Episode 139 - Politics in the Therapy Room (with Dr. Ben Caldwell)

Let’s get controversial! Is it a good idea for a therapist to project their own political views onto a client? For today’s guest Ruth, the answer is a resounding “no.” We hear her story of a therapist who took her political advocacy too far, and Dr. Ben Caldwell rejoins us to explore the ethics of discussing politics in therapy. Plus, how can therapists know if they are trauma-informed enough for their clients?

Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today’s episode is sponsored by Journal Party.

Introduction: 0:00 – 8:55

Part One: 8:55 – 44:33

Part Two: 44:33 – 1:24:21

Part Three: 1:24:21 – 1:27:42

Show Notes:

• Donate to Samaritan’s Purse (Ethiopia Projects)

• Ben Caldwell Labs

• Think Like the Test Podcast

• Marketing of professional counselors: A Q-Sort study of best practices.

• Ben Caldwell Performing Poetry

• Transcript

  Carrie Wiita [00:00:00]:

  Welcome to Very Bad Therapy, a closer look at what goes wrong in the counseling room and how it could go better, as told by the clients who survived.

  Ben Fineman [00:00:09]:

  From Los Angeles, I'm Caroline Wiita. And I'm Ben Fineman, legally encouraged to say that this podcast does not constitute therapeutic advice. But it will get interesting.

  Ben Caldwell [00:00:18]:

  Let's get started.

  Carrie Wiita [00:00:25]:

  Hey Carrie. Hi Ben.

  Ben Fineman [00:00:28]:

  Alright so we've been talking now for about 20 minutes about what to talk about in this introduction. Yeah. And I have to say our first idea, which we can't do for very obvious ethical reasons, which would have been great, was to do a deep dive into this therapist Facebook post we just came across.

  Carrie Wiita [00:00:48]:

  And we're not doing that because it was not anonymously posted. So we have we have ethics and standards. So we're not we're not going to talk about it, but we really want to. But If anybody out there enjoys reality TV and is not yet a member of the therapist supporting therapist Facebook group,

  Ben Fineman [00:01:07]:

  hop on in there, grab some popcorn and you'll have hours of entertainment. We can't say which post, but honestly, Carrie, pick a day because any any day

  Carrie Wiita [00:01:17]:

  brings forth the newest gifts of therapist drama. Whenever I'm telling other therapists, I'm like, you may want to consider joining the therapist Facebook groups because there are some good networking opportunities. You can find some good answers to questions that may be hard to find on like the BBS's website, whatever. I'm always like, but just know what you're walking into. I don't condone or endorse the entirety of it. I just want you to take everything with a grain of salt.

  Ben Fineman [00:01:46]:

  Yeah. I think the therapist from the story we hear today from our guest Ruth quite possibly is a therapist in 1 of these blowups, these Facebook droughts. But before we get into that, our next idea, Kari, in terms of what you talked about in the intro, you had heard through the grapevine that PESI, like the worldwide leader, at least here in the States, so the statewide leader of therapist trainings and certifications, was now offering board certifications.

  Carrie Wiita [00:02:15]:

  Okay. Okay. Now it started, it started with something else. So, OK, well, I have read a study that was very interesting, but it was a study about like how to consumers pick a therapist. And they presented study participants with 4 different ways of writing the exact, more or less, same credentials. There were some variation, but it was basically a generic, I think John Smith was the name they used, a professional counselor in Texas. They showed 1 variation had like John Smith and then like LPC, NCB, NCMHE, whatever. Then the next 1 was like another some other permutation of alphabet soup and something else. And then then they offered also like John Smith, board certified counselor, John Smith, nationally certified, nationally certified counselor. And essentially the upshot of the study was that they found that the acronyms had no impact on the consumer's choice whatsoever. In fact, they actively tried to ignore all of the letters. It was statistical noise, the author said. But what was statistically significantly associated with consumers' interest in a particular provider, was the word board-certified counselor or nationally certified counselor. They were mostly interested if you had 2 or more board-certified specializations. They were more interested if you were a board certified counselor. And then the next like runner-up was nationally certified counselor. So I didn't know, I'm MFT. I did not know that, like my understanding was that there was no opportunity for us to get board certified, right? There's no board to certify it. So first I was like, Oh, is that just getting a license like from our, from the board of behavioral sciences? No, it turns out it's not that, but I didn't know what it was. So it turns out, I guess, MFTs can't get this, but counselors in the counseling profession, there is something called the, hold on, what is it? The National Board, the NBCC. This is the National Board for Certified Counselors. And so I was like, what the like, what is that? And the whole thing is like, you know, I'm sure as I'm sure you do, my sense is like board certified. I know that from doctoring, right? Like doctors, that's hard. You almost wouldn't go to a specialist who wasn't board certified in their specialty. Right.

  Ben Fineman [00:04:52]:

  Yeah. I mean, I don't know what this means for therapists. And I am what I find most interesting is that after like watching you do 20 minutes of research and making various frustrating noises. I'm no closer. Neither 1 of us are any closer to understanding. Is that an issue that our field... I would guess that some 90 plus percent of therapists, at least in America, if you ask them to explain certifications versus board certifications versus... I don't know how to make any sense of any of this. It's just what it's like. What can you put forth on your website to look more attractive to clients? And that seems like a problem that none of this means much or makes sense to any of us, at least to me or to you, I think. I completely agree. No, because it's like so first I'm looking at like I had heard that like you could get board certification through PESI, right? And I was like, no way.

  Carrie Wiita [00:05:45]:

  And so I'm looking at this is what the 20 took 20 minutes was. We were looking through the PESI website and we found all kinds of cool certification. You can get a bunch of different letters after your name. From the study, we know that that means nothing to consumers So I wouldn't pay for a bunch of extra letters after your name. But you can call yourself, for example, something like you can call yourself certified in dialectical behavior therapy and a certified personality disorder professional. You can call yourself that, a certified personality disorder professional. And PESI is a national organization, so I think you could call yourself a nationally certified personality disorder professional. And no one's the wiser. Well, so you are then rightly pointing out, like, but is that board certification? And like, I don't know. Let's go find out what the NBCC is. Right. So now I've just spent like whatever, 10 minutes on the NBCC website. And honestly, I can't tell the difference between the the National Board for Certified Counselors and PESI. I can't really tell. A lot more ads on PESI, but still, they both are like committed to educating mental health professionals.

  Ben Fineman [00:07:02]:

  So here's where I've landed after this conversation is that the next logical step for us is not to keep doing this podcast, but to create some institution where we can sell fancy sounding titles, ideally board certifications. What that board is won't matter. And we will get sued. This might be up there with money, with therapy cab as my greatest idea. I think it is. We can board certify people in cognitive illusions. Should we talk about today's episode? We can offer people certifications in listening to our podcast.

  Carrie Wiita [00:07:38]:

  Let's do it. Yeah, I don't know if any certification of any kind was really involved in our client's story today, to be honest with you. Yeah, so we are joined by Ruth, who describes her experience

  Ben Fineman [00:07:49]:

  of just questioning some things in our current national political discourse here in America in therapy and being met with a therapist who was very insistent that her perspectives were in fact objectively wrong. We also talked with Dr. Ben Caldwell to discuss the ethics of talking about politics and therapy and also another fun conversation about the very nature of being trauma informed and what does it mean and when should therapists refer out? Lots of fun stuff here in this 1, Carrie.

  Carrie Wiita [00:08:18]:

  Yes, absolutely.

  Ben Fineman [00:08:19]:

  I can't wait. Should we do an ad break and then jump in? Yeah, let's do it.

  Carrie Wiita [00:08:25]:

  Journaling is a great intervention to use with clients. But like any out-of-session activity, it can be hard for clients to actually do it. The Journal Party podcast can help. It's a free resource available on Apple Podcasts, Spotify, or wherever you like to get podcasts. Join Alex Gallner as he hosts a journaling party complete with funky grooves to write along to. Follow the prompts or follow your heart as you journal along with Alex and the rest of the community. Journal Party the podcast is available now.

  Ben Fineman [00:09:00]:

  And for today's episode, we are delighted to be joined by Ruth. Hi, Ruth. Thank you so much for being on Very Bad Therapy. Thank you so much for having me. I'm super excited to be here. So we'd love to have you begin just where it feels right for you in terms of any information that would be helpful to share to kind of set the stage a bit for your bad therapy experience.

  Ruth [00:09:18]:

  Sure. So I decided that I wanted to go to therapy when I was about 25, so I'm 29 now. So a few years ago, I was a manager of a very large coffee corporation, Starbucks. I was a store manager and I was a young manager, you know, running a $2 million business. And I actually started doing that when I was 22. So I was just in a leadership role at a very young age, running very high volume stores, leading a lot of people and as you probably know my company is a very socially loud company, like very takes a stance on things, you know just has a very loud opinion and shares it and that's part of the reason why I fell in love with it to begin with. But I was just having a really hard time when I was in 25 and I just felt like I wasn't leading well. I just felt like my body was on fire every time I was going to work. I couldn't understand why. A little bit further back, my mom was deported to Ethiopia in 2018 and that was really traumatic and I hadn't worked through that, didn't know that it was trauma, I didn't even know what trauma was and I, you know, my I was adopted at a very young age. I was adopted when I was 14. It's a very like complicated long story, but there was just a lot of things that I just hadn't worked through and then when COVID happened Starbucks was the only thing that was open if you guys were, I know it wasn't necessarily as much in California, but in Arizona we were open and We were the only thing open. So being a manager, dealing with that, and managing people throughout that, and dealing with customers, and navigating all of that was just a lot. It just seemed that everything was just, I need help. I was just struggling. So I decided to contact, Starbucks was doing a free EAP and so the, which is a play assistance program and so there was a bunch of therapists that I could choose from and I found 1 and I didn't, there was just a list, there was no pictures or anything. So I just picked 1 out and I was like Ariel, it's great, perfect. So just picked her out and I called her and she was actually doing in-person sessions. So I was like, oh my gosh, this is amazing. So that was kind of when it started. I decided to go. I didn't know what was wrong. I just knew there's no way my body is supposed to feel like I'm on fire all the time and I couldn't understand why I couldn't show up for work and lead these people. And I was just kind of like, let's tough it out. But I couldn't do it. And so I just knew I needed help. And also other people were telling me I needed help.

  Carrie Wiita [00:12:11]:

  Wow. Oh, my goodness. That's like a perfect storm of all kinds of things to to get someone into the I mean, like I'm so impressed that you like in even in the middle of all of that and juggling all of the different responsibilities and the chaos of the world at the time, but also what you had been through that you decided to like do this thing for yourself, which that's pretty great. I feel terrible already knowing that you have ended up on our show. So did you have to wait long to get started or were you able to get right in to see Ariel or?

  Ruth [00:12:48]:

  So yeah, I mean she, I was able to get in like the following week after I called and reached out to her. So it was pretty, I would say pretty quick. I was really busy anyway. So I really didn't know what to expect. I had been to therapy maybe like 1 time before and I was young so I don't really remember a lot of it. So I really didn't have an idea of what to expect. I didn't really look at her licensure. I didn't really, I was just like whatever my job provided this person so I'm gonna go. My first interaction with her was that she was really nice, like she was somebody that I could see myself building a relationship with and her office was kind of like, it was really dark, but it was very like cozy in a way. She knew how to like create that experience in her office and I liked that and it was just like a lot of question asking, like what what brings you in, like things that I expected and I really I had no idea what my identity was. I had no idea like why I was there and I really needed her help with figuring that out. So I just started sharing like my my childhood and my personal like the big things that I just shared with you like my mom was deported. I was also adopted when I was 14, so it was later age adoption and all these things and so she had the same face that mostly everybody says or does when I share that and that just kind of started it and so session after session, I came back and it was just like getting information, like there's a lot of information to gain. So I totally understood that. I knew that there wasn't gonna be a lot of like work yet but then it was like 6789 sessions and it was like I'm just going in and talking to her which felt really good. I want to make sure that like at that time it felt really good because I didn't have somebody to talk to at that time So there was a part of it that was therapeutic in the talking sense way, but I also was just like, are we, what can I do? Like give me some homework. I didn't even know therapists gave homework at that time. I was just like, can you help me? And so around the time of I want to say it was the elections like right before I think I was right before the elections, right? So like my company was taking like major stances on social issues that were going on at the time and I was having to have these really big conversations with my team and I would have these conversations and my breath would get really short, like I would just be like, my skin would crawl, like I was just like, I don't know if I agree with some of these conversations that I'm having and I just didn't know where I stood. I think that that's a really hard thing for people to deal with sometimes with all these social issues and politics. This is why people don't like they're just like this is too much. I don't know. I'm overwhelmed and so to be a leader I felt like I had to take the same stance as my company and that was not my body was not responding well to that and I think it was just because I just didn't know enough. So I was like I need to talk to my therapist about this and I decided to be upfront and honest about what I was thinking. I was like, what's wrong with Donald Trump? Like I know he's a jerk, but like what what does he actually stand for? Like what good has he done? Like what? I just like asking these questions because every time I tried to it was just kind of like how dare you? Like that was kind of those responses that I was getting were like he's a white supremacist. Like okay what does that mean? You know just questions that I just wanted to understand more. Same with Biden, like I was doing the same thing. And so I was just like trying to talk to her about what I was processing about conservative being conservative or being a Democrat, like just all of these, all these Republican Democrats, excuse me, and what felt good to me and what didn't and she was like well wouldn't... This is when it started to go bad. She... Her body language changed a lot and I like was like not really sure what was going on and she was like, well there's no way somebody like you could vote for somebody like Donald Trump. And I was like, what do you mean? She was like, because of your situation and what happened and she was like, your mom was deported under his presidency. Like you, we wouldn't have any reason to and I was like, well, yeah, like that situation happened, but I'm not, I just want to understand like why people support like clearly there's a ton of people that support him I want to understand why and this is any pull this is the same thing I'm doing with this part you know our election coming up It's just I want to understand them. And she was very defensive. So she would say to me, okay, well, tell me, she'll be like, tell me why you would vote for somebody like him. And she would tell me about conversations that she had with her husband about things that had been recently pop popping up on the news and telling me how wrong I was to question them. I'm now studying to become a therapist. I just took my ethics class. And now after taking my ethics class, I was like, oh my gosh, this is so unethical.

  Ben Fineman [00:18:26]:

  There's a couple of threads that I want to tie together a bit on what you're saying because earlier you were describing how it felt good to just talk about how you were feeling, but it didn't seem like there was any goal setting. It didn't seem like the therapist checked in and said, is this what you want to get out of your experience? So It sounds to me like therapy felt very open-ended, undefined in a way, which I think for some clients is helpful, for others is not. But the therapist should be understanding from the client's perspective, is this what they're looking for? And it seemed like that allowed a lot of space for the conversation to shift from a therapeutic conversation to kind of like your run of the mill, like political disagreement or defensiveness where 1 person isn't interested in having a conversation, they want to tell the other person why they're wrong. And it seems like that's not what you were looking for, understandably. So I guess I'm curious in that moment, what did you want from her when you were just kind of processing your uncertainty about the candidates and how you were feeling and how it impacted you at work? If this therapist had said, Ruth, I'm curious, what do you want to get out of this session? What would you have said in response?

  Ruth [00:19:39]:

  I think as sad as it sounds, I was pretty young, but I think I wanted validation. I think I wanted her to tell me that what I was thinking was okay because what I was thinking went against my company, went against my family, went against a lot of things that I wouldn't even say like family but certain family members um went against a lot of social things and I wasn't even defining myself as a certain political party. I was just questioning a lot and that of course makes anything feel So I think I was just like, I think I needed to feel safe being okay with these questions that I was asking. And I think I just wanted to have like dialogue about it that was like safe. Does that make sense?

  Carrie Wiita [00:20:32]:

  Yeah, I think so. I mean, and I, it strikes me too that you had mentioned, and I'm not sure how explicit this, this was with your therapist in session, but you had just, you know, just now when you were telling us, you'd said that Like what kind of prompted you to want to bring it into therapy was how bad your kind of physiological response, your somatic response at work was getting when you were kind of being put in this position of leading the conversation around something that felt really incongruous for you. And you know, and so I imagine it strikes me again, I get, I get to sit in the armchair quarterback position back here and in hindsight, everything is 2020. So of course, I can say, well, it sure seems to me like what might've been more helpful was maybe processing of the physical experience that you were having, how that was connected to your emotional experience, how that was connected to your responsibilities at work and conflict or tension you might be feeling vis-a-vis your job rather than what seems to have happened, which is a jumping to trying to change your mind about the thing. Is that right?

  Ruth [00:21:49]:

  Yeah, I would definitely say that. I didn't know where I stood. I didn't know. I think what I needed to be told is that it's okay and that it's okay also that it can change. I felt like this pressure from my company and I, they didn't, but that's what it felt like as a leader. It was just like you have to, even with things like vaccines, like I had to, for me, I was like, okay, like, I want to give somebody the option to take some time to think about it. But that was not the way my company was going. We're at a lot of companies, you know, and it was just it just felt wrong, like dissonance. It was just like, and I didn't know, I just needed my therapist to just like tell me that it's okay and that and just to listen to my thought process and maybe like even help me with some resources that I could, you know, look up and read. I really was, I don't think that I was asking for a lot, like now that I have, I'll tell you about the the next therapist I went to after, but like there wasn't a bad situation happen, but like the next therapist was when I realized how wrong like, you know the this current situation was but Yeah, I totally sorry. I went sidetracked. But yes, I totally agree with what you're saying. For her to be able to tell me that I was wrong and to tell me that my way of thinking was wrong and basically she decided that my previous experiences, which I understand, but like my previous experiences defined how I think and politically like that yes, that's kind of sometimes how it works, but in this situation there were many other factors that went into my mom's deportation. There was many other factors that went into other things that have happened in my life that would influence me to choose a certain political party or another, you know, there's so many other things. I just, I I'm just shocked. I think I was just really shocked for her and she she had such an emotional response and I think that that was triggering for my therapist to have such an emotional response to how I'm expressing myself. Like it was just it created this divide. Immediately when she started to be it it turned into a you against me conversation

  Carrie Wiita [00:24:20]:

  How did it feel for you when that when you shared this in therapy? And then that is what kind of came back at you. It just felt like she was

  Ruth [00:24:28]:

  the same as everyone else it was like I just felt like really alone. I just felt that like great, like now my own therapist thinks that I'm... I don't know, but it was also mind-blowing to me at the time because I was just like, my therapist should be proud that I'm thinking differently or thinking objectively, like, you know, like, but so it's kind of mad, but I would say it made me feel also to like, it made me feel like I was disappointing her.

  Carrie Wiita [00:25:01]:

  Oh, gosh.

  Ben Fineman [00:25:03]:

  Do you feel like the therapy could have been overall a positive experience or helpful experience even if you disagreed politically with her on some of these issues or maybe not even disagreed but didn't agree. If you knew that she stood somewhere different than you in terms of how she viewed the election and the candidates, but she still had empathy and curiosity about how you felt, would that have been okay? Or do you feel like you needed somebody who was more aligned with where you were at politically?

  Ruth [00:25:37]:

  I definitely did not need somebody that was aligned with me politically all I needed was somebody that could make me feel safe and Not tell me what she thinks just don't tell me like just separate yourself and I know that a lot of people like I don't mind self-disclosure. I love it when you know therapists self-disclose with me, but I do have boundaries with it as far as like what it like politics and stuff like that or if they're unable to compose themselves, you know and having that conversation to where I just don't want to feel like it's you against me. So I think that it could have been, if we didn't talk about that, I think that I could have just really appreciated and had a better taste in my mouth of that experience with her because there were things that we were talking through that were helpful, like when I went I didn't really have an identity. So I found out like that I like certain types of food. I like certain types of people. I found out more about like wow, this job is not for me anymore, like there were things that were helpful but I had a lot of trauma and I needed trauma work and this therapist did not do trauma work, but I didn't know that I needed trauma work and I don't know if she like, you know what I mean? I, if I were her, I would have just been like, hey, like I don't know if it was a competence thing, but I would have been like, hey, like you need some some trauma, trauma work, some deeper work and referred me out if she wasn't capable of doing that. I just think that there was a competency issue, like the surface level stuff, she was great with, but I just think that there was a deeper level of therapy that I needed.

  Carrie Wiita [00:27:31]:

  I have a question for you, if you can, if you feel like conjecturing. So it sounds like if she had, and this is like a classic kind of debate in therapy land, right, is as a therapist, if you come to realize that you as a person have like a different view or perspective or whatever then values, whatever from your client, do you bring that into the room? Do you name it Or do you not? And so, you know, that's I pretty sure that the research has not shown that either way is better than the other. But definitely there are ways to manage each of those. And it it seems like the big issue here was that she She named it, brought it into the room, but did it in a not a helpful way at all. And in fact, a way that made you feel alone, like alienated, disconnected, and almost cast you in an adversarial relationship with her. So I'm curious, like, it seems like it would have been better for like you said, just to for her to not share that, keep it to herself. I'm curious, like what would have been like for you, do you think? If she had kept it to herself And then like you found out later somehow that she actually had these completely opposite views. What would that do you have any idea what that might have been like for you?

  Ruth [00:28:56]:

  I would have been like impressed. I it's just like It's really hard. I being a therapist is hard. I'm not a therapist yet but it's just like when you have something that you feel so strongly about and not be able to share that or like have conversation like that's difficult. Just be really impressed. I just it's just the truth. I I wasn't like super attached to her. I was my next therapist, but it was fine for me to I'm fine with her having whatever she believes. I actually love that there's a part of me that appreciates and loves how passionate she was about her views. I was jealous of that. I was jealous that she had, I didn't know how to get there and I needed her help to help me get there because I wanted to have, does that make sense? I wanted to have a stance on something and not feel so confused.

  Ben Fineman [00:29:54]:

  It seems like it's the difference between this therapist saying, I am going to tell you what is the right way for you to think. And the therapist saying, I want to help you find the right way to think for yourself.

  Ruth [00:30:06]:

  Exactly. You're totally right. It was, it's identity work. It's like helping me get to where I want to be because I could say I'm a conservative, I'm a Republican, but I don't know why, and I don't know why, or a Democrat, or like, you know, anything, but like, there's still a disconnect no matter what. And I just wish that she, I don't know, I think a lot about the situation of like me now going back there. I feel like I could have a conversation of what went wrong and I think that it would actually go well But I think that there was just maybe like some more question asking that she could have done to help me get to where I wanted to be, if that makes sense. It just it, the last 2 sessions became so much about her at the last session. I think I maybe spoke like twice Whoa, wait, what what happened in the last 2 sessions? She just went on tangent like I'm not kidding like the way we would start the session was about something dumb that Trump was doing or something dumb that was happening with Republicans or like she would just start sessions like that and I you know, like me now would be like I would totally be handle it a lot differently but me then I didn't know how to what to do I was just like okay I'll just listen. So then I was just like well sorry language here but I was like fuck it I'm just gonna listen and see if I can ask any. I'm like why do you think like that? It's almost like we shifted. I didn't know what else to do. I was like I honestly it felt like she like if something took over her I think that this is also too I think why people stay away from politics. Something happens to somebody and it just takes over their ability to like think of who they're talking to or or be in grounded in reality. She just went off and it was not in, it was just giving me facts, you know, like I think, I think that there was a part of me that was like educate me, so I don't think that this wasn't like all unhelpful. I can look at it as like okay well she did talk to me about what another side thinks so I guess like that's what I could take out of this but that was I don't know if I was like gaslighting myself or whatever during those last 2 sessions, but I just that last session, The last session I remember calling my friend and telling her, I'm like, you'll never guess what just happened in therapy. And I didn't even think to myself, get out. My friend was the 1 that did that. I was so lost. So I was I was I was just like, OK, yeah, like I need to find another therapist.

  Carrie Wiita [00:33:07]:

  Can I ask how many sessions like transpired between when you initially brought up your perspective And like you found out that she was like totally on the other side? And then how many sessions then would you say you stayed before you ended up leaving? Probably like 3 months. And I was going once a week. Wow. OK, cool. OK, so so so you stuck with it that long and then you said something about like the last 2 sessions. You really didn't say much. Do you have a sense of like what kind of like spiraled, like what changed to the point where those last 2 sessions were so dominated by her?

  Ruth [00:33:45]:

  Well, I mean, like I wasn't talking and that's what was help... That was just helping me get through life was just even though the type of therapy that I was going was not effective for me, it... At least I could talk, at least I could feel heard and at least I could share about what I'm experiencing and that wasn't happening anymore. It was her dominating everything and it was so weird because that's not how she seemed at first and I don't think that she, I wouldn't even, I don't know, I'm giving positive intent here. I don't think that she is like that. I just think with the topic that she just didn't know how to control herself And I think that also like there's a part of me too that I was like maybe she just cared for me so much that she wanted me to see, you know, I don't know, maybe that's again, I don't know. That's so generous. I really get that. So nice. I can tell that she cared about me like I showed up I was never canceled like I showed up a lot and we built a relationship, but Yeah, I just didn't have my own thoughts my own feelings and I and my body was on fire, like just like the last session it was like why does my body feel like I'm at Starbucks right now? And so you know and the reason why I became so in tune with my body was because of the next therapist that I found and just like to touch on that, I don't want to go that into it, but she very much was like I came in, you know, she listened, she looks at me like with she's like you what, you know, she was just kind of like shocked with from the adoption to the deportation to all this stuff and she was like oh great your therapist did some foundational work for me and so now we can move forward and little did she know until we started seeing each other that I had 0 foundation and you know she got me on a plan like she she was asked me what my goals were. She immediately started me in EMDR. She immediately, you know started doing like taught me what beliefs were, limited beliefs were, you know, talked me, gave me tools like this is what I was looking for and it was just night and day and when I talked about politics because I finally got to a point where I could talk about it with this new therapist, she would just ask me questions about it and she would totally understand where I was coming from or add to what I was saying. She didn't say, I feel that way too, I think that way too, or I think you're dumb.

  Ben Fineman [00:36:31]:

  There's something so, I think so important about what you're saying, at least from my perspective, which is the first therapist didn't ask you for what your goals were, didn't come up with anything resembling a treatment plan or give you space to provide feedback about how you felt therapy was going. And so when it went off the rails, there was no very easy way for either of you to point to it and say, this doesn't fit with the goals we've talked about. What are we doing? Let's get back on track. The next therapist defined what you are going to be doing together. There was a structure to it. So in the event that a conversation went off the rails, political or otherwise, both of you would have been very well within your right to say, like, hold on a sec, I think we've gotten sidetracked here. Is this helpful? Probably not. Let's return to our treatment plan in a sense, the goals that we're working on. But without that, there was just this risk of things falling off a cliff with the first therapist. And I mean, that's my takeaway is how much it seems like defining therapy for you allowed therapy to go well with the second 1, as opposed to the first 1, where it was just this amorphous process that was so easily sidetracked.

  Ruth [00:37:44]:

  Totally. I mean, I hope I don't eat my words when I am a therapist, but I think that I would be able to tell when somebody has little to no identity, right? Like in the first couple sessions, like really does not know themselves, does not know where they stand on anything and I think I would be able to assess that I think you know and it's just like so I the only thing that really just makes me upset like today about it like a lot of stuff with it with it but it's just that she didn't do that for me like she didn't think like wow like this person is really struggling with who they are and has to do with a lot of being adopted at a later age in life and losing their mom and things like that, you know, like these, like she needs something that I can't give her. Like to me, I just feel that the politics stuff was really frustrating and upsetting and the things she said to me were upsetting and frustrating. But to me the biggest issue is the competency. It was just that she needs somebody else. She needs somebody that's not me that can actually go through like trauma or whatever else. Like I think I wanted to share this story just because like I think competency is something that is just like it's a it's a it's a basic rule, right? It's a it's in the code of ethics. It's something we learn about but it's just like this is what happens when you take somebody on that, like you really can't treat, you know, like that has these deeper issues. And this is the repercussions of it. All, all it did was just set me back. It didn't, it didn't really like there are some things that helped, but I could have found this therapist, this next therapist. And yeah, it's just competency in my opinion.

  Carrie Wiita [00:39:43]:

  How, from your perspective, like thinking back now, like as a client, how could that first therapist have introduced that idea that like, you know, maybe this is maybe I don't know. I don't as a therapist, I don't know what I'm doing here or I'm not a good fit. Or like, how could that therapist have like introduced that in in a way that was like supportive and would have Helped you as opposed to like giving you the message like whoa like this way too much for me. I can't handle you I value transparency.

  Ruth [00:40:15]:

  So to me just because my things were on fire in my life didn't mean that I didn't appreciate honesty and so what I wish that she could have done or what I hope that she would have done is was say to me like you know Ruth you've gone through some stuff like you have a lot of stuff and you have something called trauma like educate me. I didn't know even what trauma was and this is produced by this, this and this and these things are going to require a level of work that I can't, I can't give to you. I wish I could but I'm just not and you deserve to see somebody that can actually help you with these specific things. Here are some recommendations and you know, like what would you need from me? Like do you want to stay with me until you start another therapist? Do you want to just giving me options making me feel like I don't know that to me would have made me feel like protected, loved, cared for, because I was just flailing. I had no structure in my life. And so for somebody to say that, I would have had so much more respect for her in that scenario.

  Ben Fineman [00:41:34]:

  Ruth, is there anything else either that we haven't covered yet or anything that you feel is just really important to underline about your experience that you would want our listeners to take away?

  Ruth [00:41:46]:

  Yes, I definitely would say, I mean, in these examples that I talked about, I talked a lot about like my body being just on fire, my body just being you know, like just things that were happening in my body that I felt and to as cliche as it sounds to pay attention because it was telling me the entire time that I was with the wrong therapist, I was with in the wrong company, I was in these conversations that I was having, I was not supposed to be having. I it just all summed a lot of things up for me, you know, and so just paying attention to that. And number 2, like it's okay to be somebody that needs maybe more structure in, in therapy, like it's okay to, like that's why there's so many different types of therapy modality or therapy count, like there'd be ways to be able to to meet somebody where they're at, like different, it's okay to need that and a lot of the things that I talked about like I didn't vocalize anything. I didn't tell her that what she was saying was hurting my feelings or anything like that and I would now but I think that there that's just something that I would just it's okay to need that structure and then number 3 it's okay to question things that people are telling you not to question. And it does not matter, like, I am Black, I am an immigrant, I'm not even from here, I have all of these things that would point me to 1 political party, but I could, you know, maybe I sit on the other side. Those things might not define you and it's okay to switch, it's okay to question, even if there's a whole social agenda that's against that. So that's what I would say.

  Ben Fineman [00:43:34]:

  Thank you and we really appreciate you taking the time to share all of that, to share your experience with us and with our listeners. If anybody wants to say thank you for sharing your story by way of donating to a charity that you support, Is there 1 that you have in mind?

  Ruth [00:43:47]:

  Yes, so this is a Christian organization, so it's something to just note, but it's called Samaritans Purse, and I'm specifically talking about the 1 in Ethiopia. So when you donate, you can actually pick which, It's a non-profit organization, natural disasters, food, just in general, they do a ton of non-profit work within areas of need. My mom specifically works in Ethiopia for that organization, and they always need any type of support. They run completely off of donations. So I would say that. Thank you so much. We'll have links on the

  Carrie Wiita [00:44:26]:

  show notes and website. Ruth, thank you again so much for sharing your story today. Thank you for listening and thank you for being great.

  Ben Fineman [00:44:38]:

  Hey, everyone. This is the part of the show where we take a moment to say thank you so much for all the ways you continue to support Very Bad Therapy. It always helps us tremendously for you to leave us a rating and review on iTunes or wherever you get your podcasts. You can also join our Patreon community where for $5 a month, we release bonus episodes. Carrie, I think the most recent 1 is part 2 of our look into bad therapist Facebook posts. And coming up, we haven't recorded it yet, but you and I are going to create our own modality, CBT 2.0, aka Carrie Benn Therapy. We may just revolutionize the field Or we may just talk our normal bullshit. We may create a board and certify people in

  Carrie Wiita [00:45:22]:

  CBT 2.0.

  Ben Fineman [00:45:24]:

  So get ahead of the curve. Be an early adopter. Come join us at patreon.com slash very bad therapy. And we are happy once again to have Dr. Ben Caldwell on as our expert guest and Ben this is a bit of a unique scenario because not only are Carrie and I excited to talk to you but Ruth had actually requested you by name to be the expert on this episode. So you have

  Ben Caldwell [00:45:49]:

  kind of some big expectations here to live up to our expectations, but also Ruth's as well. Well, I'm honored and I will fall woefully short of those expectations, but I'll do what I can.

  Ben Fineman [00:46:01]:

  Well, to start, how about just reintroducing yourself to anybody listening who is not familiar with your work?

  Ben Caldwell [00:46:07]:

  Well, thank you. It's always good to be with you both. I'm Ben Caldwell. I'm a licensed MFT in California. I'm on the faculty. I'm an adjunct faculty for Cal State Northridge in the MFT program. And I do exam prep and books and stuff through my company, Ben Caldwell Labs.

  Ben Fineman [00:46:23]:

  So I think there's 2 really interesting topics here that emerged from our conversation with Ruth. 1 being the ethics of talking about politics in therapy and how that might show up, and another being the ethics of referring out when there's a competency issue that's either perceived by the client, that's perceived by the therapist, or both. So I think the more fun conversation, the more hot button conversation is talking about political views in therapy and the related ethics. So just generally speaking, what are your thoughts around this broad topic of a therapist bringing their own political views into therapy with a client?

  Ben Caldwell [00:47:02]:

  Well, I think it's a great question and as we get closer to the next presidential election, it's going to be more of a hot button issue again. The ethical standards that we have around self-disclosure are really pretty limited. And if you look historically across different forms of mental health care, there's a whole range of opinion about self-disclosure generally, political self-disclosure more specifically. So it's not like we can point to there being a hard and fast rule that says either don't do it or do it in this way. The fact is you can have political views as a therapist, most of us do, it'd be really hard not to, And you can bring those views into the room. Now, whether it's a good idea is a very different question, but there's no particular prohibition. So then we get into, like, what's the effect going to be on the relationship if you bring your politics into the room and and that I think is where things get interesting.

  Carrie Wiita [00:48:11]:

  You said that you made the point there that there's no prohibition against it to go way swing way the other side. Is there any level of ethical obligation to share, particularly if something comes up in the room with a client where, you know, your political beliefs maybe directly impact or have something to do with something the client is bringing up in the room. Is there an expectation that you should at some level share that?

  Ben Caldwell [00:48:41]:

  No. And I think a lot of therapists will say that it would be a bad idea to call out every instance of value difference that emerges in therapy, right? You're certainly not obligated to, and the downside tends to outweigh the upside of pointing out where those differences exist, especially if the client would otherwise not know. If a client expresses a political viewpoint that you don't happen to agree with, How important is it really to the therapy for you to say, well, I personally land in a different place? What's the upside?

  Carrie Wiita [00:49:24]:

  Well, that was a question I had for Ruth actually during our conversation. I was curious for her how she would feel, how she would have felt, like, you know, kind of reimagining if things had gone differently, how she would feel if she had shared what was going on for her, and then if her therapist did not share her position. And then if Ruth were to find out later on that in somehow maybe not by intentional disclosure by the therapist, maybe seeing her at a rally or, you know, whatever, some other way finding out about the therapist's actual political position, you know, Would that affect her in any way? Would that be a betrayal in any way? Ruth certainly didn't feel like it would have been. It felt like that would have been better for her. But I'm sure of hearing other conversations where other people would have felt differently, other clients in that position would have felt differently, they would have felt a sense of betrayal. I guess that's where my mind goes. I really don't know what the answer is here, so I'm not pushing for 1 way or the other. But in terms of an upside, that's kind of where I see where the upside might be in terms of transparency.

  Ben Caldwell [00:50:37]:

  Like protecting against the possibility of a future feeling of betrayal later if it were to come out that, oh, we're not on the same team after all. I thought we were on the same team. It turns out we're not. Yeah, yeah, exactly. I mean, like I might feel uncomfortable.

  Carrie Wiita [00:50:53]:

  I'm trying to think, if this has not happened to me in session, but you know, if I'm faced with working with a client whose beliefs are dramatically different from mine. And I don't say anything. And yeah, I hold space. I can imagine, I can see how a client might register my non-committal or just like, holding space and not bringing my own opinions into it as an affirmation or validation or like, you know, I, a tacit endorsement, right? Particularly if it's a conversation that is ongoing over multiple, multiple sessions. And then I would be concerned, like, would, how would that client feel then to 1 day find out that in fact, my own personal beliefs are just like 180 degrees different. I imagine that might affect a client, some clients, obviously not Ruth, but some clients may feel like, I have been sharing this with you in good faith and you have never revealed this to me. That's what I would be worried about.

  Ben Caldwell [00:52:04]:

  I hear that, and I understand the desire for some therapists to be in a place of transparency. At the same time, there is the possibility of a different kind of reaction from that client. Like if they were to see later on, they were to see that you were at a rally on the other side of a political issue or an election or whatever, they had had this conversation going on with you for many sessions, maybe even many months, where they were being open and clear about their opinions and their political beliefs and it's on a different side and they found you to be accepting, validating, honoring of their perspective. Couldn't that client also think, wow, what a great therapist, to be able to not make this discussion about them, to be able to keep the focus on me and what I believe and to validate that even though internally the therapist was in a different place from me the whole time. Like, that's awesome that they did that and didn't make it into a political debate or a power struggle in therapy, right? You were able to hold space for the client to have the beliefs that they have.

  Ben Fineman [00:53:23]:

  I want to take that 1 step further because I think what you're saying sounds great in theory and it sounds ideal in a lot of ways, But I'm thinking of what Ruth said that she just wanted validation from her therapist when Ruth was questioning certain things, when she was expressing certain views or curiosities. And I'm wondering what therapists should do practically, not theoretically, but practically if a client is saying, what is the problem with Trump or with Biden or some political view? And let's take it even 1 step further than what Ruth was saying. Let's imagine a hypothetical where the client is just venting and saying, isn't this the worst that this person is doing this thing to these people? And the therapist has a different view and can't honestly validate it and say, I agree or I know how you feel. How does a therapist tow that line to be validating when they actually disagree with the client's perspective or may just not agree but not feel strongly 1 way or the other.

  Ben Caldwell [00:54:17]:

  So I'm gonna tell you this thing now that if more couples understood this, I would be out of a job as a couple therapist. So maybe keep this a little bit quiet, But there is a big, big gulf between disagreeing with somebody and being unable to validate them. Every single day when we do therapy, sometimes every session of the day, We empathize with feelings and experiences and world views that are different from our own. And saying, I understand, I get it, I can see where you're coming from with that. That makes sense to me. All of those phrases are very different from saying You're right Ruth said that she primarily wanted validation and I Sort of I hear that as somebody saying I want to know that what I'm thinking is okay, that I'm not crazy. Right. And we as therapists do that all the time. We tell people, no, you're, you're not crazy to have this reaction, to have this feeling, to have this experience. And we can do that without agreeing, without sharing their opinion, without landing in the same place. We can still empathize fully and effectively. And as a clinician, I feel like that's a big part of our job when we're dealing with any area of difference with a client is to be able to empathize and validate whether we agree or not.

  Carrie Wiita [00:56:04]:

  I want to call out my own hypocrisy here because I'm sitting here listening to you and I'm thinking, well, yeah, yeah, for sure. Like if I imagine the situation is different, right? What if the client, for example, is sharing that they are queer, right? And the therapist has their own beliefs that they don't agree, they're not on board with that, they don't like it, whatever their actual, however they frame it, it runs counter to their own belief system. You know, I'm sitting here being like, yeah, exactly, keep that shit to yourself and don't cause harm to your clients. And, but then I have to be honest with myself and think, put myself in the position of, okay, what if I'm sitting there and it's me as the therapist in the room with a client who say feels very strongly against abortion, for example, which is an issue I feel very strongly about in favor of access to abortion. I am gonna have a real hard time engaging and holding that space. And instantly my brain is squirreling around for an out and I land on, you know, well, theoretically, you know, plenty of people say therapy's political. And, you know, if I have a, you know, if I'm coming from a more activist or a narrative perspective, then, you know, maybe to some extent, it's my responsibility to share my perspective. And I'm just recognizing I'm coming up with this because it's when I frame it as an issue that I feel strongly about. I feel like I will, of course, I should say something. So tell me why I'm wrong.

  Ben Caldwell [00:57:50]:

  Well, I appreciate you're noticing what's happening inside of you there, because what you're what you're saying, it sounds like is that you feel this very strong pull to voice some political opinions, but not all. And that it's okay to bring in political views around some issues where you're going to bring the client to your side, not on other issues where it's really better for the therapist to stay out of it. And listen, I'm not actually that much of a believer in like hard and fast universal rules. So I don't think it's fair or right to say that you should always bring in your views or that you should never bring in your views. But I do think that you ought to be clear on what your principles are around self-disclosure, around the role of politics in therapy. And listen, that viewpoint that therapy is a political act, I agree with that. I think that therapy is a political act because anytime you get involved in empowering disadvantaged people, You are changing the political balance, the power balance of a community or a society. So I think it's 100% true that therapy is a political act, but that is quite different from, Therefore, part of the role of the therapist is to bring people on to my team.

  Ben Fineman [00:59:21]:

  It gets into such a gray area. And there's something I think about often, which is where the line exists between doing therapy and doing advocacy. And I think this is a tricky issue for a lot of people where a client might bring something up and you might genuinely feel that it's in the client's best interest to help them see things from a different perspective. To help change their, maybe even change their political views, change their views on society because it might, as you said, Ben, it might serve to empower them in a way. But it just seems because there is no quote unquote right way to see the world and people who are strong advocates for anything will by default feel like they have arrived at the right way to see the world that they should then convince other people to agree with. So how do you as a therapist define the line between doing therapy and being an advocate when the end goal would be changing a client's view about the world?

  Ben Caldwell [01:00:19]:

  I'm not sure that there is a line as such. Sometimes therapy is overtly advocacy. Sometimes we're helping clients push back against larger systemic influences that are causing problems for themselves or their families. Sometimes we're teaching clients how to advocate for themselves with insurance, with court systems, or with others. And so to say that therapy and advocacy have a line between them, I'm not sure that they do, but I do think we need to be very cautious about what our role is. And so, for an example, are you familiar with the Log Cabin Republicans?

  Ben Fineman [01:01:08]:

  Yeah, although I think it's probably helpful to explain who they are, especially to people outside of the United States listening.

  Ben Caldwell [01:01:15]:

  Sure, so the Republican Party is 1 of the 2 big political parties in the U.S. And within the Republican Party there is a subgroup called the Log Cabin Republicans that is an LGBT group within the Republican Party that, at least in recent times, the Republican Party has had some animosity toward LGBT populations generally. If you get a client as a therapist who is a member of the log cabin Republicans, then there are a bunch of different ways that you could conceptualize that sort of membership. And 1 way that a therapist might think about it is that that client must have such a deep level of self-hatred that they really, in order for them to be in the Republican Party, they must have such a deep level of self-hatred that really my job as a therapist is going to be to talk with them about genuineness and affirmation being their true selves And in order to do that, they really need to be in the Democratic Party. That's 1 way to think about it, is I need to change this person's political views for the sake of their well-being. What an infantilizing perspective from the therapist to say that I know better than the client how the client should identify politically. Because the members of the log cabin Republicans are often very well aware of the animosity toward LGBT populations within the Republican Party, and yet they've made a conscious choice to stay within the party, sometimes to try to change that perspective from within, and sometimes because they feel alignment with enough of the party's other principles that they feel like in spite of the animosity toward this part of their identity that it's still the better political home for them. And so for the therapist, you either take on this perspective of, I know better than you where you need to be politically, or you work harder to understand why they are where they are politically. And it seems like the latter is just a much better choice.

  Carrie Wiita [01:03:40]:

  I so again, I'm so aware that like you're speaking my language and I'm like, yeah, that is what I agree with as well, because like when I think about it in terms of like, you know, purely theoretical therapy, theoretical processes or whatever, you know, those are the theoretical approaches that I reject that don't sit well with me, never have. The ones are more interpretive and definitely like, you know, put the therapist in a position of where the point of therapy is for the therapist to identify seeming counter counterintuitive or the word is escaping me, but things that are going on for the client that seem to be pointing to some sort of pathology, right? And that the role of the therapist is to point those out and kind of challenge and hopefully change from their perspective, change the client's mind on it. And that doesn't sit well with me. I obviously prefer a theoretical perspective that hears that from the client and wants to know, oh, how did that come about for you? How did you become a log cabin Republican? But then I have to check myself and say, well, the research seems to suggest that both of those approaches to therapy work, just because I like 1 better than the other as a therapist doesn't mean that my way is right. Are you saying that from a ethical standpoint, no matter how you approach therapy theoretically, it is probably ethically safer to use a perspective that is curious about how that came about for the client, as opposed to prescriptive.

  Ben Caldwell [01:05:23]:

  There's a lot in that question.

  Carrie Wiita [01:05:25]:

  So yeah, yeah, that's it's unfair. Can you just fix it for me, please? I don't like discord. What is that? What's the word I'm looking for? I can't. I don't like dissonance in my head.

  Ben Fineman [01:05:42]:

  You're in the wrong field, Carrie. No, seriously.

  Ben Caldwell [01:05:48]:

  Here's what I would say by way of entirely avoiding your question. Yes, when you look at different theoretical models for how to do therapy, There are some that take on more of an expert role for the therapist and some that take on or that put the therapist in more of a collaborative role and it doesn't seem like 1 of those is better than the other. However, I have not seen and listen maybe I'm mistaken about this I just haven't seen maybe it's out there I haven't seen any research that is specific to the therapist believing it necessary to change the political views of the client and how well that might work. In fact the only thing I've seen that's sort of remotely in the neighborhood is an older study looking at value difference in therapy between therapist and client and finding that those value differences can be a contributor to dropout. So if you really... And listen, I'm drawing some inferences here that go farther than what this study did, so a grain of salt. But if you as a clinician are engaging in our struggles in therapy over value differences, it's hard to imagine that going well. Like, yes, once in a while you might convince a client, but if you convince them, is that great work? You know, if you sort of pressured them, there is of course the ethical mandate that we don't impose our values on our clients. Right? We can have our values, we can give voice to our values, but we can't make it a condition of therapy that the client adopt our values in order to either remain in therapy with us or to remain in our good graces. Like we have to be able to allow for value difference. Have I ever told you guys about my brother, Casey?

  Carrie Wiita [01:07:59]:

  Oh, I don't think so.

  Ben Caldwell [01:08:01]:

  So I love my brother. He's about a year and a half older than me. He works for the state of California and he and I are in different places politically, but I love talking politics with the guy because number 1, he's well informed. His, his choices come from well-informed places. And number 2, we're able to talk about politics in some depth from informed places without trying to change each other's minds. Those conversations would be very different if it felt like he was trying to change my mind or I was trying to change his like There's no there's no pressure Explicit or implied in those conversations. It's just really fascinating I'm curious to know how he got there in those places where he and I differ. And so when we think about how to handle political differences in the room with clients, I think part of our job is to find the places where we can connect. Because we and our clients, we typically want a lot of the same stuff. We want safety, we want opportunity, we want good roads and schools, right? We want to feel heard in larger systems. We want a justice system that is actually just. We want help for the sick and the needy. Like, people who are in wildly different places politically and often still connect around some of the bases for why they believe what they believe. It's often just that we have different ideas about what the best way is to get there, but we want the same things. And we actually, at the core of it, often share a lot of the same values. Now, it doesn't mean that we share all the same values, right? There are things that we can disagree on that are important. I don't mean to minimize those, but I sometimes will hear clinicians say things like, you know, I can empathize with domestic abusers. I can empathize with people who've been through all kinds of trauma, I can empathize with the bully, I can empathize with etc. Etc. Etc. I just for the life of me cannot understand, cannot empathize with a hardcore progressive or a hardcore Republican conservative. And when I hear that, I hear that clinician saying that they're just making a choice not to try. Because we can find pieces of clients that we can connect with, no matter what the areas of difference are. And that's actually a skill that we are supposed to be building and strengthening throughout our careers, is being able to work with someone effectively, to understand and empathize with them, even in the presence of difference. That was a very long answer that entirely avoided your question

  Ben Fineman [01:11:19]:

  How would it feel it at this point to to shift the focus and talk about the theme of competency in therapy? Because this is something else that Ruth brought up that I think is a very interesting ethical area with no clearly defined answer because she was saying that she came to arrive at the conclusion that she needed trauma work. The therapist did not have the competency to provide that. And in Ruth's mind, the therapist should have recognized this and explained it and referred out. And I think there's a lot there to unpack. And I mean, I have some questions, Carrie, I'm sure you do as well, but Ben, I'm curious, is there anything that comes to mind for you just generally speaking about this idea of competency in therapy when it is kind of an ambiguous thing about Is the therapist equipped to treat certain clients?

  Ben Caldwell [01:12:03]:

  Yeah, I think that's that's a great setup and I would just for for broad contextualization I'd say that across the mental health professions there there's always an ethical standard about competence about your scope of competence and that you shouldn't be working in areas that go beyond your particular education, training, and experience. And that's great in concept, but it's often really challenging as applied to specific situations because there's no magic number for like how much training, how much experience, how much education is enough and yeah I'm as guilty of this as anybody else but from a place of ego it's it's easy to think as a therapist, oh yeah I can totally treat that, when you may or may not actually have the capacity to treat that all that well. So it is challenging And sometimes it won't come out until many sessions or even many months into therapy that the client has this particular issue that as a therapist, you really aren't equipped for. And so then you have to do some complicated math about, Okay, we have a very strong working relationship, but I might not have the skill set necessary for this particular content area. Do I refer out for this content area? Do I refer the client out overall so they're with a new clinician and in some ways building a brand new therapeutic relationship? Do we put our own treatment on pause for a little bit? There's no singular right answer to that. It requires that we are thoughtful about what's going to be in the client's best interests. That's not easy.

  Carrie Wiita [01:13:47]:

  What strikes me though is that, And I'm not sure how I feel about it, but no graduate school is graduating their therapists and saying, but just so you know, you're not ready to treat trauma yet. Yeah. So at what point, like if you have gotten a degree and the educational system is saying you're good to treat people without limitations, you just got to do it under supervision, the state is saying you just need to do supervision, but nobody actually ever needs to see you work with a client. We just need your word for it. How is a therapist supposed to do that self-analysis of whether they are competent to work with a given client, a given topic or content or diagnosis? How are we supposed to know?

  Ben Caldwell [01:14:36]:

  Well I think there are a couple of really good gauges you can use. And 1 is your own confidence. If you feel well-equipped going in, like, okay, maybe I haven't done a lot of work with this before, but I feel strongly that I know what to do here. I know what the accepted treatments are for this issue. I know what this is supposed to look like. I've got some resources I can draw on as necessary to kind of help me out along the way. If you feel that, then that's at least a pretty good indicator that you're gonna start in good faith. The other good indicator is outcome monitoring. And what a great case for routine outcome monitoring as part of the therapeutic process, because the proof about competency is kind of in the pudding, as they say, right? Either the treatment's going to be working or it's not. And if you are tracking progress, tracking outcomes along the way, then you can see and the client can see whether you are making the progress that you would hope to make doing the work that you're doing. If it turns out that the treatment you're providing is not working for this particular client doesn't mean that anybody necessarily has done anything wrong. You got into it in good faith. But it can be an indicator that, you know what, maybe I am not the right therapist for this particular issue with this particular client, and a referral would be appropriate. Let's not keep banging our heads against the wall and doing a treatment that's not having a positive impact. Let's actually get the client into a more helpful treatment as soon as possible. I could not agree more with that. And I think it does,

  Ben Fineman [01:16:23]:

  what you're getting at Ben, I think it does a lot to brush off the unavoidable ambiguity about competency. Like there are some very clear, clearly defined diagnoses, scenarios, where a therapist can know ahead of time, I am not competent to work with this particular client. But when it comes to something like being trauma informed, a topic that, Cara, you and I are about to do a study hall episode on, and I don't know about you, but I haven't dove into the research yet. But I bet what we're going to find is that it's not clearly defined and not black and white. And it seems like if you as a therapist are trying to make sure that you are doing trauma-informed work with a client, what you will find is that for some clients, you are trauma-informed and you have had successful treatment. And for other clients, maybe you're not trauma-informed enough. And I think these are all maybe even meaningless, Not meaningless, but kind of meaningless words because you can't say, do you do trauma-informed work? Because every therapist will say yes, but also no sometimes. And the answer lies in, are you effective in working with clients who are showing up with trauma? And you can't truly know that without doing some form of outcome monitoring. And so this idea that therapists should know if they are trauma-informed enough for a particular client and refer out is almost impossible to operationalize. How do you know that unless you see in actual data or from actual client feedback that therapy isn't helpful enough? And even then it may have nothing to do with your level of being trauma informed. It may just be that you're the best trauma therapist in the world, but it's not a good fit for you as a client because they trigger your political beliefs and you get too emotional and start spouting out your views and it gets in the way of doing good trauma work. Maybe this therapist was a great trauma therapist who just couldn't get out of her own way. We'll never know, but if you do something that is tangible like monitor outcomes, it almost doesn't matter at the end of the day because you know, are you helping your clients or not? And that's what matters.

  Ben Caldwell [01:18:22]:

  Totally. And I think it's such a great way of avoiding the sort of buzzword trap. And I loved what you said there about, you know, maybe it's meaningless. No, no, no, it's not meaningless. Well, okay, it's meaningless. Trauma-informed, like, there are real principles there, but it's not a binary, right? It's not like somebody either is or is not trauma-informed. There are degrees of doing trauma-informed work versus less trauma-informed work. And you can get into all kinds of cognitive pretzels about, you know, how trauma-informed is this particular way of working with this particular client at this particular time, or you can measure your outcomes and you can see is it working or not. And you can almost go backwards into, well, if it's working, then part of the reason why it's working might be that I am embedding some trauma-informed principles of care here. And just as an aside, every year, she's gonna be so embarrassed when she hears this, every year I write my wife this little book of very terrible poetry as like a holiday gift. I try for at least 1 of those every year to put in some poem that is lighthearted but about our work. I can't remember how long ago it was, but sometime in the past few years I did this poem making fun of the buzzwords involved in therapist training. I remember I put this line in, also I am trauma-informed. I have been informed of trauma because I feel like that's a lot of what it is that people are saying, right? There's no certificate, there's no like stamp of trauma-informed, like either you're doing good trauma work or you're not. And that that term trauma informed again, it is meant to mean real things, but it is often used in ways that are entirely meaningless.

  Carrie Wiita [01:20:33]:

  Now, I want to hear Ben Caldwell's poetry. No, you do not. I'm learning so much about Ben Caldwell this episode.

  Ben Fineman [01:20:42]:

  I agree. I think it's just turned to like, what is it? Slam poetry. What is it? It's just turn. It's like a jam. New Patreon episode. The moth

  Carrie Wiita [01:20:52]:

  BBT BBT moth starring Ben Caldwell

  Ben Caldwell [01:20:55]:

  several years ago. You might be familiar with this institution in LA called the Poetry Lounge and and I a few years ago was a regular attendee and every so often would get up on stage and acknowledge that compared to the rest of the crowd, I looked like middle management. And I would read 1 of my not great works of not quite art and it went over surprisingly well.

  Carrie Wiita [01:21:27]:

  Oh my God. Is there evidence on YouTube anywhere? If there is, I will find it. I will find it. I will link it in the show notes, everyone. There is not. God damn it. There is not. I don't know how we ended up here, but I'm so glad we did.

  Ben Fineman [01:21:40]:

  Ben, do you have anything we haven't gotten to yet? Any closing thoughts about what Ruth was sharing that feels worth going over before we bid you a temporary farewell.

  Ben Caldwell [01:21:51]:

  I think my final thought probably should have been my first thought here, which is Ruth sounds awesome. I wish that we had 10, 000 Ruth's as therapists because even though she and I might not agree on everything, I'm so in admiration in respect of her desire to deeply question what other people are telling her should just be assumed, right, or should just be accepted without questioning. That is such a valuable desire, such a valuable skill. It's something that I wish every therapist could do and good for Ruth. Like I I'm so happy that she's becoming a therapist and and I think she's gonna wind up being a wonderful therapist because of her willingness to challenge typical assumptions.

  Carrie Wiita [01:22:55]:

  I could not agree more.

  Ben Fineman [01:22:58]:

  Yeah. Amen. Well, on that note, Ben, is there anything that you want to shout out how people can find your work, get in touch? Yeah, all the normal stuff.

  Ben Caldwell [01:23:07]:

  Well, you can find my poetry at no, I'm just kidding. All of my exam prep stuff and books, all that that's at Ben Caldwell labs.com.

  Carrie Wiita [01:23:19]:

  We will have links to that in the show notes and the website and also any links I can find to Ben Caldwell's poetry performances. I will be looking to the dark ends of the Internet. Thank you so much, Ben Caldwell, for joining us today.

  Ben Caldwell [01:23:35]:

  It is always a pleasure. Oh, can I plug 1 other thing here real quick? Of course. So if you're listening to this, you are already a podcast listener, which means that you are 98 percent of the way to listening to the Think Like the Test podcast with me and the wonderful Kerry Weta. So look for that on all your favorite podcast platforms. And Ben, you and I should also do a podcast at some point just to confuse everyone. And we can call it The 2 Bens. The 2 Bens. If this is an indication about the quality of your poetry, color me skeptical. It is an indication about the quality of my poetry, which is why no 1 should ever read it

  Ben Fineman [01:24:26]:

  Well, Carrie we've had too much listener mail in the last couple weeks following our very fun EMDR episode. So I think we have to read at least some of it because we've had a lot of interesting, thoughtful, not too many angry emails about what us and Angela had to say about EMDR.

  Carrie Wiita [01:24:45]:

  Yeah, I was, I've been pleasantly surprised and very grateful for the lack of vitriol, even even from the people who disagreed with us. Yeah.

  Ben Fineman [01:24:55]:

  Well, someone who did not disagree with us but brought the client perspective of having received EMDR was former guest of the show, Monica Sudakov, and a friend of ours. So Monica wrote in, Hey Ben and Carrie, it's your longtime fan Monica. What a fascinating episode on EMDR. So I had some thoughts to share. I've done EMDR and I have mixed feelings about it. Was it the miracle they promised? No. Did I get some benefit? Yes. Did it cure my PTSD? No. I will say that I do think it was an effective way to do exposure therapy, but perhaps what I think it helped me with was a few other things. In this case, EMDR itself was less what worked but the conduit through which these other things were established. 1, it helped me to feel safer and learn to trust my therapist. In a way, by distracting me I was able to tap into the yuck without feeling quite as vulnerable or ashamed. 2, It does focus quite a bit on what you are feeling in your body as you talk about trauma. For someone with sexual abuse in my past, I was very disconnected from my body. Having the suds and stopping to check in with my body constantly helped to reconnect me and allow myself to determine where I hold my trauma. This has helped me in the here and now to more quickly sense that I'm getting triggered so I don't go into a flashback so rapidly or at all. That's a win. 3, because so much of the protocol focuses on establishing a safe space that can get used in any modality. Having that anchored and well-developed is super for being more mindful and helping to self-soothe when triggered. As to its efficacy in any other type of treatment, that sounds dubious to me too. Also, it's only a very beginning into trauma work, which takes a ton of time with a therapist you feel safe with. Ultimately going back to, it's the therapeutic alliance dummy, LOL. Hope that's of interest. Great show. And thank you, Monica, for writing in and sharing those thoughts. I think it's beautiful. I think it really speaks to the fact that EMDR is effective for a lot of people. Is it the bilateral stimulation? Maybe not. Is it the neuroscience? Maybe not. Is it that for some people it really resonates and is helpful?

  Carrie Wiita [01:26:55]:

  Yeah. I have nothing better to say. That was just so lovely. And I'm sure It sums up a lot of folks experiences with the MDR, probably both on both sides of the of the coffee table, I guess, as it were. Agreed. Thank you for listening to Very Bad Therapy. The views and opinions expressed do not constitute therapeutic or legal advice, nor do they represent any entity other than ourselves or our guests.

  Ben Fineman [01:27:27]:

  Visit us at verybadtherapy.com for more content, ways to support the podcast, or to let us know if you have a story you'd like to share on the show. If you'd like to join our Patreon community and get access to our monthly bonus episodes, check us out at patreon.com slash verybadtherapy.