Clinician on the Couch: My interview with Psych Central on what it’s like to be a psychotherapist

For those who are interested, you can check out this interview I did for the folks at Psych Central, on being and becoming a psychotherapist.

Below is the text of the interview itself and here is the link to the Psych Central piece.

1. What’s surprised you the most about being a therapist?
I was surprised by how complex, difficult, and life changing the process of becoming a therapist was for me. Like most therapists, when I first started out I thought psychology was fascinating, and I just wanted to help people. In my first clinical placement, at The Salvation Army, I learned how difficult the work was, not just from an intellectual perspective, but from an emotional one. Many people assume the hardest part about being a therapist is hearing sad stories all day.
While patients’ stories were often quite sad, what surprised me was the personal emotional investment the work required and the way the work gets inside you. It surprised me how both powerful and disrupting it can be to fully absorb another person’s emotional experience, especially the most disturbed parts of them. I quickly learned that in order to help my patients most effectively, I had to allow myself to be truly open not just to the content of what they are saying, but the emotions and experiences that come up in the room while I am with them. I have learned that it is only when we have allowed ourselves to experience as much as possible of our patients’ emotional lives that we can find the words and expressions that can finally help them to heal. You can’t really get away with merely being a bystander if you want to really help your patients.
The field as a whole is finding out that the process of healing in therapy more and more requires a process that is similar to how a parent attunes to their young child’s emotional life. The process of having one’s emotional life recognized, respected, and understood is the basis for how we learn that we are lovable, and also learn to love.

Like many therapists, I came from a family where I was often in the caretaker role. This can be a problem when a therapist feels they need to “fix” a client by helping them to feel better, rather than “being” with them first, and figuring out how to help from there.
I would say I was still helpful to the people I saw in my first year, partly because I had already had a good deal of therapy myself beforehand, but doing the work required a whole new level of self-exploration. We have to be with them, and take responsibility for their therapy, while at the same time letting go of responsibility for “fixing” them. If a patient senses that WE need them to get better, that’s not good. Holding and negotiating these tensions in the treatment is highly important, but very difficult for a would-be therapist to imagine before they get into the work.

2. What’s the latest and greatest book you’ve read related to mental health, psychology or psychotherapy? 
The Body Keeps the Score by Bessel van der Kolk is a wonderful book about trauma that combines a neuroscientific and psychological perspective. It is a fascinating account of how the brain and body hold, express, and release trauma. I think it’s a must-read for therapists, and there are some exciting new therapies that I’m sure will come out of the work he is describing.

3. What’s the biggest myth about therapy?
I would say that the biggest myth is that a therapist is just someone who listens, or just reflects back what a patient is saying. The depiction of therapists in Hollywood is often that of these pushovers who overanalyze and don’t really do much to help, when the best therapists have clear boundaries, are deeply engaged with their patients, and are often both literally and figuratively saving lives.
To go a little deeper, I think this depiction is a reflection of the fears people have about therapy who either haven’t tried it, or have had negative experiences. The idea that a therapist can see things in your emotional life of which you aren’t aware about can be very threatening to the image we have of ourselves as the captain of our ship.

4. What seems to be the biggest obstacle for clients in therapy?
Lucille Ball once said, “Love yourself, and everything else will fall into place.” I really agree with this statement. Difficulty loving oneself is also the thing, at base, that brings most people into therapy.
It sounds simple, but it is anything but. Self-love is often misunderstood, and gets confused for its opposite, self-obsession. People that talk about themselves all of the time and have no room for others are doing the opposite of self-love: They are self-obsessed because they don’t love themselves enough to be able to relax and enjoy others. I believe that figuring out the obstacles to feeling safe to be truly yourself is the ultimate aim of therapy.

5. What’s the most challenging part about being a therapist?
To figure out how to digest all the emotional material that comes up in a treatment, feed it back to the patient in a way they can digest, and do this in a way that feels like it’s coming from you instead of hiding behind theory or technique, is quite a challenge.
Another way of putting this is that the ultimate challenge and goal as a therapist is to learn to love yourself, because if you can do this, it will be much easier to help others do the same. Here is the real taboo that isn’t often talked about in these terms by therapists because there is a danger of it sounding trite: We heal our patients by acting lovingly toward them in a particular way, and we cannot show someone love and acceptance if we don’t know how to love ourselves.
To give you an example, much of therapy involves helping people to digest their anger in a way that’s more productive. It is common for a patient to get angry with a therapist in this process, even say attacking things towards them. If the therapist is overly insecure, they will be much more likely to attack back, which obviously can cause problems. Just like in a relationship with a spouse or one’s child, love often takes the form of not retaliating, but digesting the anger and trying to do something useful with it, rather than collapsing or retaliating.
I would call that a form of love, albeit one that isn’t often thought about as love. Being verbally attacked is surely not what people picture when they imagine becoming a therapist, but if the therapist can find a way to digest what it means that the patient is angry, and feed that back to them in a way they can hear, such moments can be transformative.

6. What do you love about being a therapist?
What I love most about being a therapist is hard to put into words, because I think it involves some of the most profound aspects of being human, and we don’t have words for all of that. But I will say that it has something to do with the deep sense of connection I feel to my patients, and the joy that I feel when I see a patient begin to connect with their true selves in ways they have never done before. You can feel them come alive, and it is truly breathtaking. These moments make all the difficult stuff very worth it, and make me feel truly lucky to be doing the work that I do.

7. What’s the best advice you can offer to readers on leading a meaningful life?
M. Scott Peck said, “If you pursue happiness, you might be disappointed. If you pursue love, happiness will follow.” As I have already said, learning how to love others starts with learning how to love yourself, and that is an ability that’s really hard to learn through books or by yourself. In other words, it often requires therapy.
Also, learning how to appreciate the small things in life and be grateful for what you have is vital to feeling satisfied. This has been described in many ways by many authors, but is connected to the idea of being present to your immediate experience of the world, for inside you and outside of you.
In sum: Try to be present, concentrate on being able to be fully yourself, and on having satisfying relationships in your life. If you find any of these too difficult to do on your own, which most people do at some point, find a good therapist!

8. If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why?
I would probably choose the same path. I think that I underestimated how much meaning I could get from other careers when I first started out. But it’s hard to imagine myself doing anything else, especially since being in the field has changed who I am for the better.
I think it would have been impossible to know the changes that would come about in the field as a whole, such as the need to market on the internet, etc., but which have changed the field a great deal. I still would have done the same thing, I believe, but I would have taken a business class or marketing much earlier.
Many therapists are good at helping people, but have trouble earning a living for themselves. I was one of them, but I’ve learned that we can’t help our patients if we don’t take care of ourselves.

9. If there’s one thing you wished your clients knew about treatment or mental illness, what would it be?
I try to tell them the things that I wish they knew if I feel it is helpful, but what I try to help them really absorb is that it is their illness or neurosis that causes them to feel that they aren’t enough. It’s not reality.
Many people also believe that they shouldn’t have mental illness because it is “just in their head” as if that means they should have control over it, when in fact we are in control of only a small portion, albeit an important portion, of what goes on in our heads.
To accept that their suffering is not their fault is a huge relief for patients. It’s hard enough to suffer from mental illness without beating yourself up or feeling shame for suffering. However, beating yourself up is also often part of the mental illness, which some patients have a hard time letting go of, for various reasons.

10. What personally do you do to cope with stress in your life?
I like to laugh, so comedy in all forms is really important in my life. I even use it in my work, when appropriate. I am on a soccer team with friends, which is really helpful to me, because it gets my body moving and inspires me to keep in shape so I don’t collapse on the field!
It’s also a social outlet and kind of a meditative exercise for me. I play goalkeeper, and when I’m in goal, I can’t think about anything else besides what’s in front of me: the ball, the players, and the field. Even the wind is important to take into account at times, so it really puts me in touch with my surroundings and gets me out of my head, which is important after a week of sitting and listening. I think anything that can take us out of our heads for a little while can be very valuable.
Last but not least, I try to minimize distractions when I’m with my friends and family so that I can enjoy the heck out of them. Over the years, I have learned to be more fully myself in all contexts, which is related to being able to be present. Life is not as stressful if you’re not trying to be someone more than you are. That doesn’t mean you don’t make mistakes and learn from them; it just means that it’s possible to take your flaws into account, and still feel important and lovable.
Again, learning to really feel love for yourself is the work of therapy and I think the key to leading a life that is as happy and stress-free as possible.

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