“You Have to Be It to See It” – And Other Phrases to Improve Psychotherapist Well-Being

The work of a psychotherapist can be emotionally taxing. Psychotherapists must deal with the day-to-day micro-stressors, such as treating people with unpleasant emotions and difficult interpersonal situations. In addition, many psychotherapists will experience, at some time in their careers, a macro-stressor, such as having patients die from suicide, being threatened with an assault from a patient, being the victim of patient stalking, or some other traumatic work-related event (Norcross & VandenBos, 2018). As a result of these stressors, many psychotherapists may experience stress or burnout, which can impact the quality of their work.

Psychotherapists with compromised emotional well-being tend to have worse patient outcomes. For example, Delgadillo et al. (2018) found that patients had better outcomes when their psychotherapists scored lower on a burnout scale compared to patients treated by psychotherapists who scored higher on the same scale. Other studies have also found a similar association between psychotherapists’ well-being and patient outcomes. For example, Salyers et al. (2015) found that psychotherapists who experienced high levels of burnout believed that they delivered a lower quality of services to their patients. These findings make intuitive sense and are supported by other literature showing that psychotherapists who experience a high degree of emotional distress may have difficulty attending to their patients’ emotions or controlling their own emotions in psychotherapy.

Of course, the well-being of psychotherapists is multi-determined and depends, in part, on the totality of their working conditions as well as their strengths and vulnerabilities. The stressors can be even more impactful if psychotherapists do not have a social support system, have high administrative burdens (Yang & Hayes, 2020), have pre-existing vulnerabilities (i.e., personal history of adverse childhood experiences; La Mott & Martin, 2019), or have adopted unrelenting perfectionist standards for themselves or engage in excessive self-sacrifice (Kaeding et al., 2017; Simpson et al., 2019). These factors may be relevant to the extent that they impact the ability of psychotherapists to regulate their emotions.

Given the importance of self-care and emotional regulation, various scholars have proposed interventions or strategies to help psychotherapists protect and enhance their well-being. The strategy chosen may depend on each psychotherapist’s needs, strengths, and circumstances – no strategy is appropriate for every psychotherapist (Norcross & VandenBos, 2018).

Some emotional regulation strategies are pragmatic and straightforward, such as setting limits on one’s caseload, taking breaks during the day, and ensuring time for relaxation and vacations. Other strategies focus on processing or responding to the numerous micro-stressors encountered throughout the workday, as well as the macro-experiences that arise from them. These could include strategies for increasing pleasant emotions or decreasing unpleasant emotions.

Sternlieb has offered three brief and memorable phrases to help psychologists who want to downregulate their negative emotions: “You have to be it to see it,” “You have to name it to tame it,” and “You have to share it to bear it” (Sternlieb, 2013, p. 21). These three phrases require action on the part of psychotherapists: seeing or acknowledging the emotion, naming or labeling it, and sharing it with someone. These phrases are catchy, easy to remember, and highlight important information about self-care.

The “Name it to tame it” phrase was originated by Dr. Daniel Siegel (Mindfulness, n.d.). Dr. Sternlieb developed the other phrases after years of working with healthcare professionals in Balint and other self-help groups. Other sources have used similar phrases, although the origins are unclear. For example, Billy Jean King used the phrase “see it to be it” to refer to the necessity of visualizing women’s participation in sports before it can actually happen. This appears to be an example of different persons using different contexts to describe different events. To our knowledge, there was no cross-fertilization of ideas (http://www.goodreads.com/quotes/43749-you-have-to-see-it-to-be-it)

However, it is worth examining whether these phrases accurately reflect what is scientifically known about emotional regulation. Generally speaking, cognitive reappraisals, self-awareness, and non-judgmental acceptance are effective strategies for regulating one’s emotions. In contrast, emotional suppression—avoiding or hiding one’s feelings due to the potential consequences—is an ineffective strategy. Do these three phrases accurately reflect these findings?   

“You Have to Be It to See It”

The work of a psychotherapist necessarily involves emotional suppression at some time or another. For example, a highly disturbed patient may engage in therapy-interfering behaviors, such as missing appointments without canceling, repeatedly showing up late, failing to pay for services as agreed upon, or making harsh comments directed at the psychotherapist. This effort to control one’s emotional reactions, known as emotional labor, also occurs among other healthcare and non-healthcare professionals (e.g., consider a mechanic who has to deal with an angry customer after learning the cost of car repairs). Emotional labor, however, can result in emotional exhaustion (Clarke et al., 2021). When psychotherapists are in these stressful situations during a session, it is usually productive for them to temporarily suppress their spontaneous anger or hurt and respond to the provocations with a calm and understanding voice. A good psychotherapist tries to step back, gain perspective, understand the origin of the problematic behavior, and respond accordingly.

Although short-term emotional suppression may be necessary in a professional setting, it is generally not a sustainable strategy for regulating emotions in the long run. Psychotherapists who suppress or deny their emotions will likely suffer in the long run unless they recognize and accept their emotional pain. Thompson et al. (2014) found that maladaptive coping responses, such as denial (a form of suppression), were related to subsequent feelings of burnout. Some psychotherapists who hold themselves to impossibly high standards may believe they should have such excellent emotional health and psychological equilibrium that they can endure these difficult situations without experiencing painful emotions. All of us may be vulnerable to these impossibly high standards and deny, minimize, or suppress the emotional pain that comes from psychotherapeutic work.

Consequently, the phrase “You have to be it to see it” is helpful as it sensitizes psychologists to the perils of emotional suppression. Of course, any brief phrase must balance memorability with precision or comprehensiveness. A phrase like “You will promote your well-being in the long run if you acknowledge feelings rather than suppressing them” may be more scientifically exact but less memorable.

“You Have to Name It to Tame It”

Labeling and consciously naming emotions is an important strategy in emotional regulation. Emotional labeling is commonly used in cognitive behavioral therapy or dialectical behavior therapy, and it appears to reduce negative emotions. Moreover, preliminary evidence suggests it can be helpful for non-clinical and clinical populations to practice this strategy (Fitzpatrick et al., 2019). Perhaps it is effective because it allows for the non-judgmental acceptance of emotions or facilitates cognitive reappraisal. The phrase “You must name it to tame it” captures that finding very well.

Naming our experiences can be a crucial first step in determining the most suitable options for addressing our needs. For example, knowing that we feel hungry can help us decide whether it is a good time and prudent to seek nourishment. Conversely, recognizing one’s frustration with a patient allows the psychotherapist to help us consider options to address that frustration. Psychotherapists can choose to address the process rather than merely reacting defensively to the patient’s behaviors. Monitoring countertransference entails monitoring the emotions that others evoke in us and how we respond, as well as the expectation we have for that response.

“You Have to Share It to Bear It”

Another way to counter emotional suppression is to share one’s emotions. Sharing is a multifaceted concept that involves articulating the narrative, reinforcing the need to acknowledge and name the emotion. This allows psychotherapists to think through their reactions with the support of trusted colleagues who will offer unconditional acceptance of their work yet remain caring enough to give honest and helpful feedback on their behavior. This sharing may help psychotherapists reappraise their responses and reactions to the stressors they experienced.

This may be why sharing in ongoing consultation groups is recommended for psychotherapists who work with patients with personality disorders, as they (Koerner, 2012). These groups can help psychotherapists acknowledge, express, and reappraise their feelings in a non-judgmental and accepting atmosphere. It is helpful to gain perspective and remember that the patient is acting this way because they have learned that it is the best way (or perhaps the only way they know) to reach their goals. The group may help the psychotherapist understand the patient’s perceptions and attempt to see things from their perspective.

Sternlieb’s third phrase, “You have to share it to bear it,” appears valid because it reminds psychotherapists to think through, process, and reappraise their emotions with supportive colleagues. Receiving validation from one’s peers reduces the burden of bearing the myriad patient problems alone, thus reducing practitioner isolation, a factor associated with burnout (Yang & Hayes, 2020).

Further Thoughts

The three phrases encourage psychotherapists to engage in mindful practices. Mindful approaches help psychotherapists develop non-judgmental acceptance of their emotions. This involves bifurcated attention or “being aware of both the client’s and their own emotional state” (Nissen-Lie et al., 2023, p. 90). Psychotherapists benefit by making this awareness a daily habit in their professional lives.

Perhaps we can create additional phrases for therapist regulation strategies. Some ideas include:

• “Is this a patient’s problem to be solved or a self-worth issue to be resolved?”
• “You must not judge it or you will fudge it.”
• “You must accept or you will be schlepped.”
• “Be curious, not furious.”

While these phrases may not compare to those created and identified by Sternlieb, perhaps a self-care seminar could ask participants to create their own self-awareness phrases to use both in and out of client sessions. Creating unique phrases that align with the individual therapist’s needs may establish a greater connection to the words and potentially increase their impact and/or effectiveness. 

Practice Pointers

Psychotherapists tend to achieve better patient outcomes when they prioritize and enhance their own well-being, which can involve various strategies tailored to their unique needs and circumstances. This could consist of learning better ways to regulate emotions. Sternlieb’s three memorable phrases are anchored on sound, evidence-based practices for emotional regulation. Remembering these phrases can help psychotherapists regulate their feelings because they remind them of the importance of:

• Recognizing the emotions generated by their work.
• Naming or labeling their emotions.
• Sharing and reappraising their emotions within a supportive community of peers