A Curious Calling Unconscious Motivations for Practicing
Psychotherapy - 2nd Edition
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CONTENTS
Foreword by Sheldon Roth, M.D. xi
Acknowledgment xiii
1
The Fascination of Psychotherapy 1
A Neglected Topic
Why Bother?
Transference and Countertransference
Two-Person Psychology
Selection of Trainees
Conscious Motivations
Sources of Data
Female Therapists
The "Fifth Profession"
2
The Attempt to Master One's Own Conflicts 17
Mental Health Professionals
Clinical Psychology Students
vii
viii A CURIOUS CALLING
Psychiatric Residents
Psychoanalytic Candidates
Family Background
Handicap or Asset?
3
Satisfactions and Psychological Benefits Derived
from the Practice of Psychotherapy 37
4
Motives Related to Instinctual Aims 49
Indirect Sexual Gratification
Direct Sexual Gratification
Aggressive Strivings
Reaction Formation against Aggression
Expressions of Aggression
Masochistic Tendencies
Unresolved Oedipal Conflict
5
Motives Related to Narcissism and the
Development of the Self 97
Use of the Patient as a Mirroring or Idealized
Selfobject
The Attempt to Realize an Aggrandized Ego-Ideal
Parental Narcissistic Disturbance
Maternal Identification
Identity Diffusion
I
Motives Involving Object Relations 131
Dependency
Separation
Power and Control
The Wish to Drive the Other Person Crazy
Intimacy
Rescue Fantasies and the Need for Reparation
CONTENTS ix
7
Therapist Profiles 175
Subjects
Materials
Procedure
Results
Therapist 1: Ms. Ryan
Therapist 2: Dr. Jacobs
Therapist 3: Tom
Therapist 4: Anne
Therapist 5: Dr. Kramer
Therapist 6: Julie
Therapist 7: Dr. Glaser
Therapist 8: Dr. Lucas
Therapist 9: Dr. Moore
Conclusions and Further Reflections 237
Dangers of Deficient Self-Knowledge
Burnout in Therapists
Selection of Trainees
Professional Training
Clinical Supervision
Personal Therapy
Finding a Balance
Beyond Nostalgia
Appendix 261
References 265
Index 287
FOREWORD
Psychotherapeutic theory has been open to the revision or casting
out of many venerated theoretical ancestors. Certain lingering clin-
ical specters, however, still haunt us. Prime among these are neu-
trality and the relative indifference accorded to the impact of the
therapist's personality. The original therapeutic frame suggested a
laboratory-bound, scientific therapist who was sufficiently neutral
to fit all types, ages, and conditions and both sexes. Clinical expe-
rience has taught us otherwise: contemporary sensitive accounts of
transference include the countertransference. Yet there has re-
mained a vast ignorance of the personality of those who attempt
the impossible profession of healing minds. It is important to de-
scribe this missing link in the interaction of therapy in order to
gauge its influence.
The value of this book lies not only in the satisfaction of ques-
tions answered, but also in those questions it raises. Consideration
of the topics reviewed in this volume will convince the reader of
their complexity. Undoubtedly, many further years of research are
required to achieve adequate perspective on such complex issues
as the optimal combination of the therapeutic pair according to
gender, ethnicity, personality, sexual preference, and so on. I sus-
pect that this book will encourage many to pursue this daunting
subject of self-study.
xi
xii FOREWORD
A unique and outstanding feature of this volume is found in the
chapter containing character sketches (disguised) of psychothera-
pists. The therapists who have stepped forward and offered us a
piece of their lives have provided our profession with • precious
gift. With tactful questioning and dignified revelation, Dr. Sussman
leads the reader through the privileged portal of understanding.
Character is action. Through the example of these psychothera-
pists, self-analysis is graciously and enduringly etched into our
professional image.
Sheldon Roth, M.D.
Newton, MA
ACKNOWLEDGMENT
A major impetus for this study comes from my own experiences
as a psychotherapy patient. When I first consulted It therapist, in
my late teens, I was entering unfamiliar territory. Like most nov-
ices, I felt a strange mixture of excitement and dread. There seemed
to be no structure or guidelines, no way of knowing how to pro-
ceed or what to expect of the therapist. This unusual state of affairs
brought with it a sense of freedom, but also left me wondering:
"Just who is this person sitting across from me? Why has he chosen
this odd sort of work, and what exactly does he get out of it?"
I imagine that such musings are fairly typical of psychotherapy
clients. In my case, however, they were not fleeting thoughts but
developed into deep and lasting concerns as I encountered a suc-
cession of therapists who by ill chance were particularly idiosyn-
cratic. It was years later, during my clinical training, that I came to
understand from a theoretical perspective what I had suspected all
along: much of what these therapists did met their own needs
rather than mine. Even more disturbing was the realization that this
aspect of my therapeutic relationships had remained totally unac-
knowledged and unexplored. Thus, the difficulties that I con-
fronted in attempting to come to terms with my own problems
eventually spawned my interest in the underlying motives of psy-
chotherapists. While I regret having chosen to work with certain
xiii
xiv ACKNOWLEDGMENT
practitioners, ultimately I must acknowledge them, for without
their blunders and peculiarities I would have never written this
book.
My thinking regarding clinical matters has been influenced by
the many supervisors from whom I have learned. I would like to
thank Stephen Farina, Leonard Horowitz, Sydney Smith, Patrick
Dattore, David Beale, David Bellows-Blakely, Vincent Leoni,
Frank Schwoeri, William Annitto, Fred Gross, Deena Adler, Ilda
Ficher, Herb Walker, Talia Eisenstein, Judith Coche, Naomi Rosen-
berg, Leslie Poul Melman, Robert Gordon, Anita Bell, Frances
Hovey, Andrew Saykin, and Steven Stelzer.
This volume is an outgrowth of my doctoral dissertation, com-
pleted at Hahnemann University in 1987. I would like to acknowl-
edge my gratitude to the members of the thesis committee, Pat
Bricklin, Jules Abrams, and Ed Volkman, all of whom are currently
associated with Widener University's Institute for Graduate Clini-
cal Psychology. I am especially indebted to Dr. Abrams, who
encouraged me to return to the topic after dropping it in near
despair and switching to one that did not touch so close to home.
Special thanks are due to Melanie Wilson, who played an integral
part in writing the dissertation, and to Angel Eberhardt, whose
warmth and sense of humor were much appreciated during my
years at Hahnemann. During my fellowship at the Menninger
Foundation, I received helpful comments and suggestions from
Glen Gabbard, Jon Allen, Sydney Smith, and Mary Ann Clifft.
Were it not for Dr. Gabbard's urging, I may never have sought to
publish this work. I would like to express my appreciation to
Sanford Gifford of the Boston Psychoanalytic Institute for allowing
me to make use of the library facilities, and to Ann Menashi, the
Institute's wonderful librarian. Thanks also to Bernie Horan, Muriel
Jorgensen, Leslie Block, and Anne Patota for help in preparing the
final manuscript, and to Norma Pomerantz for her enthusiasm and
support.
I would also like to thank Sheldon Roth, who has been instru-
mental in bringing this work to fruition. Unsure of myself, I sug-
gested a collaboration, but he insisted, "No, Michael, this is your
book." Although I was paralyzed by the notion that it must be an
earth-shaking achievement, he tempered my grandiosity by declar-
ACKNOWLEDGMENT xv
ing, "You may yet achieve something earth-shaking in your lifetime,
but this won't be itl It will be, however, useful book:' Reframed
in this manner, a tenacious case of writer's block was swiftly
overcome. Both he and Jason Aronson have provided me with
good deal of support and encouragement, as have Jane Fagnant,
Jay Smith (who also supplied creative consultation), Marcella
Bohn, Ronnie Solomon, Kelly Blight, the clinical and clerical staff
at Stoney Brook Counseling Center (especially Judith Schwartz,
who was mysteriously linked to number of fortuitous events), my
sister-in-law Jane Sussman, my cousin Karen Sivin, and my broth-
ers, Daniel and Paul. I am deeply grateful to my parents, Maurice
and Raquel, for their encouragement throughout my years of train-
ing and for instilling within me a fierce curiosity and love of
knowledge.
Finally, I would like to express my appreciation to the therapists
who participated in my study and who graciously agreed to be
profiled in Chapter 7. There appears to be stigma within the
profession against therapist self-disclosure, not only in relation to
clients, with whom such a prohibition can often be justified, but
also in relation to students and colleagues, with whom it usually
cannot. I admire these therapists who were willing to share mate-
rial of such personal and intimate nature in order to further our
profession's understanding of an important topic. It is my hope that
this volume may contribute to the rejection of such a stigma and
add momentum to the trend toward greater openness regarding
the therapist's contribution to the therapeutic process.
1
THE FASCINATION
OF PSYCHOTHERAPY
The road to becoming a professional psychotherapist is typically
long and arduous. Having arrived, the practitioner of psychother-
apy is often emotionally taxed; the process is frequently character-
ized by a good deal of anxiety, ambiguity, and doubt. The thera-
peutic outcome, moreover, is always uncertain, and when progress
is made it is often painfully slow to manifest. Given this rather
forbidding scenario, it seems remarkable that anyone ever enters
what Freud (1937) deemed one of "those 'impossible' professions in
which one can be sure beforehand of achieving unsatisfying re-
sults" (p. 248). With each generation, however, there emerges a
ready supply of individuals who are willing and eager to pursue
this curious calling. What, one wonders, are the underlying motiva-
tions that provide the impetus for such an undertaking? This is the
complex and intriguing question to which this book is addressed.
The picture that has just been sketched is admittedly one-sided,
overlooking the many satisfactions that this work may entail. More-
over, students may initially have a limited idea of what they are
getting into when they decide to become therapists. Nevertheless,
one must conclude that, for certain people, the practice of psycho-
3
4 A CURIOUS CALLING
therapy holds a fascination and appeal that remains somewhat
difficult to fathom.
A NEGLECTED TOPIC
In a 1929 paper entitled "The Psychology of the Psychotherapist,"
Edward Glover comments as follows:
A cursory glance at the syllabus of any representative body of
psychologists is sufficient to remind us how rarely psychotherapists
inflict on themselves the discipline of self-examination. Papers on the
subject-matter of clinical investigation are as plentiful as black-
berries, but only once in a while is the instrument of investigation,
the psychotherapist himself, subjected to purposive scrutiny. [po 1]
Today, more than 60 years later, it cannot be stated that this
situation has been fully remedied. The influence of the therapist's
personality and motivations on the therapeutic process remains 8
relatively neglected area of inquiry.
Perhaps the most basic tenet of the psychoanalytic approach to
personality is that unconscious motivations play a major role in
human functioning and are largely responsible for the suffering
that brings many individuals into psychotherapeutic treatment.
From the psychoanalytic perspective, any therapeutic approach
that neglects such hidden strivings must remain relatively superfi-
cial and focus on symptomatic relief rather than fundamental char-
acter change. Given the emphasis placed on the importance of
unconscious motivations in understanding human behavior, the
attention that has been paid in the psychoanalytic literature to the
unconscious motivations of the analyst seems rather meager.
It is difficult to attribute this state of affairs to any failing on the
part of the founder of psychoanalysis. With his publication of The
Interpretation of Dreams, Freud (1900) set an example that few
have lived up to. Freud subjected himself to intense self-scrutiny,
courageously disclosing the workings of his own unconscious
thought processes as well as his pathological tendencies. Refusing
to set himself above those distressed individuals who sought his
THE FASCINATION OF PSYCHOTHERAPY 5
help, Freud applied the same model of neurosis to studying his own
psyche as he did to those of his patients. '
It was Freud's honest self-appraisal that enabled him to balance
his concept of transference with the complementary notion of
countertransference. Although he introduced the term as early as
1910, the concept of countertransference remained relatively ne-
glected until the latter part of this century. Indeed, Racker (1953a)
went so far as to liken the status of the concept to that of "a child of
whom the parents are ashamed" (p. 314).
Since the mid-1980s the field has witnessed a burgeoning interest
in the personal lives of psychotherapists (Goldberg 1986, Guy 1987,
Kottler 1986). While such studies may still not be as plentiful as
blackberries, there does appear to be a growing acknowledgment
of the importance of the therapist's subjective experience. This
trend may be related to the fact that the research literature has yet
to find strong support for the differential effectiveness of particu-
lar schools or techniques of psychotherapy (Dryden and Spurling
1989).
WHY BOTHER?
Perhaps therapists' motivations have been neglected for good rea-
son. Do they really matter? One could certainly argue, for instance,
that automobile mechanics do not need to know why they chose to
fix cars for a living in order to perform adequately. Why should
psychotherapists be any different? Well, to begin, humans are far
more complex than cars, and human interactions can be exceed-
ingly complicated and multifaceted. Secondly, introspection is un-
likely to provide mechanics with greater understanding of motor
vehicles, but it may very well aid clinicians in understanding their
fellow humans. A third distinction is that the therapist generally
uses no mechanical instruments, no technology. It is the person of
the therapist that constitutes his or her primary tool. Therefore, the
psychological makeup of the individual psychotherapist must de-
termine, to a large extent, the effectiveness of the treatment.
Despite his emphasis on intellectual insight, Freud (1905b) be-
lieved that the therapist's personality is B crucial factor in the
6 A CURIOUS CALLING
therapeutic process. He notes: "It is not a modern dictum but an
old saying of physicians that these diseases are not cured by the
drug but by the physician, that is, by the personality of the physi-
cian, inasmuch as through it he exerts a mental influence" (p. 259).
Jung (1934) wrote that "the personality and attitude of the doctor
are of supreme importance" (p. 160). Based on his research find-
ings, Strupp (1958, 1959) concluded that a therapist's personal
influence outweighs the effects of particular techniques on treat-
ment outcome. He found support for the notion that therapists'
unconscious attitudes subtly bias their "technical" approach to ther-
apy cases, including diagnostic formulations, prognostic estimates,
treatment plans and goals, and the nature of their interventions.
Strupp (1959) reached the conclusion that "in the absence of a
favorable emotional matrix, no amount of expert technique could
shift the psychodynamic balance in the direction of therapeutic
growth" (p. 349).
Therapists' backgrounds and experiences can also shape their
theories of personality, their views of psychopathology, and their
interests in particular patient populations. Using a psychobiograph-
ical model, Stolorow and Atwood (1979) describe the influence
of life experiences on the theories of Freud, J ung, Reich, and Rank.
They propose, for instance, that J ung' s personal concerns with
feelings of isolation and self-dissolution led to his conception of the
collective unconscious. Adler, who grew up in the shadow of an
older brother, built his personality theory around the concepts of
sibling rivalry and the inferiority complex. Further examples are
cited by Kottler (1986), such as the therapist who in childhood lost
her mother from cancer and came to view all psychopathology in
terms of maternal deprivation, or the social worker who had diffi-
culties dealing with authority figures and was drawn to working
with rebellious adolescents.
Late in life, Freud addressed the issue of the personality and
psychopathology of the analyst as it relates to the analytic process.
In "Analysis Terminable and Interminable" (1937), he points out
that no one claims that a physician with lung or heart trouble is
incapable of properly treating internal diseases in others. Even so,
Freud concedes that the situation is not entirely analogous to the
treatment of psychological disorders: "The analyst, on the other
THE FASCINATION OF PSYCHOTHERAPY 7
hand, because of the peculiar conditions of his work, is really
prevented by his own defects from discerning his patient's situation
correctly and reacting to it in a manner conducive to cure" (p. 401).
One such "defect," it can be argued, is a motivation of which the
practitioner is unaware for entering the profession.
Even if the importance of the topic is granted, it might still
be asserted that the matter is best left unexamined. The follow-
ing argument can be made: Is it not enough that there exist individ-
uals willing to learn and practice such a difficult and demanding
profession without having to question their deepest and darkest
motives? And if all sorts of unsavory dynamics should emerge,
might this not produce disenchantment, disappointment, and even
cynicism?
But how can psychotherapists purport to dispel the illusions
of their clients while protecting and maintaining their own? Fur-
thermore, a therapist's belief in and commitment to the thera-
peutic process ought not to be based on naive idealism, but
rather on realistic appraisal. Psychoanalysis has had a good deal
to say about the general question of the role of unconscious fac-
tors in the choice of occupation. Whether sculpting is viewed
as a sublimation of the wish to play with feces, or surgery as rI
constructive channeling of sadistic impulses, it is generally as-
sumed that even the most intellectual and sublime activities are
powered, at least in part, by primitive instinctual strivings. Is
the activity of the therapist or analyst l the exception to the rule?
Shall we accept at face value the proposition that they are moti-
vated purely by the altruistic desire to understand and to help
others? This investigation begins and proceeds on the assumption
that such a stance is ultimately antitherapeutic, and that it is only
when the practitioner's unconscious motivations are discovered
and understood that their destructive potential can be held in
check.
A final note is provided by the Jungian analyst, Guggenbuhl-
Craig (1971), who comments that no person acts out of exclusively
"pure" motives:
lThe terms therapist and analyst will be used, for the most part, interchangeably.
8 A CURIOUS CALLING
Even the noblest deeds are based on pure and impure, light and dark
motivations. Because of this, many people and their actions are un-
justly ridiculed or compromised. A generous philanthropist is almost
always motivated, among other things, by the desire to be respected
and honored for his generosity. His philanthropy is in no way less
valuable for that. Similarly, a social worker strongly prompted by
power motives may nevertheless make decisions helpful to his client.
But there is a great danger that the more the case worker pretends to
himself that he is operating only from selfless motives, the more
influential his power shadow will become until it finally betrays him
into making some very questionable decisions. [pp. 10-11]
TRANSFERENCE
AND COUNTERTRANSFERENCE
Faced with a succession of analytic patients who became enamored
of him, Freud refused to believe that this pattern was merely a
reflection of his personal charm. Instead, he was ultimately able to
discover the phenomenon of transference, which soon became a
central pillar of psychoanalytic theory and clinical practice. Freud
(1905a) wrote:
What are transferences? They are new editions or facsimiles of the
impulses and phantasies which are aroused and made conscious
during the progress of the analysis; but they have this peculiarity,
which is characteristic for their species, that they replace an earlier
person by the person of the physician. To put it another way: a whole
series of psychological experiences are revived, not as belonging to
the past, but as applying to the person of the physician at the present
moment. [po 116]
Thus, transference refers to the patient's tendency to displace
childhood feelings and attitudes onto the current relationship with
the analyst.
Unlike the concept of transference, there is little consensus re-
garding the meaning of the term countertransference. The classical
definition is the narrowest, referring only to the analyst's transfer-
ences to the patient. These responses are outside of awareness, and
