Dear Therapist:

I was recently researching therapists for someone with significant difficulties related to her mother. In the process, I came across the name of the mother of a childhood friend, which stood out because my friend had a very difficult relationship with her which led to serious issues. 

This raised some big questions for me. If a therapist has struggled profoundly in the very relational area they specialize in, how should that be understood? Therapists are human and face personal challenges, but is there a baseline level of emotional health and self-awareness required to practice responsibly?

What safeguards exist to ensure therapists are fit to practice, and what practical steps can clients take to assess whether a therapist is emotionally healthy and fit to practice?

Response:

You’re asking some very complicated questions. They go to the heart of transference, countertransference, and the general capacity of a mental health professional to practice responsibly.

I’ll describe transference and countertransference as they relate to your concerns. First, though, I’ll address the broader question of how to think about a therapist’s personal struggles—especially when they seem to mirror the very issues they treat.

Many people would hesitate to see a marriage counselor who has never been married, feeling that without firsthand experience of marital stress, a therapist couldn’t truly understand. There is some validity to this. Yet taken to its logical extreme, this would mean a therapist would need to have experienced depression, anxiety, OCD, ADHD, and countless other challenges in order to help others with them.

In reality, therapists are trained to gather information carefully and to be empathetic (rather than sympathetic), allowing them to understand another person’s experience without needing to have lived it themselves. That said, when it comes to certain relational issues—such as mother-child dynamics—clients often feel more comfortable working with someone who has personal familiarity with similar struggles.

Sometimes, people unconsciously idealize therapists, imagining that they have everything figured out: perfect marriages, perfect relationships, and perfect emotional regulation. Of course, this isn’t true. Therapists are human. They have problems, blind spots, and vulnerabilities, and they often struggle to apply their own advice to their own lives.

This doesn’t automatically mean that a therapist who has significant difficulties—either generally or in specific areas—cannot help others. It simply means they are human, with their own emotions, insecurities, and triggers.

Transference refers to the process by which a client develops feelings or relational patterns toward the therapist that reflect important relationships in their life. For example, a therapist may come to represent a client’s mother, allowing the client to work through unresolved emotions connected to that relationship.

Countertransference occurs when the therapist’s own emotional material enters the therapeutic relationship. This is not always a problem. In fact, when a therapist is aware of it, countertransference can sometimes be used constructively to better understand the client. The key is awareness.

If a therapist is using sessions to work through their own issues, or repeatedly shifts the focus toward their personal needs, this is a serious problem. If they are unable to stay emotionally present with a client around a particular topic because it activates unresolved issues of their own, that must be addressed. And if they are unaware of this process altogether, it becomes even more concerning.

Therapists don’t need to be perfect. They don’t need to have every answer, and they don’t need to have resolved every area of their own lives. But they do need to be self-aware, reflective, and emotionally grounded. Without these qualities, a therapist may not be fit to practice. Still, simply having personal struggles—even significant ones—does not, in itself, disqualify someone from being an effective therapist.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Woodmere, NY

 adjunct professor at Touro University

 Graduate School of Social Work

 author of Self-Esteem: A Primer

 www.ylcsw.com / 516-218-4200