What It Cost Us
By David W. McMillan Ph.D.
I remember when I began my career as a therapist more than thirty years ago. People came to see me, paid me good money, twice as much as a plumber, or an auto mechanic, more than an accountant and some lawyers (though not all lawyers). It felt like stealing to me then. Sitting, listening, caring, hearing stories that were better than soap operas, watching people grow, learn and feel better as they unburdened themselves. What a way to make a living. What a privilege to feel love’s healing energy flowing out of me into the sometimes-gaping wounds in front of me.
I would say things that in my then thirty years I could not possibly have understood. I think these things were in the air around my patients, waiting for someone to say to them who had listened long enough to be qualified to speak. Though the words would come out of my mouth, they didn’t feel like they came from my brain or my experience. I think these words came from somewhere else that I have never understood. Perhaps they came from their guardian angel or their great great grandmother or somewhere in the zeitgeist around them.
I learned as my clients learned. What a privilege it was to sit with the truth, talking and listening to the truth in the context of love and compassion.
It wasn’t many years later that I began to have a different perspective on my work as a psychotherapist. My back hurt from sitting still in one place not moving. I figured out that being a therapist took its toll. I was seeing between 40-50 client hours a week. My neck was stiff. When I turned to look left or right, my body had to turn from the waist instead of from my neck. My lower back ached. Sharp pains flashed in my head and neck or in my lower back and down my legs. I couldn’t run or jog for fear of setting off another wave of muscle spasms. Daily yoga was eventually my salvation, though if I go for a time without stretching, my aches and pains return.
Another problem that became obvious was that I had lost whatever social skill I once had. I was addicted to talking with people on an intimate emotional level. Small talk began to bore me. I had little patience for the superficial. This might have been an acceptable regression if I had not found myself suddenly single. As I tried to court my now wife, Marietta, I found myself not knowing what to say. I had no tools for small talk. I was used to starting conversations with the words, “How can I help you?”
I had no ready jokes, no hobbies to mention, little awareness of anything beyond my practice. The only things in my head of interest to anyone else were my client’s stories which I could not tell. I could listen to the deep hurts and pains of Marietta’s life and childhood, but Marietta was very psychologically well-balanced and had no need to confess her past regrets or narcissistic wounds to me.
I became aware of what is perhaps the greatest liability of being a psychotherapist, when I took up golf again after a fifteen-year layoff. I would go to the golf course as a single and hope to catch on with a group that would have room for one. After a time, I expected to become part of a regular foursome. I waited months and no one invited me to join his or her regular group. After three years I caught on to a group of men who were all old enough to be my father. They were great and I enjoyed their companionship, but I had wanted to play golf with my same age peers.
Finally, it occurred to me that men my own age didn’t want to play with me. They wanted to play golf and let it all hang out without having a shrink analyze their behavior. I can’t say as I blame them.
Then, there were the parties and public gatherings where I would see people I knew intimately and I couldn’t speak to them. If they came up to me, I never knew how to introduce them to my wife and the most embarrassing thing was that I developed the capacity to forget my patient’s names. I often would see people about whom I knew everything except their names. It didn’t bother my therapy much. I could get by without knowing names. Sometimes their name would come to me or they might mention it in reporting a conversation with themselves. Where it got to me was in public situations, when they smiled at me and walked straight for me with their hand out, expecting to be introduced to my wife.
That was bad enough, but what gives me the biggest start is when they act as if they don’t know me at all. Of course, that is their right. They deserve their confidentially. That is what they pay us for. And we are well paid.
I have yet to mention the damage that our work does to our souls. We all have clients who see God in us. It is a well-known part of transference and transference is an essential element to a healthy psychotherapy alliance. As I began this work, I had many fears and doubts that I dared not let myself admit. I covered them with an arrogant bravado that I supported with my client’s testimonials to my greatness.
If I had not had Bob Stepbach to consult with every week for 15 years, my narcissism and arrogance would be even worse than it is. Our soul and character are in great danger when we believe our client’s words that we are special and wise. They are desperate for us to be that. In return for our safe harbor, they often offer us grandiose praise that we believe at our peril.
As I write this, I am in Costa Rica near the equator Pacific Coast, indulging myself and escaping winter for one week in January just after Christmas, when no one in interested in seeing me and it won’t cost me so much in lost work. It’s beautiful here. I talk to many US expatriates. They seem as disconnected as I feel. They live here now, but they have no voice in their world. Some of them have not even bothered to learn the language. Though it is beautiful here and the weather is always the same, warm not hot, humid but not sticky, the stories they tell are of their home, where they once belonged but no longer do.
Belonging is a question that has always bothered me. As a therapist, I learned that I have more power and am more effective in the center of the therapist role. The further I move from the center of my role, the less effective I am. It is like a tree, in the center of the trunk closest to the root, the tree is strongest there. The further one moves from that point, the tree becomes weaker and weaker until out on the limb the tree is very weak. A good therapist may take risks, but a good one takes these risks in her office, in her chair, speaking to a client after having put in many hours listening and caring. From inside the role, from inside the compassion I have given for hours, from inside a well-built bond of trust, I can say almost anything to my client.
Outside this context my words have little weight. My presence is less than relevant. I don’t belong at my patient’s tables, in their golf foursomes or at their parties. My consultation, while valuable in my office, dearly sought after by my patients, means nothing in a social context, even when the topic might be social policy about families or children. My ideas are especially irrelevant concerning politics or sports.
As I sit here in this tropic paradise, I see tracks of the giant sea turtles coming back here from the ocean after years of swimming hundreds of miles from this spot only to find this same spot on the beach where their egg once hatched. There they dig a hole in the sand and lay eggs and return to the ocean. They repeat this process several times in their lives. They know this spot. It belongs to them. Nothing short of death will stop them from returning here. Salmon do the same in the cold waters of the North America Northwest. They swim out in the ocean and return to the mouth of the river, where they first joined the ocean. They swim upstream to the spot where they emerged from an egg. There in that spot they lay more eggs.
I have tried to return home, to the place where I was born. I lived there for my first eighteen years. The topography is the same. The house I grew up in is the same. Many of the trees are still there. As I search for where I belong, it is certainly not there now.
I belong in my current house, with my wife and dog, with a few friends who are not intimidated by my diagnostic skills, (which by the way are useless to me since I believe that diagnostic labels are counterproductive to the therapeutic process). I belong in my office often with my dog. But I really don’t belong anywhere else.
A major reason for this is my poor social skills. Yet, another that I share with all therapists is that not belonging is part of the price we pay. This is the real reason we collect our fee, to dispense love without guilt, to expect nothing in return but the fee we are paid, to get no social leverage or any entitlement to participate in social aspects of life that are part of the culture.
To be a therapist, is to be marginal, to not belong, to be without a place where we can be publicly seen and heard. We are sanctuary to others, a place away from their life events. If we were to become a part of their world, we would lose our position as refuge for our clients. We are a refuge precisely because we are not part of their world. Though it may be a surprise to us that when we accidentally enter their world that we are not welcome, it shouldn’t be. Being marginal, not belonging is part of what it costs us to be a shaman to our parish of clients. Who wants to take their shaman, priest, rabbi, pastor or therapist home with them?
We pay a price to do this work. It has its rewards, though we are no longer paid twice as much as plumbers or auto mechanics. One of these rewards is the opportunity that we have to dance with the spirit, to be love’s vessel and to participate in emotional growth and psychological reconstruction. Though this is rewarding, there is a void in what we do. We cannot tell our parents or spouses about the good work we do. We can’t gossip and unburden ourselves from the secrets we carry. This is why we need one another. This is the reason NPI was formed. This is the reason NPI should live up to its founding charge, to nurture caregivers, to give CEU’s to any meeting where two or more of us are gathered. We need each other and we need NPI to help us come together to hear and care about the work we do.
The workshops, the luncheons and the speakers that come to us from the East and West coasts are valuable resources that NPI makes available to us. But these assets were not the reason NPI was formed. NPI was formed to introduce us to one another, to allow us to develop communities where we belong within our profession.
Brian Wind and Murphy Thomas spoke to NPI about how we can become impaired professionals. They contended that isolation was a main contributor. They believed that small cell groups of professionals meeting regularly was the vaccine as well as the rehabilitative medicine for professionals.
These small groups were the reason NPI was formed. The objective, at least of this founder, was to nurture these small communities, to help therapists find places where they belonged, where they can tell their story, where they will be able to feel a sense of community.
Tell NPI board members to extend their support to these small groups. Urge them to build a registry of these groups. Encourage them to provide CEU’s to NPI members who meet together to nurture their professionalism and their personal well-being. This is a part of NPI’s mission that has yet to be accomplished.