When Therapy Becomes Untherapeutic

How the Counseling Profession got Healing all Wrong

I’ve been sitting on this post for a while now, for two reasons: 1) I am a Counselor Educator and I teach and train counselors-in-training. Therefore, the things I have written about in this post will no doubt be seen as controversial by some of my colleagues. 2) Grief.

I have been grieving the profession I dedicated my life to for many years now. I grieve the harm it has done to me, the harm it has done to my clients, and the systemic harm it continues to perpetuate today.

I wish I could say that I felt differently, but I don’t. In fact, working as a Counselor Educator has further reinforced to me that collectively as a field we have got the process of healing all wrong.

Let me explain…

Yesterday, I made a post about how, at 14 years old, I was diagnosed by two different counselors with two radically different diagnoses, which you can read about here.

My intention in making that post was to highlight how hard it is to actually separate clinician bias from the act of making a diagnosis.

Now let me be clear, I am aware that diagnosing certain conditions has been helpful for many clients, particularly those individuals who identify on the Autism Spectrum or have conditions like Post-Traumatic Stress Disorder, which can normalize their symptoms.

I am not saying we should throw out the DSM altogether. However, I am saying we need to question its efficacy…or rather, if it is actually helpful to use right now.

As a Counselor Educator, I have to be perfectly honest, I am very concerned about the current state of the world and our counselors-in-training’s ability to handle it.

I do not think our programs have done a good job preparing students to be therapists, in part because they have taken the humanity out of being a therapist.

Counselors-in-training today learn how to diagnose, label symptoms, and then subsequently develop treatment plans to “fix” those symptoms. But what I am continuously seeing more and more of is that our future counselors do not know how to “sit” with clients, let alone themselves.

As I said in my last post, anyone can read the DSM or the Diagnostic and Statistical Manual and diagnose themselves. But that doesn’t inherently make it helpful.

Moreover, because the DSM is written in a way that is open to interpretation on behalf of the clinician, it means that it is easy for an individual to meet criteria for many different diagnoses.

When clients came into my office, I was usually not their first therapist. Most of my clients came in with five different diagnoses from five different counselors. They had been through therapy before, done CBT, EMDR, Brainspotting – you name it, they tried it.

My clients would convince me they had ADHD and all sorts of diagnoses, and then two weeks later, they would watch a TikTok video and tell me that they had a different condition.

And here lies the problem.

Clients and therapists alike have become so obsessed with finding the “right” diagnosis that they focus on the symptoms as opposed to the person.

And it is built around the belief that the “right” diagnosis will help the counselor or therapist treat the client more effectively.

But if the diagnosis is always changing, then what good is it?

It makes it confusing for both the client and the counselor, and it takes away from what actually works in therapy.

The sitting, the being, the holding space.

Moreover, it is important to note that the counseling and subsequent mental health professions didn’t always use to be like this.

I was part of the first generation of counselors trained under the new CACREP standards, or the Council for Accreditation of Counseling and Related Educational Programs. This organization sets the standards for what counselor-in-training nationwide are expected to learn.

Prior to the implementation of this program, counseling programs were based on a more humanistic model. One that emphasized being present in session and holding space for clients, which was developed based on the work of Carl Rogers and other Humanistic therapists’ research and approaches to treatment.

Initially, this standardization was meant to be beneficial, and it has good intentions. It was meant to streamline programs to ensure that counselors across the nation would all learn the same things. It was also thought that if all counseling education programs adopted CACREP, it would make licensure portability easier for counselors.

The idea was simple: train everyone on the same model and create better therapists.

Yet that didn’t happen…

Licensure portability still doesn’t exist for counselors across state lines, despite the attempts the Counselor Compact has made to bring this goal to fruition.

Moreover, I can’t say if the standardization of counseling programs has made better counselors…I can say it has greatly contributed to counselor burnout.

Counselor Burnout

A 2021 study by Cook and her colleagues found that novice counselors reported high rates of burnout at alarming rates. The authors of the study defined “novice counselors” as counselors working towards licensure, i.e., they were under supervision and just barely graduated from their master’s or doctoral counseling programs.

The symptoms of burnout, which were self-reported among the new counseling professionals, were alarming to say the least. Among the sample of 246 novice counselors, whose average age was 36.9 years old, the authors found 12 categories of self-reported burnout symptoms.

While I won’t cover all of the symptoms here. I want to highlight a few of them.

First and foremost, the novice professionals reported that they felt increased stress, irritability, anxiety, and depression because of their work. Along with negative emotional experiences, the novice counselors also reported symptoms of cognitive impairment, such as trouble focusing, memory issues, or feeling distracted in session. They also reported unhealthy work environments, including long hours and high-acuity caseloads, as well as unsupportive supervisors. The counselors reported feeling unable to complete their documentation and paperwork. Moreover, many counselors reported that their careers had a negative impact on their personal relationships and caused them to engage in negative coping patterns such as overeating, engaging in substance use, and other potentially risky behaviors. It was even reported that among some individuals, a subcategory was found for those struggling with suicidal ideation as a response to questioning their career choice.

As a Counselor Educator, this concerns me for many reasons. I have often questioned whether we are harming our counselors-in-training with our overemphasis on standardization and the rigorous training requirements we put them through, which can increase students’ feelings of stress. Moreover, I remember my own experience in an internship and how my fear of not being able to get the required number of direct hours to graduate caused me to cancel plans with my family members or avoid visiting my friends. I remember how early in my career I was working in negative environments where I was expected to work for little pay, and for long hours with no oversight or supervision. It was during those experiences that I was encouraged to diagnose the clients the most for insurance purposes so that the clinic could continue to make money. And I remember questioning if this was really all “worth it?”

Which leads me to my final point. Among all the personal consequences of burnout among novice counselors, there were also two categories that I think Counselor Educators should be very concerned about. Those being: a) feeling unfulfilled in counseling work and b) self-perceived ineffectiveness as a counselor.

In other words, we are not preparing our students to be good therapists.

There, I said it.

We are preparing them to be burnout machines who work for little to no pay and are expected to diagnose and “fix” clients by throwing a bunch of evidence-based techniques at them.

Yet, it is clear that this method of treatment does not appear to be therapeutic for the client or the counselor.

Effectively, counseling, and therefore therapy, has become untherapeutic, and it is negatively impacting both therapists and clients.

Counselors don’t feel prepared to handle clients in part because the overemphasis on diagnosis has prevented them from being able to see their clients as human. I hear it all the time, so many of my students and supervisees worry about saying the “wrong thing” in session or making a wrong diagnosis, that they are unable to be actually present with their clients.

What this leads to is pathologizing clients and overdiagnosing them. It leads to a kitchen-sink approach to therapy, where counselors throw all the techniques, advice, and tools at their clients, yet nothing sticks because they haven’t gotten to know their clients beyond the label they have been given for insurance purposes.

And because they’re overworked and feel the need to overdiagnose or intellectualize their clients’ symptoms, they don’t slow down and get to know their clients. Therefore, nothing works. Clients don’t get better because their treatment isn’t tailored to them, which in turn makes counselors feel ineffective.

That experience of feeling ineffective quickly leads to questioning one’s contribution to the field. Causing them to question if they are fulfilled.

I don’t think it’s at all random that a 2023 study by Motivo Health found that roughly 60% of novice counselors will never make it to licensure.

60%. To put that in perspective, if you are a graduating therapist in a class of 20 people. 10 or more of your cohort members, or you, will quit the profession before attaining licensure.

In other words, most individuals who go through counseling programs won’t even last 10 years in the field, since the licensure process is 2 years at minimum post-graduation. This is a poor return on investment, and it clearly shows that CACREP and the standardization of counseling programs, with their overemphasis on diagnosing and implementation of more direct clinical hours/standards, have not helped the field.

Moreover, new counselors often fail to consider the consequences of overdiagnosing clients. I know I did as a new therapist.

It wasn’t until I had been working for a few years that I discovered that a diagnosis, even one as common as Major Depressive Disorder, can lead to individuals having higher insurance rates or premiums they have to pay for.

Thus, when I compare it to my own experience of being misdiagnosed at 14, it makes me wonder if our obsession with the DSM and pathologizing clients is actually helping anything.

Let’s face it, right now the world is headed towards a very scary place. People are losing their jobs, people are being separated from their families, and ICE is threatening to increase surveillance of individuals who oppose Trump.

People are fucking terrified.

If you don’t meet the criteria for a disorder in the DSM right now, you clearly haven’t been awake to what is happening.

As of right now, I guarantee that all of us have at least one diagnosis we could meet criteria for.

Whether that is Generalized Anxiety, Major Depressive Disorder, or even PTSD.

Ask yourself, how well have you slept the last couple of weeks?

Are you more irritable than usual?

Do you feel paranoid or anxious?

Have you wanted to avoid engaging in activities you used to regularly partake in, like going to work, exercising, or spending time with friends?

Do you have a sense of impending doom?

…yeah, I’m sure, like me, you are experiencing all of these…which begs the question, if we are all experiencing it….why can’t we just focus on that?

Why even bother with a diagnosis, especially if it is only going to raise our individual insurance rates?

I think a more important question for me is, why do therapists continue to feel the need to diagnose clients when clearly no one is doing well right now?

As if that would actually help anything…

You know what would be more therapeutic during this time?

To sit, to validate, to listen.

To admit we don’t have the answers and we cannot “fix” things for our clients.

To admit that we are in the same boat as our clients, and being human, especially right now, is really fucking hard.

What good is a diagnosis if an entire nation is experiencing it? - At that point, it is just reflective of the larger collective human condition.

Reclaiming the Human in the Therapist

It is for these reasons that I believe CACREP has largely contributed to therapist burnout. When a program becomes accredited, they are forced to teach a standardized curriculum. What is the easiest method to teach? The one that is most reinforced by insurance companies, of course. Thus, contributing to the rise of diagnostic codes.

Moreover, this overemphasis on standardization causes counselors-in-training to become constantly anxious and terrified of messing up, which leads them to hide behind diagnosing their clients as opposed to actually being present with them in session.

Right now, I don’t think it’s helpful for counseling programs to teach students how to diagnose clients – you want to know why…because things are only going to get worse. More and more individuals in the country will experience trauma, anxiety, and depression at higher rates because it is a normal and valid response to an oppressive system and militarized government.

Yeah, none of us, counselors or clients, are walking away scot-free from this one, folks…

We are all going to have lasting impacts from this, which means if our entire nation is responding to trauma…how is a diagnosis going to help us?

If anything, it appears that a diagnosis now can lead individuals to have to pay for higher rates of insurance when SNAP benefits are being cut and families can’t afford to feed their children.

What people need right now is not their therapist or some TikTok mental health “expert” telling them that they have 20 different diagnoses. They need someone to normalize being human with them.

Which is exactly what I needed at 14, and to be frank…what most clients need as well.

Clients do not need to be pathologized. Not when it is clear that what is happening is affecting all of us.

I think it is time that we, as a counseling profession, admit that real healing and therapy occur when someone feels seen as a whole person….and that can only happen if the therapist is able to show up and be a whole person themselves.

Not hiding behind a TikTok reel or a diagnosis, but admitting to their clients, that yeah…this human shit is hard and I don’t have all the answers.

It’s about time we brought back the soul into the psychotherapy…which, funnily enough, is what the word Psyche means.

We are missing that human connection when it comes to therapy, and it is that lack of human empathy that leads to our clients getting sicker and our therapists becoming burned out.

As I mentioned above, it didn’t used to be this way. When I talk with older therapists in the field, they express that they had more work-life balance prior to the days before the CACREP standards and the emphasis on diagnosing clients for insurance purposes came to be. They report that they felt fulfilled by their work with clients, that they experienced mutual benefit from their work with them, because they used a more relational approach.

That humanistic approach is what Carl Rogers and many of his colleagues emphasized…and in truth, that approach is much older than any of them.

That approach is reflective of the wisdom of female and folk healers who existed long before the profession of psychotherapy came to be. Long before counseling and our CACREP standards. It is deeply intuitive, relational, and yes, feminine wisdom.

It is the wisdom that has informed my yonic theory and my approach to working with clients and supervision.

At its core, feminine wisdom is ultimately about community. It’s about feeling connected and identifying in the shared experience of being human. It is that human approach which reminds us of our connection to the soul or Psyche, an inherently feminine principle I discuss in my theory, which you can read more about here or listen to on my podcast.

We’ve tried the standardized approach. The emphasis on diagnoses and evidence-based theories, but ask yourself. Has it worked?

Has it made you feel like you actually made a difference in your client’s life? Or was it the moment of human connection you had with them? Was it that moment you laughed with them? Held space, and they revealed their most vulnerable parts to you.

If you are a therapist, think about the times in session where you have felt most fulfilled…I can almost guarantee it wasn’t when you were explaining a diagnosis to your client. It was when you picked up on their energy in session, or you felt yourself sharing in a moment of connection with them.

It was when your soul and their soul connected.

Sitting and being with all that is wrapped up in this crazy, wonderful, terrifying experience of being human.

OX,

Your Dark Fairy Godmother

If you would like to learn more about my Yonic Theory, check out The Yonic Journal:

Resources:

Cook, R. M., Fye, H. J., Jones, J. L., & Baltrinic, E. R. (2021). Self-reported symptoms of burnout in novice professional counselors: A content analysis. The Professional Counselor, 11(1), 31–45. https://doi.org/10.15241/rmc.11.1.31

Motivo Health. (2023). The Mental Health Therapist Shortage Starts at Graduation: How to Help the 57% that Never Attain Licensure. Retrieved from https://4776111.fs1.hubspotusercontent-na1.net/hubfs/4776111/Motivo_Whitepaper.pdf