Charred and cindered

By Graham Lindegger

I've often felt as if I have led a rather protected professional life, with relatively little trauma to drive me from the profession. After listening to stories of colleagues who have been subjected to experiences of verbal or physical abuse, ethical nightmares, blackmail, the intricacies of psychotic transferences, or (even worse) fascist medical aids, I decided I had experienced a remarkably dull professional life, certainly as far as personal threats and traumas were concerned.

But there has been one major stress that I have often been aware of and do seem to have survived, and that is the experience of disillusionment or cynicism. This, I think, is a constant and often unnoticed threat to psychotherapists in practice, especially those in private practice.

I am often moved when close friends who are psychologists, or professional colleagues, talk of a sense of disillusionment with psychology or psychotherapy and decide to move on to other pastures. I feel a deep sense of sadness about this, especially thinking back on their enthusiasm in the past, and their determination to make a life and career of psychotherapy and psychology. Of course there are also many others who move out of psychology or psychotherapy, not out of disillusionment, but because they discover new, alternate and sometimes more personally and financially rewarding ways of spending their working lives.

I can and do understand how and why psychologists become disillusioned with psychology and psychotherapy, and have sometimes experienced doses of both. But on the whole, having been in practice as a psychologist for close on 30 years now, I still feel excited, fascinated and enthusiastic about psychology and psychotherapy, and moved at the privilege of sharing people's personal narratives. Having said this, though, I fear that I may soon be struck down with a severe and untreatable dose of both cynicism and disillusionment. So I have asked myself what contributes to both, and what acts as sources of resilience for both.

I feel sure that one of the greatest sources of stress for people in private practice is crudely financial pressure, the constant anxiety of whether there will be enough clients, enough sessions, and enough cheques at the end of the month. This is further compounded by changes in medical insurance structures, and difficulties in getting medical insurers to pay psychologists' accounts. I have watched colleagues severely worn down by this anxiety, and been eternally grateful that I do not depend for my living on this form on income.

If private practitioners are worn down by financial anxiety, my twenty years of part-time work in various state-run South African hospitals has left me with the impression that psychologists in these institutions are equally burdened by their oppressive structures of bureaucracy, and turf wars which make ongoing enthusiasm and optimism difficult.

But I also suspect that one of the greatest sources of stress to psychologists and psychotherapists, especially those in private practice, is the experience of professional and personal loneliness. Spending most of one's life enclosed in a private office, hearing the confidential tales of people's lives, must be lonely. Not having anyone with whom to share these experiences might be even more lonely.

With all its burdens, continuing professional development (CPD) has provided an added opportunity for psychologists to find support and stimulation from one another. I have always counted myself lucky to be working in a stimulating university environment where I have company and support from colleagues, and opportunities to reflect together on difficult or challenging aspects of our work.

Psychotherapy is an intense and demanding personal activity, despite some public illusions that all one needs to do is listen and nod. I would imagine that long days of this sort of intense activity with little respite must gradually wear many psychologists down. Working in an environment that provides me with many opportunities for varied and challenging work makes the little psychotherapy that I do far easier and less demanding.

I have increasingly thought that it is unwise to only do psychotherapy as one's form of income and work, and that it is always wise to diversify as far as possible. Teaching and research has also been an enormous bonus for me, providing opportunities to critically and creatively reflect on my experience of psychological practice, and providing constant sources of self-renewal. Generations of eager and enthusiastic students have also reminded me of my own initial fascination with psychology and psychotherapy.

One of the experiences to bring me closest to the brink of disillusionment with psychology was the series of severe difficulties that have faced the national organization and profession of psychology in South Africa in recent years. I found myself disillusioned that a profession informed by deeply human values could be caught in these professional conflicts and wars, and saddened at the news of a long standing colleague who has decided to go into retirement as a result of the damage done to him by the national conflict.

I continue to believe in the important contribution made by psychologists doing psychotherapy in various sectors of the economy and society, even though this may never make banner headlines. The challenge remains that of how to find ways of avoiding being worn into cynicism and disillusionment.

Professor Graham Lindegger is the head of the School of Psychology, University of Natal, Pietermaritzburg, South Africa, and a contributing editor to New Therapist.

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