On Learning from the Patient by Patrick Casement

Following on in the genre of reading books about how much therapists can learn from their clients, as well as the other way round, I picked up On Learning from the Patient by Patrick Casement from the library the other day.

Casement stresses the importance of keeping an open mind: not just in terms of the things clients are saying, but also about one’s own theoretical outlook as a therapist. There is a danger, he says, of responding to clients “with a false sense of recognition.”

Not only should we be prepared to look at the world outside of our comfortable theoretical framework, but we should also remember that each client is an individual. Just because two clients discuss issues that seem, on the surface, to be similar, that doesn’t mean they are.

This is a viewpoint that I have heard repeatedly over the years, both on recent psychotherapy courses and in prior psychology training. However, it is rare to find someone who actually believes it enough to practise what they preach. I don’t know Casement, but I suspect he might do just that.

It also intrigued me to get a glimpse into the world behind the curtain of professionalism that many therapists like to insist is intrinsic to the practice. Any good therapist, claims Casement, will adapt to their patients even if they don’t admit it to other therapists.

Casement advocates a more open approach, not only with clients but also between therapists. This is something I have noticed in training: students are often told that they must never bend the frame they have put in place; that the rules are there for a reason, etc. etc.

But I have found in my journey with my own therapist that the most useful work we do together is when she is being flexible. Therapy is, after all, a human relationship – albeit one with an unusual setup – and human relationships don’t easily fit into frames and formulae.

I enjoyed On Learning from the Patient, and I particularly liked some of the case studies illustrating the points Casement was arguing. In some ways, it’s a confusing book to read while you’re training, because it goes against so much of what is being taught.

In any industry, though, it’s important to remember that we have to learn the rules first, so that we can bend or break them later in an informed way; and therapy is no different.

I would like to revisit this book in a few years’ time, once I have some clinical hours behind me, and see what I think of it then.

1 Comment

  1. I’ve found exactly the same with my therapist. The willingness to meet me half way (some of the time) means a lot, and goes a long way to deepening the therapeutic relationship and for me, building trust.


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