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0:00 in this video I'm going to share my best advice for new therapist I clinical psychologist dr. Ali Mattu welcome back to the psych show the idea for this video actually came from a DM I got from Leah Jacobs who said hello dr. Matta I'm starting my mental health practicum this week good luck I hope it went well any advice for starters in the field so I have trained psychologists and social workers psychiatrists and across every stage of training beginning middle and end there's six things that keep coming up for me in my supervision in my classes in every experience I have with trainees so I want to share that advice
0:45 with you in this video number one get direct feedback my very first training experience I was working one-on-one with patients and my treatments were all videotaped so my patient would consent to this they know this is a training clinic and as a result everything was videotaped my supervisor would watch that videotape take notes and during hours hourly supervision would give me feedback the very first therapy session I ever had my supervisor reviewed it watched it and said Ali who is this person I don't recognize them they're nothing like you and I was really shocked and scared and anxious and uncomfortable and we watched the videotape back and
1:31 she said look you're sitting on the edge of your seat you're writing everything down in a clipboard you don't look like the comfortable casual Californian that I know you are I was working in DC so me being a Californian kind of stuck out and how relaxed I was and wearing flip-flops to supervision and all the stuff that I would not do now but anyways she picked up on this idea that I was acting in a way that was not consistent with who I was and it was it was showing not only in the video but probably with the patient who I was working with whether it's video tape supervision audio recorded supervision doing role plays with a supervisor trying something out and then
2:17 immediately getting feedback on it that is the key to getting better it taps into a training technique called deliberate practice this is how musicians trained this is how athletes and Olympians train the important thing here is to do a thing get direct feedback on it have an opportunity to weave in that feedback try again and keep getting feedback and in the circle you go of improving number two take on a case that scares you I got a lot of experience treating OCD early on in my training and I started to feel pretty comfortable with it one of the things I wasn't comfortable with was treating the autism spectrum and so one opportunity came up to treat a case that involved
3:03 autism spectrum and OCD and school refusal which is when you refuse to go to school and it really really scared me if I couldn't help this person they wouldn't be going to school and they might get kicked out of this school that they worked very hard to get into take on a case like that as long as your supervisor is okay with it and comfortable with it because you might learn things that you never really knew before well that is obvious whenever you learn something you usually learn stuff you didn't know before but you might discover things that surprised you like I learned through working with that case that I actually really enjoyed working with people on the autism spectrum and everything I learned on that case
3:50 influence all the cases I saw later on after I was out of grad school because I saw so much anxiety and autism spectrum those things can come together so often so take on a case that scares you talk to your supervisor about ways in which you can push yourself this also works both ways I sought out a training experience at Saint Elizabeth's Hospital in Washington DC that was just too much and not a good fit for me and I really struggled in that externship that I had at the same time I learned a lot about what isn't a good fit for me what is a blind-spot and I learned what do I do in situations where I'm I'm
4:36 struggling and those skills are just as important as skills related to learning what you really enjoy doing and and all of that so take on one thing each training experience that really scares you number three own your ignorance when I was first starting to work with kids and parents I did a lot of parent training which is helping parents to learn the skills to deal with very difficult situations oftentimes oppositional behavior and in these situations you don't just need parenting skills but you kind of need super parenting skills so I was working with this one family and the kid had oppositional behavior and a lot of anxious behavior so I was applying all the stuff I learned from my supervisor and then I realized that this
5:25 parent actually there's twins here it's not just one kid that I'm treating but this other kid is a variable in the equation so the parents started asking me all these questions about well how do you apply how do you apply a timeout when there's another kid in the room I remember not knowing the answer to this question and I remember making something up it didn't feel like I was making something up it felt like I was kind of pulling something out of my head that made sense but I wasn't 100% sure about this because I had never been in the situation before I never had to apply this concept to this situation and that's just part of the ignorance of
6:10 being a therapist the more you have experiences treating people the more you will be able to answer those kind of questions but when you don't know the answer don't make something up say I'm not sure about that I'm gonna talk to my supervisor I'm gonna consult with my colleagues and I'll get back to you I don't want to tell you something that might not be true or might not be evidence-based so a moment and I'll get back to you about that one so many of us struggle with impostor syndrome as therapists we feel like we're we're younger than our patients and we don't have as much life experience or we're not parents ourselves so how can I ever possibly help a parent or I've never experienced
6:56 bipolar depression so how am I gonna know about this or you fall into the trap of the dunning-kruger effect where you might overestimate your experiences even though you're inexperienced at this thing all that stuff can happen and it can make you want to see something that might not be true or you might be completely ignorant of so be aware of that embrace the ignorance and get back to your patient tell them I'm not sure I don't know I'll get back to you this is usually going to be relationship enhancing it's not going to destroy or damage the relationship it'll make the person feel like you're really taking them seriously and you're taking this work very seriously a note about supervision here a good supervisor will
7:41 check in about this kind of stuff but many of us who have been in the field longer struggle with something called the curse of wisdom which means it's very hard when you know something to remember what it was like to not know that thing so there will be times where I might be working with the trainee and I'll say oh in this session you probably want to create a fear and avoidance hierarchy with your patient and I'll say that and then I might realize wait has this trainee ever created one of those do they know what that means have I just created a situation where I've I've instilled all this anxiety because they don't know how to do that and they might be scared to ask me so hopefully your supervisor will check in about this stuff but if you get asked to do
8:28 something in supervision and you don't know how to do that embrace that ignorance and just ask can you can you please show me how you would do that can we roleplay how to do that with my patient ask those kind of questions and you'll be able to to really learn from these situations number four you are not a savior one of my first patients as a full-time psychologist came in with one problem and it turned out that this person had a much more severe problem and I tried for a few months to help them out as best as I could and it became clear that this person needed what's called a higher level of care they needed to be not
9:14 outpatient once a week therapy but they needed to be an inpatient treatment they needed a psychiatrist to get involved to help out with medications they needed a social worker to get them connected with more resources basically they needed a lot more than I could offer the problem is I spent way too much time thinking there should be more I can do to help this person there should be more that I can do to save this person if I just work harder maybe I can help them out for many years I struggle with this idea of defining Who I am as a therapist based upon how well my patients are doing I don't do that anymore what I've
10:00 learned is your job as a therapist it's not to go in and save someone it's not to go in and help them solve all of their problems it's not to to quote-unquote fix them I really hate that word because that implies there's something wrong with people and that implies they're damaged and I I hate that language but that's a tangent this is not your responsibility as a therapist your responsibility is to provide the most effective ethical responsive treatment to that person that you can do within your abilities and the limitations of the environment that you're in you have to ask yourself not is my patient getting better but because that's
10:46 something you can't control you have to ask yourself am i providing the best treatment I possibly can in the situation knowing what I know your job is to help them learn how to solve their own problems help them learn what their strengths are how to apply them to the situation's they're in your job is to help them become a resilient person number five know your blind spots when I was working at a Counseling Center in grad school I started seeing someone who's struggling with being homesick and being away from their family at that time I was dealing with similar things myself being very far away from my family and a lot of tough stuff happening in my family and feeling like I'm not there to help everyone who's going through this it
11:34 wasn't a good match that person saw me for one session and then they fired me they felt like I was disconnected and I wasn't there for them that was the first time I realized this is a blind spot for me as a therapist it was at that point now my blind spot has changed I'm cool with homesickness not dealing with those issues but for me now someone dealing with tough stuff related to very young children like toddlers that's a blind spot for me because I now have my own toddler and I deal with those worries myself so you have to know what's difficult for you I've discovered that seeing patients at 3 and 4 o'clock my energy weight dips down at that time and I have to take care of myself I have to
12:19 make sure I have a snack between those hours or before those hours I have to have some matcha tea or a coffee if it's a really tough day before those hours so I'm able to to get through it or ideally not schedule anyone at that time and do phone calls and notes or take my lunch hour during that time I learned that what's the other thing I wanted to say about this doo doo oh yes I've learned about the problems I'm very good at treating oftentimes anxiety OCD takes Tourette's hair-pulling narrow picking I've learned about things that I can do pretty well or I can get some additional
13:05 consultation from colleagues to think my way through that bipolar depression is one of those also substance use is one of those and then I've learned about the things that I am not good at and really don't understand that well and I need to refer out to colleagues so eating disorders is a big example of that I can treat bulimia related issues but anorexia I'm not good at treating that at all every therapist has her blind spots and your blind spots will change as you move forward in your career discover what they are and if you struggle at something great you've discovered one of your blind spots and you can now get consultation from colleague get support from supervisors or refer those cases to someone else
13:54 number six start practicing good boundaries when I was in grad school I did not charge people for missed sessions most site shows that had a policy of you have to cancel within 24 hours or 48 hours unless there's a major health concern or emergency reason and if you don't cancel within that time period you might be charged your copay or some type of type of small fee this is super important because if people just no-show it's really gonna have an impact on the clinic at large what I thought at that time is well I don't need to worry about this because I'm a trainee I have a very low fee it's not gonna make a big deal and I don't want to feel bad by telling my patient that they missed that well guess what when I graduated when I got my degree when I
14:40 got licensed I still was doing that thing I was still not charging people for miss sessions and then it had a huge impact on me a huge impact I would have to see more patients because I am NOT practicing those good boundaries and letting my person know hey you missed this session we had this cancellation policy as a result you're gonna be charged this fee when I started doing that things got better and I felt good about myself and I didn't it didn't feel like it was this awkward thing between me and my patients so if you don't start practicing good boundaries now while you're a trainee you're not gonna magically have good boundaries when you're a full time therapist so whether that means charging your patients when they no-show or whether that means only checking email
15:27 and voicemail within business hours and only responding to those message just during business hours or it might mean taking vacation taking time off I can't tell you how many times I've talked to trainees and I've said you know I've noticed you haven't taken any days off this semester at all what's going on and usually people are taken aback like oh oh what do you mean I'm working really hard I'm trying to do everything and I'm like this is a tough job and if you don't take care of yourself no one's gonna step in and be like hey why aren't you taking care of yourself so start practicing these good boundaries now start making those good habits now so that when you're out of grad school those habits will already be there I know this is really hard to do
16:13 and some of your supervisors probably don't have good boundaries themselves so just pick one thing pick one thing you'd like to practice a bit more and just work on that one in fact that's good advice for all of these skills there's so much stuff I wish I could get into but there's not enough time so I want you to check out this Twitter thread there's lots of great advice that of some of my friends and colleagues have shared and if you'd like to learn more about career advice for therapists check out this playlist I've got videos on a wide variety of topics stuff like what I wish I knew before I went into therapy how I analyze my patients lots of other good stuff and if you're in grad school right now check out this video which has my best survival tips for graduate
17:01 students temper the get boo challenge of the week this week what is happening is two of my closest friends from New York City are coming to visit me here in California they're the first guess we're having since my family moved here to California and I'm really anxious about it because our home is not in the state I want it to be by having a toddler things are very messy I'm gonna try to clean those up but more importantly I just don't feel like things are where I want them to be to have guests over I get into a lot of this perfectionistic thinking when I have guests over I want the place to feel homey and welcoming and I wanted to also feel like it's lived in and right now we don't have any
17:46 photographs of family up on our walls I really wish I did so for me that get comfortable being uncomfortable thing I'm working on this week is being okay with that being okay with things not being the way I want them to and stop fighting with that thought of things need to be up and look a certain way and come to terms with it let go that tug of war battle I have with this thought and just sort of let it be and practice being okay with that the comment of the week for this week comes from Katie Jo Katie made a comment that made me feel so good because I spent so much time making this video about Star Wars arises Skywalker spent a lot of time scripting it out filming it going to see the movie
18:32 reacting to it so much so much stuff went into that video and I made that video and I kept thinking like no one's gonna watch this or not as many people as I want are gonna watch it all that sort of stuff that goes through a youtubers head and then Katie made this from super nice comment that made me feel so good where she said me has never seen Star Wars nor do I care about it also me watches the entire thing because I love all these videos Thank You Katie made me feel so so good like it was totally worth it because this video might have just brought some joy or some new perspective or something in your life enough for you to make that comment so thank you you made me feel so good about doing this stuff
