The Joys of Being a Psychotherapist Earl C. Brown, PhD
Sometimes, in the dark of night, awake and worried about a patient, I wonder: Why am I putting myself through this? I have to skip over the fact that being a therapist is a relatively nice, clean, respected way to make a decent living because I glimpse other ways I might earn an even better living which seem equally nice, clean, and respected. What I have finally settled upon, as explanation, are some joys which I regularly experience in therapy and which I suppose I would less regularly experience in any other occupation.
Of sorrows, there are plenty. I have toyed with the idea that I am "sentenced" to a life of therapy by my therapeutic role in my family of origin. At times, I have accused myself of masochistically choosing a life of fellow-suffering. At other times, I have accused myself of finding in therapy the perfect reinforcement of grandiose notions about my personal attractiveness and power. More sympathetically, I can write about myself as a person with a long history of wanting help, who was harmed by some would-be helpers, and who can now enter a helping relationship most comfortably from the helping side.
I find more company, among therapists, when attending to sorrows. After all, therapy is work and we get paid to do it. Nobody said it was going to be fun. To the contrary, I was told that it was hard work and I would earn my pay. Pleasure was to be sought outside of work. Thus, to admit the enjoyment of work was to bring pay and livelihood into question.
In the kind of therapy I do, which is psychodynamically informed and of long duration, there is an emphasis on emotions. In the early phases, there tends to be either little expression of feeling or the expression of mainly dire/dour feelings. What I know is that joy and joviality, euphoria and exhilaration, happiness and laughter are also feelings, as istheir natural expressions. These, too, have a rightful place in therapy, in the patient and the therapist, although probably sooner in the therapist than in the patient. Of those joys which sustain me in my practice, I have identified six to write about, namely: intimacy, love, competency, service, purity, and wholeness.
First, I know the joy of spending relatively large amounts of time in a discriminating intimacy with my patients. This is, at once, the most problematic and the most rewarding kind of time to spend with anyone. Intimacy means getting close to someone, without the usual formalities, distractions and interferences, without the need of the customary game plans, maneuverings, and manipulations. I use the adjective "discriminating" to qualify intimacy because discernment and good judgment are both necessary for the evolving mutual decision that it is safe (here and now, with this person) to be intimate. At base is a persuasion that—in this relationship —I can be fully myself without fear that I will not be seen, or seen as other than who I am. Eric Berne was a cogent analyst of intimacy. His observations and experiments led him to the conclusion that most people were lucky if they spent more than five minutes of their lives in truly intimate relationship. I am lucky.
Second, I know the joy of humanistic love. Long ago, I realized that my ability to love was limited by my ability to know, either myself or another person. To the extent that I do not know someone, my love for them remains tentative. Frequently the association to love is romantic, a "best foot forward" kind of love. Often, this reduces to: "I love your presentation of yourself to me as loving me." It is not uncommon to hear a patient in essence say: "Well, yes, you love me, but that's only because I have shielded you from the worst of me; if you really knew me—like I know me—you wouldn't love me at all." Psychotherapy, by virtue of a paid contractual arrangement relieves both parties of any obligation in therapy to do any more than therapy. This arrangement provides a rare opportunity to purely and simply get to know each other. And probably, with time, to know each other is to love each other, in that curious way humans have of embracing whoever is close, and safe, and abiding.
Third, I know the joy of professional competence. I remember being in a forest, watching a deer jump over a creek. To my surprise, once on the other side, the deer circled to jump the creek again, and again, and again. I surmised that the animal was thrilled by its own skill and grace. Sometimes, in therapy, I have felt like I supposed that deer felt: within my domain, challenged by what was before me, able to do what there was to be done, and thrilled at my performance. Certainly, in the middle sessions of the course of therapy, with intimacy and love in evidence, I have found that the entirety of my being was called into question, tested, and strained. Occasionally, all that I have to offer is not enough and, still, has to be enough, supplemented by what the patient can throw into the breech. I know of no other occupation which would with such regularity require the employment of all my personal and professional resources. I am complex, as are my patients, and there is joy in being challenged to my utmost.
Fourth, I know the joy of service. By service I refer to the relatively frequent making of felicitous differences in another person's life, in ways which are immediate, direct, and meaningful to both myself and my patient. I recall the report of one of those national surveys a couple of years ago. This one asked high school seniors what they wanted to do with their lives. Their predominant answer was: I want to do something that will make a difference in someone else's life. When I was in my teens, I wanted (beyond survival) to grow up and do something worthwhile. Well, I have grown up and I am doing something worthwhile. Daily, I impact some patients in a way that they know and I know. We spend a lot of time monitoring those changes, noting what has been done and what has yet to be done. The connection between us is not always good and there are slippages in recognition. There are times when I feel like I have made an impact and there is no sign of confirmation; there are other times when a patient exclaims: "God, that was a great session last week!" and I can't remember what happened. This joy of service is not continuous; it has to compete with bouts of dismay. Still, there are joyous moments I remember in times of disappointment.
The fifth joy is purity (and I discarded "childlikeness" in titling this one). What I have in mind is sharing in the discovery of that stratum of the patient's being which is developmentally early and possessed of qualities of innocence, straightforwardness, and trust. I opted for purity, aware of the contrast with pollution, because of my conviction that we each are at our lifelong best during that earliest time of life when there was no split between our nature and nature itself. In an unhurried practice, the very conditions of therapy are regressively inclined. For most of us, it was only in those earlier years that we were—as in therapy—accepted as dependent, attended to exclusively, and loved simply for who we were. The naturalness and spontaneity of early childhood, with clearly centered imagic and intuitive awareness, has been prized as a source of adult pleasure in many cultures throughout history. More in our time and place, persons as diverse as Eric Berne, Liv Ullman, and Ruth Carter Stapleton have written about the importance and value of reclaiming our birthright.
No easy task, the process of therapy requires the unmasking of socially condoned violence done to the child. In therapy, the uncovering process requires digging through layers of neglect and indifference, contempt and ridicule, shame and humiliation, criticism and guilt, exploitation and manipulation. Almost without exception, each breakthrough involves breakage and releases costly feelings of outrage, hatred, and murderousness. The reparative process calls for understanding, acceptance, and support, along with a ritualistic observance of the symbolic meanings of the events which come to light. The procedures I have used to facilitate this process proceed from the patient's intuition, felt experience, and impulse, combined with my faith in the patient's primacy, veridicality, and self-healing capacity.
Often, my patient is more exact about what is off the path we travel than what is underfoot. The very ground is dreadful. What I know to do is stop and sense slowly, focusing on images in fantasy and localizations of tension in the body. Sometimes, a fantasy or feeling will yield an impulse which—carried through to action—will take the next step. Our concerted creativity may provide an avenue for exploratory acting-out in the office building or an experimental foray in the community. When successful, such "taking a stand" is not only affirming, but also encouraging.
For over a year now, I have tended two-year-old children in a church school. They have taught me more than I knew about primary process and more than I remember about being little the first time. I am informed by those kids about looking and really seeing, listening and really hearing, smelling and being affected by the smell, touching and feeling the sensation of touch. Also, about the emergence of impulse, the engagement in action, and the frustration of intent, through inability or interference. Also, I know more about feelings which need translation to words for which there are no words also, about the approach to someone, the scariness of their presence, the standing back, and, gradually, sidling up closer. I have visited the three-year-old children, but didn't want to stay; they've already lost it. They are intent upon learning to fit in, to go along, to be good. In my work with a patient in a regressed state, we may recapture that primal purity of perception, feeling, and bodily expression, which radiates integrity—joyous to behold.
As the sixth and last, I write of the joy of wholeness. By this I mean that happy, satisfied, and contented feeling that comes when psychic territory has been reclaimed and the border of consciousness has been expanded. I partake of this process through identification and compassionate involvement with my patient. Thus, to the extent that I am represented in my patient, so also is my patient represented in me. My patient's struggle becomes my struggle. As I share in my patient's pain, so also do I share in my patient's relieved happiness. As I share in the despair, so also do I share in the renewed hope. As I share in the hatred, so also do I share in the newfound love. The net effect of such involvement is to nudge me closer to the full depth and range of my own passions: fearsome, sad, angry, and glad.
Now, I am discharged. I have written what I know to write on joy and psychotherapy. Troubled by the necessary artificiality of abstraction, categorization, and verbal description, I still feel good.
Earl C Brown was a past president (1984-1986) and founding member of the Academy. He chaired the doctoral program in Clinical Psychology at Georgia State University and practiced psychotherapy in Atlanta, Georgia.