4 Taboo Topics for Therapists

There are lots of things therapists worry about but rarely discuss with one another. For whatever reason, we are often ashamed to discuss these things, possibly because it may bring up our own insecurities and make us vulnerable to one another.

And the few times I’ve seen therapists bring these things up I often see the “smoke and mirrors” effect where others respond by avoiding the issue or diverting to other topics. Even worse, the therapist that originally brought up the question is sometimes reprimanded or made to feel inferior! Well, I’m going to bring some of these things to light… so that you know plenty of us in the mental health community are thinking about the same things you are.

• Income- We all know there are “rich” therapists, those who are struggling, and those in between. However, we rarely talk to one another about what is a realistic business plan, how to incorporate insurance into a practice without reducing your income, and how to plan for all the expenses of being in business. Profit and helping people are not mutually exclusive things that we must choose between. Thankfully, this topic is becoming more common in our professional organization meetings and in online forums. I hope this continues so that therapists don’t think they are greedy for wanting a living wage that equals their educational level.

• Safety- This was always a big one for me when I was doing clinical work. I didn’t work in the safest environment but I was expected to accept this fact and assume the physical risk without question. Unfortunately, this fact was not fully disclosed to me until I was deep in my agency job… and it certainly wasn’t anything a naive, recent graduate was thinking to ask about in an interview! But it’s the truth- some clients pose a risk to us. This doesn’t mean we can’t work with them but it does mean we may need to work with them a little differently. More importantly, it means we need clinical supervisors who are comfortable discussing these topics and who are skilled in strategies that maintain therapist safety while still creating an environment for clinical progress with the client. I’d love to see this topic addressed more at conferences. I know I relentlessly sought training and guidance related to safety and rarely found helpful resources.

• Feelings for Clients- We have feelings about our clients. All. The. Time. Sometimes our clients annoy us, sometimes they make us feel helpless, sometimes we’re attracted to them. We are human and not immune to the possibilities that human interaction presents. These feelings are not inherently wrong, either, although they often make therapists feel confused or shameful. The important thing about these feelings is to seek consultation. You have a unique but professional relationship with your clients so when something makes you uncomfortable you need someone you can talk to… and I’m not talking about venting to feel better. I mean you need another professional to talk with so they can help you figure out what steps to take and keep you accountable (and, hopefully, remind you that these feelings are totally normally and nothing to be ashamed of).

• Documentation- Raise your hand if you got awesome training in grad school on how to keep documentation… hm… anybody? I spent four years in grad school and you know how much training I got on this topic… one hour. That’s right- one hour of a single class (that day, not the whole semester) was dedicated to learning how to write notes. No one ever talked about treatment planning… in four years (yeah, let that sink in). Thankfully, I got some training in how to collect intake information during my psychological assessment class (thanks, Dr. Susan Gamble). Documentation is this weird, mysterious thing that no one ever talks about but everyone worries about. Why is it so neglected when it’s so essential to our daily work?

Hopefully, you recognize this is a specialty of mine and I really hope to teach therapists how to do this well and to take away the embarrassment of asking questions about documentation. Trust me- everyone else is wondering the same thing you are! And if you’re still a little embarrassed but dying to get some questions answered, sign up for my free newsletter and crash course (psst… no one but me and you will know you did!).

Did any of these topics hit home for you? Do you have any helpful resources for other therapists to help with some of these taboo questions? Post them in the comments below so we can open up the discussion and help one another out!