Can One Be A 'Master Therapist'?

It is from Adam Phillips and Todd Dufresne (in his very astute introduction to a new translation of Beyond the Pleasure Principle) that I have learned to regard the whole concept of being a 'master' of something with a good deal of skepticism. 

In several of his books (but perhaps especially Terrors and Experts from 1997, and more recently his The Cure for Psychoanalysis), Phillips notes that we should in fact be suspicious of the whole idea of mastery of the psyche (and much else). Any psychoanalysis or psychoanalyst that promises such a thing exceeds its brief, Phillips says, arguing that there is no such psychoanalytic equivalent as the King's English or an 'authorized translation' or editio typica of the mind. 

I must say that it has taken me rather a long time to make my peace with this, but I think Phillips is right: mastery is not ever completely possible, and it should in fact be interrogated when such a desire reveals itself. Though I have spent rather a lot of time on the analytic couch, and it has been invaluable in ways too numerous to mention, it was only my second analysis that led me to let go of my infantile wishes for omnipotence and omniscience and to abandon the hope that I ever could examine and thus come to control every part of my mind, draining it of all ambivalence and ambiguity and the anxiety both sometimes produce. (Put in a Winnicottian way, I would be tempted here to say I'm on better terms with my primary process!)

I have achieved a lot of insight, but it is not and never will be complete, nor anything approaching mastery, and I am now not only at peace with that but--thanks again to Phillips--rather amused (instead of alarmed and angered) at the surprises my unconscious will produce from time to time. As Phillips says "A good life entails the tolerance and enjoyment of inner complexity....There is no final resolution here" (On Flirtation: Psychoanalytic Essays on the Uncommitted Life).

None of this is to say, however, that 'mastery'--as in mastering a skill--is something I reject. Quite to the contrary, I do believe that when it comes to such practices as learning languages, playing piano, or comparable activities, mastery can and should be aimed at. 

That is especially the case with psychotherapy though--as we shall see--it seems paradoxically true that one crucial hallmark of being a 'master psychotherapist' is precisely an ongoing uncertainty about whether one is a master or not, and a recognition that one still has things to learn. The master therapist, it seems to me, is the one who never feels he has learned everything. 

With this as background, I picked up Jeffrey Kottler and Jon Carlson's On Being a Master Therapist: Practicing What You Preach (Wiley, 2014) and read it with interest. 

The authors begin on the right footing, by raising the right questions, asking whether 'mastery' of therapy is "based on the mastery of certain clinical skills, particular personal qualities, or professional characteristics" (p.11). They next note problematic ways of finding master therapists: do you self-nominate? are you nominated by colleagues? are patients who love you or got better with you able to nominate you as a master?

All of these selection methods have, of course, problems, so we are no closer to an answer of how and where one might find master therapists. Instead, the authors add additional questions: does mastery differ based on the type of therapist or therapy? They inch towards an answer by suggesting that "no two master therapists perform therapy in the same way" (p.16). 

From here we get some suggested characteristics that are likely to be encountered in those recognized as masters:

• they are more inventive
• they are more humble
• they are uncomfortable drawing attention to themselves
• they prefer difficult truths to comforting illusions
• they are emotionally honest with themselves and their patients
• they perceive things, and more quickly, that others usually miss

This takes us up to the end of ch.1 where the authors write: "the concept of a master therapist is neither easy to define nor easy to grasp, especially considering all the different ways such excellence might be manifested" (p.24). 

Ch.2 takes us into increasingly familiar territory: examining the person of the therapist and noting that good therapists are those who "think differently in a multitude of ways," enabling them to make connections others might miss, and to "apply a variety of complex theoretical constructs and then adapt them to any particular case" (29). 

Forming the Alliance:

From here they quote Barry Duncan to the effect that forming "solid therapeutic alliances" is the key to distinguishing great therapists from the mediocre. But this must extend not merely to the worried well, or the patients you like or find similar to yourself or can easily relate to: it must extend to those court-ordered into treatment, those extremely reluctant or resistant to engaging with you, those whose lives seem radically different from your own. If you can build a solid alliance with these sorts of people, then you may be on your way to mastery.

Additional signs that you are on your way include:

• flexibility
• creativity (reinventing therapy for each patient)
• originality: finding your own voice
• learning from mistakes
• evolving views responding to new evidence
• seeing the patient as the greatest teacher.

Learning How to Listen:

Ch. 3 focuses on deep compassion and caring, while ch.4 looks at the skills of a master listener. These latter are marked by an ability, of course, to listen with the third ear, which enables them to hear between the lines, to hear what is doubled, denied, denigrated, overlooked, and so on. 

Your listening is supplemented by sight: what is the patient doing when they tell you for the third time in ten minutes that life is great? What are they not doing that you might well expect them to do? 

Listening prompts speech, and here the authors say master therapists are not afraid to draw on a variety of approaches, including being quite directive when it is appropriate. But most of the time good listening requires that one be as centred in the session and focused on the patient as possible: "Many experts that being present is the most important element of helping others heal" (p.85). 

Speaking the Truth in Love:

When one does speak, the so-called master therapist will "practice transparent honesty with as much tact and diplomacy as appropriate," always guaranteeing to the patient that you will be truthful and will say the things nobody else will say (p.111).

Be Not Afraid to Make Mistakes:

The authors quote several researchers, including Scott Miller and Bruce Wampold, to the effect that not only are great therapists going to make mistakes, but they may "make more mistakes than others, or at least are more inclined to admit them" (p.129). Such therapists are more self-critical, looking honestly at what they are doing and not doing, and what is working and not working. They fault themselves--and not the patient--if things are not working; but they are also gracious towards themselves in their criticism. Their self-critiques are not totalized or masochistic.

Obtaining Feedback:

The authors note the importance of obtaining accurate, useful feedback from patients on a regular basis. This can prevent ruptures from worsening and patients simply silently walking away. Duncan has written about this, as has Scott Miller, and before them Jerome Frank. 

Key Personality Traits:

At the end of ch. 10, the authors list what they regard as key personality traits in great therapists:

1. Trustworthiness
2. Dependability
3. Integrity
4. Flexibly tolerant
5. Modestly self-assured (believing in the patient, the process, and themselves)
6. Truthful
7. Spontaneous and Intuitive without being Impulsive
8. Kindness

But the most important trait is the outgrowth of kindness: love. As they begin to wrap the book up, Kottler and Carlson devote a chapter to the role of Love, putting me in mind of Freud's celebrated comment to Jung in a 1911 letter that "essentially, one might say, the cure is effected by love."