January Book of The Month

written by Marnie McGann

Whether you are a novice or experienced practitioner, Therapeutic Mastery by Charles H. Kramer, MD, is a seriously good book for achieving mastery in psychotherapeutic practice. Kramer starts from the ground up with the creative growth, development, and physical and mental health of the therapist. He wants therapists to be authentic, freed, exhilarated, and open to possibilities.

His ethos mirrors that of Milton Erickson’s as he writes: “Mastery has to do with using a full range of our internal resources, our entire cast of characters. It means removing the self-imposed limits that shackle us, limits that keep us in ordinary competence or even mediocrity. Opening up to our latent creativity means letting go of the attachment to years of training in technique and theory. It means not being dominated by a relentless need to find and solve problems…It means being prepared for whatever presents itself, accepting results without rationalization, and without worry whether the technique was ‘right’ or fits a theory.”

Trained as a physician, Kramer became interested in psychiatry while serving in the Air Force. In the late 1950s, he became a pioneer in the emerging field of family therapy and in 1968 he founded the Family Institute of Chicago. He and his wife Jan were co-therapists and co-teachers for 20 years in couples and family therapy.

With more than 50 years’ experience in the healing arts, Kramer interlaces his own wisdom and insight with that of Eastern religious leaders, philosophers, scientists, and famous writers. The quotes he chooses reflect his vast experience with relationships, communication, internal selves, body work, Eastern and Western philosophies, morality and spirituality, and altered states of consciousness.

In Part 1, The Therapist in Action, Kramer stresses that being wedded to a technique kills spontaneous, dynamic therapy. He instead promotes discovering and using one’s own distinctive style. He maintains that therapists are not well trained in personal development, which he says is vital to good therapy. Emotional connectedness, standards, and honesty about self are also important. He writes: “Believe in your identity and opinions. Therapy is an act of pride, of narcissism—you might as well admit it. Use its energy to keep going.”

Kramer offers short personal vignettes of his therapeutic experiences—the good outcomes as well as failures. At the end of each chapter there are bullet points of reflections and questions, both of which are thought-provoking.

“What most people actually need,” Kramer says, “is hard to find: a trusted health coordinator with the ability to offer medical know-how, compassionate insight, and spiritual guidance.” He also offers: “Psychotherapy is an art/science to be practiced with imagination and skill using the best ‘materials.’ It calls for a passion for quality, impatience with the second-rate, and a deep belief that excellence is its own reward, for therapist and patient alike.”

Part II, The Therapist as Human Being, focuses on the qualities of the therapist—“wholeness, uniqueness, aliveness, openness, compassion, integrity…” Kramer addresses therapist vulnerabilities, empathy and limits, one’s own therapy experiences, and spirituality. “Effective therapists are realistic optimists,” Kramer writes “they know the worst that can happen, yet they believe that things will get better…[that] good things will happen.”

He also writes, “Delete your need to understand…Need interferes, is a way to control and live by the idea rather than by the flow of reality. Without need, we are without encumbrance to experience what is.”

He believes that intelligence can either work in therapy or not. He writes, “…training for an art is incomplete when thinking brains are valued above intuitive hearts.” He also says that being grounded spiritually puts you in a much better position to offer more effective therapy: “…art is a spiritual experience, whether we are creating it or appreciating it…Neglect of the spiritual dimension in patient care leaves a vacuum in our practice…” Clients are eager to talk about life’s mysteries, their beliefs, and religious traditions. Don’t disappoint them.

In Part III, Kramer focuses on the totality of the therapist. He encourages therapists to face their fears, not to be overwhelmed by death, dying, and disability; to accept and appreciate life’s mysteries, to grow through the transitions.

In Part IV Kramer talks about what and how much to reveal to clients. The therapist who withholds all personal information can come off as robotic and have little rapport with the patient. The therapist who offers too many personal details can make the patient uncomfortable. Kramer promotes balance. Patients want someone they can relate to; someone with their own life experiences. Kramer writes: “When we share our life experiences, we connect without patients and they connect with us, and all of us connect with life…I want patients to know they will be getting something useful from me, not only relief at pouring out their story. I want them to realize that this is a mutual relationship with a human being with feelings, opinions, life experiences—who is not reluctant to talk about them when the time is ripe.”

Self-disclosure is effective because it demonstrates empathy. When in doubt about whether to share something personal, Kramer says to wait. You can always share it, but the timing may be off.

“The therapist who shares thoughts and feelings offers a rare gift: an insider’s view of what goes on in the heart and mind of someone who compassionately cares about us and who may have insights we have yet to grasp. It does not matter if the perspective is off the mark. It is the process of thinking and feeling that is absorbed…When you tell people about your life, you offer a bit of yourself for identification. A template—one way, among many, of being in the world. Therapist examples, undistorted by transference, are useful to identify with or reject.”

The final chapter of the book delves into leadership and mastery and what the author calls the “accomplishment triangle” (vision, action, and commitment). Kramer maintains there must be a leader in therapy. Therapists should not be afraid to lead because clients are looking for guidance. “When we believe we offer a legitimate service, are available to people in trouble, and are paid for it,” Kramer writes, “we take on the mantle of leadership whether we like it or not. Goes with the territory.”

But therapy should be more of a co-leadership. Kramer offers a quote by Ghandi, “There go my people, I must hurry and catch up with them because I’m their leader.” Kramer writes: Good leadership take old-fashioned courage to let go of fear, create the right ambience, dare to step out, rise to the challenge, even a dollop of defiance.”

The last part of the book is on the accomplishment triangle and the therapist’s vision. There must be a vision before there can be commitment and action. Problems will always arise, but what are perceived as stumbling blocks can be turned into steppingstones. “A problem is only a problem,” Kramer writes, “when it is defined as a problem. When one has a broader vision, problems move into the domain of possibilities.”