Q&A with Sue Levin

This blog post was initially published in Spanish in the Ecuadorian blog IRYSE.org. The name of the column series is Contributions and Significant Authors in Relational Constructionism-Social Constructionism. Sue Levin is Executive Director of HGI Counseling.

1. How does your philosophical position contribute, what is different in the therapy processes, in the face of the crisis that the pandemic has meant in relationships and societies?

 The first thing I should say is that due to my administrative position, as the executive director of HGI, I do not have many clients.  This has been true for the past 5 years or so.  At this time, I only have two active clients, so my current clinical experience is limited except for the many people that I supervise.  I have seven supervisees at this time. 

The pandemic has challenged many of the therapists I work with (as a supervisor and in workshops).  Initially, many therapists resisted working online via videotechnology, saying that they did not think it would be effective.  As flexibility, and “meeting the client where they are”, are important philosophical and theoretical positions of my work, I have always been willing to step out of my comfort zone and into whatever environment was best for the client.  This has included using a mobile unit (like a recreational vehicle) to have teams visit apartment complexes where people were re-homed after Hurricane Katrina displaced them to Houston, from New Orleans.  It also includes doing home-based therapy, working in partner agencies, schools, etc.  Working online is something HGI has been offering clients for many years, so for some of us, it was not an issue.

Clients, at least 90-95% of them, responded well to the shift to videotherapy.  Some, who did not have access to computers, used their phones to continue sessions.  Using the phone without a visual screen is not my preference, however, I find it is still effective and I have had very good therapeutic outcomes with clients on the phone.

Philosophically, being comfortable with uncertainty, being appreciative and resource-based, and having years of experience with being creative, reflective, and team-based gave me many ways to manage the challenges of the pandemic.  Challenges for us included: decisions about how and when to close and reopen offices (we are still navigating this!); hiring and starting new therapists and interns with video/remote orientation periods; revising training programs from in-person to online; and deciding to help host and administer the ICCP V congress. Much of this was new and unusual for us, however, I believe that the foundations of our philosophy and the collaborative and dialogical ways of being have allowed HGI to flourish and grow during this period.

2. What does it mean and what is the point of being a therapist for you today?

After more than 30 years as a therapist, I can share some reflections about being a therapist.  Today, there is an excitement and openness about therapy that I have not seen.  I believe this is a result of two major issues, the first, the efforts for many years to de-stigmatize mental health, and the second, the impact of the pandemic.  I believe these two things have come together to create a major shift in the way therapy and mental health are viewed in society.  This may be more in the United States, where I am situated and therefore, more familiar.  What I see, however, in the pharmaceutical advertisements on TV, among other places, is that they are no longer using the term “mental illness”.  This has been replaced with other terms such as “mental health challenges” and many are talking about emotional wellness, self-care, etc. 

The pandemic has normalized experiences of anxiety, loneliness, fear and stress among others.  Businesses and companies have recognized the impact on their workers and provided more support, flex and free time, and access to therapy.  There has been an enormous amount of attention on ways of coping with these issues. It has been easy to find free webinars and podcasts that promote self-care and mental health.  Therapy has become a needed and accepted part of making it through the pandemic.

As a therapist, I have seen the need for therapy increase with my [limited] clients who have presented with more acute and increased anxiety.  One of my young clients was dealing with manageable social anxiety (I am using these terms for ease of description, and because they fit with this client’s experience) but during the pandemic when his school shutdown he became preoccupied with cleanliness and developed many rituals around hand- and body-washing.  With the easing of the pandemic and his re-involvement in summer jobs, his focus on these rituals has begun to subside.

I currently believe that therapists are (and will be) in critical need for a long time to come, though I also think that there will be more and more expanding types of help for people struggling with mental health issues.  Here I am thinking of a “walking” therapist, I know, who goes on walks with her clients.  I am also thinking of our colleague, Dr. Susan Swim, who sees clients at her ranch and uses horses as co-therapists.  Being playful and using improv, like our colleague, Dr. Saliha Bava writes about, adds creativity and fun to therapeutic practice.  Mind-body practices, such as meditation, yoga, guided imagery, etc., are all helpful, depending on the client, their particular interests, challenges and goals.  These options and opportunities excite me and keep me interested and passionate about being a therapist.

3. What does it mean to you to be creative in a therapeutic relationship?

I believe I mentioned some of the ways creativity are part of therapy in the last response.  However, I think that our way of working, Collaborative Dialogical Therapy, is creative in its very essence.  This is because it is not a formula, not manualized, and not replicated from one client to another.  Each session, each conversation, each course of therapy, is unique and created anew.  So, though there are some guiding principles, such as “not knowing”, being curious, respect, multiple stories, etc., the way that these show up in the therapy room is not predictable, and therefore it is always a creative act. 

4. How does -be- contribute to having this ethical stance in a social-relational transformation?

The philosophy of social construction and the idea of multiplicity leads me to be aware that my ways of thinking about things, my values and guiding principles, are up for examination and reflection. I know I must pay attention to how I privilege my ideas, as I believe that I am not “right” or have “better” ideas than anyone else.  This is the foundational belief system that creates an ethics of practice for me.

In taking a Collaborative-Dialogical stance, I believe that I am fundamentally choosing conversational paths that are ethical.  When respect for the client, respect for their situation, respect for their wishes, and respect for the therapeutic relationship, lead my work, it is difficult not to be on a good, ethical path.  And, I believe that doing work that is open to others, in a public way, makes me part of a community that shares and contributes to my ethical position.  Thank you for inviting me to write about this, as one way to be part of this process.

5. The wealth of training-supervision-covision consists of…. The richness of dialogues and conversations with those who are new learners is full of potential.  If one is open to always learning, then being a supervisor/trainer/co-learner is a growth process for all involved.  The process provides opportunities to share and explore ideas while being challenged and questioned about assumptions that the more “experienced supervisor” may have begun to take for granted.  All involved are able to grow and explore new ways of working and being with clients and with others.  Harry Goolishian used to say that we need to change our ideas at least 10% a year.  Working with new learners allows for us to be exposed to those who are fresh in the field.  They often bring current thinking from their universities, from other work-settings, and have other experiences for us to consider

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