How the systems you work in can make or break you as a therapist

One of the most challenging things about being a therapist is coming to terms with the systems within which we work.

We are often taught about ideal ways of practice, to deliver therapy, and work with clients in our university trainings. Only to find that the workplaces and funding models we work within present significant challenges or require us to do the opposite of what we learned and may now passionately believe is right. Sometimes we even work with funding systems that we know result in poorer outcomes or a worsening of the mental health for our clients.

Frustrations with systems show up in many ways. For me, the first was when I realised diagnostic labels were the key to accessing anything for any client. The ideal way of practicing I’d learned about in my undergraduate in which symptoms and patterns were addressed holistically didn’t seem to be something that happened. I found myself feeling guilty that I was stigmatising and medicalising my clients by engaging in diagnosing them with mental illnesses.

Since then, there have been the challenges of helping clients navigate inflexible hospital systems, Medicare models that make people believe in 6 and 10 session fixes, the very real absence of publicly funded safety net for the most vulnerable and insurance funding systems with their over-focus on reporting and monitoring.

Therapists often focus on the impact of these systems on clients but more recently I’ve started to think “What is the impact of working within these systems on therapists?” How does it affect therapists to watch clients flounder in systems and struggle to get assistance or to develop new symptoms in response to a punitive or highly monitored rehabilitation program?

Therapists believe in change. We work every day to help people create change, whilst also generally being passionate about self-development. This means that the impact of working within systems that make change challenging or even block change can feel anywhere from mildly disappointing to depressing.

Working within these systems seems to create a few responses amongst therapists :

  • Excessive self-sacrificing to accommodate for failings in the publicly funded health system and personally attempting to meet the need of vulnerable clients.
  • Finding loopholes to work the way you want while making it seem like your compliant with the system (for example giving people soft diagnoses like adjustment disorder or hiding from your manager you’ve seen a client for 12 sessions that you were only supposed to discharge after 6).
  • Seeing working within the systems as a necessary evil and better than nothing. Redefining what you were taught as “not the real world”.
  • Developing new beliefs to support the way you work. For example, if diagnosing people with mental illness was previously seen as labeling, you may develop the belief that diagnosis is essential as it guides treatment.
  • Finding income streams that don’t rely on funding models that require you to bend your ideals.
  • Developing a learned helplessness response, burning out, and leaving the profession.

No matter how I look at it it’s hard to see how therapists can’t be affected by the systems within which we try to help people.

This means to survive and thrive in your career as a therapist you need to find ways to take care of yourself.

This might look like:

  • Getting regular supervision to help support you with systems issues.
  • Your own individual therapy, particularly if you have a subjugation schema and tend to be either overly compliant with systems or overcompensate by being anti-authority.
  • Monitoring the impact of systems on you, not just your clients. 
  • Looking for signs of learned helplessness and making decisions as to whether those workplaces or funding models are best for you before you experience burnout.
  • Identifying what kind of workplace is the best fit for your health. One where you can use our clinical skills and feel good about what you do. Where you can be the agent of change you set out to be at the beginning of your career journey.

It’s not just about your clients, your health and well-being matter too. Therapists need to be agents of change in their own lives too. 

You can build a career as a therapist that supports your wellbeing if you dare to stop self-sacrificing and subjugating your needs at all costs.

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