On being a therapist PDF
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i On Being a Therapist ii iii ON BEING A THERAPIST z FIFTH EDITION JEFFREY A. KOTTLER 1 iv 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Oxford University Press 2017 First Edition published in 1986 by Jossey-Bass, a Wiley Imprint Second Edition copyright 1993 by Jossey-Bass, a Wiley Imprint Third Edition copyright 2003 by Jossey-Bass, a Wiley Imprint Fourth Edition copyright 2010 by Jossey-Bass, a Wiley Imprint All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging- in- Publication Data Names: Kottler, Jeffrey A. Title: On being a therapist / Jeffrey A. Kottler. Description: Fifth edition. | New York, NY : Oxford University Press, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016029437 | ISBN 9780190641542 (alk. paper) Subjects: LCSH: Psychotherapists— Psychology. | Psychotherapy—Practice— Psychological aspects. Classification: LCC RC480.5 .K68 2017 | DDC 616.89/ 14092— dc23 LC record available at https:// lccn.loc.gov/ 2016029437 1 3 5 7 9 8 6 4 2 Printed by LSC Communications, United States of America v Contents Preface vii Acknowledgments xiii 1. The Therapist’s Journey 1 2. Struggles for Power and Influence 17 3. Personal and Professional Lives 31 4. On Being a Therapeutic Storyteller— and Listener 51 5. How Clients Change Their Therapists 65 6. Hardships of Therapeutic Practice 79 7. Being Imperfect, Living with Failure 103 8. Patients Who Test Our Patience 115 9. Boredom and Burnout 135 10. That Which Is Not Said 163 11. Lies We Tell Ourselves— and Others 177 12. Alternative Therapies for Therapists 195 13. Toward Creativity and Personal Growth 223 14. On Being a Client: How to Get the Most from Therapy 243 vi vi Contents Appendix A: Discussion Questions 273 References 275 About the Author 291 Name Index 293 Subject Index 299 vii Preface The climate for being a therapist has changed so dramatically that the field is all but unrecognizable to those who began their careers when the first edition of this book was published 30 years ago. This was a time when clients were mostly white, female, and upper middle class, when therapy was believed to take a long time (at least months, if not years) to be considered viable, and when insurance companies would pay 90% of whatever we charged, with no lifetime limit or restrictions on frequency of sessions. Now we practice in an era when more indigent, immigrant, and working- class clients are being served, often presenting much more severe problems. In addition, many caseloads are filled with court- ordered and involuntarily referred clients. Whereas once upon a time therapists followed Freud’s lead of specializing in the so- called worried well or the neurotic middle class, we now reach a far more diverse population, representing every conceivable cultural, age, ethnic, racial, religious, socioeconomic, and sexual orientation back- ground. Whereas it had once been the case that therapists must master the intricacies of a handful of different theoretical orientations, with increased blending and integration of models into more pragmatic, evidence- based practice, it is now just as important to learn the unique and most significant aspects of the various cultural backgrounds of our clients. We are also asked to treat an increasing variety of complaints, many of them not particularly amenable or responsive to therapy in the past: domestic violence, physical and sexual abuse, trauma, sexual identity issues, substance abuse, eating disorders, personality disorders, self- harm, and dissociative dis- orders. Moreover, we are being required to make a difference in increasingly brief periods of time. Whereas long- term therapy once was measured in the span of 5 to 10 years, now it is often restricted to the same number of months, or even weeks. Managed care has completely restructured the ways we operate as ther- apists, not only limiting the time we spend with clients but also dictating viii viii Preface what sorts of things we are permitted to do. In most managed care situations, the course of treatment is strictly limited, and any extension of the allowable number of visits must be approved by some external authority. Everything is about accountability, empirically supported evidence- based treatments, and measured outcomes, all within specific time parameters. Technology has also revolutionized the field in the past few decades and will only alter the landscape further in years to follow. More and more often, we are using software or websites to communicate with managed care pay- ers, send our reports and invoices, and aid our diagnostic decisions and treat- ment planning. Both therapists and clients are using the online sources as a means of instant consultation, as well as for delivering and receiving therapy. Texting, emailing, social media, and instant- messaging are becoming increas- ingly common as favored means of communication, even as a way of conduct- ing sessions. We are spending more and more time in front of a computer screen and less and less time engaged in face- to- face, intimate engagement with others. This might make us more efficient, but it certainly changes the nature of our work and our lives— and not all for the better. In many ways, the life of a therapist is far more stressful with so much continual accessibility and so little downtime. The Mysteries of Being a Therapist Since the first publication of this book, the boundaries between theoretical orientations have begun to crumble further. Most of us could once easily identify ourselves as a strong follower of one particular persuasion— as psy- chodynamic, existential, cognitive- behavioral, or one of a few dozen others. Nowadays almost everyone is eclectic and pragmatic, or at least integrative, no matter what the espoused ideology. We might call ourselves constructiv- ists, behaviorists, feminists, or humanists, and we might describe ourselves as psychodynamic, cognitive, Gestalt, narrative, or relational therapists, but the reality is that we now borrow concepts and ideas from a variety of approaches, depending on the context, culture, and presenting complaints of our clients, not to mention our own mood. One thing that has not changed much is that the process of psychother- apy still flows in two directions. This is obviously the case in the direction of influencing the client, but it is also true with respect to affecting the personal life of the clinician. This impact can be for better or for worse, making the helping professions among the most spiritually fulfilling as well as the most ix Preface ix emotionally draining human endeavors. Some of us flourish as a result of this work. We learn from those we try to help and apply what we know and under- stand to ourselves. And some of us become depleted and despondent. Over time, we may become cynical or indifferent or stale. We have long recognized the impact of various therapeutic ingredients in the changes that a client will likely undergo. We know that such factors as the therapeutic alliance, synchronized agreement of goals, reliable and accurate feedback, empathic responding, sensitive questioning, and con- structive, sensitive confrontation will often lead to greater self- acceptance and even to personality transformations in a client. But what impact do these processes have on the person facilitating them? Can the clinician be an active instigator of the therapeutic process without, in turn, being affected by its ripple effects? Can therapists be immune to the influence of prolonged exposure to human despair, conflict, and suffering? Can we resist the inevitable growth and self- awareness that come from studying other lives? Can we remain the same after being in the presence of so many who are changing? Whether we like it or not, the decision to be a therapist is also a commitment to our own growth. I remember that when this book was first published, lo these many years ago, the reviews were somewhat mixed, sometimes reflecting the pas- sionate opinions of the reviewer that there are just certain subjects that we shouldn’t be talking about in a public forum. I drew some consolation from another reviewer at the time who called me the “conscience of the profession,” and I’ve always liked the idea that I was willing to discuss taboo topics, even if sometimes awkwardly. One of my earliest heroes was the lit- tle boy in Hans Christian Andersen’s tale of The Emperor’s New Clothes, the truth speaker who says aloud what everyone else can plainly see but will not acknowledge. Likewise, early in my career I felt so lost because the things that I struggled with most never seemed to come up very often in supervision, workshops, or resources— and they were certainly never discussed in my training. I wondered constantly why it was so rare that therapists talked about their failures, or why we argued among ourselves so much about whose approach was superior to all others, or why it didn’t feel safe to talk about all the ways that doing therapy was making me a better person, or why others seemed to be so limited by the literature and research from our field when I noticed my most influential teachers came from novels, travel experiences, adventures in my own life, and especially lessons learned from clients.
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