Behind the Couch had an interesting post the other day about shame and the psychotherapist. Interesting because it seems no one thinks much about some of the issues that being a therapist raises. A couple of them jumped out at me --
I stopped saying much about what I do when I am out and about socially because not much brings silence to a group than saying, "I am a psychotherapist." People seem to think that it means I am always "on", always watching others as I do my patients. I developed a flippant habit of saying, when someone would remark that I must think they are all crazy, "Don't worry, I only work when I get paid." Which may ease the tension but never feels right in the saying and comes off sounding kind of cold. When I am out with friends or at a social gathering, I just want to be able to be there as myself, who happens to work as a psychotherapist but who also frets about my garden, knits, likes to cook, read novels, and complain about my kids from time to time.
I am not put off at all by the way therapists are portrayed in movies and the like. In Treatment stands out for me because it is pretty good at showing how things are. But the others? I don't worry about them. I hope to teach a course at the Senior College here sometime called Shrinks on Film and look at some of the ways therapy has been shown in movies. I think I will start with What About Bob?
We are a motley lot, we psychotherapists are. We all do something similar but we come from a number of different professional directions -- medicine, psychology, social work, nursing, education. And we have varying degrees of identification with our basic professional group. I suppose this diversity of backgrounds is a strength of sorts but I believe that more it is a hindrance. Because we do not speak in a unified voice for ourselves and what we do. We engage in meaningless turf battles which has resulted in control of much of the field now resting with insurance companies and managed care rather than with those of us in practice.
A lot of psychotherapists have become kind of demoralized in the last 10 or 15 years as third parties have come more and more to determine what they could do. As therapy per se becomes less and less valued by these third party payers, incomes have dropped and some community clinics no longer even offer therapy at all. I suspect this will continue to be the case for those who practice in clinic settings or are dependent on insurance payments. A practice model which doesn't work all that well for physical medicine when applied to mental health and therapy becomes ludicrous, a mess of evidence-based treatments that aren't resting on good evidence, on outcome research that is only done with one modality. And on it goes.
And this is mostly our own fault -- or at least the fault of the folks who reman inside that system and who cling so stubbornly to turf that is shrinking by the day.
Still and all, for me, it is a privilege to be able to do the work I do. It's a minor thing to deal with the way people react when they know I am a therapist, extremely minor when compared to the intense satisfaction of being able to be a small part of the journey of the people I work with.