Jeffrey Kottler on Being a Therapist
This book, On Being a Therapist, is now in its fifth edition (Oxford University Press, 2017). As the author, Jeffrey Kottler, notes in the introduction, it could scarcely have been imagined in the mid-1980s, when this book was first published, how much would change today in the field of psychotherapy--not just advances in techniques, but in psychopharmacology, the insurance industry, and much else besides. Nevertheless, the author has sought to keep the book updated in light of new developments while aiming it at the widest audience of clinicians from all backgrounds--social work, psychology, counselling, psychiatry. He says it is especially aimed at students in all those disciplines who get into one of those professions without always fully realizing the personal consequences, with which he begins the book in Ch.1: The Therapist's Journey.
In this chapter the author sketches out the lofty potential of the therapeutic vocation: the ability to make a change in the lives of others unlike anything else, leading potentially to "spiritual transcendence" (p.1).
The ability to effect such change depends in good measure on the therapist's personality. Here Kottler echoes something much remarked upon in many other publications: above and beyond theoretical orientation and even certain techniques, the personality, and from it the therapeutic alliance, are fundamental, leading to change not just for patients but also therapists themselves. Kottler notes that therapy can produce an "altered state of consciousness" in both therapist and patient. This is especially so if the alignment is right and healthy, when there can be a kind of "second sight" at work.
Much like Nina Coltart (whom he does not quote or seem to have read), Kottler speaks of the importance of faith in the process, faith in the therapist, as being key factors in helping motivate people to seek and find change. Beyond that, Kottler suggests we go too far in thinking we can always and everywhere pinpoint the cause of change, even after lengthy in-depth study. Therapists have to have "learned to love this sort of ambiguity and complexity" or else probably find another career (p.5). A little later Kottler says that "I have never really trusted anyone who claims to understand how therapy works. I think it is far too complex" (14).
That complexity and ambiguity can open the door to self-understanding and experimentation by the therapist, who also functions as a model: if the therapist models courage, it may aid the patient in being courageous enough to risk and experiment with change in his or her own life.
Ch.2: Struggles for Power and Influence contains some important reflections on serious issues.
Kottler begins by noting something that goes back at least to Freud: resistance. Therapists want to encourage change, but patients will not only resist that, but turn the tables, fighting to change not themselves but the therapist. They will want the therapist to take their side, to adopt their view, to love them more, to reduce and belittle the therapist and thus attempt to work out their own sadomasochistic transferences (a process which, as several others--e.g., Robert Stoller--have recognized, is often a reflection of early trauma).
Kottler notes a change here that has occurred in the last several decades: the decline of the therapist as all-knowing, largely aloof guru or expert. Thankfully that is a model and an approach largely in disfavor today. Instead patients increasingly see therapists as people with specialized training and insight whose job is to help patients discover what it is they want and need, and try to help them attain that at least in part. Kottler uses the metaphor of a "coach" here to try to capture something of this shift. He also speaks of the therapist as "model" of some beliefs, behaviors, and practices that the patient may very much want to try out and eventually adopt.
What is it that therapists should model? Here Kottler notes numerous important and distinguishing characteristics of therapists, including their
A few other random things that stuck out to me in this book: In his fifth chapter, Kottler notes how much of "continuing education" is a scam, designed to offer a continuing source of cash and credentialing power to various groups, but very often only the most superficial "education" imaginable. I've heard this from other therapists, and from perusing some prominent websites, seen it up close.
His reflections on seduction in the transference is especially useful. Noting that patients may be seductive for reasons other than the straightforwardly or explicitly sexual, he notes that regardless of motives, there are no easy ways to deal with this problem. He further notes this can be a desire to establish a deep emotional relationship rather than a physical one, and that this obtains even when patient and therapist are of the same sex.
Kottler is also helpful on dealing with difficult patients, offering several insights, starting with the fact that it is important to recognize that at least some of the time it may not be them, but you: are you too impatient to change them, too resentful of a perceived loss of control in the relationship? Maybe they are "difficult" and resentful and resistant because the relationship is misaligned. As my supervisor often says, you need in these moments to check the goals of therapy because chances are good the "resistance" here is due to a misalignment of goals--e.g., the therapist wants to go farther, or faster, or further into an area than the patient does or can currently handle.
In this light, Kottler also offers advice I've seen in others: resistance is a powerful message. Try to understand and interpret it. What is it protecting? What was its function?
Perhaps more important, and certainly more difficult, is to ask yourself whether "it could be said that much of client resistance results, in part, from some blocking that occurs in the therapist" (p.208). This, as I've also learned from Otto Kernberg and Nina Coltart, is where mining the counter-transference is crucial for knowledge about blockages in the therapist as well, of course, as--possibly--the patient.
But look, moreover, at cultural background to see if some of the struggles can be located here. Regardless of origin or cause, the therapist needs to remain flexible, patient, compassionate, and available to help people change at their own pace when they are ready, recognizing that some people may never get there or may be incurable. Have the humility to admit this, and also to admit that sometimes the most difficult patients can also be the greatest teachers.
Finally, have not only humility, but plenty of self-compassion, Kottler reiterates several times. This is good advice I've seen in others, including Adam Phillips, about whom much more another time.
In this chapter the author sketches out the lofty potential of the therapeutic vocation: the ability to make a change in the lives of others unlike anything else, leading potentially to "spiritual transcendence" (p.1).
The ability to effect such change depends in good measure on the therapist's personality. Here Kottler echoes something much remarked upon in many other publications: above and beyond theoretical orientation and even certain techniques, the personality, and from it the therapeutic alliance, are fundamental, leading to change not just for patients but also therapists themselves. Kottler notes that therapy can produce an "altered state of consciousness" in both therapist and patient. This is especially so if the alignment is right and healthy, when there can be a kind of "second sight" at work.
Much like Nina Coltart (whom he does not quote or seem to have read), Kottler speaks of the importance of faith in the process, faith in the therapist, as being key factors in helping motivate people to seek and find change. Beyond that, Kottler suggests we go too far in thinking we can always and everywhere pinpoint the cause of change, even after lengthy in-depth study. Therapists have to have "learned to love this sort of ambiguity and complexity" or else probably find another career (p.5). A little later Kottler says that "I have never really trusted anyone who claims to understand how therapy works. I think it is far too complex" (14).
That complexity and ambiguity can open the door to self-understanding and experimentation by the therapist, who also functions as a model: if the therapist models courage, it may aid the patient in being courageous enough to risk and experiment with change in his or her own life.
Ch.2: Struggles for Power and Influence contains some important reflections on serious issues.
Kottler begins by noting something that goes back at least to Freud: resistance. Therapists want to encourage change, but patients will not only resist that, but turn the tables, fighting to change not themselves but the therapist. They will want the therapist to take their side, to adopt their view, to love them more, to reduce and belittle the therapist and thus attempt to work out their own sadomasochistic transferences (a process which, as several others--e.g., Robert Stoller--have recognized, is often a reflection of early trauma).
Kottler notes a change here that has occurred in the last several decades: the decline of the therapist as all-knowing, largely aloof guru or expert. Thankfully that is a model and an approach largely in disfavor today. Instead patients increasingly see therapists as people with specialized training and insight whose job is to help patients discover what it is they want and need, and try to help them attain that at least in part. Kottler uses the metaphor of a "coach" here to try to capture something of this shift. He also speaks of the therapist as "model" of some beliefs, behaviors, and practices that the patient may very much want to try out and eventually adopt.
What is it that therapists should model? Here Kottler notes numerous important and distinguishing characteristics of therapists, including their
- tolerance
- sincerity
- serenity
- tranquility
- self-assurance
- self-disciplined regularity that can nonetheless be spontaneous
A few other random things that stuck out to me in this book: In his fifth chapter, Kottler notes how much of "continuing education" is a scam, designed to offer a continuing source of cash and credentialing power to various groups, but very often only the most superficial "education" imaginable. I've heard this from other therapists, and from perusing some prominent websites, seen it up close.
His reflections on seduction in the transference is especially useful. Noting that patients may be seductive for reasons other than the straightforwardly or explicitly sexual, he notes that regardless of motives, there are no easy ways to deal with this problem. He further notes this can be a desire to establish a deep emotional relationship rather than a physical one, and that this obtains even when patient and therapist are of the same sex.
Kottler is also helpful on dealing with difficult patients, offering several insights, starting with the fact that it is important to recognize that at least some of the time it may not be them, but you: are you too impatient to change them, too resentful of a perceived loss of control in the relationship? Maybe they are "difficult" and resentful and resistant because the relationship is misaligned. As my supervisor often says, you need in these moments to check the goals of therapy because chances are good the "resistance" here is due to a misalignment of goals--e.g., the therapist wants to go farther, or faster, or further into an area than the patient does or can currently handle.
In this light, Kottler also offers advice I've seen in others: resistance is a powerful message. Try to understand and interpret it. What is it protecting? What was its function?
Perhaps more important, and certainly more difficult, is to ask yourself whether "it could be said that much of client resistance results, in part, from some blocking that occurs in the therapist" (p.208). This, as I've also learned from Otto Kernberg and Nina Coltart, is where mining the counter-transference is crucial for knowledge about blockages in the therapist as well, of course, as--possibly--the patient.
But look, moreover, at cultural background to see if some of the struggles can be located here. Regardless of origin or cause, the therapist needs to remain flexible, patient, compassionate, and available to help people change at their own pace when they are ready, recognizing that some people may never get there or may be incurable. Have the humility to admit this, and also to admit that sometimes the most difficult patients can also be the greatest teachers.
Finally, have not only humility, but plenty of self-compassion, Kottler reiterates several times. This is good advice I've seen in others, including Adam Phillips, about whom much more another time.
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