Psychotherapists Are the Luckiest People on Earth By Allen Frances, MD on 11/21/23 - 7:31 AM

An almost completely neglected topic in psychotherapy is how much patients teach their therapists — not only to become better therapists, but also to become better people. Many of the best hours of my life have been spent doing psychotherapy, and many of my favorite people were the patients I did it with.

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Early in my career, I realized that I was a better person when doing psychotherapy than in my other relationships — much more empathic; much less selfish. Gradually, my work with patients helped smooth the rough spots in my personality, making me a better husband, father, grandfather, teacher, and friend. This piece is a small thank you for the great debt I owe my patients. I could not be more grateful and will now enumerate some of the many gifts I’ve received from my clinical work over the years. 

Ten Ways Patients Make Us Better People

1. Close Relationships: Our ability to engage in close relationships derives from inborn mammalian nature interacting with early nurture — but later life experiences play a big role in enhancing or reducing our comfort with intimacy. The essence of psychotherapy is forming a therapeutic alliance, which often turns out to be therapeutic for both partners — teaching each how to become more comfortable getting closer to people.

2. Empathy: The ability to understand what other people feel and to see life through their eyes is also partly inborn, partly nurtured — but no profession other than psychotherapy requires and enhances it so much. Empathy muscles grow with exercise — every session is an opportunity to build and stretch our capacity to feel and express empathy.

3. Courage Under Fire: My patients have all had much more difficult lives than my relatively easy one. And almost uniformly, they have, more or less, lived with the hand they were dealt with a courage and grit I am not sure I could have managed. I will never complain about the challenges and disappointments in my life because I have witnessed the grace shown by my patients in facing much more difficult lives.

4. Emotional Honesty: Most people lie only rarely, but few people are emotionally honest most of the time, with themselves or others. It requires too much work and isn’t really necessary in everyday life. But psychotherapy is different — patients have to feel, think, and do things with a degree of honesty not normally required of them — and their honesty rubs off on us.

5. Resilience: One of my patients described his life as “knocked down eight times, get up nine times.” Patients get knocked down over and over again — not only by the expectable exigencies of their external lives, but also by the internal problems that are the focus of treatment. I have been amazed and inspired by how often patients get up that ninth time — how seemingly insuperable problems and hopeless situations turn out just fine because they have the guts to keep trying and never give up hope.

6. Good Minutes: Psychotherapy isn't always complicated — for many patients, the goal is to maximize good minutes each day and enhance the appreciation of life’s little pleasures. This has certainly rubbed off on me.

7. Unselfishness: A basic precept guiding the therapist’s behavior is to always put the patient’s interests first and to never be selfish or exploitative in even the most subtle ways. This also rubbed off, if to a lesser degree, in my therapy relationships.

8. Humility: Working with patients taught me that what I don’t know about life and people is a lot, and that I often do and say dumb things. I also learned that patients could readily forgive and forget my errors of the mind but had trouble forgiving and forgetting my errors of the heart.

9. Acceptance: Sounds corny but doing psychotherapy with patients teaches you the wisdom to know what to try to change and what to accept — in them and in yourself.

10. Gratitude: I have had my share of failure as a psychotherapist — people who left treatment with the accurate feeling that I hadn’t helped them. But patients who did well were often very generous in their gratitude in a way that taught me to be openly grateful to them and to other people in my life.  

Magic Moments in Psychotherapy

Psychotherapists are the luckiest people on earth because our profession allows us to participate in so many deeply meaningful relationships — hour after hour, each and every workday. Certainly, this makes for a demanding career, but a richly rewarding one. And psychotherapy done well never gets routine or dull. You always have to be alert to the possibility that a “magic moment” will occur — an opportunity for you to make a big difference in your patients’ lives or for them to make a big difference in yours. Patients are not your friends but may sometimes be, in a way, closer — when you are both changed through the special intimacy of the therapeutic relationship. Our patients can be our best teachers. Mine certainly have!

Questions for Thought and Discussion

What are your impressions of the author’s premise?

Who among your own patients/clients has taught you important lessons?

Might you ever express gratitude directly to a patient for a lesson taught? 

File under: A Day in the Life of a Therapist, Musings and Reflections