Your crazy is your best clinical tool

"Your pain is evidence of your participation in the world, not a liability to your therapy practice."

We are all in the same boat. It’s easy to brush this idea off, or pay it lip service, but leaning into the truth of our shared reality and struggle, particularly as therapists, is a hard and often unclear path. We are taught seemingly conflicting practices in our graduate programs—don’t assume the expert role, but also if you’re going to be effective you have to be an expert. The problematic message beneath this dichotomy is that healers are well and their clients are sick. So what happens when the healer isn’t as well as her role seems to require her to be?

I have a long history with Major Depressive Disorder. I currently meet criteria for Postpartum Depression. I’ve experienced intense suicidal ideation in the past and intrusive thoughts of ending it all were my cue to start meds after I had my last baby. Throughout two rounds of PPD, and at least 5 depressive episodes, I have also been a therapist full time, working with people presenting with symptoms that sometimes weren’t as severe as my own. Six months into starting my private practice 7 years ago, I had a big depressive episode, triggered by a bad breakup. Sleeping all the time, barely eating, telling almost no one, I felt myself slipping into the grips of a debilitating black hole. The worst part of that episode wasn’t the symptoms though, it was the imposter syndrome that showed up every time I sat down across from a client. I wondered if they could tell my eyes were puffy from crying, if they could hear how hollow my voice sounded. My shame voice screamed, “How can you possibly help anyone when you can’t even help yourself?”

Then a miracle happened. Through the fog of my depression and shame, I noticed that my clients were actually doing great, better even than they were before I hit my low. When I stepped back and looked at the content of my sessions, we were going deeper, connecting more profoundly, uncovering more hurt than I ever had when I was comfortable and well.

I did some major work on my underlying narrative of self during that depressive episode. I checked all the boxes for managing depression from meds to therapy to exercise to meditation. I rode it out and nurtured myself back to a place that was certainly more balanced and peaceful than I had ever been in my life. As the symptoms slowly dissipated, I had some time reflect on what had made such a painful time for me such a productive time in my practice. I realized that the more I owned my experience of sadness, hopelessness, and hurt, the more empathy and insight I had available to offer my clients. I didn’t have to just imagine what it felt like to be in my clients shoes, I was living it.

As I’ve worked to ditch the shame around my own depression, and have reframed my experience of mental illness as an asset to my work, I’ve started to develop a different relationship with self-disclosure. My story has a different purpose now than it did when I was living the worst part of it. The memory of depression, and the steps that worked to get me out of it, now have a new usefulness, helping me to connect with clients from a place of hope and acceptance. Nothing is more powerful at eradicating stigma around mental illness than saying “hey, me too.” And no skill is more effective at building hope than someone’s lived experience of healing.

That’s not to say I start every session with “have I told you about how depressed I used to be?” Skillful disclosure has two features: 1) Full acceptance and integration of your own struggle as evidenced by minimal shame or willingness to lean into shame and 2) Clear purpose for moving a client forward without egoic gain on the therapists’ part. You’ll know when you have work to do around integrating your own hurt when you feel triggered, resentful, or frustrated by a client whose presenting problem sounds eerily familiar to your own experience. Once  you’ve done acceptance work, you can be intentional about sharing your story or parts of it when you hear a client struggling with shame around their illness or minimizing their need for care or support. Non-egoic self-disclosure targets a specific need for validation, connection, or insight.

If you are therapist with a history of disordered eating, and you are sitting across from a young woman detailing frantic calorie restriction and over exercising, your history is a path to healing. If you survived an abusive relationship and have a client that is struggling to break away from her own abuser, your story is her hope. Your pain is evidence of your participation in the world, not a liability to your therapy practice. Our role as experts neither protects us from difficulty nor requires that we live a struggle-free life to be effective or legitimate. Chances are, many of you were called to this field as a result of your own suffering. What if that wasn’t an accident?

I’d love to hear how you are using your whole story to better serve your clients. Drop me a line on Facebook or Instagram @drcandicecreasman or email me at drcandicecreasman@gmail.com.