In the Therapist’s Chair
If there is only one therapy book you read this year, then this is the one. In the easygoing, almost effortless style of Irvin Yalom, Nancy McWilliams and Jeffrey A. Kottler, Dr. Jacqueline Simon Gunn has created a moving, insightful and poignant set of six case studies in her first book, “In the Therapist’s Chair.” Through the eyes of a sensitive, gentle and intuitive therapist (although she does admit to getting enraged occasionally), she weaves the stories of long-term clients who suffer from debilitating conditions such as body dysmorphism, sadomasochism, sexualized relationships, abandonment issues, self-hatred and anorexia nervosa. There is also a section on envious clients, self-disclosure, close encounters with clients outside the office while unshowered and braless, gift-giving and the integral meaning of hugs – among many others.
Dr. Gunn has 14 years’ experience with adult patients and specializes in trauma, eating disorders, alternative lifestyles, interpersonal therapy, incest, sexual, physical and emotional abuse and sports psychology. She has an M.A. in both phenomenological psychology and forensic psychology and has also achieved a doctorate of psychology in clinical psychology. She has also completed a two-year certificate program specializing in eating disorders, addictions and compulsive behavior and is an affiliate of the William Alanson White Institute. Dr Gunn is the psychology internship training director and clinical supervisor of the trauma program at the Karen Horney Clinic in Manhattan.
This book is a vivid and unique opportunity to peer inside a normally isolated, hermetically sealed dyadic environment with all its mutual connections and conniptions. She has seen a lot, heard a lot, felt even more and knows how to translate that experience into a very genuine and authentic form of writing with flow and rhythm and a humorous, self-deprecating bent.
If you are interested in learning what countertransference really feels like for a therapist, open her book. Then sit back and be prepared to laugh, cry, get educated in the complicated labyrinth of transference and countertransference issues, and become informed on how the therapeutic process actually works. The secret of her success is that she uses deceptively simple words and clear and concise terms to convey angst-filled, difficult situations and conditions which have far greater and complex inner meaning than their surface appearance would suggest.
Dr. Gunn uses her experiences as a clinical psychologist to take a personal journey with six patients. She says she has been “incredibly influenced by existential writings from both philosophical and more dynamic psychological perspectives … and was trained in phenomenology and ontology.” She is a firm believer in the importance of the unconscious, defenses, cultural influences and the relational process that occurs within the therapeutic relationship and has written this book primarily for the beginning therapist.
Her approach is one of therapist/client equality – both affect each other and self-awareness on the part of the therapist is crucial to success. She says, “In order to be open and receptive to each patient’s particular uniqueness we need to be sufficiently accepting of ourselves. We need to be aware of our own unique traits, whether they elevate our feelings of self-worth or make us uncomfortable. Self-awareness, empathy and acceptance of both our strengths and inadequacies are all vitally important to our work with our patients.”
One of the most empathic and outstandingly awful synchronicities takes place with patient K, whose mother has died of pancreatic cancer. During his long-term therapy Gunn’s beloved mother becomes ill and dies also of pancreatic cancer. She makes the decision to share this knowledge with him. It is a credit to her that she uses her mother’s death to create intimacy and trust and to further the therapeutic relationship. It eventually enables this young man to share his thoughts and feelings more openly and he experiences much comfort and validation. It was a gamble that worked.
Gunn is not a great lover of textbook purism, diagnoses and labeling and feels they are unhelpful. She prefers to use herself as a therapeutic tool rather than be the “Tabula Rasa”, the blank slate of therapy most popular in Sigmund Freud’s era. In her chapter on self-acceptance and self-exploration she says with much inside knowledge that “patients don’t want to feel that they are being analyzed via textbook knowledge; they want to feel genuine collaborative relationships with their therapists.”
Then there is the linear process of psychotherapy itself. She explains, “A great many patients come into treatment in crisis, and it is vitally important for clinicians to bear witness to and process the crisis before moving the therapy forward.” In other words, timing is everything. Knowing when and how to probe and interpret is the very essence of therapy and helps resolve patients’ issues. Sometimes, against all established therapy rules, and as most therapists do occasionally, she gives very straightforward, blunt and concrete advice. During a session with a client who cannot leave her abusive partner she finally loses control. Raising her voice, she shouts, “He doesn’t want to be with you! A man who loves you and wants to spend his life with you does not behave like this…” Apparently it had the desired effect; the client was able to fully separate from this man.
Vacation time is always fraught with separation anxiety for the patient and, it would appear, for the therapist as well. It was a patient’s dream that alerted Gunn to vacation transference in one of her long-term dependent clients. The client started sobbing, stormed out of therapy ten minutes before the session was over and didn’t come back for two months. “I was at a loss,” Gunn states. “I felt abandoned by S and guilty for going on vacation which, rationally, I knew I deserved.” Using her countertransference feelings she deduces through projective identification that this client was suffering from abandonment issues by her romantic partners. It was the experiential pangs that enabled her to feel what her patient was feeling.
Gunn often uses gut feelings or experiential psychotherapy to understand the dynamics of patient issues. One client she was seeing had emotional sadomasochistic issues and projected those onto Gunn, who felt the sadism and masochism was being enacted in the therapy room. Patients can reenact the same set of dynamics within the therapeutic relationship as they do outside the therapist’s room and this phenomenon is captured all through the book. While merging is not always good for the relationship, sometimes it can give valuable insight into why patients recreate disastrous environments for themselves and repeat them time and time again.
Hugging also gets a mention and I feel she has a most sensible approach to surprise hugs by patients who lack boundaries: Accept the hugs and process and interpret them with the client at an appropriate time. How simple! How refreshing! How validating! How sane! Never deny a needy client a warm, bona fide authentic hug. Using attachment theory as a basis for her approach, she understands the need for skin touch, a sensory perception that is vital for brain development regardless of age – not just in a newborn baby but also in a middle-aged therapy client.
Gunn not only touches patients, she gets down and dirty with them. She enters into their personal world and fantasies and offers different perspectives and diverse ways to see the same problem; she shines a new light into dark recesses. There is amazing tenderness, gentleness and curiosity in the unfolding and unraveling and therapy grows and matures like a rose blooming from a bud. If her aim was to guide the potential patient and beginner therapist through the gentle ongoing evolution of therapy then she has achieved her goal. Her clever connections and intelligent interpretations between events, behavior, thoughts and feelings enable the reader to participate in those “aha” moments that are the pure crux of therapy. The case studies are all riveting, compelling, captivating and engaging. I read the book in two days and wanted more.
One of the cogent reasons why she is successful can be summed up in a quote by patient K, “There is nothing like the love of a mother.” All clients are different and Gunn adapts her style to suit their needs, rather like the good mother of teenage children. This is the essence of a super-therapist – being motherly and being a good mother. She has a rapport with them that is illuminated throughout her writing. Regardless of their reasons for coming to see her, she is nonjudgmental and empathizes greatly. She is a master at her craft, both in therapy and in writing. I look forward to reading any other books she chooses to write on the same subject in the future.
In the Therapist’s Chair
By Dr. Jacqueline Simon Gunn
Xlibris: April 2010
Paperback, 126 pages
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Neale, S. (2013). In the Therapist’s Chair. Psych Central. Retrieved on February 11, 2016, from http://psychcentral.com/lib/in-the-therapists-chair/