Episode 34

Episode 34: Very Bad Therapists [featuring Ben Fineman & Carrie Wiite]

Very Bad Therapists. They exist. The profession makes mistakes.

And we need to talk about it, hold ourselves accountable, and learn from our mistakes.

I talk with Ben Fineman and Carrie Wiita, the co-hosts of the Very Bad Therapy Podcast about their own experiences launching a podcast about the unfortunate experiences that clients endure during therapy sessions.

We talk about changes in the field, the necessity for continuous and ongoing training and supervision, and how to learn from mistakes that have an impact on the clients we serve.

This may feel like a polarizing topic, but it's one that needs to be an ongoing conversation in the field.

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A Thanks to Our Sponsor!

I would also like to thank The Receptionist for sponsoring this episode.

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The software sends an immediate notification to the therapist when a client checks in, and can even ask if any patient information has changed since their last visit.

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Transcript

PATRICK CASALE: Are you tired of running to the lobby to see if your next appointment has arrived? Would you like a more discreet, stress-free way for your clients to check-in? Take a deep breath. The Receptionist for iPad empowers your practice to create a Zen-like check-in experience.

This episode of the All Things Private Practice Podcast is sponsored by The Receptionist for iPad. It's the highest-rated digital check-in software for therapy offices and behavioral health clinics, used by thousands of practitioners across the country, including, Dr. Jenna Robinson, our guests on this podcast back in episode 29.

The Receptionist for iPad is a simple, inexpensive way to allow your clients to discreetly check in, to notify providers of a patient's arrival, and to ensure your front lobby is stress-free. The software sends an immediate notification to the therapist when a client checks in and could even ask if any patient information has changed or needs to be updated since their last visit.

Sign up for a free 14-day trial of The Receptionist for iPad by going to thereceptionist.com/private practice. When you do, you'll also receive a $25 Amazon gift card.

Hey, everyone, you are listening to another episode of the All Things Private Practice Podcast. I am joined today by two wonderful human beings out in California, the Co-hosts of Very Bad Therapy Podcast, Ben Fineman, Carrie Wiite. Carrie just graduated with her Master's for Marriage and Family Therapy. Ben is an Associate Licensed Marriage and Family Therapist and the Clinical Director of something I can't remember. We are going to talk today about how they kind of created this really, really cool concept behind a podcast, their stories, working together during COVID, and anything else that comes up. And I am really happy to have you both on, and Ben I know you're sick, so I appreciate you making the time too.

BEN FINEMAN: Yeah, my pleasure. Thanks, Patrick.

CARRIE WIITE: Yeah, thanks for having us on, Patrick. Appreciate it.

PATRICK CASALE: Not a problem. So, before we started recording, Carrie is… got that set up with her podcast where she's just kind of adapting on the fly. And I was talking about how I had to do that in St. Pete, Florida. And that's the fun thing about being an entrepreneur sometimes, it's just like adaptability and figuring things out. So, I want to kind of turn it over to the both of you to tell a little bit about your story about figuring things out. So, you both just graduated recently, or over the last couple of years, you have this podcast, and you're kind of really building this audience because every time I see favorite podcasts recommended on the Facebook groups, yours pops up every time, and I hope that you're really proud of that, because I think you just had your, was it your 100th episode that came out?

BEN FINEMAN: Yep.

CARRIE WIITE: Yeah, yeah, we did. Thank you. That's so exciting to hear because sometimes we're not sure if we're just in our own little echo chambers, thanks. But, yeah, no we actually met while we were both in grad school. We were at separate programs, but we were fans of a podcast, The Modern Therapist's Survival Guide podcast with Curt Widhalm and Catie Vernoy. And because of that, we both reached out to that podcast separately asking some questions and we ended up getting connected through Curt.

And we just started kind of hanging out, going to lunch, talking, talking a lot about the things that we were learning about therapy, therapy land, things we were confused about, didn't really understand. And we, fortunately, both realized that we were kind of going through the same thing, which was realizing that stuff that we were really interested in outside of class wasn't really showing up in our programs. And so, the more we talked about it with each other, the more we wondered a little bit if we were insane. We were just absolutely way off the mark or if there was something more to explore here. And then, one day, Ben came to me he was like, "I have this idea."

PATRICK CASALE: Did he whisper like that or was it?

en? Do you want to [CROSSTALK:

BEN FINEMAN: I didn't realize it was like that powerful of a memory that it brings back the place and-

CARRIE WIITE: Oh my God, it feels horrible. Oh, everything. I remember exactly where I was sitting. We were at the Whole Foods in Burbank on Olive Avenue. And we were in the restaurant. I was sitting at a chair and Ben was standing in front of me facing me and behind him was, you remember the exact game, Ben Fineman. There was a sports ball event happening on the screen behind him. And the last time I told this story Ben was like, "Oh, yeah, that was this game." Do you remember which game it was?

BEN FINEMAN: Yeah, I was just playing coy. I remember all this as well.

ITE: Oh, you're so [INAUDIBLE:

BEN FINEMAN: Yeah, and so, Carrie and I are both similar in that we wanted to figure out what works in therapy, how we get better at therapy, what is better, like, figure everything out before we see our first clients so that we can do it well. And we both found it peculiar. And it was so nice to hear this from Carrie as well when we started to hang out that our graduate education's focused a lot on how to do therapy well, and we'd watch videos of famous people doing perfect therapy, and they'd be doing it with actors or volunteers at conferences. I think there was one series of videos I watched with Gerald Corey, the author of A Textbook, where he does like 15 different fake sessions with the same client going over different modalities, which is great to see as a model.

But then, simultaneously, Carrie and I were getting into the research on therapy outcomes. And the reality that for just about half of clients therapy doesn't help, which is stunning to hear, but seems to be fairly accurate. I mean, half a century of research at this point.

But we didn't really get a lot of info on what happens when it seems like therapy isn't going well, what happens when therapy actively harms a client, because that can happen as well. So, there was no resource for this. And at least for me, my anxious self wanted to know what are all these things so I can not do them. And Carrie and I came up with this idea of let's talk with people who have been to therapy, had bad experiences, and give them a place to voice those experiences, for two reasons.

One is, it'll help us and hopefully therapists as well understand better what it looks like from the client's perspective when therapy doesn't go well. But also, it's our form of advocacy. We both believe very strongly that to be in this field is in some way to be an advocate. And right now, there really aren't a lot of places for clients to go if they feel like therapy hasn't helped. And it's actually kind of the opposite, the message our field gives them, which is you're resistant, you're not ready for therapy, dot, dot, dot.

Sometimes, it's not a good fit, sometimes, you get a bad therapist, and there wasn't a space for this. And it's been incredibly validating the emails we've got from clients of therapy who have said, "I thought I was completely alone. Thank you so much for making me realize this wasn't about me, this wasn't my fault." And so, we just set off to see where this podcast would take us. And we haven't had too much control or planning about where we want it to go. We just really believed in what we were doing and we were open to seeing where it would end up.

PATRICK CASALE: I really like that because sometimes those are the most beautiful places to end up to without a plan. And I'm a planner for the most part. So, I struggle sometimes to relinquish that, like, I need to know the steps to get here and where this is going to go. But letting it just happen naturally is really how the most authentic experience really happens, I think.

And I love that you're giving this platform because not only is it helping clinicians, right? But it's also, like you said, empowering clients, empowering clients to normalize an experience that happens way too often. Because we all know these experiences, you obviously talk about them all the time. I grew up in a family of therapists, I definitely know these experiences. And ultimately, clients don't have a lot of ways to advocate for what they need. I mean, we give them like an informed consent with a little blurb that says, "If this didn't go well call this line." Right? But who the hell reads the informed consent. And also, like, who remembers to do that when a bad interaction happens?

And so often, it's about the report, it's about the relationship, right? But also, as I have coached a lot of therapists in this community all over the country over the last couple of years, there's a lot of therapists that just don't have their shit together. And that comes out in sessions. And that really impacts the clients. And it's really detrimental.

CARRIE WIITE: Well, I'll be honest, you know, also, I feel like a lot of the time, I don't know if it's most of the time, much of the time, something that one client could experience as bad therapy, the very next client will think is fabulous therapy, it's great therapy, you know? And so, that was I think the misconception I had going into this project was, we will hear all of these stories about therapy, I will get an exhaustive list of all the ways one can do bad therapy, and then, I'll never do bad therapy, like, just not doing any of those things on the list.

And like, we realized very early on that just the variety and the just spectrum of things that could go wrong in therapy, there's no way you're going to avoid doing something wrong in therapy, number one. Like, something categorically wrong, but there are, well, I would say, we always walk this back, you can absolutely avoid like grooming your clients, like don't do that.

But you know, the things that kind of come up that one client might think is just so unprofessional, inappropriate, rude, off-putting, torpedoes the relationship, whatever. The next client might find really resonating or really deepen the therapeutic relationship, or, you know, opened up their eyes to like a different way of being, and you know, all of the great things that we love in therapy, and so, where I have really come around to on this thing is that I don't think that I can ever avoid doing bad therapy. I want all therapists to know you can't avoid doing bad therapy. So, if it's a given that you are eventually going to do bad therapy with a client because what matters is the client perceives it to be bad therapy, right? If you're going to do it, what do you do?

And we've really learned that the overarching lesson really is, how do you recover the relationship? How do you repair the relationship after things have gone wrong? I think that knowing that there is something tangible that we can work on as therapists, even if we can't avoid doing bad therapy has been really helpful for me. I don't know, Ben, do you agree with that?

BEN FINEMAN: I have nothing to add. I think that was wonderfully put.

CARRIE WIITE: Thanks.

PATRICK CASALE: I think that's wonderfully put. And you're right, like, there are definitely avoidable things, right? Like, there are very clear-cut boundaries and ethical guidelines of like, don't have sex with your clients, don't drink with your clients, like don't do certain things that you absolutely should not be doing. Don't go sit at a bar with your client and order a drink. Like, there are definitely things people that when you're listening, like, definitely do not do. And if you are a client who is experiencing anything like that, please make sure you are reporting something.

But nevertheless, you're right. Like, it is inevitable because it's all about perception and that client's reality, right? So, you could be "Doing everything textbook" and correct, and accurate by the book, whatever the case may be. And the client may not like your personality, or style, or the way you said something. And that is the client's reality. And I think that therapists will often interpret that as if, like you said, the clients being resistant, they weren't ready for change, the client has A, B, and C diagnoses. Maybe the client just wasn't invested in treatment, because if something's so insignificant, ran them off, and clearly they weren't ready to be here.

And it's like, no, in reality, it has nothing to do with that. It just probably wasn't a good fit. And you may have said something, you know, that just landed wrong. And that's okay, right? The client gets provider choice for a reason. So, I think it's really important to highlight that. And the realization of like, you said, you can have this checklist, you can have this, like, thing that you kind of go by your Bible, so to speak, for your practice. But at the end of the day, human behavior is so different from one person to the next, and you could use the same approach or a different approach, and it could be perceived in a completely different way.

BEN FINEMAN: I think there's something in the culture of therapy land that we get brought into in our grad programs, and training, and supervision at continuing education that communicates that there is a right way to do things or even a right stance to take. And this graded in grad programs through exams, this is evaluated in the licensing process through exams.

And I'm not saying exams are bad, but I think they communicate that the way to become a good therapist is to memorize all the things, demonstrate that you have learned all the things, and then, go out and perform it and return back to your supervisor and talk about having done the right things. All of this evaluates how good you are at remembering and talking about therapy. It has nothing to do with how good you are at therapy.

And it creates shame, I think in a lot of us, where if therapy doesn't go well if we get the message from a client that something happened that was harmful, or that therapy is ineffective, or a client drops out, what we feel is shame, because we are instructed to know how to do therapy correct. And it's impossible.

Therapy is this incredibly beautiful impossible concept to understand. And every therapeutic relationship is different. And I mean, this sounds like fluff. But there is some truth to it. And if people get out of grad school, become licensed, and they haven't deconstructed the reality that what we're told about how to become a good therapist does not correlate to actually being a good therapist. When therapy inevitably does not go well or client drops out the first thing to do is feel shitty, the second thing we do is look for reassurance, and then, the third thing we do, hopefully, is work on ourselves to try and get better as therapists.

But I think that's always going to be in third place. And you see this in a lot of the therapist's Facebook groups, where something will happen and a client will have dropped out of therapy, or a therapist will have gotten a bad review, or something will happen, and somebody will need support around it, emotional support, logical support around or logistical support on what to do in certain cases. And rarely do people chime in and say, "Well, what could you have done differently to get a better outcome for that client?"

And I think that connects back to the fact that none of us want to face the reality that a significant percentage of our clients will not be helped, a smaller percentage of our clients will actively decline therapy. I mean, this is what the research shows is true for everybody. So, what do we do? We have to accept that this is the reality, work to be as effective as we can on behalf of our clients, and recognize that when therapy goes wrong like Carrie said, you have a choice. What do you do? I think there is a tendency to shift the blame to clients, because we're not given the freedom to say sometimes we have good intentions and we fuck up and that is okay. What happens next?

CARRIE WIITE: And we're not taught how to have confidence or self-esteem, I guess, like as a provider, as a clinician, as a therapist beyond, you know, our client's outcomes. And so, in, you know, kind of terrible way our professional identity becomes dependent on our client's behavior. And so, if our clients continue coming back if our clients talk about what an amazing therapist you are, then we feel like, "Okay, I did a good job." But if those things go away, if clients drop out, if that thing… there was actually in another therapist Facebook group I saw a clinician bemoaning like in a joking way, but like bemoaning that like, the client was saying a friend had said something so brilliant recently that really made an impact. And the clinician was, like, "I said that like two months ago. And like, how do I talk to the client that I said that first?"

And it was kind of like, whoa, whoa, whoa, whoa, whoa. Like, why are you feeling such a need to take credit for that to make sure that your client sees the credit. And it's because we aren't given by the field, by our school, by the supervisors, whatever, we're not given a framework to understand our value and worth as a clinician independent of our clients and I think that's really dangerous.

PATRICK CASALE: Both of you just made such great points and it is really dangerous. And I think a lot of clinicians, unfortunately, get into the field to heal themselves through the work that they do. So, if interactions, "Don't go well" right, and like both of you are saying, then we interpret it as a reflection of sense of self instead of just the recognition of like, it just wasn't a good experience for the client for whatever reason.

And if we get into the field to heal ourselves or whatever trauma history or experiences we've had, that's a really unhealthy and even borderline co-dependent mentality to say, like, I'm reliant upon the outcome. And if you're relying upon the outcome, you really can't do good work, because you can't actually drop in and be authentic, and be present, because you're thinking in one way or another about the outcome. And I think that that makes a big difference. And that is, when a lot of insecurity, a lot of imposter syndrome, a lot of shit starts to surface when an interaction doesn't go well. And I think so often we try to place the blame somewhere else.

And that's why I love the process of feedback in therapy and encouraging feedback in therapy of like, and even talking to your clients day one, during informed consent about feedback, and therapy, and how it's crucial. And I will name that with my clients. I don't have many clients left at this point in my career, but you know, just saying, like, I want to check in about how this is going, how this relationship feels, knowing that you will not hurt my feelings and that provider choice is fucking crucial because if this doesn't feel like a good fit for a variety of reasons, I want to make sure that you land in the right spot so that therapy doesn't feel like something you don't want to attempt again, which we see way too often in our field.

CARRIE WIITE: I was going to give you the floor to talk about feedback-informed treatment, Ben, but if you don't pick up that baton, I'm going to take it.

BEN FINEMAN: Are you?

CARRIE WIITE: Feedback-informed treatment is one of the things that Ben and I like super bonded over. So, we both come from, you know, non-healthcare oriented backgrounds, originally. I was an actor for a very long time in Los Angeles. And, you know, for a lot of reasons got out of that, and pivoted over to this, to therapy, but once I got into grad school and learning how to be a therapist, one of the things that like really confused me was how am I supposed to know what's working and what isn't working? Like, there must be some sort of, you know, category. Even in, you know, my acting career, it's very fuzzy. Like, it's not like there's… you don't get a scorecard at the end of every audition. But you can start to suss out what works and what doesn't.

But in therapy, it's almost like no one really talked about, like, that being important in any way, shape, or form, which on some level, I think, made me panic a little, because I'm thinking like, "How am I supposed to gauge my performance as a therapist without like putting all of that pressure, you know, on the client to do it for me?"

And I'm talking to Ben, you know, we had started reading The Heart and Soul Change, and a lot of other like, you know, bits and pieces from the common factors, part of the field, and learning about these things called routine outcome monitoring and feedback informed treatment, which seemed so common sense.

You know, routine outcome monitoring is giving your clients regularly, you know, a measure of some kind. There's a bunch of different things. Ben and I love the ORS and SRS from Scott Miller that is very, very simple, but you do it every single session. And what I think I really like about that is it gives the client a very formalized language to give feedback, so hopefully, when it works well they aren't faced with the only option to give feedback is to look the person in the eyes, this person who has been so generous and heard all of their shit, and help them, you know, on their worst days to look them in the eyes and say this isn't working, or you did something that hurt me. That is an almost insurmountable thing for most clients to do. We hear it again, and again, and again on our podcast. It is such a minority of clients who are able to, you know, find the courage, or strength, or something to look their clinician in the eyes and say, "Something's not working here."

But so routine outcome monitoring and the feedback matters gives you this kind of standardized form of keeping track, is it working, is it not working? You as a clinician have the option of like keeping an eye on it, right? And so that you can tell through the measures is this working? Is there something going on and maybe my client doesn't feel comfortable telling and maybe there's something I can investigate here? Push a little bit harder on like, is there something you need to tell me? Is there something that's not working? It makes all the sense in the world to me.

And I don't know, my senses, I feel based on absolutely no evidence, but just kind of like an anecdotal sense. I feel like it's getting more popular in our field. Ben, last time I asked you this question, you disagreed with me? Do you still disagree with me?

BEN FINEMAN: I do still. I think it's just confirmation bias, because we care about it, so we seek out other people who care about it. And it seems like more people are aware of it. And hearing you talk about it makes me think of where this field has evolved from. So Patrick, a few years ago Carrie and I said, "We're going to write a book, we're going to write a book for clients of therapy, where we trace the history of therapy in the first couple chapters to explain why is the cultural awareness about therapy, what it is present day, and then all of the misconceptions, and what clients should know about what works in therapy, what to prioritize, etc." And then, we got busy and didn't write it.

But the first chapter was written about the history of psychotherapy. And you can see very clearly that this goes back hundreds of years, that psychotherapy and where it came from has always been tethered to the idea that there are experts who know what to do to help people in distress. And we're starting to realize that it's not as simple as you break your leg, you go to see a surgeon, they fix your leg, the end. There is a best way to fix a broken leg. You can argue with it if you want, but you're going to get worse care. You can choose to take, I don't know, herbal treatments, instead of getting surgery, you're going to have a limp. If that's your choice, great.

But it's not objectively better in terms of healing the bone if that's your goal. And so, if somebody is coming in for therapy and there's this idea in our field that we should know exactly what to do to help them, it's tied to this centuries-long history of where our field came from. It doesn't have to be that way. But you see it in school, you see it in books, you see it in trainings, you see it in the idea that you have to get certified in certain things to be ethical at treating other things. And by the way, the research on that shows no conclusions that this is factual. It just makes you more confident that you can do the things, lets you charge a higher price for your services, which may be nice if that's your goal. But so much of this can be untangled and like laid bare in front and say, "We don't have to do it a fixed way."

And if you hold that, and you hold this idea of monitoring client outcomes, and seeking client feedback, so much opens up that you can take all of the expert knowledge and apply it and it might lead to a great outcome, especially, if that's what the client expects.

If they come in and say, "I'm depressed, I read that I need CBT." Great, give them CBT. But if they come in and say, "I don't feel good, I don't know what's going to help, I don't even know how to describe it." Give them whatever they want that you can provide, as long as there's a framework and it's not completely off the wall. It's not one of those harmful therapies that some of our colleagues have written about. There's so much freedom in therapy.

And I get why grad programs, and trainings, and CEs that they have to narrow it down in a sense. But we have the freedom to widen it, to get creative, to bring ourselves into the room, to bring the client's worldview into the room, and that that excites me. So, when you can do that by soliciting feedback, by monitoring outcomes, you can make therapy more effective, which ultimately should be all of our top priority, I think.

PATRICK CASALE: Yeah, that's very, very well said. And I'm glad you went there towards the end, because taking the client's worldview and putting it into account, right? Like, cultural consideration is huge. So, if we're saying the only way we can do therapy effectively is A, B, and C, you're really alienating a lot of people from seeking treatment or support, because if we are saying I only do CBT because it's evidence-based, or I only do A, B and C because it's evidence-based, most of that research is done on white men throughout the history of the last couple decades. So, we are really excluding entire populations if we say there is only one way to do therapy.

Now, I love the idea of always looking for feedback. And Carrie, I like what you're saying. And then, Ben, I like your counterargument that like, no, that's not actually happening consistently, because I could see both being true to some extent. And the reality is like there's a power dynamic at play, right? If you don't have these conversations, and you can't talk about some of the stuff with your clients with like, how could I ever give my therapist feedback if like they're the expert here, right? And again, that can become really uncomfortable.

I remember having a therapist who asked me, she was like, notoriously 15 minutes late to every session, and it really, really fucking bothered me. And I never felt like I could say anything and it was building resentment in me and even as a therapist, I was like, I don't think I named this, I think I just deal with this, like, resentment.

both went for the [INAUDIBLE:

CARRIE WIITE: Yeah, a lot.

BEN FINEMAN: I mean, it's so hard for me to, defend is the wrong word, but it's so hard for me to think that it's okay for a therapist to be 15 minutes late repeatedly for a client unless that's something you've established, and it fits how both of you like to operate. But Patrick, and I'm the same way, if you want it to start on time, and it doesn't, I think the therapist needs to address that or at the very least provide space to talk about it.

And this is another lesson we've learned on our podcast is those things are not deal breakers for clients. It's not giving them space to talk about it. And then, if you do, making sure you're not defensive. So often what we hear is, this small thing happened, I really wasn't sure if it was a big deal, but I brought it up and the therapist explained why it wasn't a big deal or invalidated me or said something and kept doing it. And then, things snowball and it goes back to the humility that is so important in being an effective therapist, because you will make mistakes, not with all clients, not, you know, egregiously enough that they end up on our podcast, but you cannot fuck up as a therapist, it's inevitable if you do a good enough job of creating a safe space for the client to bring that to you. You let them know well before it's necessary that you want their feedback. It's like a piggy bank. You may not need that money. But if you do at some point, you're going to be really glad you have it.

You can't just tell a client after a rupture, "Hey, give me your feedback." It might not be safe. That's a process that starts from day one of creating that safety. So, if you've done that, when and if you make a mistake, and a client brings it to you to recognize whatever feeling comes up in that moment, and it's probably going to be shame, defensiveness, and just say, thank you so much for sharing that, how did that impact you, I'm going to try and do better. And that can lead to the most effective therapy, because you're modeling something beautiful, you're creating something beautiful. And the stories we hear are the opposite of that, where the therapist is like, "You're too sensitive."

CARRIE WIITE: Yeah, so true, and I mean, that's something we recently addressed on the show, too, was, we know that there is probably some level of… and we've heard it a little bit. I think each of us have heard it in our own, you know, circles of like, "I hope I don't end up on your show." You know, from therapists.

And like, number one, our show is not built around, you know, castigating therapists, or it's not about public shaming, it's not a therapist Hillary. Like, that's not what our show is about. We don't name the therapists. We should deliberately try to eliminate all identifying information, because who the therapist is, is not the point. What the client experienced is the point of our show.

But we recently had a conversation about, you know, like, if therapists do have a fear of ending up on our show. And my fervent hope is that therapists, like, don't fear that, like, I hope that we can normalize making mistakes, because we are human and we are going to make mistakes. Or I hope that we can normalize that to the point where if a therapist finds out that their client has gone on our show, I hope the therapist can, like, you know, I mean, feel your feelings and like, oh cat like that sucks, you know? But it's not an indictment of you as a human. And what can you learn from the experience?

We also have a colleague, Halina Brook, who we met through the podcast because she as a client went through the board disciplinary process with her therapist, who did end up getting disciplined by the board. Halina had lodged a complaint against her therapist and gone through the process which by the way, not particularly nice for clients to go through. That would be a whole other show.

So, Halina now works with therapists who have been, like, faced with the disciplinary action by a board. And it's amazing work because these are clients coming to her wanting to get better, wanting to see the disciplinary process. And that was what Halina is advice on a recent episode of our show was if this has happened to you if you've gotten to the point where you're having a disciplinary action be brought against you lean into that process, what can you learn from it? How can you grow from it as a clinician?

Admittedly, with the disciplinary process, there is a punishment aspect of it. But there is supposed to be also a growth aspect to it. And I hope that that is something that clients, therapists, everything can take from the stories on our show. We really aim towards growth, which is why we have experts come on to kind of help us kind of give their thoughts about how the client's story, like, how it could have gone better, what circumstances could have been in place so that that experience didn't happen. Or if it did happen, could have been fixed, could have been saved in some way, because we really are oriented towards growth.

PATRICK CASALE: Yeah, I love that you both made separate but similar points. And the takeaway, the big takeaway, well, two, one, normalizing the fact that we are human beings and make mistakes, that's really important. I preach that all the time. As therapists, we are still human regardless of our degree type, license type, we still are going to have bad days, we're going to have off days, we're going to make mistakes, we're going to late cancel on our clients, sometimes. Like, that stuff is going to fucking happen. But you have to own it. And you have to have accountability around it. It should not be your client's responsibility for those mistakes. It should just be the learning process, the ownership, and the accountability process. I think that's really, really important.

Like Ben was saying, if you invite feedback, or if you check in with a client, and they name how they're feeling, and you get defensive, or if you belittle or dismiss, like you said, Carrie, that relationship is probably beyond repair then, because there's no chance in hell that client is going to trust you going forward or even want to work with you. And sometimes people have to, right? Like, they don't have the resource or the means to work with anybody else. And then, they feel trapped in this process of like, "Oh, fuck therapy, and no wonder why nobody goes to therapy." Right? And that's a big component of this.

And then, like you're saying, Carrie, the disciplinary process, and people who say, "I hope I don't end up on your show." If it elicits a response emotionally, if you feel a certain feeling and you're listening to Ben and Carrie's podcast, you've probably done something similar then. That may not be you that they're talking about, but you may have had a similar interaction. And when you notice that, that's a really good time to learn from that experience, and implement change, and training, and supervision, and potentially more consultation, because this is a field that is ever-evolving. And if we act as if we just plateau and know everything, and we're the "experts" then I think not only are we doing our clients a disservice, but we're doing ourselves and our profession a disservice.

CARRIE WIITE: Yeah, I couldn't agree more.

BEN FINEMAN: I would just say because, Patrick, you mentioned that people probably listen to our show either because they've had a similar experience as a therapist or they're curious about it. And I would just say that's true for some episodes. I sincerely hope that people listening have not… some of the most egregious things we've heard, a therapist physically tackling their client, a therapist giving their client a cup to urinate in to test to see if he was gay. And this episode, we just recorded it, so at the time of recording right now, it hasn't aired.

Carrie and I are advocates for psychedelic-assisted therapy. We are not advocates for what this one therapist did, which was taking psilocybin herself and then texting her client while tripping. Don't do that. And if you've done that, and you're listening to our show, because you're curious if anybody else has done that, that would be statistically very unlikely that there are more than one therapists out there who have done this, but please don't do that.

CARRIE WIITE: Yeah, no, don't do that. Don't do that.

BEN FINEMAN: Sure, sure.

PATRICK CASALE: Yeah. That's a good asterisk. I shouldn't generalize in black and white language, but yes, if some of those situations are arising, and you're like, "Oh, is that me." Then yeah, it's probably you and that is just really inappropriate and the stuff that we hear, right? It just boggles your mind.

And I think we fight so fucking hard to reduce the stigma and shame around receiving mental health support, that when we hear these egregious acts that happen it is so challenging sometimes to win people back and saying like healing can happen, and that shouldn't have happened to you.

BEN FINEMAN: And I think there's an interesting philosophical question in there, which is, what is the right approach to normalizing this more broadly among laypeople? We got a review once that said, "Please don't increase the stigma of therapy." And I get that. You don't want to push clients away who realize that there is a chance, however small, that bad therapy will happen to them. But at the same time, if this is not normalized, when it does happen, clients will inevitably internalize it. That's another thing we've learned, is clients will walk away and say, "I must have done something, I must be too broken for therapy, I must have brought on this behavior by the therapist." Which is not true. So, I don't have an answer for it, but it's a very interesting question, how do you normalize if this happens while also not discouraging clients from seeking out services? It's a hard puzzle to solve.

PATRICK CASALE: Something I talk about a lot and that's a wonderful point. And this isn't going to solve that question. But like, there's bad everything, right? Like, you've probably been to a bad doctor, a bad waiter, a bad eye doctor, a bad Uber... Like, people are people. So, at the end of the day when we have certain professions on a pedestal as if these professions can do no wrong, that's flawed thinking, but that's a societal message that we received, that's how media portrays things. I mean, there's so many complex layers to that.

But I do think if we can normalize the fact that like, yeah, there are bad experiences in this, but at least it's not the norm, right? Like, it's not going to happen 99% of the time. Like, there is risk in everything that we do, especially, when we're vulnerable and looking for help, like, there's always going to be risk.

I'll give a short example. And this is not mental health, well, kind of is mental health-related, but like I have a weird rare throat condition that I have to have surgery on for the rest of my fucking life. And I ended up seeing a specialist in Asheville. And he told me for the 30 minutes we spent together, "I'm the expert, because I've made so many mistakes. If you want someone smarter, you should go call this person three hours away." Continued to say that, "…if you want someone smarter than me, and I know it's hard to believe there could be someone smarter than me…" And all I could think about for that 30 minutes was like that other person's name and phone number, and that's all I could pixelate on, because like, I've got to get the fuck out of here, I'm clearly not letting this person cut my throat open, and I've got to call whoever he's suggesting.

And like, those experiences happen all the time. And more importantly, to think about, for people of color, and trans people, and people with marginalized identities not feeling like they can speak up in those situations or that they have another choice. So, we know research would say that there's a lot of power dynamic there, too. And I just am so thankful that I know my resources, I know my advocacy abilities. And I knew very damn sure that I was never going to let that guy do surgery on me. And now I have a doctor that's three and a half hours away that I have to see every couple of months, but like, it's better than the alternative. And I just know that I have to have throat surgery. So, I better be with someone who I trust. And she didn't give me information that was any different, right? Like, it was just the bedside manner in which the fucking information was delivered.

teresting strategy [CROSSTALK:

And I feel like sometimes we as therapists get so like caught up and isolated in therapy land that we forget what that is like as a client and we forget that that's what our clients are thinking when they come into the room. And so, you know, I'll often hear therapists talk about like, "Oh, I don't need to use feedback-informed treatment or I don't need to use routine outcome monitoring measures, right? Because I know that my clients feel comfortable giving me feedback. I know that. They'll tell me how they feel. Every three months I'll ask how they're doing and I know that they feel comfortable telling me."

No, you don't, because unless you really plumb the depths of like, what were they thinking therapy was when they came to you, you don't know what they were expecting, and you don't know what misconceptions they might still be holding on to. And one of those that I think is the most persistent and I think that's demonstrated in how many people end up on our show, one of the misconceptions is that my therapist probably knows what's right, knows what's better for me. I've heard therapy is supposed to be hard, so if anything's going wrong, this must be the "hard" that they're talking about.

And a lot of clients will stay in these relationships with therapists that aren't helpful, that are harmful sometimes, and one of the things that we have been surprised, I think, at how many clients actually end up listening to our show and I think a fervent hope of both of ours is that clients of therapy feel more empowered to tell their therapist that something isn't working quite right. The way you would tell, you know, your hairstylist, if they have given you a haircut you don't like, you know, "Can you please fix it a little bit shorter, a little bit, you know, wish it was longer?" I don't know, whatever.

But you know, can we in some way kind of flatten that dynamic, that power dynamic a little bit, and give clients a little bit more control over the process without taking away whatever magic happens when they think they're going to an expert, who is going to help them with their mental health crisis.

BEN FINEMAN: Therapy is so interesting and hard, because I agree with everything you're saying, Carrie, and it sounds great. But at the same time, sometimes clients come in, and they say, "I read that I need this treatment for what I'm going through." And what we know from common factor of research is that if clients have specific expectations and you can meet those expectations, therapy is going to go much better than if that's not the case.

And so Carrie and I, after we met, we both ended up training at the same site in our line. We were in the same supervision group, which was wonderful. It was a narrative therapy group. Carrie and I both love narrative therapy. We love postmodern approaches to therapy. And we would walk away from supervision sometimes and say, "Well, what if a client just really wants advice? What if a client really just wants CBT? Am I supposed to help deconstruct their notions and dominant discourses around why I shouldn't give them advice?" And the answer can't be yes, because then we're prioritizing ourselves. It's so tricky.

And sorry, I agree with everything, you're saying, Carrie, but I can't help but shake this uncomfortable feeling that if a client knows what they want, and it's something that we feel like is not client-centered, is not advocating in certain ways we want to advocate for our clients, who are we doing it for if we're not honoring their requests?

And we can talk about my failures as much as we want. I think one of the greatest successes I've had over the years working as a therapist is learning to be okay, doing approaches to therapy that I don't really deep down fully believe in, but I know I can deliver in a way that instills confidence in clients. I can believe in it, because I know, it will help them if I do it well, and if it works for them, and if they tell me it's helping, that's the more important part.

I can put on that hat. It may feel uncomfortable, it may feel like I'm acting as a certain kind of therapist. But who am I to say you don't need CBT, or you don't need EMDR, or you don't need whatever it is you've come in for and think at the bottom of your heart this is what you need.

CARRIE WIITE: Yeah, but the crucial thing, I think, that you're pointing out here is that you may not believe EMDR is the magic pill. But, at your core, you believe that therapy works.

BEN FINEMAN: Right.

CARRIE WIITE: And that's what the underpinning, right? Like, I think that you know, all the research shows that you as a therapist need to have confidence and faith in your approach, in your service that you're providing. Otherwise, outcomes are impacted. But I think that maybe you're right. Like, it needs to come from a confidence in therapy in general. But you can also have an awareness of what that means, that therapy, in general, can mean a million different things. Like, it's infinite spectrum.

BEN FINEMAN: Yeah, I think the example I like to give to describe what you're referring to, Carrie, is I got trained in EMDR a year ago, and the EMDR people are very convinced that EMDR is great, which is wonderful. And it's going to make it more effective if you believe it's that effective. But of course, not all clients are going to feel like it's what they want, even if they think it's what they want. Maybe 1% of clients are going to be like, "You know what? This isn't for me."

And so, in the training, I asked, I said, "What happens if it's not helpful? The client says it's not working, or they say they don't want to do it anymore?" And their response was, "Just keep doing it. Do it and do it like you'll get past this reluctance. There's some block."

CARRIE WIITE: Do it harder.

BEN FINEMAN: Yeah, do it harder, do it more, do it faster, do it harder, do it better. That cannot be the answer. There has to be some point that we get to as therapists where if a client says it's not what they want, and they're not suggesting it's helpful, and if you're monitoring outcomes, and it's not helpful, you say, "Okay, maybe I'll refer you out, maybe we'll try this other approach. Let's talk about it." The answer can never be just keep doing what you're doing as the therapist. If that's your approach, I think you've been sold a, what's the expression…?

CARRIE WIITE: Bill of goods.

BEN FINEMAN: You've been sold a bill of goods that this is a magic pill. It's not, it can't be. Therapy is too complex.

PATRICK CASALE: That's a great point. I mean, really great point. And I think you have to not conform to a one size fits all approach too, right? Like, this is not black and white, like, this is not binary. We need to really understand that you have to meet the client where they're at and try to provide what they're asking for. And if it's just out of your scope, then absolutely refer out because that, again, is doing the client a service, right?

Like, if someone calls me and says, "I want to work on disordered eating." I certainly don't work on disordered eating. I'm going to refer you to someone who's a specialist. But if they're asking, like, "Do you take a more coaching approach? I see that you're a coach now and a therapist." I would probably say yes, and there was a part of me that would say, "Oh, that feels really unethical. How could I do that?" But I have some clients who want to work on their small business stuff, and they're like, "I'm working on my insecurity and emotion around small business." "Okay, let's fucking do that. Like, I'm happy to meet you where you're at and have that conversation."

But I think the therapist in me from like five years ago would have been like, "I don't think I can do that, that feels like it's too blurry or too messy. I think I have to, like, find you a business coach." But in reality, I think owning a small business, and your mental health go hand in hand. So like, if you want to work on that, by all means, let's work on that.

CARRIE WIITE: Out of curiosity, Patrick, how did you make that kind of jump from therapist to five years ago to feeling today like that is something that you can deliver as a therapist/coach?

PATRICK CASALE: It's a great question. I mean, a ton of my own therapy, I have been in and out of my own therapy since I was five. And we could go down the subject of like, should therapists have therapists? And I think the answer is absolutely fucking yes. But nevertheless, that's not the point.

You know, I think it's a lot of my own work, right? And then, also working through some stuff that comes up. But then more and more that I'm working with clients and seeing the outcomes, right? And seeing the relationships that get built, and seeing the correlation between rapport, and trust, and relationship, and outcome, whatever we want to quantify or qualify outcome as, the realization of like, just being real, being authentic, is really the ability to create accessibility, because if I can be real, and highlight the fact that I know what it's like to struggle, without it being self-serving, without it doing it just for me, right, so that the therapist is comforted by the client.

So, what I mean by that, and I know like, maybe that didn't even make sense, the way my brain is conceptualizing this, but I used to only work with men struggling with addiction when I started out. I myself am in recovery from a gambling addiction, I talk about it all the time. And what I realized is, if I'm like the buttoned-up, no disclosure, I'm not going to like, "if you don't want to be here, I'm going to refer you out." type of provider. that's not in alignment with who I am. And that doesn't work with my mentality. So, I started to like curse in my content, drops some F-bombs here and there, disclose about my own addiction and recovery, talk to clients about how things are hard, but they can get better, and I can't guarantee that they will, and then, start to really understand that this process is a beautiful one. But it is messy. And it's complicated. And as long as I think you're doing things with your client's best interest in mind, you can try things out and see what works.

And then the realization of like, each client is so different, even if two clients come in with addiction-related concern, does that mean the same thing is going to work for both of them? Absolutely not. Does one want to go to 12-step and one doesn't want to do anything at all and wants to do like harm reduction? And I have to be okay with both and if I'm not okay with both, that's my time to grow and learn from that, because I know a lot of therapists who work in the addiction field for very black and white concrete thinking, right? It's either 12-step, and pray this away, or like, maybe we're going to do whatever seems to make sense for you. And I know as someone who needed therapy for my own gambling, the 12-step model didn't work, right? And like I had tried, and tried, and tried, and "Failed attempt after a failed attempt." You get to be made to think like there's something wrong with me, why can't I get this?

I very well know I'm destroying my life and everyone around me, but I can't stop. So, I'm defected, clearly. But nevertheless, meeting a harm reduction-minded and attachment-focused therapist who was like, "No, like pump the fucking brakes, man. Like, there's nothing wrong with you. You're just coping for something that you don't know how to use your skills to kind of manage, this childhood trauma experience, or whatever the case may be."

So, I think it's also having therapists like that, who give you permission to do things differently, who give you permission to heal differently. And then, in turn, taking that as a therapist and putting it into my practice. I think that's always shaped how I've desired to be. I just want authenticity. I want people to normalize that we all struggle. And I think if as therapists we can talk about the struggle, then my clients can look at my content or see my story and say like, there's hope, there's light at the end of the tunnel. If this guy has a master's degree and "has it all together" which I don't, but ultimately, has recovered, then maybe I can too, or maybe life doesn't always have to feel so shitty all the time. But sometimes it does. And I think both can be true.

CARRIE WIITE: I love that so much. I mean, thank you for such an honest answer. I am such a social constructionist and I belong. But the more I've thought about therapy, and read about therapy, and read the research, and heard stories, like what you're talking about, the more I feel like there is room to kind of invent therapy to some extent. I see the wisdom.

I say this on the show, I love models, sometimes, I do. Like, I mean, we had a client come on, not too long ago talking about CBT, how she'd really wanted CBT, and what she got was not really CBT. And the expert that we had had on, Alyssa Davis, talked about what CBT looks like when it's done right. And the more she talked to at us, she's like, "Yes."

See, if I was a client and if this approach worked for me, this would be amazing. It would feel so comforting to know that there is this model that somebody really smart, put together, and it's been tested a lot, and it's worked for a ton of people, it's a tried and true approach, and if it works for me, great. The problem is, you know, if somebody is coming to therapy, and that approach doesn't work for them, like you said, they feel like they're defective, they feel like, you know, therapy is not working for them, because they're not doing it right, or you know, maybe it will work eventually if I just try harder, if EMDR harder, you know? Like, will it eventually work, right? But I do-

BEN FINEMAN: Wave your finger faster? Wave it slower, go diagonal, do this, wiggle your finger as you're waving.

CARRIE WIITE: Wait, stepping.

BEN FINEMAN: Yes.

xtent put together [INAUDIBLE:

BEN FINEMAN: I'm still thinking of binaural beats [INAUDIBLE 00:51:42].

CARRIE WIITE: But I think that there's so much room for therapy to be co-constructed, you know, to some extent in the room between the therapist and client. And yeah, I love that. So, yeah.

PATRICK CASALE: You know, speaking on that, like, I've had therapists in the midst of my like darkest days tell me that, "If you don't stop gambling, I won't see you anymore." I'm like, "But I'm still showing up to your office. So like, what am I supposed to fucking do?"

And I think those types of experiences, if you don't know that experiences can be different are experiences that could potentially turn someone off from therapy for good, not using someone's pronouns that they use, like, not being culturally sensitive.

Like, all of these things can lead to damaging relationships beyond repair. And I just think that we have to do better. Like, therapists have to do better and be aware, like you are both highlighting that we make mistakes. And I think it's really important to just own it, and then, learn from it and grow. And we teach our clients to do that all the time. But we are not the best at practicing what we preach in this profession.

CARRIE WIITE: Oh, man, standing ovation.

PATRICK CASALE: Yeah, I mean, we could talk about this for hours. And I'm really glad that the two of you have found one another in this venture and are just like out there having these conversations that can be really difficult to have, and can certainly lead to feedback from people who may disagree. But that is the beauty of kind of like, advocating like you both said, and just, you know, standing up for what you believe in. So, I just want to really applaud you both for what you're doing and the work that you're creating together. Thank you.

CARRIE WIITE: Thank you so much.

PATRICK CASALE: And I appreciate you both coming on and making the time, and us finally, like, coordinating our very busy schedules together. And yeah, it means a lot. So, just continue doing what you're doing and if you can both just kind of tell the audience where they can find your stuff and where they can follow you, I would greatly appreciate it and I think everyone would benefit from it, too.

BEN FINEMAN: Yeah, we're at verybadtherapy.com. You can find our podcast anywhere you get your podcasts. We have a Facebook page. I think it's just facebook.com/verybadtherapy. We have an Instagram page that Carrie created three years ago, updated four times, and then, abandoned.

CARRIE WIITE: Were they four? Yeah, I think it was four times.

BEN FINEMAN: With the most recent photo being when I let my hair grow out during the pandemic and my fiancé like teased it out, so it's out of control. And she just stopped updating it.

CARRIE WIITE: Well, I can't talk bad but-

BEN FINEMAN: I wish you could follow us on Instagram to get no updates but see my hair-

CARRIE WIITE: That's bad.

BEN FINEMAN: …wild?

CARRIE WIITE: It's worth it, guys, it's worth it.

BEN FINEMAN: I think that's it.

CARRIE WIITE: Yeah.

BEN FINEMAN: Is that where we're at?

CARRIE WIITE: Yeah, verybadtherapy.com or anywhere you get your podcasts.

ccount immediately [CROSSTALK:

CARRIE WIITE: Now watch how many new followers you just got us there. Now we'll actually add more photos.

PATRICK CASALE: Well, that will all be in the show notes for everyone listening. And I really appreciate both of you coming on. Maybe we'll include the title page with Ben's hair and-

CARRIE WIITE: Oh, do it.

PATRICK CASALE: …I do appreciate it very much. And, again, it's been good meeting you and just seeing that you're in the community and doing the work that you're doing.

CARRIE WIITE: Thank you so much, Patrick.

BEN FINEMAN: Thanks, Patrick.

PATRICK CASALE: You're welcome and for everyone listening to the All Things Private Practice Podcast new episodes coming out every single Sunday on all major platforms everywhere you get your podcast. Listen, download, like, subscribe, and share, and we will see you next week. Doubt yourself, do it anyway

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About your host

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Patrick Casale

Hi, I'm Patrick. I’m a neurodivergent entrepreneur and therapist who truly believes in the power of disclosure, vulnerability, and authenticity. It’s become more and more clear to me that people are either attracted or repelled by what we put out into the world, and we can’t “be everything for everyone.” Through a lot of trial and tribulation, a gambling addiction, and an Autism/ADHD diagnosis, I’ve learned that being your TRUE self is what draws people in and creates connection. I have tattoos related to Lord Of The Rings, Travel, and Anthony Bourdain. And I travel constantly. Becoming an entrepreneur and working through my fears (they still exist) have allowed me to do more of the things I love. That’s my goal for you with this podcast — to use fear as a gas pedal, not a brake, and to learn how to reclaim and own your voice so that you can create your own entrepreneurial journey.