If you’re a therapist, ideally, you have access to intervention training and a good clinical supervisor. What if you don’t? Many new therapists, social workers, and other psychosocial professionals enter the field without concrete psychotherapy intervention training, and most without sufficient experience to know how to immediately implement it in every unique presenting situation. One may be an intern that is hopefully closely supervised and guided. Another may have earned an entire, relevant graduate degree without specifics on evidence-based psychotherapy practice included. There is hope, however, since this is where most of us started either way. Being a therapist may wrack your nerves at baseline.
Articles in the Therapy 101 series will focus on tips, tricks, and tools that can help get you started if you can’t get intervention training immediately and/or you can’t use clinical supervision to get you over the anxiety. What follows is only the beginning, and does not necessarily make you more qualified, magically clinically licensed, and does not offer specific intervention training.
Please note: This series is not intended to endorse practicing therapy without intervention training, licensure, or good clinical supervision, but rather empower social workers without the tools and resources to get needed training keep their therapy job, and get to the next, best practice step.
So where to start?
If you’re not new to providing therapy, imagine the last time a client said something that really threw you for a loop. You didn’t know what to say. You didn’t know what to do. Maybe you sputtered a bit. Maybe you were just silent. Maybe you communicated volumes with shocked nonverbal cues. Either way, you felt like there was a void or crisis you couldn’t adequately fill or resolve. If you are new to providing therapy, this may very well describe your day job! Congrats! It’s pretty exciting even with that semi-regular feeling of helplessness.
What is therapy anyway?
Therapy is generally defined in the dictionary as “medical treatment of disease”, but since you are probably a social worker or social work student, we will assume you are more likely to be curious about psychotherapy, which we will refer to simply as “therapy” for the rest of this article, and which the National Alliance on Mental Illness defines:
Psychotherapy, also known as “talk therapy,” is when a person speaks with a trained therapist in a safe and confidential environment to explore and understand feelings and behaviors and gain coping skills.
That could very easily be you with or without specific intervention training. If you have a Master of Social Work degree, you are trained in Human Behavior in the Social Environment and Social Work Practice, at the very least. That may be a little consolation to you as a new or inexperienced practitioner of therapy, so what do you do first when you don’t know what to do next?
Know Your ABCs
- A for Affect – How do you feel? What emotions are you experiencing?
- B for Behavior – What do you do? What actions do you take or have you taken?
- C for Cognition – What are your thoughts? What are you thinking?
These are the most core questions you will ask any client/consumer and once you connect them to a trigger/context, you’re one hop, skip and jump away from many forms of therapy. They can come in any order. In fact, many psychotherapy styles specifically focus on thoughts, feelings, actions, and behavior so being comfortable asking these questions, or falling back to them when you’re not sure what else to say and the “strategic silence” you improvised or rationalized is going on a little too long.
Imagine a client describes something you have never heard about before, have never heard described to you by someone who experienced it, or is quite clearly traumatic. You may picture yourself as the perfect therapist knowing just the right question to ask to pop the clearly present keg of catharsis. Chances are, you will not have the perfect question in a situation like this. But you can always ask the following:
“What are your thoughts on that?”
“How do you feel about that?”
“What did you do beforehand? Afterwards? As it was happening?”
These three questions can (almost) literally be repeated into infinity:
What did you think and feel after you did that thing?
What thoughts and feelings led up to doing that thing?
What did you do/think/feel next?
How often do you think/feel/do that? When was the first time?
If you’re not careful, you can actually end up asking questions into infinity, because clients and everyone else tend to really enjoy when someone sincerely asks them questions about themselves. Stay tuned for a post on setting boundaries on your allotted time and everything else in a future post.
Also, don’t forget the other “A”
The above does not include the trigger or as Albert Ellis stated it “activating event.” The questions above will become less random and purely reactive to the client’s responses as you organize them around triggering events, people, situations, activities, and places.
Albert Ellis, who established Rational Emotive Behavior Therapy, had his own ABC’s which can be similarly helpful if you’re first trying to wrap your head around how to provide therapy: A for Adversity or Activating event, B for Belief about the Adversity, and C for Consequences.
I know and am comfortable with my ABCs: What next?
A previous mentor once suggested picking a “home” theory and/or technique to fall back on when you’re not sure where to start. Different theories and techniques are certainly more effective with different client populations, so there’s nothing wrong with being a bit eclectic, but as a therapist, you will be working with people who are most overwhelmed, anxious confused, angry, or sad. It’s likely you won’t always know where to start or what to say. This makes sense, because it’s likely for many new to therapy that they don’t know what the “right” thing to say is either, and they’re the premier expert on themselves.
There are many options with which to start:
- Cognitive behavioral therapy forms (rational emotive behavioral therapy, trauma focused CBT, etc.)
- Motivational interviewing
- Psychodynamic/psychoanalytic (many models including brief psychodynamic therapy)
- Solution-Focused Therapy
Once you have decided what theory and intervention you want or need to start with, seek certified training. Some of the links above will take you to official training for each style, which will ensure you are actually getting the training that has been studied to be effective for that style.
It is great and best practice to do the full training and receive certification in whatever theory’s intervention you select, and if that’s an option you should certainly do it. Many therapy programs do not reimburse your extensive training in a therapy discipline. If that’s the case, and you can afford a three day, single day, or couple hour training in an intervention style, you may be able to use techniques, if not the entire intervention. You could use open-ended questions, affirmations, reflective listening, and summaries, but not be implementing the actual Motivational Interviewing intervention.
Posts in the Therapy 101 series focus on tips, tricks, and tools that can help get you started as a social worker practicing as a therapist. They do not necessarily make one more qualified, a licensed, clinical therapist, and does not provide specific intervention training or information.
This series is not intended as an endorsement of practicing therapy without intervention training, licensure, or good clinical supervision, but rather empower social workers without the tools and resources to get needed training keep their therapy job, and get to the next, best practice step.