Stresses of the psychotherapeutic role

In this paper I have reviewed the literature concerning the distressing or painful aspects of the psychotherapeutic role. The literature describes both painful aspects of psychiatric residency as well as difficulties and distress encountered in post-training practice of psychotherapy. After summarizing the major sources of emotional distress for therapists, the view was advanced that a failure to cope adequately with distress generated during the training period may lead an individual to continued distress and distortion of the psychotherapeutic role throughout his career. The major forms this distortion may take were also summarized. Strategies to reduce or correct these painful aspects of training and practice were suggested. Most of these focus on greater attention to these problems during the training period which is regarded as formative. Instructing trainees about the distressing nature of some aspects of the therapeutic work, practical suggestions to reduce the intensity of this distress, and intensive didactic work on patients and clinical situations likely to be especially distressing were recommended. It appears that we work in a profession both troubled and troubling. For those of us who are firmly convinced of the value of our work, the open discussion of the distressing aspects of the psychotherapeutic role is both necessary and welcome. It is only by candid and frequent discussion and exploration that we may arrive at effective remedies for these problems. If the training period is indeed a formative stage of professional development when enduring patterns may be established, then the open discussion of these difficulties with trainees and an increased focus on the problems during the training period may be an important first step in evolving better strategies to alleviate the distress generated by intensive work with disturbed patients.