A PSYCHOTHERAPIST STRUGGLES WITH PAINFUL SELF-DOUBT
Even a healer makes mistakes
“I’ll make this my last appointment,” said Lisa, a female psychotherapy patient I had been treating for only six weeks.
My head jerked back towards her. “Your last appointment?” My voice squeaked out in surprise. “How come?”
“My husband and I have been talking on the phone every night,” she said
She flipped her hair back away from her eyes. It looked like she had just had it cut and streaked with blonde highlights. She smiled at me. I smiled back. A tug of uneasiness pulled on me. I shifted my weight to get my back comfortable against the hard surface of the chair.
“What do you two talk about?”
“The kids. The happy times our family had together.”
I watched the corners of her mouth flicker upward. Her brown eyes looked bright and sparkly. I nodded, uncertain about what to say next.
“You know,” she said. “We miss each other. We thought we should spend more time together, eventually even live together again.”
Suddenly, the right words came to me. Your husband has been sleeping with another woman. That is why you kicked him out. Don’t let him move back into your house. I could say it in a loud, firm voice. Of course, I didn’t say anything at all. I struggled to make sure my mouth didn’t sink into a deep frown. I had made this mistake with a previous patient, Angela, and I wanted to avoid making it again.
Angela was a nurse, married for fifteen years, with two pre-teen daughters. I had treated her for eight months several years earlier. She came to see me because she was unhappy in her marriage. Each week she told me a different story about her husband, Harry. Harry spent little time with the family. Harry followed her around the house yelling at her in front of their children. Harry was even scrolling through a dating site. After two months of this, I hated Harry. A sharper tone edged into my voice each week when I asked her why she stayed married to him.
One day Angela didn’t show up for her appointment. She didn’t call me back when I phoned to find out if she had forgotten and wanted to rebook. I never heard from her again. Right away, I knew I had made a mistake. I hadn’t respected her timing. I had been careless with my tone. I had failed to empathize with her desperate need to stay with a husband she could barely tolerate. My therapeutic mistake taught me a lesson as important as any I learned in my four years of graduate school: be gentle when challenging a patient’s decision.
“I wonder if you are moving too quickly,” I said to Lisa in my best, soft, whispery therapist voice.
“I don’t think so,” she said.
She buttoned her sweater. We sat there, smiling at one another. “What do you think?” she said.
“About what?”
“Me and my husband.”
“I don’t know,” I said. “What I think is less important than what you think.”
“I miss him. I believe it is worth giving our marriage another try.”
“You don’t have to let him move back in,” I said. “You can spend time together and live apart. Kind of test each other out. See how it goes. There is no rush.” In my mind, I was flashing a bright yellow light at her.
Lisa was fumbling with her purse, not looking at me. My warning sign hadn’t registered. I felt tempted to lay out all the reasons why her decision didn’t make sense. I didn’t want to say goodbye, and I was worried she was making a mistake. Then I remembered my heavy-handed approach with Angela and realized I should handle Lisa with care. “Are you sure you don’t want another appointment?” I said.
“I’m sure.”
“You can always come back.”
She stood up and grabbed her purse.
“How about seeing a marriage counselor before you get back together? I can recommend someone.”
“Yeah, maybe,” she replied. “I don’t think we will need to do that.”
I locked my office door and went out to the car. The drive between my office and home took fifteen minutes. I used the time to decompress from the day, thinking about what to make for dinner and which TV show to watch.
I walked in the door and slid a frozen Trader Joe’s chicken tikka masala into the microwave. Then I switched on the Great British Baking Show and sat on the sofa, spooning the food into my mouth. Those bakers making a fancy frosted cake weren’t holding my attention; I was worried about Lisa. Sure, things looked good right now. But what about all the times her husband had promised fidelity and betrayed her? If she gave him another chance — for the fifth time, I thought, although I had lost count by now — I was sure he would break her heart.
Why was Lisa taking what looked to be an enormous risk? Psychotherapists often say that past behavior predicts future behavior, and her husband’s repeated instances of infidelity suggested a pattern he seemed unlikely to break. Although Lisa saw the pattern, she couldn’t escape her fears of being on her own. Greg had always promised to take care of her. She had depended on him to manage her life. Lisa had gone right from her mother’s home to the home she had made with Greg. She didn’t have the confidence that she could take care of herself. If there was even the slightest possibility the marriage might work out, Lisa was willing to take the chance. Who was I to take issue with that? When my marriage unraveled, I felt as she did right now.
I switched off the TV and wandered into the kitchen for a late-night snack of saltine crackers with sweet, sticky strawberry jam. Comfort food. This had become a common pattern on the nights when I was preoccupied with a patient, wondering if I had done enough to help her.
When I started practicing psychotherapy, I assumed self-doubt was normal for a new therapist. I thought over time, once I had more experience, all my patients would get better, and I would no longer worry if I had done a good job. But that hasn’t been the case.
Sometimes I’ve thought about whether I would have more consistent success if I followed a particular type of psychotherapy. There are many schools of thought about the best approach to treatment. Psychodynamic therapists, for example, help patients understand how the family they grew up in shaped them. According to this theory, insight into family dynamics will lead to change. In contrast, cognitive/behavioral therapists encourage patients to recognize how their distorted thinking affects their mood. These therapists want their patients to identify their automatic, negative thoughts and replace them with more positive, rational ones.
Some research indicates cognitive/behavioral treatment, particularly for anxiety disorders, is the most successful form of psychotherapy. However, other studies, including one provocatively entitled “Are All Psychotherapies Created Equal?” in Scientific American, suggest that different treatment approaches are equally efficacious. Consequently, many therapists practice in an eclectic fashion, as I do, using whichever theory best addresses the patient’s problem. I like to think my approach is flexible, tailored to the kind of problem the patient brings to me. Still, sometimes I imagine myself throwing spaghetti on the wall in my therapy office to see what sticks.
On one of those days when I was preoccupied with my self-doubt, I scrolled through various websites until I found a 2020 Aeon magazine research report by Helene Nissen-Lie. She found that therapists with varying experience levels all felt some self-doubt and suggested that self-doubt can even be a good trait. The report encouraged psychotherapists to listen to their patients’ feedback and to self-correct their approach, as I had done between my Angela debacle and meeting Lisa. However, there was one thing which these researchers neglected to consider: even if self-doubt was a good basis from which to hone one’s professional skills, it didn’t feel good.
It was late, time for bed. I pictured Lisa’s husband giving up his girlfriend, coming home on time each night to make her feel important to him, not a disposable piece of trash. Oops, where did the word “trash” come from, I wondered? It was easy to remember. It was the feeling I had with my husband more than thirty years earlier.
You can find out more about this story in Bouncing Back: How Women Lose & Find Themselves in Marriage & Divorce which is available on Amazon and Bookshop.org.
