Mar 03

Hardest Part of Being a Therapist

Being a therapist: what’s it really like?

Several years ago psychologist Ryan Howes conducted The Seven Questions Project in which he asked “big names in the world of psychotherapy” a series of pertinent questions. Although not everyone answered his request to participate, the ones who did were thoughtful in their responses.

When I recently found his series of Psychology Today blog posts about this and reviewed his queries, the one I found most interesting was the fifth: What’s the toughest part of being a therapist? (For the others, click on the link provided above.) And then I read Howes’s own conclusion regarding the project, which included the following:

“Best Question: I thought it would be questions one, four or seven, but question five (the toughest part of being a therapist) turned out to be the most revealing.”

Below are selected excerpts of some of the therapists’ answers to this specific question.

Thomas Szasz(1920-2012)

Individual psychotherapy — that is, engaging a distressed fellow human in a disciplined conversation and human relationship – requires that the therapist have the proper temperament and philosophy of life for such work. By that I mean that the therapist must be patient, modest, and a perceptive listener, rather than a talker and advice-giver…

Even if the foregoing conditions are satisfied, the therapist’s task may not be easy or enviable, as he may be required to be passive in the face of the client’s self-destructive behavior and tolerate the client’s choosing to stick to his familiar, self-limiting life strategies and not risk entering on the path of liberation.

Harriet Lerner

The toughest part of being a therapist is that you constantly run up against your limitations.

Jeffrey Barnett 

One major challenge of being a psychotherapist is to pay attention to our own functioning, monitor our effectiveness, and to practice ongoing self-care…Just like our clients we must deal with life’s challenges and stresses.

Nada Stotland

Perhaps the most difficult aspect of doing psychotherapy is listening to and absorbing patients’ psychic pain.

Irvin Yalom

Well, I think it’s just holding so much pain at times. Worrying about my patients. Seeing some people that I really can’t help, who in some ways are beyond help. Or seeing a sociopath knowing I can’t really do anything for him or can’t reach him. Or watching some people who are throwing their lives away on drugs and there’s so little you can do about it.

James H. Bray

Not taking client’s problems home with you. Many people come for psychotherapy with significant emotional distress and pain. It is important to leave that with the client and not take it home with you.

John Gray

…Whenever I even start to notice a sense of frustration within myself I recognize that I’m not giving a very good message to my client. Whenever you’re frustrated with someone you’re telling them, “you’re not enough, you’re not doing it right, you’re not living up to my expectations.” That’s not helping the client, it’s not helping yourself.

Glen O. Gabbard

The toughest part of being a therapist is being truly “present” with the patient. The demands placed on a therapist in a typical day of psychotherapy are truly extraordinary. The therapist must be present in a way that allows the patient to feel heard, validated, and understood.

Donald Meichenbaum

The toughest part of being a therapist is how NOT to get caught up with all of the questionable psychotherapeutic “BULLSHIT” that pervades the field.

David D. Burns  

…Learning to accept failure on multiple levels is, to my way of thinking, the key to become a world-class therapist. But that means humility, and setting your ego aside, while you develop superb new technical skills.

Sep 13

Thomas Szasz: The Real Man and His Theories

It may be for any number of personal or professional reasons, including that one of my relatives was involuntarily hospitalized repeatedly for paranoid schizophrenia during my younger years, that I was drawn to the work of Thomas Szasz a long long time ago, even before I became a therapist. A psychiatrist and academic who wrote prolifically about the rights of those with “mental illness,” a term he rejected famously in his classic 1961 book The Myth of Mental Illness, Szasz died this week at the age of 92.

From his Manifesto, written in 1998 and made available on his website:

Mental illness is a metaphor (metaphorical disease). The word ‘disease’ denotes a demonstrable biological process that affects the bodies of living organisms (plants, animals, and humans). The term ‘mental illness’ refers to the undesirable thoughts, feelings, and behaviors of persons. Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish. As the whale is not a fish, mental illness is not a disease. Individuals with brain diseases (bad brains) or kidney diseases (bad kidneys) are literally sick. Individuals with mental diseases (bad behaviors), like societies with economic diseases (bad fiscal policies), are metaphorically sick. The classification of (mis)behavior as illness provides an ideological justification for state-sponsored social control as medical treatment.

He was against not only involuntary mental hospitalization but also “psychiatric slavery” and the insanity defense. He was for the separation of psychiatry and state as well as the presumption of competence of psychiatric “defendants.” For more detail on any of these, click on the above Manifesto link.

Although Thomas Szasz continued to write throughout his life, A Lexicon of Lunacy (1993) is the most recent book I have of his. In it, he talks about the misuse of psychiatric language and states that “the entire vocabulary of psychiatry is pseudoscientific slang.”

Yes, I did stop keeping up with his writing—but his views on the words we use as well as his efforts against psychiatric coercion and the over-medicalizing of mental issues (or what he called “problems in living“) always stay with me.

The truth about mental health and psychiatry, I believe, is somewhere between Szasz and the current medical model. Jeffrey Oliver wrote an article called “The Myth of Thomas Szasz” that appeared in The New Atlantis in 2006. Interestingly, when asked to reflect on his legacy, Szasz tells the journalist that he really didn’t expect to have a significant impact on the field of psychiatry. He certainly knew, moreover, that conventional psychiatry had pushed him aside a long time ago. States Oliver:

Although Szasz’s critique often became a caricature, his intuition about the limits and deformations of modern psychiatry cannot be ignored. Many sick people have surely benefited from psychiatric treatment, both ‘talk therapy’ and pharmacotherapy. But psychiatry’s long history of error — from snake pits to ice baths to spinning chairs to electroshock to lobotomy — should give us pause. Skepticism is not backwardness, even if Szasz often took his skepticism to rhetorical extremes…

After forty years of comparing psychiatrists to the scum of the earth, Szasz now stands as one of the biggest obstacles to his own ideas. It is simply too easy to dismiss him as an axe-grinding zealot, a ‘musician who does not like music,’ as one critic put it. ‘The atheist who cannot stop speaking about God.’ But perhaps a new generation of critics will arise — aware of psychiatry’s achievements but also its limits, leading us not to extremes but to a much-needed reformation of psychiatry from within, and a much-needed de-medicalization of human life in the culture as a whole.

MORE THOMAS SZASZ (QUOTES) 

If you talk to God, you are praying. If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If God talks to you, you are a schizophrenic.

Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic.

Doubt is to certainty as neurosis is to psychosis. The neurotic is in doubt and has fears about persons and things; the psychotic has convictions and makes claims about them. In short, the neurotic has problems, the psychotic has solutions.

The concept of disease is fast replacing the concept of responsibility. With increasing zeal Americans use and interpret the assertion “I am sick” as equivalent to the assertion “I am not responsible”: Smokers say they are not responsible for smoking, drinkers that they are not responsible for drinking, gamblers that they are not responsible for gambling, and mothers who murder their infants that they are not responsible for killing. To prove their point — and to capitalize on their self-destructive and destructive behavior — smokers, drinkers, gamblers, and insanity acquitees are suing tobacco companies, liquor companies, gambling casinos, and physicians.

Suicide is a fundamental human right. This does not mean that it is desirable. It only means that society does not have the moral right to interfere, by force, with a person’s decision to commit this act. The result is a far-reaching infantilization and dehumanization of the suicidal person.

He who does not accept and respect those who want to reject life does not truly accept and respect life itself.

It is easier to do one’s duty to others than to one’s self. If you do your duty to others, you are considered reliable. If you do your duty to yourself, you are considered selfish.