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5 Lessons from a 50-year Psychotherapy Career

A seasoned professional shares five lessons from the profession.

Key points

  • A successful psychotherapy career requires a specific combination of interests, soft skills, and personality traits.
  • The more willing you are to openly question your professional motivations, the better off you (and your clients) will be.
  • The long road to a career in psychotherapy, while fraught with bureaucracy and other challenges, can be well worth it.
Source: Source: Pixabay (IG: ElisaRiva)

As a clinical professor of psychiatry, supervising analyst, and co-founder of the International Psychotherapy Institute, I meet many aspiring psychotherapists just beginning their careers. My own journey began in 1967 with my psychiatry residency; the intervening years have taught me a lot about what it takes to be part of this great profession. In this piece, I have distilled some of the major lessons of my 50-year career into five major points to consider as you decide if this career is right for you.

1. No single medication is a cure-all.

I became a psychiatrist and psychotherapist when psychoactive medications were in their infancy; we prescribed them, but we could not rely on them. My cohort learned to treat almost everyone psycho-therapeutically — and we now know this is a crucial component of treatment, even when medication is highly effective. Today, while antidepressants, antipsychotics, and mood-stabilizing medications are more common — and, admittedly, much more effective than 50 years ago — talk therapy remains the fundamental component of the therapeutic process. Human connection is a necessary part of psychotherapy and all mental health interventions.

  • So you can ask yourself: Do I recognize the benefits of psychotherapy in my own life?

2. Stay curious, approachable, and open.

Even as a medical intern, I found ample opportunities to be a fledgling therapist. Once, a heart disease patient asked to talk to me, rather than her attending doctor, as she knew I was headed towards psychiatry; the nature of our interactions demonstrated to her that I wanted to learn about mental health and her physical ailments. (Hers was a fascinating story of blocked mourning expressed through chest pain, but … that’s for another day.) While titles like “doctor” or “psychotherapist” carry a certain degree of social leverage, your primary objective is to be an empathetic human being.

  • As a therapist, try asking yourself: Do I seek to understand what motivates people, even those I find challenging?

3. Getting your education will take a long time.

There’s no way around it: Becoming a psychotherapist or psychoanalyst is a long process. I had the ambition to do this from early on, in the days when psychoanalysis was very much in fashion and long before the popular press declared that Freud was dead. I got a good start in my residency and then went off to Washington, DC, feeling — I sheepishly admit — that I knew everything. Of course, it turned out there was a great deal more to learn.

Because of my time in the Public Health Service during the Vietnam War, and then a yearlong sabbatical in England at the the Tavistock Clinic, I did not start formal analytic training until much later, when I was 36, at a time when my colleagues in other areas of medicine — to say nothing of my attorney or business friends — were already well established in their careers. My own institute endeavors to help candidates get through their training as efficiently as possible, but that still means at least four or five years of postgraduate training.

  • It will help to ask yourself: Can I tolerate the feeling of being left behind as I adopt a longer career trajectory?

4. Psychotherapy training can feel patronizing.

While the foundational pieces of my education have served me well, analytic training is infantilizing, and many of my instructors’ attitudes are elitist. (Not everyone had that attitude, but it was frequent enough to leave a bitter taste.) In those days, the American Psychoanalytic Association would even fail analytic graduates who applied for national certification at an alarming rate — and that was nothing compared to their attitude to non-medical professionals who applied for training. A lawsuit by psychologists in the mid-1980s broke open the medical bias against non-medical trainees. It made analytic training widely available to all mental health disciplines, but many instructors you may encounter may still act as though they are above reproach.

I like to think the International Institute for Psychoanalytic Training, where I teach, treats trainees like adults fully worthy of respect, all the more so because they volunteer for long training. For my part, I strive to treat my own trainees as peers while they learn.

  • Check-in, and answer honestly: How do I handle condescension and bureaucracy?

5. Psychoanalysis is an immensely rewarding career.

Freud died 80 years ago (that’s the part where we have to admit he is dead), but psychoanalysis is very much alive. It is a wonderful, thriving, developing field, and it remains the best tool for that ineffable inquiry into the central human question: what makes us tick. Analysis lets us examine this problem from multiple perspectives: our trauma, our family, our culture, even our own brain chemistry. For instance, I have applied my professional training to political and social issues, interpersonal challenges, and even critical readings of plays. (My psychoanalyst wife and I published a book of our psychoanalytic play reviews: A Doctor in the House Seat.)

Moreover, my career as a psychoanalyst opened up a literal world of opportunity; much of my recent work has been based in China and Russia, where I frequently travel (COVID rates permitting). My newest book, Marriage and Family in Modern China, explores how modern China's social issues and history find expression in the intimate interior of Chinese families.

  • So, here is the final challenge: Can I see myself happy in this career for 30, 40, or even 50 years?

Is a career in psychotherapy or psychoanalysis for you? That is only for you to decide. I suggest you ponder the questions above as you consider the cost and benefits, risks, and rewards of a career in psychotherapy. I can tell you that this career requires a long-haul mindset, a thick skin for both elitism and banality, a natural curiosity about your patients (and yourself!), a temperate view of psychoactive drugs, and a genuine interest in helping those at crossroads in their lives. In this psychotherapist’s professional opinion: the effort is completely worth it!

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