What Does Mental Health Look Like? : WHEN TO SAY GOODBYE TO YOUR THERAPIST <i> by Catherine Johnson Ph.D (Simon & Schuster: $17.95; 224 pp.) </i>


“When to Say Goodbye to Your Therapist” is in many respects a “how to” manual directed at the ever-growing number of Americans who turn to psychotherapy for solace and/or solutions. Catherine Johnson seeks to illuminate the difficulty many clients face in evaluating the usefulness of therapy. More specifically, as the title asserts, she explores the ambiguities of ending (or “terminating,” as the professional lexicon has it) treatment. Johnson draws on recent studies aimed at establishing who benefits most from therapy (and at what point in the course of treatment such benefits can be expected). She writes primarily of individual psychotherapy, with an emphasis on psychodynamic and cognitive orientations. And she has gathered personal accounts by individuals of their psychotherapeutic journeys.

The author suggests that many people end up staying in therapy, and at times with the wrong therapist, because of an inability to clearly evaluate their progress or lack thereof. The factors that contribute to their dilemma are the subject of this book. Johnson offers what is essentially a step-by-step consumer guide toward understanding what often goes on in therapy, what ought to go on, and when it is time to leave. She touches on a wide range of topics: how to choose a therapist; how to distinguish issues related to transference and countertransference; the ways money and power influence (if they don’t directly determine) the course and outcome of treatment. And of course, she examines the various criteria for ending therapy.

Throughout her discussion, Johnson makes several provocative (albeit hardly original) observations about our therapeutic culture (a culture that will embrace a book such as hers). She scrutinizes the manner in which power struggles are played out within the therapist-patient relationship; and she is especially perceptive about the unspoken assumptions that serve as the foundation for psychotherapy. She tellingly observes that “while therapists have developed a sophisticated set of criteria for identifying and characterizing mental illness, they do not possess an adequate set of criteria either for identifying ‘ideal mental health’ (usually called ‘positive mental health’ in the literature) or for measuring the degree of progress a patient has made. In short, therapists are underschooled when it comes to knowing what it looks like when a patient gets better.” Now that statement deserves a lot more attention. Supporting such incisive observations with references to numerous studies, Johnson manages to do what she has set out to do: to demystify psychotherapy and in the process restore to the reader/client a measure of power and knowledge often relinquished in therapy.

Yet, as a self-help guide this book clearly suffers from many of the weaknesses of the genre. It can be repetitive, simplistic and lacking in any sustained depth. Although Johnson relies on ample statements from her informants in order to illustrate her arguments, their voices are flat and two-dimensional. Sounding very much alike, and ultimately too much like the author herself, the statements lose the immediacy and punch they were undoubtedly intended to deliver. And Johnson appears all too pat and without nuance when offering such pragmatic advice as, “If you are serious about wanting to make it on your own without therapy, the period of missing your therapist simply has to be gotten through. You leave therapy and you miss your therapist, but you don’t go back.”


The suffering that brings people into treatment is multilayered and complex. Johnson is clearly aware of that fact. Yet the formulaic style of her book ends up flattening out that complexity, even as it manages to shed some light on the process of psychotherapy.