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?

More importantly:

1. Is there a pattern to the emotional life of a therapist?
2. Must he change himself in order to do the work?
3. Is he changed by the work?
4. 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.

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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.”

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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.