Academic journal article American Journal of Psychotherapy

When the Therapist Is in Crisis: Personal and Professional Implications for Small Community Psychotherapy Practices

Academic journal article American Journal of Psychotherapy

When the Therapist Is in Crisis: Personal and Professional Implications for Small Community Psychotherapy Practices

Article excerpt

Nine years ago our son was seriously injured; our lives, previously so private, suddenly became very exposed. As a therapist in a small community, I do not have the luxury of much privacy or anonymity. When I experienced this sudden crisis, practical and psychodynamic issues came into play in my therapeutic relationships. My husband and I each have private practices with offices in the same building and previously also in our home. We faced new challenges while attempting to provide for our clients and care for our son. There were issues of coverage for our practice, how much information about our crisis to reveal, and coping once we felt ready to return to work. Likewise, we have colleagues who have also experienced turmoil in their personal lives from serious illness or addiction, death of a spouse, or divorce. This article is a result of conversations with some of these colleagues as well as our own experience. The article addresses the issues therapists struggle when in a crisis, such as losing privacy, setting limitations on work, handling client reactions, and becoming aware of and managing feelings and behaviors when one is vulnerable. It also offers suggestions to therapists for preparing to meet client needs in the event such crises arise.

KEYWORDS: small community; coping; crisis; privacy; preparedness


Most of us will face personal crises at some points in our lives. Going through personal crisis as a psychotherapist, especially in a small community, can present special challenges. This article addresses the issues that arise in the course of facing personal crisis and is based on our experience and those of some of our colleagues. Some issues are practical: how clients are contacted to cancel appointments, how much information to reveal about the crisis, how to arrange for coverage, and when to return to work. Other issues stress therapeutic skillscoping with difficult clients when we ourselves are in pain, handling client anxiety, anger and dependency, plus managing our own reactions as we strive to do our jobs while grieving and being vulnerable.

My husband and I have been psychotherapists in a small community for the past 30 years. David is a social worker, treating individuals and couples, and has worked in several community agencies, including at our local hospital as Director of Social Work.

I am a psychiatric nurse practitioner in a full-time private practice, providing talk therapy and psychopharmacology. My practice is based on a bio-psycho-social model and clients entering treatment are evaluated not only for their presenting problems, symptoms, and history, but also for thorough medical history, assessment of current physical problems and medications. If necessary I order blood tests and encourage up-to-date physicals as needed.

In therapy sessions the focus is as much on a client's current social context, nutrition, substance use, exercise, as it is on other coping strategies, past traumas and family history. My training and clinical experiences are within a psychodynamic framework. I work within the context of an Interpersonal Psychotherapy model, initially developed by Gerald Klerman and Myrna Weissman (1993) for clients with depression. This fits well with my practice population. I engage each client in an empathic relationship that promotes trust, self-awareness of moods and behaviors, and positive change. Treatment is "solution focused," using the "possibility" approach of therapy as developed by Bill O'Hanlon and others (1999), which emphasizes problem-solving in the here and now.

I see clients with depression or other mood disorders more frequently at the beginning of treatment and then less frequently for maintenance and relapse prevention. I view my role as an educator and collaborator with my clients; we partner in planning their treatment and improved well-being.

Because my therapeutic role with many of my clients focuses on being a health educator, my small-community based practice is not quite as impacted by boundary keeping as a practitioner providing long-term psychotherapy, yet keeping boundaries is always an issue. …

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