On Quitting The Practice of Psychotherapy

On Quitting The Practice of Psychotherapy

by Michael Sussman
Former psychotherapist Michael Sussman discusses the perils of psychotherapy practice and the wisdom of knowing when to quit.
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Workplace Wounds

My name is Michael Sussman and I’m a recovering psychotherapist.

By this I don’t mean that I am a therapist who attends Alcoholics Anonymous, but rather that I’m in recovery from being a therapist.

Ironically, working as a therapist aggravated the very same wounds that first drew me to the field.

I made a decent living as a clinician, and took great satisfaction in helping people in distress. Over time, however, the strains of practice overwhelmed my own coping capacities and I was forced to close up shop. Ironically, it appears that working as a therapist aggravated the very same wounds that first drew me to the field.

Like many practitioners, my early family experiences groomed me for the role of psychotherapist. As a typical middle child, I felt unsure of my place in the family and hungered for acceptance. I dealt with these insecurities by becoming mother’s little helper and confidante. Outwardly, I did all I could to help her care for my younger brother. But underlying feelings of jealousy and malice toward the intruder drove me to torment my brother on the sly. This, and my failure to somehow heal my parents’ troubled marriage, left me with deep reservoirs of guilt and remorse. As I’d later learn, such feelings—along with intense needs to atone and make amends—supply a powerful impetus toward pursuing a career in the helping professions.

Unfortunately, they also provided fertile soil for the development of emotional illness. By the age of 15, I was already showing signs of depression. In my late teens I dropped out of college and joined a cult, and by my early twenties I was bouncing in and out of psychiatric wards with bouts of both depression and mania.

I eventually stabilized enough to return to school and earn a bachelor’s degree in music composition and performance. And who knows? If I’d become a professional musician or a music teacher, perhaps I would never have suffered another episode of severe mental illness Instead, with considerable trepidation, I entered graduate training in clinical psychology.

From the start, graduate school undermined my emotional stability by weakening my defenses. As I learned in class, we all employ an array of defense mechanisms to help maintain psychological equilibrium. These protective strategies tend to function largely outside of conscious awareness. Why? Because our psychic defenses—like a nation’s military strategies—must remain concealed in order to be effective. If you become aware, for instance, that you’re using denial to avoid facing painful feelings, those feelings are more likely to emerge.

By gaining understanding of these defensive maneuvers, my own defenses were inevitably compromised. And in a variant of what has been dubbed medical students’ disease, I began experiencing the symptoms of the disorders we covered in class.

If studying psychopathology was a bit dodgy, actually working with disturbed people turned out to be downright perilous. The empathy that allowed me to tune in and connect with patients also left me vulnerable to taking on their pain. In addition, I was ill prepared for the enormous burden of responsibility entailed in caring for the sick. During my third year, a middle-aged patient of mine jumped to her death from the window of her 20th-floor apartment, shortly after transferring to a new therapist. Though devastated by her death, it only intensified my dedication to the calling.

But as the years passed, the emotional toll mounted. Overly dedicated to work, I neglected my social life and grew increasingly isolated. Rather than freeing me from an introspective disposition, clinical practice only deepened it. And while clinical successes were exhilarating, they did little to assuage the guilt from my childhood “crimes.” Clinical setbacks and failures, on the other hand, intensified my inner sense of badness. Far from bringing redemption, the practice of psychotherapy engendered in me what the psychiatrist Richard Chessick termed soul sadness.

Ultimately, my career was cut short by full blown major depressive episodes requiring electroshock treatment. I’m better now and have had former patients literally plead with me to return to practice. But my susceptibility to depression precludes me from providing emotional stability to others. Moreover, I can no longer ignore the fact that practicing psychotherapy is hazardous to my own health.


So, what broader lessons can be drawn from my saga?

First, wanting to help people is not sufficient reason for becoming a therapist. Admissions committees must help applicants explore their hidden motivations for practice.
Wanting to help people is not sufficient reason for becoming a therapist. Admissions committees must help applicants explore their hidden motivations for practice.

Second, although a mild to moderate degree of emotional conflict needn’t be problematic, training programs ought to be wary of admitting applicants with a history of serious mental illness.

Third, all applicants ought to be fully warned about the potential dangers inherent in learning and practicing psychotherapy, and therapist self-care should be included in the curriculum.

Fourth, the last bastion of the stigma of mental illness appears to be within the mental health profession itself. It can no longer be denied that a substantial percentage of practitioners are significantly stressed or impaired. It’s imperative that the professional community stops fostering shame, and begins creating an environment in which struggling clinicians dare to reach out for help and support.

Meanwhile, I’m writing fiction. I’ve spoken to several former colleagues who are also in recovery. One runs her own bakery, another owns a bookstore, and a third raises llamas. What’s disturbing to contemplate is that, in all likelihood, there are thousands of therapists out there who ought to be doing something else, but continue to practice.

*This article was originally published in the May/June 2013 issue of New Therapist magazine.

© New Therapist 2013
Michael  Sussman Michael Sussman, Psy.D., is the author of A Curious Calling: Unconscious Motivations for Practicing Psychotherapy and the fantasy novel, Crashing Eden. He also edited the collection of essays A Perilous Calling: The Hazards of Psychotherapy Practice.