How does a psychotherapist protect him or herself from infection by the “craziness” of a patient or client? My clients sometimes ask me this - often from a vague fear that what’s going on inside them could be contagious, and overwhelm or harm others as well, especially the people they need to remain sane and safe for them.

I’ve often remarked that one of the benefits of the standard two-parent family is the capacity of each parent to protect the children from the ‘craziness’ of the other. (Much of my work stems from an absence of this protection.) We therapists also need protective structures for this same reason.

One of the promises I make upon accepting a new client is that “It’s my job to be more powerful than your problems” - and that if I need help to do that, I’ll take the responsibility to get it.

All this came rushing back onto me during a recent weekend, when I spent a few days at home recuperating from the nadir of a rather nasty cold. It is my seeming good fortune that over the years my system will wait until I have some ‘free time’ to take the opportunity to hit me fully with some latest bug. Fortunately this happens only every couple years.

So here I had over two days to myself, during which to drip, sniffle, and sneeze freely. (I do love that brief endorphin rush after a hearty sneeze!) I ventured outside only to shovel the night’s light snowfall so the neighbors and mail carrier wouldn’t get concerned.

During that weekend retreat into vulnerability, I picked up Stephen King’s latest collection of short stories, Just After Sunset , in which I found his newest story (2008), “N.”. Within the first page you know there’s a suicide, and by the second page you know it’s of a psychiatrist - the result of a particular patient. 54 pages of pure Stephen King! Upon finishing, I sat for awhile, dazed. I knew I had to pay some attention here.

There’s no denying that clients often bring me material from their darkest recesses - or at least their desperate attempts to make order out of that chaos. Sometimes it’s awhile before they’re able to face it consciously (if ever). Order out of chaos . That’s the key to much of human endeavor. Sometimes it can lead to controlling others to the point of abuse. Sometimes it’s an addiction, or a neurosis, or holding tightly to a particular religious teaching or pattern - or a compulsive disorder (King talks about that). Some personality patterns it seems are themselves formed to control a pervading anxiety, one that would otherwise overwhelm. My work is to help heal the patient while at the same time protecting their “sanity” - which sometimes is a rather thin cord.

Even at the gym where I exercise regularly, I have a sense that everybody there is ‘running from some sort of demon’ - mine being open heart surgery a half dozen years ago.

King writes, “Then a man begins to think the only purpose served by his perceptions is to mask the knowledge of terrible other worlds - that is a crisis of the psyche.” (p232) Reality can become “thin” - and to assume what’s on the other side of that membrane is always benevolent is woefully naïve, and can lead to disaster (about which King is the master storyteller). I recall the ancient Celtic prayer: “God between me and all harm” - or even, “Lead us not into temptation.” Therefore I do understand the terror of some of my clients, and the fear that their “thin spaces” may at any moment collapse on them - and then wondering if I could still help them.

A year or two ago, perhaps at my last serious ‘cold’ - I was in my chiropractor's office. He asked me “Do you know why you have a cold?” I said “Viruses?” He said “No, there are always viruses around - the reason you have a cold is because your immune system is weak.” Point well taken.

So as a therapist, I need to keep my own psychic immune system strong. When this current cold was still just ‘brooding’ at the back of my throat, my massage therapist said “Bill, you’re taking your clients home with you again” - it wasn’t even a question, she can tell every time! And that’s why I add her services to my own regimen of self care.

And so I work to take care of myself. I have a strong spiritual practice, which includes praying for my clients daily - relegating any sense that I should handle it all alone. I can still improve in the areas of nutrition and exercise, but have made good strides. I limit the number of clients I can see each week, so I can give them the attention they deserve, and forestall burnout. (It reduces my income, but I don’t do this kind of work to get rich anyway.) And I work to take time for myself as well - both locally and getting out-of-town time.

Currently a couple other therapists have chosen my services for this purpose, which I take as a great compliment. And I also have my own therapy resources, as the need and opportunity arise.

I’ve come to consider that self-care is not natural to humans, so it needs to be consciously and habitually developed. That’s why I say I “work” at it - for my own sake as well as for my clients. Physician, heal thyself first.

Paying attention myself, I wish you well.