Why We Treat: The Inherent Juxtaposition of the Helping Professions

By Dr. Jason N. Camu

licensed clinical psychologist


Ironically it seems obvious that our chosen profession is perhaps the greatest metaphor for the implementation of unconscious psychological defense. Over the years I am in the least let down, and at the most genuinely surprised, when a colleague says: “I really just wanted to help people and that’s why I became a psychologist.” We are indeed just as vulnerable to our own blind spots as are our patients.

The motivation to help others is as much a part of our own personal upbringing and biology as are the presenting problems and symptoms of our patients. Said differently, the choice to become a psychologist will include our own unresolved emotional issues and conflicts—this is certainly not a novel proposition. But the subsequent step of personal and professional introspection includes very difficult questions for the psychologist.

Why do we choose such an obviously masochistic profession? We listen to people’s problems for hours on end. We often complain about being overworked and underpaid. If one pays attention to our conversations amongst ourselves, we are also an exceedingly critical group. The role of psychologist could be viewed as not about working through our own personal issues, but about using the career and doctor position to deny, sublimate, and avoid issues while simultaneously acting out to gain pleasure.

Close examination yields more precisely these insecurities and vulnerabilities. Perhaps not surprisingly, one of our most troubled patient groups can provide a mirror reflection of our own painful inadequacies — the narcissistic patient. Our obvious identification with this patient, as evidenced by career choice, is the guarded secret. The result is a career choice that is the psychological defense. Of course we want to feel valued, loved, special, and powerful.

The helping professions provide a wonderful vehicle to solidify denial and avoidance while also providing a near perfect sublimation. Much like the attorney who is rewarded for reducing his adversary to spittle with guile, aggression and force, we too are rewarded. We help those in need, we are special in our suffering whilst also embodying the most revered qualities of human beings — we have compassion and empathy and put the needs of others before our own. At least it would seem so.

Speaking so highly of ourselves is a delicate exercise, because we must be careful to deny our pride as well. To be too impressed with one’s self is selfish, egocentric, and narcissistic. To indulge oneself in the hour of treatment is to take the attention from the patient to utilize the interaction for ourselves. Consequently we defend our modesty as indeed unrivaled. Perhaps.

Narcissism. The word is provocative and has multiple meanings for the clinical psychologist. Whatever the case, the narcissistic patient is often loathed by many in the helping professions. Why must we hate pride and selfishness so much? Because “we” are bigger than, of course. We mock the unsophisticated and transparent narcissistic defenses. We are so much smarter than the narcissist who must demean and diminish others to feel powerful. He or she makes others feel uncomfortable and small in the unconscious goal of feeling powerful. The insecurity is projected onto the object and often identified with when the receiver feels threatened or intimidated. When the treating clinician experiences the projection in a form of broadly defined

countertransference, he or she is enraged. Ironically, the aforementioned summary should sound familiar — we too are perpetrators.

How dare that patient make us feel so insecure, even intimidated. After all we are the doctors. Intellectually we can strike back. How ridiculous they look with their overstated presence; the cars, couture, carats and glitter, all to feel whole, special, and safe. As we work so hard to separate ourselves from this type of patient, that very same hard work can serve a synonymous function.

Similarly, the genesis of motivation for some who enter the field of psychology is based in narcissistic injury. Said succinctly, the psychologist’s own insecurities, needs for power, control, gratification and subsequent sadism may be primary motivators to become a helper.

Helpers would appear to be those without the intention of personal gain. Yet the field of clinical psychology is replete with opportunity for covert abuses. Foremost we are often experienced by others as “mind readers.” “Are you analyzing me right now,” is not unusual to hear at a party. Or, “those tests don’t really tell you anything.” We are feared and while many cannot acknowledge a fear of us openly, a psychologist has the power to intimidate. We are in a position of authority and inequity. Even if you are treating a peer, you are the voyeur with the privilege of intrusive questions, personal probing, and the one charged with holding secrets. If not for fear of our intelligence and fantasized mind reading abilities, we are at least scary because we are the keepers of what could be the ultimate weapon. In short, our role makes us feel powerful.

We are able to withhold, disclose, rescue, direct, and even taunt. What of the ill-timed interpretation for a bright patient; are you certain that the exploration of affect on that day was not designed to diminish him or her to reassert a personal emotional need for the self. How curious is supervision when we patronize, dramatize, and sexualize all to keep our selves feeling healthy, stimulated, and most importantly distinct from the patient.

My intention in writing on this subject matter is again to promote wonder about who we are, and why we treat. Consequently we may develop a greater understanding of what is really helpful to our patients. My general experience is that anger, aggression, selfishness, desires for power and control, and even sadistic hurtful wishes are commonly denied amongst helping professionals. Rather, some embrace the antithetical — peace, calm and serenity — the makings of reaction formation.

It seems almost sad that healthy narcissism must be so vehemently denied and concealed within a profession. Understanding our ugliness if it must be judged, can include a functional compromise formation resulting in greater acceptance of ourselves. Such acceptance and compassion for our own intense needs and forceful drives can also include greater compassion for the weaknesses of others, including our least favorite patients.

It is not unusual for my voice to be considered self-absorbed or even “cocky;” I have been criticized for both. If the reader is looking to find fault in this author for his rather presumptuous posit, I have successfully engendered the merging of the content and process. To correspond regarding this or other articles, please contact me, Dr. Jason Camu via email at: dr.camu@fuelforemotionalhealth.com.

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