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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 NetChild and Adolescent Treatment for Social Work PracticeChoosing an Online TherapistChronic DepressionClinical Dilemmas in PsychotherapyClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCognitive Therapy for Challenging ProblemsCompassionConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsControlConversations About Psychology and Sexual OrientationCoping with BPDCouch FictionCounseling in GenderlandCounseling with Choice TheoryCouple SkillsCrazy for YouCreating a Life of Meaning and CompassionCreating HysteriaCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDeafness In MindDecoding the Ethics CodeDeconstructing PsychotherapyDeep Brain StimulationDemystifying TherapyDepression 101Depression in ContextDialogues on DifferenceDissociative ChildrenDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing CBTE-TherapyEarly WarningEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveErrant SelvesEssays on Philosophical CounselingEssentials of Wais-III AssessmentEthically Challenged ProfessionsEthics and Values in PsychotherapyEthics in Plain EnglishEthics in Psychotherapy and CounselingExercise-Based Interventions for Mental IllnessExistential PsychotherapyExpectationExploring the Self through PhotographyExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFear of IntimacyFlourishingFolie a DeuxForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFoundations of Ethical Practice, Research, and Teaching in PsychologyFreud and the Question of PseudoscienceFrom Morality to Mental HealthFundamentals of Psychoanalytic TechniqueGenes on the CouchGod & TherapyHalf Empty, Half FullHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHandbook of Evidence-Based Therapies for Children and AdolescentsHealing the Heart and Mind with MindfulnessHeinz KohutHelping Children Cope With Disasters and TerrorismHigh RiskHistory of PsychotherapyHow and Why Are Some Therapists Better Than Others?How Clients Make Therapy WorkHow People ChangeHow Psychotherapists DevelopHow to Fail As a TherapistHow to Go to TherapyHypnosis for Inner Conflict ResolutionHypnosis for Smoking CessationI Never Promised You a Rose GardenIf Only I Had KnownIn Others' EyesIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyInside the SessionInside TherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt's Not as Bad as It SeemsIt’s Your HourLearning ACTLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMaybe You Should Talk to SomeoneMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulnessMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMoments of EngagementMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessMultifamily Groups in the Treatment of Severe Psychiatric DisordersNarrative PracticeNietzsche and PsychotherapyOn the CouchOne Nation Under TherapyOur Inner WorldOur Last Great IllusionOutsider ArtOutsider Art and Art TherapyOvercoming Destructive Beliefs, Feelings, and BehaviorsOverexposedPathways to SpiritualityPersonality and PsychotherapyPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical Issues in Counseling and PsychotherapyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPillar of SaltPlan BPlato, Not Prozac!Polarities of ExperiencesPower GamesPractical Psychoanalysis for Therapists and PatientsPrinciples and Practice of Sex TherapyProcess-Based CBTPromoting Healthy AttachmentsPsychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy and ConfidentialityPsychotherapy As PraxisPsychotherapy East and WestPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersPsychotherapy Is Worth ItPsychotherapy Isn't What You ThinkPsychotherapy with Adolescent Girls and Young WomenPsychotherapy with Children and AdolescentsPsychotherapy without the SelfPsychotherapy, American Culture, and Social PolicyRapid Cognitive TherapyRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRebuilding Shattered LivesReclaiming Our ChildrenRecovery OptionsRelationalityRent Two Films and Let's Talk in the MorningSaving the Modern SoulScience and Pseudoscience in Clinical PsychologySecond-order Change in PsychotherapySelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSelf-Disclosure in Psychotherapy and RecoverySerious ShoppingSex, Therapy, and KidsSexual Orientation and Psychodynamic PsychotherapySigns of SafetySoul Murder RevisitedStaring at the SunStraight to JesusStrangers to OurselvesSubjective Experience and the Logic of the OtherTaking America Off DrugsTales of PsychotherapyTales of UnknowingTalk is Not EnoughTalking Cures and Placebo EffectsTelling SecretsThe Behavioral Medicine Treatment PlannerThe Body in PsychotherapyThe Brief Couples Therapy Homework Planner with DiskThe Case Formulation Approach to Cognitive-Behavior TherapyThe Challenge for Psychoanalysis and PsychotherapyThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Couch and the TreeThe Couples Psychotherapy Treatment PlannerThe Crucible of ExperienceThe Cure of SoulsThe Death of PsychotherapyThe Education of Mrs. BemisThe Ethical Treatment of DepressionThe Ethics of PsychoanalysisThe Gay and Lesbian Psychotherapy Treatment PlannerThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Healing JourneyThe Heart & Soul of ChangeThe Heroic ClientThe Husbands and Wives ClubThe Incurable RomanticThe Love CureThe Making of a TherapistThe Mindful TherapistThe Mirror Crack'dThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New Rational TherapyThe Older Adult Psychotherapy Treatment PlannerThe Other Side of DesireThe Pastoral Counseling Treatment PlannerThe Philosopher's Autobiography The Pornographer's GriefThe Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem of EvilThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Psychotherapy Documentation PrimerThe Psychotherapy of HopeThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Sex Lives of TeenagersThe Talking CureThe Therapeutic "Aha!"The Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Therapist's Ultimate Solution BookThe Trauma of Everyday LifeThe Trouble with IllnessThe UnsayableThe Way of the JournalTheory and Practice of Brief TherapyTherapy with ChildrenTherapy's DelusionsTheraScribe 3.0 for WindowsTheraScribe 4.0Thinking about ThinkingThinking for CliniciansThinking for CliniciansThoughts Without a ThinkerThriveToward a Psychology of AwakeningTracking Mental Health OutcomesTrauma, Truth and ReconciliationTreating Attachment DisordersTreatment for Chronic DepressionTreatment Plans and Interventions for Depression and Anxiety DisordersUnderstanding Child MolestersUnspeakable Truths and Happy EndingsWhat the Buddha FeltWhat Works for Whom?What Works for Whom? Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy
Psychotherapy is a social
phenomenon that is part of modern culture. In many cases it has little to do with
academic or professional training. Some
psychotherapists have been trained as psychologists or psychiatrists, but they
are a minority. Psychotherapy is carried out all over the world by (mostly)
social workers, counselors, teachers, clergy, psychologists, psychiatrists, and
whoever feels like it.
This has a history. Sigmund Freud,
supposedly the father of the "talking cure", was not a psychologist
or a psychiatrist, but a neurologist. In many countries, there is an official
regulation of professional psychology, psychiatry, or social work but such
labels as "psychoanalyst",
"psychotherapist", or "counselor" are not registered,
certified, licensed, or otherwise protected by legislation in most countries
where they are commonly in use.
On any given day, or night, in
Paris, London, New York, Los Angeles, or Buenos Aires (for psychotherapy tends
to flourish in the modern metropolis) anybody who so desires can practice
psychotherapy, as there are no government regulation or professional standards
for this activity. It is clear that not only can anybody be a psychotherapist,
but also anybody can start a new psychotherapy school or "technique",
as there are no clear standards of care (unlike medicine, engineering, or
In the Introduction, Cozolino writes:
"Like most other professional careers, being a psychotherapist involves
mastering a large and ever-growing body of knowledge, learning a variety of
skills, and navigating complex relationships"(p. xv). As shown above, this
view of psychotherapy as a professional activity is totally unwarranted, but the author of this textbook is not
concerned about any of the issues raised above (he mentions social workers as separate from psychotherapists and
seems to be unaware of the fact that most psychotherapists in the world are social workers!).
While anybody can practice
psychotherapy without any formal training, tens of thousands of students all
over the world are being trained for practicing psychotherapy.
Cozolino's goal is to help those
students in training for becoming "therapists", and the book is
intended to serve as the basic textbook in graduate courses on psychotherapy
wherever such courses are given. The intended audience is made up of students
who would be starting their practicum experiences under supervision.
The perspective offered in this
book on human behavior is what would be called
Psychodynamic, which means
incorporating the basic premises of psychoanalysis as a general theory and the
basic premises of psychoanalysis as a psychotherapy system, while not adhering
to most of the actual practices of psychoanalysis as psychotherapy.
"Therapists study an
individual's unconscious by examining such things as distortions of reality,
incongruities between words and actions, and the origins and effects of
psychological symptoms. Freud's projective hypothesis describes the process by
which our brains unconsciously organize our experiences of the world" (p.
The author's basic theory of human
behavior is that "We are guided and directed by multiple unconscious
processes of memory and emotion... Our temperaments and personal histories
create patterns of thinking and feeling that direct our behavior outside of
awareness. Although we all begin life in a state of complete egocentrism, we
can learn to have a broader perspective through experience and education.
Learning about our personal, cultural, and human biases should be a primary
focus of the training of every therapist" (p. xvii).
Psychotherapy is defined as "
an interpersonal learning environment similar in many ways to proper parenting.
In both, we tend to learn best when supported by a nurturing relationship with
an emphatic other, while being encouraged to confront life's challenges. We
also learn best in a moderate state of arousal; too little puts us to sleep and
too much triggers a fight-flight state that makes positive learning
impossible" (p. 31). What Cozolino presents can be described as an
"eclectic psychodynamic" model, and he advocates "a stance of
not knowing" (p. 11), with flexibility about protocol which allows for
calling a client on the phone to apologize for a poorly conducted session, as a
result of the therapist's own blindness to his inner processes.
Cozolino states that "...being
a competent therapist requires a simultaneous exploration of one's inner world
of private thoughts. When we begin training, we embark on two simultaneous
journeys: one outward into the professional world and the other inward, through
the labyrinths of our own psyches"(p. xv). This is based on his experience
teaching courses on psychotherapy, where "...the focus of my classes has
shifted from an emphasis on the techniques of therapy to an exploration of the
therapist's inner world" (p. 169). This is the rationale for the book's
emphasis on the psychotherapist's self-knowledge.
In classical psychoanalytic terms,
becoming a therapist, according to this book, means constantly analyzing one's
countertransference. The book also utilizes the classical psychoanalytic
terminology of transference, interpretation, and resistance. The author
endorses the projective hypothesis to the extent of assuming the validity of
so-called projective tests, which indicates a lack of familiarity with the
research literature on psychological testing.
In addition to its classical psychodynamic approach, this book offers us a moderate dose of "New Age" ideas, confirming the common East Coast biases about California swamis, satirized long ago by Kurt Vonnegut (1965). The author recommends meditation, yoga, and martial arts to create "mindfulness" in therapists, and his list of references and suggested readings includes such names as Carlos Castaneda, Paulo Coelho, "The Secret Life of Bees" and "The Holy Teachings of Vimalakirti", in addition to some fairly orthodox and highbrow psychoanalytic books.
Early on in the book, Cozolino
asks: "Why are therapists so vulnerable to doubts about our own competence
and sanity? ...We have a sense of our own fears, insecurities, and
"craziness" while we accord others their polished social presentation...Most
therapists grew up struggling to be loved and accepted by others...many of us
find it difficult to believe others can be of help to us" (p. 6). This
insightful passage ignores the possibility that the lack of any standards or
agreed-upon criteria for efficacy adds much to the insecurity of
psychotherapists. The self-knowledge ideal presented in this book is morally
laudable, but the lack of clear standards for either training or practice puts
much of psychotherapy today under a cloud, and on the margins of ethical
Vonnegut, K. Jr. (1965). God Bless You, Mr. Rosewater. New York: Dell Publishing
2005 Benjamin Beit-Hallahmi
Benjamin Beit-Hallahmi, trained as
a clinical psychologist, has written about the ideology and morality of
psychotherapy, most extensively in his book Despair
and Deliverance. He is currently working on a study of psychotherapists who
took seriously fantasies of Satanic ritual abuse.