An Interview with Therapist Blake Thompson
Blake Thompson, LMHC, MA is a Psychotherapist and Executive Director of Seattle Anxiety Specialists. He is a clinical supervisor and also provides both individual and group psychotherapy.
Nicole Izquierdo: Hi, everyone. Thanks, Blake, for joining us today for this installment of the Seattle Psychiatrist Interview Series. This is a special one, it's called Meet the Team. I'm Nicole Izquierdo, I'm a research intern at Seattle Anxiety Specialists.
So Blake here, he is the practice's executive director. He serves as a clinical supervisor and he also provides individual and group psychotherapy. The first question for today is telling our listeners a little bit about yourself.
Blake Thompson: Hey, thanks, Nicole. Yeah, that was a good introduction. Oh man, what to say about me? Well, I am married and I have a one-year-old daughter that keeps me up at night, but whom I love very much. I love reading. I find people really complicated and fascinating. A big part of what draws me to therapy still and to the field is that the more I learn, I feel like the more questions I still have. I feel like I haven't gotten bored yet. I still feel confused, so staying curious.
Nicole Izquierdo: That's good. Let's start off with, what is it that got you interested in becoming a therapist?
Blake Thompson: That's a good question. Well, one of my big inspirations for becoming a therapist was a comedy movie. I don't know if you've seen “I Heart Huckabees”. No? Yeah, older Dustin Hoffman, Lily Tomlin, Jude Law film. Great movie, very funny, but yeah, I think that put the idea in my head. I had been to therapy when I was younger and I think that experience really shaped me. Being a client, I think, was really impactful. But yeah I'd been really interested in philosophy in school and I don't think I ever really considered, you know, psychology. I think I took one psychology class in all of college. I was really not interested in psychology. The idea that I would do something professionally that was related to a subject that I just wasn't really interested in wasn't super appealing to me at the time, but as I went to graduate school in philosophy, more and more of the stuff that I was interested in philosophy started to bleed over into psychology and I got more and more interested.
In philosophy, a lot of what we're doing is conceptual analysis. We're thinking about not minds and brains, but the stuff that are the constituents of thoughts. We're really focused on ideas like justice and the good life and truth and causation and all of these ideas that are really central to the thoughts that we think on a day-to-day basis. I just got more and more interested in the machinery that realizes that and more and more aware of thinking processes as processes, and not just as like, you know, and less and less focused on abstract.
By the end of grad school, I think I was starting to think about a jump into psychology, away from philosophy. I was talking with people about just what there was in that professional space, and the idea of becoming a therapist hadn't yet coalesced, but I think talking with folks about what therapy was like as a profession, what was interesting in it, how it was different than other forms of healthcare, yeah that was definitely, those conversations really helped shape that direction.
While I was in grad school, I really didn't like teaching very much. That was not something that I found super rewarding, but I loved tutoring, doing one-on-one work with students. I think really reflecting on that process and how much more I liked tutoring than I liked teaching helped also solidify for me that I would like doing therapy, because it looks a lot like tutoring in a lot of ways.
Nicole Izquierdo: With that extensive background in philosophy, how would you say it has impacted your therapy style and the way that you go about counseling?
Blake Thompson: Yeah, cool. That's a good question. I think so much of what we do as therapists is we reframe things for clients. Clients come in with, something's happened, there's an event, a situation, or even just themselves presenting in a certain way, the various processes that make up our lives, and they've got a particular perspective on it. That perspective is part of what explains the way they feel, the way they're acting. We help clients to see different ways of looking at their lives, of looking at the situations that they're navigating. That helps them develop the psychological flexibility, helps them develop this ability to look at things from different perspectives and to free up the way they feel and free up the way they act to become less rigid, less stuck.
A lot of what philosophy is, is conceptualizing and re-conceptualizing things. It isn’t so much, it's not an empirical discipline, it's a discipline where we're thinking about, okay, well, what's a different way of looking at this, what's the right way of looking at something? It might not be contesting facts, it might be, it's often a question of what's the right frame to put on something.
So yeah, in terms of what philosophy looks like, there are a lot of similarities. It's less often a matter of what are the right facts and more often a matter of what's the right way to conceptualize a particular thing. So too for therapy, it's often not a matter of what are the right facts, like this person is just dead wrong about something, it's more a matter of like are they applying the right conceptual scheme to it?
Nicole Izquierdo: Thank you. Are there any areas or disorders or age groups that you specialize in?
Blake Thompson: I pretty much only work with adults, rarely see adolescents and I don't work at all with children. I don't work with couples. Yeah, I pretty much just work with adults. I work with a pretty broad range of people, but I really enjoy working with folks who've got cluster C personality disorders, like avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder (OCPD).
I really enjoy working with folks who've got high functioning or low support needs, autism adults that are like, especially folks who struggle with deficit in theory of mind, which is really pretty common for folks who've got high functioning autism. They might not necessarily lack social skills, which I think is often how that gets conceptualized, oftentimes they lack awareness of how social interactions work and how other people think. One thing that I find really rewarding about working with those folks is that a big part of the work is explaining how other minds work to them and working with them to help them see that. That project is, for me, really rewarding. It becomes a really interesting, like theoretical discussion about how to make sense of other people and how to understand interactions with them and how to navigate those interactions. Yeah, it ends up looking a lot like philosophy tutoring.
Nicole Izquierdo: I know you've touched on this a little bit, but would you mind describing how your treatment approach is, to make it simplified for the viewers? Is it solution-focused, do you help them manage stress with CBT techniques, or do you have other ways to go about it?
Blake Thompson: Yeah. I'm somebody who thinks that the different approaches to therapy are all valuable, for the most part. Maybe not all of them are valuable, there's certain things, like primal scream therapy, that maybe deserve to end up in the dust bin. But among the well-regarded extent approaches to therapy, those pretty much all have a place in my mind. First, second, third wave CBT I think is great, and that stuff is especially great for what used to be called axis one conditions: major depressive disorder, generalized anxiety disorder, social phobia, OCD.
I use exposure therapy, I use ACT, rely on DBT principles. You know, sort of like broad, everything that fits within that broad CBT umbrella I think is super valuable, all of these insights from behavioral psychology and cognitive psychology. That stuff, in some ways it can be really solution-focused, it can be really focused on symptoms, but yeah, at the end of the day, it's evidence-based and often it doesn't take a million years to see some positive impact in someone's life.
There are other people who come into therapy who have more characterological, what used to be called axis two, issues, like maybe they're struggling with narcissism or entitlement, maybe it's like they find it impossible to stand up for themselves, they're constantly subjugating their needs, maybe they're perfectionists or workaholics struggling with unrelenting standards, chronic sense of defectiveness that they can't shake, behaving in ways that kind of perplex them, like they find certain behaviors necessary or are driven to do certain things that in retrospect they can't really make sense of but in the moment feel like they have to do them.
A lot of that stuff is the stuff that when it's more intense, we would call it a personality disorder, but most people struggle with some of this stuff to some extent. We used to frame this stuff as just neuroticism. Neuroticism has taken on a technical meaning in personality psychology, but it's the kind of stuff that would make you a really great sitcom character. Depression doesn't really make you an interesting sitcom character, but an inability to stand up for yourself makes you a great sitcom character. Narcissism, entitlement, particularness, perfectionism, workaholism, all of these things make someone an interesting character. Yeah, I find working with these folks really endearing.
I think psychodynamic therapy is a really, really helpful approach for this kind of stuff. I think even the CBT world has really acknowledged this, that the best way to help folks deal with this stuff really is a more autobiographical approach to therapy, it's an approach to therapy that is focused on looking back and reprocessing the unmet emotional needs that were the foundation for these behaviors, that were the foundation for these, what at the time were adaptations, but are no longer adaptive.
There are still other reasons that people come to therapy. Sometimes it's not that somebody has a mental health disorder, it might be that they just have a lot of environmental stressors. There isn't something wrong with them, there's something wrong with their environment. If you're the director of an environmental nonprofit and the head of the EPA is cutting all of the funding to protect the wetlands or something, you're scrambling to figure out what to do, you're sweating bullets, something that you really care about is under threat, you might lose your job, whatever, therapy could be helpful for you, but probably it might not look like CBT and it might not look like psychodynamic therapy.
It might look more like supportive counseling, it might look more like Rogerian supportive counseling, where maybe the thing you need is not to explore your relationship with your parents, maybe the thing you need is not to identify cognitive distortions. Maybe you don't have any cognitive distortions, maybe the reason that you're so stressed out is that you're seeing things accurately, but you need to process that stress. You need some place, someone to be a sounding board and to help you think through what you could do that would be an adaptive coping response. That, I think, is a big part of the work too.
A lot of people come to therapy not because they've got generalized anxiety disorder, but maybe because they just found out that their spouse is cheating on them or their kid just died or they lost their job or they just graduated from college and they don't know what they want to do with their life. There are these reasons that people come to therapy that don't have anything to do with having a disorder. All of that stuff might be causing stress, but it's not anxiety in a clinical sense. CBT and psychodynamic therapy might not really be well-suited to addressing those issues. I think that, what's often called the third wave in psychology, like Rogerian therapy, I think is really, really well suited to working with folks who are navigating normal life stressors and do want support with that stuff.
Yeah, and again, I think they're even more like what's the right theoretical orientation. It depends on the person, there's going to be for couples, Gottman approaches, EFT approaches. I think existential therapy is really helpful for folks who struggling with questions about meaning and purpose and identity. Those are things that CBT might not be able to tap into very well, psychodynamic therapy might not be able to tap into very well, Rogerian therapy might not be able to tap into very well, but having a working understanding of some sort might provide you with a leg up as a therapist to help you tackle these questions.
Nicole Izquierdo: Yeah, I like that. There's not a one-size-fits-all approach, every client is unique with unique needs and unique environments and pasts. I like that, thank you.
How would you describe therapy to someone who's not familiar with it at all, or who's hesitant to start treatment, especially with the stigma on mental health treatment? Like you just said, I feel like there's a big misconception that people go to therapy because they have a mental health diagnosis disorder, but some people just go, like you said, when there's overwhelming environmental stressors and they need help with coping mechanisms. How would you describe it or reframe it to encourage those people that are hesitant?
Blake Thompson: Yeah. I think people are hesitant for different reasons, and I think getting clear on our own hesitancy can be really helpful. We're often afraid of things that we don't know and afraid of things that have been stigmatized. A lot of men don't go to therapy because they find it hard to get help from other people. I mean, there's the cliché about men not asking for directions, not asking for help at the store. I think there's an extension of that for a lot of men around therapy, that they shouldn't open up, they shouldn't be vulnerable, they shouldn't share things. A lot of that is culturally normed. If that's what someone's struggling with, I think recognizing that is really the first step.
But there are other reasons why people don't come to therapy. In terms of OCD, for example, sometimes people have horrible intrusive thoughts, thoughts of like murdering people, for example, thoughts of deviant sexual acts. They might worry that if someone, if their therapist were to hear this from them, they might think that they intend to kill someone or kill themselves or what have you, and so they don't go. Suicidal people might not go to therapy because they're worried about getting committed to inpatient, or people struggling with substance abuse might not want to go because they're ambivalent and don't really want to stop drinking or using whatever product they're using.
Often when people are struggling with the question of whether or not to go to therapy, there's some ambivalence within them. There's some part of them that wants to go and some part of them that is repelled by the idea. I think that it might be the right decision. I mean, I'm really open to the idea that therapy is not for everyone. Therapy is not this perfect cure-all that is going to save us from ourselves. It is really helpful. I became a therapist and I'm still a therapist because I really do believe that it is really, really helpful, and for some people really profoundly helpful.
But I think really what we can do, what we ought to do, is identify that ambivalence, try to articulate it. What is that, what is this tension? What's this part of me that, A, wants to go, why is that, and what's the part of me that's telling me not to go? What is that? Where is that coming from? There's a little microphone in my brain and who's at the microphone? Who's like issuing the instructions? This fear, is that being put into me by my culture, is that put into me by like my parents, is that my bully from my youth speaking to me? Trying to get some clarity on where did I get this idea from that I need to be afraid of this thing, why am I hesitant about this, just spending some time investigating that for ourselves, sitting with that ambivalence, trying to unpack it. I think that's really productive.
Nicole Izquierdo: Thank you. You're also executive director at the practice. Can you tell me a little bit more about what this role entails?
Blake Thompson: Yeah. As a mental healthcare practice, we've got a number of administrative functions that are just important on a yearly basis. We have to renew our malpractice insurance every year, we've got to renew our lease with our landlord, we've got to make sure that we've got working internet, we've got to make sure we've got tea and coffee for our clients, we've got to make sure that staff are getting paid on time. Basically, it's all of this kind of behind-the-scenes stuff.
Our office manager, Jonathan, he focuses on really the day-to-day administrative functions of the practice. He's answering the phone, he's sending faxes, he's scheduling people, he's dealing with billing issues and all that kind of stuff. I deal with the longer-term administrative stuff, so I'm talking to our lawyers, I'm talking to our insurance companies, I'm talking to our landlord, I'm making sure all our contracts are in order, making sure paperwork for our clients gets updated as it needs to be. It's not like the most glamorous stuff, but it's important. It's all stuff that allows our therapists to just focus on being therapists and not have to worry about all of those questions and concerns that come up when you're in solo practice. Part of the benefit of being in a group practice is that, for most of the clinicians, not me, but most of them, they get to just focus on being a therapist, which is really nice for them.
Nicole Izquierdo: This question is steering into the more personal direction, but how has becoming a parent impacted the way you view the world or the way you interact with your clients? Because it's this whole new identity, parenthood, that you're grappling with. If you don't mind.
Blake Thompson: No, no, that's great. It's definitely opened my eyes to what parenthood is like. Obviously, not what parenthood is like for everyone, I have my own experience of parenthood. But I think being a parent is a lot more difficult and a lot more rewarding, both, than I sort of imagined it would be. I think it really does change the way that I look at, the way I think about my clients who are parents. It's helped me understand their perspective a lot better. It's also helped inform the way I interact with clients who are struggling with the question of whether to have kids. It's given me a lot of perspective there. I think in both of those areas, it's really had a positive impact on my work.
I think the area where it's had a negative impact is I get a lot less sleep sometimes now and that has unintended consequences. I think even during this interview, I'm probably rambling more than I would normally, but I'm running on like four hours of sleep. It is what it is.
Nicole Izquierdo: Thank you. Thank you for sharing that. Again, another personal one, but where do you see yourself in five years?
Blake Thompson: Oh, cool. Well, I'm really excited to continue to kind of grow SAS. I mean, I think that the one thing that we haven't done much of up to this point but that I'd like to see us do a lot more of is develop continuing education. I think that's an area that I'd like to have us devote more resources to, I think both in terms of providing good local, evidence-based therapy education, which is the thing that there's often not enough of, but also my particular background and my particular strengths as a therapist, I think having a background in philosophy, also having a background in psychology, I'm, I think, really well positioned to both provide existential therapy, but also to provide good instruction in it. I think over the next five years, I'm going to really work on developing curriculum so that I can provide really good continuing education in existential psychotherapy.
Nicole Izquierdo: That's great. Last one, if you have any last words of advice for our listeners or anything else you'd like to add.
Blake Thompson: Oh, well, if you watched, thanks for tuning in. The one thing that I'm really, I think, struck by, and that is, there are plenty of trainings in plenty of different kinds of psychotherapy, but one approach to therapy that I think doesn't get enough press time that I think is a really, really innovative and really, really helpful approach to therapy is ACT, A-C-T. I would encourage anyone who's a clinician or who's a client who's trying to figure out what else they can do to promote their own personal development, their own personal growth, either as a provider or as just a person in the world, I don't think ACT is everything, like I said before about approaches to psychotherapy, I don't think that any one approach can fully capture everything there is to being a person and address every sort of concern that we have, but I think ACT is uniquely helpful for how simple it is. I think it is remarkable how beneficial it is and how intuitive it is.
There's a great self-help book by Steven Hayes, who is one of the main developers of ACT, called “Get Out of Your Mind and Into Your Life.” There are millions of copies of this thing that have been printed, but I would encourage anyone who has any questions about how to apply therapeutic principles to their life, how to take the next steps. Sometimes therapy is too expensive, sometimes therapy is inaccessible, sometimes you feel like the therapists that you're finding aren't a good fit for you. There are really, really great therapeutic workbooks out there that are based on evidence-based psychology. This book by Steven Hayes, “Get Out of Your Mind and Into Your Life,” it's a phenomenal book and the ACT principles that it's based on are super, super helpful. I'd encourage anybody who's considering therapy, who's ambivalent about it, checking it out. Again, it might not be the thing for you, but it's about as close to a one-size-fit-all, helpful across the board approach to therapy that I've ever found. I really want to shout from the rooftops, everybody should know more about ACT than they probably already do.
Nicole Izquierdo: Well, thank you so much for sharing that, and thank you so much for joining us, Blake. We really appreciate you taking the time to speak with us.
Blake Thompson: Hey, thanks, Nicole.
Editor: Jennifer (Ghahari) Smith, Ph.D.