Challenges in Making a Sustainable Living as a Therapist

What are the emotional/psychological factors that limit a thriving practice for therapists (and helping professionals generally)?

Preparatory considerations for workshop in Brighton on 4 July 2015.

• Most workshops for therapists on this topic of making a living focus on the actual business skills needed, or on your own ambivalence about charging money (self-worth).
• The decisive factor for making a living as a therapist: what is the EMOTIONAL cost of the therapeutic position in an ‘impossible profession’?
• How do the relational dilemmas (necessarily) inherent in the work affect the therapist’s well-being? How do we absorb, process and ‘compost’ emotional material?
• How does the particular intricacy of each client-therapist relationship hook into the therapist’s ‘habitual position’ and become exhausting?
• Therapy as the impossible profession is potentially demanding and exhausting ALL the time, but the issue becomes most obvious around frame and money negotiations.
• The impossibility of therapy manifests in meta-level discussions & struggles: questions of whether, how, why therapy works (or doesn't) and its frame and boundaries.
• How do you answer the question whether the client’s investment into therapy will be useful & worth it? Somewhere between priceless and useless!
• How do you then work out the level of fees you charge (fixed or sliding scale), and how do you present that to clients (especially those who expect to pay by the minute, as for a lawyer)?
• How do you respond to clients who challenge your sincerity by saying: “You only care about me because of the money I pay you?” – and is it true?
• How do you respond to a client who accuses you of ‘emotional prostitution’, or who protests against their dependency on a professional ‘selling love’?
• How do you deal with clients’ requests for reductions in fees or changes to the weekly frequency of sessions which are inconvenient to you?
• When clients are thinking about terminating, to what extent do you think about their process or about the income you stand to lose (it’s uncomfortable, but true that it does happen!)?
• How do you handle clients ‘getting worse’ as a necessary part of the process, and how do you communicate that to them, and negotiate the fall-out?
• How do you understand and respond to breaks in the working alliance or thresholds in the process, which manifest as an attitude of ambivalence in the client and their commitment to therapy?
• When a client is complaining and protesting, how can we understand deeply what perception and experience the client has of therapy, and what unconscious constructions may be involved?
• How do you negotiate arrangements and contracts with clients that are safe, consistent and reliable as well as doing justice to the client’s individual needs, requirements and situation?
• How do you get beyond simplistic frameworks and business models borrowed from other professions, and find a practice and arrangements that suit you and the work of therapy?
• How do you process the subliminal bodymind impact of the therapeutic relationship on yourself, including vicarious traumatisation?
• How do you inhabit your own wounds when they get touched upon by the client’s process? What if being a therapist IS part of your wounding?
• Harold Searles suggested more than 70 years ago that one of the most difficult issues of therapy is the therapist’s mother transference onto the client.
• The bodymind process of the therapist’s ‘habitual position’ – the way they inhabit the therapeutic position – is the most critical factor in a sustainable practice.
• The therapist’s ‘habitual position’ is a mixture of their character style incl relational patterns, their own therapy and training and supervision/CPD.
• How a therapist ‘constructs’ therapy – consciously and unconsciously – through the lens of their own childhood scenario and family system affects how sustainable their practice becomes.
• The therapist’s ‘habitual position’ influences how fully I can engage the inevitable and necessary conflicts of therapy, and how I am able to process these conflicts.
• As a therapist I need to fully and openly engage the client's conflicts intersubjectively; my mirror neurons ensure that I will absorb these.
• Processing the conflicts I engage and absorb depends on my ‘implicit relational knowing’ and my bodymind process – my embodiment - as a therapist.
• How can I generate spontaneous AND reflective, embodied AND imaginative space to maximise the processing of intersubjective conflict?
• How can an understanding of the paradoxical nature of therapeutic enactments create more space within the therapeutic position?