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Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBecoming MyselfBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the 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In their 15- year study Orlinsky and Rǿnnestad have given the therapeutic community a great insight into the development and experiences of psychotherapists throughout their careers. The path from novice to experienced therapist can be a precarious one, and has been related to the stages of human development (Stovholt, 2001). The beginning counsellor has the awkwardness and self consiousness of an adolescent, and it has been a largely neglected subject as to how one moves from this awkwardness to becoming an experienced, effective and wise practitioner deriving a sense of satisfaction from one's work. Orlinsky and Rǿnnestad's work is timely due to the increasing awareness of burnout as a very real hazard of working with troubled clients.
It is interesting how little research has been conducted to date on the characteristics of psychotherapists and their experiences of working with their clients in therapeutic settings. This is despite research demonstrating repeatedly (eg. Teyber and McClure's research, 2000) that it is the relationship or therapist's ability to form a 'therapeutic alliance' with the client that determines the effectiveness of therapy, irrespective of theoretical orientation. One of the basic assumptions explained in the book is that as the therapist develops within themselves, the stronger this alliance is and the more easily t can be achieved. Orlinksy and Rǿnnestad include in the first section a thorough review of the relevant literature and discuss at great depth the concept of 'psychotherapist development'. As the authors state in the first section, 'the ultimate aim of development is the improvement of practice', and this is the focus of the work – how are we to improve our practice with clients, be more effective, increase our positive experiences of practice and prevent harmful negative experiences of practice.
The rationale behind the study is clearly stated as to investigate the development of psychotherapists, the circumstances that impact on this development and how it impacts of the therapist's career. The authors begin to describe how they conducted this immense study, involving almost 5000 participants (psychotherapists, psychologists, psychiatrists, counsellors, social workers), from novices to experienced therapists, across 15 countries and more than 15 theoretical orientations. As you might imagine, this was no straightforward study, and Orlinsky and Rǿnnestad give the reader a lengthy explanation of the questionnaire development, sample selection and methods of analysis. Throughout the book they remain acutely aware of the limitations of the study and warn the reader of the usual vicissitudes of data collection and the effects on the representativeness of the sample. The explanations are detailed and supported by quantitative data and tables. This will be of great importance to the researcher however the psychotherapist looking for some insight or validation into the therapeutic experience may find themselves skipping to the study findings.
The concept of 'therapeutic experience' was organised into two broad dimensions of Healing Involvement and Stressful Involvement, with Stressful Involvement being identified as placing the therapist at risk of burnout or damaging practice. Aspects such as Relational Manner, In Session Feelings and Relational Agency were examined. Development was organised into Currently Experienced Growth and Cumulative Career Development.
Interestingly, the biggest predictor of Cumulative Career Development, more so than even length of practice, was depth and breadth of a therapist's experience across treatment modalities. The expansion of a therapists' Cumulative Career Development also showed to significantly decrease the likelihood of therapeutic work as being experienced as Stressful Involvement, and perhaps thus safeguarding the therapist's longevity of practice. Currently Experienced Growth also predicted feelings of Healing Involvement.
Section IV - Integrations and Implications is, in my opinion the highlight of the book and likely of most interest to practicing psychotherapists looking for insights into the sometimes mysterious experiences of therapeutic involvement and 'being a therapist'. One might read this section to validate or compare their own experiences with other therapists, for the purposes of providing effective supervision to trainee counsellors or in regards to the development of a training programme. The authors do not disappoint, they clearly outline the findings for the reader and go on to make some extremely valuable suggestions for those providing training, supervision or in current practice. The authors' own experiences in teaching and therapy becomes increasingly apparent as they provide insightful, sensitive and realistic suggestions for the training and supervision of novices as well as how one may continue to experience work satisfaction many years into their career.
Stovholt, T.M, (2001). The Resilient Practitioner, Boston: Allyn & Bacon.
Teyber, E. & McClure F. (2000) Therapist Variables. In.Snyder, C. & Ingram, R. (Eds) Handbook of Psychological Change: Psychotherapy Processes and Practices for the 21st Century. New York: Wiley
© 2007 Marieke Geoghegan
Marieke Geoghegan studied Psychology and Rehabilitation Counselling at The University of Western Australia and Curtin University or Technology, Western Australia, before commencing a Masters in Counselling. She has a special interest in Burnout in the Counselling Profession and Therapist Development and Characteristics.