Roadblocks on the Journey of Psychotherapy (Book Review)

Title:  Roadblocks on the Journey of Psychotherapy
Author:  Hall, Jane
Publisher:  Jason Aronson
Reviewed By:  Karen Zelan, Vol. XXVIII, No. 3 (Summer 2008), p 69

This is a teaching book for novice therapists in conducting psychoanalytically oriented psychotherapy. The book consists of “how-to” chapters rather than a collection of inspirational essays. The recommendations to beginners on conducting psychotherapy are often embodied in “lists” appearing at the end of many chapters. It is not always clear to which psychoanalytic theory and practice the lists refer. The lists do not appear to derive from psychotherapeutic theory and expert practice and thus are not grounded in cogent explanations of how psychotherapy works and why.

The author’s stated aim of psychotherapy falls within the traditional goals of psychotherapeutic practice: “Psychoanalytically informed psychotherapy is the work of making connections—between past and present, conscious and unconscious, dream and waking life, patient and therapist, fantasy and enactment. In making these connections, both parties cooperate in making tears in the fabric of life and sometimes in reweaving them” (p. 2).

The problem with the exegesis is an apparently arbitrary substitution of the word “roadblock” for the perfectly appropriate and descriptive word “resistance.” The Concise OED defines “roadblock” as “a barrier or barricade on a road, especially one set up by the authorities to stop and examine traffic.” Why eschew the historically understood term, resistance, meaning a patient’s temporary or longstanding difficulty in applying a psychoanalytic concept to him, with a word that denotes difficulties in negotiating traffic? Resistance was a perfectly good term for Sigmund Freud, the father of psychoanalysis, and has been used appropriately and graciously for years by psychoanalytically oriented psychotherapists. It is a happily parsimonious term to describe the dilemmas both patient and psychotherapist encounter as they endeavor to understand the patient’s core problems, including the therapist’s countertransference tendencies.

This book’s exposition on what psychotherapy entails may confuse the novice therapist. It implies that the work can be reduced to clever lists, seemingly designed to make the understanding of difficult therapeutic work easy by a set of pedestrian rules. It is as though novice therapists can hone their craft by adhering to a series of prescriptions set up by someone else who cannot possibly know the quandaries and questions of the individual beginner, hard at work attempting to understand his or her patient. One such list offered by the author is titled Travel

Tips: “The rules of the road are not meant to constrain, but to keep the travelers safe” (p. 8). Here the author has so overused the highway metaphor and its roadblocks that I fear the crux of her message to novice therapists will be misinterpreted.

To quote some rules of the road:

Benevolent curiosity is the compass.
The therapist’s walking shoes are consistent and reliable.
Countertransference is her radar.
Neutrality is her life vest.
Humor saves the day.

These prescriptions talk down to novice therapists whom the author seems to view as bumbling in a china shop. There’s no avoiding that a novice therapist will feel awkward and insecure in a situation in which she is mandated to cure. Novice therapists will stumble time and again. That’s how they learn. Making mistakes is an inevitable but valuable part of the psychotherapeutic learning process! Novice therapists don’t come ready-made for the job. Yet they are excited by the learning process, a fact which is easily communicated to the patients, who are also engaged by the prospect of learning more about themselves, encouraged by the prospect because it carries the promise of a happy and productive future life.

The author ends her book on a poignant note, one to which most psychotherapists will resonate:

“As I realize that I have reached the end of the tunnel with this book, I feel as a patient feels at the end of psychoanalytic work: worried that I haven’t done it well enough, fearful that I’ve left something out, sad that I won’t any longer have it to occupy me every day, proud that I’ve done this work, and hopeful that others will appreciate my endeavor.” (p. 245)

As the book’s reviewer, I found much of interest in it despite my lengthy critique. I urge the author to explore further the resistance patients experience when called upon to understand their deepest anxieties and struggle to realize their most treasured dreams.

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