book review

Psychotherapy: lives intersecting

• review by Irena Domachowska

As a psychotherapist you come into contact with your clients and build a high level of intimacy within a relatively short period of time. You try to use all your professional skills to help the client build up their ressources or resolve their inner conflicts in order to live a more happy and fulfilled life. The shortcoming is that, in case you are succesful, you never see your clients again. Most practitioners accept that fact without a further ado and only sometimes wonder what happens with their clients years after the therapy. Louis Breger, in his latest book Psychotherapy: Lives Intersecting, goes beyond just wondering. He had the courage to contact clients that he treated 10, 15, 20 years ago and ask them to describe the effects that the therapy had on their lives. Furthermore, he describes what effects his psychoanalytical training and psychotherapy had on his own private life. As a psychologist at the beginning of my career, I found both of Breger’s angles extremely interesting and given that Breger brings it with honesty and insightfulness this book was both educational and funny. For psychologists educated within the behavioral-cognitive framework and constricted to 8-session treatments by insurance companies, stories about psychotherapy taking 15 years, 3 times a week sound like from another fairy tale. One of Berger’s clients commented "I probably came to your office 125 times before you really started to talk." and it really makes one question the effectiveness/time ratio of psychoanalysis.

The anecdotes of what happens behind the closed door of a therapeutic room give almost voyeuristic pleasure. To protect his clients' privacy, Berger only shortly describes the patients' background, concentrating on the therapeutic process and moments reffered to in the letters. Although most accounts of his clients are positive, Berger has enough self-distance as not to shy away from more critical words. Berger describes sessions when events from his personal life affected his behavior and sometimes apologizes for it. Also the silence and neutral attitude often come back as subject of criticism both of his clients and himself. However, at moments when the letters become almost too positive, he recalls a time when a chair broke under him and he fell on his ass in the middle of the session.

Berger was trained within the most conservative psychoanalytic approach. He decribes his education process and how his own experience on the other side of the couch made him doubt the effectiveness of psychoanalysis. In a later stage of his career, he started experimenting with self-disclosure. His clients come back to moments when he decided to reveal some private information, stating that it helped them to gain more trust towards their therapist. Although Breger’s book does not provide scientific evidence for the effectiveness of self-disclosure, it definitely converges with Irving Yalom’s philosophy. Irving Yalom, one of the best contemporary psychotherapists, has experimented a lot with self-disclosure and its influence on the effectiveness of therapy and encourages other therapists to maintain as much transparency as possible. However, both Berger and Yalom stress that all personal information should be revealed with the aim of helping the client. They also caution against using too much self-disclosure at the beginning of the therapy.

Berger’s clients often describe moments when Berger was deeply moved and crying. Although just contrary to the strict psychoanalytic framework, those moments were found to be most influential and often considered milestones in therapy. At the recent conference on emotions (CERE) at the University of Kent, I attended a lecture by Catelijne 't Lam who, in her master thesis, investigated the attitudes of therapists towards crying during therapy (both of their clients and of themselves). She found that, irrespective of the theoretical backround (from psychoanalytic to client-centered), about 85% of the therapists admitted to crying during a session at least once in their career. Therapists' tears are still a taboo in psychotherapeutic training and research is lacking as what effects does it exert on the therapy. Berger’s book provides some subjective account of that matter and might be a first step into investigating the matter further.

References

Breger, Louis (2012). Psychotherapy: Lives Intersecting. New Brunswick: Transaction Publishers