A Therapist’s Journal Entry

Today, a long-term client said something to me that I haven’t been able to shake.

We’ve been doing some difficult work lately, although probably not the kind of “work” people imagine when they think about therapy. I’ve had to set harder boundaries. I’ve had to remind them that I am not the fix. Therapy is not the fix. The tools can help, but eventually they have to learn that they can carry what belongs to them without needing someone else to make it go away.

Today, as we talked through that, they said:

“I came here to feel better. I don’t feel better. But what I have now is bigger.”

I knew exactly what they meant. They had learned that therapy cannot make everything go away. Coping mechanisms cannot make everything go away. There are things in this life that cannot be processed, regulated, reframed, medicated, EMDR’d, or therapized into nonexistence.

They still hurt. But they can hold it now. They don’t have to numb it. They recognizes what is happening. They know what to do with themselves when it comes. They can experience suffering without buckling underneath it.

And somehow, later tonight, I found myself needing the very lesson they had just articulated to me.

Then, I turned on Theo Von’s podcast with Laura Delano, and listening to them, hurt.

https://youtu.be/QK1q5yTRY7s?si=-geA5qokMhkjGpCI

I hurt for both of them and for other people who have been given some version of the promise that we can make this go away. Maybe through medication. Maybe through therapy. Maybe through the next diagnosis, the next explanation, the next modality.

And I kept thinking:

We shouldn’t promise healing. That is Christ’s job alone.

We try to help. Or at least, I do.

And one of the worst thoughts I ever have as a therapist is:

I’m not helping.

It is an awful thing to confront. I can’t express the hopelessness that comes along with that thought. The depth of failure that tags along is near suffocating.

Because I don’t get to protect myself from that possibility by saying that therapy is inherently helpful simply because someone keeps showing up. I don’t get to decide that another six months of treatment must be clinically necessary because there are still appointments available on my calendar.

I have to ask. Is this helping?

Does this person still need treatment? Am I treating something that needs treatment, or have we reached the point where being human simply hurts? And if I really confront the possibility that I cannot make someone better, the questions can cascade quickly.

Then what am I doing?

What is any of this for?

Did I waste $60,000 on a master’s degree only to eventually arrive at the realization that life on this plane is painful?

Period.

I think that is partly why Ecclesiastes keeps coming to mind tonight. The futility of things.

My faith has always informed my work. I tell every client some version of this: Someday I will die and face Jesus, and when I account for this work, I cannot hear anything other than that I valued the lives that sought me and that I never took advantage of them.

That standard matters to me.

And sometimes it puts me directly at odds with the incentives of my own profession. Indefinite treatment fills appointment slots. A client who believes they continually need me pays the bills.

There is always another problem to explore. Another layer. Another treatment target. Another modality. Another explanation for why the discomfort remains.

There is always more “work to do.”

Except sometimes there isn’t. Sometimes I believe the ethical thing is to say:

We treated what needed treatment.

You know what this is now.

You have the tools.

You can carry this.

You don’t need me anymore.

Go live your life.

That is terrible for client retention.

I increasingly believe it is central to my calling.

And yet, I would be lying if I said it doesn’t get lonely.

It does.

It feels profoundly countercultural sometimes, including within psychology itself. Discomfort increasingly seems to demand an explanation. An explanation becomes a diagnosis. A diagnosis offers the possibility of a treatment. Treatment offers the possibility of relief.

And when the relief wears off, there is always another explanation waiting.

Another therapist. Another diagnosis. Another intervention. Another promise.

I don’t want to participate in that simply because it would be easier. That doesn’t mean I believe treatment is useless. Quite the opposite. Trauma should be treated when trauma treatment is indicated. Medication can be enormously helpful. EMDR can be appropriate. CBT can change lives. Sometimes people come to therapy suffering terribly and genuinely do feel substantially better.

We should treat what is treatable.

Teach what is learnable.

Relieve what can reasonably be relieved.

But I increasingly believe we must also refuse to pathologize whatever remains simply because it hurts.

Because suffering is part of this.

And perhaps the hardest thing for me to accept is that helping someone does not mean healing them. I cannot do that.

Maybe I spent $60,000 learning a collection of ways to understand human behavior and suffering so that, for a relatively brief period in another person’s life, I can help reduce what can be reduced, change what can be changed, teach what can be learned, and refuse to exploit what remains.

And then let them go.

Tonight, that feels both meaningful and terribly small.

I believe God called me to this work. Tonight, the calling also feels heavy. I don’t have a tidy ending for that. I don’t particularly want one.

I started writing all of this because I felt lonely in what I believe about therapy. Somewhere along the way, I realized I was asking a much bigger question:

If suffering cannot ultimately be eliminated, what is the purpose of devoting my life to helping people who suffer?

And then I came back to what my client said this afternoon.

“I don’t feel better. But what I have now is bigger.”

Funny.

Because tonight, I don’t necessarily feel better either. The profession hasn’t changed. The tension between my faith, my integrity, my livelihood, and the culture around therapy hasn’t disappeared. I still wonder whether I am helping enough. I still feel the weight of knowing that sometimes there simply isn’t another intervention that will make something stop hurting.

But maybe I don’t need to make those things disappear tonight.

Maybe I can hold them.

Maybe faithfulness was never supposed to mean that the work wouldn’t become heavy.

Maybe helping was never supposed to mean healing.

And maybe the thing I have spent years trying to teach the people who sit across from me is something I needed one of them to hand back to me today:

The goal is not always to make suffering disappear. Sometimes we become capable of carrying what remains.

Today, apparently, the client taught the therapist.