Every counselor has a client on their caseload they dread. The reasons we dread this client vary.
Sometimes we dread this client because they repeat the same boring stories over and over again, constantly complaining but never taking action. Other times we dread this client because we feel helpless with the immensity of their trauma. Despite all the processing and resourcing, this client still seems to be stuck, and our best efforts seem pointless.
But we really, really want to help.
So we talk with our supervisor or our consultation group, trying to find some way to feel better about seeing this client. Our peers and supervisors try to be helpful. They say things like, “well, they wouldn't be coming back if they weren’t getting anything out of it.” Which feels true…but we still find ourselves dreading the next session.
So we blame ourselves. We wonder, “why can’t I just see the good work I’m doing with this client?”
I want to propose an idea. It’s a crazy idea. A radical idea. The idea is: It’s not you. You’re actually tapping into something much larger, a fundamental problem in the field of psychotherapy.
But in order to explain this idea, I first have to tell you about the history of UFC.
Rorion Gracie and the Birth of UFC
In 1993 Rorion Gracie had a simple idea. He wanted to get the world's greatest martial artists from every discipline in one arena and have them fight it out. Whoever won would be the Ultimate Fighting Champion - hence the name UFC.
Before this, there were many disparate disciplines of martial arts and self-defense. Aikido, Tai Chi Chuan, Brazilian Jiu-Jitsu, Karate, boxing, wrestling—the list goes on and on. Many different gyms taught these disciplines, often claiming they were the gold standard of fighting. The trouble was, there was no actual way to know if any of this was true.
Oh, of course, Rorion thought he knew. He was the head of a family very invested in the Brazilian Jiu-Jitsu style of fighting. But, even though he was convinced, his conviction didn’t mean anything. The karate guy down the street was just as confident. The only way to be sure, to actually prove it to the world, would be to put his Brazilian Jiu-Jitsu in an arena with anyone else who wanted to fight and duke it out. So he created UFC.
The early days of UFC were wild. They didn’t really have rules or even weight classes like you have now. You’d see tiny guys going up against sumo wrestlers. What became evident pretty quickly was that some disciplines and gyms were far superior to others. In fact, you could classify most into three broad groups: the useless tier, the limited tier, and the champion tier.
The Useless Tier, the Limited Tier, and the Champion Tier
The useless tier consists of disciplines and gyms that offer no practical fighting skills. To call them useless might sound harsh, because these disciplines and gyms might have been useful for exercise, socializing, or spiritual benefit, but these gyms didn’t market themselves that way. They claimed to offer fighting skills.
These gyms (now playfully called “McDojos”) were able to lead large numbers of people astray because the teachers never had to prove they were good at fighting. Instead, the teachers would hide behind stories, saying things like “well, since I’m such a master, if I were to fight you I’d hurt you.”
Of course, framed that way, many students would continue down this false path hoping one day to be as powerful as the teacher.
The limited tier is a step above the useless tier. These are disciplines and gyms that teach real fighting skills, but these skills are limited in some way. Boxing is a classic example of this. Learning to throw a punch is an important skill for fighting; however, what happens when you fall to the ground? If a wrestler can weather the first few punches and get in close to a boxer, he could easily take the boxer to the ground, and it would be game over.
The champion tier consists of disciplines that provide skills that work against most other fighters. It turns out Rorion Gracie was right [1]. He believed Brazilian Jiu-Jitsu would dominate most other disciplines. His son, Royce, won the first few UFC titles, and now UFC is dominated by Brazilian Jiu-Jitsu.
Why we get stuck with therapy clients.
So what does any of this have to do with psychotherapy?
Psychotherapy is in its pre-UFC days.
In the days before UFC, the average person picked a gym because it was closest to their house, or their friends went there, or because it was affordable. The thing they didn’t do was pick a gym because it had proven itself best in the ring. Because they couldn’t. Because no one had ever pitted the disciplines against each other in such a public way before. They simply didn’t have the information.
The same is true for most graduate programs.
We become a social worker because our aunt was a social worker and she said they have great retirement benefits. We go to ABC University because they’re in our town and we’ve gone to their games since we were kids. We go to the local community college because we get reduced tuition and they offer night classes, which fits with our schedule.
What we don’t do is pick based on which one will make us the best therapist. Because we can’t. Because schools aren’t tracking how effective they are and they certainly aren't publishing that data.
This is why some of us get stuck with therapy clients. We went to a school that was “accredited” but never actually put itself on the mat. So we thought we learned the skills, but we didn’t.
In the days before UFC, the disciplines could explain away weaknesses in their approach. For example, karate assumes you’re standing up. But what if you get taken to the ground? Some karate teachers would respond, “well, if you’re good enough at karate, you won’t get taken down. Besides, it’s dishonorable to fight on the ground anyway.” But after UFC, those excuses faded away. Once you’re put in the ring, if you want to survive, you’ve got to learn to fight on the ground; otherwise, you’ll quickly get pinned and have to tap out.
The same is true for most therapy models.
Most models explain away weaknesses in their approach. For example, the typical EMDR training assumes the client is motivated and ready for the EMDR sets. But what if you get a client who is ambivalent about change? In fact, research shows most clients are ambivalent about change [2]. An EMDR trainer might respond, “well, if you create enough safety, your clients will be motivated. Besides, we teach resourcing anyway.”
But those excuses don’t help Monday morning when you’re working with a client. Once you’re in session, you need motivation skills to work with ambivalence. Otherwise, the client’s problem will just keep punching you in the face until you want to tap out.
This is why some of us get stuck with therapy clients. We’re using a model which is the “gold standard” but has a serious hole that gets explained away. So we thought we were prepared, but we weren’t.
How do we use this to get unstuck with therapy clients?
And that’s my crazy idea. We get stuck with therapy clients because we don’t have the skills we need.
So we need the UFC of therapy.
If we had the UFC of therapy, we would easily be able to see that certain schools are the McDojos of the therapy world, cranking out “black belts” while never actually teaching students the skills necessary to do their job. If we had this clarity, we would easily identify the holes in our own models, instead of blaming ourselves when we get stuck with therapy clients.
Of course, we can’t just televise all of our sessions. But there are three things we could do to get the benefits of UFC.
Universities can track and publish their outcomes. If you go to a fertility clinic, they will tell you what percentage of women who come to their clinics end up with a baby. Universities could do the same. They could track student outcomes and publish their data. They could easily say, “our first years help 50% of clients and in their third years help 75% of their clients. So over the course of your time here, you can expect to improve that much.”
We could train clinicians like we train professional athletes. Professional athletes do three big things amateurs don’t. Pros know their stats, watch their tapes, and work with a coach. Therapists can do all of these. In fact, we have research-backed processes for each of these. Researchers call knowing your stats Routine Outcome Monitoring, watching tape Process Coding, and working with a coach Deliberate Practice. If professional athletes are doing this, why aren’t we? We’re professional therapists, after all.
We could have more therapy competitions. For instance, Sentio hosts a yearly therapy competition called “Therapist Throwdown,” where new therapists compete for prizes in therapy competitions. Basically, trainees sign up and are sent a tape of an actor pretending to be a client. The trainee watches the tape and records themselves improvising a response. The responses are then rated by a panel of expert psychotherapists. The top-rated finalists are invited to the final competition, and the winners win a cash prize. It’s basically the therapy version of a slam dunk contest. What if Therapist Throwdown became more prolific? What if the prizes became more well-known?That would be a good thing. Imagine being able to look at a school’s or supervisor’s website and seeing, “I’ve coached/taught the last five winners of the Therapist Throwdown.” It would be a huge validation of that supervisor's skills.
The way we train now throws us into the arena unprepared. Let's fix this.
This is important because when we aren’t getting good training, we’re essentially being thrown into the arena unprepared. And we want good training. We’re desperate for it. We flock to certificate programs, get specializations, and go on to Ph.D. programs, all hoping to be better at what we’re doing. And the thing is, I think we deserve it.
Instead of dreading that client with depression or that client with trauma, I think therapists should be so skilled that we have the confidence to walk into a session, see the client’s struggle clearly, and be able to say, “hey, I see the fight you’re facing. I’m in your corner, and I know the exact approach to KO this thing.”
That’s the kind of training I’m willing to fight for.
Best,
Jordan (the counselor)
-Fin-
P.S. If you want to participate in the 2024 Therapist Throwdown you an do so here:
{Notes}
[1] This is a bit of a simplification. BJJ is mostly a grappling (think wrestling) discipline, so fighters will often complement their skill set with something else like striking (boxing). So BJJ isn’t perfect or complete by any means. Still, in general, most modern UFC fighters have a BJJ base because it's just that useful.
[2] A while back a friend of mine kept getting stuck with a female trauma survivor. She kept trying to use EMDR with the client, but every time she attempted, the client would have some excuse or something else she wanted to tell the therapist. Because the client kept bringing up new questions, they never got around to doing the EMDR sets.
So she brought the case to her EMDR consultant, who encouraged my friend to pick different targets for EMDR.
I don’t think that was the problem. See we know there are five stages of change:
Precontemplation - where the client is unaware of having a problem.
Contemplation - where the client is aware of having a problem and thinking about change.
Preparation - where the client is preparing to take action.
Action - where the client is taking action to change.
Maintenance - where the client is working on ways to maintain the change.
I think both my friend and her consultant were acting as though the client was in the action stage of change, but the client was probably in the contemplation stage of change. She didn’t need more sets of EMDR or better targets. She needed to process through if she even wanted to make the change, what the change would require of her, what she might have to give up if she changed, or some other sort of motivation work.
If you liked this post, consider reading this next. It's about how to know if you're an effective therapist.
Jordan Harris, Ph.D., LMFT-S, LPC-S, received his Doctor of Philosophy in Marriage and Family Therapy from the University of Louisiana Monroe. He is a licensed professional counselor and a licensed marriage and family therapist in the state of Arkansas, USA. In his clinical work, he enjoys working with couples. He also runs a blog on deliberate practice for therapists and counselors at Jordanthecounselor.com.
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