We often read psychology books that focus on patients. Therapist Tanya Byron flips that idea and focuses on the psychologist, recalling her own years of training at various London hospitals and clinics. She was a 23-year-old PhD student, acting as a marriage counsellor, a therapist to drug addicts, a counsellor to Alzheimer’s patients and others — learning the gamut of skills a clinical psychologist must have. It was difficult understanding how to distance herself from patients and offer practical advice to those who had been through horrific events, such as the Holocaust. Very little turned out as expected, as she explains in The Skeleton Cupboard, the Making of a Clinical Psychologist. Her colleagues and patients are described so as not to reveal their identities. Our conversation has been shortened for length.

Why did you decide to become a psychologist?

When I was 15 my grandmother was murdered. I don’t think I decided to be a psychologist at that time, but that tragedy put me very firmly on that path. My grandmother’s death resulted in the conviction of a woman who was eight months pregnant and a heroin user. She was sentenced to manslaughter with diminished responsibility and was given a three-year custodial sentence. She was out in 18 months.

I felt tremendous rage at the loss of my grandmother and the way she lost her life, and rage at how I felt the murderer’s sentence didn’t fit the crime. I couldn’t rationalize it my head. I wrote to the (British) home secretary, who wrote back a trite letter saying, “Sorry for your loss but this is the law.” I tried to manage my rage by exploring how this happened and why. I was 15, pretty idealistic; life was sweet and then it wasn’t. I started reading books about serial killers and then got into books about the brain and behaviour and ones that explored issues about mental health. That started my interest in psychology.

A lot of practitioners talk about people they have worked with. But few talk about their own experiences. There is a them and an us, and I don’t subscribe to that. When I thought about writing this book, I wanted to be open about my own issues.

Your book focuses on the time when you were a psychology student in graduate school. Some of the encounters you had in your clinical training were scary. I’m thinking about Ray. Tell me about him.

This happened on my first training placement. It was my very first clinical year and it was in a very busy central London hospital with a large outpatient and in-patient psychiatric department. This was a situation where my naiveté and lack of experience could have got me into a lot of trouble.

My patient presented with panic attacks and anxiety, which is pretty straightforward in cognitive psychology. It was my lack of experience, pushing too hard and misunderstanding his history, that ended up with him feeling compromised and emasculated by this young woman in her 20s.

He pulled a knife and threatened to cut out my eyes. I’ve learned a lot from the incident. It was absolutely terrifying but it broke through that naive sense that you can ask anything and have this relationship with your patient. For me it was a wake-up call, nevertheless frightening at the time. It was being thrown in the deep end.

It is hard to get it absolutely right with some patients. You note your personal failures, like Mo, whom you met in drug rehab and then found years later on the street. How do you deal with patients who don’t recover, who have gone back to the lives they led before you tried to help them?

We are driven by a psychological need to be needed. Rescue fantasies are common and you come across desperate people in desperate situations and think you can save them. With Mo, I didn’t treat her for her drug addiction; it was an effort to help her with a violent relationship she had with her partner, a relationship she likely saw in her parents.

I worked really hard to get her away from this guy who was also using drugs. She was a very bright woman and I remember attaching myself to her. To cut a long story short, she went back to him. It had been after months and months of support and enabling her and helping her feel more assertive about her needs and rights. Then he turned up with a tacky bunch of flowers and tears and they fell into each other’s arms, and she would come back two weeks later beaten up. That was the revolving door of these violent domestic relationships.

You can’t help everyone all of the time. It is an incredibly difficult thing but you have to get your head around it because, if you don’t, you burn out and you are no good to anyone. There aren’t always happy endings.

How do you separate yourself from your work?

My personal life is very satisfying: my kids are at home, my mom lives around the corner. I go to exercise classes. My life is rich and full. By the time I have left work, written up my notes, listened to my colleagues and am in the car going home, I am listening to the radio and thinking about the dogs that need to be walked and the kids and life. I’m done for the day.