Are Psychotherapists In Their Own Psychotherapy?

Recently, one of my patients asked if I am in my own personal psychotherapy. I’ve heard that question fairly often, however this time I paused for a moment and noticed that I began to ask myself a familiar a set of therapeutic-type-questions: “why is this patient asking me this? What purpose does it serve for the patient’s mind? How should I answer this question and what ramifications will the answer have? Should I answer ‘yes’ or simply ‘why are you asking’”? In this case I did something rather uncharacteristic for me. Instead of turning it back to my patient (which is probably the most sound therapeutic technique), I decided to see what would happen if I answered “yes”. That turned out to be a moment of connection that humanized and de-stigmatized the experience of being in psychotherapy for my patient. But it did something else too…

Another question I am often asked is: “how do you do it? How do you not take the work home with you?” These are interesting questions to think about.

The reason, and the answer to the questions above, lies in social support. Most therapists are or have been in psychotherapy as a patient. Indeed, the American Psychological Association formerly mandated that all graduate students in clinical psychology programs be in psychotherapy. This rule was poorly received, because graduate students usually cannot afford a full course of psychotherapy. So the graduate programs solved this by having graduate students get psychotherapy at their university counseling center. Well, the problem with this is that graduate students are usually the therapists in the counseling center and nobody wanted to get therapy from their friends. So the APA was forced to relax this rule. It’s no longer mandated that graduate students in clinical psychology be in therapy but most still do it because psychotherapists need the support. Indeed, most therapists have numerous ways of getting support, psychotherapy being only one. Many psychotherapists also seek out a professional supervisor, who is another psychotherapist who they see in order to discuss the complicated case material that arises during a course of psychotherapy. I myself belong to a supervision group.

I decided to tell my patient that I both am a patient in psychotherapy as well as an ongoing student of psychotherapy in the supervision group. I explained that psychotherapists often are just as affected by the complicated interpersonal dynamics and life stresses that our patients are. This in turn helped my patient feel less isolated, less incompetent, and more able to stay mindful. Irvin Yalom, an eminent psychotherapist and author of psychotherapeutic books, writes often of his deep affinity and sympathy for “the working psychotherapist”. For Yalom, “working” refers to working as a patient, in addition to working as a psychotherapist. That if a person is going to enter into psychotherapy as a patient, they must learn to think like a psychotherapist but that also if a psychotherapist is going to commit to working with a patient, they must learn to think like a patient too!

Yalom stresses how important it is for psychotherapists to also be working as a patient in order to get support for themselves because therapists are people too, and in order to be able to be a good psychotherapist, they need to be able to be present with their patient. Paradoxically, not only is it hard to not bring work home, it’s hard to not bring home stress to work! And it turns out, this is really hard to do. Everybody is affected by stress. This is one of the cornerstones of human psychology and it follows that a stressed out psychotherapist is going to be too preoccupied, tired, and downright not present in session.

This idea of support is even more important during the holiday season. There is a colloquial idea that depression, anxiety, attachment difficulties, stress, suicide, etc. all goes up during the holidays. This is actually not correct. The data shows that these difficulties go up immediately after the holidays. The reason appears to be that during the holidays most people are around other people and have some form of social connection. It’s when that support is withdrawn, when everybody goes home, that people begin to feel the affects of that withdrawal. Thus, it appears even more important to garner consistent support during the post-holiday season, whether you are a psychotherapist or not.