To Be a Therapist

Reflections from the other side of the client-therapist relationship.

Posted Jan 10, 2019

People often say to me, “I couldn’t do your job. I’d take it home with me and worry about my clients.” I’m not always sure if I should be honest. We’d all like to believe that anyone in our life—maybe especially our therapist—thinks about us intensely when we are not present. Maybe we hope that we take up a lot of their brain space, even that they may be wringing their hands with concern and hope that we are well.

I do hope my clients are well. The truth is though, I do not take my clients home with me and my hunch is that most therapists do not, if they are truly honest with themselves. Like everyone else, I’m pretty quickly consumed by myself and my ego once those hours end. And even if we do take clients home, frankly, it is probably as objects of gratification or punishment— I’m good or bad because the client sees me that way, because I succeeded or failed.

But, then again, sometimes the work does come home with me.

I practice primarily cognitive-behavioral psychotherapy, helping people identify patterns that are or are not helpful. In the service of working with and changing those patterns I do sometimes share how I experience clients, a sense in the room, even a self-disclosure of my own emotional reaction as I sit with them. Usually, that’s as self-disclosed as I get. Almost none of my clients know if I’m married or not, have a kid or not, any of the things in that bio down there. Rarely is self-disclosure useful. It is not required for a deep emotional connection or to help. But, sometimes self-disclosure is an overture of vulnerability and is therapy-relevant, an opportunity for a client to express new or stick to old patterns. One of the most powerful examples of this was when my father was sick and dying of cancer.

My father was sometimes suddenly hospitalized out of town. Short-notice session cancellations happened occasionally. After peer consultation, I found it made sense to disclose the context of cancellation, to warn clients that this would happen again. A few weeks before I shared my personal situation, a male client had late-canceled an appointment. I charged him the fee (standard policy). He raged at the financial charge then, never forgiving me for what he felt was an injustice. When I shared with him later that my father was sick, dying and that I may need to cancel sometimes, his response was “Well if it’s less than 24 hours can I charge you 70 bucks?” His eyes were aflame with rage and his body language was aggressive. I sat stunned and pained at his reaction. My emotions were so raw that I could not disclose that reaction to him and knowing him as I did, I knew his personality pathology was such that empathy was nearly impossible for him. I could no longer work effectively with him though. I carried resentment, hurt, and anger. I was able to transition him from my care. His reaction I would describe as somewhat inhumane and remarkably narcissistic; it still hurts now and it certainly followed me home.

There is a more lovely way I’ve taken clients home, though. After an afternoon session with a brilliant, kind, and emotionally-tortured woman, I saw her walking away from my office while I got in my car to leave for the day. I was struck suddenly with piercing care and compassion from seeing her putting earphones on as she walked alone in the late-afternoon sunlight. This simple act—that she didn’t know I witnessed—held her humanity, her day-to-day struggle to just live and survive and try to find joy. I saw hope and loneliness at the same time. Suddenly all the loneliness and pain she had suffered, the art and beauty she created, were alive to me. I felt so much tenderness for her, protectiveness of all the parts of her. It quickly spread inside me, a vision of the naked vulnerability in all of us trying to survive and find joy and love, to make art from suffering. I had to cry in my car before I went home, crying for human pain and suffering, crying for joy and love. I cried knowing that the connection and help I give my clients really, truly matters and that I am so very humbled and privileged to be allowed to exercise my values and love every single working day. That my clients trust me with their humanity—even if it is cruel or hurtful sometimes—is remarkable and powerful.

So, I suppose that yes, I DO take my clients home with me—but it is actually in a much more enriching and integrated way that one might imagine.