How to be a therapist when the world is on fire

Being a therapist is a complicated, complex, and evolving job and identity. We know our patients intimately, but we are never romantic or sexual with them. We know more about them than anyone else in their lives, but we’re not their friends or family members. We keep a therapeutic distance to facilitate warmth and trust and relationship, but we’re not cold or fake– nor do we say too much about our lives. Usually, this therapeutic distance helps our patients share what’s really happening for them without them becoming confused by their therapist’s needs or desires. But what happens when the issues that impact our patients are also impacting us? Keeping a therapeutic distance is no longer possible in the same way we’re accustomed. Sometimes, we find ourselves in the middle of a shared experience that can rock us from our seats and into something unexpected.

Even though sometimes we don’t like thinking about this, therapists are human, too. (I’d say both patients AND therapists don’t like thinking about this.) And there’s a good chance, if you’re a therapist, you live in the same community as your patients. During traumatic and devastating events, you may be as impacted as your patients. For example, when the twin towers were decimated on 9/11, therapists reported feeling the same chaos and trauma that their patients were feeling. In a paper “The psychotherapy of trauma and the trauma of psychotherapy: Talking to therapists about 9/11”, Karen Seely interviewed 29 psychotherapists who had sprung into action during the aftermath of 9/11. “You suspend all that you’ve ever learned about how to be in the perfect setting with the two chairs properly placed and the pristine office with the box of tissues available,” one therapist interviewee said. This therapist’s world was on fire, as was her frame, the container that kept her safe so she could do the work she was trained to do. But, her patients’ world was also in chaos, devastated, transformed by force.

Everyone’s world was on fire, exploded, broken at the seams. The container no longer held, and something new had to be created.

Today, as I write this in Berkeley, CA, with red eyes and an itchy nose, a headache and foggy brain from the dense atmospheric smoke hurtling down from the dozens of Napa and Santa Rosa fires, I’m thinking about how overwhelming it all feels. My container is busted. I can’t breathe. I realize that I don’t really stop to think about the air until I don’t have access to it.

This fire is nowhere near contained.

And yet, I still go to work. On days when the world is on fire, I’m not sure how I muster the energy to get there in the morning other than a sense of commitment and trust. This is the unspoken pact between myself and my patients: that we trust the other to arrive.

My first few patients describe the smoke-filled air, the orange sun, the apocalyptic feeling. I sneeze several times from inhaling ash on my way to work, and my patients sympathize. They, too, have headaches, anxieties about loved ones, worries that they will be consumed by something they have no control over. We are each feeling this way, though with our own personal mixtures of history, anxiety, and anticipation.

My own analyst describes Bion’s concept of O, the destructive force so powerful and so random that none of us can control. Horrible things happen to good people. “O doesn’t care about how good a person you are. It’s a hurricane, a person shooting into a crowd, a wildfire. O just destroys,” she says.

When our world is on fire, no matter how we feel about ourselves or each other, we are forced to be in this together.

That is not to say we are all impacted the same. I am not at risk of being displaced, like my colleagues and friends up in the North Bay. My colleagues share themes of their sessions with me: People afraid they will have to evacuate at any moment, with just a twist of the wind. People who have lost homes, or are at risk of losing their homes, and can’t come in for sessions because they may have to collect their pets and their go-bags and get out quickly. People for the first time realizing that the things they read about on the news could happen to them, too. And, my colleagues are wondering some of the same things. Are their own go-bags ready? Are the kids and pets inside, able to be scooped up at a moment’s notice?

There are other impacts of this fire that I will never feel, though I may know them and be on the lookout for them. The incarcerated women who fight these fires, some losing their lives, and none receiving certificates of firefighting to use after release. People whose homes are gone but who are undocumented have a devastating conflict on their hands: do they register at a shelter, and run the risk of their residence status being noticed and punished, leading to deportation and a second homelessness? Do people who are low- or no-income pick up their loved pets from the animal shelter with burns and broken limbs that they cannot afford to fix? And other impossible decisions people have to make: Should they leave their homes? If yes, what do they bring and what do they leave behind? And if they leave, will they have a home to return to?

The world is on fire around us. None of us are spared completely, but some of us are in more pain and devastation than others. In some cases we just can’t do therapy right now because the immediate need to save your physical body is too great. In some cases, we can. When the walls are burning, this is when we are forced to redefine the container.

When there is a destructive element that feels too overwhelming to contain, these are the moments when we need each other the most. These are the moments to remember that there is connection and containment in our relationships. These psychic and emotional spaces that we’ve built up through years of meeting each other authentically are psychic havens, even if the walls are literally on fire. Our healing connection is in our relationships and in our contact with each other. Containment can be found in our mutual survival, resilience, and contact.

Being a therapist when the world is on fire requires us to muster all our training and soul. I don’t mean the kind of training you get in an academic institution, or the rules of your internal psychoanalytic police. I mean the training we get from our patients, day to day, that teaches us how to show up authentically and in real-time relationship with them (and each other). You know that feeling: Where your heart is raw and open, but you can still make links between what she says now and what she’s said before, between what you feel now and what you felt before sitting with this person, baring her soul to you, week after week.

The experience of human connection is a therapeutic containment that no fire can break down.

For up-to-date information about the California wildfires and actions you can take, please visit this Google doc: https://docs.google.com/document/d/14ZhXDNaL260p5OempaFbCrsYBe_5pvNvDqV7xcwn95s/preview

There is also an excellent series on Your Call Radio with Rose Aguilar here: http://yourcallradio.org/

Paper Cited: 
The Psychotherapy of Trauma and The Trauma of Psychotherapy: Talking to Therapists About 9–11
March 2003
Karen Seeley
Columbia University
http://www.columbia-coi.com/media/papers/seeley_pot.pdf