The Making of a Therapist

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 plumbing).

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. 83)

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 practice.

Reference:

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.