Freud himself would be appalled by this. "Every analyst should periodically -- at intervals of five years or so -- submit himself to analysis," he said. Unfortunately -- and ironically -- many psychotherapists are reluctant to seek therapy. In a survey by Guy and James Liaboe, Ph.D., for example, therapists said they were hesitant to enter therapy "because of feelings of embarrassment or humiliation, doubts concerning the efficacy of therapy, previous negative experiences with personal therapy, and feelings of superiority that hinder their ability to identify their own need for treatment." Others are hesitant to seek therapy because of professional `complications' -- that is, they cannot find a therapist nearby whom they do not already know in another context. Or they mistakenly believe, as many patients do, that seeking therapy is a sign of failure.
"I worry," says psychologist Karen Saakvitne, Ph.D., "about the implication that the therapists who are in therapy are the ones who are impaired. They are the ones acting in their clients' best interest. I'm more worried about the therapists who don't seek help."
WOUNDED THERAPISTS
Maybe there's an upside to all these problems among psychologists -- if, say, a therapist needs to have experienced pain and suffering in order to relate to his or her clients' pain and suffering. This "wounded healer" concept is, I believe, woven into the fabric of the mental health profession. When I served as chair of a university psychology department, I helped evaluate candidates for our marriage and family counseling program. The admission process -- interview questions, essays, and so on -- was structured, albeit subtly, to screen out people who hadn't suffered enough. What's more, I've heard colleagues express concern about the occasional student or trainee who, through no fault of his or her own, came from an unbroken home.
Data supporting this idea, however, are hard to find. "There's no evidence whatsoever that you need a history of psychological problems in order to be a good therapist," insists John Norcross. "In some studies, in the first few sessions only, [patients see] the wounded therapist as a little more empathetic, but the effect doesn't last. Experience with pain can enhance a therapist's sensitivity, but that doesn't necessarily translate into good outcomes."
"I don't think therapists need to have had the same experiences as their clients," adds psychologist Laurie Pearlman, Ph.D. "As long as the therapist can feel those feelings, he or she can connect with clients."
On the other hand, in 1989 psychologists Pilar Poal, Ph.D., and John R. Weisz, Ph.D., found that therapists who faced serious problems in their own childhood are more effective at helping child clients talk about their problems, perhaps because of greater empathy. That study, however, is practically the only one that supports the wounded-healer hypothesis.
THERAPEUTIC ADVICE
So you've gotten into therapy because your life is falling apart -- and now you have to keep one eye on your therapist just in case his or her life is falling apart, too? Basically, yes. Like it or not, you, the client, are probably carrying the major responsibility for spotting the signs of distress or impairment in your therapist, especially if you're seeing an independent practitioner. The current president of the California Psychological Association, Steven F. Bucky, Ph.D., puts it this way: "The truth of the matter is that unless someone complains about an impaired therapist, there is no protection for the client."
Here are some tips for protecting yourself from impaired mental health professionals, and, perhaps, in so doing, for helping them overcome their own problems. Remember, therapists are people, too.
First, it's probably safer to bring your problems to a practitioner who works in a group setting. Independent, isolated therapists are probably at greatest risk for having undetected and untreated problems of their own. On the other hand, therapists working for managed care organizations or working under the gun of insurance companies are exposed to special constraints and stressors that may limit their ability to help you.
Second, trust your gut. "If you get the feeling that there's a problem, you shouldn't deny what your instincts are telling you," says Kilburg. If, during your session, a little voice in your head begins screaming, "This guy's eyes remind me of my college roommate's when he was tripping on acid," don't be afraid to ask questions.
Indeed, any time your therapist shows clear signs of personal distress or impairment, bring your concerns to his or her attention. (Ideally, do this on the therapist's dime, after your session is over.) If you're uneasy about raising the issue with your therapist, talk to one of his or her colleagues about it. Or, consider finding a new therapist. If you think your therapist's problem is serious and has the potential to do harm, report it to the appropriate professional organization or licensing body (see below). You have legitimate cause for concern if your therapist:
shows signs of excessive fatigue, such as red eyes or sleepiness.
touches you inappropriately or tries to see you socially.
smells of alcohol, or you see liquor bottles or drug paraphernalia in the office.
has trouble seeing or hearing.
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