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CHAPTER TWO: Relational perspectives on the therapeutic action of psychoanalysis

Jane Ryan Karnac Books ePub

Neil Altman

An historical perspective

Lewis Aron (1995) once commented that in order to make a creative contribution to the psychoanalytic literature, one has to be prepared to revise, even overturn, all of psychoanalytic theory. Psychoanalytic theory is an integrated set of conceptions that forms a system in which each part depends on all the other parts. Not everyone has agreed with this systemic conception of psychoanalysis; for example, it has been argued (Gill, 1976) that the metapsychology of psychoanalysis (e.g., the structural theory of id, ego, and superego) is independent of the clinical theory (of transference and resistance). Thus, one could get rid of the metapsychology without affecting the clinical theory. On the other hand, much of the literature in relational psychoanalysis over the past twenty years has been concerned with developing the far-reaching implications for psychoanalytic theory and practice of the “relational turn”, i.e., the shift from regarding drives as fundamental to mental life, to regarding relational configurations as fundamental in the external world and in the internal world. In 1983, Jay Greenberg and Stephen Mitchell shook up the psychoanalytic world by systematizing and making explicit this shift that they claimed was taking place across a range of psychoanalytic schools of thought, from drive theory to relational theory. Since then, the implications that have emerged include, but are not limited to: redefinitions of the notion of neutrality (Aron, 1996, 2003; Green-berg, 1986), the emergence of the concept of “enactment” (Aron, 1996; Bass, 2003; Black, 2003; Jacobs, 1986), the re-emergence of dissociation as a fundamental organizing principle of the mind (Bromberg, 1999; Davies, 1999), a reconsideration of self-disclosure in psychoanalysis (Aron, 1992), new psychoanalytic epistemologies (Hoffman, 1998; Mitchell, 1993), new concepts of “mutuality” and “asymmetry” (Aron, 1992), reconsiderations of gender (Benjamin, 1995; Dimen, 2003; Goldner, 1991; Harris, 1991), race (Altman, 2000; Leary, 1997, 2000), and sexual orientation (Domenici & Lesser, 1995). In this paper, I spell out some of the implications of the relational turn for the theory of the therapeutic action of psychoanalysis. In the background of this discussion are considerations of what constitutes health and pathology; thus moral judgments, considerations as to what constitutes a good life, will be inevitably implicated and I attempt to make them explicit when I notice them in the background of the theories being discussed. We will see that ideas as to what constitutes a good life will also be found in ideas about what constitutes a good analysis. Let us begin with the first generation of analysts: Freud and his contemporaries.

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CHAPTER FIVE: Rhythm, reorientation, reversal: deep reorganization of the self in psychotherapy

Jane Ryan Karnac Books ePub

Roz Carroll

“Life itself is an expression of self-organisation”

(Sardar & Abrams, 1998, p. 77)

What makes psychotherapy work is a question that is both impossible to answer conclusively and yet necessary to address. In this chapter I propose that psychotherapy “works” in the same way that life works (or evolves), only in a more concentrated form by intensifying and containing specific processes that occur in all living developing systems (from cells to individuals, to communities, etc.).

Psychotherapy was once presented to the public as a detective story: clues to the unconscious expertly spotted by the therapist-sleuth leading to a reconstruction of traumatic events in childhood. In this linear account revelation brings catharsis, insight, and healing. Actually this search for a hidden story remains a fairly central feature of psychotherapy, but today’s version of therapy encompasses many more nuanced levels of information and interaction that are marked by non-linear cycles of disorganization–reorganization. The emphasis has moved from discovering the origins of neurotic patterns to working directly with relating as a human capacity.1

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CHAPTER TEN: The big picture

Jane Ryan Karnac Books ePub

Carol Holmes

The fact that the discipline of psychotherapy is recognizable by over four hundred competing models attests to its lack of a unified theory and it is this feature more than anything else that underlines the fact that we don’t know how psychotherapy works. What we do know is that these factions in psychotherapy are implicitly or explicitly committed to a particular philosophy of human nature that informs their conception of health and their method for achieving this satisfactory state. Existential psychotherapy for example, is grounded in existential philosophy and the phenomenological method and its practitioners view the recognition of anxiety as an indication and positive sign of the person’s understanding of their uncertain and mortal position in the world. Psychoanalysis, on the other hand, considers the prevalence of anxiety as an indication of unconscious conflict and psychopathol-ogy that requires psychoanalytic intervention. Each school within the profession is therefore underpinned by a philosophy that determines its conceptualizations of both mental health and pathology. Furthermore, unlike the scientific tradition, the schisms that characterize the field of psychotherapy are further compounded and estranged by a general lack of dialogue and cooperation between therapists and researchers from these competing hypothetical approaches. As Feltham points out “It is arguable that the field of twentieth-century psychotherapy has been fundamentally characterised by serious disagreement on views of human nature, aetiology of psychological dysfunction, treatment rationales and goals” (1997, p. 1). Feltham further claims that these divisions interfere with the likelihood of systematically examining these significant inconsistencies and suggests that we have difficulty in questioning our assertions of truth and reality: “It seems to me that we are as least as resistant to examining our therapeutic truth claims as our clients often are to examining their longstanding and unproductive scripts and narratives” (ibid., p. 2). I believe that it is not the lack of certainty that inhibits our ability to better understand how psychotherapy works, but the certainty with which psychotherapists from these clannish schools cling tenaciously to their denominational positions. From my own experience there also seems to be a general lack of courtesy, regard, and modesty on the part of psychotherapists for any position other than their own.

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CHAPTER SEVEN: Primal psychotherapy

Jane Ryan Karnac Books ePub

Susan Cowan-Jenssen

Primal psychotherapy is a development of Arthur Janov’s cathartic primal therapy which flowered rather dramatically in America in the 1970s and 1980s. In this chapter I look at what was significant and useful in Janov’s contribution to psychotherapy what were its weaknesses, and how primal psychotherapy evolved. As I began to write on the background of primal therapy it struck me that catharsis, or abreaction, i.e., emotional release, has an interesting history in psychotherapy since it gets discovered and then rediscovered with rather monotonous regularity. But first: what is meant by the word “primal”?

The Oxford English Dictionary defines “primal” as “Belonging to the first age or earliest stage; original; primitive; primeval”. Freud was to use the expression “primal scene” to describe the impact of a child witnessing parental intercourse. Arthur Janov (1970) used the expression “primal pains” to describe the “original, early hurts upon which later neurosis is built”. For Janov, neurosis was not necessarily sexual in origin or necessarily linked to the trauma of one event, but is the culmination of hurts that result from the unmet needs of the infant and child:

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CHAPTER ELEVEN: Is the psychotherapist s authenticity a crucial key to therapeutic change?

Jane Ryan Karnac Books ePub

Dianne Campbell LeFevre

“Bion was very aware in his later years that psychoanalysis was not effecting change in patients. He was very aware of patients who looked as though they had changed; those who had put on the clothing of an analysed person, but remained unchanged within. In particular, he was conscious of those patients who subtly copied the analyst, took on his words, outlook and attitude, but in whom there was no change within. In other words there was an absence of alpha function and the articulations of the patient were an evacuation of beta elements. He tried to probe into this problem and his investigations into foetal life were one of his attempts to do so. The problem, however, remains unsolved”

(Symington & Symington, 1996, p. 173)

The subject being considered in this chapter is whether authenticity might be a key to therapeutic change, whether it contributes to what works, whether it helps—to use Wittgenstein’s metaphor— the fly to escape from the fly-bottle. Such a proposal carries the dangers of the author being seen to be encoding the message: “Am I not the most authentic, the most virtuous of you all?” and, like the ugly sister, getting the deserved reply. Similarly, presenting case material always carries the danger of exhibitionistically flouting one’s strengths or masochistically advertising weaknesses.

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