i've been super curious about this for a while now-- isn't it very lonely being a therapist? your clients come to you with all sorts of problems and you're not allowed to talk about it to anyone (except maybe your own therapist? but then THEY'RE the one in your situation. it's a cycle) i'm just curious as to how you manage that every day!
Heya
It’s not actually. Because I do so much agency work - I have a lot of people to talk to if I need it. Group supervision, individual supervision and other members of my team are all covered in my agency’s informed consent. Anyone I need to talk to about a case for a clinically relevant reason within the scope of that consent - I can talk to. Not just like for funnies but for help or guidance, for case consultation or countertransfer.
I’m also required to speak, in very specific circumstances, to speak generally about the therapy (is the client attending? are treatment goals being achieved? Do additional supports need to be in place?) or write up evaluations for the school. I get the opportunity to talk to teachers and other staff - I have consent to just do it but I do my best to let the clients know when I’m doing that.
I also am part of an ongoing consult group where I get together with a bunch of other therapist and we talk cases. My clients are also aware of this. I trust those women as much as I trust anyone clinically. We’ve been meeting for years so I trust them to know me too - and my blind spots. We don’t use identifiable information but we get suggestions and advice. We don’t say I’m treating Jon Snow, age 35, living in Winterfell for major depression who has been expressing a delusions about dragons but I might say I’m seeing a man in his thirties. I’ve been treating him for six months and we’ve worked on primarily depressive thoughts/feelings. Recently, he’s been describing? I don’t know. Delusions maybe? I’m kinda a loss for next steps here. You can’t identify “Jon Snow, age 35, from Winterfell” from the second. And the group itself is also bound by confidentiality.
I also have therapist friends in a variety of positions. I have mentors with decades of experience who I can reach out to. I got friends I went to graduate school with or whom I’ve worked with in the past. If I’m lost, you can bet I “phone a friend.” I can call and consult if I’m worried or concerned about something that is their area of expertise. How does a referral for your program?/ Would situation X be appropriate for your clinic? / Does situation X have a psychosis flavor to you? / Do you have any suggestions for how to work with X?/ I had a situation where I did X but now I’m wondering where, if anywhere, your program could have been called. Can I run a situation by you and have you tell me where you guys could have been called? And what your program would do?
You want your therapist to be able to reach out to other professionals. You want your therapist to get a second opinion and not become an echo chamber of their own thoughts. You want them to get advice and suggestions about how best to deal with a situation they aren’t as familiar with.
As the personal aspect? My partner often when it’s been a bad day at work. They know my own history and can guess by my reaction what the general source can be (especially when it aligns to my own history). From my friends, I often will solicit kid and animal pics on the rough ones. They don’t need to know why or the specific. And I can talk about my feelings. I had a huge amount of countertransfer around client using a slur towards me in a non-violent way (just as part of language) and it felt like the floor dropped out beneath me. I handled it well in session but I got to my car, called a queer friend of mine and cried. I shared that an incident had happened (word was used about me but not in violence in the course of my day) and that I was having a huge reaction. I needed help processing my own reaction because I was really upset. Or I can call a friend and say, “Today was really fucking hard. I’m really fucking sad and this fucking hurts.” and get a ton of support but again - no client information is exchanged just how I’m feeling and that I need support. Sometimes, I just need to hear about how they are with their kids and what’s going on in their life because I know and trust the friends I asked love their kids and do their best to nurture and love them.
Even with my own personal therapist, I use descriptors or fake names to refer to client situations so even their I do my best to protect confidentiality.
My clients have gifted me with their trust and that feels sacred to me. It doesn’t feel like a burden to me.
