Dear Dr. Cox,
I’ve been thinking about our last supervision meeting and I have some questions. You always seem like you have it all together. You know your stuff and never appear distressed. Like an Olympic athlete who trains and trains. But what happens when the trained athlete pulls a muscle? We expect these unfortunate events to happen to athletes from time to time – we don’t look down on them when they get hurt. But what about therapists? Why do people expect us to have all our crap together? What if we get depressed or experience a trauma? We are only people too, right? Or should we “know better?”
Think about an oncologist who develops lung cancer after smoking for 25 years. We can all easily say that this doctor knew the consequences and therefore he gets no sympathy from anyone. He knew better. But he too is only human. I guess people hold us to this higher standard because of our experience and training. We know how PTSD develops, so we should be able to avoid it, right?
Last week when your client relapsed and almost killed a whole family with her drunk driving, you cried. You said, Sometimes I hate this job. It startled me at first, but then I felt relieved. How are we supposed to deal with that kind of news? After working so hard to help someone help themselves?
I’ve confessed that I (sometimes) hate this job. Glad to hear you weren’t too disappointed in me. In truth, I have a love/hate relationship with this work. Miracles happen every day and I get to be a part of that. I feel humbled and grateful because, as jobs go, this one is actually making the world a better place, one marriage, one family, one person at a time. And if I have to work for a living (as I’ll have to do until I literally go phlunk like a sandbag on the floor, at the very end), I might as well do something that forces me to learn, constantly, to layer concentration upon education, upon self-awareness, upon compassion, upon mindfulness and continued training and an ear for the ethics of every moment. It’s all good.
And it’s completely exhausting.
We are vessels. And, as such, we absorb and contain the troubles of others.
At the end of the day, I can’t stand to hear anybody talk, even my own family. And if I work a five-day clinical week, as I’ve done lately, I feel utter despair by Friday afternoon and fantasize about an empty, white room or a secluded cabin in the woods with no television, no phone, no mail, nobody needing me for miles.
I need to empty out again.
A question fizzes in my gray matter: Shouldn’t the therapist have a therapist? Someone tough enough and awake enough to track our feelings? After logging thirty psychotherapy hours in a week, don’t we deserve somebody to donate one hour to us? Sit and listen? Really try to understand? Does anybody care about the stories the therapist needs to tell? Or are we a class of persons who must perpetually suck it up, forget we have needs, be constantly available to other people’s needs, to make a living? A class of people who must always protect others from our own stress?
Many of us cannot afford the very service we provide so skillfully to others. Or if we can afford it, we often have trouble finding someone who can stay just a bit ahead of us, get a 360-degree perspective on our work and trauma stories, offer wisdom and guidance, and tolerate the complexity of our moods and longings.
Will the good therapist soon evolve into a kind of receptive being who lives a shorter lifespan but is built for listening only – not venting – like some aboriginal with twelve toes.
How are we supposed to deal? I’m starting a list for you. More later . . .
It’s hard to stay empathic 24/7 when no one asks about my problems. Friends ask for free advice like a family member would ask a doctor to diagnose their runny nose. We’re all work horses even though we do no manual labor. Our jobs never stop. But listening to negative and traumatic stories day in and day out brings up my own monsters. Is this normal?
I’ve written a poem about the therapist’s dilemma. Hope you like it.
Her life is a never ending chapter of pain, sorrow, despair, and hopelessness. Why did she choose this road? The road of endless heartache, it goes on and on, it never ends once it has begun. She chose this road, this life that she knows all too well. The trauma, the pain, the empathy, the compassion. Her life is important. She matters.
She sits in an all too familiar leather chair, soft, yet tattered. The company she keeps is not dissimilar to herself, she feels their pain, yet they know nothing of her own. Her words come easy, as if she is an actor who has memorized a script. Her script is her life. She is not unlike a fireman pulling a child from a burning building or a surgeon making a vital transplant to save a life. She saves lives. Her life is important. She matters.
She smiles, an all too easy smile. It’s a practiced grin that has taken many years to perfect. She feels discomfort in other’s words as the words bring back her own darkness. Her darkness that has seen light but always returns to shadows. She invites the shadows to bring others light. Her life is important. She matters.
Dana Christian, M.A.
Your poetry hits home – like having a sidewalk artist sketch your caricature. And yes, I do think it’s normal to have your own monsters sneak out of the closet as you listen to your clients. Some say they go away in time. But do we really want them to? I think the monsters keep us connected to the people we serve. My monsters – depression, childhood trauma, money stress, disconnection from my partner, on and on and on – keep me awake to the suffering of my clients. They motivate me to care.
The problem, as I see it, lies not with the fact that you and I need our own therapy. The problem lies at the intersection of psychology and the marketplace.
Some research shows we’re less effective after 25 client hours per week – and I know that’s true for me. But when I cracked open my APA workforce survey a few years ago, the definition for full-time practice included 40 or more client-contact hours per week! Who decided that and what kind of garden vegetables did they have stuck up their rear ends?
But do we know anyone paying the bills, saving for retirement, and living comfortably, who sees only 25 clients a week?
This path chose us. Not the reverse. Now we have to survive the path, and nurture ourselves well enough that we can be effective on it.
As promised, here’s my list: Self care for therapists.
- EMDR. I think all mental health workers need EMDR therapy. We witness so much pain that we must somehow metabolize in order to sleep, get up the next day, and be present for our families and our clients. EMDR jump-starts the nervous system to process disturbing information and find it a home in the filing system. It calms and balances. It promotes clear thinking. It helps resolve long-term trauma and restores empathy for the self.
- A clean, green diet. I’m not a nutritionist, but I’ve learned a lot from my friend and health coach, Meg Worden, who once told me that greens are the lungs of the planet. We need to detox from our addictions to things like refined sugar and dairy products – and replace them (at least for the most part) with plants. As with EMDR, eating green promotes clear-headedness and calm.
- Daily Exercise. This one goes without saying, but when you’re working so hard just to survive graduate school, you might skip your cardio routine and collapse on the couch some days. I understand that first hand. And I know now that past the age of 35, I could not function without daily exercise. While I walk, my brain works on these complex cases, in the background, leaving me free to smell the lilacs and listen to 80s funk.
- Your right amount of sleep, solitude, and down time. This can’t be overstated. You’re good – and when people discover this, they will refer clients to you and ask you to testify in court and fill out their FMLA forms and see them on Friday night and call them on Sunday and read their long emails and rush a report and reduce your fee so you need to see an extra person and go over your session time and be there for them endlessly. Which you simply cannot do. Guard your schedule ruthlessly. Go to bed by 10:00 consistently. Stop working when it’s time to go home. Ignore email on the weekend. Let the phone answer itself. You are more important than all of it.
- Peer and friend support. We need a circle of trusted people who will take the therapist chair with us and let us vent. We need a professional mentor, a best-friend type of listener, a therapist type of listener, a priest or rabbi, a significant other, and maybe a business coach. We need to luxuriate in being the speaker – at least once a week with someone. We need people who consider the big picture and look out for our health, who remind us our mission and purpose, remind us our services are worth money. We need people who cock their heads when we start to sound “off.” We need advice, guidance, sounding boards, and second opinions. We need friends who make us talk about other things besides psychology.
More later . . .
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