As mentioned in Healing Yourself as You Heal Others, often the work you do as a therapist with clients leads you to discover and face your own personal wounds.
This personal journey is essentially a requirement to avoid having your own issues interfere with the therapy you are conducting with your clients via counter-transference that could manifest itself in a variety of ways such as avoidance of certain topics, distancing, anger etc.
Furthermore, the acknowledgment of your own wounds is important for your own personal growth; you cannot heal from denied feelings or wounds.
While I fully recognize the importance of examining all my feelings and reactions to the things that clients share, I wish that this part of the clinical training/work could be a little less painful…
Last week, I had my first experience of having to arrange for a client of mine (let’s call her Z) to be hospitalized. Thankfully, Z is well now and only required a brief stay in the hospital to feel stabilized.
To backtrack, Z had just experienced two upsetting events in her life: her boyfriend had broken up with her and she had failed an important licensing exam. Due to the fact that Z has the borderline personality disorder, she took the separation from her boyfriend particularly hard and felt rather lost.
After my unsuccessful attempts at trying to get Z to see that not all was lost (she could retake her licensing exam etc.), Z requested to be hospitalized. I consulted with my supervisor on how one goes about doing this and then arranged for Z to be admitted to the emergency psychiatry department with the help of her psychiatrist and our departmental nurse.
Once Z was taken to the emergency psychiatry department, I planned on simply resuming my normal activities for the day. This meant co-facilitating a supportive men’s group with my supervisor.
However, as I sat down and tried to partake in the group, the enormity of what I had gone through with Z hit me. It wasn’t just that I had a potentially (2nd) close call of suicide with a client. It was that this event triggered in me memories of my having taken someone dear to me (let’s call her N) nearly three years ago to an emergency room and all the events on that particular day leading up to taking N to the emergency room.
It had been an awful horribly painful day and I was flooded with memories of that day. My supervisor must have seen something in my face because she asked me if I was ok and said that if I needed to work on something else at that time, it was fine.
I took her up on her kind offer and excused myself from the group and went to my office and found myself needing to cry for a few minutes. I was then able to get back on the horse, so to speak, after doing some paperwork.
Later, I shared with my supervisor that I would need her help on not feeling responsible for N, that due to my own personal issues, my counter-transference toward Z was likely to be that I would feel overly responsible for her.
My supervisor listened to me and explained to me that I cannot see Z as more than a patient. She explained to me that my relationships with my clients are temporary; they are not like with friends or family members. I may care for them professionally but I may not care for them as if they are a family member. I would not be able to manage if I were to do this. I have to maintain some distance.
Since then, I am feeling better and have let go of feeling responsible, although these types of occurrences are emotionally exhausting and draining.
In short, the process of becoming a therapist makes you need to acknowledge and work through any unresolved painful memories because the different scenarios and stories your clients share may trigger memories of of your past experiences.
Have stories clients shared or experiences you’ve gone through with them triggered in you past painful memories? What are some things that you have found helpful to get through the pain?
Photo Credits:
qthomasbower Heart of the Mind
Mad Sarah Arepper7 (green design)
Dorlee, what a thoughtful and vulnerable post! I liked the way your supervisor framed the therapy relationship as temporary. The relationships with your friend and family members are “eternal and internal” in terms of object relationships.
I think it takes a lot of courage to tell a supervisor that you are going to need help when it comes to things like this. You did a great job of slowing down and exploring your internal process as well as sharing it with your readers. I’m sure many will benefit from it!
Thanks so much, Mike for your kind and thoughtful feedback.
This was a particularly difficult post for me to write.
Dorlee
Dorlee: Ah – vulnerability is such a paradox. It is so scary to allow ourselves to be “vulnerable” by exposing our fears and yet it is also one of the most direct paths to growth and healing. You are so brave.
I admire you. You put your cards on the table (one of the many qualities about New Yorkers that I admire…..but of course – this is such a generalized and biased statement…forgive me!)
But seriously, the only way I have been able to deal with the times when clients raise painful issues in me, is to let myself feel it, take a lot of “alone time” and meditate as much as I can – even if my thoughts want to wander back to pain…the effort to stay in the here and now usually pays off for me, no matter how difficult it is.
Thanks for your enlightening post.
Terry
Thanks so much, Terry for your kind words of support and guidance.
Actually, I’m not a New Yorker although I’ve been living here for quite a long time 🙂
That’s interesting that you have used meditation as a way of coping with feeling pain that has been stirred up.
In my case, it was important for me not to block the pain as had been my normal prior (maladaptive) coping method and so I was consciously “accepting” the pain, so to speak.
However, it sounds like you found using meditation allowed you to both feel the pain and get some relief so that sounds like a great strategy for me to apply. I will try that next time.
Thanks again,
Dorlee
Hi Dorlee,
What an amazing post! You’re raising some pretty profound philosophical questions about how to connect with someone in a therapeutic relationship with integrity, without drowning in it. I think it’s a tricky balancing act.
I certainly don’t pretend to have the answers, so here are some questions:
If the philosophies/religions from around the world encourage us to free our mind and open our heart to ALL people, then would there be any long-term negative consequences to a career strategy that involves closing our heart a bit to our clients? Could that be going in the wrong direction as a human being? And if so, would the alternative be to free our mind of negative thoughts that are interfering with our work — such as thoughts about what we “should” or “shouldn’t” be able to do? With a free mind, can we keep our heart open?
I know you’ll find the way that’s best for you, and I’m rooting for you every step!
All the best,
Deb
Hi Deb,
You’ve given me much food for thought, so to speak, with all the interesting questions you’ve raised…
Thanks so much for all your support and encouragement. I can feel you rooting for me 🙂
Best,
Dorlee
I agree with all the other comments, Dorlee, I really admire the openness and willingness to be vulnerable that went into writing this post. You present a wonderful model for other developing therapists.
Maintaining an open heart with clients while not taking ownership of their pain and choices is a very fine balance. In my opinion, a mindfulness meditation practice really helps with learning that balance.
My approach to working with my own feelings that get triggered is very similar to several that have been voiced–I let myself feel what comes up. When it is “my stuff” that is coming up I take note of it in a session and temporarily shelve it until a later point when I can be alone to really be with the feelings. This approach works best if one has already done a good part of one’s own work in therapy. If one hasn’t, then the likelihood of getting stuck (not making progress) is greater.
Thanks so much for taking the risk to share all of what you have been struggling with. I think I can speak for all of us when I say that we ARE rooting for you.
Thanks so much, Nancy, for your very kind comments. It was very helpful to hear your approach on how you handle the work with clients when your emotions have been triggered.
I remember you having recommended the mindfulness meditation a while ago with respect to increasing one’s focus…I had tried it for a while and liked it but then somehow lost track of doing it once things got too busy.
But now I see that I should continue to do it – it will only help as various emotions get triggered.
And thanks so much for all the rooting/ encouragement:) – it’s most appreciated!
Dorlee,
I appreciated this post so much. I think that learning how to acknowledge our own struggles with respect to our work as therapists is a huge part of the journey to being a skilled, ethical practitioners. As I read this post, I appreciated both your honesty and vulnerability with your supervisor, and your continued vulnerability in writing the post.
I agree with previous posters who discussed self-care tools such as meditation, mindfulness practice, and our own therapy. I think that we need to be diligent about our self-care. That is what gives us the firm foundation to hold emotionally safe spaces for our clients (and to maintain our own health as we do so).
Thanks so much, Ann 🙂
Interestingly, as you mention the need to address our own struggles as a key component of the process to becoming a clinician, I’m remembering that there were some professors who had recommended that we engage in our own therapy if we had not prior to the beginning of our studies.
That said, I do not think that I fully understood until recently what was meant by that or to what extent we need to work on ourselves…
With much appreciation for your encouraging feedback and helpful guidance,
Dorlee
Hi Dorlee,
I like what Nancy said about maintaining an open heart with clients while not taking ownership of their pain or choices. The goal is to stay both engaged and separate at the same time. Maintaining that balance is the key to therapeutic connectedness and good self care.
I believe it is important to develop a genuine connection with our clients in order for them to feel safe enough to take risks in treatment. This is especially true for those clients who suffer from the impact of betrayal trauma and/or insecure attachment, which is most of my caseload. Bearing witness to our clients’ pain leaves us vulnerable in many ways. It opens us up to being triggered by our own unresolved painful experiences, as we resonate with our clients’ pain. It also makes it hard for us to detach from our clients’ pain when a session is over.
We need to be attuned to our clients’ suffering, without being consumed by it. Vicarious traumatization is an occupational hazard that we need to guard against. Some people describe it as having one foot in the door and one foot out of the door, being both engaged and detached at the same time. In my view we need to be fully engaged with our clients, yet also fully separate so we are not overwhelmed by our clients’ suffering. This is a very delicate balancing act.
Mindfulness of our reactions during sessions is essential. Containment strategies are also essential. Containment during the session is needed when our reactions are based on our own issues that need to be set aside to prevent interference with our therapeutic presence. Containment after the session is needed when we are having difficulty shifting gears from resonating with a client’s pain.
Dorlee, I continue to be impressed with your openness and self-reflective capacity, and your efforts to synthesize all you are learning in this blog. Keep up the great work!
Warmly,
Andrea
Hi Andrea,
Yes, as you and Nancy so eloquently put it, one of the many things on my “learning to be a therapist” list is to find a way to maintain “an open heart with clients while not taking ownership of their pain or choices.”
Containment after the session and adequate self-care are two additional items…
Thanks so much for all your guidance and support.
I can’t tell you how much it means to me to have you and my other twitter friends being there for me along this journey.
Warmly,
Dorlee
Dorlee,
As time goes on, and you gain more experience, you will be able to find your own way, using a variety of techniques.
As a classroom teacher, I remember coming up with strategies for classroom management. Sometimes, and with certain classes, all worked well. Other times, other techniques were required. The lesson I gained from this experience was that you use what works. When you aren’t getting the results you’d like, modify, change and ask for suggestions and/or help.
I never used to understand the idea that our interactions are mirrors for us – both what is positive and negative. I get it now – that it doesn’t have to be the exact same thing that is being mirrored – that it is a chance for us to learn, change and grow – to forgive – to heal – to love.
As I continue to practise my techniques, I’ve noticed that I move through things much more quickly. Resilience is restored.
I look forward to hearing how you learn, change and grow, if you should decide to share it with us.
Marianna,
Thanks so much for visiting and sharing insights and lessons learned from your experience being a classroom teacher.
What you are saying makes a lot of sense – to use what works; our toolbox and comfort with using the various techniques increase over time; and that our resilience improves as we learn, change and grow.
It was so nice to meet you 🙂 I hope to see you again soon.
Best,
Dorlee
Happy to see you used my abstract collage portrait in this interesting article…!
It is such a beautiful work of art!
Thanks so much, QThomasBower, for allowing me to use it 🙂
I had a similar situation happen when I first started my grad program. I was working in a supported housing environment, and has a resident confide in me their feeling about being homeless. The client had been homeless prior to entering the program, and had confided their feelings in how they felt no one was willing to help them in their situation but when word got out that this client was homeless with a child everyone was quick to help get the child removed from their custody. I remember a rise of emotions come over me, and I excused myself to go cry in the bathroom. Later I reflected with my supervisor that I had lost my father a few months prior due to homelessness, and it was just too much to bare. My supervisor and I met a couple times after that to talk through those emotions, and I felt relieved to know that my emotions were normal and expected but like you said in your post this client is temporary and not family. I could not allow the emotions from this client to come home with me.
Thank you for sharing, Emily
I can only imagine how painful and difficult that must have been for you.
Best,
Dorlee