The Myth of the Untroubled Therapist

Private life, professional practice

Marie Adams

• Verlag: Routledge
• Jahr: 2013
• ISBN:
  9781134745241
• Auflage: 1
• Thema: Psicologia
• Thema: Consulenza psicoterapeutica

Therapists are often expected to be immune to the kind of problems that they help clients through. This book serves to demonstrate that this is certainly not the case: they are no more resistant to difficult and unexpected personal circumstances than anyone else. In this book Marie Adams looks into the kind of problems that therapists can be afraid to face in their own lives, including divorce, bereavement, illness, depression and anxiety and uses the experience of others to examine the best ways of dealing with them.

The Myth of the Untroubled Therapist looks at the lives of forty practitioners to learn how they coped during times of personal strife. CBT, psychoanalytic, integrative and humanistic therapists from an international array of backgrounds were interviewed about how they believed their personal lives affected their work with clients. Over half admitted to suffering from depression since entering the profession and many continued practising while ill or under great stress. Some admitted to using their work as a 'buffer' against their personal circumstances in an attempt to avoid focusing on their own pain. Using clinical examples, personal experience, research literature and the voices of the many therapists interviewed, Adams challenges mental health professionals to take a step back and consider their own well-being as a vital first step to promoting insight and change in those they seek to help.

Linking therapists' personal histories to their choice of career, The Myth of the Untroubled Therapist pinpoints some of the key elements that may serve, and sometimes undermine, counsellors working in private practice or mental health settings. The book is ideal for counsellors and psychotherapists as well as social workers and those working within any kind of helping profession.

1 The untroubled therapist Buying the myth

DOI: 10.4324/9781315880167-2

There are perhaps two questions here:

1. Why did you train to become a therapist?
2. Why did you really train to become a therapist?

The first is likely the story you gave the interviewing panel when first applying to become a counsellor/psychologist/psychotherapist. Not quite a ‘myth’, it isn't the real story either. Applying to join a training programme with rigorous standards of personal integrity, you are hardly likely to want to expose yourself too deeply. Nor is it appropriate to do so.

But the second question is the deeper, truer issue, often worked out in therapy, through long hours of battle with depression or internal demons. It is the drive behind how you behave, maintain, or struggle with relationships. Within these greater or lesser archaic traumas will rest the more profound truth of why you are training, or have become a therapist: the reason behind the reason, if you like, and the less ‘pure’ motivation for training as a therapist, echoing as it does an infantile deficit, or need. In every therapist there is also a client, as in every physician there is also a patient. To deny that equation is to deny the other, the very person whom we purport to want to help. And placing ourselves in a position of being the ‘carer’ rather than the one seeking help may help sustain the delusion that we are not in ‘need’. Yalom says that during his training he was continually reminded of the idea of the ‘fully analysed therapist’ (2002, p. 8), a notion he recognises now cannot possibly be true. This would also, in my view, mean believing we live in a state of stasis, without movement or texture in our lives — a kind of emotional fat-lining.

Therapy is increasingly a prerequisite for training as a therapist — even CBT therapists and psychologists training in academic settings are now encouraged to avail themselves of psychotherapy for at least a short period. As a trainer and examiner of psychotherapists, I am always concerned when I detect a resistance to engaging in any further therapy following training, as if therapeutic nirvana can be achieved through the attendance of so many hours. The truth is, we may need to revisit earlier trauma over and over again during our lives, each new decade perhaps bringing new elements to the fore. We see this in our clients: those who have suffered sexual abuse for instance, may find some peace through therapy in their twenties, but becoming a parent may raise new anxieties that must be contained and resolved a few years later. Why should this not be true with us, particularly as every day we work with the pain and trauma of others, some of which will echo our own life experiences? We can rise above it, of course, looking down on our clients from the dazzling height of our own delusions of perfection, or we can accept that we are sometimes troubled souls, with vulnerabilities of our own. A fair number of gurus may act as a warning.

The trouble with gurus

Gurus are a paradoxical lot. The very nature of being a guru is that you have followers, which lends itself to intense idealisation. And the higher up we are on the pedestal, the further the drop when we hit the ground. So why is it that there are those who aspire to such heady and precarious heights?

Most of us are not gurus, of course. We are working therapists, on the front line of the profession in private practice or within a mental health system. We work hard and juggle our professional lives against the backdrop of our personal lives, and mostly we manage. Gurus, however, seem to have a hard time of it. The effort of combining public scrutiny with human frailty seems to aggravate both into points of extreme.

R.D. Laing was perhaps the most influential psychiatrist during the 1960s and 1970s and even into the 1980s. That he changed people's perception of madness is an understatement. As a therapist he was certainly remarkable, if his public demonstrations are anything to go by: he notoriously stripped down naked to sit with an equally naked patient suffering psychosis. However, ‘As a man Laing could be mean and cruel, especially to those close to him. But he clearly also had a remarkable ability to relate to people, men and women, in extreme states of suffering’ (Gordon, 2009).

His own son writes, ‘My relationship with Ronnie has greatly improved since his death’ (Laing, 2006, p. xxi), making it clear in a single sentence that his father, the guru, was hardly an ideal parent. Laing's struggles with alcohol, relationships and his own fragile mental health are well documented (Barston, 1996 21; Gordon, 2009; Laing, 2006).

Perhaps less well known is the personal struggle faced by Scott Peck, the American psychiatrist and guru who wrote The Road Less Travelled (1978), which sat at the top of the New York Times best seller list long enough to warrant an entry in the Guinness Book of World Records. In America he sold seven million copies of the book and another three million worldwide. As Jones points out in his biography, by the time he died Peck was ostracised from his children and his wife of forty years had finally left him following years of alcohol and drug abuse and an endless series of affairs. ‘His psychotherapeutic secret,’ writes Jones, ‘to the extent it was a secret, was that he knew what people yearned for, even when they didn't quite know themselves, because he yearned for it too. His skill was this ability to convey his understanding of their yearning in words that helped’ (Jones, 2007, p. 9).

Eric Berne, the founder of transactional analysis, also struggled within his personal life. Although he redefined the word ‘game’ as a psychological metaphor (Berne, 1964), his biographers — both of them disciples — cannot escape the fact that he was a ‘Master Gamesman’ himself, unable to control his impulses or adhere to the very principles he established and to which so many people now aspire: to live an ‘adult’, game-free life (Jorgensen and Jorgensen, 1984).

I have mentioned only a few here, with very public profiles, but the list of leading therapists who showed evidence of human frailty, and who clung to their narcissistic perch rather than do anything about it, may be endless. Throughout the psychotherapeutic world, in big ponds and little ponds, there are countless gurus who head the pack and draw us in with their grace, wisdom and often their sublime confidence. Never doubt for a single moment that they are human too.

Beware the wounded healer?

Guy argues that ‘the therapist's own pain may serve to motivate entry into the mental health feld in the hopes of relieving similar pain in others’ (1987, p. 15), but he goes on to warn:

For those psychotherapists who continue in psychic distress, there may be the wish to share vicariously in the healing of others when personal relief seems unattainable. In such cases, the work of psychotherapy may take on a near messianic quality, as though personal relief will be achieved only when the gods are satisfied with the shaman's self-sacrifice and abnegation. (p. 15)

If we are drawn to particular aspects of practice, it is likely that even if we are effective in our work, dangers also lurk. Writing of ‘development work’, for instance, Renn (2012) points out that the therapist may feel ‘legitimate’ parental feelings towards the patient:

However, it needs to be acknowledged that there is a heightened countertransferential risk in developmental work of the therapist using the patient vicariously as a source of narcissistic gratification, to relieve guilt, to overcome feelings of helplessness or to gratify his or her own infantile needs. (p. 94)

Mair (1994) argues that psychotherapists ‘exploit the mystique of the expert healer’ suggesting that ‘psychotherapy, like medicine, is said to be based on knowledge. Perhaps, like the medicine of eighty years ago, its true foundation is on the myth of knowledge’ (p. 136). Therapy, she says, works because ‘therapists deceive themselves’ into believing that what they do has a scientific basis, and the patient believes them in turn, creating a form of ‘placebo’ effect (p. 167).

In his book Against Therapy (1989), Jeffrey Masson created a splash, outlining from his perspective the foibles of a number of well-known therapists including Jung, Freud, Ferenczi, Perls and Rogers. Interestingly, Masson grew up with a guru — his parents were in thrall to a ‘mystic’ who even lived for many years with the family in Los Angeles (Masson, 1993). Masson appears to have spent much of his early life alternating between idealisation and denigration: for a time he was even director of the Sigmund Freud archives.

A kind of anti-therapist guru himself, Masson is unforgiving in his approach. It is hard not to believe that he holds a grudge, perhaps sometimes driving those who think he has a point into a defensive position, for instance concerning the underlying motives for someone working as a psychotherapist. Claiming that many of us put the advancement of our career, or theoretical perspective, ahead of the welfare of our patients, he is ‘sceptical of anybody who profits from another person's suffering’ (Masson, 1989, p. 39).

‘No one can act out of exclusively pure motives,’ concurs Guggenbuhl-Craig, from a less damning position, ‘Even the noblest deeds are based on pure and impure motives’. He further suggests that if a therapist deludes himself that his motives are selfless, he is more likely to act inappropriately within the consulting room (1971, p. 10).

Guggenbuhl-Craig writes from a Jungian perspective, focusing on the ‘shadow’ side of anyone entering the helping professions, including social workers, physicians and psychotherapists. How many times have I heard myself, as well as colleagues, refer to the nebulous ‘shadow’ in all of us? We pay verbal homage to ying and yang, the ‘shadow side’ and the notion of opposites, but in reality we may often avoid deeper consideration of the ‘shadow’ highlighting, as it does, uncomfortable aspects of the self. A well-established colleague of mine insists that therapy doesn't really begin until the therapist is through training. Until then, says my friend, the trainee more or less treads water, dipping occasionally but only as far as he thinks he can go safely without jeopardising his future as a therapist. He needs to be seen to be in good mental health. Stirring up the mud underneath is just a little too unsettling for most of us, exposing as it does the less noble side of ourselves.

On the other hand, the notion of ‘pure and impure’ rather reduces our internal complexity to good and bad, or black and white, like the cowboys of my childhood where all the bad guys invariably wore black Stetsons and the heroes always wore white. Our histories are what they are, and our motives for becoming therapists are rarely straightforward or simple. Out of consideration of the more distressing elements of our underlying motivations might actually develop a deeper appreciation of the self and, by extension, our clients.

Truth in fiction

Paradoxically, it is often in fiction or in the movies and on television that a more realistic portrayal of therapists is sometimes given, as in the television series The Sopranos where, during one troubling episode, the psychiatrist is sorely tempted to seek revenge on her rapist by telling her mob boss client what has happened. In Patrick McGrath's powerful novel, Trauma (2008), a psychiatrist is mercilessly driven by the unknown secret of his past. Fitzgerald's Tender is the Night (1933) tells the story of Nick Diver falling prey to the wounded charms of a patient, his narcissism leading them both towards inevitable destruction.

There are also deeply corrosive portrayals of psychiatrists and psychotherapists portrayed on the screen and in books, including Katzenbach's The Analyst (2002), where the eponymous hero begins as a rather stiff and repressed character and ends up akin to Rambo after being stalked by a client.

A more compassionate, but no less worrying tale is Alistair Campbell's All in the Mind (2008), the story of a therapist falling apart, in the end committing suicide rather than seeking help to fight his demons. Along the way he takes comfort from his clients, a questionable means of finding support and very different from deriving satisfaction through one's work. Perhaps this illustrates the dilemma of many therapists who find seeking help after qualifying more shaming than helpful, sometimes to their detriment.

The Existential therapist Irvin Yalom has written of therapeutic hubris in his novel, Lying on the Couch (1996), focusing on a community of therapists, some of whom are motivated by greed and the narcissistic imperative not to be seen as vulnerable. One notable character, from the beginning of the book, believes that he is above the laws and moral imperatives that underlie the basics of ethical practice. Clearly, these are therapists who risk bringing their own preoccupations into the clinical setting to the detriment of their clients. In this novel, it is the therapist who proves himself a ‘good’ therapist who struggles the most deeply, working hard to understand and accept his susceptibility to life's temptations.

In 2005, Paul Whitehouse brought the BBC series Help to the screen. Whitehouse played a series of characters, while Chris Langham portrayed the very human psychotherapist who clearly struggles in his concern and care for his patients and his helplessness at their often overwhelming need. In his personal life, he cannot even give voice to his affection for his secretary. In a terrible paradox, Langham was later embroiled in scandal, incurring a jail term for sex with an underage girl and the series ran for only one season.

The American version of the Israeli television series In Therapy with Gabriel Byrne is particularly evocative of the ‘human’ therapist who also does good work. From the first episode Byrne is face to face with the erotic transference, his own discomfort manifest in his gentle fiddling with his wedding ring. In this episode he resists, but the task is not always easy, particularly as he struggles within the apparent confines and unhappiness of his own marriage.

This is just a snapshot of the fictional literature on therapy, but it is interesting to note that it is often only in novels or in drama that we can sometimes bear to see ourselves portrayed in truly human form. The truth, perhaps, often cuts too deep a narcissistic wound. We may also fear that we will expose ourselves to personal and professional sanctions if we expose our vulnerabilities in too public a forum. Silence, then, is a form of defence, and the wider therapeutic community is deprived of the benefit of many therapists' personal experience and insight.

Therapists' distress

In my study of forty the...