Excerpt from Chapter 1

Having just published a new book (which I announced here last week) "The Analyst's Vulnerability: Impact on theory and practice," I have chosen to do my best getting the word out on LinkedIn. My hope is not only of gaining readership from those I am connected with, but also that those who buy and read the book will spread the word, including reviewing the book on Amazon. Toward this end, I will be posting material from each of the seven chapters so that potential readers will have the opportunity to "Look Inside" the book in a deeper way than what is offered on Amazon. What follows is a excerpt from Chapter 1--"The Analyst's Early Experience" that discusses how our early role as caretakers in our families of origin leads to a variety of attitudes and behaviors that comprise our strengths and our weaknesses. Our fear of doing harm, most often seen in therapist's worrying that limit-setting or confrontations may lead to suicide or some form of psychic damage, is common and often impedes the treatment. The objective in writing about this is to encourage clinicians to be more self-aware, understanding that this fear is shared by most colleagues, particularly early in their careers, and emanates from our own childhood experiences.

The Fear of Doing Harm

From Freud’s early admonitions to act like a surgeon to current controversies regarding any systematic use of self-disclosure, the theme that consistently arises is that of potential harm.?From my perspective, this fear of doing harm exceeds the expectable caution born out of legitimate professional concern for doing right by the patient.?

?Since most analysts are very decent, hard-working, dedicated professionals, why would such a fear be so pervasive??I think Searles’ argument about our shared guilt goes a long way in understanding these edicts.?Even if it is suppressed, at some level, we all know that we are getting some personal needs met in our relationships with our patients.?Is the hidden knowledge of this personal benefit producing so much guilt and shame that we need to overemphasize our role as not only “good enough” caregivers, but also as self-sacrificing humanitarians (Orange, 2016)? Moreover, to what extent is this fear of harming patients a reaction formation in response to the repressed anger that arises from our internal mandate to put others first??Although it is quite evident from reading the literature that our fear of doing harm is substantial, there is little discussion of why this is so. On this topic, Prodgers (1991) cites Storr (1979), saying,

?"Storr?(1979)?makes similar points about the?personality?of the therapist. Anecdotal evidence points to a high incidence of depressed mothers amongst trainee psychotherapists who acquired a sensitivity through judging her moods. They also learn to put their own feeling?secondary?to hers—another prerequisite for the therapist. Making demands often then leads to?guilt?and fears of damaging others in relationships. Putting others first is the safe option but inevitably means?repression of aggression." (pp. 146-147)

?Thus, our unfailing preoccupation with being good can be seen as a reaction formation—an irrational defense against our own guilt and anger about having precociously surrendered our own well-being (Miller, 1997). Focusing on the needs of others, and developing a finely tuned ability to instantly read another’s moods, necessarily produces a degree of resentment.?What child wants to be his/her mother’s or family’s keeper??Yet expressing this resentment runs counter to the role of soother and peacemaker, and therein lies the problem.?I think that therapists of all persuasions have an aversion to expressing anger toward their patients or even feeling it, because it stimulates this irrational fear of not only failing to soothe, but also to harm. This is the conundrum that we need to break free from.