The Oura ring that I use to track my health gives me three primary scores every day. When I wake up, I receive a readiness score, a sleep score and an activity level score from the day before. All of these are out of 100, with the higher daily score perceived as better.
To achieve a high score on my activity level, I need to move every hour during the day, not spend too much time being sedentary and complete my daily energy expenditure goal. For example, on a recent day where I exceeded the 600 calorie goal from exercise, I managed to burn 628 calories by walking 9,015 steps or 9.1km.
As a clinical psychologist working in private practice, I often see 7 or 8 people for 50–60 minutes each, five days a week. There was essentially no break between clients except for maybe a lunch break in the middle of the day. Which meant that there was little chance of meeting my daily expenditure goal unless I did at least 90 minutes of walking either before or after work.
Add in the time needed to get to work and back home, plus marketing and consulting with doctors or referrers. Then treatment planning, further reading, and writing of case notes, reports and letters. It sure doesn’t leave much time or energy for the exercise I want to do. Let alone quality relationships, housework, hobbies, self-care, and sleep outside of my work responsibilities.
An Unhealthy Trap?
“If you weren’t loved for who you were, then what you are going to do is work to make yourself loveable. And the way you make yourself loveable is to be of service to everybody else and not have any needs yourself”Gabor Mate
As a clinical psychologist, I have tested myself on many validated surveys. One that I particularly like is the Young Schema Questionnaire. It helps people determine which of the 18 maladaptive life traps or schemas they fall into most. Some of my top schemas from 2018 were: Self-sacrifice (1st), emotional deprivation (2nd), subjugation (4th) and approval-seeking (6th).
With these schemas, the predominant traps that I can fall into are sacrificing my needs for others and choosing relationships where others can’t meet my emotional needs. I can also pretend that I don’t have any requirements and try to be what others want me to be rather than who I am.
All of these qualities help me to be a good therapist. I can tune into what others want and need, put these things first regardless of what I want to talk about, disregard my own needs and be what others want me to be.
But what are the personal consequences for me?
Seeing too many clients in a week can make me emotionally drained, physically less healthy than I want to be and chronically fatigued. It can result in me cooking less for myself than I would like to. I instead resort to fast food on these nights because it is convenient and more manageable. My brain also tells me that I deserve to treat myself. So I spend more time sitting on the couch and watching TV or scrolling on the phone than I want to. I can’t be bothered being as creative or as expressive as I would like to be. And I isolate myself too much, choosing to take a break from the world instead of connecting with others in ways that I would like to.
What do I need?
Equal relationships. I need to put my needs at the same level as others. I need to choose friendships and partners that are as aware of my feelings and desires as they are of their own. I need them to be as encouraging towards me meeting my needs as we are towards meeting theirs. I need to be authentic and not be punished for this, even if it is different from what is traditional for society or what they want. I need to be aware of what I want and not feel ashamed of doing these activities or meeting these needs.
While this sounds nice and healthy, a therapeutic relationship is ideally not equal. The role is to be there for the other person to help them meet their needs, understand themselves and become the person they want to be. Yes, boundaries are essential to set and enforce, but for the long term benefit of the client, not for me.
Maybe I can look at a therapeutic relationship as equal in some way. It is at least transactionally. Nobody is forcing me to take on the role of therapist. I am choosing to do it. They are paying for a service, and I am being compensated financially for it. I enjoy helping others improve if they want to. I am also trying to be authentic as a person in my role as a therapist. However, the aim is to help meet the client’s emotional needs and improve their psychological well-being, not my own.
A supervisor of mine once said, “a needy psychologist is a dangerous psychologist”. Therefore psychologists who try to get any of their needs met with clients are stepping away from their proper role. Furthermore, they can harm the other person if they are not careful.
Yes, I can learn things along the way. I can also make genuine connections with the people that I see. However, it must be about what is best for the client, not myself as the therapist.
As long as I can ensure that my life outside of my job meets my needs, being a therapist is not a problem. However, I must achieve a healthy balance between helping others at work while having enough time and energy to help myself in the ways that I want in my life outside of it.
Is it possible to find a healthy balance?
To not be exhausted from my work as a therapist, seeing five clients has to be the maximum on any given day. However, I’m not too sure if this maximum would be achievable five days per week either. Two to four days per week seems much more desirable if a healthy balance is an overall goal.
During the pandemic lockdowns in Melbourne in 2020, I was working a lot more than that. One week, I did 39 hours of sessions with clients, or five straight days of nearly eight clients per day. On one day, I also saw ten clients without a lunch break. As all of the sessions were via Telehealth, I’m unsure if I even stood up out of my chair. Although I had the capacity to do this, it sure doesn’t mean that it was healthy for me.
“If you don’t know how to say no, your body will say it for you through physical illnesses”Gabor Mate
On January 2nd, 2021, I suffered a stroke in my left cerebellum. I nearly died and was in a coma for a few weeks. After brain surgery and having part of my brain removed, the long road to recovery began.
I am luckily doing quite well now, only six months later. My personality and cognitive functions are essentially the same as what they were before the stroke. My balance and coordination have improved, but I will never return to playing sport at the level I did before the stroke.
Fortunately, I have a second chance at life. I could rush back to how I did things before. However, I want to live in a way that is positive for me and my health. I want to enjoy my life and the relationships that I have with others outside of my work.
I want to continue helping others meet their needs and express their feelings through their therapy. I don’t want to be a different psychologist from how I have been or care less about the people I see and talk with. However, I do not want to do this at the expense of my vitality and longevity.
I hope that I can find the balance that means that I can keep living this incredible life in a way that is enjoyable, nourishing and sustainable for me.
Dr Damon Ashworth
11 thoughts on “What if Being a Therapist is Unhealthy?”
When I was working as a mental health nurse, when I was in a session with a client, it was all about their needs. Outside of that, I needed to manage what I took on and attend to my own needs so that I could give my clients 100% when I was with them. I couldn’t expect clients to help meet my needs, but I could set boundaries to ensure that I had the space and time to attend to my own needs.
Exactly. That’s how it has to be. Limiting the number of sessions each day or week so that a therapist’s needs can be attended to outside of this.
It seems almost unfathomable to think that me, a housewife, would be giving someone as esteemed as yourself any kind of advice, but I feel as though I can here. In 2013, I myself was receiving Cognitive Behavioural Therapy for Obsessive Compulsive Disorder (the “Pure O” variety, not that it really matters) and therapy changed my life, with this little bit of advice and experience, I hope that I can help you change yours.
You’ve already recognised that setting limits can be beneficial to your health, and this is something that was so crucial for me, too. I used to clean from when I got up until when I went to bed, and where did that get me? Exhausted, depressed, malnourished and often with not much to show for my work the nest day. My hair was often messy and my shirt was often stained. I looked like someone who had no respect for herself, because crucially, even if I said I did, I didn’t. It was a vicious downward spiral between letting life not respect me and and me not respecting myself enough to stand up for my wants and needs – so I started setting limits. Moreover, instead of setting output limits (eg. Clean the kitchen) like I usually did, I started setting input limits (eg. Clean the breakfast bar in ten minutes), I also set a limit on how many tasks I could do in a day (I worked that out at 2 big ones or 8 small ones) and if something else cropped up, one of my my pre-planned tasks would have to wait. It didn’t matter if the recycling needed to go out as well, my husband could do that or it could get done the next day. In place of the added workload that I would have had, I’ve had a lot more time for me to do the things that I want and need to do – shower, exercise, listen to music, watch a couple of therapy videos on Youtube (I have been relapsing a bit lately – far too much news consumption!) or even just get some extra sleep. You already know that your body will tell you when it needs a break, so listen to it. Instead of making that extra coffee, plan for an early night. Instead of hitting the gym for the 200th time this year and staring at the same depressing blank wall, go for a bike ride and enjoy the scenery, and if I have to get down on my crunchy knees and beg of you, remember to say “no” more often – that was my number one mistake. The day that you take back control of your life is the day that you will feel so much better physically, mentally and emotionally, I promise you 🙂 Good luck!
PS. I mentioned about putting tasks off if something crops up, but does that work in clinical psychology? I believe that it can, and most people know that emergencies can happen at any time. I believe that with a polite phone call ahead of an appointment, a lot of people will understand if you have to rearrange suddenly. Remember, you too are only human 🙂
Thanks, Helen. I definitely try not to put off sessions with clients if I can, but after COVID-19 and how unpredictable things have been, we’ve all had to be a bit more flexible. In general, people have been pretty understanding too.
That’s good, Dr Ashworth. Of course it’s not something that we should endeavour to do too often, but if it’s necessary, it’s always nice to know that you still have that option to fall back on,
Fascinating and thoughtful perspective. I had assumed the process of counseling others was a good way to manage your own issues. The implications are important for people who go into mental health professions in search of self treatment.
Thank you. I think it can definitely lead to some good insights and knowledge and skills along the way, but I would never recommend for people to become counsellors so that they can sort through their own issues in session with clients
I’ve often wondered if it was a good idea for psychologists, psychiatrists, social workers, etc, to be seeing as many people as they do. So it was really interesting to read your thoughts on it. I suspect that 3 a day would be closer to what is really viable. People will say, who is going to pay for that to happen? But with fewer clients, wouldn’t sessions become more productive, when you’re able to be more thoughtful about them? It reminds me of how we’ve known that in education learning goes up as class sizes drop, yet decade after decade, significant drops in class sizes never come.
Your stroke is frightening news – as someone who dealt with head injuries from motor vehicle accidents for 40+ years in the insurance industry, I know how complex, difficult and enigmatic brain injuries can be. It sounds to me like you’re recovering much better than most, and that’s good to hear.
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Thanks Alan, I feel very lucky, and definitely want to see if there is a way to be a therapist in a sustainable way, as I do enjoy it when I am not too fatigued or burnt out.
Yes, definitely lucky, but you must be doing much that is right.
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I hope so. All I can do is try to be as healthy as I can, take my medication, manage my stress when it occurs, and hopefully reduce my risk of relapse!
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