1st Edition

Addressing Challenging Moments in Psychotherapy Clinical Wisdom for Working with Individuals, Groups and Couples

By Jerome S. Gans Copyright 2022
    140 Pages
    by Routledge

    140 Pages
    by Routledge

    This practical and helpful volume details how clinicians can work through various common challenges in individual, couple, or group psychotherapy.

    Chapters draw upon clinical wisdom gleaned from the author’s 48 years as a practicing psychiatrist to address topics such as using countertransference for therapeutic purposes; resistance, especially when it needs to be the focus of the therapy; and a prioritization of exploration over explanation. Along with theory and clinical observations, Dr. Gans offers a series of "Clinical Pearls," pithy comments that highlight different interventions to a wide range of clinical challenges. These include patient hostility, the abrupt and unilateral termination of therapy, the therapist’s loss of compassionate neutrality when treating a couple, and many more. Many of the "Clinical Pearls" prioritize working in the here-and-now. In addition to offering advice and strategies for therapists, the book also addresses concerns like the matter of fees in private practice and the virtue of moral courage on the part of the therapist.

    Written with clarity, heart, and an abundance of clinical wisdom, Addressing Challenging Moments in Psychotherapy is essential reading for all clinicians, teachers, and supervisors of psychotherapy. 

    Part I: Introduction; Part II: Clinical Observations; 1. There Is No Completely Objective Data in Interpersonal Relations. The Way I Am with You Partly Determines the Way You Are with Me; 2.  Many Natural Reactions Are Not Helpful and Many Helpful Reactions Do Not Come Naturally; 3. With Some Patients There Is No Risk of Ever Establishing the Truth; 4. In Most Cases, All Things Being Considered, People Are Doing the Best They Can. If You Don’t Think So, You Probably Don’t Have Enough Information, or You Do Not Fully Understand the Information You Do Have; 5. It Is at the Boundaries That Meaningful Psychotherapeutic Work Takes Place; 6. In Chronic Marital Discord, Each Is Contributing Approximately 50% of the Problem No Matter How Asymmetrically They Present or Seem During the Course of Therapy; 7. Internal Conflict Can Masquerade as Dialogue; 8. One of The Fringe Benefits of Being a Psychotherapist Is All That We Can Learn from Our Patients; 9. Seemingly Innocuous Patient Comments Often Yield Valuable Information About the Patient, the Patient-Therapist Relationship and the Phase of the Therapy; 10. Shame Is a Painful, Ubiquitous, Debilitating and Often Hidden Emotion; 11. Ideas Are One of The Most Powerful Medications; Part III: Clinical Pearls; 12. Shifting Focus from There-And-Then to Here-And-Now; 13. Employing Irony and Paradox for Therapeutic Purposes; 14. Using Countertransference for Therapeutic Purposes; 15.  Responding Therapeutically to Patients’ Questions; 16. Securing the Patient’s Attention; 17. Dealing with the Group’s Resistance; 18. Encouraging the use of imagination; 19. Welcoming and Deepening the Negative Side of Ambivalence; 20. Employing Methods of the Existential School of Psychiatry; 21. Miscellaneous; Notes.


    Jerome S. Gans, MD, is a Distinguished Life Fellow of the American Group Psychotherapy Association and the American Psychiatric Association. Now retired, he previously worked in private practice and as Associate Clinical Professor of Psychiatry, Harvard Medical School.

    "This book is the wonderfully rich distillation of 48 years of experience treating individuals, couples and groups in a variety of settings. Dr Gans shows his considerable wisdom and compassion throughout the variety of clinical examples. He covers a wide variety of therapeutic challenges ranging from threatened suicide to seemingly casual remarks. The book offers a compelling combination of thoughtful and sophisticated analysis with eminently clear writing and will help clinicians at all levels to reflect more deeply about each therapy session they conduct." Eleanor F. Counselman, EdD, ABPP, CGP, DLFAGPA, Distinguished Fellow and immediate past President, the American Group Psychotherapy Association

    "Dr. Gans writes with clarity and deep appreciation for the psychotherapeutic process. His book illuminates the ways in which effective therapists must use themselves expertly as therapeutic agents, fully integrating their knowledge, understanding, compassion and humanity. Throughout, he demonstrates how the values of therapist decency and deep care for our patients, interface with our theories and techniques. Gans writes with passion, wisdom, humor and abiding respect for his patients and their inspiring courage and resilience." Molyn Leszcz, MD, FRCPC, CGP, DFAGPA, Professor of Psychiatry, University of Toronto and President, the American Group Psychotherapy Association

    "It is a cause for celebration when a highly experienced, trusted clinician and teacher, such as Jerry Gans, delivers a work that is as fresh, original, stimulating, provocative and helpful as this book. It reflects a current wish for more creative and innovative ways of working and offers numerous valuable ideas for interacting with clients in unconventional but impactful ways, in individual, couple and group therapy. Paradox, irony and surprise abound. The author offers not just his own ideas but encourages readers to find their own voice as psychotherapists: free, spontaneous and playful." Morris Nitsun, Training Analyst, the Institute of Group Analysis, London, and author of The Anti-Group and The Group as an Object of Desire

    "In his book, Dr. Gans weaves selected clinical pearls. Shame, marital discord, countertransferance and pain—Gans illuminates different aspects related to relationships. Skillfully and lovingly he leads us to the depth of the challenge inherent in the therapeutic encounter. With characteristic eloquence and sincerity, he captures the reader's heart as he shares interventions, explains rationale and shares powerful insights." Sharon Sagi Berg, MA, Group Analyst, Psychotherapist, Director of Tel Aviv Schema Therapy Center

    "There are many useful books on beginning and continuing psychotherapy, but I sincerely doubt there are many as enjoyable to read as this one. Using a wealth of telling examples from psychotherapy and supervision, including candid examples of his own work and countertransference processing, Dr. Gans addresses matters that speak, first, to the primary concern of novice therapists: ‘What do I say?’; and to the concerns of more advanced therapists: ‘How do I get this therapy unstuck?’…The text positively bristles with clinical examples from both his private practice and his extensive supervisory role. With laudable candor, like all great teachers, he often imparts his own personal countertransference difficulties and their resolutions to illustrate a point. The net effect is that this book will provide a kind of short-cut to the depth of his experience in a readily accessible form. The writing is clear and vivid and will remind clinicians of every stripe of their actual practices." - Thomas G. Gutheil, MD, Psychiatric Times, September 2021

    "As the sun sets on Dr Gans’ long career as therapist, psychiatrist, and teacher, we are served a delicious meal of clinical wisdom; a meal that will nourish our creativity for years to come…he brings an astonishingly fresh and innovative approach to the challenging moments we experience in psychotherapy." - Dale C. Godby, Ph.D, International Journal of Group Psychotherapy, 72

    "Dr. Gans has written a clear-eyed, intelligent, and pragmatic depiction of one man's successful practice of that endangered species, long-term psychodynamic psychotherapy. His basic belief that ‘people are doing the best they can’ clearly extends to therapists and patients alike. In these challenging years of pandemic practice, what could be more necessary or welcome?" - Betsey Edwards

    "…a must read for the novice and seasoned clinician alike." – Fran Weiss, American Journal of Psychotherapy, 75(2), p. 102

    "During the journey of becoming a therapist and developing one's own professional identity, each trainee has to rely on teachers and supervisors who hopefully provide relevant theory but most importantly, clinical insight and guidance... I do not know Jerome Gans personally, but I do feel like I have gained another good teacher on equal footing who it is worth learning from. His book has certainly 'enhance[d] the treatment of [my] patients and [has brought] new life to [my] clinical practice' (p.7)." - Maria Puschbeck-Raetzell, Group Analysis

    "Of the multitude of books about psychotherapy, there are few that offer the recurring wisdom leavened with humility to be found in Jerome Gans’ Addressing Challenging Moments in Psychotherapy. Early in the book, Gans writes, with his typical wit: "When I arrived at Massachusetts Mental Health Center in July 1968 to begin my psychiatric residency, I was smarter than I would ever be again" (p. 18). There is a genuine modesty in the pages of this book, but it is always combined with the wisdom that psychotherapy is a complex process, as much art as science, and the recognition that an intervention for one person might not be the best intervention for another... Gans offers the fortunate reader many gems as he makes evident how he deeply loved his work and his patients and grew profoundly as a result. As he says, "Being intimately involved in our patients’ lives provides us with lessons for life, opportunities for self-reflection, an appreciation for human suffering and resilience, and a unique exposure to life’s paradoxes and apparent mysteries" (p. 38)." -  Joseph Shay, PhD, Psychodynamic Psychiatry