Creating a Web of Connection


Creating a Web of Connection

Therapists in Search of Community

January/February 2019


Deran Young knows it’s not easy being first. It’s not easy being the first person in your family to graduate from college. Or the first in your family to own a home. It’s especially difficult being the first in your family to climb out of crushing poverty in 1970s Wichita Falls, Texas, where it was an unspoken rule for most black families like hers to keep your head down.

In the projects, your problems were your own, Young remembers, even if it meant walking yourself to preschool because your mother couldn’t stand up after an especially intense night of smoking crack cocaine. But with many neighbors in the same boat, your problems were, in a way, everyone else’s, too. And as long as there was food on the table and a roof over your head, could you really complain? At age 5, on mornings when Young made a wrong turn and got lost on her way to kindergarten, she’d repeat the same mantra in her head: just keep going. Someday, you’ll figure it out.

These days, Young is helping others find their firsts, too. Two years ago, she founded Black Therapists Rock, an online community of black therapists that currently has more than 22,000 members. Mostly using Facebook, the organization functions primarily to help clinicians reach places where talk of therapy is virtually nonexistent—places like Young’s hometown. But the group serves another important purpose: it’s a resource for therapists to network, get advice about challenging cases, find referrals, and meet potential mentors, especially if they’re struggling to land their first real clinical job or pass a licensure exam.

It’s also a place where many black therapists finally discover—often for the first time in a decades-long career—a sense of camaraderie with other professionals like them. In online chats, they can often relate to each other’s upbringings, lingering traumas, and common experiences, such as being the only therapist of color in a practice, or finding the techniques they learned in grad school better suited to white clients than African Americans like themselves. For Young, who spent seven years doing military mental health care alongside mostly white colleagues, the feeling of not belonging was constant. “I felt like such an outlier, an outsider,” she says. “I was losing my sense of purpose, and I needed inspiration.” In characteristic fashion, Young took the initiative to do something about it.

To be sure, numerous professional organizations offer networking opportunities for black therapists, the most prominent of which are the Association of Black Psychologists (ABPSI) and the National Association of Black Social Workers (NABSW), both formed during the height of the civil rights movement, and each with tens of thousands of members. But while these organizations serve a valuable purpose, Young says, they’re professional organizations first and foremost, lacking a needed human element or a real spirit of community. And while each organization offers an annual conference, it’s tough to keep a sense of collegiality and mission alive once the music dies and everyone returns to the professional isolation of their practice back home.

This is where Black Therapists Rock is shaking things up, using a variety of online tools like instant messaging, blogs, live videos, and Facebook groups so members who live near one another can find ways to meet in person. For her part, Young makes a regular habit of communicating through Facebook videos with the community she’s created, sharing her own story—including recent struggles like her divorce, single parenting, and relationship issues—and encouraging others to do the same.

“At first, I felt like I had to keep my personal experiences a secret,” Young explains, “But once I started revealing them, people started saying, ‘Wow, you’re just like me!’ I’m making mental health an everyday thing, and it’s brought me far more respect, more trust, and more clients than any marketing strategy ever could.” Within one year of the start of Black Therapists Rock, more than 15,000 people joined the group’s Facebook page. Currently, the organization has over 20,000 Facebook members, overtaking its more senior ABPSI and NABSW counterparts.

If Black Therapists Rock’s success can be attributed to anything, it’s that therapists are hungry for community. And no wonder. It’s no mystery that in the field of mental health care, work schedules are often erratic, the work itself emotionally demanding, and most therapists feel cut off from colleagues. According to the APA, up to 60 percent of mental health practitioners regularly experience signs of burnout.

But many of the suggested preventive measures, even those from leading experts, offer little more than simplistic suggestions for therapists at their wit’s end. “Rather than struggle with difficult cases on your own, seek consultation from experts and colleagues,” reads a page titled “Therapist Burnout: Facts, Causes and Prevention,” on the homepage of a popular therapy web site. “Make time to engage in activities you enjoy,” it adds, “or simply have downtime with people who are close to you.” Easier said than done.

Numerous statistics point to a steady uptick in social isolation and loneliness, and its negative impacts on our physical and emotional health are well-documented. According to a 2017 Harvard Business Review piece written by former US Surgeon General Vivek Murthy, the last 50 years have seen the rates of loneliness double, regardless of geographic location, gender, race, or ethnicity. A March 2018 study published by Cigna, a health service company, found that two in five Americans feel that their relationships aren’t meaningful, and suffer from feelings of isolation. Are therapists—ostensibly, purveyors of self-care—really any better off?


Out of the Frying Pan

While some therapist populations are more vulnerable than others, many clinicians have come up with their own creative strategies to counter personal and professional isolation. Recently graduated students new to the demands of practice feel especially disoriented, says Sarah Epstein, who graduated from Jefferson State University in May and began working at the Council for Relationships in Philadelphia soon afterward. “In school, we all went through the same process of learning,” Epstein says of her small cohort. “But in regular practice, the work can get pretty lonely.”

She says the clinic where she works is constantly bustling, with anywhere between 5 and 10 therapists running up and down the halls at any given moment, but they’re often short on free time, pulled between sessions with clients and handling the business side of practice. “Finding camaraderie,” she says, “has been slower than expected.”

What’s made things harder for Epstein is the lack of institutional support for her transition into a new professional role, a therapist in the early stage of her career. Although peer supervision is available at her clinic, and she’s become increasingly comfortable popping into a colleague’s office, Epstein says it lacks the sense of safety and camaraderie that her grad-school cohort provided. “It’s tough to go from that built-in community to a monthly one-hour supervision with people you just met and a supervisor you don’t know very well,” she says.

Initially, Epstein tried to coordinate meet-ups with former classmates who lived nearby, but conflicting schedules got in the way. Instead, she turned to online communities to find support—specifically, Facebook pages for marriage and family therapists like herself. She also found a group on Reddit, simply titled “Psychotherapy,” where participants can bounce ideas off each other about how to settle into practice or share clinical resources. For now, Epstein says she’ll settle for these “little snippets of companionship,” as she calls them, until she gets to know her colleagues better. “The hard part,” she says, “is that in the beginning of your career you need community the most at a time when you’re least likely to have it.”

While she’s optimistic, Epstein says graduate schools need to do more to prepare students for the transition they’ll be making to full-time clinical work. “How great would it be if a graduate program sat you down and said, ‘Okay, you’re going to be scattered about. Find people in your cohort who are doing the same type of gig as you. Go find your people.”


Is Anyone Out There?

But what if you don’t work in a large city? Few therapists—novice or veteran—are fighting more of an uphill battle when it comes to finding community than the rural therapist. A June 2018 study from the American Journal of Preventive Medicine found that 65 percent of nonmetropolitan counties don’t have a psychiatrist, and 47 percent don’t have a psychologist. With mental health care being largely inaccessible in these communities, therapists who work in these areas are feeling increasingly squeezed, as what little clinical resources do exist are slowly drying up, along with opportunities for professional support and connection. Between 2010 and 2017, almost 80 rural hospitals in the United States were shuttered. Hundreds more are at risk of closing.

Twelve years ago, Gordon Brewer got his start working at an agency supporting at-risk children and their families in Kingsport, Tennessee, nestled beside the Appalachian Mountains and roughly a half-hour drive from a string of West Virginia coal mines, not far from where he grew up. It’s a place, he says, where you don’t have to drive far to be “in the middle of nowhere,” and where people sometimes travel two hours round trip just to get their grocery shopping done. With many of his clients unable to foot travel costs themselves, the bulk of Brewer’s work involved home visits, which meant driving an average of 200 miles a day—most times alone—just to visit a single client.

“It’s probably the most demanding job I’ve ever had,” Brewer recalls. Being on call 24/7 for crisis interventions, on top of working 60-hour workweeks, got to be too much, and he eventually decided to start his own private practice in 2010. But although he gained more autonomy, he lost what little social connection he had with his colleagues at the agency. “When you move into private practice, it can get really lonely if you’re not actively seeking out other therapists,” he says. To break the monotony, he turned to podcasts, most of which pertained to building a therapy business. Although it wasn’t face-to-face interaction, Brewer says he enjoyed the intimate, conversational tone of the shows so much that they inspired him to create his own podcast, The Practice of Therapy, in 2016.

Not long afterward, he began to look for online communities that offered the potential to meet other business-oriented therapists in person. He joined several groups on Facebook and LinkedIn, and connected with two therapists online who happened to live reasonably nearby. After messaging them, they decided to meet up. Now, every two months, the three make a point of getting together for coffee downtown, where they trade stories about getting a private practice off the ground. “Social media gave me so many opportunities I didn’t have before,” Brewer says. “I met so many people who had the same worries and questions as me. Each of us was starting anew.”

His best advice for therapists making the move into a solo private practice is to be patient with the process. It takes about two years to get fully settled if you’re starting from scratch, he says, and establishing a community with other therapists—whether in person or online—is essential. Reach out to everyone you can find to establish a network, he adds, like emergency-clinic directors, doctors, or pastors. He admits that although this a gradual process in smaller communities, persistence pays off. “In rural areas, you have to be especially proactive,” he says. “Things aren’t just going to fall into your lap.”


Finding a New Community

Not every therapist is lucky enough to find a community before it’s too late. For those in the thick of isolation-fueled burnout, finding your way out can be a herculean task. Even seeking help can be misconstrued as a professional failure. Although it’s commonly discussed that burnout prevention isn’t just a best practice but an ethical mandate, many struggling therapists still suffer silently. Consider the language in the 2014 ACA Code of Ethics, on personal responsibility, which includes the statement that “counselors engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual well-being to best meet their professional responsibilities.” Community may be a remedy for burnout, but what happens when the community you turn to for help doesn’t have an answer?

Jessica Smith had known since high school that she wanted to be a therapist. So when she got her “dream job” as an addiction counselor in Denver six years ago, she poured her heart into the work. Every day, she came to the office early and made sure she was the last person to leave. On her commute to and from the clinic, she’d think of creative ways to work with clients. And in sessions, she’d get pleasantly lost in therapeutic conversations and feel a euphoric high after appointments.

But growing up in a home where substance abuse and physical assault were regular occurrences, she suspects some of her clients’ stories hit too close to home. She knew she’d reached a breaking point when, during one particular session, it felt as if an invisible wall was separating her and the client. “I felt as if my heart was closing up,” she says. “I was totally disconnected.” By her fourth year of working as a therapist, Smith went “from ‘crispy’ to full-fledged burnout.” And while she says she had colleagues and a supervisor she could approach for help, “certain topics were taboo.” Burnout, she says, was one of them.

Smith eventually ap­proached her supervisor and the director at her agency for help, but received little help or guidance. “Everything I learned about burnout was how to prevent it,” Smith says, “not how to move through it. My mentors and supervisors just didn’t talk about it. It was almost seen as a personal flaw—as if there was something I should’ve been doing differently, as opposed to a problem in our professional framework.” After much deliberation, she decided to take a month-long leave of absence to regroup and recharge.

Smith had dabbled in Buddhist meditation before. But now facing the biggest challenge of her career, and looking for clarity, she immersed herself fully in the practice. She traveled to nearby Crestone, Colorado, considered by the area’s native tribes to be a place of special spiritual power, where she spent the next six days at a Zen monastery. Each morning, she woke up at four o’clock, meditated for two hours, ate breakfast in silence, and then meditated again. The experience was life-changing. When her month of leave was over, she joined a therapist sangha—meaning assembly or community in Sanskrit—to keep the momentum going. The sangha promised to meet twice a month for two hours at a time, to share their various challenges as young therapists and practice mindfulness together. “It’s been one of the most rewarding experiences of my life,” Smith says, “both personally and professionally.”

In addition, she decided to create an all-female therapist support group. She found five colleagues she trusted, and the women agreed to meet for two hours once a month. Unlike a traditional peer supervision group, like the one back at the agency, Smith says their discussions are more free-ranging. “Clients will come up,” she explains, “but we’re focusing on our wounds and triggers and giving feedback and support in a very non-consultation form.” Also, unlike most supervision groups, this one has no leader. “We’re all leaders and participants at the same time,” she says. “There’s no set plan or structure. We just sort of let it flow.”

Finding a new community that embraces vulnerability has transformed her professional life, Smith says. Not long after taking her leave of absence, she decided to start her own private practice. Today, she’s upfront with clients about her trauma history and her experience with burnout. They appreciate her honesty, she says. Meanwhile, her sangha and women’s group keep her grounded, even when clinical work gets tough.


Tending the Flock

Sometimes peer groups simply aren’t enough. What if you need a little more guidance? If you’re an aspiring or new therapist, a mentorship might be your best bet. Just how common—and crucial to professional survival—are these arrangements? According to The Clinical Supervisor, an estimated 82 percent of doctoral students are mentored. The relationship, it notes, is “extremely important for student development.” According to a 2010 study in Academic Psychiatry, some minority graduate students even say that “without the support that these programs provided, they would have abandoned their academic careers.”

Alexandra Solomon, a therapist and assistant professor at Northwestern University, fondly remembers a moment from last year’s Psychotherapy Networker Symposium where renowned couples therapist Esther Perel was approached by a small group of admiring graduate students after her keynote address. They told her how much they appreciated her fresh take on modern couplehood. “Why don’t you join us for dinner later?” Perel asked the students, gesturing to two colleagues standing nearby.

The students were starstruck, and gratefully accepted the invitation. But after they walked away, one of Perel’s male colleagues voiced his reservation. “Do we really need to take them out for dinner?” he asked. “You know darn well,” Perel retorted, “that if Carol Gilligan had invited us to dinner 30 years ago, it would’ve made such a difference to us.”

For Solomon, the moment struck a chord, one she says comes at a pivotal moment in our field. Today, more new graduates are going it alone, she explains, opening their own practices and finding themselves adrift without the guidance of their more seasoned colleagues. “Ten years ago,” she says, “it was really unusual for a student to go from graduate school into anything that felt like private practice.” Instead, many new graduates got their start at robust, federally funded agencies that shepherded them through their early careers with ample clinical supervision. With less of this support today, says Solomon, “mentorships are more important than ever.”

For her part, Solomon makes a point of staying in contact with both current and former students. Some will reach out on social media to get her two cents on a difficult case. She occasionally invites the newly minted therapists to guest-lecture in her classes. And sometimes, she says, it’s important to make time that’s just for collegiality and support, and give the more clinical discussions a rest.

Once a year, she invites her graduate students to her house for what she calls an “unofficial focus group.” She buys a few bottles of wine and snacks, and for a couple hours, everyone takes turns reading passages from a favorite therapist’s new book, discusses modern trends in relationships and marriage, or chats about the latest dating app to hit the market. It’s a safe, relaxed space, where Solomon says she isn’t afraid to share details about her own life. “I’m bringing my whole self to the discussion,” she says. “It helps me maintain the sense that whatever I do, however my professional role may change, I’m still me.”


Community Meets Practice

It might seem like therapists who’ve found their own little slice of community have arrived, so to speak. But even veteran therapists say that while finding community is one thing, maintaining it is another. For therapists like Alden Mahlberg, community doesn’t come standard. Keeping it alive takes work.

Mahlberg is the director of the Integral Psychology Center (IPC) in Madison, Wisconsin. But when it comes to directing, he says less is more. In fact, he doesn’t particularly like his title and says he avoids using it when he can. Doing away with the hierarchical model of most private practices, each of IPC’s nine therapists shares a stake in the company, contributing a part of their income back to the company based on hours worked. The company also sets aside an annual budget for professional trainings, should clinicians want to sharpen or expand their skills. “Therapists don’t work for IPC,” he says. “The IPC works for therapists.”

But things weren’t always this way. Almost 28 years ago, before Mahlberg took over the IPC, his supervisor—the practice’s founder—retired, leaving his employees to shape the business as they saw fit. After putting their heads together, they had a vision. They’d not only create a communal practice in which each member shared ownership of the business, but they’d make therapists’ personal and professional well-being a priority, eliminating the competitive element that Mahlberg says corrupts too many private practices, where colleagues fight over clients and silently keep track of each other’s hours to see who’s pulling, or not pulling, their weight.

Once a month, the clinicians gather in the office and sit in a circle. But this isn’t any ordinary peer supervision. The meeting begins with what Mahlberg calls a “clearing” exercise, where they close their eyes and take several minutes to reflect inward on anything they think might be interfering with their work—be it a professional issue or something more personal. “As we move from person to person, we give the interference a voice—each member weighing in on the problem—and then set it aside,” Mahlberg says.

Next, they take several more minutes to meditate silently. Afterward, they read the practice’s value statements aloud: the promise to treat each other respectfully, value each other’s different learning and teaching styles, and prioritize their clients’ well-being in any service they provide. Finally, the members reflect on how well they think the practice has been following these standards.

But the therapists also make collegiality a priority in between these meetings. When they aren’t seeing clients, they have a policy of keeping their office doors ajar, so colleagues will feel comfortable coming to each other if they need to discuss a clinical issue, or even if they’re just having a bad day and need some cheering up. “The benefit on our stress levels has been enormous,” Mahlberg says. “Little gestures like this send the message that we’re here for each other.”


Coming Home

In August, Deran Young’s Black Therapists Rock community held its second annual conference. As social worker Tamala Floyd walked to and from her workshops, an almost indescribable feeling began to sweep over her. Left and right, she watched as other black conferencegoers took new friends by the wrist and led them to other attendees. “You’ve got to meet this person!” they exclaimed. “You two are doing the same work!”

As she sat in workshops with names like “The Heart and Soul of a Black Man,” she saw tears well up in the eyes of those around her. And when she got behind a podium to present her own workshop on the challenges of black mother–daughter relationships and saw heads nod in affirmation as she spoke, she knew she’d found a family unlike any other. “Making these connections is invaluable for me personally and for my practice,” she says.

Of course, no matter what their specialty area or type of practice, therapists are always on the lookout for the next big clinical advance—a new approach, or tool, or research finding that will take their outcomes to a new level. But perhaps that next big thing on the therapeutic horizon will be less about what they offer their clients in the consulting room and more about what they can offer each other outside it.

Maybe, in some future therapy world, connecting deeply and frequently, face to face or even screen to screen, will be a continuing education requirement. Maybe specific training in how to build your own community support, even if you find yourself in a rural area, will become a mandatory part of every program. Maybe burgeoning clinicians won’t be so often left to figure it out on their own before it’s too late. In a society where loneliness seems to be a growing problem for everyone, maybe this could be the field’s most transformative development yet.

***

Chris Lyford is the assistant editor at Psychotherapy Networker. Rich Simon, PhD, is the editor.

PHOTO © LEONORA HAMILL




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