Three-and-a-half years ago I quit my career as a psychotherapist. I’d done it for ten years in New York City and had given it my all. It was a career that chose me, loudly, when I was 27 years old. Prior to that I had been working as a children’s musician but was seeking something deeper and more satisfying. Being a therapist provided me just that. I learned a huge amount from it and I believe I was helpful to a lot of people. It also represented a vital stage in my life. But then the time came to leave. That also came as a sort of revelation.
People often ask me why I quit. To me there are many answers. One is that I was no longer finding the work so interesting. I had been seeing about thirty people a week, and often more, for fifty weeks a year, for years and years. I had developed a strong skill set, but found that toward the end I was no longer learning as much. Yet for the first five or six or seven years of being a therapist I struggled against the learning curve every day. Every day was a challenge, and while not an easy one, I loved it. It was extremely stressful, because often I wasn’t quite sure what to do or what to say or how to behave. I was constantly taking risks — emotional risks — and really expanding sides of myself. This high degree of testing not only engaged me at a deeply personal level, but also really improved me as a clinician. That was gratifying.
But at some point I started to realize I wasn’t getting much better. I had plateaued. I noticed that I wasn’t thinking so much after work about the people who came to me for help. I noticed that I wasn’t seeking out consultation so much any more, either formally or informally. I felt I could heed my own counsel most of the time, and often I didn’t even need that; sometimes I even felt like I was on autopilot. Had I become arrogant or simply just experienced? I’m not entirely sure, though I like to think it was more of the latter and less of the former.
One thing I’ve learned about myself is that if I’m not learning a lot, a real lot — whether the learning is exciting or painful or both — I get bored. And I think I was beginning to get bored as a therapist. It was becoming routine. It was becoming a job. And one thing I stand by is that being a therapist is no job for a person who’s just doing a job. Being a therapist is much more like being an artist. And for those first six or seven or eight years of my work, I strived to be an artist. I was an expanding universe, a surfer riding a huge wave of unknown. And I was loving it. I loved waking up every morning and looking at my schedule book to see whom I would be meeting that day. And I loved seeing as many people as I possibly could. No matter that my brain felt like mush each evening. Every person coming to me excited me; every one. I was thrilled to join them on their journey, and I felt it, even knew it, to be a profound privilege. But then, later, well, it really became more of a routine. At random moments I noticed things popping into my head that I heard other, older therapists hint at: that they wanted to work with people who had milder problems and could pay more. They wanted people who paid cash so they didn’t have to deal with insurance companies. And they wanted to cull out the “difficult” or low-fee clients.
So occasionally thoughts like this started coming into my mind. And I felt sickened by them. I felt they were wrong. Unethical. I had always felt that it was my job to work with anyone who wanted to work with me — any adult, that is. On a side note, I always felt it was questionable to work with children. Although I love children, some deep part of me felt that children didn’t belong in therapy. I felt it sent them a bad and incorrect message: that somehow they, and not the people who hold the real responsibility over their lives, are the problem and they are the ones who need the fixing. Although this may be a bit simplistic, I still felt it is so strongly that I just couldn’t comfortably and in good conscience work with them. So I didn’t. But I did work with basically any adult, no matter what his or her issues or ability to pay, who wanted my services. And that felt right to me. I didn’t specialize. And this challenged me as well. I really got to work with a wide swath of humanity — and not just in English. Occasionally I worked in Spanish as well, even though my Spanish was not-quite-perfect. This challenged me too. I felt it was my job to be challenged.
I also came to realize over time that I don’t feel therapy is a field that should make someone rich. Somehow it never felt right for me to get rich off someone else’s struggle. I feel being a therapist is a job of service, and that brings sacrifice. I was repeatedly sickened when I heard of young clients of mine who worked at coffee shops and thrift stores for ten dollars an hour who had had previous therapists charging them $150 a session. That is highway robbery. Most of these clients resolved nothing in their relationship with these shysters; instead their therapy just added increased financial-related anxiety to their already-present list of stressors. It made me feel good to see people for what they could reasonably pay. That felt fair. Plus I occasionally did work with people who could afford more.
But I think a big part of what made me realize it was time to end my work as a therapist was that I was getting burned out. I have come to realize my mind and body could not soak up any more of the pain I was absorbing. The emotional pain. I heard about trauma all day, every day. I heard about such intense trauma that it really got to me. Not everyone I worked with spoke about trauma directly, but that didn’t necessarily make it easier for me; I felt their trauma anyway. I came to realize that everyone in the world was traumatized, myself included. Some more, some less. But I never met anyone who escaped it. Meanwhile, sometimes it was easier for me when people spoke about their trauma directly; at least it was there on the table. It often took more energy for me to listen to people who were buffering their trauma. Then I had to take in both the trauma and the buffering.
So I swallowed a lot of trauma. And I think it contributed to making me sick. About halfway through my time as a therapist I developed ulcerative colitis. Over time it got worse, such that toward the end my doctor said he thought I might have Crohn’s disease and might at some point have to have my colon removed. Out of fear for my safety I ended up going on a lot of physical meds. In some ways I am amazed that I listened to him, especially considering I easily saw through the fallacy of psych meds. But I was scared and I really didn’t have good enough support. But had I been able to listen more closely to my own body I would have heard all that trauma stored up in me, my own and everyone else’s. It was screaming. It was screaming for me to learn to take better care of myself. To focus more on me for a change.
Interestingly, when I quit therapy I started getting better, and rather quickly. I managed to taper off five years of heavy meds over the course of a year and I watched my colitis improve all the while. Within a year-and-a-half of ending my work I was all well. And only a couple years before that I had seriously wondered if this disease might end up killing me.
Meanwhile, another reason I quit being a therapist was that I was finding other things that I enjoyed, other areas of creativity that called to my artistic side. I started making movies, and people liked them. I started writing songs again and recording albums. And that was fun. I started traveling a bit. That made me happy.
All this helped me realize that I needed more. I needed to break the intense work-work-work cycle. But some people said, “Why don’t you just cut down your practice a little so you can do more things you like at the same time? Live in moderation…”
Although I liked that idea in theory, in reality it wasn’t me. Not when it came to therapy. Toward the end of my practice I found myself getting more referrals than ever, especially after I made my first movie and published a book or two. People in desperation contacted me all the time. Sometimes new people every day. And I discovered that it wasn’t in my personality to say “no” to people in desperate need. And this was made much more difficult for me since I knew basically no other local therapists to whom I really trusted referring people, especially people in serious struggle who didn’t fit into the conventional mental health system. Many of the people I worked with were people whom no therapists I knew wanted to work with or could connect with effectively. Some of these people were scary and aggressive. Some were really “out there.” Some had unpleasant criminal histories. Some despised pills and hospitalization. (I considered this a good sign.) Some were full of rage at the mental health system. (Often this was a good sign too.) And no small number appeared to be brain damaged from psychiatry’s treatments. Yet many of these “difficult” folks, the ones that almost no professionals wanted, I liked the best. So often they had a fighting spirit, and I respected that. I related to them. So I said “yes” to them. Yes, yes, yes. I gave them everything I had. I would have had difficulty living with myself had I said “no.”
Was I a fool? I don’t know. I don’t think so, because again, I felt that by calling myself a therapist I had an obligation to give it my all. To connect. To listen. To relate. To try to understand. Not to turn away. Some may call me naive, and some did, but I didn’t care and still don’t. What I was doing felt right to me. And when I found myself wanting to say “no,” I knew it was time for me to go. So I started planning my exit. And one day I quit. (I did give the people I worked with more than a year’s notice.)
Now it is three-and-a-half years later. I have spent a lot of time reflecting on those therapy years, and I have gained some new insight into them. Perspective. And that is what has really called me to write this essay. I’ve had a lot of wild experiences in and around the mental health system these last three-and-a-half years, just not as a therapist. I’ve now become a world traveler who visits mental health programs and organizations of all stripes and varieties. I’ve made more films on the mental health system and have become a lecturer too. I’ve also become a friend to many who have been in the mental health system in all sorts of ways. And I’ve become a guest in the homes of many present and former mental patients and therapists and psychiatrists and family members of those who have been in the system. And I’ve heard thousands of new stories. It’s been quite a journey.
I want to share a few things that I’ve learned about therapy. One is that even though I feel I was a better-than-average therapist, I feel that a lot of my mental health training made me arrogant. It taught me to feel that I was better than the people I was working with. That I was somehow different. It taught me to feel that I knew the answers and they didn’t. It also taught me to feel that I should know the answers, that I should be a fountain of wisdom and maturity and confidence. Well, what about all those times when I had no clue what to do or say? This was especially difficult when people had super-serious problems that had no simple solutions, especially given the surrounding, broken mental health climate. How was I, with all my training in arrogance, supposed to be an expert when I had no clue what to do? No wonder all my colleagues were shunting these so-called “refractory” people to the hospital and pushing them on meds. They were a threat to “us.” If we were to retain our supposed expertise we needed to get rid of these “difficult” people, and fast. If we actually tried to engage them in human connection they would risk toppling our house of cards.
It took me a while to figure out that my job wasn’t to save anyone. My job, half the time, was just to shut up and listen. For many people I worked with that was more than they’d ever gotten in the mental health field. And when I did shut up and listen I actually learned a lot more from them than I’d ever learned from my professors and supervisors. These people had real experience. And a lot of it was very painful. Even ugly. What amazed me was how strong they were. I cried almost every day as a therapist. And many times I genuinely wondered to myself why some of these people who came to me hadn’t committed suicide long before. Eventually I learned — at least when it felt right — to ask them such questions, openly. And what I found is that most people really appreciated honesty. They took it as real acknowledgment. And it opened doors to conversation.
Then there was another thing that troubled me: this idea that I as a therapist was supposed to be this utterly private person without problems or a history of my own. School pushed that one on me too. I remember in my first year of work, with traumatized Vietnam combat vets in New York City, I co-facilitated with my supervisor, a vet himself, a PTSD group for vets who also had substance abuse issues. A lot of the group members were going to AA. At that time I was going to Al-Anon every day — Al-Anon being the Twelve Step Program for families and friends of alcoholics. My mom was an alcoholic and Al-Anon really helped me for a few years there. I wanted to tell the group that I went to Al-Anon. Sharing this felt like the most natural thing in the world for me. But my supervisor, who had twenty years of experience on me, forbid me. He said that I needed to have boundaries. So I wasn’t allowed to be myself. That really hurt me. Especially because I somehow internalized his message. And it started me on a bad track. And it didn’t help that basically all other supervisors and therapeutic authority figures I knew echoed his same message.
This also damaged my ability to trust myself. In my heart I knew it was fine to share many of the truths about myself. I had loved Al-Anon for that; we were allowed to be our authentic selves there. That was normal. We were peers, no matter what our background. But somehow in therapy everything was different. Somehow being a peer was frowned upon. For reasons unknown there had to be a big mysterious power differential between “us” and “the patient.” I now am really questioning that. And I’m also questioning all that crap about transference — where the “client” transfers all his childhood material onto the therapist and the therapist is supposed to “work with the transference” and at times even be something of a blank slate in order to encourage transference. Gross. I now think transference is something to try to discourage — that is, to acknowledge and to work to resolve. I prefer to have a real relationship between the real me and a real person sitting across from me. Yes, people can and often will project their unresolved stuff onto me, and I can and often will project my unresolved stuff back onto them, but the goal is to make clear sense of my side of this as quickly as possible and also help the person I’m with make sense of their side. And I think too much therapy training and too many of the sacred mores of conventional psychotherapy do the opposite.
Also, I remember at the end of my first year of doing therapy, at the veterans clinic, I was ending my relationship with the wife of a dying vet. She was from Puerto Rico and spoke no English, and since I spoke moderately good-enough Spanish they’d assigned her to me. She just loved me, and I loved her too. As we were “terminating,” to use that distasteful therapy lingo, she said she wanted to bring me a real home-cooked Spanish meal of chicken and rice and beans. In social work school they’d taught us not to accept gifts; it was a big no-no: “bad boundaries.” But I wanted to accept it. So I asked my supervisor. He said “no.” But I thought he was a jerk — and a culturally myopic one at that — so I asked several of the other therapists at the clinic, even one who was Latino, and they all said “no” as well. No, no, no. But I felt that given the power and pain and intimacy in our relationship — the woman said that I had become a son to her — I felt the correct answer was “yes.” Yes, yes, yes. But I told her “no.” I was too scared to go against all my superiors. And on some deeper level, which troubles me the most, some part of me figured they must know better.
She was hurt by this. I tried to explain to her that I wasn’t allowed to do it, and she tried to convince me to do it anyway. She said, “If you’re scared that they’ll see me bringing you food, why don’t you just come over to our apartment for supper? They don’t understand our relationship. My other children would love to meet you, and my husband would welcome you with open arms. We talk about you all the time. They know you are helping their Mami.”
But I couldn’t. All those stupid rules. All my inner fears. My self-doubt. My lack of credentials. My newness. So I stuck by my “no.” And I regretted it. I still remember the look in her eyes. That look of such sadness and disappointment. I felt like a jerk and a coward. And I felt confused.
These last three-and-a-half years I don’t have to play by those stupid rules. I have become a real peer to people once again. And I love it. I am not better than, I am not more special than, I don’t have a fancy title, my fancy degrees and license don’t mean anything anymore and I don’t have to play an externally-defined, state-sanctioned role. I can just be me. Me — someone who trusts myself and allows myself to do what feels right. I still have a lot of boundaries — and I always did anyway, even before I became a therapist — but now they feel natural. Not externally imposed. If it feels right to say yes, I say yes. And I love it that I don’t have to take money from people. Yes, rarely here and there I do undertake some sort of consultation for a bit of money, but I don’t do it my old way. And even toward the end of being a therapist I was operating very differently from how I did it at the beginning. I had loosened up a ton. I allowed myself to be myself much more. And that felt great. I think I would have lost my mind had I continued to play that fake, distant role. My calling in life was not to be fake.
Now, maybe this essay sounds very anti-therapy. Perhaps it’s just the mood that I’m in. But there’s another side of me — a side that does think about therapy. About returning to the work. But how? I would never want to go back to being a therapist like I was, sitting alone in an office and keeping a rigid schedule and living with all that pressure. That doesn’t mean that I now devalue the work I did, especially the private practice work I did, which represents some of the most independent work I’d ever done, because I do value it. I just don’t know that I want to enter into so many super-responsible, longterm, intensive relationships. I don’t know that I could handle that again.
I think I might consider, someday, doing shorter-term therapy. Or maybe not even therapy. Maybe more like consulting. I myself never did well in psychotherapy as a so-called client. Pretty much I hated all my past therapists, or at least I hate them now. At the time I really hoped for them to help me, somehow, and none of them did. And one or two of them really hurt me. Messed with my head badly. Instead what really helped me was self-therapy. Journaling. Living a healthy lifestyle. Surrounding myself with loving, healthy friends. Meditating. Being creative. Avoiding toxic people, including my family of origin. These things were my salvation.
I was very motivated to help myself, and there is some part of me that is now drawn much more than ever to work with people who are super-motivated to help themselves. I don’t care how many problems they have, because to me that is not the issue. The deciding factor in people’s ability to get better, I think, to improve their lives and to learn and to heal, is their motivation to change. Their willingness to grow. Their openness to accepting some outside ideas and trying new things. Their ability to sacrifice their comfort for a purpose.
I value these kinds of people. That said, I still am very empathic and sensitive to those who are deeply stuck, those who have been so beaten down by the system and by life and by their childhoods and by the pills that they don’t know what to do to help themselves. I meet so many people like this on my travels. I often stay at their homes. So many of them are simply lovely. And, as in years past, I often don’t have great answers for them. I may enjoy their company, but I don’t know how to help them untangle their knots. Maybe someday I will know better. But I do see how brutalizing life can be.
And yet what is my role in this world? I am not totally sure. For these last few years I have been making movies and doing a lot of writing. Thankfully the movies bring in enough money to keep me afloat. And that’s good enough for me. It actually makes me happy, because I never went into filmmaking to make a living. I did it instead to spread a message. So it is gratifying to see that message spread. And also I have been having a lot more fun these past years. Enjoying myself. I always told the people I worked with that having good fun was an important part of life. Now I doing a lot more of it myself, and frankly it’s such a relief. I needed it, I need it now and I think I’m going to continue to need it.
So maybe all of this, all that I’m doing, is part of my healing gift. All this traveling, all this exploring, all this writing and sharing and creating, all this visiting and witnessing and listening. All this learning and synthesizing. All this experimentation. But what is this? And who am I? I sometimes have people tell me that I am still a therapist. I usually argue that I am not. “Former therapist,” I say. But maybe being a therapist is something bigger and broader than that which I previously considered. I don’t know. But I am open to the idea.
Of further interest:
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.