Emotional Labor in Psychotherapy

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The psychotherapist in training is taught, among other things, certain skills of emotional self-management, ones which induce a gap between affect and its expression. She is taught to acknowledge her feelings, sometimes intensely negative ones, toward her clients, but to not "bring these into the room." She is taught to maintain an attitude of "unconditional positive regard," even when this is not what she, in her heart, feels. These practices are justified, when they are justified, by the needs of the client. The client is just that – a paying client – and the purpose of the therapeutic encounter is the client's own insight and growth, which the therapist is there to serve and support.

I was reminded of these edicts recently when reading Arlie Russell Hochschild's profound 1979 study, The Managed Heart: Commercialization of Human Feeling. Hochschild's work concerns a range of professions, including physicians and social workers, but her primary object of study is flight attendants, as these were trained by Delta in the 1970s. The flight attendant's training bears an uncanny resemblance to the training of the therapist: She is taught to keep her inner feelings about her passengers in check, in order that their experience is as pleasant as possible. Some of the instructions to flight attendants in training are more blatant than those given to would-be therapists. For example, the flight attendant is instructed to smile frequently, which is generally not an expectation of therapists. But their general tenor is very much the same.

Hochschild's central thesis is that a certain class of workers is expected to perform "emotional labor" – which involves not the manipulation of machines or of money but of feelings, their own and those of others. This emotional labor is compensated – not always very well – but it also bears a cost. The emotional laborer experiences an estrangement from her own feelings, and sometimes shuts down altogether, or "goes robot," in the phrase of one of Hochschild's interviewees. The emotional laborer, in one way or another, pays the price for her work – and it is typically her work, for the lion's share of emotional labor continues to be done by women.

For Hochschild, one difference between the working life of the flight attendant and that of the psychotherapist is that the former goes through explicit training and supervision on the management of her emotions, while the latter is taught to internalize certain norms through exposure to the practice of her profession. But, increasingly, as the education of social workers and other potential psychotherapists becomes more standardized, this line is beginning to blur, and the kind of explicit instruction on emotional self-management that was once the province of flight attendants is now spreading outward to the education of people in professions that traditionally accepted a greater degree of idiosyncracy.

Only in recent years has this aspect of therapeutic practice been acknowledged in the academic literature. James Clarke of Curtin University in Australia and his co-authors have published several papers detailing the emotional labor done by psychotherapists and its contribution to a signal issue for psychotherapists: burnout, and especially the aspect of burnout involving "emotional exhaustion." The emotional labor done by therapists takes a toll, one which Curtin and his colleagues suggest may be addressed by the very same mechanisms that are helpful to clients, especially psychological flexibility and self-compassion.

As Clarke and his co-authors observe, this work has generally not been done, and psychotherapy has not been included in many large-scale studies of emotional labor. Why not? I suggest that one reason is that many psychotherapists would not understand themselves as being engaged in emotional labor. The flight attendant is engaged in a service profession and is obliged to maintain a certain false front in order to provide good service. But the psychotherapist typically does not understand herself in this way. She is engaged in a "relational" encounter with her client, one which transcends the more petty demands of, for example, the service industry.

But it is possible that this framing of the psychotherapist's work only makes things worse, by estranging her still farther from her emotional labor. The flight attendant can complain with colleagues about rude passengers, and engage in minor acts of rebellion: Hochschild describes one flight attendant who "accidentally" spills a drink on a particularly frustrating passenger. These forms of decompression are not always available to the practicing psychotherapist, who is asked to understand her client as charitably as possible even when outside of providing psychotherapy. One of the dangers of emotional labor is that one loses a sense of where one's professional self ends and where one's true self begins. This is a danger that is especially acute for the psychotherapist, whose emotional labor goes especially deep.

So I think the practicing psychotherapist has a lot to learn from Hochschild's study. Despite their superficial dissimilarities, there is a deep symmetry between the predicament of the flight attendant and that of the psychotherapist, and in certain ways the psychotherapist's is worse. It is a further question whether this should lower our opinion of the emotional labor involved in psychotherapy or whether, on the contrary, it ought to raise our esteem for the work of the flight attendant.