- There seems to be so much mysticism
around therapists and therapy in general.
Many people feeling like therapists themselves
are really elusive, and we don't really know what they do.
They're almost like the wizard of Oz
hiding behind a curtain, pulling levers,
making things happen, seems so secret and so magical.
But the truth about therapists, obviously, I am one,
we're just regular people just like you.
We have good days, we have bad days.
Some of us are good at our jobs, others really suck.
Some of us work extremely long hours
and see a ton of patients, others are very specific,
and only see a certain type of struggle in their patients.
Either way, today's video is all about what we think,
and what goes on behind the scenes.
You seem to want to know, so let's get into it.
There are so many new people on the channel.
Welcome, welcome, welcome to the community.
Make sure you're subscribed,
and you have your notifications turned on
because I put out videos every Monday and Thursday,
and I don't want you to miss out.
But let's just jump into today's topic.
(hip-hop instrumental music)
Now, the first question that I want to address is,
what do we do between patients?
Many of you have asked me this.
Why is it a 50 minute hour instead of an hour long?
What is with that 10 minutes?
Why do I pay for an hour, and I only get 50 minutes?
I hear that all the time, and the truth about it is,
A, we don't run like trains, we're not always on schedule.
People don't show up on time, we can't just, you know,
let's say our appointment's at 1:00,
at 1:50 I can't be like, "Okay, well,
"that's it, time to get out."
That's kind of rude, it's really hard,
sometimes we're wrapping things up.
Sometimes we're talking about homework.
Sometimes we're trying to gather ourselves,
so that we can leave without crying.
In therapy, it doesn't just run
on this strict schedule, so those 10 minutes gives us
a little buffer to wrap things up, take payment,
write the notes that we need to write.
Maybe eat, maybe pee because, you know,
we're human, fill up our water, get more coffee.
I might also have to make a call to your psychiatrist
or other treatment team members to keep them
up to date on what's going on with you. (breathes deeply)
There's a lot to do in that 10 minutes, and frankly,
to be quite honest, I never get it all done.
I'm always, like, ending sessions,
let's say I'm finishing all of my clients by like 6:00 PM.
There's always at least an hour afterwards
we're I'm finishing up my notes,
making sure superbills are going out, making sure calls
are getting made, emails returned, et cetera.
Because I don't have an office manager,
most therapists don't, it's just me.
So when I'm all done I have to catch up
on all those things that didn't get done
in those 10 minutes because trust me
they go by like pew. (snaps fingers)
The second, and most asked question is,
what do therapists really think during session?
And it kind of makes me laugh because I don't even know
if even as a therapist I know what my therapist
is thinking because everyone's gonna be different.
But I'll give you kind of a rough idea
of what's going through our head session after session.
As I'm sure you've realized, or I hope now you'll realize,
we as therapists because we're outside of a situation,
and we're not emotionally involved in it,
we realize so many things way before our patients do.
You know that shitty relationship you're in
that you just can't figure out why it doesn't work?
We probably already know.
We've realized it, we also hate
that relationship, wish you'd get out of it,
and try to help you find your way there.
We may also recognize the "hey, the way
"that you're responding seems a lot like your mom,
"and that's tied into the fact that your dad was this way,
"and then your uncle did this."
We see a lot of that way before you do.
And what that really means is,
and this is why I actually love being a therapist,
is instead of getting frustrated,
because a bad therapist would get frustrated,
and they would try to push you to that objective,
or to that realization more quickly than you're ready.
But a good therapist, and what I hope I am
is a good therapist, is we're kind of patient with it.
And I see it kind of like I'm a detective.
Or, and this sounds really weird
to say it this way, but maybe I'm like the criminal,
and I'm leaving clues behind so that you can find
all the evidence you need to guide you back
to what I already know, and what I've figured out.
And, of course, you're gonna do that at your own time.
So it's kind of up to me to make sure
that I'm leaving all the proper evidence to get you there.
But, yeah, we realize a lot of stuff way ahead of time,
and we're just kind of waiting for you to catch up.
We also notice everything.
Do you make eye contact, do you?
Do you struggle to make eye contact?
Do you fidget a lot, do you pick
at your nails, do you flap your foot around?
Do you like to lay on the couch
6and put your hand over your face.
Do you like to sit on the very edge of your seat.
I used to have this client that I can almost guarantee
that in the two years I saw her,
her back never touched the back of my couch.
She had an anxiety disorder, so it was very obvious.
But we have to notice all of that.
We have to notice all the fidgets,
all the things that happen, so that A,
I can tell if my diagnosis is really correct.
B, if you struggle with dissociation I can know
when you're going there, and when that's happening.
And C, I can also make sure the treatment
that you're getting, let's say you're
on medication as well, is it working?
Are the behavioral techniques
that I'm giving you making things better?
Are the fidgets, and the urge to move
all the time, is that stuff going away?
It can really help for me to pay attention.
So really, and I think Shawn also says this
to me a lot, I'd make a great detective.
Maybe that's why I like all those analogies.
But it's really helpful for me to pay attention.
So know that whether you like it
or not your therapist is noticing everything.
Moving on to the third question about
what therapists really do, is what the heck
do you write in all of those notes.
The truth is, and I've talked about this a little bit
in other videos, it's not very exciting stuff.
The first is diagnosis stuff.
What are the symptoms, what are kind of the things
that we're noticing, the behavioral things?
Are they fidgeting, do they move a lot?
Do they struggle to make eye contact,
did they dissociate, what is it?
All of that has to be documented.
That's usually done in our intake form,
where we're noting what brought you in,
what symptoms you're feeling, and all of that.
But throughout our notes, our progress notes
with you each and every session, there will be things noted
in there about your diagnosis to,
honestly, make sure it's correct.
The next thing that goes in our notes is logistical stuff.
Medication, when was your last
appointment with your psychiatrist?
What medications are you on, how much,
how often, are you liking it? Et cetera.
The next is, you know, when did you see your doctor last?
Did we get the bloodwork from that?
Did everything look really good?
Are we following up, did we make calls to them?
What about your weight?
I see a lot of eating disorder patients,
so I have to weigh them regularly.
I check in with their dietician, and we see if the weight
is the same, because people try to be sneaky,
and make themselves weigh more as a way
to say they're getting better when they're really not.
But we catch you, so all of that's really important.
I have to take note of that, so that I can kind of track it
through our treatment, and make sure that all of our goals,
and all of the, you know, tools, and tips,
and tricks I'm offering for you are actually helpful
and in line with where you're at.
On that same line then, runs into homework.
What are some of the things that we're working on?
Have they been completed or not, were you able to or not?
Are you committed to treatment or not?
A lot of that goes into our notes
because I have to know what I'm following up on.
In between sessions, I don't even think I mentioned this,
is that I read the last, you know,
maybe one or two session notes,
like all the progress notes I took
so that I make sure I remember where we were at,
what we were talking about, and what homework you had
because I need to follow up on it to make sure
that it's getting done, and that it's appropriate.
Also, as a CBT and DBT based therapist,
I have a lot of treatment plans going on,
so in there are those treatment plans.
And I like to think of them as living,
breathing documents, meaning they change all the time.
So I may have a sheet on one side of my file.
I always have those, you know, files that open. Pew.
And on this side would be a treatment plan,
and I just mark on it.
As of the date we're doing this instead.
Done with that, check in that box, and I'm working along.
So I have to keep up with where we're at
and working towards the goals that you and I have discussed
to make sure that you're really getting out
of therapy what you need to get out of it.
Overall, notes are extremely dry.
They're not written like a story,
you can't follow along and feel like you know somebody.
It's more something that we do legally and ethically
to make sure that you're getting the proper care,
and that we're doing all the things we're supposed to do.
I don't recommend, as you remember
I've said this before, I don't recommend getting all
of your files and reading them through.
It can be really upsetting, really triggering,
and also, it can feel like a lot is left out,
because it is, we can't write everything down.
It's mainly just logistical stuff, like I said,
the medication, and what symptoms are you showing?
How are you doing, did you do your homework?
What's your weight, are you feeling better,
how's the treatment plan?
It's very, you know, kind of bullet-pointed.
So overall, the main reason notes even exist,
and the main reason we keep these is for legal
and ethical purposes, as well as to make it easier for you
to transition to other treatment programs,
or to get referrals to other professionals as needed.
And the fourth question that many
of you wanted me to talk about is,
do we think about our patients in between sessions?
And I'd be lying if I said no.
We're humans too, we care about you.
I didn't spend all this time in school,
and all that time gathering hours,
not to mention stressing over the licensing exam.
And then continuing to learn about what I want to do each
and every year, so that I can continue
to be licensed, just for shits and giggles.
I did it because I care about people.
And when I take a client on, I do it
because I feel that I can help them.
And I think together we can work towards their goals.
So, overall, of course I'm gonna think
about my clients in between sessions
because I'm looking for new ways to help them.
I want you to do well, I want you to feel better.
I want you to get better in the quickest
and easiest way possible.
So if I'm at a different conference,
let's say, learning about something,
and something pops up that I think could help my client,
of course, they're gonna be in the back of my mind always.
If I'm reading a book, and it's a tip that's helpful
to me personally, and I think, oh, I could probably apply
that to so-and-so, that might really help.
Or even if I'm watching a TV show,
and I see someone doing something,
And I think, oh, they could do that.
So, of course, it'd be a lie to say
that we don't think about patients in between sessions.
But that isn't to say that we're available all the time.
And I know that this seems like a strange transition,
but boundaries are so important.
If you see a therapist who lets you call,
and text them, and email them all the time,
and there's no boundaries, there's no talk
about what's appropriate and what's not, it's not okay.
Therapists are taught so much in school
to be very protective of that boundary
to keep you safe and to keep us safe.
The reason it keeps you safe is
it keeps the relationship therapeutic.
If we get too close it changes the dynamic,
and it becomes like a friendship,
which isn't actually as helpful because as you know,
if you've been in therapy for any length of time,
there are gonna be times when the therapist has to push you
a little, and give a little bit of that tough love.
And in a friendship it doesn't really workout.
And on the therapist side it protects us, boundaries
are important because it keeps us from burning out.
Overall, just know that therapists
are people too just like you.
The only difference is that you come
to see us, and we are trained
to help you, and guide you through things.
So know that everything that goes on between sessions,
and our mind during sessions, if we're good at our job,
and if we're invested, should be all
about helping you, all about moving you
towards your goals in the best way possible.
Just make sure that you like your therapist,
you feel connected to them,
and you know that they're on your side.
And that's truly when the magic
and mysticism of therapy can take place.
I hope you found this video helpful.
This was actually really fun to think about.
It took me a while to put the video together because
it's just something that I hadn't honestly thought of.
But let me know in the comments.
What are other things you want me to talk about?
Are there other subjects you want to know
what a therapist thinks, or what we do, or how it works?
Let me know, and I will see you next time, bye.