The Therapist’s Couch – 1. (My) Boundaries

Dear Friends,

Mental health treatment is unique in medical care services. At one point, mental health therapy-students had to sit on the therapist’s couch to work through their own personal issues, before becoming a licensed mental health clinician. There is no other medical position where the clinician was encouraged to personally work through the issues they study/treat–a cancer doctor does not have to recover from cancer to become a cancer doctor; a dentist does not have to receive fillings for gum recession to become a dentist.

If I recall correctly, the rule was in place for three reasons, if not more: (1) In order to learn the schools of therapy accurately, (2) prevent unethical mental health care via counter-transference, (3) become self-aware in their strengths and weaknesses as mental health professionals. Transference occurs frequently. It is the dynamic of the patient identifying traits in their clinician, strongly linked to someone or something they have known before–and reacting accordingly. Counter-transference occurs in the opposite direction: The clinician reacts to their patient or their patient’s story in some personal way, due to unresolved issues in their personal or professional lives. The negative risk in counter-transference is fairly obvious: It distracts the clinician from focusing on patient care.

By the time I began my studies, this approach was no longer a requirement. The rule was softened in light of the diverse student backgrounds, and a questioning of whether it was absolutely necessary in order to create an effective mental health professional.

At the same time, I heard about coaching. It is a lucrative and trendy field, requiring little to no formal training or education. Becoming a coach involves no boards, no systems of accountability, and no insurances asking for a justified reason to pay for it. Clients have nobody to appeal to if they are dissatisfied or if they feel taken advantage of. While it was a lucrative option, I did not follow that distraction. It is an honor to work with human lives; high ethics produce high quality care.

Well, I decided I would invest in receiving treatment for myself while I was in formal training. I have never regretted the total commitment I gave to that investment. I believe it is one of the critical reasons I am able to refrain from the temptations to share information about myself that is irrelevant for the patient’s healing journey.

That said, I am human, and mental health treatment deals with human lives. I do have real responses for my patients. They see me express concern for their child who received a death threat at school, and who is also my patient; I then suggest signing a release so that I may advocate for the child while obtaining collateral information. They see my joy and elation when they close on their first home, after they finalize their divorce. They see me ask questions when I demonstrate that I do not know everything about their personal experience.

I appreciate the history of how mental health treatment developed. Out of my respect for it–I have always had multiple supervisors. You may be able to fool one supervisor you are doing a perfect job without counter-transference, but you probably cannot fool multiple. And I don’t see a true benefit to fooling anyone in that regard. I enjoy telling my patients there are multiple eyes on my work at all times. I enjoy receiving their reactions to that information when we meet for our first session. One of my prayers is to always be connected to supervisors with high ethics and relaxed shoulders. The accompanying prayer is that I demonstrate high ethics with a relaxed smile from my heart.

Warmly,

Ellice

EMDR Therapist, Licensed Professional Counselor