Still, I Became A Therapist

I. A REHAB VIGNETTE

They wanted to leave against medical advice from the residential rehab facility. We were sitting in the little clinical office that we used for admissions. Outside, a siren wailed. I wondered if the client across from me heard it too.

“I’m not trying to talk you out of it,” I told them. “You get to make that call. But I’d like to sit with you while you think it through, if that’s okay.”

They let me sit with them.

I meant it - I wasn’t being strategic. I didn’t need them to choose “right;” I honestly didn’t know what that was. I didn’t know what I would do in that situation - I am an autistic homebody, and I would have found the situation overwhelming and oppressive.

A few hours later, still at the rehab, they told me I was very good at my job.

At that point, I’d been a therapist for three months. I didn’t believe them, but I didn’t forget it, either.

I hadn’t fixed anything. I’d simply stayed.

II. BECAUSE I BELIEVED IN IT, EVEN WHEN IT HURT ME

I didn’t become a therapist out of naivety. I became one because I knew exactly what therapy could do.

It had saved me - while also mislabeling me and hurting me. I walked into rooms that changed my life and others that left bruises no one could see. One therapist’s office smelled of lavender and superiority. Another of vanilla and unexpected grace.

I knew that the thing people call therapy - the licensed, credentialed, state-supervised, neatly coded thing - wasn’t always the same as care. Care doesn’t need a billing code. Care doesn’t pathologize survival. But when the work is real, when it’s held with honesty and skill, it can split your life into before and after.

That mattered enough to me to make it my life.

I didn’t choose this because it was easy. I chose it because it was worth doing - and worth doing well. I would’ve found something else to do if this work hadn’t been worth the cost. I could have found something better to do if I didn’t believe that therapy had some promise.

So I stayed. I became the kind of therapist I would trust with my own story. The kind who wouldn’t pathologize my autistic intensity and who’d see the structural violence beneath my PTSD.

III. PROFESSIONALISM AS PERFORMANCE

Many places I trained and worked, I saw similar rules:

Don’t challenge the diagnosis.

Don’t complicate the narrative.

Don’t love your clients too visibly.

Don’t name the systems. Only the symptoms. Symptoms are manageable.

I watched colleagues speak about “unconditional positive regard” while chatting about a client’s “noncompliance.” I watched clinicians shame clients for avoiding therapy - never naming the very real reasons people avoid being watched and documented and never acknowledging how the system itself induces trauma.

It wasn’t malicious. It was normalized. The distance was protocol. You weren’t supposed to see the client’s dignity if it interfered with your treatment plan.

Unconditional positive regard doesn’t mean believing clients are perfect. It means believing that being perfect isn’t the requirement for being treated with dignity.

IV. SURVIVAL LOOKS LIKE RESISTANCE WHEN YOU’RE NOT THE ONE SURVIVING

What gets called “good therapy” in many places is often therapy that flatters the system. It rewards insight when it sounds like an apology for having had the audacity to hurt and progress when it looks like self-blame. It presents healing as a clean quiet.

Most of the clients I’ve worked with are angry, dissociative, vivid, funny, and tired.

Often, they’re told that their exhaustion makes them difficult cases. I’ve been called difficult, too.

What I’ve learned is: difficult is often code for “you won’t make yourself smaller to make this easier for me to watch” and “you keep saying what I was hoping wouldn’t have to be said.”

Defiance is a word, but not what I would use. That’s grief, made legible.

V. I’M NOT TRYING TO FIX ANYONE

What I try to offer is simple: care without performance.

That means not making clients audition for empathy. I won’t make my clients pay that tax.

That means not requiring that someone crumple in session just to prove they’re not lying and not conflating stoicism with dishonesty.

That also means saying things like: “I believe you.”

And: “You don’t have to say more than that if you don’t want to, but you can if it feels safe.”

And: “Thank you for telling me.”

I tell my clients that I will always be honest about what I write in the chart. Their insight is not being measured. Showing up is their job, while the therapy is my job - as long as they came and met me as a human, they did great in therapy today.

I don’t believe in pretending the system isn’t there. That’s dishonesty I won’t indulge. I just refuse to build my practice around its expectations.

VI. ETHICAL COHERENCE KEEPS ME SAFE

I bill insurance. I use diagnosis codes. I document session content. Precision is my shield.

I’m very careful about what I don’t do. My “don’ts” are my ethical scaffolding.

I don’t pretend the DSM is neutral. It was built on bones. I don’t use diagnoses as leverage. I don’t write things in the chart that I wouldn’t say in the room.

I don’t conflate clinical clarity with system compliance. Clarity serves the client. Compliance serves the machine. Eviction isn’t a symptom. Systemic racism isn’t a cognitive distortion.

I often use Adjustment Disorder. I sometimes tell clients it means, “the system failed you.” It means pain makes sense here.

I am precise because I believe in precision as an act of resistance. I don’t use precision to flatten anyone. I use it to protect the client’s agency - because every clinical note is an act of interpretation, and I want mine to be interpretable with their dignity centered.

VII. PERFORMING SAFETY IS NOT THE SAME AS BEING SAFE

Before I was a therapist - before I was even a client - I was already practicing how to make people comfortable in my presence. I didn’t have the words “autistic masking” yet. I just knew that when I was fully myself - literal and intense - people seemed to respond poorly.

I began to study people. I read etiquette books like sacred texts. I practiced how to make eye contact, even when it physically hurt. I traded my needs for palatability. I memorized the patterns of human behavior like they were weather.

Still, I missed a lot - the jokes that were made at my expense and the ways I was being managed by social cues I hadn’t learned yet. It made me guarded. Hyper-observant.

By the time I got to Pomona College, I could perform a version of neuronormativity that was close enough. I could be quirky without threatening anyone. I could package my intensity in palatable doses. My privilege gave me systemic cover - white skin, daughter of an attorney, hyperverbal, and Texan-accented. People gave me the benefit of the doubt.

It opened doors and muffled alarms. It worked so well that it took me a long time to understand what it was costing me.

What looked like competence was often compliance. What looked like poise was often pain. I wasn’t safe. I was just legible.

That distinction came into sharp relief in my thirties. I was empty. I didn’t know how to keep performing palatability without disappearing inside it like a ghost.

VIII. THE RECKONING

That’s when I found myself in therapy - not for the first time, but for the first time with a clinician who saw my whole case and not just my fluency.

It changed me.

I don’t want my clients to feel that pain I had once felt: that in order to be believed, I must contort. That in order to be helped, I must appear broken in the right ways.

I won’t reproduce that logic of extraction. I won’t reward coherence over truth, because a lack of coherence so often means that there just isn’t a container big enough to hold the complexity of surviving crushing systems.

If someone sits across from me and can’t look me in the eye, I don’t assume what that means.

That’s not sentiment. It’s a refusal to pathologize what I’ve lived through myself.

I’m not here to perform neutrality. Neutrality is a lie and complicity. I’m here to create a space where nobody else has to wear the itchy sweater of being someone they’re not in order to be heard.

IX. THEY SAY “THANK YOU FOR BEING HERE”

I have often been told, “Thank you for being here.” Thank you for not disappearing. Thank you for not demanding performance.

I let people be complex without punishing them for it.

X. I STAYED BECAUSE IT HURT TO WATCH PEOPLE LEAVE

I’ve known people who did extraordinary work before burning out. Therapists who were bold, radical, tender, and unwilling to perform niceness or pathologize survival.

Some left the field with broken hearts.

Some stayed and got tired.

Some are still trying to remember what their work used to feel like.

I think about them all the time, their absence like holes in the fabric of care.

XI. CLOSING: STAYING IS NOT THE SAME AS SAVING

Staying doesn’t make me a hero, but it does make me accountable.

Every time someone sits across from me and takes the risk of being known, I’m holding a kind of debt - one I didn’t create, but inherited from a profession built on harm.

I try to pay it down every day.

When they ask, “What are you doing here?”

I say, “The same thing as you.” Surviving. Building sanctuary in the ruins.