[content notice: I’m going to talk about what it’s like for me to be a therapist and not everyone is excited to hear about this perspective, even though all therapists are also regular humans, too. If that’s you, maybe skip this one]
The whole time I was in grad school I was waiting for someone to tell me what therapy really is and I never really felt like anyone could explain it. We read a lot about human development and being a blank slate (or not, depending on which old white person’s school of thought you follow). We did role play, we talked about how to be culturally humble and not make assumptions about people’s experiences based on their identities and all of that was definitely helpful, don’t get me wrong. But whenever I was actually faced with sitting in a room with someone and talking about their problems it felt like I didn’t really know what I was doing. As an intern, I tried to bring in cognitive behavioral therapy worksheets to help my teen clients learn about their anxiety and depression but it seemed weirdly formal and like school and not very helpful or interesting. My professors and supervisors talked about “being in the room” and “using the silence” but they didn’t explain what that meant. I am a nervous talker, so that was hard for me and I wanted to ask my professors what they did—with their hands, their thoughts, their anxious energy—when waiting for someone to open up. I probably should have actually asked, but it felt like something I was supposed to intuit and I didn’t want to reveal myself to be an imposter.
I started my first therapy job in the middle of the pandemic, so the first year and a half I was practicing I didn’t meet with any of my clients in person. We were doing all of our sessions on Zoom or awkward phone calls, which made it even harder to know what therapy was. Everyone I worked with, including my supervisors and the leaders of my agency, was driving without a map. We were all figuring out telehealth as we went along, so no one could really help me figure out this new territory. I had strict billing requirements [the number of hours of therapy I was supposed to do in a week], but it was hard to convince people in May 2020 that they should try talking to me remotely if we might be “back in person in a few weeks”. Partly because of pressure to perform, but mostly because I wanted to figure out how to help the people on the other end of the phone line, I rushed to figure out what version of therapy would work for me in this setting. I found that it was hard to “use the silence” on a phone call because people are conditioned to think that a conversation is over after a long pause and they would just hang up. So I leaned into a therapy truism, that the relationship between therapist and client is the most important factor in successful therapy. I focused on just really trying to get to know the people I was talking to, remembering things about them, and trying to make it feel like talking to me was a good use of their time, even if we couldn’t see each other, which was often the case.
As an aside: It’s already hard to get people to come to therapy in community mental health. Most people who want to be seen have experienced significant trauma in their relationships, have been on a waitlist for months, and maybe have had 3 or 4 therapists leave them for other jobs already. It’s hard to open up and connect with someone new when people are always letting you down. Then there’s all the logistical challenges: transportation and childcare issues, rigid yet unpredictable work schedules, unstable housing, abusive family members and partners, visitation schedules, medical issues, etc. etc. etc. Telehealth made some of these things easier, but it also made it really hard for anyone who didn’t live alone to be able to really talk about things freely without other people overhearing them. All this to say, when people do show up, I want to really make it worth their time.
It turns out that what I was doing is basically a style of therapy called relational therapy. In this model you form a solid relationship with the client you’re working with and use that to help them not only process their feelings, but also understand what a healthy relationship looks and feels like. It also turns out that you don’t need too many fancy supplies to do this kind of therapy (useful when you can’t be in the same room as your clients), and that it’s really helpful for people who haven’t had very many experiences being in any kind of relationship that felt safe or stable. Once I realized this, I learned more about relational therapy and integrating it in with the other types of therapy I use, and I felt like I was finally starting to figure out what I was doing, though I still didn’t know if I was really doing it right.
After most people had had two COVID vaccines, I went back to doing in-person therapy and found that it was even more powerful for my clients to connect with them in this way. I am so proud of the work they did in this time—I saw people who had been working on things for years, some of them for decades, make significant changes in their lives. It felt like all the things I was supposed to see and feel and was rewarding and amazing.
And then there were the other feelings.
Therapy school gave me many tools for helping clients but aside from a few surface-level lectures about “the importance of self care”, we didn’t really talk about what it would be like for us, not in a way that stuck with me anyway (in fairness, I’m not sure anything could have prepared me for the experience of doing therapy for the first time during a global pandemic). At the time, I thought what we were learning was helpful and, when I graduated, I thought I knew what to expect. We talked at length about concepts like transference [when you remind your client of people they know and you use that help them make sense of things] and countertransference [when clients remind you of people you know and you use that information in conversations with your supervisor to make sure you’re focusing on the right things in both your own therapy and therapy with your clients] and what to do when they came up in our work. What I didn’t realize was what it would actually feel like.
As I worked with clients for a year, then stretching into two years, I got to know them better—due to the nature of what we were talking about, better than I know some of my friends—and our conversations moved beyond tips for controlling panic attacks and dealing with depression laundry. We talked about people who had hurt them, traumatized them, and let them down. Even though I worked with people from all ages, the majority of these things happened to my clients as children or adolescents—impressionable years that have a significant impact on identity development. And so sometimes 25-30 hours of my week were spent hearing about these relational wounds from people’s childhoods. And then I started spending more time thinking about people who had hurt me and let me down in that period of my life. It wasn’t that my clients were reminding me of people I’d known in my life—I knew to anticipate that—they were reminding me of myself, people I’d been before and the ways those versions of myself had hurt others or been hurt. Then there were the times that I worked with a client who didn’t really have a strong identity and I felt an internal struggle, like I was temporarily transferring part of myself to help stabilize the person I was working with to help them understand how to build their own sense of self.
It wasn’t all the time and both of these things were usually fleeting, expected, and manageable in small doses, but then there were the times when everyone seemed to be struggling at the same time and my agency was continuing to pressure me to see more clients than felt sustainable for me and in those moments it felt like parts of me were being pulled in all directions away from me and I was in danger of not having any left for myself. During one of these difficult periods, I listened exclusively to Sour by Olivia Rodrigo because I felt stuck being myself at 17 when I wasn’t at work. (I did the same thing with Rubber Soul when I was feeling very 13). At another particularly bad time, I had to spend several consecutive weekends parked under a weighted blanket, partly because that’s a sensory thing that feels nice to me, and partly because I felt like I needed something to weigh me down and keep all the parts of me from floating away.
I’ve written before about the fact that I can’t turn my goddamn brain off. It’s a blessing and a curse: being analytical and able to consider things (data, situations, people, relationships) from many sides is a pretty useful set of therapy skills, but having anxiety and obsessive, intrusive thoughts makes it really hard to let things go. There is a point for most situations where analysis stops being helpful and starts to be compulsive. At this point in my life I have processed the distressing events of my mostly comfortable childhood and adolescence to death. I do not need to revisit them anymore. And yet, I persist. In intense periods in the past few years, I have been thrown back again and again into the actual feeling of being 12 and lonely, of being 16 and broken-hearted, of being 19 and traumatized—never for longer than a few hours but often so intensely that I’m left with an indescribable kind of emotional hangover. This phenomenon relates to another kind of therapy, Internal Family Systems, that I’m now exploring more to understand how and why different parts of us act this way sometimes [if Dick Schwartz or Frank Anderson happen upon this blog post for some reason: I’d love a subsidized level 1 certification slot!]
I want to be clear again that it isn’t all the time—I work primarily with teens and young adults and I wouldn’t be able to do that if I spent every single work day reliving all the things I found hard about those times in my life. Generally speaking, I’ve figured out how to have strong boundaries around my time and energy related to work. But it does happen, and it happened enough in the past year that I decided I had to leave my job* and do a different kind of therapy for a while, while I rest and figure some of this stuff out.
*I also had a bunch of other reasons for leaving that I’ll get into another time.
It seems like this is what therapy is, and it makes sense in retrospect that it was so hard for my professors and all the therapists whose work we read to articulate what it would feel like for this to be my life [I’ll also talk another time about how messed up it is that the start that most people get in this field is working too many hours trying to help people with some of the most complex problems with very little training and abysmal pay]. So maybe all of this is normal, in some weird way? I’ve talked to my own therapist and many of my peers and a lot of what I’ve described seems to resonate, but it also seems to me like there’s something about my brain that makes this experience of countertransference and emotional contagion more intense for me than for other therapists I know. When I’m feeling down on myself, that knowledge makes me think I should do something else with my life, something that feels less intense. And like, who knows, I might do that at some point. When I’m feeling more optimistic though, I think the experience I’ve had of hating myself, resenting my brain and how it makes me feel weird and crazy and different from everyone is exactly why I am able to be a therapist. In addition to being pretty good at making people feel comfortable and safe, I also know what it’s like to really struggle to be a person sometimes which, it turns out, is why most people come to therapy.
So what is therapy, exactly? For me and the kind of therapy I do right now, this is what I’ve landed on: therapy is a science experiment, it’s practicing connection in a safe and controlled lab; it’s me helping my client build a spaceship and then sending them out into the world to test it out. If the test fails (and it often does), we bring it back in and tinker around with it together. Sometimes I don’t know what to do but my boss or my client does and that’s ok! Science is collaborative and everyone involved in the process has something to give and something to learn. Once the spaceship can fly, the client can travel around but I have them bring it back to the lab to run tests, making sure it works in all kinds of conditions, adding extra bells and whistles. Sometimes I share brief stories about when I built my own spaceship because I’m a human, not a robot, and building a spaceship is weird and hard and it’s nice to be able to relate to someone else’s story.
One day the spaceship will have all the controls and safety equipment and snacks anyone on board might need and my client can fly off for however long they want, maybe forever. Just in case, there are pit-stops in space for repairs, and the client can always bring their spaceship back to the lab for maintenance. Even if it’s not me, there’s always someone in the lab to help, just in case.
Many thanks to J, J, C, M and M for listening to various versions of this in the past few months. Y’all are great.
weary traveler 