The Isolated Therapist: An Invitation to Trouble

by Carol Campbell, MFT

All too often a variety of circumstance luring the inattentive or unaware psychotherapist into the dangers associated with persistent isolation from peers. In this article I make the case for constant vigilance on the part of ethical MFT's to ensure that we provide an essential element of our own professional self care: regular contact with respected peers.

I remember having been impressed in graduate school by the high percentage of students who scored as strongly introverted on the Myers-Briggs Typology Indicator. This impression has only deepened over the years. I have met hundreds of therapists, and I do not doubt that a strong majority of them are not only energized by being alone, but in fact have been drawn to this work in part because of the relative solitude that it offers. Particularly in a private practice setting, a therapist spends a great deal of time alone writing case notes, waiting for clients to arrive, passing the time when there are breaks in the schedule, etc.

Often the practical reality of shared office space also encourages solitude. By definition, if you are sharing an office with someone else, you will be there when the other person is not. I recall several conversations over the years when I have asked someone how their office mate is, and the friend tells me he or she does not know because their paths seldom cross. Too often when their paths do cross, one or both therapists are in a hurry and cannot spare the time for significant conversation.

Enjoying solitude is obviously not problematic in and of itself. However, I have seen therapists walk on a slippery slope when they do not balance their need or desire for solitude with the many benefits of interactions with peers.

For example, there are those who are self-conscious about their work. They think they should know everything about being a therapist, and are reluctant to be perceived by others as a proverbial greenhorn, or worse yet, ignorant or foolish. Rather than ask a colleague how someone else might approach a particular problem or situation, these therapists will quietly charge ahead with whatever solution comes to mind. To them the imagined risk of being unmasked as a great pre-tender produces greater fear the risk of making a clinical or business error. Most likely, the client will be the one to suffer.

By setting our lives up in such a way that we seldom share quality time with other therapists, we deprive ourselves of the opportunity to receive the restorative benefit of accurate mirroring that other therapists can easily provide. Self psychology teaches that we have a lifelong need to be mirrored accurately by those around us in order to maintain a cohesive sense of self. While it can feel soothing for a family member to say, "You seem especially drained tonight, dear," my guess is that we would get even more value from hearing a colleague say, "Three borderline clients in one day?? I'm impressed that you have the energy to walk to your car and drive home!"

Therapists who make it a point to spend time with colleagues have a built-in opportunity for formal or informal case consultation. Aside from personal therapy, perhaps nothing is more important for minimizing ineffective or dangerous treatment of clients than the courageous act of holding one's work out for thoughtful observation by respected colleagues. I have no doubt at all that the most effective and successful therapists are those who regularly pay for consultation on their work.

Finally, therapists who work in isolation cannot count on colleagues to confront them when it becomes obvious that something is wrong. I would like to see a study done on therapists who cross sexual boundaries with their clients: what percentage of these therapists work in isolation? I am aware of a couple of instances where medical problems have interfered with a therapist's judgment; intervention by courageous colleagues was what minimized potential harm to the clients involved. What if those therapists had been working in isolation?

Those who cannot get through the examination process and choose to practice illegally present another concern. In one instance, such a person quietly operated an isolated private practice for years; he attracted mostly clients with dissociative identity disorder, and proceeded to have dual relationships with them, causing great harm to the clients and endless legal troubles for himself when he was eventually discovered.

Avoiding isolation as a therapist is a bit like having insurance. It does not guarantee that you will never become alcoholic and show up for sessions under the influence, but it increases the chances that someone who cares about you will be there to help you find a way out of whatever mess you are in. Whether you choose to socialize, seek consultation, participate in SCV-CAMFT chapter activities, interact with others at continuing education classes, or create an office environment that encourages interacting, it will serve your best interests and that of your clients if you make it a priority to take care of yourself by not becoming an isolated therapist.

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Carol L. Campbell, MFT, is a licensed marriage and family therapist providing psychotherapy and psychoanalysis for individual adults and couples in Palo Alto, California. She has degrees from Brown University and Santa Clara University and has been licensed since 1991. Carol is a graduate of the Palo Alto Psychoanalytic Psychotherapy Training Program sponsored at Stanford by the San Francisco Center for Psychoanalysis and was a candidate at the Psychoanalytic Institute of Northern California in San Francisco from 2010-2011. She is also a clinical member of the California Association of Marriage and Family Therapists and the Northern California Society for Psychoanalytic Psychology.