AIDS: The Therapist's Journey


I am a person, also a social worker, who has been living with AIDS since 1982. Although I do not have AIDS myself, I was diagnosed as HIV positive in 1988 and the disease and all of the personal and professional issues surrounding it have profoundly influenced my life for over a decade. In 1984 my oldest brother died as a result of AIDS followed by my best friend and partner in my practice in 1989. Six men who lived in my apartment building have died from AIDS in the past 12 years, as have numerous acquaintances, colleagues, and several close friends. Four of my closest friends are currently seriously ill with complications from AIDS. The man I love and share my life with has AIDS. When patients and therapists are dealing with virtually identical life crises simultaneously, the potential for therapeutic mistakes is enormous. Therapists must be highly skilled and self-aware in order to avert such dangers.

As a therapist with a largely gay male practice, I work with people who are living with AIDS or who are intimately affected by it every day. Before the onset of AIDS, active alcoholism, drug addiction and Hepatitis B were the only life-threatening illnesses likely to kill my patients. My first professional experience with AIDS was in 1981 when a psychotherapy client began exhibiting symptoms of what we now know is HIV illness. At that time AIDS was unknown but shortly thereafter, the syndrome was labeled "Gay Related Immune Deficiency" (GRID). It soon became clear to me that the men who were sick with this new disease had lived no differently than I had for many years. I assumed that if these people were getting sick, there was an excellent chance that the same thing could or would probably happen to me. In 1983, I began to volunteer at Gay Men's Health Crisis (GMHC), working with people with AIDS, and supervising other volunteers. I still volunteer at GMHC. In the past 12 years, over 100 patients in my private practice have died from AIDS. My purpose in relating the above experiences is to attempt to describe how I, along with so many others, am able to survive and thrive emotionally, psychologically, and spiritually in the midst of this plague and how I continue to do this work without becoming burned-out.

Colleagues and friends often ask me how it is that I've been able to work in AIDS for so long, dealing with all the pain and suffering endemic to this patient population. Others ask whether it's overwhelming to have intimately known and worked with so many people who have died or who are dying.

As an action-oriented person I have had to struggle to learn that I am indeed doing something by simply sitting with clients, caring about them, and encouraging them to share any and all of their feelings about what is happening to them. Of course, I am unable to change the outcome of their illness. Accepting this reality, more than anything else, has taught me how to tolerate discomfort.

The discomfort I experience is about many things. Often it arises from a genuine empathetic connection with clients who are honestly experiencing feelings about their loss of health, career, lover, and their own imminent death. Once I have grown to care about a person comes all the accompanying discomfort about losing that person. Sometimes there is simply the uneasiness of being close to a person who is very ill or who is dying, simply because this reminds me of the fragility of my own good health.

What follows are some case examples that illustrate the challenges inherent in attempting to provide competent treatment while living and practicing under the shadows of HIV/AIDS.

Disclosing the Therapist's HIV Status?
A Classic Case of Countertransference
Discussing Death
Professional Challenges of Psychotherapy with People Living with HIV/AIDS
Avoiding Burnout
Other Articles by Michael Shernoff

Published in A Perilous Calling: The Hazards of Psychotherapy Practice, M. Sussman, Editor, 1994: John Wiley & Sons by Michael Shernoff, MSW
© 1996 Michael Shernoff

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