Rookie Therapists, Rookie Family Support

“Thank you for the opportunity to work with your son,” the therapist said at our last appointment. “I’ve learned so much.” He had been a good therapist but a very inexperienced one. The old therapist had moved out of state and my son needed an appointment with no lag time, so we traded off waiting for someone experienced with having someone quickly. I knew from the beginning that he was a rookie, but the advantages outweighed that, or so I thought. He had grown in his understanding of us and the next person would reap that benefit. Just not us.

My complicated son was a challenge to even the most experienced therapists. His laundry list of diagnoses and symptoms didn’t fit neatly into any slot. But inexperienced therapists mistook his anxiety for ADHD and his meltdowns for conduct he could be enticed to control with star charts. Both were untrue. We had to wade through these tentative, by-the-book steps each time we had someone who was a rookie.

Complicated kids with significant mental health problems get matched to newbie therapists every day. Veteran parents talk online or in support groups about ways to speed up their learning curve. We share our hard won knowledge with them and try to temper their faith in the system with our practicality. Sometimes it works.

The very best match is for a complicated child to see an experienced therapist. That therapist draws on their book learning, just like rookies do, and knows when to throw some of it out the door. They pull strongly on their own hard won knowledge and have a really good idea of when to stay the course or try something new. They often see parents as allies, bolstering our belief in ourselves. They get it.

Many years ago, I heard Robert Brooks, a child psychologist, speak about children and building resilience. Although I was fascinated by the topic, what I still remember was that he said he should probably go back and apologize to the patients he treated early on in his career, which was an unexpected thing for a psychologist to say. There was so much he didn’t know, he had realized. He gave his then-best in those early days, but lacked the wisdom, experience and empathy he gained over time. Those are precious components in the work of therapy, ingredients that are built steadily and slowly, which make an enormous difference.

Recently, I had a chance to co-author a chapter on family advocacy in a handbook for the American Psychological Association with Kathleen Ferreira. We wrote about the work of family partners and family support specialists and how their impact is unparalleled. We were enthusiastic about promoting the importance of family advocacy in a volume that will probably be used to educate new psychologists. We paused midway through and talked about the mismatch we both see between complicated kids and inexperienced therapists. “It happens with family advocates, too,” I said and we immediately saw the parallels and went on to toss that idea about several times.

Most professions recognize that the beginner, the one who has the initial required qualifications, still has a long way to go. In sports and law enforcement, the newbies are called rookies. Other professions, like social work, have different levels of licensure, which indicates both experience and education. In other occupations, such as being an electrician or plumber, there are well-defined levels of expertise. This is also true in professions as diverse as musicians and carpenters. A light bulb went off for both of us and we decided to apply this to family advocates.

At the novice level, we wrote, there is a great deal of enthusiasm, but also “well meaning mistakes.” Next, at the apprentice level, the family support person has greater skills and is beginning to understand how tough the system can be to navigate. At this stage, people often realize that while they did everything right, they didn’t get the results they intended. Third, at the journeyman level, the family advocate has more good days, better results, has seen more and is becoming adept. Finally, at the master level, we wrote, the family support person or family advocate “does not guess, but rather knows what to do. The advocate has skills that often make the work look effortless to others, and that is reflected in the results.” This is the ladder to mastery – from novice to expert.

Family advocacy or family support work is still pretty new and we are all still trying to find ways to talk about it. When my son was young and we were trying to educate a rookie therapist, I noticed that my fellow family support specialists were all over the map in terms of expertise. Some had it all together with mountains of knowledge and skills. They were comfortable helping families whose children had significant mental health needs navigate through special education, call their insurer or make their case to state agencies. Others knew some of that, but not all. Still others were rookies, enthusiastic, knowing their own experiences could help the families going down the same road. But they had a lot to learn like any newbie does. When this work was new, we were quiet about our learning curve. We were working toward acceptance, endorsement and validation of our work. It was the right thing to focus on then.

That was then. I’ve been the novice, apprentice, journeyman and master. I’ve faked it, hoping no one saw my skill gaps and I’ve said, “Let’s figure it out together.” Like that rookie therapist my son had, I’ve learned from every parent who was gracious enough to teach me what they knew. In the end though, complicated kids and families do better when there is expertise. Rookies, please learn quickly.

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About the Author

Lisa Lambert

Lisa Lambert is the executive director of Parent/Professional Advocacy League (PPAL), a statewide, family-run, grassroots nonprofit organization based in Boston. Lisa serves on the Advisory Council for the Children’s Mental Health Network. Lisa’s areas of expertise include mental health policy, systems advocacy and family-driven research. Realizing that individual parent and youth stories need to be supported by data, Lisa authored several family-driven studies which highlighted the challenges families encountered when accessing services, their perspectives on psychotropic medications and the training needs of family partners. Lisa has been instrumental in working with local and national media to highlight the concerns of families and youth.  She is dedicated to ensuring that family voice is included in every state and national conversation about the policies, practices or services that impact them.

Read more of Lisa Lambert’s blog posts on the PPAL website.

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