Strategies for client retention and engagement (with Claire Trevitt)

[00:00:05] Bronwyn: Hey, mental workers. You're listening to the Mental Work podcast, the podcast about working in mental health for early career mental health workers. I'm your host, Bronwyn Milkins, and today we're talking about retaining clients who are unsure about change.

In this episode, we're going to explore the real and very common struggle of client retention, especially when working with clients who are ambivalent or not quite ready to change. We'll unpack why this happens, how early career mental health workers can respond, and practical ways to foster engagement even when clients seem on the fence.

Today's guest is Claire Trevitt. Hi Claire.

[00:00:39] Claire: Hi, Bron.

[00:00:40] Bronwyn: It's lovely to have you back. Could you please remind listeners who you are for those who haven't heard you before?

[00:00:46] Claire: Sure. So my name's Claire and I am a psychologist and I'm board approved supervisor. And I do a lot of work in supervision, particularly for provisional psychologists, um, for some of the four plus two, um, people who are still going, and five plus one people. And I also have a very small private practice where I see clients, um, presenting generally with a history of complex trauma.

[00:01:13] Bronwyn: Lovely. And I wanted you to come on this episode specifically because I know you do a lot of supervision and I know you are well versed in seeing the challenges that early career psychs face, and so I wanted to ask you what your relationship is to this topic. Is this something you've observed that maybe early career psychs have trouble with, with retaining clients, or something you've experienced personally?

[00:01:33] Claire: I would be surprised if all psychologists hadn't experienced this at some point. Um, I've certainly experienced this personally, and, and I still do to, to some extent. I think I'm getting a little, um, better at discerning the types of clients before I see them, um, in terms of whether or not they feel ready for the type of therapy and the approach that I might be offering. But, um, I think retention is an issue for all psychologists, and I do, uh, speak to people in supervision about this quite frequently because as you said, it's a really common concern.

[00:02:10] Bronwyn: Yeah, absolutely. So what prompted this episode as well was that I had a listener reach out to me and say, look, Bron, I'm an early career psychologist and I feel like I'm struggling with retention, and I feel there's a lot of pressure from my workplace to make sure that clients stay, in like they're monitoring, but I feel like it's really hard with clients who are ambivalent or on the fence even about change. And so, I agree that I think this is a common experience. I don't think it's unique to this listener who reached out. I'm wondering if you have any thoughts on why that might be the case, particularly for early career clinicians.

[00:02:45] Claire: I think psychologists want to do a good job. We go into this profession because we want to support people, and so when we find ourselves struggling to do that, we can begin to question what we might be doing wrong. Um, and of course there are so many factors that may impact a client's, um, ability to work in a particular way and to engage in therapy because it is quite a different relationship and it is quite a different process, particularly if people haven't been in therapy before.

[00:03:22] Bronwyn: Yeah, absolutely.

[00:03:23] Claire: I think as therapists we are very used to the language, we know what therapy entails, and so partly where I think there is a, a little bit of an assumption that we have around what therapy is and feeling that that might be more understood by the general population than it, than it actually is.

[00:03:45] Bronwyn: Yes, I completely agree. Like there's, for example, something that I tell clients a lot, particularly when I was more early career and I was more influenced by CBT, but I used to tell them that what happens here in the therapy space is only a small part of change, and what happens outside of therapy is also very important, so that if clients are relying on what's happening in therapy to see the most change in their life for where they want to get to be, that's not right. It's, it's what happens outside in those hours, outside of this one hour, that's important, but most people wouldn't understand that unless you tell them.

[00:04:20] Claire: Absolutely. Yeah, and I love the fact that you really would set that up with people because... absolutely, there's so many expectations. I think for us in early career psychs, I mean, we've got so much to think about. So when clients come in, we wanna do a great job. We've got interventions to remember. We've got all of the intake processes to remember in terms of explaining confidentiality, um, and explaining different, um, processes or different interventions, providing psychoeducation. There are so many different things that we can draw on in the session that if we actually really sit down and think about it, it's no wonder that we sometimes might become a little bit overwhelmed in that process and feel a bit stuck.

And not all clients present with the same level of readiness. And it also depends on where they come from and how they come into the service. Like has someone else suggested that they come for therapy? Was it a family member that said, you know, you really need to work on something and they've taken that on board and come in. Or are they being referred by an organization for, um, like in the workers' comp sector, for example, where people are not necessarily choosing to see a psychologist, but it's part of the process.

And so there are lots of different reasons why somebody might come in that again, I think might impact their level of readiness, or clients might think they are ready but actually find it's quite confronting.

[00:05:49] Bronwyn: So what I'm hearing is there are lots of other reasons other than me being bad at therapy for why a client might disengage from therapy and I might have difficulty retaining them.

[00:06:00] Claire: Absolutely, and probably there are more reasons and more likelihood that it's due to other factors than it is that the therapist is bad. Yeah, it's, I think we look to ourselves and hold ourselves accountable when things are not working, and obviously that's important to self-reflect, but also I think in the process of doing that, we can miss all of the other reasons why clients may not be responding.

[00:06:26] Bronwyn: I'm just curious, like over time for you, you are quite an experienced psychologist, do you feel like it's become different or easier to retain clients for you?

[00:06:34] Claire: I think I have become, better at recognizing which clients are ready and which clients might not be. So when I'm more, I think I'm more able to predict which clients will stay for longer compared to which clients might dip in and out or prefer just a few sessions because I tend to work reasonably longer term.

Then I would generally expect clients to stay for probably at least six months, maybe longer. There are certain clients, I think they're, they're probably not gonna stay longer than a few sessions, and that's okay if I feel they're getting benefit from that. But I also tend to set things up maybe a little bit more clearly now, and I've got the ability to do this because I've got my own practice.

And I know that this isn't possible for everybody, but I do actually screen most of my clients over the phone first to get a sense of whether I'm a good fit for them. I explain my therapeutic style so that when they come in and see me, they've got a sense of how I would work and what I'm likely to do and not do, 'cause if they're looking for, say, CBT, and they've been referred for CBT, I'm probably not the best match for them. But if they've been referred for EMDR and maybe some somatic type work, then yes, I am able to support them with that.

[00:07:59] Bronwyn: And I know you do a lot of psychodynamic therapy as well, and I've read the websites of a few psychodynamic psychotherapists and one thing they said that stood out to me as interesting was they said that they only want clients who can do weekly or fortnightly and they won't accept clients who can't do, I guess, more regularly than that. So that's, it's an expectation for the sorts of, uh, attendance that they are seeking.

[00:08:21] Claire: Yes, that's actually a really important point because while I don't necessarily tell clients that I work psychodynamically, because I feel that that's maybe a term they don't necessarily understand, but people tend to understand EMDR, um, but I will describe that I work from a sort of a... I use a psychotherapy approach and, and I'm very interested in their past experiences and how that impacts the present. So I explain it in those, sort of layman's terms if you like.

But I do always set up a, if possible, the same time each week or fortnight, and I make sure that before I book an appointment that they, my timing is going to work for them on a regular basis and that we are going to be able to set up a regular time. So that is actually very consistent with a psychodynamic approach, and it does then provide that, I guess, that added assessment and for me to determine whether or not a client is wanting something more regular or if they're just wanting to dip in and out.

[00:09:27] Bronwyn: That makes a lot of sense. I just wanna return to something you said earlier, which was that you feel that you are better able to recognize which clients will stay and which might not. Could you, uh, link us in with these hot tips for how you can spot client ambivalence or contemplation? What might that look like in the therapy room? How can we spot it?

[00:09:47] Claire: Attendance I think is a really big factor. So if somebody is arriving on time and they are attending regularly, so they're not canceling sessions or changing sessions, but they're attending quite reliably, then that's a really good sign of, I guess, their commitment compared to somebody who might arrive late the first session, and then they might say, "oh, actually I can't do next week, maybe I can contact you again to get another appointment", and I sort of get the sense that, there isn't that level of commitment or that I may or may not hear from them in a fortnight or whenever they've said they would call.

And so there is, it's usually around the attendance that I get that, that sense because it's, it's how are they coming into the space? Um, and is there this level of commitment that's actually being demonstrated?

[00:10:41] Bronwyn: Are there any other signs?

[00:10:43] Claire: I think also how the client presents in the room and their level of, not, not engagement, but their level of sort of willingness to take concepts on board, whether or not my approach would resonate with them, um, or whether it, they might be perhaps saying, this isn't what I thought it would be, or I was looking for something else.

I try and check in with clients if I feel as though I'm missing something... I'm not sort of reaching them in the way that I would like to. So I might explain something or provide some psychoeducation, and then I'll check in and say, you know, how does that land for you? Does that make sense to you? And I'm looking for their response to see whether or not I'm on the right track. So I guess whether it's a reflection, whether it's a question... Whatever it is that I'm doing with them in the room, I'm always trying to track their sense of, yes, that makes sense, or, yes, you've understood me because that is telling me that, that I am reaching them.

[00:11:51] Bronwyn: Yeah, I get what you are saying, and I feel like that resonates with me too. When I reflect on instances where clients maybe have come for a session, I think what I've observed is, I was going to say before, like, too much agreeableness, but I don't think that was quite what I was looking for. I think it was what you were describing, which was you say something and then maybe the level of interest that you can see from them and the attunement with, I've put this out there, does that go for you? And it's quite low. It just feels a little bit off, is the best way I can describe it.

[00:12:29] Claire: Yeah. It's the difference between a yes, that's exactly what it was, versus a, yeah, yeah... And I'm thinking, I don't think I'm quite reaching...

[00:12:38] Bronwyn: Exactly that is, that is the feeling and that is the thought. And I think another thing for me is like, uh, it's difficult to discern because sometimes people are guarded at a first session, which is really understandable, like you're a stranger to them, and they may have mistrust due to previous interactions with health professionals. But sometimes I've noticed in those that don't come back, it is a shortening of answers and perhaps nodding without full, uh, extension of what they're saying.

[00:13:08] Claire: Yeah, I think it is, it's the level of engagement, whether or not we... I don't wanna describe it as a, as a willingness because they've obviously come into the space, and they're obviously wanting to, but it's the level of, um, connection that they might feel with what we have to offer or whether they can even take what we have to offer. Because I think, now as therapists, we have a skillset that we want to use and not all clients can use that.

[00:13:38] Bronwyn: Exactly, exactly. And like you said before, some people may think that they are more ready than they actually are. So they come in being like, I'm going to do 12 sessions of EMDR therapy, and they fully come committed to that. But when it actually starts, it's like, oh, this is activating a lot for me, more than I thought it would. And maybe. Maybe this is too much for me, which is so understandable as well.

[00:14:02] Claire: And I think in that situation, and I, that's a really important point you're making around whether maybe it is too much. I think that is sometimes where we can begin to really slow down and attune to that, because sometimes it can be overwhelming, but that doesn't mean that the client needs to give up on that. And I think if we can track that and we can name that and notice that in the session, then again, we can reconnect with the client at the level that they need us to be there for.

[00:14:32] Bronwyn: Yeah. And that was going to be my next question, 'cause it's like if we've got these ideas around what ambivalence might look like or not being quite ready, looks like how can we keep clients engaged? What are some practical strategies? So you were just describing their keeping track of whether they are engaged, naming that. Have you got any phrases or anything that could help us out?

[00:14:54] Claire: Again, it's around tracking what's happening for the client, which is going to be so individual. Um, but I think it would be checking in, how is this landing for you? You know, is this pace okay? Is this... so I think that the first session, if a client is tentative, I would probably want to be leading them a little bit, but really checking in quite frequently. Not to the point where they're sort of feeling that they're, they're being interrogated, but it's more a sense of obtaining the level of, I guess, the level of permission that, that you have to begin to... I maybe ask questions. You know, is it okay if I ask you a little bit about your childhood, for example? Um, and they say, oh, I don't really like talking about my childhood. I probably say that's, that's fair enough. I'm not gonna ask you to talk about anything that isn't comfortable for you. You know, would you feel comfortable, you know, telling me a little bit about what brought you into the room, for example.

So I would change the subject but try and stay with them, which I think is, um, something that, you know, it comes around... it's about the, the therapeutic relationship and does require us to know... very much attune to where the client's at in the moment.

So I think the asking permission and not feeling as though we have to get every question answered on that intake form is, I think, a really important one because if we go at the client's pace, then I think we, we will probably have more chance of engaging them.

In terms of readiness, it can be tricky to determine whether that readiness is a level of resistance and discomfort and fear, or whether it's maybe a disinterest or a, you know, a change of mind or something very unconscious around, you know, all of that. Not really wanting to go there and not feeling able to go somewhere.

So sometimes we do need to be quite gentle and quite slow, and as therapists we've got the skills we wanna use, we really wanna help people, and I think one of the risks that we run is in trying to overdeliver and trying to do too much. So in those situations, sometimes slowing down and really checking in I think can feel a little bit counterintuitive, but can actually be quite helpful.

[00:17:20] Bronwyn: I really love that, and I was nodding vigorously when you said we try to do too much because I completely resonate with that, and I've had supervision around the very topic of me feeling like I haven't done enough if I haven't given a client X number of skills, and not doing enough in that therapy session.

But as you say, pacing is so important, particularly when we think of clients who are, I guess most clients actually, probably all clients need to have some sort of pacing. Um, and if we do too much, despite our enthusiasm and wanting to be useful, it can really overstep and make people feel, I guess, just activated and not really enjoying the therapeutic encounter.

[00:18:00] Claire: Yeah, and it's really important for us to check on that even if I... sometimes, you know, I feel like I ask my clients quite frequently, you know, how is this for you? What you know, am I going too quickly? Am I going to, um, too slowly, you know, is this information, you know, feeling like it's right for you? Would you be interested in me teaching you a particular strategy? And because, I feel like I'm constantly asking them, I'm not trying to, um... it's not to pacify myself, it's to check in that they are comfortable with the pace that I'm going. Because some, some clients say, give me homework. I love homework. And I say, okay, I must remember to give you homework at the end of the session because I know that's really important for you. Other clients, I think they're probably not going to do this, so I might sort of hold back a little bit.

[00:18:49] Bronwyn: So it's individual and it's tracking as you go along, listening to the client, putting that into the relationship and how you proceed.

[00:19:00] Claire: It is. And the other thing I think is, is um, the obvious one is asking the client. You know, what is it you wanna get from coming here, you know. If they haven't chosen to be there, well, I know that this wasn't your choice, but given that you are here, is there something that we can do that would be helpful? Sometimes clients will say, I don't know, because they don't understand necessarily what therapy can entail. So it can also be helpful to have, um, I, I've borrowed this term and I really love this term, um, from Janina Fisher, I'm not sure if you're familiar with, she calls, she uses a menu of choices.

[00:19:40] Bronwyn: Yeah, I was literally gonna say the menu, yeah.

[00:19:44] Claire: And I just love that term because it's about saying, okay, you are not sure what what to do here, so here are some options. You know, we could work on some strategies for, you know, helping you, um, alleviate anxiety. That could include maybe some breathing exercises, it could include some mindfulness. I can provide you some information on some of this and, uh, explain to you what I think might be happening so that you've got a clearer understanding.

And you begin to present them with choices, and then the client might say, you know what, actually I'd love to understand a little bit more about that. So then they have made the decision and then we are responding to their choice and they're much more likely, I think, to engage with that than if we say, "you know what I thought today we'd do some relaxation exercises. So this is what we're gonna do. What I'm gonna do is I'm gonna get you to close your eyes and we get clients to do exercises and then at the end say, and how was that?", and the client's like, uh, yeah, that was, that was fine. Sometimes you'll, sometimes they'll really enjoy it and you'll get a sense of, um, it was perfect for them, but sometimes we just go blindly into interventions. The client's got no idea what's coming, and then they're kind of confused or it hasn't necessarily been what they've wanted for the session.

So I think, you know, setting things up really clearly at the beginning of the session because we, again, we forget if we've got a manualized process that we go through or we've got a treatment plan, we might forget that the client doesn't know that off by heart, doesn't necessarily know what's coming or why it's happening. Or they might have had something happen that week and we're kind of on our track and they're on a different path.

[00:21:30] Bronwyn: Yes, definitely. I often think that, and I've used the menu of choice with success. I think I've done it quite a few times actually. Um, and I found that it's worked quite well and it also helped me clarify what it is that I do as a psychologist. I was like, oh, I can help with this and I do that and I help people with their emotions and I can show you different ways of doing this. Um, and I found that giving them that choice and empowerment was really good for them.

[00:21:54] Claire: Mm. Particularly when they don't know.

[00:21:56] Bronwyn: Yeah.

[00:21:57] Claire: -is really very much for clients that say I, I, I don't know. I'm a bit lost here, so we can provide some guidance and some direction for them, so yeah.

[00:22:07] Bronwyn: Um, one thing that is recommended by some people that psychologists can do is to give clients a rating scale. So there are a few rating scales out there of therapeutic alliance, and you can measure just how good the session was from the client's perspective across a few domains. Is that something that you've tried or, or recommended?

[00:22:29] Claire: It is not something that I've tried personally, because I think I'm constantly checking in anyway. And so I feel like that I embed that into my natural kind of questioning. But I do think it's a very useful exercise for tracking what's happening in sessions session, and I believe that the outcome rating scale, it's literally just four questions.

[00:22:48] Bronwyn: It is.

[00:22:50] Claire: Yeah, it could be asked very quickly, and I do think there's really good evidence for asking clients that information. Um, so that's, that's one option as well to, to just get a sense from the outset whether or not what you're providing is what they're looking for.

[00:23:08] Bronwyn: I really like how you are encouraging of this checking in. I was just reflecting on, like, how I might receive a massage and I really like it when the massage just checks in on me. Like, is this okay? Is this okay here? Is this still good? And I don't find it annoying. And so the reason I'm bringing it up is because I think some early career clinicians, they can think that they're being quite annoying. But when I reflect on my own experience, I don't think I've ever been annoyed with a clinician for checking in on me.

[00:23:34] Claire: I don't think so either, I completely agree. I think that it's not for our benefit. It's not like, am I doing a good job? We are saying, are you okay? And so, and and we'll, we'll be bearing it too. It's not like saying, is that okay? Are you okay? Are you okay? The same question over and over. It's like, is this pace okay? Does that make sense to you? Would it be okay if we did this? So it's checking in constantly, but it's more sort of weaving it into the session and what and the flow of the session.

[00:24:09] Bronwyn: Yes. I find that's really helpful as well because it gives clients the confidence to disagree with us. At least in my experience, I find when I check in and I might notice something like I might say to a client, um, when I gave you this last time, I noticed that you looked away, um, I'm wondering if this is okay for me to give to you. I think it actually helps them to feel better about being like, no, it's not okay. Or, I didn't like it last time, and I'd be like, great, that's so helpful to know because I could do something different this time. And it's just so informative and I wouldn't have gotten that information otherwise.

[00:24:45] Claire: Yeah, that is so important because, and your response there to the client and saying, look, thanks for telling me that, I'm so pleased that you were able to share that with me, gives them permission to be able to do that, not only in session with you, but hopefully they might then also go out of session and realize that it's okay to have their own opinions or their own choices, and for that to be accepted by others. I mean, that's the long-term goal for our clients, what, what we model in session. So I think it's so important because that's what we are trying to do for them, um, and support our clients.

[00:25:20] Bronwyn: I'm wondering what are some common missteps that early career clinicians might make when trying to engage clients who might be ambivalent or not coming to therapy of their own choice?

[00:25:30] Claire: I think sometimes not checking in enough, so if a client doesn't turn up for a session, for example, it can sometimes be helpful just to call and check in, and say, look, I noticed you didn't come to the session, um, and you know, I'm wondering if something might have happened in our last session or if something maybe is happening for you. And so to really- ideally have that conversation over the phone with them, um, if, if there another session isn't scheduled, so to really follow up out of concern for the client.

And I think the other thing is around trying to do too much. So I think it's, you know, when we try and pack so much into a session and a client feel ends up feeling overwhelmed, you know, we wanna give, we wanna give them their money's worth, we wanna feel like we are using the skills that we've been trained to use and we want to feel like we can deliver these treatment plans that we have developed, and I think sometimes we can feel under pressure to provide more than actually is needed.

I mean, I think the reality of it is, is if we... I like the idea of breaking the session down. If you think about the first sort of 10, maybe 15 minutes of catching up and then doing some work or an exercise or an intervention, whatever that might be for maybe around 20 minutes, and then having the last part of the session as really sort of wrapping up and closing. If we think about using the middle part of that session for an intervention, it's not a massive amount of time and in order to deliver an intervention effectively, we do want to put time into that. Because whatever form of therapy we're offering, there's usually going to need to be some, I, I feel some practical exercise that needs to take place in the session, whether it's a demonstration or an explanation or working through that with the client in session, and then usually that might be about them taking it away and doing that at home or practicing something in between sessions.

And I would be sticking to one or two things, rather than trying to really jam pack lots of things in and it can really, I think, put people under pressure. Some clients can take that, you know, some clients if they're working on a manualized program and they're really motivated and they're really like, you know, lapping it in, they're really sort of. They're really taking it in and they're getting really infused by the process and it's like, give me more, give me more, and they're taking it away and doing homework, then, yes, absolutely, just, just, you know, put more into the session.

But where clients I think are a bit ambivalent, we need to take it, I think, a bit more slowly and try and really give value to the interventions that we are trying to support them with so that they can really see the value rather than, I'm gonna give you this exercise, see how you go with it

[00:28:50] Bronwyn: Yeah, less is more is what I'm hearing.

[00:28:54] Claire: And demonstrate it in the session. So if you want someone to practice mindfulness at home, do a mindfulness exercise in session, and then check in with them to see if that's something they'd be interested in practicing at home. Because the chances are they won't do it unless they've had the benefit of doing it in the session.

[00:29:14] Bronwyn: I remember, like, maybe in the first two weeks that I was delivering therapy, that was something that I learned. I was just having a casual conversation with a colleague and it must have come up, something to the effect of, I was saying, oh, I was talking about mindfulness. And then my colleague was like, did you actually show them mindfulness? And I was like, no. I should do that. No, I did not. Um, yeah, it made a big difference straight away.

[00:29:41] Claire: It does. It does. And I think as clinicians, we think, oh gosh, I can't spend 10, 15 minutes at the session doing a mindfulness exercise because then I'm not doing anything. But actually you are.

[00:29:54] Bronwyn: Totally, absolutely. It's so important. I completely agree with that approach.

One thing I wanted to ask you was, if there is a situation where a listener is having a genuine issue with client retention, so let's say it's not the environmental factors. They're having similar clients to other colleagues at their practice, and it really is genuinely, there seems to be a difference between clinicians in that one clinician is really having trouble retaining clients in more than one or two sessions. Um, so it might be some clinician factors. What are we doing for that clinician?

[00:30:29] Claire: I think if a clinician is struggling and they feel that it may be skills-based, then supervision, of course. I would maybe be encouraging them, depending on what stage they're at in their practice, but I would maybe be encouraging them to record some sessions, particularly sessions that they might be finding challenging with clients who they may be struggling to engage with. Get some consent if possible, to record those sessions and then get some feedback on what might be happening in those sessions. Because if it is the clinician and the clinician is early in their career, then there could be some steps that could be taken to quite easily remedy that.

And rather than sitting with this, I'm no good. I can't do this. I'm gonna be a bad therapist and I'm never gonna be able to engage people like my peers can. And all of those kind of thoughts that we can ruminate over... I would take some practical action to see what, what is happening and what can we do, if anything. Because it may be, you know, that client- you know, you, I can see you're trying, you know, it might be that I can see you're trying and actually, you know, I'm not sure that that client is ready and maybe the reason that you're struggling is X, Y, Z. Or maybe it's their therapeutic approach. Or maybe it's something else. But I think getting feedback on that I think would be really important because, yeah, how else do we build skills?

[00:32:03] Bronwyn: I like what you said that it is probably easy to address because I think it would be. Like, I'm just thinking of two situations in my head, which might be clinician skill-based. For example, if a clinician spends 35 minutes of the session explaining confidentiality, I completely understand from the clinicians perspective , they're like, I'm giving informed consent. I'm doing the whole form, I'm going through it completely... But the potential consequence is that the client leaves the session feeling unheard. So that's really easy to correct.

Another example is if the clinician has a client, for example, who has an anxiety disorder and is like, great, exposure therapy, let's start that now in session one. Um, that would also be quite easy to correct with video feedback.

So I completely agree that with video feedback that could be really effective, and then taking that to supervision, these very understandable behaviors, which are, which are not consequential, but so easy to modify, could be really helpful.

[00:32:59] Claire: Absolutely. And I think we- you and I, I know have talked about this before around the therapeutic relationship and also in transference and counter transference, we- I think when we are taught therapy models, we are not necessarily taught around the therapeutic relationship unless we are, um, learning a model that really emphasizes that there is the sense of, well, we need to build rapport, but sometimes, you know, that rapport building might also require some refinement. And really, I guess looking at some of those micro skills and how one may be able to respond to certain things that the client is saying or not saying can also be really valuable.

I mean, I've, I'm doing some training at the moment and part of that requires me to do supervision groups and I've got people observing and, you know, I make mistakes and it's been so valuable to get feedback on real time sessions, they're role plays, but to get feedback on real time sessions to be told, this is your strength and this is an area you can work on. And I'm finding that that's beneficial for me when I get that feedback personally, but also I'm watching my colleagues and getting feedback from other people's role plays and it's so valuable to get that, and I'm still benefiting from that now, 20 years later.

[00:34:29] Bronwyn: It's good to know that the learning continues and that... I guess, like what I'm hearing from you as well is that you're not overly down on yourself, which I think early career clinicians can be, so they can be overly critical and be like, I'm so bad I'm not retaining clients. This must mean that I'm a bad clinician. But it's learning and it's taking that nonjudgmental, compassionate approach to yourself rather than being absolutist and quite critical.

[00:34:54] Claire: Yeah. Yeah. Which is often easier said than done.

[00:34:57] Bronwyn: Totally.

[00:34:58] Claire: And the other thing I'd like to say, um, with that, is that with supervision, getting a supervisor that is going to be supportive and is going to help you to develop those skills, um, because you do need a balance, I think, when you are starting out of support and encouragement and to have your strengths highlighted as well as being supported with areas to develop. And so if you are finding that supervision isn't giving you that balance, then I'd be encouraging people to seek out supervision that is going to, is gonna help you to develop those skills. And also I think our internship, um, uh, pathway, and I'm not sure about the Master's programs, but I think that we are provided with basic training and intervention, but we are not necessarily given in-depth training in a model of therapy. And my suggestion to people is as soon as you can find a model of therapy that resonates for you and train properly so that you have a framework to draw on.

That may or may not work for everybody, but that you have a framework to draw on in terms of your treatment planning and your formulation, the interventions that you provide in therapy, because I think that can give you a lot of confidence, rather than, you know, and I'm thinking of the, the very early career sites who may even still be provisional psychologists. I think that we are often trying to pick and choose different interventions and trying to sort of weave in what's we sort of understand maybe as more of a CBT style model, but isn't necessarily in the form of a full CBT training.

[00:37:00] Bronwyn: Yes. Yeah, I completely agree. I agree with the confidence building, and I always think of it from the perspective of the client as well. Like, clients come in with a few questions. One of them is, can this person help me? Is this person going to see me for me and not judge me understand me? And I think having a model of therapist can really answer that question of, can this person help me, um, for the client. Um, and it, it gives us that confidence as well. I think it's a good one-to-one, and it, I think it can help retention as well.

[00:37:31] Claire: Yes. And there's another thing I was thinking of as well as you were saying that, because it's like, yeah, is this therapy gonna work for this particular individual, is what are the clients that you're gonna work best with? Because. Some people are gonna work really well with clients presenting, maybe with depression. Some people like to work in trauma. Some people love complexity. Some people like to work, um, in that neuro affirming space. And of course we've got clinicians that are supporting clients presenting with, with, they're presenting very, very differently with very different presentations, but also, um, very different sort of characteristics and ages and genders.

And thinking about the types of clients that you are gonna work best with. And it's not about excluding everybody else, but I know for myself that the sort of people that I work best with are people who are adults who have experienced some kind of early trauma, usually people that really want to have an understanding of why they behave in certain ways. They want to get a sense of how they past has influenced their present and how that continues to play out in their current life. And I find that when I get clients that fit that, then I work best.

[00:39:02] Bronwyn: That makes a lot of sense. And it really points to, I guess, the overall message of this episode, which is that we might be thinking it's a issue to do with us, or that the client is simply ambivalent, but there are a lot of factors to consider here, and I guess exploring those factors in supervision and through self-reflection can be really beneficial.

[00:39:23] Claire: Hmm. I think so. I think because it is as you said, it's this- it's all of the other factors that we really do need to tune into. Yes, we do need to take responsibility, but I think the listeners that you are referring to are the people that are really conscious of wanting to do a good job.

[00:39:42] Bronwyn: Yes. Yeah. Yeah, I think pretty much all of us, we just wanna be really helpful.

[00:39:48] Claire: Exactly. And we wanna create the conditions that are gonna allow us to do that too. And the more pressure that we are under, we know from, you know, the research around stress and around sort of trauma is that the more sort of activated our own nervous systems, the, the more difficult it can be for us to think logically. And, and so of course then it becomes this sort of, oh, I'm doing something wrong, I'm to blame, and it can buy into all of those kind of schemas and core beliefs and early patterns that we might be presenting with, rather than, what actually is this situation here, and let's look at it objectively.

[00:40:27] Bronwyn: Claire, you've been so helpful today. Is there anything else that you hope listeners will take away from our conversation today?

[00:40:34] Claire: I would hope that people will come away, hopefully looking at this a little bit more broadly, um, rather than just looking to themselves and you know, their own inadequacies. Because I think that we come with so many skills, there's so much learning that goes into becoming a psychologist, and there's so much that you would have had to demonstrate to in order to actually be where you're at. And so I think it's what I would really hope people do, or able to do, is to really recognize what they do bring, um, and that if this is a struggle, it's likely a struggle not just for them but for others, but that there are things that can be done

[00:41:27] Bronwyn: That's a really nice message. I'll leave listeners with my own message because I haven't had an opportunity to say it, and I just think it's a, it's a good thing because I like it... which is that I was reading a book, it must have been a few years ago, and it was on feedback informed treatment, and I latched onto this statistic that was in the book, which said that the average number of sessions attended by clients is one. And yeah, and I was like, I like that statistic. I'm gonna implant that in my long-term memory, um, because it was deeply reassuring and I was like, great one, one is the average. Anything better than one is I'm doing good.

[00:42:03] Claire: Actually, I think the Medicare statistics, I don't know them, um, I don't have them to hand, but I do believe that most people don't finish the 10 sessions.

[00:42:11] Bronwyn: Yes. Yeah, exactly. Yeah. So yeah, I feel like if we are getting people breathing down our necks being like, you need to retain more, it's like actually, like the average is one, people don't use them more.

[00:42:22] Claire: Yeah. And, and you know, are those, um, you know, are the expectations realistic as well? Yeah, yeah, which is a whole other story. But yeah, I think that that's another question I would want to just add to the mix.

[00:42:38] Bronwyn: Exactly. Exactly. Well, thank you so much, Claire. I really love chatting with you and hearing your wisdom and reassurance and clarity and calmness. It is lovely.

[00:42:48] Claire: It's been an absolute pleasure to be here. Thank you, Bron. I really appreciate the opportunity and I really enjoy chatting with you.

[00:42:55] Bronwyn: Claire, if listeners do wanna learn more about you or get in touch, where can they find you?

[00:43:00] Claire: Thank you. Yes, you can find me at thegrowingtherapist.com.au, which is my website. Uh, I'm on Instagram and on Facebook. And I also have a private practice, Holistic Psychology Services. And I co-host the Between Two Psychs podcast. And I will soon be releasing my solo podcast, The Growing Therapist, um, before the end of the year. So watch this space for that.

[00:43:26] Bronwyn: Lovely. Thanks so much, Claire.

And listeners, if this episode hit home for you, would love your support, follow Mental Work on your podcast app, leave us a rating or review and share this episode with a fellow early career mental health worker who might be feeling the same way.

Thanks for listening to Mental Work. I'm Bronwyn Milkins. Have a good one, and catch you next time.