On Being a Small Town Therapist

There are two ways to live your life. One as though nothing is a miracle. The other is as though everything is a miracle.   Albert Einstein

Even the sky at dusk is something of a miracle

I was a psychotherapist in a small town. People often ask me, "how on earth did you do this?" One of the ways I have thrived and survived in my small town as a psychotherapist was by believing that there are more miracles than most people realize.

A very cool thing about being a therapist in a small town is this: it is not uncommon for me to see some of these walking miracles from time to time. I still see and revel in seeing:

•  the women who came to counseling because of late stage cancer only to rally and is still going strong;
• the young woman suffering from anorexia and bulimia now thriving and in her own business;
• the man who was debilitated by social anxiety disorder who got perspective and a sense of humor about himself;
• many women widowed far too young who I walked through the process of grief and they happily partnered again;
• the women who's husband strayed, asked for a divorce and then recanted when she said, "OK";
• the couple who almost divorced and decided to give it a second chance and are now enjoying their grandchildren;
• the abused young woman now in a happy, healthy marriage;
• the man who got sober despite everyone scoffing that he could never do it;
• the many, many who got sober and are flourishing.  

Here they are, walking around enjoying life.  This is truly thrilling and gratifying to me. When we meet, we acknowledge each other, smiling and chatting on the street, in the grocery store, on one of the trail hikes. I always choose to acknowledge these old clients. Each of them is celebrating their new life and I got to be a small part of that. Miracles.

Yet professional journals and some of the ethics rules advise that interaction with clients outside of the office is unethical or forbidden. These rules mostly make commonsense , but some of the other rules are really written for the big city therapist. Obviously they know nothing about small towns. I have attended the gamut: baptisms to marriages to funerals and I do so proudly, to honor the clients. If  a client requests that I come, usually I'll go. Should a guest be curious as to why I'm there, I'm vague in my answer and redirect the attention on them instead. Works almost always for me and the client. However, sometimes the client will introduce me, without qualm, "this is my shrink."

There are the many sensible ethical rules such as, don't share a client's personal history without their permission. I keep all information about clients absolutely confidential. Another example is: don't have a sexual relationship with a client, present or former. In the words of my teenage clients--duh, as if!  Some of their other rules such as no fraternization outside of the office? No can do in a small town.

I have developed my own rules for small town therapists:

1. Always be the gracious host to your clients, you don't need to be cold. In my thirty five years of being a therapist in a small town I've never had to advertise except to announce groups. Word of mouth works well if you give great service.
2. Be open with your clients. Against professional advice, I have my walls peppered with pictures of my husband and my family. I want my clients to know who I am. I may not answer, but they can ask me anything. Hell, I'm on Facebook and furthermore they can ask anyone in town that has been here more than a week anything about me. Granted I am an extrovert with introverted leanings so that means I am basically friendly to everyone. Confuses some clients, but that's what I do.
3. I think it's a breeze to tell if someone doesn't want to be acknowledged. This truthfully happens to me only rarely and I respect that. I notice the body language: the averted eyes, the sudden interest in a laundry soap, the hurried step. I get it.
4. Declare your political stance and openly work for the good of the community. I have always been flagrantly involved with politics in our town and actively worked on many campaigns. Interestingly,  people have not run to the hills just knowing I'm an active Democrat. Conservative Republicans and I even have moments of good natured teasing in the office.
5. It is possible to "consult" with a casual friend and then years later become genuine friends. This works best when it's not one on one. For example, my husband and I have had an occasional dinner with a client and her new spouse. It's been well over a decade since her husband's death. Felt fine. This would not work with a client with whom I've had an in depth prolonged professional relationship.
6. However, if you have recently finished counseling with a client and he/she asks you to go to a celebratory lunch, don't, it's far too awkward to fall into the therapist/client roles. Needless to say, I learned this the hard way when I'd been in business only a couple of years.
7. If a client asks you to a celebration where scads of other are in attendance, if convenient, go. Share in the joy. Weddings are wonderful, if not-- leave.
8. I think it is imperative to attend funerals of clients, or their family members. Step up to the plate and be there for your grieving client or their family. If for legitimate reasons you can't attend the funeral in person send a note to your client and their family. This should be obvious but many therapist hide behind the 'rules'.



A small bit of our family from a wonderful wedding

Finally, love and enjoy the privilege of working intimately with people you may run into at any moment. If you can't do so, this may rule out you seeing the miracles that are all around and happening each day in a small town.

susansmagicfeather copyright 2018 Susan R. Grout all rights reserved