The Difficult Profession: A Plea for an Extreme Measure of Tolerance
It is a challenging and unique aspect of our profession to have one’s professional identity so intimately linked with one’s personal self. The therapist’s identity is an amalgam of professional role that is intertwined with a personal sense of self. The professional and the personal dimensions of self are variables in a complex non-linear equation describing the therapist’s identity.
Becoming a therapist is not a simple process of acquiring skills and an increased efficiency in using these skills. It is a journey, whose curriculum is personal growth and whose learning curve is analogous to the learning curve of life. It is bound up with one’s creativity, courage, and insecurities. It involves facing painful aspects of oneself, coming to terms with limitations and realizing potentials. It is the journey of the wounded-healer whose knowledge of self and courage to be vulnerable are the source of empathy and healing in the therapeutic relationship.
To be a wounded-healer in our contemporary society is challenging. It will be more challenging as health care, including mental health, becomes increasingly controlled by large systems of care. The identity of the wounded-healer is antithetical to many of our cultural values, values that have been internalized over development. It also goes against the grain of much of graduate school and post-graduate training. The culture values individuality, achievement, excellence, professionalism, and a type of courage wedded to a façade of invulnerability. The wounded-healer values vulnerability and compassion and extends a soft hand of forgiveness to life’s continuous gradient of difficulty. The wounded-healer views ambiguity, disorder, failure, and fragmentation as meaningful psychological states and faces the other receptively and is open to their influence.
This practice of psychotherapy isn’t for everybody. We are privileged to a special intimacy that entails an equally special responsibility. Day after day hour after hour we hear the most intimate details of a person’s life. We absorb the pain, complaints, anguish and hope of our patients. What we absorb triggers empathy, anger, personal pain, as well as doubts about our capacity to help. We suffer the same symptoms and difficulties as our clients. We return to our families and have the same conflicts with spouse and children. We drink too much, get angry over minor events, divorce, worry about finances, and hold on to shameful secrets.
Not all therapists identify with the concept of the wounded-healer or the understanding of the nature of psychic pain embodied by this concept. The deep value that this perspective provides for the individual and ultimately for the culture exists in the conversation about pain and vulnerability. If life is full of struggle and suffering, then psychotherapy is one of several cultural antidotes. It creates a sanctuary to hold pain, rage, inadequacy, vulnerability, and all that feels unacceptable to the individual. This holding supports and facilitates growth within the individual and on a level that is neither measurable nor easily perceived buffers tensions in the larger social groups.
As wounded-therapists, many of us experience conflicts between our professional role and what we deeply feel about ourselves. The paradox we experience as therapists is that while we work tenaciously and compassionately to heal our patients, there is ongoing risk and temptation to close ourselves off to those unhealthy wounded parts of our personalities. We feel pressure and responsibility to present a competent, stable, professional persona to our patients, colleagues, and even friends.
There is considerable shame associated with feeling wounded, weak, confused, insecure, and inadequate, especially for a therapist. There is a natural incentive to split the self into professional and personal domains. The professional self embodies preferred often idealized qualities, what Jody Messler Davies (1) has called the “preferred version of self.” In contrast the personal self holds the remainder, the devalued, non-preferred shadow qualities that we feel ashamed of. Many of us over course of our careers lose patience and compassion for our wounds while embracing those qualities of the Healer.
There exists a tacit belief that is pathognomic of this split: we can be one way with our colleagues, another way with our significant others, and yet another way with our clients without there being a systemic effect. The psychotherapeutic situation unwittingly enables this split in that it establishes the therapist as a good, secure object for clients. This structural aspect of the therapeutic relationship reinforces the “preferred version of self” and works against vulnerability.
While most therapists honor the ethical and legal constraints placed on getting their personal needs met through therapy, unconsciously they relate to the therapeutic setting in a Winnicotian (2) implicitly shoring up and restoring the “preferred version of self” through the routines and enactments of therapy. The unseen systemic effect plays out in the positive transference. Gershon Molad (3), an Israeli psychoanalyst, feels that the therapist who needs to hide devalued aspects of self and is traumatized by the fear of exposure (afraid to be him or herself in professional settings and ashamed of this fear) moves back into the therapy space with an unexpressed need to be repaired in the dialogue with his/her patient. In this manner our patients unwittingly become our therapists.
“What makes a good therapist” asks Lou Cozolino (4) in the opening of his book The Making of a Therapist. He answers, “The courage to face one’s fears, limitations, and confusions.” I would add that the courage to face one’s fears involves the willingness to be known by others, including patients. One needs a witness: somebody other than one’s personal therapist to exorcise the demonic effects of shame. If we protect our weakness too strenuously, it exerts power as a semi-autonomous force within our personality at the expense of authenticity and vulnerability. To move against the conventional expectations of professionalism and our own sense of self-protectiveness requires an extreme measure of tolerance to enable the self to be.
1. Davies, J.M. (2004). Whose Bad Objects Are We Anyway?: Repetition and Our Elusive Love Affair with Evil. Psychoanal. Dial., 14:711-732
2. Winnicott, D.W., (1968) “The use of an object and relating through cross identifications.” In Playing and Reality, Basic Books, 1971.
3. Molad, G. H. (2001) “On Presenting One’s Case: Embraced Trauma and the Dialogue Between Analysts” Psychoanalytic Review 88(1), 95-111.
4. Cozolino, L (2004) The Making of a Therapist: A Practical Guide for the Inner Journey.