New white paper: The therapist as client…Or not? Should therapists be in therapy?
(Download a copy of this white paper to your computer by clicking here or simply read it below.)
Most therapists I know go into this field to help people.
I bet you did too. Humor me for a second as I invite you to do a short visualization exercise.
I want you to think about one of your favorite therapy client success stories. Remember that special client and the pain or confusion they experienced before seeking your counsel.
Picture them in your mind when they first came into your office. Remember their posture, tone of voice and the energy they projected. Now, fast forward through your treatment and see them emerging. The pain is less (or gone). The fear is manageable and the future looks incredibly bright. Breathe in the joy that you feel when you look at the transformation with that client.
What an amazing privilege it is to be a therapist.
People share their deepest worries and pain with us. They trust us with their hearts and their future. It is an amazing honor to do this work.
And month after month, we help people. No matter what your theoretical orientation, we do this work because we want to help people. We believe in the healing process of our work. Simply put, we believe in therapy.
Incredibly, the Psychotherapy Networker reports: “Surveys find that 20 to 25% of therapists have never sat in the client’s chair.”
When I first read that, I didn’t believe it. Can you? How can we be so clear of the benefits and power of therapy if that many in our profession have never tried it?
The reasons that therapists don’t seek therapy are interesting. Some say they felt they never needed it. Others say that they have other ways to reduce stress and do their personal growth – such as meditation or yoga.
Physician – heal thyself.
I have met therapists like that. In my graduate school, many of the students had never been in therapy. They hadn’t spent anytime on their family of origin issues or had someone be a mirror looking at their cognitions and behavior. I asked one gal why she never sought therapy and she blinked a few times before responding, “I never needed it, I guess. I had a very happy childhood and I am happy now.”
Is it just me? Or is this a problem? Are we saying we are “good enough” and don’t need further exploration?
When discussing why therapy is important, Virginia Satir once said, “We can’t see our own backside.” Truer words cannot be said. We don’t know what we don’t know. Have you ever stood behind the woman in the supermarket line who forgot to comb the back of her hair? You want to scream, “Get a mirror and check the back of your hair before you go out next time.” Yet this is exactly what we are doing when we don’t seek out someone to help us see what we can’t … when we don’t have our own mirror as a great therapist.
It is hard to help people grow past where you have grown.
These words were given to me by a sage supervisor when I was a brand new therapist. These words kept me in personal therapy for many years and helped me to grow into the woman and therapist I wanted to be. I look back at the person I was 20 years ago when I started my counseling training. I was perpetually scared. I had been single for many years even though I said I wanted to be married. I couldn’t figure out why I wasn’t partnered yet. I lived many days with the sole goal of trying to be perfect – or at least trying to disguising the fact that I wasn’t.
So, back then, when clients came to me with similar issues, I could help them conceptually. I spent hours offering interventions and ideas. That supervisor told me “When you find yourself saying something over and over, maybe it is time you listened to yourself.”
The old joke is that therapists are the only people that need 30 hours of therapy a week.
Providing therapy certainly helps us become better clinicians and better people. We can’t help but grow personally and professionally with the myriad of lessons our clients teach us.
Yet, isn’t it important to seek out our own personal growth as well? Shouldn’t we seek out our own therapy? A knowledgeable, differentiated, empathic person who can regularly challenge us to become more authentic, happier, and more content with our lives and ourselves? Why aren’t all of us turning to therapy to help us become the person we are called to be? Especially since we profess to others the benefits.
There are many laws and ethical guidelines to protect the client from inappropriate therapists and therapy. These include everything from sexual contact to record keeping. Somedays I think there are too many laws – and some of them harm more than they help.
But what about the client who chooses and bonds with a therapist who has not done the internal personal growth work necessary to be really helpful to the client? Is it just a Darwinism? The client leaves when the therapist is no longer helpful?
I sincerely wonder how many clients leave therapy thinking they failed when in reality the therapist’s unexplored personal issues got in the way.
Daily our clients put their hearts, their hopes and their trust in us.
They deserve our best. While we will never “have it all together” – I think it is essential that we do what we can to make sure we provide the safest place for them…the place where they to can grow into the whole, happy person they are called to be.
Yes, there many things we can do to increase our effectiveness. Continuing education is mandated and important. Supervision is powerful and, in my opinion, necessary – no matter how seasoned the therapist. Mediation and yoga can bring us back to ourselves in extraordinary ways.
Is it enough? Is it okay that 20 – 25% of clinicians are treating people without ever having sought therapy themselves?
Does saying we believe in therapy but feeling we (personally) don’t need it, say something about us? Some might call that a bit narcissistic.
How can we walk in integrity with our profession if we don’t respect it enough to take advantage of the numerous benefits?
Last year, I formed the International Therapist Leadership Institute – an organization dedicated to enhancing and enriching the lives and careers of therapists worldwide. It came to me one day when I was listening to a commercial spoofing therapy. The (spoofed) therapist was charging the client for tissues and for privacy.
I decided that I didn’t want the general public to believe that type of nonsense. I want our profession and the dedicated clinicians in it to be respected. I want the general public to see therapy as an effective solution to emotional or relational problems.
I want the respect our profession once had to be returned.
But, hey, just between us…why do you think that we lack some respect? Is it that many therapists are getting licensed or credentialed without looking at their own issues?
We owe it to ourselves and to our clients to do the best work we can. While I don’t think therapists need to be in therapy forever, it is important to take the time to see what we cannot see. As we do, we can grow in ways that serve us, our families and our clients.
I believe it is an issue of integrity. We need to walk our talk.
So, I ask again, who is sitting in your chair?
I welcome your comments! Feel free to leave them below.
In your service,
Casey Truffo
Casey Truffo, MFT is a licensed psychotherapist, award winning speaker, and author of Be A Wealthy Therapist: Finally You Can Make a Living While Making a Difference. She is a mentor coach to therapists on five continents. Her mission is to support and enhance the lives and careers of therapists worldwide. For your free five-part report. “The Future of Therapy – Don’t Let These Five Things Catch You By Surprise.” visit: http://www.TherapistLeadershipInstitute.com
{ 58 comments… read them below or add one }
I believe therapists must be in therapy themselves if possible. When we as therapists are able to experience the benefits on a personal level, we are able to be more genuine in our practice and be more effective therapists. Healing is a lifelong process and as therapists it is more important we do the work ourselves. We can’t heal others if we are not healing ourselves.
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 ourselves.
But it is also true that increased awareness can come from, among other activities, reading a good novel.
In therapy, as in life, change related to increased awareness.
Reply
Thanks for this question and interesting discussion.
Too many programs are not recommending or requiring psychotherapy for psychotherapy students. I think this is particularly true for academically-oriented programs (Boulder model), which do not emphasize psychotherapy training as much as Psy.D. programs. I think it is difficult to understand the vulnerability of the patient without having been one, and it is also difficult to understand how it feels to be understood on a deep level–or to be misunderstood.
I’m a veteran of 40 years, over 40,000 (good grief!) face-to-face sessions, 12 years of supervision and 7 years of teaching and setting up a Transpersonal Psych Counseling Dept at JFK in Calif. I’m not saying all of this to impress you (well maybe a little), but mostly to say that psychotherapy for psychotherapists is not only a must, but I, too, belief it is unethical for a psychotherapist to function as such without it. In the very, very rare cases where (as in one of the posts above), the person has such life experience that will give them the empathy and abilities necessary to truly serve another human being, perhaps it is not necessary. I personally have never met such a human being.
Our ability to fool ourselves and delude ourselves into thinking we do NOT have blind spots is truly awesome. As David (above) so eloquently stated, the incredible experience of having another highly trained and competent person sitting with you and focussing his or her very well-honed attention on you is a very healing, revealing, and I believe, necessary experience for you to be able to turn around and do the same.
I really appreciate that you have started this discussion, Casey, and loved reading the responses.
Over the past thirty years, in my lectures and interviews around the world, I have regularly advised audiences to “never go to a therapist who doesn’t have a therapist” or s/he will “simply saddle you with his/her problems. Indeed, when the intake form shows that my new client has just dropped another therapist, I ask the reason and invariably receive an answer that says the therapist needed therapy.
Casey,
i come down 100% on the side of therapy for therapists. Among other things therapists and therapists-in-training need all the support for their person that they can get as they go through the often stressful process of becoming a person who can sit with others who are in pain.
Being empathic is wonderful but it is not enough. You need to be able to manage your empathy and separate your feelings from the clients as well as resonating with them. That takes some pretty solid self knowledge.
I wonder if most of the 20-25% who feel they don’t need therapy are therapists who are trained to use scripts and manualized procedures? I suppose if you are essentially a “technician” you may not feel that you are using yourself as a therapeutic instrument.
You will not easily get away without therapy if you are trained in psychodynamic therapy!
One reason that training programs do not always make it mandatory is because they do not feel that it is ethical or legal to “force” students to have therapy…. but then other programs just make it mandatory and let the students decide before they apply whether they want to accept the terms of admission!
Susan
Casey. I couldn’t agree with you more about therapists needing to sit in the client’s chair. I came across this link several years ago from England that says there is research suggesting the opposite and kept it because it seemed so counter-intuitive and ludicrous. Here you go:
http://www.mindfields.org.uk/index.php?pid=71
Lindsey
It does not surprise me; I see the negative results with “colleagues” I unfortunately associate with. Every therapist/counselor needs to be in their own therapy; especially when you think you do not need it. It is a privilege to do the work we do – only when we do the work as well.
Casey,
interesting article. You may be interested in a blog I wrote about talk therapy for happy people. It’s on my website.
Best,
Kelly
I agree that it should be a requirement that we be in personal therapy for a period of time before practicing.
My countertransference issues always give me a clue as to what is happening with the client but that is because I know what they are and can immediately translate them to the client’s benefit.
Good for you for bringing this topic up!!
This is a great discussion. It is, in my opinion, sad that we even have to have it. It angers and astounds me that persons who seek to “sell” themselves as competent, safe, professional psychotherapists…who are, for all practical purposes, a caregiver and healer of the soul have never used the primary tool of that which they sell. I often tell folks who are searching for a therapist to ask the potential therapist: Do you consult with other professional peers about your clients/cases for additional help and support? Have you ever been in therapy for yourself (I, also, tell the potential client that the therapy journey is private and do not expect the therapist to divulge their own journey.)?
Therapy is soul work. It is not about “cure” or being “happy” or “becoming balanced”. It is without question a sacred journey to create a life that is interesting, adventurous and meaningful. It is not necessary to label it as sacred…it just is. All the posts have said it better than I. May we practice what we preach…Royce
I have been enraptured by the article and comments. As the daughter of a therapist, my childhood was not normal! I saw the world through a system lens, through a therapist eyes in how people relate, loyalty issues, defensiveness and why that can be triggered, peoples emotional vulnerability and how it can come out in many different ways. I have had soul-lightening conversations with his amazing insight into things I was struggling with. Perhaps this is a form of therapy, albeit it not “official therapy” since it’s a parent who happens to also be a therapist with healthy boundaries. I just know the power of transformation that comes from conversations outside a therapy room.
For me what I wonder based on everyones comments:
1. Do you believe the only treatment for a client is to find a therapist who has experienced their exact issue? What happens if you’re Jaycee Dugaard, since nobody has experienced 18 years in captivity and rearing two children from rape? Wouldn’t her counselors be using all their training, without personal experiences, to help? That is an extreme case but there are still hundreds of situations the vast majority of therapists will never have experienced, but still use their training and skills to help clients with.
2. Are all therapists equal or might some of those 80% who have seen a therapist find a poor therapist who doesn’t help them grow, but emboldens their worldview that may be not-quite-so-healthy? This may then translate into the very odd behavior seen by friends of mine with amazing tales of crazy therapists.
3. What about therapy is so vital to personal growth? I know dear people who have in some ways grown more self-absorbed in therapy. They aren’t called on their odd behaviors, because the therapist never sees them except in the office. The therapist isn’t aware of a great portion of their life because the client themself isn’t aware enough to even express it with their therapist. (So yes, I am expressing my bias towards systems/family therapy.)
4. Does empathy necessarily grow being “on the other side of the couch?” If you’ve got a high emotional IQ, great childhood, fairly “charmed life”, might the experience of doing therapy “because your grad program requires it” not actually assist you in feeling the deep pain of clients? Perhaps time spent with others would be more valuable than self-exploration of a fairly dull, happy life. This may not be in the form of being a therapist intern, but volunteering for domestic abuse shelters, homeless shelters, sitting in the NICU for a month watching the pain and horror, or sitting in a cancer ward. In other words, if most grad students are 20somethings without a ton of “real life” experience, throwing them in high humanity situations might be more impactful than sitting with a therapist.
Respectfully a “lay person” who works with therapists, is the daughter of one and wife of another,
Elizabeth Doherty Thomas
Hi Casey,
I believe one of the most valuable “side effects” of being in therapy – for a therapist – is in reinforcing our own humanity and helping us stay humble.
I am a life-long therapy client and I wouldn’t have it any other way. It not only has gotten me through some very, very tough times, but also it has taught me from internalized experience what it feels like to let someone in to see the real me, warts and all.
I cannot fathom how someone who has never been in therapy could ever understand what it feels like to be a client. It’s such a complex experience, so personal and intimate. People can be surgeons without having had surgery, but that’s not an on-going relationship, and the relationship, I believe, is what heals.
I can’t say I was shocked; the numbers were consistent with my cohort in graduate school. However, “we don’t know, what we don’t know.” No matter how aware, conscious or psychologically minded one is, omniscience is not available. If a therapist does not believe in her trade enough to pursue some counseling for self improvement, how can she truly believe in the value of what she has to offer?
It speaks to a willingness to look in the mirror and a willingness to be as open as we ask our clients to be with us.
I am shocked to read that 20-25% of therapists have never been a client, have never done their own work, and never experienced those confusing feelings when one sits in the ‘other’ chair. I agree totally that one can only take a client as far as we have been. If I am not willing to explore the deep, dark side of myself, how can I possibly walk with a client who is doing that work? So often, when a client is lost in a deep fog, lost in the dark forest, and unsure of the way out, I sometimes say, “I have been there, and I trust you will find your way out as well.” The relief on their face is amazing. Being in therapy has been the BEST education and preparation for being a therapist. One truly understands the value of surrendering to another your struggles, pain and trusting the other with your stuff! How gently my therapists over the years have walked with me, cared for me, and sustained me. Their love and care formed me as a therapist so that I can extend that same compassion and empathy to my clients. I remember once a gal in graduate school say, ‘I know I have to do 50 hours of therapy in order to graduate, but I don’t know what to talk about for that long!’ I sadly wondered how she would be able to sit with clients for that many hours. Ok, I will stop, but wanted to put my two cents in on this one. I am passionate about this issue, as I can see that Casey is as well.
A very interesting article. I had not realized the percentage of therapists who had not been in therapy was so low. I appreciated the comments on the effect of this on clients and how clients might leave the therapist when they cannot grow beyond the therapist. But for me, the most powerful reason for a therapist to have had their own therapy is the ability of the therapist to understand what it FEELS like being in therapy. If one has not had that experience, I can hardly imagine how the therapist can have the empathy (not sympathy) needed to provide a good therapeutic experience. If I had not had therapy for myself, I would not have a clue how very difficult it is for clients to broach sensitive subjects, emotionally, psychologically and even viscerally. Thinking that it is difficult to talk about some subjects is NOT the same as having experienced this difficulty oneself as as therapist in therapy. Training programs should require this. It is sort of like saying that you know all about having a new baby in the house because you “read” lots of books about what it is like. Reading about it and talking to friends about it does NOT prepare you for the terrible fatigue that accompanies taking care of a newborn. And I think that clients can intuitively know when therapist has little idea of what they are going through. It has to come through the therapist’s choice of words, affect, gestures, etc. Often we can just tell a wise person from one that is not wise. Wisdom connotes prior knowledge of an experience and lessons learned from same.
In my opinion if the clinician hasn’t done his or her own personal work, they are hindered in effectiveness, limited in empathy, and possibly even ethically challenged.
In contrast, a person who’s been down to the dark places of their life, who’s mucked around up close and personal with depression, anxiety, panic attack, rage, despair, addiction, sexual abuse, and their siblings makes a far better therapist than the one who’s only been a tourist to those swamplands of humanity. I respect a therapist who bears the scars of wounds healed by his or her cohorts and colleagues. I don’t want a voyeur as a therapist, I want a blooded veteran. I don’t want a scholar, researcher, dilettante or academic for a therapist, I want someone who knows from the gut what the landscape feels like down there in the stink. That is why the better training programs demand that trainees are in therapy! And not just a few times; but over a long period to tackle real issues – no role playing allowed!
In the old days, some therapy was neccessary to graduate from a program as someone qualified to do therapy. Even those of us who don’t have any major outstanding issues can use the opportunity to look at countertransference issues, ways we respond to certain types of clients, when we are placing our own expectations on clients instead of letting therapy be driven by their pacing and goal needs, etc. I would love to see this become a graduation requirement and Continuing Ed requrement for licensure.
I do not often take public positions or stances on issues. However, this particular one is a bit more provocative than most and so I thought I might join the chorus and add a voice…off pitch though it might be from lack of public practice. I apologize in advance if somehow my voice comes out a bit louder than I might prefer…
The viewpoint I’m approaching this conversation from is based on the idea that we’re discussing the merits of therapists seeking psychotherapy. Since I feel certain “psychotherapy” means something a bit different even to a group of licensed experts, I will be as clear as I can be about what I am suggesting by psychotherapy in this context (and hopefully clarify my point). Certainly, there is an element in any clinical practice that revolves more around case management of either relatively serious AXIS I Type issues (and general diagnostic/clinical issues, although hopefully less AXIS II if possible…that is another discussion) or just plain old bread and butter counseling that is the day in day out business of what we do all the time.
Regardless of the orientation used to facilitate change, the ultimate goal is generally to assist our clients in implementing a solution-focused strategy. Sometimes we help a client reevaluate cognitions; other times, we may assist a couple as they learn to more effectively convey feelings of intimacy; the list could go on endlessly. It also includes being able to help that occasional very serious potential lethal person who might commit suicide without the correct intervention. We all know the countless variations on the theme. In my mind, this is great counseling. I say this only because the topic was initially presented as “going to see a therapist”. This is a large percentage of how therapy is seen and presented.
However, it seems to me that this discussion revolves more around a somewhat different proposition. That being, is there a fundamental basis for therapists to be in “psychotherapy”? Well, what is the difference between the goal-directed, solution-focused variants of counseling and “psychotherapy”? I am going to try and consider the question on its merits. First and foremost…no therapist who has reasonable boundaries and cares for his or her friends can truly practice their trade in a serious manner with a friend or family member. That is not to say that our relationships with others who have “therapist-type” backgrounds aren’t amazing. I have those types of relationships and they are a true blessing in my life. However, even though I listen closely to my friends and when necessary, will shift gears somewhat, it is rare that someone in my personal life experiences my professional trade. Why? OK…here is the real deal…that would mean I left my own needs outside the door…they could become angry with me and I would not take it personally…in fact, they could end the relationship and I would be able to know it was more a function of their internal issues than my own, as my issues would magically have to be “not at stake.” I would never want to feel that way in my personal life…period. So for me…the issue at hand is not a contrast of “outstanding interpersonal relationships” or “psychotherapy”. Being a therapist is not a hobby…nor is it casual. It is my profession and it is as serious as the sun. This is in no way negates the value of wonderful friendships and in fact, raises them to a “protected status”. For me, these are unrelated issues that have no bearing on one another whatsoever. When I walk out the door of my office, I hope to close the door. Psychotherapy is not a thing I like to have hanging around day in and day out.
What happens behind that closed door, which is done with the most guarded levels of confidentiality, years of training, measured boundaries, absolutely focused attention and the highest level possible of interpersonal care and giving, is and better be something no friend should do with me, or me them. Yes, we have times where we help each other. But I want a friend to be involved with me and to be intimate, to know they are on the line as well…I want them included in the deal. Authentic as we can figure out how to be…
Because true psychotherapy…well it has to be a different experience. How? Well…Here is my side of the story…from the other chair so to speak. If I am with a really good psychotherapist…I have created an opportunity to take a short time out of my life in a very private place with this highly gifted person so I can explore my life and consider it in ways that I more than likely would not with friends or on my own. I think of it like getting to going for a hike…a wonderful set of hikes or journeys and having the best guide ever… Sometimes I can go for a while and things may not really be very clear or I may not find a lot. It is the ongoing relationship that we experience. We walk together…sitting and chatting. Sometimetime it is wonderous. Other times, when I feel I am going in circles, I think I experience what every client I have ever had has experienced when they start to question therapy or wonder where therapy is going. I gain empathy for what they experience and I see things I might never have seen. I find myself reflecting more often. I look for blind spots in my life that are just around the corner. I have discovered I have them in places I never might have guessed.
For me psychotherapy has little to do with chasing down problems, fixing family issues, dealing with pathologies, or being broken in any way. Although sometimes I might do any one of these things…that is life. Rather it is the luxury of finding an absolutely wonderful, remarkably well-trained person who for one-hour takes the time to walk with me down my chosen path for that usually all-too brief period of time on my day (well…let’s be real clear…I love it to be Tuesday mid or late mornings right now). I rarely know where the hike (ok…session) will lead. I almost always am amazed at this…it feels silly and a bit embarrassing to admit that…after so many years…but it still kind of tickles me, a little like an unexpected Christmas present. Even better is the reality that over time, the paths I explore wind back together again and again. I see things and learn about my life, my wife and our marriage, how I think, my children, my world and everything in it in ways that change my life and legacy. Sometimes I cry…other times I laugh…still others I have become angry. Mostly, I have simply grown. Over many years, I have been very blessed and have had a few different therapists that have been in my life in wonderful ways. They all reside in my heart and mind and without knowing it, will wander down the paths of my family’s generations.
Sometimes it is more often…others less. Life’s rhythms change. The climate of life shifts. I do like Tuesdays if I can find one here and there. I like to run also…but sometimes I stop for a while. Marathon training has its place as does everything in life. Everything has a time and place. So maybe I just go to the gym instead or do something else. But I hope to find my way back to another hike.
After 30 years working in the field of mental health and over 25,000 hours face to face therapy, I still feel blessed to have the opportunity to provide counseling and psychotherapy services for individuals, couples and families in my community. I attribute much of my longevity and success to the time I have been fortunate enough to spend with a few gifted colleagues in their offices as they have allowed me to entrust my care and psychological growth in their remarkably caring hands.
So for me, I believe psychotherapy can provide therapists opportunities. It is not about judging others on their choices or deciding if my colleagues should or should not make a given choice. I have enough to do managing my own life and always value the opportunity to hear from others. I appreciate the chance to share these experiences as I feel they have been important in my life and career. Many, many years ago I was asked to give a talk when my classmates and I finished our graduate degree. At that time, I shared many of these same principles. Now, a very long way from there, I have the luxury of saying similar words with a touch more wisdom (I hope) and …having “walked the talk” as Casey would say. I love hiking and am deeply grateful for the guides who have taken the time to walk with me along the way.
David L. Christopher, M.S., MFT
SanDiegoTherapist.com
David,
Thank you for taking the time to write this beautiful post.
Warmly,
Casey
This is excellent, David — I hope you put this as an article in one of the magazines (maybe AAMFT). I’ve written another comment below.
I’ve enjoyed following the flow of this discussion, but one thing stands out to me…..we seem to be viewing the need for therapy on having problems or not. Besides that, what about the experience of an examined life? There’s no doubt in my mind that taking a look at who you are in your world is as beneficial for therapists as working out a particular problem. And, also, being able to move through our own experience of this kind of work will help us open up areas for our clients beyond just healing particular problem areas.
All therapists need to have therapy at some point in time because of the certainty of struggling with Vicarious Trauma or Second-Hand Shock. Consistently listening to trauma-content stories, while utilizing the taxing skill of controlled empathy, creates a brainstrain that can ultimately affect the health and well-being of the therapist. Countertransference, or the triggering of the therapist’s own personal pain, is inevitable and intensifies the adverse effects of VT. Therapists need to build an inner consciousness of their own historical “hurts” so they can minimize the negative impact of Second-Hand Shock. Our book, “Day After Day the Price You Pay” provides a compelling explanation and healing journey to combat this silent thief that robs us of our spiritual, emotional and physical well-being.
I could not agree with you more. My masters program required a year of therapy; individual, family, couple, group, whatever, just be in “the other chair”. I think that is an essential component to being an effective therapist. I have a therapist I see for “tune ups” several times a year, and I believe it keeps me aware and authentic for my own clients. I have to question what really keeps people in our profession from seeking out their own therapy in order to stay on top of his/her own stuff, which could hinder their ability to optimally treat his/her own clientele.
While I disagree with Maureen’s take on the forum for processing one’s issues, she raises some very good points. I’d like to present her (and all of us) with a scenario, just to see how people might respond (with or without a history of personal therapy).
Older gentleman walks into your office. He’s having problems with his teenage son. As you get to know him, he truly seems like a lovely man, a good soul, in Yiddish, a mensch. He says “We even have a round dining room table so that we can have lively debates over dinner.” And yet, his son’s developmentally appropriate rebelliousness (and symptomatic rebelliousness) troubles him deeply. You, as his therapist, struggle with helping him. The question is, “Why?” Some points to consider:
1. Are you empathically listening? Or is sympathy taking over? In other words, what’s going on with your countertransference? Might you be identifying with him?
2. Let’s say, for the sake of this exercise, your own father passed away 5 years ago. Painful as it was, you processed it in your own way. Does seeing this “father figure” walk through the door and describe your own childhood trigger anything for you?
3. What if the reason the son’s behavior is troubling him so much is because it’s triggering the father’s own family of origin issues? If countertransference, feelings of identification, etc. are omnipresent in the room, how might you help him reach those own experiences?
4. Given that you are “stuck” with this patient, is this a time for therapy? Supervision? Both?
I look forward to hearing thoughts on this…
Lee
Stamford, CT
I can’t tell you how excited you wrote this article and it has come to light. One of my greatest learnings in my journey with Spirit and energy healing, is the knowing that ‘you can’t take someone where you haven’t been?’ It has held me in good stead, and I hope your article gives many therapists a little push in the ….proverbial.
Casey,
Its so nice to see you front and center on this topic. I wonder too how many therapists are in long term work or doing deeper work…I think many of us are shaped by our experiences with our own therpists.
I also marvel at how few therapists are in supervision as well, and have been studying and writing on this for some time (see why we resist supervision at http://www.goodpracticeinstitute.blogspot.com).
I think we sometimes forget just how good and relieving, how important and vital it is, to talk…to be heard, to just stop and discuss and reflect. We miss out on so much if we dont. We need it, I believe, in order to continue to do our good work!
Melissa
How about a contrarian view?
The problem with the premise is the assumption that therapy is good for everyone. I learned from Alan Bergin’s research that therapy usually helps, and sometimes hurts. That is, there are supershrinks, shrinks, and pseudoshrinks. There appears to be a significant risk that therapy will harm. Not a large risk, but it is clearly there. Bergin taught us that the risks were centered around particular therapists. Maybe they needed therapy, I don’t know. So therapy is not a benign process.
When I was in grad school, I didn’t know enough to tell one from the other. I didn’t have therapy, but I had lots of supervision.
My view is that I wouldn’t recommend therapy for everyone, just as I wouldn’t recommend knee surgery. I had the surgery, it seemed to help, some, but I would think everyone should have it.
Therapy means “the treatment of disease or disorders, as by some remedial, rehabilitating, or curative process.” If one is not diseased or disordered, why get therapy? It seems that we have lost touch with what our profession is about if we think that all should have it.
I had training / supervision from Milton Erickson. It was confusing but useful. Supervision with John Weakland was a wonderful, growing experience. So also with Ernst Beier. Other therapists who weren’t famous were also great supervisors. Not one ever suggested I needed therapy. My own published research suggests I am on the supershrink end of the spectrum (he said modestly). So perhaps I am the black swan, or maybe a white crow. I didn’t have it, didn’t appear to ever need it. I have 33 years of stable marriage, four great kids who never needed therapy, and thoroughly enjoy my life.
It seems unusual to me that we would suggest a treatment for a disease or disorder to those who don’t have the disorder. I also saw, when I did my internship in a psychoanalytic center (which I have completely recovered from thankfully), there were people who made their living treating students who seemed to my uneducated eye to function rather well. Why were they treated? It would be mean-spirited of me to suggest to keep their therapists busy, but that is secretly what I wondered.
Lynn Johnson, Ph.D.
http://enjoylifebook.com
A little P.S. to my previous post — Of course in grad school we had to have a few nominal hours of going to therapy in order to graduate, and of course, while interning, I had supervision discussions, but I was addressing the YEARS of therapy you were advocating, and the many posts here are in full agreement with you… I hope you will print my lone dissenting voice that was in my previous post, about how we should, of course, process our stuff, I simply don’t believe unto death that it MUST be done with a therapist. It must be done, and if done properly, it will be therapeutic, but it does not mean only therapists can be therapeutic, or that only therapists are who you should process issues with… Thanks again, Maureen
Maureen,
I take your point and am delighted you shared your thoughts! I expect many are thinking what you took the time to write!
Bless you,
Casey
Learning how to help others requires knowledge and experience. Experience treating others and experience being treated. The expression, Healer Heal Thyself is true yet in the sense that we need guidance to go through the process of healing.
Each patient that comes into our office is there to tell us what we need to work on. If we are successful in our evolution, our patients will be too.
Hello Casey,
I couldn’t disagree with you more on this particular subject! While I think therapy is a wonderful tool for many, it’s not the only way someone can gain insight and process issues or have tremendous growth!
In grad school, I remember being surprised that so many students wanted to be in the position of being a help to others, when they hadn’t processed any of their issues (as declared by themselves, not from any assumption on my part!). Clearly they would benefit from therapy themselves, and I encourage that, but to say if a therapist has NOT had therapy themselves, it’s because they must be narcissistic is just so wrong of you to say, on so many levels!
Not everyone had a sick childhood… Not everyone has pain they haven’t acknowledged… I had sort of a Leave It To Beaver childhood, and I have such open parents, everything was and is discussed! We even had a round dining room table because my Dad wanted us to all to feel welcome and to openly participate in lively conversations and debates over differing opinions, without having to defer to some figurative or otherwise “head of the table”. We (my siblings & I) learned about Dad’s life & Mom’s life, and the hardships and the issues they came up with, and got to learn a lot about love and life and open communication. We didn’t have secrets about our families and what things meant…
As adults, unless one lives in a bubble, of course we all have things happen in all our lives for good or ill at times, depending on the circumstances… Of course these times need to be processed, and mine were! My friends are so therapeutic and always have been! They’re insightful, educated and all come from varying types of lives, with rich and diverse perspectives and approaches… 3 of them are therapists themselves, the others are not. All are well-educated and live life well, with joy and love and God and family and friendships that are solid, not fleeting — people I respect and love and value… My friends have processed many things with me over the years, and it has been invaluable!!
Had I not had such a strong network of wonderful people in my life who can be objective, regardless of friendship, who were there to process things with me, then perhaps I would’ve seen a therapist… But I had true “therapy” with my friends and family! And as a therapist, I know the difference between a friend just saying what you want to hear, and a healing, therapeutic processing, regardless of whether or not what is being said is what one wants to hear!
So no, Casey, not all therapists who have never been in therapy themselves are narcissists, and neither are we limited in our approach, unable to help clients get very far…
You clearly de-value all the rich, beautiful, healthy, helpful and truly therapeutic relationships we therapists are blessed to have in our lives when you say things like that! And for those who DON’T have such a blessing, well, then therapy is a must…
But then again, I’m not a back or white, all or nothing thinker… I live in the gray, where many outcomes are possible! It’s all about how well you know yourself, how able you are to articulate your needs to those in your inner circle, to those with whom you want to process things with… And for them to know you well enough to say things you might not. If you don’t have a sense of self, or an ability to analyze your interior world so as to put into words the areas of struggle, the issues you want to process, then maybe your rich, select circle of friends won’t be as therapeutic as mine have been… And they REALLY have been, including the non-therapist friends I have…
So while I understand your gross over-generalization (it was my thought in grad school about the majority of my classmates), I will encourage you to please leave room for recognizing the possibility that there are a few blessed souls out there (besides me), who HAVE worked through their stuff, just not in a therapists office, who DID have healthy childhoods, and who DO have loving connections, and who ARE able to help their clients go way beyond far, and that with the inevitible bumps in life, and in moments of pain that all we humans experience, it really IS possible to do the work of processing all of that, without actually going to see a therapist…
I think the more important point, that I am in total agreement with you about, is that we ALL need to process stuff at one time or another, and if you don’t, it will block your path to moving forward, and will no doubt impede the growth of your practice… THAT, I agree with you about… I just don’t happen to think it simply MUST be doneONLY in a therapist’s office, or that nothing else will do…
Thanks for hearing me out on my differing point of view!
Many blessings to you,
Maureen in Irvine, California
Maureen,
Thanks for taking the time to write such a lovely counterpoint. You clearly are a great gift to all that know you.
Hugs,
Casey
I’m happy and relieved to see someone write about this topic. Thank you, Casey. As a clncial supervisor at a mental health clinic, I find it very difficult to discuss counter transference issues with clinicians who have never been in therapy. I find therapists who have not done their own work get defensive when I bring up counter transference, as if I’m implying there is something wrong with them rather than as a way to understand the client’s behavior and better serve them. Working with them is a lot more work for me and it is difficult to encourage them to get into therapy b/c it can cross a professional line if not discussed tactfully. The therapists I supervise who have been or are in therapy, are generally more emotionally available, not as defensive and use the counter transference issues we openly discuss, to better themselves as people and clinicians. This makes my job easier and more fulfilling and hopefully provides better therapy to our clients.
Touche! At my traineeship, one of the counselors there was from the UCS MFT program. He mentioned that personal therapy was optional and who had time to do that? I was shocked to hear this. I’ve learned so much about myself from my own therapy and absolutely agree with you, Casey!
It’s uncanny how so many of my clients’ issues mirror my own. If I had not had the 25+ years of therapy that I’ve had, I would not be able to help them. The wonderful part of this work is that it continually presents new challenges, and I find that I never stop learning about new aspects of myself. Ongoing therapy gives me an opportunity to process this material, make it conscious, and then integrate it so that I don’t act it out on my clients. I can’t tell you how many highly credentialed (and highly narcissistic) therapists I have seen who have not done their work, and as a result do a lot of harm. Therapy should not only be a requirement for acquiring a license, it should be required to maintain a license.
Hi Casey,
Love the message. The other side of that 20% is the 80% who have engaged in the therapeutic process. This is wonderful news, it means that most of us are walking our talk and a “B” average for the profession. I agree with you that it is vital to sit on the other side of the chair and continue to grow. There is a high “burn-out” rate among those in this profession and I strongly believe that these are the ones who may blame their clients rather than looking at themselves via counseling. I think that graduate school that do not require personal participation in therapy do a great disservice to the profession. It needs start at that level. Grist for the Mill.
I can thank you enough for running this article. I am an MFT Intern at an acute-care psychiatric hospital in Southern California, and I make no secret to my colleagues that I have a therapist whom I see periodically. I am amazed at how many times I receive a response something to the effect that, “Well, if I thought I needed it I would go.” Or worse, “don’t you think a therapist who can’t deal with their own problems without help should re-think their choice of a career?”!!!! Wow!!!! That attitude frightens me more than I can say. I had a great clinical supervisor once who used to say, “Therapists will work out their issues, either in their own therapy, on their own time, or they will work them out on their clients at their clients expense – and that’s malpractice.” I believe that appropriate self-care is one of the most critical responsibilities we have to our clients. And certainly, it speaks to our integrity as professionals. Your article was an encouraging breath of fresh air!
Casey,
I agree with you 100%. I believe that all therapists as part of their graduate program and/or licensing process should have to be in therapy. “You can only go as far with your clients as you have gone with yourself!” I firmly believe this statement which is why I offer a reduced fee for graduate students studying to be therapists. How are therapists going to understand what it is like to be a patient? Having been in therapy several different times in my life, I know that my own issues do not affect my patients. I worry about therapists who say they do not need therapy.
I have sent e-mails requesting downloads from the free teleclasses and have not heard anything back. Is anyone there getting my e-mail?
I completely agree that therapists need to have completed many hours of therapy before sitting with clients. I too was in school with students who had never been in therapy and was shocked. We need to keep exploring our issues as long as we have a body. I know some of my local psychology programs are actually increasing the personal therapy requirement for graduation. Yeah!!!!!
That is fantastic news!
Great article. At one time I wrote a similar piece on the subject. I’m a firm believer in the importance of therapists doing their own work – and the BBS in California clearly feels the same way by triple counting personal therapy hours in training.
If we’re not aware of our own wounds and triggers, how will we be able to stay mindful of keeping our own countertransference from negatively impacting our clients?
Consider for a moment a particular client who gets under your skin…there are possibly reasons other than the obvious of their behavior. Perhaps they tap into something a bit more personal for you.
It’s my belief personal therapy should be mandatory for licensure – another way to help ensure the public is protected from therapists who do damage by playing out their issues before their vulnerable clients who sit before them.
It’s not just you. Nice job, Casey.
Lisa Brookes Kift, MFT
The Toolbox at http://www.LisaKiftTherapy.com
A Resource for Emotional and Relationship Health
Thank you for your comments Lisa. I love to hear them.
Casey–I think your white paper is right on. As a psychoanalytically oriented therapist, personal therapy and/or analysis is a requirement of training. I honestly don’t know what other training institutes suggest or require. However, I don’t think it’s theoretical orientation that should guide therapists’ use of personal therapy; it’s, as you suggest, integrity. Several years ago, there was a movie called “The Doctor” (with William Hurt, I believe), which was all about how a cold, poor bedside manner physician changed his whole view on medicine when he himself developed cancer and needed to undergo treatment. I can’t remember, but this might have been based on a true story. The point is this: you can’t possibly do your best work unless you have experienced that which you’re offering. While I was studying for my licensing exam many years ago, I came across a statistic. I can’t remember the source, but basically, the stat said that after an analysis of variance, the ONLY factor that predicted success on the licensing exam was the clinician’s history of having been in personal therapy. Not grad school. Not internship. Not years of experience or hours spent studying. Personal therapy. It’s that important. So, again, thanks for an excellent paper!
You’re Welcome Lee, I’m so glad you posted a response. Thank you.
I agree with your comments about therapist needing to work on their own family of origini issues before they can be an effective therapist. Relationship issues can also become a stickiy problem which can be coming from FOO or trauma experienced with previous relationships. I myself have many hundred of hours of therapy. I considered Continuing education as a therapy specifically, related to violence, abuse and traumas.
I couldn’t agree more about the benefits of therapists partaking in therapy. My desire to become a therapist was definitely fueled by my own positive experience in dealing with childhood issues. It was easy for me to believe in the validity of therapy because it had significantly changed the quality of my own life. I think it’s beneficial to continue therapy from time to time. The challenge now is finding a therapist I can trust who is not already a friend or close colleague from a local professional group. A question to you all – any thoughts on a “co-op” group for providing therapy to colleagues without developing dual relationships?
I think it’s important all right for a therapist to participate in personal and/or family, couples therapy. Having the experience of being a client helps you understand what the process is like… how a client feels after a session, between sessions, before sessions, feelings toward the process, the therapist, the room. Things you found helpful and not-so-helpful as a client are very informative.
I agree Cynthia. How you feel as a client can never be “taught”. You must go through the process to understand.
I do believe this is a problem. When I was in my doctoral program there were several doctoral students who shared with pride that they hadn’t ever been in therapy until this program when they needed to do 25 hours of it. In order to
have true empathy and compassion we need to have experienced what it’s like to be in the other chair, how vulnerable a place it can be. If we don’t know ourselves we
will act our issues out in countertransference reactions.
So true Evelyn.
Casey, I think you are so right about this. I remember in my group therapy course, run as group therapy, there were folks in my group that claimed to have “no problems” and “a great childhood.” Having grown up in a dysfunctional family, I envied them. But almost without exception these were the folks that displayed the most pain as the walls came down and the truth became apparent. It showed me that no one is immune from problems. Their problems were different than mine, certainly, but no less real and no less distressing. I think every therapist needs to sit on the couch, to learn not only about themselves, but about the experience of the client. Without that experience, I don’t think one can be as effective as one might.
Well said Stephanie. Thank you for this post.
Casey, I couldn’t agree with you more! I always read what you write and think about responding, and don’t. This time, I am compelled to respond. I absolutely would not take on an intern, either in an agency nor in my private practice, who had not been or was not going to be in therapy. You put it just beautifully when you quoted Virginia Satir. I didn’t know that she said that an she was right on. In some cases, administrators of agencies, even though they might have been clinicians, didn’t care about that. In one agency, the administrator accepted an intern who bragged about not having ever been in therapy. I would not supervise him. In CA. now, as a result of some of our efforts some time ago, the MFT license requires that a trainee/intern have at least 100 hours of therapy and they get extra hours for that. When I think/feel that it’s time for me to go back to therapy, I always ask the therapist whether or not s/he has been in therapy. At my age, I still have enough of my own issues without taking on those of the therapist. Thanks for reading.
I’m so glad you wrote in and responded on this very important issue Zora. I love hearing from all of you. Please do keep in touch.
It is beyond me how anyone could be a therapist without having been in therapy themselves. My own therapy and supervision were the biggest contributors to my success as a therapist. I also had to show that I had been a therapy client in order to graduate from my Master’s program. I find the 20-25% figure appalling. Yikes! Thanks for bringing this to people’s attention.
Thanks for your comment Susuan