It may be a strange analogy within the context of therapy, but do you ever experience being in a clinical session with an individual client, or a group, and the dynamics of that session give you some kind of butterflies? That feeling of excitement because you want to know more, of hope that the unknown will turn out okay, of belonging because you feel you are in the right place, of achievement because you have found something special, and of awe because you have witnessed someone’s spark?
I recently saw my first clients with pronounced clinical depression, and the bleakness of those presentations stopped me in my tracks. Every day, I work with chaos, anger, sadness, ups and downs, glimmers of hope and joy, life and death, shame, guilt, anxiety, to name just a few. But bleakness to the point where there is no alternative, no hope, no light, no movement… well, I was not ready for that.
And this got me thinking about a lecture in my first year of Dramatherapy training, where a lecturer said – and I’m paraphrasing here: “Just because you’re becoming therapists, it doesn’t mean that you can, or should, work with everyone and every kind of condition. You actually have a choice on that.”
I remember how deeply that resonated with me, because I recognised that a part of me did think that I would be somehow responsible to respond to all the problems of the world. I remember mumbling that to myself for days… “I have a choice. I have a choice. I have choice.”
Sometimes there is nothing scarier than having choice. It means that a decision must be made. That something must be left. That something must be taken. And that we are responsible for the consequences of whatever that decision is.
I also remember thinking “How selfish!”. How selfish that I, a therapist, could refuse to help someone, when I’ve been given all these tools to do just that. And yet, there was also a relief: I didn’t have to help everyone.
And through the years, I have been not only actively and consciously making this choice, but I have also been noticing something else. That, perhaps, whatever butterflies a therapist experiences towards a specific client group or clinical context, may be in alignment with some kind of inner talent, skill…an aptitude. Allow me to expand on this.
In my first year of training, I also remember having a chat with one of the lecturers about which client groups I wanted to work with, both practically in terms of my clinical placements, but also generally, in terms of profession and career. It was always very clear to me that I wanted to work within addiction, and with gay men. These were clearly aligned and influenced by my own lived experience and by wanting to know more about myself, by helping others through similar experiences.
It sounds selfish, I know. But I believe that this is something mostly unconscious at first, rather than conscious – this idea that we might want to know more about ourselves, by working with others who share similar life experiences. This became more conscious to me, the more clients I met and worked with. And also, sometimes it’s not even about the condition or context, but about the effects, the aftermath of an experience. For instance, a great friend of mine has never spent time in prison, and yet, she has great affinity and aptitude to work and empathise within that field. Even in my work within addiction, I notice it every day, that I have much greater empathy and affinity towards clients who have overcome active addiction and are now in active recovery. I tend to find the aftermath of active addiction much more fascinating.
Why has this come about now? I have been noticing through the years, and particularly in the past few weeks, that there are certain clinical presentations to which I’m really drawn to and am greatly curious about, and others to which I’m not. And when this occurs in a session, when I’m not drawn towards something or feel no curiosity at all, I notice it immediately, because I always feel like I have to “work at it”.
I felt this particularly during the sessions where I was presented with complete bleakness. I was taken aback, not simply because I couldn’t get through, but also because there was a part of me which, frankly, didn’t necessarily want to get through. This got me thinking about the why of this occurrence, and also why I literally feel so alive in certain clinical contexts, and so indifferent in others. As I’m writing this, my inner therapist just said: “There’s probably a reason in your lived experience for why this is, and if you give it enough time and space, you’ll know exactly why.”
He’s right. My inner therapist tends to be right. And as I think about it further, without getting into much detail, I can connect why I tend to distance myself from both intense bleakness and active chaos – such as psychosis, or drugs withdrawal. I’ve learned and witnessed how well I can create deeply profound connections with individuals who, whilst still experiencing chaos and distress, are also willing and stable enough to want to create some kind of change in their lives.
I feel this may be related with my 7 years of active spiritual practice. If there’s a willingness and an awareness that change is required, no matter how faint this is, and no matter how many difficulties that individual has experienced in the past, or is experiencing in the present, then my curiosity, my drive, my empathy, are fully there. But if I can’t feel that from the client, then those traits don’t seem to make an appearance.
I have been very aware of my choices recently, both in relation to what I feel curious about, and to how much chaos I am willing to engage with on a daily basis. I have been noticing that my aptitudes, and my butterflies, may lie in clinical contexts and presentations where someone has already decided to change, no matter how determined or faint that decision is. And then I look at and talk to some of my colleagues and realise that their butterflies lie elsewhere.
This is the beauty of healthcare professions, and where we can find relief from the potential pressure of wanting to help everyone: there is always someone who is interested, driven to help, experiencing butterflies, in every single clinical presentation that exists. I don’t have to worry about helping everyone, because there are other professionals who are helping people at every single stage of their recovery. I don’t need to feel guilty about not feeling more curious at the earlier stages of someone’s treatment, because someone else is, and I feel that the combination of my knowledge, skills, and talents, is better served when there is a certain level of, or potential for, stability and balance.