I am often asked what it is like to be a therapist. I guess people are naturally curious about a person who gets to hear so many secrets about so many lives. So in response I thought I would just type, in a stream-of-consciousness sort of way, about what it is like (for me) to be a therapist, how I approach the work, the rewards and the challenges. This will not be a comprehensive description of my or any therapist's approach. That said, here goes:
First I must say that it is an honour to be graced with the gift of peoples' life stories. It never ceases to amaze me the highs and lows people have experienced in their lives. So many twists and turns, yet surprisingly always similar, common themes of the triumph and turmoil in a human life.
Since I do not work in a medical setting, I refer to those who come to me as clients, not patients. As well, most people I see are not 'sick' and thus do not qualify for the term 'patient', to my mind. If they are at immediate risk of hurting them self or someone else, I make sure they see a psychiatrist in a hospital setting for diagnosis and treatment. Usually, it is people who feel stuck, depressed, discontent or anxious about their lives who arrive as clients. Most folks who enter therapy are 'regular' people who just want some help over a particular hurdle or who want to reflect on persistent patterns in their life.
I have learned over the years to pay very close attention to the first things a client says when I greet them. While it may seem like some mundane, weather-related or getting-to-know-you remarks, they often are harbingers of issues, paradoxes, even insights that will emerge in the session. Sometimes after the initial greetings, I will think to myself, "Well, that little law of first statements will not apply today", and invariably once into the session I will find myself making a link back to what they said when they entered the room. It's quite uncanny. The psyche seems to have its own agenda, quite unconscious at times for the person, but revealed in everyday comments as they enter the door.
I set my office up as a comfortable 'living-room' type setting. There is never a desk between the client and myself as that would be a barrier or boundary which could inhibit free conversational exchange. Perhaps there are psychoanalysts that still use 'the couch', but I do not know of any of my colleagues who do not sit across from the client facing each other (unlike the stereotypical seating-arrangement in the cartoon above).
Sometimes I have wondered at a first visit if I was suited to work with a particular client, noting that I did not find them likable, or found them somehow 'off-putting'. Without exception, by the end of the work together, I will have discovered many endearing, likable aspects to the person Everyone is likable and lovable if you take the time to get to know them. Okay, almost everyone ... but the almosts are very rare.
One could not be blamed for assuming that psychotherapy is an easy job - park yourself in a chair, listen, take a few notes, make a few pithy, well-timed, helpful remarks and you are done. Well, from my perspective ... not quite. Good psychotherapy requires focused attention and attunement on multiple levels. This multi-leveled attunement requires a lot of energy.
Every client comes in with a story to tell. As they tell their story and explain their problem or issue, as the therapist I must simultaneously be attuned to the following:
* the details of their story - the words, the content, the players, their childhood history, etc. etc., so I can respond sensibly and the person can feel understood
* the non-verbal signals - how does the way they use their body speak of their struggle(s) -- what is their body saying that is not evident in their words/story -- are they able to maintain eye contact
* what is the person not saying, leaving out, avoiding talking about -- what might their psyche be trying to tell me that is not evident in the content of the story/words ...
* what is their ego strength -- are they able to cope with the stressors in their life -- are there ways that they are at risk (or could put other persons at risk) -- how defended are they against reflecting on the truth of their life -- how able and/or willing are they to confront their pain -- how able and/or willing are they to make changes -- how identified are they as the 'victim' in their circumstance -- Making these assessments tells me, among other things, at what speed I can proceed with the work ahead ...
* what key pieces of developmental growth work are they resisting or avoiding -- what might be the underlying issue that eventually has to be addressed
* are there immediate ways they need help to manage stress -- do they have support in their life -- how alone are they in the world
* are there ways I can offer some immediate affirmation for how they are handling their situation
Some of the above is trying to assess, beyond their written intake history, what it is like to walk in this person's shoes and live in their mind ... This is called attunement. Clients perceive when the therapist is well-attuned to them and their situation and this helps them feel relaxed and at ease.
Clients need to be informed of the therapist's particular approach (cognitive/behavioral; psycho-dynamic; Jungian, etc. etc.) and of the ground rules and expectations of the joint work together (honesty, no self-harm, confidentiality, etc.) And, of course, the client needs to be able to ask any questions in order to feel comfortable enough to proceed. I always tell clients at the beginning of a first session that they should be assessing their comfort level with me and if they are not comfortable to feel free to continue the search for the right therapist for them. It is always evident this comment is appreciated and I don't recall anyone has taken me up on the offer - yet.
Each person enters the consultation room with their own special vibe or energy. Some come seeking energy (without being consciously aware of it) and can leave a therapist feeling sucked dry. I have found this feeling in myself is often a signal of a certain personality disorder in the client. This is another area where a therapist has to attune their attention - assessing their own reactions to the client. Their own gut reactions to the client hold a lot of information - but first the therapist must sort out whether it is truly information about the client, or if it is information about them self and the work they (the therapist) need to do!
Well, that is enough of my rambling for now. I hope it has given you a tiny glimpse into what it is like to work as a psychotherapist. Do keep in mind that therapists all have their own approach and style and that no two will be the same. I know there are therapists who read this blog and there may be some screaming "but you forgot ....", and I know I have left out tons of essentials ingredients that make good therapy soup - but I have simply shared the ones that came to mind for today. Perhaps I will write more at a later date. If you have questions I will be glad to answer them.
The thought is quiet as a flake
A crash without a sound
How life's reverberation
Its explanation found!
It is a joy to be hidden but a disaster not to be found.