This has been a hell of a year to be a therapist. I mean, it’s been a hell of a year to be a human, but we therapists have a front row seat to the ways in which it’s been a hell of a year to be human. And that’s made it a hell of a year to be a therapist.
Aside from converting an entire group practice’s caseloads to telehealth, which we did in the scope of a very frenetic weekend, here’s what’s made this year unique: processing collective trauma alongside our clients.
Therapists should process their stuff first
Throughout my career as a therapist, there’s been a dominant narrative telling us that if we’re dealing with something huge in our lives, we should consider referring clients who are dealing with the same thing to a different therapist.
For example, if a therapist were going through a divorce, best practice would be for that person to stop taking clients who were going through the same thing. That therapist might decide, “you know, while I’m going through this, I have too much baggage to support clients who are divorcing. If someone who’s going through a divorce calls me, I’m going to refer them to a different therapist. Also, I think I’m going to take a break from doing couples therapy for a little while.”
And that would absolutely be the right move. The fact of the matter is, that therapist wouldn’t have enough emotional distance from a client experiencing the same thing to be fully present with them. Recognizing that isn’t avoidant; it’s clinically responsible.
This doesn’t mean that the therapist could never work with couples or individuals in the midst of a divorce again. It just means that best practice would be to give it some time, process their experience with their own therapist, and find enough emotional distance from what they had been through to support others well.
Eventually, the things we avoid while we’re in them may become the client issues we are the most passionate about. When I was navigating IVF two years ago, I started referring clients dealing with infertility to other clinicians. Now that I’m “through the woods” – ha – on that, I really love working with clients who are navigating this, because I bring lived experience to the table in a way that helps clients feel especially supported.
What a therapist does during therapy
A therapist named Vanessa Setteducato once told me that when she’s in session with a client, she imagines a giant bookshelf behind herself. When she feels her “stuff” coming up – something she recognizes is about her, rather than the client – she visualizes herself taking her “stuff” and placing it on the shelf behind her.
I love this so much. Since she told me about this trick, I’ve used it in almost every therapy session I’ve done. A client is telling me about their trip to the zoo, and I reflexively think “ooh, the zoo is open, I should go!” Then I put it on the shelf. A client tells me about an argument they had with their boyfriend, and I’m reminded of a similar argument I had with an ex. It goes on the shelf. And so on.
There are a lot of misconceptions about what therapists do.
Many people think we give advice. Although we may make recommendations (“when’s the last time you got some fresh air?” “have you ever tried journaling?”), we typically don’t give firm advice. This is especially true for major life decisions. A good therapist will never tell you to leave your partner, change jobs, or cut off contact with a toxic parent.
Many people think we sit and nod, maybe even occasionally nod off. This is also inaccurate. Many clients have stories of inattentive therapists – and if we’re being very transparent, many therapists have stories of days they didn’t have the capacity to show up for clients the way they wanted to.
(I, myself, once took a red-eye flight from Los Angeles to Boston, and drove straight from the airport to the office. Let’s just say I learned an important lesson that day about taking care of myself before I can take care of other people. Deep apologies if you were one of the clients I saw that day.)
But good therapists “show up” for their clients, in every sense of the word.
They provide a safe container to talk about hard stuff. Sure, “container” refers to the the physical office (or Zoom room) where therapy takes place. But more importantly, the therapist themself is a container for whatever the client needs to pour into them. (If you’ve read the book The Giver by Lois Lowry, I often think about how I relate to Jonas’s role as the “keeper of memories”.)
Every therapist I’ve ever met has had a client say, “I have to pay you to care about me!” But we aren’t paid for our caring. We are paid for our time, our experience, our full attention. But most of all, we are paid to put our own baggage aside for 50 minutes, and give our whole selves to the clients who sit in front of us.
This requires us to develop deep, consistent self-care practices so that we can exert the emotional energy to shove our own pile of stuff out of the way and be fully present for our clients.
Depending on the day, this requires some heavy lifting for the imaginary bookshelves behind us.
Depending on the day, this may require referring out a client whose story hits a little bit too close to home.
The COVID of it all
But for the past year, we haven’t been able to decline clients who are dealing with what we’re processing right now, because everyone is processing the same thing. This is the meaning behind that phrase – collective trauma – that you keep hearing.
We are all processing a world where, as of a year ago, people were suddenly poisonous, where huge swaths of our lives were put on hold, where, at very least, someone you knew was likely to have a loved one die. Simultaneously, we all processed the murder of George Floyd, the week-long limbo of the presidential election, and the Capitol uprising.
At the time the pandemic began, I was operating a group practice with 5 therapists working at Through the Woods. If a therapist on my staff had said, “you know, I would really like to refer out any clients who are dealing with COVID anxiety or political overwhelm, because those are things I’m dealing with myself, and I have a lot of baggage around that right now,” I would have responded: “But… that’s all of our clients.”
So instead, our invisible bookshelves have been very, very full.
We visit them between sessions to look at the contents, we make of them what we can, and we show up for our clients. But more than ever before, we are all in this together.
And so we do the best we can. We show up. We meet with our clients. We help them brainstorm ways to stop feeling so angry and sad and afraid all the time. Our clients tell us that they’re going to try to take walks before logging onto work every morning, take stretching breaks in the middle of the day, request a week off from work to travel to an Airbnb, do yoga videos, bake bread, disconnect from screens, read books, and do socially distanced visits with loved ones.
“I should do that, too,” we think, and we stick it on the bookshelf behind us to look at later.
And then, when the session is over, we do… because it’s how we keep showing up for our clients.