When the therapist goes to therapy

I recently watched the TV series “In Treatment" follows Dr Paul Weston, a psychotherapist in his fifties, through his weekly sessions with patients who come from different ages and backgrounds.

The set is strikingly simple, a therapist’s clinic with a comfortable sofa and the usual decoration of books and framed certificates. No outdoor scenes, no car chases, no CGI. We watch Dr Paul navigates the sessions with his clients listening and reflecting, asking the right questions, and providing a safe space. At times he has to restrain his own emotions when a patient becomes hostile or flirtatious, because he knows those feelings are not directed at him but at someone in the patient’s life.

We then see him meet his supervisor and mentor, Dr Gina, who listens to him as he lets down his guard and speaks freely about his emotions, how his clients make him feel, and about how distant he has become from his wife, who tells him that he cares about his clients more than he cares about his family. As a psychiatrist, I felt I could relate to what Dr Paul was experiencing in his daily life and to the way his job affects his personal life.

The series does a great job of displaying the emotional labour of sitting with another person’s pain, hour after hour, and remaining useful. We are trained to notice everything in the patient and almost nothing in ourselves. Burnout among health professionals is rarely dramatic. It rarely announces itself as a collapse but arrives slowly. The clinic list that once felt meaningful becomes a queue to be cleared, the interesting case becomes the difficult patient, and the colleague’s question becomes an interruption. We become efficient yet slightly absent. We finish the day with very little energy, and we tell ourselves this is temporary, that it will settle when more staff join the team, but in reality, it rarely does. There is also a particular kind of stigma at work here.

Those of us who spend our careers persuading others to seek help are often the last to seek it ourselves. Admitting that the work has affected us can feel like admitting incompetence. The truth is actually the opposite. The therapist who has never examined his reactions is the one most likely to act them out, with a patient, with a trainee, or at home. As mental health professionals, we need a listener who is patient and compassionate. In many countries, supervision is often treated as something for trainees which stops them from qualifying. In my opinion, it should be a lifelong thing that is offered by a trusted senior colleague, a peer support group where clinicians can say how their clients make them feel, without fear of being judged.

The series raises a point we rarely address how being a therapist can drain your empathy so that by the time you reach home, there is very little left to give your family. And if one is not careful, the roles quietly reverse. Coffee with a son or a daughter stops being time to bond and becomes an unannounced therapy session, in which the psychiatrist is the one venting or quietly seeking acknowledgement for a good day at work.

In my opinion, A good therapy session differs significantly from a surgical operation. Nobody sees the life we saved, and no one is waiting at home to be told about it.

Dr Hamed al Sinawi

The writer is a senior consultant psychiatrist, SQU Hospital