To be a psychotherapist takes years of school and a lot of reading and writing about various aspects of human behavior. Many students fresh out of school with not much patient contact or real therapeutic hours under their belt, think that they fully know what it is like to be a therapist. They don’t. While school and books definitely prepare you for sounding like a trained therapist, nothing but real experience and hundreds of hours of patient contact, can prepare you for even the basics of what it’s like to be a therapist.
Many people who see me doing my job say, “I want to do that” and I never discourage them. I just tell them that if they are doing it from their hearts then they should pursue it. If they are doing it because they think it pays well, then they should seek another career. If they are doing it because it looks easy, then they should definitely seek another career. Even students who have spent years in undergrad and then graduate school are disillusioned and thus disappointed when they actually start seeing clients of their own. A few, those meant to truly be in the field, will love it, even when it’s frustrating. Others will hate it, but stay because they’ve fooled themselves to believe they are supposed to be therapist, and most end up becoming very bad therapists… or program directors. A large portion will leave the field altogether and seek employment that is more fulfilling and they should.
So what are the things that school and books can’t prepare you for when it comes to being a psychotherapist? Well I will cover one topic every now and then instead of trying to cram a top 10 list, but we’ll start with mental fatigue.
Being a psychotherapist is exhausting. Sure it’s not the same as lifting bricks all day, but it’s a different kind of exhaustion. People will say, all you do is sit and listen all day, how can that be exhausting. Well actively listening, being thoughtful, sustaining alertness, using your memory and paying attention to someone for 50 minute stretches throughout the day is very draining. Not to mention the stories you hear and have to process. Stories that are sometimes so sad that you have to hold yourself back from tears, or stories that trigger counter-transference issues because they remind you of some part of your own life.
There is also other things that make it taxing such as doing notes, scheduling, dealing with insurance companies and billing. There’s also that part about managing risks, having to figure out how much of a risk someone is to themselves or others. My main job right now is assessing suicidality in inmates who have exhibited a risk for suicide. It can become very stressful.
On top of that, sometimes your friends and even strangers who meet you and find out you’re a psychotherapist will treat you differently.
Strangers will either be fascinated and want to tell you about their problems, or a “friends”, or they will not talk much out of fear that you are always analyzing people. We do know how to turn it off, well at least turn it down. Your friends will most likely have you as their default free therapist, yet will not offer you much advice/help since “you’re a therapist, you should be able to figure out your own problems.” Oh, I’ve heard that too many times.
It can be exhausting because being a therapist, once you’ve done it long enough, becomes who you are. You don’t leave it behind at 5pm, even when you think you do. It’s always there with you and if you aren’t careful and don’t take care of yourself, it will drain you.
The link below is to a very well written article that details some of the hardest and most exhausting parts about being a therapist.
Licensed Mental Health Counselor 
I can’t imagine a more mentally exhausting job than actively listening to people all day long. It’s easy to understand how one would experience mental fatigue, perhaps followed closely by a cynical view of humankind.
Thank you for taking the time to read and respond. I do see many therapist who develop a cynical view of humankind as you said. I tend to not believe people very much when I first meet them, which at times has put me at odds with my girlfriend because I don’t “like” most people until I truly get to know them because I know the mask and lies, conscious and unconscious people tell and display initially. I second guess almost everything they say until proven to be correct. It’s dangerous both ways. Some of my new employees are fairly green when it comes to working with the inmate population and tend to think that everyone is telling the truth and that they are innocent, when really 90% of the inmates are just manipulating the newbies.
Thank you, Torey, for thoughtfully addressing this conversation rather than glibly skimming the surface. It’s an important topic and one in which mental health professionals in training need to be better prepared for. I see too many potentially gifted therapists leave the field, as you not, because they were not introduced for this aspect of the work and not adequately “suited up” for the experience. Without the knowledge recognize the impact and without the tools to manage the the stress of our work, every mental health professional is vulnerable to making poor choices, struggling with those consequences, and even leaving the field disillusioned.
And, thank you, thank you for linking back to Amy Flaherty’s guest post on my blog Private Practice from the Inside Out! It’s how I’ve discovered your blog here. I look forward to learning from you, networking with you, and sharing what I know, too!
Hi Tamara, thank you for such a professional and thorough response. Amy’s post was wonderful.
In my experience, people who would make “bad” therapist have managed to find their way out of direct client contact through being program managers, working for insurance companies or doing some type of career where they do very little therapy. I do cringe when I run across “bad” therapist who are actively practicing, but many of them are still fairly new or are working with a population they aren’t very familiar with. I currently am experiencing a bit of that now. As the director of mental health, I have two new employees, one who doesn’t have much experience dealing with clients and another who doesn’t have much experience dealing with this population of clients (inmates). They both at times do and say things that make me cringe, but I am working it out with them through constant supervision and hope that within the next few weeks some of their bad habits and poor judgments will be diminished.
Thank you, Torey, for thoughtfully addressing this conversation rather than glibly skimming the surface. It’s an important topic and one in which mental health professionals in training need to be better prepared for. I see too many potentially gifted therapists leave the field, as you not, because they were not introduced for this aspect of the work and not adequately “suited up” for the experience. Without the knowledge recognize the impact and without the tools to manage the the stress of our work, every mental health professional is vulnerable to making poor choices, struggling with those consequences, and even leaving the field disillusioned.
And, thank you, thank you for linking back to Amy Flaherty’s guest post on my blog Private Practice from the Inside Out! It’s how I’ve discovered your blog here. I look forward to learning from you, networking with you, and sharing what I know, too!