Clinicians on the Couch: 10 Questions with Therapist Ali Miller

Ali Miller
Every month we get a behind-the-scenes glimpse into how clinicians from all over the world work and live. They share everything from the toughest part about being a therapist to the most rewarding. They also reveal the biggest obstacle for clients, along with the one thing they wish they knew. Plus, they share whether they’d travel the same professional path again, and how they personally cope with stress. And there’s a whole lot more!

This month we’re happy to feature Ali Miller, MA, MFT, a psychotherapist in private practice in Berkeley and San Francisco, Calif. She helps adults live more authentic, empowered, and connected lives through psychotherapy, couples counseling and women’s therapy groups.

Miller also provides trainings and consultation to helping professionals on “Nonviolent Communication in the Therapeutic Setting,” as well as sharing Nonviolent Communication through public and private workshops.

With a passion for self-compassion, she created a website called “Befriending Ourselves: Resources for Inner Peace and Compassionate Self-Care”: . Her practice website is .

1. What’s surprised you the most about being a therapist?

There’s an endless amount to learn! There are so many different approaches to therapy, and new approaches are being developed all the time. A client’s experience with one therapist can be totally different than with another therapist, not only because each therapist is a unique individual, but also because therapists come from so many different perspectives.

I believe the fit between therapist and client is extremely important, so if you haven’t benefitted from one type of therapy, don’t be dismayed, because there are so many different types out there.

2. What’s the latest and greatest book you’ve read related to mental health, psychology or psychotherapy?

I recently read Hold Me Tight by Sue Johnson, and really loved it. Sue Johnson developed Emotionally Focused Therapy for couples, and does a great job of explaining attachment theory in this book. The essence of it that I took with me is that as social creatures it is human nature to need other people. There is nothing wrong with us for wanting connection — we need it!

The book helps normalize and celebrate our interdependence. Johnson also helps people better understand why they might experience pain when their partner doesn’t respond to them optimally, and what to do about it. The book gave me a lot of hope about the potential for repairing ruptures in romantic relationships, and I think having this hope makes me a better couples therapist.

3. What’s the biggest myth about therapy?

Oh, there are so many myths about therapy; it’s hard to pick the biggest! Perhaps the biggest myth about therapy, or one that I think does the most damage, is that therapy is about an expert fixing a broken patient. There’s this misconception that people who go to therapy have something “wrong” with them and that the therapist is there to fix them. Unfortunately, many traditional therapeutic approaches actually perpetuate this view by diagnosing and pathologizing the people who are seeking support. There is still a stigma around going to therapy, and I think it has to do with this view.

That’s why I resonate so much with Carl Rogers’s person-centered approach to therapy. This approach posits that while therapists have a lot of training and experience to share with the people who come to see us, ultimately clients are the experts on themselves.

By holding each of my clients with respect and high regard, showing up as genuinely as I can, and focusing on empathically understanding what it’s like for them to be them, we co-create a therapeutic relationship that is, in itself, a major part of the healing process. I’m there as an empathic companion, trusting that they have what they need inside themselves and that with empathic and caring support they can access those inner resources.

4. What seems to be the biggest obstacle for clients in therapy?

I see a lot of people who are really hard on themselves, who tend to be their own worst critics. A challenge for them is self-compassion, relating to themselves with acceptance, kindness, and gentleness.

Over the years I noticed that one thing most of my clients had in common was a lot of self-criticism and self-judgment, which is why I started to specialize in helping people develop self-compassion.

I find that shaming or blaming ourselves is actually an obstacle to long-lasting change, so supporting clients in relating to themselves more compassionately is really fundamental to my approach to change.

I love the quote by Carl Rogers that captures this perspective: “The curious paradox is that when I accept myself just as I am, then I can change.”

5. What’s the most challenging part about being a therapist?

I’d say by far the biggest challenge I’ve faced in the 15 years that I’ve been in this field involves working with my own self-doubt. I started this career when I was very young and was challenged with insecurities about my competence for many years. It’s the kind of job where you learn as you go, and since the work involves direct contact with people, you’re learning how to be a therapist by providing therapy to actual human beings who are suffering. Scary!

How’d I get through it? I did my best; was as honest as I could be with my colleagues, teachers, and supervisors about my fears and insecurities; took lots of trainings; read lots of books; and did a lot of personal healing through therapy, spiritual practice, and Nonviolent Communication, which supported me in developing more self-acceptance and self-compassion.

Now I can say that I’m way less challenged by self-doubt, am able to be much more present with my clients, and I finally have a sense that I have a lot to offer. It took awhile, though, and that self-doubt still pops up every so often. Now when it comes up I see how it’s related to how much I care about my clients and this work, and how passionately I want to be of service and to feel good about my contribution.

6. What do you love about being a therapist?

I love so much about being a therapist! It’s really a dream job for me in that I get to be present with people and do my best to give them an experience of being heard and understood. I’m amazed and impressed by the power of empathy, and I love contributing to the relief people feel when they’ve been heard and accepted as they are.

I consider myself an empathy advocate, so getting to offer empathy to others for a living is incredibly satisfying. It is such an honor to hold space for people to talk about and explore the parts of their lives that are challenging and to celebrate their growth and accomplishments.

I also love that I can work in multiple modalities, seeing people individually, as couples, and leading groups. My women’s groups called “Authentic Connection” are particularly satisfying for me because they provide a space for women to come together to tell the truth about their lives and see that they’re not alone with their struggles.

There’s a lot of isolation in this modern culture of ours, so I feel gratified that I can create a space where that isolation falls away and I can contribute to there being a little less alienation in the world.

7. What’s the best advice you can offer to readers on leading a meaningful life?

I remember when I was taking care of my mother when she was dying people would say to me, “You put your life on hold.” This never resonated for me because I just felt like this was my life. My life for a few months was about taking care of my mom and being with her while she was still alive, whereas prior to her getting sick, my life was about something else. My focus shifted, my priorities shifted, but it was still my life.

How could I put my life on hold? That phrase doesn’t even make sense to me.

I don’t know if it’s possible to lead a meaningful life. I think we just live meaningful moments, and those moments, when we string them together, become a life. I guess my humble advice would be to be as awake as possible in each moment.

Be as connected as you can to what you are feeling and needing in as many moments as possible, and take actions to try to meet your needs, including your need to care for others.

When I was caring for my mom, my life was full of meaning because I was 100 percent clear that I was doing what I wanted to be doing. That clarity felt great. We don’t always have 100 percent clarity, and I don’t think we need to, but it sure feels good when we do.

I think the best we can do is to be as present as we can for this life, and the meaning comes out of that. One practice I love that helps me return to presence is to picture myself on a planet in the middle of the universe. This reminds me simultaneously of how insignificant I am and how lucky I am to be alive. And it reminds me that here I am, in this moment, on this planet, living this life. Then anything I do feels meaningful, because I’m consciously here.

8. If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why?

I really loved my graduate school, California Institute of Integral Studies, and I would definitely do it all over again. My process of becoming a therapist was full of discovery, growth, and exposure to so many interesting approaches to healing. I feel really privileged to have been in a position to take advantage of the enriching and nurturing education provided by C.I.I.S. I think being a therapist is the best job in the world for me.

I do wish that I had been exposed to Nonviolent Communication (the work of Marshall Rosenberg) earlier. It has become the core of my therapeutic approach, and I didn’t discover it until three years after I finished graduate school. This is one reason why I’m passionate about sharing Nonviolent Communication with other therapists as a trainer and consultant. It isn’t taught in many graduate school programs and I think it is such a powerful healing modality, so I want therapists-in-training to have the exposure that I wish I’d had.

9. If there’s one thing you wished your clients knew about treatment or mental illness, what would it be?

I want all of my clients and all people to know that, as Buddhist teacher Cheri Huber says, “There is nothing wrong with you.” (She wrote a great book with this title). As human beings, we suffer. That was the Buddha’s first noble truth: There is suffering.

There are lots of variations of suffering. And some psychiatrists got together at some point and tried to give us a conceptual way of understanding these different forms of suffering, and created diagnoses of “mental disorders.”

These diagnoses can reinforce the painful belief that something is “wrong” with you if you’re suffering. So if you’ve been given a diagnosis and you notice that it is perpetuating self-criticism or shame, I’d suggest letting the diagnosis go and focusing on what you’re actually experiencing.

Diagnoses are not facts; they are attempts to understand human suffering, and if they’re not helpful for you, don’t buy it. There are many other ways to understand and relate to suffering, so find a way that helps you love yourself and live the life you want to live.

10. What personally do you do to cope with stress in your life?

There are many things I try to do regularly to maintain a sense of well-being, such as yoga; hikes in nature; connecting with loved ones; therapy; journaling; getting massages; and attending a support group and a consultation group with colleague-friends.

Through the Nonviolent Communication community I’m a part of, I have what we call an “empathy buddy,” and I talk with her weekly. We usually split an hour, so I’ll give her empathy for a half hour and she’ll give me empathy for a half hour. The more support I have, the less stressed I am. So when I notice I’m getting more stressed out, I try to get more support, usually in the form of empathy from friends, a call to my therapist for an extra session, or asking people for practical help.

I think asking for help is one of the hardest things to do and also one of the bravest because it feels so vulnerable. It’s an edge for me, as I think it is for a lot of therapists.

Oh, and watching “The Daily Show” has been an important stress-reliever for me, but now I’m grieving because Jon Stewart left! Indeed, life is suffering.

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Shared by: Margarita Tartakovsky, M.S., Contributing Blogger

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