Psychotherapy is a social
phenomenon that is part of modern culture. In many cases it has little to do with
academic or professional training. Some
psychotherapists have been trained as psychologists or psychiatrists, but they
are a minority. Psychotherapy is carried out all over the world by (mostly)
social workers, counselors, teachers, clergy, psychologists, psychiatrists, and
whoever feels like it.
This has a history. Sigmund Freud,
supposedly the father of the "talking cure", was not a psychologist
or a psychiatrist, but a neurologist. In many countries, there is an official
regulation of professional psychology, psychiatry, or social work but such
labels as "psychoanalyst",
"psychotherapist", or "counselor" are not registered,
certified, licensed, or otherwise protected by legislation in most countries
where they are commonly in use.
On any given day, or night, in
Paris, London, New York, Los Angeles, or Buenos Aires (for psychotherapy tends
to flourish in the modern metropolis) anybody who so desires can practice
psychotherapy, as there are no government regulation or professional standards
for this activity. It is clear that not only can anybody be a psychotherapist,
but also anybody can start a new psychotherapy school or "technique",
as there are no clear standards of care (unlike medicine, engineering, or
In the Introduction, Cozolino writes:
"Like most other professional careers, being a psychotherapist involves
mastering a large and ever-growing body of knowledge, learning a variety of
skills, and navigating complex relationships"(p. xv). As shown above, this
view of psychotherapy as a professional activity is totally unwarranted, but the author of this textbook is not
concerned about any of the issues raised above (he mentions social workers as separate from psychotherapists and
seems to be unaware of the fact that most psychotherapists in the world are social workers!).
While anybody can practice
psychotherapy without any formal training, tens of thousands of students all
over the world are being trained for practicing psychotherapy.
Cozolino's goal is to help those
students in training for becoming "therapists", and the book is
intended to serve as the basic textbook in graduate courses on psychotherapy
wherever such courses are given. The intended audience is made up of students
who would be starting their practicum experiences under supervision.
The perspective offered in this
book on human behavior is what would be called
Psychodynamic, which means
incorporating the basic premises of psychoanalysis as a general theory and the
basic premises of psychoanalysis as a psychotherapy system, while not adhering
to most of the actual practices of psychoanalysis as psychotherapy.
"Therapists study an
individual's unconscious by examining such things as distortions of reality,
incongruities between words and actions, and the origins and effects of
psychological symptoms. Freud's projective hypothesis describes the process by
which our brains unconsciously organize our experiences of the world" (p.
The author's basic theory of human
behavior is that "We are guided and directed by multiple unconscious
processes of memory and emotion... Our temperaments and personal histories
create patterns of thinking and feeling that direct our behavior outside of
awareness. Although we all begin life in a state of complete egocentrism, we
can learn to have a broader perspective through experience and education.
Learning about our personal, cultural, and human biases should be a primary
focus of the training of every therapist" (p. xvii).
Psychotherapy is defined as "
an interpersonal learning environment similar in many ways to proper parenting.
In both, we tend to learn best when supported by a nurturing relationship with
an emphatic other, while being encouraged to confront life's challenges. We
also learn best in a moderate state of arousal; too little puts us to sleep and
too much triggers a fight-flight state that makes positive learning
impossible" (p. 31). What Cozolino presents can be described as an
"eclectic psychodynamic" model, and he advocates "a stance of
not knowing" (p. 11), with flexibility about protocol which allows for
calling a client on the phone to apologize for a poorly conducted session, as a
result of the therapist's own blindness to his inner processes.
Cozolino states that "...being
a competent therapist requires a simultaneous exploration of one's inner world
of private thoughts. When we begin training, we embark on two simultaneous
journeys: one outward into the professional world and the other inward, through
the labyrinths of our own psyches"(p. xv). This is based on his experience
teaching courses on psychotherapy, where "...the focus of my classes has
shifted from an emphasis on the techniques of therapy to an exploration of the
therapist's inner world" (p. 169). This is the rationale for the book's
emphasis on the psychotherapist's self-knowledge.
In classical psychoanalytic terms,
becoming a therapist, according to this book, means constantly analyzing one's
countertransference. The book also utilizes the classical psychoanalytic
terminology of transference, interpretation, and resistance. The author
endorses the projective hypothesis to the extent of assuming the validity of
so-called projective tests, which indicates a lack of familiarity with the
research literature on psychological testing.
In addition to its classical psychodynamic approach, this book offers us a moderate dose of "New Age" ideas, confirming the common East Coast biases about California swamis, satirized long ago by Kurt Vonnegut (1965). The author recommends meditation, yoga, and martial arts to create "mindfulness" in therapists, and his list of references and suggested readings includes such names as Carlos Castaneda, Paulo Coelho, "The Secret Life of Bees" and "The Holy Teachings of Vimalakirti", in addition to some fairly orthodox and highbrow psychoanalytic books.
Early on in the book, Cozolino
asks: "Why are therapists so vulnerable to doubts about our own competence
and sanity? ...We have a sense of our own fears, insecurities, and
"craziness" while we accord others their polished social presentation...Most
therapists grew up struggling to be loved and accepted by others...many of us
find it difficult to believe others can be of help to us" (p. 6). This
insightful passage ignores the possibility that the lack of any standards or
agreed-upon criteria for efficacy adds much to the insecurity of
psychotherapists. The self-knowledge ideal presented in this book is morally
laudable, but the lack of clear standards for either training or practice puts
much of psychotherapy today under a cloud, and on the margins of ethical
Vonnegut, K. Jr. (1965). God Bless You, Mr. Rosewater. New York: Dell Publishing
2005 Benjamin Beit-Hallahmi
Benjamin Beit-Hallahmi, trained as
a clinical psychologist, has written about the ideology and morality of
psychotherapy, most extensively in his book Despair
and Deliverance. He is currently working on a study of psychotherapists who
took seriously fantasies of Satanic ritual abuse.