Encountering Fear and Loathing in the Therapist’s Psyche

It is 7pm on a Friday night. Thousands of people are unwinding over cocktails in crowded bars and restaurants all over San Francisco, but I’m in my bathtub, chin on my knees, tears streaming down my face.

I feel hopeless, powerless, deflated and incompetent. I question my ability to be effective in the face of what feels like insurmountable obstacles.

I ask myself, “How on earth can one hour a week ever make a difference to a client whose entire life is falling apart?” and, “How do I help this client step back from the precipice of suicide and find a reason to embrace life, when life is so challenging, so complex, and such a struggle from day-to-day?”

When I turn on the cold faucet to adjust the temperature, my feelings of overwhelm and helplessness threatens to drown me.

Emotions swirl through the hot water, some pop like bubbles, new ones arise. Slowly, I make my way from “sad” to “mad.” I begin to rail at injustices of epic proportions: the six-year-old who was molested by her own father; the man who was beaten to within an inch of his life by an abusive partner and sustained 42 fractures; the young woman whose mother repeatedly scalded her with hot water as punishment for poor grades. I grasp at anger in order to push away fear and helplessness. I scramble for some way to organize the storm of emotion coursing through me.

In my mind’s eye, I open my calendar and categorize my schedule for the week by themes; it offers some perspective on my current emotional landscape.

Monday: Childhood Sexual Abuse, Incest, Domestic Violence, Tragic Accident, Adult Child of Alcoholic Parents, Bereavement, Immigration Trauma & Discrimination, Political Stress

Tuesday: Childhood Emotional and Physical Abuse, Infidelity and Betrayal, Severe Anxiety and Panic Attacks, Generalized Anxiety, Incest, Severe Childhood Neglect

Wednesday: Abandonment, Childhood Abuse, Gender Identity, Codependence

Thursday: Bereavement, Divorce, Childhood Sexual Abuse, Anxiety, PTSD, Immigration Trauma, Infidelity

Friday: Divorce, Workplace Discrimination, Immigration Ban, Workplace Performance Anxiety, Bereavement, Suicidality

The same schedule, re-categorized by emotions, maps the widest range of feeling words possible. While the overt focus of a session may be the feelings that a client is willing or able to tolerate, that’s only the tip of the iceberg. What lies beneath is the unresolved, the complex, the split-off, the disowned and the vilified – both for the therapist and the client.

Being an effective therapist requires the ability to de-center our feelings during the session, in order to focus on the client. While a client may be flooded by self-loathing, the therapist’s emotional landscape may be colored with anger, sadness, shame, disgust, helplessness, compassion, anguish and self-loathing.

Rushing through our busy work days, struggling to manage our over scheduled lives, and in our constant efforts to play catch up, we sometimes forget how rich our feelings are, especially the ones we hold in check during sessions.

In order to create repair through relationship, I’m constantly challenged to dive into the messiness of my own humanity. I frequently encounter feelings that I had long held at bay: anger, disgust, guilt, powerlessness, shame, despair, mistrust.

I invite other feelings to join me for a walk, a bath or on an empty page in my journal: emptiness, cynicism, suspicion, terror, wariness. And others I share space within my body while we whip around in space, almost not hearing the music: panic, grief, doubt, dejection, rejection, dismay, grief, anguish.

The richness of my own feelings unveils the complexity of the therapeutic alliance where feelings can be projected, disowned, transferred, rejected and reclaimed. A client’s perfectionism masks her anxiety while activating my overwhelm; I experience loathing towards a client which I later learn is a projective identification of the way his mother felt towards him. My frustration with a client’s slow progress surfaces as feelings of incompetence and guilt.

In spite of my years of experience, I still need gentle reminders to engage with the raw, (sometimes) subterranean traces of split-off feelings. In weekly consults with supportive colleagues, I give myself permission to deeply acknowledge how much pain and suffering I have intimately encountered during the week. I fumble awkwardly trying to explain how ineffective I feel with a client, only to be reminded of the richness of the therapeutic encounter.

Being a therapist involves plumbing the depths of our human experience. When I consciously choose to welcome my fear and loathing, I feel connected to and enlivened by the resilience that allows our courageous clients to come to therapy. And sometimes, just like in therapy, as I embrace our shared humanity, the fear abates and the loathing transforms into self-compassion.