An old patient called me the other day. It seems as she had changed careers and was now in graduate school studying counseling. She was given an assignment to ask a professional some questions and she emailed me to ask if I would help. I was glad to hear from her, thought about it and said I would see if I could help, and scheduled a phone time. Some of the questions she asked got me to thinking.

Her first question was “How do you take care of yourself?” I could answer it personally or as a professional and so I chose the latter as I was pretty sure that was really what she needed for her assignment. I believe by that she meant “how do I keep my professionalism without losing myself in the emotional connection and attachment with a patient?” I explained that having been a therapist for over 35 years and I kind of do this naturally, but at the beginning it was not so easy not continually to worry about my patients and stop thinking about them at the end of a day. I explained that it is not that I don’t care about the problems they face, but it’s just that I can separate myself from my work when I need to. I likened it to being an actor. Not that I am an actor, but an actor can live the role but still maintain that part of him/herself that is them. I am myself and very real in my work but I also know that I am an observer and a helper

I understand connecting and am totally ‘there’ yet I also have a separate view and can analyze. I am apart and yet very much with the person. I also said to her that not everyone is able to connect and empathize, and you need to know who you are and what you care about, and whether this work is for you. A therapist or counselor has to be themselves but also be able to use their skills and understanding to help but not get lost in the process. I said that it is not for everyone.   I do not think that a therapist who is aloof and distant, no matter how brilliant, can give a patient what they need. It takes a certain kind of person who is empathic, connected and interested in others, as well as someone who has the training and skills to be a psychotherapist. She said she thought she had what it takes and would love the work.

She then asked if there were people who annoyed me or who I would not work with or if there were any experiences that scared me. I explained that there are certain kinds of pathology that I know I could not deal with.  I would have a hard time with mandated sex offenders in my role as a therapist- ‘mandated’ being the key word – or psychopaths. But I also explained that I have changed in my ability to deal with certain kinds of problems. As I grow and change as a human being, so has my understanding of issues such as illness, aging, bereavement and the like.

When she asked me if I had ever been confronted with a difficult situation, I told her of one when I worked a long time ago at a psychiatric aftercare facility. A man came into my office and after sitting for a while, he looked at me and said “you look like the man who killed my mother”. Then he began getting out of his chair and was moving towards me. Luckily there were security guards and a buzzer. I was behind a desk and security took him away.

Another incident which I did not tell her about, was when I was newly in private practice, a man came in to my office and began telling me about himself. It was about ten minutes into the session before I realized that he had unzipped his pants, taken out his penis and had begun masturbating. It was a dilemma as to how to handle it but I asked him to zip up and leave. I might have handled it differently today but this was also a long time ago.

Another question she asked was whether the problems people come to see me about have changed over time. I explained that basically the underlying emotions that people experience and need to deal with have remained pretty much the same, but that the externals or presenting problems can look very different and how people approach things and what they look for in the way of solutions has changed. I also mentioned that people are more open in talking about certain things in therapy such as sexual issues, drug and alcohol problems, and are more open about sexual identity and preference.  Thankfully there is less that is taboo.  There has also been a major shift in how people communicate with all the technological changes, but when all is said and done, people are still people.  There is much more openness and talk and media coverage, but little is new when it comes to the human condition.  We just have more of it and more is in the open.

We ended with her thanking me and me wishing her good luck. I thought if I could ever get my book published, it might help a few people. But I’ve been told I need a ‘media platform’. A blog is not enough.