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Stress in Psychotherapists
Edited by Ved P.Varma

London and New York

 First published 1997
by Routledge
11 New Fetter Lane, London EC4P 4EE
This edition published in the Taylor & Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s Collection
of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
Simultaneously published in the USA and Canada
by Routledge
29 West 35th Street, New York, NY 10001
© 1997 Ved P.Varma, selection and editorial matter;
individual chapters © the contributors
All rights reserved. No part of this book may be
reprinted or reproduced or utilized in any form or by
any electronic, mechanical, or other means, now known
or hereafter invented, including photocopying and
recording, or in any information storage or retrieval
system, without permission in writing from the
publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the
British Library
Library of Congress Cataloguing in Publication Data
Stress in psychotherapists/edited by Ved P.Varma.
Includes bibliographical references and index.
1. Psychotherapists-Job stress. I. Varma, Ved P.
[DNLM: 1. Psychotherapy. 2. Stress, Psychological.
3. Occupational Health. WM 420 S915 1996]
RC451.4.P79S77 1996
616.89′14′023–dc20
DNLM/DLC
for Library of Congress 96–4647

ISBN 0-203-36016-8 Master e-book ISBN

ISBN 0-203-37272-7 (Adobe eReader Format)

ISBN 0-415-12174-4 (hbk)
ISBN 0-415-12175-2 (pbk)
 Contents

List of contributors vi
Preface viii
Ved Varma

1 The experience of being a psychotherapist 1

Christopher Dare
2 Stress and the personality of the psychotherapist 8
Francis Dale
3 Stress in trainee psychotherapists 18
Delia Cushway
4 Stresses in child psychotherapists 35
Francis Dale
5 Risks to the worker with disturbed adolescents 47
Arthur Hyatt Williams
6 Stress in psychotherapists who work with adults 59
Cassie Cooper
7 Stress in psychotherapists who work with dysfunctional families 71
Philip Barker
8 Stress in the therapist and the Bagshaw Syndrome 83
Valerie Sinason
9 Stress in counsellors and therapists working with bereavement 94
Susan Wallbank
10 Therapeutic work as a minister 104
Louis Marteau
11 Stresses in cognitive behavioural psychotherapists 116
David Jones
12 Stress in group psychotherapy 131
Meg Sharpe
13 Stresses in psychotherapists inside the National Health Service 149
Andrew Skarbek
14 Stress in psychotherapists working outside the National Health Service 158
Irene Bloomfield
15 Stress and psychotherapy: an overview 174
Frank Margison

Index 195
 Contributors

Philip Barker, Professor, Department of Psychiatry and Paediatrics, University of

Calgary, Canada.
Irene Bloomfield, Psychotherapist in private practice, London.
Cassie Cooper, Senior Lecturer in Counselling and Psychotherapy, University of
Westminster, Harrow Annex.
Delia Cushway, School of Psychology, University of Birmingham.
Francis Dale, Principal Child and Adult Psychotherapist, Devon.
Christopher Dare, Senior Lecturer in Psychotherapy, Department of Psychiatry,
Institute of Psychiatry, University of London.
David Jones, Senior Lecturer in Psychology, Birkbeck College, University of London,
Chartered Clinical Psychologist.
Frank Margison, Consultant Psychotherapist, Gaskell House, Swinton Grove,
Manchester.
Louis Marteau, RC Priest, Founder of the Dympna Centre, London.
Meg Sharpe, The Group-Analytic Practice, London.
Valerie Sinason, Consultant Child Psychotherapist, Tavistock Clinic and St George’s
Hospital, London.
Andrew Skarbek, Consultant Psychotherapist, Runwell, Rochford and Basildon
Hospitals, Essex.
Susan Wallbank, Co-ordinating Counsellor, Cruse, London.
Arthur Hyatt Williams, formerly Consultant Adolescent Psychiatrist, Tavistock Clinic,
London.
 Preface

Over the last twenty or so years psychotherapists have made a great contribution to the
mental health problems of their fellow human beings and there has been a great need for
them to do so. As Malcolm Pines wrote in 1974 (Varma 1974), rising living standards in
underdeveloped countries often precede and may eventually lead to revolution. Similar
conditions in advanced western societies lead to a demand for psychotherapy—the
hungry mind replaces the empty belly; the emotional sickness shows.
Almost all of us in advanced western societies have experienced stress at one time or
another, in our personal relationships, in our work, in our health, or in all of these and
other areas as well. Psychotherapists have experienced more stress than other people
because they deal with the stressed and the stressors.
The other reason why psychotherapists experience more stress is a result of the
inherent complexity of their subject (Bloch 1982). This complexity is reflected in the vast
array of different psychotherapeutic approaches. The number of ‘schools’ of
psychotherapy well exceeds 100 and a recent publication contained almost 1,000 pages
describing no less than 64 ‘innovative’ approaches (ibid.). In this book, rather than trying
to represent this enormous field, I have taken what seems to me the more sensible course
of showing how stress affects psychotherapists working with different aspects of three
fundamental models of which virtually all the others are variations: the psychodynamic,
the humanist-existential, and the behavioural.
During the last thirty years work has been done on stress in a wide range of
occupations (Payne and Firth-Cozens 1987), but it is only recently that books have begun
to appear which deal with stress in specific occupational groups. So far as I know, this is
one of the first books to look at the question of stress in psychotherapists, although
chapters on stress have appeared in books dealing with different aspects of
psychotherapy, and papers have appeared in journals. Inevitably, I have had to be
selective and it has not been possible to cover all aspects of the question as fully as one
might have wished. Nevertheless, I believe that the subject is an important and neglected
one and it is my hope that this book will not only prove helpful to those who read it, but
will also act as a catalyst for further work.

REFERENCES

Bloch, Sidney (1982) What is Psychotherapy? Oxford: Oxford University Press.

Payne, Roy and Firth-Cozens, Jenny (1987) Stress in Health Professionals, Chichester:
John Wiley.
Varma, Ved P. (1973) Stresses in Children, London: University of London Press.
Varma, Ved P. (ed.) (1974) Psychotherapy Today, London: Constable.
Ved P.Varma
 Chapter 1
The experience of being a psychotherapist
Christopher Dare

A recently appointed high-up official in a Mental Health Trust had courteously set up a
meeting with me in pursuit of his conscientious wish to understand more of the services
provided within his new responsibilities. He naturally wanted to know of what
psychotherapy consisted. He displayed a genuine curiosity, a wish to learn and to place
the psychotherapy business alongside his previous experience of other businesses. He had
worked in industry and he wanted to make a parallel between the activity of the
psychotherapist and his own experience of giving career advice to junior staff in his
previous executive positions. At the same time, he displayed a characteristic fear: people
could get an excess of advice and support and might grow to rely too much upon it. He
feared that receiving psychotherapy might become an indulgence; it might create a risky
dependence. He also displayed a belief that there could be something unhealthy about
talking a lot about feelings. In saying such things he revealed all that characterises a very
English attitude towards the subject. In many ways it is surprising that someone accepting
a position in a Mental Health Trust in the United Kingdom at the present time would be
comfortable with his own attitude. The field of psychodynamic psychotherapy owes a
great deal to the British school of psychoanalytic thinking. It is also true that the subject,
as a professional practice, is now undergoing a veritable explosion in the numbers of
psychotherapists within Britain. The recently established register of psychotherapists
demonstrates how many organisations are currently developing standards of practice and
are training psychotherapists. At one time such trainings were almost exclusive to
London (with one training each in Aberdeen and Edinburgh). Now psychotherapy
courses are available in many centres throughout Britain, with, for the first time, an
evolution of university-based diplomas and masters degrees in the subject. There is an
even more marked development in the more ‘sanitised’, apparently cheaper form of
talking treatments which are encompassed by the concepts and practices of counselling.
In my discussion with this senior executive, I chose not to confront the inconsistency in
his attitude and side-stepped the issues. I talked of the particular psychiatric conditions
that interest me and for which ‘psychological treatments’ alone are the only ones that
have been shown to work. (These are, specifically, the so-called eating disorders,
especially those associated with self-starvation, which have been shown to be singularly
unresponsive to pharmacological therapies, and for which effective residential treatments
are expensive and scarce; see Dare et al. 1995). My response was tactical and I failed to
talk with him about the origins of his beliefs about what is for me my life’s work. Of
course, his views are indeed common and representative and have an important place in
 Stress in Psychotherapists 2
any understanding of the phenomenon of psychotherapy. The common attitude to
psychotherapy includes two persistent myths.

THE FIRST MYTH

Psychotherapy is nothing much more than an everyday matter of a cheerful and friendly
chat, commonly available over the garden fence. Contrary to this belief, psychotherapy is
a highly technical professional activity that uses a wide range of complex intellectual
models, one class of which (that derived from the scientific psychology of learning and
cognition) is justified by detailed and sophisticated psychological experiments. The other
main class (psychodynamic or psychoanalytic psychotherapy) is sustained by a century-
long process of changing and refining complex and subtle views of mental function
through clinical experience with tens of thousands of patients. It is disheartening for those
of us who work in this field that even apparently informed criticism of our subject
addresses psychotherapy as though it were a unitary and essentially unchanging body of
knowledge and practice. A ‘sound-bite psychiatrist’, much used by the media to comment
upon the passing scene, derided psychotherapy because there were so many named
varieties of the activity, as though it could not possibly be evidence of the multiplicity of
practices in response to the multiplicity of problems and situations in which people need
psychological help.

THE SECOND MYTH

Psychotherapy (specifically psychoanalytic psychotherapy) probably does not work to

any beneficial ends but is potentially dangerous. Psychoanalytic psychotherapy, in
particular, is portrayed as an implausible and futile mish-mash which has no claims to
efficacy but which can cause dangerous dependence and even suicide. Again the facts are
in opposition to this myth. Psychotherapy has been shown by large numbers of studies to
be a powerful treatment. It has been shown that the common ingredient of all
psychotherapies, the provision of warmth and empathic understanding, has such potency
that it is technically quite difficult to show the specific ingredients of different forms of
psychotherapy, the variance deriving from different techniques being swamped by the
non-specific power of talking treatments (Luborsky et al. 1975). Studies of the changes
people experience in the course of therapy show that there is a very rapid response indeed
to the provision of a thoughtful, caring, professional listening (Howard et al. 1986). The
proportion of people reporting marked improvement in their subjective feelings rapidly
increases within a few sessions of treatment (in comparison with matched groups who are
not getting help). This ‘dose effect’ has been shown in many studies. The rate of change
of objective measures of psychological state, that is, of changes that an external
investigator reports, is also quite steep, but not as much as that of the subjective feelings.
Symptoms, anxieties, depressions and so on change quite quickly, whilst self-esteem
difficulties and relationship problems take much longer to improve. Specific
psychological treatments directed at a particular focus or target can produce rapid change,
 The experience of being a psychotherapist 3
although it is not always well sustained. For example, in the field that I know best, that of
eating disorder, we are some way along the path of showing just the sort of specific
effects that different psychotherapies exert on different patients, in different contexts,
with different sub-groups of the conditions. In addition, there is a beginning literature on
the risks of psychotherapy, which, none the less, are often considerably less than the risks
of not giving psychological treatment, in those situations where it is indicated. For
example, in young adult patients with schizophrenia, whose families are critical of their
diagnosed family member, the patient’s risk of relapse is seriously heightened if specific
psychological help is not given to the patient and family to help cope with the criticism.

THE ORIGINS OF PSYCHOTHERAPY

Psychiatry, as a medical sub-specialty, has existed for perhaps two centuries, although
physicians have had a role in the care of those designated as mentally ill for very many
centuries. (The psychiatric hospital at which I work, the Bethlem Royal Hospital, joined
with the Maudsley Hospital, is shortly to celebrate its 750th anniversary). Some aspects
of this medical help have had a psychological intent. For example, the moral treatment
developed progressively in the first half of the nineteenth century, initiated by such as
Philippe Pinel in Paris, and continued by Hack Tuke in York and John Connolly in
Colchester, implied an essentially psychological approach. The giving up of constraint
and the attempt at a moral reorientation constituted an early form of something like
psychotherapy. Likewise, philosophers from Immanuel Kant onwards have believed that
their special preoccupation with reason and morality offered an approach to mental
disorder. The ideas of the philosophers and the humanisation of the hospital management
of the mentally ill certainly have an honourable claim to the history of psychotherapy.
It is more often proposed that the likely antique origins of psychotherapy are the advice
and support that pastors and priests have been offering since such roles became
differentiated within human society. Such an idea is commonly offered in the somewhat
derogatory manner that I had felt was behind the senior manager’s conversation with
myself reported above. I think that it is linked to the proposition that psychotherapy,
particularly psychoanalytic psychotherapy, is in any case quasi-religious, the underlying
ideas depending more on faith than on reason.
It is obvious that the activity now known as psychotherapy had some antecedents in
age-old human concerns. Since time immemorial, it would seem, one person would offer
another support and advice out of their own shared and different experiences of life’s
problems and their solutions. In a non-professional setting, a priest or a pastor has a
greater duty towards his faith and the wider body of the flock, than to the one person
alone. A friend or relative, likewise, will have responsibilities, when giving advice, to be
concerned with other family members and mutual friends. There are limits imposed by
tact, courtesy and convention within the informal setting that need not oblige the
professional. A complementarity can be expected in the social give and take of
supporting and advising. Love will provide an unconditional form of personal support
and care, but the long-term nature of such a context makes it quite different from a
professional activity. The care given will be part of the maintenance of the relationship
 Stress in Psychotherapists 4
concomitant with the expectation of the enduring future that is implicit in love
relationships. Likewise a priest or family practitioner can offer personal psychological
help, but everyone knows that if such occurs, it is only a part of the relationship, being
offered alongside the principal project, priestly or medical. However, psychotherapy is,
historically speaking, a new and distinctive activity. First, the personal support and
psychological help is the purpose of the meeting. It is not incidental to the other things.
Second, it is conducted professionally, that is to say, the one person, the client or patient,
goes to the psychotherapist, expecting that the latter will be functioning as best he can in
the patient’s or client’s interests. (It is probable that most psychotherapists are women.
However, the present author is male and ‘he’ is used to mean ‘he or she’ when referring
to a psychotherapist.) The psychotherapist tries to have a point of view that is specifically
and only for the other. This is the problem of being a psychotherapist. However, the
professional activity poses peculiar difficulties for its practitioners. The implication that
psychotherapy is nothing new, except for its mumbo jumbo, is part of a suspicious
response existing not only in the minds of intelligent members of the public, in
academics, in doctors and in psychologists but also, I believe, in ourselves, the
psychological therapists. I think that psychotherapy is beset by the uncertainties of its
practitioners. The reasons for and consequences of this uncertainty are the main focus of
the remainder of this chapter.

THE UNCERTAINTY OF THE PSYCHOTHERAPIST

For most occasions in which we meet with another person, we know the point of the
contact. Meetings with friends and family may seem to be exceptions to this but the
family is a social organisation, usually essential, existing for the support, nurturance and
care of its members, but having a corporate as well as an individualistic function.
Meetings with family members have a function, but one that is so intrinsic to our lives
that we never need be aware of the purpose, except when there exists an obligation above
our own active volition. We are so used to knowing what families are for, have been
socialised to perform properly from such a young age, that we do not realise how
precisely and accurately we fit in with our family role.
The strong tendency to fit in with the expected role is strong, something for which we
are precisely, psychologically adapted. Indeed, it is clear that when we enter any new
social situation, in our formal professional life or in the course of our social meetings, we
carefully observe the rules of communication and the structure of the power and
allegiances of the situation. We do this swiftly and outside of consciousness, in order that
we do not offend and so that we can find out how we ourselves will fit with this new
situation. It is with these highly refined and well learned social skills that a
psychotherapist meets a patient or client. However, in the usual social situation of leisure,
travel, work or play, we are trying to adapt and accommodate ourselves in as gracious
and comfortable way as possible, so as not to challenge the given order, to intrude on
private closeness or to offend those upon whom we depend in a novel setting. In the
process of meeting with a group or an individual, family members as well as friends or
acquaintances not only have an axe to grind—the fulfilment of their own purpose and
 The experience of being a psychotherapist 5
role in the meeting—but this interest is accepted as having self-serving aspects since the
social context acknowledges a process of mutually beneficial social exchange. A
psychotherapist has to strive to be truly altruistic and this goes against the grain.
Customarily, we are all highly orientated towards maintaining a social and family order
derived from our own wider culture and the particular religious, political and family
points of view. The professional activity of a psychotherapist requires attention to be paid
to those things that are expected and to which social custom would require conformity,
not in order to comply, but to use this as information about the problem to be faced. For
example, it is quite natural, in a social situation, to ask for and obtain reassurance. A
stranger on a station platform will ask of a passer-by whether or not the train that is about
to leave is going to a particular destination. The passer-by will answer straightforwardly.
A psychotherapist in response to a comparable request for reassurance, as to where things
are going, may not simply give the automatically reassuring answer, but must question
the process itself. Is the question realistic? Can anyone know where a particular
psychological process is leading, or if the outcome will be satisfactory in relation to some
as yet unknown, future psychological state?
The psychotherapist has to restrain the customary response, or, finding himself blurting
out a social response, has to try to understand what the pressures are that led him so to do,
to use the reaction as a piece of information about the processes that the patient or client
tends to evoke. That is, the therapist has to treat with suspicion his own normal social
reactions. The reaction must be taken as evidence of counter-transference acting out; not
a forbidden process, for such enactments are inevitable, but as a phenomenon to be
understood very specifically in context. Such events in the here-and-now can have a
potential for usefulness but are also a source of possible error. For example, in a
diagnostic interview with a patient with long-standing and distressing preoccupations for
which many people had unavailingly tried to give help, I found myself feeling quite
controlled and disconcerted. The patient repeatedly demanded that I tell him whether or
not I could offer help, before I even knew what the problem was. I inadvertently showed
my own responsive impatience. The patient burst into tears of anger and hurt, saying that
he always upset people from whom he wanted advice. It slowly became apparent that he
was someone who had had to look after himself from an early age, had managed to do so
quite extraordinarily well, through many hard times, but he had never been able to form
sustained, close love relationships. It was easy to see that he had a set, a tendency to
prevent himself getting the closeness for which he so longed in relationships. Patients
express the nature of their problems not only in their account of their history and their
current life, but in the sort of incidents and processes that occur in their relationship with
the psychotherapist. This discovery of the transference process that Freud made upwards
of one hundred years ago has conflicting effects. On the one hand, it means that the
psychotherapist can find himself being inducted into repeating the patient’s problems in a
very painful manner. On the other hand, the vivid quality of such events, occurring not as
part of a reported experience but in the exact present in the therapy room, are especially
powerful, showing the problem, facilitating an exploration of its accompaniments and
suggesting possible routes for the avoidance of like difficulties. The psychotherapist has
to take up a position that has many of the qualities of an intense closeness with the patient
or client. This is necessary in order to know what the problem is for the patient or client,
 Stress in Psychotherapists 6
it enables appreciation of the feelings as accurately as possible, and is essential to make a
therapeutic relationship with the patient. Within psychotherapy patients are usually
confronted with difficult, often hidden parts of themselves. The revelations are
embarrassing and painful. This is only likely to occur if patients feel respected and know
that their pain is sensitively heard. However, in order to manage the tendency to enter
into a relationship that is too social to be helpful, the psychotherapist has both to be an
emotionally present and empathically effective presence for the patient but also has to
preserve a distance. Some separation from the patient is required so that the professional
scrutiny of the relationship is maintained. The psychotherapist cannot afford to become
so involved as to be unable to make forceful therapeutic responses, if indicated and
timely. For a specific patient, in a particular setting within which psychotherapy can
occur, there is much variation of the precise nature of the balance of emotional directness
and responsiveness within a professional framework, the psychotherapist assessing the
meaning of what transpires and retaining the capacity to make helpful interventions.

EFFECTS OF THE AGE OF THE PATIENT

Working with children is quite different from working with adolescents and adults. It is
very easy for children to feel very attacked in therapy. It is unusual, especially in the
early phases of treatment, for children to believe that the therapy is for them. Commonly
parents, teachers, social workers or courts recommend psychotherapy for a child because
of worries about behaviour. Children are capable of communicating their own distress,
but help can be experienced as being to do with misbehaviour or badness. Adolescents
often believe that their problems are unique, and cannot be accepted or felt by others. The
psychotherapist can be seen as both alien and intrusive. Adults, especially perhaps men,
in our culture believe that there is shame in experiencing panic, in being overwhelmed
and helpless.
The aim of life, and therefore of psychotherapy, differs with different age groups. An
adolescent is trying to maintain a pathway that shows allegiance to the past, to childhood
relationships, but which takes a track which specifies the adolescent’s own needs and
individuality. The elderly are usually engaged in a survey of their life achievements and
how these fit with earlier hopes and expectations. The needs and therapeutic aims of a
person with children and grandchildren are likely to be different from those of people
who find their social support and companionship in non-family relationships.

CONJOINT RELATIONSHIP THERAPIES

In the last twenty-five years, effective forms of relationship psychotherapy have been
devised. Some of these can be undertaken with the patient alone, but sometimes treatment
for the problems of the individual are most quickly and efficaciously undertaken in the
context of the person’s natural psychological setting. Throughout life, the psychotherapist
must consider the intimate personal relationships of the patient in order to ask what the
aims of treatment are likely to be and to determine whether or not conjoint therapy
 The experience of being a psychotherapist 7
(couple or family therapy) is more appropriate. The conduct of such conjoint treatments
imposes additional intensity and potential for disturbing counter-transferences upon the
psychotherapist, but at the same time can increase the range and effectiveness of such
treatments.

GROUP PSYCHOTHERAPY

For some people, group therapy is a much more natural setting for psychological growth
and for gaining mastery of frightening and difficult symptoms and relationship problems.
Some patients are very supported by the finding that they have difficulties similar to
those of others and that they can help others in a psychotherapeutic group, when they had
believed themselves to be quite without resources. It can feel safer to reveal feelings at
the slower pace that characterises group treatments. A vulnerable patient can feel
protected from the scrutiny of the psychotherapist about whom a fantasy of psychological
resourcefulness and invulnerability may be woven, leading the therapist to be seen as
remote and unsympathetic. Other members of a group can debunk such a fantasy or can
be a bulwark against the feared disparagement of the professional.
Psychotherapies differ in the intellectual framework and hence the technical
preoccupations they embody, in the intensity of the therapy to be undertaken, and in the
context (individual, couple, family or group). Different age groups have differing needs
determined by the stage and the current course of their development: the aims of a
particular psychotherapy are affected by the life-cycle location of the patient.
Psychotherapy is shaped by the nature of the patients’ problems and their own
perceptions of what they want from the treatment, and, in addition, what form of
psychotherapy that they can accept will be determined by their general expectations of
what constitutes professional help. Although a psychotherapist may believe that what he
is doing is determined by his own intellectual stance and by a professional assessment of
the patient’s needs, he will be unaware of the extent to which his apparently professional,
self-determined activities are structured by the patient’s contribution. The uncertainty
established by the subtle interaction between himself, his own unconscious mental
processes, and the multi-layered processes with the patient, make the conduct of
psychotherapy necessarily inclined often to be bewildering and unnerving.

REFERENCES

Dare, C., Eisler, I., Colahan, M., Crowther, C., Senior, R. and Asen, E. (1995) ‘The
listening heart and the Chi square: clinical and empirical perceptions in the family
therapy of anorexia nervosa’, Journal of Family Therapy 17:19–45.
Howard, K.I., Kapta, S.M., Krause, M.S. and Orlinsky, D.E. (1986) ‘The dose-effect
relationship in psychotherapy’, American Psychologist 41: 159–64.
Luborsky, I., Singer, B. and Luborsky, L. (1975) ‘Comparative studies of
psychotherapies: is it true that “everyone has one and almost all have prizes”?’
Archives of General Psychiatry 32:995–1008.
 Chapter 2
Stress and the personality of the psychotherapist
Francis Dale

In this chapter, we will be looking at the relationship between the way stress is
experienced and dealt with and the personality of the psychotherapist. The main
contention will be that certain individual characteristics in the therapist’s personality are
helpful and of value in managing stress; and furthermore, while some of these may be
innate, that these, and other traits can be aquired in the course of working as a therapist—
because the nature of the work requires them to be present.
Bearing this in mind, before we can talk about the emotional and mental functioning of
the psychotherapist, we need to explore those character traits in the personalities of
psychotherapists which are most conducive to helping them deal with stress in a positive
and constructive manner.
I will try to draw out some of the important characteristics in the personality of the
psychotherapist by examining the role of the psychotherapist; the nature of the work that
he is called on to do; and the emotional and mental stress that engaging in this kind of
work invariably involves.
As there are so many varied forms of psychotherapy—each with its own theoretical,
philosophical and clinical orientation—it will be important to deal with the more general
and perhaps universally agreed characteristics which are generally thought to be a
prerequisite of all psychotherapists (regardless of their orientation) before dealing in
more depth with those psychotherapies, and psychotherapists, where the very nature of
the psychotherapeutic process, and the success or failure of treatment, may depend on the
kind of relationship which develops between patient and therapist.
Implicit in the above notion is the idea that, in some forms of psychotherapeutic
intervention, the personality of the psychotherapist is of less relevance or importance for
successful therapeutic outcomes than is the particular technique used.
For example, if we were to construct a continuum or scale which registered the extent
to which the personality of the therapist was an essential component of the treatment, it
would become immediately obvious that different models of psychotherapy require
correspondingly greater or lesser involvement of the psychotherapist’s whole personality.
At one end of the continuum we would find those psychotherapies which are more
symptom-based, time-limited and didactic—for example, the behavioural, cognitive and
systemic models—while at the other, we would find those psychotherapies which deal
with the symptom as metaphor, are open-ended, person-centred and mutually interactive.
Amongst these are all those psychotherapies which come under the umbrella of
psychodynamic therapy.
 Stress and the personality of the psychotherapist 9

THE DEMANDS OF THE WORK

The characteristics which determine the personality traits of psychotherapists are,

inevitably, shaped by the nature of the work involved and the demands that such work
places on those professionals engaged in it.
It is a two-way process—therapeutic work attracts certain types of individual, whilst
the work itself—over time—brings about changes in certain aspects of personality
structure and functioning.
If we look first at the wide variety of underlying motivations for wanting to work
therapeutically with people we can begin to see how complex and difficult an issue it is.

THE MOTIVATION OF THE PSYCHOTHERAPIST

Although the following list is not exhaustive it will, I hope, give some idea of the multi-
determined and frequently unconscious factors which lie behind a choice to work with
disturbed and unhappy individuals.

Making reparation
Many of us have, in our personal experience, been confronted with pain, misery and
despair in people we are close to, or love, but have been unable to help them. This can
sometimes be a very powerful motivating factor in the choice to be a therapist. I know,
for example, of one person whose real reason for working with handicapped people
stemmed from her experience of having a sister who was mentally handicapped.

Guilt
This can arise from the same kind of situation as described in the above example. The
same therapist may have been equally motivated by guilt at being the normal child or
because of angry or destructive emotions directed at the sister who took up so much of
her parents’ time or who caused so much trouble and anxiety.

Displacement
This refers to a psychical mechanism in which one defends oneself against having to
acknowledge and suffer from one’s own hidden pathology by displacing, projecting, or
locating it in someone else.

Omnipotent control
This is frequently related to displacement and is based on a fear or even terror of
whatever one is avoiding inside of oneself.