Holding Two Worlds Together—Apart: On the Duality of Being a Therapist

• Consigned to Separate Lives
• Who’s Internalizing Whom?
• Therapy as Co-Regulation
• How Odd Our Profession Is!
• The Sharing of Intimacy

Consigned to Separate Lives

Am I the only therapist who sometimes feels that she lives two separate lives? One with my friends, family, and loved ones; and another entangled in the stories of my client’s lives, dramas, and company. What other professions dictate that the personal life can’t intersect with the professional? CIA agent, detective, spy? The duality of being a therapist often feels to me like I am holding onto two different worlds at the same time. Yet, as mysterious as what goes on between me and client often is, the paradox is that it is also meant to be an open and safe space where they can truly allow themselves to be authentic.

Therapists, social workers, psychologists, counselors, healers, and superheroes live double lives. We go to work every day and immerse ourselves in the stories of our clients. We fight for them, cry with them, laugh, get angry, and know things about them that most people don’t. We form relationships and bonds. We see them at their lowest, and watch them transform, fall again, move through relationships, pain, loss, birth, and death. We come to care about them deeply. We learn to love them. Yet we go home each and every day, and the people in our intimate lives know nothing about these stories. Sure, our significant other may know that we had a rough day or that we had to send our chronically suicidal patient to the hospital yet again, but they don’t know and will never know the complex, rich lives that we learn to treasure. The stories we hold dear and how brightly our clients’ souls shine even during agonizing darkness are ours alone, not to share outside of the therapeutic space.

Who’s Internalizing Whom?

I went back to school in my mid thirties to get my MSW and felt like I didn’t have much time to spare to really do what I wanted to do. I wanted to know people. To really know them. It was naïve of me to think that getting to truly see my people while having them tucked away from my real world would be easy. Just part of the job. However, it remains something that I often think about, struggle with, and theorize over as my career progresses. Part of the old school education I received when entering this field centered around a stoicism towards our people that I can’t quite understand. I was trained to travel the profession with an ingrained fear that it’s weird, and even wrong, to think about my clients when I am not with them. They are the ones who are supposed to internalize me in order to “feel better”—the process is not supposed to work the other way around!

To internalize is to incorporate within oneself guiding principles learned in the course of socialization. One of the biggest wins my clients experience is when they begin to internalize me outside of the room. When my re-parenting, nurturing, and insight become guiding lights in their every day, and when they don’t feel alone and know that the faithful kindness I provide them within our relationship is present even outside of our being near one other. Much is written about this phenomenon and the changes that clients start to make when they take us in. But what about the other way around? What about when we internalize our clients? I have thought about this often.

In his brilliant book The Gift of Therapy, Irvin Yalom urges us to allow our clients to matter to us, to allow them entry into our minds and to influence us. He also asks us to share this with them. When I read those words, layers of shame and frustration within myself seemed to melt away. For so long I felt guilty that I thought about my clients and their worlds long after our weekly meetings ended. How liberating it was to allow them to be with me, change me, to think of them, and allow their stories to move parts of me as well. One day, I was having a particularly hard week personally. I was letting old feelings of “not good enough” seep into my story. Not a good enough parent, wife, daughter, friend—you get the drill. I was sitting in session with a client, and she looked over to me and told me she wanted to send me an article she found online that “made me think of you because it talks about unconditional love.”

We finished our session, and I forgot about the article she had sent me. Only later in the evening when I was winding down for the day did I open what she sent me. As I read the words on that page, something that I had been missing all week snapped me back to reality. It said, “When you doubt yourself, when you feel the world turning swiftly against you—keep loving. Love so big that you become it, because you are love.” I cried. My client got it, and she gave the gift back to me. I thought of her knowing this, even when I did not. Next week in session, I gulped deeply and said, “Thank you—you gave me a gift last week, and it helped me.” Glossy, tear-filled eyes from both of us. It appears that internalizing my client was as important as the other way around. As we are told by Diana Fosha, client and therapist can and often do exist in the mind of the other.

Therapy as Co-Regulation

My job is to expertly track, monitor, and regulate not only the nervous systems of my clients, but my own as well—to hold two worlds simultaneously together at the same time. As I notice the body language, rhythm, facial expressions, and breathing rate of the people with whom I work, so do I track my own. In turn, my client and I are dancing together with two nervous systems coming in and out of connection—regulating (and sometimes mis-attuning) each other. One time, there was some extremely disappointing news that I had to share with one of my clients, and as I waited for our session, my anxiety was at an all-time high. How was she going to take the news? Was it going to set her back? My heart was in knots. My mind was racing. I was clearly overthinking everything. The session time came, and the second I saw her eyes my anxiety seemed to melt away. I heard myself say, “It’s going to be ok.” It was that quick, that simple, and that magic. I felt safe in our relationship, as did she. There were few words. We didn’t need it. Our nervous systems just knew, and we were both ok.

After that incident I asked myself, “What was that?” I even brought it up in my case consultation that week. I was afraid that I was being self-indulgent or entangled in some mysterious transference/counter-transference fiasco. Allan Schore tells us that psychotherapy entails intersubjective work which is focused more on being with rather than doing for clients, especially during moments of affective stress. In looking back, I realize that moment was not about what was spoken or wasn’t, but rather how we were with one another that made all the difference—for both of us.

“How do you do it?” “How can you not let any of this stuff get to you?” “It must be hard.” These are just a few of the comments and questions I have received from those in my personal life. I am not sure why people think that it doesn’t get to me (us). The fact is that it’s not only ok that it gets to me, it’s necessary. I am not talking about compassion fatigue or vicarious trauma, which can all too well happen if I don’t monitor and take care of my own self as well. I am talking about the actual day-to-day lives of my clients that I am privy to, are a part of, and are engrossed with. How can I “shut it off” when somebody I know intimately tells me a harrowing tale of abuse and neglect—or about when somebody mistreats them—or, conversely, when they start to fall in love and the things that at one time seemed impossible are starting to blossom? These things impact me. I take them with me and carry them as I walk through my day even outside of the therapy room. The resonances that work to create neural circuitry and bond the hearts and minds of our clients do the same for us—if we allow them to.

I’m not going to lie, sometimes I want the buzz in my mind of the two simultaneous worlds, mine and theirs (so many of them!) to shut off, because honestly, I need a break. But as I tell so many of my clients, resisting the natural contours of the mind is part of the problem. If we simply observe and validate that something touched us, and we hold it dear to us, that we are worried, or afraid that we said the wrong thing, then maybe we can all relax in knowing that our hearts and minds are human, too. I am not meant to “shut it off” and be “numb” to my clients’ experiences and stories. I must allow them to change me, move me, and be brave enough to let them know they did.

How Odd Our Profession Is!

As I go about my daily life outside of my office and socialize with friends and family I often find myself catching my words when something reminds me of one of my clients or it relates to what so-and-so said in session. I could be having a rip-roaring girl’s night out with a couple of girlfriends, and when I see one of them wearing a butterfly necklace made of rhinestones, I think to myself, “Oh, Grace (name changed) would love that!” It latches onto the tip of my tongue, ready to spill out. None of my friends know Grace, or the fact that she loves butterflies—but I do, and I immediately think of her. How weird that I can’t really share that, and it’s just a fleeting thought that only I know. How odd our profession is, I think to myself in that moment. It’s like a cozy little secret compartment in a part of my brain that carries all their cobwebs, but nobody in my “real” life really knows how important or special this person is to me—or that they love butterflies. How odd it is indeed.

There are some days that are intensely difficult—when crisis seems to erupt at every turn or the stories seem to be too hard to bear. Having spent some hectic days while working at an IOP/PHP and continuing to do so because most of my clients struggle with complex trauma, there are moments when it feels like I am energetically depleted and exhausted. Talking a client down from the brink of suicide and having them agree to go to a hospital, mediating between difficult family members, or listening to a violent fight as I try to call the police. All in a day’s work. Come home, look forlorn, have my husband ask me if everything is ok and if there is anything he can do. Do I try to explain or just sit with it, do I try to forget it, or tuck it back into the part of my brain that is called “work”? The next day I silently make my coffee in the morning. “You need to find a way to detach, Anna,” my husband says. How easy that is to say—but how hard it is to practice. I see people week after week—some for years. I don’t see some of my friends and family as much as I see my clients. Yet somehow the two worlds have to remain separate, both somewhat hidden from the other.

I open my daily planner and notice one of my scribbles on the back page: “is it my broken heart—Or—yours that I feel?” There are days when I am strangely unsure—but it becomes my job to find out. Giving into the empathic powers that are my work’s calling can be extraordinarily challenging on some days and make me susceptible to compassion fatigue and vicarious trauma. Guilty of both. Holding space for and witnessing suffering opens me up to wounds as well. Another interesting paradox—to truly heal them, we must allow our people to influence us and let them know it, but doing so can open our own cuts as well.

Yet it’s not always so harrowing and serious. In and during therapy, I laugh—a lot. What an often misunderstood part of the work. To go on the journey of pain, I must also find and allow lightness to enter the chambers of healing. I’m not talking about laughter as a defense or a way to deflect shame and fear. When I was a little girl, we had to sit Shiva (a seven day mourning period for Jews) after somebody passed away. Some of the best moments would be spent laughing. Yes, there were tears and anger and irritation as I was stuck with my family for seven days, watching various people coming in and out with tray upon tray of food and reminiscing about our loved one’s demise. It was comforting to spend time with friends and family during the first painful days of loss. But what I recall most is the first time that laughter erupted. It was like somebody allowed us to have that feeling, too. Grief and sadness were making room for joy and the hope that laughter would again find us.

My clients are some of the funniest people I know. They joke, smile, and belly laugh—and they can still do it after unthinkable loss, tragedy, and heartache. What can be more beautiful than that? And I laugh with them, for if I am to hold space for all the bad stuff, there has to be room —lots of room—for the light stuff, too. Laughter can be just as intimate as pain.

The Sharing of Intimacy

Intimacy is closeness between two people that builds over time. Intimacy—real intimacy—is allowing our raw, unrehearsed reality to spill out in front of another and be held in their embrace with resonance, acceptance, and nurturance. I was speaking with a colleague recently about how sometimes it’s hard for our loved ones to understand that “not taking your work personally” can be difficult to maintain. “Don’t you feel like the connections you have with your people is sometimes more intimate than you have with some of your friends and family?” she said. Yes! I know some of these people better than I know some of the closest people in my real life. How peculiar this work is, how incredibly glorious and beautiful in its capacity to let us know the essence of another soul. Yet how divided it often feels from the realm of our everyday life. The intimacy that is created in a therapeutic relationship, if cultivated correctly and appropriately, can change both our lives because part of their journey is ours, too. Here we are traveling together and separately at the same time.

Some days I feel like it’s a lonely road to travel down this path. It makes me go to chambers in my mind that others don’t know exist, thinking about people and things that others know nothing about. I question the real from the imaginary and how these divergent paths meet at a central place and have the capacity to move mountains and change lives. Both theirs and my own. I still get confused by it all. I am learning to accept some of the limitations and unrequited longing that both I as therapist and my clients must live with within this relationship. I am working on finding peace in knowing that my time with my clients doesn’t have to be real to anyone but myself and them to matter. In that respect, I am incredibly lucky to have a bond that has the power to transform, shake me into feeling more alive, and cultivate the ability to give and receive love. That is the legacy I impart to my clients as they embrace the world at large—and perhaps the one they leave me with as well.



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