Episode 8: Self-Reflection Skills That Make Therapy Safer with author, Beth Canalichio LCSW

Sabrina talk candidly with LCSW and author Beth Canalichio about why therapists need consistent self-reflection and why getting our own therapy can make us more effective and less reactive with clients. We unpack blind spots, burnout, and the ethics of staying client-centered when our feelings, beliefs, or the broader culture get loud.
• the case for therapists doing their own therapy
• noticing reactions as signals to slow down
• blind spots, biases, and cultural assumptions
• countertransference, discomfort, and when to seek supervision
• ethical duty to refer out when needed
• burnout risks, boundaries, time off, and caseload limits
• practical tools like journaling, mindfulness, and peer consult
• using reflection to strengthen rapport and the therapeutic alliance
• staying as neutral as possible amid politics, faith differences, and social media pressure

Transcript

Welcome And Topic Setup

SPEAKER_02 2:08

Welcome to the Therapist Lounge. I'm Sabrina Duang, your host and licensed clinical social worker here with Beth Calicio, who's also a licensed clinical social worker. Thanks so much, Beth, for joining me today. Thank you for having me. So just um wanting to talk today about the practice of self-reflection and therapy and as therapists. I think both of us combined have about 50 years of therapy and just the importance of why we need to do that self-reflection piece, giving us time after sessions, even. I know sometimes we're about offering our services and time to clients, but what that opportunity can bring us and the benefits for clients. Just maybe you want to start around your own self-reflection practice and what that was like for you.

SPEAKER_00 3:04

Well, I think I think one of the most important pieces to that is getting your own therapy. And that taught me a lot about being aware of when I'm having a reaction to something, that's when I need to pay attention. And I I don't know, my personal master's program did not require therapy, but I wished all the programs did, or at least encouraged it or spoke about it.

SPEAKER_02 3:41

Right. I I heard of colleagues attending a master's program where it was a requirement that they went through their own therapy during um their their program and how enriching that experience would be to be able to work through perhaps your own emotional reactions to things and your own assumptions and biases. I think that's different than writing an assignment, for example, on it. I'd done in my programming.

SPEAKER_00 4:09

Your program required it.

SPEAKER_02 4:11

Mm-hmm. Yeah, just to talk about the biases, right? Writing it down as a reflection practice, um, cultural assumptions assumptions, any sort of blind spots that we had, and to talk about it. But I think there's something about experiencing your own counseling sessions too as you go along the program.

SPEAKER_00 4:30

And and I I mean, I have to say that it's still quite amazing how we have so many blind spots. I I found that a lot when I was treating people that there were just so many issues within themselves that they could not see without my assistance or the assistance of a professional. And the same thing happens to therapists. Sometimes we just can't see what's there.

SPEAKER_02 4:58

I think it's great to understand your own, you know, personal triggers and what triggers you in working maybe with different populations or clients and why and and developing coping tools. And you know, I think it's important to talk about it versus see it as something wrong.

SPEAKER_00 5:16

Absolutely. There's it's so empowering when we can do a deep dive into our personal issues or things that are troublesome for us. It's um nothing to be ashamed of. It's it's a strength.

SPEAKER_02 5:30

Definitely. And I think it's it's helpful when we're supporting someone in enhancing their own self-awareness that we help to understand our own self-awareness and where it's at. And I remember attending a workshop where they said, especially as clinicians, you think you're the most self-aware, but I think there's only like a really small percentage they shared. And I just thought to myself, no, but I'm self-aware.

SPEAKER_00 6:03

It's like how dare they. Exactly. Exactly. And that's when our our ego, our our ego um gets in the way.

SPEAKER_02 6:17

Definitely. We want to think that we're very open, non-biased as as social workers, as clinicians being in this field, the helping professions.

SPEAKER_00 6:28

Well, and I want to add, I mean, this may be obvious, but it's not only an issue for not recognizing biases, um, but also if we can't see in ourselves our opportunities to work on something or the wound that we carry, how are we going to see it in the client and most effectively help them or not? Um so I think that's a really important piece of this.

Blind Spots Biases And Countertransference

SPEAKER_02 6:57

Right. I just attending training about survivors around narcissists and talk about there might be some counter-transference or or biases or come up with different personalities or different experiences in session. That is great that it was talked about and how to process it in in working with different people, right? And I think it's okay if there is a level of discomfort to seek supervision, process it, and refer to maybe someone who may not have those perhaps internal experiences in helping the client too.

SPEAKER_00 7:40

Agreed. And that that is a very healthy part of the process is to recognize when it's not healthy for you to continue treating this patient, or you don't have the skills, or as you said, you have the biases, or that you're really struggling with the counter transference issues that uh a therapist has an obligation to refer if if they're not able to resolve it with supervision.

SPEAKER_01 8:06

Uh-huh.

unknown 8:08

Right.

Burnout Boundaries And Time Off

SPEAKER_02 8:08

And there's certain populations that we might be very empathetic towards, like kids and feeling like we have to do something or worrying about things a bit more. Um, and then processing there what's happening for us as well, and making sure it's within our our role and our scope. I think it's just being aware of those emotional responses that we have towards clients, seeing if you're working with your then your level of competence, if you're experiencing burnout even that can be hard. Um I think then the expectation is to carry certain caseload or to meet a certain direct number of hours of places, right? You might feel like asking for support might be frowned upon. A burnout is a real thing. It is.

SPEAKER_00 8:57

And I I felt like uh as a therapist, I learned early on, thankfully, that I needed routine time off. And first I thought, well, gosh, there are plenty of professions that don't have to take this much time off. But um if you're if you're experiencing burnout, then you're not able to not only take care of yourself, but properly take care of the client either.

SPEAKER_02 9:24

Right. It might be frowned upon to take time off or have a mental health day or see lesser number of clients. But depending on, you know, if you're seeing a lot of clients have experienced trauma, burnout might be more significant if you're seeing a bigger caseload. So you need to see less people and it's maintaining those boundaries. I think sometimes social workers are the worst at worst having those boundaries.

SPEAKER_00 9:53

I really tried as I got um more into being in private practice to figure out what the number of clients was that I felt the most healthy and the most grounded and balanced. And also, you know, sometimes we have to be aware of, as you mentioned, like if you're working with a lot of trauma, how many of those cases do we have? And maybe sometimes we might have to limit um certain numbers of different types of cases.

SPEAKER_02 10:28

But self-awareness involves ongoing examination of emotional reactions, reflection on clinical work, right? Why why you choose specific interventions, being able to reflect on what worked, what didn't. And if you don't have time in between sessions, it's a bit hard to to reflect on that.

SPEAKER_01 10:48

It is.

SPEAKER_00 10:57

And that does, you know, require trying to keep trying to keep on time, which can be challenging. So that you have a few minutes in between or that you're not seeing back to back for eight hours just to take a breather and take a step back.

SPEAKER_02 11:19

And and being able to do that, there's different tools that can help during those times of taking a step back, right? Whether personal therapy, reflective journaling, mindful practices, professional education.

SPEAKER_00 11:34

And leaning on leaning on your colleagues. I I think private practice in particular can be very isolating. So to seek out supports and make connections with other therapists in your community. So you have someone you can reach out to. I know I I had some colleagues that I really leaned on at times. And when they text me or called me that they needed some support, I've really tried to make it a priority to get back to them quickly because I know how that how that feels. So working on developing a network is important.

SPEAKER_02 12:11

Being able to consult, peer consult around themes or cases where there might be challenges with movement or progress within the session or consulting around therapeutic alliance.

SPEAKER_00 12:24

Definitely it's helpful. And and with people who will, you know, if you're asking for their honest feedback, that you want to have those people in your circle who are going to give you that honest feedback.

SPEAKER_02 12:35

When we look at what matters, self-reflective practice, it's about enhancing that therapeutic effectiveness and reducing harm. So when you're consulting with others, it helps to ensure that um that you're doing what any other clinician would do in the profession and strengthens that ethical decision making. That's right. And preventing that burnout. There's sometimes those ethical dilemmas that do come up or rupture and rapport. And it's helpful to get ideas and and how to repair that or what to do in those cases. Otherwise, I think we kind of practice on autopilot or reinforce power imbalances.

SPEAKER_00 13:19

Yes. I, you know, no matter how seasoned you are as a therapist, there's always room to grow and there are always blind spots.

SPEAKER_02 13:28

There's ways and and stages, there's different ways to reflect. There's gives a reflective cycle, looking at what happened in the session, your feelings, what was good or bad about the experience, sort of evaluating it, why did it happen, what theories or concepts help explain, right? Conclusion and action plan. So just helping to sort of debrieze. You're not left stuck with different feelings or emotions about things that happened and and having a process helps.

SPEAKER_00 14:00

Yeah, so it's much better to clean clean those things up. And part of self-reflection is being aware enough when you have to do that.

SPEAKER_01 14:13

When it's necessary.

Reflection In Session And Building Rapport

SPEAKER_02 14:20

Was there times that you felt the self-self-reflective practice was really you know helpful or terms of your own evaluation or working through something? I think for me it helps even in session as well, too, right? If I'm noticing, okay, I might need to have to use a different model here or suggest a different coping tool.

SPEAKER_00 14:42

I think for me, there were some difficult cases that I've had that uh maybe have required a report for a client who um may have been angry that taking it out on me, projecting it onto me. Those were cases that I I had two people in particular that I would lean on. So self-reflection with them was always so beneficial. I really feel like their presence was key for me in many of those cases.

SPEAKER_02 15:16

So understand things from a different perspective, different angle, to be able to share what your experience was, work through your own personal goals, prevent that burnout. So also doing that piece with the client, too, right? Checking in where things are at for them, summarizing session, how that felt for them, or what did they think about the recommendations, make sure they're engaged in the process. And I think self-reflection sure helps us to go deep, but it might even help us with how do we even build rapport or start off our sessions, right? To so just diving right in. How can we just create that rapport and have a general dialogue to help build on that relationship?

SPEAKER_00 15:57

I agree. I think that's a big deal. I think it's a really big deal when you sit down with someone for the first time who's coming to you with deeply personal issues. You may be someone in their life that they're telling things to you for the first time that they've never told anyone else. That it's it's crucial how we develop the rapport. And again, as we get more seasoned and or burnout occurs, we can sort of miss the importance of that.

SPEAKER_02 16:33

I was wondering for you, Beth, like did you were there times that you scheduled in reflective practice or supervision, or what did that look like for you?

SPEAKER_00 16:44

Definitely early on, uh, was scheduled early on in my career. I feel like again, I could have had blind spots that I'm not seeing, but I felt like I was very aware of when I was having a reaction or needed to pay attention, and that's when I would seek out support or just take some time when I had a quiet moment to to think about what was coming up in me or what I needed to address with the client. So I didn't as I got more seasoned, I didn't have any specific supervision time scheduled. I did work to I I had no problem asking for help on on issues, and I'm I'm really happy about that piece. And so it was pretty much when I felt like I needed it.

SPEAKER_02 17:46

Right. Yeah, for myself, I would do both as well. I would make sure it's it's scheduled to to reflect on cases on the week, on any feelings that that came up for myself. And then also as things came up, just you know, reached out to consult as well. I think that's key as well, too, right? Is the professional development, education, researching. So not only that reflective observation about thinking what's happening in that experience, but you're thinking of linking it to theories, models, new understanding, applying new insights and into practice later.

SPEAKER_00 18:26

Yes. Uh and to include, you know, the newest research.

SPEAKER_02 18:31

Yes, because that can certainly change. And I'm always thinking of do no harm, right? And wanting to make sure that a client feels supported. Harm is is paramount to what we do.

unknown 18:43

Yeah.

SPEAKER_02 18:45

So I think various ways to reflect, have it be part of a process day to day, whether it's journal writing, practicing mindfulness, consulting, and having it very, you know, practical. And also, too, it's it's helpful to explore around cultural and social positioning, how you feel as a clinician with things, privilege and power, and working through having those conversations and in session.

SPEAKER_00 19:14

And and I do I, you know, this this is concerning too with the political climate. I'm not sure what your experience has been, but I still believe, uh, based on my training and my experience, that it's important that we do our best to remain neutral, and that's part of self-reflection. I I've had some really um sad and uncomfortable experiences on social media, which I'm not on very much, but where other therapists are attacking other therapists for their personal views. And that's brought up a concern to me that how are those therapists behaving in the treatment room with clients if they're attacking other therapists for their beliefs. So I think it's important to be mindful of being as neutral as possible.

SPEAKER_02 20:10

As a clinician, there's about advocacy and support, but it also needs to be where the client is at. That's right. Um and for me being an immigrant and a clinician and seeing about you must out there, do it this or else you look like this, that was very conflicting for me. And I can appreciate how it might feel for for clients as well, too. So it's it's about, like you said, remaining neutral and um supporting the client to work through what's what's helpful for them. But yes, I definitely think that social media sometimes can um have a different perspective on things that aren't always ethical.

SPEAKER_00 20:55

Yes. And if this whole idea of self-reflection, if you're unable to have civil dialogue with another therapist, um I it may be it may be important to do some self-reflection on what that's about for you.

SPEAKER_02 21:10

Um it's looking at what feelings that you have as a clinician and and making sure not to influence. And I've, you know, even talked about therapists who might help people of different faiths, how to not put your take or spin our own faith and whatnot in in the session as well, too. Right. So um I think that's where reflection and supervision is important to make sure you're remaining neutral. Because I think right now social media makes it look like you shouldn't be neutral on things. That's a great example that you offered about faith. Well, I think that's where reflecting helps to check in and notice okay, what am I feeling in my own body right now? How is the client feeling in the session? having a conversation around around things and what's ours to own or not.

SPEAKER_00 22:05

Yes. That's a um that's a very helpful question to ask. Mm-hmm.

SPEAKER_02 22:16

Yeah, and I think in in recent training and assessments, it's helpful to ask some of the questions ahead of time around what's important for you culturally to have in these sessions or that you'd like to practice. Because we might have some assumptions and they might not be accurate. I remember early on my career working with different groups and populations and um you know sometimes there's biased assumptions of people being certain culture like how they're wanting to celebrate you know with certain foods or whatever ending a program and I think the easiest thing to do is just ask and be curious.

SPEAKER_00 22:53

Yeah stop yeah saying something like tell me about that or educate me or help me understand or I'm not familiar with this.

Emotional Fitness Humility And Closing

SPEAKER_02 23:01

Um right or what languaging to use reflecting is really helpful um these times and to make sure that we still have boundaries was there anything else you wanted to add about self-awareness ethical self-monitoring use of circus supervision the only thing is to say I think it's crucial for therapists to to work regularly on being emotionally fit.

SPEAKER_00 23:34

We're all going to have our struggles and our difficulties um but if it's in our mind's eye on a regular basis to pay attention and to grow and to be humble and put our ego aside and embrace what our blind spots are and what our difficulties are we're going to be better therapists and serve the client much better and in a much healthier way.

SPEAKER_02 24:05

And it's not just taking courses or training but how to you know be open to different ideas in peer consultation or um hearing about maybe those blind spots it might be hard to to hear in in supervision.

SPEAKER_01 24:24

It can be not be bad.

SPEAKER_00 24:28

Well I do know that I because my program didn't mandate therapy I didn't get therapy till a few years into being a therapist and I can tell you I was a far better therapist after therapy than I was beforehand.

SPEAKER_02 24:43

Yes I mean having our own therapy should definitely be be part of it more deeper personally than perhaps supervision can offer. And it's certainly benefit. And I think if we're you know encouraging clients to do that it's also doing it as well too for ourselves. Well thank you so much for sharing your knowledge with me today Beth and your experiences as a clinician and sharing both the importance that self-reflection and supervision and therapy have done for you.

SPEAKER_00 25:14

Thank you this is a great topic for other therapists to think about and talk about and listen to so thank you for putting it out there