Hearing Voices by Venessa Bowers, MSW, LCSW, LAC and Melody Stiles, MSW, LCSW, MAC, LCAC

Ever heard the adage that, “every therapist needs a therapist?” Did you ever wonder if it were a true statement? Why do those “professionals” need to talk about their stuff? Surely, needing one’s own therapist must make a weak clinician, right?

Could it be that to do therapeutic work, one has to either be an unconscionable gossip, a glutton for punishment, a vindictive voyeur, or a sociopath in psychologist’s clothing? How about an overly aggressive advocate who doesn’t know her place? Someone who confuses professional boundaries and love on a daily basis – sometimes on a minute by minute basis? Someone who has their own demons and has either learned to ask them to tea or has run screaming from the mental health office they inhabit? I can say that at least from my perspective, there are days when I have felt as if I was all of those things. But that’s not why I reach out to my good pal, Melody on a regular basis. And I reach out for more than “shop talk.” I reach out to connect to another human soul who fundamentally, by the nature of the “shop” understands this work. But she also understands me. She gets my kind of crazy. More than that, she’s funny.

So. That said, I tapped my pal for a polka into the realm of voices we hear regularly – from our clients, our peers and colleagues, policy makers, media, other health care providers and society in general as an attempt to invite you as reader into the temple of the mind that can easily crumble under pressure if not properly shorn up. Further to demonstrate where wrecking balls come from and that those things that seek to damage the mind and soul are certainly everywhere.

Let’s set the framework from the beginning:

  • If you can’t stand reading about this issue from the writing of two clinicians – hit escape now.
  • If you sort of want to check it out, put a timer on for yourself so you can give yourself an excuse to need to wash the dishes that you’ve left sitting in the sink for two days.
  • If you just think this is something folks need to “pray their way out of,” please make your way to the nearest church and hope God is available in the very moment you need Him/Her/It.
  • If on the other hand you want to know what mental illness looks like, how it is treated or left untreated and who is responsible for many of those decisions, settle into our big comfy therapist chair while we take turns on our not-so-Freudian couch to spin you a story that is stranger than any fiction two creative women can make up. Please take notes – that’s imperative for proper documentation. Just sayin.

Meet Mel:

Being a professional social worker in direct practice (aka psychotherapy/substance abuse) is a risky business on a lot of levels. Which is why most of my colleagues have been in therapy themselves and some continue to be in treatment themselves from time to time; just to be sure they are “clean.” If you are wondering what on earth I’m talking about in my usage of the word, “clean,” please read on.

Consider that your job is to sit in a room alone with a different person every hour of your work day, listening to the difficulties in this individual’s (or couple’s or family’s) life. Trust me when I tell you, these stories are not usually amusing or fun. The stories can be inspirational, courageous, and even jaw-dropping at times. Most often they are about the crimes we commit against other people: horrible, abusive, painful reports on how human beings treat each other. And, your job is to listen to it. Be in the moment with your client. And, you can’t tell anyone, ever. Unless there is a risk of future harm to your client or someone else, then you are forced by law to report it and there is a very good chance you will never see your client again.

This is your job.

If you work in community mental health or a group practice, chances are good that the biggest stress you deal with has very little to do with your clients. The stress usually comes from the people who are your colleagues or, in the case of working for an agency, the administrators. Some of the craziest people I’ve ever met are other therapists, be they social workers, psychologists, psychiatrists, marital and family therapists, etc. For obvious reasons, our field attracts the craziest of the crazy. And some people believe, even after all of the readings and study and practice of all of the years of higher education, that they can solve what ails themselves by doing the work we do every day. Of course, just the opposite seems to be the case. I am here to tell you that if you have an unresolved issue you are struggling with as an individual and you do this kind of work, not only will your clients suffer, but every client who walks into your office and sits on your couch will seem to have the exact same problem you have! So, this is why it’s so crucial to deal with your own issues and leave them at the door when you go to work.

I will now toss this back to Venessa to address the issue of one of the other occupational hazards that plague people like us: family and friends that begin a sentence with, “I know you’re not my therapist, but…”

When I first read Mel’s prompt I thought and actually said to her “Awww Shit.” I hate this statement. I hate to think that when I answer the phone the call will be from someone I love wanting me to “shrink” his/her situation. First of all, folks like Mel and I bound by the National Association of Social Workers’ Code of Ethics which states that we cannot, under any circumstance, enter into what is called a “dual relationship.” What that means if I know you personally, I cannot help you professionally and vice-versa. Why? Because intrinsically, there is a power imbalance between helping professionals and their clients – we are charged to see the world of the client through objective (to the extent that that is possible, as we are humans) eyes. If I know your husband is a jerk and treats you like shit because I’ve watched him do it, and you come to me “as a friend” for advice, I’m in a double bind – I love you as my friend and want you to be happy, but I also know that as your friend, what you need most is a trained professional who does not have the cloudiness of emotion to help you find the solution to what ails you. If you are my friend, then you know I am fiercely loyal and have emotional and visceral responses to maltreatment of any kind. Asking me to shrink your situation, robs me of being the kind of friend I’ve been all along. It changes the relationship for the worse. I must now guard my historically emotional and honest responses with you because you are a client. Be clear – I’m am not saying that a therapist in relationship with a client is less than emotional or honest – it is a different level of those qualities because it only exists in the space and time of the therapeutic alliance. It is time bound – it doesn’t or at least shouldn’t last 20 years. If it does last that long, then there are bigger issues to unravel. And as a therapist, I only know what a client chooses to disclose – I’m not privy to extra information that I would have from a friendship or family relationship.

On the other hand, what’s wrong with offering advice to a friend from a therapeutic perspective? Well, I’m not your therapist. And this is our version of “insider trading” – while it might not be illegal for us, it is profoundly unethical, can harm another person, and damage our professional credibility including and not limited to sanctions on or loss of license. My professional world must also stop at my personal door – much like Mel was saying earlier about or personal stuff needing to stay out of our offices. But isn’t having the answer and withholding it cruel? Perhaps, if any therapist actually “had the answer,” it might be cruel. That is a fundamental misconception about therapists – we do not (and most certainly should never claim to) have the answers for another person’s life. We are there to assist the client in finding his/her OWN answers – ones that work best for the life that person lives.

It breaks down like this: Let’s say Sally calls me to ask me about some issues she is having with her 8 year old son. I know almost immediately what she is describing is a disorder that I treat in other children. However tearfully she begs me for “my take on it” I can only refer her to another therapist – I may make recommendations on folks I trust that work with kids (which is the benefit of having a therapist friend) or listen to her feelings and offer friendship-based support. Beyond that, I can do nothing. If I say what I think to be the case – and she gets a different opinion or even the same opinion and doesn’t like either – our friendship is over – I’ve labeled her child. I’ve called into question her ability to parent, or whatever. It’s crossing a line.

Sometimes the line is clear. Sometimes it’s not. But, for me is that the relationships I have with people I love in my personal life are far too important to cloud them with professional judgments. Relationships are hard enough without this emotional contamination.

Finally, I am the best co-dependent you will ever meet. When a family member or friend wants to shift a relationship into a clinical one – I’m really likely to jump to the challenge – after all, I know what’s best for you (clears throat). Believe me, there are plenty of times when I wish I could shrink someone close to me. But, that pulls me back into my stuff which sends me right back to my own therapist’s couch. To be a good friend or a good therapist, I have to stay as “clean” as possible – I cannot allow my own buttons to be pushed like that because I will find myself in a heap of trouble – professionally and personally. And honestly, I think a “real” friend wouldn’t ever ask for that from a therapist friend. Unless you want a friendship to end, then you need to not attempt to manipulate a person in this profession to “fix it” for you. We can’t.

Now, back to Mel to talk about“things that keep a therapist up at night.” Beyond hormonal fluctuation, insane cats enjoying nocturnal activity and snoring spouses, the things that keep us up at night involve the occasional decision to self-probe as to whether we could have done something differently with a client.

This usually happens when something has gone terribly wrong in the therapeutic process or something just isn’t going quite as we had hoped it would. For example, a client is struggling with substance abuse behavior, but has been clean and sober for several months, is going to meetings, is getting all kinds of support from family and friends and then reports to you that they have been using again for several weeks and no one (including you) has even been suspicious.

So you toss and turn with the questions:

  1. What did I miss?
  2. Did the client say something that I recall feeling even slightly uncomfortable about, but I blew off because they seemed to be doing so well?
  3. What did I miss?
  4. What am I doing wrong?
  5. Am I really a horrible therapist?
  6. If anyone finds out I’m a fraud, no one will ever send me a single client ever again.
  7. What did I miss?
  8. I’m sure I will be sanctioned by the NASW for being a fraud.
  9. How did I ever think I would be any good at this?
  10. What did I miss?

Or something along these lines. And, unfortunately, the answer is almost always that you missed nothing, you can’t control the behavior of anyone other than yourself and you are doing a fine job.

But you don’t believe it. Because your client just relapsed and therefore it must be your fault, because we all know that it’s not the client’s fault because relapse is part of recovery, right? Right. It’s part of the process. We expect relapse. So, yes, it is most certainly must your fault.

This sort of insanity is what we will get better at taming over time and with experience. Once a social worker has 10+ years of practice under her belt, she will only torture herself like this in extreme circumstances, such as the death of a client (accidental overdose, accidental death or suicide). Thankfully, most of us don’t have that many of those cases and if you are talking with colleagues, they will help you stop the self-torture when it occurs.

I think the other rough part of doing what we do is the knowing that we are different from other people. We see things other people don’t see. And guess what? Everybody else knows this too. We are weird, no longer fit in with most people, and realize that our jobs are very lonely. I will throw this back to Venessa to discuss this topic.

I think this notion of being different, somehow set apart from others, is something I really struggle with as a professional and as a person, in general. It’s not just the training or the job or the education that makes us different – it’s this almost second sight we possess. As therapists, we see things other don’t see, don’t want to see, can’t see, or won’t see. And once we see it, we cannot become unseeing. It presents a bright red letters scrawled across a stark white wall.

And that’s why others tend to distance themselves from us on a personal level – who wants to be someone’s white wall? Who wants to be read by a therapist whom you do not pay to keep your secrets? Once a friend told me that after I first went into the field, and she admitted even before, that she felt like I “scanned her.” I asked what she meant by that and she stated flatly “Sometimes talking to you is like being in an MRI – you’re not just listening to me, you are tuning into my facial expression, body language, speech pattern, for God’s sake, even how many times I blink per minute looking for a flaw, a place that’s damaged, something to fix and what’s worse? You’ve ALWAYS been that way.” Needless-to-say, I was really hurt by this statement because it sounded like I was a cold machine or a voyeur rooting around in people’s lives, as if I couldn’t possibly be counted on to have real relationships with people without “diagnosing them.” That friendship ended. It wasn’t the first and I’m quite certain, it won’t be the last.

And that’s the thing – I’m not trying to diagnose people. I’m trying to connect and unfortunately, I’m not always good at that so I make intense eye contact, I listen and reflect back what is said to me, I shift my body position to let people know I’m fully present. And that scares the shit out of people.

Then, there’s the piece Mel talked about earlier – what our clients’ tell us, can never be repeated – to anyone – unless that person is going to hurt themselves or someone else. So the deep, dark areas of their lives that they confide to a therapist means we are often left sitting in the dark while they leave the room, better for the healing that comes of having their voices heard. If you are a good therapist, the loneliness is profound because people really trust you and tell you the scarcest parts of their souls while you sit with them, holding onto the rope to pull them out of the dark.

I often end my day feeling as if I’ve been drinking water out of a fire hose. I’m flooded with feelings that aren’t mine, that are mine, that are weird, that are …and I’m drained. Being an introvert by nature means that too much “touch” from other people saps my energy, again creating the “different than/other than, loneliness.” Then people will say “What I like best about you is how ‘real’ you are.” Um, yeah. First, wait right here until I get “real” with you – bet you don’t like it then. Second, I’m not a unicorn. Third, try being “real” sometime – I kinda sucks but is a fairly necessary personality trait and behavior choice.

Add into the “different than other people” concept the idea that therapists have their own crap to deal with too. Mel and I were both raised in immigrant homes – recent immigrants. Um, we’re real different than folks who’ve families have been here since the 1700s. There are also huge cultural differences – Mel and I were both raised in major cities – so working with people from rural areas is a culture shock. We don’t claim the same spiritual perspective as the people with whom we work. We aren’t living the same towns in which we grew up. Our need to be ethical in word and deed also separates us from others. We don’t lie to clients. We just don’t.

So, if you roll all that up into a hot mess and put a bow on it – that is most therapist’ experience in the world. We have our own dragons to slay and that allows us to help others find the tools to slay their own. However, we too are humans who need love and care and connection. We are not the Oracle of Delphi. We’re people.

This brings us to the close of our first installment of “Hearing Voices.” Please tune in for more tales.

Bright Blessings

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