Q&A with Brian Murphy, LMHC

Brian Murphy, LMHC is Director of Outpatient Services at Arbour Counseling Services, Jamaica Plain. With more than 20 years’ experience, Brian trains and mentors cohorts of Masters-level students from universities in the greater Boston area for their field internships. Here he offers his perspective and advice to future caregivers on the challenges and rewards of working in the mental health treatment industry.


You’ve been in this field for a very long time. What do you enjoy most about your work?

This field is constantly changing and evolving. We’re learning new things, and it’s always important for us to be up on new treatment techniques, research, and information. It is expected but also exciting to keep your training current to ensure you’re doing the best practice. There are professional meetings I go to now that I used to go to 10 years ago, and the things we talk about are completely different. The way we treat certain patients is different; the kind of techniques we use and way we collaborate is different. I have a shelf here of books that are useless right now.

What have you seen change the most?

The patient population has changed drastically from 50 years ago, even 20 years ago. We need more individuals who can work with more acute patients. A lot of our outpatient clients are coming out of the hospital quicker, they’re still experiencing a lot of symptoms, and so we’re being tasked with caring for people who are sicker than they used to be. Especially in the face of the opioid epidemic, we’re seeing more individuals with co-occurring psychiatric and addiction disorders that require a different course of treatment than say an individual diagnosed with an eating disorder or ADD with Anxiety. Our continuum of dual diagnosis programs aim to give participants a heightened level of self-awareness about their addiction, solid relapse prevention skills, and a variety of coping skills to help them become more independent, self-caring, and functioning adults in recovery.

Many of the patients served by Arbour Counseling Services are in transition housing or are homeless. Are there unique difficulties working with this population as opposed to other clients?

We have a fair amount of people who don’t show up for appointments and I hear members of my team asking, “What can I do to make sure my patients are getting in? How do I make a better connection with my clients in this community to help them with compliance and being active in their treatment?” There used to be an idea where if the client doesn’t show up for therapy it means they’re not interested, so it’s not the therapist’s responsibility to call them or send them a letter or anything. But the reality is that we have to do things differently than we used to. We have to reach out to our clients, we have to remind them of appointments. We have to meet the patient where they’re at.  You build a relationship with your client and get them to be more compliant with treatment.

Depending on what kind of shelter the person is in, there are issues around timing for instance. Clients have to schedule appointments around when they need to be in line at the shelter, because if they’re not in line on time they might not get a bed. We as caregivers have to be cognizant of this because the patient is not going to come here for therapy over getting a bed for the night. Then of course many of the shelters are not dry shelters, they’re “wet” or “damp” shelters where people are drinking and drugging. It’s a difficult environment for a client to be in who may be working on abstinence or recovery and most of the people around them are high or using. Unfortunately, medications can be stolen at shelters and that causes challenges in keeping the patient on their prescribed regimen. That then adds to the burden of having to make another visit to get their needed medication.

What are some of the biggest challenges facing the mental health field right now?

We’re struggling with finding enough staff to meet the demand for mental health and substance abuse treatment. If you go on Indeed to take a look at what’s out there for mental health counseling, everybody’s trying to hire qualified clinicians.

You’ve worked with hundreds of students training to become Licensed Mental Health Clinicians or Licensed Certified Social Workers. Are there any common misconceptions they have or anything they are surprised by?

Many often don’t realize the amount of challenges that patients have in their lives. There’s an idea that maybe they come here and sit down with someone who may otherwise be healthy – they may have a job, a house, a spouse and kids and family, when in fact many of our clients don’t have any of that. That’s a difficult reality for new students sometimes. Students coming out of the classroom are focused on learning therapeutic techniques and how to work with clients in and around their mental illness and counseling, but in fact they’re faced with lots of case management and navigating the social services system, and that’s something that often times they don’t expect. Maybe their first patient doesn’t know where they’re going to be eating. There are these more immediate needs that the client has, and that’s not always addressed or made clear from words in a textbook.

So the field work is more than just credits towards a degree.

Oh, absolutely. Almost every field has opportunities for internships and practicums as you progress through your career. These are required within the mental health industry for good reason. Hands-on work is a primary source of skill development and learning how to be a therapist. It’s not just an adjunct to your academic schooling. This is where most of the learning happens. This is where you learn how to work with patients.

What’s the biggest lesson you’ve learned from not only patients but future mental health workers as well?

You always have to take a step back and remember that you’re in a helping field, a field where you’re going to positively impact the lives of other people. So while you don’t feel like filling out paperwork at the moment you have to remember that the person has a life outside of your office. That person has challenges out there and we need to do the best we can to help them meet those challenges. By filling out that paperwork you are helping. It might not be exactly what you expected, but it’s that broader sense of helping somebody. And in fact you’re building a relationship with that person too. They’re going to see you as valuable, that their time coming to see you is valuable. Then you can get down to work on other things.