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Musings of the Long-Distance Therapist

Over 40 years of almost continuous practice: It is hard to really comprehend that amount of time. I do comprehend, though, what a blessing it is to have been part of a profession that has brought richness and meaning to so many days of my life. I am grateful.
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In a few months, I will turn 70. It will be over 40 years that I have been in clinical practice.

That sentence is actually a pretty shocking one to compose. It hardly seems possible. Forty years is a very long time. So many of my colleagues from the early days no longer practice psychotherapy. They left the field for various reasons, some very early on. Being a clinical social worker, or a family and marriage therapist doesn't pay very well. The working conditions are not always pleasant, clients are disappointed, they are angry, they lash out, they fire you without notice and sometimes even explanation. You are sitting still much of the day absorbing the pain, the shame, the trauma, the fury of your clients. If you work in an agency you can be subject to crushing piles of paperwork and a remarkable lack of respect.

And then there is the weight of responsibility, or felt responsibility, for the well-being of others. There is always the prospect that you will fail. There is the dire prospect that the client will harm themselves or others.

But like the song says, "I'm still here."

Quite a surprise. Starting out, I thought I would never make it, that my high level of anxiety would kill me. But as I client once scolded me, I am persistent, "like a dog with a bone" is the way she put it: not pretty, but apt.

I've never been much good at puzzles, either crossword puzzles, picture puzzles, or Sudoku. You can always have the puzzle page of the New York Times out of my newspaper anytime you want.

But the puzzle of a personality I find intensely engaging. Without exception every new client is a new puzzle, an original. Why this symptom and not that? What happened? Why (seek treatment) now and not before? Why did he survive and she didn't? Why did this sibling make it through an abusive childhood and the other one, not so much?

And the key to the puzzle is not written in a book anywhere, there is no standard protocol, the way I work anyhow. It's always a new task to figure it out, how to treat this person. What's going to work?

Then there is my fascination with the story, the narrative of a life. I spent a lot of time as a child with the "orange biographies," biographies of "great Americans." Our small town library had what seemed liked hundreds of them. I took a stack out every two weeks. I consumed everything thing from the story of Davy Crockett, frontiersman, to Florence Nightingale, Mary Todd Lincoln, Jane Addams, George Washington. So was it the history that I loved so much, or the prospect of greatness? Perhaps if I read enough of them, maybe I could join their ranks? No, I think it was the story of lives, lived. And I'm still here, with those stories.

It is a privileged perch, the perch of the therapist. One gets to witness all the lives not lived: What it's like being related to the mob, or to be the neglected child of great wealth. I get a taste of growing up in Lake Woebegone, Garrison Keillor's fictitious small Midwestern town, without having ever been to Minnesota. I get to talk to the voices that populate the inner world of seriously traumatized individuals.

The "privileged perch" can be hazardous. There is no doubt that if you work with trauma, as so many of us do, that your world view is darkened thereby.

The tales of ritualistic abuse and sadistic cruelty toward children are often hard for people to believe, even therapists. A supervisee, new to the treatment of the long-term effects of extreme trauma, once asked if I believed the tales of multiple rapes and torture that her patients and mine recalled. I really cannot, of course, offer a definitive answer in any particular case. No one can. But we did live through a century when state sanctioned murder and torture and rape were applied on a mass scale, so why not?

Here are a few things I have learned from being a therapist:

1. Motivation counts more than the extent of pathology. People who desperately want to get better, generally do.

2. Safety counts more than anything. Anything one can do to help a client feel safe with you and in your office facilitates the healing. Maybe it is the healing.

3. Chemistry counts. Who you are is what counts: "The person of the therapist is the converting catalyst, not his order or credo...not his exquisitely chosen words or denominational silences." (1)

4. Spirit often arises from the extremities of suffering. It's almost uncanny how those who have survived early and extreme trauma and make it into my office, arrive with rather robust spiritual lives. Not conventionally religious, they are still believers in the transcendent and credit those experiences with their survival. These patients have taught me a lot about spirit and spirituality.

Over 40 years of almost continuous practice: It is hard to really comprehend that amount of time. I do comprehend, though, what a blessing it is to have been part of a profession that has brought richness and meaning to so many days of my life. I am grateful.

1. A General Theory of Love, Lewis, T.,Amini, F., Lannon, R., p.187.