I have used a variety of therapeutic orientations in my psychotherapy practice behavioral, cognitive, brief, client-centered, psychodynamic, humanistic, and family systems. The list goes on, spanning more years than I care to admit. In helping clients to deal with difficult issues, I have added self-disclosure to this list. This serves to underscore that someone else has experienced what they are
going through and encourages empathy between the client and therapist. The client feels understood without feeling “one down.
To some in the field of psychotherapy, the idea of equality and therapist self-disclosure is antithetical to good treatment. I know, because in the past I numbered myself among those who believed this to be true.
The latest evolution in my thinking, therefore, came as a complete surprise to me. As a wounded healer with a history of manic depression going back 30 years, as I became more comfortable with my recovery, I was able to bring this area of expertise to the treatment of others who also have mental illness. I recognize, and clients confirm, the helpfulness of working with a therapist who has been through what they have been through. It is one thing to understand how psychotic thinking impacts one’s ability to make rational decisions; it is quite another to know how the thought impacts one’s logical thinking.
Recently, I was asked by a client to speak to a court evaluator regarding the client’s visitation rights with his children. The client needed a place to sort out mixed feelings about his ex-wife and his role as a father. At one point the evaluator asked if we were doing any “deep work.” I had difficulty expressing that the client needed a place to sort out mixed feelings, not to delve into the deep recesses of his unconscious mind. I felt intimidated by the expression, “deep work.” Because we as therapists cannot seem to move past the status quo and the “tried and true,” I felt uncomfortable with my belief that wider self-disclosure and equality between therapist and client benefits treatment. Today, as described in the following case, my discomfort at self-disclosure has disappeared:
John, age 32, has had anxiety most of his life. He was acutely shy and would be diagnosed today with social phobia. In his early 20’s John began to experience panic attacks and became phobic to most social gatherings. He had few friends and was becoming increasingly isolated. We began therapy by cultivating a conversational dialogue. Though mundane, reporting daily details helped John to talk about himself in a manner that was non-threatening. As he became more comfortable, he gradually began to share feelings of how he felt about himself and his difficulty living in this world, shut off from others. I shared with him my own confrontations with myself at a younger age, my self-consciousness at social encounters, and the discomfort of trying to engage in and maintain conversations. I expressed to John several ways I had confronted my anxiety, suggesting he might find ways of his own to do the same, as we delved deeper into his emotional life and the beginnings of his difficulty with anxiety. My honest input of similarities between us dovetailed with his growing need to understand what happens in others so afflicted. He came to understand there are those who experience life in the same way as he and still find ways to cope. Our relationship began to signify his resolve to venture into the world on his own.
Today, John has been able to conquer his demons. Being able to share with him not only my past history, but my emotional experiences as well, has enabled him to let go of his fears. He realizes his fears are only as big as he has allowed them to be.
Self-disclosure and equality, along with a sense of connection and oneness, merge to create change. If allowed to emerge, clients bloom in an atmosphere of mutual give and take.
I get something from these relationships as well. I am transported to a mindset that is uplifting and satisfying. I feel fulfilled. This is not only important to my personal well-being, but it enhances my work as well. I have learned that as therapists, we listen. The question is, how do we respond?
The Bipolar Therapist: Speaking Out About Speaking Up
Wounded Healer - The Bipolar Therapist
My article below as originally published for BP Magazine and they were kind enough to let me share it here on my blog.
Wounded Healer
I am a therapist. And I have been there.
I have seen the images of grandiose creations and experienced ever-evolving thoughts. I have believed myself to be the recipient of special knowledge deeded to me by God and have woken up morning after morning vigilant to the possibility of attack by inner voices of terror. These mornings, times of resignation to the voice in my head that would have me believe I was holy, has left me gravely disappointed. I was not holy. After exhaustion from hours of dancing to the tune of mania, I have been engulfed in despair, the likes of which I’d never experienced, much less believed possible. Exaltation followed by crassness, then the belief that suicide was the avenue that would bring me home
Diagnosed with bipolar disorder more than 35 years ago and on medication without an episode for 24, I have a perspective of what works and what doesn’t. Still, sometimes it is hard for me to know who is the client and who is the therapist.
Nowadays, I deal with symptoms as they appear. Residual and brief, periods of melancholy generally don’t last long, but anxiety has become a regular visitor. After 35 years, I admit its existence and do my best to ignore it. When that doesn’t work, I meditate.
Getting better takes work. Persistence is the name of the game. When I hear clients voice their frustrations about an issue they are working through, and the anger and discouragement it engenders, I am reminded of my own past. I sometimes visit that “me” through clients’ present experiences. Recovery from major mental illness isn’t for sissies. It takes determination and the refusal to take no for an answer. What irony that the ones most likely to be sidelined for life are the ones who often need the greatest strength. It’s a lifetime pursuit, a path to the heroic.
I sit at my desk and review my case notes for the day. It’s a quiet time, a time to reflect. I am tired after a full day of sessions, yet, alert to a sense of satisfaction. My clients compose a chapter of my day, my life an image of connections made with others who share a common bond. It’s something I carry with me at any given time. Thinking back on my day, each client is a memory of an earlier memory – mine. Having bipolar disorder myself, I have lived much of what they are going through, and mercifully, have survived. The recovery of others helps me with a recovery of my own.
A draftee during the Vietnam War, I worked as a social worker/psychotherapist. It is only by chance and genetics that this psychotherapist later became ill. I did not come to this field in sickness, but in health.
When working with my clients, one of my strongest tools is self-disclosure. They’re more likely to feel heard by a therapist who is aware of how it feels from the inside. I am a “wounded healer.”
Fragile, I know I could regress at any moment in time. My empathy is tempered by my judgment and experience. Continuing to strive for understanding keeps me motivated to learn more. Thanks to the sheer volume of clients I have treated along the way who have taught me so much and helped me correct my mistakes; I have become a better therapist.
Recovery can follow only after hopelessness has brought acceptance. The decision to recover - and that’s what it is - a decision, must be made by the individual. When the final struggle to accept is made, only then does treatment begin and with it, hope and help from others. We need to confirm our worst fears: “We have a problem, and it isn’t going to go away.”
I love the normalcy I live. It sustains me. Bipolar disorder once made a shambles of my life. I now strive to accept the miracles found in the mundane: a flower’s scent, the touch of a loving wife, a clear thought, a client’s smile. I don’t have to be manic to experience the thrill of life. I have merely to be present in its moments
Donald Kern is a licensed psychotherapist practicing in Woodland Hills, California. He has recently written Mind Gone Awry (Kern/Isaac Nathan Publishing, 2007) a bipolar memoir available on his website: Kerntherapy.com or at Amazon.com. He can be contacted at info@kerntherapy.com
