My mind was racing as I gripped the steering wheel. What if we shouldn’t be together? What if this relationship isn’t enough? What if I don’t love him enough? What if we’re together for the wrong reasons? What if . . . .
My heartbeat accelerated. My chest constricted. I felt flush as the thoughts came faster and faster, tumbling over one another, vying for my attention. I was headed toward a full-scale panic attack.
In my mind, I pored through snapshots from my relationship with my partner, searching for proof that we should be together. I revisited the funny moments and the times I felt deeply in love. I replayed those scenes in my head like applying a balm, trying to reassure myself that I’d made the right choice to be with him. Finally, my breathing began to slow, and the muscles in my chest loosened their grip. I turned up the radio and stared at the stretch of highway ahead. Then, my brain found some weakness in my argument, some question I didn’t have a ready answer for, and the panic stepped back in as the what ifs restarted their chorus. I let out an exasperated sigh as I exited the highway and headed toward the clinic, where I’d be seeing clients as a marriage and family therapist intern.
Once in the clinic, I slipped into my routine. I did my paperwork. I helped prepare the rooms for sessions. I met with my supervisor and fellow students to discuss our cases. I joked with a friend about a Sal Minuchin video we’d seen in class of him smoking in session and telling a family exactly what he thought of them. From behind the one-way mirror, I watched another therapist intern meet with a couple. I went into my assigned room and met with my clients, one after another. In between sessions and meetings and paperwork and laughing with friends, the thoughts would try to sneak back in—what if . . .—before I’d hush them away, reminding them that now wasn’t the time.
But, as usual, back in my car after a long day at work, there they were, waiting for me, ready to pounce full force.
Why Can’t I Fix Myself?
My graduate school years were some of the most difficult of my life. For the usual reasons, but also because my focus on my relationship wasn’t the byproduct of a distressed partnership, but a manifestation of my obsessive-compulsive disorder. The particular O in my OCD focuses on romantic relationships, contamination, and, before I left the faith, scrupulosity. OCD tells me I need to be certain that touching my earring won’t infect my hand with germs, or that thinking a cussword won’t send me to hell. It tells me I need to be certain that I’m with the right person. Of course, none of these things is certain. OCD seeks certainty in a world that offers none.
In graduate school, my symptoms were at a peak. When my brain wasn’t fully occupied, it churned through a series of intrusive thoughts, catapulting me through the same fears over and over again. My body simmered with anxiety, at times culminating in panic attacks. I lost weight from not eating enough, and from not being able to keep down what I did eat. I was in weekly therapy, and had been for years, but I wasn’t getting better. At one point, I considered admitting myself to inpatient treatment.
It’s been 10 years since those difficult times, and my OCD is more effectively managed now, but—like most folks who have chronic mental illness—I still have to work at keeping my symptoms at bay. To much of the public, mental illness conjures images of people restrained in psychiatric wards who have difficulty staying employed or maintaining meaningful relationships. But most of us with mental illness go to work each day, get married, raise children, and so on. Most of us are hiding in plain sight.
As a culture, we don’t have the language for what it means to struggle with mental health issues and continue to perform well in life. That day in grad school, I was able to have a near panic attack and then walk into the room to do therapy, because functioning while highly anxious is how I’ve survived. I had OCD while waiting tables in high school and while studying in the college library. I had it while standing in the breathless heat of July on my wedding day. I’ve lived with the disorder longer than I haven’t.
It didn’t feel unusual for me to be in crisis and still show up, because that’s what I’d always done. But at some point, I started to feel like a hypocrite. Here I was, ostensibly learning how to help people, but unable to help myself. For the first time in my life, it didn’t feel okay to have mental illness.
In my last job before graduate school, I’d told a coworker about my OCD. “Oh Erica, a disorder?” she said incredulously. “Are you sure?” I answered yes, firmly. I didn’t shrink from the truth, and I wasn’t ashamed. But when I became a therapist, something shifted. A mix of therapist culture and my own ego led a part of me to believe that because of my training, I should be “fixed” by now—that I should know how to fix myself.
Recently, a debate raged on #TherapistTwitter over whether clinicians should drink a beverage while in session. Not alcohol, but any drink! (Apparently, therapists don’t get thirsty?) Last year, in a Facebook group, I saw one clinician chastise another for yawning during a session. They’d never yawn in session, this person told the other therapist, and they couldn’t ever imagine doing so. These kinds of judgments come from the misconception that to be a therapist is to have no needs, weaknesses, or issues of our own. Instead, we’re to serve as a perfect container for our clients’ pain with no smudges, chips, or cracks in our professional veneer.
We all know this isn’t realistic. Even therapists without a mental illness struggle. If you do this work long enough, eventually, you’ll experience anxiety, depression, grief—or a global pandemic. Having to hold our own pain while we meet the pain of others is inevitable.
A Way Forward
Navigating our own inner pain, psychological or otherwise, is a part of our work as therapists. Despite our education and experience, knowledge about a condition or problem doesn’t make those struggles go away. I’d known for years that I had OCD, and once in training, could fully describe its symptomology and recommended treatment approaches. But insight did nothing to improve my symptoms.
It was perhaps the third (or fourth?) medication I tried that had a significant impact. Within a few weeks of taking it, I began to experience relief from daily intrusive thoughts for the first time since adolescence. I hadn’t known—or at least couldn’t remember—what I’d been missing. Going through each day without a choir of doubts and fears playing on an endless loop in the background was foreign to me. I marveled at life with a quiet brain.
I would’ve stayed on the medication indefinitely, but it killed my sleep. While my daytime anxiety decreased significantly, my brain was on high alert at night—not about anything in particular, but it wouldn’t stop yammering in the dark. I tried sleeping pills. I tried alternating days of taking meds and not. I tried not taking meds on the weekend so that I could recover from the sleeplessness of the week. But the exhaustion wore me down, and I stopped taking medication altogether.
One afternoon, riding in the car with a friend, I realized the meds were fully out of my system. I reflexively turned down the volume on the radio—not because the music was too loud, but because my brain felt overwhelmed. There wasn’t space in my head for my anxiety and the music. As I adjusted the knob, I realized the last time I’d done this was several months earlier, before I got on the medication. On meds, I had the mental energy to ignore what annoyed or distracted me. Off meds, my brain spent much of its time focused on my anxious process. Filtering out other inputs was too much work.
That moment confirmed that I’d need to find another way to manage my symptoms. To combat the slide back into old mental patterns, I decided to practice using tools from Acceptance and Commitment Therapy, a model that had proven helpful to many clients I’d worked with. ACT teaches that painful thoughts, feelings, and circumstances are unavoidable. Instead of wasting energy and time trying to get rid of them, we focus on living according to our values—the principles, behaviors, and ideas that are meaningful or important to us.
ACT teaches that engaging with a thought—even challenging it—gives it power. Instead, we allow thoughts to be, and choose how and when we respond to them. When the thought creeps in my head that maybe I shouldn’t be in a relationship, I can let the thought exist without arguing with it or needing to prove it is or isn’t true. I can go further and tell myself, maybe it is true, who knows? I can never know if the person I chose to be with is the absolute best choice I could’ve made. What I do know is that I’ve made a choice to live by my values, and my values include commitment to this person I love.
I’m not cured and still deal with daily anxiety, but I have more joy than I had before. OCD left so little space for me. To roam more freely is a gift.
The Therapist as a Whole Person
It’s an open secret that many clinicians deal with mental illness, and this is often a catalyst for us getting into the work. But we don’t talk publicly about what it’s like to be a therapist while struggling with our own mental health concerns. Instead, we put ourselves in a double bind. We preach that mental health issues are part of the human condition and encourage others to release their shame surrounding mental illness, but then we tell fellow clinicians they shouldn’t show their needs or struggles. How can we expect a therapist to feel safe admitting they’re having a depressive episode when they’re attacked for yawning during a session? How can we share that we’re having panic attacks when we’re not supposed to need (or just want!) a glass of water in the room? Who is this mythical therapist who has no pain, no fallibility, no body?
My hope is that I can help normalize the idea that clinicians can share their own battles with mental illness. We owe it to ourselves and each other to be honest about our own challenges and respond to our colleagues with compassion. We aren’t, in fact, perfect vessels for the suffering of others. By sharing our own difficulties, we increase the likelihood that colleagues will feel safe enough to ask for help when needed. We deepen our empathy for clients by recognizing our mutual struggle, and we avoid taking a position above the fray, in a place of unattainable and unrealistic perfection.
I’d been honest with my peers and my professors about having anxiety in graduate school, but I hadn’t shared the depth of my symptoms, or how much I was suffering. Part of me had worried that if I had, I might’ve been dismissed. Despite strong grades and evaluations, I hadn’t known whether my professors would believe I was capable of doing therapy while struggling. I’d worried they’d think I was “too broken.”
I wonder how different my experience would’ve been if I’d trained in a time when more therapists were sharing their own experiences with mental illness. What would it be like if we discussed how they navigated these conditions while still showing up for clients? What would it mean for our understanding of how people continue to function at high levels despite their symptoms? How might it help a clinician recognize and accept when they need to step back from their work?
Finally, how might it help us develop empathy for our colleagues—something we extend so easily to clients but often seem to lack with one another?
PHOTO © ISTOCK/SDI PRODUCTIONS
Erica R. Turner, LMFT, is the owner of Rosewater Therapy, as well as an Adjunct Faculty member in the Couple and Family Therapy program at the University of Maryland, College Park. She’s the cofounder of Therapy is Not a Dirty Word, an events and advocacy program that works to bridge the gap between therapists and the public. Visit www.rosewatertherapy.com.