Books and Other Publications
A USER'S GUIDE TO THERAPY
What to Expect and How You Can Benefit
Book Review by Gail Nagel LISW-CP, DPNAP
Printed in the Clinical Social Work Association Newsletter - Summer 2009
Gail Nagel LISW-CP, DPNAP
A User’s Guide to Therapy: What to Expect & How You Can Benefit,
by Tamara L. Kaiser, Ph.D.
I’d never been in therapy before becoming a therapist. IfI’d read this book prior to training, my development as a therapist would have been greatly enhanced, having seen the process from the client’s point of view. By deconstructing the mystery of the therapist encounter, author Kaiser allows it is complex, but nonetheless an understandable process. Her language is approachable and sidesteps the clinical jargon so popular in our field. Absenting the psychiatric terminology and specific diagnoses, she helps ‘normalize’ the difficulties a client might offer in describing their state. Kaiser includes, from Kate Scharff’s Therapy Demystified, a list of reasons that people enter therapy that is relatively complete. Throughout this volume,the author should be commended for making the process more one of seeking mental health than one of cure for mental illness.
Kaiser, who is a clinical social worker by training and practice, defines the goal of therapy “to raise your awareness about who you are, what your life is all about, and how you relate to yourself and the world.” Following this definition is a gentle defining paragraph focused on awareness and change rather than on symptom reduction.
Early in the book, a focus on boundaries begins with the comment that “your relationship with your therapist is one way.” This is a precaution stated and adhered to by all of us but seldom heard by clients. Kaiser, by way of case examples and cogent comments, keeps the focus on the client. It is after all, all about them.
An interesting framework utilized by Kaiser in Chapter2 is in answering the question, “What makes therapy work?” This section demystifies the client’s reasonable question about how talk can make things change. She illuminates the common factors of change with a ratio, beginning, as all work in clinical social work does, with the client. Forty percent rests squarely on the client and extra-therapeutic circumstances. This surfeit of one’s human experience influences how we approach any change we attempt.
Another 30% of the change process lies within the therapeutic relationship, giving the responsibility to the client to work with their therapists rather than depending on them to do the work. She ably discourses on the interactive nature of the alliance.
Fifteen percent is attributed to attitude. What level of hope and positive expectation does the client bring to the consultation? It goes a long way in helping the client accept that therapy doesn’t always feel good nor does it always flow downstream. Clarifying with the client the uncomfortable nature of therapy goes a long way in helping them to tolerate that very state.
The final factor in change is the 15% ascribed to the technique selected by the therapist. The author does a good job in her discussion of approaches, clarifying the distinctions. The psychodynamic, family systems and CBT approaches are quite extensively reviewed with shorter and less focus on humanism and experiential techniques. It would be worthwhile, should you provide clients with a depiction of your therapy perspective, to review her language. It is direct and clear without psychiatric terminology. A thorough reading would give a client some sense of what process might suit their particular style.
I was most pleased with Kaiser’s description of the role of the therapist, juggling the use of power and authority with the self-determination of the client. Recognizing the collaborative nature of therapy and helping the client accept their power within the relationship is a task not always easily accomplished.
Her discussion regarding power and authority has drawn on the work of Marilyn Peterson in her book, At Personal Risk. If you haven’t read this, put it on your “must read list.” She shares insights into our struggle with power and the attendant tension that arises in the relationship with the client. Reading Kaiser’s instruction to the client, and Peterson’s instruction to the therapist, provides a dialogue well worth reviewing.