really love this study of wh..] (89:89) (Super) Codes: [Energy, energizer, seeing clients] [Quotes] No memos
I really love this study of what it means to be human, and this process of transformation and the possibility of joy, and love, and invulnerability, kind of. It’s quick to let go of what could feel stressful
P 8: transcript 8.doc - 8:27 Codes: [Therapy attitudes, expectation of change]
230 There’s not one condition that doesn’t get experienced in the mind, so healing is universal. All of healing is equally simple for all people because it’s always involving a change in the way that they are seeing something that they think is it, but they have made it what it is for them, and they don’t know it yet. And I’m trying to create a climate in which they can wake up and see it and make a choice and it is gone that quick, it doesn’t take time to heal. It happens the minute you change the way you see it. And now instead of a judgment that terrifies, is a creative, loving idea. It just feels wonderful.
P 8: transcript 8.doc - 8:42 Codes: [Therapy attitudes, expectation of change] When you come and you want it, it can be quick, and when you don’t, that’s okay.
P 8: transcript 8.doc - 8:51 Codes: [Therapy attitudes, patient with slow process of change] Some one could give me a new detail and they hadn’t talked about their job or anything that was profound, but they had given me a new detail, they demonstrated an emotion that they hadn’t before so therapy was progressing, and you know that sort of thing helped me.
P 9: Transcript 9.doc - 9:5 Codes: [Energy, energizer, seeing clients] I agree with the idea of "passionate commitment" in any venue of human endeavor. I do this, not for the money, I do this because I love it. I am never, at least so far, in that place where I have been many times in my life, of wondering A) what was I doing with my life, or B) how long this had to go before I could do something more interesting. I've never had that before, not at all.
P 9: Transcript 9.doc - 9:6 Codes: [Personal Characteristics, flow state] If we are agreeing on what passion and commitment are, from my standpoint that is someone who looked forward to and was engaged in their work in the here-and-now. Who derived a very unquantifiable energy from that work. The work didn't debilitate me, it keeps me fresh. It supplies me with energy, in fact. It's almost as if it were another kind of "version" like introversion or extroversion where this "therapist version" was where I got energy. Maybe that is it's own motivator, it's energizing for me, so it maintains my interest always. I don't see any dead spots, or places in me as a therapist where I say "I've got to do something else with my life because I'm feeling stagnant, or this is draining me.
P 9: Transcript 9.doc - 9:14 Codes: [Energy, energizer, interesting clients] An interesting case-- a boring case that gets interesting.
P 9: Transcript 9.doc - 9:15 Codes: [Energy, energizer, seeing growth in clients] Movement in therapy, growth that I can recognize, even if the client doesn't see it. Even if they are weeping and wailing, if everything is miserable and falling apart, if I can see something I hadn't seen before in a client, that gives me energy.
231 P 9: Transcript 9.doc - 9:16 Codes: [Energy, energy depleter, clients who are disengaged] Where I find myself getting sleepy is when it is the same story over and over. Eventually I'll say something, maybe not in two or three sessions of that, but eventually I'll say, "You know what, I'm getting sleepy, and I think it's because I've heard this story so many times I can almost tell it to you." They will look at me, like "I'm boring you?", and a few times I've said, "Yea, what else is new?" or "Let's talk about why you are stuck right here. Let's find what this means right here, and dig down a little deeper and find why it's such a sticking place." Or, if I figure that the "stuckness" is a ruse, in other words that they need to stay sick, for some reason, they think those symptoms are valuble, I just go back to the tried and true thing of "Let's see now, what it is that you want to change about yourself with my help? What could be different than it is right now, and how could I help?" Sometimes that will unstick them, sometimes it won't. Sometimes it will expose the hypocrisy on their part, in other words, I've seen through the ruse, and I'm starting to realize that they need to be sick, and them coming to a therapist is validating that sickness, and therefore that validation gets them a reward out of here. If that's the case, I'll just sort of tread water until they get tired of me asking or pestering them about it and they just vanish. It's fine, because it's not therapy.
P 9: Transcript 9.doc - 9:21 Codes: [Personal characteristics, art] I got interested in psychology when I was really pretty young. It was a toss-up between fine- art, and psychology and I was in psychology when I first went into college, and happened to walk through the art building on my way somewhere and looked around at age 22 and said, ' these people are doing what we're just talking about' so I changed my major to fine-art. And so then I got an undergraduate degree in fine art, and went on and got a graduate degree in fine art, and the psychological foundations of what this all comes from was continuously fascinating, and I never let go of that.
P 9: Transcript 9.doc - 9:22 Codes: [Therapy attitudes, relationship genuine as well as professional] [Therapy attitudes, uniqueness of clients] You know, I did not want to see people as a lab rat or as a subject, I wanted to see them as human beings living their lives with whatever problems might come up, and what they did with that in the whole, them in the environment, them in their world. Not they as isolated bundles of psychic energy or symptomatology, or anything like that, so I chose social work specifically because I knew it was a route to becoming a therapist but it was a route through a different field, a different lens in looking at human beings.
P 9: Transcript 9.doc - 9:23 Codes: [Personal characteristics, art] But you're making an association in your interest in the arts - literally in art - and your interest in psychotherapy. Absolutely, oh, absolutely. Say more about that. That's what these things are - these things are concretizations of what thought and perception and interpretation end up being. One way we concretize it is behavior. But another way is in these records of that.
232 P 9: Transcript 9.doc - 9:33 Codes: [Personal characteristics, art] I used to make art that way. You know I painted and uh, since I've done this for a living, it's very interesting - I have not done much painting at all. It's very interesting. I've set myself up a great place to work. I have all my art supplies - I have everything I ever need , you know, and I just don't sit, I just don't Feel the need? No, NO and I think that it's because this is replacing that in a way that was very similar. Something happens in this that happened when I was painting. I take pictures which is like instant art - you know I'll just go out and just kind of in a sense draw a line around something that I like. You know, and that's satisfying and I bring the pictures here. I change those, just kind of as I think of it. But that does it in terms of getting that art yaya out. Now before, when I was in school or when I supported myself for quite awhile building houses and when I was doing that I would always need to be painting. If I didn't paint, it would build up inside me - it would be like a compulsion inside me - it had to happen and I would go paint and I'd feel better again, you know. That's just vanished since I've done this. So something about this and that are the same in me. That's fascinating. Yeah, and I have no clue where that's coming from. It's generating a result or some kind of creative process is being satisfied inside me when I sit and do psytchotherapy and I don't know - if I ever find out I'll sit down and write it down. Write it down and send it to me. Yeah, I'll let you know, or let the world know - I used to be an artist and I can't do art anymore but I feel fine about it because sometimes when artists can't do art anymore they go to pieces. And I've had that experience in having that art thing taken away from me or I couldn't do it or it was like art block you know and I'd start to disintegrate - I'd start to feel less competency until it came back and I could do art again.
P 9: Transcript 9.doc - 9:44 Codes: [Energy, energizer, seeing clients] Who derived a very unquantifiable energy from that work. The work didn't debilitate me, it keeps me fresh. It supplies me with energy, in fact. It's almost as if it were another kind of "version" like introversion or extroversion where this "therapist version" was where I got energy. Maybe that is it's own motivator, it's energizing for me, so it maintains my interest always. I don't see any dead spots, or places in me as a therapist where I say "I've got to do something else with my life because I'm feeling stagnant, or this is draining me.
P 9: Transcript 9.doc - 9:47 Codes: [Therapy attitudes, process] In a way, it's kind of detective work, it's not untangling or puzzle-piecing, I don't know who you would put that. But that's the feeling I get when I'm sitting in this chair, and I'm constantly fascinated and it's always interesting, I don't use my own, God forbid, experience or material to help them or use that as an example for them, because that would be debilitating. That would be replacing their psychic contents with my own projections, and then we are both dealing with unreal things. I don't know if that makes sense, but that's what came to mind when you said that.
P 9: Transcript 9.doc - 9:50
233 Codes: [Personal characteristics, art] Yes, it's a craft, actually. I see it as way more of a craft than anything else. I think aspects of it can be quantified, you know, but it's mostly a qualitative field, and it has to do with a nuanced kind of a relationship. It's a very artificial relationship. But it's nuanced in such a way that it, in a way it's like a big mirror, that reflects back at the client so the client can have a picture of who they are and what they're doing.
P 9: Transcript 9.doc - 9:53 Codes: [Employer factors, talking about cases] Yeah, I feel I have ample opportunity and then if I've got an hour with nothing to do, or if somebody cancels on me or something I could just roam the halls and just buttonhole anybody. I've never run into anybody in this agency who is unwilling to talk about something or to sit down and help me understand what I'm seeing, so yeah, I've got plenty of that.
P 9: Transcript 9.doc - 9:59 Codes: [Therapy attitudes, uniqueness of clients] In a way, it's kind of detective work, it's not untangling or puzzle-piecing, I don't know who you would put that. But that's the feeling I get when I'm sitting in this chair, and I'm constantly fascinated and it's always interesting
P 9: Transcript 9.doc - 9:61 Codes: [Therapy attitudes, uniqueness of clients] It doesn't matter. The most fantastical story a client could tell me would be indicative of they way the world, and that's what's important. And it happens!
P 9: Transcript 9.doc - 9:62 Codes: [Therapy attitudes, uniqueness of clients] If I were given some kind of protocol, and said "you are to follow this, for example, engage in nothing but time-limited therapy, you know, for these disorders we will allow these amount of sessions, and we would like you to cover this material in each session," I'll go work somewhere else. And that doesn't happen here. And I think management here tends to look at outcomes, much more that micromanage day-by-day interactions. Is that client getting better? How long have you seen that client? And what's the symptomatic presentation like now compared to intake? You know, if it's improved or if you can see some kind of symptom relief or the client's goals having been met, you know, do you need to keep meeting with that client anymore?
P10: Transcript 10.doc - 10:8 Codes: [Energy, energizer, seeing clients] I'd say 75% of the time it's easy for me, maybe even 80% of the time. There are times, though, that it kind of drags on and gets a little bit hard.
P10: Transcript 10.doc - 10:9 Codes: [Energy, energizer, seeing clients] [Energy, energizer, seeing growth in clients] That's a good question. I don't know why it's draining for other people, what that burnout thing is all about. I think there are people who just don't enjoy therapy, they enjoy other
234 types of social work, but not therapy. For me, it is really gratifying to me to see the light go on in people's eyes, getting the benefits of their progress, it makes me feel good to see them. I have a, it's very easy for me to see patterns in behavior and to spot where to go next, it just comes to me, and it's just fun. It's kind of like a game to me, and I have fun doing it. I really love it when I see people making progress, and I can usually do that in a session--okay, maybe not progress, but insight. I love it when they have insight.
P10: Transcript 10.doc - 10:10 Codes: [Therapy attitudes, change expectations with seriously mentally ill] I think it depends on the client. You know, the rule of thirds. I have a client that I've had from the very beginning, and some people think, you know they've been coming every week for three years, but for people who are very personality disordered individuals, progress is very slow, but it's happening. I have other clients, usually young women, single moms, who can come in and six sessions, I can do solution-focused therapy with them and get them out of the door really quick. So it just really depends upon how entrenched they are in their problems.
P10: Transcript 10.doc - 10:16 Codes: [Personal characteristics, art] I'm a knitwear designer. And, so I kind of have an artistic thing I do outside.
P10: Transcript 10.doc - 10:17 Codes: [Energy, energizer, seeing growth in clients] I have one client who came to me three years ago who was very very very ill. And she was diagnosed schizoaffective but there was a real strong suspicion that she was borderline. And she was very, I mean really high risk, very complicated, difficult client and over three years I've seen her every week. Eventually I did get her into the DBT therapy program and I've watched her, who I think nobody had any faith that she would get better, I watched her get better. And just in the past six months she's made so much progress that she's become…she was a writer and she has been writing poetry. I have her poetry - stacks and stacks of poetry that is.. she could write for the New Yorker… it's just stunning. And she's registered now to go to the University of Utah this spring and she's volunteering at NAMI and I just am so pleased. I'm so pleased with the progress she's made. It's that kind of thing.
P10: Transcript 10.doc - 10:21 [You know, and they just go on ..] (126:126) (Super) Codes: [Therapy attitudes, patient with slow process of change] No memos
You know, and they just go on and on and on and on with their stories, and through their stories - I sit and listen and they come and they find their own insight and their own answers and I just kind of guide them along.
P10: Transcript 10.doc - 10:33 Codes: [Personal characteristics, art] I'm always making artistic analogies in my therapy. I'm a very visual person, (Keeping my board?), I always have my board out that I'm, you know, writing on, helping people to see
235 visually. Because of the particular kind of work I do, as a fiber artist, it's very specific patterns that create beautiful pieces of fabric. I can see, I can see patterns in a lot of things I do, and I can see patterns in behavior. I think it helps me to see the patterns quicker. I'm always drawing. And my latest thing is that people are like a kaleidoscope. All of the little pieces of glass are all there - the environment turns it and it looks like a completely different picture, but it's all the same thing. You know. (laughs) Doing that kind of thing. One of my interests has been resilience. I love resiliency. Doing that kind of thing. And when I do a resilience group, part of what I have - I don't have many requirements, except that you come, and you have to be involved in a creative project because it's part of being resilient. It's activating the problem-solving (laughs - can't think of the word she wants) and so they have to begin. Every week they have to do some sort of creative project. And at the end of the 10 weeks they bring their creative project in. It gets those creative juices flowing and it is amazing the things they bring in and how it's part of their healing - the creative process. So, yeah, I um use it a lot.
P10: Transcript 10.doc - 10:45 Codes: [Therapy attitudes, uniqueness of clients] It's kind of like a game to me, and I have fun doing it.
P10: Transcript 10.doc - 10:47 Codes: [Therapy attitudes, uniqueness of clients] You know I really kind of tailor make each approach to each individual. I mean there are some clients that I take kind of a Doctor Phil approach with and am really kind of in your face, and this is what you need to do - that's pretty rare with me but sometimes I do.
P11: Transcript 11.doc - 11:3 Codes: [Personal characteristics, art] Started off doing carpentry, then moved on to owning my own business, doing high-end, custom furniture. Did you consider yourself an artisan? I guess so; I was surprised by it. I didn't know I was, but I found out I was pretty creative.
P11: Transcript 11.doc - 11:10 Codes: [Energy, energy depleter, clients who are disengaged] Energy depleters are…well, no-shows. I think for me it's hard to-- when you work with a person that has a kind of dysthymic presentation and can't summon the motivation, it's almost to me less dysthymia than depressive personality disorder, sometimes that can be depleting to me. You can't create energy in the session to make things happen. I find myself almost falling asleep, not knowing how to create energy in the session for change. I think that would be the one that stands out the most.
P11: Transcript 11.doc - 11:13 Codes: [Personal characteristics, art] My current one, that has been at the top the last year or so is photography. That takes me outdoors a lot, so nature and photography are, and friends, I have a good set of friends. I'm also passionate about cooking; I'm passionate about a lot of things. Still doing woodwork?
236 No, no woodwork. All that energy is gone. That's what keeps me moving, and I'm very active when I'm not at work doing stuff. Don't watch the TV much, I am doing photography for two hours a day. Have you ever made any connection between your artistic passions and psychotherapy? Yea, they come from the same kind of energy. That's why woodworking was so good for me, because I didn't know I was creative, and the feedback I got and the community is very creative, I was very successful at this. For me, the creativity feels about the same, the energy feels about the same. So you feel a similar kind of energy when you are doing a therapy session… As when I was designing something, I was able to design a lot, have a lot of people do the woodwork at the end. But also there was an analytical, you know there are pieces, in furniture making its all about construction pieces, putting things together, therapy is the same to me, it’s about putting things together, finding something that you can use, and shaping it, and creating something. So it feels a lot the same. And the other thing, you are helping the other person create that.
P11: Transcript 11.doc - 11:16 Codes: [Energy, energizer, seeing clients] Is there anything about doing therapy that you just hate? (Long pause.) Not one thing. I can't think of anything I don't like about it.
P11: Transcript 11.doc - 11:20 Codes: [Energy, energy depleter, clients who are disengaged] That would be the adult dysthymic client. I've never really found a way to impact that very well. When you say you haven’t found a way to impact that, have you found a way to maintain your own motivation with those clients? Yea, but I probably have waned some, to be honest with you. I find myself feeling sleepy in the sessions, they're probably the most difficult clients I work with, and I work with all kinds, with children, I work with adults…
P11: Transcript 11.doc - 11:26 Codes: [Personal characteristics, flow of therapy, enjoying the art form] When I'm at my best, I'm kind of kind of flowing, I have access to my unconscious, and I'm feeling in the present moment, just experiencing… that's when I'm at my best. Is it a pleasant state? It's very pleasant; it's a real Zen thing. That way, you are just so tuned into what is going on, I'm able to connect and respond…
P11: Transcript 11.doc - 11:29 Codes: [Employer factors, talking about cases] [Energy, energizer, team of colleagues] There would be a lot of getting together to staff cases, I have a lot of good people, and they all like getting their work and their jobs, and one of the ways that we keep that going is we have a once-a-week clinical staffing, the meetings are a blend of getting the work done, and just laughing. A lot of humor, you could look at parts of the meeting and thing, "that's a
237 waste of time", but the business gets done, but also the people connect and let off some steam.
P11: Transcript 11.doc - 11:47 Codes: [Energy, energizer, seeing clients] It's very pleasant; it's a real Zen thing. That way, you are just so tuned into what is going on, I'm able to connect and respond…
P11: Transcript 11.doc - 11:49 Codes: [Therapy attitudes, uniqueness of clients] I'm trying to find something or some way to really fall in love with the client, or like the client or appreciate them. Sometimes I say that therapy is just liking somebody long enough until they get better. Finding a way to really like them, to really engage.
P11: Transcript 11.doc - 11:50 Codes: [Therapy attitudes, uniqueness of clients] Both, it just depends on the individual client, and things that I don't understand. I've seen four or five sessions and that's it, there is major change, and sometimes I've seen clients over two years. I tell my clients, " Usually, if you're working on some aspect of your personality or behavior, you ought to plan on a year--not necessarily come into therapy for a year, but invest in a year-long project. That could include reading, experimenting, coming into therapy.
P11: Transcript 11.doc - 11:51 Codes: [Therapy attitudes, uniqueness of clients] Find something in every client that you really like, just find that, and if you can't then send them on to someone who can.
P13: Transcript 13.doc - 13:9 Codes: [Energy, energizer, seeing growth in clients] I have one boy that I've been working with for two years. His diagnosis is PDD, depression, so he comes off awkward socially. But his father, what is really neat is he wanted his dad, we don't see that a lot. His father took off from work just to take care of his son. He wasn't properly diagnosed until he came here, which was ten years. It was pretty frustrating to go ten years of your life, and have a boy who is not doing well because of a missed diagnosis. The growth that he has, working with him every week, teaching him social skills and getting to know him, and knowing him for who he is, and not judging him for that, has really brought him out of his shell. It allows him to apply it to other environments; this particular kid has grown so much. I think that is why I am here-- it hasn't been an overnight change, I have been working with him almost weekly for over a year and a half, and then with his dad. Seeing the growth in his Dad, it wasn't just him, it was his Dad too, and his sister learning how to help him in a productive way. His Dad would go to parenting support groups and he has done very good work.
Can you articulate what it is in that story that describes what you love so much about being a psychotherapist?
238 Seeing a boy who didn't smile at all smile. A boy who, when he came in, would barely make eye contact, could barely say two words. Now comes in, tells his dad to leave, and is just engaging-- appropriately engaging. He'll talk to me, and make eye contact, just small changes. I don't think he recognizes them, his dad does, and his grandparents do, but I think that is it- - to see a little boy who is just miserable, be happy.
P13: Transcript 13.doc - 13:12 Codes: [Energy, energy depleter, clients who are disengaged] There is one, there is only one family that I can think of that frustrated me. The boy is diagnosed with conduct disorder and he just refused anything. Mom would sit on the couch and climb up in a little ball, it just didn't matter. No matter what I did, even sitting in with the other supervisor, there was nothing that we could do, because they didn't want to. And that was the frustrating thing. Other than that, no.
P13: Transcript 13.doc - 13:16 Codes: [Therapy attitudes, patient with slow process of change] As first when I started, probably more rapid change. Because when you get out of graduate school, you're all, "I'm going after it", but then there is the realization that change is slow. Sometimes our expectations supersede their expectations. We have all these hopes and dreams, but that isn't where they are at. One of my clients, we were talking, and she really wants to drop out of school, so we mapped out everything in her life, and what she wanted to know as opposed to in the future, and I think she thought I wanted her to go to college. So she put down college, and I said is that really what you want to do, and she finally said, no, I want to go college. But it was allowing her to dictate what her future looked like, and not what I wanted. Just because I went to college, doesn't mean it's for everyone. So, I think at first, yea, kind of get in there and change the world kind of thing, slowly and surely realizing that it's slow. What I've noticed is that slow changes last over the long haul, and quick changes are like, they last a week and then it's start over. Learning that has helpful.
P13: Transcript 13.doc - 13:19 Codes: [Employer factors, mission driven] [Employer factors, supervision] [Employer factors, talking about cases] Probably not taking extra time to just talk. To talk about countertransference, to talk about how life in general is going, (my supervisor) will ask, "how are things in your life?", and he's not asking how I am as a therapist, he's talking about it in general. I think if the supervisors didn't care, or if they were all just Type As and interested in how things were business oriented, that would probably drive me insane, if there were no feelings or emotions about it, just "get everything done and don't come to me." I've worked in different fields like that, and it is really bothersome. You want that support, people in (names company) have said children's outpatient is the best place to work, because it's not like that throughout (company.) You hear a lot of complaints about other parts of (company).
P13: Transcript 13.doc - 13:35 Codes: [Therapy attitudes, uniqueness of clients] They are good people here. And for the most part, my families are pleasant people. I mean, there are times where it gets kind of up in arms, but with exception of one family, I like my families, and I like to see them, and have them come in and say, "Johnny did this today'" and I say, "Okay, we've been working on it for two months.
239 P13: Transcript 13.doc - 13:36 Codes: [Therapy attitudes, uniqueness of clients] Regardless of the stories that you hear about people's lives, the narratives that they come in with, to be able to allow them to tell their stories.
P13: Transcript 13.doc - 13:37 Codes: [Therapy attitudes, uniqueness of clients] I think you hit it all in that we are just people who want to make a difference. But a difference in a way that is going to feel helpful to us-- because you build on each relationship, you learn what you can use to help the next family that comes in, "Let's try this."
P14: Transcript 12.doc - 14:15 Codes: [Energy, energizer, seeing clients] I find that listening to others talk about their therapy is very invigorating. I think we are lucky in this system to get quite a bit of that input. But I would say really just spending people in the doing of therapy. Groups are really invigorating; I really enjoy all the action. Teenagers are really amazing.
P14: Transcript 12.doc - 14:17 Codes: [Energy, energizer, seeing growth in clients] One of the things that happened to me, just a funny coincidence, when I was working years ago with younger kids in our day treatment program, I have always been pretty invested in working with our clients, but I think I was really a little overly invested then, but was really making some nice relationships with the kids. One of the kids that I had worked with as a second or third grader wrote me a few years ago, and said that he would like to put me and three others in the forward of his textbook. He's teaching in London, and has published his third textbook in his area, and he would really like to thank us for his start. I think that is the epitome of a good teacher, a good therapist, to give that opportunity to develop, not to mold them into this thing that is yourself, but rather, to give them the skills to go on and be whatever they can be. I felt like he was the greatest example in my life of someone who took a very challenging beginning and molded that to someone who is him.
P14: Transcript 12.doc - 14:28 Codes: [Energy, energy depleter, clients who are disengaged] There a few people that I work with that like to come in and just run through a litany of negative events. I assume that they sort of believe that that catharsis somehow is going to make them feel better, and they don't seem to want to change, They don't want to look at what they are doing. I guess that part of it is that I feel excluded from that situation, because they are them and they are just running this, and trying to break into that--if I can't break into that, that is the least motivating client to me, because they just won't get there. Really withdrawn teenagers-- most of the time I can get past that "yep, nope", but there's a few, where I wonder if they have anything past that. And they're pretty frustrating.
P14: Transcript 12.doc - 14:32 Codes: [Employer factors, talking about cases]
240 I love working as a team here. We will get together here and just chat, and it's not something that you could rearrange, but it's not precluded by a) they way we are situated, or b) how we our schedules overlap. The more time that I find that I am able to sit and talk with my colleagues, certainly there is a downside to that in terms of you're doing too much of it, it's detracting from doing work, per se. But I do think that kind of group discussion really keeps me motivated, I find that helpful.
P14: Transcript 12.doc - 14:36 Codes: [Therapy attitudes, uniqueness of clients] Trying to figure out their world view, their values, how all that fits with some pieces that can shift just enough that they will find some greater joy in their relationship together.
P15: Transcript 14.doc - 15:7 Codes: [Energy, energizer, seeing clients] The kids that I see. I just really, really like kids. Just having them come into my office or go out into the office, and it's like (Shouts name!) and they get excited to come in. That's a real big one.
P15: Transcript 14.doc - 15:10 Codes: [Energy, energizer, seeing clients] But it's mostly the kids.
P15: Transcript 14.doc - 15:11 Codes: [Energy, energy depleter, clients who are disengaged] Real low-functioning parents. I like the kids a lot more than the parents some times.
P15: Transcript 14.doc - 15:17 Codes: [Energy, energizer, seeing growth in clients] This is something that happened, way, way back when I was at the Children's Center. (Names director of program) once said "Oftentimes, you have no idea what impact you have on a child, sometimes the most you hope for is you light a little candle that carries them through the rough times later on, even if they don't consciously remember it, there's a little piece of you that you leave with them." This sort of happened one year, there was a little boy, his name was Tony, and we had a pretty conflictual relationship, he was a pretty angry kid. He once threw a Tonka truck through this huge plate glass window. He had these rages, and I'd have to sit on him, so he was a pretty intense kid. He was about four at the time. Some years later, maybe five years later when I was working (here) we were staffing a case with an adult therapist, and he mentioned this woman's name. And I said, "Does she have a kid named Tony?" And he said yea, and I said, "I used to see him at the Children's Center." So one day I was in a children's group, and this therapist knocked on the door and said, "Can you come out for a second, I have someone who wants to see you." And there was this boy, who was ten and the time. And he looked at me and said, "(Therapist's name!) and jumped into my arms, and he said do you remember this person and that person, and do you remember when you used to read me Ferdinand the Bull, and do you remember this… and it was like six years later, and he remembered all this little stuff. He didn't remember me sitting on him or the throwing the truck, he remembered the good stuff. So that's what I think about with these kids, is that they will, hopefully, carry that with them, and that's what keeps you energized. You don't get that very often, but every now and then you do.
241 P15: Transcript 14.doc - 15:28 Codes: [Energy, energizer, seeing clients] For some children and some families, it's pleasurable, and feels easy and effortless and fun and flowing, and active, and even though it is therapy we are laughing and having a good time together, and mutually energizing. I feel like I am giving to them, and they are giving back to me, and it grows, and that's really fun.
P15: Transcript 14.doc - 15:29 Codes: [Energy, energy depleter, clients who are disengaged] Sometimes, it's like you are pulling teeth, and that's really hard and you're thinking hard, and you're getting frustrated, so I would say it changes.
P16: Transcript 15.doc - 16:13 Codes: [Energy, energizer, seeing clients] [Energy, energizer, seeing growth in clients] The positive energy that I receive in the session from the client when we are working on how their perceptions affect their thoughts and when they have that kind of "aha" moment, and have a better awareness of it. That gives me a ton of energy.
P16: Transcript 15.doc - 16:19 Codes: [Energy, energizer, seeing growth in clients] I started working with this young woman who had experienced severe childhood trauma, and had formed DID and borderline personality disorder, and had terribly disregulated mood, and had been in and out of the state hospital and the acute facility. Through perseverance and determination over that past year, and commitment to sort of stepping out of the box, both on her part and my part as well, in separating her from her barriers that were stagnating her progress, this young woman has recently just, she's had her ups and downs, and she will for a while, but she has begun to recognize what has influenced her life and why she interprets things the way that she does and how she has protected herself in really unhealthy ways in the past. She used to come into my office and curl up in a ball and it would be like a dentist trying to pull teeth. But through patience and perseverance, the commitment that we would work through this, this young woman comes to my office, sometimes I can't get her to stop talking. Her ability to recognize and acknowledge what has gone on in her life, and what control and choices she has in her life now, is just amazing. I'm so grateful, because there were a couple of times that I found myself getting sucked into that kind of borderline black hole, and pulling myself out with my colleagues help and supervision and pushing forward instead of getting burned out, and being patient with it, is truly what being a passionately committed psychotherapist is about.
P16: Transcript 15.doc - 16:20 Codes: [Energy, energizer, seeing growth in clients] It's watching a young woman who would dissociate and self-mutilate and have her suicidal behaviors every single day of her life, watching her be able to eventually cut back on those coping skills.
P16: Transcript 15.doc - 16:21 Codes: [Therapy attitudes, patient with slow process of change]
242 Yes, it's all about the progress. Like you said, watching an incredibly difficult client make incremental changes. I have learned in this job that we try to convince our clients not to get that quick fix, yet I think sometimes as therapists that we want that quick, immediate gratification. I think as a young therapist coming into this, I had to learn very quickly that immediate gratification, as a therapist isn't going to happen very often. There may be some clients that you get that from, but it is that delayed gratification, that sticking it out and working through it and seeing the long-term results of what you can get by being patient.
P16: Transcript 15.doc - 16:30 Codes: [Energy, energizer, seeing clients] I feel very grounded, and very centered, and focused. Learning how to be focused I gained from, I was into athletics and performance, and competition group all through college, and learning how to focus and be fully, put my full attention into the task that I am doing is very much me. I'm very into my session, I'm not just hearing what my client is saying, I'm watching their body language, I'm looking at the energy, I'm way okay with pausing, silence doesn't bother me I think it's important to just sit in it. I don't have to react immediately to something that a client may say. I'd say my energies are fully focused 95% of the time, you know, everybody has their days.
P16: Transcript 15.doc - 16:43 Codes: [Therapy attitudes, uniqueness of clients] I'm very into my session, I'm not just hearing what my client is saying, I'm watching their body language, I'm looking at the energy, I'm way okay with pausing, silence doesn't bother me I think it's important to just sit in it. I don't have to react immediately to something that a client may say. I'd say my energies are fully focused 95% of the time, you know, everybody has their days.
Code Family: Personal fit with role: will to intimacy
Codes (4): [Personal characteristics, engagement, importance of] [Therapy attitudes, connectedness, enjoys creating sense] [Therapy attitudes, intimacy, enjoys] [Therapy attitudes, relationship genuine as well as professional] Quotation(s): 56
P 1: Transcript 1.doc - 1:24 Codes: [Therapy attitudes, intimacy, enjoys] People come in and they sit down, it’s intimacy, its closeness.
P 1: Transcript 1.doc - 1:26 Codes: [Therapy attitudes, intimacy, enjoys] It’s the intimacy. It’s the closeness.
P 1: Transcript 1.doc - 1:62 Codes: [Personal characteristics, engagement, importance of] Try to engage with clients,
P 1: Transcript 1.doc - 1:66
243 Codes: [Therapy attitudes, intimacy, enjoys] It’s the intimacy. It’s the closeness.
P 2: Transcript 2.doc - 2:10 Codes: [Therapy attitudes, intimacy, enjoys] it’s getting to sit in front of people every day
P 2: Transcript 2.doc - 2:17 Codes: [Personal characteristics, engagement, importance of] I get to be present for 50 minute cycles, 6 times a day or whatever, and I’m just present and there,
P 2: Transcript 2.doc - 2:37 Codes: [Therapy attitudes, intimacy, enjoys] it was an intimacy. I think what I like is the intimacy.
P 2: Transcript 2.doc - 2:38 Codes: [Therapy attitudes, relationship genuine as well as professional] It’s very real so I don’t know. I don’t know if that explains that. In a way it’s a sad story, not a success story.
P 2: Transcript 2.doc - 2:40 Codes:[Therapy attitudes, intimacy, enjoys] [Therapy attitudes, significance of role] So I think the interconnectedness is… you know I’ve spent half my career here in a small town, and I really get attached in a way you don’t in the city. I see these people at City Market, I see them at the library I see these people at the movies. It’s not that my clients live in one part of town and I live in another. It’s not that I see them once a week and it’s very isolated. I know their grandmothers, and I see their aunts and uncles passed out on the lawn drunk on the weekend. I see the living/walking genogram every day. There’s an intimacy.
P 2: Transcript 2.doc - 2:58 Codes: [Therapy attitudes, relationship genuine as well as professional] I think it was a personal loss more than anything. I really loved this kid. He was the kind of kid that I really saw myself you know getting a wedding invitation in the mail. 15 years from now saying I’m in New York, and I’ve found the perfect woman. This was a kid I kind of knew would be around. For me it was more than professional, way more than professional. It was just more that I really really liked him.
P 3: transcript 3.doc - 3:21 Codes: [Therapy attitudes, connectedness, enjoys creating sense] [Therapy attitudes, fragility of clients] I remember several years ago we had a group, that had a female co-therapist, her name was Shannon Wheeler, who was an amazing woman. We were doing a group with about ten women, it was a victim's group, women survivors. We had a very, very, damaged woman who agreed to come if she could just sit in the corner, who agreed to come if she didn't have to participate, who agreed to come if no one would touch her…and she did that. I remember the night when something clicked for her. I don't know what was happening in
244 the group, that affected her--but she started to cry one night, and I remember one of the ladies going over to sit by her, and we were all watching to see if she would allow this woman to touch her--and she did. She let this woman touch her, and another woman sat on the other side and held her hand, and another woman went around behind her and she had all the women sitting around her in the corner, hugging this woman. I don't know why that came to mind when you asked the question… But that's the moment I thought of.
P 3: transcript 3.doc - 3:22 Codes: [Therapy attitudes, connectedness, enjoys creating sense] I have a strong belief that we don't do very well on our own--unless we have social connections, unless we are around other people, we aren't going to be healthy. I think the process of this woman watching other women trust and share and touch each other somehow helped this woman get past her own training, you don't do any of that-- I think helping others trust and connect, helping people feel safe, creating a place where they can learn differently from their childhood training that said you were not supposed to do. I think this is a big piece of what we do.
P 3: transcript 3.doc - 3:23 Codes: [Therapy attitudes, connectedness, enjoys creating sense] Yes-- it's very satisfying to have someone who has never had that sense, or at least not had that experience recently, and they have, because of what happens in the therapy room, they are either able to connect for the first time, or to reconnect, I find that very satisfying.
P 4: transcript 4.doc - 4:24 Codes: [Personal characteristics, engagement, importance of] Individual therapy is like--if someone wants to learn to play the piano, like they could come her and I could tell them a few things, but if I don't ever get to see them practice, it seems pretty flimsy to me, whereas in our groups, like even our skills group, I love it because it's life and there are other people, and however they show up in life is how they show up in this group, because they can't do anything else, whereas in here this is such a sterile environment in my office, so I think this is what keeps me energized. Right in the moment I get to see how they show up and we get to work on it right in the moment, kind of like a piano lesson they are playing and I'm right there, and so the kind of work, and the style, its just a good fit for me. It's energizing, it just is. And they love it because they can feel a difference, so they are making progress, but I'm also being richly fed, because therapeutically its just invigorating.
P 4: transcript 4.doc - 4:62 Codes: [Personal characteristics, engagement, importance of] I'd say I've shown up for pretty much everything I do,
P 4: transcript 4.doc - 4:66 Codes: [Personal characteristics, engagement, importance of] I think with my clients, part of the success is that that engaging style does work, because they feel safe and there is that relationship to start with I can do a lot more. I've never thought of that before, but I think that is part of why I'm able to do things or they are able to follow through when I ask them to be in a skills group they will do that because they trust me.
245 P 4: transcript 4.doc - 4:70 Codes: [Energy, energizer, seeing clients] [Personal characteristics, engagement, importance of] I love it because it's life and there are other people, and however they show up in life is how they show up in this group, because they can't do anything else, whereas in here this is such a sterile environment in my office, so I think this is what keeps me energized. Right in the moment I get to see how they show up and we get to work on it right in the moment, kind of like a piano lesson they are playing and I'm right there, and so the kind of work, and the style, its just a good fit for me. It's energizing, it just is. And they love it because they can feel a difference, so they are making progress, but I'm also being richly fed, because therapeutically its just invigorating.
P 4: transcript 4.doc - 4:77 Codes: [Personal characteristics, engagement, importance of] I just think whatever I do I want to do really well, I care about not so much about how I do, but how I show up in that event, this isn't just a job, this is like how I choose to spend my time, so it very important that my values are congruent and that I have the autonomy to create what energizes me in terms of working with clients.
P 5: Transcript 5.doc - 5:21 Codes: [Therapy attitudes, equality in relationship/mutual goal setting] [Therapy attitudes, relationship genuine as well as professional] [Therapy attitudes, responsibility-- tx vs. client] The biggest one is trying to interact with people the same way, no matter where I am. Whether it's at home, or church, or in therapy, I just try to be the same person wherever I am at, that takes some of the load off.
P 7: Transcript 7.doc - 7:6 Codes: [Therapy attitudes, relationship genuine as well as professional] I think I have a quality of being real. There’s not a lot of pretense to me, and I’m approachable. I think that is what they saw, as well as my dedication to be as much help not only to my clients, but to other people, giving them feedback
P 7: Transcript 7.doc - 7:22 Codes: [Therapy attitudes, intimacy, enjoys] [Therapy attitudes, relationship genuine as well as professional] Making that connection with clients, not as a patient and therapist, but on a very personal level, I look for that all the time. That is my joy.
P 8: transcript 8.doc - 8:24 Codes: [Personal characteristics, engagement, importance of] It’s hard to say, but I just know that when I was sort of active, if I was God, how would I create-I love being loving, and I love being engaging. Why, I don’t know, I just do. It’s just joyful.
P 8: transcript 8.doc - 8:52 Codes: [Therapy attitudes, relationship genuine as well as professional]
246 how is it that you interact with clients that makes up this thing I’m calling passionate commitment? Just loving them
P 9: Transcript 9.doc - 9:10 Codes: [Therapy attitudes, relationship genuine as well as professional] I try to be me. It's the information that I share, that I hope is about them, and not about me. I don't try to pose or act in a certain way, or pretend that I'm not feeling something when I really am. I usually tell them that I am, or try to reflect back to them in that very annoying way that some therapists do as if I never had an opinion about anything. If I have an opinion about things, I'll let them know right off the bat. One client I-- well, I didn't kick her out, but I was on the verge of it. She stomped out of my office when I refused to let her use the word "nigger". I just didn't want to hear it, it's ugly and not in my office. I'll take the therapeutic hit in that one and I did. She walked out and said I wouldn't let her express herself, which was true. And I won't, I'd reached my own line with that. But that's very very… I don't think it's happened again. But no, I don't try to hide behind any analytic façade. Where you are is where the client sits and I sit where I am. I like to sit facing them, I don't like an off-angle so eye contact can be avoided, and I like to see if we can relate for even fifty minutes.
P 9: Transcript 9.doc - 9:12 Codes: [Therapy attitudes, relationship genuine as well as professional] What I have learned in my little time doing this is that people want to be related to and taken seriously as human beings. They don't want--I wouldn't want-- my feeling in my training years, and here in my work, is they don't want a machine and they don't want someone who is going to "scrutinize" them. I don't want to ever be viewed as someone who scrutinizes. I want to viewed as someone who joins and listens to them, and takes them seriously. Because what they say is serious, and if they are bullshitting you , it doesn't matter, because the fantasy is just as valuable
P 9: Transcript 9.doc - 9:22 Codes: [Therapy attitudes, relationship genuine as well as professional] [Therapy attitudes, uniqueness of clients] You know, I did not want to see people as a lab rat or as a subject, I wanted to see them as human beings living their lives with whatever problems might come up, and what they did with that in the whole, them in the environment, them in their world. Not they as isolated bundles of psychic energy or symptomatology, or anything like that, so I chose social work specifically because I knew it was a route to becoming a therapist but it was a route through a different field, a different lense in looking at human beings.
P10: Transcript 10.doc - 10:22 Codes: [Therapy attitudes, relationship genuine as well as professional] I'm very much me with my clients. I'm very much me. I never see myself as the expert. I don't take that approach with my clients. I am not the expert. You know, you're the expert. You're inside your own skin. You know your own answers. We're going to work together and I'm going to help you find those answers, but they're your answers.
P10: Transcript 10.doc - 10:42
247 Codes: [Personal characteristics, engagement, importance of] I draw on the client's energy. If the client is in a meditative… I guess I'm more engaged and then I kind of morph into whatever mood they're in and act accordingly to where they are. I have clients who are very meditative and I do that when they're in that mode and I think that I really ….. um…. I draw on their energy when they come in and that's how I kind of color whatever I do.
P10: Transcript 10.doc - 10:46 Codes: [Personal characteristics, engagement, importance of] part of my therapy is I'm very ' in the moment' therapist so I'm not a lot in the past or a lot in the future
P11: Transcript 11.doc - 11:6 Codes: [Personal characteristics, engagement, importance of] You know, I don't know if it is, I know from interviewing therapists that the passion, I guess... it just seems that some people are so detached from it, they don't read, they don't study, they can't articulate their own theories, their own practice.
P11: Transcript 11.doc - 11:8 Codes: [Personal characteristics, engagement, importance of] [Personal characteristics, optimism/strength based] There's a detachment, and the burned out ones, usually you'll hear them talking negatively about their clients, I can't even imagine.
P11: Transcript 11.doc - 11:9 Codes: [Therapy attitudes, intimacy, enjoys] I think it's the relationship that gives energy to me, being able to connect up with another human being and to share of their world and to, I think that's what provides energy. I think that the relationship that you develop with somebody in therapy is most of the time, just incredible. It does, it produces your energy for the day and for the moment of the session, I think that is where the energy comes from.
P11: Transcript 11.doc - 11:14 Codes: [Therapy attitudes, intimacy, enjoys] I believe in evidence-based treatment and I like manualized approaches, I like that kind of stuff. I think it is a real balance between the two. The art is in the connection, the relationship, and using that as the basis.
P11: Transcript 11.doc - 11:22 Codes: [Personal characteristics, engagement, importance of] [Therapy attitudes, intimacy, enjoys] It's very interactive--very interactive. I'm trying to find a way to really listen, I'm trying to find something or some way to really fall in love with the client, or like the client or appreciate them. Sometimes I say that therapy is just liking somebody long enough until they get better. Finding a way to really like them, to really engage. I had a friend who was a therapist for years and he was retiring, he had been a therapist for thirty years. I talked about therapy being an intimate experience for me, and he just about bristled. I don't know what
248 he was thinking, but to me it is a very intimate very engaging relationship. To me, that's what makes it work. The other person, so many people we are working with have never had that, never had that foundation, never had that other person appreciate them. A woman I am working with right now, and I find it appropriate, at the end of the session she gives me a hug, and I think it is appropriate in the situation, but I don't think that has happening in ten year, three times. I don't do that, I keep that boundary clear, but for some reason this woman, and it seems appropriate to me, she said "Am I violating your boundaries?", and I said "no, I'm fine with it." But it's a very engaged…I don't sit back and be real clinical about it or…
P11: Transcript 11.doc - 11:30 Codes: [Personal characteristics, engagement, importance of] I've been trained in NLP, and in NLP there is toward and away from motivation. Away from is "if you don't get your paperwork done… toward motivation, I like that, you're moving toward something. When you ask why did you leave your last job, "I was looking for something new, a new experience…"
P11: Transcript 11.doc - 11:46 Codes: [Therapy attitudes, relationship genuine as well as professional] I had a friend who was a therapist for years and he was retiring, he had been a therapist for thirty years. I talked about therapy being an intimate experience for me, and he just about bristled. I don't know what he was thinking, but to me it is a very intimate very engaging relationship. To me, that's what makes it work. The other person, so many people we are working with have never had that, never had that foundation, never had that other person appreciate them. A woman I am working with right now, and I find it appropriate, at the end of the session she gives me a hug, and I think it is appropriate in the situation, but I don't think that has happening in ten year, three times. I don't do that, I keep that boundary clear, but for some reason this woman, and it seems appropriate to me, she said "Am I violating your boundaries?", and I said "no, I'm fine with it." But it's a very engaged…I don't sit back and be real clinical about it or…
P13: Transcript 13.doc - 13:4 Codes: [Active strategies, focus on work] [Therapy attitudes, relationship genuine as well as professional] I was in a high burnout job, so I don't think it is about longevity-- I think it is about enjoying what you do, and enjoying the people you are around, and not getting into the "he-said she- said" kind of stuff. Not worrying so much about the bureaucracy, kind of rolling with the punches, with yea, you know, you may not like it, but there's not a lot you can do to change that kind of stuff, that's just par for the course. I think too, they don't like who they work with, sometimes there is some negativity about the how people talk about their clients. With very few exceptions, I can honestly say I like all my clients--all the kids, all my families, you know, there are frustrating moments, but for the most part I like who I work with. I know my niche, too: It's not younger kids.
P13: Transcript 13.doc - 13:13 Codes: [Personal characteristics, optimism/strength based] [Therapy attitudes, relationship genuine as well as professional]
249 There are clients I like more than others, and I think it is good to have them longer, I have a relationship. But once I build a relationship, I like them all just the same. Because I see potential in every child who comes here and every family that comes here.
P13: Transcript 13.doc - 13:14 Codes: [Personal characteristics, engagement, importance of] [Therapy attitudes, relationship genuine as well as professional] It is a genuine emotion. I play with the kids, I get down on the floor, I use humor a lot, joke around with the kids, and joke around with the family. (Names supervisor) once told me it is about the relationship; it's not about the knowledge that you have, so I really took that to heart. So I have fun with my families. When it comes to business, we get down to it and we do what we need to do. Sometimes we are just talking, and it has nothing to do with therapy, which is about getting to know them. Not that I divulge a great deal of personal information, but it is just, what do they like, what do they not like, what do they do, and try to work on that. I'm a kid myself, in so many ways; I'm an adult with a kid's frame of mind. I know the latest music; I can talk to them about things on their own level. Parents and I will laugh about how we feel, because they don't even know what Gilligan's Island is, but we have a good time that way. There is this one mother, and we do that a lot, and we will start laughing, and that is an icebreaker, just to have fun. Even when we are having fun, I can ask them questions and they will talk to me. My supervisor would probably say, and I think he's probably right, that sometimes my engagement, although it works, may be too fast paced. He is going to work with me on that.
P13: Transcript 13.doc - 13:15 Codes: [Personal characteristics, engagement, importance of] Like with that little boy with PDD, I think both. We taught him some skills, we went into the school and talked with them, it is multi-facial, relationships help. If they know I'm there, I'm not going to judge them, they know that I'm not going to take sides, I don't side with the parents, I don't do that, and I'm very up-front with that, and I try to keep that very balanced. It takes everybody, and it takes learning skills, but knowing there is one person in their corner, helps them. Working with the school to understand mental health issues. Because they don't understand mental health issues. They just think because they have a concentration problem, it's all ADHD. That turns kids around, too, because they have a chance. It levels the playing field, so they have the same chance as everybody else to make it, and graduate from high school, and go on to bigger and better things. I always tell them, "When you are rich and famous, don't forget us little guys." There is a genuine, "I want you too succeed, and the sky is the limit, and just because you have a mental health problem, doesn't mean that you can't make it out there." I never let anyone use "I have a mental health issue as an excuse. ADHD, good for you. To learn and understand what it means to have Aspergers or Bipolar, or whatever that means, to educate the kids too. It means, because I have this, I have to use other skills to grow, and move on.
P13: Transcript 13.doc - 13:23 Codes: [Personal characteristics, engagement, importance of] How are you at handling anger, conflict, or crisis in the room--is that difficult for you to deal with?
250 I think it heightens it-- and this is what (supervisor) and I have been working on, because I tend to run at a fairly high pace. It heightens it in a way that is energizing…? Yes, but also in a way that is detrimental, because I jump. Rather than, "here's the problem, let's back up…" I move into the problem solving way too quickly, instead of "let's look at the moment", and that is my biggest problem, because I move at a very high pace. I also think that is what keeps me passionate, is that I move at a high pace, and I'm constantly moving. They joke about it here. I think I am able to laugh at myself. I know I am not the end all and be all to these families-- they have made it before without me, and they will again. I just hope that my influence will be that one little thing of knowing that someone in their lives cared about them. Sometimes that is all that it takes-- for the kids that have lived in the ghettos, and the barrios, all it took was one person. And all of a sudden, they do great things. If I can be that one person, wonderful. That they remember when they are eighteen or nineteen and getting out on their own.
P13: Transcript 13.doc - 13:24 Codes: [Personal characteristics, fit] [Therapy attitudes, relationship genuine as well as professional] A lot of it has to do with fit-- because you have to build a relationship. Without a relationship, you don't have anything, you could have all the skills in the world and nobody is going to listen to you. I think it is probably 70-75% is fit. So that fit is that you are good at forming relationships and maybe, also that you have a real high need for relationships to be part of the therapy? Absolutely. That you can feel some genuine concern. And the thing with kids is they know when you care. When I'm watching a kid, I can tell when I've lost them. You can see it in you are going way off the deep end, or if I'm too engaged with the parent, and the kid is just looking around, and doing his thing, I can see that and pull him back in. And the only way you do that is by having a relationship; it's not a skill.
P13: Transcript 13.doc - 13:25 Codes: [Therapy attitudes, relationship genuine as well as professional] [Therapy attitudes, responsibility-- tx vs. client] Absolutely. The longest client I have has been here all the three years I have been here. And she says, "You know me too well." But she is moving on; she is ready to do her own thing. And that was about the relationship, not skills that I had. Because it wasn't anything that I did. It was her ability to see, and her Mom's ability to see what she needed. That's the skill-- I'm the eyes that see it, now you have to see it. I think skill has very little to do with it.
P13: Transcript 13.doc - 13:26 Codes: [Therapy attitudes, relationship genuine as well as professional] No-- I think it is just a genuineness. Regardless of the stories that you hear about people's lives, the narratives that they come in with, to be able to allow them to tell their stories.
P13: Transcript 13.doc - 13:30 Codes: [Therapy attitudes, relationship genuine as well as professional] It's good to have that "Let's go change the world" but how you promote that in your own life is your capability of forming relationships, and enjoying those relationships.
251 P14: Transcript 12.doc - 14:4 Codes: [Personal characteristics, helping profession.] [Therapy attitudes, intimacy, enjoys] I really do like being around people, I don't like selling things. Well, that's not really true, I do like selling my opinion a lot. But the thing that really clicks is the whole interaction, and seeing change and becoming involved in this relationship, that is a funny relationship, in that it is not a friendship, but it really is an intimate relationship, and I like that, and it's doing something that is helping them improve their life. I do believe that part of what clicks for me is the sense of helping them, that I'm making the world a better place, it sounds corny, but it really does feel like that. Like I'm not just out there trying to market something that won't better someone's life, you know, the latest VCR or DVD or whatever, it's not like a marketing technology.
P14: Transcript 12.doc - 14:5 Codes: [Therapy attitudes, intimacy, enjoys] [Therapy attitudes, spirituality] That is an interesting piece. At one point, I worried that I was filling up a social void, and that it was meeting a social need, and I had done some therapy around that, because I was worried about it. As I've kind of grown and looked more in depth at it, I think the piece that clicks in me is more of a-- I don't know who to describe it-- a universal connection. I think it-- it sounds kind of religious, and it does fit into that-- it's a spiritual piece of being connected to the world at large, and this is a way for me to connect with as much of the world as I can in a caring way. It's the spiritual piece that clicks for me. I'd have to go into more of my religious beliefs to expand on that.
P14: Transcript 12.doc - 14:24 Codes: [Personal characteristics, fit] [Therapy attitudes, relationship genuine as well as professional] Perhaps another thing that I do, and I don't know where I picked that up, but I have a really strong ability to remember what they have talked about. So somebody says, "you remember so-and-so, and remember how I was having…" and I can recount some of that situation. I think it says, "yea, you really are paying attention." Because it is almost like I can replay their life. Very often I get feedback, "how do you remember that stuff about me?" I think that is one of those natural fits, one of those things that makes it work for them and more enjoyable for them, in that I really do enjoy that connection.
P14: Transcript 12.doc - 14:25 Codes: [Therapy attitudes, intimacy, enjoys] Very often I get feedback, "how do you remember that stuff about me?" I think that is one of those natural fits, one of those things that makes it work for them and more enjoyable for them, in that I really do enjoy that connection.
P15: Transcript 14.doc - 15:4 Codes: [Therapy attitudes, intimacy, enjoys] I got my bachelors in Michigan in special ed for emotionally disturbed, and then I taught school for a year, and found that isn't what I wanted to do. The teaching got in the way of the relationship and I wanted to do stuff with the kids, not teach them math and reading.
P15: Transcript 14.doc - 15:20
252 Codes: [Personal characteristics, engagement, importance of] [Therapy attitudes, relationship genuine as well as professional] But I would say I'm a really active therapist, real engaged, I rarely see a kid by himself or herself. I usually have a parent in here, and we are working together, or we are doing play therapy with a child with the parent as a witness, trying to engage them and help them join in the play. It's very clear to me that I'm going to be gone, and the kid needs to have that primary relationship with the parent, and have them as a confidante. I have, as a reference, for kids four or five on up, kind of a way I generally operate. When they come in, I have these feelings posters up on the wall. I have them sit down in the feelings chair, and we have them look at the feelings chart, and they point out some feelings that they've had this week, at least three feelings they've had and if the parent is there they will help. And if they say I'm happy or I haven't had any feelings then I will engage the parent, "Can you think of some times?" Or "So and so said he was happy all week. Did he feel happy all week?" Or I'll say "What about last night when your Mom said it was time for bed, or time to do your homework?" So I'll elicit feelings, and there again, depending on the age of the kid. With older kids I will often do kind of a work session, catch up if we've done a behavior chart or talk about problems, and kind of see how that is going, we'll do some work or talking and then as a reward for working hard or talking they get to choose a game, and we'll play something all together. Sometimes if kids aren't able to, or just can't sit still, where it doesn't feel right, I'll do, especially with older kids, where we take turns picking games. I'll do the feelings game, or the mad/sad game, or the talking/feeling/doing game, or I'll use my feelings blocks or something that's kind of therapy, then you pick a game, and we'll take turns. I've got my feelings ball that the kids like a lot. The purple one is one that a student made me years ago. We just bounce it back and forth and read the statement and fill in the blanks. I do this a lot with kids and whole families. One day, this turned up missing and one family was so upset, they said, "Where's your feelings ball?" And later they came in with this big blue ball, and they were so excited, they said, "We're going to make a new feelings ball." And we passed it around, and they took turns writing things on it and everybody got to help, so now I have two feelings balls. It's fun, that's the neat thing about working with kids of all ages, is every session is different. It's not just sitting and talking with an adult, which I think would be real boring.
P15: Transcript 14.doc - 15:30 Codes: [Personal characteristics, engagement, importance of] I would say overall, I'm pretty active, I'm not the kind to sit back and say, "Uh hum, uh hum," I'm pretty engaged.
P15: Transcript 14.doc - 15:36 Codes: [Personal characteristics, engagement, importance of] I sort of worry about people who come in-- not so much with kids therapists, kids therapists tend to come in with this energy, but with adults, "I'm really interested in understanding people, and figuring out what makes people tick," and it's (makes snoring sound.) I don't know that that is it.
P16: Transcript 15.doc - 16:24 Codes: [Therapy attitudes, intimacy, enjoys] [Therapy attitudes, relationship genuine as well as professional]
253 There's definitely professional boundaries that are necessary, but at the same time there is a level of intimacy that occurs between a therapist and their client.
P16: Transcript 15.doc - 16:26 Codes: [Therapy attitudes, relationship genuine as well as professional] Especially when I work with such a continuum of reactive attachment disordered children to kind of the budding borderline adolescent to the full blown borderline personality disorder, and attachment is such an issue when it comes to treatment and successful treatment that if I'm going to expect them to trust me, I have to show them that I trust them as well. I hope that made sense.
P16: Transcript 15.doc - 16:33 Codes: [Personal characteristics, engagement, importance of] I have to do a lot of milieu therapy in talking to foster parents, talking to the kids outside of the office, working on actual behavior changes at the home. When it comes to milieu therapy here, making outreach calls to clients, that you can't bill for, insuring that the client, not necessarily case management, because that's not the therapist's role, but that kind of thing provides for success. Doing coaching of skills, especially DBT, being available to the client, if they're ready to work but they need some ideas, being available to do coaching for the client, but at the same time I think because we as passionately committed psychotherapists get into that, our opportunities for learning kind of dissipate.
Code Family: Transcendence: Locating significance of Psychotherapy Within Communal Responsibility
Codes (4): [Personal characteristics, family values] [Personal characteristics, helping profession.] [Therapy attitudes, responsibility, accepts high level of personal] [Therapy attitudes, significance of role] Quotation(s): 41
P 1: Transcript 1.doc - 1:3 Codes: [Personal characteristics, helping profession.] desire to do that, it’s helping.
P 1: Transcript 1.doc - 1:13 Codes: [Personal characteristics, family values] I grew up Christian, a Christian household in the LDS church-very devout Mormon-- not the kind that you might live around up in Alpine. I think I’m more of a liberal. The humanistic ethic, if a person…the church whether it can be criticized in some ways or not they’ve done a good job as do most religions in general whether it be eastern religions they promote a humanistic ethic which says to help other people is good ,to serve other people is noble, it is a substantive pursuit.
P 1: Transcript 1.doc - 1:14 Codes: [Personal characteristics, helping profession.] helping profession.
P 1: Transcript 1.doc - 1:16
254 Codes: [Personal characteristics, helping profession.] position to help
P 1: Transcript 1.doc - 1:17 Codes: [Personal characteristics, helping profession.] helping profession.
P 1: Transcript 1.doc - 1:18 Codes: [Personal characteristics, helping profession.] helping.
P 1: Transcript 1.doc - 1:19 Codes: [Personal characteristics, helping profession.] to help other people is good
P 1: Transcript 1.doc - 1:20 Codes: [Personal characteristics, helping profession.] serving other people.
P 1: Transcript 1.doc - 1:29 Codes: [Personal characteristics, helping profession.] There are few professions I think where you can help people in as substantive a way.
P 1: Transcript 1.doc - 1:37 Codes: [Personal characteristics, helping profession.] To be a healer means to help someone in some substantive way, hopefully a profound way,
P 1: Transcript 1.doc - 1:39 Codes: [Personal characteristics, helping profession.] it ‘s just a very very vital exercise, two people coming together and one was the healer and the other is sort of the healee, and you could do the same. We could each recount clients with whom it’s particularly gratifying.
P 1: Transcript 1.doc - 1:48 Codes: [Personal characteristics, enhanced feeling for disenfranchised] [Therapy attitudes, significance of role] On the statue of Liberty it says “Bring me your tired, your poor, the huddled masses. And you can sometimes judge a society by how well it deals with its weakest members. And sop usually those that struggle the most to work at improving, are those that struggle the most and are really the most vulnerable psychologically and have the most the most vulnerable and the least capable. It’s not…I’ve tried to encourage a certain pathos, and regard for them that they would probably do more if they could. They have a certain brain capacity and their chemistry, and upbringing that has put them at a disadvantage, so I guess having a compassion and an understanding and having a certain tolerance that this is the best they can do and they don’t get people that listen carefully and they don’t get a lot of support from other that they value at least on my good days I use that to help me
255 P 1: Transcript 1.doc - 1:57 Codes: [Personal characteristics, family values] and I sort of made that decision after I had been a full-time missionary, if I didn’t have that humanistic ethic, I don’t think I would have been a therapist,
P 2: Transcript 2.doc - 2:3 Codes: [Personal characteristics, helping profession.] I thought I could do social work and kind of get what I want to do, what would be meaningful to me out of that career.
P 2: Transcript 2.doc - 2:9 Codes: [Personal characteristics, helping profession.] something that is meaningful for me,
P 2: Transcript 2.doc - 2:34 Codes: [Therapy attitudes, significance of role] especially in a small town is my husband and I got really intimate with the community quickly, you know we’ve only been here almost 7 years, and I have kids come up to me all the time and say, ‘remember when I was in first grade, and I say no I didn’t move her until you were in the 7th grade, and they’re like ‘no, you’ve always been here” parents will do that to me too, they’ll say do you remember coming to my kids kindergarten graduation? And I’ll say no, your child was in the fourth grade. It’s been really nice, there hasn’t been this kind of I know all the people experience, like you’re not locals until you’ve been here for a hundred years, or whatever. It feels like we got embraced really really quickly. And that feels so nice to be in a small town like Moab and to feel like part of the community. In a real way. That’s really nice for us, but I think , I think what you need also, and this is the ego gratifying part is that you can make more of an impact in a small town, or you can feel your impact more
P 2: Transcript 2.doc - 2:40 Codes: [Therapy attitudes, intimacy, enjoys] [Therapy attitudes, signficance of role] So I think the interconnectedness is… you know I’ve spent half my career here in a small town, and I really get attached in a way you don’t in the city. I see these people at City Market, I see them at the library I see these people at the movies. It’s not that my clients live in one part of town and I live in another. It’s not that I see them once a week and it’s very isolated. I know their grandmothers, and I see their aunts and uncles passed out on the lawn drunk on the weekend. I see the living/waling genogram every day. There’s an intimacy.
P 2: Transcript 2.doc - 2:42 Codes: [Therapy attitudes, responsibility, accepts high level of personal] But even though I know this, my first thought was that this was my fault. Kind of …I should have known, I need to quit, I’m missing things. And then the next week when I got a call saying that a 13 year old had killed himself at Grand Oasis I have a 13 year old that I work with at Grand Oasis and I turned to my husband and said if it’s my client I’ll be tendering my resignation when I get home. I will not do this anymore. It really took a lot of reassurance from colleagues really, from case managers, who just said, you’ve worked with how many people? And how many have killed themselves? So let’s keep this in perspective. It’s not like you’re doing any harm, like everybody’s killing themselves that you work with.
256 But there was definitely, I mean when I walked up to the door of that house because they wouldn’t say the name over the air, that if it was my client, I would have quit. It went to an ego thing. I would have thought if 2 of my clients have killed themselves in a month I’d quit.
P 2: Transcript 2.doc - 2:50 Codes: [Therapy attitudes, significance of role] I don’t have any people generally die on me. But I take my work really seriously. It’s really important to me.
P 2: Transcript 2.doc - 2:66 Codes: [Personal characteristics, helping profession.] My life is not hard work. But I think you still need to believe, and feel like you’re doing something meaningful.
P 3: transcript 3.doc - 3:4 Codes: [Therapy attitudes, signficance of role] went on a crusade, went on a mission
P 4: transcript 4.doc - 4:25 Codes: [Therapy attitudes, signficance of role] this is a profession where we are dealing with human beings and, I just show up different.
P 4: transcript 4.doc - 4:68 Codes: [Personal characteristics, family values] some of it could be the environment I grew up in, to be quite frank. My dad's in this field, and my mom was the director of a senior citizen's center, so I grew up around people that were pretty-- they both loved what they did., my mom did things just because, she was delightful and amazing. I think growing up in that environment where you did things not because you had to, but because you wanted to, that's how they live, that's how they still live.
P 5: Transcript 5.doc - 5:2 Codes: [Personal characteristics, helping profession.] I always wanted to do something with people, to work with people in some kind of helping field. I wasn't sure what that was for a while, and started out with my general education things in school, and just through looking around and checking out different majors and careers, kind of whittled it down to working with people in therapy. What was it that you found clicked for you when you started doing this? For a while, I thought about law and medicine and those things just didn't seem as personal. Therapy had more of a personal feel to it, and felt more like really helping. The aspect of helping with their relational or family or emotional situation appealed to me.
P 5: Transcript 5.doc - 5:37 Codes: [Personal characteristics, helping profession.] Again, one thing that comes to mind is that I just feel that I've always had a care, a concern, about people. I think that is mandatory for someone to be a passionately committed
257 psychotherapist, is just a general care for your fellow man, for people that are uncomfortable.
P 5: Transcript 5.doc - 5:38 Codes: [Personal characteristics, family values] Growing up, I come from a family of five brothers, I'm the oldest of five boys, there was lots of cousins, aunts, uncles. There's a religious belief for me about people and how we interact and are related. That's something that is hard to describe, that feeling in your stomach of seeing someone hurting or suffering or unhappy in life and a feeling of sad, that's an unfortunate situation for someone to be in, wanting another life that could be better.
P 7: Transcript 7.doc - 7:2 Codes: [Personal characteristics, family values] I think it was my Dad. My father was a professor at the School of Social Work for a number of years. I didn’t know him in the academic setting, I never did see him teach. I only knew him in private at home, and had a lot of respect for him and they way he conducted himself and treated people. I found as I aged, I didn’t pay any attention to it when I was small, there were people who respected him as much a I did, you know, students would drop by , and I could tell by the way they interacted with him that they thought very highly of him. I think that social work was taught from the time I was very small, even though I didn’t know a lot about it, I saw it in action.
P 7: Transcript 7.doc - 7:5 Codes: [Personal characteristics, helping profession.] Yea. I’m more dedicated to helping people, I think.
P 7: Transcript 7.doc - 7:14 Codes: [Therapy attitudes, signficance of role] I think one of the most rewarding experiences I’ve ever had is when I was sent to Enterprise and had to meet the needs of that little rural community. That is just such an interesting and diverse place, because the town of Enterprise has about 1400 people, I suppose, so it is small. It’s very closed, they don’t like outsiders. The person up there that recognized that they had mental health needs was a PA (Physician’s assistant) at the clinic, who was an outsider too. He came to us and said, “We really have a lot of people out here that need to be seen.” There’s also an area outside of Enterprise that they call “the Valley” it’s rural, there’s Newcastle, and have you ever been to Modina? It’s a little tiny railroad town that used to be big when the railroad was around. Now it’s a ghost town with four or five occupants, so it’s a funky little place. There are squatters out there; they can buy the land for a very cheap price. But the land has nothing on it, just rocks, a sage brush or two. So people can buy this land very cheap and go out there and literally put up plywood huts with no running water. The way the PA would find the mental health needs is they would come to him because they were sick and then he would call me and say, “I really think we should link you up with this person,”, so I would go out and see them. They are people who would live in these…I had one client who lived in a series of trailers, he had driven his old school bus out there when he was a hippie, parked it, it had all flat tires, and he had these trailers that he had picked up along the way that he used for different things. One was his bedroom, one
258 was his cooking trailer, one was the trailer where he raised rabbits, because that is what he lived on. The one I’m thinking about is the gal that was blatantly psychotic and she was a methamphetamine addict, and she had no teeth. Of course, out there they don’t have the ability to deal with drug and alcohol problems, and she didn’t have Medicaid, ever since she was a small child she had had crossed eyes, and had never known that they could be fixed. She had massive medical needs, and she was psychotic-running around naked on the desert. The police picked her up, wrapped her in a blanket, brought her into the clinic because she had lice and some other medical problems, and then they referred her to me. I hooked her up with Medicaid; she didn’t know anything about that. She was from Texas and some guy from Texas who brewed his own beer that she lived with was out there digging gold mine, literally. He was out there with a bucket and pick and was digging a shaft and was sure he was going to gold. The last time I saw her, I’m not the therapist up there anymore, she was wearing clothes she had just purchased from D.I. She had seen the dentist, and had partials now so that she could smile-she wouldn’t smile before-she was not psychotic anymore, she had made the connection between the methamphetamine abuse and the psychosis. She had had an operation to cut the muscles that made her eyes crossed, so she could actually see. She told me once that she could see out of both eyes, but she saw different things out of each eye. It’s not like us when we look at something and our brain connects those two images, so what she would do is deliberately ignore the one eye and look out the other one, which ever one she wanted to see. And she calls me up whenever she comes to town, “How are you?”
P 7: Transcript 7.doc - 7:34 Codes: [Personal characteristics, helping profession.] I think a lot of people in the profession are ego-driven. I think to be really successful in this, your ego as a therapist has to take a back seat. You have to put other people’s needs before your own.
P 8: transcript 8.doc - 8:4 Codes: [Personal characteristics, helping profession.] I always wanted to do therapy, and I wanted to be a therapist or doctor, but I was, nothing had clicked at that point,
P 8: transcript 8.doc - 8:54 Codes: [Therapy attitudes, signficance of role] [Therapy attitudes, sprituality] I think on some levels the “Jesus model” even though it was outside organized religion. But there was something inside that position that I think was fascinating, or I was so scared I was just saying “I don’t know which way to go, but give my mother’s its so important to us that you know Jesus as your savior, and so forth…” that they never saw what I’m seeing, but I was exposed to that literature, and as far as the Pearl of Precious Price, there is a way of seeing everything where everything gets transformed and I think I have gotten a glimpse of, and look forward to being even more a part of my life and something that can, you know, continue to grow.
P 9: Transcript 9.doc - 9:27 Codes: [Therapy attitudes, signficance of role]
259 I've never had the feeling that what I do is superfluous or we're just here because of the medicaid role, you know. People bring clients to me and say "Can you help this person?" and so that helps me understand that I"ve got a role here.
P 9: Transcript 9.doc - 9:51 Codes: [Personal characteristics, helping profession.] Private practice doesn't appeal to me. It never had when I got into this. Personally I consider it corrupt. There's a huge incentive to keep somebody sick. Here there is none of that. I feel very wanted by this group of people. I feel very very necessary to the group effort. I've never had the feeling that what I do is superfluous or we're just here because of the medicaid role, you know. People bring clients to me and say "Can you help this person?" and so that helps me understand that I"ve got a role here.
P11: Transcript 11.doc - 11:2 Codes: [Personal characteristics, doing other helping work before therapy] [Personal characteristics, helping profession.] Oh, gee… I can tell you the moment, actually. It was in the late sixties or 1970, I was in California. It was the hippie days, I was hanging out with a group of people, and of course there were drugs, and there were a couple of sixteen year old girls there who were in trouble, and I was trying to figure out where I was going to go in my life and it just dawned on me in that moment that that is what I was going to do. It took me quite a journey to get here, but that was actually the moment that I needed to do something. But there were years in between… I'd run into… I was a Vista volunteer for a while, so I did my work for four or five years on a bachelor's level, then I went off for a few years on a woodworking odyssey for sixteen years, but I always knew that I'd come back to do this. It was always in my plans to go back and get my Masters. There was just something about that moment that just defined what I wanted to be.
P11: Transcript 11.doc - 11:19 Codes: [Personal characteristics, helping profession.] Yea, even--it's funny, in ninth grade I took one of those career tests and social work came out at the bottom. Well, whatever. But I got halfway through a graduate degree, some psychology thing on a part-time basis when I was still working in the mid-eighties, and I stopped, and I said no-- I was going to do this my way. The other thing about it is that I am a social worker, I truly, we work with low-income, Medicaid population and I'm a social worker and I work with a social work population. I'm a social worker first and a therapist second. So even all during out woodworking career, every year we would build a roll top desk and donate it to some program that would donate money to help kids, so we did that every year, raised 3,4,5,6 thousand dollars every year for some organization that helped kids. You said something that piqued my interest when you said I'm a social worker first and therapist second, I interested if that is something that helps you working in the public community mental health system, do you think that those who put the psychotherapist first have a harder time? Yea, I think to work somewhere like this, you have to be able to see well beyond the realm of the therapy room to help people. You have to understand Maslow's hierarchy of needs, you've got to understand the kids are embedded in families and communities and you have to be able to see all of that to really be able to help them. To take a child into your room
260 week after week and work with them without this understanding has limited value, I think. I would more often be here with the family, talk to the school, change something in the community about how they react to this kid. So you have to have a social worker's view of things. We have psychologists here, but they are basically acting like social workers, maybe do a little bit of testing, but really act in a social worker role.
P11: Transcript 11.doc - 11:42 Codes: [Therapy attitudes, significance of role] I just have this real curiosity about who they are and how they got to be the way that they are, how they function, and in a larger sense, families just fascinate me, the system does, and in the larger sense, how they are embedded in the community. It's the same kind of thing; it's this intense curiosity. I think that people are so interesting, and really wonderful, they're just great.
P11: Transcript 11.doc - 11:44 Codes: [Personal characteristics, helping profession.] The other thing about it is that I am a social worker, I truly, we work with low-income, Medicaid population and I'm a social worker and I work with a social work population. I'm a social worker first and a therapist second. So even all during out woodworking career, every year we would build a roll top desk and donate it to some program that would donate money to help kids, so we did that every year, raised 3,4,5,6 thousand dollars every year for some organization that helped kids.
P11: Transcript 11.doc - 11:45 Codes: [Therapy attitudes, significance of role] You have to understand Maslow's hierarchy of needs, you've got to understand the kids are embedded in families and communities and you have to be able to see all of that to really be able to help them. To take a child into your room week after week and work with them without this understanding has limited value, I think. I would more often be here with the family, talk to the school, change something in the community about how they react to this kid. So you have to have a social worker's view of things. We have psychologists here, but they are basically acting like social workers, maybe do a little bit of testing, but really act in a social worker role.
P13: Transcript 13.doc - 13:32 Codes: [Personal characteristics, helping profession.] They taught me more than I taught them, about what having fun is, and what helping really means. About giving people their own lives, even with disabilities. That was the catalyst that made me want to do more, that's why I wanted to go to graduate school, I'd hit the plateau of what I could do, and in order to go on to the next level, I had to have my master's degree. That's why I choose social work--unlike psychology, that is just based on individual I wanted to do family and everything. I wanted to be able to look at the big picture, saw a lot of these individuals that were institutionalized, that if they had some family help, they probably wouldn't have ended up institutionalize. So that was the catalyst, I saw a real need for more family kind of help.
P14: Transcript 12.doc - 14:4
261 Codes: [Personal characteristics, helping profession.] [Therapy attitudes, intimacy, enjoys] I really do like being around people, I don't like selling things. Well, that's not really true, I do like selling my opinion a lot. But the thing that really clicks is the whole interaction, and seeing change and becoming involved in this relationship, that is a funny relationship, in that it is not a friendship, but it really is an intimate relationship, and I like that, and it's doing something that is helping them improve their life. I do believe that part of what clicks for me is the sense of helping them, that I'm making the world a better place, it sounds corny, but it really does feel like that. Like I'm not just out there trying to market something that won't better someone's life, you know, the latest VCR or DVD or whatever, it's not like a marketing technology.
Code Family: Transcendence: Recognition of Spiritual Nature of Therapy
Codes (1): [Therapy attitudes, spirituality] Quotation(s): 15
P 1: Transcript 1.doc - 1:23 Codes: [Therapy attitudes, spirituality] So many professions are about making money for your family, and getting people to buy your products and that’s profession. Psychological, our psyche, our psychological functioning, is almost at the core of who we are.
P 4: transcript 4.doc - 4:75 Codes: [Therapy attitudes, spirituality] I have children in my life, my brother's friend's children, I think they are instant renewal. I just, spiritually, do what I can to stay grounded that way. And that's just been a process, and it's really just been about the last year and a half that I've understood the need for that level of balance, and I do believe my work is a lot better now.
P 6: transcript 6.doc - 6:14 Codes: [Energy, energizers, esthetics] [Therapy attitudes, spirituality] Absolutely. I have a little hot tub I can sit in, and its really incredibly beautiful where I live, and you can look up and see more stars that you can imagine and sort of put my own trivial little concerns in perspective, and feel connected-- that is absolutely my spirituality. It's sort of an existential, transcendental blend of things, absolutely.
P 6: transcript 6.doc - 6:25 Codes: [Therapy attitudes, spirituality] That was somewhat spiritual because I could go to Mexico and re-prioritize what was important and what wasn't. Because here were people who didn't have a lot of money, didn't have a lot of things, yet they could be happy. I think when I was stressed out just to go and be in that different kind of environment to get away and in a spiritual sense to appreciate the transitory nature of us and the stuff that was stressing me helped me to let go of that.
P 6: transcript 6.doc - 6:42 Codes: [Therapy attitudes, spirituality]
262 I'm not dogmatically evangelical in any religious belief, but I draw a big distinction between religiosity and spirituality, and I consider myself highly spiritual and not religious.
P 8: transcript 8.doc - 8:10 Codes: [Therapy attitudes, spirituality] Shortly after that I went to college and studied biology and all this stuff, and I realized that the theology of religion is insane, as best I could see, I couldn’t see any sense in it. But being like Jesus-I quit praying, quit going to church, and so forth, but there’s something about this message of salvation, and if you believe you go to heaven when you die, and if you don’t, you go to hell, I thought, I don’t even want to have anything to do with that God. Being like what Jesus was like, being in an interpersonal situation and thinking, what would Jesus do here; it wouldn’t be unusual to try to go in that direction
P 8: transcript 8.doc - 8:12 Codes: [Therapy attitudes, spirituality] It’s like a religion in the sense that I can take all the religious concepts, view them totally differently than they do, but find they fit together. But it involves not believing anything, rather than believing anything. It’s a religion of not believing that gives you heaven here now.
P 8: transcript 8.doc - 8:13 Codes: [Therapy attitudes, spirituality] Have a metaphysic, where you see that there is just now, when your body dies your mind very likely is going to see it like it always was, you can just speed up the process and start seeing how neat it was, how much incredible love-life is rooted, and it all starts when you look for love, love comes running at you. When you look for judgment, fear comes running at you, so it’s your choice: fear or love, a judgment or a creative idea.
P 8: transcript 8.doc - 8:23 Codes: [Therapy attitudes, spirituality] if they don’t accept it in this life, they will see it when they die, their perception will possible be corrected, even for a few seconds and they will see, and they will all be okay.
P 8: transcript 8.doc - 8:46 Codes: [personal characteristics, curiosity] [Therapy attitudes, spirituality] I really love this study of what it means to be human, and this process of transformation and the possibility of joy, and love, and invulnerability
P 8: transcript 8.doc - 8:54 Codes: [Therapy attitudes, significance of role] [Therapy attitudes, spirituality] I think on some levels the “Jesus model” even though it was outside organized religion. But there was something inside that position that I think was fascinating, or I was so scared I was just saying “I don’t know which way to go, but give my mother’s its so important to us that you know Jesus as your savior, and so forth…” that they never saw what I’m seeing, but I was exposed to that literature, and as far as the Pearl of Precious Price, there is a way of seeing everything where everything gets transformed and I think I have gotten a glimpse of,
263 and look forward to being even more a part of my life and something that can, you know, continue to grow.
P 9: Transcript 9.doc - 9:4 Codes: [Therapy attitudes, spirituality] I still am amazed at the very un-namable things that happen in psychotherapy and the power that that relationship holds, and the very real almost trans-personal events that take place, I can't describe it better than that
P14: Transcript 12.doc - 14:5 Codes: [Therapy attitudes, intimacy, enjoys] [Therapy attitudes, spirituality] That is an interesting piece. At one point, I worried that I was filling up a social void, and that it was meeting a social need, and I had done some therapy around that, because I was worried about it. As I've kind of grown and looked more in depth at it, I think the piece that clicks in me is more of a-- I don't know who to describe it-- a universal connection. I think it-- it sounds kind of religious, and it does fit into that-- it's a spiritual piece of being connected to the world at large, and this is a way for me to connect with as much of the world as I can in a caring way. It's the spiritual piece that clicks for me. I'd have to go into more of my religious beliefs to expand on that.
P16: Transcript 15.doc - 16:9 Codes: [Therapy attitudes, spirituality] And the other piece is spiritually, I'm a very spiritual person, so I recognize for my clients to have success, they have to have balance as well, so I bring that aspect into my treatment.
P16: Transcript 15.doc - 16:10 Codes: [Therapy attitudes, spirituality] I look at, I have a belief that I have to do the footwork in life, but at the same time I come into connection with people for reasons that can't be answered. And knowing, recognizing, I feel like I have the ability to recognize when that very positive energy is going on in my session.
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