Nicole Arzt, licensed marriage and family therapist (LMFT), writes this book structured for the soon-to-be-in-the-field/recently-in-the-field therapist. With chapters titled "(Almost) Everything I Believed About Therapists Was Wrong", "How to Be a Better Therapist When You Still Feel Clueless", and "How to Be a Therapist in the Modern World" amongst others, it's pretty evident that this book would be a helpful read for the person considering being a therapist, the one about to start graduate school, and definitely that student anxiously expecting to vomit outside of their practicum and/or internship room before they see their first client (hello Me from Several Years Ago).
Honestly, it's also probably a great refresher for those-in-depth-in-the-field, but I can't speak for that population. Sure, some of this is geared more toward beginning baby clinicians, but I also think it does a good job of normalizing what so many clinicians run into: imposter syndrome, countertransference, struggling with boundaries, time management. I'm all for reminders as we move through life because sometimes we forget the important bits - we're human, that's normal.
The tasty tidbits!
I gave it: 3.5/5 stars
The book club gave it: 7.33/10
Meant for: Clinicians / Clients
Sorry therapy-goers, this book isn't really for you. There's two little parts that are relevant for you, and you can find them by clicking here (or just scrolling below).
Read on for a fuller review.
My Review: An Easy Read
When I tell you I breezed through this book, I mean it. Nicole Arzt writes like I imagine she speaks - straightforward, knowledgable, and kind. She's got a decent amount of experience in the therapy realm, as she writes that she has worked in multiple settings including schools, hospitals, nonprofits, residential, and private practice.
I liked her vulnerability in admitting she would've wished for a book like this when she was just starting out. I also liked the times she admitted her flaws - like resenting the 'I'm always perfect' peer or pitying her peer suffering from burnout and feeling holier-than-thou. I loved when she wrote about her inability to set boundaries and the harm that it ultimately caused.
However, I occasionally felt like this book was missing some depth or some substance. I was hoping for some more in-depth vignettes, although I recognize this might've not been possible or feasible. This book was missing citations and that's kind of a big no-no.
The Best Burnout/Self-Care Chapter I've Ever Read
Let me preface this with the fact that I have a list of 40+ psychotherapy books gathering digital dust on my Notes app and there likely are some damn great books out there that address burnout well, or even better. We've acknowledged I have very little psychotherapy book reading under my belt, cool. I really have no excuse for this other than young adult fiction is absolutely my bread-and-butter and sometimes psychoeducation just... isn't.
That being said: this book is the first time I have ever seen anything specify between internal burnout versus external burnout. Past supervisors? Just labeled it burnout and helped me identify a self-care list. Grad school? Burnout, and massive emphasis on shoving self-care down your throat while telling you that you're expected to take care of yourself (and your partner, household, family, friends, pets) while finding balance doing a 32 hour unpaid internship while working 20+ hours at minimum wage to pay rent and taking classes for your degree.
Reading this chapter made me go: "Oh. Oooooh. OH!" As I realized that when I was feeling recently burnt out at my agency job, the daily baths, baking, time with my dog and all the force-fed self-care in the world wasn't revitalizing me because I was not suffering from internal burnout. I was suffering from external burnout. Shit, I wish grad school had taught me that there was a difference. I wasted a lot of water and time in the tub feeling exhausted and wondering why the hell I wasn't feeling any better despite chowing down on the self-care regime so carefully prescribed by my graduate school professors several years prior.
This chapter alone made the purchase worth it to me. I really enjoyed this framing. When there is this implicit emphasis on burnout as a general concept, there's often a lot of blame associated. Counselors need to do more self care. If you're feeling burnt out, seek supervision or go to therapy. Maybe there's something in your personal life affecting your ability to be present in your professional life. I felt guilt and was second-guessing a lot of myself, even after leaving my clinic job, because I wondered why I wasn't able to keep the burnout at bay. I wondered why my self-care wasn't revitalizing me. I look back now and realize my self-care was preventing my burnout from being a cliff-dive off the edge and instead was turning it into a gentle slope downhill. Yet the guilt lingered. This chapter was the first time it started to alleviate.
P.S. I want to be a bit more specific regarding my external burnout. This was related to policies and procedures at my workplace and had nothing to do with my clients.
The Book Club Review: It's Alright
We mostly criticized the book the majority of our meeting. We actually had to pause, acknowledge what we were doing, and make an effort to share the things we liked.
This might be easiest if I share it in list value.
Disliked:
That many items were lacking context, especially in the chapter on boundaries. "It depends" would be a great way of identifying some items as definitely not okay and others as definitely acceptable.
That one chapter was dedicated to being the best employee at an agency... and another chapter that acknowledged the toxic work environment that is often pervasive in community mental health agencies.
Some chapters were more on-surface-level and definitely lacked depth.
Liked:
The ARC statements for setting boundaries. Loved these in contrast to the typical "I statements" often used.
The amount of normalizing the book does do
The part that focused on countertransference and how it might show up for a clinician
Additionally, the part that focused on transference and what that might look like
Overall, a decent read. We wished it had more to it. We were happy with what we did get from it and we did get a decent amount.
For Clients
Like I mentioned above, dear therapy-goers, this book isn't geared toward you. It's written for your therapist, your counselor, your clinician. We aren't perfect humans and sometimes we struggle with the same thing you do like insecurity, fears of making mistakes, and setting boundaries. Here's a not-so-secret secret: Just like you like being validated, reassured, and reminded that what you're experiencing is normal within the grand human spectrum... so does your therapist. And this book does that for us.
Here's the first part of this book that I think would be beneficial for a therapy-goer to know about therapists and therapy.
"Myth: Therapists Give Advice
Advice isn't in limited supply. [People] have endless self-help books, blog posts, and inspirational quotes offering advice. Some of it is thought-provoking; most of it is one-dimensional and useless. Many times, [people] know what to do in a given situation. Therapists help explore the barriers that lie between knowing and doing.
Sometimes, [therapists] think we know what is best for our clients. Sometimes, we think the right answer is painfully obvious. [...]
But if the problems were this simplistic, if life existed on an obvious black-and-white plane, why have any need for therapy at all? Wouldn't a single session fix the client['s issue]? Wouldn't a few cliched lines of advice cure the issue?
It isn't [a therapist's] job to tell [the] clients what to do or how to do it. For one, that method assumes that we have all the right answers (and we don't). [...]
[A therapist's] job is to provide support and compassion. We support people in finding their conclusions about how they want to live their lives. We don't force them onto our preferred paths [for them]." (p. 17).
In sum: Your therapist is there to support you making the choices you make and to help you explore why those are your choices. It's not a therapists job to tell you what to do, or to decide your "ultimate path" and prod you down it. Therapists aren't carriage-drivers and clients aren't horses. I picture therapists more like the stereotypical Old Wise Man archetype.
Sitting with you in the darkest of times, walking beside you on your journey, being supportive and not telling you what to do but helping you learn. This is your world, and we're just in it with you.
And the second part.
"Eliminate the Notion of Symptom-Free
Before my first-ever therapy session as a client, I held a lovely fantasy about therapy being this mystical, elusive experience. I imagined myself in the charming and dimly lit space, and I pictured myself revealing all the fragments of my self to an all-knowing mind reader. I'd feel safe from the first moment. I'd cry, and it would feel cathartic. She would listen compassionately before offering me the magical answer that would solve my distress.
Here's what really happened: During the intake session, when she asked what brought me to therapy, I rambled about a recent argument with one of my friends. I spent the next fifty minutes avoiding and downplaying anything resembling a genuine struggle. Although I hoped for some brilliant insight, she only prodded me with questions that made me feel even more insecure and uncertain. She was a skilled therapist, but I left the session convinced that therapy was a sham. I didn't feel fixed. What kind of shoddy business was this?
[...]
[Therapists] work with the conditions, not against them. We also advocate for acceptance. Acceptance isn't a free pass for ongoing distress or self-destruction. Acceptance means embracing mental illness for what it is-messy, imperfect, but not impossible to treat. [Therapists] help [their] clients release unrealistic expectations of themselves.
[...]
That said, perfection doesn't exist, and symptom-free is a form of perfection." (pgs. 83-85).
To summarize: she expected her therapist to read her mind, herself to have a full emotional exorcism, and receive the perfect answer that would fix everything. If this is your expectation for therapy and your therapist - readjust. This will not happen. Therapists are good at body language, but we don't know what you won't tell us. The emotional vomiting might happen and it likely isn't going to make you feel peachy-keen after. And it isn't reasonable to expect a therapist to give you the magical mystical answer that fixes you. You aren't broken, there isn't a magical mystical answer, and as mentioned above - it's not the therapist's job to tell you what to do. We're here to support you make the adjustments you need and also accept that sometimes it's about minimizing and mitigating, not erasing.
Final Pieces
It's a fairly decent read. It's probably a read best served for those who are contemplating becoming a therapist, are in graduate school, or have just left school. Other populations of therapy-givers can also find this book helpful, but there may be less nuggets of wisdom than they'd expect.
We were curious of what a sister-book written for clients would look like. We were hoping this book might be more geared toward clients based on the title alone - I might've not noticed the entire title was Sometimes Therapy is Awkward: A Collection of Life-Changing Insights for the Modern Clinician. Oops.
If you've got the funds or the library access to this book, it might be worth picking up. Especially if you struggle with feeling incompetent or with imposter's syndrome. AND if you're feeling like you're the expect badass clinician who can do no wrong... please read this book and remind yourself to be humble and seek to take one piece of new information from this. We aren't infallible and it's good to remind ourselves of that.