Jeff Levy, LCSW
Mental Health, Relationships, Trauma, Identity
Jeff Levy, LCSW
(originally posted on Branching Out: The Live Oak Blog, October 2014)
I imagine a record screeching to a halt with that last request. I can hear therapists and intake coordinators around the country struggling with how to best respond.
I imagine some of us will try to deflect that last question and, instead, try to get information about the qualities of a therapist this person may be looking for. Still others may see this request as symptomatic of larger concerns and indicative of boundary issues. I’d like to hope others of us may respond with something like this: “I have a few people in mind. Can you tell me a little more about what’s going on for you?
Sharing Histories of Depression
Warren was a client of mine for many years. He initially came because he was dealing with his elderly mother’s failing health. He was an only child and felt a great deal of stress trying to manage her doctor’s appointments, meals, and day to day support. He wasn’t sleeping and had lost his appetite. He also reported having trouble focusing at work.
“I know this feeling,” he said one day. “There have been other times in my life when I didn’t want to get up in the morning and didn’t want to go to work. Eventually, I felt better, but it took awhile. This time, I don’t have the luxury of waiting until I feel better to take care of my mother.”
After gathering information about Warren’s history, we talked more explicitly about his depression. After some thought, he believed he’d had episodes of depression from the time he was a teenager. Those times tended to be shorter in duration. As an adult, he remembered them lasting anywhere from a month or two, to six months or longer.
It wasn’t just the depression that was troubling Warren. He also felt ashamed. He had a very responsible management position in a large public relations firm and believed others would judge him if they knew he was feeling depressed—even if they also knew his mother was very ill. Despite many discussions, Warren couldn’t let go of his sense of himself as weak or defective because he was having trouble with day to day functioning.
During one session, we were talking about this and I was inviting Warren to be more gentle with himself. “Have you ever been depressed? If you have, you’d know it’s not so easy,” he challenged. I tried to explore further with him his own judgments about his depression when he interrupted me. “You haven’t answered my question. Have you ever been depressed?”
I’ve had people ask me all sorts of things about myself over the years. As a younger clinician, I tended to respond with more questions in part because I had been taught to explore the meaning behind such questions. In retrospect though, I think I responded with more questions as a way to defend myself from answering my clients directly.
In Warren’s case, I really didn’t have to gather more information about why he was asking me this question. He felt isolated and alone in his depression. He didn’t feel like he could talk about it with friends because he feared judgment. In the past, he’d also made statements alluding to my lack of “really” understanding how he felt. I had the sense he discounted some of our discussions because he saw me as “other” and therefore not able to truly understand.
I felt like several minutes passed before I answered his question, probably because I was scrolling through my repertoire of possible responses. “Yes,” I finally said. “I have had times in my life when I’ve felt depressed and alone. “ I felt myself exhale while feeling a mix of relief and vulnerability. “Wow,” he responded. I really didn’t think you’d answer me directly.”
Having the Same Concerns as Our Clients
Circumstances were slightly different with my client, Marianne, who was also a therapist. She had been struggling with mild depression for as long as she could remember, and this was occasionally exacerbated by more severe periods of depression.
Marianne thought therapists with mental health issues should not be treating others who may have some of the same issues. I’d not shared any information with Marianne about my own dealings with depression, but suddenly felt like I’d be discredited by her if I did.
We spent some time talking about this as it related to her concerns about working with her own clients who were dealing with depression. “How can I help them,” she wondered, “if I also deal with times in my life when I feel depressed. I just don’t think I should be trying to help anyone when I can’t help myself.”
I tried to explore this with Marianne through the lens of her expectations of perfection; that if she wasn’t excellent, or perfect, she would be of no use to others. She knew this belief was one of the results of having been physically abused as a child. Intellectually she knew she wasn’t responsible for the abuse, but on a more visceral level, she believed that if she had “been better” the abuse would never have occurred.
Sharing Anxiety With Our Colleagues
I also consult with other social service professionals about clinical and administrative issues. Grace was an extremely intelligent, insightful, and empathic administrator at a community mental health center. As part of her work, she did presentations for staff and board members of the center.
One day she shared that her anxiety was growing. There were times, she explained, before she had to speak in front of a large group, her heart started racing and she got “cold sweats.” Grace heard me speak on a number of occasions. “I wish I could be as calm as you are when you present in front of groups,” she shared. “You always seem so incredibly at ease.”
I smiled. “I’m glad it seems that way from the audience. But as I get older, I notice that I feel more and more anxious before public speaking. Despite teaching for over 30 years, every time I get a new group of students, I don’t sleep the night before.” I saw her shock and relief.
“Are you serious…and not just trying to make me feel better?” she asked. I told her I was absolutely serious, and that I was experimenting with different methods to manage my anxiety before speaking. Together, we talked about grounding exercises and mindfulness strategies before and after speaking engagements.
We Perpetuate Stigma Around Mental Health
It’s much more common and even acceptable, in the substance abuse treatment community, for therapists and counselors to disclose histories of abuse and recovery. And as most folks in recovery will agree, relapse is a part of recovery. I understand that in sharing personal stories of recovery, there is an infusion of hope. This kind of sharing is not as readily accepted in other mental health circles.
Perhaps this idea of not sharing our own histories comes from early psychoanalytic perspectives emphasizing the therapist as a “blank slate.” This idea of refraining from disclosure is supported by many therapists today. I’m often met with cocked heads and frowns when I talk with some colleagues about sharing my experiences of depression and anxiety with my clients.
When the impetus for sharing such information comes from my own desire to share for personal gain rather than to help my client, it isn’t appropriate for me to share. But there’s something else operating here—some stigma that is still attached to mental health challenges—and we therapists continue to perpetuate it.
There is no shame in having anxiety, depression or any other mental health challenge. Yet when we talk about the complexity of identity, or holding multiple identities as we strive for culturally competent practice, we don’t typically invite discussion about how having depression or anxiety might be one of these identities that influences, and is influenced by, our other identities.
Even in my teaching of graduate social work students, exercises around intersecting identities, I seldom include identities related to mental health. We collude by our failure to address these identities and, in so doing, relegate them to a place of shame and secrecy. My students will sometimes share their own mental health struggles with me, but only in the form of a personal journal and, even then, there is usually a qualifying statement: “I feel embarrassed saying this…” or “I don’t know if this is crossing a boundary but…”
When I think of my friends and colleagues who are therapists, almost all are in therapy or have been in therapy, and over half have also taken some type of antidepressant or anti-anxiety medication at some point in their lives. I can tell by our discussions that many of us still have some degree of shame and reluctance to share this part of ourselves, especially with our colleagues who are therapists.
I’m thinking of my therapist client Marianne again, who believes we shouldn’t treat those people who are struggling with mental health issues if we haven’t gotten a handle on those same issues ourselves. I would agree if we are talking about having a mental health concern that makes it hard for us to function or be present with our clients.
I worry though, that by believing we should, as social workers, counselors, psychologists, or marriage and family therapists, have no mental health challenges, or have all our mental health challenges completely resolved in order to see clients, we perpetuate stigma and “otherizing” of our clients.
There is No “Other”
We are them. They are us. There are not people with problems and people who help people with problems. We are all people with problems who help people with problems. There is nothing wrong with that, and nothing to be ashamed of.
I hope we will get to a place where a client can ask for a therapist who has experienced anxiety, or depression, for example, and have us respond without judgment. We don’t judge clients who ask for male therapists, or female therapists, or Christian therapists, or gay therapists.
These client questions are grounded in a desire to be understood in some way. And while understanding isn’t guaranteed when we hold the same (or similar) identities, it is our clients’ right to ask these questions and for us to respond with honesty, respect and empathy.
So, if you’d like to see a therapist who has dealt with depression and anxiety, please feel free to give me a call.
Knowing your own darkness is the best method for dealing with the darkness of other people.
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