Clueless, Wounded Healer = Sought-After TV Star ?

"You have such an easy job," a youngster once said to me. "You just sit in your office, people come to visit you, and you talk and play games with them."

While it may not seem like it, a mental health specialist’s job is actually very hard work; and it may even be hazardous to one’s own mental and physical well-being. Staggering around with what seems like the weight of the world on their shoulders, practitioners can suffer from compassion fatigue, otherwise known as caregiver syndrome. Freud himself, who became increasingly pessimistic about the value of psychoanalysis as he aged, called the work of psychic healing an "impossible profession.”

To be sure, we in the field of clinical psychology may have it easy compared to other forms of manual labor, but we clearly have certain job hazards. Unlike the efforts of carpenters and craftsmen, psychotherapeutic work rarely yields immediate, tangible, measurable results. Moreover, therapists work in an environment which often leads to frustration, self doubt, and emotional depletion: sessions are almost always conducted in isolation with patients who are often emotionally demanding or resistant to treatment. Therapeutic relationships are predominately one-way; the therapist is there to support and listen to the client, but who is there to support and listen to the counselor? Add the annoyance of paperwork and managed care, and it is no wonder that therapists, particularly men, in shockingly high numbers are dropping out of the field…or worse: surveys have even shown that (1) women now outnumber men in fields like psychology and counseling and (2) the highest suicide rate among physicians belongs to male psychiatrists.

Sad to say, one of my favorite psychologists has decided to call it quits rather than face another grueling year. More accurately, he was canned or cancelled from his job. You see, HBO has pulled the plug on the series “In Treatment,” announcing no plans to continue with the show as previously formatted. In the past I have written - very favorably, I might add - in my newsletters about this program which brilliantly showed the possibilities and pitfalls of therapy. The show starred Gabriel Byrne as Dr. Paul Weston, a psychotherapist who was amazingly insightful about patients’ problems but who had great difficulty coping with his own.

In many respects, last year’s third season of "In Treatment" was the most exciting to watch, although it was painful at times as Paul grappled with his professional and personal failures and losses. Paul’s patients last season were less likable and harder to empathize with than in previous seasons. For example, there was Sunil, an angry 52 year old professor and widower brought to New York from his home in Calcutta to live with his very westernized son and his family. And there was Jesse, an adopted, gay, troubled 16 year old who was cutting classes, sleeping around, selling his Adderall, staying out all night, cursing at his shrink, and being generally difficult.

Quite a difficult caseload, even for someone as skilled as Paul in penetrating to the core issues of his patients. Paul’s efforts were brilliant although the results were sometimes not at all what Paul set out to achieve. Such complications added to Paul’s frustrations.

To help him cope with his own loneliness and other personal issues, including this season his fear of developing the same illness that took the life of his father, each week Paul had a session with his own therapist. But unlike previous seasons, Paul’s own treatment this time was with Adele, not someone warm and cuddly, but a more traditional therapist with clear boundaries who tried to reflect back and interpret rather than advise. Paul was intrigued by this young but wise clinician, but he was also petulant and rude with her.

The series ended with a real cliffhanger: Paul was sinking into a darker and darker place where he seemed lost, locked in and no longer sure that he could continue his work as a therapist effectively. Before the final credits, Paul quit his own therapy and walked out into the real world, first moving towards the viewer and then turning and walking away. It seems that even the best of the best can get “Byrned” out!

The basic question is how can therapists, supposedly skilled and knowledgeable in the emotional, cognitive, and social domains, wind up being so clueless and having such a negative effect on their own lives and those of their spouses and children? Why does the phenomenon of the “wounded healer” apply to so many psychologists, psychiatrists and other mental health workers? Some experts in the field argue that this is the way it should be. The only true healer, they claim, is someone who has experienced pain and loss and who can acknowledge his vulnerabilities.

I readily admit that the death of my father while I was in college led me first to seek therapy and then to consider psychology as a career choice. Nonetheless, even if most mental health professionals have had problems, as I did, before entering the profession, this doesn’t mean we will be ineffective; studying and being aware of our problems may actually give us an edge is helping others.

But some writers go one step further. They speculate that even if you didn’t have personal problems before entering the profession, then being a therapist will surely create new ones. From this perspective, therapists’ intimate relationships with spouses and children are perforce fraught with difficulty and appear to be an extension and almost perversion of their therapeutic work.

The person who has explored this and other issues in the field of clinical psychology most extensively is Dr. Ofer Zur (www.zurinstitute.com). According to Zur, psychotherapists' skills and knowledge can have a profound effect on their families' lives. The misuse of their skills, whether through the employment of jargon, diagnosing, overinterpreting, disengaging, or being a “total understanding” know-it-all, is likely to have a negative impact on spouses and children. In response to these actions, many children and partners of therapists build emotional shields against the therapists' intrusion and disregard. Due to the nature of the profession, writes Dr. Zur, many family members experience feelings of exclusion and inferiority in regard to the patients who, after all, have the full, undivided attention of the therapist and are treated with patience and courtesy. My daughter has told me that, as a youngster, she felt that way at times; so did the daughter of the famous psychologist, Erik H Erickson, who in the book In The Shadow of Fame, shared her insights into the rewards as well as the costs of being the offspring of a quintessential father figure. Sue Erikson Bloland pointed out that her dad himself enjoyed telling the story of the psychoanalyst’s daughter who, when asked what she wanted to be when she grew up, answered, "A patient."

It is no laughing matter that the public persona or (to borrow a computing term) avatar which works for the therapist in his office can wreak havoc if applied to his personal life. Dr. Sigmund Jekyll in the clinical setting truly can become a dangerous, lonely, emotionally drained and draining Mr. Hide-Away-Warm-Feelings when it comes to dealing with family and friends.

Is there hope for the “wounded healer?” How could someone like Paul Westin reactivate his practice and restore his sense of personal balance? My cavalier approach would be to continue the program, with Paul seeking a different type of therapy, this time with a male therapist or male life coach. For that matter, why not a more behaviorist approach? Couldn’t Paul explore slow breathing, visualizations, body scans, open focus meditation, physical movement (like tai chi or Qigong), exercise, or expressive arts, among others? Couldn’t he join an online peer support group of fellow travelers in his profession, such as the Networker Excel Club or the International Center for Clinical Excellence? Why not encourage him to develop more of a life outside of work, to have friends, interests and activity that are away from therapy? He could do all of these, of course, but how interesting would that be? If HBO is worried about ratings now, who would bother to watch a show of a healed or healing healer? Let’s face it: viewers are more fascinated by scruffy, vulnerable, flawed doctors such as Paul Westin or “House” (from the television series of the same name) whose social and emotional scars are a driving force in their need to fix the problems of others while at the same time harming themselves. The viewing public, it seems, does not like doctors who have healed well or who are too well heeled!

So I can safely say that I will not seek, nor will I accept, a role in any reality show or shrink series. As I bid a sad farewell to Dr. Paul Westin, I for one will continue, with little fanfare, to practice the “impossible profession.” You see, what may seem like easy work is actually a very demanding job, constantly dealing with the fickleness and uncertainty of life. There are times that I, too, may, inadvertently, shortchange my clients or family members; and for this I am very sorry. There are times that my work will bring me pain and unhappiness. But this is perfectly OK so long as I manage my unhappiness to not damage others. Not only do I need to take care of others; but first and foremost I need to take good care of myself. I need exercise, rest, sun, and engagement. I also sometimes need to be unhappy alone. So do those I love. I will laugh. And if we can connect and laugh together, then we are in for a treat if not a treatment.