Therapists Reveal How They Keep Their Emotions In Check With Their Worst Clients
Believe it or not, I have a psychology degree. My initial intent was to go into counseling but I figured out pretty quickly that I have no emotional off switch. Empathy is an important part of being a therapist, but you need the ability to put it down sometimes. Apparently I'm not the only person who hasn't quite mastered that skill.
One Reddit user asked:
Therapists of reddit, how do you keep your emotions in check while attempting to counsel the most vile of your clients? Surely you have some sessions that just rock your core, or have you really "heard it all"?
Here are some of the more insightful answers...
Not My Time
Regardless of what the person in front of me has experienced, they survived and are seeking help in the here and now. I've found that, as a new therapist, nothing is about me when i'm interacting with a client. It's not my time, it's theirs, so even if I feel a strong reaction in the moment, I give myself permission to set it aside until i am able to take my own time to process. I've definitely cried in the bathroom after rough sessions though.
When I was a caseworker, I used to find it easier to observe professional boundaries and ensure I provided good counselling, etc., with clients I didn't like, compared to clients I did like.
In the case of the former, I always had the mindset of "OK, I don't like this person, so I need to be careful to ensure I conduct myself professionally at all times".
With people I liked, there was always a greater risk of slipping into interpersonal dynamics more akin to friendship, which can be harder to detect (as a degree of friendliness is generally required to provide good counselling and therapeutic support. Characteristics of appropriate conduct, in that respect, can be a much fuzzier line than the professional requirement to not rip into someone for being reprehensible twat).
Like A Wind Tunnel
Honestly, one of the ways I feel most differently from most people is in my level of empathy. I think I'm unusual in this regard, even compared to most other psychologists. I tend to think that if someone really wants to change, they deserve help in making that change. One of the things I find most frustrating about reddit is how quickly people will dismiss other humans as trash. Even those who do the most vile things are human, and they often (although admittedly not all) hate themselves as much, if not more, than others do for doing those things. It's a bit cliche, but people aren't vile, actions are.
Having said that, there are clients who manage to push my buttons, but in general they've not been therapy clients. People in therapy usually want change, and if they don't (for example, they're there because they're forced to be there), I won't continue therapy with them. It's a waste of time. Other clients who do bother me (that I'm evaluating), I try to be aware of my reaction and look at it objectively, in terms of having a job to do, to understand what it is about their behavior that's pushing my buttons because in almost all cases its the same thing that's pushing others' buttons as well. I think of myself as a social psychological testing equipment in that case, sort of like a wind tunnel or something.
Covered In Crap
I'm not a therapist yet, but it's what I want to do and I'm studying to become one. One of the things were taught is unconditional positive regard, and one of the "tricks" we were taught to help us with it is to think of every person being inherently a good person, with it being their experiences that shape who they have become. A good example is the fact that abusers have often been abused themselves.
I don't normally believe in souls, but I find it helps to conceptualize everyone as having a pure soul that gets covered in crap due to what happens in their life. But most of that crap isn't their fault, so you can try to look past it to the good soul underneath. Obviously this doesn't mean you excuse or condone the horrible things people do, it just lets you understand it, at least a little, which does a lot to look past the bad.
In all honesty I think this is probably the best thing I've learned in my entire degree, and I've tried to apply it to anyone in my life who annoys or irritates me. I have found that it increases my tolerance and patience for the little things when I look beyond the thing and think about why they might be doing it.
I sometimes think I must be close to having heard it all but after 20 years, yes, I still get surprises and hear new things from clients.
I can honestly say that there have been very, very few 'vile' clients. I love my work and have a lot of respect for people who are brave enough to come to therapy - its hard work to go through therapy. Its OK as a therapist to have emotional responses to our clients, in fact if you're not then I'd be a bit worried about the therapist. But its being able to recognise what emotions are about my 'stuff' and what emotions are about the clients 'stuff' and dealing with it appropriately. my 'stuff' get set aside for my own therapy & supervision sessions. you learn how and when to identify your own emotions and work with them or set them aside in your training.
Sometimes it is very therapeutic for the client to see my emotional response. Getting sad about a clients abuse can help them to see that what happened to them was not OK when working with abuse clients. Many clients don't have a good connection to their emotions so they learn by seeing my reactions.
I've only had a few clients that might be considered 'vile' - I noticed my emotional response and then set it aside for later and get back to the clients responses. in these cases showing emotions would have been dangerous as they were both sex offenders. Afterwards, yes I did feel 'rocked to the core' and talked about it in supervision, did lots of self care.
There are some stories I've heard that give me nightmares. having a good supervisor/therapist is critical in doing lots of trauma/abuse work as is having done your own therapy, though this is less common these days.
Don't Get Involved
I was a therapist in a forensic facility. I treated serial killers, stalkers, arsonists, etc.
Some of my colleagues had to do a lot of self-care stuff, but honestly I never brought it home with me. Maybe I have a dark streak myself or maybe it's just that at the end of the day it's a job. You get used to the clients. I actually really enjoyed it.
People are people. I remember sitting in a transport bus with a mass shooter in the back in shackles just shooting the shit and cracking jokes. People aren't 100% the worst thing they ever did 100% of the time.
Also, in therapist school (usually a master's or PhD in social work, psychology, or counseling) they spend years teaching you how to treat people without getting personally involved. It's like a muscle you train. You can care about someone and have empathy for them without getting emotionally tangled up in their experience, it just takes practice and direction.
I'm trying to remember if I ever heard anything that "rocked me to my core". I heard stuff that was absolutely mind-bendingly crazy, but...idk...I never heard anything that kept me up at night.
Oooof there are people you come across that make your stomach turn (cue to a pretty serious personality disorder.) One tool I use to muster up empathy and positive regard is imagining what life would be like to be them. Picturing the world through their eyes and how people respond to them daily. Even though their response is different then my imagination it usually is sad, lonely and gives me motivation to help them. That's a simpler one. There are also tools we are trained to use to figure out what it is about someone that is bothersome and how to respond to them in a way that promotes growth. The thought here is that if it's bothersome to a therapist- it's bothersome and negatively impacted interpersonal relationships outside of the therapy session. Our job is to help a client learn and change these things to improve relationships (assuming they want that.)
Sense Of Community
I am mostly desensitized to it all. It doesn't mean I don't have emotions or don't care but my focus is to always validate and explore solutions rather than wallow in the trauma i am hearing. When you are in the mind set of helping the person in front of you, the context of what they are actually saying makes it manageable because you feel useful.
But of course, there are days where I hear a story and hits my heart and I can't shake it for days. During those times I have really practice self care. It's helpful to talk to others in the profession too. There's a sense of community there for sure.
Not a therapist, but I had a friend who was an LCSW (licensed social worker, aka a shrink ) for 30 years.
She would not accept narcissists for treatment.
She said they were incurable, as a group tended to like to play mind games with the therapist, and she had personal issues with narcissist relatives in her childhood.
I imagine other therapists simply do the same, they just don't accept clients who make them extremely uncomfortable.
Value Of Life
I honestly feel like I've heard it all. I'll acknowledge that my experience is atypical, as I work night shift in a level 1 trauma center ER downtown in a major US city. I do crisis counseling, psychiatric assessments, and brief clinical interventions to people experiencing their first psychiatric crisis. Our ER gets all kinds - murderers, child abusers, people with major personality disorders, etc. At the end of the day they are just as human as I am, and while their life experience is different from mine, they deserve the same empathy and respect that I deserve. Part of the reason why I became a counselor is that I have a deep respect for the dignity and value of life. Even if that life is calling me "f*cking ugly" or sh!tting into their own hand, rolling it into a ball, and using it like a bowling ball in our hallways...
Fame always come with a price!
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