Sandra Buechler, “Still Practicing: The Heartaches and Joys of a Clinical Career” (Routledge, 2012)

In Still Practicing: The Heartaches and Joys of a Clinical Career (Routledge, 2012), Sandra Buechler suggests that shame and loss are key components of a clinical career, and we would be best served to accept their presence and get used to their ongoing tug and pull.

Indeed, clinical training is rife with shame. Buechler reminds us that in training to be a clinician, unlike most other professions, one must investigate one’s defenses, one’s inner conflicts and do so in public. How to mitigate the shame that ensues? She suggests that we can certainly reduce shame about shame. Shame then must be accepted as an ineluctable aspect of the training.

The same with loss: losses of patients, all in good time or out of the blue, also prompt grief reactions and perhaps more shame in the clinician. Shame about shame begets rage, and according to her mentor, Sullivan, anger helps us to cohere in the face of dissolution. She wonders aloud whether shame and loss, suffered in silence, don’t end up prompting us to attack colleagues of different analytic stripes, or within our own ranks so as to shore ourselves up. Are the old battles among analysts a displacement of sorts?

Yet when an analysand leaves us, even if it is a well-planned termination, the experience is unique. No one we know knows the patient and even if we knew people who did we are bound by confidentiality to say nothing. So the analyst carries around unacknowledged and, in a way. unacknowledgeable losses.

Managing these feelings is of interest to Buechler as is the use of writing as a way to transform. Her book is a unique blend of memoir, emotion theory, and a survey of clinical life–and as such, it is in the tradition of new forms of psychoanalytic writing. As an interviewee she was full of clarity and verve and her words will be like salve on a wound for the clinician who is suffering from the slings and arrows, as well as the heartaches and joys, of a clinical career.

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