On Becoming a Psychotherapist

Windy Dryden, Laurence Spurling, Windy Dryden, Laurence Spurling

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317752028
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Why do people want to become a psychotherapist? How do they translate this desire into reality?

On Becoming a Psychotherapist explores these and related questions. Ten leading therapists write about their profession and their careers, examining how and why they became psychotherapists. The contributors, representing a wide cross-section of their profession, come from both Britain and America, from different theoretical backgrounds, and are at different stages in their careers. They write in a personal and revealing way about their childhoods, families, colleagues, and training. This absorbing and fascinating book offers a fresh perspective on psychotherapy and the people attracted to it.

This Classic Edition of the book includes a new introduction written by the authors and will be invaluable for qualified psychotherapists and those in training.

Part I Introduction

Chapter 1 The therapist as a crucial variable in psychotherapy

Paul Gilbert, William Hughes and Windy Dryden

DOI: 10.4324/9781315796932-1

Introduction

Strupp in chapter 7 argues that the conduct of effective therapy depends on the person of the therapist and the skilful execution of professional craft. Since this book deals with the former, in this chapter we focus on the therapist as a crucial variable in psychotherapy. This chapter should be seen then as providing a context for the autobiographical chapters that follow.

Some historical remarks

Psychotherapeutic encounters are well recorded throughout human history. What counts as such an encounter and how it unfolds reflect historical and cultural processes (Ellenberger 1970). For example, in some cultures, mental distress is viewed as a problem with ‘spirit forces’ which possess a soul, a situation requiring the intervention of a powerful shaman. Throughout the Middle Ages mental illness was often regarded as the result of transgression and sin (Zilboorg and Henry 1941) requiring punitive treatment. Even today the dividing line between psychotherapy and spiritual guidance can become blurred (London 1986). Hence the human predisposition to engage in a relationship for the purpose of overcoming psychological distress is not a twentieth-century invention but stretches back many centuries.

In non-Western and pre-twentieth century therapeutic approaches, there was often a tendency to regard the personality of the ‘healer’ as the key factor in therapeutic effectiveness. For example Franz Anton Mesmer (1734–1815), whose approach was the forerunner of hypnosis, was effective as a healer not because of any real force of ‘magnetism’ but because he had an extraordinarily compelling personality (Ellenberger 1970). With some exceptions, however, we live in an age dominated by the miracles of physical medicine and a fascination with the techniques of the healer. While there is some wisdom to this, there is also need for caution. Can anyone who learns the techniques of their trade be as effective as anyone else? What leads a person to adopt and feel more comfortable with one set of techniques rather than another? What maintains and motivates a therapist in working with distress over many years? What decides whether an individual is able to work with serious psychiatric or borderline clients or stays with mild anxiety conditions? In an ideal world we would say that science chooses and people take up techniques according to their proven efficiency. But we doubt this is often the case. In order to answer these questions one needs to return to the issue of therapist variables (McConnaughty 1987). This is the purpose of this chapter: who becomes a psychotherapist and what affects their way of working?

Who becomes a therapist?

Although it is common to hear young children express professional aims in terms of train driver, doctor or pilot, psychotherapy as a profession is probably considered rather later in life. To some degree the decision to enter training relates to many complex social and personal variables. As Pilgrim points out: ‘it is social class of origin rather than individual psychopathology that is more likely to determine whether a person becomes a nurse in Rampton or a psychoanalyst in Hampstead’ (1987: 101). Further he cites evidence that social classes tend to recruit from their own. The number of therapists with working class origins is rather less than those of middle or upper class origins. The profession of psychotherapy, like other professions, operates subtle but significant power control over entrants. For example, it is virtually impossible in Britain to become a consultant psychotherapist in the National Health Service, without a medical training, yet there is no evidence that a medical training gives rise to the best therapists. Different professions (e.g., medicine and psychology) have fought more than the odd battle over trying to prescribe who is able to do what to whom. Professionalism always runs a risk of élitism in its efforts to ensure good practice.

These social factors apart, personal factors are also extremely important. Many are drawn towards psychotherapy as a career because of their own personal difficulties. These may be worked through during training, or projected on to patients as a way of resolving personal distress (Kottler 1986). In medicine people may choose psychiatry for its better promotion prospects rather than any particular desire to become a ‘mind healer’. In psychology students may commence their clinical or counselling training with only the vaguest idea of what is involved. Nevertheless it is our experience that students are often too ready to attach themselves to a particular school of practice and boldly claim a title for themselves, such as behaviourist or humanist, etc. This may reflect a degree of uncertainty and a desire to project oneself as having positive views, but it can lead to a premature closure on various psychotherapy approaches and in extreme cases to dogmatism. As cognitive science shows, people tend to attend to things they already identify with and reject things they do not.

What therapy?

If it is not scientific criteria that decide what kind of therapy a person chooses to practise (and it often is not) then what other factors might be involved? The first is as serendipitous as historical accident. During training a person may encounter a particularly charismatic teacher who is able to inspire his or her students with ideas and concepts. They may wish to be like him or her and are persuaded as much on the basis of the personality and effectiveness of the teacher as they are from statistics or theory. The fact that the teacher may claim to be, for example, a behaviourist yet achieve therapeutic results using the most lax of techniques is often unnoticed. As Yalom (1980) points out, despite the passivity that psychoanalytic theory insists upon, Freud was not passive, but would often speak with a patient’s family, encourage them to behave in certain ways to the patient (e.g. facilitating exposure in cases of agoraphobia) and was not averse to inviting patients to tea with his family or even making personal friends of them.

The second kind of historical accident reflects the availability of learning experiences. If one studies at an institution where the only philosophy to mental life is, for example, behaviourist or psychoanalytic, then it is not surprising if this becomes the dominant orientation for the therapist to adopt. Indeed, as for life in general, the explanation and theoretical axioms one adopts in large part relate to the culture to which one is exposed. This is as true for psychotherapy as it is for religion and politics. The adoption of psychotherapeutic techniques reflects as much a social process as a scientific one.

The third historical accident relates to personal experiences and needs. Kottler (1986) cites the case of the therapist who had lost her mother from cancer in childhood and sees all psychopathology in terms of mother-child deprivation; or the case of the social worker who had problems in dealing with authority and chose to work with rebellious adolescents. Many examples can be noted from history. Alfred Adler (1870–1937) grew in the shadow of an older brother. In his work we see the issues of sibling rivalry and his introduction of the concepts, inferiority and superiority complexes (Ellenberger 1970). Jung’s deeply religious orientation, his interest in Gnosticism and spirituality arose from his religious upbringing (his father and grandfather both being pastors). Hence psychotherapists are not decontextualized beings who, as tabulae rasae, are ready to be stamped with learnt technique. Rather they are individuals in search of a method which fits with their personal experiences.

In other cultures and times in history the shaman or healer was expected to have undergone some personal experience of suffering which changed his/her perception of the world (Ellenberger 1970). In our culture, however, there is an implicit assumption that therapists should be psychologically strong, and strenuous efforts may be made to hide personal experiences of suffering. Psychotherapists and mental health workers are not supposed to get depressed or anxious and those who do are often regarded by colleagues as somehow inferior or weak. Like it or not Western culture is obsessed with macho-like images of psychological health and perpetuates a collusion of denial (Rippere and Williams 1985).

Who is suitable to be a therapist?

Whenever this question is raised it inevitably leads one to ask this question of oneself. Many traditional training institutions (e.g. medical and psychology departments) continue to regard intellectual ability as central in the selection of clinicians and the assumption is often made that successful applications have the right qualities for the helping professions or can be helped to acquire them. But, as for music, artistic or writing ability, training may only partly compensate for lack of, in this case, empathy, openness, lack of hostility, etc. Although one may be able to teach someone how to use empathy, it may be much more difficult to train someone to have empathy.

To what extent people can learn to be empathic rather than mimic empathic behaviour is a debatable point. True empathy may only be possible through openness to oneself and teaching is then concerned with how to use a talent the person already possesses. The lower the capacity for true empathy, the greater the possibility of projection (Goldstein and Michaels 1985).

There is general agreement that certain types of people are not suited for the profession of psychotherapy. These are individuals who are compulsively self-reliant, emotionally defended, or with severe narcissistic difficulties. There is little evidence as to whether such people are harmful to their clients but general impressions are that they may well be. A psychiatrist in training recently admitted that she could not stand depressives because ‘they were so wimpish’. She prided herself on the importance of emotional control. People with autocratic personalities find their way into psychotherapy training as do other types, but the nature of their defences may make their understanding of some patients very difficult. Of course, some patients may gain some relief from autocrats; especially those who seek a collusion of denial.

In psychotherapy there are particular kinds of therapist thinking and evaluating which may interfere with therapy. Ellis (1983) has reviewed many of these, but they include making it a ‘must’ to follow the right technique or to get someone better, and various forms of negative self-criticism, if this does not happen. Therapists who are prone to personalize (‘it’s my fault my patient killed himself’) or to project blame (‘it’s the patient’s fault, he was just inadequate’) quickly run into problems.

The degree of perceived control over another’s suffering or recovery is an important question of attribution which requires further research. Therapists who ‘personalize’ tend to model a style they are trying to educate patients away from, and this can also lead to defensive caring. Here the therapists’ main concern is to avoid making a mistake which would lower self-esteem.

They become more concerned with what they are doing rather than listening to, and ‘being with’, the patient. Therapists who project, however, are more likely to be rigid in therapeutic encounters and see difficulties in therapy as relating to a patient’s ‘resistances’. In all forms of psychotherapy, good therapists are encouraged to be sceptical and check for alternatives without self- or other-downing. Many of these styles, especially personalization and projection, will have significant bearing on the transference and countertransference. As McConnaughty (1987) points out, there are many therapist variables that are important ingredients in the therapeutic process, e.g. cognitive style, current state of health, level of fatigue, burn out, to name but a few.

What training?

The type of psychotherapeutic training a person obtains is, as we have seen, partly a matter of historical accident relating to social and personal factors. Increasingly, short courses in particular techniques are being offered. Hence various professionals can go on two or three day courses where counselling, cognitive therapy or existential therapy workshops are offered. This allows therapists to learn a variety of techniques from different perspectives—no bad thing perhaps. On the other hand there is probably no suitable substitute for learning at least one approach to therapy well, and being aware of its strengths and weaknesses. Furthermore, training must include education in the kinds of difficulties for which the approach is not suitable, at least not without extensive training on the part of the therapist. On many occasions when I (Paul Gilbert) have invited students to bring cases for discussion, they tried to discuss people who by most criteria have personality problems (see Rutter 1987) and who are best seen by experienced professionals rather than beginning therapists.

The second point about training pertains to the issue of personal experience of therapy. In psychoanalytic therapy personal analysis is required. At present we know of no good evidence to show that a personal therapy does increase effectiveness. Indeed many clinical trials of the newer therapies use relatively novice therapists trained in a particular technique. There is, of course, anecdotal evidence that people do change their way of practice after a personal therapy. However, much may depend on whether therapy is voluntarily undertaken or simply engaged in as a required part of accredited training. In our experience, many therapists who undertake therapy for themselves, rather than to meet professional requirements, have commented that they obtained a different insight into the power of affect when they themselves were having to work through problems. The ability to deal more effectively and honestly with one’s own affect is probably central to the development of caring. Coming to know oneself is not always a joyful experience.

Mair poses three questions that therapists should ask themselves: 1) Who or what do I trust? 2) How can I enter into another’s way of experiencing? and 3) How much of myself or others am I willing to know? As he points out, our knowing is about focusing: ‘Every way of knowing is, at the same time, a way of ignoring, of turning a particular blind eye, or seeking not to know’ (Mair 1987: 118). If a therapist turns a blind eye to things in himself so may the client; dark areas are projected or denied. Therapists may care for their clients as they themselves would like to be cared for, unaware that this is not what their clients need.

So long as technique becomes the new touchstone of psychotherapeutic practice these issues remain secondary concerns. As trainers, we are increasingly under pressure to ‘pass on skills’ (which is not without its financial benefits). Comparatively little attention is given to the ‘people’ these skills are imparted to.

Finally we should point out that therapists often do not keep to techniques, even when they are credited as bei...

Table of contents

• Cover Page
• Half Title Page
• Series
• Title Page
• Copyright Page
• Contents
• Introduction: On Becoming a Psychotherapist revisited
• Contributors
• Preface
• Part I Introduction
• Part II The contributions
• Part III Commentaries
• Appendix
• Author index
• Subject index