There are times in the life of a psychotherapist when our own life circumstances or recent events make it difficult or unwise to see clients with issues and needs that come too close to what we are dealing with personally.  Decisions to limit our practice are individual and personal, and there aren’t any general rules to follow.  In this blog post, I will share some of the issues that have arisen for me and the decisions I have made at different times in my professional practice.

As I was completing my post-graduate hours for licensure and anticipating the establishment of my independent practice, I made a decision to limit my practice to adult psychotherapy.  I had some training in child and family therapy, though it was a minor focus for me.  At the time I became licensed, I had two children and realized that my temperament was better suited to dealing with the complexities of parenting and child development in my personal life only.  I enjoyed what was usually a somewhat less chaotic environment in my work with individual adults and couples, and it was helpful to not have the frequent need for consulting with other parties as is necessary when working with children and families while I was raising my own children.  I was both a better mother and a better therapist by keeping that separation.  When my children were older and out of the house, I saw a small number of adolescents as referrals came my way and I found it comfortable to take on the challenges of working with parents and children in that developmental life stage.

I came to a second decision when I faced a separation and divorce.  I recognized that I felt less confident in working with couples as a result of the end of my marriage, and didn’t do any couple therapy for a period of a few years.  When I felt I was ready to resume seeing couples, I got some training and consultation to add to my skill base and to ensure that I was looking clearly at the issues being presented by my couple clients.  My work with individual adults has continued to be the primary focus of my work, but I have seen a small number of couples over the subsequent years.

Another decision that arose for me was related to a single client, when I initiated the end of therapy.  I had worked with this individual for more than a year when she began coming to sessions with a pattern of regularly berating me and the therapy.  She didn’t seem open to examining the origin of her feelings or to reflecting on the meaning of her anger toward and blame of me.  I worked with this pattern for a number of weeks, then came to realize that I had begun to dread the sessions and to shut down my emotional openness to her and our therapeutic relationship.  This troubled me, since I know that I use my emotional connection with the client as the most important aspect of the healing relationship between us.  I worked with my sense of emotional distance but found I was unable to shift it.  I didn’t feel safe being open with her when I was met so often with criticism and rage.  This issue touched on experiences I had had in personal relationships, which I had resolved and were no longer active.  However, the residue of those experiences as well as my own personality and interpersonal patterns didn’t allow me to move beyond my response of self-protection.  I decided I couldn’t continue as her therapist, since I knew I wasn’t able to do my best work with her.  I shared this decision with her, telling her that I had become aware that I wasn’t able to feel open and connected with her and under those circumstances, it wasn’t ethical for me to continue working with her.  I acknowledged that this was an issue that was specific to me and that other therapists might not have the same response.  She was unhappy and angry with my decision, but I remained clear and spent several sessions completing the therapy and providing recommendations for her to continue her work with someone else.

A final issue that came up in my practice more recently was when my father had a serious health crisis.  At the time he became ill, I was in the early stage of work with a client whose father had died 4 months earlier.  She was in a very intense state of grief and her therapy was completely focused on her father’s death.  My father’s health crisis lasted a couple weeks after which he improved slowly over the next few months.  I had a few sessions with this client in which I was somewhat preoccupied with the similarity between her situation and mine, but this lifted quickly.  If my father had remained ill or had died, it would have been difficult for me to continue with this client.  I’m not sure what I would have done, but I would have needed to consider whether I could provide the treatment she needed.  Getting additional consultation might have helped, and increasing the frequency of my own psychotherapy would have been wise.  If I decided that my own preoccupation was a serious interference, I would face a decision about whether ending the therapy was in the best interest of the client.  Ending the therapy would have presented her with another loss, but continuing might not have provided her with the best care.  More than likely, I would have explained the dilemma to my client and asked her to join me in thinking through what would be best for her.

I share these examples as illustrations of how I have navigated decisions about my practice based on events and issues in my personal life.  Other therapists have navigated similar decisions in different ways.  As I said earlier, there are no general rules.  However, throughout our professional lives, we need to exercise our skills of self-awareness, seek consultation from trusted peers and mentors, and notice when our personal issues arise in our work with different clients.