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Young, R.M. (2004). Vicissitudes of Therapists' Self-Esteem. Free Associations, 11(4):497-518.

(2004). Free Associations, 11(4):497-518

Vicissitudes of Therapists' Self-Esteem1

Robert M. Young

I Have Chosen a Topic that it is not easy to think or write about, one that is elusive and that is easy to satirize or to conflate with egotism. Yet, I think it is an important one, one about which I have seen no extensive reflections in the psychoanalytic literature. I dare say that each of you thinks about it from time to time. I want to consider what contributes to and detracts from our self-esteem as therapists. I think most of us would be embarrassed to speak or write about how insecure we often feel. I'm old and have had some status, so I have decided to risk it.

We become psychotherapists for all sorts of reasons, among them that we have been helped by psychotherapy, that we are interested in human nature, that we want to help people, that we want to have a job in which there aren't bosses hovering about and telling us what to do. All of the above apply to me, especially the last one. I was working as a publisher and having a tough time. I found myself thinking that if all else fails, I can be a therapist where only the patient and I are in the frame and no one can interfere. I was, of course, sorely mistaken. First you have to get trained and then you have to get patients. To get automatic referrals you have to get a job in an institution, and there are precious few of those. Most of us are in private practice, which means that we rely for the most part on colleagues to refer patients to us. I know that one can put one's name in the Yellow Pages, write to local GPs, leaflet, have people sent by one's training organization, and so on, but most patients come to me from personal referrals, and most of us, including me, don't get as many of those as we would like.


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