The Psychotherapists Own Psychotherapy: Patient and Clinician Perspectives (Book Review)
Author: Geller, Jesse D., John C. Norcross, and David E. Orlinsky
Publisher: Oxford University Press
Reviewed By: Mary C. Pharis, Vol. XXVI, 4 (Fall 2006), pp. 68-69
This is an impressive book. It must have been no small editorial feat to herd 32 different author-cats into producing the 27 drastically different chapters on a topic so loaded with emotional charge as the therapist’s own psychotherapy. Yet Jesse Geller, John Norcross and David Orlinsky have done so with clear vision, editorial muscle, and admirable finesse. Their efforts have yielded an interesting volume which, despite its challenging mix of personal reports from therapist patients, observations from therapists’ therapists, and an extensive compilation of research findings, somehow comes together to leave readers with the conviction that they have received the very best available current status report on the topic.
The book is divided into three major parts. Part One, “The Therapist’s Therapy in Different Theoretical Orientations,” is comprised of five essays detailing the historical models and expectations for a trainee’s own therapy within the Freudian analytic, the Jungian analytic, the Experiential-Humanistic, the Cognitive Behavioral, and the Systemic/Family Therapy traditions. These contributions are valuable as much for their historical summaries of general training issues within each of these different therapeutic perspectives as they are for their specific current focus on the expectations (or lack thereof) regarding a trainee’s personal therapy.
Part Two, “Being a Therapist-Patient,” begins with five first-hand accounts written by therapist-patients. Chapters by Harry Guntrip on his two analyses (with Fairbairn and Winnicott), and by Jesse Geller on his experiences as a patient with five different analytic therapists at different times in his career are especially fascinating. Following these five personal accounts are five additional chapters which pull together the somewhat scanty research findings the therapist’s personal therapy in the United States, Europe, and elsewhere in the world; the primary reasons and presenting problems such therapists offer for entering therapy themselves; the selection factors they use in choosing their own therapists; and a research review of how psychotherapists view the outcome of their own therapy.
We learn that around three-quarters of all U.S. mental health professionals have had at least one episode of personal therapy, and within the subcategory of self-identified psychoanalytically- or psychodynamically-oriented clinicians (both analysts and all others including psychologists and social workers) the percentage ranges from 82 to 97 percent. (Almost all the studies find that clinicians in those two subgroups are considerably more likely to report they have sought personal therapy for themselves than are clinicians with other theoretical orientations. An aside: who are those 3 to 18 percent of self-identified psychoanalytically or psychodynamically oriented clinicians who report they have never had any personal therapy!?).
On average a therapist’s psychotherapy is longer and more intensive than treatment for members of the general population, and this is even more true of the psychotherapy received by psychoanalytically or psychodynamically oriented clinicians. Individual treatment is the mode therapists select for themselves about 80 percent of the time, and “as a rule psychotherapists pursue personal treatment on more than one occasion (p. 173)” Readers will no doubt be happy to learn that “Even when accounting for cognitive dissonance and rosy memories, the vast majority of therapists seem to have had very positive experiences [in their personal therapy] (p. 215).” Moreover, therapists report that their own experience in a personal therapy has a substantial and positive impact on their abilities to offer warmth, empathy, and genuine connection to their own patients, and has been of significant help to them in their awareness of countertransference issues and the subtleties of any therapy relationship. In summarizing the research data on the therapist’s personal therapy, the authors conclude, “It is difficult to imagine any other group, however defined, that utilizes psychotherapy more frequently and enthusiastically than psychotherapists themselves (p. 190).”
Part Three, “Being a Therapist’s Therapist,” begins with six chapters on the personal experiences of psychotherapists of different theoretical orientations who report that they have had substantial experience treating other therapists. The accounts include separate reports by therapists who practice within psychoanalytic, cognitive, feminist, existential–humanistic, gestalt, and marital/family perspectives, and one additional chapter on treating impaired therapists or “wounded healers.” Emanuel Berman’s contribution “On Analyzing Colleagues, (Trainees Included)” reports in exceedingly specific detail from the analyst’s perspective how an analysis is affected by the issues and character structures of candidates in analytic training. The last chapter in this section by Gary Schoener does not quite fit with the others, but it is an excellent and troubling review of a therapist’s dilemmas when working with mental health colleagues who have significant personal pathology. Following these personal reports there is again a section reporting on the sparse research on the topic of providing personal therapy to other therapists.
While Part Two confirms that a substantial majority of therapists of all orientations (analytically oriented clinicians in particular) not only enter therapy in very large numbers, for lengthy periods of time, and often repeatedly at different points in their careers, and by large margins find the effort highly rewarding, Part Three confirms that it is no simple matter to be the therapist who is selected to provide such services to colleagues.
Many of the therapist’s therapists mention in one way or another that they experience increased anxiety about their own abilities when they accept a therapist colleague as a patient, and they fear that they will be subject to more criticism. Many report an increased need to understand and manage boundary issues and the difficulties those create especially in communities where the therapists are likely to be encountering one another at meetings and conferences or socially, a likelihood that is substantially greater than it would be with non-clinician patients. Many of them mention an increased sense of vulnerability, and a need for personal security in one’s own identity and value system when taking on another mental health professional as a patient. Geller notes that therapist-patients “are more likely to detect those moments when their therapists deviate from accepted practices (p. 381)” and they are likely to know a great deal more about their therapist’s personal characteristics, reputations, and theoretical orientations than do lay patients. Yet in Geller, Norcross and Orlinsky’s chapter on “Research Conducting Psychotherapy with Mental Health Professionals,” the therapist’s therapists report that their work with mental health colleagues is highly satisfying: they see clinicians as “better clients” and they feel they are contributing to the profession by helping colleagues become more effective personally and professionally.
I certainly can recommend this interesting book to any Division 39 members but if no one else reads it, I hope those 3 to 18 percent of self-identified psychoanalytically or psychodynamically oriented clinicians who report they have never had any personal therapy will do so. I’m guessing they are the very ones who need to read it most.
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