You Can't UN-know Unless You Have Dementia Or Are Defending

I've been thinking a lot lately about how to have healthy boundaries with friends when you are in the helping professions. This is a particularly tricky thing for people whose trade is in listening and communicating, and even moreso for women, whose often trade socially in the same thing. When your job is being there for others it can strain friendships that are based on being there for that friend. Many of us in the helping professions find ourselves there for a reason. It usually has something to do with the fact that being there for others comes naturally for us. Many of us have been the "go-to" person in our families and with friends as long as we can remember. It might be so much a part of us that we never even consider the fact that we have a choice about it.

That is, until we start taking on our clients and seeing the similarities between them and people that we care about in our personal lives. Sometimes our clients will provoke reactions in us (COUNTERTRANSFERENCE) and we are trained to always be aware, always questioning, always seeking supervision about our own countertransference reactions. This is important because as a clinician, it's unhelpful for me to muddy the waters of therapy with my own provocations. So it appears that there are mechanisms built into the profession to prevent this from happening (as much as is humanly possible). When it does happen, we're trained to bring it up and deal with it withing the therapeutic dyad. We clinicians are always talking about our relationships with our clients because they are a stage wherein the client plays out past and current relationship problems that plague them.

But what about the other direction? If we have mechanisms in place to protect the client, why are there not similar mechanisms in place to protect the clinician? I don't mean supervision for how the therapeutic relationship affects us. What protects the clinician from carrying what they learn in courses, practica, and therapeutic experience back into their own personal relationships such as those with their family, spouses, and friends?

My training in therapy and my own experience as a therapy patient has taught me to actively listen, to carefully consider the usefullness of anything that I say, and to be hypersensitive to diagnostic issues as well as defense mechanisms. This is stuff I really can't un-learn. I've practiced it so much that it's a part of me, the way a virtuoso violinist feels the instrument is part of his or her arm. The difference is that the virtuoso can put their instrument down. I can't put my brain down. It comes with me whereever I go and whatever conversation I enter into. And so when a loved-one approaches me to talk about a personal problem, I have two -tracks running in my conscious brain: the one that responds like a normal human being and friend, and the one that gets a running commentary of "shrink think." Before I entered training, I thought that it was SO COOL that I was analytical and insightful and a good listener. People appreciated it and sought me out to talk about their problems and I felt special. I had a place in our little community that felt shammanistic and wise-womanish, and really fed my naricisstic longings to be important and wanted. Then I started training and practiced for almost 10 years. I honed my skills and refined my art. Like all little, anxiety-ridden, high-achievers, I practised self-care with the same dedication and discipline with which I studied. I began to notice that I had all the patience in the world for my clients -- even the ones who were "stuck," or "borderline-y."

But friends and family started to drain the life out of me.

Not all friends, not all family, mind you. There seemed to begin to emerge a delineation among the people I know and care about. There were those who "got it" and those who didn't. Those who "got it" noticed my stress levels and inquired about them. They seemed intersted to know what the stress of grad school was like and how I was coping. Our conversations ebbed and flowed in terms of who needed support. But most of all, the ASKED before they began a emotionally draining conversation if I had the reserves to listen to them or if it was a good/bad time for that kind of friendship activity. Those who did not "get it" continued to talk, talk, talk at me oblivious to the signs that I was flagging or unable to cope with being there for them in that moment. I realized that I had to do something about this or I was going to start resenting some of the people I cared about. So I did what most therapists do; I opened up a discussion about our relationship and attempted to articulate my needs while still respecting the other person's feelings and needs for support. What I needed people to understand was that I love them, care about them, want them to be happy, and yes, even want to be there for them. Because of the work I do, and particularly when my own emotional resources are low because I am experiencing my own personal troubles, I can't always martial the psychological stamina to be there for them in a way that mimics or takes on elements of therapy.

We often talk in therapy about the consequences of setting boundaries. When people make changes in their lives (hopefully for their own health), it means that relationship with others can change. I often talk to patients about how they may be surprised at who cheers on their changes and who protests them. After all, we've been relating to people in a certain way for a long time. People are going to notice the change, even if they can't articulate it. Some people will have been wishing for us to change and others may have really liked how they could relate to us pre-change. And who will react like what is often tricky to predict. Most people are living in transference most of the time and so not necessarily in possession of the self-awareness to think of what they bring to a relationship and not necessarily secure enough to accept that another person's change is not necessarily about them.

In the past little while, I've been attempting to talk to the people in my life that I care about to let them know that boundary-setting is something that I need to do to be healthy while I do my job as a therapist. Some of them really get it and we've had some fantastic discussions about how to navigate tricky situations and recover from misunderstandings and misteps. A few people have completely shit on my head about it. Ha, I recall when I had a miscarriage back in March and I was trying to explain to a friend that I was too "out of it" to listen to her (the miscarriage had just happened a week previously). This was the first time the friend has heard about the miscarriage and she said, "Yeah, yeah, but I really need to talk you. I'm very upset!" I can laugh about this now, but at the time, I was frozen -- unsure if I was going to cry or punch her in the face.

The things is I CAN'T UNKNOW what I know about being a good therapist. When a loved one tells me something personal, my brain automatically starts churning through what I know about their history, their personality, their habits. I start making connections and wanting to point out insights as they occur to me. But that's what a therapist does. Unconditial positive regard, kind honesty, utmost reliability. I can do those last two things in a friendship or family relationship. But I struggle with unconditional positive regard. I don't want to react to my friends in a therapist-y way, yet I can't unknow what I know about what would be helpful when someone comes to me with a problem! So what is a therapist to do? Therapy relationships are one-way streets. The therapist is there for the client and NOT the other way around. But friendships should go two ways. What happens when one person in the relationship cannot tolerate that? Or worse, their defenses are so high and thick that they can't even see that this is a problem? We can UN-know things when we are defensive. Things that are too psychologically painful get shoved down, repressed, denied, transfered, projected to the point that the person defending literally cannot access the defended-against phenomenon in their conscious minds. And recently, I learned first-hand that people with dementia can also UN-know things that they previously knew. I learned this when my father didn't recognize me anymore when I visited him before he died this summer. But I can't pretend that I don't know how to be a good listener or see a connection in a friend's talk and behaviour.

So the question becomes what to do about what I know. One idea is to set it aside when talking to friends. To give myself permission to react like a friend and not a therapist. I struggle with this because sometimes my friend reaction is the complete opposite of helpful. Sometimes I want to say to a friend, "Go fuck yourself, you're being a douchebag." But I know that's not going to help the situation. Sometimes I can edit it down to something less reactive like, "I'm feeling really irritated by what you are saying and that makes me think that I don't have the resources right now to listen to you. Can I call you in a day or two when I'm feeling more refressed?" But that sounds so weird and forced "holier-than-thou."

Huh, do you know it's actually written in our college (Psychologist) ethics that we are supposed to hold ourselves to a higher standard than the rest of society in terms of how we conduct ourselves personally and professionally? No pressure there. I think we need to be taught, mentored IN TRAINING, IN CIRRICULA, to navigate these social difficulties and be prepared for the fact that some of our relationships may not survive our training. As far as I know, there is no written theory on navigating boundaries with personal relationships as a psychologist. And it's so tricky! Think about it. If I were a registered massage therapist, I could tell my friends not to ask me for a massage because I do that at work all day. Just like I would expect not to have friends demand me to look at that rash on their back if I was an MD, or do their taxes for free if I was an accountant. But massages, medical checkups, and taxes are not the currency of social relationships. Talking, listening, communicating is! And we naturally bond over discussing intimacies and supporting each other. And I don't want to have friends who never share anything personal with me! So where should this line be for those of us who communicate and support others for a living? THAT is the course I want in grad school. But there isn't one.

So I guess I need to either write it or find a really awesome mentor.