GARY R. RACUSIN, STEPHEN I. ABRAMOWITZ, AND WILLIAM D.

WINTER

Becoming a Therapist: Family Dynamics and Career Choice

This study submitted psychotherapists' recalled experiences in their families of origin to intensive psychodynamic analysis. The data were collected by using the intensive interview methodology developed by Henry, Sims, and Spray. Seven male and seven female therapists reported physical and behavioral conditions in their families of origin, which suggest helpless rage and conflict over the expression and acceptance of intimacy. Their current professional functioning reflects these early family experiences, including sensitivity to interpersonal stress and need to control interpersonal relations. The results are discussed in relation to the findings of Henry and his associates.

Personal motivations for choosing psychotherapy as a career have long been of interest (e.g., Freud, 1953; Roe, 1953), with conjecture centering on factors rooted in the family of origin. Formulations have focused on the relationship of personal experience in the family to professional functioning as a therapist. Menninger (1957) believed that therapists experienced emotional rejection in their families of origin. They project this history in their interest in lonely, eccentric, and unloved people. This self-concept is intolerably painful and is therefore repressed, and professional functioning provides perpetual self-healing. Ford (1963), reflecting on his experience with trainees, hypothesized that therapists undertake training to deal correctively with conflict arising out of early personal history. He cited a pattern of dominating mothers who were central to therapists' emotional and physical wellbeing and fathers who were passive and nonnurturant. Ford inferred that such childhood experiences present severe threats to the therapists' ego integrity, requiring many years of working through conflicting objects and identifications during the therapists' training. Burton (1970, 1972, 1975) conducted an oral history survey of a small sample of therapists and qualitatively analyzed their reflections. He discussed how the therapeutic interaction satisfies the therapists' own emotional needs. Like Menninger and Ford, he felt that professional functioning offers shelter from interpersonal conflicts originating in the family. Family life sensitizes the therapist to emotional pain and provides powerful personal motivation for career choice. Burton further concluded that these dynamics unconsciously restrict the therapist's efforts at conflict resolution to therapeutic encounters, at the expense of personal relationships. Relevant empirical research has appeared only within the past 8 years. Henry, Sims, and Spray (1973) confirmed that psychotherapists' family relationships were indeed stressful (e.g., physical illness, difficulties in expression of affect, adolescent struggles over independence). This history appeared to foster interpersonal sensitivity and a desire to understand human relations. However, Henry et al. did not believe that these experiences were sufficient to account for the choice of a mental health career; they were unconvinced that these background correlates distinguished mental health professionals from other professional groups. Family stress was regarded as distinctive only when coupled with therapists' generally superior intellectual development. Harris (1975) used Henry et al.'s intensive interview methodology to explore
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childhood recollections of a small sample of child therapists. She too inferred the existence of interpersonal stress in therapists' families. Specifically, parents' lack of emotional responsiveness necessitated that therapists turn to other adults for emotional support. Harris believed that these childhood deprivations facilitated therapists' capacity to empathize with their patients. In contrast to Henry el al., however, she felt that these characteristics were a hallmark of therapists. The research literature is thus equivocal regarding the impact of therapists' early family experiences on career choice. The current research was designed to bridge the clinical and empirical literature by generating dynamic formulations from qualitative as well as quantitative data. We employed the intensive interview format of Henry ct al. (1971, 1973) but subjected the data to more expressly psychodynamic and family process analyses. Because ol the large amount of data collected, this first report is concerned only with the relationship of therapists' childhood recollections to their careers. The relevance of family residues 10 therapists' marital functioning, the linkages between marital and professional life, and therapists' current perceptions of their own career development will be considered elsewhere. Method
SUBJECTS

The subjects were seven male and seven female therapists. Each was nominated by colleagues in the San Francisco Bay Area as comfortable with the high degree of selfdisclosure demanded by the study. The therapists all held degrees in clinical psychology, nine at the master's level and five at the doctoral. Although engaged in various secondary professional pursuits, all were primarily involved in clinical work. Therapists reported a substantial amount of postgraduate clinical experience (M = 6.9 years) and were employed in a roughly equivalent mix of public and private settings. Five therapists identified their theoretical orientation as neoanalytie, with the remainder distributed approximately equally among humanistic/existential, eclectic, bchaviorist,

CiARY R. RACUSIN is a doctoral candidate in the graduate group in clinical psychology al the University of California, Dams. Hit, research interests include personality Jactors associated with psychotherapists' career choice and current jiinctionmg ami occupational stress in health care delivery. STEPHEN I. ABRAMOWITZ received his PhD in clinical psychology from the University of Colorado in 1972. He is currently As sociale Projessor of Psychology and Director of Research in the Department of Psychiatry at. the University of California, Dams. His research interests include the politics oj professional practice and couritertransference processes in psychotherapy. WILLIAM 13. WINTER received his PhD in clinical psychology from the University of Michigan in 1953. lie is currently Projessor of Psychology and Director oj the Clinical and Community Psychology Programs at San Jose Slate University. He holds research interests in family systems, psychosomatic medicine, and bioenergelics. THANKS ARE DUE Nancy Moss and Christine Davidson for their help in confirming or disconjirming initial inferences drawn from the data. REQUESTS TOR REPRINTS should he sent to Gary R. Racusm, Department of Psychiatry, University of California, Davis, Sacramento Medical Center, 2315 Stockton Boulevard, Sacramento, California 95817.

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and gestalt. Male and female therapists were similar in age (M = 36.7 and 35.6 years, respectively). Six male and six female therapists had experienced at least one session of some form of personal psychotherapy.
PROCEDURE

Interview Process Interviews were tape-recorded by the investigator at a place and time of the subject's convenience. At the beginning of the interview, informed consent was obtained and confidentiality was assured. The therapist completed a demographic data sheet, and interview data were then gathered by the investigator. A structured series of 10 questions adapted from a questionnaire developed by Henry, Sims, and Spray (1971, 1973) inquired into the family of origin and possible roots of the therapist's eventual occupational choice (e.g., What specific roles, if any, would you say you have played in your family?). Information gained from interviews with therapists' spouses will be included in subsequent reports. Interviewer The interviewer was the first author, then a 26-year-old male in the 2nd year of a graduate program in clinical psychology. His preparation for the use of clinical interviews as a research tool included 5 years as a paraprofessional therapist at a community mental health center.
DATA ANALYSIS

Reliability of Quantitative Method A coding manual and accompanying tally sheet were first devised to permit the interview tapes to be coded systematically. Two types of quantitative information were coded, reflecting different levels of abstraction from the data. First, subjects' responses to interview questions were classified into major categories. Second, certain responses requiring greater abstraction were rated along a variety of dimensions utilizing either 6-point, bipolar scales or nominal categories. The interviewer and a female graduate student in clinical psychology then coded five randomly selected interviews. Interrater reliability for the 13 scaled dimensions was estimated via Pearsonian correlation and that for the three categorical dimensions was estimated via percentage agreement. Since correlations based on n = 5 are unstable, their average (r = .70) was taken as a rough measure of interjudge concordance on the bipolar ratings. Despite a range of from three to nine categories per nominal scale (M = 6.0), agreement reached 84%. Qualitative Method The qualitative analysis entailed the interviewer's subjective identification of thematic patterns in subjects' responses and educated speculation as to their possible etiologies and interrelations. To minimize idiosyncratic interpretation, professional colleagues were approached for convergence at successive levels of inference. Vol. 12, No. 2 April 1981 PROFESSIONAL PSYCHOLOGY 273

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Results and Discussion The results are presented in relation to the dynamic formulation they prompt: (a) that lack of nurturance encountered by future therapists in their families of origin generated feelings of helpless rage (Buss, 1961) and ambivalence toward interpersonal intimacy and (b) that the choice of psychotherapy as a career represents a defense against that helplessness by ensuring control over intimacy. Before proceeding, a brief review of the main constraints on interpretation seems prudent. The sample consists only of therapists who attained their career objective and thus perhaps those aspirants whose childhood conflicts over intimacy were most amenable to resolution. Likewise, the design did not allow for comparative data from siblings, nonpsychologist therapists, or other health care professionals. Although data analysis revealed no apparent differences between master's and doctoral-level psychologists, such heterogeneity may have influenced results. Finally, inferences are drawn from data based on therapists' own perceptions, so that the question of the degree to which projection and defensive rationalization were operative must be reckoned with.
PHYSICAL AND PSYCHOLOGICAL HEALTH

All 14 families had at least one member with a physical or behavioral difficulty involving presumed psychogenic factors. Fathers had the highest incidence of physical complaints, followed by mothers and the therapists themselves. Only one sibling had physical problems. Fathers' physical difficulties (heart attack, high blood pressure, diabetes) were all potentially aggravated by stress; one mother and the one sibling (both high blood pressure) and one therapist (asthma) also had such a problem. Psychological difficulties were even more numerous. Eight mothers, seven fathers, seven siblings and four therapists themselves were thought to have experienced such problems. Most of the difficulties were a mixture of neurosis and character disorder. Three parents were reported to have abused their children. Six others had physical conditions frequently psychogenic in origin; five siblings but none of the therapists had such psychogenic problems. Despite the range of difficulties presented, none of the parents and only two of the siblings and one of the therapists (as children) had undergone psychotherapy, suggesting defensiveness in the families about psychological issues. We regard these physical and behavioral conditions as manifestations of conflicts surrounding intimacy in therapists' families of origin. For example, people with chronic physical ailments demand large doses of unilateral nurturance for their care. The stricken person is the recipient and is generally not expected to reciprocate. The expression of intimacy in this setting may therefore be construed as devclopmentally primitive, as it parallels the unidirectional provision of nurturance by parents of very young children. At the same time, chronic physical illness allows the family to circumvent the need both to negotiate intimacy and to express emotionality in a more mature manner. The need for physical care may lock the family into one dominant mode of expressing intimacy, which effectively precludes the reciprocal expression of emotionality. Psychotherapy is likewise a nonreciprocal relationship, with the significant difference that the therapist now wields the power. Alcoholism and child abuse, syndromes that constituted 12 of the 38 psychological 274 PROFESSIONAL PSYCHOLOGY Vol. 12, No. 2 April 1981

problems reported, illustrate behavioral expressions that differ from chronic physical problems in their effects on other family members. Specifically, both syndromes frequently entail physical abuse (Adams, 1976; Krimmel, 1973). In the two cases of alcoholism, battering of children and spouses was in fact involved. Ambivalence regarding intimacy is manifested because physical contact is made between family members, although in an extremely punitive form (Amsterdam, Note 1). Physical intimacy is literally painful, potentially fatal, and very frightening. Therapists' early experiences in interpersonal relations may, therefore, have served as training grounds for sensitivity to interpersonal stress. In some cases, sensitivity to nuances of interpersonal functioning may have been necessitated out of fear for physical safety. This kind of empalhic understanding is commonly considered to be a valuable therapeutic commodity (Matarazzo, 1978).
PARENTS' OCCUPATIONAL STATUS

All occupations were assigned social statuses according to two systems: the Occupational Scale in Hollingshead's (Note 2) Four-Factor Index of Social Status and a classification system developed by Fendrich and Tarleau (1973). The latter categorizes occupations along a continuum ranging from those offering rewards of money in the private sector to those that offer the opportunity to express creativity and perform humanistic service. The two schemas yielded compatible information. The Hollingshead data support a pattern of upward mobility among therapists pointed out by Henry, Sims, and Spray (1971). Eight therapists had already surpassed the highest level attained by either parent. In five other cases in which fathers had achieved the highest level possible, therapists matched their fathers' proficiency. The Fendrich and Tarleau results, however, suggest an important qualitative difference in occupational choices. In 12 cases, the therapists had selected a professional calling that was at the opposite end of the spectrum from that of either parent, one concerned with human service as distinguished from an orientation toward the accumulation of wealth and status. None of the fathers was drawn to a human service occupation, which maximizes the chance to gratify nurturance needs. Assuming that occupational choice is a reflection of personality organization (Roe, 1953), it may be hypothesized that these men were also not especially nurturant with their own children. Mothers evidently were primarily responsible for their children's care. Six male and five female therapists reported that their mother was the parent with whom they felt closest. Therapists may have allied with mothers against fathers, thereby identifying with the role of underdog and further limiting the degree of paternal closeness. The role of therapist itself implies a certain degree of traditional feminine identification. Therapists' early identification with mothers against fathers may be recurrently expressed in their efforts to provide nurturance that their patients are not receiving elsewhere. Henry et al. (1973) raised the question of the extent to which therapists' mothers were actually able to carry out their mandate as primary nurturers. Five of the therapists' mothers were reported to have experienced serious psychological problems (two alcoholic, two depressed, and one suffering frequent migraine headaches). Therapists may have sought out a career that affords them emotional intimacy on a daily basis to compensate for parental deprivations experienced from very early on.
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PARENTS' MARITAL RELATIONSHIPS

Ratings of therapists' perceptions of their parents' marital relationship indicated that parents were only moderately close, both emotionally and physically, with one another. Parents had only a limited capacity for age-appropriate emotional expression. Marital relationships were quite stressful due to both impaired relationship functioning and to the pressures of jobs and finances. Parents tended to sustain these stressful marriages, as there was only one separation and no divorces. In two instances, the parents evidently moved over time into a relationship of "alienated intimacy," spending much time together without really liking each other. Therapists were enmeshed in these stressful marriages. Many felt that having children provided the parents with a buffer for maintaining a desired degree of emotional distance between each other, whereas some felt that children placed severe financial strains on the marriage. In one marriage, the decision to have a child represented a last-ditch effort to keep the couple together. The decision to have children thus may be seen as further reflecting ambivalence regarding intimacy. The parents wanted a relationship that would substitute for the intimacy lacking in the marriage, yet wanted to preserve the marital status quo. These impressions support the formulation that therapists perceived their family environment as nonnurturant and stressful. The parents' malfunctioning relationships may help to explain therapists' attraction to highly structured transactions of intimacy. The decision to be a therapist may represent an attempt to achieve interpersonal intimacy in safe, controlled relationships where the degree of stress can be regulated by the therapist.
THERAPISTS' ROLES IN FAMILY OF ORIGIN

Half of the therapists (three males and four females) felt that their primary role had been providing parenting in the form of responsibility for family functions or nurturing. Most of these therapists felt they had filled this role for at least one parent. For two additional therapists, one male and one female, parenting was a secondary role. Three therapists played a role of counselor or mediator, which entailed being aware of the family's emotional life, providing advice and consultation about others' private concerns, and being responsible for reducing family tensions and resolving arguments. If "parenting" and "counseling" arc understood to involve caretaking of one kind or another, then these two roles together were identified as foremost by almost three fourths of the therapists. These individuals reported themselves to have played roles designed to fulfill the needs of others. Therapists apparently were sought out from an early age because of their ability to satisfy important emotional needs of family members. Therapists were perhaps defined by their families as affectively or "therapeutically" oriented, singled out for their effectiveness in dealing with emotional life, and labeled by other family members as confidantes or counselors. In a more negative sense, this identification may also have branded therapists as being in some way "different" from the rest. The extent to which the process of identification and assumption of role may have been overt or unconscious remains in question. However, since these roles may be conceptualized as fulfilling wishes that stem from the parents' inadequacies, it seems reasonable to assume that the process was largely unconscious. 276 PROFESSIONAL PSYCHOLOGY Vol. 12, No. 2 April 1981

OTHER IMPORTANT FAMILY FIGURES

Therapists evidently sought out others for emotional intimacy at an early age. For example, most therapists felt more closeness with siblings than with either parent. At the same time, only one fourth of the therapists who had siblings had a strong sense of closeness with them, implying that even here intimacy was not great. Children in these families may have achieved only limited success in providing the nurturancc lacking in their filial relationships. Eight therapists reported some other family relation to have had significant impact on their emotional or physical welfare, and the impact was almost always viewed as positive. In all but one instance, this individual was female (aunts and grandmothers); the lone exception was a male therapist who felt that his maternal grandparents as a couple had provided him with much compensatory parenting. In view of the predominant pattern of sex role functioning when the therapists were children, it would seem that this prevalence of women implicates therapists' attempts to obtain nurturing and, in a word, mothering in the traditional sense.
Implications FUTURE RESEARCH

The conception and design of this study were based on the pioneering research of Henry, Sims, and Spray (1971, 1973). In several respects, our findings concur with those of the Chicago researchers. We too found among our sample of therapists frequent deprivation of parental nurturance and upward social mobility. In other important respects, however, our findings diverge from those of Henry et al. (1973). Psychologically related physical or behavioral difficulties were present in the families of origin of all 14 therapists in our sample, suggesting substantial interpersonal stress. In summarizing his research, Henry (1978) reported that therapists' family relationships were generally positive and that they experienced relatively little emotional distress during childhood. About one fourth of his sample had a history of conflicted family relations, a figure that he concluded did not distinguish therapists from other populations. The number of psychosomatic disturbances in our therapists' families of origin suggest otherwise. The interview format of the current study may have permitted deeper exploration than Henry et al. (1971, 1973) were able to achieve, even in their intensive subsample interviews. Alternatively, the incidence of psychosomatic difficulties we detected may be idiosyncratic to our small and admittedly unrepresentative sample. More extensive research is needed to arbitrate this discrepancy. Given the absence of control occupations in Henry et al.'s and our research, a pressing need exists for future research to establish a baseline of family and psychosomatic conflicts against which to compare psychotherapists.
CLINICAL DIRECTIONS

The formulation relating therapists' experiences in their families of origin to career choice might be of use in assessing candidates for therapy training. If therapists strongly committed to the profession manifest the dynamics that characterize our sample, their presence in an applicant's background could signify a promising trainee. Interviews and applications could be structured to include questions probing the rclVol.l2,No.2 April 1'981 PROFESSIONAL PSYCHOLOGY 277

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evant areas. A candidate's experiences in the family of origin would not be the only or major factors considered, but they could contribute to an overall picture of training appropriateness. It would be of interest to study whether therapists with these background characteristics arc especially empathic or effective. Supervisors might find the formulation useful in identifying specific countertransference issues in their trainees. Some examples here might include uneven exercise of control in therapy, problems with business-oriented individuals, and rage responses to "clinging," passive-dependent patients and those with psychosomatic complaints. The impact of personal dynamics on professional functioning also has implications for daily treatment issues. Therapists' awareness of their covert motivations for career choice should facilitate professional growth and maximize effective therapeutic functioning. In addition to analysts and those family therapists whose professional training included extensive self-analysis, many therapists can benefit from a clearer understanding of the personal roots of their own professional choices. REFERENCE NOTES 1. Amsterdam, H. B. Personal communication, October 6, 1978. 2. Hollingshead, A. B. Four-factor index of social status. Unpublished manuscript, 1975. (Available from August B. Hollingshcad, Sumner Professor Emeritus, Department of Sociology, Yale University, 140 Prospect Street, New Haven, Connecticut 06520.) REFERENCES Adams, W. V. The physically abused child: A review. Journal of Pediatric Psychology, 1976, 7(2), 7-11. Burton, A. The adoration of the patient and its disillusionment. American Journal of Psychoanalysis, 1970, 24(3), 494-498. Burton, A. & Associates. Twelve therapists. San Francisco: Jossey-Bass, 1972. Burton, A. Therapist satisfaction. American Journal of Psychoanalysis, 1975, .35(2), 115122.

Buss, A. The psychology of aggression. New York: Wiley, 1961. Fendrich, J. M., & Tarleau, A. Marching to a different drummer: Occupational and political correlates of former student activists. Social Forces, 1973, 52, 245-252. Ford, E. S. C. Being and becoming a psychotherapist: The search for identity. American Journal of Psychotherapy, 1963, 17, 472-482. Freud, S. The interpretation of dreams. In J. Strachey (Ed.), The standard edition of the complete psychological works ojSigmund Freud (Vols. 4 & 5). London: Hogarth Press, 1953. Harris, B. M. Recalled childhood experiences of effective child psychotherapists. (Doctoral Dissertation, California School of Professional Psychology, San Francisco, 1975.) Dissertation Abstracts International, 1976, 36, 3607B. Henry, W. E. Personal and social identities of psychotherapists. In A. Gurman & A. Razin (Eds.), Effective psychotherapy: A handbook of research. New York: Pergamon Press,
1978.

Flenry, W. E., Sims, J., & Spray, S. L. '1'he fifth profession: Becoming a psychotherapist. San Francisco: Jossey-Bass, 1971. Henry, W. E., Sims, J., & Spray, S. L. Public anil private lives of psychotherapists. San F'randsco: Jossey-Bass, 1973. 278 PROFESSIONAL PSYCHOLOGY Vol. 12, No. 2 April 1981

Krimmel, H. E. The alcoholic and his family. In P. Bourne & R. Fox (Eds.), Alcoholism: Progress in research and treatment. New York: Academic Press, 1973. Matarazzo, R. Research on the teaching and learning of psychotherapeutic skills. In S. Garfield & A. Bergin (Eds.), Handbook of psychotherapy and behavior change: An empirical analysis (2nd ed.). New York: Wiley, 1978. Menninger, K. Psychological factors in the choice of medicine as a profession. Bulletin of the Mennmger Clinic, 1957, 21, 51-58, 99-106. Roe, A. A psychological study of emminent psychologists and anthropologists and a comparison with biological and physical scientists. Psychological Monographs, 1953, 67(2, Whole No.

352).

Received March 31, 1980

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