Therapists: What it's really like

Each year, I vow I'm going to write a piece of fiction that does not have any therapists in it. after more than 20 years working as a therapist, I suppose I'm a little bored with the whole therapist as character thing. But even when I'm not focusing primarily on my novel-in-progress, in which therapists and clients are my cast of characters, therapists creep into my other work in big and small ways. Therapists fascinate me with their (typically) big hearts, their blind spots into their (our) own psyches, and the magnitude of what they must do each day, not just as people on the front lines trying to help clients with their most serious and personal problems, but as helping professionals working within systems of care which are often dysfunctional and oppressive. And where complex characters meet obstacles and conflicts, therein lies the stuff of great storytelling.

Practicing psychotherapy today is an honor, a privilege, and very often, a pretty bad career choice from a number of practical standpoints.  I continue to do it myself because I love my clients and it has become an inexorable part of who I am; also, because I can now balance it with a writing career, and because I'm at a point in my career where I can do it as a private practice therapist. But before this was 20 years of agency work in a lot of different settings. Agency mental health and/or addictions treatment work is, with very few exceptions, underpaid, undervalued, and structured in ways that neither serve therapists nor clients. As a result, there is frequent turnover and therapist burnout, isolation, and low morale.

If you're a therapist working in an agency setting, you typically have one of two employment scenarios. In the first, you are a low-pay salaried employee who must meet high productivity requirements (how many clients you see per day/week/month). Although you have benefits and are "allowed" sick and vacation days, it's difficult to use them without doubling up on work before and after to make up productivity points.

In the second scenario, you work fee for service, which means you don't have to jump through productivity hoops, but you also get no sick, family sick, or vacation time, and you lose your pay for the hour whenever a client fails to show up.

I have tried both scenarios over the years. Both are difficult in their own way. But when I became a single mother, working this way became impossible.

As I write this, therapists and other human service professionals from a local agency I've never worked with are picketing after months of unsuccessful negotiation efforts regarding terrible pay, unreasonable productivity requirements, and other intolerable working conditions. I feel their pain and frustration and hope they are able to win improved working conditions so they can resume providing services to clients who need them.

We therapists cannot give adequate help if we are not okay ourselves. When a therapist has to face relentless hardship just to do their job every day, that makes for great fiction. But it makes for a less than stellar quality of  life.