Q: In the mid-sized city where I practice, I’ve become one of the “therapists who see therapists.” The problem is, I’m not sure I like providing psychotherapy to people like us. Maybe because we swim in the same waters, their defenses are sophisticated and hard to recognize. They know too much about the “backstage” of the therapeutic process. Though I like and admire these clients, I also dread my meetings with them. What do I have to offer that they don’t already know?
Part of the magic of psychotherapy is that most of our clients don’t fully understand how it works. Mystery can produce powerful placebo effects, such as the instillation of hope and the activation of the client’s own self-healing capacities. One of the reasons I find acupuncture and Chinese herbal medicine so helpful, for example, is that I have no idea how they work. When my acupuncturist explains what she’s doing and why, I nod, but really, I’m dumbfounded. My ignorance is part of what potentiates the effects of the needles and bitter-tasting herbs. I trust her because she’s kind, has a cool office with a relaxed vibe, takes her time with me, pays close attention to where I’m hurting, and is confident in what she’s doing.
Our clients who are healers themselves and seeking relief through modalities they may have received training in and know quite well, have fewer illusions—especially if they’re seeing a therapist who practices from a similar theoretical orientation. So, how do you remain confident and reclaim some of the magic inherent in the process?
Authenticity
From the polyvagal framework, we know that the focused attunement of a psychotherapist who is genuinely paying attention—sometimes called right hemisphere to right hemisphere engagement—lies at the heart of psychological healing. Psychotherapy is a process that takes place in a rich co-regulatory environment where two nervous systems join to alleviate suffering: one to tell the story of adversity with emotional authenticity and one to hold it with steady compassion; two bodies in sync. To accomplish this alignment, the emphasis on my own expertise and what I know about research and theory doesn’t matter and actually can produce an unhelpful distance.
Rather, with my therapist-clients, I’m more likely to share vulnerable facts about myself, about my marriage and parenting experiences, and my experiences as a son and a therapy client trying to get over my own carefully curated professional self to get at the real, messy issues I most need to address. I’m careful to minimize how much time I take up with self-disclosure —after all it’s their hour!—but this kind of honest, relatable sharing supports a deeper, more fearless connection. It levels the playing field, lowers anxiety, decreases feelings of comparison and competition, and increases safety.
Identifying Self-Protective Habits
There are a couple self-protective habits that I’ll gently identify and invite therapist-clients to explore. As children growing up, many therapists were lauded for being good, intuitive listeners and compelled to take care of others in ways that distracted them from their own developmental needs. When they attended graduate school, they learned additional skills that make them even more powerful as listeners and counselors. They learned the guardrails of the therapeutic role, the boundaries and compartmentalization of their own needs, which makes them effective professionally, and they became increasingly intentional and strategic in how they navigate relationships: expert interpersonal chess players! Unfortunately, in their personal lives, these habits of careful self-curation can distance them from their real human selves and from family members and friends. It can make it even harder to get their own human needs met. In our real social and family lives, we all want to be seen and known, but we can’t be seen behind a mask.
Often, I begin a session asking a therapist-client: “Tell me how you’re doing this week.” What often follows is a thoughtful—and interesting!—case conceptualization of her husband. I ask the same question again, curious about them—“But tell me how you’re really doing”—and this time they give a case conceptualization of their daughter. There’s a countertransference challenge here. I usually find the case conceptualization answer compelling and might be seduced to listen, but in this situation, it’s an unhelpful collegial behavior. I’ll be fooled into not paying attention to them. “Do you notice that your responses to my question are about other people, but there’s no ‘you’ in your story?” I’ll ask.
With my therapist-clients, I find it useful to discuss the ways at the end of their professional day they bring their therapist self home, case managing or counseling family members, in ways that may be helpful to the family member, may even be appreciated and lauded, but that’s ultimately dishonest and disconnecting. It’s a way they shortchange themselves in their personal relationships by neglecting their own needs. All of us do a little of this, but there can be a temptation to lean too heavily on therapist skills in nontherapy relationships to our own detriment.
The Self-Therapizing Client
Another self-protective habit I notice with therapist-clients: They tell me a story about their lives, one with genuine struggle and confusion, and then launch into what they know about how a therapist would respond to them. “Of course, I know this is a normal response when parents launch their children into college and the grief I’m feeling won’t last forever. I can use self-regulation skills to manage my feelings.” It’s almost as if there are two halves to their response: their real human story of struggle and then what they’d say to themselves if they were their own therapist.
This could make for an easy session: I could just kick back and let my client do all the work! But in reality, it shuts me out of the therapeutic relationship. The client doesn’t sit with their own vulnerability and give me the chance to accompany them. I’m simply watching them be their own therapist. “Do you want to stay with the sadness and struggle for a bit longer?” I might offer. “Do you want to allow me to be with you in the messiness of it, without having to clean it up with therapist talk too soon? You don’t have to be so alone with all this.”
Embracing Messiness
With their highly cultivated sense of interpersonal intention at work and at home, therapist-clients can struggle with a deadening lack of spontaneity and authenticity. I often encourage these clients to imagine how they’d engage in specific situations with people in their lives from a sloppier, less curated place. What would it look like to relinquish control a little bit? Or to value their irrational and confusing emotions as portals to the real? Can they tolerate raising the temperature in their personal relationships a notch or two and expressing anger, disappointment, and fear? Would it be okay to act in ways that might not feel appropriate as a therapist in a room with a client, but that could infuse their home lives with genuineness and life force energy? Can they tolerate an escalation of a personal conflict into an uncertain outcome that’s not under their total control and influence?
Our therapist-clients can be some of the most vulnerable clients we work with. Because the work they do is so taxing, physically and emotionally, it can predispose them to illness, depression, and anxiety. Their training compels them to compartmentalize their own feelings and needs. They’re far more prone than most clients to develop professional habits that bleed into their personal lives and lead to feelings of loneliness and emptiness. The therapy we provide offers them a chance to flex into a different part of their brains and nervous systems, to be messier and more spontaneous, and ultimately to feel seen and cared for in ways that benefit them, their families, and ultimately their own clients.
Wayne Scott
Wayne Scott, MA, LCSW is a psychotherapist and writer in Portland, Oregon. His memoir, “The Maps They Gave Us: One Marriage Reimagined,” about a couples’ adventures in marital therapy, is available at: https://www.waynescottwrites.com/.
