Take Care of Yourself

We all experience loss, physical decline, illness, heartbreak, uncertainty and all the other dilemmas that come with being human.  For therapists, there is a danger of becoming captured by the illusion of “having it all together” when it comes to coping with our own problems.  We learn to keep our experience out of the conversation with clients, except in those rare instances when it can serve a therapeutic purpose for them.  Sometimes, therapy is a very lonely profession because we become good at keeping ourselves out of the dialogue.  The paradox is that while we are guarding against inappropriate self-disclosure, we are also taught to be acutely aware of our inner world and reactions to what clients are sharing with us.  The importance of countertransference is ingrained in us through our training.  So, there we sit in the big chair, highly aware of our reactions and how a client’s story is affecting us yet cautioned about expressing feelings or thoughts based on our own experiences.  This can leave us with an accumulation of strong emotions and memories that we must hold and find a way to work through outside of the therapist-client relationship. 

That’s one reason why it’s important to seek help for ourselves.  In order to protect confidentiality, friends and family are not the ones we can go to for help when it comes to our need to talk, particularly if it is something triggered by our work with a client. One of the dilemmas of being a therapist over many years is that you get very good at listening.  It can become a dilemma because others come to expect that from you.  There are times when I realize that I need to talk about something I’m going through and I long for someone to ask, “how are you doing?”.   We so often assume that our physicians are feeling healthy, that our dentists don’t have dentures, and that therapists don’t have problems.  Clients and students often assume we have a perfect, wonderful life; conflict-free relationships, well-adjusted children, financial security and other aspects of a fully realized, happy existence.  Because of the need to limit self-disclosure in our work, we inadvertently contribute to that fantasy.  Our training to appear calm and our attention to effective communication skills and relationship building create an illusion of invulnerability to the challenges that everyone experiences.  Don’t fall for that yourself.  Be human.  Ask for help.  Take time to sit in the other chair and find someone to listen to you. 

There’s Only Us, Part 3

The first two of the four noble truths in Buddhist philosophy are that: 1.  Everyone wants to be happy, and 2.  Everyone suffers.  That is what connects us to each other.  Even when there are no solutions to erase another person’s pain, we can bring a compassionate presence.  We can bear witnesses to our shared human experience.  For addiction and mental illness, stigma and isolation turn pain into suffering.  We can help to mitigate that.  Pain is unavoidable in life, but suffering can be managed and reduced by connection to others.  It is painful when someone we love leaves us, but it creates suffering when we believe that loss means we are un-lovable or doomed to be lonely forever.  Suffering is how we describe the meaning of pain in a way that diminishes us. Pain wounds us, but suffering prevents the wound from healing.  We can’t create a life free of painful experiences, but we can learn to reduce the degree of our suffering.

As I’ve been in this profession over the course of four decades, it has become clear to me that our painful, challenging experiences are the foundation for developing compassion.  Certainly, not everyone finds the path through crisis that leads to a greater capacity for caring and compassion.   Pain, however, can be a terrific teacher.  It shatters illusions and opens doors to connection with others who have suffered.  I believe that some problems, like addiction, often begin as a solution to avoiding pain.  Many people who develop an addiction have a history of trauma or abuse.  Over time, however, the “solution” becomes the problem and people suffer from both the history of trauma and the myriad problems associated with addiction.  Ultimately, no matter where you go, there you are.  As the Randy Newman song, “Guilty” goes, “…it takes a whole lot of medicine for me pretend that I’m somebody else”.  

I’m always aware of the importance of being present for my patients and not diverting their attention to my experiences.  It’s a cardinal rule, and rightly so, that the person in the “big chair” doesn’t take center stage.  Therapy is not about the therapist; the patient’s needs are always the focus.  There are those instances, however, when we can say “I know how it feels to be scared…to be rejected…to be lonely…to feel hopeless…to feel lost”.  Empathy is compassion in action.  I know from my experience in the “little chair” when I’ve sought help, just how healing it can be to have someone who is willing to be with me in my pain.  Being in the presence of a compassionate person – someone who can bear witness – is a powerful experience.  To feel that we are not alone, that someone cares about our well-being. That is how suffering is subdued.  That’s the work we’ve chosen to do as therapists.  I appreciate all the techniques and innovative approaches that we have developed over the years to help people.  I have seen quite a few approaches to therapy and different methodologies come and go (anyone today practicing “Primal Scream Therapy”?).  I’ve certainly tried many different strategies to be of help to my patients, from EMDR to mindfulness training.  My experience, however, is that there is nothing more effective than focusing on our shared human condition.  

It’s my hope that when we sit in the big chair, we don’t forget our connection to the joys and sorrows of our own experience.  Without that awareness and appreciation of our happiness and suffering, how do we connect in a meaningful way to those experiences in others?  I believe that an important goal of psychotherapy is to help us cope with pain in a manner that doesn’t increase our suffering.  Through acknowledging our own painful experiences and how we have learned to cope, we share hope and reduce stigma. 

There’s Only Us, Part 2

There’s Only Us, Part 2

One of the people who helped me understand the reality of “there’s only us” was renowned psychotherapist Carl Rogers.  His book On Becoming a Person (Rogers, 1961) had significantly influenced my philosophy of human nature when I was working on my master’s degree in counseling psychology in the late 1970’s.  I was fortunate to hear him speak at the first “Evolution of Psychotherapy” conference in 1985 in Phoenix, Arizona.  He was talking about his life as a researcher, teacher and therapist.  He had shared several of the seminal experiences that shaped his work, many of which I was familiar with from his writings.  He shared a recent experience, however, that became another “awakening” regarding the “us and them” dilemma.  Not long before the conference, Dr. Roger’s wife had died.  He talked about the enormous impact of the loss and the profound grief he experienced.  He was still an active professional and continued to work following her death.  Coping with his grief was sometimes difficult.  What I was most struck by was his description of how isolated he felt.  He was the teacher, master therapist and mentor; it would be inappropriate to bring his own experience to the forefront.  He described that one day a student noticed his sadness and simply asked him “Are you OK?”.  Dr. Rogers shared his deep gratitude that someone had been willing to ask him if he was doing alright and to offer him compassion and an invitation to talk about his sorrow. 

I had often debated whether to share some of my experiences with depression and anxiety with my students and colleagues and had always chosen not to.  I instead maintained the aura of “professionalism”.  Dr. Rogers description of how isolating and difficult it was to contain his grief and the appreciation he had for the student who showed him compassion encouraged me to step out of the role of teacher and be a human being.  Now, when I facilitate classes on “Abnormal Psychology” (one of my least favorite course titles) or “Issues in Mental Health”, I tell my students about my history of panic attacks and periods of depression.  We talk about “us”.  When I first experienced panic attacks, I was fortunate to find a wonderful therapist and to learn some skills that helped me cope more effectively and remain free of symptoms for the past thirty years.  It was clear, however, that many students were currently experiencing the effects of anxiety, depression, and other mental health challenges.  Having open, honest discussions were helpful, so several of my students and I formed a chapter of NAMI (National Alliance on Mental Illness) on Campus to make our small college a more welcoming and supportive environment for those of us who have experienced a psychological challenge.  And who hasn’t been impacted by either their own or a loved one’s struggles with mental illness? 

Stigma silences many of us.  My concern was whether I could be considered an effective, competent mental health professional and teacher if I admitted that I had struggled with depression and anxiety.  During classroom discussions, many students were courageous in sharing their challenges with addiction, mental illness or trauma and I was always grateful for their willingness to be open and to confront the stigma.  When I first risked sharing some of my history with panic attacks and depression, I was grateful for the understanding and support that students and colleagues extended to me.  It gave them a chance to ask questions and for us have a dialogue about mental illness on a more personal level. The silence was broken.  Now, it isn’t “us” and “them”, there’s only us.  I think our willingness as professionals in the field to share some of our personal experiences can help better shape our students and trainees.  It certainly reminds us that we are a part of, not apart from, the human condition. 

Lessons from the Big Chair

This is a blog dedicated to the lessons learned by those of us who have worked as psychotherapists over the course of several decades.  I hope to share our experiences and pay tribute to those who have taught us these lessons; our patients, students and colleagues.  “Big Chair” is a reflection and dialogue about how this work has changed us and our understanding of the human condition. Hopefully, the work of a psychotherapist makes a significant impact on both those we serve and on us as well. Anyone who has been in the field for some time recognizes that the dilemmas our patients struggle with are reflections of problems we all face. It is my hope that this blog will provide an appreciation of the impact that this work can have on our own lives. I believe we set out to help others change and, in the process, change ourselves.

I invite those who have been working in the counseling and psychotherapy profession to share your experiences.  How has this career changed you? How are you different now than when you began?  What would you like to share with others about what this career has taught you?  What have been your most enlightening experiences, both positive and negative?  Please join in the conversation as we build this community.  I hope it will be a place of reflection, appreciation, learning and support.  Thank you for connecting with us.