The Therapist in the Real World: What You Never Learn in Graduate School (But Really Need to Know)

Book Review: The Therapist in the Real World

“There is — and always has been — a disconnection between the idealistic discourse of academia and the practical realities of working in the trenches.” It is with this that Jeffrey A. Kottler introduces us to his new book, The Therapist in the Real World: What You Never Learn in Graduate School (But Really Need to Know). Kottler sets out to provide the unfiltered truth about being a therapist — even if it alarms us.

“Professional preparation is neither designed for nor able to equip individuals with everything they will need to know in the real world,” Kottler writes. This might just be why many students consistently report confusion in grad school. And what they miss, Kottler tells us, is the “bigger picture.” That bigger picture is not simply what to do with clients, but how to be with clients — which includes all of the emotional and relational components that most graduate programs overlook.

But the process of therapy is changing too, Kottler writes. And one major problem is that “there are just too many of us.” Lately there is more pressure on us to deliver quick solutions, methods that can be proven, and competition with medications. All of this places a greater moral responsibility on therapists, who, Kottler explains, can often feel like imposters. While therapists are often perceived as all-knowing, many — Kottler refers to his early professors — “were just faking it.”

Kottler’s argument is that therapists are not perfect, and therapy itself has some negative side effects on the clinician. We can feel isolated, become narcissistic, become accustomed to one-way intimacy, and feel depleted emotionally.

What often draws us to the field, Kottler writes, is “the desire to work through one’s own emotional conflicts.” And that field, he tells us, with its abundance of different therapeutic orientations, is one of “organized confusion.” But one thing all effective therapy has in common is a relational connection: as Kottler puts it, the glue that holds everything together. And, though it may be chaotic at times, it is a chaos we can learn to use effectively. “Chaos theory,” Kottler writes, “with its respect for uncertainty and complexity, honors the wonder of the unknown and the inexplicable.” And post-modern thinking, he writes, encourages us to value chaos. In terms of therapy, it helps us recognize the client as an active partner in the process.

Kottler is frank, but also encouraging. “In the real world the choice of framework is not based solely, or even primarily, on what a therapist believes is most useful,” he writes, “but rather involves far more personal motives that reflect our values and preferences.” And what really matters, Kottler writes, is the human connection. After all, many clients come to therapy feeling isolated due to a lack of intimacy, persistent conflict, lost love, or unsatisfying relationships.

Kottler uses examples of client interactions to help us understand that clients, in many ways, are our best teachers, especially when something is new. “Regardless of what we do, and how we do it, the uniqueness and foreignness of the experience [of therapy] is partially what contributes to its impact,” he writes. And since we may suffer from an illusion of control, a tendency toward confirmation bias, and a misperception of progress, we should be asking our clients if they feel what we are doing is helpful.

And we should also recognize vicarious learning, and how witnessing change during the therapeutic process allows us to engage in a sort of “parallel process” where we start to better understand our own issues.

But while therapy is about relationships, it is also about telling stories: the stories clients tells themselves about their lives; the stories that help us learn, conceptualize information, convert fragments and images into coherent narratives, and, ultimately, help us change.

“The brain,” Kottler writes, “is a storied organ,” and one that provides significant benefit in the process of therapy. All therapists should develop the capacity to be better storytellers, he writes, and his book offers many useful tips.

Moving on to evidence-based practice, Kottler speaks with the clarity of many years of practice: “It’s ironic that many of those who most worship at the altar of evidence-based practice seem to ignore the evidence that the relationships they develop with their clients may be just as important, if not more so, than their empirically supported ‘treatments,’” he writes. But, he admits he has done the same. “Full disclosure: I am as guilty as anyone else of sometimes mistrusting that what I do in sessions is anything more than a sleight of hand.”

Kottler also discusses some very practical issues: the benefits and costs of private practice versus public service; how to deliver effective presentations; how to make the most of writing opportunities; and how to navigate organizational politics.

Here again, Kottler’s message is sobering: Therapists “are used to getting their way and not taking no for an answer,” are “attracted to relationships in which they can be in control,” and “tend to be more than a little narcissistic and self-centered, with an inflated sense of self-importance.”

Kottler offers useful strategies for survival, such as examining our role in the conflict, diversifying our lives, confronting injustices, and being trustworthy.

Lastly, he shows us how to get the most out of supervision, use creativity to facilitate breakthroughs, admit when we are lost, express curiosity rather than doubt, and teach people to help us when we are stuck — all pivotal skills of effective therapists in the real world.

The Therapist in the Real World: What You Never Learn in Graduate School (But Really Need to Know)
Norton Professional, July 2015
Paperback, 320 pages

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Shared by: Margarita Tartakovsky, M.S., Contributing Blogger

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