Decades ago, I got interested in finding the correlations among a client’s perceptions of therapy, the therapist’s view of it, and an outside researcher’s observations. So I asked a colleague to interview some of my former clients to record their notions about what had happened in therapy with me. Beyond their self-reporting, she made her own evaluation about how well they were doing now. Then, without telling me their experiences or her assessments, she recorded my recollections of the cases.
It was a lot like celestial navigation. We planned to take the sights of three different stars (so to speak) and find where they intersected—so we could discover where we are and where to go from here.
The results were startling.
The mother in one family reported, “Dr. Treadway saved our lives. We’d never have made it without him.” The two adult children and the father had nodded in solemn agreement. Yet my researcher observed that the daughter was still severely anorectic, the mother was frantically trying to manage everyone, and the father had clearly been drinking prior to the interview. My recollection of the case was that the therapy had ended with no progress when the family’s insurance had run out, but apparently they felt it had been successful.
Conversely, another family, which I’d always considered to be one of my stellar success stories, reported that the therapy had been completely ineffectual. They attributed the dramatic improvement in their situation to the fact that they’d started attending church together during the same period.
The coup de grace was the interview with my former client Susan. I had fond memories of my 18 sessions with Sue, who’d come at the behest of her parents during her first year of college. I’d liked Sue immensely, and remember trying to be a wise, kind, safe therapist for her, one who could help her navigate the treacherous waters of college life.
Sue was in law school when she said the following to my researcher: “Oh, I remember Dr. Treadwell. He was a shrink my parents made me see a couple of times during the first few weeks of college. He was a nice enough man, I guess, but I don’t actually remember whether therapy was helpful.” After a beat, she added, “Oh, wait, I do remember something. One time he walked me to my car because it was late and the parking lot light wasn’t on. He said something incredible that changed my life that night.”
“What did he say?” my researcher asked eagerly.
After a long pause Sue replied, “Gee, I don’t remember.” And when my interviewer asked me about it, I didn’t even remember the walk to the car.
Did that one moment in a parking lot really change Sue’s life? What role does therapy play in helping people change their lives, anyway? Is it hubris to think that what we do makes any difference at all? I’ve always been interested in these questions—and at times they’ve haunted me. But from my vantage point at the end of long career, these questions seem inextricably linked with the privilege and pain of our calling as therapists.
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As I reflect on this calling, and what’s kept me doing this work for so long, I remember two of my early clients, Chip and Ann. They were just 21 when they’d gotten married, but by that time, all four of their parents had died of alcoholism. Chip was a factory worker; Ann was working as a secretary. This was in 1984, and they were both miserable—newlyweds drowning in the responsibilities of trying to make ends meet and parenting Chip’s three younger siblings, who were living with them in a tiny apartment.
In the first session, Ann complained about Chip’s drinking, and he complained about her nagging. They readily acknowledged that they were completely overwhelmed, exhausted, and agitated. A sense of hopelessness pervaded the room. Despite my best efforts, the session was going nowhere, and then, out of the blue, I asked them about their first date.
They started to chuckle.
“Well, Doc, I wouldn’t exactly call it a date,” Chip said with a sheepish smile.
“No kidding,” Ann chimed in. “It was pouring rain, and a bunch of us were huddled under the bleachers at a high school football game. I was freezing my ass off because I was in this stupid cheerleader outfit, and this lug I’d never seen before offers me his letter jacket. Big hero he is,” she finished with an affectionate nudge.
“Yeah,” he winked, “she wasn’t complaining, either.”
Now they were both laughing with each other.
“The next thing I know, he’s trying to warm me up by putting his arms around me,” Ann went on. “That actually felt good, but all of a sudden, he tried to kiss me, and I yanked my head back, so he ended up planting a wet one on my chin. The guy had no moves.”
“You married me, didn’t you?” he retorted somewhat flirtatiously.
“Fuck you, clown,” she teased back, blushing.
“Now you’re talking,” he said with a leer.
They left that first session holding hands—and I thought I’d done great work.
But as we continued together, Chip’s alcoholism slowly got worse, and Ann got to be more and more of the classic overfunctioning, micromanaging spouse of an alcoholic. Still pretty young, I tried everything I knew to do at the time, and became somewhat of an overfunctioning, codependent therapist. In truth, I ended up sort of adopting them. I hung in there with them for years. Nothing changed until Chip got a DUI, finally went into treatment, and began AA. Although I only saw them occasionally after that, I was proud to be invited to his 10-year sobriety celebration—and again, I thought I’d done great work.
But the story continues. I started seeing them regularly again when their daughters were adolescents. Chip and Ann fought all the time about parenting issues, and we worked together for a while without making much headway. Eventually, they stopped coming because Chip thought that Ann and I sometimes ganged up on him.
Then, Chip started drinking again, and became aggressive and mean. Ann managed to drag him back in to therapy, but he was defiantly belligerent. He said to us both, “My parents drank themselves to death. Why should I be any different? I’m not coming back here!”
Two weeks after that, Chip drank a ton of booze and went missing. Ann called me in desperation. “I think he’s going to kill himself,” she cried.
I felt panicked, too. “Call the cops,” I urged.
“What’s the point of that, Treadway?’’ she snapped. “They won’t do anything. I’m going to find him!” she announced suddenly and hung up the phone.
I sat in my office feeling completely helpless. Despite being a lifelong atheist, I prayed.
Eventually, Ann found him. She drove to an abandoned train station she knew was on his regular jogging route, walked around to the back of the building, and saw him lying in a pool of blood. He’d slashed his wrists badly, but she’d gotten to him in the nick of time.
This time, I questioned everything about my work.
Yet the story continues still. They came back. And last year, after I hadn’t seen them in a while, they stopped in for a friendly visit to show me pictures of their first grandchild. Chip’s been sober for nine years, and he’s now retired. Ann’s thinking of retiring, too. They’re talking about taking trips abroad together.
“You know, it’s all your fault we stayed together,” Ann teased me.
“Hardly,” I grinned. “You guys were stuck with each other after your first date under the bleachers.”
“I can’t believe you remember that, Doc,” Chip said.
“Let’s face it, you guys are unforgettable,” I told him.
The three of us shared a laugh. It was a miracle they’d gotten where they were, and I was grateful to have been part of it. But looking back on my work with them, I don’t see a lot of brilliant interventions or strategies. Often, I’d felt helplessly and hopelessly stuck as their therapist, and yet, even if all I did was doggedly show up, I know I made a difference in their lives.
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Why do we do this unpredictable, often heart-wrenching, sometimes rewarding work? For many of us, the calling is personal. When I lead workshops for therapists, I frequently ask how many people recognize their calling to become therapists arising out of their own childhood experiences and trauma. Typically, 80 percent of the audience raise their hands.
Yes, we were the sisters and the brothers in whom the family confided. We protected the younger siblings. We comforted Mom after Dad walked out, or vice versa. We were the peacemakers. We had our hearts broken. We took care of others as a way of taking care of ourselves.
My calling began the summer I was 16. My mom was depressed, overmedicated, drinking, and in bed most of the time. My dad and I went out to dinner a lot. That’s when I tried to became their couples therapist. I’d listen over dinner to my dad talk about how worried he was about my mother, and I’d try to say kind and reassuring things.
In the mornings, my dad and I would try to cheer up my mother, dancing in front of her bed and singing old vaudeville songs while holding pretend canes. Sometimes she’d grant us a small smile.
Once, I tried to help her directly, saying, “You know, Mom, it must feel terrible to just stay in bed all—”
“Mind your own business, David,” she snapped back at me.
I felt like she’d slapped me in the face. It took me decades to understand what she was trying to tell me: that it wasn’t my job to take care of her and my dad.
I’d been a Prince Hal type, the third son, an immature and wild kid, prone to partying and chasing girls. But after my mother had killed herself, my father and older sister had gone into a mental hospital, and my older brother had retreated to Florida and his booze, I was suddenly the head of the family.
So I spent my weekends driving up from Philadelphia, where I was attending college, to see my dad at McLean Hospital in Boston, and then on the way back down, visiting my sister in New York City at Columbia Presbyterian Hospital, where she’d been taken after attempting suicide.
Oddly, for the first time in my life, I felt really good about who I was and what I was doing. I felt like I mattered. I felt strong and grown up. And I felt surprised and guilty that I didn’t feel any pain or become squashed by despair.
Of course I became a therapist. I loved connecting with my clients and being there for them. And I loved the feeling of mattering and being important in their lives. In fact, connecting to their pain helped me feel connected to my own. From the safety of the therapist’s chair, I could borrow their tears.
It took decades for me to do my own work on myself, to own my own tears, and to not need my clients for my grieving. None of us has gone into this line of work to be famous or make money. It’s a pathway to our own healing, and that’s why we often dare to go the extra mile, dare to love our clients.
Sometimes our own emotional needs get in the way of doing good work. I know in my case, my codependency can morph from commitment and compassion into overfunctioning and even enabling my clients. So I’ve had to work hard on my own healing, as most of us do. We aren’t simply wounded healers; we must heal ourselves, however slowly. As we do that, we bring that light and love to those we’re privileged to work with. This is “paying it forward.”
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But being a therapist can create a kind of ersatz intimacy in our lives, in which we can stay cocooned if we’re not careful. Personally, being a wise and loving clinician has been a lot easier than being a husband, father, or friend. For years, there were times when my emotional needs were more easily met in the safety of my role as a therapist. And there were times when I gave my clients my best self while giving my family only leftovers.
The same vulnerability that allows us to connect deeply with our clients can impair our judgment and cause harm. So we all have a profound responsibility to make sure our work, our caring, our love is in the service of our clients and not ourselves. We have a professional duty to continuously explore our own emotional issues, and it’s critical that none of us work without ongoing support and supervision.
We don’t practice a knowable science: we’re practitioners of a mysterious art. There are so many ways to make mistakes, overlook something, and get stuck. We all need to be reviewing our cases with a peer group or supervisor—no matter how experienced we are, how many clients we’ve seen, how many challenging issues we think we’ve successfully addressed, or at the very least learned from.
There have been times in my career when, out of my own mix of hubris and embarrassment, I haven’t followed this sage advice. Pride has led me to make mistakes. We teach our clients to ask for help scaling the difficult mountains in their lives, yet sometimes we think we should be able to do the climb alone. That’s not safe for us or our clients.
Part of being a healer is to have our own centering practice, in which we connect our small, insignificant lives to a pattern of meaning in the universe in whatever way we understand it. This sense of perspective allows us to stay humble as we respond to our clients’ suffering and risk having a powerful impact on their lives.
Many of us struggle to reconcile our rational minds and our yearning for spiritual connection. Years ago, a friend of mine presented a lowest-common-denominator description of the higher power that bypasses tangled questions of God and gets to the heart of the matter. We were presenting to some young graduate students on the subject of spirituality and AA. My friend, a talented social worker and a longtime member of AA, has a tough, blunt speaking style, which sometimes belies the twinkle in her eye.
“When I was an active drunk,” she said to the audience, “I was an atheist, and I didn’t believe in any of this God crap! I’ve been sober for 15 years, and still don’t believe in any of this God crap!”
The startled audience froze. She glared at them and went on. “There’s only one thing you need to know to have the healing presence of the higher power in your life.” She paused. You could’ve heard a pin drop. “The only thing you need to know about the higher power is that you’re not it!”
Time and again, I’ve walked into my office about to see dangerous, suicidal, out-of-control clients and repeated to myself: David, you’re not it. Then I ask for help, just as I did for Chip and Ann. I don’t know if God is on the other end of the line when I pray, but I do know that prayer is good for me. It puts me in the right relationship to the universe. It puts me in touch with how little I am. It breaks through my grandiose self-importance and sense of responsibility. It’s not all about me.
My job is to do my best, but our efforts don’t ensure that the therapy will help, or even that we won’t do harm.
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I have on my desk a silver mouth harp. It was given to me by Elena, a client I treated after her husband had had an affair. She went through a tumultuous divorce and a profound grief response. We worked well together, and she gave me the mouth harp at our final session—a gift of appreciation, she’s said.
Nine months later, she returned to therapy for what she called a tune-up. She seemed to be in good shape. She was back to work, and I was quite complimentary about the progress she’d made. It felt like an affirming session. Two weeks later, she killed herself.
There must have been some clues, but I didn’t see them.
I keep the mouth harp in front of me so that I never forget her. It’s also a reminder to always, always stay fully alert to the people sitting in front of me. I’ll never know if there was something I might have said or done that could have prevented what happened with Elena. This is the risk we take every day.
I know this. Our challenge is to dare to love with our whole heart.
And if we do, grace happens.
David Treadway, PhD, excepted some this material from his latest book, Treating Couples Well: A Practical Guide to Collaborative Couple Therapy. David has been a therapist and trainer for 40 years. He’s also the author of Home Before Dark: A Family Portrait of Cancer and Healing and three other books. Contact: firstname.lastname@example.org.
ILLUSTRATION © ROY SCOTT