I’m scared.
I know you’re scared, too.
I hear and understand the things that therapists are afraid of, and I know that there are a lot of directly-competing pressures on us all, from outside of us and within us, that keep us afraid.
There are thoughts I share very openly here on this blog that I KNOW will make a lot of therapists uncomfortable, or even draw criticism—which is uncomfortable for me, too. But I am sharing these thoughts specifically BECAUSE I know we all feel afraid.
I know we’re all afraid of something happening to our livelihood, to our ability to provide for ourselves and our families. I know that we’re all afraid of what would happen if we lost our licenses, or if we were sued. I’ve been afraid of the same things, and I truly don’t think fear is wrong to feel.
Often times, I hear therapists afraid of losing clients, of not being able to pay their bills, of lawsuits, of a subpoena to appear in court, of what happens when clients start cancelling appointments, of someone trying to take advantage of them, of being lied to, of insurance clawbacks and audits, of moving to solo private practice from a group practice, of working with certain types of people with certain types of presenting problems, of working in our offices alone, of accidentally breaking a law we didn’t know existed, of the infinite scenarios of what could go wrong.
There’s really SO MUCH to be afraid of in the therapy micro-universe! All of our experiences and interactions are one on one, quiet and private; no one else is there in the room to weigh in and advise, or corroborate our experiences, or to help. We can end up feeling so alone and isolated, so much of the time.
Honestly? I don’t really know how I survived the early years of being a therapist AND ALSO a young woman, alone in rooms with people who sometimes scared me, sometimes violently threatened me—sometimes actually harmed me or used violence toward me, sometimes insisted I couldn’t possibly know what I was talking about. I know that it affected me when it happened, and made me question myself deeply in every way possible. I know that I’ve lost count of how many times I’ve wanted to quit and go work in a bakery, or library, or plant nursery (or any other quiet, non-peopley work).
I’ve been afraid a lot, just like we all have.
I feel most afraid, though, of how our fear makes us close ourselves away from the humanity of someone else when we are in the therapist role—especially when closing ourselves away from our clients.
I watch some therapists become guarded and frustrated when they feel slighted by a client perhaps forgetting about an appointment and no-showing. I watch some therapists even advising other therapists to guard and defend themselves from our clients, even recommending that they send the client a cold and impersonal email after years of work together, stating something like, “if you don’t contact me back within 3 days to reschedule/confirm your appointment/explain why you no-showed/pay the no show fee, I will be taking you off my schedule and closing your file.”
I have a growing concern that this self-defensive reaction to our fear, the instinct to defend ourselves without asking more questions or without waiting to find out what’s going on, the assumptions that then lead us to decide that clients are mistreating us or disrespecting us, is causing us to disconnect emotionally in some significantly impactful ways from the people we serve. And how can therapists do our work effectively while being profoundly emotionally disconnected in that way?
For example, therapists who hold a great deal of concern and fear that people will lie to/take advantage of/manipulate us will likely approach all new prospective clients with that feeling right alongside their need to fill their schedule to make income ends meet. Perhaps we might present to this new client defensively or in a closed-off way, especially with someone who is hyperaware toward the feelings of others following trauma with parents/attachment figures. The client will likely pick up on *something* feeling a little strange about this emotional exchange, but also, may be so exhausted by the extremely difficult search for a therapist, that they may offer us the benefit of the doubt, assume the therapist is having a rough day or something, and go ahead and schedule. I can imagine many scenarios where, as the client works with the therapist, they feel our defensiveness and detachment on a continuing basis, and feel increasingly uncomfortable. Because of the fear of reactivity from the therapist, they might simply no-show to an appointment (and many therapists will interpret this as “ghosting” because they are by nature seeing the situation with themselves at the center, vs the client and their experience/feelings being at the center), or perhaps might cancel all future appointments by sending a short email or text, and avoid having any direct confrontation. I can imagine, then, that the therapist finds this situation hurtful or frustrating, and then becomes even MORE entrenched in the belief that clients don’t care about us and will treat us in ways we find disrespectful or hurtful. Then the cycle begins over again, leaving the therapist closer and closer to a sense of being burned out and feeling unsuccessful in their work.
I feel like I see various different expressions and versions of the above in my experiences chatting with other therapists. And we may be so exhausted and pushing so hard that we don’t really notice ourselves becoming emotionally distanced and detached. Sometimes we may not even notice that we are expressing our own unacknowledged anger/frustration/grief/hopelessness toward our clients, because we don’t know why things just don’t seem to work, why it has to be so hard all the time. We may not even be aware we feel it—but that definitely doesn’t mean that the other human beings who share space with us don’t feel it and experience it in us.
I’m at a point where I feel so aware of my own constantly-churning emotional self that I’m almost hypervigilant about what others will take from my words, my facial expressions, my responses or lack thereof… I worry that my “thinking face” (thanks Zoom for showing me what it looks like) will express anger or displeasure. I worry that my frustration with what feel like gatekeeping, exploitative regulations put in place by therapist licensing boards will come across as disrespect for them (note: I do not actually respect those rules, but I also don’t want my licensing board to KNOW I do not respect them). I worry that when I speak out loud in our professional community about implementing a Pay What You Can fee system (a thus far unpopular idea among the self-described “entrepreneur and business owner” contingent of therapists aiming to make six figure incomes), someone will get angry enough to target me and try to find some way to get me in trouble with the licensing board, even though I have done nothing wrong by offering very-low-fee services.
But living in these fears is too painful. It steals away the joy and connection and pleasure in doing my work, and cheats me into an automatic buy-in to capitalist ideals and trying to hoard resources to protect myself. That is not who I am, and not aligned with my values. I HAVE TO do something else, because I cannot sustain the emotional energy needed to live with this much fear.
So I fight not to be suffocated and silenced by the fear. I write this blog. I try to have difficult conversations when I can, and try not to shy away from the particular discomfort of talking with colleagues about the big questions and worries and concerns about being a therapist in this devastated/devastating world that needs so much healing and asks so much from us.
And I try to listen to myself and my own internal voice, track my gut instincts when they’re trying to guide me, try to “do my own work” to learn how my body responds when I’m triggered in a place of trauma or whenever I feel otherwise fearful. I try to reach toward others, try to offer gentleness and grace for wherever they are (and I hold space in my mind that that’s what I hope someone else would try to afford me, and I hold my own boundary where I am disrespected or harmed by another).
And, well, I don’t think that there’s a secret to getting rid of fear.
But I actually don’t even think we need to get rid of fear. Fear will always be a core part of the human experience, and we therapists are, among many other things, decidedly human. Some people would say we need to be able to have a relationship with our fear.
I aspire to see fear as a “helper” wherever I can (when I have the capacity to extend that grace to it, which isn’t always, of course—I’m obviously still a human just like everyone else). I do think that there is a key we can find that will unlock some of the trickier parts of this fear within us, and I believe it’s contained in the process of examining our own experiences and trauma in the world, and trying to understand ourselves. I believe it’s contained within assessing what our core values are, and imagining what kind of person we’d like to show up as every day. I believe it’s contained within community-building, and valuing one another as community. I believe in these tools and perspectives as concrete, actionable ways to build ourselves up bravely in the face of all there is to be afraid of.
I’m still a little scared, sharing these words and speaking them to my peers and to anyone else listening, but I also know I am saying it because I have a fundamental wish to be connected with you, reader. I want to know if you feel afraid, I want to talk together about the sweetness and the difficulty! I want to stay in relationship and in community, and I want you to know I see you. I want you to know I still value you whether you agree with me or not, because you are your own wonderful, unique, self-created human being, and you are part of my community and my world, so you matter to me. When I think about you reading this, I feel and deeply sense your presence! You matter to me, even if you don’t like me/like what I say, because I believe in your deservingness of space for what you think and feel. My making space for what I think and feel does not take away from yours, and your making space for what you think and feel does not take away from mine. We are standing on the same ground, holding the same precious gift of humanity within us. And if there’s any way that I can help it, I hope to never lose connection with yours.
Kayte, I love your courage to name it, to acknowledge the FEAR that holds us back, that distances us from our clients, our colleagues, our friends, family and from our selves!