Often, after chance encounters on the subway or a restaurant- or even just in front of the building when I dash out between sessions to grab a cup of tea, I’ll hear from a startled client: “Oh, I thought you were taller!”

I usually respond: “Yes! Funny – I am actually a short person!

So many questions emerge about these shape-shifting impressions – many explored together with clients when we are back in the office. Other queries play out in private or with my professional and personal supports:

Is this merely the client’s essential need to see me as “big”? Is it their projection, idealization, transference that makes me loom large in the office?

Do I claim my limited authority appropriately? Or do I fail to take sufficient ownership of my mastery, fighting against any whiff of idealization? Or perhaps am I too puffed up, inflating myself, taking up more room than I should? Do I shrink my patients, or do they shrink themselves? Are there ways I initiate this illusion? Am bigger than I realize? Smaller than I am admitting?

Is the illusion co-created, the necessary outgrowth of the role I have assumed in their lives, the innate power-differential between therapist and patient? Or an unspoken expectation that I am unconsciously compelled to live up to?

Of course, the answer is “yes” to all of it – at once and at any given time.

Thank goodness for all the belittling, devaluing, deflating content that emerges in the therapeutic process, or a gal could get a swelled head.

But the question that emerges more and more for me at mid-life, having spent all of my adulthood immersed in the therapeutic process in some form or another: What effect does all this expanding and contracting, stretching and shrinking, inflation and deflation have on my being, on my personality, on my persona outside of the office?

Can it wear out my elastic? Will I always snap back into shape? Do I have the strength to continually experience both ends of the polarity? How does it effect my behavior with loved ones, strangers, acquaintances? How does this vocation shape, prune, contort, and wear on my identity?

Many years ago when my analyst and I prepared for him to undergo a potentially life-threatening surgery he asked me, as one of his oldest (meaning earliest not elderly) clients, if anything happened, would I speak about his work, about who he was in the room, because otherwise, no one would know.

I understood exactly.

Working in secrecy, in privacy, in confidence means that many aspects of our identities live behind the veil too. Just as clients often wonder if they are “real” people in my life, I wonder too if the attentiveness, nurturance, patience, and insight that I can channel in office are actually “real” aspects of my personality that I can claim as my own, or if they only can exist in the consultation room, in co-created transactions with clients. Would the people in my daily life who encounter my needs directly, who experience my fussy, fretful, defended, unreflective, selfish, wise-cracking, frail moments even recognize the strength and equanimity I am able to summon in short bursts when I am working in a transitional space?

A dear friend who is the son of a shrink told me about his experience of coincidental encounters with his parent’s patients out in the world: “I’d look and I’d know immediately who they were.” he said, “They were the ones who were getting the good stuff.”

For the therapist, the profession, by its very nature, acts as a chronic, seductive call to hand over all of your better nature, all your altruistic and charitable impulses, all of your golden kernels of wisdom, patience, nurturance, sensitivity and generosity, leaving your friends and loved ones with nothing but cold, inedible cobs and table scraps.

Empathy-fatigue is the cruelest occupational by-product.

It requires constant vigilance and monitoring to make sure you are giving a sufficient but not excessive amount of your emotional attention to clients, even those in desperate need, no matter how deep your affection for them. Passing through alternating states of imbalance is inevitable and unavoidable as the pendulum sings and circles past center, calibrating and compensating for the emotional output.

There are late evenings, sometimes whole days, maybe even a few weeks at a time spent tapped out, mildly irritable, impatient for gratification, comfort, restoration. When you spend all day being your best self – your worst, most needy ravenous self will inevitably emerge – most likely in your intimate personal relationships – hopefully in ways that are claimed and acknowledged and that allow for compassion and reparation for yourself and everyone around you.

“Talking like a shrink” is another common professional hazard: The use of strange, jargon-y speech combined with a concerned tilt of the head, micro-nodding, an unnaturally soothing, overly modulated almost-but-not-quite-inauthentic tone of voice, with a hint of concealed impatience, an aroma of condescension, and subtle notes of repressed rage and baby-talk.

I fight against “shrink talk” with everything I’ve got both, in the office and at large. I curse, use the crass vernacular, any practical metaphor I can grab hold of. I throw everything but the kitchen sink at it. And still now and then, while sorting through something mucky (therapy-speak translation: “processing conflicted self-states”) it slips out. Soon, hopefully, my children will be old enough to mock me mercilessly when this happens – which will be warranted and helpful.

Talking-binges: My husband and close friends bear the brunt of all the unspoken backed up self-referential nonsense, mind-minutia, random thoughts and mini-epiphanies about myself and my own needs that have emerged during the week. Luckily for them, I’m perfectly content to have them only half-listen while I talk my fool head off – spilling out all my dammed-up verbiage.

Weirdly, there are also just as many moments – commonly during times when the work has been particularly demanding after some great achievement, crushing failure, or professional milestone has occurred – when the combination of the intensity of the work and the requirements of confidentiality leave you with absolutely nothing to say at all:

“What is new you ask? Hmmm, it feels like a lot, but I guess really, nothing much…. nothing really…. just work, life… Boring I guess. How is your new job going?”

I suspect, that another one of the intermittent side-effects of being a therapist is superficially impaired listening in social relationships. After concentrating intently on others all work week, I am, at week’s end, left with a kind of social attention deficit: distractibility, diffuse attentiveness, unintentional interruptions, confusional loss of the conversational thread, unwitting changes of topic – as my brain releases its hyper-focus on all the mechanisms of communication: the unconscious slips of the tongue, telling word-choices, and unfinished sentences inherent to therapeutic conversation. My nearest and dearest offer me some time-limited forbearance – before they tease and challenge me to pull myself back together and pay balanced attention. I am grateful for both their patience and for their limit-setting.

I do know that when real needs are on the table that I can usually summon my best self, listen with deep attunement, and serve as a generous friendly resource. In times of crisis I am an effective, incisive receptive and emotionally available “go-to” friend and partner.

That being said, I have become significantly harder to befriend over the years. New relationships undergo significant vetting. Outside of the office I swerve and dodge, erect boundaries and hold even slightly imbalanced relationships at bay.

Most people seem to have at least one or two friends who are beautiful wrecks, messy charmers, or substitute younger siblings, who they enjoy taking care of, where a little more care is given than can be received. Often this imbalance is corrected for in other ways: the more vulnerable friend is loyal, funny, appreciative, enjoyable and allows the more stabilizing friend to identify (or over-identify) with an earlier phase of development, or to have some vicarious experience of a larger, more passionate, and expansive, if messier range of feelings.

I have learned, often with great sorrow, that I am not capable of sustaining that contract any longer – at least not while doing the work I do, and raising young children – even for some lovely people that I enjoy, admire, root for, and feel deeply moved by.

In my non-work relationships I am ravenous for full mutuality, equality, for a balanced exchange of giving and receiving. I invest my time in people that I can turn to, who call me out, tease me, make me laugh, distract me, indulge me and confront me. Friends and loved ones who are not impressed, know that I need exactly as much as they do, even when I am unable by professional mandate or fatigue to say why I am depleted. The relationships with people who are direct and strong-minded and out spoken, who don’t ask me to decode them, are the ones that allow me to fill my belly, laughing deeply and appreciatively at my own expense.

This is what all therapists need from their intimates to keep them from getting stuck or becoming bored, boring and brittle, swallowed whole by their own professional shadow.

That’s what keeps the snap in my elastic.

copyright © 2012
All rights reserved Martha Crawford

28 responses

  1. Thanks so much for writing this post! You’ve captured my experience and the experience of so many other mental health professionals around the world – and you’ve done so beautifully!

    Happy to find whatashrinkthinks. I think you may be my new favorite blog!

    Tamara G. Suttle, M.Ed., LPC
    Castle Rock, Colorado, USA

  2. Thank you so much Tamara! That is wonderful to hear that I am not the only one who experiences and wonders about such things! Staying truly open and available – porous, grounded and balanced at the same time is an on-going negotiation.
    Thanks so much for reading and for your kind words.



  3. I notice your frequent use of the word ‘affection’ but have not seen you use the word ‘love’ to describe your feelings towards your clients. Do your feelings of affection for a client ever grow as strong as love?

  4. My little boy answered the phone a couple of times when it was my couples counselor and then later my group therapy counselor. After I hung up he said, “They all sound the same.”

  5. Pingback: The Hazards of Practicing Mental Health: What Our Colleagues in Mental Health Know . . . and Our Family and Friends Do Not | Private Practice from the Inside Out

  6. Sure. Love by my own definition – Commonly.

    But I think individual projections/ associations to the word “love” have so many things tangled up with it: Need, hunger, sexuality, clinging, attachment – that can be burdensome or sticky to use, unless its really properly sorted and so I don’t use it lightly, or without lots of exploration about what it means to all involved. “Affection” doesn’t have the same opportunity for misunderstanding.

    and I also personally think of love as a way of behaving towards people. Feelings are transitory. I may have feelings of love, boredom, hate, connection, shame, protectiveness, anxiety – but they will pass through and shift – Love is an action that I can “do” no matter what emotional sensations I may be experiencing moment by moment.

    M .

  7. I’m a clinician, LCSW and I relate so well to your words. A couple weeks ago I signed up for a women’s group study at our church. This morning I go and it’s a small group of 13 and we go around the room telling about ourselves. I was number 12 and after the 3rd person spoke about life – well, I knew I would be drained before I even made it to the office.

  8. Thanks so much for writing this post! You’ve captured my experience and the experience of so many other mental health professionals around the world – and you’ve done so beautifully!

    I’m happy to find whatashrinkthings and happy to pass your post along. I think you are my new favorite blog!

    Tamara G. Suttle, M.Ed., LPC
    Castle Rock,Colorado, USA

  9. I’ve had similar experiences in community groups – I haven’t yet found the magical balance point – Its part of the intense “vetting” process, and the need to guard my stores of empathy and attunement.

    Thanks for reading and for your comments.

  10. the feelings of being spent after a week of work, as well as the energy needed to balance life and work definitely resonates with me, as well as figuring out how to maintain existing friendships and relationships.

    on a lighter note, the woman who used to cut my hair commented how i was very quiet in the chair. she was used to people gabbing away, while i just enjoyed the opportunity to simply enjoy the silence and be attuned to someone else.

  11. I’ve been thinking about this piece since I read it (as I usually do with anything you write here… these posts all stay with me for a while), and when I read this ( today, I saw some correlation which I found interesting. It just made me think about the differences between being “anonymous” and offering help (and readers building a persona that is likely larger-than-life) and being physically present and offering help (but clients still building an imaginary persona). I found it interesting that these two pretty different types of people/occupations share something so similiar in that issue.

  12. Wow, what a lovely piece that is… I think there are real connections here:
    I’ve often felt this same association to clients I’ve worked with who are managing experiences of fame or wide renown in their fields – (not that I have ever experienced either of those things!) And it seems the facade of celebrity, the blank-screen of anonymity, and the boundaries around therapy create opportunities for all of us to project all of our unmet needs and fantasies, upon.
    In therapy – these projections become the work of the therapy itself – but projections always have some effect on the person on the receiving end as well – both positive and negative – which must be made conscious and managed in order to avoid dangerous, alienating states of inflation.

    Thanks so much for the link, and for the thought-provoking comment.


  13. Thanks for your response!

    So true that the projections have an effect on the person on the receiving end as well.

    Interesting point about the clients who have experienced fame or also have a “persona” – I hadn’t even considered that aspect as well.

    I can only imagine the mixed feelings/pressure that “Sugar” might be feeling in regards to revealing herself. I’ll be interested to see what happens after the world knows her identity!

  14. Martha, I’ve been trawling the internet in vain for some time now, trying to find a blog, an article, anything, that sensitively speaks of the challenges we face as therapists – and not just those clinically identified in the academic literature.

    Thank you for this post. I have been practising for a few years now and am on the verge of “closing shop” because I cannot figure out how to deal with the immense dread, disconnection and frequent boredom (horror that I am saying this out loud!) I feel in relation to my patients – or why I am feeling this. There is a tremendous sense of shame and failure associated with such feelings.

    I will most certainly be backtracking through your blog to see if you write about any of these kinds of experiences in the course of your work.


  15. In my life, experiences of dread, disconnection and boredom emerge when I have become too isolated, have underestimated my own hungers, or have some disruption in my ability to feed myself outside of the consultation room. Giving something away that I have become starved for can become too much to bear – and a sign for me to reach out more deeply toward my own supports.
    Sometimes depletion comes when I have been too overextended – masochistic in relation to my work – trying frantically to get the speck out of their eye when there is a board in my own.

    Other times: I have allowed my caseload to become too imbalanced- with too many clients at once either working through irritable, rejecting defenses/security operations or extreme (if transient) states of dependency at one time. I try to refer any new, incoming challenging cases, or new intense crisis work to other clinicians when I am feeling emotionally dry or depleted.

    Winnicott said that he could only work with one client moving through corrective regression at a time….

    I try to save the work that requires more bravery for a time when I feel fueled and courageous.

    Wishing you comfort and balance


  16. Hi Martha– another deep meditation that strikes precisely at our difficulties of maintaining and wanting to maintain our outside relationships. The last part resonated most with me– I also no longer expend energy in non-equal relationships where I need to take a busman’s holiday and expend such mental and emotional energy. thanks–

  17. Thank you, Martha. This resonates with me and I think a lot of what you say speaks to the experience I am currently having.

    Thank you for taking the time to write such a thoughtful reply!


  18. Thanks Robin, it’s been fascinating watching supervisees and trainees reorganize their social relationships as they consolidate their professional identities – and sad to watch them mourn the loss of such relationships. I think such nurturing connections – even with some significant imbalances between the nurturer and the nurtured – can be extremely generative and mutually beneficial between people who have not made nurturing their profession.

    Thanks for reading, as always –


  19. I just diagnosed myself with social attention deficit. . . Being a therapist has been my vocation for 25 years, and I just find that I value “alone” time so much more so than others. Loved this article – thank you for your insights and thoughts about life as a therapist!

  20. Well, I’m reading up through your archives, and find so much of what you articulate to be thoughtful and well-placed.

    But – I am commenting because this post brought up something that I’ve been trying to sort out. The next time it happens, I’ll ask her more specifically if she has any idea why she keeps making the same miscalculation/error of fact.


    My height is 5’6″.

    Because one of the things I am working to change is disordered eating, my height/weight ratio comes up from time to time (to time to time….).

    During 6+ years of working with her, on each instance that it does come up my therapist refers to my height as 5’8, or 5’9. I correct her each time. For, though I’d like to be taller, and am glad that someone thinks I am – I’m a stickler for fact-accuracy, AND, those inches truly are significant in this situation. I know she has my correct height written down in different places – but she always says, “I just always think of you as tall. Really? You’re 5’6″? ”

    And I, I always think of us as the same height – but she is actually about 5’4″.

    Of course, much of our time together is spent sitting which can account for some of this. But I am fascinated by our respective perception discrepancies. I have theories abundant.

  21. That IS interesting… I would imagine, if it were MY counter-transferential distortion – that it could be an expression of my admiration and pride for someone I was working with… Maybe even missing out some of their “littler” more vulnerable self-states.

    If our relationship were in a difficult position, or working through a patch of intense crisis in the patients life – it might be a way that I unconsciously identified with the patient by feeling over-whelmed by the crisis at hand… What is it, in the room, that seems bigger than it really is?

    Your therapist would of course have her own associations and own connections as will you – but its an interesting route to explore!

    Thanks for your thought-provoking comments!


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