Acad Psychiatry DOI 10.1007/s40596-014-0259-8
FEATURE: PERSPECTIVE
The Trials, Triumphs, and Tribulations of a Therapist-in-Training Arpita Goswami Banerjee
Received: 15 October 2014 / Accepted: 11 November 2014 # Academic Psychiatry 2014
It was summer of 2014. After completing 2 years of residency training, I was about to embark on my outpatient psychotherapy practice. It had been a rigorous 2 years, transitioning from my role as a brand new psychiatry resident, grappling with the nuances of a new health-care system, the Philadelphia accent, intense inpatient rotations and night floats to that of psychiatrist whose world was segregated into compassionate, thoughtful hours listening and trying to help people come to a deeper understanding of their lives. As I sat down with my colleagues and clinic supervisors in the Tabor Road office, we would be sharing, my supervisors went over the filing systems, billing procedures, and ethical issues like protecting confidentiality, therapist-patient boundaries, respecting patient’s autonomy, signing informed consent and reminders—‘document, document, document.’ But never discussing how I would get these clients. I fully assumed, in what now seems like a wondrous fit of naïveté, that I would make phone calls to the clients, greet them with the appropriate expression of concern and eagerness, and they would come. Except that they did not. A few days after setting up my office, infusing tranquil professionalism into the tiny space—the fresh plants, the abstract art on the walls, and the box of tissues—I waited for clients to call back. A week passed and my appointment book looked particularly dismal. Gradually, the clients started filtering in and so did my mounting excitement about testing my skills as a therapist. As I greeted my first client in the clinic, the words of one of my mentors reverberated in my mind—‘Remember you already know a lot about supportive psychotherapy, you have learnt it from your parents, teachers and friends and it has helped you to come this far in life.’ Yes, I know supportive psychotherapy, I A. G. Banerjee (*) Einstein Medical Center, Philadelphia, PA, USA e-mail: [email protected]
have people’s skill, I will be able to ‘help my client.’ Little did I know what was in store for me behind the closed door of my little office! My client started talking about the losses in her life, breaking down completely in a tearful rhapsody. My reaction? I jumped up from my chair to offer her the tissue box, ran out of the room to get her a glass of water. My discomfort was written boldly on my demeanor. Discussing the incident with my supervisor, I was enlightened about my presumably appropriate ‘knee-jerk reaction.’ It had made me overlook useful information I could have gained if I had identified the transference. In this case, my client was conflating me with her prior therapist, who had transferred her few weeks back. A few instances with my clients have been particularly humorous. A brown-haired client came to her second session wearing a blond curly wig resulting in my overlooking her in the waiting area and asking the receptionist about my patient. ‘Doc this is me you are asking about.’ And I looked at her again, doubts creeping in my mind—‘is this the same lady who had straight brown hair when I first saw her?’ Another client pointed out to me that I was wearing my cardigan inside out. How do I react? I decided to react the natural way, bit embarrassed and then laughing it off, thanking the client for noticing. Or the Albanian client, whose surname was difficult for me to pronounce. She reassured me—‘I understand doc, I am a foreigner in this country too and we have difficult names.’ And the kid I was having difficulty connecting with, in my initial session, offered me a cough drop candy when he saw me coughing! I was hesitant at first—am I crossing the boundary in accepting the candy from an innocent kid? But my humane self rose above my professional one and I accepted the candy and thanked the kid. That helped in cementing our therapeutic alliance in the subsequent sessions. During our introductory courses on psychotherapy, one of my mentors taught us ‘Structure binds Affect’ which means that a formal structure of the 50-min session works well to
Acad Psychiatry
give people a designated space and context in which to delve into difficult issues and then leave safely, without wounds exposed. When I started a session, I faced a big stumbling block—how do I structure the sessions? Should I set the agenda and start with focusing on the client’s goal or should I be the passive listener to better understand the intricacies of my client’s sufferings? I struggled to transition from an ‘active advisor’ to a ‘passive patron.’ Two months into the outpatient practice, I have managed to book a few weekly clients back to back, so that when the pager beeps indicating the arrival of my next client, I feel a sense of achievement that I labored so hard for. My clients engage in their sessions, some easily finding ways to connect, while some holding themselves back. I discovered a sense of im-
mense gratification in my work, getting attuned to all the subtle suggestions and gestures at play in an ongoing, face-to-face therapeutic session—helping people understand themselves better so they feel less alone, suffer less, and feel stronger. I know that being a therapist is not about having the right tools and the right words to say that would make someone feel better. It is about being able to stay truly present and accepting of someone else’s pain or fear, and that staying connected in hard moments is healing. A Jewish proverb comes to my mind when I describe my work as a therapist—‘I ask not for a lighter burden, but for broader shoulders’—learning from various life events of someone’s journey as they broaden their shoulders, and walking along beside them, is a rich and rewarding experience for me.
FEATURE: PERSPECTIVE
The Trials, Triumphs, and Tribulations of a Therapist-in-Training Arpita Goswami Banerjee
Received: 15 October 2014 / Accepted: 11 November 2014 # Academic Psychiatry 2014
It was summer of 2014. After completing 2 years of residency training, I was about to embark on my outpatient psychotherapy practice. It had been a rigorous 2 years, transitioning from my role as a brand new psychiatry resident, grappling with the nuances of a new health-care system, the Philadelphia accent, intense inpatient rotations and night floats to that of psychiatrist whose world was segregated into compassionate, thoughtful hours listening and trying to help people come to a deeper understanding of their lives. As I sat down with my colleagues and clinic supervisors in the Tabor Road office, we would be sharing, my supervisors went over the filing systems, billing procedures, and ethical issues like protecting confidentiality, therapist-patient boundaries, respecting patient’s autonomy, signing informed consent and reminders—‘document, document, document.’ But never discussing how I would get these clients. I fully assumed, in what now seems like a wondrous fit of naïveté, that I would make phone calls to the clients, greet them with the appropriate expression of concern and eagerness, and they would come. Except that they did not. A few days after setting up my office, infusing tranquil professionalism into the tiny space—the fresh plants, the abstract art on the walls, and the box of tissues—I waited for clients to call back. A week passed and my appointment book looked particularly dismal. Gradually, the clients started filtering in and so did my mounting excitement about testing my skills as a therapist. As I greeted my first client in the clinic, the words of one of my mentors reverberated in my mind—‘Remember you already know a lot about supportive psychotherapy, you have learnt it from your parents, teachers and friends and it has helped you to come this far in life.’ Yes, I know supportive psychotherapy, I A. G. Banerjee (*) Einstein Medical Center, Philadelphia, PA, USA e-mail: [email protected]
have people’s skill, I will be able to ‘help my client.’ Little did I know what was in store for me behind the closed door of my little office! My client started talking about the losses in her life, breaking down completely in a tearful rhapsody. My reaction? I jumped up from my chair to offer her the tissue box, ran out of the room to get her a glass of water. My discomfort was written boldly on my demeanor. Discussing the incident with my supervisor, I was enlightened about my presumably appropriate ‘knee-jerk reaction.’ It had made me overlook useful information I could have gained if I had identified the transference. In this case, my client was conflating me with her prior therapist, who had transferred her few weeks back. A few instances with my clients have been particularly humorous. A brown-haired client came to her second session wearing a blond curly wig resulting in my overlooking her in the waiting area and asking the receptionist about my patient. ‘Doc this is me you are asking about.’ And I looked at her again, doubts creeping in my mind—‘is this the same lady who had straight brown hair when I first saw her?’ Another client pointed out to me that I was wearing my cardigan inside out. How do I react? I decided to react the natural way, bit embarrassed and then laughing it off, thanking the client for noticing. Or the Albanian client, whose surname was difficult for me to pronounce. She reassured me—‘I understand doc, I am a foreigner in this country too and we have difficult names.’ And the kid I was having difficulty connecting with, in my initial session, offered me a cough drop candy when he saw me coughing! I was hesitant at first—am I crossing the boundary in accepting the candy from an innocent kid? But my humane self rose above my professional one and I accepted the candy and thanked the kid. That helped in cementing our therapeutic alliance in the subsequent sessions. During our introductory courses on psychotherapy, one of my mentors taught us ‘Structure binds Affect’ which means that a formal structure of the 50-min session works well to
Acad Psychiatry
give people a designated space and context in which to delve into difficult issues and then leave safely, without wounds exposed. When I started a session, I faced a big stumbling block—how do I structure the sessions? Should I set the agenda and start with focusing on the client’s goal or should I be the passive listener to better understand the intricacies of my client’s sufferings? I struggled to transition from an ‘active advisor’ to a ‘passive patron.’ Two months into the outpatient practice, I have managed to book a few weekly clients back to back, so that when the pager beeps indicating the arrival of my next client, I feel a sense of achievement that I labored so hard for. My clients engage in their sessions, some easily finding ways to connect, while some holding themselves back. I discovered a sense of im-
mense gratification in my work, getting attuned to all the subtle suggestions and gestures at play in an ongoing, face-to-face therapeutic session—helping people understand themselves better so they feel less alone, suffer less, and feel stronger. I know that being a therapist is not about having the right tools and the right words to say that would make someone feel better. It is about being able to stay truly present and accepting of someone else’s pain or fear, and that staying connected in hard moments is healing. A Jewish proverb comes to my mind when I describe my work as a therapist—‘I ask not for a lighter burden, but for broader shoulders’—learning from various life events of someone’s journey as they broaden their shoulders, and walking along beside them, is a rich and rewarding experience for me.
