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CHAPTER TWO. A different kind of psychotherapy

Bernardine Bishop Karnac Books ePub

Dorothy Daniell

Introduction

Itrained as a psychoanalytic psychotherapist, and have many years of experience working with individual patients in a traditional consulting room setting. For the past two years I have been involved in a different kind of psychotherapy at The Refugee Therapy Centre in north London. The chapter that follows describes one of my cases there. It is based on my thoughts, feelings and observations in spending one hour a week with a young refugee couple. They came at first with their 5-month-old baby. During the time I have known them they have had a second baby; the elder child is now two and a half. For reasons of confidentiality I am not describing details of their identity and backgrounds.

I am fortunate to have been able to work with a young woman interpreter from the same culture as the clients. It has been immensely rewarding sharing the experience with her, as will emerge later.

When I am describing work at the Refugee Therapy Centre I shall refer to clients: for work in private practice I shall refer to patients. This corresponds to what is usual in both situations and helps clarification. It is also usual to describe people who are yet without permission to stay here as “asylum seekers”. Those who have been granted status are known as “refugees”. The family I have been working with are asylum seekers; but I use the term refugees throughout to cover the wider picture.

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Medium 9781855759473

CHAPTER ONE. Mechanisms and mysteries

Karnac Books ePub

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.

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CHAPTER SIX. The crouching monk: disability in the consulting room

Bernardine Bishop Karnac Books ePub

The crouching monk: disability in the consulting room

Marie Conyers

Introduction

When I was invited to contribute a chapter to this volume on the theme of difference my immediate response was an amalgam of feelings. I was flattered, anxious that my paper would not be good enough, and intrigued, but I also had a sense of wry amusement because “difference” has been an ever-present theme in my consulting room. What seems self-evident, but I feel also needs to be stated, is that in all consulting rooms there will be differences that come to bear on the work.

I am registered as partially sighted and people notice that my pupils are elongated, giving my eyes a somewhat catlike appearance. Due to congenital cerebral palsy, I also formerly walked with a limp which was recently corrected through surgical intervention. The operation meant I took a six-week break from work, after which I used crutches, not knowing at the time how long it would be before I would be able to walk unaided.

This chapter aims to examine the significance for my patients and myself of the impact of my new disability, and will hopefully stimulate others into further thought about the impact of physical differences, temporary and permanent, in the consulting room.

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CHAPTER THREE. Racism as a borderline issue: the avoidance and marginalization of race in psychotherapy

Bernardine Bishop Karnac Books ePub

Frank Lowe

“Nations and peoples are largely the stories they feed themselves. If they tell themselves stories that are lies, they will suffer the future consequences of those lies. If they tell themselves stories that face their own truths, they will free their histories for future flowerings.”

Ben Okri, Birds of Heaven (1996)

This chapter highlights the failure of psychoanalysis to face its own truths about issues of race and white racism in the selection and training of psychotherapists and in the delivery of psychotherapy. It explores possible reasons for this failure and calls for action to make psychotherapy less racially exclusive and more responsive to the needs of a multiracial and multicultural society.

Much has been written about psychotherapy as a predominantly white middle-class activity. In Britain this concern has led to the development of intercultural therapy as a way of addressing psy-chotherapy’s inaccessibility to people from black and ethnic minority communities. The work of Jaffar Kareem, Lennox Thomas and Fahad Dalal has stimulated numerous seminars and conferences on psychotherapy, race and culture. However, despite increased awareness, the evidence suggests that these issues are generally avoided or marginalized by the profession.

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CHAPTER FIVE. The pregnant therapist

Bernardine Bishop Karnac Books ePub

The pregnant therapist

Sue Gottlieb

Introduction

The pregnant woman cannot fail to evoke powerful feelings in all around her; whether such feelings are denied or embraced, she calls forth a complex and varying mixture of delight, concern, fear and disgust, along with envy of her capacity to conceive and bear a baby, and jealousy of the baby in its phantasized state of uterine bliss. I would like to consider what happens to her analytic practice when she is a psychoanalytic therapist.

The emotions and ideas evoked by pregnancy might be normal grist for the analytic mill were it not for the fact that the therapist’s pregnancy itself constitutes such an intrusion into the analytic setting as it has been established. Not only will the usual open-ended continuity be interrupted by maternity leave and perhaps by unforeseen complications, but also, and more importantly, pregnancy breaches the usual degree of analytic anonymity by bringing the personal life of the therapist right into the therapy in a particularly dramatic way. Uniquely, a third person - the unborn baby - is physically present in the consulting room, and pregnancy is an unmistakeable “admission” of sexual activity and a statement about a relationship to a man and a family. In a sense, the patient suffers the loss of an illusion - an illusion fostered to some degree by the protected analytic setting - that the therapist exists only in her consulting room and only in relation to the patient.

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