Interview with a Therapist

Who knows what a therapist might say under the influence of truth serum? Well, upcoming are unguarded words from this writer, a counselor retired, but not retiring from the challenge of interrogation. No drugs were necessary, but some background first.

I recently was named one of the 2017 Top Therapy Bloggers by Online Counseling Programs. How nice, I thought. Yet mingled with my gratitude came a second nagging question: why not the one and only Top Blogger of 2017? And then, why just 2017? Why not the top therapy writer of the decade? Or top blogger in the universe? Ah, well, I’ll have to make do. Life is tough.

Oh yes, the interview. The kind folks at Online Counseling Programs asked me nine questions. If you’d like an overview of my perspective on sexual attraction to patients, the training of psychologists, the challenge of maintaining boundaries, how the therapist (not the client) is changed by therapy, and the specifics of my career, you’ll find a good deal in my interview responses.

Another therapist would give different answers, although those currently in practice are careful not to share much about themselves. My retirement gives me the freedom to say a few things active counselors are wise not to touch. Please don’t assume they’d respond in the same way even if they were retired. What I offer is my perspective only, not unassailable truth.

Here are the questions:

  1. When and why did you originally create your psychotherapy blog?
  2. What do you hope to achieve by maintaining it?
  3. We highlighted your recent post, “The Arc of a Therapist’s Emotional Life,” because you offer such insightful musings on the therapist’s emotional life as it informs and is shaped by his professional work. One of the points you make is the difference in sympathizing versus empathizing with clients’ emotional states. How would you recommend that mental health professionals in training maintain emotional boundaries with their clients?
  4. Can you walk us through what motivated you to become a psychotherapist, as well as the educational journey you took to get there?
  5. How have you seen your blog and profession evolve over the years?
  6. During your nearly three decades as a practicing psychotherapist, what would you say were your most challenging and rewarding experiences, and why?
  7. What advice would you offer to aspiring psychotherapists?
  8. Music plays a major role in your blog. What has been the value and influence of music in your practice of psychotherapy?
  9. Is there anything else you’d like to add?

My answers? Click here.

The top image is a still photo of Harold Lloyd from his 1920 silent movie, High and Dizzy.

The Arc of a Therapist’s Emotional Life

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.

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.

How Vulnerable Can We Be? Emotional Openness in Therapists and Performers

We get to see public people expressing private emotions on TV. Allowing themselves to be vulnerable. Not only on dating shows. Politicians do it on occasion, including George W. Bush, whose voice cracked and eyes moistened more often than any U.S. President I can remember.

Still, most of us try to stay in control. We hesitate to let down our guard for fear someone will reach into our chest and rip out our already wounded heart. In my experience, however, some of the most touching public situations occur when a self-possessed person displays the courage to live so much in the unselfconscious moment that the voice breaks or tears flow a bit. Before I tell you about my own challenge with this, I will relate two other public examples, as well as describing a therapist’s hesitancy to feel too much in session.

Fred Spector, a retired Chicago Symphony Orchestra violinist, told this story in 2001 about an event then three decades old:

We were doing the Verdi Requiem and we knew that the mother of Carlo Maria Giulini, the conductor, died (unexpectedly, while he was in Chicago). He walked on stage (to rehearse with us), starts to conduct the Requiem and stops. He was crying and he said ‘They want me to come home (to Italy). What good is that? My mother is dead. It is more important that I have this experience with you and the Verdi Requiem and think about my mother.’ And now he’s got us all crying, the whole orchestra in tears. ‘That’s more important because then I can experience and think about my mother in this marvelous Requiem. … and those were the greatest performances I’ve ever played of the Verdi Requiem, bar none. … We wanted to get that feeling he wanted for his mother.

Giulini was a private, ever-dignified, old world man (born in 1914) for whom this exposure was uncustomary if not unseemly. Indeed, the orchestra and chorus had been instructed by an administrator not to say anything to him about his loss. Such a direction could only have come from Giulini or his wife.

Of course, it’s one thing to be unguarded in an empty hall and another to “lose it” during performance. Indeed, among the greatest sins of public musical or theatrical presentation is to be so moved by the words you can’t do your job: enable the audience to experience emotion while you remain in control. I am aware of one instance alone when the rule was violated, but the artist succeeded anyway.

A 1947 Edinburgh Festival rendition of Gustav Mahler’s Das Lied von der Erde (The Song of the Earth) was the occasion. This hour-long song-symphony portrays the transient beauties of existence and concludes in a 30-minute Abschied (Farewell) to a friend and to life, based on ancient Chinese poetry.

The work’s last moments are a whisper of exquisite, heart-rending beauty as the singer reflects on the passing away of human life, while the world itself blooms anew every spring, “forever.” The last word — “forever” or “eternally” (“ewig” in German) — recurs several times, ever more muted against the fading, shimmering, ethereal consolation of the orchestra.

According to Neville Cardus, a critic for the Manchester Guardian, Kathleen Ferrier, the contralto soloist, was “unable to enunciate the closing words.” Moved by the music, she broke down.

Ferrier, a 35-year-old woman soon to become an international celebrity, was then new to this composition and in awe of Bruno Walter, the 70-year-old conductor who had been the composer’s disciple and given the work its world première in 1911. Cardus tells the story of his arrival backstage after the curtain calls:

I took courage and forced my way into the artists’ room, where I introduced myself to this beauteous (unselfconsciously beauteous) creature. As though she had known me all her life she said: ‘I have made a fool of myself, breaking down like that.’

When Walter came into the room she went to him, apologizing. He took her hands, saying: ‘My child, if we had all been artists like you, we should every one of us have broken down.’

For Cardus, it was one of the greatest, most life-changing performances he heard in a long career as a music critic.

Where does a therapist fit in our discussion? He is not a public performer, but must empathize with his patient. Unmoved by the human suffering he witnesses, he is of no value. But what if he is moved to the extreme? Were he to experience the same level of emotion as his client, he himself would become the patient. The room would be occupied by two people equally anguished, both needing support and relief with no one available to give it.

Someone must possess a therapeutic (but not unfeeling) distance from the suffering. The therapist must.

My own challenge with public vulnerability came in toasting my first child’s marriage. Tears interfere with an adoring parent’s speech at many such events. A guest’s attention is then drawn to the speaker’s unraveling, however sympathetic or touching, not his words about the newly married couple. I wanted the assembly to know what I had to say about my daughter and son-in-law, the better to appreciate them. The language, properly spoken, would externalize the internal, convey emotion, and move the audience.

The problem was, in practicing I could not get through the speech. Time after time I tried, time after time I failed, overwhelmed. Were I to tell you the number of rehearsals I attempted, starting months in advance, I suspect you would not believe me.

The day came — the moment came — and I still had not a single run-through without the internal tidal wave overwhelming my words. Once on stage, however, — finally, finally — the elusive control arrived and the toast went well. I was not as emotionally “present” as I could have been, but the cost of unconsciously distancing myself from my sentiments was the price for moving the audience by words and delivery, not becoming overwrought and a bit incoherent.

Why am I reminded of all this? I just completed a course at the University of Chicago’s Graham School in which our instructor, near the class’s end, discovered her voice cracking with emotion. Sometimes this happens in intimate conversation, frequently in counseling, but not so often at the U of C, and not from this confident and expert guide to literature. She said (to someone else) after the session, she “didn’t know where that came from.”

But, you know what? It capped a great class discussion of a moving novel with a flourish. Sometimes one needs to go with the flow, even if the flow is both figurative and literal.

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The painting at the top of the page is called Tightrope Walker by Jean-Louis Forain(1885). The next image is Australian Artistic Gymnast, Lauren Mitchell at the 41st World Artistic Gymnastics Championship in London, UK, October 14, 2009. The photo was taken by Steven Rasmussen, Explorerdk. The following picture is Gymnast Feet on Beam, January 19, 2008, by Raphael Goetter. All are sourced from Wikimedia Commons. Finally comes Tightrope Walker by August Macke (1914), sourced from WikiArt.org/

Being Excluded From Your Therapist’s Life: Reasons You Haven’t Heard Before

598px-Ethiopian_Stop_Sign.svg

We’ve all had idols. Perhaps a sports hero, an older sibling, a teacher, or — God help you — your therapist. In the latter case, authorities tell you why a relationship outside the office is not permitted:

  • The shrink might exploit you.
  • Progress would be hindered if your therapist occupied the dual role of therapist and friend.
  • A healer needs downtime.
  • Personal information about the counselor complicates the transference relationship: the extent to which your issues will play out in session.
  • The therapist would be of little help if he feels too much of your pain, as he will if you become more than a patient — an important part of his life outside.
  • The ethical guidelines of the therapist’s profession prohibit intimacy.

Much of this sounds unfair and unfortunate to the patient, however true. Many believe they would benefit by having MORE of the therapist. Jealousy of those who claim more of him isn’t unusual. Additionally, the imbalance of the relationship is troubling. You pay the doctor, but hear little personal about him. The shrink takes your cash and wants to be told everything about you. I’ll try to shine a different light on this subject:

  1. Therapists are human. No one who admires, say, John Hamm or Scarlett Johansson, imagines them on the potty. At least, I hope not. Neither do those who esteem their psychoanalyst hold an image in mind of this particular pose. We stand on feet of clay and need to clip the toenails on those feet. In real life, we get bored, say the wrong thing, lose patience, etc. We are not always sensitive and sometimes we are self-serving. You understand this in the abstract, but don’t witness it. It’s not pretty.
  2. Think about the best dinner you ever had. Now consider having the same meal morning and night. Would you enjoy the food as much? Too much familiarity with anything dulls the experience. To some extent, your therapist’s time is precious because it is in short supply. You visit him once or perhaps twice a week while watching a rapidly advancing clock. Were you to win more access to him, you’d find the contact less special. Even for those psychologists who are terrific human beings, familiarity breeds routine. Should you disbelieve this, I can refer you to my wife and children. They love me like crazy, but also recognize me as the sweaty guy who doesn’t enjoy being disturbed while I’m riding my exercycle or lifting weights.
  3. Many a client needs, at least for a time, to believe we are incredibly special — gifted to heal the hopeless. The illusion of magic works for the patient and is created by the patient. He must think of the counselor as a paragon of virtue and virtuosity. The halo placed atop the psychologist’s head is an imaginative construction of the client, possible because he lacks a detailed vision of who the therapist is. Only with this undeserved enhancement of his benefactor can the man on the couch stand up to walk the tight rope therapy requires: exposing his secrets, tolerating emotional pain, and taking behavioral risks.  Should he see behind the shrink’s professional mask, he might hesitate. The worse for him.
  4. Because you have limited contact with us, we can make the time special for you. The counselor’s job is to invest every bit of his knowledge and concentration on you for the better part of an hour. He does not regularly do this at home, with his friends, on vacation or at the movies. He performs his wizardry for a small number of people. That is, an expert counselor does this for all his clients and only his clients. He tries to make you his exclusive focus every second of the 50-minute hour. Indeed, the shrink can only accomplish this because the time is short. You might think you would accept a lower-intensity version of the doctor, but I doubt it. And you shouldn’t accept such a thing if you already do. Patients receive the best of us in a very special way. Yes, we offer love and more hours of contact to those outside the office. You, however, and others who sit where you sit, get something no one else gets: the healing art.

I doubt that anything written above will dim your desire — cause you to give up what some of you want or think would please you: a chunk of the doctor’s real life. As I’ve said, in some ways it might be best that you don’t relinquish this wish. Still, occasionally a therapist, like a parent, is right when he says, “I’m doing this — keeping these limits — for your own good.” Granted, the frustration may persist. I hope, however, you recognize an element of necessity in your dilemma.

A good life requires our effort to accept those things we cannot change. However disappointing, no one gets everything he wants. The only exception is a kid in a candy store, and he leaves the sweet shop with an upset stomach.

A follow-up to this post can be found here: How would a Friendship with your Therapist Work?

I just came upon this NY Times column adding still one more perspective on therapist boundaries: http://opinionator.blogs.nytimes.com/2015/04/21/beyond-the-boundary-principle/#more-156706/

The Ethiopian Stop Sign is the work of Gigillo83 and is sourced from Wikimedia Commons.