Over the last 10 years I've worked in inpatient treatment, private practice and in outpatient care and have come across a great number of therapists and have heard their reasons about why they decided to train. The reasons fall roughly into 3 categories: they knew from a young age that they wanted to do the job, they had a life changing experience and decided to train (this is the most common); they decided later on in life that this was something they were interested in and decided to change careers. Now I own my own outpatient clinic and it's my turn to hire therapists to be part of what I've created and I find myself asking this question on a regular basis...why?
I had my first personal therapy when I was 19 years old. When I was training I was also required to have personal therapy as part of my course. I found it incredibly difficult to find a therapist that I felt heard me and who I felt connected to and now several years later, I put it down to this: some people become therapists because they themselves avoid intimacy in relationships and want to remain in control of the relationships that they are in. Having a sense of this in the relationships that I've had with some therapists has led me to consider how much I've held back for fear of investing in something that was in some how artificial and therefore unsafe.
When we work with someone we present ourselves as 'the well party'. Our patient's dysfunctions are presented to us as a puzzle to be solved; our own dysfunctions however are withheld from the relationship even though they play a major part in the success of that individual's therapy. So many of the people that we work with in the clinic are people who struggle to form intimate relationships with other people, part of the healing process is to demonstrate this using the therapeutic relationship as an example. For a healthy relationship to develop between patient and healer the relationship must be based on truth. If as therapists, we withhold so much of ourselves from our patients, how can we really facilitate change? My experience with some of the therapists that I'd worked with is that they hid their need for control in a relationship behind the term 'boundaries'. It's true that we need boundaries in any relationship to feel safe, but a boundary is not a wall, it is not something to be used as a tool for keeping people at a distance. A boundary is supposed to allow us to experience closeness and intimacy safely.
When I talk about sharing part of ourselves, I'm not necessarily referring to personal disclosure. I'm talking in the most basic terms about person centred care and maintain the core conditions of congruence, unconditional positive regard and empathy. When part of us is so invested in maintaining control of the relationship how can we truly meet these conditions? One psychiatrist and writer Irvin Yalom is famed for championing an intimate type of therapy between healer and patient. In his book The Gift of Therapy he describes a moving session with a female patient who was suffering with cancer. The woman had recently lost all of her hair and was struggling to come to terms with her physical change. She tells Yalom that she fears that he must be repulsed by her baldness, he responds in the contrary. He requests her permission to act on impulse and runs his hands through some of the remaining strands of hair on her head. The impact of this act is hugely intimate and moving for them both.
If so many of us choose this profession because of some challenging life experience, we need to ask ourselves...having experienced trauma or acute vulnerability ourselves, are we prepared to accept and share that part of ourselves in the work that we do with our patients? It is my view that in order to offer people the best possible chance of recovery we have to offer them something more intimate than clinical expertise....we have to offer them part of ourselves. Not an aloof superiority where we offer help with one hand and push them away from us with the other. When I consider the relationships that I've had with patients over the years I can say with conviction that they although my patients perhaps know very little about me, that they will have felt cared for on a deep level and that their sense of this has aided their healing enormously. Sometimes it's what we offer to our patients off the clock and outside of the therapy room that resonates with them so profoundly.