Inside the Head of a Therapist

My third book on psychotherapy is Annotated Psychotherapy, A Session by Session Look at How a Therapist Thinks, published by Routledge, Taylor & Francis Group, 2024.

After a brief review of some fundamental principles, Annotated Psychotherapy employs a unique format to demonstrate how effective psychotherapy works. It uses a “script” to present session transcripts for eight different clients/patients. In each session every statement by the therapist is followed by an explanation of her thoughts and the reason for her chosen response. These annotations show the reader how the psychotherapist balances support for the therapeutic alliance with her interventions to help clients/patients reach their treatment goals. Discussion sections after each transcript and a glossary provide helpful explanatory material for the key ideas and concepts.

Why add Annotated Psychotherapy to the extensive library of books on psychotherapy? I believe it fills an unmet need.

Training health care providers in most specialties follows the apprentice model. Close observation of senior members of the profession provides extensive opportunities for hands-on learning. A surgeon-in-training assists at operations. An experienced physical therapist demonstrates procedures to a beginning physical therapist. A student nurse shadows the duties of a registered nurse. Medical students watch residents and attendings perform hands-on treatment.

In all these teaching opportunities, the apprentice is physically present as the care is provided, hears the expert explain the treatment as it takes place, sees first-hand what is being done as it happens, and is able to question the proficient mentor in real time. With these advantages, trainees learn from an experienced practitioner not only what to do and how to do it but when and why it is done.

The prospects for apprentice learning in behavioral health training, however, are quite different. In many programs, opportunities to discover how experienced therapists think and how they interact with their clients are often limited.  Because of time constraints in a crowded curriculum, exercises, such as case discussions with supervisors, allow coverage of just a few main topics. As silent observers watching a senior therapist’s interview through a one-way glass or on video, trainees cannot access and thus appreciate the internal judgments and reasoning behind what they see happening.

Even though limited, these valuable clinical exercises allow trainees to model themselves after an admired teacher, providing examples of their style and techniques. They may pick up and store a particular approach, a turn of phrase or an effective interview technique. What these learning exercises lack, however, is the ongoing, moment-to-moment knowledge of the therapist’s internal rationale for what the observers see; in other words, they are unable to monitor the therapist’s cognitive process.

Even with an opportunity afterwards to discuss the interview, the instructor will be able to provide only a partial and general explanation for their responses and not the detailed relevant ideas that underlie each of them. As useful as these exercises are, most training programs can only allot time for infrequent demonstrations. After graduation, even these few eyewitness opportunities are usually lost.

Annotated Psychotherapy attempts to offer the missing element of the therapist’s cognitive process. It documents the most detailed and instructive information about the therapist’s handling of a variety of clinical cases. The therapy transcripts provide immediate commentary and allow the reader full access to the therapist’s ongoing assessment and decision process. While it attempts to supplement a limitation found in some training programs, the result should be of interest to therapists at every level of experience and regardless of their professional disciplines.

Annotated Psychotherapy and earlier books by Richard Makover are available on Amazon and can be found here.