Anyone who knows anyone who is a clinical psychologist or other kind of psychotherapist will know about the stories they carry in their minds and hearts. Stories of other people’s struggles, pain, trauma, hurt, love and sometimes, wonderfully, recovery. When the psychologist returns home, the stories stay with them, but now in a parallel world of partners, children, friends and mundanity. What is this life like for the psychologist and her loved ones? How do they cope?
Some clues come from in-depth interviews with nine senior psychologists and three senior psychiatrists in Norway, published recently in Psychotherapy Research by Marit Råbu and her colleagues. The interviewees – 7 women and 5 men, aged 68 to 86 – had worked as psychotherapists for between 35 and 56 years and some were now retired. All had started out their careers with a psychoanalytic orientation, but several had since branched into other approaches, including cognitive therapy.
Asked to reflect on their life’s work, a recurring theme in the therapists’ comments was that it had been a privilege, a humbling experience to come so close to other people’s lives, to witness their pain and suffering and see their sometimes remarkable ability to cope and adapt. The therapists described how this insight had affected their own personal growth as they “used different parts of themselves with different clients”. It had also enriched their own personal relationships, they said, by teaching them to be humble and accepting of others.
However, the interviewees also described the burden of feeling so much responsibility for clients, and being exposed to so much suffering. If anything, they said that age and experience had made them more sensitive and there was an accumulating effect of “sorrowful things” over the course of a career.
One of the most difficult challenges had been working with suicidal clients, feeling helpless in changing abusive situations, and in the worst cases, dealing with the grief of a client taking his or her own life. Some spoke of a guilt at not being to provide enough support to their clients. “That is perhaps the heaviest part,” said one therapist, “to possess so much responsibility and to learn how much loneliness these patients experience.”
This stress affected the therapists’ own personal relationships. “You populate your inner life with people you don’t live your life with,” said one, “leaving little room for more than perhaps your closest family.” Others described how they withdrew from any conflict with their spouses, and perhaps tolerated too much just for an easy life at home. One male therapist said his wife described him as “contactless” when he returned from work.
But overall, the therapists spoke of their careers as having enriched their lives, and how their role had become a vital part of their identity. They had coped, they explained, by constructing with their close relatives a way of managing the burden of their clinical work – they described the importance of self-compassion and of protecting one’s inner space. The researchers said “this involved the cultivation of other interests, socialising with others outside of the profession, making music, painting, and taking care of the body by exercising in a variety of ways.” All but one interviewee was active in the arts, such as playing a musical instrument or painting. The therapists also highlighted the benefits of time spent in nature, and the importance of “collegial support or supervision” throughout their career.
Qualitative, open-ended research of this kind produces rich material for analysis and reflection, but inevitably at the cost of methodological control, making it hard to know how much the findings apply generally or only to the small sample of interviewees.
The researchers acknowledged that their own “humanistic and relational orientation” may have influenced the questions they asked and the way they interpreted the answers. Also, the nature of the sample (lifelong therapists) may have led to biased accounts simply by virtue of the fact these therapists had all chosen to stay in psychotherapy for their entire careers. Reflections on working in psychotherapy from therapists who have chosen to re-route into research or teaching might be very different.
The interviewees’ perspectives will also likely have been shaped by their having embarked on a career in psychotherapy at a time of great freedom and optimism for the profession. Clinical psychologists starting out today may be confronted by different challenges, such as funding cuts, intense scrutiny of therapeutic outcomes and a demand for highly systematised forms of therapy.