We’re Gonna Need a Bigger Therapist!









Long ago, when I first started my practice, I also started therapy of my own. Oh sure, I had been in “therapy” before, in L.A. (during my internship at the UCLA Neuropsychiatric Institute), if you want to call it therapy. One guy was into wrestling around on the floor of his office with his patients, and once, when I tried to talk to him about my bad back, he mockingly said, “Ooooh, poor baby!”: maybe he was pissed off that it meant I wasn’t gonna be a good candidate for his half-Nelsons down on the rug!

Another guy believed that the way to mental health was to become an ‘expert’ at something. His ‘specialty area’ was humor, but after a few months of nothing really happening in our sessions, I wasn’t laughing.

But what did I know? I mean, I thought, well, maybe they were fabulous therapists, and I was just a dud as a patient. (Hmm, does this give you any idea of my psychological problems at the time?)

So, after I moved to the Bay Area in the late Seventies, and started my private practice, I finally had enough money, and time, to actually be in therapy myself, hopefully with a ‘real’ therapist. I know this probably sounds weird to a lot of you reading this: how could a psychologist who needs therapy, and who hasn’t really even been in therapy, actually do therapy? Well, it’s not nearly as weird as it sounds. First of all, here’s a news flash:

All therapists are Just People!

They have their own issues, their peccadilloes, and their emotional tics, just like anybody else. And, for that matter, while we’re at it, I might as well share some other late-breaking news:

You don’t have to be ‘together,’ yourself, to be a good therapist!

I know it sounds funny, and it may not make sense to a ‘layman,’ but it’s absolutely true. I’ve known many excellent therapists whose own personal lives were lived in a basket, and I’ve certainly had many therapists as patients who, at times in their life, occupied prime acreage on the Funny Farm. But that didn’t mean they weren’t good therapists! In fact, some experience of ‘bad times’ and some time logged on the couch oneself, is almost a qualification for being a good therapist.

After all, the stuff you get from books and teachers can only take you so far in understanding, and dealing with, psychotherapy patients. Beyond a certain point, you’ve got to either be able to identify in some way with what people are struggling with, or at least have some empathy for their woes, neither of which you get by having had a perfect life. While a therapist should at least have a commitment to growth and change in his own life, I don’t feel he needs to have “gotten there” in order to help others. No, being unfinished business oneself is not a disqualification for being a good therapist; but being a hypocrite, i.e. one who smugly helps others with their problems, without an awareness of one’s own problems, or a commitment to working on them – now a dude like that is a no-show in my little black book of therapist referrals.

It’s true, therapists are often seen as role models by their patients, are looked up to, and seen as experts and maybe even paragons of a sort, but while this doesn’t preclude therapists having problems of their own, it does mean that they can’t drag them into the therapy relationship like pet poodles. This is where “disclosure” often becomes an issue: I don’t believe in the old ‘blank slate’ policy, whereby the therapist displays no reaction whatsoever to anything the patient says, sitting there like a cigar store Indian when the patient says, “I just got accepted to Yale!” and then when the patient says, “Aren’t you even happy for me?” responds with, “So, what are you feeling right now?”

What are they feeling right now?

Well, probably that you’re an asshole, for starters.

No, I’ve been there, done that, on the patient end and the therapist end, and I feel that this style is unnecessarily withholding and emotionally miserly, leading to exaggerated hurt, insecurity and desperation on the part of the patient, that isn’t even part of their real ‘work,’ but rather an artifact of the method itself.

On the other hand, you definitely don’t want to be intruding on the patient’s rightful space in therapy, by constantly throwing your own personal reactions, experiences or feelings out there. There is a time and place for such disclosure, and it’s when it is of service to the patient and the therapy, not just because it occurs to you, because it’s a great story, or because, “I don’t know – it just came up,” which the ex-therapist of a patient of mine routinely gave as a ‘reason’ for his constant, interruptive disclosures. Dude, self-disclosure in therapy is not a burp: it’s a wisely-meted-out resource, to be used for the benefit of the patient only. Yes, I self-disclose nowadays a lot more than I used to, but I know what I’m doing, as opposed to when I was a beginner, when it was wiser to keep my mouth shut and just listen. Besides, I have enough life experience now to come up with stuff that’s actually relevant, rather than just playing word-association, to wit:

Patient: I grew up on a farm.

Gregg: Oh – I used to have a chicken!

Ouch! See what I mean? Relevance, and therapeutic benefit, are the keys, not cleverness or sloppy over-identification.

But back to my first ‘real’ therapy. Well, this guy came highly recommended. He was an older guy, a big muckamuck in an esteemed local psychotherapy training program, and had been around the Berkeley therapy scene for decades. In other words, as a current young woman patient of mine would say, he was supposed to be “the shit.” Well, like I say, what did I know? I knew about doing therapy, not being therapized. I knew my way of operating, but also knew there are many ways to skin a cat, so whatever he did, I figured it had the Good Housekeeping Seal of Approval.

Well, the first session was, shall we say, a little spare. I rattled on about my marriage at the time (not so hot), my depression (mild to moderate), and anything else that was bothering, frustrating, or torturing me, while he sat there in silence, puffing on a (mostly unlit) pipe, fiddling with pipe cleaners and other paraphernalia of the pipe-maintenance trade, making occasional furtive entries on a little yellow pad. I once saw a couple where the woman really loved her dog and was pretty lukewarm about her husband. Once, the husband got so fed up he yelled, “When I die, I want to come back as your dog!” Well, when I died I wanted to come back as this guy’s pipe: it seemed like the only way I was ever going to get any attention out of him.

Oh, did I mention that my basic ‘presenting etiological problem’ was having two narcissistic parents, who were unable to get their heads out of their own popos and pay any real attention to me? Hmmm . . .

Well, we went on like that for weeks, months, years. Me talking, him puffing – only taking small breaks to raise an eyebrow, smirk, or chuckle to himself.

Oh, yes, one more thing: he also took breaks to answer his telephone.

Yes, you heard me right: I said, “answer his telephone.”

During my sessions.

To talk to his other patients, right out loud.

During my sessions.

Oh, and did I mention that the basis of my problems was that I had two narcissistic parents who . . .

And one more thing: he was almost always late in coming out to get me. And his previous patient was a real cute girl. And he was late because he always ‘ran over’ with her. And he had a reputation around town as a ladies’ man.

I finally got up the nerve one day to say, “Why are you always late?”

No response.

“You always run overtime with that girl you see before me.”


“It annoys me. Is there something going on with her and you that you’re not dealing with?”


“Look, I’m asking you a direct question: what’s going on with you and her, that always makes you late for my sessions?”


“I’m getting sick of this cat and mouse routine.”


He answered the phone, talking chummily with someone for at least two full minutes.

“And another thing: stop answering your phone on my time. I’m paying for a full session, not to mention for getting your full attention.”


“Maybe if you ended your sessions on time, you’d have time to answer your phone calls on your own time.”

Furtive note.

“Don’t you have anything to say? Because if you don’t, I’m not sure I can continue this.”,

With that, he actually put down his pipe and actually spoke, in actual words: “You’ve been complaining since you got here. What do you think is going on with you today?”

I almost said, “Better watch out – I think your pipe’s getting lonely down there,” but I was too stunned to say anything for a minute. I mean, dude – you’re going to be friggin’ late to sessions for months at a time, play footsie with your cute girl patients, answer your damn phone on my dime, and then blame me for complaining about it?

I sat there with my head spinning for a few minutes, and then he announced the end of the session: exactly on time, as always.

Before the next session, I decided it would be our last – and I use the word “our” loosely. Part of me (the part that needed therapy!) was still trying to make excuses for him:

Maybe I was wrong about his running overtime with the cute girl.

Maybe I was wrong about his always starting sessions late with me.

Maybe he had a right to answer his phone during my sessions: he certainly seemed to think he did.

Maybe his not responding was actually good for me. Maybe his not caring was good for me.

Maybe I was a chronic complainer.

Maybe this, maybe that.

Yeah, and maybe if your aunt had a beard, she’d be your uncle.

Well, that last session was a classic.

A doozy.

A lulu.

A pip.

Look, when you’re a therapy patient, about the only real ‘power’ you have over your therapist is two things: time and money. Because, in the final analysis, those are the only two things that the therapist is really entitled to from you. So, to have an ‘effect’ on the therapist, the only real things you can do are to withhold time (be late, ‘forget’ sessions, cancel, demand extra time, not be available, cut back the frequency of meetings), or withhold money (‘forget’ to pay, pay late, refuse to pay, demand reduced fees, say it’s not worth it). But you shouldn’t have to use the threat of time or money to get the therapist to care: I mean, he or she is supposed to care ‘just because,’ right?


I came in to the session (which started late, of course), and announced that this was going to be my last one. I mean, Jesus, this should have evoked some kind of big response from him – if not because it meant he had failed me, then because he didn’t want to fail me.



Well, then, at least because it meant I wasn’t going to be paying him anymore.



So, back to my announcement, which went something like this: “I’ve decided, based on how you’ve treated me, that I don’t think this is doing me any good, and that to continue to go along with it would mean accepting the way I was treated in my family, which you’ve pointed out many times, was abusive – or at least when I said it was abusive, you puffed on your pipe and didn’t take any notes, which I take to be agreement in principle.”


“So, like I say, this is my last session.”


I sat there, waiting for a response, and not getting one. Heck, even with starting late, we still had at least thirty minutes to go. Thirty long minutes. Thirty minutes of angry silence, humiliated silence, punctuated by puffing and smirking. I mean, after a while, I even started hoping the damn phone would ring.

Finally, I just couldn’t sit there and take it anymore: I had to put an end to it. I stood up and said, “Well, I guess this is goodbye – to you, and your damn pipe.”

I was just starting for the door, when he suddenly spoke. “That’s the healthiest thing you’ve done in your whole therapy.”

I could have said, “And that’s the first right thing you’ve said in my whole therapy,” but I didn’t.

It felt bad: kind of like threatening to break up with a girl and all she says is, “The door swings both ways: don’t let it hit you in the ass on your way out.”

There was nothing to say. I walked out the door and never came back.

Well, he was right: it was the healthiest thing I had done in my whole therapy. And I did learn some things from it all – or at least it started me on the road to some important learnings:

I learned, finally, to trust my own perception of situations, instead of always believing people who “know more than me.”

I learned that, at least for me, when dealing with self-absorbed narcissists, the only proper response is, “I think we’re done here.”

And, oh yes, I learned something else, too: if this clown was thought of as a big whoop in the therapist community, if he was considered to be the ‘real deal,’ well, then I certainly didn’t have anything to be ashamed of as a therapist. At least I cared about my patients. At least I fought for them. At least I responded when they were upset, or hurt, or felt ignored, or not taken seriously.

I also learned that sometimes, a guy who’s a total fraud, a bullshitter, an insincere ass, and a phony, can be lauded and idealized by a whole community of ‘sophisticated’ people. Some people have the gift of gab, or charm, or power politics, or just intelligent psychopathy, that lets them fool most of the people most of the time.

And you know what – that’s okay, but the thing is, I don’t have to buy it. It may sound simple, or obvious, but the biggest thing I think I learned from Dr. Puffer was to sit and listen politely to people (including ‘experts’), then say to myself,

“Yeah – that’s what you think, bud.”

So there it is: from him, I learned to walk away, and from him, I learned to think for myself.

Of course, I never did learn to answer my phone during my patients’ sessions, but then, nobody’s perfect.

















Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.