09/01/2024
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The WORK of a Psychotherapist
By Sarah Belle
“What people do not understand about our work is the way we are present in each and every session. Mentally, emotionally, and yes even physically. They do not even begin to understand how much mental work it is.
If someone questions why seeing 5 or 6 clients in one day is hard, stressful, and exhausting – usually with the argument that most people work LOTS more hours in a day so what are you complaining about – have them do this exercise.
Ask the person to sit opposite you. Ask them to listen to you talk about something very painful for the next hour without getting up to move, p*e, get a drink, or distract to focus on something else. They are not allowed to lose focus or check out for the entire hour.
Let them know they need to listen intently to everything you are saying because they are about to have to do the following:
They will need to reflect, empathize, and synthesize. For the entire hour.
They will need to listen without solving and to be present with your pain without flinching.
They need to understand that you may share a deeply traumatic experience with them that you have NEVER told anyone else about before. In your entire life. They must hold awareness of the gravity of that.
And that's not even the work yet. Because along with all the above they also need to work the mental puzzle for the entire hour.
Ask them to think the entire time about not only what emotions are showing up for you, but to try to make sense of everything flying around, track all the themes, and pull together the narrative threads you are throwing out in seemingly unrelated topics and stories. It’s their job to see the patterns and threads, to pull them together, and help you make sense of them.
They must listen, they must remember all the dynamics at play in your life including relationships, your history, other major events that have happened to you and how all of those are intersecting and impacting/informing your current pain. They must attend to your physical regulation state and decide how to move with that. They must decide what therapeutic direction to go and must be able to shift that at any given moment. They need to decide what puzzle pieces fit where and how best to get you to process those.
They also need to track new information coming in from you and decide how that fits with all of the above.
They also need to notice what is going on in their own body and their own emotional reactions and manage those while simultaneously doing all of the above. They need to manage the stiffness and body aches from sitting for hours at a time as well as any tension their body is feeling from being present with someone’s pain for an entire hour.
At the end of the hour - heck make it 50 mins to go easy on them - they now need to write a progress note (demonstrating medical necessity), go p*e, slam down a snack, and manage three incoming texts from clients wanting to change appointment times.
They then need to turn around and do it all again with the next client who will present an entirely new puzzle.
Then again and again and again and again and again and again. All day long. Every day this week.
Outside of session time they will need to attend to emails, phone calls, paperwork, and all the logistics of running their own business.
If there is a crisis, they will also need to carve out time, mental space, and energy to deal with that. They will need to find time to debrief to make sure they did everything correctly and to manage the emotional and physical fallout from dealing with the crisis. Most of the time they will be questioning every move they made, so there’s also that.
Mostly ask them to notice how exhausting it is to sit and listen in a deep and meaningful way.
Our work is not like other work.”
-Sarah Belle
