Where You End & The Client Begins

Katie, an emergency department nurse, arrived for her session a few minutes early, still dressed in teal scrubs. We’d been working together for about a month. I was tying up loose ends from a busy morning with clients and a lunch break cut short by a consultation call.

“Okay, I’m just going to take a moment here so I can be present with you,” I said as Katie entered my consulting room and sat down. I made a subtle but important clinical choice based on what I knew about Katie, her goals in therapy, and my own past struggles with self-sacrifice. I sensed this was an opportunity to have her witness me engaging in a moment of micro self-care that could serve not just me, but maybe even our work together.

I closed my eyes and took a deep breath, noticing the feeling of the firm cushion beneath me. As I exhaled, I felt myself slowing down. I took another breath in and out, giving myself an opportunity to settle. About a minute later, when I opened my eyes, Katie was waiting patiently, gazing at me with a curious expression on her face.

A hardworking mother and wife, Katie was sensitive and thoughtful. She tended to feel hyper-responsible for other people, a trait that kept her hopping from one person’s need to the next. She knew she was depressed but couldn’t put her finger on why. My sense was that Katie had relinquished her inner knowing from a young age, keeping her feelings buried so as not to burden those around her. Over time, her chronic self-sacrifice had turned into self-abandonment, and she’d lost confidence in her ability to know her preferences, needs, and feelings.

“It’s really good to see you,” I said, feeling more present and available. “How are you?”

“I’m… good.” She was smiling.

“I’m glad to hear it. Where would you like us to start?”

“Well, it’s been a crazy day. This morning, my son forgot his lunch, so I had to swing by his school with something I picked up on the fly,” she said. “I ended up late for work, which I felt terrible about. Then we were slammed all day, and during my lunch break, my mom called in a panic about her health again, so now I’m feeling like I should make a trip to spend time with her.” Katie sighed as she looked around the room. “I was hoping to get a weekend to do what I want to do, but I guess that’s out.” As she looked at me, tears welled up in her eyes.

In some ways, listening to her pattern of self-sacrifice was like looking in a mirror. Katie’s issue was also my issue—one I’d been working on for years.

In moments like this, some therapists might feel compelled to “join” Katie in her frustration, as part of me felt pulled to do, saying, “Oh, I’m so sorry this is happening! I feel frustrated on your behalf!” But Katie had told me that with previous therapists, she’d always ended up feeling like she was helping them. She needed my help understanding where and when the emotional lessons feeding this pattern of self-sacrifice had taken place, so she could shift her focus away from over-giving and toward self-compassion.

My studies and training undergirded my work with Katie, but an important part of what I had to offer her also came from having done my own work around similar patterns.

Person of the Therapist

At our next session, after settling onto my couch, the first thing Katie did was close her eyes and take a few deep breaths. As her eyes fluttered open, I waited, careful to allow her to speak first.

“That moment last week was huge,” she said. “When I saw you breathe.”

“Say more about that,” I invited.

“I realized it’s okay to pause and breathe to slow myself down.” She shrugged shyly. “I did it a lot between patients this week, and it helped.”

I’ve worked with clinicians and teachers who practice brief centering meditations. Witnessing them give themselves space to breathe and become more present has had a greater impact on me than being given directives like “slow down” or “practice self-care.”

My own formation as a therapist has been shaped by this kind of relational learning, which is inseparable from who I am. And in my practice, my race, religion, spiritual philosophy, and cultural norms have intersected with my clients’ at times, raising questions I return to often. Knowing that my life experience informs how I do therapy, when do I disclose parts of my own story in the service of a client and when do I refrain? How do I bring my own experience of being a person into the therapeutic relationship in a way that’s helpful rather than harmful?

These questions demarcate what our field calls the Person of the Therapist (POTT)—how clinicians incorporate their own life experience, including their values, into work with clients. And yet, how we operationalize POTT remains slippery, elusive, and nebulous—more of an art than a science. The guidelines on how to do this safely and ethically aren’t generally taught in graduate school.

Although family therapist Harry Aponte formalized POTT as a framework for understanding how our life experiences shape our clinical work, the idea of it is threaded through multiple therapeutic traditions, and I was learning about the therapist’s use of self long before Aponte’s book was published.

My graduate program emphasized mind–body–spirit integration and required weekly individual therapy and group process sessions. The coursework included writing reflective papers that encouraged us to look inward at our experiences and articulate them in pairs and small groups. Class discussions were engaging and deep. Teachers were accepting and invested. With a small cohort of students of varying ages and socioeconomic statuses from different parts of the country, I felt safe enough to be vulnerable and share, even when my classmates’ perceptions and perspectives were different from mine.

In one of my earliest sessions in our process group, my teacher asked for a volunteer. My hand shot up; I was eager to dive in and experience the work. Then, as I felt the entire cohort turn their caring attention toward me, a massive lump rose in my throat, and I broke down and cried.

In debriefing the experience, a classmate inquired about my sadness. “What made you so sad?” I felt myself grow teary again. I didn’t have words to explain it and felt guilty for taking up the group’s time with something I couldn’t articulate.

“I don’t know,” I said. “It just erupted.”

Later, I realized my sorrow was related to a lifetime of feeling unseen and suppressing my voice and emotions. Being witnessed and held by the collective energy of the group touched a deep wound—even as it also provided healing.

Over time, reparative training experiences like these helped me pay attention to my values, access somatic cues, and use my voice to connect authentically. I grew increasingly aware of my body and mind not only as a way of understanding myself, but as tools to use in the therapy room.

Had I not had this training experience, I imagine I would’ve been inclined to empathize with Katie without supporting her to attune to her own values or access her internal somatic cues. I might’ve commiserated with her identity as a daughter and mother, in a sandwich generation, or suggested being assertive with her husband about taking on more childcare responsibilities. But for women like Katie, the deeper work is about how she relates to herself. Pausing and attuning to our own feelings, sensations, and thoughts is how we begin undoing our conditioning to default to external cues.

Learning to Skillfully Use Oneself

In sessions, I often ask myself, “How might presenting a new perspective or sharing some of my own experience support my client’s goals?” This could mean disclosing that I, too, am a stepparent, or naming the value I’ve found in paying attention to the gut-squeezing reaction that lets me know something’s amiss. It could mean empathizing with the challenge of deciding to go no-contact with a family member. Discernment is the key when it comes to knowing what to share. The reality is that the same disclosure—“I know how hard it can be to lose a parent”—might validate a lonely client while leading a self-sacrificing one to disconnect from their grief and shift into caretaking mode.

Because I knew Katie’s goals for therapy included prioritizing her own needs and developing a stronger sense of self, I was on the lookout for opportunities to demonstrate what had worked for me on both these fronts. Witnessing me make space for myself, which helped me make space for her, gave Katie permission to do the same.

Aponte’s POTT model highlights the idea that each person has a “signature theme”—a core pattern related to culture, early family-of-origin experiences, traumas, and personal struggles that show up in the work. The schema of self-sacrifice is one of mine.

Growing up with caregivers who were sometimes volatile and at other times aloof, I became hyper-responsible, monitoring others’ moods to keep the peace, anticipating their needs, and making myself small to stay safe. Katie’s story echoed my own. I knew from experience that helping her recognize her own needs could jumpstart the healthy self-interest she hadn’t been able to access in her family of origin.

Katie had told me in our first session that she didn’t know what she wanted other than to “feel better” and “be less tired.” She feared the guilt of letting others down and felt pulled in different directions by commitments and relationships that no longer felt satisfying. I wanted to help Katie see that her perpetual self-sacrifice was creating her depression and fatigue. And, according to Aponte, it’s okay that my own self-sacrificing tendencies weren’t entirely resolved as I helped Katie work with hers.

We don’t have to completely resolve our issues to use ourselves and our experiences in service of clients’ healing. As one of my favorite grad school teachers used to say, “Sometimes we’re just a single step ahead of our clients.”

“Last night, Mike got upset as he was getting the kids ready for bed, and I just took over,” Katie admitted with a sigh. “His frustration made me uncomfortable—like he was upset with me—and even though I’d just come off a 12-hour shift, I told him I’d handle it.”

She could have been recounting bedtime in my house not all that long ago. Stay focused on Katie, I reminded myself. The smash-the-patriarchy feminist in me wanted to shout, “Women do endless amounts of childcare and emotional labor—what about what you need?!” The Mama Bear in me wanted to commiserate. And the Buddhist psychologist in me wanted to offer, “Mike is also a suffering being.” Luckily, the recovering self-sacrificer in me knew that gently confronting her and helping her see what she herself was doing to perpetuate her resentment and exhaustion would likely be most helpful. I knew this because during my graduate school days, being compassionately challenged by my own therapist to consider my part in self-betrayal had made a big impression on me.

“And how was that for you?” I brought awareness to my body to center myself. “What’d you notice when you took over?”

“Honestly, it didn’t feel great. I was tired. I wished he’d just handled it. Once the kids were in bed, he wanted to hang out and watch a show, but I felt annoyed and exhausted and wanted to be alone.”

“So, you jumped in to save him because his anger felt uncomfortable,” I said, “even though you were running on empty. And this led to feelings of isolation and resentment.” I spoke slowly, hoping to convey through facial expressions and body language that I was familiar with the shame of self-betrayal. “In saving him, you sacrificed yourself.” I kept my voice gentle as I tracked the impact of my words on her.

Her tense shoulders softened and she looked down.

“You’re right, I just…” She slowly shook her head and reached for a tissue. “I don’t know why I do that or what I should do differently.”

“What you’re doing makes sense for the inner child part of you. As you’ve shared before, that part found a way to stay safe and connected by taking responsibility for your mom’s overwhelm. But today, taking too much responsibility creates a disconnect with Mike. When you’re over-giving, you end up resentful.”

Katie nodded. I could feel her tenderness and grief. We took several quiet moments together before moving on. “When you’re ready, let’s talk about other ways of responding that might help you stay in your emotional lane rather than swerving into Mike’s.”

A few weeks later, Katie shared a similar incident. This time, the outcome was different.

“I could tell Mike was getting irritated with the kids again, but I reminded myself that he’s allowed to have his feelings and experience of parenthood. That’s not my responsibility to manage. So, I closed my eyes, took a breath, and felt my aching muscles. Then, I said, ‘You’ve got this,’ and went to take a bath. After he got the kids to sleep, we cuddled and watched some television.” She smiled and her eyes sparkled. “It was nice.”

This was a major shift for Katie.

As therapists, we’re trained to listen for content, track patterns, and formulate interventions. But there are moments when what heals isn’t just what we say, but how we are. Moments when the client isn’t taking in our words so much as watching how we show up, both for them and for ourselves.

The paradox of POTT is that our lived experience becomes most useful not when we share it, but when we metabolize it—when we’ve worked with our own patterns enough that they show up as steadiness, restraint, or the ability to stay with our clients even as they grapple with strong emotions, painful beliefs, and self-sabotage.

I still have moments when I self-abandon. My body tenses and I feel pulled into old, familiar patterns. At other times, I slow down long enough to feel my breath and body and a subtle space opens up within me where I find freedom to choose how I want to respond. This is what we invite our clients to do, too.

Katie’s growth reminded me of why who we are as people is never really separate from our work. How we show up in the clinical space, with all our issues—resolved and unresolved—is what has the greatest impact on those we serve. Ultimately, the question isn’t whether our struggles belong in the therapy room. It’s relating to them in new ways that help us show up skillfully for the people we serve.