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Our Passions, Our Day Jobs

Therapist, Know Thyself

For psychotherapists, maintaining a stable, flawless public image is critical. But when a marriage and family counselor actually goes through a mid-life crisis herself, all bets are off and here come the tattoos, affairs, and professional infidelities.

Credit: Lauren Tamaki.

Therapy is my life. But at 49 I got divorced and I stopped caring what my clients needed me to be. I let my inner child run free, and I didn’t care what my clients knew of it. Well, OK, so I didn’t want them to know I was sleeping with the 28-year-old-high-school-dropout-ponytailed-pothead-philosopher-handyman who lived next door to me, but that was none of their business.

I went to work and I listened to what I wanted to listen to, I spoke how I wanted to speak, I laughed at what I wanted laugh at. I released my irreverence and my skepticism and my tongue. No longer would I allow myself to feel bound to a dress code of dull colors, modest skirts and slacks, boring shoes, and an occasional argyle sweater. I would donate those clothes to school teachers or real-estate agents. I chopped off my hair, pierced my nose, wore Edward Scissorhands T-shirts with torn jeans, short skirts with skull-and-cross-bones tights, bright headbands, gothic jewelry, and motorcycle boots. But I didn’t fully announce my new status—I continued to wear my wedding ring. Months later I replaced it with costume jewelry. I felt like I was cheating on my clients, but who’s going to listen to a divorced marriage and family therapist? What was I supposed to do, reveal my own dysfunctional life and plunge my clients into hopelessness and depression? Leave them feeling like the professional they depended on was not actually dependable? Give them a reason to speculate about my derangement? No, I did not take my infidelity that far, and even as I abandoned my professional persona, my clients kept coming to sit on my couch and whisper and weep and yell their pain and their hardship and their brokenness. They deserved something in exchange for their courage, but did they really expect me to heal them?

The hidden covenant of being a marriage and family therapist is that we must allow our clients, as well as the general public, to hold on to their delusions that we are omnipotent and almost perfect. It could be considered the Mary Poppins Rule: Therapists are practically perfect in every way, and we never explain anything. The Mary Poppins Rule is passed down to us from our teachers and mentors in the form of osmosis because it is against the unspoken rules to speak of it. Compliance is mandatory, spit spot, so I couldn’t have my clients knowing that my daughter was bi-polar, or that my husband was chronically unemployed, or that my grandfather was an abusive alcoholic. I couldn’t have them knowing that therapy was crap. They wanted to believe in me, to see evidence that healthy, happy relationships could be theirs. They wanted to follow my lead. Poor little sheep.

 

There was some precedence for my newfound attitude. Twenty years ago when I decided that I wanted to wear the mantle of psychotherapist, that I wanted entitlement to a certain cerebral status, that I wanted to have my word mistaken for absolute truth, I went to see an older psychologist friend of mine, an earth mother who wore paisley peasant skirts and sensible shoes. She had told me that her clients liked her because she was practical and down to earth. “After doing this work so long,” she’d said, “I’m like a wise old sage now, and that means I don’t have to be so concerned with talking the talk and walking the walk. I’m much better at just being myself.” This gnawed at my brain for years. Could I just be myself and still do The Work? Would my clients still listen? Would I still have clients? What the hell, I thought; I love my work, but what would be wrong with a little time off? So I decided to try it. I would just be myself.

I couldn’t have my clients knowing that my daughter was bi-polar, or that my husband was chronically unemployed. I couldn’t have them knowing that therapy was crap.

When I was married I tried harder to be what my clients needed me to be. If they needed a savior I jumped on my white horse; if they needed a referee I donned the striped shirt. Diagnostician? No problem, I have a white coat. Sleuth? Shine up the magnifying glass. And if a crystal ball was what they needed I, too, could wear that paisley peasant skirt. I left my true self at home, because it was all about The Work.

But divorce makes you re-evaluate your life on every level. I found myself standing on the shores of a vast credibility gap, along with scores of other experts who’d been sucked into the rip tide of hypocrisy. Doctors, dentists, lawyers, teachers, pastors, and even God seemed to say, “Do as I say, not as I do.” What the hell kind of modeling is that? And what happens when clinicians are caught red-handed in the paradox of being expert and human at the same time? Should we deny it? Should we continue pretending our lives are perfect so we don’t lose credibility with our clients? (They don’t want to know anyway.) Denial is the preferred answer for psychotherapists of all varieties because, taken together, we are just one giant undifferentiated ego mass.

When my brief relationship with the 28-year-old-high-school-dropout-ponytailed-pothead-philosopher-handyman who lived next door to me ended, I got my first tattoo. Three inches in diameter, the flower of Aphrodite sits at the base of my neck just below my C7 vertebrae. As the myth goes, after Adonis was killed by a wild boar, grief-stricken Aphrodite dragged his body to the sea, and wherever his blood dripped upon the forest floor a beautiful flower bloomed. I love this story.

One summer day in 2009 I had an initial—and final—session with a woman named Donna. Over the phone, she had explained that her 32-year-old daughter was dating someone she didn’t like. At all. Donna’s extreme dislike for her daughter’s boyfriend was causing a chasm in the relationship between Donna and her daughter, and she wanted help mending it.

Any time I first open my waiting room door to greet a new client, I get an immediate read on their read on me. When I opened my door for Donna, she stiffened as her eyes settled on my silver nasal ring. Donna rose from the chair like a robot to shake my extended hand, which was manicured with black nail polish and a plethora of silver rings, one of them a snake. Maintaining my open-mindedness and non-judgmental attitude, what we call unconditional positive regard, I led her into my office and we began our chat.

“What don’t you like about your daughter’s boyfriend?” I asked Donna.

“Well,” she said, “I just don’t trust him. I don’t think he is a very good person.”

“Does he treat your daughter poorly?” I asked.

“No, he is kind to her. But he just seems like trouble.”

“What about him gives you that impression?”

Donna was having a hard time articulating exactly what she had against the boyfriend, so I fired off elimination questions: Does he have a criminal record? Does he have a job? Is he an addict? Is he a dropout? Does he have scary friends? Is he a bad influence? Does he bathe?

“It’s nothing like that. He just doesn’t look like a trustworthy person,” Donna said.

“Well, what does he look like?” I asked.

“We always raised our children to be respectable, you know, and I don’t think he was raised the same way.”

“But what does he look like?” I repeated.

“Um, well, he has long hair and he has a lot of tattoos, you know.”

Still maintaining my unconditional positive regard for Donna, I removed my sweater, revealing the flower of Aphrodite and the prominent red star on my shoulder. For those of you not up on the lingo, that’s what we call being passive-aggressive.

 

I blame Sigmund Freud. He is the one who set psychotherapists up to be experts in the first place. Just think of all that we associate with his name: analysis, hypnosis, neurosis, narcissism, the unconscious, The Interpretation of Dreams, the Oedipus complex, psycho-sexual development, the id, the ego, the libido. It’s a complicated psychoscape that no ordinary person would dare enter. No, no, no. One has to be an expert to set foot on this ground.

Behind his sterile white coat, Freud hid his inferiority complex and his pervasive sexual perversion. The fraud. Like many others, I believe that Freud poached scenes of sexual deviancy from his patients, inserted his own self-analysis into “objective” cases, fabricated patients’ free associations, practiced creative record-keeping, concealed sources, and even crawled between the sheets with his wife’s sister Minna. Oh, yes, there was also his love affair with cocaine. Let’s not forget his treatment of Dr. Ernst Fleishl von Markow’s morphine addiction. Speedball, anyone? Yet the world still idolizes Freud. Legal systems and medical systems and educational systems still hold fast to many of his diagnoses, techniques, and theories as if they’d been proven by scientific method. Coked-out lying pervert.

What happens when clinicians are caught red-handed in the paradox of being expert and human at the same time? Should we deny it? Should we continue pretending our lives are perfect so we don’t lose credibility with our clients?

Carl Rogers wrote The Clinical Treatment of The Problem Child in 1939. Rogers, a founder in the humanistic psychology movement and the father of client-centered therapy, confused matters for clinicians by insisting on what he coined as unconditional positive regard for clients. While on the surface client-centered therapy seemed the opposite of Freudian-style clinical analysis, it still kept therapists in the expert position. Now we were in charge of nurturing our clients into personal growth through complete support, acceptance, open-mindedness, and a non-judgmental attitude. Only an expert could do that. (Apparently, our clients were incapable of growing on their own.) Rogers should have known that was just a setup for codependent therapists, i.e., all of us,  to go chameleon and hide from our clients any contradictions in our own lives. That would needlessly upset our clients, and upsetting people contradicts unconditional positive regard, right?

In 1946 Murray Bowen began working with families of schizophrenics, and the branch of psychotherapy known as family systems was born. Now therapists could understand individuals based upon their family contexts, and the whole family could be treated, and blamed, for craziness. In his study of families of schizophrenics, Bowen came up with the key idea of differentiation. Differentiated individuals are able to maintain objectivity during times of adversity because they can detach emotionally from others. According to Bowen, if you can’t detach, you are enmeshed and reactive, what Freud would have called hysterical. A therapist had to be differentiated personally in order to coach others into the same state. Again, we were called to be experts. Bowen, by the way, is also the father of the “I-Statement.” Personally, I have always thought the I-Statement is really a You-Statement, i.e., I hate it when you ask me to pretend to be something I am not.

Since the 1960s there has been a cascade of theories on psychotherapy for families and couples, each one forking into more, each fork splitting into more, each split splintering into even more. Structural Family Therapy, Strategic Family Therapy, Behavioral Family Therapy, Psychoeducational Family Therapy, the Mental Research Institute Model, Experiential Family Therapy, Narrative Family Therapy, the Gottman Method. There are hundreds of them. All about The Work.

 

Nowhere is the importance of The Work more evident than at the National Conference of the American Association of Marriage and Family Therapy. Therapists from around the world flock to the conference. We descend upon our host city, we primp, we prink, we peacock, we pontificate, we pooh-pooh, we strut, we swagger, we soak up and suck up, we look up and hook up, we idolize, we demonize, we drink, we dance, we drop from exhaustion, and we do it over again the next day. Remember, it’s all about The Work.

As a whole, therapists don’t hurry much. It doesn’t fit our professional persona. But at the AAMFT conference, attendees scramble for seats in the best workshops like monkeys racing for piles of shiny objects. We are drawn by the content, the continuing education credits, and the presenters—a hierarchy of gurus, gods, and geniuses.

First you have the Old Establishment, men and women with coffee-stained teeth, long gray frizzy hair, permafrowns, tent dresses, shabby suits, hippie jewelry, large purses, large briefcases, large shoes, large vocabularies, and large followings espousing the merits of their theories. Long-stale case studies that we’ve all heard before.

If you were to ask my female colleagues, Schnarch was the best thing since the vibrating dildo. He even used the word “fuck” in his lectures, and therapists never say fuck in public.

Then there are the Up-and-Comings with veneered teeth, frosted tips, French tips, private practice tips, frameless glasses, short red dresses, stiletto heels, navy blue silk suits, Italian loafers, shallow voices, shallow topics, and shallow research vying for the attention of an audience of starry-eyed students and neophytes. They give the Old Establishment due credit for their contributions to The Work (it would be bad form not to), without which, the Up-and-Comings could not have advanced their own, far more evolved theories.

Enter the Heretics. They come to conquer. They twist old ideas into new forms. They twist familiar words into new meanings. They twist our brains inside out. They tear at the edges of our Code of Ethics with calls for a new transparency. It seems nothing escapes the scope of their vision: theories of Foucault, Bateson, Satir, Bowen, and even Freud. None are safe from dissection, dismemberment, and reassembly into a hybrid whose whole looks nothing like its parts. They are blue-collar workers turned therapists turned tycoons turned demigods. Their workshops have standing room only. They sell the most books. Conference organizers love them.

Dr. David Schnarch (yes, that’s his real name, do not attempt pronunciation with food in your mouth), is currently the hottest heretic in sex therapy. At the AAMFT conference a few years back, two members of my cohort had been assigned to interview him for our periodical. If you were to ask my female colleagues, Schnarch was the best thing since the vibrating dildo. He even used the word “fuck” in his lectures, and therapists never say fuck in public.

My colleagues settled into a quiet corner of the lobby for the interview. “It should only take about 30 minutes,” one of them had told me, “and then let’s all go to dinner.”

When I returned 45 minutes later, all five of the other women in my contingent were gathered round the esteemed Dr. Schnarch, lapping up his words, leaning into his gestures, widening their eyes as he raised and lowered his eyebrow. Yes, that’s singular. A spectacular caterpillarian unibrow perched atop black, bulging, googly eyes. My peers giggled like schoolgirls. Hypnotized. Intoxicated. Spellbound. Was Schnarch some kind of magical pimp? Was this porn by proxy? Or did my colleagues just need some fresh ideas to believe in? Dinner was hours away.

 

We walk the walk, and we talk the talk. From the moment we sit down in our first Theory Survey class, we are groomed in how to wear the professional persona. The best way I can describe it is to say: be an authority, be articulate, be affable, be hard, be soft, be a scholar, be candid, be in charge, be compassionate, be lofty, be learned, be erudite, be understanding, be unbiased, be a beacon, be benign, and wear beige. When learning to be a therapist, you pay as much attention to your professional persona as you do to the theories and techniques, maybe more. It becomes second nature, it changes who you are in your personal life. If you let it.

At one of my peer consultation groups, my colleagues and I were brainstorming ideas for desperate parents of teenagers. Sue, my colleague with the highest IQ, had teenagers of her own at the time, as did I. We both knew the first step in working with parents of teens was to invoke the Mary Poppins Rule. What would our clients think if they knew the truth of what goes on in our homes?

Appalling. Deplorable. Despicable. Reprehensible. Yes, my behavior was all of those things. But my daughter never pulled that shit again.

Sue confessed that earlier in the week she had had an episode with her fifteen-year-old son that might have been cause for a visit from Child Protective Services. Sue was at the end of her rope; Sean was just beginning to assert his independence. A 1 a.m. school-night curfew was a ridiculous requirement for an independent young fellow. “Why do you have to be such a bitch, Mom!” he yelled. Sue felt reason leave her body, she saw her hand go for his throat, she felt super-human strength surge through her arms. She pinned him against the wall and spoke with the menace of Michael Corleone. “Don’t you ever talk to me like that again.” Did I mention that Sue is five feet, zero inches tall?

Meanwhile, I was having my own stellar parenting moments. My sixteen-year-old daughter was deeply entrenched in her war with me over just about everything. Cleaning her room, staying out late, doing her homework, informing us of her whereabouts, lying, drinking, skipping class—you get the picture. Several months into this war (or was it years? I don’t recall) I sat her down for yet another talk. Well, a debate. A lecture. OK, it was a screamfest.

My daughter screamed, “One day I’m just gonna kill myself ‘cause I know it will hurt you, Mom!”

Did you know that blood will actually boil at 212˚ F?

“Yes, you’re right it will hurt me!” I screamed back, my blood pushing the mercury to 213˚ F. “But guess what? YOU’D BE DEAD!” I slammed her door so hard I broke the latch.

Appalling. Deplorable. Despicable. Reprehensible. Yes, my behavior was all of those things. But my daughter never pulled that shit again.

 

It is a closely guarded secret among therapists that the outcome of The Work can be roughly divided into thirds. One third of clients improve, one third of clients stay the same, and one third of clients get worse. That’s right, worse. It’s the Divine Proportion, the Golden Ratio, the Mean of Phidias. It is the natural order.

My partner, Xavier, doesn’t much believe in therapy. As he said, “No offense, doll, but what you do is for weak people who either can’t think for themselves or have no common sense.”

“At least they know they don’t have common sense,” I said. I considered Xavier’s big aquamarine eyes, his broken nose, his crooked smile, his chestnut goatee with just a touch of gray, and the way he tilts his head when he adores me; all the things I love about his pretty face were not enough. I was still pissed. “Maybe you should get some therapy for your attitude,” I said. “Or how about your nicotine addiction? Any psychotard has the common sense to know smoking will kill you.”

To be fair, Xavier doesn’t really know what I do. He doesn’t know the complex tango of words, emotions, and behaviors it takes to listen to a 14-year-old girl rant about what stupid-annoying-idiot-controlling-evil-lifewrecking-assholes her parents are, let her believe I agree, and then lead her into softening her rebellion. He doesn’t know the finesse it takes to seduce a cheating husband into confessing to his wife so they have a chance to repair their relationship. He doesn’t know the practiced grace it takes to lead a grieving widow, a suicidal teenager, or a financially ruined couple to walk among the living again.

Therapy probably wouldn’t work for Xavier precisely because he doesn’t believe in it. But does he have to say so? Apparently he didn’t get the memo: Only Janeen can say that therapy is crap. Xavier wouldn’t give credibility to a single word from a therapist’s mouth. Wait, what does that say about our relationship? Is he a non-believer because of me? He’ll never stop smoking.

My friend Alice, on the other hand, is a believer in spite of me. In 2005 she called me with the news that her husband had returned from a trip with an epiphany instead of a gift. He came home with thrilling ideas, with passion for the future, with a new zest for life. He wanted to explore, he wanted to experiment, he wanted to start a new business. He wanted a divorce.

Alice wanted the name of a marriage and family therapist. I referred her to Kate. There is nothing quite like the feeling of unwittingly referring one of your closest friends to an incompetent therapist. Instead of holding Alice’s husband accountable for sleeping with his wife’s cousin (yes, that’s right, her cousin), Kate urged Alice to be patient and understanding and give him “space.” How could Kate not see that my friend’s husband was just a dirty pig-faced cousin poker? Had I not supervised Kate myself when I was an adjunct professor at Seattle Pacific University, I would have thought she purchased a mail-order diploma. I feared her incompetence tarnished my reputation, and my friendship. I referred Alice to Sue. Yes, the same Sue who pinned her son against the wall.

Sue couldn’t save Alice’s marriage. God couldn’t even do that, and why would He want to? But Sue did support her and give her insights that helped make the divorce emotionally survivable. Sue did what Kate should have done. She gave marriage and family therapists, and me, a good name. She validated our professional existence, no matter how dysfunctional our private lives were.

 

In Escape From Babel: Toward A Unifying Language for Psychotherapy Practice, Scott D. Miller, Barry L. Duncan, and Mark A. Hubble ask therapists to shake their allegiance to masters and models. They tell us that psychotherapy’s division into hundreds of different models is all for naught because research shows that our approach, our guru, or our technique don’t matter. So our schooling and training are irrelevant? What matters, they say, is the therapeutic relationship itself. And how, I ask, can you have a therapeutic relationship, or any relationship, if you are not yourself? And if therapists are their true selves, how can therapy be crap?

Therapists are not supposed to accept gifts, but most of us do accept very small ones. In my 18 years of digging around in peoples’ heads, I have been given many tokens of gratitude. Starbucks coffee cards, self-help books for my office library, drawings of flowers and rainbows, a teddy bear, a classical music CD, a lizard handcrafted from Sculpey dough, and a jar of Dutch mayonnaise. Well, maybe mayonnaise isn’t a token of gratitude—it’s hard to tell with the Dutch. But the point is, at least some of my clients are grateful for my work.

And to be honest, I have done good work. I have saved teenagers from menacing peers, from eating disorders, from self-mutilation, from suicidal thoughts. I have repaired relationships between spouses and kids and parents and siblings and friends. I have protected children from abusive parents, from the ravages of divorce, and from the psychological hits of learning disabilities. I have shown the grief-stricken there are reasons to get up in the morning. I have led many back from the brink of their personal abysses. With or without a ring in my nose or a 28-year-old in my bed, I have had my share of cases with successful outcomes. At least a third.

Janeen McGuire Nelson is a therapist, a writer, an artist, and a mom. Her work has appeared in Seattle’s Child Magazine, the Montreal Review, various local newspapers, and the upcoming anthology Joy, Interrupted. More by Janeen McGuire Nelson