Why I am not a therapist

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Years ago a dear friend of mine who happens to be a pastor told me he thought I would be a good pastor. I felt a small swell of pride. But I also squirmed.

“I’m flattered,” I said, “and maybe you’re right that I have some of the skills. But I don’t think it’s in the cards. I would be too skeptical of my own motivations. Some people who are in the helping professions are in it primarily to work through something or absolve themselves of something. I fear that would be me.”

He looked at me with fond amusement for a moment, then, ever pastoral, told me the following parable:

“There once was a young boy scout who was especially philosophically minded. He was in the process of earning his service badges. One day he was standing on a street corner and saw an old woman who looked like she might need a hand crossing the street. ‘It wouldn’t be right for me to help her because my motivations wouldn’t be pure,’ said the young boy to himself. And the old woman stepped into the street and was hit by a bus.”

The parable had its desired effect, and needless to say, it stuck with me. But I didn’t enroll in a seminary the next day, and I still haven’t.

Within the same year, another dear friend, this one a therapist, said she thought I’d be a good therapist. I felt the same swell of pride followed by the same squirm. I called to mind the parable of the boy scout. This time it didn’t sit quite right.

I like it when smart, competent people in the helping professions tell me they think I could do what they do. It makes me feel like they think I’m wise. It makes me feel like they see some of the aspects of me that I most like about myself: psychological mindedness, perceptiveness, verbal abilities, deep emotional sensitivity, and the desire and ability to care for others. Oftentimes people who aren’t psychologically minded don’t see these things in me because I also have kind of a sharp edge, a hard exterior, a set of quills. I like it when people see past that.

Of course, lots of people helpfully suggest careers for me. These have ranged from veterinary technician to electrician to teaching professor to restaurateur. These land on me in all kinds of ways, depending on the degree of ludicrousness. Now, none of the people who suggested the above careers was a vet tech or an electrician or a teaching professor or a restaurateur. They were Concerned Citizens who want to make sure my life is 1) comfortable for me and 2) legible to them. No, the only people who are eager to tell me I could do what they do are helping professionals.

I don’t think this means that I am oh-so-saintly, that my good qualities are just leaking out of me. I think it probably means that people in the helping professions are proud of what they do, and they convey their esteem by ascribing their valued traits to others. Therapist and pastor aren’t just any helping professions, though. No one would ever tell me I would make a good nurse, for example, because I wouldn’t. Therapist and pastor are both spiritual callings: to be a remotely good one of either, you have to have some sensitivity to the higher and lower realms. I think this is probably the thing therapists and pastors are pointing to in me when they say I could be a good one, even as many therapists disown and disavow the esoteric nature of the work. Just because it is occluded doesn’t mean it’s gone.

Maybe it is true that I have good pastor qualities, good therapist qualities. I think I also have some qualities that might really interfere with my work as either one of those things. I can be scattered, really ornery, avoidant, a bit flaky, a bit capricious, very awkward in some circumstances, sometimes cocky, strident, supremely stubborn, and even a bit dismissive. I’m terrible at answering emails because I don’t give a shit about most of them. I could sand the edges off some of these traits with some good training, probably, but I don’t think I’ll ever get good at answering emails or pretending to care about things that I do not care about.

But my traits aren’t the biggest reasons why I’m not a therapist or a pastor anyway. All kinds of people with all kinds of bad traits become therapists and pastors. The biggest reasons I’m not a therapist or a pastor are both more practical and more philosophical. For the rest of the essay I’m gonna focus more on the therapist vocation because it’s the one that Miss Apprehension writes about.

Let’s start with the practical: school

Fuck school. I hate school. I am bad at school. School also hates me and is bad to me. School doesn’t want me there any more than I want to be there. To be a therapist, you have to go to school, at the master’s level at the very least. If I were to go to therapy school it would be at the doctoral level; I have no interest in an MSW or an MFT or whatever new credential they’ve cooked up recently. This isn’t for prestige reasons, it’s because I actually want to be taught things, and having watched a great many people, friends and otherwise, go through the social work school in my city (the top-ranked one in the country, so you’d think it would be representative or better), I’m pretty sure therapy master’s programs don’t teach you very much, certainly not much of what I want to learn. Of course, I don’t even have a bachelor’s (dropout), and I don’t have money to get a bachelor’s, and even if I did, I do not want to.

But let’s say, theoretically, that I was able to bite the bullet and get a bachelor’s and then a doctorate in, say, clinical psychology, and then some postgraduate analytic training (which would be my desire). Would I actually want to do the work? And would I be able to? And what is the work, anyway? Who is it for? Who and what does it serve?

Would I actually want to do the work?

If this question means “do I want to help people mitigate their suffering?”, then the answer is yes, I think so. But I don’t really have the constitution or skill set to be, say, an aid worker; I am not the endlessly giving, self-abnegating type. One of the appealing things about practicing psychotherapy is that it is a container around which there is a frame. The traditional therapeutic dyad is one in which there are clear roles, a clearly designated place and time in which those roles are inhabited. You, the patient¹, have your messy feeling in my office at 1:00pm on Tuesdays, and I, the analyst, help you tease out the threads of the feelings and make meaning of them; then at 1:50pm, we clean up, you go home, and you and I do not interact with each other for the next 6 days and 23 hours, strictly speaking. This rigid Frame is in place ostensibly for the benefit of the patient, especially the highly neurotic or disorganized (psychologically speaking) patient. The frame provides the patient with a place set apart, a clearly demarcated psychic and physical space, for plunging into the muck. Traditionally the frame has been a mystifying device, among other things; the place set apart is a sacred pocket dimension in which only the patient and the therapist exist, and the therapist’s only purpose on earth is to attend to the patient. For the disorganized patient, the frame provides a boundary to throw herself against, a place where she ends and the Other begins, the other, in this case, being the remote, authoritative, mothering Mage of the Unconscious. So the frame protect the therapist, too. It keeps each patient’s shit neatly and safely tucked away in one hour of the week; it keeps it from getting all over the therapist and all over all of the therapist’s other patients.

The Frame comes from the days of yore in which psychoanalysis was the only kind of psychotherapy there was. The Frame as I just described it is the analytic frame, and psychoanalysis is pretty out of vogue these days. One of my good friends who is entering her second year in the MSW program in my city recently told me that she has not heard the word “frame” uttered even once in her training so far, which is somewhat sobering. But the Frame persists in the form of Boundaries around The Hour and Out Of Session Contact and Self Disclosure.

Of course, while the Contained, Framed nature of the work can be one of the greatest features of the work, it is 1) actually pretty antithetical to my worldview and values, and 2) where some of the greatest weaknesses of the work can lie (more of what exactly I mean by that some other time). I don’t want to be someone’s remote, authoritative Mage of the Unconscious. Well, I kind of do, actually, but that’s not all I want: I don’t want to be someone’s Mage of the Unconscious at the expense of all other axes of relating, which is what the therapeutic Frame mandates. So-called “dual relationships” are not only extremely taboo, they can also rise to the level of illegality in some jurisdictions and circumstances (fucking). One of the things that they do teach you in therapist school, I hear, is risk management. How do you avoid accidentally fucking one of your patients? You keep them at arm’s length.

What is lost in keeping a patient at arm’s length? A great deal, I would argue.

There’s a school of thought descended from psychoanalysis that’s sometimes called the relational school. It is a theoretical orientation, not a modality, so any stripe of therapist could call herself² relational. Relational psychotherapy is therapy that is explicitly focused on the relationship between therapist and patient. Relational psychotherapists believe that a patient’s healing is located in and generated by that relationship. There are many many therapists in the world who believe that for the purposes of healing, the pocket dimension of the Framed relationship is just as good as or better than a more normal, out-in-the-world type of relationship. I am sure that is true for some people. But I am also sure that it is not true for ALL people. It is not true for me.

Once upon a time, many moons ago, when I was really mad at one of my therapists, I said some kind of mean things about the therapeutic relationship (in the abstract, though of course I was really just talking about my own anger at the present therapeutic relationship). I said it wasn’t a relationship at all. I said it was a facsimile of a relationship. I said it was more like a video game than a real connection. I stand by the emotional truth of those statements. But I recognize also that “real” relationships can happen within extremely rigid boundaries. “Transference” and “countertransference” are just fancy names for the regular emotions that we all have all the time in all of our relationships. Transference hate and transference love are just regular hate and love. The fancy modifiers are just another aspect of the Frame.

Simply keeping a patient at arm’s length as a matter of principle actually doesn’t work that well at preventing therapists from fucking their clients, it turns out. So who is all this really for?

I’ll tell you who it’s for.

The Frame is for therapists as much as or maybe even more than it is for patients. I don’t mean this in a “risk management” way. I mean that the kind of person who becomes a therapist is the kind of person who needs to keep themselves safe from other people’s deepest darkest shit to the same (very great) degree that they need to go toward people’s shit. By “need”, I mean in this case a deep and strong unconscious drive. A person becomes a therapist because they are magnetically drawn to people’s pain. A person becomes a therapist because they are terribly afraid of their own pain. A person becomes a therapist because they cannot bear to look upon another person’s particular pain for any longer than an hour per week, because they pain it would bring up in them would be intolerable.

Are these generalizations? Well, surely. But I think they’re apt and true as generalizations; I know and have known a lot of therapists and therapists in training. These are also aspects of myself that I recognize very clearly and am not crazy about. So you could call these observations projections, if you like. I am drawn to people’s pain in a way that sometimes feels out of my control. I see it and feel it even—especially—when I do not want to. I am, I think on some deep level, afraid of my own pain. And I cannot tolerate the pain of others for any sustained amount of time because of the pain it generates in me. I can’t bear to witness injustice. I am very susceptible to what people in the field call moral injury.

I mentioned earlier that I think there’s a lot that is lost in holding patients at arm’s length. Because even while the Frame protects the therapist from their patient’ pain, it also keeps out other things. If you are a therapist, you can love your patients, but you can’t keep that love. You can’t love them the way you can love someone you know in real life. You can’t lend them money when they need it, you can’t drop off food when they’re sick, you can’t go to their kid’s graduation, you can’t go to their mom’s funeral. You could visit them in the hospital under some circumstances, but it would have to be in a Professional Capacity. You can’t drive out and find them if their car breaks down and their cellphone dies. You can’t hold them close when they are weeping. And this is one way I know that therapist is not the role for me. The urge to abdicate my responsibility to my loved ones is one that I often feel, not because I am a lazy selfish bitch (or at least not only), but more because I fear the weight and profundity of the responsibility of caring for someone. I fear fucking up in a bad way. It would be so awesome and convenient if I only had the opportunity to fail any given person one hour per week.

All these fears are things in me that I want to work against. I want to face them. I don’t want to build my entire career around accommodating and perpetuating my fears. I don’t want to use the guise of a Helping Profession to smuggle in avoidance. I don’t want to protect my heart at the cost of rightly ordered relationship.

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When I set out to write this essay, I had in mind that I was going to write down a whole bunch of stuff about the state apparatus and capitalist interests and other Structural things. I thought I was going to talk about high ideals and morals and reification and reproduction, and the stuff about the Frame would just be a few paragraphs of introduction. But the truth I have discovered by writing this is that whatever yarn I spin for myself about Society, whether or not it’s true, the heart stuff is of much greater import to me: I am not a therapist because some of the things that make therapists therapists are things I don’t like about myself. I am not a therapist because I don’t want to be the kind of person that would want to become a therapist.

I had also thought that this essay was going to be called “why I will never become a therapist”. The lady doth protest too much! The fact that I’m thinking so hard about why I don’t want to become a therapist means that I very well might.

I am psychologically minded enough to know that the harder I resist something, the more it persists in sneakier, more sophisticated ways. Maybe if I leave the door open, my inner therapist won’t feel the need to reenact The Shawshank Redemption.

1. Much has been made over the years of the “patient” vs. “client” nomenclature, and some clinicians have chosen to eschew both, opting instead for “the people I work with”. Because I have a pretty strong bias toward the analytic tradition, toward historicism, and clarity whenever possible, for this essay “patient” it is.

2. Guess which sex is more into the relational school?