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Working With Outpatient Therapists

Kathleen Galleher, PhD.
Vol. VI No. 1
January/February 2002

Community members often need the help of a therapist, and communities are frequently at a loss as to what kind of therapist the person needs and what to expect from him/her. If individuals request help on their own, the community frequently allows them to choose their therapist. However, when a superior requests that a member seek counseling because behavioral or emotional problems are interfering with their functioning in community or ministry, there is often more at stake in therapist selection. In either case. there are several things to consider when seeking a therapist who will benefit both client and community.

All therapists should be appropriately licensed by a state board, which means they have had acceptable training that follows standard practices set by the profession. In addition, these therapists are familiar with and bound by the ethics of the profession and the laws of the state.

Not all therapists are created equal or have equal success with all clients or issues. For example, a person dealing with alcoholism needs a different treatment modality from someone who struggles with sexual attraction to minors. Whenever possible, seek a therapist who has training or experience with the client's issues. If they do not, ask for a referral.

It is also helpful to work with therapists who know about religious life. Many times people naively view men and women religious as "single" rather than appreciating the importance of their commitment to community and ministry. They may also miss the complexity of living in community. Talking to a new therapist and explaining some of the particulars of your community or ministry if s/he is unfamiliar with them, can be very helpful.

REASONABLE EXPECTATIONS
Therapy may be either short or long-term, depending on the goals. If a relatively healthy individual is coping with a specific issue, such as the death of a parent, s/he might see a therapist on a weekly or bi-weekly basis for 3-4 months. Individuals coping with severe behavioral problems, such as addiction, or sexual compulsivity, may need specialized treatment with addiction specialists combined with often daily 12 step meetings. For significant childhood issues, such as abuse, they may need consistent treatment over the course of several years. Persons experiencing difficulty in most relational realms (i.e. community, work, family, and friends,) may need consistent therapy over several years and also require several modalities of therapy (individual and group). These personality problems are some of the most difficult to change and costly in terms of resources because they have to do with the basic way in which an individual approaches life.

Change is a life-long process. Therapy can certainly be helpful, but it is not a miraculous process. However, it is reasonable to expect some behavioral and interpersonal change in an individual who is engaged in productive therapy. Certainly if a member has been in weekly therapy for several years and there is no discernable improvement in his/her interactions in community or in work functioning, it is reasonable to question and explore if a different therapist or therapy modality would be more effective.

WORKING WITH THERAPISTS
It is helpful if the superior discusses treatment goals and length of treatment with the therapist and client at the beginning of treatment to establish realistic expectations. The therapist can then let the community know how it can be most helpful in supporting the member in therapy. This discussion should also include an explicit understanding of what, when and how communication will take place between the therapist and the superior/community as treatment progresses. Some therapists may offer to facilitate community meetings while others will welcome very little interaction with the community. In all cases, the client must consent for information to be shared or it remains confidential (except if there is danger to self or others). The client usually signs a "release of information" designating with whom the therapist may share information.

Therapists do not see everyday behaviors and sometimes the best information about a client's behavior comes from others who live with him/her. However, clients may also become "identified" as "the one with the problem" and may become a target for others' frustrations or control issues. For example, a client may be identified as "always angry" because she is the only one to voice her anger in an otherwise conflict-avoidant community. Therapists are hesitant to be the messenger of the community's complaints and will most often encourage community members to confront the inappropriate behavior.

A helpful model is to have regularly scheduled meetings (e.g., 3 times a year) in which the therapist, superior, and client talk together about issues as they relate to goals and functioning in the community. Personal details about the client's work would remain between the client and therapist. However, what impacts daily and community life (e.g., attendance at community prayer, meals, or interactions with other community members,) might be freely discussed. These communications should take place with all three people present so there is no concern about secrecy. Sometimes there may be feedback about ways the community might change to create a healthier environment.

It is important to find a therapist whose philosophy fits the needs of the community and client. Clear expectations and open lines of communication can be a key to growth for all.

Kathleen Galleher, Ph.D. is a licensed psychologist at SLI.

LUKENOTES is a bimonthly publication of Saint Luke Institute.
Permission to use these materials must be requested in writing by contacting
lukenotes@sli.org

SLI EDUCATION DEPARTMENT
Saint Luke Institute
8901 New Hampshire Ave.
Silver Spring, MD 20903
(301) 422-5499 • (301) 422-5519 (fax)

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