The impatient therapist: managed care and countertransference

The conduct of therapy is particularly vulnerable to the influence of impatience. External pressures on the therapist to work quickly intrude on the session. When therapists are unconscious of their own impatience, it is more likely to reduce their ability to listen fully, to understand the extent of the patient's problems, and to participate in the rapidly shifting dance that makes therapy effective. Since the external factors that encourage this impatience are unlikely to abate, therapists need to become more aware of these influences and to consciously develop coping strategies. Impatience can arise from a number of places-the departure from any plan or timetable we have set for therapy, a desire to satisfy third parties, worry that the work is not progressing quickly enough, doubts about our ability to help, fear of "failure," confusion of process with "product," and attachment to favorite treatments. Aversion, attachment, and confusion have been well charted by Buddhist writers as hindrances to clear perception. The solution they propose is to face these obstacles directly, by noting their appearance, development, and passing away. While frequently an unpleasant process, such self-examination maximizes our chances of listening carefully and compassionately to each person who consults us.