Freud referred to psychoanalysis and, by extension, psychotherapy as the “impossible profession” because of the difficulties in achieving satisfactory results. The authors in this book address and elaborate on the occupational hazards of being a therapist and offer useful suggestions and advice about managing them. This second edition (originally published in 2007) includes a new chapter on mindfulness as well as new case examples from practitioners. The book combines a review of relevant research, experience of master clinicians, and candid disclosure by the authors. The authors are psychologists practicing in the United States who run workshops in self-renewal for mental health practitioners. One of the authors, John Norcross, has published many other self-help books. The authors describe the book as a field guide rather than an instruction manual. The book is practical and general enough for each reader to tailor the material to individual needs and vulnerabilities. It is written in an informal anecdotal style, which allows the reader to easily identify and engage with the material. At the end of each of the 13 chapters, there is a useful checklist that enables the reader to reflect on his or her own approach to self-care.
The proposed aim of the book is to promote self-care and point out solutions to prevent professional impairment. The book begins with a chapter called “Valuing the Person of the Psychotherapist,” which reviews some of the research on psychotherapist self-care and encourages the practitioner to invest in herself or himself. The chapter entitled “Recognizing the Hazards” provides a comprehensive and honest discussion of some of the strains of the profession, which include difficult patient behaviours, adverse working conditions, emotional depletion, the need to maintain confidentiality, psychological isolation, and personal disruptions. Several subsequent chapters address what could be described as a Maslowian hierarchy of needs for mental health practitioners. One chapter recognizes basic physiological needs: the need for sleep, exercise, nutrition, and hydration. Another chapter emphasises the therapist’s needs for nurturing relationships such as a rich personal life, peer support, and supervision as a way of combating professional isolation. There is a chapter emphasizing the needs for boundary setting as well as for healthy escapes. Finally, corresponding to needs for self-actualization and transcendence, there is a chapter called “Cultivating Spirituality and Mission.” In this they discuss Maslow’s sense of personal mission or a calling outside oneself.
The authors describe themselves as practicing an integrative approach to therapy and employ various theoretical approaches in their advice to the reader. In one chapter called “Restructuring Cognitions,” they discuss ideas of irrational beliefs explored in rational emotive therapy. They refer to the prevalent “musturabions” that psychotherapists inflict upon themselves such as the need to be liked by and cure every client. Another chapter about maintaining mindfulness concentrates on the need for self-compassion.
Some useful quotes from both Sigmund and Anna Freud add insight into defence mechanisms employed by therapists. Anna Freud made the telling observation that becoming a psychotherapist was one of the most sophisticated defence mechanisms, granting us an aura of control and superiority and avoiding personal evaluation ourselves. This idea is later elaborated upon in a discussion of some of the less healthy reasons why a person might want to become a psychotherapist such as the desire to combat loneliness, the need to live vicariously through others, or the need to maintain a god-like position of control. The need to be aware of one’s underlying vulnerabilities or perhaps omnipotent fantasies about self-cure by becoming a therapist is addressed in the chapter called “Profiting from Personal Psychotherapy.” The authors quote Freud’s apt observation: “Tis only a matter of degree of brokenness between patient and practitioner.”
One of the major difficulties that psychotherapists face is the management of countertransference. The challenge is how to contain and metabolize the raw primitive emotions that one is exposed to daily and always maintain an unruffled therapeutic mask. And then to be able to remove the mask in one’s private life. The one page devoted to this topic in the book is terse and condensed. Perhaps one of the difficulties in the book is that it is so broad in reach that it sometimes fails to offer detailed attention to some specific areas.
This book does not present startling new insights. However, reading the book serves almost as a salve. It helps break the sense of loneliness that solo practitioners experience. I would recommend this book to new mental health professionals and to more seasoned mental health practitioners who are on the brink of emotional depletion or implosion.