A Therapist Can't Say That

 Sex with clients.It’s an interesting topic because it’s both very taboo and not at all polarizing. Many taboo topics are just that because discussion of them invites conflict. Sexual  boundary transgressions aren’t like that. We can pretty much all agree that they’re wrong and bad.So then why is it so hard to talk about?I would argue that in this case, it’s because of fear of being in any way associated with a transgression of that magnitude, and the vicarious shame of being part of a group whose members sometimes commit these transgressions.But we have to talk about it and here’s why: a 2017 paper reviewed multiple studies and found that as many as 7 to 12% of therapists surveyed in those studies admitted to having sexual contact with a client. And that’s in self-reported surveys. The consensus among people who study and write about this topic is that the actual numbers are probably much higher.Obviously, just agreeing that we shouldn't do that and then moving on isn't working.We need to be having conversations that go beyond, “it’s wrong,” and “here’s some tips for holding boundaries,” especially if you are a supervisor or therapist of therapists. At some point, you will have a supervisee or client who comes to you about sexual attraction to a client and how you respond can make or break whether they go on to act on it.To guide us in wrestling with this very fraught subject in a deeper, broader, and more generative way, I am so excited to bring you my conversation with psychologist and author Dr. Andrea Celenza.Andrea Celenza, Ph.D. is a Training and Supervising Analyst at the Boston Psychoanalytic Society and Institute and Assistant Clinical Professor at Harvard Medical School. She is also Adjunct Faculty at the NYU Post-Doctoral Program in Psychoanalysis and The Florida Psychoanalytic Center. She has written numerous papers on love, sexuality and psychoanalysis. Her third book, entitled, Transference, Love, and Being: Essential Essays from the Field, was published in 2022 by Routledge. Dr. Celenza is in private practice in Lexington, Massachusetts, USA.        Content note: This episode contains brief, non-graphic mentions of sexual assault, incest, and suicidalityListen to the full episode to hear:Why we need to reframe sexual boundary violations as something we are all potentially vulnerable toRisk factors and precursors for boundary transgressors and how they overlap with non-transgressorsHow the therapeutic relationship can mimic common problematic childhood dynamics for therapistsThe impact of negative transference on the potential for boundary transgressionsWhy we have to be aware of and positively leverage the power imbalances inherent in the therapist-client relationshipWhy we have to learn to capture and tolerate multiplicity in ourselves and our patientsLearn more about Dr. Andrea Celenza:WebsiteLearn more about Riva Stoudt:Into the Woods CounselingInstagramResources:Sexual boundary violations: A century of violations and a time to analyze.Confronting Our Stories: Recentering Narrative Work In Trauma Therapy

Being in therapy as a therapist, and being a therapist for therapists, is a bit like magicians trying to entertain each other. We’ve studied the tricks and techniques. We’ve seen behind the curtain and we can’t pretend otherwise.There is enormous pressure for each of us to do our own work in therapy in order to be good clinicians for our clients, but therapists are truly a special population. We carry the weight of other people’s stuff, and we’re much more likely to need to unload about our work in session. And yet, knowing what we know, it can be difficult to let go–about work or whatever we’re trying to parse through–without fear of being judged as bad therapists.On the clinician side, we know, or at least sense, that therapists need something a bit more from us, but there’s no specific training in just what that is or how to give it.So what do we do? How do we approach being in therapy as a therapist and providing therapy to therapists?I’ve been mulling over those questions since my conversation with Dr. Elene Herrera in the last episode, and today I’m digging into where I think we can go from here.Listen to the full episode to hear:How therapists’ inside knowledge of the therapeutic process and of being a therapist impacts our experience of therapyWhat needs to change on the macro level of our professional culture to better provide treatment for therapist clientsWhy we have got to stop being so quick to harshly judge each other if we want to be better clinicians to each otherWhy we need to accept and invite human messiness into our sessions with therapists as clientsWhat we can do in session to break through barriers to get our therapist clients to be vulnerable with usLearn more about Riva Stoudt:Into the Woods CounselingInstagramResources:Behind the Scenes: When Therapists Become Clients with Dr. Elena Herrera

Why is it so hard to be in therapy as a therapist?Why is it so hard sometimes to be a therapist for other therapists? What happens when we sit down and try to play this game we play with each other?I’ve been wanting to do an episode on therapists as clients since I conceived of this show, so I’m excited to share my conversation with Dr. Elena Herrera today.Dr. Herrera specializes in working with therapists as clients, and shares some unique insights about challenges and patterns she has noticed in her work, as well as frequent themes of shame and embarrassment and fear of judgment that come up when therapists seek therapy.We also dug into the broader issues of therapists feeling that they need to have achieved “well-adjustedness” in order to be good therapists, what it is that makes seeking therapy as a therapist feel so very vulnerable, and what happens when our work comes with us into the room.Dr. Elena Herrera is a bilingual (English/Spanish) speaking psychologist with over 15 years of experience treating adults, youth, and families. She has worked in college counseling centers, children's crisis clinics, and community mental health clinics helping clients from various ethnic, cultural, and economic backgrounds. She has experience working with a range of populations, from people facing extreme emotional crises, to college students adjusting to life away from home, and engineers and techies experiencing burn out and fatigue. Dr. Herrera is also a clinical supervisor, training and mentoring future psychologists. Currently, her practice focuses on treating men and women in tech and engineering, couples, and other therapists.Listen to the full episode to hear:The challenges of maintaining professional boundaries and distance when working with someone whose experiences may be so similar to your ownWhy seeking therapy evokes so much shame for therapistsThe layered fear of judgment, personally and professionally, that often comes up for therapists in therapyWhy letting go of the therapist identity feels so vulnerableWhat happens when therapists bring their work with them into therapyWhy it’s vital for therapists to put aside rigid rules and listen when a client reveals boundary or ethical violationsLearn more about Dr. Elena Herrera:Herrera Psychological Serviceshttps://www.linkedin.com/in/elena-herrera-psy-d-9737024/Facebook: @DrElenitaLearn more about Riva Stoudt:Into the Woods CounselingInstagram

Trauma therapists are often told that we have to prepare our clients for any and all disruptions to our schedules well in advance, to avoid causing harm to them or causing therapeutic rupture.But life happens. We have unexpected and unforeseen circumstances that mean that we may have to suddenly cancel sessions or rearrange our entire schedules around a new preschool pickup time. (Ask me how I know).And there are most likely therapists out there on TikTok or in Facebook groups who will judge us any time we have to make a last-minute cancellation or otherwise allow our own personal lives to intersect with the lives of our patients.It’s vulnerable to admit to patients that we aren’t perfect, that we have messy lives, that we aren’t in what Onyx Fujii and Asher Pandjiris called “a state of perpetual wellbeing,” in the last episode.If our clients’ perceptions of who a therapist can and should be are disrupted by our vulnerabilities, needs, and limitations, what does that mean about who they think a therapist can and should be?Since my conversation with Onyx and Asher, and with a whole lot of disruption in my own life and schedule, I’ve been thinking a lot about what happens when our clients encounter our humanity.Today, I’m digging into why it feels so vulnerable to share our life circumstances with our clients, why our fears of rupture when we have to might be exaggerated, and how cultural expectations of therapists as aspirational figures impact how our clients perceive us and what we do.Listen to the full episode to hear:Why we’re so afraid of violating the taboo of our personal lives impacting our clientsWhy our clients’ compassion and kindness in the face of our challenges is scaryThe intersection of mental health stigma and the therapist as an aspirational figureHow mainstream perceptions of what therapy is and does impact who our clients think we should beWhat happens when therapy influencers on social media give clients unrealistic expectations for healing and wellnessLearn more about Riva Stoudt:Into the Woods CounselingInstagramResources:The Use of Self in Therapy, Michelle Baldwin, ed.

If you’ve been in this field for even a couple of hours or so, you have almost certainly had someone try to impress upon you the importance of self-care. Not usually in the context of your self being valued for its own sake, but self-care that enables you to show up effectively for your clients.On the face of it, there’s not much to disagree with there. Yes, when we are adequately cared for, we are better equipped to show up and care for our clients.And yet, we’ve been taught that our self-care, and by extension our need for care, should be invisible to our clients. The tenet that if we are doing self-care right, it will be invisible, can contribute to the sense we often have that critical elements that comprise our humanity are a secret that we must keep away from our clients.The belief that exposure to our fallibility will harm our clients is so interwoven into the substrate of this field that we rarely think to ask the question, what are the harms we are doing by hiding our fallibility? What opportunities for connection with our clients are being lost when we perform what today’s guests describe as a “constructed state of perpetual well-being?”Onyx Fujii (they/them) is queer, non-binary, chronically ill, culturally Jewish, mixed-race clinical social worker in private practice in Philadephia (on unceded Lenni-Lenape land). Healing justice is at the core of their multidisciplinary practice where they offer trauma-informed, anti-oppressive psychotherapy, clinical supervision, and cultural humility facilitation and consultation; focusing on the intersections of gender, sexual orientation, race, chronic illness, and disability. In 2021, they became a co-founder and co-director of the Kintsugi Therapist Collective, a virtual community of care workers dedicated to embodied and liberatory visions of care. Their professional practices and writing center on the significance of identity, trauma, (in)visibility, and connection. They are committed to sustaining a social justice-orientated business that aims to empower and liberate through compassion and understanding.Asher Pandjiris (they/they) believes that everyone deserves to be supported in dealing with their own legacies of trauma and psychic suffering so that we can more easefully navigate this neoliberal/capitalist/deeply racist, transphobic and ableist heteropatriarchy that is traumatic for everyone, especially folks who are highly sensitive and/or navigate multisystemic oppression. The programs and workshops they offer are aimed at supporting folks in these challenges. They love hosting the Living in this Queer Body podcast and facilitating programs on topics that they feel deeply passionate about. Listen to the full episode to hear:How performing professionalism and well-being contributes to burnout, especially for marginalized and chronically ill therapistsHow acknowledging their physical and mental needs has actually created points of connection for Onyx and their clientsWhy Asher allows themself to “fail” their clients by showing up imperfectlyHow honesty and transparency can actually improve the reparative client-therapist relationshipWhy therapists may be uniquely expected not to need the same kinds of care as their clientsLearn more about Onyx Fujii and Asher Pandjiris and Kintsugi Therapist Collective:Kintsugi Therapist CollectiveInstagram: @kintsugitherapistcollective Learn more about Riva Stoudt:Into the Woods CounselingInstagramResources:We Need Not Be Fine: A manifesto for mental healthcare workers who can’t go on like this

For the last few weeks, I’ve been reflecting on the conversation I shared with you in episode 2.1 with Silvana Espinoza Lau about therapeutic goal setting.And what I’ve realized is that when you set out to look at the topic of setting goals in therapy in anything more than a superficial light, you relatively quickly start running into the question of what therapy is.Why, in order to examine the topic of therapeutic goals deeply and honestly, do we first have to reckon with the question of what therapy is?The existence of therapeutic goals implies something important about therapy: Therapy is a goal-directed activity.We aren’t just passing the time. Therapy is supposed to accomplish something. The intention is to get somewhere different than where you started, no matter how granular or broad your goals may be. If you don’t, it didn’t work.So what is it that we are setting out to achieve? What’s the overarching goal that we all share in the goal-directed activity of therapy, regardless of the diverse theories and delivery systems we subscribe to?What is the big goal of therapy?Listen to the full episode to hear:Why the concept of improving mental health raises more questions than it answersWhat differentiates therapy from other activities intended to mitigate human sufferingThe real impact of goal-setting in therapyWhat therapy has in common with game theory and playLearn more about Riva Stoudt:Into the Woods CounselingInstagramResources:EPISODE 16: Marketing With IntegrityDeep Play, Diane Ackerman

In the final episode of my last season, Therapists As Makers of Culture, I asked you to think about what kind of professional culture you want to leave behind for the next generation of therapists and clients. We have an opportunity, with a little luck and intention and skill, to change something important about the structures of how things have been. We have an opportunity to lay the foundations for a different, hopefully better, culture of therapy that we’d like to leave behind for whoever comes next.I want to make a professional culture where we challenge ourselves and each other to stretch our capacities to hold complexity.In this conversation with Silvana Espinoza Lau, we’re discussing some of those complexities.We’re talking about how we determine and assess where we’re actually trying to go with clients when we embark on the journey of therapy with them, the importance of paying attention to all of the different and sometimes competing agendas that inform a client’s stated goals, and how we can use connection and curiosity as our guideposts.Silvana Espinoza Lau (she/her/ella), is a healer and settler in unceded Kalapuya land of the Champinefu band. She holds several privileged and marginalized identities that inform the way she supports people. Experiencing an oppressive system, that at times told her she did not belong, has given her enough empathy to support people who have felt othered, unseen, underserved, and underrepresented.She loves to support individuals who feel as the representatives of their culture, or who feel in between cultures. She especially likes to support BIPoC, a population that has been largely underserved and asked to adjust to Western norms.Even though she believes in anti-oppression, decolonization, and liberation, her hope is to move towards dismantling and recreating therapy as centering the people who have been forced to exist at the margins due to our current oppressive systems.Listen to the full episode to hear:The complex set of factors that impact how therapists approach goal-setting before a client even gets in the room, from education to pressure from insurance companiesWhy we need to acknowledge the biases and agendas we bring to our practice, and the wider context of cultural agendas that impact our clientsWhy measured progress is not the same as real healing, especially within oppressive systemsHow to lean into curiosity and connection when working with clients with differing identitiesLearn more about Silvana Espinoza Lau: Seventh Self Consulting@ecolonizeyourpractice on InstagramLearn more about Riva Stoudt:Into the Woods CounselingInstagramResources:Pedagogy of the Oppressed, Paulo Freire

As I've been reflecting on the conversation Dr. K Hixson and I had about clinical supervision and reflecting on the past season of this podcast, I keep coming back to the piece we stumbled upon about clinical supervisors as culture makers, culture replicators, and culture changers.It feels very fitting that we got there because this podcast itself was born out of the desire to change the culture of our profession. And as I've been sitting with that over the past few weeks, I’m becoming more aware of how important I think it is that as therapists–all of us, clinical supervisors or not–we cultivate an understanding of ourselves as makers of culture.And while it may not come naturally to us to think of ourselves as makers of culture, human culture is made by humans.We are all producing or reproducing that every day within our spheres of influence. And of course, the bigger that sphere and the greater your influence within that sphere, the more power you have as a maker or unmaker or reproducer of culture.And we know from Spiderman that with great power comes great responsibility.So the question remains, what kind of culture do we want to make?Listen to the full episode to hear:Why all therapists need to recognize the power and influence we wield, no matter the size of our practicesHow to think of culture in terms of lineages of interpersonal influenceThe shifts in therapists’ professional culture that I hope we will makeLearn more about Riva Stoudt:Into the Woods CounselingAbout RivaInstagramResources:The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients, Irvin YalomMaxine Hong Kingston

When you hear the phrase “clinical supervision” what do you think of?For me, the first thing that comes to mind is stacks of paperwork - or whatever the electronic version of that is. I think of the years-long slog of racking up hours while marching towards that finish line of professional legitimacy: licensure.It's not a very alive-sounding phrase, is it - “clinical supervision?”  It sounds, well, clinical. And then - “supervision,” not really most people's idea of what sounds like a great time. It conjures up visions of surveillance, of being put under a microscope. Or from the supervisor's side, of being the teacher with the whistle on the playground who has to watch all the kids at recess and make sure nobody cracks their head open falling off the monkey bars.But if we extricate ourselves from the trap of looking at clinical supervision through the lens of bureaucratic hoop-jumping and box-checking, if we divest from centering risk management in our clinical and supervisory relationships, if we can tolerate our anxiety about someone falling off the monkey bars here and there,  if we can do that, we can see something more profound in the space that's left.In this dance of apprentice and mentor, we are building professional lineages that will shape the culture of our profession potentially long after we are no longer around. So what kind of culture do we want to shape? Today I'm speaking again with my dear friend, colleague, and mentor Dr. K Hixson about clinical supervision.Dr. Hixson has made clinical supervision and training supervisors a cornerstone of their practice, and the conversation you're going to hear us having today is born out of a shared vision for what clinical supervision has the potential to be.Listen to the full episode to hear:The power of good clinical supervision to help early career therapists learn and unlearn, and repair relationships to power post-grad schoolWhy clinical supervisors need to let go of their perception of themselves as the expert in order to develop excellenceWhy risk tolerance–not risk aversion–is an essential quality for clinical supervisorsWhy supervisors need to consider the impact they have in shaping the culture of early career and future therapistsLearn more about Dr. K Hixson:WebsiteLearn more about Riva Stoudt:Into the Woods CounselingInstagram

On episode 15, creative director and brand strategist Rachael Kay Albers said something that I have been turning over and over in my mind since:Marketing artificially accelerates the pace of human relationships.As soon as I heard her say that, something started to click for me about why therapists tend to dislike marketing, and it centers around the concept of artificiality.We see artificiality as phony or fake, as standing in opposition to authenticity. And therapists love to see ourselves as being driven by authenticity. We want to get under the external layers and into the real, raw stuff. It’s what we do.It’s not exactly a revelation that the primary complaint I hear from therapists about marketing is that it feels fake or superficial or inauthentic.But Rachael’s comment made me realize it goes deeper than that. And it can’t be remedied by telling us to just be authentic or ethical or don’t be a slime ball and overpromise results.What’s really happening is that we accurately perceive that marketing manipulates and speeds up the pace of our relationships with our clients. And we do not like that.But the more I think about it, the more I ask myself, aren’t we doing that anyway by the very nature of the work we do? Isn’t there a layer of artifice inherent and necessary to the work that we do?Listen to the full episode to hear:What aspects of our relationships with clients our marketing speeds up and why that’s not the worst thingWhy artifice and authenticity are not opposites, or mutually exclusive in our practicesHow a measure of artifice can actually facilitate authenticity and be in alignment with our integrityLearn more about Riva Stoudt:Into the Woods CounselingAbout RivaInstagramResources:A Therapist Can’t Say That Ep 15: Is Ethical Marketing Possible? with Rachael Kay Albers