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