Academic journal article Canadian Journal of Counselling and Psychotherapy

Imparting Self-Care Practices to Therapists: What the Experts Recommend/ Entrainer Des Pratiques D'auto-Soin Chez Les Therapeutes : Recommandations Des Experts

Academic journal article Canadian Journal of Counselling and Psychotherapy

Imparting Self-Care Practices to Therapists: What the Experts Recommend/ Entrainer Des Pratiques D'auto-Soin Chez Les Therapeutes : Recommandations Des Experts

Article excerpt

From unwanted intrusion to central agent of change, the appreciation for the role of the person of the psychotherapist in psychotherapy has shifted radically since the early 1900s. Whereas traditional psychoanalysis aimed for "optimal abstinence and relative anonymity" (Wolitzky, 2003, p. 48) in an effort to cleanse the therapy hour from therapist countertransference and sentiment (Freud, 1910), many current theoretical conceptualizations have come to value the working alliance and real relationship and encourage therapists to be transparent, self disclosing, spontaneous, and authentic (Lambert & Ogles, 2004; Rowan & Jacobs, 2002; Sussman, 2007).

Theoretical perspectives, such as social-constructivism, relational psychotherapy, and intersubjective models, view the therapist as a coparticipant in psychotherapy; therapist subjectivity, "including his or her assumptions, biases, concerns, motivations, and emotional conflicts" (Sussman, 2007, p. xviii), is consequential. In fact, we now estimate that the magnitude of therapeutic impact that is attributable to the therapist as a person is eight times greater than treatment technique (Lambert, 1989). Indeed, it is understood that therapist characteristics and the emergent therapeutic relationship are second only to client characteristics in terms of impact on psychotherapy process and outcome (Duncan, Miller, Wampold, & Hubble, 2010). It is no longer possible to mask the person and the contribution of the therapist: "Science and practice impressively converge on the conclusion that the person of the clinician is the locus of successful psychotherapy" (Norcross & Guy, 2007, p. 3).

Therapist well-being has thus emerged as a critical component of psychotherapy; it is considered by many theorists to be the foundation of their craft (Baldwin, 2000; Deutsch, 1985; Hackney & Cormier, 2005; Mahoney, 1991; Rogers, 1992, 2007). For example, Beutler, Machado, and Neufeldt (1994) reviewed 15 studies published between 1968 and 1991 and concluded that therapist emotional well-being was positively correlated with treatment benefit. Other studies have confirmed the link between therapist ways of being and positive outcome. A study of therapist effects in patient change reports that 28% of growth on scores relating to Global Assessment of Functioning (GAF) and 21% of changes measured by the Inventory of Personal Problems are attributable to therapist differences, including therapist difficulties in practice, interpersonal style, and relational skills (Nissen-Lie, Monsen, Ulleberg, & Ronnestad, 2013). Therapist difficulties would be a predictor of patient outcome.

It is not uncommon for therapists to suffer from emotional distress. Studies reveal that levels of self-reported personal distress among therapists can reach 74.3% (Guy, Poelstra, & Stark, 1989). Furthermore, 90% of therapists report that their emotional problems are directly related to their role as therapist (Guy, 1987). Clearly, while clinical work is rewarding, it extorts a high cost from the personal and professional functioning of the therapist (Guy, 2000; Mahoney, 1991; Norcross, 2000). Work-related distress has a range of consequences on the personal life of the therapist. Depression (Mahoney, 1991), stress (Shapiro, Astin, Bishop, & Cordova, 2005), burnout (Skovholt, Grier, & Hanson, 2001), suicide (Deutsch, 1985; Hannigan, Edwards, & Burnard, 2004), alcoholism, emotional depletion, physical isolation and psychic withdrawal (Laidig, 2007), and disturbed interpersonal relationships have been underscored among hazards that are related to the exercise of the "impossible profession" (Freud, 1937). On a professional level, therapist distress is linked to sexual involvement with clients (Remley & Herlihy, 2007), and can cause therapists to abandon their career prematurely (Theriault & Gazzola, 2008a).

Therapist distress is also thought to have an impact on therapeutic process; it can lead to alterations in the length of therapy and the timing of interventions (Strean, 1993), emotional detachment, loss of authenticity (Norcross, 2007), referrals (Loganbill, Hardy, & Delworth, 1982), disengagement and withdrawal in seasoned therapists (Theriault & Gazzola, 2006), and early terminations (Brady, Guy, Poelstra, & Brown, 1996; Piselli, Halgin, & MacEwan, 2011). …

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