1st Edition

Still Practicing
The Heartaches and Joys of a Clinical Career

ISBN 9780415879132
Published April 6, 2012 by Routledge
248 Pages

USD $52.95

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Book Description

"Still practicing" has several meanings. Still practicing suggests that the balance of heartaches and joys must not deter us from pursuing a clinical practice. At the same time, still practicing suggests that for the clinician "practice" never "makes perfect." We continue to refine our clinical instruments over our entire working lives.

Framed by her previous work on the concept of emotional balance, Sandra Buechler investigates how vicissitudes in a clinical career can have a profound and lasting impact on the clinician's emotional balance, and considers how the clinician's resilience is maintained in the face of the personal fallout of a lifetime of clinical practice. At each juncture, from training to early phases of clinical experience, through mid and late career, she asks, what can help us maintain a vital interest in our work? How do we not burn out?

Aimed at the nexus of the personal and theoretical, Still Practicing concentrates on the sadness, feelings of shame, and satisfactions inherent in practice, and encourages newcomers and veterans alike to make career choices mindful of their potential long-term impact on their feelings about being therapists. It poses a question vital to the life of the clinician: How can we strike a balance between the work's inevitable pain and its potential joy?

Table of Contents

Introduction: The Personal Impact of Lifelong Clinical Practice. Part I: Hardships in Training. Failing to Cultivate Clinical Strengths. Emotional Hazards of Clinical Training. Part II: Early Career Vicissitudes. Traumatically Overwhelming Professional Settings. Difficult Patients as First Cases. Part III: Evolving Requirements. Ongoing Challenges to the Clinician's Sense of Self. Cocreated Dysfunctional Patterns of Relating. Bearing Isolation and Sorrow: Chronic Mourning in Clinicians. Part IV: Sustaining Practice. The Ordinary Tragedies of an Analytic Life. Transcending Shame and Sorrow. Analytic Resilience. Epilogue: Still Practicing.

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Sandra Buechler, Ph.D., is a Training and Supervising Analyst at the William Alanson White Institute in New York City, and supervises at Columbia Presbyterian Medical Center and at the Institute for Contemporary Psychotherapy.  A member of the editorial board of Contemporary Psychoanalysis, she is the author of Clinical Values: Emotions that Guide Psychoanalytic Treatment (Analytic Press, 2004) and Making a Difference in Patients' Lives (Routledge, 2008), and has written papers on the analyst's experiences of loneliness, loss, joy, and other aspects of the clinician's feelings.


‘I am profoundly appreciative of the life lessons I take with me on closing the back cover of this book’Cleonie White, Psychotherapy, Vol. 51, N.2, 324-325

"Overwhelmed? Burned out? Wondering if you have missed your chance to deliver your optimum psychoanalytic impact upon the world of psychoanalysis and/or your patients' lives? Sandra Buechler is back again—now in her most seasoned moments—with this timely prescription for and description of the quiet endemic nihilism which plagues so many of our field. She elicits our field's veil of shame, silence, and reluctance to address the struggles she tackles so elegantly. From the refreshing perspective of a lived lifetime, Sandra has just what it takes to speak to all phases of the psychoanalyst's life cycle and, as our unconscious whisperer, to deliver a sustainable blueprint for our hope and change." - Chap Attwell, M.D., NYU School of Medicine

"In this compelling meditation on psychoanalytic training and practice, Sandra Buechler bears passionate witness to elements of being and becoming an analyst that few others have described. Never losing compassion for the novice she once was, she offers younger colleagues the most valuable support there is: relentless honesty about the demoralizing, lonely, moving, fascinating, and deeply satisfying world of practice that they are entering. Essential as it will be to psychoanalytic candidates, this book is equally nourishing to the experienced analyst." - Nancy McWilliams, Ph.D., Rutgers Graduate School of Applied and Professional Psychology

"If the concept of 'experience-near' didn't exist in our professional vocabulary, we would have been forced to invent it to describe Sandra Buechler's writing. Unlike much of our professional literature, Buechler is always down-to-earth, avoids idealizations, and pinpoints many experiences in the work of psychoanalysts and psychotherapists which are more often the topic of informal oral discussions among colleagues rather than of written papers and books. She discusses—among many topics—the painful formative experiences of beginners, vulnerable to demoralizing shaming during their training, to toxic work environments, and to the painful impact of very difficult patients (whom senior professionals may prefer not to treat). She discusses the pain of constantly separating from beloved patients through termination, and the even sharper pain when a patient dies. She talks of the anxiety around a diminishing practice, of the dangers of burnout, and of the slow process of developing resilience. I believe each one of us can find herself or himself in some of her vivid and insightful examples." - Emanuel Berman, Ph.D., Training Analyst, Israel Psychoanalytic Society

"This is a useful book for all practitioners, and particularly those involved in training. The author’s wisdom is summed up for me in the following sentence (pxvii): ‘I hope that my clinical encounters with shame and sorrow will strengthen me to bear the personal and professional losses my future holds’." Els van Ooijen - Therapy Today, October 2012

"As a psychoanalyst with 37 years of experience, I take pleasure in recommending without reservation Still Practicing: The Heartaches and Joys of a Clinical Career to teachers of psychoanalysis, the seasoned practitioner, students just beginning their analytic training, and prospective patients considering going into psychoanalysis."  - Alma H. Bond, PsycCRITIQUES, October 31, 2012, Vol. 57

"I am profoundly appreciative of the life lessons I take with me on closing the back cover of this book, not least of which is the startling reminder that, in the face of the most devastating experience of loss, “mourning with strength” (p. 64) is a possibility available to us because “[l]ife is constantly renewing itself, in the miracle of resiliency” (p. 201). I, for one, am very thankful that Dr. Sandra Buechler is “Still Practicing!” - Cleonie White, the William Alanson White Institute of Psychiatry, Psychoanalysis, and Psychology,  Psychotherapy

"With compassion and curiosity, Buechler, with a long and objectively successful career, reflects back on the challenges to maintaing a sense of hope, joy and curiosity when faced with the losses, endings and self-doubts that haunt us daily, taking their toll on clinicans and their patients, peers and candidates through the potential repercussions in the coutnless boundary violations and other acting out this can provoke... Buechler's book is both a plea and a renewal of vows toward the profession she loves." -Victoria Malkin Ph.D., L.P., American Journal of Psychoanalysis, 2014