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Elusive Elements in Practice

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The third volume in the The Practice of Psychotherapy series, Elusive Elements in Practice brings together a collection of papers, examining their ideas and theories more commonly regarded as off-centre, or indeed elusive, in psychoanalytic psychotherapy. The papers in this volume concentrate on the religious and spiritual dimension of the therapeutic encounter, the "aesthetic experience", creativity and mysticism. These "moments of relatedness", or meetings of minds, are discussed and examined with the help of clinical examples.'...[psychotherapists] tend to agree on what is just too eccentric and is to be regarded with reserve and suspicion. These ideas are left on the margins and, getting less attention, they are more elusive. They will not get concentrated consideration either in the consulting room or in the study. This is one reason why they are more elusive. But such neglect may cause potentially good ideas to be lost, as well as ridiculous ones.'- From the IntroductionContributors:Patricia Allen; Bernardine Bishop; Faye Carey; Nathan Field; Angela Foster; Josephine Klein; Steven Mendoza; and Victoria O'Connell.

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CHAPTER ONE. Mechanisms and mysteries

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Nathan Field

When my patient John first came to see me he was depressed, confused and virtually at the end of his tether. He had not expected to feel so deeply upset when his father died some months earlier. He had fallen out with him many years before, quite unable to forgive him for what he felt was a lifetime of harshness and intimidation. He had barely spoken to him even at his mother’s funeral. From his teens onward John had thought of his father as a brute, he saw himself as his victim, and his mother as a martyr. What frightened him now was his unexpected grief at his father’s death.

In the therapy, because I was more or less his father’s age, he transferred onto me his fear and hatred of male authority figures. I worked hard to sustain an empathic attitude and interpret as helpfully as I could; but he remained deeply mistrustful and interpretations never seemed to sink in. Even though he didn’t explicitly reject them, I suspected that they ran off him like rain off plate glass.

The label I might apply to John is “paranoid-schizoid”: the paranoia refers to his underlying fear and suspicion; the schizoid means split. By dying his father had become a good object, and I a bad one. John tended to see most of his life in terms of opposites. Usually the opposites did not meet; they just co-existed, like heads on one side of a coin and tails on the other, and John could only believe in the side which was uppermost. Most people who come for therapy function at a similar level. In their judgments they switch from black to white, friend to foe, love to hate, pain to pleasure. Each state of mind, while it persists, totally defines their reality, then flips to its opposite, and carries the same conviction. Like a coin, there is no space for anything in between, namely thought. They live in what I would call the realm of the two-dimensional. I use this term to convey that their perceptions are distorted, rather in the way that large continents are distorted on a map as compared to a globe, and it is little wonder their lives feel existentially flat.

 

CHAPTER TWO. Love, the aesthetic conflict and the self

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Patricia Allen

In 1988 Dr Donald Meltzer and Meg Harris Williams wrote a book on “the role of the aesthetic conflict in development, art and violence”. The Apprehension of Beauty added a new dimension to psychoanalytic thinking on development at that time. It was a dimension which suggested that Meltzer’s thinking was close to the work of another great innovator, Dr Michael Fordham. While Meltzer’s ideas grew from within the Kleinian tradition, Fordham was a follower of Jung. Fordham’s work as a child psychiatrist and, later, analyst, led him to postulate a theory of early development. His model was based on Jung’s concept of the self as the totality of the psyche with its personal and collective aspects and he demonstrated its relevance to infancy. Thus, Fordham brought to analytical psychology a coherent model of development. Whereas Jung’s idea was of a self becoming active in mid-life through the process of individuation, Fordham’s theory was that there exists a primary self, a primary state of integration, a psychosomatic unity, which deintegrates and reintegrates as the infant instigates a relationship with his mother. In The Apprehension of Beauty, the authors write imaginatively of the mental life of the foetus and the new-born. They say:

 

CHAPTER THREE. The emerging religious dimension of knowing in psychoanalysis

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Steven Mendoza

Introduction

Freud treated religion as an illusory belief system explaining natural phenomena and establishing inhibitors of instinctual drives as a pseudo-moral system-regulating behaviour. Religious experience, as against religious belief and religious observance, he seems to have dismissed as an oceanic, that is manic, process even more divorced than belief from the function of the ego to test reality. Bion, an impeccable scholar of Freud, writes in 1967 as though he expects us to take for granted “experience of God”, “religious awe”, “ineffable experience”. He says, “The psychoanalyst accepts the reality of reverence and awe.” Commenting in 1967 on his earlier paper “Notes on the theory of schizophrenia”, on the complementary senses of memory and desire, he explains:

… There needs to be a recognized formulation which is understood by all psycho-analysts to display the invariants in an event which is unconscious because obscured by memory, although it has happened, and an event which is manifest because disclosed by desire though it has not happened. Memory and desire may be regarded as past and future “senses” (analogous to the mathematical concept of “sense” and applying indifferently to time or space) of the same “thing”. Making use of sense in this way a formulation would have the same value as “memory “, the former referring to an event that had happened and the latter referring to an event that had not happened and therefore not usually described as being “remembered”. A patient who could be described in terms of conversational English as “remembering” something that had not happened would resemble a patient who was described as hallucinated. Conversely the patient who did not remember what had happened, through the operation of or remembered what had not happened, through the operation of the same agency, should likewise be recognized as belonging to the same underlying group of “hallucinosis”.

 

CHAPTER FOUR. Therapy by design: style in the therapeutic encounter

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Faye Carey

Introduction

As with art, the point of psychotherapy is change. People make art, or come to it, seeking transformation—within, and without. Psychotherapy as a creative process is often compared with literature, but the comparison extends to the visual arts, too. Further, the similarity of process applies to both therapist and patient. In this chapter I consider some of the transformational or creative characteristics that these two enterprises hold in common for both participants.

In speaking of creativity I have in mind both individual originality and the ordinary inventiveness which I see as fundamental to being alive, as well as the specialized creativity we associate with art. I am looking at what the two practices, art and psychotherapy, may have in common and to this end I am thinking of the session as a creative work in its own right, with the authorship of that work shared between the patient and the therapist, each acting as both artist and audience for one another. I shall start by describing a session which I hope will bring out some of the features of the creative process which I believe these two practices hold in common.

 

CHAPTER FIVE. Narcissism, the mystics’ remedy

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Josephine Klein

“Grant, I may not like puddle lie
In a corrupt security,
Where, if a traveller water crave,
He finds it dead, and in a grave;
But as this restless, vocal spring
All day and night doth run, and sing,
And, though here born, yet is acquainted
Elsewhere, and flowing keeps untainted;
So let me all my busy age
In thy free services engage …”

Vaughan, “The Dawning”, 1622-1695

And in this century,

“As for the spirit of poverty, I do not remember any moment when it was not in me, although only to that unfortunately small extent which is compatible with my imperfection. I fell in love with St. Francis of Assisi as soon as I came to know about him. I always believed and hoped that one day Fate would force upon me the condition of vagabond and beggar which he embraced freely. Actually I felt the same way about prison”

Weil, 1950, p. 31

Just now a circular from the Salvation Army comes through the I door to remind us that every Salvation Army Officer, on being I commissioned, promises

for Christ’s sake, to care for the poor, feed the hungry, clothe the naked, love the unlovable, and befriend the friendless.

 

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