Welcome back to the Therapy Spot! This week, I interviewed Roberta Omin, LCSW, who has worked in the mental health field for over thirty years. Currently, she works in private practice in two different locations. One is in White Plains, and the other is located in Ossining, New York. She specializes in treating clients — including couples and families as well as individuals — with chronic, acute, or life-threatening illnesses. She came on the show to share her insights on a very fascinating topic. What happens when a therapist falls seriously ill and has to enter medical treatment? Should therapists share this information with their clients? How can that impact the relationship between therapist and client?
Roberta certainly speaks from experience. After her own experience with breast cancer, she conducted over fifty interviews with therapists and clients in similar situations. As a result of that research, she published articles on the subject, including “When the Therapist Becomes the Medical Patient” in the Journal of Social Work in End-of-Life and Palliative Care (2014). So join me, and let’s hear what Roberta had to say.
A Crisis of Authenticity
Traditional therapeutic guidelines said that therapists should keep their personal lives out of their sessions. In the interest of following those guidelines, Roberta initially chose not to share her cancer diagnosis with her clients. It became harder and harder, however, to keep her condition a secret. She found that her illness — or rather, the secrecy around her illness — disrupted these relationships.
Her crisis of authenticity came when Roberta knew she had to begin chemo. “People are going to figure it out! They’ll look at that wig and know it’s a wig! […] I felt so uncomfortable. Therapy is about being real, and not having secrets. But here I had this secret. […] I wasn’t doing my part in [the relationship].”
When Roberta did choose to share, she removed the secrecy from the issue. She made the decision to be honest and open and, instead of a wig, she wore a scarf. Roberta used that to begin a dialogue. “We were authentic with each other. It became obvious that it was better to share, than to let people wonder, and have that get in the way of the therapeutic relationship.”
“People don’t talk about this”
Roberta’s other impetus to study this topic came from her work with oncology social workers, as well as her experience in a support group for cancer patients. In both settings, the same issues came up again and again: illness, and the need for secrecy. Roberta took note of the silence around illness, and felt the need to bring it to light.
In order to do so, she interviewed fifty people. She cast a wide net in order to hear all the sides. Her interview subjects included:
- Therapists with chronic or life-threatening illness
- Clients whose therapists had been ill or even died
- Colleagues and family members of therapists
So what did Roberta learn from all these interviews? She learned she wasn’t alone! Most therapists had a similar “crisis of authenticity” and felt compelled to share. They knew that withholding important information could damage the therapeutic relationship.
But some therapists didn’t want to share. They struggled with the question of how they could possibly disclose this information while still preserving the relationship and building trust. Often, these therapists had protector parts coming up. Those parts said things like, “I don’t want people to worry.” Or even, “I don’t want people to think I’m dying.”
Clients come to therapy to create safety, trust, and intimacy. If therapists fail to share because of their own protective parts, that has an impact. It can bring up a client’s past trauma around loss, rejection, and secrecy.
Finding the Balance
Therapists in this situation may have the occasional client who tries to step into a caretaking role. How you as a therapist choose to deal with this can be a wonderful trailhead. Naturally, it’s important to remember your boundaries and be very clear with them. Stress-proof the relationship! Remind these clients that this isn’t their job, and you have a support system.
Roberta recommends that other therapists do the work to truly know themselves. “Just like your clients, you, too, have injuries, betrayals, and abandonments. No one is immune!” Be aware of all of your parts. Do that work so you can have as much Self energy as possible for your client work.
As a natural outgrowth of her work, Roberta developed what she calls “the Principles of Contextual Self-Led Disclosure.” These principles benefit everyone in the therapeutic relationship. They include:
- The work we do with ourselves
- Awareness of our clients’ issues
- How we handle disclosure
- How we handle post-disclosure
She will present this concept at the IFS conference in Rhode Island, from October 27th through 29th, 2017.