Thursday, June 28, 2012

On Being a Psychotherapist

Clients, as well as friends, often say to me, "I don't know how you do your job," and then follow it up with one of the following questions or comments.

"Don't you get tired of hearing people whining?"

The answer:  Occasionally, but not as often as you might imagine.  For the most part, at the point someone picks up the phone to engage my services, they are ready to do something different.  They are suffering, or struggling, or overwhelmed at the moment,  and their usual ways of coping are not enough, or may even be making things worse.  And while they may be temporarily stuck in a state of victimhood, or self-absorption, or worst of all, hopelessness, the pain is real, and the courage and trust it takes to enlist the help of a stranger to find a way out of the suffering is a very good sign.  No one truly wants to be miserable; it may simply have become a habit, a default mode of existence.

That being said, I too am human, and occasionally when a client is going down that road AGAIN, I think of Billy Crystal (Dr. Ben Sobel) in Analyze This:  He is listening to a client, complaining about her boyfriend Steve for the umpteenth time, and he begins to fantasize a response:

Dr. Sobel: Well, what I think you should do... is stop whining about this pathetic loser. 
[Sobel stands up] 
Dr. Sobel: You are a tragedy queen! "Oh, Steve doesn't like me!" "Steve doesn't respect me!" Oh, who gives a shit? GET A FUCKIN' LIFE! 

"Isn't it hard to just listen all day long?"

The answer:  Listening is important, and something that comes easily to me in this setting, but I damn well better be doing more that just listening.  It is a very active listening, one in which I am both emotionally engaged with my client and reflecting that engagement, while also a part of me is stepped back and observing, contemplating the meanings, implications and nuances, making connections with what else I know about my client.  Then, there is a response of some kind required, allowing the right words to come forth which might help them toward greater self-awareness, self-acceptance, insight and motivation to move beyond their current situation and habitual modes of responding.    Sometimes, just bearing witness in a compassionate and non-judgmental way to someone's experience is all that is necessary, at least until I feel more sure about what the helpful thing to do or say actually is.  But my style is fairly interactive and pro-active, not just reflective.

Best advice I ever got from a supervisor:  When you are not sure what to say, don't say anything.

"It must be draining/stressful/difficult to hear so much pain."

The answer:  Yes, sometimes it really is.  Rape, assault, emotional abuse, sexual abuse during childhood, addiction, death, grief, loneliness, self-loathing, betrayal, dreams deferred, utter and abject hopelessness, intense suicidal thoughts and feelings...yes, some days are harder that others.  I try to make sure that I meet my needs for socializing, exercising, rest, fun, meditation etc. so that I have energy reserves and balance.  The more experienced I have become, the easier it has gotten (usually) to keep boundaries in place and to know my job is not to be the savior.  And embracing the idea that pain is a part of life, but suffering need not be so, helps too.  Pain is not mine to take away, and it is in the suffering I can be helpful, but ultimately the degree to which someone profits from what I am able to do is not in my power either.

But I know I carry it sometimes.  When I get a deep tissue massage, I can tell that my back and shoulders are the physical repository for whatever I haven't let flow through me, professionally and personally.  I was surprised the first time I cried on the massage table; now when it happens, I understand why.

"How do you know what to do?"

The answer: Like all professions, mine has its techniques and its knowledge base to apply. God knows all that time spent in school and on practicum and internship better have taught me something.  And like all other sciences, it has empirical validation.  Like all healing practices, it has various interventions.  Like all relationships, it is based on shared humanity. And like all creative arts, the psychotherapeutic interaction is something alive and emerging in the present moment.  Each moment is unique, and when I am most genuine, responsive and attuned, experience and intuition guide me as to how to best respond.

However, it should go without saying that sometimes I don't know what the hell to do.  Occasionally in a session with someone I am distracted and off-kilter and I feel like I should refund their copayment.    Sometimes I totally put my foot in it and I will say or suggest something that is way off the mark from where my patient actually is.  Luckily, most people are forgiving of this and will simply correct me so that I can get back on track with them.

And sometimes I feel like I am not being helpful at all, because I am not seeing evidence of what I think  should constitute improvement, or change, or diminishing symptoms.  That is when a collegial consultation comes in handy.  Other times, I simply must remind myself that I never see the full picture from an hour in my office, and that some things take a lot of time.  And finally, sometimes things simply not getting worse is actual improvement.

The bottom line is, it is often hard for anyone to imagine doing someone else's job.  Mine is not especially heroic or unusual.  I can't fathom being an ER surgeon or  a soldier, but neither can I really imagine being an accountant or an architect.  If we are lucky, that is because we are doing exactly what we feel we are meant to be doing, and simply can't imagine it any other way.   So what seems impossible or boring or frightening to the outside observer does not feel that way to the person doing it.

I do feel lucky.  I love being a psychotherapist.  I feel honored and humbled to be trusted to walk with someone for a part of their path; at best, this allows me to be an agent of healing.   At worst,  I am simply present with someone, perhaps planting a seed that will blossom later.  

What is not to love?

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