In Praise of the Life of a Psychotherapist

In Praise of the Life of a Psychotherapist

by Catherine Ambrose
Looking beyond day-to-day rigors and challenges from behind the couch, seasoned clinician Catherine Ambrose reflects on the gratitude and growth she continues to experience helping others.

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Clients often ask me how I can stand listening to them drone, whine or complain.
Clients often ask me how I can stand listening to them drone, whine or complain. Just yesterday someone said, “I’ll bet you need a stiff drink after listening to this stuff all day”. I can safely say after nearly 25 years in practice that I have never had this day that they seem to imagine—a long, tedious day of listening to self-pity and self-absorption. Particularly lately, what I feel is mostly gratitude. Somehow, I get to do this: come to work to listen to the stories of the intimate lives of others, to know and to love the hard-fought struggles of their lives, and to share and assist in their journeys toward healing, growth, and transformation. And what I have been thinking about a lot lately is how those journeys have in turn shaped my own journey in myriad positive ways. I know I am far from alone in my experience, and that my grateful thoughts could not begin to be comprehensive, but I think it is useful for us as psychotherapists in what is often a beleaguered world to remind ourselves of the many personal and psychological benefits of our chosen path, such as emotional maturity, unlimited opportunity for continuing education, learning about love, practicing mindfulness and self-awareness, accepting failure, and fostering resilience.

Emotional Maturity


For me, much of this feeling of gratitude is a happy by-product of maturity. When I was younger, I was so afraid of not being enough, or of doing something wrong, or of not being liked, that it was harder for me to stay focused on the great gift of being able to do this kind of work. As I have aged and grown in confidence, the energy I used to expend fussing about my own probable inadequacy no longer draws as much from my other resources. I am able much more easily to make myself fully available to another without such a weighty anchor of self-doubt and self-consciousness. Another reason for gratitude: I managed to find myself in one of the few fields of work where a few gray hairs and wrinkles, and the maturity that hopefully comes with them, is a benefit.

In turn, maturity seems also to be a by-product of the work. I have often thought that one of the reasons therapists are so often drawn to various forms of meditation is that mindfulness is an intrinsic aspect of the work of psychotherapy. Years of practice in itself create a habit of focused attention that is a growth-promoting emotional self-discipline. There is self-surrender in entering a session that I have come to welcome wholeheartedly. It is not as though I have ever completely and perfectly stayed attuned and present for every moment, but like mindfulness meditation, I and all of us who do this wander in our minds, draw ourselves back, wonder about the wandering—and return. Unless the stress of my own personal day is truly overwhelming,
listening to others helps me to move into a mindful space and draws me out of myself
listening to others helps me to move into a mindful space and draws me out of myself. The constant practice of moving into this mode of being no matter how tired or irritated or stressed or sad I may be is a daily workout that leaves me stronger, more flexible, and more resilient in all aspects of my life.

Unlimited Continuing Education


Learning as a psychotherapist is a lifelong project. In seeking ways to help clients, I read and consult and attend workshops and, in the process, learn about myself and understand myself and them better. Often when a client is exploring an issue or attempting to create change it challenges me—because I want to feel my own integrity with them—to push to grow equally. I cannot suggest assertiveness without finding it within myself, ask clients to trust their own authority without trusting mine, or ask clients to challenge their own fears and avoidances without challenging my own. So many of my clients are or are learning to be brave, loving, compassionate, and skilled, among many other gifts, and I am grateful for the opportunity to share in and learn from their growth.

To give a recent example, I have been working with a woman who has been trying to cope with a serious illness, recent job loss, and a disintegrating marriage to a husband who is psychologically unravelling and will likely end up in prison, all while trying to keep life stable and sane for two small children. In the last few weeks, her home went into foreclosure and she had to get a restraining order against her husband. She came into a recent session not surprisingly sad and overwhelmed, but in the context of our conversation mentioned that she had gotten a journal so she could keep a daily record of all the things she is grateful for. She is worried with all that is happening in her life that her perception will become distorted if she doesn’t make an active effort to recall what is good and positive. Having never faced the kind of comprehensive disaster she is now confronting, I truly don’t know how well I would marshal my psychological and spiritual resources to meet it, but I know her example has added to whatever resources I will bring to bear to cope with whatever inevitable hurts arrive in my life. I hope I will be able to remember that in the face of enormous losses and challenges, it was clear to her that she needed to focus on successes, however small, on moments of beauty, and gestures of kindness and generosity. I am grateful that in a context where I am supposed to be the guide, I am also so often guided.

Love


As therapists, we are rightfully cautious about how we think about love in our work, but
I have come to feel that love is inevitably a part of any authentic caring relationship
I have come to feel that love is inevitably a part of any authentic caring relationship, and therefore an inevitable part of most therapy. Love of course is a big word and can be used to describe a lot of different relationships, from one we have with chocolate to one we have with a lifetime companion. I mean the non-possessive, boundaried love that is often created within the unique intimacy of the therapy relationship.

Recently I participated in an exercise in meditation class that I believe is relatively common but was completely new and unexpected to me. We class members were led, eyes closed, to sit in two rows of chairs facing each other. When we opened our eyes, we were asked to look into the eyes of the person across from us with all the love and understanding in our hearts and to imagine that this face across from us was the face of the divine here on earth. I gazed into the beautiful brown eyes of the middle-aged man across from me, a total stranger recently arrived in the US from India, and saw myself reflected in them. Both of us teared up as we grasped each other’s sweaty hands. We were totally unknown to each other, but for those moments, intensely close. It was far from a perfectly transcendent moment—it is uncomfortable to stare at length into the eyes of a stranger, and I found myself worrying about the unattractiveness of my blotchy, tearstained face, or if he wanted me to let go of the hand I was inexplicably clutching like a lifeline—but I was powerfully moved, and shocked by my sense of recognition and awe. We were asked to close our eyes again and shifted our seats before opening our eyes to another, a different stranger, to whom we were to open our hearts in love and share that deep, long and reciprocal gaze. The message was a yogic one, about the divine that dwells in all of us if we choose to see it, but it also made me think about love in therapy, and how this exercise resembles in many ways what we do in our offices day and in and day out.

We ask another person to open themselves up, to sustain our gaze, and to trust that we will see them as gently and with as much acceptance as we can. When we add compassion, empathy, understanding, patience, respect—all the things we strive for in our stance as professionals—we also, at some level, will feel love. And I find that this makes me, on good days, look at the world and myself more gently, with more forgiveness. This is a lesson I want to learn, again and again—more so now, in a world that seems increasingly focused on hate and division.

Speaking about a therapist’s experience of love creates a lot of anxiety—I am a little anxious trying to write about it, knowing as I do the chorus of objections and concerns that arise about boundary violations or crossings if the love we experience is not managed safely or professionally. I have seen from the front row how love in a therapy relationship can be abused—I have clients who have had sex with prior therapists, been subject to other sorts of boundary crossings (too much information about the therapist’s personal life, coffee at Starbucks, stock tips, or non-standard payment arrangements to name a few), or have been bullied into behavioral changes that support the therapist’s ego and self-esteem rather than the client’s goals—and I am well aware the effects of even the smallest of these boundary violations are devastating to clients. Because love is such a charged and complicated word, I do not use it with clients, but not saying it does not mean I don’t feel it or have the need to make sense of the experience of it clinically, personally, and spiritually. And I believe that the non-possessive, boundaried intimacy of therapy relationships has taught me much about love, and I am a better human for practicing loving others in this way.

Mindfulness and Self-Awareness


For most of us, the most comfortable and familiar way to think about love or any other emotional experience centered on the dynamic relationship between therapist and client is as a transference/countertransference phenomenon. That involves a certain exercise in mindfulness, a capacity to be open and aware of one’s own experience and to think about and feel how that experience is a communication from and about the client—often a disowned or unmet need—and consider how to use that information in a healing, compassionate way. It is also an exercise in self-awareness, because our slates are not blank, and we have our own unruly psyches to manage. The experience of love (or hate, or any other emotion), however it is manifested, becomes an opportunity to feel without acting, to explore different narrative possibilities and feel them out for their truth and consistency or self-delusion and wishfulness, just to name a few possibilities. There is no real way to be fully engaged without feeling, but as therapists we learn to watch the feeling as we feel it. This capacity for mindful self-awareness is perhaps the Rosetta Stone of positive emotional functioning, the skill we try to teach our clients in every session, and the skill that determines our success in helping them heal. It has also, of course, made me happier and more effective in all my relationships.

Accepting Failure and Protecting Resilience


It is unpleasant to fail, and I don’t enjoy it, but my work as a therapist has given me a ton of practice, and I have learned to accept failures more gracefully, with less unproductive self-criticism and more and more balanced self-examination. I have gotten it wrong more times and in more ways than I can possibly count. Every day, every session. Today, eager to make my own point, I dragged a client who was really hurting onto a small tangent because of a thought that was interesting to me, but not at all his direction or focus. I stumbled back to really listening to him, but the diversion created a small but avoidable need for repair and re-attunement. And that was a good session, on a good day!
But constant practice helps me to keep my balance, not get overly focused on mistakes, and move on to attend to things that are really important.
But constant practice helps me to keep my balance, not get overly focused on mistakes, and move on to attend to things that are really important.

Often as therapists we focus on issues of burnout or secondary trauma, and certainly these issues are real, especially in settings where therapists have limited control or access to support. I am inclined to believe that much of the possible psychic damage is not about the actual work we do, but the environment we do it in. If we see too many patients, fail to maintain reasonable boundaries, do not have adequate opportunities for supervision or consultation, try to meet unreasonable expectations or fail to care for ourselves psychologically outside of sessions, we will suffer in our work—both in our ability to do it well and in our own psyches. Without these boundaries, we cannot foster and protect our own resilience. But in the presence of control and support, we sometimes forget to emphasize in much of our dialogue about life as a psychotherapist how very fortunate we are as therapists to be able to engage in work that is entirely about finding meaning and healing through relationship.

In Conclusion


I also feel a little bit of guilt about my good fortune. I am spoiled. People are hurt at all levels of society, but I am not in the trenches, and I deal less than many with the horribly complicating factors of socioeconomic stress. And those other huge structural issues—such as racism, sexism, and homophobia—are somewhat blunted for my largely educated and economically stable clients. I have a group practice with colleagues I love and respect, and whose intellectual and clinical growth has interwoven with mine for over almost 20 years.
It would be churlish not to be grateful for such fertile soil in which to grow.
It would be churlish not to be grateful for such fertile soil in which to grow.

We are all aware of the downsides of our vocation: the pay is not great; although we have a lot of freedom, those of us in private practice do not have the practical benefits many professionals take for granted, such as sick or vacation days, or health insurance that is less than astronomical; we tend to be made fun of in the popular culture; we have limited job security; the importance of our work is undervalued, misunderstood, or misrepresented by many; if you do the work well, you will be no stranger to self-doubt and uncertainty; you have to metabolize a lot of ugly stuff; and new acquaintances tend to become uneasy when you tell them what you do, just to name a few. But the world is not rich with opportunities to make a living in ways that feel intellectually and morally coherent and also promote emotional health and growth. It is a life of service in many respects, but also a life of service to the self, an opportunity to try to do good and to try to be good. That is a lot to be grateful for. 

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Bios
Catherine Ambrose is a psychodynamically oriented psychotherapist with 20 years of experience in private practice, mostly at The Temenos Center for Psychotherapy and Personal Growth. She specializes in treating women with eating disorders and couples with relationship problems. She recently graduated from New Directions: Writing with a Psychological Edge, a 3-year program in writing and psychoanalysis sponsored by the Washington Center for Psychoanalysis. Her work has been published in Voices: The Art and Science of Psychotherapy.