Even Therapists Have Guilt!

From the desk of Dr. Jonathan Lasson

Dr. Jonathan Lasson:

Therapists are Human: The Experience of Guilt from a Therapist’s Viewpoint

The phone call came from a rabbi friend of mine. “Joe is dead, and they believe it was a suicide.” My reaction was typical for my personality. I asked the rabbi some basic questions, expressed my sympathies without becoming overly emotional, and then I obsessed.

Joe had been a client of mine for close to a year. It all began with some testing required by Joe’s school because he was having difficulty, both academically and socially. The testing revealed that Joe possessed superior intelligence, but he also had a strong tendency to misread social cues. This led to social alienation and feelings of inferiority. Joe was becoming more and more reserved, which concerned his parents to the point of referring him for therapy. His interests had become narrower, and he seemed to take very little pleasure in activities that he once enjoyed. His siblings and friends had also noticed the change but were too afraid or ambivalent to get involved.

It appeared that Joe was improving with process-oriented therapy. In fact, the last time I saw him he looked better than ever. He had a spring in his step, dressed more fashionably and seemed surprisingly calm, which was a stark contrast to the overly anxious Joe whom I had been treating for the past year. I should have taken that as a warning sign, but I made the cardinal mistake that many colleagues in the field make when assessing suicide risk. I interpreted his calm as a sign that he had made a miraculous recovery. In reality, the calm was most probably due to the fact that he had made up his mind to end his life and was now comfortable with his decision.

As a therapist, and I can only speak for myself, I felt woefully unprepared for the guilt feelings that would consume me. I felt I should have done something different, a feeling therapists must confront after something drastic happens like the suicide of a patient. In my case this was certainly true. In hindsight, I second-guessed myself and said all the common things that therapists think about after a suicide. How come I did not recognize the signs earlier on? I should have increased the number of sessions per week. I should have put together an anti-suicide contract. The guilt factor certainly plays a role in a therapist’s life. It can lead a therapist to question his abilities and, in some cases, leave the profession altogether.

Informal conversations with my colleagues have led me to believe that post-suicide guilt is one of the most significant, if not the major, areas of guilt that we experience as mental health providers.

This sense of toxic therapist guilt might be the direct result of unresolved guilt feelings that have permeated the minds of therapists and counselors throughout time. Therapists are humans. We make mistakes. We feel guilty. Giving the wrong advice is almost never an intentional act. However, we tend to second-guess ourselves when things do not work out well for our clients, and we breathe a sigh of relief when our clients improve based on our skillful therapeutic techniques.

Take for example Dr. Tim Smith, a clinical psychologist with over ten years of experience. All throughout his practice, Dr. Smith felt very confident about his abilities and received many compliments and positive feedback from his clients. Then one day he received a call from the distraught mother of a seventeen-year-old girl who was hospitalized after she overdosed on barbiturates. She later died after not waking from her comatose state. A suicide note was left in her bedroom. The mother was calling to inform Dr. Smith of her daughter’s passing, and she wanted to reassure him that there was nothing he could have done to prevent her daughter’s suicide. She just wanted to thank him for trying. It does not always work out that a parent will call to assuage the guilt of the therapist. However, most therapists will experience a guilt that is similar to PTSD with flashbacks to previous sessions and the compensatory actions that follow the obsessive thoughts that are often self-destructive in nature.

In short, therapists have emotions just like any feeling person. We experience guilt. We experience sadness. We experience loneliness. When I first entered the mental health field, I was told a ‘truism’ that psychology is a lonely profession. Years later I can attest to that truth. Therapy can help even for the most seasoned therapists.

Dr. Jonathan Lasson is an adjunct professor of psychology and is in private practice in Baltimore, MD.