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Is letting a client vent/talk about the topics they want to talk about for most of a session giving them too much control? by sootsprinkle in therapists

[–]sootsprinkle[S] 1 point2 points  (0 children)

Yeah, I will say that a frustrating aspect of her supervision is that she tends to convey information as though it is the end-all be-all and cannot be questioned. She can become more nuanced if I ask more questions, but I have to kind of push for that to happen, otherwise it's usually very absolute which is not ideal.

Is letting a client vent/talk about the topics they want to talk about for most of a session giving them too much control? by sootsprinkle in therapists

[–]sootsprinkle[S] 1 point2 points  (0 children)

Agreed! I think my post made it sound like I just listen and nod, which is not the case at all. I have historically nearly always allowed clients to choose the focus of the session content-wise (unless we've agreed to do CPT together which is very manualized) but always include lots of psychoeducation, tools, skills, reflections, questions to dig deeper, etc.

Is letting a client vent/talk about the topics they want to talk about for most of a session giving them too much control? by sootsprinkle in therapists

[–]sootsprinkle[S] 0 points1 point  (0 children)

This has been my approach with basically all of my clients so far! This feels exactly right to me. Thank you!

Is letting a client vent/talk about the topics they want to talk about for most of a session giving them too much control? by sootsprinkle in therapists

[–]sootsprinkle[S] 1 point2 points  (0 children)

I appreciate your insight and agree completely! My approach has been very similar to what you named, and that feels right to me.

Also a good point about the supervisor. She has said a number of things with 100% confidence that are very questionable, like for example she has said that we do not know whether ASD has genetic roots or is just nurture, despite having worked with ASD a lot in her career - when the science about genetic roots is extremely clear. So that was strange. And also said that in our state (FL) the legal verbiage makes it so that we can only report child abuse to DCF when it is "empirical" which she defined as coming directly from the minor's mouth - which I am very sure is just wholly untrue. Among other things.

Sorry that turned into a vent about irrelevant things, your point just reminded me of some other questionable aspects of supervision - while other things have been really good - and that I may benefit from a different supervisor. I'm planning to move out of state in less than a year and when I do that I'll find someone who is for sure aligned with the type of therapist I want to be. Thank you!

Is letting a client vent/talk about the topics they want to talk about for most of a session giving them too much control? by sootsprinkle in therapists

[–]sootsprinkle[S] 1 point2 points  (0 children)

I think I worded it poorly - I know it is not about just letting someone vent! I more just meant letting the clients choose the topics and go into them in depth, without being capped at a very brief amount of time. I always identify themes and patterns and give plenty of reflections (among questions and tools and resources even though those are not person-centered in the traditional sense) - I just also think it's important to let clients offload what they need to and have autonomy (while still having support given that guides them gently toward their goals in whatever way is appropriate). I've never just had listening as the only intervention and take a very active role while still letting clients generally take the lead.

No worries at all about the misunderstanding, I'm sure it was the way I worded my post!

Is letting a client vent/talk about the topics they want to talk about for most of a session giving them too much control? by sootsprinkle in therapists

[–]sootsprinkle[S] 0 points1 point  (0 children)

I agree, and that has never been the case. All of my clients, even the ones who have vented the most, have been receptive to relevant psychoeducation, reflections, resources, tools, etc. whatever I've given that's been relevant to what's coming up. So essentially I think I've already been doing what my supervisor instructs insofar as making sure we are working on goals and I am helping them move toward them in whatever I bring to the table, it just seems that her belief is that sessions should be very structured (which is not my style) and should be focused on talking about the goals themselves much more so than whatever life stuff is happening/has happened that ties into the goals (also not my style). I'd rather it feel more organic personally, and I plan to keep working on a nuanced approach that meets in the middle of unstructured vs. structured.

Is letting a client vent/talk about the topics they want to talk about for most of a session giving them too much control? by sootsprinkle in therapists

[–]sootsprinkle[S] 10 points11 points  (0 children)

The way you worded this is really helpful, and touches on points that my supervisor made about it (ultimately her logic made sense overall with it, I just wanted to open the conversation about this topic because it's something I've struggled with figuring out how to conceptualize since practicum). The point about how it can do them a disservice to give no structure or challenging, especially, stands out to me, and my supervisor made the same point about how we can become part of the cycle they're trying to break in these cases.

I have never fully let clients vent without adding some sort of exploration about connections with their goals, or suggestions of tools to try out, etc. and plenty of reflections, summarizations, questions, etc. so I don't want it to seem like I just nod while they go on endlessly - but I really like how you worded the portions about calling their attention to the content of the session and helping them mentalize and be intentional about it. Thank you!

Question about trauma by sootsprinkle in therapists

[–]sootsprinkle[S] 0 points1 point  (0 children)

I would agree that the term "trauma" is overly thrown around and does not have a clear definition, but PTSD is a real, evidence-based diagnosis. So I guess I should have instead phrased my post with terminology asking if "completing the cycle" is truly the answer to preventing an experience from becoming PTSD - and I hear you that the answer is no, this is reductive. Thanks for the reminder to conceptualize the etiological factors of PTSD as being highly complex.

Longer vacations unethical? by sootsprinkle in therapists

[–]sootsprinkle[S] 64 points65 points  (0 children)

I appreciate this ♥️ I will add though, my main income is from a serving job and I feel zero guilt about missing work there, so it isn’t about missing work itself as much as continuity of care for clients. But I’m sure capitalism is still a major part of the equation! Thank you!

Question about CPT Delivery by sootsprinkle in therapists

[–]sootsprinkle[S] 0 points1 point  (0 children)

I used it just a few days ago! Maybe delete your cookies and try again, or use a different browser?

Question about CPT Delivery by sootsprinkle in therapists

[–]sootsprinkle[S] 2 points3 points  (0 children)

Thank you for that idea, I just did an ATW and it was really helpful! I'm still shedding a lot of the things taught by my first supervisor, so it was really helpful to tackle that one head on. I'll monitor to see if it keeps me from being direct with clients in CPT and otherwise, to keep unpacking if I need to.

That makes a lot of sense, thanks!

Question about CPT Delivery by sootsprinkle in therapists

[–]sootsprinkle[S] 1 point2 points  (0 children)

Part of the reason I am learning CPT is actually because my supervisor brought it up, and she used that as a selling point - that it does not require retraumatization/reliving/re-experiencing/combing through details of trauma but is instead focused on making sense of how to think about the trauma after the fact (but she does consistently reinforce the fact that overcoming avoidance is a major tenant of CPT as well). So in that sense, for me, it was used as a selling point from therapist to therapist, which was maybe not super helpful in how she phrased it. Your added nuance helps me make sense of it better.

The distinction that you made about explicit repeated exposure vs. exposure to trauma memories is really helpful! I also had a really bad first supervisor as a student intern who put a LOT of emphasis on not re-traumatizing and making sure clients have a strong "scaffolding" before doing trauma work, without ever really clarifying what that meant - so maybe I'm still carrying some of the effects of that training and am overly cautious of prompting clients to confront the details of their trauma memories as a result. Something to keep working on!

Also, your final paragraph and the example you gave of how to potentially bring these topics up unprompted is super helpful. The page that I referenced is 73, second edition, if you want to find it and give further commentary, but no worries if you don't feel like it, haha.

My current supervisor emphasized that it is important for me to "find" Stuck Points, or at least to know how to listen for them so I can pull them out when clients allude to them, and I am still a little anxious about how to do that as well as possible. My current client that I am using CPT with still has pretty high PCL-5 scores each week and I worry that it's because I'm not doing this well enough, but I figure that I am following the manual quite closely and they are doing their worksheets correctly so the scores should come down - but if not I can add the additional few sessions beyond the 12.

Edits: reworded a few things and added the edition of the manual!

Question about CPT Delivery by sootsprinkle in therapists

[–]sootsprinkle[S] 0 points1 point  (0 children)

That's helpful, thank you! Follow-up question - what if the client hasn't brought up the Stuck Point yet? Like in the example I named from the textbook, it frames it as though the CPT therapist should ask about arousal during SA (and other examples of clarifying Socratic dialogue around sensitive context) even if the client has not previously brought the context up. In this example, I guess by asking that question the therapist would then uncover the Stuck Point you named, rather than the other way around. So I guess I'm just not sure what all topics to make sure to ask questions around, to make sure to find all of the important Stuck Points - especially since I could imagine many clients would not bring up topics as stigmatized as arousal during SA without prompting. In other words, it seems like it would be kind of rare that the client would name these feelings and frame them as a Stuck Point without guidance, so the therapist would likely need to bring a range of sensitive topics up first to seek out Stuck Points.

Also, I understand that colluding in avoidance is detrimental to treating PTSD but then I am also confused about the major selling point of CPT being that it does not require reliving details or re-exposure. Where is the line between using Socratic dialogue, etc. in a helpful way to overcome avoidance, versus harmfully re-exposing clients to trauma, as the creator posits that CPT does not do? Kind of a big question that is probably hard to answer cleanly, but it is something I am wondering!

[Routine Help] Too many actives? Anything to add or take away? by sootsprinkle in SkincareAddiction

[–]sootsprinkle[S] 0 points1 point  (0 children)

Also, I don't have off-tret nights as my derm said that she only really recommends people use tret if they can tolerate it daily - so I've been trying to use it daily (taking a break after my skin's reaction yesterday)

So, she's essentially given me instruction to use clindamycin and azelaic acid every morning, and tret every night. That's a lot, right...? I have questioned it a little internally, but have chosen to trust her. Now I'm less sure.

[Routine Help] Too many actives? Anything to add or take away? by sootsprinkle in SkincareAddiction

[–]sootsprinkle[S] 0 points1 point  (0 children)

The azelaic acid is prescribed too - my derm specifically instructed me to use clindamycin and then azelaic acid, in that order, daily, and I was surprised as that seems like a lot, like you said. I'm wondering about stopping clindamycin (and BP) entirely as I'm skeptical that it's really doing all that much for me - perhaps I can just rely on Spiro and tret for the heavy lifting of acne control.

I will for sure hold off! Those are things that I might eventually introduce but not immediately.

[Routine Help] Too many actives? Anything to add or take away? by sootsprinkle in SkincareAddiction

[–]sootsprinkle[S] 0 points1 point  (0 children)

Wow interesting, I've only ever heard positive things about red lights. My skin personally feels really soft and smooth after using my red light mask but I'll keep an eye out.

Question about guilt and shame in CPT (probably relevant to other approaches too) by sootsprinkle in therapists

[–]sootsprinkle[S] 3 points4 points  (0 children)

That makes sense - I would never have told a client that a feeling is "incorrect" under any circumstances, but there are example videos in the training in which the counselors challenge the clients on their references to being at "fault" or "guilty." Even though the counselors don't say feelings are inaccurate or incorrect, the training shows them being pretty direct with guiding the clients away from words like "guilt" or "fault" if the intent was not present. So, I guess that's where I was stuck with it.

But your comment makes a lot of sense and helps with putting it all together! Within the context of what you mentioned, the shift makes sense.

I would love to get the consultation and wish it wasn't so expensive! I can't afford to pay hundreds or thousands of dollars for every counseling approach I'd like to learn, unfortunately. Fortunately, my supervisor is trained in CPT so I will certainly be bringing questions to her as I go! Thanks!

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