Page 8 of 23
Challenges and Risks: Challenges to the Therapist
- Emotional Depletion: The psychotherapy profession consists mainly of working long hours in isolation. Therapists deal primarily with people in crisis and pain. They are supposed to offer these people support, empathy, interpretation, explanation, direction, or advice. They are expected to give endlessly while expecting nothing in return, except the fee. Not surprisingly, this results in practitioners' emotional depletion, in the therapists' sense that there is nothing more they can give to themselves or to anyone else.
- Isolation: Not only do therapists work mostly in private settings, but also a growing number of laws, codes, and regulations concerning confidentiality and anonymity exacerbate the therapists' sense of loneliness and isolation. In addition, therapists work when most people are off work.
- Helplessness and Sense of Inefficiency: Unlike carpenters, gardeners, or surgeons, psychotherapists rarely see immediate, profound, or tangible results from their efforts. The work is often slow, and with difficult or charactologically impaired people, they may never see improvement. Even when therapy is effective in relieving painful symptoms and termination is successful, patients leave. With them goes the knowledge of the long-term effect the work has had on their lives. In addition, the lack of easily available scientific and measurable ways to evaluate the outcome of therapy leaves therapists wondering whether or not they are being truly effective and helpful. They may question their entire involvement with what Freud calls "the impossible profession."
- Grandiosity and Omnipotence: Patients often put therapists on pedestals. They may idealize the therapists, ascribing to them super-human abilities to see, understand, and heal. In the private setting of psychotherapy, these projections may repeat themselves every fifty minutes. Combined with a lack of critical feedback from objective sources, this may encourage in clinicians the development of what Ernest Jones labeled "the God Syndrome."
- Depression, Sadness and Vicarious Traumatization: Working constantly with people in pain, who feel suicidal, or are grieving over the loss of loved ones, or those severely traumatized, often takes a heavy toll on practitioners. The psychotherapist can be infected with a patient's sadness; a condition Jung called "psychic poisoning." The term "vicarious traumatization" has been introduced in recent years and has become even more popular after the events of September 11, 2001. Vicarious traumatization refers to the cumulative effect upon the trauma therapist of working with survivors of traumatic life events. It is a process in which the therapist's experience is negatively affected through empathic engagement with clients' trauma material.
- Conflicting Clinical, Ethical, and Legal Considerations: The rapidly growing number of state laws, combined with the continual updating of ethical guidelines, leave clinicians in a quandary. The question of how to act when conflicting mandates are present (for example whether to act in the best interest of the patient, to follow the ethical guidelines, or obey the laws) may be difficult to decide. Regardless of the final decision, therapists are bound to feel stressed, compromised, and frustrated.
- Split Personality-Public vs. Private: Traditional therapy emphasizes a rigid separation of the therapist's professional and personal life. With some types of people this differentiation is crucial for therapeutic and safety reasons. However, the preoccupation with such separation has led therapists to live isolated and limited lives and to exclude a sizable part of their community and their public lives from their experience.