The Therapist's Therapy
When psychoanalysis came to Canada, it retained more of its European and originally Freudian ideas and practices in some respects than it did when it came to the United States. One glaring example of this is in training requirements: Americans until recently required medical training before application to analytic training; Canadians never did.
When I was an undergraduate in psychology in Ottawa in the 90s seriously contemplating analytic training, I knew I was not cut out for, nor did I have any interest in attending, medical school. Fortunately, following the model Freud first put forth in The Question of Lay Analysis, I knew there was an open path for me, allowing me to combine my scholarly interests with the clinical: I would obtain a doctorate--whether in history, psychology, religious studies, or possibly philosophy was not clear to me then--and then train as an analyst at the institute in Montreal. Many others had done this before me and it was long since commonplace in Canada as across most of Europe and elsewhere. In that book, Freud in fact spoke of the ideal analyst as being neither a priest nor a physician but a "secular pastoral worker," a very curious phrase which was, and remains, inspiring to me.
The other requirement, of course, universally adopted--even in the US--was that analysts had first to be analysands, and thus undergo a training analysis.
Moreover, Freud recognized very late in life, in "Analysis Terminable and Interminable," the need for ongoing treatment. Freud has reassuring words when he counsels that "Every analyst ought periodically himself to submit to analysis, at intervals of, say, five years, without any feeling of shame in so doing." (One of the things I admire about Nina Coltart, is her regular reminders throughout her books of the need for analysts and therapists to go back into therapy even occasionally or to "get a bit of supervision" as she puts it flatly if the counter-transference is getting out of hand or other difficulties arise.)
Since returning to the clinical field more recently, and this time in the United States, I am frankly amazed not just at how long it took American institutes to admit more than just physicians, but to a broader phenomenon across the entire mental health field and outside of analytic institutes: the lack of any sort of requirement for personal therapy on the part of those who train to be therapists in other programs--clinical social workers, mental health counsellors, etc.
I am aware, having read more than a few stories of abuse, that the requirement for therapy necessitates very careful handling so that it does not end up reinforcing certain existing ideological prejudices or power structures while hiding behind clinical concerns. Not unlike certain professors holding up their doctoral students because of "political" disagreements with other members of the jury (which I have seen first hand), certain analysts could hold up certain trainees as being "insufficiently analyzed" or "resistant" when in fact these trainees just disagreed with their analyst, or were more inclined to, say, a Kleinian or Adlerian or Freudian approach that did not sit well with their supervisors.
So there are dangers to be avoided, but avoiding them is far from an insurmountable problem. This returns me to my original question, phrased in the following words in the introduction to a very absorbing, richly researched, and important book on an unjustly neglected topic: Jesse D. Geller, John C. Norcross, and David E. Orlinsky, The Psychotherapist’s Own Psychotherapy : Patient and Clinician Perspectives (Oxford University Press, 2005). Here in their introduction these authors ask how and why is it that "in most European countries, a requisite number of hours of personal therapy is obligatory in order to become accredited or licensed as a psychotherapist" but "in the United States, by contrast, only analytic training institutes and a few graduate programs require a course of personal therapy" (p.5)?
Much of the rest of this book--a collection of essays from people in many countries and operating from a variety of traditions--seeks to begin to look at the frequency of, resistance to, and unique aspects uncovered in, the psychotherapy undertaken by those who are themselves therapists of some sort, noting that "many important questions about the psychotherapy of psychotherapists have not been answered or even asked by empirical investigators" (7).
I was especially interested in a chapter by the late Harry Guntrip on being in analysis with Fairbairn and Winnicott, two of the most important figures in the British object-relations school that I have read the most about and for whom I have enormous respect. For Guntrip, the trauma of losing a brother at 3 was "softened up" by his 2 analyses but not solved: that happened after. In this, he seems a perfect illustration of something Adam Phillips said when he noted that "The cure can begin only after the treatment has ended." One can certainly debate that, but I have found it very true in my own life.
By this I think we must include the realization not only that the analysis itself helped directly, but it also gave one the skills to carry on a regular self-analysis and create what Fred Busch called a "psychoanalytic mind."
Guntrip, Fairbairn, and Winnicott--and more recently Phillips--remain hugely important and valuable to me in very large part because they illustrate how valuable a "psychoanalytic mind" is to avoiding the dangers of rigid ideological thinking, including those too attached to one theoretical orientation! As Guntrip puts it, theory can be "a useful servant but a bad master, liable to produce orthodox defenders of every variety of the faith" (63).
So this book varies across theoretical persuasions, but is able to draw some generalizations, noting, e.g., that "therapists enter personal treatment an average of two to three times during their careers—and probably for and during developmentally propitious crises." What is curious to me is the further reporting that even as therapists enter their own therapy, with, presumably, some self-awareness into the dynamics of resistance that they themselves see in their own patients, they cannot resist these dynamics when they are the patient: "Directly and indirectly, all of the therapist-patients in this book reported that no matter how intellectually prepared they were to collaborate, they could not 'resist resisting'" (6).
That resistance may keep some from entering therapy, which I would regard as a great pity. More than that, I would have to wonder: how much (to speak in a Kohutian way) of a usable self do you have available for your patients whom you hope to treat in therapy? If you are one of those blessedly free but vanishingly rare people with enormous reserves of the self available, and few to no traumatic memories to work through, then praise God. But for the rest of us, the answer to the question of the psychotherapist's own psychotherapy should be: "Yes, please, let us have some more!"
When I was an undergraduate in psychology in Ottawa in the 90s seriously contemplating analytic training, I knew I was not cut out for, nor did I have any interest in attending, medical school. Fortunately, following the model Freud first put forth in The Question of Lay Analysis, I knew there was an open path for me, allowing me to combine my scholarly interests with the clinical: I would obtain a doctorate--whether in history, psychology, religious studies, or possibly philosophy was not clear to me then--and then train as an analyst at the institute in Montreal. Many others had done this before me and it was long since commonplace in Canada as across most of Europe and elsewhere. In that book, Freud in fact spoke of the ideal analyst as being neither a priest nor a physician but a "secular pastoral worker," a very curious phrase which was, and remains, inspiring to me.
The other requirement, of course, universally adopted--even in the US--was that analysts had first to be analysands, and thus undergo a training analysis.
Moreover, Freud recognized very late in life, in "Analysis Terminable and Interminable," the need for ongoing treatment. Freud has reassuring words when he counsels that "Every analyst ought periodically himself to submit to analysis, at intervals of, say, five years, without any feeling of shame in so doing." (One of the things I admire about Nina Coltart, is her regular reminders throughout her books of the need for analysts and therapists to go back into therapy even occasionally or to "get a bit of supervision" as she puts it flatly if the counter-transference is getting out of hand or other difficulties arise.)
Since returning to the clinical field more recently, and this time in the United States, I am frankly amazed not just at how long it took American institutes to admit more than just physicians, but to a broader phenomenon across the entire mental health field and outside of analytic institutes: the lack of any sort of requirement for personal therapy on the part of those who train to be therapists in other programs--clinical social workers, mental health counsellors, etc.
I am aware, having read more than a few stories of abuse, that the requirement for therapy necessitates very careful handling so that it does not end up reinforcing certain existing ideological prejudices or power structures while hiding behind clinical concerns. Not unlike certain professors holding up their doctoral students because of "political" disagreements with other members of the jury (which I have seen first hand), certain analysts could hold up certain trainees as being "insufficiently analyzed" or "resistant" when in fact these trainees just disagreed with their analyst, or were more inclined to, say, a Kleinian or Adlerian or Freudian approach that did not sit well with their supervisors.
So there are dangers to be avoided, but avoiding them is far from an insurmountable problem. This returns me to my original question, phrased in the following words in the introduction to a very absorbing, richly researched, and important book on an unjustly neglected topic: Jesse D. Geller, John C. Norcross, and David E. Orlinsky, The Psychotherapist’s Own Psychotherapy : Patient and Clinician Perspectives (Oxford University Press, 2005). Here in their introduction these authors ask how and why is it that "in most European countries, a requisite number of hours of personal therapy is obligatory in order to become accredited or licensed as a psychotherapist" but "in the United States, by contrast, only analytic training institutes and a few graduate programs require a course of personal therapy" (p.5)?
Much of the rest of this book--a collection of essays from people in many countries and operating from a variety of traditions--seeks to begin to look at the frequency of, resistance to, and unique aspects uncovered in, the psychotherapy undertaken by those who are themselves therapists of some sort, noting that "many important questions about the psychotherapy of psychotherapists have not been answered or even asked by empirical investigators" (7).
I was especially interested in a chapter by the late Harry Guntrip on being in analysis with Fairbairn and Winnicott, two of the most important figures in the British object-relations school that I have read the most about and for whom I have enormous respect. For Guntrip, the trauma of losing a brother at 3 was "softened up" by his 2 analyses but not solved: that happened after. In this, he seems a perfect illustration of something Adam Phillips said when he noted that "The cure can begin only after the treatment has ended." One can certainly debate that, but I have found it very true in my own life.
By this I think we must include the realization not only that the analysis itself helped directly, but it also gave one the skills to carry on a regular self-analysis and create what Fred Busch called a "psychoanalytic mind."
Guntrip, Fairbairn, and Winnicott--and more recently Phillips--remain hugely important and valuable to me in very large part because they illustrate how valuable a "psychoanalytic mind" is to avoiding the dangers of rigid ideological thinking, including those too attached to one theoretical orientation! As Guntrip puts it, theory can be "a useful servant but a bad master, liable to produce orthodox defenders of every variety of the faith" (63).
So this book varies across theoretical persuasions, but is able to draw some generalizations, noting, e.g., that "therapists enter personal treatment an average of two to three times during their careers—and probably for and during developmentally propitious crises." What is curious to me is the further reporting that even as therapists enter their own therapy, with, presumably, some self-awareness into the dynamics of resistance that they themselves see in their own patients, they cannot resist these dynamics when they are the patient: "Directly and indirectly, all of the therapist-patients in this book reported that no matter how intellectually prepared they were to collaborate, they could not 'resist resisting'" (6).
That resistance may keep some from entering therapy, which I would regard as a great pity. More than that, I would have to wonder: how much (to speak in a Kohutian way) of a usable self do you have available for your patients whom you hope to treat in therapy? If you are one of those blessedly free but vanishingly rare people with enormous reserves of the self available, and few to no traumatic memories to work through, then praise God. But for the rest of us, the answer to the question of the psychotherapist's own psychotherapy should be: "Yes, please, let us have some more!"