James Donnelly, DSW, LCSW

In this refreshing and candid presentation of an issue as old as the profession … but remarkably unattended, Irwin Hirsch takes us through several layers of possibilities regarding  a therapists choice between his or her self interest and that of a client.

A central theme around  which he builds his argument is that of the quite human tendency on any therapist’s part to avoid discomfort in the relationship with a client. Clinically, the necessity to challenge the comfortable equilibrium in the  transference relationship is at the heart  of a transference analysis that leads to therapeutic change … for both the client and the therapist. Mutuality of risk and growth are, in Hirsch’s presentation, the bedrock of  clinical and ethical truth.

Self interest of the therapist, broadly defined by Hirsch, is the avoidance of discomfort in the relationship. The majority of the book is on  the elaboration of the various roots of potential discomfort for the therapist. In the subsequent chapters he examines those roots in remarkably  candid detail using his own therapeutic experience and  instances in treatment he felt failed to meet the standard he sets for himself and the profession. His clinical examples are detailed and, along with the theme of the book, very productively thought provoking. If it was his intention to move us to ’examine our conscience’ as he does his own in this book, he has achieved  his goal.

Reviewing factors such as personality, theoretic preference, life circumstances, cherished configurations of relationship and the unacknowledged emotional needs of the therapist,  economic dependence for practitioners in private practice is for Hirsch the major determining factor for therapists avoidance of the challenges of therapeutic discomfort. It is a remarkably frank exploration of  this dependence that both provokes us to face the real dilemmas of this reality; dilemmas of which, he contends, are quite conscious and  responded to with deliberate choices of treatment style.

At times, Hirsch’s presentation approaches a feeling of confession but this is not a guilt expiating presentation.  Rather, it is a frank acknowledgment of the human condition … shared by therapist and client alike. Candor and authentic mutuality in the therapeutic relationship is the consistently presented redeeming element … despite our unavoidable failures around this issue. We do act out of self interest with our clients; no surprise. Acknowledgment, redirection and the willingness to endure the discomfort of  honest transference analysis are the means of  therapeutic change for both therapist and client.

There are, among his insightful and stimulating topics,  chapters that deserve special attention. The chapter on Psychoanalytic Theory and its Unexamined Comforts is extremely clear and useful. It provokes one to examine assumptions of treatment and a variety therapeutic of blind spots. The last two chapters on the role and power of money and its influence on the therapeutic process, as well as issues such as client selection and competition among therapists for clients,  highlight the dark side of mental  health provision in our current health care climate.

Coasting in the Countertransference is rewarding  provocative read that keeps our therapeutic feet to the fire of the ethical foundations of  all healing relationships.

©  2010 James Donnelly, DSW.LCSW

All rights reserved

South Garden Press, New York

For thoughts and comments, please send to: jdonnellydsw@gmail.com