How to Maintain Your Therapeutic Dignity with Blood Dripping Down Your Chin By Margaret Rutherford, PhD on 6/18/19 - 2:59 PM

When we moved from Dallas, Texas to Fayetteville, Arkansas back in 1993, I quickly realized that any therapeutic anonymity I'd experienced in Texas was a big “not happenin,” that is unless I wanted to hole up in my house and never partake of food, fun or the festivities that went on in my lovely new hometown. The place was too small and just Southern enough where your business wasn’t just yours.

Now, after practicing 26 years in Arkansas, I'm far from reclusive so I regularly run into people I’ve seen as patients. I’ve been aware of how running into one another in public might impact their relationship with me and any work we did together, but often it was the result of simply living.

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I'd been in Arkansas for about four years when I auditioned and earned the role of radical feminist and socialist Emma Goldman in the vaudeville musical TinTypes. I came on stage at one point in roller skates, singing raucously and playing violin...badly. I worried a bit, “Does anyone really want to see their therapist doing that?” When I played the passionate Desiree in Little Night Music, a patient told me they had to quit seeing me, “Because you kissed another man.” I explained about how kissing on stage is not really kissing, and we looked into her feelings. My son had a horrific tantrum at a toddler birthday party that violently came to a halt when his very hard head bounced off my lip, causing blood to spurt all over me and him. And of course, the story in my head became, “Hmmm...are those moms I’ve seen questioning my competence?”

It's like trying to live your real life while also retaining some amount of therapeutic professional respect and dignity—in roller skates and with blood dripping down your chin.

Since that fateful afternoon, I've taken even more risks—and hope that the ethical disclosure gods don't chew me up and spit me out. For several years, I've had a blog and a podcast and I'm quite open there as well. I respect that this isn't everyone's cup of tea. And might not, depending on your theoretical orientation, sound like good, responsible practice. But I've come to believe that we as therapists may be unintentionally enabling the silence of mental illness stigma by not being more up front about our own struggles.

Don't get me wrong. I use discretion. I go many a day without saying a word about myself. My job is to listen, to hold, to contain, to suggest, to educate, and to guide. However, I've revealed that I went through a divorce when I think it will be helpful. Actually, two divorces. But that's not the point. I've also disclosed that I have performance anxiety, panic attacks, and a history of anorexia, again, when I think it's helpful for the patient. And I reveal that I've been on both sides of the couch—as patient and psychologist.

The criteria? If it's truly helpful to the patient and not about some need I have to “share.” What I've experienced is that my openness is respected. My vulnerability and risk—helpful. People now tell me, “Your openness about your own vulnerabilities gives me more permission to do the same.”

This all came dramatically to the fore two years ago, when I presented in a local This Is My Brave show. If you don't know this organization, it was begun by Jennifer Marshall, who'd been blogging anonymously about her bipolar disorder for years. It was only when she came forward—as herself—that her blog's audience skyrocketed. And she realized that her vulnerability mattered. The organization now hosts programs both nationally and internationally, featuring people with mental illness telling their stories to a live audience.

When I agreed to do it, I thought it wouldn't be anything. I'd already been writing about my anxiety. So, what could be difficult about it? Once again, my own running narrative was ill-conceived. It was quite emotional. And hard. Yet I'm so glad I did it. I've revealed my own vulnerability, my own passions, and my own struggles. Bloody chin and all. 

File under: The Art of Psychotherapy, Musings and Reflections