Q and A with Cy Leist, LMSW
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Cy Leist is a Licensed Master Social Worker who focuses on helping people achieve their goals by blending evidence-based practices with a strong therapeutic relationship. He sees clients as agents of change and creates a safe space for them to be their whole selves. He has experience working with college students and young adults, as well as the LGBTQ+ community. Cy uses various therapeutic approaches, including humanistic therapy, solution-focused therapy, and CBT, which are effective for depression, anxiety, stress, and low self-esteem. He graduated from Mississippi College with a Bachelor of Science in Psychology and later earned a Master of Social Work degree from the University of Memphis. He values lifelong learning and cultural humility.
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1.What are the top benefits of seeing a therapist or counselor?
There are numerous reasons to see a therapist or counselor, depending on your needs and what you are seeking from the experience. One of the biggest benefits of working with a therapist is being able to work through internal and/or external struggles with a neutral third party who is not involved in other areas of your life. Past clients have shared with me that it is helpful for them to talk freely about all the facets of their lives and relationships without worrying whether such information will be shared between friends or family members. Another benefit of therapy is being able to process events that have happened outside of the therapy room. For many clients, the therapeutic hour is almost like a “time-out” in the middle of a sports game. “Okay, I’ve been working towards these goals; how is it going?". This fight happened with my friend; I’m not sure how to handle it.” Life can be so hectic that it’s hard to find a moment to stop and process what has transpired or reflect on progress towards a goal. At the end of a session, I want a client to feel as though they are more energized and prepared to tackle life’s hardships. Finally, a top benefit of therapy is that it helps you learn more about yourself and how to solve the issues you are facing. Movies and TV can portray therapy as a time when you sit with a professional and they give you advice. That’s not exactly how true therapy should work, at least in my opinion. While I will always work with clients to create steps towards goals, offer guidance, and provide psychoeducation, I believe my ultimate goal is to create a space where clients feel safe and be a co-pilot in helping them empower themselves to be their own agents of change.
2. What made you choose to work in the mental health field?
I chose to work in the mental health field because it is a profession that merges my natural gifts with an area of wellness about which I am passionate. For as long as I can remember, I have always been the person that people would come to and ask for guidance. I have always had a knack for seeing patterns in behavior as well as the deeper meaning behind people’s surface-level actions. Once I entered college, I dove into the world of psychology and have loved it ever since. I love the experience of personally and meaningfully working with someone to create positive change in their lives. Seeing my clients succeed in their goals remains one of my great joys. Therapy is only successful when the client puts in the work outside of the therapy room, so to see someone’s success gives me so much pride in them and what they have accomplished in-between sessions.
3. Can you share your approach to therapy and how you create a safe space for your clients to open up and be themselves?
My approach to therapy is a humanistic approach with an emphasis on being solution-focused. Humanistic therapy is an evidence-based model that prioritizes the therapeutic relationship with unconditional positive regard. I believe that therapeutic outcomes are only as strong as the relationship between a client and their therapist. This means that not only do I want to really get to know and invest in my clients, but I also want them to see me as an authentic human being. Being solution-focused emphasizes working with clients to create goals and outline action plans through which their goals can be achieved. This type of therapy is traditionally done in the short term; however, I also utilize solution-focused techniques with long-term clients when new stressors arise.
4. You mention working with college students and young adults as a population of special interest in your bio. What unique challenges or issues have you observed in this group, and how do you tailor your therapy to address them? Could you tell us more about your background and experiences, especially those that have influenced your approach to therapy?
I am very fortunate to have spent a year working at a college counseling center as some students’ primary therapist. While my experiences do not allow me to speak for the whole student population, there were several challenges and issues I observed more frequently. One of the biggest challenges my peers and I noticed was that students entering therapy had already self-diagnosed based on information they saw on social media. Several of my clients referenced DSM-V diagnoses in a manner inconsistent with the actual criteria, and some of them were fearful they had a disorder based on vague information they had read online. When these topics came up in the therapy room, I would ask the client about where they saw the material and their beliefs about why they might have a certain disorder. I then initiated an honest conversation about misinformation on the internet and remained clear and transparent about the real DSM-V diagnostic criteria. Another challenge I noticed was students wanting a therapist they felt was personable and could relate to them. I found that my age and position as a student intern allowed students to feel at ease and comfortable with me more quickly than they might have had I been older. Having had an intern counselor myself as a student, I know first-hand the unique bond that can be formed with that dynamic, and I was able to utilize that instinctual kinship to boost the client’s therapeutic outcomes.
In terms of presenting problems that I noticed, I saw many students dealing with depression, anxiety, and low self-esteem. College can be an intense time for many people transitioning from adolescence to early adulthood. Because very few high schools offer psychology and mental health courses, students are often reflecting for the first time on topics such as boundary-setting, coping skills, and individualization. Many of my clients experienced familial dysfunction and were just beginning to process how their relationships with certain family members had impacted them. I found that my emphasis on building the therapeutic relationship and being authentic and honest in the room helped facilitate the client’s trust and created a space with decreased anxiety and fear of judgment. I was also many of my clients' first therapists, and that added an extra layer of responsibility to my actions. After hearing so many horror stories from people regarding past experiences with therapists, I never want to be the reason that someone does not believe in therapy or is afraid to seek out a clinician.
5. For members of the LGBTQ+ community, finding a therapist who understands their unique experiences can be vital. Could you tell us more about your work with this community and how you provide support and understanding?
While I am passionate about providing services to LGBTQ+ people, I must first acknowledge that my experience as an LGBTQ+ person does not provide me with the gift of understanding the experiences of everyone else in the community. I never want to make an assumption about someone and their life simply because they are LGBTQ+. At the same time, I also know that my being an LGBTQ+ clinician will bring many future clients an extra layer of comfort and security. When working with clients, I always want to use their preferred pronouns as well as their preferred name. I am also very vocal about my support for the community. If someone is uncomfortable disclosing their sexual orientation, I would at least want them to know that I would be supportive of them should they ever decide to come out. Additionally, I think it is important for every clinician, LGBTQ+ or not, to have a list of resources and referrals that are accepting of the community. So often, clients are referred to businesses that engage in discriminatory practices that are not accepting of them. Being able to confidently provide someone with greater services while also protecting their identity is a top priority.
6. You emphasize the importance of the therapeutic relationship. How do you go about building and maintaining a strong therapeutic relationship with your clients?
Just as all relationships look different outside of the therapy room, so do the relationships built between me and my clients. I try my best to adapt to the client and their needs while also staying true to myself. Similar to any relationship, sometimes the connection happens quickly and seamlessly. Other times, I may feel some resistance from the client to fully engage in the process. Regardless, I strive to refrain from judgment and remain willing and able to fully engage. I always want to meet the client where they are and give it time. Sometimes it is the clients who seem the least interested that end up being the most invested and the hardest working towards their goals!
I am also unafraid of ethical self-disclosure, especially at the beginning of treatment. By self-disclosure, I mean trivial statements or additives to the conversation, not actually telling the client about my life and my story. For example, while walking a new client back to my office, I said, “Is that shirt referencing the ‘Percy Jackson’ series? Those are great books.” The client got the biggest smile on their face and said, “You’re the first person who has noticed! "We ended up building a strong therapeutic alliance that resulted in great client success. Comments like that, when made sparingly and appropriately, humanize you to the client and help create a feeling of comfortability and connection that I have found to be extremely beneficial to treatment.
7. Can you provide insights into some of the evidence-based practices you incorporate into your therapeutic approach, especially for clients dealing with issues like depression, anxiety, stress, and low self-esteem?
In essence, I use a humanistic approach to therapy, and I regularly practice solution-focused and cognitive behavioral techniques in my service delivery. For clients with depression, anxiety, and stress, I will begin by asking questions assessing what depression looks like for them, such as, “How long have you been feeling this way? Have you noticed any changes in sleeping and/or eating patterns? When do you notice symptoms most prominently? "Asking clients the “miracle question” can also be useful: “You wake up tomorrow and a miracle has occurred. Your problem(s) have been solved. What has changed?"This can help both client and clinician better conceptualize the problem and better understand how to address it. Additionally, it is always appropriate to screen for self-harming behaviors and suicidal and/or homicidal risk. After the initial assessment, I then like to ask the client, “When do you notice the problem is less prominent? "The client’s answer can be quite instructive and often serves as the basis for forming a treatment plan. For example, let’s say a client tells me, “I feel less anxious when I prepare my meals in advance and set out my clothes for work the night before.” I can then respond, “I can see how that would make your mornings easier. How would you feel about trying to get your lunches and outfits prepared at least three nights before work each week until our next session? "In some cases, the client creates their own natural treatment plan without even realizing it.
Addressing issues of low self-esteem can incorporate some of the techniques I just discussed; however, there are some key differences. Self-esteem oftentimes relates back to one’s value system and the way they view themselves with regard to those around them. I like to begin by exploring the client’s worldview and value system and the way those factors engage with the worldview and value system of those around them. Once the client formulates their values and ways in which they want to live their life, greater work can be done to individuate the client and work towards creating a life of which they are intrinsically proud. I am also a firm believer in modeling encouragement and unconditional support within the therapy room. Sadly, many clients have never felt seen and uplifted exactly as they are. By affirming and validating their thoughts and experiences, the clinician can model for the client a better way for them to treat themselves. I am constantly thinking about the behavior I am modeling for clients, and I strive to do so responsibly and effectively.
8. Could you explain what the "person-in-environment" (PIE) perspective means and how it influences your work as a social worker and therapist?
The “person-in-environment” (PIE) perspective is the bedrock of social work services and a value by which I strive to live. Simply put, it means that a clinician must look at the client’s behaviors and present problems within their greater environmental context and not just within the confines of their psyche. Some great examples involve viewing behavior through the lens of cultural norms. In several Asian cultures, direct eye contact is considered rude. This is understood and widely accepted within those cultures, yet some American clinicians working with such a client might misrepresent their lack of eye contact as fitting a diagnostic criterion for a certain disorder. How children behave can provide other demonstrations of the PIE perspective.
Is a teenager acting in a rebellious and aggressive way the byproduct of a clinical disorder, or does it stem from a volatile household dynamic in which the parents are constantly fighting and ignoring the needs of their child?
Could it be a combination of both?
These are the questions social workers must try to answer, and they strongly inform the way I deliver therapeutic services.
9. Lifelong learning is one of your core values. How do you ensure you stay up-to-date with the latest developments in the field of mental health, and how does this benefit your clients?
I am a huge believer in life-long learning, and I am always finding ways in which I can learn more. As social workers, we must enroll in “Continuing Education” credits each year to retain our licensure. Such credits span numerous areas of research and can be accrued through seminars, workshops, and courses. Additionally, I need to remain aware of current events and how our political landscape is impacting certain clients. I also believe that it is important to learn from the younger generations, such as Generation Z. Ultimately, they will be the ones to grow up and influence the fields of social work, psychology, and counseling. Rather than combat them, I believe it is important to listen to what they have to say and be open to how they want to advance the field. Language is a great example of something that is constantly changing. The word “queer,” which has historically been used in demeaning and offensive ways, is now prominently used as a neutral term indicative of someone’s sexual orientation. It is in this way that clinicians must stay up-to-date and aware of societal changes over time.
10. Cultural humility is a term you mention. Can you elaborate on the concept and how it informs your work both inside and outside the therapy room?
Cultural humility is another concept that is key to the practice of social work. It refutes the idea of “cultural competence,” which implies that a person can become fully informed of a cultural identity or social group of which they themselves are not a part. The humility piece of the term refers to the fact that no one will ever be able to fully understand the lived experiences of others, especially those of another cultural background. Culture is a broad term that can encompass many facets of one’s identity: race, ethnicity, gender, country of origin, sexual identity, etc. Even an area of life such as food can play a part in who one is. As a clinician, I operate by the belief that I can never stop learning about cultures of which I am not a part, and there will never be a point in which I have learned “enough.” Additionally, I must reflect on my own cultural background, how they impact the therapeutic space I create, and potential learned biases that I need to work on combatting.
11. As a mental health service provider, what strategies or tools do you find particularly effective in helping clients cope with and manage stress and anxiety?
This is a tricky question to answer because different people respond to different strategies. Also, different clinicians tend to gravitate towards certain tools over others. For example, a peer of mine regularly uses clinical worksheets as activities during therapy sessions. She reports good outcomes and client satisfaction through this process. I, on the other hand, rarely use worksheets and handouts during sessions. I will always print handouts for clients to take home with them, but I rarely sit and walk them through a worksheet during our brief 45-minute windows of time. I am flexible, though; if I know a client is a tactical learner and enjoys activities, then I will absolutely provide that in-session. I have used a book to provide psychoeducation: Atlas of the Heart by Brene Brown. Several of my clients responded quite positively to some passages in the book, and I plan on having it available in my office at Forward for future use.
In thinking specifically about stress and anxiety, I would reference back to Question #7 of this document. I like to ask screening questions during an initial assessment. In subsequent sessions, scaling questions can be helpful. “On a scale of 1-10, how is your anxiety right now?” At the end of the session, “1-10, how is the anxiety now? "Using scaling questions at the beginning and end of a session can help assess whether their time with you is benefiting them in the moment. I like to ask clients, “There is a road ahead of you with less anxiety. On that road, there are several anxiety hurdles. What do they look like? Where do they come from? "This helps in isolating the main causes of anxiety and stress so you can target them directly.
12. In your experience, what advice would you give to individuals who may be hesitant to seek therapy, especially if they are unsure about where to begin or what to expect from the process?
There are several things I would tell someone hesitant about therapy and/or someone who has never been in therapy before. First, I would say that therapy is work. That might be a difficult answer for some, but it is the truth. I think many people have this idea that clients sit in a room, tell the therapist their problems, and then the therapist simply gives them advice and tells them how to fix it. While a therapist does have good tips, tricks, and possible treatment plans to offer, it is ultimately up to the client to empower themselves, find solutions that work for them, and make changes outside of the therapy room. In keeping with that idea, I would advise a potential client to really think about what their goals are in pursuing therapy.
What will it look like for therapy to be successful?
Feeling less anxious?
Discovering the right college major?
Learning to set better boundaries?
While goals can always be changed and adapted over time, having an initial idea of what you’re looking for will help the therapist envision the best treatment plan for you.
Finally, I would impress upon a new client that all therapists have their own unique style and way of doing therapy. The way I do therapy may not be how you want it, and that’s okay. Sometimes it takes someone a couple of tries before they find a therapist that is the perfect fit for them. I would tell someone to try and not get frustrated if it takes a little bit to find the best connection; it will be well worth the wait when you find that clinician. In a similar vein, I must acknowledge all of the people who have had horrific experiences with unethical therapists in the past. It saddens me whenever I hear someone say that therapy is not for them after having been with a therapist who acted inappropriately. While I can’t erase what those therapists did, I do want to humbly say that there are genuine, kind, and professional therapists who would love to give you a better experience. I, as a therapist myself, acknowledge that some clients have simply been too hurt to try again; I have to respect that and validate those emotions.
