What Happens When Therapists Reveal Their Own Inner Struggles?


Counselor and artist Sara Nash discusses her own experiences of feeling “overwhelmingly lost, in pain, invisible, and at times, hopeless” — and asks whether it’s truly good that she rarely shares these feelings when she talks to college students about suicidal ideation.

“It is ironic that in a field that believes fiercely in the power of speaking about painful issues, mental health professionals are reluctant to talk about our own lived experiences of emotional and mental health challenges, and we tend to stigmatize one another for speaking up about our stories,” writes Nash. “Our training teaches us to focus on other people’s pain, and to avoid discussing our challenges, even with our colleagues as we go through school. The reasons for this are complex, but I believe we do this, in part, because somewhere along the line we got worried about revealing our vulnerability. We got scared that our vulnerability might make us appear less qualified, less credible, and we started policing each other. We bought into the myth of professionalism-perfectionism and now are facing an isolation similar to that which burdens so many college students.”

Me too (Saranash.com, February 19, 2015)


  1. Also known as “boundaries”. It comes back to the medical model and the idea that when someone is experiencing emotional turmoil it is pathological and not a part of normal human reaction to adverse life circumstances.

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  2. I use self-disclosure all the time as a way to create better trust and a sense of personal credibility. I do it in a way that doesn’t require the person I’m talking to to take care of me in any way, but as a means of reducing the power imbalance and letting them know that their suffering isn’t that unusual or “bad.” Unfortunately, the DSM now allows clinicians to completely distance themselves from their clients and “analyze” them and “categorize” them and “treat” them as if they were somehow a different species altogether.

    Boundaries means doing what is good for the client rather than what is good for you as a clinician. It does not mean avoiding any impression of your own vulnerability and humanness. Selective self-disclosure is a powerful way to help clients understand that they are not malfunctioning, but are part of the human race’s struggle to make sense out of this confusing, horrific, and wonderful world we are a part of.

    —- Steve

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      • This is also my interpretation of appropriate boundaries, and also how my agency understands the idea of healthy, healing collaborative partnership in counseling.

        I work in a rural community organization, so I’m not in any way trying to suggest that this is the dominant perspective throughout the system. Only to offer some hope that perhaps its also not totally “unique.”

        Perhaps there is more of a struggle between perspectives, with scattered advocates and agencies that strongly endorse a more holistic and affirming way…

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        • Andrew, I would have predicted that you would respond that way! I wish I could send you some clients.

          I think having a really good sense of boundaries requires having a good perspective on your own needs and issues, and I think that’s what differentiates people who can do this from those who can’t. It’s not “good boundaries” when you are holding back your own humanity and acting like a cold or robotic person with no heart. But I think some clinicians interpret it that way because that is what keeps them safe from the uncertainty, pain, and messiness of really connecting with someone on a personal level. It is just plain safer to avoid that discomfort and “diagnose” from a distance. It also explains why medication is so appealing to some clinicians – if they can make the client’s discomfort disappear, they don’t have to deal with their own.

          I find that the ability to sit with that discomfort is what helps the people I talk to end up feeling better. It is also what helps me figure out what to say and do that might be helpful. If I kept a big emotional distance, I don’t know how I’d ever figure out what to do! The information I need is internal to the client, and I have to connect with them in order to find out what their needs are and why they might be acting or feeling the way they do. I really don’t know any other way to do therapy!

          —- Steve

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