One of my favorite quotes from Pema Chodron is when she explains the first Noble Truth of Buddhism: “Existence is Suffering.” In her book When Things Fall Apart she writes:
The first noble truth of the Buddha is that when we feel
suffering, it doesn’t mean that something is wrong. What
a relief. Finally someone told the truth. Suffering is part of
life, and we don’t have to feel it’s happening because we
personally made the wrong move.
Patients often come to me to hoping therapy will make them feel good. I tell them that that is not what psychotherapy is for. Psychotherapy is not aimed at making you feel good: Psychotherapy helps you learn how to not feel good, at least the way I practice it. Because the truth is out, there is suffering in the world, and in our lives. Can we learn how to not feel good? How to sit with what feelings arise without eating, starving, cutting, drinking, smoking, sexing our way out of it? Although I didn’t coin the phrase “Don’t just do something, sit there,” my patients often hear it for the first time in our work together.
When I consult with therapists on how to build their practice, or how to use technology, you’d be surprised how much shame, anger and sadness can come up for them. A lot of times they have been avoiding looking at how they do the business part of their work, as if it were completely divorced from their fears of failure, grandiose defenses, and ethical quandries. It takes courage to get to the tender spot that is hurting their business. We have to weave our way past the following bugbears:
“I don’t do this for the money, I do it for the patients.”
“I don’t care if what I tell the insurance company I’m charging is what I’m actually charging, insurance companies are evil.”
“Whatever I have to do to play the game is fine, as long as I can do good work with my patients.”
“I don’t want to know how this billing, marketing, business stuff works, my practice is doing just fine.”
“I don’t know anything about Skype, and I don’t really care.”
One of the great things about working with therapists, though, is that sooner rather than later they hear the defensiveness in their words, and we settle down to not feel good together so we can clear away the shame cluttering their practice. Generally what I find is that their shame comes down to this, see if this internal monologue sounds familiar:
“I have suffered long and hard to get where I am today. I have worked long hours for free, spent money I didn’t have, to get an education that is often undervalued in the world. Even before that, I was always helping people in my life, even when they were supposed to be taking care of me. I waited for someone to notice that I was trying so hard, and finally I gave up. I’m going to have to take care of myself, no one else will. But even though I’ve built my life and work up around that structure, part of me waits with fear for someone to take my work and livelihood away from me. Sooner or later they are going to figure out that I have been faking this adult thing, this independent therapist thing, and then it will be all over, and I won’t have even that.”
If any of this sounds familiar to you, if it is what lies underneath the fears and the avoidance that are gumming up your practice, please read on.
Things were difficult for you, and you didn’t do anything personally wrong to bring this upon yourself. Things will be difficult again, and that won’t be because somebody discovers and punishes you. Suffering is part of life, and we need to pay attention to it, but not personalize it. The clearer you get with this the more clearly you’ll be able to look at your work and business. And the more you do this, the more you’ll face your fears and start to practice in an integrated way, and make money.
On the other hand, if you insist on living your life and practicing your work in accordance with the narrative of fear and entitlement above, all bets are off. Paradoxical perhaps, but maybe you have already noticed how we can manifest irrational fears into real life. Because these fears are the ones that have you stuttering on the phone to UBH during peer reviews, or getting nervous whenever a patient or their insurance company has a billing question. These feelings of anger and entitlement are what make you envious of your colleagues when they try something new in their practice, or promote a book, or launch an online practice. Leave these fears unchecked and your practice will get more rigid, the walls of your office more close, and even if you never get caught for some of the business practices you do you’ll tire yourself out justifying yourself.
I love it when colleagues come to work with me and trust me to tell them the way I see it. I love it when we get honest and the fear starts to go away. I love the relief and the organization that comes in its place. I see priorities shift, new models of working open up, and people rediscover why they like being a therapist. And I see them make more money with less guilt.
You may not agree with everything I write here, and you may not see psychotherapy or business practices the same way I do. No one, least of all me, thinks you should. But my blog is much like working with me in person, I promise I’ll call it as I see it. I think anything less is a waste of your time and money and disrespectful to you. And I won’t collude with you in your disrespecting yourself.