Book Review: The Myth of the Untroubled Therapist. Private life, professional practice

The Myth of the Untroubled Therapist. Private life, professional practice

Marie Adams. (2014). London: Routledge

The author of this important book, Marie Adams, who was trained in the psychoanalytic tradition, conducted interviews with 40 fellow therapists (from broadly four traditions; psychoanalytic, humanistic, integrative and CBT) as part of her doctoral research. She was interested in therapists' experience of life events and the possible impact these may have on professional practice. Adams tells us that there is a personal investment in researching this topic. She experienced two significant life events that impacted considerably on her professional life; the first was her husband's illness and the second a six months period where a professional claim was made against her, which eventually was dropped. She cites fear and shame as being the two most powerful emotions accompanying her in those two difficult periods of her life.

Adams invites the reader to think whether in any given moment we are working at the service or at the expense of our clients. If we are experiencing intense fear does it mean that we steer away from certain topics with clients? Does it mean we don't work with certain clients or only work with them in certain ways? If we are feeling gripped by intense shame are we hiding aspects of ourselves for fear of exposure and are we then discouraging clients from looking at their own shame in turn?

The author starts off in the first chapter examining what made us become therapists in the first place. Most of us will probably have been asked at some point why we have chosen this profession and most of us will have a narrative around this. Adams attempts to go a step further from the question why did you train to become a therapist to why did you really train to become a therapist? She looks at the background stories of the various therapists she interviewed and how some had traumatic childhood experiences that have led them into this profession, with the explicit sense that they wanted to help people with similar backgrounds. Some were saying that they could not work with a certain group of people, precisely because they reminded them of their past experience.

Are there self-motifs here, the author asks, of attempting to repair in others what could not be repaired in one's own life? Seeking intimacy in the therapeutic encounter when experiencing intimacy in one's private life is difficult and painful? Adams reveals that she struggles with clients who seem emotionally dead as it reminds her of her mother who was not emotionally available. She wonders how conscious she has been of trying to infuse clients with life, because the opposite for her was unbearable. The life events that she chose for the book were parenthood (or the pain around not having children), the challenges of working from home, working whilst in intense chronic physical pain or living with life threatening illnesses, or experiencing episodes of depression (although no definition was sought from what the various therapists meant by the term depression) or high levels of anxiety, and the loss of loved ones. The author weaved into her questions examples of therapists who have experienced such events; how some found it difficult to accept their own vulnerability, how some took refuge in working because in difficult times that was the only constant in their lives, how some reluctantly had to admit that they were not fit to work and had to take time out. There were also a few therapists who could not see a connection between what happened in their own lives and their professional life.

Adams looks at the choice of training modality and makes tentative links between modality and how adverse life events are conceptualized. She suggests that CBT therapists were more likely thinking about managing situations whereas she felt psychoanalysts were more inclined trying to gain an understanding of what was going on. She also talked about the different levels of personal therapy therapists had undergone. Adams feels that personal therapy, supervision and talking to fellow colleagues are important safeguards and that self-awareness is a crucial factor. She feels that therapy is an important component perhaps particularly after training where therapy becomes a choice rather than a requirement, and she has found that not many of her experienced interviewees were using personal therapy as a resource, wondering why and whether this was not a blind spot.

Adams' book is an important one I feel, because it raises all the above points that need to be reflected upon, because of the nature of therapeutic work, because of the vulnerability that some clients bring to the therapeutic encounter, and the responsibility I believe we have as therapists to help our clients be in touch with their own choices and truths. Given the importance of these questions, the book did not make for easy reading. Perhaps because I started to examine whether and if so how the myth of the untroubled therapist creeps in for me, or whether perhaps more accurately I have a sense that I must be a good therapist at all times!

Upon reflection I felt it was more useful to think about the "good enough therapist", just as Winnicott spoke about the 'good enough mother'. This seems more realistic and in fact feels more of an open concept than an either/or position. We have good days and we have bad days, stuff happens in our lives, inevitably, and they will have an impact on our clients. For example, I was working with clients throughout all of my pregnancies, some of which have ended in miscarriages, and the clients inevitably witnessed the changing states in me, even if they didn't 'know' I was pregnant or even when pregnancies were lost.

I agree with Marie Adams that self-awareness is key, as a process of reflection, some of which goes to the supervisor, or to peers, even friends in the way of generally reflecting on life events and what it means to be human, and to build in a process, as Patrick Casement so helpfully suggested, of connecting to the internal supervisor and learning from our clients and from mistakes. Self-awareness and reflection protect against the danger of black and white thinking and brings us into a stance that looks for the different shades of a situation; it allows for complexity. The existential approach for example looks at the complex self within a complex world that develops in a multitude of ways, including the therapeutic encounter. The phenomenological approach in turn pays particular attention to what is there, to what arises in the moment of the therapeutic context and relationship, by paying particular attention to assumptions.

Marie Adams, who admits to a psychoanalytic bias, paid much attention to the unconscious, of how past painful experiences may play out still for the therapist today and the dangers of that. To me this idea felt a bit persecutory whilst reading the book, as if this emphasis on the unconscious, almost seen as something that we can't quite escape contributed to me feeling a bit unsettled in my abilities to be conscious and aware of choice. It is the claim made against her in particular, so it seems, that made her write this book, and I imagine it must have been an incredibly anxiety provoking time. I wonder how much this anxiety was still with her whilst researching this topic and writing the book or perhaps it was in the writing of the book that she could lay something to rest?

What Marie Adams is not particularly touching upon in the book, and it is related to self-awareness, is self-care, or to open the term up 'care'. This brings me to think about several terms Heidegger used to describe our experiences of being-in-the-world, in relation to others and the world around us. Such as his term Sorge (care for self or others or something), Fuersorge (a more active stance of taking care of an other or something), Umsicht (an awareness for the immediate environment in which we find ourselves in) all of which point our mindful noticing of the related nature of our existence in any given moment in time in any given environment. Therefore, I can't take care of an other without taking care of myself, I can't be caring to an other without being caring to myself, I can't project care towards an other without it illuminating my world of care too. Any separation between me and the other would be living in bad faith. Any projection of care towards an other without considering my needs of care would be living in bad faith.

Therefore the existence of the therapist in relationship with his client puts both of them in a wider context of being human where dilemmas, paradoxes, our mortality, and our fundamental aloneness and need for connection are brought into the foreground. I feel these considerations can be useful with regards to the questions raised in this book and point to further questions such as what it means to be a therapist, what our roles are as therapists and what it is like to sit with clients. Clients quite often will bring issues to the encounter that have resonance, and sometimes these issues can be troubling and can catapult us into a maelstrom of chaotic and overwhelming feelings. But we are professionals too, and have been trained, and have the skill and tools, and hopefully the support, to work through these moments, both for ourselves between sessions, and in sessions with

Sara Angelini