Phoenix Publishing House, 2019
Reviewer: Ben Scanlan
Brett Kahr has continued his prolific writing career (three books in 2018, three to be published in 2019) to bring us How to Flourish as a Psychotherapist, as both a reflection on his forty-year career to date, and what feels like an aspirational challenge, with the task to colleagues to go above and beyond the idea of ‘survival’, first advocated and acknowledged by Nina Coltart in How to Survive as a Psychotherapist (1993). Kahr’s premise is that “nothing could be more important, psychotherapy practitioners must not only survive but we must also thrive in order to derive true satisfaction from our work” (p.xiv). Even in the title and aspirations he is trying to go beyond ‘psychotherapy’ as a thing in and of itself, and as such is setting a high standard. This is, to a degree, intimidating, as well as diminishing of the core of the profession. Throughout the book, I get a sense of the deep care and compassion Kahr feels for his clients – or patients, in his language – but I’m struck that this doesn’t seem to be enough for him, and the book is based on the premise that it shouldn’t be enough for the reader either.
I should make a disclosure of having a prior relationship with Kahr, having been supervised by him during my final term on the MA at Regent’s University. All that year, the clamour around his interpretations and supervisory ability had augmented, as the number of my peers who’d been supervised by him had grown term on term, and with it an inevitable infatuation. Possessing a misalignment with psychoanalytic theory, along with a strong sense of rebellion, I was slightly unhappy at being in his supervision group. I expressed a discomfort in our first meeting, which he graciously took, and offered me thanks for my honesty. My recollection isn’t perfect, but I think I lasted three further weeks before I joined my colleagues in being a convert. So it’s fair to say that I had an expectation prior to reading this book, both of the author, his style, and the insightfulness, all based on my own experience.
The book is divided into four parts of five chapters, each with three sub-sections consisting of a couple of pages. The title of the parts – ‘Building a Secure Base’, ‘The Art of Prospering’, ‘Thriving Beyond the Consulting Room’ and ‘Surviving Success’ – give some insight into the contents, but not a huge amount. To go through all the chapters would provide little aside from words, but they range from thoughts on exercise to holidays, writing, and the need to read as much as possible from the traditional big beasts of history such as Freud, Winnicott et al..
Kahr’s style is engaging; indeed I read the book from cover to cover inside five days and didn’t feel I was pushing it in doing so. Partly this is the format, as chapters flow easily and are wonderfully digestable in an easy-to-read-between-clients format. Though I did find there to be something quite disarming about his insistence on not using abbreviations, and the way in which information is communicated; I’m unsure of the last time I read British Broadcasting Corporation rather than BBC, such is its universality. This precision of language gave me a certain security that Kahr had really thought about what exactly he was saying, and a confidence as a result; perhaps something worth bearing in mind. I appreciated the honesty of his tales of being unable to write a conference write-up and just not doing it, which encouraged me that writing, as with psychotherapy, is something that takes practice.
There are omissions that are notable: social media and engagement with anything technological is not addressed, although it is acknowledged as being outside his scope of expertise and experience (p.64). Kahr communicates with clients solely in session, and by them leaving him a message on his landline answerphone. No emails, no mobile phones. Indeed there is a section solely devoted to ‘Answering the Telephone’ (pp.69-71) which in some ways strikes me as archaic and not in-the-world as I understand it, yet as somebody with a website, email address, mobile, and Facebook page I’m struck that clients can reach me via a variety of routes. As such it’s applicability here is limited.
Kahr’s base premise that thriving is necessary to derive satisfaction from the work is a challenge to accept, as a lot of his thriving is based on not actually being-a-psychotherapist, rather being-somebody-who-talks-about-or-researches-psychotherapy. There is an inherent criticism of those who are less scholarly or inclined to read; I have peers who I would recommend at the drop of a hat who aren’t academic, and indeed my own experience of academia (eleven years in higher education) is that success doesn’t need to be grounded in the library. The narrowing of what it takes to be a good psychotherapist seems constructed to justify Kahr’s own life choices; there is of course nothing wrong with that, but it does leave the book lacking alternatives. An example lies in chapter nineteen, ‘Nurturing the Ageing Spine’, where Kahr says “I will generally be away for the last week of July, as well as all four weeks in August. I do so because I need to do so.” (p.169). There is a huge amount of presumption here, including that one’s partner has control over their holiday, that one has a contract with clients whereby the client cannot miss sessions unless their therapist is away, and so on and so forth. This feels a long way from how I, and most of my peers, practice.
The idea of prejudice is present, but not explicitly, and not in a reflective way. In chapter two, ‘Assessing One’s Own Sanity’, Kahr talks about the difficulties he had in financing five-times-a-week analysis. To do so he “had to pay a significant fee for many years, and I worked extremely hard and managed my finances very carefully in order to do so. Not everyone wishes to make such an investment or has the confidence that such an investment will reap sufficient dividends” (p.17). As I mention earlier, there is a lot implied here, primarily that a level of investment in training is accessible to everybody, or at least those with “a few pounds sterling or dollars already in the bank for a rainy day” (p.19). This line hugely undersells the cost, and therefore the limitations (my own training cost about £50,000 in hard cash and another £70,000 in lost income, and these figures resonate with the handful of colleagues asked in a basic straw poll). While I recognise there is a choice, his stance doesn’t acknowledge his own privilege, nor the potential struggle of others who feasibly could not achieve UKCP accreditation alongside ‘life’. Here there is an opportunity to engage with the idea of privilege, and that Kahr doesn’t take it up is a sad omission.
Clearly there are issues with this book, and I feel very critical having re-read the above. I would encourage any (relatively) new psychotherapist to invest the time in this, with the caveat that a more grounding title might be “How I Flourish as a Psychotherapist and Other Associated Roles”. There is a danger for the reader to feel struck that they don’t do nearly enough reading, or make as full use of their time as Kahr. Certainly, that’s what I was left with initially. However, Kahr does address this, implicitly, when talking about cultivating brilliant mentors as he “strongly recommend[s] that every trainee psychotherapist and every newly qualified psychotherapist should, actually, work very hard to identify with his or her teachers while, at the same time, reserving the right to dis-identify as well” (p.42).
I’ve tried to adopt a similar approach to this work. Kahr clearly has a passion for study, literature and learning, as well as an aptitude having started his higher education at Oxford as a psychology student (p.59). While I don’t identify in me the need to read The Standard Edition of the Complete Psychological Works of Sigmund Freud (p.27), I do wonder whether I have adopted enough of a scholarly attitude outside of the texts set by tutors. On a macro level, I feel inspired to really examine what I’m doing as a newly-qualified psychotherapist, and whether I really am striving to do the best for my clients, and for myself.
Ben Scanlan is an Existential Psychotherapist and Supervisor in private practice in Canada Water and London Bridge. He has worked in the NHS, in sport and the charity sector, and has an interest in working with men and suicidal clients.