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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 NINE: The value of attachment theory in understanding how psychotherapy works

Jane Ryan Karnac Books ePub

James Pollard

The conceptual and procedural problems in assessment of the effectiveness of psychotherapy are daunting. It is not possible here to review the many approaches that have been offered. Each approach raises its own technical issues and reflects a particular value base. The problems are so great that many psychotherapists have retreated from the problem altogether or become content to theorize the impossibility of the task.

In the public sector the profession faces demands for “evidence based practice” and measurements of outcomes on the model of the randomized clinical trial. Many individuals report that they have found psychotherapy to have been helpful to them. This individual experience is so persuasive that psychotherapy flourishes in the private sector. Psychotherapists owe it to those who finance their own psychotherapy, as much as to public sector managers, to remain committed to the task of developing and supporting an account of how and why psychotherapy works. Not least psychotherapists owe it to their patients to offer an account of what they mean by “psychotherapy works”.

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CHAPTER EIGHT: Containment: the technical and the tacit in successful psychotherapy

Jane Ryan Karnac Books ePub

Robert M. Young

Idon’t know how psychotherapy works. However, I don’t find that very odd. I have some ideas, but to tell the truth I think of them as a way of comforting myself while I get on with doing psychotherapy, something I do more than thirty hours a week and think about for quite a lot more hours as I teach, write, edit, and talk to colleagues. What I propose to do in this paper is share those ideas and to look behind them to other ideas that I believe to be more helpful in explaining what I do.

First, of course, psychotherapists, at least ones of my persuasion, make interpretations. I was taught only to make transference interpretations, but after I stopped having supervisions, i.e., after a decade of training and postgraduate training, I slowly moved on to making any interpretation I thought might help my patients. Then one day a patient asked me what was the relationship between my interpretations and therapeutic benefit. There was a time I’d interpret the question, but I thought it a reasonable one, and this patient was not prone to use theory as a place to hide. The answer I had been taught was that a truthful or accurate interpretation of a patient’s unconscious motivations, the more primitive the better, and after being worked through, reduces primitive anxieties. This, in turn, makes the patient less trapped in his or her neurotic patterns. The emphasis was on the accuracy of the interpretation.

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CHAPTER SIX: When thought is not enough

Jane Ryan 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 THREE: The questions we have to ask (ourselves) before we answer the question: “How does psychotherapy work?”

Jane Ryan Karnac Books ePub

Joseph Schwartz

Iwas an experimental physicist before I became a psychotherapist. The experimental part of my previous career has been very helpful in dealing with theoretical issues in psychoanalysis. Traditionally experimentalists have always been very very critical of theory. The important thing for an experimentalist is that the theory be right, not that it be intriguing, or interesting, or even beautiful. The experimental question is not “Well, could it be that?” The experimental question is “Is it that?”

Although there always needs to be space for exploration of theoretical issues, my appraisal of the field of psychoanalysis over the past twenty years is that psychoanalysis is at a particular point in its historical development where too many people are playing around with psychoanalytic ideas and not enough colleagues are asking, “Is it that?”

There are very many different ideas being put forward to answer the question “How does therapy work”, or indeed, “Does therapy work?” But what the field has lacked is a disciplined engagement between practitioners with a view to sorting things out. It is not good enough for us to sit in our separate corners, slag each other off, and turn up our noses at how our colleagues have understood the experience of the consulting room. There is a certain discipline in natural science, not very well understood within psychoanalysis, that our field sorely needs. My psychoanalytic colleagues seem to carry around a lot of the ambient mythology about the so-called precision, and the so-called objectivity of natural science that appears not to apply to the subjectivities involved in psychoanalysis. The result has been that our community has lost track of the salient point of any exploration of human experience: it takes discipline to get results.

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