Letters to a young therapist.

Mary Pipher (2003).

Letters to a young therapist, New York: Basic Books. 181 pp. $12.96. ISBN 0465057675.

Mary Pipher is the author of six books, including Reviving Ophelia, Another Century, The Shelter of Each Other, and her most recent book, The Middle of Everywhere: The World's Refugees Come to Our Town. She is a psychotherapist in Lincoln, Nebraska.

In Letters to a Young Therapist, Mary Pipher candidly reveals the triumphs and tribulations of her nearly thirty years of experiences as a clinical psychologist. The author artfully shares her wisdom by writing a series of letters to Laura, a young therapist whom she mentored. This style of writing makes the book engaging throughout as the reader is guided in dealing with the challenges of psychotherapy and living life as a therapist. A unique perspective into what a therapist really does in the office with patients is offered and is done in a way is refreshingly free of psychological jargon.

There is substantial benefit to being exposed to a seasoned clinician's thoughts about life, the human condition, clinical practice and our profession as a whole. As someone who teaches graduate level psychology students, I have some sense of how difficult it can be to process the amount of information in our field. My clinical practicum students often wonder how to choose an approach to working with clients; this book is one I will definitely recommend to aid them in this process. It is helpful that the author shares not only what she does in clinical work, yet has even more impact because the reader is informed of the author's thinking and reasoning process.

Pipher describes her goals for her clients as follows: "I want people to leave feeling calmer, kinder and more optimistic. I want them to be more intentional in their choices and, in many cases, less impulsive in their appetites" (p. xiii). Her expressed desire for people is to embrace their humanity, admitting their flaws and feelings of vulnerability. A practical, common sense approach to therapy is used along with a focus on trusting in the process of therapy. The therapist provides the client with "another point of view on their own particular mixed-up universe," (p. xv) as they are allowed to explore their inner world within a safe relationship.

It is clear Pipher that has been able to benefit from mainstream psychological training and yet has resisted becoming caught up in dogma or the latest fad. She thinks independently about the human condition and considers the broad context of human behavior. For example, she believes many mental health problems are created by our "deeply dysfunctional culture" (p. xvii). Pipher rightfully challenges our culture of ignoring the problems of children, refugees, the aged and the poor. The media, which do not encourage people to think about world peace or spiritual needs, is also implicated.

The letters in this book are divided into four seasons, and were the result of a yearlong writing project, which began on December 2, 2001. The first part of the book contains her letters from Winter. Pipher begins by sharing her life story, constructing a breadcrumb trail and highlighting many defining moments. Pipher was an avid reader as a child and shares how reading expanded her mind at an early age. Moving on, she discusses her choice of psychology as a career and the virtues needed to be a good therapist. The author believes therapists need to be reasonably well adjusted and encourages therapists to understand the value of the natural world and the potential benefit of animals for clients.

Included among the Winter letters is an excellent discussion of the family bashing that often occurs in therapy. Our goal should be to strengthen families and articulate what families do for people, rather than just how dysfunctional they may be. With clients from very abusive families, she says, "Find someone to love that is family. Even if it is your second cousin twice removed, seek out that person and build a family relationship. Everyone needs kin" (p. 29). In a winter letter about deepening therapy, Pipher discusses the importance of connecting surface complaints to deeper issues. Clients are helped to consider the effects of their behavior on others, not just how they feel about how they have been treated. An emphasis is placed on balance and on helping rigid clients see alternate solutions. The secret of our work is helping clients make connections. Affect, behavior and thinking need to be connected as well as past, present and future.

Spring, the second season of letters, includes selections on pain, happiness, using metaphors, endurance, self-care, medication and dating. In the introduction to Letters to a Young Therapist, Pipher states she has a PhD in human suffering. Indeed, in the selection of letters on pain, it is clear the author has a healthy perspective on pain. Clients are encouraged to face their pain as the author believes most of the craziness of the world is caused by running from pain. Part of being emotionally healthy is being able to learn and grow from life's experiences. Happiness is not about doing your own thing, but about contentment, relationships, productive work and meaning. She also comments on the research that suggests religious people are happier than non-religious people.

Pipher presents a balanced approach to the issue of recommending medication in her letter to Laura on this issue. Recognizing, for example, that theories about the cause of depression range from biochemical, genetic, and environmental to spiritual and existential, she proposes that an important task for the therapist is to help clients distinguish between depression and sorrow. Another Spring letter provides some useful thoughts about dating. Clients are encouraged to carefully evaluate their prospective partners and to go slowly as it takes time to see people in many settings. Dating is compared to an emotional minefield and a rigged game, but must be played for people to have families of their own.

The third part of the book contains the Summer letters to Laura and includes reflections on marriage, family, intentionality, emotional weather, swimming, danger, and therapy and writing. Based on thirty years of working with couples, Pipher conveys a clear understanding of marital dynamics and the challenges of working with couples in therapy. Reinforcing positive statements made by a spouse while challenging negative ones is one approach utilized. The author's reflections about family therapy are also insightful. She eloquently states the following: "We must dance between the raindrops to do family work. Our job is to validate every point of view and, at the same time, stay out of trouble with other family members" (pp. 104-105). Rules within families, family alliances and family secrets are also discussed. The letter on families is one of her longer letters and is a "must read" for anyone working with families.

Pipher's letter on intentionality is filled with wisdom on sorting through the vast array of one's choices in life. For example, she advocates the importance of being thoughtful about our use of time. The harmful messages from our culture are also identified along with the need for parents to help children sort out these messages. An excellent thought from Plato about education involving teaching our children to find pleasure in the right things concludes this letter. In another Summer letter, an issue is addressed that is frequently not emphasized in training programs, that being, the possibility of physical harm inflicted by clients. In this sobering letter, therapists are encouraged to protect themselves and have a plan for potential danger.

The Fall letters include reflections on ethics, story doctors, resistance, failures, healing solutions from all over the world, and yearning. In an important letter on ethics, Pipher addresses issues regarding labeling and the potential harmful implication of giving a client a diagnosis. Also included in this letter is a very interesting discussion on the difference between understanding and approval of clients. In a creative letter called Story Doctors, the author states that therapists are primarily storytellers as they help clients to view the world more optimistically. One technique to help her clients become more hopeful is to ask what he/she gained from sad experiences.

The difficulty of change is a topic addressed in the letter on resistance. Recognizing people do exactly what they want to do, the author advises the therapist to deflect resistance rather than meet it head on. She suggests statements like, "I agree with part of what you are saying, but there is a small part I wonder about" or "I wonder if you have even the slightest doubts about your current position" (p. 155). In addition, the importance of the client feeling heard and accepted is emphasized. Failures are an inevitable part of doing therapy. Revealing some of her mistakes over the years, Pipher discusses what she has learned from them and shares her process of dealing with her own imperfections.

In one of the final letters in the book, Pipher turns to alternative forms of healing in assisting clients. Practices in other cultures are considered and valued. In her final words of wisdom, a frank letter to Laura is written about the painful reality of just how hard life can be and is for many people. Life is filled with sorrow, but also great joy. Our role as therapists is to provide our clients assistance in coping and developing resources to deal with facing the struggles in their lives.

While reading Letters to a Young Therapist, I was reminded of an assignment required of my Theories of Personality classes. At the end of the course students write a paper outlining their own theory of personality. It is a way of integrating concepts from foundational personality theorists and making these concepts their own. These papers, although of course a source of anxiety, are often quite creative. In a similar way, Pipher has taken all that she has learned from her training and clinical practice and shared this knowledge with all of us in the easy to digest form of these letters to Laura.

It would be exciting if this work encourages other seasoned clinicians to do the same and candidly share their clinical wisdom. A recent book from Cozolino (2004) also offers clinical insights and wisdom from his years of clinical experience, especially emphasizing the need for the therapist's personal growth. Both books reflect a sense of humility from the authors. In fact, Pipher states we have an ethical responsibility to realize we don't know everything. She encourages Laura to "respect the complexity of the universe with all its uproar and glory" (p. 180). Personally, I find such statements to be very encouraging and consistent with a Christian worldview. Pipher also acknowledges her values influence her work, and states emphatically that our responsibility is to be honest with our clients about our values.

In conclusion, I would recommend this book to mental health professionals and pastoral counselors. There is much clinical insight and knowledge to be gained. The material is presented in such an enjoyable manner the reader will hardly realize how much he/she is learning.

REVIEWERS FOR THIS ISSUE

BECK, JAMES R., Ph.D., is a Professor of Counseling at Denver Seminary and the author of The Psychology of Paul (2002).

O'DONNELL, KELLY, PsyD, is a psychologist based in Europe. His emphases are in the member care/human resource field, and include crisis management, expatriate adjustment, and developing member care affiliations. He has edited three volumes: Doing Member Care Well (2002), Missionary Care (1992), and Helping Missionaries Grow (1988).

HEDGESPETH, JOANNE, PhD, is a licensed clinical psychologist, serves as a commissioner for the Board of Psychology in California, and is a faculty member at Pepperdine University. Prior to teaching at Pepperdine, she served as a psychologist in the United States Air Force. Dr. Hedgespeth has completed a postdoctoral fellowship in child clinical psychology at the Reiss-Davis Child Study Center. She recently completed psychoanalytic training at the Psychoanalytic Center of California and obtained a certificate in psychoanalysis.

Reviewed by JOANNE HEDGESPETH, PhD