Sarah DeMichele, MD, admits hers might be the only job where hearing “you’re so normal!” is high praise. It’s true her profession—psychiatry— comes with an unusual amount of baggage. There’s the old stigma that “therapists are for crazy people” or that all shrinks are themselves nuts. She’s so used to the awkward pause when people learn she’s a psychiatrist that she has a standing comeback: “Don’t worry, I’m off the clock,” she’ll say. “Feel free to carry on!”
Puhleeze, she sometimes thinks. As director of medical services at the nonprofit Council for Relationships in Philadelphia and mom of two active teens, Andrew, 16, and William, 14, some days she hardly has brain space left to plan dinner, let alone secretly “psychoanalyze” acquaintances.
Teamwork at Work
From Facebook to fortune cookies, advice is everywhere. Bona fide therapy? Most of us realize it’s best left to professionals, including social workers, psychotherapists, clinical psychologists and psychiatrists—the only ones who deal with meds.
It’s common these days for mental health professionals to collaborate on care. Psychiatrists may make an initial diagnosis, prescribe medication and then manage dosages in follow-up appointments. In the meantime, other pros provide regular therapy sessions. The money differential: Psychiatrists average $200,000 a year (hey, med school ain’t cheap) and charge $250 an hour or more. Psychotherapists make $75 to $200 hourly. Money aside, the team approach is effective because the answers aren’t clear-cut. Mental illness involves, ahem, gray areas. Sharing assessments helps practitioners arrive at better care plans.
They plan and, as much as possible, make peace with uncertainty. “If you had an infection, we’d know what antibiotic to use,” says Gariane Gunter, MD, a psychiatrist at a community clinic in Batesburg-Leesville, SC, and mom to Isabella, 7. But mental health doesn’t work that way, she notes. “You need to listen to someone and choose, among a lot of information presented, what medications, if any, would help. Sometimes, it’s a matter of trial and error.”
Sometimes a matter of trial and error, always a matter of trust. It’s the foundation of the work.
Social worker and psychotherapist Jackie Price, who runs a private practice specializing in children, has a Brio train set, multiple dollhouses and a sand tub with buried treasures—and lots of Kleenex—in her Brighton, MI, office. The first thing she does is discuss confidentiality. “I tell kids my office is a vault, and nothing leaves it.”
Because she works in a small community, where she’s raised Jake, 22, Alex, 19, and Maddie, 16, Jackie tells her patients she’ll follow their social cues if she runs into them outside the office: “If you pretend you don’t know me, I’ll pretend, too. If you want to say hi, I’ll say it back.”
Once there’s trust, a good therapist becomes part interviewer, part sleuth to get to the root of the problem, says Crystal Rice, mom of Lily, 3, and Fiora, 21 months, who runs a private practice in Hagerstown, MD. When she once had trouble getting an Afghanistan war veteran to open up, Crystal had him create a visual diary of his feelings on Pinterest. He chose chaotic abstract art, loaded with blacks and reds. Reviewing the images together unearthed a lot of emotion and led to treatment breakthroughs.
Since you’re regularly wading into deep waters, you’ve got to keep your own “flotation devices” handy, therapist moms say. “It can be a high-risk profession emotionally,” offers Lisa Carmack, PhD, a Los Angeles–based licensed clinical psychologist and mom of Sophie, 7. in addition to running a private practice, she supervises six therapists in a community health clinic who work with highly traumatized kids and families. They hear stories of drug abuse, rape and violence.
“The job requires empathy, but also a certain stoicism,” Lisa explains. What you hear from a battered child may make your stomach churn, but you can’t walk away or blurt out “That’s horrible!” What you can do, as Lisa frequently does, is go for a pavement-pounding run after work, kickbox or vent in your journal.
Still, the tough cases leak in no matter how disciplined you are, so burnout is a professional hazard. In fact, studies have shown therapists are at risk for “vicarious trauma.” Hearing so many tough stories over time can impact your mood, dampening your outlook on life and humanity.
That’s why Lisa tells the clinic’s staff to monitor their own mental health: Are they sleeping okay, eating well? Do they have unexplained pain? “Therapists may develop neck and shoulder pains,” she says. “You’ll see them walking around with their shoulders hunched up like they’re carrying the weight of the world.” There’s no one way to cope with the stress. Yoga and deep breathing may not cut it, Lisa says. “Sometimes it’s just being self-aware. Some days I’ll come home and tell my husband, ‘I can’t be present for you right now. I just need a sandwich and Judge Judy.’ ”
Crystal knows she has trouble “letting it go.” So she de-stresses with eastern meditation techniques, plus a more western visualization of herself mentally “clocking in” and “clocking out.” Jackie gets help from her kids: “They’ve said, ‘Hey, mom, think you might need a bath or something?’ when my stress is apparent. Early on, I was known to take two to three baths a day.”
The profession is so worth the emotional weight, say moms. “You’re helping someone get to a better place and have a better life,” says Gariane.
The Doctor Is In
When she wants to be.
Psychiatry is known to be one of the most family-friendly specialties in medicine. (Envious MDs are fond of grumbling that psychiatrists work “bankers’ hours.”) Gariane’s full-time is 30 hours a week, Fridays off. Twice a week, she tutors at Isabella’s school.
The counseling side is often as forgiving. Clinics keep regular hours, and if family emergencies arise, patients can usually be rescheduled. Therapists in private practice set their own hours, although when you start out you may need to accommodate your patients’ preferences over your own. Translation: night and weekend appointments.
Plus, the industry is collegial. It’s common for therapists to back each other up and cover for each other during vacations. That’s not to say they don’t have awkward moments juggling job and family like the rest of us. Psych moms spill about 3 a.m. calls that wake the household or trying to shush a child while taking a call from a patient in crisis. But it’s rare. More often, professional techniques make the household operate more smoothly. The trick is to use those techniques with finesse.
“Occasionally my kids will ask me to quit ‘using therapy’ on them,” Jackie says, laughing. Ixnay asking a teen you’ve just grounded, Now, how does that make you feel? She credits her child psychology work with making her a more aware parent: “Hearing what children wish was different in their homes keeps me on my toes as to how I want my home to be.” And she follows her training when daughter Maddie wails about feeling super-stressed. “I’m not doing her any favors by immediately trying to fix it,” she says. “I ask her how she thinks she might handle it, and I listen.”
Whether or not therapy makes for a better mother, therapists overwhelmingly say motherhood makes for better therapy—think flexibility, empathy and sanity in the face of irrationality (hello, 3-year-olds!). Jackie says parenthood makes her practice what she preaches. “Encouraging my clients to ‘live in the gray’ is one of my most-used techniques. Parenting is not black or white. It is gray and messy.” And, often, wonderful.
Lessons from the Front
- Leave an out. Make sure your office setup allows an easy exit for you and your patient so no one feels trapped.
- Take your own advice. Identify your healthiest coping suggestions—and use them to decompress from a day’s work. (Small biz bosses and corporate managers, are you listening?)
- Mix up your caseload. As in many jobs, you want to vary your assignments so you’re not dealing with the same kinds of trauma back-to-back.
- Expect tears. Have tissues and water on hand. Hmmm, HR pros take note.