One of the hardest things for me to tackle during my treatment and recovery process has been having to switch roles from being a therapist to being a patient. This role reversal has lead to some road blocks in my process, because it is difficult to go from working with clients on certain topics and then having to face them myself. So, how do I deal with being a therapist while in treatment?
My journey to becoming a therapist started when I was in college. Upon entering college, I was pretty set that I would double major in Psychology and Spanish in undergrad and move onto a PhD program in Clinical Psychology. This was my plan for 2 of my 3 years. Then, I took a Counseling Ethics and Methods class with my college advisor, and I was hooked. During this class, we learned about the skills required to be a counselor and what kinds of techniques worked effectively for different disorders. I remember looking forward to that class every week, because it was always new and exciting information for me. I began to question my choice of Clinical Psychology. Did I really want to do research all the time? Did I eventually want to teach in higher education? As that semester went on, my answer to both of those questions started to lean more towards a no. Also, the idea of spending 7 more years in school sounded dreadful. Then, I took a group therapy class, which I still owe my graduation to. I
honestly do not think I would have graduated college if that class had
not happened. My own personal growth in that class made me want to help others that way. So, I began to research graduate programs in Counseling Psychology.
My final semester of college had a lot of changes in my personal life. The relationship I was in was about to face some major changes as he chose to enter the military. I accepted that, in order to make it all still work, I would need to do graduate school close to home and then relocate to be with him after he had finished his training. So, I looked into the program at UW-Milwaukee, an hour from where I was living. For being so close to home, the program had a fantastic reputation as a great school for counseling. I looked into the work that professors were doing there and decided that this would be the program for me. So, I applied and was accepted shortly after. I was excited to start this new chapter after receiving a great foundation in undergrad. Even after my relationship ended as I was beginning grad school, counseling felt like the fresh start and new journey that I was ready to take.
My Master's degree is in Educational Psychology with a focus in Community Counseling. During my time at UWM, I took the necessary classes but also additional classes in Trauma Therapy, AODA issues, and multiculturalism. I knew that my dream population would be working with veterans, after being a military brat. Trauma Therapy has always called to me; maybe because of my own experiences, but during those classes, I knew I was in the right field. The most important component of my program was my practicum experience, which I completed at a local Mental Health/AODA outpatient clinic. Working in that clinic, while incredibly overwhelming at times, was one of my most life changing experiences.
During my practicum, I was working with about 20 clients and co-facilitating 2 groups: Seeking Safety and Suboxone Recovery Psychoeducation. I also completed intake assessments as a part-time job on the side. The first few months were difficult, as I encountered business politics. But as time went on, I began to see more clients. My clients ended up being primarily women who were using substances to cope with their significant trauma histories. These women were some of the strongest people I have ever had the privilege to work with. Many of them stayed my clients for over a year. Upon graduation, I transitioned into full-time work to begin my hours towards full licensure. At that point in time, I was given 85 clients and continued to run 1-2 groups per week. I struggled with finding the balance between work and home. I often would struggle with leaving some of the experiences from my clients at the office. This also became one of my biggest triggers.
My eating disorder throughout this 5 year period had always been present. I had had some lapses, but no major relapses. I was functioning, but I was spending a lot of time compartmentalizing my own issues that were being brought up both at school and work; however, after I graduated with my Master's, things began to get worse, and it didn't go unnoticed.
My biggest ally at my job was one of my supervisors, Jane. My first day at my practicum site was a disaster. I was caught in the middle of politics, and I ended the day on the verge of tears in her office. We had a strong bond from the start, and I always felt comfortable going to her with both professional and personal issues. As I was nearing graduation, she confronted me about the possibility of having an eating disorder as she noticed I was counting calories and rarely eating. I admitted that I had been struggling, but I wasn't ready for treatment. I credit the entire start to my recovery journey to Jane. Had she not suggested that I maybe needed treatment, I never would have gone. Granted, I didn't go in the time frame she suggested, but that idea stuck with me.
So, in the summer of 2013, I went for an intake assessment at an eating disorder clinic where they recommended I go inpatient or PHP, which I refused. Their compromise was IOP, but I never went back. I was in pretty hefty denial at that point in time, so I was convinced that I didn't really need it. As time went on, Jane continually pushed for my need to have a therapist, but I continued to avoid it. Even after I left that clinic and took a new job, I was getting texts asking if I had gotten treatment yet. It helped, because I got one of those texts right before I accepted that she was right and I needed to go.
Eventually, the intense therapy I was doing with clients began to cause some burn out. I would work 10 hours a day and go home exhausted, unable to shake the stories of my clients from the day. I used some negative behaviors to cope, including restricting and binge drinking. Couple this with the negative relationship I found myself in, and it was a recipe for disaster. After that relationship ended, I cracked, drank for 3 days, and made the call for treatment.
There is nothing stranger than going from being the person asking the questions to having to answer them. My first intake session felt like some alternate universe. I was waiting for her to stop asking questions, so I could begin asking her the same ones. It felt like the practice exercises I had done in graduate school where we were fake clients for one another. This wasn't anything like that though. I had to be a real client, because I was one. I was on the receiving end for the first time and on the verge of making a commitment to being there for the foreseeable future. It was a contract I wasn't sure I was ready to sign, which I didn't on my first intake.
As a therapist, I knew what questions to anticipate during my intake. I had spent a year and a half asking others those questions; however, I knew that if I were going to start this process, I needed to take a step back and just listen. That got horribly derailed though when the first intake woman said to me, "Well, you're a therapist. What would you say your 5 axis diagnosis is?" I was taken aback and had to say to myself, "Did that really just happen? Yes, yes it did." Needless to say, I chose not to have that woman be my therapist and sought out a different clinic for my care.
My next intake was much better, but harder as well. I walked into the waiting room, and there was my brother. So, I was already very overwhelmed entering the intake. As I spoke about my history, it became clearer that my idea of doing IOP for a few weeks and going back to Milwaukee wouldn't happen. She was pushing for 10 hour PHP, an idea I was pretty staunchly against. After all, my eating disorder wasn't that bad in my mind. We compromised at 6 hour PHP. 6 hours of treatment every day? That's what I was used to working, not doing.
The first day of treatment sucks for everyone. I think if I were to go back and poll everyone I went to treatment with, most would say that the first day is the hardest. I had to submit myself to numerous appointments where I would have to tell my story multiple times and admit that maybe I had a problem. I had a new found respect for my clients who used to have multiple appointments a day at the clinic. I shared the same thing 4 times to 4 new faces and was exhausted by the end of it. The second day was the beginning of my new scheduled programming. 2 snacks, lunch, and 3 groups in the 6 hours a day I would be there. Thus began my new life as a patient.
I was very resistant to this role reversal at first. I don't think my first two weeks at McCallum really did anything, because I was so set on the idea that I would be returning to Milwaukee by the end of the 30 day leave I was granted. I couldn't just leave my work. I had clients and responsibilities to them. I had my apartment. I had friends. I had my life in Milwaukee. So, I stayed in my little bubble of denial, which solidified even more when I was upped to 10 hours a day. I couldn't be too comfortable in the patient role, because I had to go back to being the therapist in just a few short weeks. I couldn't get out of practice. Eventually, I came to the harsh realization that I couldn't go back to Milwaukee. I needed to stay and do treatment the right way, not just run away from my problems like I had before. That's the moment when I accepted that I needed to be the patient, not the professional... for now.
One of the hardest parts of this transition for me were some of the groups. The groups were a variety of process, psychoeducation, and experiential. Process groups are the type where you discuss your feelings and provide feedback and support to one another. Psychoeducation groups are where you discuss different types of coping skills, educate about disorders, etc. Experiential groups are where you use activities for expression, including: art therapy, dance, yoga, music, etc. The vast majority of these groups were psychoeducation with a particular focus on Dialetical Behavioral Therapy skills.
As a therapist, I spent 5 semesters and a lot of money on getting the education to be able to provide psychoeducation to my own clients. As a client, I was on the receiving end of information that I had already learned. This made many groups torturous. It was even more frustrating when I could explain some concepts better than therapists or was asked to do so, if they were struggling. We would be given worksheets in groups that I had previously given clients in my Recovery group. Substance Abuse and Eating Disorder Recovery share a lot of similar concepts and techniques; however, substance abuse often encourages abstinence in recovery. Using abstinence in Eating Disorder Recovery is what keeps you in treatment. So, every day, there would be multiple groups that I would have to sit in and listen to concepts I already knew. My worst day was when I had to step in for a therapist, because she was literally doing nothing while someone in group shared something incredibly difficult and triggering. All the therapist could do was stare at the floor and say, "That must have been really hard." I stepped in and provided the support from a therapist perspective to give insight and support. This created this internal conflict of therapist vs patient even stronger. I felt that I couldn't just be a client.
I would talk to my individual therapist about these struggles, particularly because I was so livid at the therapist that day. My therapist would often validate that it is difficult to step out of that role, because I spent years training for and doing it. No one really stays in this field unless they're good at their jobs. It gets to be too draining if you're not and frustrating since your clients don't make a lot of progress; however, my therapist called me out. My personal favorite response was, "Well, since you know everything from school, why are you here? Why aren't you out in the real world using it?" Touche. There's that whole idea of "Practice What You Preach;" however, the vast majority of us suck at it. She encouraged me to take things as they were: I was a patient. I was here to be receptive to treatment and the information being given to me. My identity still had a therapist component, but I needed to make space for a patient component, especially if I had any real hopes of staying in recovery long term. She encouraged me to look at myself as my own patient. "If you had a client in your shoes, what would you say to him/her?" Followed by: "If you can say that to them, why can't you say that to yourself?" She had a pretty solid point, but I still found myself judging the techniques she was using in my sessions.
It's not like I could forget all the training I had. There's no way to just shut off that information that you learned in school and make it sound brand new in treatment. Wouldn't that be nice? But there is a way to make a compromise. I did and continue to remind myself that, while I know these concepts and skills, there's always something to learn. One of my favorite things about the counseling field is the amount of collaboration between colleagues. Whenever I would find myself at a roadblock with a client, I could turn to my coworkers and supervisors who always had some alternative ideas. There's never just one pathway to a solution. There can also be multiple solutions. That's what treatment is too.
Becoming the client not only made me admit and discuss my problems and trauma, it grounded me in that, even though I am a professional, I am not the expert. No one is. Every client is different, and I'm not excluded from that. That outside perspective that I used to get from coworkers, I now get from my therapist. I have insight on both a professional and personal level on my own experiences, which has been extremely helpful in sessions, but I can't do it alone. Also, using my professional knowledge, I have some insight on what type of therapist is best for me. I struggle with therapists that I can predict what technique they will use next. I need a therapist who isn't afraid to call me on my bullshit and does not just sit back and wait for me to come to the conclusions. Silence is not a technique that works with me, because I too have been trained how to sit comfortably in it until a client is ready to talk. I have had many a mandated client who would eventually start talking, because they hate the silence. Things like this help me become a better client and, in turn, a better therapist.
Going from the therapist to the client has given me more insight than any job or classroom experience ever could. I have a new level of empathy and respect for anyone who will sit in front of me as a client, because it truly takes an incredible amount of strength to get to that chair, let alone be willing to talk when you get there. I have had to experience things I put my clients through: talking about my trauma, fear of taking and dislike of psychiatric medications, being sent to the psych ward after admitting suicidal ideations, reading and signing treatment plans that I didn't 100% agree with, and, most importantly, facing my mental health issues head on. It also gave me the insight that I was not ready to go back into practicing immediately after leaving treatment. I needed to take a break from giving therapy after completing so much of my own. This break has continued, but I believe it is one of the main factors that has kept my focus on recovery.
Jane used to tell me that she believed it should be mandated that all therapists have their own therapist. It goes back to that idea of practicing what you preach. If you aren't willing to see your own therapist, is it hypocritical to expect your clients to be completely open to your services? I don't have an answer to that question, but I know that I will never practice again without having my own therapist. Too many things are triggered for me in doing trauma therapy for me to be the best therapist I can be without one.
While my transition from therapist to client was not an easy task, it was necessary. Since I have not returned back to the counseling field yet, I cannot say for sure how my role reversal back to professional will be, but I do know that my identity as a client will maintain and continue to make me the best therapist I can be.
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