Therapist Satisfaction

Freud noted many years ago that the psychoanalytic situation was one that gave little overall satisfaction to either of its participants. It is commonly known that those who have taken part in a long-term psychoanalytic psychotherapy just as often feel unrequited as they feel pleased with the therapeutic outcome. For a germinal process in which love and positive regard have such a central place, this conclusion is indeed a disturbing one. Perhaps the feeling one has about the outcome of a psychoanalytic psychotherapy is not necessarily correlated with the actual good it does. People in general seem to feel, in retrospect, that a mother, father, or lover should have done more for them than was done.

We make an attempt to please the analysand, to make the psychotherapeutic situation the least stressful possible, and to have the patient go away happy at its conclusion. The fact that the latter occurs not as frequently as we would like is part and parcel of the whole cultural question of the meaning and value of psychoanalytic psychotherapy itself. My focus in this essay is on a somewhat different order but is related to the same question. It poses the oft-avoided question of the satisfactions of the psychotherapist, and what he seeks from his patient. My contention is that the satisfaction of the psychotherapist is as important as that of the patient and, beyond this, that it can make or break the treatment by countertransferential invasion. There is almost a silent conspiracy in the refusal to look at the treatment needs of the psychotherapist. This of course derives from general medicine where healing had a quasi-religious function extending back at least to Aesculapius and Hippocrates and where no personal reward for the healer could be countenanced. For this reason, even the economic aspects of medicine today come as a great or small shock to patients who expect their doctors to be directly modeled after Saint Francis. Observations of psychoanalytic psychotherapists