A Therapist Can't Say That

Dr. Kae Hixson and I started a new podcast! I wanted to give you a peek into what we’re up to. Welcome to The Kiln , where postgraduate education meets brave, bold, and imperfect therapy. We’re here to shake up professional culture—to make it braver and to help therapists rediscover their excitement for this work. At The Kiln , it’s okay to be imperfect. We’re building a learning community where p...

Over the course of three seasons, we have talked plenty about trauma. And yet, somehow, I have never explicitly described or discussed the modality I use with clients, Mentalization-Based Narrative Exposure Therapy (MBNET). MBNET is a methodology that Dr. Kae Hixson and I synthesized from two different approaches that we were independently trained in, and it’s what we teach at The Kiln. On today’s...

As I’ve been trying to wrap up this season of the podcast, I’ve been reflecting, in particular on my conversations about psychiatric diagnosis with Dr. Awais Aftab and Dr. Miri Forbes. I keep coming back to this question: How do we decide what human traits, behaviors, and subjective experiences to pathologize? What makes something about a person a problem that we try to fix? It’s a deeply complica...

Everyone who has a foot in the world of psychiatric diagnosis seems to agree that our diagnostic system could, at the very least, use some updating, if not burning it down and starting over. So how do we approach developing constructs of psychiatric diagnoses that are more complex, more accurate, more flexible, and more context-specific than what we’ve been taught or what exists in the DSM-V? Toda...

In my last episode, Dr. Awais Aftab and I explored the controversial nature of Borderline Personality Disorder as a diagnosis. One of the reasons I wanted to discuss BPD is that it opens the door for digging into psychiatric diagnosis itself, and that’s part of what I want to discuss more today. What is our purpose in using diagnosis? How does it benefit us as clinicians and the clients who receiv...

Suppose you polled therapists and asked them what the most controversial diagnosis is in the current version of the DSM. Many of us would likely say Borderline Personality Disorder, and it would certainly be in almost everybody's top three. I’ve been wanting to do an episode on BPD for a bit because there is something about this controversial diagnosis that allows us to explore the challenging and...

Imagine yourself saying, “I am angry at my client.”  If you immediately need to add a whole bunch of context and caveats to make that statement feel okay, you’re not alone. Admitting that we get angry with clients is uncomfortable. It’s uncomfortable with colleagues and supervisors, and it’s definitely uncomfortable with clients.  It’s even uncomfortable to admit just to ourselves. But anger is po...

Be honest. When you think about overt conflict with a client, is your first thought that it’s a site of exciting progress, full of potential for movement? No, of course not. I don’t either. If you’re like me, and I’m guessing a lot of you are, your first reaction to actual, or even hypothetical, conflict with a client is somewhere on a spectrum from deeply uncomfortable to scared. It's a shared ex...

How can we stop treating our clients like our parents?  As therapists, we often share the experience of having been a parentified child, and this shared background fundamentally shapes the way we practice therapy, creating a unique bond and understanding among us. The relational patterns we developed as children, regardless of our current relationship with our parents, deeply influence how we mana...

I’ve said it before, and I’ll say it again: as a group, therapists tend to have some pretty similar formative childhood experiences. Our shared experiences as parentified children not only draw us to this field, but according to today’s guest, they fundamentally influence and shape how we practice once we become therapists. This understanding can foster a sense of connection and empathy among us,...

As humans, we tend to like answers a lot more than we like questions. When we believe we have found answers, re-examining what we think of as truth is inherently destabilizing. In a relatively young field like neuroscience, paradigm shifts, misconceptions, corrections, retractions, and foundational remodels are inevitable. We already have more questions than answers, and each answer spawns a thous...

If you’re a therapist in 2024, odds are you have given a client a neuroscientific explanation for a symptom they’re experiencing or an intervention you’re using. You’ve probably done it sometime in the last week. So have I. Neuroscience-based language is the lingua franca of our field nowadays. As a field, we have largely abandoned the languages of behaviorism or psychoanalysis, though there are s...

Since the last episode’s conversation with hannah baer about the Jewishness of therapy, I’ve been thinking a lot about lineage. When I first decided to do an episode on the topic, I was primarily motivated by wanting a deep sense of admiration for the Jewish pioneers of the field. Their contributions, which, like any minority group, tend to get erased as they are absorbed into the dominant culture...

Raise your hand if this sounds familiar: In a group of leftie social justice therapists, someone says that therapy is a profession founded by white men. Everyone else in the room nods along and acknowledges the white male hegemonic roots of the profession, then moves on to discuss other things.  The problem with saying that white men founded therapy and is part of a white hegemonic legacy is that...

Co-conspirator and friend of the podcast, Dr. K Hixson, returns to share some exciting news about a true labor of love. We’ve joined up to create The Kiln, a comprehensive supervision and training program for pre-licensed therapists in Oregon. The Kiln will also offer continuing education to practicing clinicians. This venture was born out of our mutual frustrations and concerns with the direction...

To wrap up season two of A Therapist Can’t Say That, I’m continuing my reflections on my ten years as a therapist. I’ll be back in April with interviews on some juicy topics, but for now, here are lessons six through ten that I’ve learned over the last decade of doing this work.  Listen to the full episode to hear: Why being overly passive for fear of screwing up might be the biggest mistake of al...

Every therapist remembers their first client.  Many look back and cringe at what a bad job they think they did. But for me, I look back and remember the magic I felt in the room with my very first client.  Which isn’t to say I’ve never done a bad job with clients. I have, just like we all have. But after ten years of being a therapist, when the work I do has become part of the mundane fabric of my...

In the last episode with Dr. K Hixson, I said that our field is defined by the wish fulfillment fantasy of the parentified child. The parentified child wants nothing more than to get it right, manage the relationship, and have the parental figure be healed and available to you If you are a therapist and you think that you were not, in some way, a parentified child, you’re probably wrong or in deni...

Immediacy may seem like a stale topic, but I truly believe that it has the capacity to be the primary tool of magic in the therapeutic relationship. Immediacy is risky. Immediacy is counter-cultural. Immediacy is a disruption to our people-pleasing tendencies. Immediacy challenges us to stretch our tolerance for uncertainty. Immediacy is a key to unlocking difficult clients. Immediacy invites us t...

Inspired by my conversation in the last episode with Dr. Andrea Celenza, today I want to talk about tolerating paradoxes and about love in the context of therapy. In our conversation and in her book, Sexual Boundary Violations , Dr. Celenza discusses the concept of the “multiple irreducible levels of reality in the therapeutic relationship.”  None of those multiple realities is more or less real t...

 Sex with clients. It’s an interesting topic because it’s both very taboo and not at all polarizing. Many taboo topics are just that because discussion of them invites conflict. Sexual  boundary transgressions aren’t like that. We can pretty much all agree that they’re wrong and bad. So then why is it so hard to talk about? I would argue that in this case, it’s because of fear of being in any way...

Being in therapy as a therapist, and being a therapist for therapists, is a bit like magicians trying to entertain each other. We’ve studied the tricks and techniques. We’ve seen behind the curtain and we can’t pretend otherwise. There is enormous pressure for each of us to do our own work in therapy in order to be good clinicians for our clients, but therapists are truly a special population. We...

Why is it so hard to be in therapy as a therapist? Why is it so hard sometimes to be a therapist for other therapists?  What happens when we sit down and try to play this game we play with each other? I’ve been wanting to do an episode on therapists as clients since I conceived of this show, so I’m excited to share my conversation with Dr. Elena Herrera today. Dr. Herrera specializes in working wi...

Trauma therapists are often told that we have to prepare our clients for any and all disruptions to our schedules well in advance, to avoid causing harm to them or causing therapeutic rupture. But life happens. We have unexpected and unforeseen circumstances that mean that we may have to suddenly cancel sessions or rearrange our entire schedules around a new preschool pickup time. (Ask me how I kn...

If you’ve been in this field for even a couple of hours or so, you have almost certainly had someone try to impress upon you the importance of self-care.  Not usually in the context of your self being valued for its own sake, but self-care that enables you to show up effectively for your clients. On the face of it, there’s not much to disagree with there. Yes, when we are adequately cared for, we...