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CHAPTER TWO: Relational perspectives on the therapeutic action of psychoanalysis

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 TEN: The big picture

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 SIX: When thought is not enough

Karnac Books ePub

Nicola Diamond

Introduction: the relational approach and attachment

In this chapter I will explore a form of relational psychoanalysis, which is particularly influenced by attachment theory and related contemporary developments. The emphasis here is on the centrality of relations with others, in the context of developing a body and a sense of subjectivity. From this perspective, disturbed relations with others in early and ongoing development give rise to emotional problems that can lead to psychosomatic dysfunction and problems with the sense of “self”.

In this theoretical context, the understanding of relationships involves the view that organism and environment are interdependent. The baby’s physiological and neurological functions require facilitating relationships with key attachment figures for their optimal development. The internal world is inseparable from interactions with others. Relationships with others inform the content and form of the world of the developing individual, which is renegotiated and reorganized in later relations in an ongoing way.

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CHAPTER ONE: The fifteen key ingredients of good psychotherapy

Karnac Books ePub

Brett Kahr

Turn on your television set any night of the week, and you will be able to gorge yourself upon any number of newfangled cookery experts, or so-called celebrity chefs, who attempt to communicate the secrets of their trade to us in a stylish, entertaining fashion. Each evening at eight o’clock, we too, the ordinary viewer at home, can perch on our sitting room sofas, notepads nestling on our knees, as we learn an eminently transmissible sequence of culinary steps. First, we must choose our ingredients; then we rinse, slice and dice, baste and bake, heat or chill, lightly season, garnish with fresh parsley, and … hey presto … we have concocted a veritable replica of a British Broadcasting Corporation feast.

If only those of us who work as professional psychotherapists could communicate the nitty-gritty details of our craft with such grace and dexterity, and still manage to do so in an entertaining twenty-four minute broadcast. If only we could transform our ponderous, arcane, and stodgy textbooks into a foolproof do-it-at-home recipe, then psychotherapy would be available at the flick of a switch, and the mental health problems of Great Britain would be solved. And just imagine if some very visionary commissioning editor from the Channel Four Television Corporation did indeed commission a six-part half-hour slot on how psychotherapy works, how on earth would we translate our hard-won clinical expertise into a snappy format that would engage the attention of millions of viewers?

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CHAPTER SEVEN: Primal psychotherapy

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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