When are our work and love involvements as psychotherapists beneficial and when detrimental to ourselves and those around us, let alone our clients?

Love and work, work and love … that’s all there is.

It turns out that whilst Freud never wrote the above this frequently attributed quote continues to ring a cultural bell. So how do, as people who are psychotherapists, our work involvements affect our love life and how do our love involvements affect our work?

She said she can always read my mind better than I can.

This quote and the following quotations are from my practices. It represents too many clients (a term I will use for both ‘patients’ and ‘clients’) I have seen who are the children or partners of psychotherapists. Being a psychotherapist has many attractions, including being one’s own boss and not having to be subject to others’ organisational constraints. But, can our experience of being a psychotherapist, which for example can include learning to cleverly bat back any criticisms and appearing to know when we don’t, also be detrimental to our personal relationships with those around us? (Indeed does becoming a psychotherapist help or hinder us as examples of lives well lived?) This editorial considers the concept of involvement, which can mean ‘the state of being complicated, tangled, obscure; causing great difficulty’ (Garmonsway, 1969, p. 397) to explore whether our work as psychotherapists is not only beneficial, but can be detrimental to us, those around us, and our clients.

I want to get even better at being a psychotherapist … . I see a client who loves his work but no longer has any friends.

When is our involvement in our work detrimental to our potential love life? This was to become clear to the psychotherapist client I saw, as in the quote above, who was to realise what was happening to her was what she seemed to project on to her own client. It emerged that she didn’t want to think about her relationship with her partner and her energetic time consuming work involvements enabled her both to escape her personal life coming to mind and provide compensatory professional and therapeutic relationships. Such motivations/drives/desires/callings for escape involvements through work involvement seems quite commonplace. For example, a clinical supervisor said of his supervisee:

He is somebody whose work keeps him together.

So how can our work and other life involvements complement each other? It may be appropriate at times for our work to take our minds off our other nagging problems. However, when do our escapes into work involvements as psychotherapists make us become so ‘complicated, tangled, obscure’ that they cause ‘great difficulty’ in us being able to come to our senses?

Such unhelpful escape involvement through psychotherapeutic work was also found with another psychotherapist who came to admit:

During the last three years, I was working with 35 to 40 patients weekly and thought, or I was telling myself, that I was feeling more alive and happier than ever.

So how can we tell what is our appropriate involvement capacity? It would appear that the number of weekly client/patient sessions we can do that can be enhancing to them, those around us and ourselves appear to be a very individual matter.

Yet as psychotherapists, our very work can be seen to involve love including erotic feelings. For some of us our ‘minds, bodies and souls’ are our measuring instruments. To some extent, we do sell relationships. Thus, for example, acknowledging to ourselves whether we do or don’t have sexual stirrings can be helpful for our psychotherapeutic work. More generally we will, in varying degrees according in part to our therapeutic modality, ‘get involved’ with our clients. More generally, a vitally important area is our abilities to both enter and come out of involvements with our clients so we can appropriately interpret/reflect back etc. Furthermore, such psychotherapeutic involvement abilities include not only our short-term involvements as in the therapeutic hour but our long-term involvements in starting and ending each course of therapy.

How can we therefore appropriately come in and out of such involvements? There are more obvious serious unethical sexual involvements of psychotherapists with their clients. Yet, more generally, our very therapeutic interventions can be inappropriate because of the false ego our involvement with our work has led us to develop. We can also forget that it’s the role and the therapeutic setting, and wrongly think it is our personal attributes, that make us so admired. Such false buoying up of our ego can also make us abusive to our clients, those around us and ourselves. Perhaps, when we are on the brink of realising this, the least damaging way to shore ourselves up is by increasing our escape involvements though seeing even more clients! For such escape involvements may stop us coming to terms with the personal circumstances we fear (as was the case with the last psychotherapist quoted above).

Now it has been argued that what I’m terming ‘escape involvements’ are inevitable if we can’t integrate our death into our life. Otherwise, we need our involvements as ‘a constant tranquillisation about death’ creating concealment and inauthenticity (Heidegger, 1962, p. 298 inspired by; Tolstoy, 1981). Alternatively, we might see such escape involvements being externally initiated by an employer to keep at bay ‘unthinkable anxieties’ (Menzies Lyth, 1960) or to prevent employees from thinking other than what their employing organisation requires (Loewenthal, 2002). There again, a person with compulsive involvements has been described as ‘ … frantically active in order to prevent the real thing from happening’ (Zizek, 2006).

Perhaps, though we can have a particularly helpful insight into how we might appropriately for ‘ourselves, the other and the situation’ enter and leave involvements by returning to Freud and what he did actually write about work:

No other technique for the conduct of life attaches the individual so firmly to reality as laying emphasis on work; for his work at least gives him a secure place in a portion of reality, in the human community … . Professional activity is a source of special satisfaction if it is a freely chosen one – if, that is to say, by means of sublimation, it makes possible the use of existing inclinations, of persisting or constitutionally reinforced instinctual impulses. Freud (1930, p. 80)

Here, Freud’s key phrase is ‘Professional activity is a source of special satisfaction if it is a freely chosen one’. So how do we come to get out of ‘freely’ choosing involvements? If we are to take Hegel’s dialectic of thesis, antithesis, synthesis, it’s as if an involvement that we can’t get out of keeps us from going from our ‘thesis’ to a more holistic ‘synthesis’ and again onto an ‘antithesis’ by us remaining compartmentalised. Now this is a complex situation where for example Freud defines ‘freely chosen’ as ‘that is to say, by means of sublimation, it makes possible the use of existing inclinations, of persisting or constitutionally reinforced instinctual impulses’; and, Marxists would see our psychotherapeutic work to varying extents as alienative involvements. There would also be moral involvements imposed on us by work, family etc. For example, Freud’s sister was made to give up her piano so he could study in silence (Mitchell, 2003). But could we make more calculative involvements? Perhaps one way of finding out is to explore how we get ourselves, in this case as psychotherapists, stuck in involvements. This might, if not before, start with our training. I remember when I commenced whilst like many also working in another occupation, being told on expressing my concern in having enough time :‘You can start with a weekend and evening practice’. But then what of time for our own relationships with the dangers including that our work involvements become compensatory?

Regarding literature on the negative effects of therapeutic training ‘Thirty methods to destroy the creativity of psychoanalytic candidates’ (Kernberg, 1966) is a rare example. Perhaps when there is the idea of a training more than an education there are more negative than positive effects that can constrict our involvement abilities.

My earlier research on the involvement of people who are nurses (Loewenthal, 2002) suggested there was a similar involvement process in play to that described by Davis (2017) in her work on the ‘doctrinal conversion’ of student nurses. This is ‘progression’: from ‘initial innocence‘, ‘labelled recognition of incongruity‘, ‘psyching out‘, ‘role simulation‘, ‘provisional internalisation‘ to ‘stable internalisation’. It could be helpful if research could now take place on ‘the potential doctrinal conversion of trainee psychotherapists’.

Having said the above, it is important to emphasise that my more recent work on involvement of people who are nurses (Loewenthal & Altson, 2023) also demonstrated the positive benefits experienced of involvement in work. That research reinforced that the involvements of people who are nurses besides both enabling escapes from their personal problems and sometimes being detrimental to them, for example through their emotional labour (Hochschild, 1983), can also provide extrinsic awards through earning money; and intrinsic awards through the work itself. It is hoped that future research on the consequences and determinants of the involvement processes of people who are psychotherapists will show at least a similar intrinsic satisfaction through our work.

In conclusion, it is suggested there is a need for further research on involvement. There is currently little in the way of literature to help us with our ‘involvement abilities’ for both ‘long and short term’ ‘work and love’ involvements, including our ‘escape involvements’, ‘involvement capacities’, and ‘involvement cycles’ of our, and indeed our clients’s involvements. An exception is Goffman (1968, p. 79) where he refers to an involvement cycle whereby employees get emotionally ‘burnt’ and withdraw. Otherwise almost all the literature on involvement and related concepts from the era of Etzioni (1975) onwards is from an organisational and not an individual perspective. Hence, there is a case for far more research to be done on involvement by and for psychotherapists (as there has been on the related but different concept of attachment (Ainsworth et al., 1978; Bowlby, 1969). Such research would not of course primarily be just for the lives and work of people who are psychotherapists but to assist us with our work with people who are our clients!

Before next introducing the papers, I very much want to thank the following for their invaluable assistance in developing this issue of the European Journal of Psychotherapy and Counselling: Kevin Ball, Jocelyn Catty, Nicole Chew-Helbig, Luke Fletcher, Anastasios Gaitanidis, Anthony McSherry, Craig Newnes, Elizabeth Nicholl, Ioannis Papadopoulos, Sally Parsloe, Francesca Robinson, and Daniel Röhe.

I would also like to again thank our abstract translators: Nicole Fisher (German), Trish Talens (Spanish), Ayres Marques Pinto (Italian), Lea Misen (French) and Anna Mylona & Christina Lagogianni (Greek).

My thanks also to the book reviewers for this issue, namely, Despina Balliou and Katia Hatzilakou for reviewing Psychotherapy of the Situation in Gestalt Therapy: A field-oriented approach edited by Margherita Spagnuolo Lobb and Pietro Andrea, Elisabetta Romani for reviewing The handbook of phototherapy and therapeutic photography: For the professional and activist client by Del Loewenthal, and Alice Allen for reviewing Supervision in a Changing World: Reflections from Child Psychotherapy edited by Deirdre Dowling and Julie Kitchener.

Finally, my further thanks to the authors of the following papers of this issue. Our first paper is Between Art and Praxis: Some Reflections on Psychotherapy. Here the author, Manu Bazzano, first considers the claim that psychotherapy is an art arguing that to do this requires developing a better grasp of the craft of therapy. Manu then considers whether psychotherapy can become a praxis, linked to action, and as such become a political force in the wider, transformational sense.

Reviewers comments include:

‘Your article stresses in an articulate way the connections among psychotherapy, critical theory and aesthetics. And you argue for your strong political opinion in a solid way. I like it’.

Our next paper is:

You feel that you are stepping into a different world’: Vulnerability and biases in the treatment of anorexia nervosa. Here, the authors Panagiota Tragantzopoulou and Vaitsa Giannouli in their innovative empirical study found the Greek therapists they interviewed experienced moments of self-doubt wherein they questioned their capacity to provide an efficacious treatment plan for anorexia nervosa. Further, treatment was hindered by personal biases and issues of mistrust, overall raising doubts about the therapist’s role as confident expert.

Reviewers comments include:

‘Thank you for submitting this article. It was interesting to read’.

Our third paper is Psychotherapy in a shared foreign Language. Exploration of psychotherapists’ perceptions of multipleness in the therapeutic interaction. This interesting research is particularly relevant, as the author Lies Sercu points out that in today’s multilingual society, psychotherapists are more likely to encounter clients with a different mother tongue than their own. Participants were recruited through a Flemish professional organisation of integrative psychotherapists. All were born and living in Flanders, the Dutch speaking part of Belgium. Arising from the findings of this empirical research specific suggestions are made as to which cultural, linguistic, and personal orientations to take in providing psychotherapy in a shared foreign language and how to educate psychotherapists.

Reviewers comments include:

‘This research topic is timely and an asset to mental health practitioners’. and ‘I found this a very interesting read and a very valuable contribution to the literature. One way that I read this is how … what it brings up for psychotherapy in general about how well we can ever really “know” our clients or make assumptions about them and what they are saying’.

Our next paper is:

Instrument-Breast: A Psychoanalytic View on Musicians’ Perception of Instruments. The authors, Rhett-Lawson Mohajer and Tara Rava Zolnikov, argue, through developing European ideas in a North American context, that unlike other forms of art, music is an objectless form of art, which makes it strikingly similar to inner subjective experiences. Their research purpose, of this phenomenological qualitative research, was to understand the role of the musical instrument and the role it plays as the transitional object for adults; the instrument was used as the breast object, in line with Klein’s Object Relations Theory. Their results indicate that participants anthropomorphised their musical instruments and subjectively perceived them as possessing parental attributes and the ones associated with romantic partners. The authors conclude that their result can help inform therapists working with patients who have some musical skills to instil an endopsychic structure and repair the impacts of insecure attachment styles.

Reviewers comments include:

‘This paper reports a small qualitative research study examining musicians’ perceptions and fantasies about their instruments. It seeks to make a case, both theoretically and drawing from the empirical findings, for the idea that the musical instrument is a transitional object for the musician playing it and is used as what the author calls a “breast object”. This is an interesting proposition in an under-researched area … .I think the paper has the potential to be of interest to readers of this journal’.

The penultimate paper is Involvement or attachment theory: Exploring the determinants and consequences of individual (work) involvement with particular reference to escape motivation by Del Loewenthal and Catherine Altson. The researchers call for attention to be given to involvement and related concepts to provide new registers for exploring therapeutic clients’ lives different to attachment theory which many, as in the previous paper, have found helpful. A literature review was conducted on involvement in psychological and sociological research and shown to be primarily from an organisational rather than an individual perspective required by psychotherapy. The empirical research presented the determinants and consequences of the work involvements of people who are nurses reveals that they can be a form of ‘escape motivation’ as well as having detrimental, intrinsic and extrinsic effects. The authors conclude more research needs to be carried out to explore whether the involvement concepts can be further tested and developed to assist psychotherapeutic work.

Reviewers comments include:

‘Thank you for the opportunity to review this manuscript … As someone more in the organisational psychology domain I found it interesting to get a broader take on the topic and to connect it with other discliplinary areas’.

Our final paper is from Italy:

The borderline personality organisation in Otto F. Kernberg’ psychodynamic perspective. Here the authors, Shady Dell’Amico and Raffaele De Luca Picione examine the concept of borderline personality organisation as it was conceptualised by Otto F. Kernberg. In so doing they are able to both bring original thinking as well provide a useful account for reader’s not familiar with Kernberg’s work.

Reviewers comments include:

‘The paper examines Otto Kernberg’s concept of “borderline personality organisation”, distinguishing it from the DSM diagnosis of “borderline personality disorder”. It provides a clear, comprehensive overview of Kernberg’s seminal ideas on borderline organisation. Connecting borderline deficits like identity diffusion and splitting to disturbances in early integration of good/bad representations is theoretically rich. This highlights the importance of primitive psychic structures. Moreover, the dimensional view of borderline pathology as an underlying organisation rather than distinct category seems clinically useful. It accounts for overlap of symptoms across PD diagnoses and questions the distinct and rigid DSM categorisation’.

In conclusion, whilst it is not being suggested:

Love, work and the European Journal … that’s all there is!

it is hoped, particularly given the variety of articles and book reviews in this general issue, that you will find at least one idea here that will appropriately develop your involvement abilities.