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I'm proud to say that I was a dedicated therapist. I remained available to my clients between sessions and faithfully responded to emergencies. I was constantly struggling to support the individuals with whom I worked, while at the same time fostering self-reliance. This often proved to be a more complicated task than one might expect. To allow someone to depend upon you, who is in crisis, without fostering an unhealthy dependency, is often not a simple task.
Judith Lewis Herman, author of "Trauma and Recovery," observes that in the face of a trauma victim's tremendous pain and sense of helplessness, the therapist may attempt to defend against the dreaded helplessness, by attempting to rescue the client. While well intentioned, in moving into the role of the rescuer, the therapist implies to the client that the client is not capable of caring for herself - thus further disempowering the client. I am not the only therapist who has fallen victim to my need to rescue by blurring my own boundaries, allowing frequent contact between sessions, permitting sessions to repeatedly run over, etc. Like many other seasoned therapists, I, too, have found that rarely do my attempts to rescue lead to improvement. Instead, my experience has been that the client often demonstrates increasing neediness and dependency. In attempting to assist those client's who want very badly to be rescued, I have repeatedly found myself reminding those who expect me to provide the cure, that it is not my wisdom or efforts which will ultimately heal them, but their own.
Anne Wilson Schaef wrote in, "Beyond Therapy, Beyond Science: A New Model For Healing the Whole Person," that the professional training of therapists prepares them to be relationship addicts (co-dependents). She recalls that she was trained to believe that she was responsible for her clients; that she should be able to diagnose them; know what needed to be done to them/with them/for them to get well, and that if they committed suicide, it was somehow her fault. Schaef gradually became aware that the beliefs she'd been taught were both disrespectful and disempowering. She also understood why it was that so many psychotherapists were exhausted, while others eventually burned out. She recognized that most therapists were practicing the disease of co-dependency in their work writing, "...the way our work was structured was the disease of co-dependency. I not only had to do my recovery on a personal level, I had to do it on a professional level."
Irvin D. Yalom states in his New York Times bestseller, Love's Executioner & Other Tales Of Psychotherapy," that every therapist is aware that the crucial first step in therapy is the client's acceptance of his or her responsibility for his or her own life predicament. He then continues by observing that since clients tend to resist assuming responsibility, therapists must develop techniques to make clients aware of how they, themselves, create their own problems. How do we make our clients do anything? I agree with Yalom that the client must be responsible, yet I object to the idea that our role as therapists requires that we should make them do something, even if that something is for his or her own good. This feels unfair to both the client and the therapist, as it implies far more power and responsibility than the therapist does or should have. I do not wish to be disrespectful to Yalom, as I continue to hold his work in high regard. I have simply become very sensitive over the years as to how even the language of many of our mentors demonstrates what Schaef so adamantly protests. Yalom is far from alone in the use of such language.
While I didn't regret my level of commitment to my clients, I began to recognize the toll my practice was taking on me personally. I decided that it was important for me to relieve myself somewhat from the increasingly heavy responsibilities for the well being of others I was feeling. I reduced the number of clients I was seeing. I made myself a little less available for phone contact between sessions, and I allowed my answering service to screen more of my calls. I also increased my level of self-care. I treated myself to massage, a bit more leisure time, and began to explore bodywork in greater depth. All of these behaviors helped. However, I was still in physical pain and struggling with a number of demands in my life. I was working on my Ph.D. in addition to my practice, as well as writing a book and caring for my daughter.
Around this same time period, I began to notice while doing body work with clients, that there appeared to be a very clear connection between repressed anger and certain physical symptoms, particularly those involving muscular discomfort. The more I noted this connection, the more I began to wonder if this might apply to myself. Was I angry? I didn't seem to be. I had a loving, albeit distracted husband, supportive friends and family, and felt very fortunate overall for the many positive aspects of my life. Still, if nothing else, I was curious about what I seemed to be learning about the possible effects of anger and physical pain. I decided to look at myself more carefully. I had always thought of myself as an insightful person, and yet I recognized that I resisted digging too deeply into my psyche. It was too dark down there. Oh, sure I knew the value of self-exploration, but who, me? What was I going to learn that I hadn't already figured out years ago?
I was about to learn plenty. Was I angry? I was mad as hell! My dream for years had been to be a psychotherapist in private practice, and it had seemed as elusive to me as my fantasy as a young girl, of being on the Merv Griffin Show. Little by little, however, I completed the necessary steps to achieve my dream. Finally, I was where I had always wanted to be. Then along came Managed Care. All of the sudden I was swamped with paper work and review dates. I was constantly dealing with insurance companies for payment and negotiating with strangers over how many sessions they would authorize my clients to be seen. I was frustrated by case reviewers on an ongoing basis, and every time I turned around, it seemed I was due to be recredentialed. I'd left the public non-profit domain because of the vast amount of administrative details I was required to attend to, only to have them follow me with a vengeance. I was particularly troubled by the highly confidential information I was required to submit on a regular basis about my clients. What if it got lost in the mail? (Sure enough this finally happened).
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