Want a Private Practice in the 21st Century? Get a Thick Skin.

Photo courtesy of http://www.rhinos-irf.org/

Many therapists go into the psychotherapy field because we are sensitive to the feelings and behaviors of others.  In the clinical session, this is very important.  Even if you aren’t a Self Psychology-oriented treater, empathic attunement is crucial to understanding your patient and meeting them “where they’re at.”  People often come to therapy hoping for and expecting a corrective emotional experience, and usually that is an unspoken part of the therapy contract.  Patients desire to be understood and heard; therapists strive to understand and listen.  In this, sensitivity to what the other is communicating is key.

This is not always recognized by those outside our profession:  Many times when we are asked what we do, and when we reply that we are therapists, we hear, “Oh I could never do your job, I’m too sensitive.”  Yeah, I can do this job because I’m a really callous asshole.  I don’t ever say that in reply, usually I don’t mention I’m a therapist (if someone asks me what I do I usually leave it at, “I do interiors.”)

However, there is a place for insensitivity in owning a private practice, and that is what I want to talk about today.  Many of you are excited to begin practicing in a Web 2.0 environment.  You have your Twitter account, your professional Facebook presence, etc.  But are you psychologically ready for what comes next?

Recently I did a blog on Gamer-Affirmative therapy.  It got many positive responses that I don’t remember clearly, but one negative one of course stuck with me.  The colleague wrote on a bulletin board, “…it’s just a PR stunt. “Gay affirmative-Transgender affirmative- bla bla bla” Don’t use it…sounds stupid.”


I could get huffy, refer the person to my earlier blog on managing your online presence, but I’m not going to do that.

What’s more, if I have a thick skin, I can look at the comments more objectively, see if they are pointing out something of value to me, something about an idea or plan I hadn’t anticipated.  If they do, good deal!  If they don’t, can I let it bounce off and move on to the next one without ruminating about it too much?

If you are planning on venturing out here with your practice, are you prepared?  Can you take the good with the bad?  Can you shake off the hurtful comments?  Better yet, can you learn from them? Sure we’d like everyone to communicate on the web in a respectful, polite way.  They don’t.  Can you deal with this and move on?  If you find yourself scrolling down to that comment or email and reading it for the umpteenth time and you haven’t learned anything from it or calmed down, you are not dealing with it and moving on.

Last word, don’t rush this:  If you aren’t sure that your idea or practice focus is “ready for prime time,” who can you share it with that you trust will be more compassionate?

Oh, and if you want to donate to the International Rhino Foundation, click on the photo!  🙂


  1. Thanks for the heart-felt column. I really like the way you’re going out on your own, defining a practice based on your interests and strengths. You articulate so well, in a way that I can use, the reasons I myself have trouble doing this: fearing the negative feedback and the hostility anyone gets for trying something new and unique. I’m encouraged – hope you keep going too!! Thanks.

    • Thanks Charles! I appreciate that, and definitely keep at it and don’t let ’em get you down!

      • Hi Mike, in my view no one should be a therapist, or in any other related profession, unless they can learn to deal with feedback in the way you describe. Is that not the sign of a mature human? And is not the therapist (etc) there to model such behaviour? It seems to me to be a given. By the way, I love ‘I do interiors’ – think I’ll start using this (with an implicit credit to you of course). Thanks!

    • @ Karin, excellent point! One of the things I strive for is to be able to take constructive criticism. I also try to discern what is constructive and what is an attack. I think modeling both things can be helpful for our patients.

  2. Excellent point Mike. I think that whenever we really find our voice we need to understand there will be negative reactions from others. One of my struggles as a doctoral student, prior to doing my dissertation, was the thought that my words would really be “out there” for people to take on. It’s much easier to not let people know who I am and what I think.

    After years as a trainer and educator, I have come to expect a certain number of negative comments every time I do a workshop. I read them all over-some of them have been very helpful. Others just come with the territory: e.g., “too much time for discussion” and “not enough time for discussion”: if I have both of these comments mentioned with about the same frequency then I’m probably right on target.

    Any time we speak with a distinctive voice and share it there will be people who take issue. In a Web 2.0 world, there will be people who call it marketing. In other contexts they have other labels. Sometimes the criticisms tell us something key about what we are or aren’t doing well. And sometimes it just tells us volumes about the person who is doing the criticizing. To paraphrase a comment an internship supervisor made to me when I was learning therapy in my MSW program, every time you point a finger at someone, there are three fingers pointing back at you.

    • Loved this! And you reminded me of my experience as an adjunct at BC. Every year I do a midterm evaluation and the final evaluation. Sometimes my students point out similar things which I know are challenges. And other times different students like the same thing about the course that other students hate about it! There is no pleasing everyone, but if things are balancing out, that’s a good sign.

  3. It is definitely a different venue to receive feedback. I had learned to maintain a distance in my professional identity and role that allowed me to not take it personally when a client had negative feedback or a negative transference that allowed me to work through these periods with them. Now that I am putting myself out in a new venue, my business, which includes more of my personal thoughts, it feels more vulnerable. I just got feedback on a post I put up on my Facebook page, and I felt really bad a bout it for a few hours. Then it garnered more posts, and I thought, Hey, this is a lot more than the usual 0-1 posts I usually get. So, I am beginning to like the idea of stirring people up and getting more authentic reactions. That was my goal to begin with…

    • Well said Dan. Sometimes even the negative comments drive traffic to your info, and often the 98% of the readership that doesn’t critique your posts will come back and maybe even decide to work with you. It is also interesting how many therapists don’t understand (or maybe don’t care) that they are projecting their own conflicts and expressing their envy all over the place. Good to know for future referrals though! 🙂

  4. I enjoyed your post, Mike, I suppose because I’ve experienced exactly what you are describing (speaking of empathic attunement 🙂 ). Recently there was a “scandal” in Cincinnati when a teacher arranged a field trip for 18+ year old students to visit the Board of Elections. Some mistakes were made and suddenly in the press the teacher became a “criminal” trying to “force students to vote the democratic ticket”.

    I had to comment. Not in my professional role; just as a citizen. I didn’t believe for a moment that the teacher was trying to do anything except go to the inestimable *trouble* of arranging an educational experience.

    The point is, I was unprepared for the responses I got — and I’m used to being online. I was a “troll”, “could anyone really be that *stupid*???”, I must
    “work for NPR”, I must not believe in free elections.


    I confess that I watched the comments rolling in for several hours. On one level, it really hurt! On another, I was aghast at mentality of those participating in the discussion.

    Anyway — I certainly do agree that you have to be ready for it, learn what you can (there are great lessons in using words that effectively convey your *intended* meaning to readers — and avoiding those that don’t) — and then be able to move on.

    Which I had, until you reminded me 🙂


  5. “I do interiors.” LOL – thanks for sharing.


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