I'm thinking about going into practice as a psychotherapist, but two thoughts give me pause whenever I imagine enrolling in a clinical training institute, taking years of evening classes, and seeing paying clients: 1) I am in recovery from a mood disorder myself, and 2) I have no interest in having you put your feet up and tell me about your mother.
So I’m doing more research, which is starting to indicate to me that fortunately, neither of those have to be dealbreakers.
As a geriatric social worker who is out as both a member of the LGBTQ communities and a peer, I love working in my community. Though I am licensed in New York State, I need additional credentials to establish a private practice separate from the individual counseling and support groups I provide at my current nonprofit job. I never envisioned myself enrolling in a psychoanalytic institute, but the more I learn about the number of therapeutic approaches that fall under the rubric of modern psychoanalysis, the more I think a progressive training program here in New York City might actually be a good fit.
Last month I went to a free introductory Gestalt therapy class, despite the vehement objections of my hilarious BFF: “Don’t make clients roll around on the floor and channel their inner children!” (Apparently his only experience with a Gestalt practitioner yielded such activities.) Fortunately, New Age-y rhetoric is not necessarily what Gestalt is all about; the approach’s emphasis on experiential process and mindfulness is what I find appealing.
During the course of the three-hour class, I volunteered to participate in a 20-minute demonstration of a Gestalt session with the instructor, a seasoned therapist whose gentle approach I found tremendously appealing. So appealing, in fact, that I ended up spilling my guts in front of a group of strangers. This was not a roleplaying scenario but a real, live mini therapy session; the therapist was being authentic, so I was too. I told him, in front of a dozen other attendees, the truth: that I am considering a psychotherapy practice at the same time that I have begun coming out very publicly as a consumer of mental health services.
I am hardly the only provider of mental health and related support services in recovery from a psychiatric condition. I am passionate about the movement to alleviate shame and stigma around mental illness, and because of this, I want to encourage ongoing open dialogue about the idea of peers as providers.
I can’t lie: I had a moment of panic when my initial article about my use of psych meds went live. It had, of course, occurred to me prior to writing or submitting the piece that anyone who Googled me could access this deeply personal and potentially damning biographical information. I decided to charge ahead anyway in spite of my fears that the article’s publication would present obstacles to advancing in my career. “Did I just make a huge mistake?” I worried on the day it was published.
I am going to answer my own question with a resounding NO--not only because many of my fellow NYC-based social worker and therapist friends saw the article and provided encouragement and reassurance, but because so many of them ended up disclosing as well. I was hardly under the impression that taking antidepressants, mood stabilizers, or anti-anxiety drugs is uncommon. What I hadn’t realized was the number of people I know who are struggling with their own histories of emotional or behavioral difficulties and are also clinicians themselves. And that’s because we never talked about it. Until now.
I chose to study social work because its holistic approach to formulating interventions with individuals, families, groups, and communities and its relatively progressive code of ethics resonated with me. At its best and most competent, social work practice promotes empowerment among and support of marginalized communities. It encourages us to question the cultural norms that disenfranchise certain populations, and it helps us connect individual hardships to a bigger picture: the institutionalized systems of oppression and privilege within which our society operates. (What social work practice looks like at its worst, meantime, is far beyond the scope of this article! So I’ll stick with sounding idealistic for the time being.)
I love the ideology behind the day-to-day work of building relationships and effecting change. That’s why I pursued an MSW with a concentration in Community Organizing rather than a degree in clinical psychology, mental health counseling, or marriage and family therapy.
I will always be an activist; still, I hold in high regard the therapists who, whatever their educational backgrounds, are “in the trenches” with their clients every day. Far from diminishing the importance of the work they do, I admire it and am very grateful to participate in my own regular sessions with a competent therapist I trust completely. That being said, I am committed to helping build upon peer-based movements and incorporating lessons from mutual aid endeavors into my career.
I have learned from my work with the NYC Queer Mental Health Initiative, an all-volunteer LGBT peer support network, that it is entirely possible to hold space for clients while being authentic about our own lived experiences, and without “othering” the people sitting across from us (or next to us) talking about their problems. I am wary of feeling pressured to compromise my authenticity for the sake of maintaining someone else’s definition of professionalism--a loaded concept whose overtones of racism, classism, and sexism are so eloquently described in this article.
I know that my empathetic nature and the counseling skills I have already honed are assets in my field, but let’s face it: I’m an aging punk/goth hybrid, and I’m not great at hiding it. A superficial but relevant example can be made of my tattoos--large and colorful, they cover most of my upper body. I’ve been getting them over the course of twenty years and I will never regret them, but I am cognizant of how they make me stand out in some workplaces (darn, there went that chance to work as a hedge fund manager!). I also tend to be the token loudmouthed queer feminist at the table whenever I venture outside of my little progressive community. Could a decorated and outspoken lady like me ever really be a “blank slate”?
I already know about establishing and maintaining healthy boundaries, trust, and rapport while keeping the focus on clients’ needs, and I bear in mind at all times that our work together is not about me. But I am troubled by the power dynamic and false binary consistently perpetuated by our mental health care system: too often, it’s us versus them, professionals versus patients--othering at its finest. The status quo in our systems of care enforces a hierarchy, and dammit, I don’t like that. My goal, like that of many other practitioners, is to take a genuinely collaborative approach while relying on the theoretical knowledge I have built through my studies and years in the field. This is not unusual--but I’ll be doing this with the caveat that my clients might know I am a peer.
Since my graduation from social work school several years ago, I have attended countless mental health trainings for social workers and case managers. (Despite the aforementioned concentration in Community Organizing, I went into direct client work right after graduation due to the paucity of community organizing jobs that pay a living wage.) I’m not sure I’ve ever heard a trainer acknowledge the very real possibility that attendees themselves are peers.
As a result, crucial topics end up being left out of the conversation. What if we risk overidentifying with clients on the basis of lived experiences with certain conditions, treatments, or psych meds? Why don’t we talk about how to effectively address that? Are we afraid that we ourselves will be viewed as “crazy” by our colleagues and supervisors, and that we won’t be taken seriously as service providers? Is it more socially and professionally acceptable for, say, addiction counselors to be open about their own paths to recovery from drug or alcohol use while they are seeing clients, and if so, why?
Failing to acknowledge that discussions of trauma can hit home for workers, not just their clients, is a misstep. I can’t recall any trainer or workshop facilitator ever giving a “trigger warning" when the topic of suicidality is broached. Yes, I know well that life does not and cannot come with a trigger warning, a content warning, or even a “viewer discretion is advised.” But suicide is a game changer and one hell of a delicate topic for mental health professionals and laypeople alike--especially among LGBTQ individuals, many of whom have been traumatized by suicide loss or survived a suicide attempt.
I was aghast when a former supervisor of mine scheduled, without notifying me, a suicide prevention workshop for my department just a couple of months after I had lost my own partner to suicide (I’m giving a trigger warning of my own before you click that link; it’s intense). She knew what had recently happened to me, so my jaw dropped once the topic was announced and the discussion began. I got up and bolted from the room to avoid bursting into tears in front of the whole team.
The fact of the matter is that I'm just not a very private person. I have made it a practice to share my stories about moving toward sustainable emotional wellness as a consumer, a suicide survivor, a queer femme, and everything else that I am. Anyone who can get on the internet can access details of my history and my struggles. But that might not be a bad thing.
I remind myself that I am in good company: other mental health professionals have disclosed extensively and stayed in business, so to speak. For instance, a memoir by out lesbian psychotherapist Chana Wilson contains an exquisite level of detail about Wilson’s own difficult past growing up and coming out amid an extremely complicated family dynamic. The extensively published and accomplished psychologist Marsha Linehan developed Dialetical Behavioral Therapy (DBT) as a treatment for borderline personality disorder--which she revealed that she herself experiences. (How powerful is it to devise your own treatment modality?! Talk about DIY!) Psychiatrist Dr. Kay Redfield Jamison, an expert on bipolar disorder, went public in a memoir detailing her own experiences with depressive illnesses and a suicide attempt. And the list goes on.
So maybe my disclosures can sometimes work in my favor. A client who is struggling to make sense of her life after a loved one’s suicide will know she is in good hands with me; a client who has struggled with a mood disorder like dysthymia, cyclothymia, or bipolar disorder may seek me out for a consultation. I’ve been there, done that, and I’m not afraid to share that fact. I think it would be pretty cool if that translated into my clients not being afraid to share, either.