Today I vlog (video blog) about one of most provocative blog posts – the question about therapists being clients. I look forward to your comments.
(Press the play button to start the 1 min video – it will take a few seconds to load.)
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{ 20 comments… read them below or add one }
Of course therapists need to be thinking constantly about how to increase their own awareness. It is difficult to help our clients go beyond where we have gone ourrselves.
But it is also true that increased awareness can come from, among other activities, reading a good novel.
In therapy, as in life, every change we make is about awareness.
Greetings: I am the LHA for San Francisco Lighthouse Church located of course in San Francisco. I must agree with a number of you that believe in the importance of client-therapist relationships as being key to the client’s recovery. As an African-American man who is also a Christian, I have encountered a number of scenarios where race, class and belief system did greatly impact the relationship. I believe that as MHSA professionals we are often afraid that our training and life experience is not capable of assisting us in dealing with our clients; perhaps that is why we are consistently changing the DSM.
We are also fearful that we are imperfect and lack understanding of others — that in fact, our understanding of others may be critically flawed through personal bias. I believe that by undergoing therapy we are preventing ourselves from engaging in further psychological colonization of traditionally marginalized groups by creating a situation for ourselves in which we are able to address our own corrupted natures and exorcise them as much as possible before unconsciously turning our shadows lost upon our clients. We must realize that we enter into the healing relationship not as beams of light, but as human beings who may become co-opted by our own leser natures.
Being a Clinical Social Worker, providing psychotherapy to individuals, families and couples and having my own private practice has been an incredibly rewarding and enlightening experience. But not until I entered into my own therapy (a must, I believe) did I truly begin to understand what it’s like to be a client and the courage it takes to open up, delve into difficult and often painful issues and work towards healing and growth. As others have said already, the therapeutic experience also helps in dealing with transference and counter-transference issues that inevitably arise in providing therapy to clients. I encourage all mental health professionals who are providing therapy to have their own therapeutic experience, even if they believe they are basically doing well. Good luck and, thanks, Casey for bringing up this topic!
There seems to be an assumption that in order to have self-awareness and insight, one needs to have been in therapy. I don’t think that’s true.
Therapy isn’t the be all and end all and certainly is not the only road to self-awareness and insight. It is one way, but not the absolute way, and I think too many therapists overstate the value of therapy as the path to enlightenment, if you will.
Sure it’s probably helpful to have spent some time in the chair to better understand the process from the client’s perspective.
However, on the other hand, if I want to be a heart surgeon, do I have to have had open heart surgery first to “understand” what it’s like to be a patient? Or if I become a lawyer, do I have to have been sued or prosecuted to understand? Absolutely not.
To piggyback on what someone commented earlier, we need to be emotionally healthy and live stable lives to do excellent work with our clients. If going to therapy is a tool that helps you do that, great. But it’s not the only path to emotional health.
About some recent comments in this thread, I would like to learn more about what other paths to insight, self-awareness, and emotional health may be available besides therapy that those of us who are clinicians could recommend to the public, instead of accepting them as clients in our practices. I know, this may sound paradoxical, but please bear with me for a minute.
Freud, for example, did self-analysis but only because as he was a pioneer, there was nobody else who could analyze him. Then we have yoga, meditation, tai chi, religious faith, prayer, exercise, healthy diet, bioenergetics, massage, using art as a way of personal expression, working for the common good, or just talking to a friend, family member or significant other.
It seems to me that all of the above resources can be instrumental in helping people to feel better and get to know more about who they are. Some of them I have personally used with some success. However, I would have to ask myself, why would I have chosen to become a psychotherapist, investing all this time, energy, effort, and dedication, if I didn’t believe in its use for my own personal benefit and growth? The answer is simple, at least for me.
Thank you again for a great discussion on a fascinating topic.
Yes, yes, all therapists, just get their own therapy.
Just to add to this interesting discussion, I found this interesting quote from Carl Jung: ” the patient’s treatment begins with the doctor, so to speak. Only if the doctor knows how to cope with himself (herself) and his own problems, will he be able to teach the patient to do the same. Only then.”
The comment written by Sally von Erffa also raised an important point about the fact that therapists and their clients are not isolated people but members of a larger society and culture, which means that issues related to culture, race, and social class inevitably become a part of the work in therapy. I wonder then about those therapeutic dyads in which their members may have different backgrounds, and how this may allow for an appreciation of the subtle ways in which cultural bias can be enacted. It is in this regard that part of our own personal therapy as clinicians is to become cognizant of misconceptions and projections on the different “other,” and examine areas of ethnic, racial or religious prejudice based on personal experiencies. Besides benefiting the client and avoiding countertransference pitfalls, it will enrich the therapist’s inner world of feelings and knowledge and make her/him a more effective healer.
As my colleagues above have stated so well, I too believe that therapists need to have experienced their own therapy to be good therapists.
I, too, believe that understanding the process of therapy from the client’s standpoint is essential to forming good therapeutic alliance, as well as knowing how to shape one’s business communications with potential clients.
But more importantly is the self awareness and healing that is possible so that we are not using our work as therapists to heal ourselves, and so that we aren’t tied up in counter-transference issues to the detriment of our client’s care.
I agree that most therapists want to do healing work. I also believe that those who don’t think they need therapy probably shouldn’t do it themselves.
Graduate programs should include at least a brief period of personal therapy as part of their process of education.
It is difficult for me to believe that a therapist can adequately work through tranference issues which come up to blindside us without having ONGOING therapy. This careful examination of what the client grings up in us can broaden what we know of ourselves, them, and the treatment.
I had the good fortune to experience therapy from the director of the Dept. of Psychiatry at the Medical College of Wisconsin, Raymond Headlee, M.D. We met almost every Tues. at 2 pm for a number of years. It was the best training I could ever have received — both personally and professionally. My analogy re: grad school v. my work with Dr. Headlee is a bowl of soup v. a 7 course meal. His 30+ years of experience, credentials of psychiatrist, psychologist and psychoanalyst and, my 1:1 time with him gave me insight, training and confidence that have been useful to me every day of my 30+ years of private practice work. It takes courage to seek out therapy and to explore one’s self. Only by taking this essential step and journey ourselves, as therapists, can we grasp what our patients/clients experience. I feel it should be mandatory that every practitioner experience psychotherapy on an individual level for an established number of hours. If we need 3,000 hrs of supervised training before we are licensed — is it any less important that we be fully aware of ourselves as individuals? I have met too many therapists who view being in therapy themselves as a stigma but are quick to complain about society still being backward in holding that view. How sad for clients who are being treated by a therapist who has not experienced personal therapy. It is inevitable that there will be a disconnect between the therapist and the client. Being raised in a happy family without trauma hardly qualifies one as being self aware. I realize that not everyone has an opportunity like I did with Dr. Headlee; but, I thank God every day that I walk in to my office that Dr. Headlee was there for me — and, the people whom I treat.
Jill, I totally agree with your comments. My reply, however, is to thank you for something else: your analogy is “souper” [sorry - couldn't help that one
]. I’m collecting analogies, metaphors and teaching stories that therapists use, and this is a good one! I’d forgotten that I used to compare beef jerky with filet mignon in a similar way … but yours is even more picturesque. So thanks for your contribution to my collection! I’m doing an article on this topic and will be presenting at CAMFT on same, and will give credit to contributors, so I hope you are OK with my using this, and I will add you as a source.
In my opinion, even if you don’t “need” it for the sake of “working on issues”, you do need it *****for the sake of feeling what your client feels when he’s sitting in front of you!!!*****
Our whole profession is built on sympathy and understanding the client who comes seeking for help, so as part of that – you must also “understand” another important aspect in him – how he feels at treatment, sitting in front of somebody and spilling out his problems.
That’s what I think.
I think it is absolutely necessary to work through your own issues in therapy in order to be a good therapist. Every human being on the planet has work to do on themselves, and we can not often see our own issues by without a “mirror”. We need someone to reflect us, to challenge us, and to support our growth. I have heard it said that “one can not be a guide on a journey one has not been on”. I believe that this is true even if we experienced good, healthy parenting and have suffered no severe trauma (although most therapists got into the field because there were issues growing up that we wanted to master). We all carry our histories – both personal and those of our culture and family lineage with us. It may, in fact even be more important for someone from a privileged family, where they got all of their needs met, to work on themselves in therapy. Without self-awareness, many therapists of this type allow their inherited sense of entitlement and narcissism get in the way of truly understanding their clients. We must be able to see our clients from within the context of a larger society and culture. The work of therapy goes beyond the nuclear family, and delves into culture, race, privilege, and class. We have all been effected by or have been the perpetrators of oppression on some level.
Wellness and mental health are a continuum, not a black or white scenario. Sure, there are people who are on the far end of having severe mental health issues, and those who are healthy in their lives and relationships. But for the majority of people, life is a work in progress, with many steps and challenges along the way. There are so many opportunities for growth, and so many and levels of personal growth. It is my firm belief that we must be honest with ourselves about where we are, continue to challenge ourselves to grow further, and stretch ourselves beyond our comfort zones in order to be fully present and alive on the journey with our clients.
As a part of my training it was a pre- requisite that I do 200 hours of my personal therapy. Working through my own stuff, yes we all have our own stuff, has helped me immensly as I work with clients. And if we pretend otherwise we definitely need therapy!
I have personally met clinicians from different disciplines (psychologists, MFT’s, LCSW’s, and psychiatrists) who haven’t undergone their own personal therapy. Although I haven’t conducted any formal research on the subject, my extensive experience in the field has led me to believe that the clinician’s theoretical orientation has a lot to do with it. On one hand, contemporary psychoanalytic theories emphasize the importance of the intersubjective relationship between patient and clinician and analyze the transference and countertransference as critical components to work with in therapy. In this case, the therapist uses her or his own countertransference as a diagnostic and treatment tool. Hence, it would make a lot of sense for the clinician to have done her own personal work, particularly when treating patients with characterological disorders and histories of trauma.
On the other hand, clinicians who work strictly with a cognitive-behavioral, medical model, and one-person psychology orientation, tend not to see the patient-therapist relationship as the center of the therapy. They recognize the fact that a “therapeutic alliance” is a pre-condition for therapy to be successful; something similar to cultivating good “bedside manners.” But what it’s emphasized is the ability to come up with accurate diagnoses according to well-established DSM categories, and implement the right treatment techniques. This model doesn’t emphasize the therapist’s use of self as a tool. Therefore, in a paradoxical way, personal therapy is seen (again, according to my experience) as not only unnecessary but even frowned upon as a sign of “weakness.” The idea is that the therapist should be a model of mental health by virtue of having a title next to her name (e.g., must have the perfect marriage, be a flawless parent, have achieved financial success, lead an exemplary life, etc.)
This is an excellent and fascinating topic, and thank you for the opportunity to discuss it.
Graciela, you seem to have a good grasp on some of the reasons behind the disparity b/t those who do or do not have personal therapy. Definitely the theoretical schools that emphasize intrapsychic and intersubjectivity would require therapy/analysis before practicing. However, I see the other side, the view of being a “model of mental health perfection,” as highly flawed from the start. It’s an absolute set-up of an unhealthy hierarchical relationship: I, the all-knowing expert, know what’s best for you, the poor, miserable, flawed client. I would never knowingly refer a client to such a therapist; the whole idea is offensive to me.
I think personal therapy should definitely be a requirement for licensing as a therapist. In my view, no matter how good one’s childhood was, there will be blindspots in the therapy office. I wouldn’t teach someone to fly if I, myself, were not a pilot. And to say I taught myself would not instill confidence in most students! Even doctors have reported on the huge shift in perspective when they have become a patient (eg: read The Anatomy of Hope, written by a doctor who totally changed his medical approach after having been on the other side as a patient).
It is absolutely essential to have been in the client’s chair before becoming a therapist. Two strong reasons that I can say are that you need to experience what it is like to be on the other side of the room from the therapist and the process experience. But more importantly, I have been told that you are only able to take your clients as far as your own work in psychotherapy and I have to say that I hold true to this philosophy.
There a several reasons I think a therapist is a better clinician if s/he sits in the client chair. The one that speaks loudest to me is that a therapist who doesn’t is more likely to miss counter transference issues that inevitably surface during therapy. Missing these issues opens up the therapist to taking out their own stuff on their clients. Clients come to us wanting to trust but scared to do so. We owe it to them to do our own work. There’s always room to grow.
I was impressed that it was only 20 – 25% that have NOT “sat in the client’s chair” as you put it. I had to go to 40 sessions as part of my graduate work. While I initially found it helpful, at some point, I found it excessive. Probably 20 sessions would have been enough.
However, as I go through life and this profession, I become aware of things that crop up that need attention. The more complex cases I take, the more I find that it is helpful to process some of my own emotional responses with another clinician. Or, I’ll experience something new that I don’t know how to handle – we had a close friend commit suicide last December – and going to therapy, even briefly helps me to attend to my emotional needs so I can then be more available for others.
Another benefit of going to therapy is developing an empathy for those who sit across from you. There may be hesitation, nervousness, ambivalence, etc. and you may not fully appreciate the subtlties of these responses if you haven’t experienced them yourself.
I can’t speak for anyone else, but for me, I think going to therapy (on and off) has helped me become a better clinician for the reasons above. Others may develop themselves just fine in other ways and I think there’s room for that. And I certainly don’t advocate for making it mandatory.
It is my opinion that we as psychotherapists need to be as emotionally healthy and stable as we can be to be of good service to our clients. Not doing so puts us at increased risks of not providing clinically and ethically sound psychotherapy to our clients. Engaging in our own psychotherapy is one of the ways we can take care of ourselves so that we are able to work effectively as therapists with our clients. Additionally, sitting on the other side of the room allows us to better understand our clients experience.