HCDM 41 | Private Practice Psychologist

 

“A psychologist is an agent of change.” This undeniable fact lies in the way many psychologists guide people out of each of their unique struggles and into their new lives. Joining Dr. Richard Marn in this episode is Dr. Margaret Rutherford, a Private Practice Psychologist, to talk about her career, the different techniques of therapy she uses, and the ways she is helping patients. Painting a realistic view of the profession, she then breaks down some of the misconceptions towards psychologists and shares what students need to know about it. Margaret also talks about how she is working with patients under the current COVID-19 pandemic and where she sees the future is heading for the practice.

Listen to the podcast here:

Agents Of Change: On Being A Private Practice Psychologist With Dr. Margaret Rutherford

Is a career in the mental health of interest to you? If so, this is a great episode where we get to talk to a psychologist and learn how she helps people with some of their psychosocial and mental challenges. Our guest is Dr. Margaret Rutherford. She’s a psychologist out of Arkansas in private practice. It’s a great episode where she talks about her career, but also a little bit about her different techniques of therapy and how she helps patients. There are a lot of wonderful golden nuggets in this episode. I’m lucky that she was able to join us on this show.

Dr. Rutherford is not only a talented therapist, but she is also a blogger. She has a blog post and a podcast. That’s where we also connected as well. She’s also an author. She wrote a book to help patients who are struggling with this particular type of depression. Please tune in. There’s a lot of wonderful things in this episode I think you’ll like. If this show is interesting to you, I would love to hear back from you. Check out my website, drop your email, send me an email, DM me on my social media, or rate, like, and comment on whenever show you read to that will help bring attention to others who are interested or potentially interested in such content. That’d be very helpful. Without further ado, let’s jump into this episode.

I have a wonderful guest, Dr. Margaret Rutherford. How are you, doctor?

Thank you.

Margaret, to get things going, do you mind to please provide a bio of your background?

I have a strange route to becoming a clinical psychologist. I was a French major in college, but I loved music and wanted to be a musician. It turns out that in Dallas, when I moved there, I became a jingle singer and that’s someone who sings radio and television commercials. I loved being a musician, but I learned that lifestyle itself and never quite knowing how much you were going to make, some months would be windfalls and other months would be pre-scarce, I didn’t like that. For other reasons, it’s a tough lifestyle.

I had started volunteering at a battered women shelter in Dallas and I loved it. I heard about this thing called music therapy. All the money I had in the world, I gave to Southern Methodist University that first year. It took me 2.5 years to get a degree in Music Therapy. My last internship for Music Therapy was in a psych hospital. I watched the psychologist there. I had been in therapy myself for many years at that point. I thought, “No. This is what I want to do.” I went back to school for a whole other year, I got the psychology hours that I needed to even be interviewed and lo and behold, several programs let me in. I think it was curiosity between that. It took me nine years from the time I said, “No. I don’t want to do music. I love music, but I got to leave it to see my first patient in private practice.” It took me several years. I didn’t get my PhD until I was 38 years old.

What exactly is your job title and what do you do?

I’m a clinical psychologist. In graduate school, we learned that a psychologist is an agent of change. Since I got PhD, I’ve done all my work in private practice while I say that I also worked at the community care clinic here. I worked in the school system for a while. I’ve worked running a group for a hospital. You do therapy, assessment and consultation. You can go into neuro-psychology. The field is vast.

I know you took a little circuitous route, but what are the usual steps to get to achieve a professional degree?

To be called a psychologist, you do have to have PhD or PsyD after your name. Several programs require a Master’s in Psychology. The one I did went to did not, interestingly enough, but those are few and far between. Most people would say, you need a Master’s in Psychology and then you go on for a PhD in Psychology or that could be clinical psychology, counseling psychology or school psychology. It could be a lot of different specialties.

In 1 sentence or 2, what’s the best part of your profession?

I love learning from the struggles of other people. I don’t love their struggles, but there is wisdom that I learned from people and I feel like I’m a conduit between the people that I saw, learn from and the people who are sitting in front of me that day. That process of guiding, learning, having empathy and providing a safe place for people to heal.

What misconceptions do people have about your profession?

One thing is we’re going to somehow take control over people’s lives, that we’re going to tell them what to do and we’re not. Every program I’ve ever been to in the last decade has talked about evidence-based techniques. A lot of things have great research that this particular technique works for this particular problem. This is what makes therapy a little strange for some people. There is an art because all the meta-analyses will also show that the relationship between the therapist and the client is one of the most important factors, if not, the most important factor of choosing a psychiatrist or a therapist that you want to have that relationship, that is there for you, nurturing, caring, sometimes confronting gently, but that is an important thing. It’s important to choose someone that you trust.

HCDM 41 | Private Practice Psychologist

Private Practice Psychologist: The relationship between the therapist and the client is one of the most important factors when choosing a psychiatrist or therapist.

 

You alluded to that there are other professions that you may work with. What are those?

I work with primary care physicians, OBGYNs, oncologists, infectious disease doctors and lawyers. My referral sources are large. I do not have a specific direction. I see adults and I see a lot of trauma victims, but I don’t see only anxiety or only trauma. A lot of times, it is the most honorable thing that can happen to me or honoring thing is when someone sends me a friend or loved one.

That’s a quick summary of what you’re doing, your occupation and your career. Thanks, Margaret, for jumping into there. If you don’t mind, I have a little bit more specific questions about your profession, your career as a psychologist. You mentioned you talked mostly with adult’s trauma victims. What niche do you usually work with? Is it mostly people who go through depression or anxiety? What is the type of patients that you’re usually dealing with as a psychologist?

You can choose. When I was in school, I did rotations with children and teenagers. I did geriatric rotations. When I first started, I did work with teens and whole families because I was trained in the Southwest Family Institute in Dallas. You can be known for working with people in their 20s or 40s. You can establish whatever niche you want given the fact that I live in Northwest Arkansas and not where I got trained in Dallas. I’ve had a more generalized practice because it’s just not large enough to maintain a practice where you only have one kind of patient. I did my dissertation for example, on conversion disorders or pseudoseizures specifically. If I had stayed in Dallas, I had been offered a job at Parkland Hospital on their epilepsy unit.

My whole career would have been different because I would have continued that research and that work with a lot of trauma. The thing that I have wanted to be known for is my trauma work, as well as relationship work because I was trained in the family model at Southwest Family Institute and I’m interested in systemic thinking. You can go out there and say, “I want to be an expert in X, Y, or Z.” All people have all kinds of assessment styles and things they choose if they want to do it. It just never appealed to me.

Your practice is a little more generalized and it’s partly because of the environment that you’re working and living with?

Also, your own skills. There are some people who would rather not work with trauma. When I did a child rotation, for example, I have a harder time handling my feelings about these children who were abused. I did not have children of my own at the time. I didn’t feel particularly comfortable with kids. I do now. If someone moved to a town of 50,000 people and only saw people with a certain kind of rare disorder, you became hungry. It’s mandated that.

When you’re dealing with patients, how are you helping them? Is it typically like we imagine, people have to come into your office, sit on a couch, you’re sitting in a chair, and you’re not making eye contact with them or you could? What is the process that you’re working with these patients so they get an idea, “This is what my career would be like?”

You’re describing more of what’s called a psychoanalytic method. I’m known for a directional approach. I had a young girl come to me one time and she’d been very successful to another therapist. She said the therapy had helped her and I said, “Out of curiosity, why didn’t you go back?” She said to me, “You know that unconditional positive regard thing that one of the therapists call? You always have this unconditional positive regard for your patients.” I said, “Yes.” She said, “I heard you don’t do that.”

The newer models of therapy. You never want to talk about yourself all the time. That’s not what a therapist does. “This is what I did with my life and this is what you should do with yourself.” You have learned how to listen for not only what people are saying, but what they are not saying. What emotions they are able to express and not able to express. What kind of thinking do they have? Is it rational or does it tend to be more irrational? What is the depth of their mental illness? Do they have mild depression, a severe depression? Do they have a cyclic disorder? You’re diagnosing all the same time but you’re trying to help someone figure out what exactly is wrong. Some people walk in and they say, “I’m depressed.”

Some people walk in and have done their homework, other people are clueless about what’s going on. They don’t even know they’re having a panic attack. Some of it is psychoeducational where you want to say, “Let’s look at this and this is what you have.” What I do in therapy is I say, “What goals do you have? How would you know you were better? How can I help you reach those goals?” I don’t write them down, but there are some therapists who do. You help the patient be able to visualize where they want to go. Maybe they want to stop having nightmares. Maybe they have PTSD. What technique would best be suited and this is when you have to know these evidence-based theories. Do you do that technique? If you don’t, refer them to somebody that does. They will do better with that person than they would you. If you have the skills to see them, then you say, “This is what is in my skillset to help you. Does that sound like a good fit?” All the time they are, and you are assessing, “Do you trust me?”

When you’re seeing patients, now we’re in this COVID pandemic, are you seeing most of them in a video screen, Zoom session, or are you seeing them in an office and you’re facing each other? What’s the environment in which you work now?

Pre-pandemic, I’m a solo practitioner, which is fairly unusual in these times. Most people have formed groups. You can do that still, but I’ve rented for years and then bought my own little house and people come in 1 or 2 or 3 at a time. I do it on the hour. It’s a busy day.

How many people are you seeing in a day?

I have seen 8 to 9. In my heyday, I try not to see that many because I’m older and I get more tired. Most people probably see 5 or 6 people a day. I work now four days a week and see about six people a day. Pre-pandemic, that was all face-to-face. I would still love that to be the case because sometimes people need a good hug. I’m not being funny when I say this, you get so much information from their non-verbal behavior that is much harder to pick up via teletherapy. I have been in teletherapy since March 2020. I have some patients who’ve told me they like it better. It is more convenient and that they feel less anxious. I find it to be much harder work for the therapist to make sure that I’m conveying to them that I’m noticing that I’m reaching out emotionally and it’s much harder over a screen. So far, I’ve only had one patient say, “I don’t think I can do this.” That fine. I tried to send her to somebody that I thought was doing live therapy.

A psychologist really is an agent of change. Click To Tweet

What is your typical daylight? When do you get started and when do you end?

I have a 26-year-old now, but I used to get up and fix him breakfast and get him off to school. The typical day is I get up and exercise, I get up and walk or I work out or I do Pilates or I do something to keep my body in shape. I’m on social media. When my son left for college, I started blogging and then I started a podcast in 2016 which is highly popular. That’s how we met. I love doing that. I produced them all myself. I do not edit them. I will also get up in the morning sometimes and write or produce podcasts. I do that on the weekend. It takes a lot of hours. I love seeing patients still and yet, I liked the variety of doing the social media things as well, hear from people from all over the world and from New York.

You said some misconceptions people have about your profession is that they think that you might be controlling them. Are there other misconceptions people have?

A lot of the reason why people say they would never knock on the door of a therapist is that you need to solve your problems by yourself as if getting another perspective wouldn’t be helpful. I have fixed a few plumbing problems in my lifetime, but when my plumbing goes out, I have to call a plumber. When I got divorced, I didn’t serve as my lawyer. I got a lawyer. To me, therapists are consultants and we have a lot of experience in certain realms. I’ve sat with people who’ve wanted to kill themselves, while they were dissociating, bickering and couldn’t find their way out of a fight and I managed to guide them in a different direction.

I’m consulting. The people have to solve the problem, not me. I can help define the problem. I can help identify what might be a way that you could better your life and feel healthier, but you have to do it. Not me. If you screw up your plumbing again, the same way you screwed it up before, you have to call the plumber back. It’s a different kind of relationship than you have with anyone because the energy goes one way and the energy goes toward the patient, help them realize some things that they may not know are going on to help them. It is about things that were not as aware of.

What is the most rewarding part of your job?

It is such an honor for someone to reveal some of their dark darkest experiences, whether it was something they did themselves and they made a mistake, or whether it’s something that was done to them, and they’ve carried shame about it for years. It is such an honor to be the person that is there, listening that they trust enough to let these emotions be released. I walk away from those kinds of sessions and they’re frequent. I’m blessed to have those people do that. It does not give me power over them. It gives them a place to safely express that. Some people even say to me, “Can I leave it with you?” Of course, leave it with me. Go back to your life and we’ll come back to it the next session. That’s what they do. They almost see me as space. That is the major benefit of it. It is a privilege.

What is the least favorite part of your job?

Progress notes, insurance and a lot of people who are drawn to my field aren’t good business people. They’ve got a lot of empathy and love to talk about relationships, but sometimes the business aspect of things. You have to be careful. If that’s not a quality in you, you do need an office manager or somebody to help you with that. Progress notes, there’s a form you have to do them and insurance is a pain in the neck. A lot of therapists don’t take insurance anymore, which is interesting. We fought hard to get it and now there are a lot of therapists that do not take it. That can drive up the cost.

Changing things a little bit. Talking about your profession and its future outlook. What do you think the outlook is like for your profession as a whole?

I think there’s so much going on about neurobiology, depression and neurophysiology. I did an interview with Terri Cheney who’s got bipolar disorder and she said, she thinks that depression should be called neuropsychoimmunology because they’re looking at gut issues, opioid receptors, neural pathway reformation, things like ketamine infusions, and transcranial magnetic stimulation. All of this is beginning to give us new techniques. These are in the field of mostly depression and bipolar disorder. I put on my podcast something that is a device with your Apple Watch. It’s an app that prevent you from having PTSD nightmares. It wakes you up. It learns your sleep cycle and it does something when it senses that you’re about to go into that sleep cycle again. First, it wakes you up, but then it doesn’t do that anymore because it’s learning your sleep cycle. There are things like neurofeedback and there’s so much going on that is exciting.

What type of students do you think best flourish in this career?

Curious people. I think you have to have a lot of interest and curiosity about what’s going on. You have to think systemically. I did not go to medical school. You have to be aware of some basic medical issues, endocrine disorders, for example, diabetes. These things have some psychological counterparts that are important for you to recognize. You have to be good with people and all kinds of people. Curiosity, systemic thinking, and openness to a lot of different kinds of problems. We’ve got to mention the ethnic and cultural aspects. I’m a 60 something-year-old, white woman from the South. When I have another ethnicity or race in front of me, we have to talk about that. I have to try to make sure whether it’s through training or whether it’s through learning from them to try to understand a whole other culture’s way of looking at things. That is as fascinating in and of itself. In some people, diversity and that kind of work are what they specialize in.

Early on in the interview here, we talked about how you got started. I want to revisit that a little bit. What were you like as a student in high school and college?

I was studious. My roommate said everybody called me, “You were that girl who studies all the time.”

HCDM 41 | Private Practice Psychologist

Private Practice Psychologist: The people have to solve the problem, not the therapist. Therapists can only help define the problem and identify what might be a way that could better a patient’s life and feel healthier.

 

Were you a bit nerdy?

I was a theater and music person, so I thought I was cool. I did a lot of theater, singing and so I was either practicing music or I was studying. I had a serious boyfriend back then too. I loved college. I was Phi Beta Kappa, which was great. The thing about it that you have to realize is that when I move someplace new, Phi Beta Kappa can find me automatically. This is way before cell phones and email. They knew I’d moved and were asking for them. I’ve never given them. I also love to travel and I went to Europe after I got my French degree and lived in Switzerland and in France for a while, and then came back still bound and determined to have a degree in music. I never got a degree in music. I got one in Music Therapy. I never thought about being a psychologist. My first therapy, my personal therapy was in my early twenties, and was very helpful to me that she had a near-death experience and she’d become a psychologist because of that. She was a fascinating therapist.

Reflecting back, what would you have done differently?

Since your show is geared towards students, I think you have to look at the array of degrees there are now. There are not easier paths to becoming a mental health professional, different paths. There’s LPC, Licensed Professional Counselor. You can become a marriage and family therapist. If families and couples are what you want to see the most, you can become a Licensed Clinical Social Worker. All those degrees can be in private practice and can receive insurance. There’s a PsyD, a doctor of psychology. A PhD is a doctor in philosophy and PsyD, you do a dissertation, but you don’t have to do original research.

There are a lot of ways of approaching this now because I’m perfectionistic myself, sometimes to a fault, I was bound and determined to get a PhD and that is a pathway that can lead in lots of directions. You can teach, do an assessment, do a lot of things with it, and yet there are other ways of getting there that will suit. If you’re thinking about getting into the mental health profession, I would look into all those licensures and see what best fits your life, your pocketbook or where could you get scholarships. There are a lot of pathways to go.

You wrote a book called Perfectly Hidden Depression and it came out in November of 2019. There are some great testimonials. One was, “This book can and will save lives. Sometimes asking for help, isn’t a sign of weakness, but a sign of strength.” Why did you write this book?

This book found me. I was writing my normal weekly blog posts. I was thinking about some of the people that I see have seen in the past that I would never have diagnosed with depression. When they walked in, they looked happy, engaged, successful, tired, overworked, usually some anxiety or worry and I would give them a diagnosis of anxiety or not giving them a diagnosis at all. What I learned through the years was that was wrong. That what I noticed was there were also people who could not express painful emotion. They would look at me with this smiley face and talk to me about awful things happening to them. They’d laugh and say, “My mom used to do that to me.” That’s the key. That’s when I knew that I needed to help them unwrap that and learn how to express those emotions.

I wrote a post called The Perfectly Hidden Depressed Person: Are You One? It went viral and I never had a post go viral before. I was writing for the Huffington Post at the time. I put it on there and I forgot that I left my email on the bottom. I got hundreds of emails. This was 2014. I started looking around and I found Brené Brown’s work. I can’t believe I didn’t know it before, but I didn’t. She talks about perfectionism, shame and vulnerability. Her research is on that. She’s prolific and helped millions of people. She said that perfectionism can be linked to depression, but she stopped and saying, “It can be something that hides it.” She doesn’t directly link perfectionism and depression that I could find, except by not as directly as I thought it belonged, because I think that destructive perfectionism is what is known in the biz.

Maladaptive perfectionism can hide or cloak when is depression underneath. It’s not going to fit the criteria for classic depression. Before the pandemic, and I tried to reach Dr. Jen Ashton who’s the ABC medical correspondent. She talked about her ex-husband having died by suicide, and on-air, she said, “He didn’t fit any of the criteria for depression.” Those are the people I’m talking about. The criteria for depression are depressed mood that is noticeable and it’s a change of behavior and/or anhedonia, the lack of pleasure in previously pleasurable activities.

If one of those is not present, you’re not diagnosable as being depressed. With these people, they wouldn’t look like that at all. They wouldn’t tell you, “I’ve got lots of blessings. I’m doing great. I have one little nagging something.” I started doing my research. I found academic research on this link between different types of perfectionism and the tendency towards suicidality. Our suicide rates are growing exponentially. I know perfectionism is causing some of those and so the researchers, I know that because it’s been found in the research. It’s not my idea. I decided to write a book and with New Harbinger Publications’ great help, I published a book five years later. I published Perfectly Hidden Depression.

Here you are. You’re a doctor, psychologist, therapist, blogger, podcaster and author. That’s awesome. I’m probably leaving a few things out too. I want to shift gears a little bit here. Some rapid-fire questions to get a little bit more depth about you, if you don’t mind. Favorite day of the week.

Thursday.

Favorite junk food?

Potato chips.

What cheers you up?

A lot of the reason why people don’t visit a therapist is that they think they just need to solve problems by themselves. Click To Tweet

Laughter.

Was there a chore you hated doing as a child?

I hated making my bed.

What kind of books do you like to read?

Ones with lots of twists and turns. I don’t like horror things, but I like an in-depth story.

What’s the most beautiful place you’ve ever been to?

Paris.

If you had to live in a different state, what would it be?

Washington.

What game are you good at?

I’m good at spelling games. There is some kind of spelling game that’s out there and I’m good at spelling.

Do you mean Scrabble?

Scrabble and there’s another one too.

Would you rather not brush your hair ever or your teeth?

Hair.

HCDM 41 | Private Practice Psychologist

Perfectly Hidden Depression: How to Break Free from the Perfectionism That Masks Your Depression

Finally, this is very appropriate for you. If you could sing one song on American Idol, what would it be?

I know exactly what it would be, “Isn’t it real? Are we a pair? Me here at last on the ground. You in mid-air. Send in the clowns.”

What’s the name of that song?

Send In The Clowns.

Thank you very much, Margaret. Where can readers go to reach you and learn more about you?

I’m all over the place? My website is DrMargaretRutherford.com and you can see almost everything I do there. My podcast is The SelfWork Podcast. I’m on iHeartRadio, Spotify, Apple Podcasts and PlayerFM. My book is called Perfectly Hidden Depression. It’s at Amazon and Barnes & Noble, but give your local bookstore a help out and we will not have it on their shelves, I’m sure. I also want to point out that the book has over 60 exercises in it. It is a guide book. It’s a workbook. They didn’t want to call it that for some reason. It’s meant for you to use as a guide for yourself. That’s what it’s for. I’m on Instagram and I would love to have your readers give me a shout out.

Are people able to reach out to you even if they are not an Arkansas?

I cannot see anybody in therapy that’s not residing in the state of Arkansas. The legislature in 2021 is looking at a thing called PSYPACT that perhaps they’ll be able to after that in certain states.

You have a lot of resources that you can provide people.

We have fourteen free podcasts.

Thank you, Margaret. I appreciate you coming on this episode. It’s been great to talk to you.

You too. Take care.

Everybody, that’s our show. Thanks for tuning in. To learn more about our guest or other past guests, check out my website, HealthCareersWithDrMarn.com or HCWithDrMarn.com. If you like what you read, then please go to my website, add your name and email to my email list. That way you can get the latest announcements and news as they arise. You can also find me on Instagram @DrRichardMarn. Thank you so much for reading and catch you on the next episode.

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