I am not the man I was when I became a man. Nor am I the therapist I was on the first day I treated a patient. My question, then, is how did I get from letter A to whatever letter of the alphabet I’m now standing on?
- Is there a pattern to the emotional life of a therapist?
- Must he change himself in order to do the work?
- Is he changed by the work?
- Does he change again after the work?
In the absence of clarifying research on these questions, I’ll offer my own anecdotal observations, both of other therapists and my own journey through therapy’s emotional thicket.
I’ll begin by suggesting that counselors choose the field for one of two reasons:
- They are touched by the torturous path of humanity and wish to ameliorate suffering.
- They are fascinated by the human condition, the myriad forms of personality, and want to learn more.
Many of us chose our occupation for both of these reasons and, of course, to make a living.
Let us assume, then, that the future mental health professional comes to his work sensitive to the pain of others. Perhaps he is attuned to some portion of this by his own nature or experience. I was.
Although I do not pretend to be like all therapists, I was a bright youngster with questions about life. One of my earliest questions was, “Why am I me?” I wondered why my particular consciousness was not in someone else’s body! I also displayed awareness of racism before wide-spread marches, sit-ins, protests; before the 1955 national emergence of Rosa Parks and Martin Luther King, Jr.
My parents survived the Great Depression, my mom the victim of malnutrition and tuberculosis. She was further marked by a chaotic childhood home, a stewpot for mental disorders, including an alcoholic father and a paranoid mother. Dad survived a heart attack in late 1958. He, too, lived with the indelible tattoo of the 1930s worldwide economic drama and worked multiple jobs simultaneously into his seventh decade, both to define himself and arrest those youthful financial insecurities.
Beyond the particularities of the family, I came to an early awareness of the murder of the European Jews, though I experienced only occasional and mild anti-Semitism. I believe this consciousness preceded and heightened my recognition of racism and other forms of unfairness and mistreatment. Here was a youthful lesson that bad things can happen to good people. Thus, the stories I heard as a therapist, however harrowing, did not surprise me.
This was my emotional inheritance, the legacy shared with my brothers Eddie and Jack.
More generally, all children (including tiny therapists-to-be) need to master their emotions. We cannot cry at every setback. We discover this necessity in school, if not earlier. Those men born at the leading-edge of the post World War II “baby boom,” as I was, were raised to suppress their feelings, lest they be thought unmanly. The prohibition against male hyper-sensitivity or “softness” still is alive today, if somewhat muted.
What constitutes a “sensitive” person, however, is complicated. One can be easily hurt, moved by the pain of others, or both. If he is the former, the potential counselor must immunize himself against his own vulnerability before he can help anyone else. To do otherwise sets him up to become as needy as his client within session.
Even if the therapist is not “too sensitive,” he typically begins his therapy career with an overdeveloped sense of responsibility to “cure” his patients – extend himself to the point of riding their emotional roller coaster with them – and risk burning out. Moreover, the new counselor, by definition lacking a track record of success, uses the improvement of his patients as the scorecard of his self-worth. To desire your client’s well-being is much more fraught if your equanimity and self-concept are too closely tied to the trajectory of the patient’s treatment.
Good therapists finally do acquire a sense of competence and confidence. They achieve this, in part, by finding the proper “therapeutic distance” from the person sitting across from them. You become sympathetic, not empathetic. In other words, you offer sympathy (compassion) rather than empathy (feeling as if the other’s pain has jumped inside you and taken you over).
The counselor is privileged and enriched by witnessing the fragility and strength of his clients. He listens to their stories: all the pain and challenge of life’s stage played out in a small room. I am certain I became more humane, a better person, because of the good luck of serving others. They served me, too – made me more comfortable with my own emotional expression, to the point of throwing-off some of the strictures required to “be a man.”
Nonetheless, I now wonder whether the distancing I mentioned might come at a cost. Does the therapist’s role above the roiling turmoil of his client persist when he is with friends or relatives? Can he set aside the now automatic tendency to “ice” his feelings at work and thaw himself elsewhere? Is the therapist’s responsiveness to those in his personal life limited by the practiced program of his profession? I’m not sure.
Now retired, I find myself (and a few other ex-therapists) experiencing a wider emotional range than before. At one end, I accept personal losses more easily (the recent death of a wonderful friend, Joe Pribyl, for example). The other extreme finds me more distressed by the fraught state of the world. Is this because I am no longer in the business of creating therapeutic distance? Might it be due to emotional changes that come with aging? Is the ratcheting-up of worldwide intolerance the cause? Maybe those reasons and more.
What then is the arc of a therapist’s emotional life? Here is one possible four-staged outline:
- The child’s natural high sensitivity (amplified by the particular circumstances of his nature and experience).
- A gradual mastery, to a degree, of his emotions, at least in public.
- The essential development of therapeutic distance from the client, without losing sympathy.
- A possible thaw, after retirement, in this automatic distancing. That is, an increased tendency toward empathy rather than sympathy in leading a life beyond the shuttered office. Paradoxically, an enlarged ability to accept most losses: to roll with the punches of life.
In the end, regardless of our personal trajectory, we hope our clients will be happy – “reasonably happy,” as the pianist, Rudolph Serkin wished for his student, Richard Goode.
The counselor’s universe of experience – vicarious exposure to the lives of his patients, as well as his own private emotional journey – is a sometimes dissonant, raw, thick, lumpy, unprocessed necessity for his work. He manipulates it and sings the words his effort evokes, searching for melody in the discord. He churns it – and it churns him. Only by refining this material can the healer transmute pain into the remediation of pain.
Perhaps, like the dream of suffering that Schubert wrote about in 1822, “to sing of sorrow, it turn(s) into love.”
The top two images come from the collection of Christopher B. Steiner and date from 1915/20 and the 1920s, respectively. The final photo is called Self-portrait, by W. Helwig and is sourced from Wikimedia Commons.
I’m a little surprised not to see mention of a phase in the therapist’s life in which s/he goes through his/her own intensive therapy, working on personal injuries, demons, traumas. I say that only because I know my own therapist went through a period like that in her mid to late 20s, and it seems to have been a formative time for her. I don’t know if that’s a common experience for other therapists, however. What do you think?
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Good question. The formative days of the “talking cure,” back when Freud and his followers developed the first models for treatment, produced the idea that the therapist’s own therapy was essential. Indeed, Freud believed that therapist should do so periodically over his career, though he did a self-analysis only (as the treatment’s originator it would have been impossible to do otherwise at the start). Over 100 years later there are now so many types of therapists, I doubt there exists a consensus on this point. For example, 1994 survey of 800 psychologists by Kenneth S. Pope and Barbara G. Tabachnick reported that “most believed that therapy should be a requirement of graduate programs and licensure … .” However, even here there are some caveats. Only about 60% of those solicited for this survey participated, so the sample may be slanted toward those who give value to the importance of a therapist’s treatment because it was something they did themselves (some 84% of them). Moreover, this was a survey of psychologists only and an old one at that. Finally, for a variety of reasons, the psychiatric profession has become more “medicalized” in recent years, and a considerable number of psychiatrists (usually the only mental health professionals who can prescribe psychotropic medications) do relatively little counseling, at least much less than they did historically. On the other hand, virtually every therapist in training receives supervision and that supervision would normally deal with the manner in which the unresolved personal issues of the junior therapist are interfering with his work. Supervision and consultation are generally encouraged even once one enters independent practice, and continuing education is usually mandated by licensing agencies in order to keep practicing. I hope this provides at least a bit of an answer. Thanks for the question, La Quemada.
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“Finally, for a variety of reasons, the psychiatric profession has become more “medicalized” in recent years, and a considerable number of psychiatrists (usually the only mental health professionals who can prescribe psychotropic medications) do relatively little counseling, at least much less than they did historically.”
~ A disastrous development for the profession in which they become mere dispensers of drugs for Big Pharma to patients who become lifelong consumers for the taking.
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One of Freud’s greatest achievements was his attempt to understand the unconscious and its affect on behavior. Unconscious motivation is central to psychoanalysis. Therapists are influenced by their unconscious as are we all. Psychoanalysis is an attempt to reveal and understand these unconscious determinants. For those of us who believe in the unconscious, an understanding of these processes is essential to an understanding of our own behavior as well as the behavior of others.
As always, Harvey, thanks for adding an important perspective. Your comment adds one more reason for a therapist to undergo his own therapy, particularly of an analytic variety.
Such a beautiful meditation. I hope you enjoy the many gifts that come from “undistancing”. This brings to mind Derek Wolcott’s well-known poem. Here’s an excerpt:
The time will come
when, with elation
you will greet yourself arriving
at your own door, in your own mirror
and each will smile at the other’s welcome,
and say, sit here. Eat.
You will love again the stranger who was your self.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you..
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Thanks for the applause and the introduction to Wolcott’s poem, Evelyn. Before I bow too deeply, however, I should underline that I’m not sure about the “undistancing.” Perhaps I didn’t make this clear enough. Part of what I hoped to accomplish in writing this piece was to remove a veil from the mystery surrounding therapists. To show that we, like every other thoughtful person, reflect on who we are; and are limited by being inside ourselves, not able to see what we look like to others, even if they tell us from their own perspective, which is also only one perspective and not necessarily “the truth.” I hope I left the reader with the idea that we are all, therapists and non-therapists, in transit – moving objects – always transforming (whether aware of it or not). In effect, what I gave you and the others who happened to read this, was a snapshot: how I thought about myself on the particular day that I posted the essay. It may be unsettling to some of us to think of the world in the unstable, impermanent fashion such a statement implies. But even as I write these words, I realize I might say to myself, in two seconds more, “Oh, come off it!”
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I found this article fascinating. It’s interesting to “see” inside the mind of a therapist. What their experiences are, etc.
Most of our minds are busy, like your own, Rayne. My use of “stages” is artificial. That use is just a way of organizing the idea of the changes therapists undergo. We share much more with the “non-therapist” world than commonly thought. Glad you enjoyed it.
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Gerry, thanks for sharing your insights. It occured to me that a meditation can be a dialog with oneself; combined with writing, meditations often become a form of self-analysis. Linking this with La Quemada’s question about therapists going through their own intensive therapy, leads me to think that a “meta” stage in a therapist’s life might include continuous self-reflection/auto-therapy. Given that all of us are empathic and sympathetic to some degree (although some manage to totally repress these emotions), mustn’t a therapist develop a process for continual learning and “converting” their own raw emotions into an “energy” that propels the therapeutic relationships?
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Well, said. Phil. I certainly think of my posts in this way, in part: a kind of self-reflection or way of chewing on ideas, some of which have personal import. The therapist who is no longer reflecting on who he is and how he impacts others is not a therapist. As you’ve suggested, he must be sure that the process is productive, not just navel-gazing, and does indeed “propel” the treatment.
Dr. Stein, thanks for sharing your emotional journey as a therapist. While your therapeutic work has made you “more humane [and] a better person,” I’m sure that it has also given you a greater understanding of what it is to be human.
If we are to change “the fraught state of [our] world,” each one of us will also need to develop compassion and empathy for others. Our “emotional inheritance” speaks volumes of the man or woman we will one day become. (I cannot help but think here of our Dear Leader.)
I was not so privileged as the man to whom you refer, but my situation did inform my connection to people who were different than I was and that we shared a basic humanity. And, as you also say, my understanding is informed by the work and my continued reflection on that work. Also, re: your earlier comment regarding the “medicalization” of mental health care, very often the data demonstrate that therapy can produce as good or better outcomes for people than medicine. Obviously, a “quick fix” is preferred by many insurance companies in order to reduce costs, but often by patients who are suffering and want a remedy. Thank you, Rosaliene.
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Dear Dr. Stein,
Thank you for sharing. It helps me so much right now as a patient to better understand that therapist do think about who they are and have busy minds like most. But as you stated they are limited by having to be inside themselves. Is my perspective of my therapist ” the truth” since I really only know him from the one hour a week we spend together in session? I struggle with this and find myself wanting desperately to ask him a million personal questions, wanting to know him on a deeper level. This is how we establish trust with others. I do understand he can’t be my friend, but it’s such a one sided relationship. It’s hard to be vunerable. On the flip side, is the Therapist’s education and experience enough to know ” the truth” of his patients or is that too just one perspective? I try to be as honest and authentic as I can but wonder what he thinks.
Thank you again for sharing the pain therapist endure and all the changes they must go through themselves. I have immense respect for good therapist such as yourself caring enough even after retirement to continue to educate and keep us informed and educated. If I could start all over, I would choose your profession in a heartbeat!
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Thank you, Suzi. Much of what a patient feels toward or thinks of her therapist comes under the heading of “transference.” That word suggests we sometimes impose a vision on another person that they didn’t earn, and is based on their resemblance in some fashion to one or more important others in our history. As to the truth of what a therapist knows about you, I think it might be even more important for him to know something about you that is “useful” and helps you to grow. In the end, whatever he knows, true or not, is less important than what you come to know about yourself and how you use the new information to change yourself. Many thanks for your thoughts.
I’m so glad that you haven’t retired completely, there are still some of us who benefit from your insights here with your blog. You are sort of like a freebie therapist, your thoughts have helped me a lot in my therapeutic journey and provides some of the missing gaps that I can’t get from my own T. I’m sure your retirement is a source of joy to within your family to have you around more, particularly your grandson
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Thank you, Claire. People like you make this worth doing. I’m pleased to be of help when I can. Yes, my grandson is a pretty special little guy. Take care.
Thank you, Dr. Stein…..your blog is beneficial and very interesting.
Many thanks, Nancy.
very good blog. thanks for posting
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