Introduction
Introduction
I was in the middle of a therapy session when I realized I’d lost my wedding ring for the first time. My mind raced suddenly with thoughts not at all related to my client: where could the ring be? How could I have been so fucking careless? I was panicked—but I also had a job to do. We were deep into grieving the love of my client’s life. I tried to stay focused on him, what he was saying, what he was feeling.
But the horrible sinking feeling in my gut wouldn’t go away—and it was all too familiar. I lived with that feeling constantly. The details of what caused the feeling changed, but the feeling itself stayed the same. In this case, I anticipated the look of disappointment in my wife’s eyes. She’d chosen that ring for me, and I’d lost it.
I rarely experience that sensation anymore. I’ve done multiple tours in hell. I’ve been investigated for crimes I didn’t commit, fired for things that should have gotten me promoted, survived threats against my license, and been hit up for favors by people who conveniently forgot that they had fucked me over. After all that, I laugh now at what used to paralyze me.
The second time I lost my ring, I’d learned to marvel at the absurdities of my life. I had walked into the men’s room of my agency to find a geyser exploding out of the faucet. A little boy had somehow dismantled the sink. Despite having the mechanical ability of a turnip, I tried to fix it. And in the process somehow lost the ring again.
I gave up a minute later and placed an emergency call to our plumber. By then my shirt was soaked, and I was late for a session. I went into my office, where my client was already waiting. She laughed, so I did too. She didn’t mind if I did therapy wet, so I didn’t either. Instead of freaking out about the ring, I just texted the plumber to see if maybe he had found it in the drain.
What I’ve learned is, if you know how to laugh at yourself in healthy ways, you’ll never cease to be entertained.
I’ve been supporting trauma and addiction recovery for twenty years.
I entered the field believing I was immune to burnout, vicarious and secondary trauma, and compassion fatigue. I am a slow learner with a high pain tolerance, so it took me years to figure out I’m as susceptible to those pitfalls of the profession as anyone else. I am not Superman. You aren’t, either. And we do ourselves, and our clients, a huge disservice when we pretend otherwise.
By the same token, too often in therapy we subscribe to the notion of us and them—“us” being therapists and other professionals, “them” being the clients we’re supposed to serve. But there is not, cannot, be any separation between us. In all my work and writing, I refer to “we” and “us.” I don’t want any degree of separation between myself and those I serve. Our clients are not “populations” or “those people.” They are our brothers and sisters. They are my people. They are people like me. They are folks who look into my eyes and say beautiful things like, “Me too.” I am at my best as a therapist when I recognize myself sitting in the chair across from me.
We all want good things to come out of the shit we’ve endured. I crave ripple effects, and so with what I hope to be genuine and sincere humility, I share my victories and failures with you.
Healthy People Don’t Work in Healthcare
Here’s why we shouldn’t pretend—or worse, convince ourselves—that we’re significantly better off than most of the folks we serve: because we aren’t. We’re all various degrees of unhealthy. That’s why we’re in this business in the first place. Among those of us in the trenches, it’s the worst-kept secret: we’re all bananas. With few freakish exceptions, no well-adjusted child ever grew up to be a social worker, nurse, or therapist.
But the rigid hierarchy of healthcare reinforces the fiction of “us” and “them.” Credentials and personas dictate everything, and in order to maintain the façade of control and expertise, we act as though we know more than we do, are capable of more than we are, and have our shit together when in fact we’re coming apart at the seams. And this is true for everyone, no matter where you exist in the hierarchy. I’m fortunate to be about three-quarters of the way up the ladder, but the folks around me near the top are every bit as burned out as the C.N.A. working triple overtime shifts. We may hide it better, but we’re still fucked.
Our hypocrisy is our downfall. We do not live as we advise our clients to. We give away the very things we want to receive, and steadfastly avoid meeting our own needs. Everyone knows you can’t pour from an empty cup, yet we keep trying. My old way of dealing with the empty cup was to rip myself open, bleed into the cup, and then I had something to give. You know the routine: ignore the costs, do more, do it better, serve greatly while you’re dying inside. Ten feet tall, bulletproof, with your heart in a thousand pieces.
Our occupations are an application of reductionist philosophy. It feels good to give; it feels selfish to receive. We’re all laboring under the desperate (and mistaken) hope that contributing to the healing of others will make us feel whole and happy. Healing is a selfish act—in the best possible sense of the word—and yet we think it can be facilitated by people who are largely selfless. This appears noble. It’s not. And while our professions are honorable, our approach to them isn’t. It cannot be managed nor sustained.
Let’s cut to the chase: We will not optimally teach what we have not learned and more importantly, lived. We all want to be optimally effective. But we ignore an obvious truth: we serve intuitive and instinctual folks. They see the struggles and pain we keep hidden.
They know we’re not practicing what we preach, and this undermines everything we try to do for their benefit.
And this is our conundrum. We may be okay with failing ourselves, but we cannot tolerate the idea of failing our clients. To us, they matter. They have value. We see them in exactly the manner in which we should have been taught to see ourselves. So in order to serve them effectively, we must learn to see—and treat—ourselves with the same respect and love.
You don’t have to change for your own sake. You can do it for those you serve. There’s no bad reason to start on this road. I came back from burnout multiple times. I changed because I got sick and tired of being sick and tired. I hate being a hypocrite, and ultimately, I resolved that it simply was no longer an option to continue as I had. I started taking the advice I gave: better nutrition, sleep, exercise, and most of all, showing greater vulnerability and accepting far more support from those who love me.
I can almost feel you saying, “I’m different. I’m always okay.” I believed that too. I was wrong.
Crazy People Make Babies
My own story starts with a narcissist falling in love with a chronically depressed codependent. They married, had children for what were assuredly misguided reasons, and set about ignoring them. There were three takeaways from my childhood:
1. I don't matter. (so, I set out to prove otherwise)
2. Love must be earned (but cannot be retained)
3. Whatever I did was only worthwhile if it involved copious amounts of suffering.
Fast forward through moving once a year, being bullied throughout elementary, middle school, and early high school. A brief pause to note the substance abuse of adolescence. Arrive at blue collar, working-class poor guy, married with two kids at 22.
I was a delivery driver, (extremely codependent) husband and (completely terrified) father. Fear and codependency meant I could never do enough. Each week, I worked 80 hours and did stuff with my kids 60 hours. I never slept, never did anything to take care of myself. I lived in a constant state of burnout, running perpetually on high-octane terror.
Then, in 1994, my brother bought me a copy of Tom Robbin's Still Life with Woodpecker. The book blew my mind. Shortly thereafter I received a hand-me-down computer, and became part of an online group of Tom Robbins fans. One of the group members learned of the volunteer work I did at my kids’ school and asked why I didn’t do that for a living. I made some bitter references to being poor and uneducated. She happened to be a philanthropist (not to mention, the mom I'd always wanted), and just like that, she sent me to college. I went from being a 30-year-old with a high school education to having a graduate degree in four years.
Like most of us, I went out into social work completely petrified, but hopeful that I would receive great support and wise counsel from my colleagues and supervisors. What I experienced (with a handful of important exceptions) was a collection of really fucked up people working in organizations that felt just as fear-based and dysfunctional as my family of origin. I discovered that my colleagues were pretending they weren't obviously mentally ill, addicted, self-destructive, and various shades of neurotic. I worked for five agencies long-term before starting my own.
I was fired by three of them (two of them after I had given my resignation). I had a complaint lodged against my license for "stealing" clients from a former employer (agencies treat people like property). I was threatened with being arrested if I ever returned to a former agency because I "stole" two of my coworkers when I left (why the hell would I want to come visit after being fired?).
I've walked into a lot of unhealthy situations and run into a lot of walls. I've been propositioned for affairs more times than I care to recall. I've been offered drugs regularly and have had to explain countless times why I don't drink. I've covered for coworkers having panic attacks and been threatened by unethical supervisors.
I never wanted my own business. What I wanted was to work with people who were genuine and who could at least be open about their brokenness, if nothing else. And what I learned was that our profession is so broken, if that’s what I wanted I would have to create it myself.
Deep down, people like me believe that if you ignore painful things, they will go away. This is true not only of emotional pain but physical maladies as well. In my blue-collar days, I did a lot of damage to my back and knees. I unwittingly lived with a torn artery behind my knee for over 20 years. The pain was never all that bad until seemingly overnight it became unbearable. Eight surgeries later, I had to tell my doc to stop trying to save it for aesthetic value only and cut it off.
I returned to my clients after two months in hospitals. Most of them were at a loss. The tables had turned. They looked at my loss and didn’t know how to proceed. To each of them I explained, “My scars show. Yours don’t. Both of us deserve to heal.”
I move toward acceptance at the pace of a glacier. The lessons appear repeatedly, and the cost of not learning them is always progressively more painful. It has to hurt me sufficiently before I come to acceptance. I had to struggle for years before I realized I needed to work for myself. I had to lose a leg before I knew what I needed to be well.
But we don’t always have to learn the hard way: we can find wisdom in the experiences of others, and avoid pains that in truth are optional experiences: strife, agony, dread, intellectualizing, complicating, and avoiding.
Opportunities for reflection and journaling:
• Connect with your intuition. What are the lessons you’ve been avoiding of late?
• How often do you tend to tie yourself up in knots?
• How’s your balance of humility and self-affirmation?
