The confusion evidenced by this question is the view of psychotherapy itself. The assumption is that therapy is for crazy people, or at a minimum people who are not well. This fits well with the medical model of therapy that has been dictated by insurance companies.
Medical Model Applied To Psychotherapy Due to Insurance Companies
Insurance companies require that clients have a mental health diagnosis to be eligible for coverage or a percentage of reimbursement.The therapist must define what is “wrong” with “the patient”. And what is wrong needs to be a mental health disturbance that lasts over months or even years of the client’s life. These can cover mood disorders like depressions and anxieties, behavioral issues, like active addiction or obsessive compulsive disorder, or character disorders like narcissism or borderline personality disorder.
Most of us have some feelings or behaviors or symptoms that fit in the general range of at least couple of these diagnoses. But that isn’t how diagnoses work. Each has criterion that are far down the line on the continuum of each of these issues. For instance a lot of folks get depressed or anxious sometimes, but most are unlikely to meet the criterion for Major Depressive Disorder or Generalized Anxiety Disorder which require a particular level of consistency and severity. But for clients seeking coverage by an insurance company, the therapist will need provide them with the diagnosis in the wheelhouse of the client’s symptoms even though they are unlikely to meet the actual critereon.
Why Do People Go To Therapy?
Certainly lots of folks start therapy because of issues that fit neatly into a diagnosis. But tons of clients come because they are looking for a place to contemplate a situation in their lives, or to get support for something they are going through. People come to therapy when they have suffered a loss, through death, divorce, retirement, moving, leaving or getting fired from a job. They come to therapy because of relationship conflict, with partners, parents, kids, bosses, friends and community. They start therapy because there are aspects of their personality that trouble them, or that they seek to strengthen. Folks seek out therapy to help them craft a life they hope to build and become the people they want to be.
You don’t have to be crazy, or seriously messed up, or even have an actively problematic issue happening in your life to go to therapy. Psychotherapy is a tool for radical self-improvement. Not all people who exercise are fat. Not all people who go to church are sinners. Not all people who do yoga are balls of anxiety.
Good Psychotherapists Do, and Should, Go To Therapy
Many therapists go to therapy, as a standard practice, or at different junctures in their life. I would never refer a client to a therapist who had never been in extensive therapy. Here are some of the reasons.
- If a therapist thinks psychotherapy is a good tool, then surely they would use it, unless they only think it is good for a certain type of person. I would hate to be in a consulting room with someone who thought they didn’t need therapy but their clients did.
- While a therapist can not, nor do they need, to have had every experience their client has had, being a client in a therapy session can feel vulnerable.
It is the role that holds less power in the room and I can’t imagine being safe in a room with a therapist who had never embodied the less powerful role.
- Good psychotherapists aren’t advise-givers who sit and dispense wisdom. What they are supposed to do is be a guide on the client’s exploration of their unconscious. The unconscious can be a disorienting, murky, and frightening place. It is great to have someone who is familiar with similar terrain, inside themselves…who have traversed their own dark places and learned something about how and when to rest, explore deeper, find clues, stay safe, notice pitfalls, and when and how to leave.
- Two key characteristics of a good therapist is a hunger for truth and a boat load of courage. A good therapist has faced the kind of hard truths we access about ourselves in psychotherapy. Remember, therapists can’t help us much with the external world…the task is figuring out our patterned role in events/perspectives/interactions that we can shift for more emotional and psychological safety and freedom. It takes courage to unlock truths about ourselves we would rather not see. We want a therapist who wasn’t too afraid to see their own darkness.
- Because of our job, it is actually quite imperative the a psychotherapist go to therapy. Working with clients activates a lot inside the therapist. In all relationships, exchanges stir stuff up inside both people, but in the case of therapy, the therapist has to be highly tuned in to what is getting mobilized inside of them. Our job is to feel the pull from the interaction, but to refrain from responding prior to analyzing what has been activated in us. We have to tease apart our impulses from our thoughts on what the client is needing from us and how they are going about trying to get that. While authenticity is key, the motivation behind each and every one of our responses has to be towards the end of helping our client. In order to do the work of analyzing each moment to moment experience, we have to be highly attuned to our own issues/blind spots/Achilles heels/triggers/transference. Client’s psychic material can get lodged in us in disorienting ways, so knowing ourselves and the shape of our issues is imperative.
Both Sides of The Couch
Psychotherapy is a defining experience of my life, from both sides of the couch. Like many therapists, I had someone in my family I was desperate to save/heal/help. Since you can’t help someone who isn’t trying to save themselves, that repeatedly failed. I eventually realized saving myself from the relentlessness of my mother’s trauma would bring me at least some of the relief I longed for. When my journey freed me enough to stop repeating her mistakes and build a life of my own, a good life, I knew I could help others find the keys to unlock their own suffering.
In my mid-fifties now, I am still devoted to my own psychotherapy. I use it to find the stuck places in me that make certain change hard, to hear the critical voice I still use sometimes to diminish my truths, to tease apart the the way the shadow of my mother occasionally cast darkness and confusion on my own parenting, or in my friendships, and when I was partnered, for sure reared its ugly head. And I use it, along with clinical supervision, to keep myself a good vessel/instrument for this rich, nuanced work, which often requires use of my own unconscious to decipher the messages from my client’s inner world.
Therapy Is As Rich, Deep and Rewarding As You And Your Therapist Make It
If you and your therapist arent uncovering a complex internal, unconscious world, think about which of you is preventing/avoiding depth. Ask your therapist to think about it with you. There are many forms of therapy available to help us navigate our lives, but psychotherapy traverses the world of the unconscious.
Smith is an analytically oriented psychotherapist with 25 years in practice. She is additionally the Founder/Director of Full Living: A Psychotherapy Practice, which specializes in matching clients with seasoned clinicians in the Greater Philadelphia Area.
If you are interested in therapy and live in Philadelphia or the Greater Philadelphia Area, please let Full Living: A Psychotherapy Practice match you with a skilled, experienced psychotherapist based on your needs and issues as well as your and own therapists’ personalities and styles. All of our therapists are available for telehealth conferencing by phone or video in response to our current need for social distancing.
Here are some other posts about similar topics:
Psychotherapists are like Dance Archeologists
Attending to the Unconscious in a Psychotherapy Session
Myths about Psychotherapy (a video blog)
Tara Parker-Pope of the New York Times blog Well featured my prior post on the feelings some patients have as they imagine whether their psychotherapists have been in therapy themselves. My post was about patients’ fantasies, not the reality of therapy for therapists.
Nonetheless, many of the comments argued for the great value of such therapy, and one or two expressed amazement that such therapy is not universally required. I agree that psychotherapists have much to gain from personal therapy, and in this follow-up post, I’ll offer some reasons why.
Is therapy required in order to become a therapist? In the U.S., generally not. According to Geller, Norcross, and Orlinsky [1]: “In most European countries, a requisite number of hours of personal therapy is obligatory in order to become accredited or licensed as a psychotherapist. In the United States, by contrast, only analytic training institutes and a few graduate programs require a course of personal therapy.”
A “training analysis” is required to become a psychoanalyst — in other words, one must be analyzed oneself. However, in the U.S., personal therapy is not required to practice other schools of psychotherapy, nor to obtain licensure in mental health disciplines such as psychiatry, clinical psychology, etc.
Specific training programs within a discipline may require it, and certainly a large number of programs recommend personal psychotherapy for their trainees. Indeed, many strongly encourage it by offering referrals to therapists, low-fee therapy, time off from training to attend therapy, and so forth.
In a 1994 survey of psychologists by Kenneth Pope and Barbara Tabachnick, 84 percent reported having had psychotherapy themselves, although only 13 percent had attended a graduate program requiring personal therapy for therapists-in-training [2]. Whether by mandate, urging, or independent choice, many practicing psychotherapists can claim experience in “the other chair.”
At the most common-sense level, a therapist who knows what it is like to be a patient may be more empathic and may anticipate unstated feelings more readily than a therapist without this first-hand knowledge.
For example, vacation breaks can feel extraordinarily disruptive to patients, a fact that can be taught in lectures or textbooks (or blogs), but may not be fully appreciated until it is experienced oneself. Transference, in general, is better understood experientially than learned academically. Even non-analytic therapists can benefit by recognizing transference and other common “real-time” emotional reactions, conscious and unconscious, in their patients or clients; these can affect rapport, treatment adherence, and so forth.
Psychodynamically informed practice is a hallmark of psychiatry, even when psychodynamic treatment is not offered. The same, I would argue, is true of other mental health disciplines. Psychologists conducting CBT and clinical social workers leading support groups should know about psychodynamics too. And the best way to learn dynamics is experientially in one’s own psychotherapy.
The argument is even stronger for therapists who practice traditional psychodynamic therapy, where transference and countertransference are essential treatment tools. As I wrote last year, it takes self-knowledge to use countertransference therapeutically. Without this self-knowledge, it would be impossible to sort out the patient’s issues from one’s own.
In seminars for psychiatry residents, I point out that our field has no blood test or brain scan to directly measure thoughts and feelings in the interpersonal space. Our own feelings, countertransference broadly defined, is the sensitive instrument we bring into the consultation room. The therapist’s own psychotherapy “calibrates the instrument” so he or she can better trust its readings when applied to patients.
To me, this is the main reason to recommend therapy for therapists. In addition, others have argued that it normalizes and destigmatizes being in therapy (assuming the therapist discloses his or her personal therapy to the patient); that it improves one’s performance as a therapist non-specifically, by relieving stress and tension; and that it may give the therapist “a valuable perspective on what works and what doesn’t.” Several commenters on the NY Times blog believe the therapist’s own therapy encourages humility and may decrease errors based on hubris and unexamined countertransference:
We are to be one of the self monitoring professions, responsible in a unique way as the stewards of our treatment with our clients…. Having our own issues worked with … goes a long way toward ensuring a unique quality of care.
I would be very wary of a therapist who had never sought therapy for him or herself. To me it would smack of an ‘I don’t need it — it’s for messed up folks like you’ attitude.
I am also frequently shocked by the stories my patients will tell me about being in therapy with someone who clearly hasn’t worked on their issues. It can be very damaging to a patient…
Personal psychotherapy does not guarantee that a therapist will be caring, non-abusive, technically proficient, or effective. But there is little in psychotherapy, or in life, that is guaranteed. Psychotherapeutic work, particularly the psychoanalytic and psychodynamic varieties, seems closely tied to the therapist’s self-knowledge and willingness to self-reflect. If we are to use our own perceptions and reactions as sensitive instruments in the consultation room, we are well-advised to take good care of the equipment.
© 2011 Steven Reidbord MD. All rights reserved.
