When I was in training, I often struggled with an intense desire to know what to say or do when clients were particularly challenging. A book like The Therapist’s Answer Book would have seemed a God-send, especially given the curiously long number of problems it attempts to provide answers for. It’s author, Jerome S. Blackman has an impressive CV after 40 years in psychiatry (downloadable on his website), with a particular following in China and Romania. Intrigued by his obvious success, I really wanted to like his latest ambitious book (this follows in the wake of 101 Defenses), but it proved tough.
Maybe a culture clash explains some of my discomfort. Blackman writes from his experience of American therapy, where clients are funded from insurance plans, and perhaps the therapist is more embedded in the collective psyche as a professional helper. Secondly, although Blackman emphasises his multidisciplinary approach and takes ‘something from the best ideas that each theory has to offer’, he leans heavily toward Freudian analytic thinking – with little reference made to more recent relational and attachment work or indeed mindfulness-influenced theories and practices. A chapter When CBT Alone Is Not Working also makes me wonder about this integration.
As a US psychiatrist practising psychotherapy, ‘treatment’ and ‘diagnosis’ are core to his thinking, especially around decisions to prescribe medications. This writes off the relevance of some chapters for us UK therapists, including – When to Use Medicine and When Not To or When People Demand Medicine, What If You Opt Out of Medicare? Other chapters could be seen to reflect a more professionalised culture too, such as People Who Date Your Secretary or People Who Fall Asleep in Your Waiting Room, or indeed Elevator Phobics Who Must Take an Elevator to Your Office.
There are other problems phrased in slightly toe-curling ways: Passive, Wimpy People or Wiseguys or, my least favourite: Self-Centered People Who ‘Need a Spanking’. I also struggle with Women Who Wear Ultra-Short Skirts and/or See-Through Blouses as a ‘problem’, although Blackman does explain that ‘women who wear sexually provocative clothing cause overstimulation and conflict for heterosexual male therapists, no matter how the male therapist denies or rationalizes this.’ By offering a ‘short’ and ‘long’ answer as well as a case study or two means sacrificing a proper dig into theory, so this may account for his instructional tone.
Despite his apparent confidence in sorting people out, as his case studies largely testify, his honesty about some of his limitations are some mitigation – such as being unable to treat therapists who have seduced female clients. But I’m left wondering if those female clients wore sexually provocative clothing.