Practice Imperfect

This is our “lost episode” from Season 1 – it was so emotionally difficult for us to record that we couldn’t bring ourselves to edit it until we began to talk about recording Season 2 more than two years later! Props to Monica for gearing up to lean back in! Consider this: As beautiful and as life-affirming our work with clients can be, had you known that it could also inflict pain and hurt in the process, would you have still become a therapist? How do we make sense of this duality when we choose to empathically step into the client’s darkness and suffering with them? In The Pain Episode, our co-hosts Ian, Monica, and Bill confront what it means for us as therapists to take risks with our clients. Team PI examines our willingness to feel into the client’s difficult moments, their discomfort and their sadness, to vulnerably respond to their pain. Is there a point where you question whether you’ve gone too far in with your client, or to the contrary, what fears emerge to avoid risk in the work? How much of our own story of pain and suffering affects our decisions in the room? Either way, the clinical relationship with your client is affected. As our discussion progresses, we ask what purpose pain serves us as humans? Why does pain exist? We take a deeper dive into the mucky unknown, and discuss how leaning into the discomfort of our clients’ pain is a natural and unavoidable opportunity to be with our own pain and suffering. Team PI wrestles with the risk we take to embrace the client in their vulnerability, their brokenness, and our sustaining emotional injury in the process. If we routinely protect ourselves in our work, how well do we get to really know our client? The courage it takes to open up to our own wounds, with the intent to effect lasting change for the client comes along with risk. It is often in this moment that we remember how and why we do this work in the first place. We invite you to lean in for a vulnerable share of how sitting in the dark with a client’s pain can make us confront our own, and how therapists need to navigate through their own life experiences in the process. It’s unlikely you’ll need tissues for this episode. Co-host Bill could use a few for his audibly evident head cold though.

We wrote and recorded this mini episode to provide a little encouragement during the harrowing uncertainty of the covid-19 outbreak. Recorded on phones in people's homes by our generous guests from Season 1: Audrey Mayer LCSW, Barbara Pfingst MA Spiritual Guidance, Bonna Horovitz LCSW, Elora Kalish LCSW & Michelle Gardiner LCSW And our hosts, Monica Griffin, Bill DeSiena and Ian Laidlaw Featuring music by Like Trees

In this final episode of Season 1, we go out as we came in. Ian shares one of his life regrets in a moving and vulnerable podcast letter to a friend and reflects on fear, hope, love, friendship and failure. But also in the hope of bringing our shame into the light and creating space and community through that process. Like the best of our work as therapists. If you have been encouraged by our show, please consider helping us to develop Season 2 by donating to our GoFundMe campaign (search for "Practice Imperfect"). Any donations over $100 get a Practice Imperfect Tote Bag as a gift! And also our eternal gratitude. Supporters will also be listed on our website (unless you'd prefer to remain anonymous).

Have you ever had a client ask you to reveal your particular faith or religious practice as a condition of continuing to work together? How do we as therapists navigate the awkward moment when the client makes a demand to disclose our personal beliefs? In our latest unrehearsed role play, our therapist (played by Barbara Pfingst) keeps that ball of contemplation aloft with client “Jean” (played by Bill DeSiena), when this uncomfortable question invites self-disclosure of religious values and morals. Our client enters this session wrestling with their sister’s recent nonconforming behavior and distancing from a shared religious community, and whether it’s ok not to have a relationship with the sister because of it. What develops in session is our client considering whether other important relationships should be renegotiated, or even ended – including the reveal that the deepening relationship with therapist Barbara is on the chopping block too, should she either choose to withhold this information, or reveal values incompatible with Jean’s. In Episode 18, we watch the unfolding angst between therapist and client, and we sense that yielding to the demand for self-disclosure is precarious at best. Our client effectively hangs in with an inner conflict of how their tenets of faith and moral compass should affect decisions about whom they love and connect with. We witness our therapist working cautiously to just be with the client, without succumbing to the client’s wishes. In the aftermath, Barbara de-roles and reveals how her own inner struggle with worthiness affected her as the therapist, while Bill as himself shares how his own past experience with dogmatic faith and codependency impacted the role of client Jean. We invite you to share with the PI community how you’ve dealt with faith-based values when they’ve entered the room with your client.

Our discussion about love in psychotherapy continues: How do we convey our affection for the client sitting across from us, without crossing the line of impropriety? Psychotherapy will most naturally invite a reenactment of patterns in a person’s life, between client and therapist. When we can with intention do something in the clinical relationship to break that reenactment, to invite a chance for repair and healing in, is it ok to tell our client that we really like, even love them? If you’re looking for a light and fluffy topic right now, this is not the episode for you. Head to the kitchen and make an omelet instead. In Part 2 of the Love Episode, we dive deeper into what it means when we genuinely care about our client, when the affection we feel is mutual. The potential for powerful healing is there, side-by-side with the fear that we risk mucking things up in this clinical setting. When a person isolating in extreme emotional pain sits across from us, beckoning for an external answer to finding happiness again, it is our capacity as a loving being who can show up to simply walk with them in their pain, as an act of love, reaffirming the power of human connection. What can bring comfort in the moment is not the path out, but the companionship that a therapist can provide when there seems to be nowhere else to go. Team PI discusses our own vulnerability in the therapist setting, what happens after we affectionately open up to a client that they matter to us, and muse on whether insurance companies could measure love as an evidenced-based tool – and what our progress notes would be like if they did. And by the way, we want you to know that we love you…our listeners.

Have you ever told a client how much you like them? How you think you could be friends outside of a session, and maybe meet one day for a cup of coffee? Maybe even how you actually have feelings for them? Okay – stop the soft (or creepy) background music. We’re not talking about romantic feelings. But why and how we choose to show a client that we genuinely care for them, when doing so doesn’t disrupt their process and instead deepens it, is at the heart of this episode, Love in Psychotherapy. As professionals, we’re trained to maintain healthy boundaries, to hold back from displays of open affection toward clients, because to do otherwise could cause harm to them. We consider every client as an individual with unique challenges, yet the more common human thread for all surrounds the interpersonal issues we face. When taking a calculated risk in session to push that boundary, to offer a hug, to share words of affection, the clinical relationship can become a healing, even powerful experience for both therapist and client. It may be one of the few places for those we serve where it feels safe to just receive, devoid of some sticky obligation that doesn’t feel genuine. Our Practice Imperfect hosts discuss the riveting climax in the classic film Ordinary People, and how effective psychiatrist Dr. Berger softened the boundaries with his client Conrad in crisis to achieve an incredible breakthrough. Yes, this is Hollywood; also yes, components of their deeper relationship seem very real to our work. Team PI asks why it can feel weird after we ourselves become vulnerable with a client, and whether our own attachment styles come into play. Take a listen and also learn why Ian, Monica and Bill will not be going to the Oscars this year.

In Part 2 of our interview, guests Danielle Capra LMSW and Brian Figueroa LPC dive deeper to find peace with the notion that psychotherapy can both improve the client’s experience in the world and be self-serving to the clinician. Brian talks about how he sees our work as an art form, where the work becomes something greater than just him, yet feels personally empowering – that he can help to make a change in someone else’s world. Danielle acknowledges her own suffering and the chance for healing that comes up in session for us as therapists, along with the opportunity to help a client channel their pain into something else, which may teach them to do the same for someone they love. What are the moments we fear most that could happen when sitting across from a client? Our two psychotherapists share their worst nightmares: when the parent of an adolescent client interrupts to say that you don’t know what you’re doing (aka “you suck!”) and storms out, or when someone becomes physically intimidating. We usually choose to carry on with our work, with the courage to be vulnerable, while cautious in our decision whether to self-disclose or yield to a client’s expressed need for a hug. Our clients teach us much, our guests acknowledge. At the end of our professional day or night, it’s up to us to take care of ourselves, to get what we need to go back in and do this work again.

When have you found yourself thinking, “Who am I to be sitting with this person who has experienced life as I haven’t”? How do we navigate that fine line where we acknowledge our cultural differences, our positionality, all while making efforts to join our client, intending to meet them where they are? In this recent interview, co-host Monica sits down with two psychotherapists, Danielle Capra, LMSW, and Brian Figueroa, LPC, as they take on some awkward moments such as how it feels to explore with a client’s parent how to be a more supportive parent - when it’s apparent you’re not a parent yourself. In Part 1, our guests discuss how to handle that feeling of inadequacy when being sized up based on our differences, such as being half the age of our client’s parents, or whether we can relate to a military veteran when we’ve never had their experience. We explore how our decision to self-disclose must add value to the client’s work. To what degree does the specific population (e.g. teens or adults) and setting (e.g. outpatient or residential treatment) impact the appropriateness and level of our disclosure as therapists? In the end, our professional training allows our skills to do the talking and our humanness invites our own vulnerability and soft belly into the room, where we can find the words to say, “I’m just here to help”.

In our latest unrehearsed role play, our client “Jo” (played by Barbara Pfingst) becomes upset when our therapist (played by Bill DeSiena) effectively rejects the client’s premise that their physical symptoms, still undiagnosable, are medically related. When the evidence this client discloses in session suggests otherwise, the therapist encourages Jo to be open to explore psychological causes such as possible childhood trauma. And then the fun begins. In this episode, we witness a therapist’s challenge to avoid aligning with the client, who so desperately craves that support, without creating an irreversible rift in the relationship already built between them. For our client Jo, the therapist’s action of non-aligning quickly becomes a black-and-white scenario: if you’re not with me, you’re betraying me! How have you as therapists handled delicate moments like these? Our role play therapist works cautiously to acknowledge the rift that client Jo believes has occurred between them, while suggesting the possibility of another way forward in this relationship. And when we can’t resolve an impasse in the moment, what can we do to remain with our client in process work when sometimes both parties want to bail? Sit tight as Episode 13 unfolds.

Regardless of what we decide to consciously self-disclose, what parts of ourselves are sitting in the room when working with our clients? As therapists, we sit with another amazing human being, knowing that this practice and process is about them. Our professional training cautions us to discern what is appropriate to share of ourselves – so what do we do in session when our frightened 11-year-old child self has squished their way into our therapist seat? Clearly a symbiosis can exist in the work between us and our clients: we get our needs for validation met, we fulfill a desire to lift up another person in crisis and then we feel good about ourselves (ego alert!). And yes, as therapists we may even get to resolve issues in our own lives because of the process we enter into with our clients. In Part 2 of The Calling, our Practice Imperfect team dives deeper to pursue how our relationships with our own pasts can positively impact the work for clients. When we can bravely embrace our own vulnerability and shame, we can lean more effectively into the vulnerability of another and facilitate their courage to show up and disclose their darkest secrets. We debate in this episode whether our own needs have a place in session. What if we as therapists accept the idea that part of this work is self-serving? Listen to find out how a taxi ride in Okinawa changed Ian’s life, what Monica’s name means in Latin, and how Bill went from reading architectural drawings to creating genograms.