What Bad Therapy Taught Me About Good Therapy

[00:00:00] Carrie: It is impossible to get it right all the time, and it’s impossible to be perfect. And that’s why, you know, honestly, I think coming out of all cumulatively, like in aggregate all the stories that we heard, the one thing I’m sure of is one of the most paramount skills for therapists to get good at is rupture and repair.

[00:00:25] Carrie: The worst thing that can happen is for a client to go into therapy, be disappointed and think therapy doesn’t work, and walk away and never, ever try again when all of it could have been avoided. If at the beginning they had a better sense, I don’t think this therapist is right for me. 

[00:00:42] Marie Vakakis: Hello and welcome back to Inside Social Work.

[00:00:45] Marie Vakakis: I am thrilled today to be having a return guest. Now, this is a voice that I got to know very well listening to this podcast, very Bad therapy for so many years, and I have had Ben and Carrie [00:01:00] on the podcast before. And now I have Carrie coming back to talk to you about where things are now. And it’s been a few years, I think, since our last episode.

[00:01:09] Marie Vakakis: So welcome back, Carrie. 

[00:01:11] Carrie: Thank you so much, Marie. It’s so fun to be here again. 

[00:01:14] Marie Vakakis: I just finished listening to it actually this morning on my walk. ’cause I’m a very good last minute kind of person and we had a lot of laughs around just. Especially your and Ben’s dynamic and just all the bad therapy stories.

[00:01:28] Marie Vakakis: And I know that I still refer back to some of those episodes, but tell me where are things at now? What are you up to? 

[00:01:35] Carrie: Yeah. We went on hiatus for the podcast in 2023, I believe, is when our last episode was posted. And at the time it was a break. We were going on a break. Ben had wanted to go ahead and.

[00:01:49] Carrie: Take a pause on the podcast for a lot of reasons. You know, he was super busy and we just had a lot of things going in different directions and he wasn’t sure how [00:02:00] much further he wanted to go, like in the direction that we were going. So that episode, it was really interesting, I think, because if you listen to that or if you’ve heard that last episode, you kind of hear, I think the seeds of the directions that we both ended up pursuing.

[00:02:15] Carrie: But, uh, in the ensuing just to, he’s not here just to speak for him. He, uh, has left the field and is very happily working at a nonprofit now. I do not have another podcast yet. I’m, hopefully, I’m missing the format. So much. So hoping to get another one started coming up. What I’ve been focusing on is building.

[00:02:37] Carrie: My business when I was in grad school and listeners to the show know I talked about this quite a lot, shoehorned it into every conversation I could. I did my master’s thesis on the intersection of marketing and psychotherapy, and in that thesis developed an evidence-based framework for. Therapist, marketing and professional development called interpersonal branding.

[00:02:58] Carrie: So I’ve been focusing on [00:03:00] that and uh, launched the programme, interpersonal branding for therapists this summer, which has been a lot of fun. And this fall I will be starting as an adjunct professor at my old MFT programme at California State University Northridge, teaching professional writing. So that’s where I am these days.

[00:03:18] Carrie: So you’ve kind of left therapy as well. Well, it’s funny. So here in California, in the States and specifically in California, the way it works after you graduate, MFTs have to do, uh, see clients while they’re in graduate school. You have to earn a certain number of hours to graduate, but then once you graduate, you have to register for the first time with the state licensing board.

[00:03:39] Carrie: And so in California we have a very quirky little law that. Once you graduate, you can go ahead and do that registration anytime you want. You can wait 10, 15 years. It doesn’t matter. No penalty. But once you do register, you have six years to complete all your remaining [00:04:00] associate hours, is what we call them before you start losing older hours.

[00:04:03] Carrie: And also lose the ability to work in a private PRI in a for-profit setting essentially. So. When I graduated, I got this opportunity to work with, well at the time, working with Simple Practice Learning to turn my thesis into a course for for therapists. And so when I sat down and really looked at the math, I was going to be coming up against that six year rule if I tried to do both at the same time.

[00:04:29] Carrie: So what I’ve done for right now is put my licensing journey on pause. So not working with clients. Therapeutically like right now until I can get the business up and running at a point where I don’t need to be working around the clock every day, all day. So just focusing on working with therapists right now until I can go back to it, but I do miss it a lot.

[00:04:53] Marie Vakakis: I mean, I wouldn’t have been surprised you, he said. Yep. I’m just tired of hearing people complain all the time, [00:05:00] because your podcast was several years of hearing people’s stories, and they’re just the ones that made it to the show. There would’ve been so many submissions that that can get a little bit defeating because.

[00:05:10] Marie Vakakis: People complain when they have a bad experience, but they’re less likely to reach out and say, I had a really good one. And so we disproportionately get the bad stories. 

[00:05:20] Carrie: It’s so true. I think that’s why I enjoyed doing therapy while I did the show because I think that there were so many instances working with my own clients where, you know, there I saw therapy go, well, you know, you see the good side and you see how powerful it can be, and then to go record the show.

[00:05:39] Carrie: Be reminded of the tremendous potential for harm. And honestly, like I do really appreciate it that I had that experience while I was in training. I think it was a really, really good balance. And I do know that um, there are apparently quite a few professors or supervisors who require. Episodes of our podcast [00:06:00] as listening in their curriculum for training therapists, which I think is really cool.

[00:06:05] Carrie: I think that one of the things that we really, that was so important to us about the show was sharing those voices that don’t get heard. Because so much of our training we focus on, okay, here’s a master therapist doing it right, uh, doing it perfectly, and here’s this. Fake client, an actor or another therapist, roleplaying as a client and see the tremendous benefit they get from this amazing treatment.

[00:06:31] Carrie: And it’s a nice reminder that like that is not always how it goes. And I think it’s nice to be able to have that balance and especially when you’re in training, to see examples of like where things can go wrong and how bad they can go wrong and get a little bit of some, some insight ahead of time about how to maybe head that off at the past.

[00:06:51] Carrie: Hmm. 

[00:06:52] Marie Vakakis: So for those who have never heard of the podcast before, can you give them a little bit of a synopsis, like what is Very Bad Therapy podcast? 

[00:06:59] Carrie: [00:07:00] Yeah. Yeah. So on very bad therapy, Ben and I, who were therapists in training at the time, we interviewed clients who had had bad therapy experiences and we heard about what went wrong, and then we would also interview quote unquote experts in the field to give us an idea of how it could have gone better.

[00:07:18] Carrie: So we feel like we tried to find something in every horrible story and identify what we could learn from it. What could the therapist have done differently? What maybe the therapist wasn’t aware of about how they could have handled it in a way that would’ve been more productive for the client. There were certainly, you know, some episodes where the experiences were just so traumatic that we.

[00:07:42] Carrie: Kind of maybe just focused on that because there’s, there are some stories where there’s just nothing to salvage. But yeah, that’s what we tried to focus on, what we tried to do with this show. 

[00:07:53] Marie Vakakis: And then one of the points that, when we discussed this on the last episode, I’ll pop a link for that in the show notes that people can [00:08:00] listen to.

[00:08:00] Marie Vakakis: The first episode was that we’re all bound to make mistakes as therapists. There’s this belief somehow that people have, and I think, I think Ben used the example of maybe going or will you going to the dentist and we assume, we go to the dentist, they’ll take some x-rays, they’ll know exactly what we need and they’ll give us that.

[00:08:19] Marie Vakakis: And then we’re off on our way for six months or 12 months or however long. And I think there is that belief that people think we know this magic fix. We will see. Into their soul and will suddenly automatically know what they’re thinking, what they’re not saying, that they want to say, how that fits in with their attachment style and get this like beautiful combination of art and science to say the right thing at the right time and then magically it’s all fixed in a few sessions.

[00:08:46] Marie Vakakis: So I think there’s hearing that and, and going through that conversation again and listening to it was really reassuring that. We don’t have to know it all, and there are some really clear cases of very unethical behaviour, which we don’t need to go [00:09:00] into. But a lot of the things you had on your podcast were some were manners, like mm-hmm.

[00:09:05] Marie Vakakis: Being really late all the time, or inconsistent and some was misattunement or. Just human to human awkwardness and fumbling through or def like then getting defensive. And so what, what was some of the common themes that reflecting back now, you still hold in mind when you were trying to either, you know, not that you’re practicing anymore, but that really stuck with you, I guess.

[00:09:29] Carrie: Yeah, no, I think you mentioned honestly the, the, the word you used, defensiveness. I think that was the biggest takeaway for me and. I think something useful to keep in mind, certainly in the practice of therapy, but honestly just in life in general. When I reflect back on the stories that we heard and where things went wrong and, and how they couldn’t be salvaged, a lot of it I think has to do, it almost always comes back to therapist defensiveness and what I think I walked away [00:10:00] with this, the, the kind of a, a firm conviction that.

[00:10:04] Carrie: There are, maybe the worst thing you can do as a therapist is to have your identity of being a good therapist, be something that is too precious for you to have threatened in any way to have to hold onto that so tightly that then you put your clients in the position of having to prove that for you.

[00:10:26] Carrie: And then if. Anything happens in the dynamic where the idea that you might have done something wrong, that this idea of you being a good therapist gets threatened, that can, for some therapists become crippling. It can become like devastating and so just they are put in this position, I think, where they have to do whatever they need to do for that not to be true rather than.

[00:10:54] Carrie: Which I think, you know, the thing that we kept seeing over and over again is maybe the greatest [00:11:00] skill that a therapist can have is the ability to repair after rupture. That, you know, being able to hold in that dynamic with a client. That maybe I did do something wrong. I can’t do everything right all the time.

[00:11:14] Carrie: I’m a human. And it doesn’t mean you’re a bad therapist, and it doesn’t even mean you’re a bad person. It means there was a mistake that happened, you mistepped, and can you. Hold that and say, Hey, I’m sorry, and sit with that discomfort and sit with the client and trying to come to a resolution that fits for the client and being able to offer that repair, which I think in, in many, many cases can be the difference between good and bad therapy.

[00:11:44] Marie Vakakis: You mentioned that bit about identity and that really had me thinking about like the wounded healer. Mm. And maybe some, if anyone’s schema therapy trained or knows a bit about it, there are certain schemas that might be activated for you. And I can really see that across, not just in a therapy [00:12:00] practice, but even, you know, we have a lot of social workers listening to this podcast.

[00:12:02] Marie Vakakis: They would be working in case management or other sort of frontline services that aren’t, that have a therapeutic component. But I think. The same thing would show up because you’ve worked your butt off to get to where you’ve gotten. You’ve had to do often all these unpaid placement hours, and then you are giving a lot, often in a environment that’s not paid particularly well.

[00:12:25] Marie Vakakis: And so when someone then says, you didn’t do enough, or It wasn’t what I needed, I can see why that would be so painful and. Especially if, and a lot of women are in this field as well, and I see them giving too much of themselves in other areas of their lives. And when I do group supervision in organisations and they get me in usually around psychological hazard management and using supervision as a bit of burnout, prevention and you know, vicarious trauma and compassion fatigue to kind of monitor that those same people are giving.

[00:12:56] Marie Vakakis: So much everywhere. And so if someone comes [00:13:00] back with a, that wasn’t what I needed or that wasn’t good enough, they feel like I’m not good enough, or I’ve sacrificed so much, what more do you want for me? And so all these boundaries that weren’t enforce or that resentment just comes spilling out.

[00:13:16] Carrie: Absolutely. It’s so sad. I have such empathy for therapists when that happens, because again, I can’t emphasise this enough. We are all people. Nothing magical happens to you when you get accepted into your grad programme. Nothing magical happens when you get the license that you are somehow immune to all of these experiences that other humans have and.

[00:13:40] Carrie: It’s going to happen. You are not expected to be perfect and unfortunately, like because of the nature of the service dynamic, it’s true. You can’t escape it. That many clients do expect you to be perfect. They expect you to be the expert. They expect you to know what you’re doing in any every [00:14:00] instance, and especially something that is so interesting that I think came up.

[00:14:05] Carrie: There’s one episode that pops into my mind where you can actually do everything right according to your own way of working as a therapist, because there are so many different ways of doing it. So many different approaches. And I have in mind, you know, a client who described an experience with a therapist, and Ben and I were listening and we’re like, I can absolutely see why that therapist did.

[00:14:30] Carrie: And said what? What she did, and. The client walked away from that feeling that therapist wasn’t trauma informed. Learned later on a different from a different therapist that this client had identified as a good therapist. Honestly, it was just an a situation of better fit. She preferred that way of working that the second therapist had it.

[00:14:50] Carrie: For that client reflecting back on the first therapist. Now everything that therapist, that therapist way of working is now perceived as bad therapy when that therapist was just [00:15:00] doing a different kind of therapy. But clients don’t know. They don’t know that, and there’s no way we can’t expect them to know that.

[00:15:07] Carrie: And when we do as service providers, put ourselves out there, which we have to, by virtue of the mantle of authority that we’re given with this license and this title. We put ourselves out there as experts as like saying, I can help you. I know the way to help you and a client is going to have expectations that maybe we can’t meet.

[00:15:29] Carrie: And I think that it should be a bigger part of training that we can’t ever avoid letting people down. It’s gonna be part of the job. How do we manage that and hold that? 

[00:15:40] Marie Vakakis: That’s a really good question that I can help you bit. I want to come back to when we talk maybe a bit about the branding, because I actually don’t think many of us say that.

[00:15:47] Marie Vakakis: I think we say we work with dot, dot, dot. We work with depression, anxiety. We don’t say I can help you with because that fills like we’re promising something that a lot of maybe coaches and non-qualified people say. [00:16:00] I can fix, I can heal, I can. We don’t really talk that way, but when you were talking about the bad therapy in that, you know, trauma-informed way, it is really hard because when you’re in a room doing those trainings, every single person will have a different.

[00:16:16] Marie Vakakis: Experience of something. So I’ve been to a training where we talked about using a grounding and mindfulness technique, and then someone else was like, oh no, but if you’ve been traumatised and you’ve, you disassociate, then that’s not trauma informed because that’s asking ’em to sit with their own thoughts and the beat of their heart.

[00:16:33] Marie Vakakis: They’ll hear it in their ear and it was a big deal for them. So it’s actually, there’s no one universal way that everyone’s gonna say, yes, this is. Working for everybody. And I think this goes back to my earlier comment around people think we know exactly what they need, that it’s written all over their face, and maybe over time we notice patterns and we can recognise more subtle emotional expressions and pull things out.[00:17:00] 

[00:17:00] Marie Vakakis: But I can’t know if. For one person, a mindfulness activity is going to put them in a state of absolute bliss and for someone else that’s going to be triggering. Mm-hmm. Or the smell of lavender oil in my room brings nine out of 10 people calm and someone else, it reminds them of something that an abuser did and then it’s not trauma informed or, so it’s actually impossible to get it right.

[00:17:24] Carrie: It is impossible. That’s the only certainty is it is impossible to get it right all the time, and it’s impossible to be perfect. And that’s why, you know, honestly, I think coming out of all cumulatively, like in aggregate all the stories that we heard, the one thing I’m sure of is one of the most paramount skills for therapists to get good at is rupture and repair is to learn.

[00:17:49] Carrie: How does that look like for you? And again, because just like everything in therapy, every single intervention, everything. It is going to be different for you from [00:18:00] every other therapist and their approach. You know, I encourage therapists in training, you know, don’t watch a video or a professor demonstrated role play in class and think, oh, that is what rupture and repair looks like.

[00:18:14] Carrie: Across the board for everyone. It’s not, it has to fit for you. It has to be natural. It has to be authentic coming from you. It has to feel okay for you to do, and it is a complicated, difficult skill. But that is something like as paramount as paraphrasing, you know, it’s the ability to, how am I going to handle it, and how am I going to address with clients when things go wrong in the room.

[00:18:41] Carrie: And I, I don’t feel like, you know, I think I started to learn how to do it. I’m not saying this by saying like, I know how to do it and like, because I don’t. I think that it’s something that you learn over time, but I think it is one of the things that if you’re early in your career, it’s something I’d encourage you to put a premium in your own [00:19:00] self-development.

[00:19:00] Carrie: As a therapist, uh, finding your way of doing this. My best learning 

[00:19:06] Marie Vakakis: for that was actually working in retail because Oh, yeah. Trying to deal with a product complaint or a refund, and so being trained in that context of the customer’s always right and not to. Lose my shit even though we haven’t stocked that item in over a year.

[00:19:23] Marie Vakakis: Of course. So talking about, you know, there, there’s frameworks in, in coaching and training for retail and hospitality around that and it wasn’t then revisited in my courses at all. I don’t even think anyone mentioned rupture, even in my master’s programme in most of my training, like ’cause you do modality specific, so I might do, you know, three day MDR therapy training.

[00:19:46] Marie Vakakis: It’s expected that you know how to do therapy, so no one’s teaching you in those advanced technical skills of the modality. Presence, holding space, how to have the conversation. So if everyone assumes someone else has taught it [00:20:00] to you, and through my Gottman training, that’s when I really honed in on it by how to teach it to other people.

[00:20:06] Marie Vakakis: How to do a, there’s a particular intervention called the aftermath of the fight, how to, how it gets scripted and each person slows down and notice what they said and what the other person heard and had to apologise and take responsibility for a piece of that. So. That’s mean. I’ve now had that skill to try and do it in my friendships as well, because I think we do hold therapist or higher standard, and I get really annoyed at some of my friends who are therapists or social workers or psychologists who don’t put on their, you know, put on their big gill pants right.

[00:20:37] Marie Vakakis: And just have the tough conversation. They’re so scared of getting it wrong or saying the wrong thing that they get avoided. And I think they do that with clients as well. It’s like, oh, not my problem, or I’m just gonna let, like, there’s some anxiety around. Reaching out and saying, Hey, what happened here?

[00:20:54] Carrie: Oh, we have a lifetime of conditioning, of avoiding those conversations. And it’s, I think it’s [00:21:00] cultural. It can be specific to your family and how those conversations were ha happened or didn’t and what the ramifications of those were. But it is, all of us, I think are, are, yeah. Fighting a lifetime of conditioning.

[00:21:12] Carrie: This is one of the reasons why back when we. Had our first interview, Ben was working at the Sento Counseling Clinic as a clinic director. And what I really love about Sento, this is a great organisation for anyone who’s interested. It is an organisation on, focuses on deliberate practice. Uh, it’s Tony Rumer and Alex Vage who are researchers in the deliberate practice movement in, in therapy, and they’ve developed an MFT programme here in California.

[00:21:41] Carrie: Sento University, but you can also go to, I just, I believe you can just go to sento.org. They have an amazing free resources for therapists and one of the ones that I really love and wish had been around at the beginning of my training are, they’re essentially role plays. They’re videos of clients in [00:22:00] difficult therapeutic encounters and you’re, you have the opportunity to just.

[00:22:05] Carrie: Basically run dry runs with this practice client who’s on a video. Now their programmes get very like intense with, with a deliberate practice coach. That’s the whole point of the way they offer deliberate practice is to have somebody. Watching the interaction and able to stop the moment, give you specific training on how, like what to adjust and then have you just go back in again.

[00:22:29] Carrie: But it’s this idea of like putting the reps in and so that by the time it actually happens in session, it’s not so charged. You don’t have that instant like fight or flight, like flood of your system of, oh my God, I’m in the situation where I have to say I’m sorry. And you have the experience of like having gone through that.

[00:22:49] Carrie: Worked out that really. All those hard feelings in a low stakes environment. So yeah, if anyone is looking for kind of extra training to do on your own, check out [00:23:00] Santo. It’s, it’s really great work. 

[00:23:02] Marie Vakakis: Yeah, I love that idea of the repetition. I participated in a, um, we call it a stuck case presentation where I had to present a case that I found difficult or a presentation.

[00:23:13] Marie Vakakis: And get other people to role play those family members, not my family, the the client. Right, right. Made up family in front of a group, do the session to the point where I got flooded, I guess, or reacted and then we paused it and because it was a family therapy conference type thing, we then looked at family of Origin and saw where in family of origin.

[00:23:36] Marie Vakakis: Might have impacted that stuckness and then replay it again with the therapist supervisor coaching through it. But it makes me think, I think in um, several of your episodes, you and Ben were talking about, we don’t know why therapy works. We still don’t know. Right. But what you’re describing there is part of what works in therapy.

[00:23:54] Marie Vakakis: It’s. Repetition in a low stakes environment. It’s therapy, being a dress [00:24:00] rehearsal, to have those conversations, maybe outside of the space, to have someone there whose whole mind, but they’re there for you in that moment to replay or repeat or bring to a conscious awareness, something that you can then.

[00:24:15] Marie Vakakis: Repeat and practice and repeat, and then go and do it in the real world. So maybe there’s, there’s some parallels there between that coaching and that repetition and what works in therapy. And sometimes one powerful experience can be enough that you don’t need more, and sometimes you need more repetition.

[00:24:33] Carrie: It’s very meta, it’s very, but you’re, you’re totally right. You’re absolutely right. Hmm. 

[00:24:39] Marie Vakakis: I dunno where to go with that. It’s so exciting and could keep talking about it. But yeah, I love, I love the deliberate practice stuff, so definitely I’ll put a link to the EO website there for people. Maybe let’s talk a little bit about where you’ve shifted to now.

[00:24:51] Marie Vakakis: So you are doing some personal branding, marketing stuff. Yeah, yeah. What do we get wrong about putting ourselves out there? [00:25:00] 

[00:25:00] Carrie: Well, it’s so funny you had mentioned earlier therapists using language like we work with so and so rather than coaches or you know, other sort of kind of maybe snake oil sort of providers who, you know, say something like I can help with with a certain certainty or surety.

[00:25:17] Carrie: Right. And it’s so interesting, this literally what. What brought me into it because on the one hand I became aware that our field has a lot of these kind of baked in systems, ways of thinking that make marketing really difficult. One of these. Being like, you know, we can’t promise a result that we can’t ensure our clients get right.

[00:25:39] Carrie: And we don’t know anything. We don’t know that we can help clients. We, when they come to us, we don’t even know really, quote unquote what’s wrong with them, quote unquote, you know? And so all of a sudden we’re put here not even able to say, you know, I can help with something We feel like saying with any confidence I can help with, [00:26:00] feels like a bridge too far.

[00:26:01] Carrie: For many therapists because of all this stuff that we have in the field. I could go on for hours about about what it is that leads up to that, but we’ll leave it there. We feel like we can’t say I can help with, we feel like we have to say I I work with, but we also know from the common factors research and the clinical outcomes research.

[00:26:19] Carrie: What does makes therapy successful when it’s successful are things like instilling hope that therapy will work, getting buy-in from the client to the. Treatment plan, the rationale that the therapist is presenting, inspiring confidence that this therapist knows what they’re doing and can help, is providing a roadmap to get to better.

[00:26:41] Carrie: We also know that therapists who work from a specific framework tend to have better outcomes than therapists who are just, you know, working without any framework at all. We think of it in terms of modalities or theoretical orientations, right? And those theoretical orientations. What they are [00:27:00] is a hypothesis about what people struggle with, what it would look like for them to get better and how to get there.

[00:27:06] Carrie: So every therapist does actually have an idea about what’s wrong, quote unquote, with people what better would look like, and they have what you have chosen to do in the room to help clients get there. And it looks drastically different from orientation to orientation to modality to modality. And then within those groups there are, it looks drastically different from person to person, from therapist to therapist.

[00:27:34] Carrie: I always say like the CBT coming out of me is gonna look very different from the CBT coming out of you. Just by the virtue of the fact of we are entirely different humans. So. My mission is to push back against the ways in which our field has kind of hamstrung therapists, stifled self-expression, have really limited us in the marketplace by connecting [00:28:00] therapists to a sense of who they are as providers, who they are as helpers, and helping them articulate that in a fuller, richer way so that they can, with confidence, go.

[00:28:13] Carrie: To clients and say, I can help with this and this is how I do it. If that sounds good to you, great. If it doesn’t even better because I’m not gonna waste your time. That’s really the crux of it for me. 

[00:28:28] Marie Vakakis: Do you find that, I mean, some of that sounds a bit like niching as well, and one of the difficulties I notice in, and I’ve had that too definitely at the start, is thinking that if I say I can do these things, then.

[00:28:41] Marie Vakakis: I’m going to exclude all these other people who I can also work with and I want to be able to work with a whole range of people. So think of, I don’t know, maybe some sort of general fitness instructor. There might be a huge pool of people that they can work with. Maybe when you get into an [00:29:00] elite level, elite sports, or your particular training for a particular, like maybe you’re training for a marathon and this fitness instructor does strength, maybe there’s, there’ll be a limit to what they can do.

[00:29:10] Marie Vakakis: But for. Most of your general mood disorders or life transition moments, a lot of therapists can work with those similar presentations. And so I think people as clients, dunno what to look for. Like I almost roll my eyes when I go through Psychology Today or some other platform, and I’m like, like we specialise in this, this, this, this, this.

[00:29:29] Marie Vakakis: I’m like, no, you cannot specialise in all those things. But then I’ve been on that side where I’m saying, but I can work with all of those things. Right, right. So how do people balance this? Yeah. I don’t know, tug of war between what they can work with, what they’ve been trained to, how people are trying to find someone that gets them and maybe laser focused.

[00:29:48] Marie Vakakis: Like I even work with couples and sometimes people are like, well, how many couples have you worked with that have this exact presentation you like? 

[00:29:55] Carrie: Right. 

[00:29:56] Marie Vakakis: A 10 year age difference between partners and one person is a [00:30:00] neurodivergent and neurotypical partner. Right. They, and it’s like. 

[00:30:04] Carrie: Right. 

[00:30:05] Marie Vakakis: No, it’s, 

[00:30:06] Carrie: why is that important to you?

[00:30:07] Carrie: It’s really hard to find that balance. It’s so difficult. It is the worst, and I think that the worst thing that has happened to therapists are the marketing coaches and gurus who’ve come in and introduced this idea of niching down. And as though that is marketing and branding in and of itself, I really push back against the niching down rhetoric.

[00:30:29] Carrie: I think therapists, it’s been a real disservice, I think to therapists in how they think about talking about themselves in public. Niching down is, is legitimately a, a marketing concept that has worked in many industries, but it. Comes from product marketing where there’s a almost unlimited audience, like e-commerce, that kind of thing.

[00:30:49] Carrie: So where you as a small startup are trying to fight your way into a very big market. And so there’s this idea of niching down is supposed to help you and make, make marketing easier, [00:31:00] make selling yourself easier. Therapists are already, especially in the states, I, I’m not sure if it’s as. Quite the same worldwide, but our market, quote unquote potential clients that we can see is already artificially segmented.

[00:31:14] Carrie: Here in the states, we, our licenses are, we have multiple licenses, and so you can, you have specific licenses with specific areas of competence, and then they’re all administered by individual states, and so your license is governed by the state. You have to have a license in each individual state, which means that a licensed marriage and family therapist in California can see.

[00:31:35] Carrie: Clients who are physically present in the state of California for issues that have fallen under the scope of an LMFT. Right? So then when marketing coaches come in and tell you to narrow that even further because that’s how you’re going to stand out, I think that that can help. I mean, it can for sure, it can work if, for example, you are a marriage and family therapist who only sees high conflict couples.

[00:31:59] Carrie: [00:32:00] Right. What that does is it harnesses this assumption of authority. Any client who hears that you work with high conflict couples, they just assume that you’ve got massive, like all this expertise, maybe years of experience. There’s something about your training or your background that has given you this angle, this extra edge in working specifically with couple high conflict couples.

[00:32:23] Carrie: But the reality is there are other ways of marketing that’s called a niching strategy. There’s also something called a differentiation strategy, and that’s what I think works better for many therapists if you don’t naturally gravitate towards, I work with, you know, high conflict couples. I work with teenage girls, uh, living with disordered eating.

[00:32:43] Carrie: I, you know, if, if you don’t ’cause. We, and it feels great sometimes ’cause we already slice and dice our clients by, by diagnosis and population. But if that doesn’t feel right to you, if you have that kind of like, I, I can work with adjustment disorder, of course you can. So then if [00:33:00] that’s the kind of career you want, that’s the kind of business you wanna build, then your niche is people who wanna work with you.

[00:33:06] Carrie: Your mission then is to differentiate yourself as a provider. I always use the example of Brene Brown. I can’t think of anyone who wouldn’t want Brene Brown as their therapist. I mean, if you hate Brene Brown, then great. Okay. But she seems like a confident, competent therapist, right? And no one is thinking like, well, who does she specialise in?

[00:33:26] Carrie: What is her area of expertise? No, it’s Brene Brown or Lori Gottlieb, or you know, any Victor Yala, any of these therapists, right? So I think that more therapists have the option of taking that road of defining who they are as a provider and becoming very clear on that so that they can put that out into the public sphere as, here’s who I am, here’s how I work, here’s what I can help with and how I can help.

[00:33:53] Carrie: And once you do that, the fear for most therapists around that is, oh, but what if people don’t like me? What if they [00:34:00] don’t like. That way of working, what? Then they won’t even give me a chance. And I say, good. One of the most important things about marketing, your marketing should do two things in equal measure.

[00:34:10] Carrie: It should inspire, approach behaviour in right fit clients and avoid behaviour in wrong fit clients. And this. Goes back to, honestly, one of the things that I, that I learned from the podcast is that if you are able to accurately communicate who you are and how you work to a potential client, someone who doesn’t want what you’re doing is never going to show up in the intake session.

[00:34:36] Carrie: They’re never gonna try to force it. But if you just have like generic therapist marketing, I will walk with you on your journey and I work with couples and families and children and individuals and you know, then a consumer, a client can make up in their head a story about what therapy with you is gonna be like, and [00:35:00] maybe it works out, but also maybe they end up disappointed.

[00:35:03] Carrie: And unfortunately maybe they end up really disappointed and on our old podcast. 

[00:35:09] Marie Vakakis: So if, if people listening, because people, I mean, even if it’s professionals listening, they would also have times where they are on the other side when they are the client. Yeah. 

[00:35:18] Carrie: Yeah. 

[00:35:19] Marie Vakakis: If people are listening and they’re thinking.

[00:35:21] Marie Vakakis: How do I navigate this? So how do I, okay. I’m starting to have a little bit more compassion for therapists that it is tricky. Maybe there’s room to ask more questions. Or if you’re at a bit of a, I guess if things are feeling a bit stale or a bit of therapeutic drift, maybe you can say, Hey, can we revisit what we’re doing and why?

[00:35:45] Marie Vakakis: Anything else people can look for that they can take a bit of leadership in. 

[00:35:50] Carrie: You know, I think I’ve seen this come up more and more in the therapist, Facebook groups, therapists reacting really negatively to clients [00:36:00] who show up to an intake call with a list of questions that can feel very challenging. I.

[00:36:05] Carrie: First of all, I want to empower everyone who is seeking a service provider. That is what you can and should be doing is figuring out what is important to you and asking questions of that provider ahead of time. If you are a provider, again, this goes back to the. Difficulty of like feeling what happens for you when you feel challenged.

[00:36:27] Carrie: I really want you to understand that if somebody is asking you a list of questions, it doesn’t mean that they’re gonna be a difficult client. It means that they’re engaged already in their care and they want to make sure it’s a good fit, and let’s be realistic. You want that too, if you want them to have good outcomes.

[00:36:45] Carrie: So yeah. For anyone who is seeking a provider, I want you to start by thinking about what is most important to you. And there are lots of things that you have options on, particularly when it comes to a therapy for a therapist. [00:37:00] Everything from characteristics like gender or. Racial, cultural, ethnic, identity, age, any of those things, if they are important to you.

[00:37:10] Carrie: There’s a lot of research coming out now showing that clients who have strong preferences for a therapist or therapy approach, they have better outcomes when those strong preferences are honored. So if you have a strong preference and you think of what does a therapist look, look like to you, what kind of therapist do I need?

[00:37:30] Carrie: That’s where I want you to. Make a list of those characteristics and go find that therapist and then I, I want you to ask that service provider, you know, what do you think about people who have my kind of a problem? Like, tell me about your idea of what is therapy. What’s it for? What is it supposed to do?

[00:37:50] Carrie: I find in my programme, interpersonal branding for therapists, this is where my programme starts, is I have a two hour conversation with my therapists. They call it the intake [00:38:00] session, where I ask you this question, what is therapy? How do you do it? What is supposed to happen? What does a good outcome look like?

[00:38:08] Carrie: What is your role as a therapist? How do you function in the room? I ask these questions because often we don’t get the chance to talk about this ever, and as therapists, we think we know. The answers to these questions, but we don’t. And the reality is your marketing is literally that your marketing is and should be the answers to those questions.

[00:38:32] Carrie: So everything needs to start with being able to articulate. And so I think for a lot of those therapists who feel challenged and thrown off and instantly feel like a, a therapist is a client, is gonna be a difficult client because they’re asking questions like, what do you think about therapy? Like, how is this supposed to work?

[00:38:49] Carrie: That feeling is coming up because you haven’t really ever answered this question before yourself. So that’s, that’s why I start there. 

[00:38:58] Marie Vakakis: I love that. So a lot of [00:39:00] opportunities for people to reframe that as, it’s not difficult, it’s engaged in care. Yeah. And have some answers ready to go. Yeah. Practice them. I have on my website, I’ve made a get ready for therapy diary, so all people that start seeing me get one.

[00:39:17] Marie Vakakis: As part of their first session if they want it, and there’s a available to download, but it gets you asking yourself those questions of what are my goals? What am I here for? What am I hoping for? Is there anything I would, any adjustments? I’d like to make any homework, like all of these sorts of questions because if we don’t know.

[00:39:36] Marie Vakakis: We can always help as well. And I think it’s a, it’s a relational dance between what are your expectations? Does that match what I can do? What are your goals? Does that meet what I can do? What about then time constraints and availability and affordability and I need to see someone weekly for at least a year.

[00:39:55] Marie Vakakis: But you’re saying you can only afford one session a month. This might not be a good fit, or it [00:40:00] is those back and forth and having those tough conversations. Yes, to avoid. Bad outcomes or I guess disgruntled disappointment. 

[00:40:10] Carrie: Yeah. Yeah, yeah. And I mean, I think the worst thing that can happen is for a client to go into therapy, be disappointed and think that, not even have the thought, this was a bad fit.

[00:40:22] Carrie: The therapist had a bad day. I don’t know what to do. Think therapy doesn’t work and walk away and never ever try again when all of it could have been avoided. If at the beginning they had a better sense, I don’t think this therapist is right for me. 

[00:40:38] Marie Vakakis: Yeah, it’s really good the, we want a positive help seeking experience.

[00:40:41] Marie Vakakis: Mm-hmm. 

[00:40:42] Carrie: Absolutely. 

[00:40:43] Marie Vakakis: Well, thanks so much Carrie. We’ll put links to your stuff in the show notes and people can reach out to you if they want to do your training. Great. 

[00:40:51] Carrie: Thank you so much, Marie. It was so lovely to, to talk with you again. So good to hear your 

[00:40:55] Marie Vakakis: voice and hear some fresh 

[00:40:57] Carrie: content. 

[00:41:00] I.