On Being a Therapist

What the client brings to us in a session is so overwhelming and so full of content and feeling that we can’t hold it all. So we have to find ways to live with that—to live with all this uncertainty, all this mystery, all this ambiguity. At the same time, our clients are demanding answers and solutions.

We are playwrights in that we spontaneously compose and direct dialogue, acting out various roles of a nurturer, an authority, or a character from a client's life.

For those who are doing distance therapy, we are missing essential data and cues that were previously available to us: a client’s posture, scent, what the hands and feet are doing, where the person sits in the room, or who else is listening to the session. In addition, some of the most crucial parts of therapeutic change used to take place during the commute to and from sessions when clients would review and rehearse what they wanted to talk about, as well as the kaleidoscope of thoughts, feelings, and reactions that took place on the trip home.

human beings have an intense craving, often unfulfilled, to be understood by someone else.

We are offered glimpses, even deep searches, into the questions that haunt people the most. We experience a level of intimacy with our clients that few will ever know. We are exposed to levels of drama and emotional arousal that are at once terrifying and captivating. We get to play detective and help solve mysteries that have plagued people throughout their lives. We hear stories so amazing that they make television shows, novels, and movies seem tedious and predictable by comparison. We become companions to people who are on the verge of making significant changes— and we are transformed as well. We go to sleep at night knowing that, in some way, we have made a difference in people’s lives. There is almost a spiritual transcendence associated with much of the work we do.

The therapist’s job is to do everything in her power not just to promote self-understanding but to encourage experimentation.

When a person gives attention to unresolved issues of the past, she often must work through resistance and apprehensions. To dismantle rigid defenses, interpret unconscious motives, or reflect on unexplored feelings we must sometimes push the client to the brink of her patience and endurance. She must confront parts of herself that have been deeply buried, and she must risk the consequences of relinquishing coping strategies that have worked fairly well until this point, even with their side effects and collateral damage. There is a risk (or perhaps even a certainty) that some destabilization will occur. In order to attain real growth, the client must often be willing to experience intense confusion, disorientation, and discomfort. She leaves behind an obsolete image of herself, one that was once comfortable and familiar, and she risks not liking the person she will become. She will lose a part of herself that can never be recovered. She risks all this for the possibility of a better existence, and all she has to go on is the therapist’s word.

In the absence of certainty about what is best, in the presence of someone who is needy and vulnerable, there is a compelling urge for us to do something.