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Systems and Psychoanalysis

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'This intellectually rigorous and generative collection of papers, positioned at the intersection of systemic and psychoanalytic therapy, captures the potential synergy of bringing these two honoured traditions back into dialogue, on new terms. The editors do partisans of both fields a great service in this effort, since their long-standing mutual isolation has kept each dismissive of the other, and ignorant of developments in the other's field - to their mutual detriment. The book tracks the ways in which innovative systemic practitioners are creatively reassembling the clinical and intellectual lineaments of psychodynamic and systems thinking in their work. While the strategies are many and varied, the collection as a whole reflects some of the deepest ideals and practices of both traditions at their best: holding complexity, tolerating contradiction, seeking common ground, seeing past limiting and ideologically driven binaries, thinking and working outside the box, and honouring history and tradition, even while digging it up.' - Virginia Goldner, Ph.D. Faculty Emeritus, Ackerman Institute for the Family; Faculty, New York University Post-doctoral Program in Psychoanalysis and PsychotherapyAbout the Editors

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CHAPTER ONE: Narrative, meaning-making, and the unconscious

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Carmel Flaskas

In shaping my contribution to this book, I wanted to tackle some I current systemic therapy theory issues. My chapter is, in part, an exploration of the metaphor of narrative, and the liberation and limits of meaning-making through language. It is also about the relationship of conscious and unconscious experience, and the territory that lies between languaged stories on the one hand, and the not-yet-said and the (perhaps) “unsayable” on the other. These topics relate to the process of meaning-making, and the relationship of lived experience to “story”, as well as the relationship of the person who is constructing the story to her or his experience. Although this chapter is primarily about theory and ideas, my interest in it has been carved out in the experience of practice, and it rests on layer upon layer of wondering about the experience of therapeutic change and the process of meaning-making in psychotherapeutic work.

The structure of the discussion is quite simple. I begin by sketching the constellation of language, meaning, and the metaphor of narrative in the current context of family therapy theory. The chapter then moves to explore the complexity of the relationship of language to the realness of lived experience, along with theopportunities for meeting realness in the space between unconscious and conscious experience. Tackling narrative and meaning-making from a different angle, the next part of the theory discussion addresses some broad conditions of transformative narratives, drawing on knowledge relating to coherent attachment narratives, and the ideas of mentalization and reflective functioning. Finally, I offer a rather messy piece of practice with a set of reflections on the resonant themes.

 

CHAPTER TWO: Working with unconscious processes: psychoanalysis and systemic family therapy

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Julia Bland

This book addresses not only theoretical integration but also concerns of daily practice: how can we integrate psychoanalytic and systemic therapies, and what do we mean by integration? Working as a clinician trained in both disciplines, I find that there is a tension between the struggle to integrate (or at least hold on to both models) without denying difference, and the wish for clarity and simplicity, a sense of definite anchorage in the clinical sea. My chapter explores challenges in the integration of these two frameworks, addressing theory differences and practice, particularly with respect to working with unconscious processes in family therapy. It moves from a discussion of the cultural differences of psychoanalysis and systemic therapy and their respective contexts of theory to an exploration of their contrasting orientations to symptoms and change, and the differences in therapeutic relationship and style. Finally, clinical examples are used to explore the challenges and possibilities of using psychoanalytic and systemic ideas in working with unconscious processes in family therapy.

 

CHAPTER THREE: Is there another word for it? Countertransference in family therapy

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Sebastian Kraemer

Family systems therapists are uncomfortable using psychoF analytic terms. This reluctance restricts discussion of therapeutic process. How does one describe, for example, the therapist's subjective experiences that occur in the presence of the patient or family? Psychoanalysts call this countertransference, yet there is no equivalent word commonly used in systemic practice. Therapists who avoid the word may also avoid the concept, and thereby risk losing sight of fundamental clinical events.

Writing history backwards

“Where does all this stuff come from? How do we decide to say what we say when we work with families….?” asks Sigurd Reimers (2006, p. 230). His sources include references to earlier texts by one of the editors of this book (Carmel Flaskas) but no primary psychoanalytic ones at all. The earliest reference in Reimers’ paper is to an observation by James Framo that “it is almost impossible not to get caught up in the drama of the family interaction” (Framo, 1965, p. 197) and a candid look at the “cases that touch on a feeling of'madness’ in us” (Reimers, 2006, p. 237). Reimers is thoughtful and observant, but there is something parochial about a paper on the process of therapy that ignores the greatest body of work on the subject.

 

CHAPTER FOUR: Interpreting dreams in psychotherapy with couples: moving between the upper and lower worlds

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Deborah A. Luepnitz

Dream interpretation is a highly effective, curiously underutilized technique in the psychoanalytic treatment of D couples, allowing partners to clarify unconscious conflicts, gain compassion for the other, and deepen intimacy.

Freud, who recognized the grave importance of dreams, their role as “royal road to the unconscious” (Freud, 1900a, p. 608), treated individuals only, as have most subsequent analysts. Those analysts who have taken up the work of marital and family therapy have written little, if anything, about dreams. Two recent articles (Nicolo, Norso, & Carratelli, 2003; Scharff & Scharff, 2004) suggest that interest in such work may be growing.

The present author stumbled on new uses of dream interpretation during the treatment of a poor African-American family in the early 1980s. The identified patient, fifteen-year-old Leroy Johnson, had been in trouble since kindergarten, when he ruined the completed art projects of everyone in his class during recess. Years of truancy and vandalism led eventually to a court-ordered psychiatric evaluation on our inpatient unit for thirty days.

 

CHAPTER FIVE: Anger and boredom: unpleasant emotions in systemic therapy

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Paolo Bertrando and Teresa Arcelloni

Systemic therapy lacks a proper theory of emotion. In the early S days of systemic family therapy, the therapist focused on family interactional patterns, avoiding what the psychoanalytic paradigm had arbitrarily located in a non-observable area—the intrapsychic dimension—where emotions were thought to originate (Bertrando & Toffanetti, 2000). Afterwards, rationalism prevailed within strategic therapies. This saw human interactions as rational contracts between actors who actively sought what they considered the best for themselves (see Haley, 1976; Jackson, 1965). (Kleckner, Frank, Bland, Amendt and duRee Bryant [1992] contend that strategic therapists do not “ignore, avoid or neglect client feelings in treatment” (p. 41), and that such a “myth” is disproved by what strategic therapists actually do in sessions.) When emotions were reconsidered, they were defined as “predispositions for actions” (Maturana, 1988, p. 49) recalling, once again, their pragmatic and developmental function inside a system. Only in later years have emotions begun to find a place within social constructionist theorizing and systemic therapy (e.g., Fredman, 2004; Kavner & McNab, 2005; Pocock, 2005).Like most systemic thinkers, Maturana also emphasizes the positive functions of emotion. Little room is left for what we may define as unpleasant emotions, such as anxiety, anguish, anger, envy, ingratitude, boredom, indifference, disillusion, and disgust. There are many reasons for this. The first, though, is still traceable to the reaction to some key psychoanalytic ideas, from which systemic therapy felt a need to differentiate itself. Second is the optimistic and liberationist ideology intrinsic in the American psychotherapeutic tradition (on which most systemic family therapy was originally based): any individual is fundamentally good, and he or she is made bad only by external constrictions (Cushman, 1995). In this is rooted the tendency to see mostly resources and positive aspects in clients. This tendency was already present in Milton Erickson's work (the celebrated Ericksonian motto, that everyone always does her best, in the situation she is in; Lankton, Lankton, & Matthews, 1991), and brought to its maximum expression by narrative (White, 1995) and conversational (Anderson, 1997) therapists.

 

CHAPTER SIX: Working with emotional systems: four new maps

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David Pocock

The worst dentist I ever had was a Scotsman with terrible breath who engaged in the sort of institutionalized lying T that was common, I suspect, in the dentistry of children in the early 1960s. The phrase “It will'na hurt laddie”, I soon came to realize, heralded the onset of unavoidable squirming agony …or so I remember it. And “Never mind laddie, just a wee bit more” was a sure sign that whatever he was doing to me would not be finished this side of lunch-time. My best strategy, apart from simultaneously tensing every part of my body, was to dig my nails into my palms to try to spread the pain around as much as possible.

The best dentist I ever had, about ten years ago, was a Home Counties woman who, whenever I flinched, said, “Ooh”, as if I were a baby, which, of course, in some ways, I am. Her “Ooh” was not a direct reflection of my feeling but an acknowledgment that it hurt, plus a small modification of that hurt. The modification was a little pantomime that showed, quite unconsciously, that while she recognized the pain, she was not feeling it as I was (it would be no good for us both to squeal) but it was a compassionate acknowledgment of my discomfort and her part in causing it. Sadly, she leftthe practice after five comparatively painless years, presumably to become a saint.

 

CHAPTER SEVEN: Thinking through togetherness: developmental metaphors and systemic thinking

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Rolf Sundet and Vigdis Wie Torsteinsson

The field of systemic family therapy, usually with good reason, has been sceptical towards expert knowledge in every form. T Instead of acting as someone who knows better, the family therapist has generally recognized the client's expertise, and the co-operation and reciprocity between family and therapist as the “gold standard” of therapeutic practice. Critical voices have, however, cautioned against a disavowal of therapeutic expertise, since this might prevent the therapist from making his/her professional knowledge useful to the family (Minuchin, 1998). In this chapter, we discuss concepts drawn from the knowledge base of developmental psychology, with an extended focus on the basics of human relating (Johnsen, Sundet, & Torsteinsson, 2004). Our main purpose is to outline how these concepts can enable the therapist to work collaboratively in ways that enrich the family therapy paradigm.

Much contemporary family therapy revolves around language: the generation of change through promoting new descriptions and co-authoring new stories. While social constructionist family therapy literature insists on the basic significance of language in the generation of meaning and meaning-making processes, the understanding of how language connects with non-linguistic interplay, oreven how relational processes contribute to bringing about new linguistic expressions and new stories is sparse. When a parent says that he “understands”, but his seventeen-year-old daughter responds as if he has said just the opposite, then how do we understand and react to what is happening between them? When a boy of eight enters therapy with his mother, but refuses point-blank to talk about difficult things, how do we handle this as part of a therapeutic process where we want everybody to be involved?

 

CHAPTER EIGHT: Love and hate and the oedipal myth: the perfect bridge between the systemic and the psychoanalytic

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Jeremy Woodcock

So, who are you, reading these introductory thoughts? Can you imagine me, the writer? Can you also bring into your S mind, however vaguely, an impression of the ideas we may think about in this chapter? If so, I would conjecture that your entry into thoughts about what is being written, and the flowing together of your mind and my own, stands on ground described in psychoanalytic theory as arising from our joint resolution of the oedipal situation. The oedipal myth, as used by Freud, is often reacted to by systemic therapists as an example of the quaint absurdity of much of Freud's foundational thinking. It is also sometimes read as indicative of regressive attitudes and paradigmatic of the failure of psychoanalysis to get to grips with a balanced, gendered account of human development. The notion of the oedipal triangle was initiated by Freud, and developed by later psychoanalytic thinkers such as Klein and Winnicott, the self psychologists such as Kohut, as well as within the intersubjective psychotherapy tradition. This rich development of theory offers a powerful way for thinking about the basic building blocks of emotional life.

 

CHAPTER NINE: Reflecting processes and reflective functioning: shared concerns and challenges in systemic and psychoanalytic therapeutic practice

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Mary Donovan

Historically systemic psychotherapy evolved in contexts of making sense of the difficulties of families and individuals H not readily amenable to a classical psychoanalytic, insight-orientated approach. They sought relief for their suffering, but did not necessarily view the interpretation of intrapsychic conflict as part of this focus. Over the years, systemic family therapy has constructed an impressive repertoire of alternative styles of practice for engaging and helping people to develop their capacity to stand back and reflect on their presenting difficulties as part of the change process. Circular and reflexive questioning, as well as reflecting teams, are notable examples of this rich legacy (e.g., Andersen, 1990; Brown, 1997; Tomm, 1987a,b).

Contemporary psychoanalysis demonstrates a similar preoccupation with exploring ways of engaging and working with people not readily responsive to a traditional interpretive approach. “We no longer practice in an era in which interpretation is viewed as the exclusive therapeutic arrow in the analyst's quiver” (Gabbard & Weston, 2003, p. 823). In psychoanalytic discourse, Fonagy and Target's theory of mentalization or reflective functioning (e.g., Fonagy & Target, 1996, 2003; Fonagy, Moran, Edgcumbe, Kennedy, & Target,1993; Fonagy, Steele, Moran, Steele, & Higgitt, 1991) is a notable example of this project to broaden the repertoire of psychoanalytic practice. This chapter explores shared ground between systemic and psychoanalytic orientations that this highlights, and specifically teases out connections between the systemic perspective on reflex-ivity and reflecting processes and the psychoanalytic perspective on reflective functioning. It concludes that the truly innovative nature of integrative thinking across the different therapeutic orientations is most clearly demonstrated in the endeavour to increase the range of those engaged and helped by psychotherapy.

 

CHAPTER TEN: In the thick of culture: systemic and psychoanalytic ideas

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Inga-Britt Krause

In the introduction to a book about cross-cultural psychother-I apy, I made the comment that any cross-culturally practising psychotherapist, in some way, must feel compelled to adopt a systemic perspective (Krause, 1998). This was a statement that traced and documented my own personal journey from social anthropology to family therapy, but I also wanted to call to mind the historical connection between the two disciplines via Bateson (Krause, 2006), “culture” as a systemic idea (Krause, 2002), and the contribution of social constructionism to contemporary systemic psychotherapy.

In the same book I worked my way through different areas in which cultural patterns, symbols, and meanings impinge, constrain, and are implicated in the behaviour and experience of persons. These included kinship, emotions, ritual, taboos, and secrets. My argument was that much cultural material is outside the realm of individual awareness in the form of different types of knowledge and structures, some of which seem unquestionable and natural to individuals. (I used Bourdieu's terms doxic and habitus to refer to knowledge, which is imprinted on the body and the mind as the result of the operation of structures that are unconsciouslyregulated and that incorporate culturally structured patterns, routines, improvisations, and meanings. I quoted Bourdieu as saying, “It is because subjects do not strictly speaking know what they are doing that what they do has more meaning than they know” [Bourdieu, 1977, p. 79].) I referred to material that is “implicit”, “outside awareness”, and to those aspects that are not articulated verbally, but I did not use the term “unconscious”. This was partly because of the technical meaning of this term in psychoanalysis, but also because I felt a need to be cautious. The evidence of cultural diversity in areas outside consciousness is abundant, but questions about how this works, how we may understand it, and what kind of model or theory we may choose to use are complex. Ultimately, we all have to answer the same ethical questions about our own relationship to that with which we are engaged and to the models for which we make claims.

 

CHAPTER ELEVEN: What does the other want?

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Stephen Frosh

“O let them be left, wildness and wet;
Long live the weeds and the wilderness yet”

(Gerard Manley Hopkins, 1970, “Inversnaid”)

After a rocky start, which resulted in accusations (particularly from feminists) of normative politics and blindness to social inequality, systems theory has developed an honourable and now long tradition of engaging with oppression—gender, sexual, race, and class—and advocating democratic and emancipatory practices within therapy (e.g., Burck & Daniel, 1995; Mason & Sawyerr, 2002; McGoldrick, 1998). The shift from first order to second order cybernetics was crucial here, as it forced systemic therapists to consider their practices in a reflexive mode, a move that has resonance with the “relational “ move in psychoanalysis that has also struck a chord amongst feminists (Benjamin, 1998). Given the very large number of women working psychotherapeutically with children and families, it was perhaps predictable as well as necessary that systems therapy would have to deal with feminist concerns. Yet, subsequent extensions of the political critique toengage with “race “ and culture have provoked a very extensive and impressive attempt to come to terms with what is experienced as an even more challenging block in the therapeutic way of thinking. That is, female systemic therapists spoke from within their immediate experience when confronting sexism, and with the intellectual and political backing of a very powerful movement. In addressing issues of racialized oppression and conflict, family systems theorists and therapists—overwhelmingly white and western—have had to think through what it might mean to be confronted with “otherness”, including how they are incorporated into it and also how they might face the limits of understanding and of the appropriateness of their methods. In this context, the efforts of several senior and influential members of the systemic community to address cultural and “race “ concerns have been exemplary (Mason & Sawyerr, 2002; McGoldrick, Giordano, & Pearce, 1996), and some powerful attempts have been made to institute actively anti-racist procedures in family work (for example, by the “Just Therapy” group [Waldegrave, Tamasese, Tuhaka, & Campbell, 2003]).

 

CHAPTER TWELVE: Intersecting Levinas and Bion: the ethical container in psychoanalysis and family therapy

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Glenn Larner

In a previous publication, I defined a common ground between I psychoanalysis and family therapy as constructing a narrative or dialogical space to explore personal and relational meaning in the therapeutic relationship (Larner, 2000). Whereas the focus for family therapy is the systemic pattern of relationships, including the therapist-family interface, in psychoanalysis it is the emotional intensity of the transference relationship over the long term (Bertrando, 2002). I suggested that analyst and family therapist both integrate not-knowing and knowing in a both/and or deconstruc-tive stance of knowing not to know. Following Bion, this creates a narrative container, or reflective space, for thinking to emerge in the therapeutic conversation (Flaskas, 2002).

In this chapter, I intersect Bion's thinking with the ethical philosophy of Emmanuel Levinas in the idea of the “ethical container”. For Bion, containment is a relational process: a being with the patient in thoughtful reverie where emotional and symbolic meaning is held, interpretations are ventured, and thinking develops. For Levinas, the foundation of thinking is the ethical relation to the other. The “ethical” is the incomprehensible, the disruption of knowing by not-knowing in face-to-face encounter with the other (Larner, 2004). This intersection proposes that therapy is, first and foremost, an ethical relation where the therapist's stance of knowing not to know constructs an ethical container for thinking and for relational meaning to grow.

 

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