This book is dedicated to Jon Carlson
My coauthor, colleague, friend, and brother

1945—2017

Every profession has certain secrets of the guild. Passed on from one generation to the next throughout the ages, these are the lessons taught from wide experience. They are sometimes shortcuts that save time, or else ways to operate more efficiently and effectively while minimizing resources and reducing effort. Sometimes they include ways that maximize profits or even shortchange clients or customers through deceptive practices. Sales staff in car dealerships, for instance, are known to rely on particular methods to manipulate customers into purchasing options they don't really need, telling men that automatic door locks are for convenience while telling women that they are for safety. Waitresses in certain restaurants are required to dress seductively in tight-fitting, low-cut dresses. They are taught to lean forward when taking an order from a man to maximize the display, whereas they are inclined to kneel by the table to deemphasize this feature with other women. Mountain climbers have their little tricks as well, passed along from guides, to make their lives in treacherous environments a little more comfortable, such as using duct tape to prevent blisters or hanging their wet socks with dental floss. Magicians have their secret methods of redirection, sleight of hand, and illusions, all intended to capitalize on disguised or hidden actions beyond public view.

We counselors have our professional secrets as well to improve our functioning, most of which I hope are designed to better serve our clients. But some exceptions also rely on duplicity in order to increase our power and influence. We pretend to know more than we do, stall for time when we are stumped, and occasionally enhance our standing by appearing like magicians. However, we are also highly skilled in communication and relational engagement and thus able to read audiences accurately to know when things are working and when they are not.

One counselor I know was quite proud of the ways he had discovered to appear far more masterful than he actually felt most of the time. He loved to operate from a position of unquestioned authority and dominance, much like the Wizard of Oz. His clients were quite impressed, even astounded at times, by his seemingly mystical powers to read minds, predict the future, and even mysteriously always know exactly when the session was over even though he never wore a watch and had no direct access to a clock. In fact, the only timepiece in the room was a single small device that was actually situated next to him out of his direct view. It was a frequent topic of conversation that his clients brought up: How did he always know when time was up? He would just shrug.

This counselor, for reasons that went beyond client welfare, enjoyed using certain secrets and tricks to fool his clients into believing that he had powers that went way beyond those of mortal beings. It turns out that he had meticulously arranged his office in such a way that he could appear to be looking directly at his client while seeing the image of the clock next to him reflected in the glass of a picture hanging on the wall. He was so devious in this regard that it wasn't even a direct reflection, which might be too easy for the client to figure out; instead, the reflection of the clock bounced off the glass of one framed picture to actually become visible in another one on a side wall. So he could appear to be thoughtfully considering some idea while staring at a side wall and then suddenly announce that time was up. The client would then look around the room and wonder how the heck this counselor always knew the exact time, as if he had a clock inside his head. Of course nowadays smartwatches can aid counselors with hidden signals to accomplish the same goal of enhancing illusions of power.

I mention this example as the sort of secret within our profession that I do not wish to investigate—one that involves deception or manipulation, even if supposedly designed to improve effectiveness. Instead, I am interested in those ideas, behaviors, strategies, methods, interventions, and even little tricks learned over time that exceptional counselors have invented, inherited, developed, borrowed, stolen, or discovered that increase both professional effectiveness and personal satisfaction. I have attempted to collect and catalogue the greatest wisdom of some of the best clinicians, especially those among us who have worked long and hard to find ways to increase their effectiveness and efficiency through innovation, creativity, and dogged determination to better serve their clients.

I have been especially curious about some of the things that experienced counselors have learned, or devised for themselves and their work, that have previously gone unmentioned—or at least rarely acknowledged in a meaningful way. There has been some limited research in this area by investigators such as Barry Duncan and Scott Miller describing the way that exemplary clinicians or “supershrinks” have developed certain signature habits, such as continually asking their clients how they're doing and making adjustments accordingly, as well as simply devoting themselves wholeheartedly to achieving excellence in their work.

Throughout the past few decades I have been privileged, along with my partner Jon Carlson, to interview some of the most prominent and influential theoreticians and practitioners in our field. We were able to talk to them about some of their most unusual cases, creative breakthroughs, spiritual transcendence, greatest successes, advocacy efforts, disappointing failures, and disturbing deceptions; the clients who changed them the most; as well as their own developmental adjustments over time. During these conversations, these seminal thinkers, researchers, and clinicians revealed some of their secrets that had rarely been mentioned previously. Many disclosed, for example, that they no longer practiced the models associated with their names, having moved beyond single-theory allegiance to a far more pragmatic, integrative, flexible approach. Others mentioned the personal journeys that had led them to settle on a particular brand of helping that reflected their unique personalities, values, and preferences. There were even a few who shared their own doubts and uncertainties about the extent to which their contributions really mattered.

Although my previous focus was to target specific kinds of lessons that had been learned by eminent counselors and therapists—for instance, how they recovered from disappointments or which clients were most memorable or challenging—I am now interested in expanding this lens to encompass a far broader view of knowledge and wisdom that may have been long buried or ignored. For beginners and veterans alike, I am pleased to reveal some of the secrets and tricks of the trade that ordinarily receive little attention.

As we are all quite aware, there are so many different theories and hypotheses regarding what makes a truly excellent therapist. There are trait theories that look at personality features. There are particular training models that are purported to deliver optimal results. Advanced degrees, postgraduate workshops, supervision—are all alleged to play a role. But ultimately, beyond a requisite level of intelligence and emotional functioning, the best among us are quite simply those who have worked hardest to develop themselves. They are intensely motivated and committed to becoming the best practitioners of their craft—and they are willing to make all kinds of personal sacrifices and devote time and energy in order to make that a reality.

It's not just the so-called 10,000-hour rule, popularized by Malcolm Gladwell, that implies consistent, dedicated, reflective practice over time; it is also a matter of caring deeply about being the absolute best at what they do. Exceptional counselors have a secret that really isn't much of a secret at all: They just flat out work harder than the rest of us. I mean this not so much in terms of the number of hours they devote to their craft, how long they've been in practice, or what kind of degrees and credentials they've accumulated but rather in terms of their sheer grit and determination. They rarely feel discouraged and tend to dig in harder when they face challenges or disappointments.

I am talking about passion and excitement for the work, for the people they are helping, the kind that doesn't diminish over time. It has sometimes been noted that longtime veterans in our field can become complacent over time, slip into familiar routines, treat the calling as just a job. They think they've seen it all before. They start just going through the motions, following a long-established pattern that gets the job done, all without much drama or even concerted effort.

What about those among us who are truly exceptional? Such professionals adopt an unwavering attitude of passion for what they do. They are constantly reinventing themselves. They test their limits. They push themselves to discover new ways of operating, perhaps rendering what they'd already been doing obsolete. Rather than resenting or resisting such continuous upgrades and growth, they welcome such opportunities as the primary means by which to remain fresh and completely engaged.

My lifelong friend, colleague, coauthor, and brother, Jon Carlson was my partner in the original conception of this book. We had a number of conversations about the nature of this project, and he was instrumental in identifying many of the professionals whose voices you will hear throughout these pages. Unfortunately, he never lived long enough to actually begin writing. As I write these words, I am still mourning the loss of one of my oldest friends. Jon and I had completed a dozen books together, and this one was to be our seminal work, collecting the most cherished secrets of friends and colleagues as well as sharing some of our own best practices that we have held close to our vests throughout our 45-year careers. Jon isn't around to see how this book eventually came together, but even during his last weeks, sitting by the window in his Wisconsin home in the woods, watching the birds, we shared back and forth what we hoped this book could become. Jon died just a few weeks later.

I am grateful to the following counselors and therapists who shared their secrets: Lori Ash, Leah Brew, Jose Cervantes, Thelma Duffey, Barry Duncan, Liz Eddy, Miguel Gallardo, Carrie Grubisic, Michael Hoyt, Amanda Johnson, Philip Kirk, Stephen Lankton, Mayra Martinez, John Murphy, Ryan Neace, Sarah Pemberton, Kimberlin Phillips, Daya Singh Sandhu, Jackie Scherer, Mary Schor, Chris Williams, and Michael Yapko.

I'm also grateful to Carolyn Baker, Nancy Driver, and the staff at the American Counseling Association for their support and assistance in the development of this project.

Jeffrey A. Kottler, PhD, is one of the most prominent authors in the fields of counseling, psychotherapy, health, and education, having written more than 90 books on a wide range of subjects. Some of his most highly regarded works include On Being a Therapist; Introduction to Counseling: Voices From the Field; Learning Group Leadership; Creative Breakthroughs in Therapy; Bad Therapy; The Client Who Changed Me; Stories We've Heard, Stories We've Told: Life-Changing Narratives in Therapy and Everyday Life; The Therapist in the Real World; On Being a Master Therapist; Relationships in Counseling and the Counselor's Life; and Therapy Over 50.

Jeffrey has been a counselor, supervisor, and educator for 45 years, working in preschool, middle school, mental health center, crisis center, hospital, nongovernmental organization, university, community college, private practice, and disaster relief settings. He served as a Fulbright scholar and senior lecturer in Peru and Iceland as well as worked as a visiting professor in New Zealand, Australia, Hong Kong, Singapore, and Nepal. Jeffrey is professor emeritus of counseling at California State University, Fullerton. He currently lives in Houston, where he works on projects related to refugee trauma and is clinical professor of psychiatry at Baylor College of Medicine.

I was waiting anxiously in my office, listening for the sound of the door opening in the waiting room to signal the arrival of my new client. I had just launched my private practice a few months earlier, and I was struggling to meet even basic expenses. It was a misguided and naïve belief that I could just hang out my shingle, so to speak, and expect that people would come flocking to my door or that referral sources would deliver as promised. In fact, I had a grand total of four clients in my caseload. Oh yeah, plus this new referral, which would boost my practice by 20%!

I briefly mentioned this story in a previous book with Rick Balkin about the importance of relationships in counseling, but it bears describing in further depth to emphasize one of the secrets of exceptional counselors: their ability to connect immediately with a new client during an initial consultation. After all, the overriding goal of any initial interview is not just to collect information, as well as to form a diagnosis and treatment plan, but rather to get the client to return for a second appointment! If we can't secure that commitment, nothing else really matters, no matter how comprehensive the data we collected.

I had scheduled my precious few clients throughout the week, which means that I would go into the office to fool around, make calls, try to pretend like I had a full-time job, and then wait for my single appointment. This was a Friday, the one day of the week that I had promised never to book, but it was the only time my new client said was convenient. I was so desperate for business that I decided not to negotiate.

I arrived at my office a few hours earlier than the single scheduled appointment, supposedly to do paperwork but really just to create the illusion I had something to do. I would stare out the window across the street at a retail strip of establishments selling obscure products. One in particular that caught my eye was a place called Flute World. I wondered how one could possibly earn a living selling a single kind of musical instrument, especially one that wasn't exactly very popular. With time to spare, I actually decided to walk across the street and check the place out, then impulsively bought a flute to play with as a means of occupying myself during frequent idle times waiting for the world to discover me.

Once I assembled the instrument, with no real clue how to produce actual music, I realized that it might be a good idea to schedule some lessons, perhaps even begin after my new client left this afternoon. After all, I had little else to do. I actually started calculating in my head how much flute instruction I might be able to afford after I collected my fee.

“Self-discipline and prudence!” I reminded myself. After all, I had expenses to cover and a family to support.

I reviewed my notes regarding the person who would soon be arriving. She had been referred by her physician, whose office was in the building. I could feel my excitement building: If things worked out well and I did a good job, maybe the good doctor would send a stream of future patients and I'd be well on my way. But for now, all I knew was that she was presenting symptoms of extreme anxiety and there didn't appear to be any organic cause. “Let me know what you think,” the internist instructed me. “I'm just at a loss other than to up her prescription of Xanax.”

Already I had reviewed my books and resources about all the nuances, symptoms, causes, and precipitating factors associated with anxiety. Next I had consulted the Physicians' Desk Reference to study the dosages, side effects, and contraindications related to her medication. In other words, I had invested a tremendous amount of time and energy into preparing myself to function at my absolute best.

I put the flute away. Then I sat at my desk, drumming my fingers, willing time to speed up. If the clock sometimes seems to move glacially slow when you are sitting in a session that seems to be going nowhere, it is positively maddening when you are waiting for a new client. I always feel nervous in such circumstances, wondering whether I will know what to do or even whether I've lost my healing magic. During those first few minutes after meeting a new client I often feel a surge of panic once the person begins to speak. I usually feel lost and confused, stumbling around trying to get a handle on what might be going on and what I should do about it. I am often filled with doubts regarding whether I even have anything meaningful to offer. I start to question the legitimacy of what I'm doing: Is it really enough just to talk about problems? Will these sessions actually put in a dent in the chronic suffering that has so far been impervious to any other action or intervention?

I studied for the sixth or seventh time the brief notes that I had scribbled down after my initial phone call with the expected client: Unmarried. Early 30s. Possible anxiety disorder. Doctor says she's skittish and uncommunicative. But troubled. Prescribed Xanax. Wants Friday appointment. UGH!

As often as I read those words, they didn't really tell me much. I was eager to collect a lot more information about the case, as much to address my own uncertainties as to get to know her. I had developed some intake forms (actually I borrowed and adapted them from an agency where I had been working previously) that followed standard protocol, asking questions about presenting symptoms, prior family and medical history, lifestyle activities, current functioning, as well as provided informed consent documents. This is standard operating procedure and the way I had been trained and supervised in order to assist in differential diagnosis and treatment planning. After all, every doctor's office and mental health facility asks patients to fill out forms once they check in for an initial appointment.

I was quite curious how my new client would fill in the blanks, so I carefully attached the forms to a clipboard, stuck a pen underneath the metal clip, and began to rock back and forth in my chair, continuing to stare at the clock. Precisely 6 minutes before the appointed time I heard the door to the waiting room open and close. Actually I felt the door slam shut with a finality that seemed to shake the walls, which reminded me to get the damn thing adjusted. There were just so many little details to take care of in starting a practice from scratch that I'd never considered before. As a salaried employee of public institutions thus far in my life, I'd never needed to actually depend on outside income in order to earn a living. I was clearly way over my head.

I wondered whether I should wait until the exact time of our scheduled session or whether it would seem like I was too anxious if I greeted her earlier. Should I give her the forms now, a few minutes ahead of time, so we could start the session on time? Or maybe the time she spent filling out the forms counted on the clock? I found this all so confusing.

I decided it was better to greet her right away even if it seemed like I was overanxious. After all, she was anxious too, wasn't she? That's what her doctor had told me and why she was actually consulting me in the first place. And it felt like there was so much at stake for me. I was desperate to increase my caseload. I was beginning to wonder whether this was ever going to pan out.

I opened the door to the waiting room to find a woman who looked older than her chronological age, to use the parlance of the intake and mental status review that I was soon to begin. She looked up at me for a moment but then quickly looked away. Skittish indeed, I thought.

“Hi. I'm Dr. Kottler,” I said in my most soothing, reassuring voice. “I'll be with you in a few minutes, but before then could you please fill out these forms?” I hesitated for a moment because she still wasn't making much eye contact. “It will only take a few minutes and then we'll get started.” Another reassuring smile.

I retreated back to my office to pretend that I had something else to do besides wait for her to complete the questionnaires. I wished I could play with the new flute to occupy myself but figured that the whispery, discordant sounds I could produce thus far might sound pretty strange coming through the door. During my compulsive preparations, I'd practiced filling out the forms myself just to estimate how long it would take to complete them. Under 10 minutes was my best guess. So I waited. And waited. Then I felt a slight shudder in the walls, as if a door had been carefully opened and closed. Or maybe it was just a premonition.

But I had this terrifying thought: What if she just left? What if she walked out once I left her alone?

I tiptoed up to the door to the waiting room, slowly and carefully prying it open for a peek outside, and found to my horror that my new client—my brand new referral—had fled! The clipboard and forms were sitting on her vacant chair. For some reason, all I could think of was that the pen was missing: She took my pen! But then I noticed that it had simply fallen underneath her chair. I felt this hysterical giggle building up in my throat as I thought to myself, Well, thank goodness I still have my pen!

I lifted up the clipboard and saw scrolled in big, heavy, bold letters across the first page of the intake forms a handwritten note: “SORRY, BUT I CAN't GO THROUGH WITH THIS.”

I could feel my chest constrict. For a moment, I wondered whether I was going to be the one with a panic attack. I wanted to just sit down on the floor and cry. I had been counting so much on this client being the turning point, the one that signaled that things were finally looking up. Instead, I just lost one fifth of my caseload. I felt so discouraged that I wanted to give up. How would I pay my bills? How would I support my family? How would I ever get this practice on a solid footing?

I decided, in that moment, leaning against one of those flimsy walls for support, that I would never, ever lose a client again by failing to first engage that person in a relationship before collecting the information that I thought was usually collected. I decided that I didn't really need—or even want—to know anything about the case or the client's background until I first got to spend time with that person and form my own impressions. I didn't want to read background information, or even know what others thought, until such time that we had established some kind of alliance, some basis for trust. In retrospect, it seems ridiculous to me that we would ask clients to supply all of this incredibly personal information about themselves before they really knew who we were and that we were actually worthy of these very private data. As I reviewed my forms I realized that I was asking perfect strangers to confess their medical history, family history, medications and illicit drugs they were consuming, sleep and eating habits, sexual preferences, legal problems, previous suicidal ideation or suicide attempts, and on and on—just the kinds of things that almost anyone would be reluctant to disclose to a stranger, even a health professional. I know this flies in the face of standard practice in any medical or mental health facility, in which patients are routinely required to supply all kinds of personal details before they are allowed to meet with a health care professional. But just because this was the most convenient and efficient system didn't mean that it was really in the client's best interests or even advantageous for a future helping relationship.