CLINICIAN'S DIGEST: Therapists in Therapy

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We know surprisingly little about therapists in therapy. "What other population of psychotherapy clients that accounts for 3 to 7 percent of our daily work has been so neglected in the literature and training?" ask psychologists John C. Norcross from the University of Scranton and Jesse D. Geller, of Yale University. Yet, going into therapy may be the leading form of postgraduate education for therapists next to CEUs: Between 65 and 90 percent of therapists undergo psychotherapy, most of them several times.

Norcross and Geller think one reason the topic has been underresearched is that therapists may be cautious about protecting their own confidentiality as clients or about sharing their observations about a colleague-client. This reluctance may not be completely grounded in legalities or professional courtesy. "Anna Freud said that the most sophisticated defense mechanism she ever encountered was becoming a therapist," Norcross says, suggesting that therapists may not be too eager to put their defenses under the close scrutiny of researchers.

In two studies by Norcross and Geller, based on a sample of 328 randomly selected psychologists from the American Psychological Association's Division of Psychotherapy, 75 percent of psychologists reported having treated mental health colleagues. Their studies, in the fall issue of the journal Psychotherapy and the winter 2001 Journal of Psychotherapy Practice and Research , find that, unlike today's clients, therapist-clients overwhelmingly avoid cognitive-behavioral therapy and look for humanistic, psychoanalytic, psychodynamic or insight-oriented therapy. Although half of them have been in couples counseling at some point, 85 percent of the total hours therapists spend in therapy are spent in individual therapy. Their faith in therapy seems to pay off--58 percent describe their therapy as very helpful and 25 percent as moderately helpful. Only 5 percent described their therapy as either harmful or unhelpful.

According to the study, therapists' therapists experience unique rewards and stresses. They report that treating other therapists earns them more respect from their peers--after all, who knows better how to pick a good therapist than another therapist? They also report a dual satisfaction in both helping their fellow professionals feel better and believing that their therapist-clients then go on to do better therapy. The most frequently mentioned reward they report is "better relationships" with their therapist-clients than with other clients. Still, having a therapist-client also generates considerable anxiety among therapists' therapists about their own therapy styles, interventions and emotional reactions. The study finds that therapist-clients are more challenging and more resistant to change, despite the reward of better relationships. "It might be the appeal of the difficult," says Geller. "Maybe therapists' therapists like being stretched."

Bringing Mental Health Services to the Elderly Poor

Seniors who live in public housing are 50 percent more likely than other seniors to suffer from mental disorders such as depression, dementia or alcohol abuse. These seniors are also the least likely to seek mental health care.

Now Baltimore Mental Health Systems Inc., in collaboration with the Housing Authority of Baltimore City and Johns Hopkins Hospital psychiatrists and nurses, has developed a low-cost safety net--the Psychogeriatric Assessment, Treatment and Teaching in City Housing Program (PATCH). …