Six things worth understanding about
psychoanalytic psychotherapy
David Pococka
This paper is written for family therapists who may be curious but
sceptical about psychoanalysis and psychoanalytic psychotherapy. It examines
a number of areas of misunderstanding within mainstream family
therapy discourse (diversity, authoritarianism, terminology, blame, history
and separation) which, the author believes, have acted to help
maintain a false coherence for family therapy through a distorted
construction of the otherness of psychoanalytic therapy and, in so doing,
inhibited a potentially more productive relationship.
Introduction
The first volume of the Journal of Family Therapy in 1979 records a high
watermark of psychoanalytic thinking in family therapy in the UK
with both the editor, Christopher Dare (1981, 1988), and many
contributing authors having analytic interests (Bentovim, 1979; Box,
1979; Byng-Hall, 1979; Cooklin, 1979; Dare, 1979; Lieberman, 1979;
Skynner, 1979). At that time, the developments in object relations
theory and group analysis in this country were well placed to make a
major contribution to family therapy thinking. Structural and strategic
family therapy models ­ which tended, at least implicitly, to be
written against psychoanalytic thinking ­ had yet to achieve their
sweeping dominance of most of the 1980s. When these models in turn
were superseded ­ at least in the mainstream ­ by Milan and especially
post-Milan second order family therapy there was no return to the
same level of interchange with psychoanalytic ideas despite the
original Milan associates being analytically trained.
It is, perhaps, paradoxical that, given the dominant narrative and
social constructionist developments in family therapy over the past
decade, there has been a growing minority interest in the possibilities
r The Association for Family Therapy 2006. Published by Blackwell Publishing, 9600 Garsington
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Journal of Family Therapy (2006) 28: 352­369
0163-4445 (print); 1467-6427 (online)
a
Head of Family Therapy, Swindon CAMHS, and Psychoanalytic Psychotherapist in
Independent Practice. Address for correspondence: 3 Castle Street, Calne, Wiltshire SN11
ODX, UK. Tel: 01249 816993. E-mail: david@poey.demon.co.uk.
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for enrichment of family therapy through re-engagement with psychoanalytic
thinking (Bertrando, 2002; Donovan, 2003; Flaskas, 1996,
1997, 2002; Frosh, 1995, 2002; Jenkins, 2006; Johnsen et al., 2004;
Kraemer, 2002; Larner, 2000; Leupnitz, 1997; McFadyen, 1997;
Pocock, 1995, 1997, 2005; Schlicht and Kraemer, 2005; Speed,
1999, 2004; Woodcock, 2000). What may have changed in the therapy
world over the past ten years to make this possible?
 Family therapy is more securely established and does not need to
draw such clear distinctions with its neighbours. (Professionalization
and the role of the United Kingdom Council for Psychotherapy
are relevant factors in the United Kingdom.)
 `Systemic' is no longer a single overarching theory (or metanarrative)
for family therapy now that family therapy has incorporated
narrative and social constructionism and other big ideas which are
not obviously related to systems theory.
 Working with an individual is more acceptable in family therapy
for the same reason as above.
 Family therapists are now becoming as interested in internal
processes (such as personal narrative) as they are in interactional
ones.
 Attachment theory and parent­infant research are growing
bridges between family therapy and analytic psychotherapy.
 Understanding, not-knowing, reflexivity and making sense together
are common reference points.
 Postmodernism either explicitly or implicitly makes the drawing of
tightly boundaried therapeutic models less supportable.
 The notion of an at least partially knowable reality `beyond the
texť is rapidly gaining ground again (but without any return to
positivism or naive realism) in a number of academic circles
through the influence of critical realism (e.g. Bhaskar, 1998).
 Both psychoanalysis and family therapy have expanding evidence
bases.
 Psychoanalytic ideas continue to spread beyond the consulting
room.
 Psychoanalytic psychotherapy is more pluralistic.
 There are specific major developments in psychoanalysis ­ especially
in American psychoanalysis ­ which, to some extent, are
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either parallel or complementary to those of family therapy (e.g.
relational psychoanalysis, intersubjectivity theory and narrative
developments).
In the UK, psychoanalysis, when used as a clinical description,
generally refers to work of four or five sessions per week undertaken
by those who have qualified in a small number of (mostly Londonbased)
training establishments. Psychoanalytic psychotherapy generally
refers to work of a frequency of one to three sessions per week and
training is offered by a broader number of institutions. This distinction
does not exist in the same way in North America where both are called
psychoanalysis. I think there are differences between the two (especially
noticeable between once per week and five times per week) but
these are not easy to tie down. Psychoanalysis also has a non-clinical
meaning when used to refer to academic interests in these ideas. These
are prominent in discussions of social and cultural theory.
I will use the word `psychoanalysis' to refer broadly to all clinical
and non-clinical applications of psychoanalytic ideas and I will use the
term `psychoanalytic psychotherapy' and, to ring the changes, the
terms `analytic psychotherapy' or `psychoanalytic therapy' to refer
predominantly to clinical work with individuals.
I am using the term `family therapy' in a broad inclusive manner to
encompass a loose collection of ideas drawn largely, but not exclusively,
from three major theoretical roots ­ psychoanalytic, systemic,
narrative/social constructionist. Although, in my work with individuals,
I practise as a psychoanalytic psychotherapist (an eclectic one) I
should add that in my family therapy I do not identify myself as a
psychoanalytic family therapist. Rather, I prefer to see myself as an
eclectic family therapist who feels that many psychoanalytic ideas have
much to offer.
In this paper I have chosen six things that family therapists who are
curious but sceptical about psychoanalysis might find worth understanding.
In doing so, I am trying to correct some common active
misunderstandings about individual psychoanalytic psychotherapy
which are implicit in family therapy. I notice these all the time because
they make me wince but if I am with a family therapy audience I
notice that other people often do not wince ­ such misunderstandings
being accepted and therefore not noteworthy ­ within some parts of
family therapy culture. Here is an unusually explicit example from a
chapter by Gergen and Kaye (1992, p.172) in their book Therapy as
Social Construction.
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[P]sychoanalysts who question the foundations of psychoanalytic theory
are placed in professional peril. Under these conditions the client
confronts a relatively closed system of understanding. It is not only
that the clienťs own reality will eventually give way to the therapisťs, but
all other interpretations will also be excluded. To the extent that the
therapisťs narrative becomes the clienťs reality, and his or her options
are guided accordingly, life options for the client are severely truncated.
I used the term `active misunderstandings' earlier and, by this, I am
referring to the effect of these beliefs, or ­ in postmodern jargon ­ how
these beliefs perform. They seem to position psychoanalysis as a
discredited outsider. For example, in the above quote ­ through
making psychoanalysis the authoritarian and brainwashing other ­ it
becomes self-evident that the reader should stand firmly on the
constructionist side of the constructionist/psychoanalytic border; the
side marked `moral high grounď. This form of rhetoric both reinforces
the constructionist territory and reassures those within it that
they need not worry so much about authoritarianism. The implicit
messages are `We're not like them', `Relax, you're one of the good
guys' and `Don't go over there ­ they're so bossy and controlling'. So,
in my view, these misunderstandings help to create an identity for
family therapy; an us-ness defined by the them-ness of psychoanalysis
(see Kraemer (2002) for a fuller discussion). These processes are
common to all groups and cultures, and occur also from time to time
within family therapy (e.g. first order vs. second order, narrative vs.
systemic, and narrative vs. solution-focused therapy). Psychoanalysis
(Klein, 1935) calls this splitting; Gregory Bateson (1972) schismogenesis;
and Michel Foucault (1975) disciplinary power.
But why bother to understand more? Why should psychoanalytic
psychotherapy be of interest to family therapists? In my view, for
three reasons:
1 Therapists have, I believe, a primary duty of care not to be analytic
or systemic or narrative but to be helpful. (I note here that this term
is necessarily loosely defined when speaking of it as a generality
since helpfulness cannot be defined independently of those seeking
help.) But helpfulness, I think, must be a higher ethic than
professional identity. I believe that some clients or patients can be
helped best by psychoanalytic work. (I also believe the opposite that
individual psychoanalytic therapy is not useful for everyone
and other therapies including family therapy may be a better fit.)
Misunderstandings may act as a barrier to recognizing the potential
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helpfulness of analytic therapy in some cases and, on the basis of
this argument, are then unethical.
2 Misunderstandings may prevent family therapists from making use
of an analytic personal therapy. I think there is much more to each
of us than we can possibly know but regardless of our state of selfknowledge
and of our avowed therapeutic model we are involved
with families with all aspects of ourselves ­ even (and sometimes
especially) the ones we would prefer to keep hidden. One factor in
the renewal of dialogue between family therapy and psychoanalysis
is the number of family therapists who first came to understand
these ideas through the experience of being patients1
and found
themselves incorporating these ideas into their work.
3 Active misunderstandings waste potentially useful resources which
can enrich the thinking of family therapists.2
Indeed, since psychoanalysis
is interested in the-self-in-the-context-of-relationship (rather
than the fully interior self of some misconceptions) it is difficult to see
how such ideas could not be relevant to family therapists.
Six things
1 Psychoanalytic psychotherapy, like family therapy, is best considered not as a
model of therapy but as a heterogeneous culture
I am using the term `culture' to refer to the ideas and practices of both
family therapy and psychoanalytic psychotherapy. The identity of any
culture looks clearer from the outside and from a distance than from
the inside. (Imagine, for example, trying these days to offer a clear
one-sentence definition of family therapy.) As we know, the best way to
understand any unfamiliar culture is to avoid the kind of homogenizing
talk that gives rise to stereotypes. Descriptions of psychoanalysis
that reduce diversity are common in family therapy discourse and
often support other active misunderstandings. (It should therefore be
noted that my views can only represent a portion of what could be said
on these issues from other psychoanalytic perspectives.)
1
`Patienť is a difficult term due to possible associations with illness, and passivity. As an
ex-psychotherapy patient it does not carry these connotations for me and, in the absence of a
substantially better term, I will use it throughout the paper.
2
And vice versa. Intersubjectivity theory (e.g. Benjamin, 1999) is, in my view, a systemic
version of relationships including the analytic relationship. See also Lachmann and Beebe
(2002) who locate parent­infant research and adult treatment within an explicitly systemic
frame.
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The centre of psychoanalysis is the idea of a dynamic relationship
between the conscious and unconscious mind, but how these terms are
defined and thought about will vary a great deal within the culture.
There are variations, for example, between groups of those considering
themselves Freudians, Kleinians, Independents, Jungians, SelfPsychologists
and Relational Psychoanalysts. But within each of these
groups there are also differences. For example, the Independent
Group was formed initially as a section of the British Psychoanalytic
Society by those who did not want to identify themselves closely with
the followers of Melanie Klein or of Anna Freud. But within this group
are found those who are eclectic or those with a strong interest in
attachment theory, or perhaps those who are strongly influenced by
particular figures such as Ronald Fairbairn or Christopher Bollas.
In addition, while the ideas of each of these larger groups were
once fairly distinct, the passage of time, the fading of Sigmund Freuďs
vision of psychoanalysis as a science, a less idealized view of the
pioneers of each group, and a greater acceptance of not-knowing are
all factors leading to a blurring of the edges and mixing of ideas. The
tendency these days of most psychoanalytic training courses ­ even
those not calling themselves eclectic ­ is for greater pluralism.
As with family therapy there are also national differences in the way
cultures of psychoanalysis and psychoanalytic psychotherapy have
developed. The work of the post-Freudian Jacques Lacan is most
identified with French intellectual modernism and postmodernism
but it also has a strong foothold in Australia. Most developments in
ego psychology from the work of Anna Freud (1937) have taken place
in North America. These tend to give less emphasis to the role of both
external relationships and internal relationships (in the way that
object relations theory has developed in the UK). Ego psychology,
in turn, has been the context for the counter-development of strong
relational models in the US ­ self-psychology and intersubjectivity
theory. These, so far, have not been much taken up by UK psychoanalytic
psychotherapy which has its own relational model (object
relations theory) and a growing interest in attachment theory.
2 Authoritarianism is not ­ and cannot ever be ­ a psychoanalytic position (or
any kind of therapeutic position)
Concerns about authoritarianism in psychoanalysis are closely linked
to the second order movement in family therapy and more recently to
the ideas in the narrative and social constructionist therapies of what
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might constitute modernism (as opposed to postmodernism). In these
discussions, psychoanalysis is seen as one of the chief examples of
modernism.
In this active misunderstanding at its most stereotyped, the analytic
psychotherapist is an expert on the human mind. She knows first and
best the truth about the patient. This is because the analyst believes she
knows how to read the Rosetta Stone of the patienťs unconscious and
gradually these hidden truths are conveyed to the patient in a series of
interpretations. A more postmodern view of this might say that the
therapist and her psychoanalytic culture come to colonize the patient.
(This is close to the Gergen and Kaye (1992) quote above.) This way of
positioning psychoanalysis as other took over from the belief in
psychoanalysis as linear (rather than circular) which was prevalent
during `first order family therapy'.3
And what could underline this
power difference more than having the patient lay down on a couch
and the therapist outside the line of the patienťs vision sitting up?
I remember being so convinced by this view of analytic psychotherapy
prevalent in late 1980s family therapy that I was rather surprised
by my therapist listening very carefully, wishing to understand what I
thought and felt. Interpretations tended to be offered by her quite
tentatively and seemed generally to invite further thinking or dialogue
rather than to present some final truth. I began to wonder if
she might be a bit of a maverick. In fact, I was a little disappointed
that more was not done for me.
Analytic psychotherapy, if it is to be of any use, depends on forming
an alliance (or what family therapists might think of as working
collaboratively) with the thinking capacity of the patient (Box et al.,
1994). Even in regression (a powerful re-experiencing of early states
of mind in which the therapist frequently represents some aspect of
the patienťs internal world of relationships) there is usually an
observing and thinking part of the patient alongside that of the
therapist.
It is, of course, possible to tell patients what to think; it is not
uncommon for patients to want to be told what to think, but it can
never be therapeutic. There are, frankly, times when the idea of being
3
I have placed this term in quotation marks since I do not believe it makes good sense. It
seems commonly used to denigrate a variety of older models of family therapy (Pocock, 1999).
If a second order position is the reflexive use of theory or practice then the term `first order'
might be better reserved for any moment in any therapeutic practice when reflexivity slips and
the therapist becomes convinced that her way of seeing is the only way. None of us, I believe,
are entirely immune from first order moments.
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able to change people instrumentally (as second order family therapy
calls it) by telling them what to think and do is very appealing. If only
change was that easy! The same psychological issues may come up
scores of times and be talked about in many different ways but the
moment of change is not one in the power of the therapist. It is not
even a direct product of collaboration ­ although there can be deep
mutual satisfaction when something has been worked out together
over a long period of time. In the end the patient can only arrive at a
particular emotional truth on his own.
I would argue that analytic psychotherapy is possibly the least
didactic therapy. The learning ­ or probably it is better to say
unlearning and new learning ­ depends not on the therapisťs power
but on the patienťs experience in the analytic relationship. I think a
very good description of this experiential psychic change is found in
Bateson's (1979) ideas on binocular vision and news of a difference.
For example, a woman patient of mine, scapegoated as a child and
tyrannized by her father, is so convinced that I will shout at her if she is
ever late for a session that she makes elaborate arrangements for this
never to happen despite having to travel by bus. Inevitably, one day
the bus is delayed and she is late and sits (feeling very hot) silently
waiting for me to begin raging at her. This is explored a little and after
a while she explains that she knows it is true that I am not furious with
her. She knows this from the tone of my voice. At the same time, she
says, it still feels true that she expects me to rage at her. Both things now
seem possible, whereas before an angry internal part of her was
firmly, in fantasy, located in me. Some certainty has been dislodged in
her by this new experience.
I think there is a widespread fear of authoritarianism in contemporary
family therapy culture which seems not only to have distorted
the perception of psychoanalysis, but also to have underpinned the
first order/second order split. At times this seems to extend into a
reluctance to hold any specialist knowledge. All this, I think, is based
on a partial reading of postmodernism. Basically the postmodern
critique says that reality or truth cannot be captured or fully represented
in language. There may be many descriptions that can give an
account since reality gives quite a degree of wriggle-room. Some
family therapists have begun to worry that, if this is the case, their
knowledge can overpower the self-constructing power of those who
are seeking help. There is instead great hope placed in re-storying,
co-construction and building new narratives. But this, in effect,
reduces all experience to language and is not what postmodernism
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says. It also, as Carmel Flaskas (2002) notes, offers a very fluid notion
of the self that is at odds with everyday experiences of what it means to
be a person in which a sense of identity (even a denigrating one) is
held on to tightly for fear of disintegration.
Another important point about postmodernism is, I think, the one
made by Steven Frosh (2002). Postmodernism shows the limitations of
language in capturing reality ­ that there is a point in therapy in which
available words dry up. We are left then with our other pre-linguistic
human capacities of experiencing the other or ­ as Alice Miller (1987)
puts it ­ witnessing. This is not to say that new ways of representing
(or symbolizing) some of this experience cannot be found but we are
more frequently at the edge of our capacity for words than the
constructionist-narrative turn in therapy recognizes.
My other concern, linked to this, is that too much hope in the
capacity for re-storying leaves too small a role for the task of bearing
painful feelings in family therapy. One can simply construct a less
painful story. But I am hopeful that narrative therapy, at least as it has
been taken up in the UK, is quite strongly influenced by John ByngHalľs
(1995) interest (from attachment theory research) in emotionally
coherent stories. These are narratives that incorporate a living
history of emotional experience. I was also heartened to read Lynn
Hoffman's (2002) absorbing `Intimate History' of family therapy
which, despite steering well clear of anything psychoanalytic in family
therapy, ends with a great respect for the possibilities of unconscious
emotional communication (although using different words).
3 Psychoanalytic psychotherapy is not taught primarily through its theory
which, accordingly, does not try very hard to be reader-friendly
The culture of family therapy is, I think, distinct from that of
psychoanalysis in one way, which is in its use of technical terms.
Family therapy with its ethos of radicalism seems constantly to be reinventing
itself, with a tendency to split off from its past every few
years. Each new movement carries new terms, and one characteristic
of those family therapists who have been around for some time is that
they begin to grumble that the new jargon simply recycles old ideas. I
will not say too much about the merits of this argument but will simply
use it as a point of contrast with the opposite tendency in psychoanalytic
terminology.
Terms in psychoanalysis tend to be overly conserved (Susie Orbach,
personal communication) so that the same term can be stretched over
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the years to mean several different things. A good example is that of
`countertransference' which ­ in Freuďs (1910) original view ­ was
simply the unconscious reaction of the therapist to the patient and was
seen as a complicating factor in understanding the patient and,
therefore, rather a nuisance. Later countertransference became
seen as potential information not solely about the therapist, but also
about the patient via projective identification (Heinemann, 1950). In
relational psychoanalysis (Mitchell and Aron, 1999) the same term is
used differently again. Here the therapist is not seen as reacting to the
patienťs unconscious but each are seen as interacting at both conscious
and unconscious levels ­ in other words as a system. Thus
transference and countertransference might here be defined as all
that which is in the mind of patient and therapist respectively but in
the context of the relationship with each other. Some writers, such as
the intersubjective theorist Donna Orange (1995), have suggested a
new term ­ co-transference ­ for this.
Many of the most useful terms in psychoanalysis do not intuitively
yield up their meanings. Some exceptions are Donald Winnicotťs
(1965) idea of `emotional holding' and Wilfred Bion's (1962) `reverie'
but terms such as Melanie Klein's (1946, 1952) `paranoid schizoid
position' and `depressive position' ­ in many ways crucial to understanding
much contemporary psychoanalytic thinking ­ seem almost
perversely non-intuitive. (I will return to these terms later.)
Primary to clinical training is the training analysis or training
therapy typically three to five times per week for a minimum of five
years. The experience of being a patient is central to the training and
theoretical teaching supports this. Reading about projective identification
can be hard-going and baffling. In contrast, discovering as a
patient that what one is attributing to the therapist or others is actually
something of oneself can be shocking but also compelling and
unforgettable.
All told this makes acquiring knowledge of psychoanalytic ideas
very difficult through reading alone. I say this not to put anyone off
from reading but to help explain why terminology is often opaque
and hard-going.
4 Psychopathology and blame are not the same
The terms `pathologizing', `parent blaming' and, especially, `mother
blaming' have become, I believe, crucial and powerful boundary
markers in some parts of contemporary family therapy discourse
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and function in the same way as `linear', `first order', `modern',
`experť. In a recent conversation with a very experienced family
therapist he talked about transgenerational issues in families and
then, as an automatic aside, apologized that he might sound rather
blaming. Terms like `mother blaming' which I call badges of shame
(Pocock, 1999) only operate in a disciplinary manner if they remained
unexamined. I would like to reconsider the assumption that the
notion of psychopathology is just blaming through an analogy.
A woman breaks her right leg and is taken to casualty complaining
of considerable pain. The doctor, mindful of the dangers of pathologizing,
decides not to draw attention to the damaged leg at all but to
concentrate on strengths, and says, `But you have such a good left leg.
Have you considered hopping?'
Of course, in this example, the patient would hopefully soon
redirect the doctor back to the damaged leg. The doctor's knowledge
about pathology is in tune with the patienťs view of the matter. The
knowledge of pathology is not therefore experienced as a problem. In
fact, one would say that the doctor would not be able to discharge his
duty of care without a detailed knowledge of how the body can suffer
and a willingness to attend to this suffering. A concentration on the
strength of the undamaged leg would probably have been experienced
as neglectful and dismissive. (I should stress that no criticism of
valuable strengths-based therapeutic work is meant here. It is the
possibility that the avoidance of psychic woundedness may feel
neglectful by the patient that I wish to highlight.)
A more complex problem is presented in analytic psychotherapy.
Here attempts by the patient to feel better may lead to unbearable
aspects of the self being projected outside and on to others. The
therapisťs knowledge of these processes (hopefully, carried
within a frame of uncertainty) is not going to be received immediately
as helpful and may well be experienced as persecutory and
blaming.
There is no doubt that psychoanalysis contains some potentially
good put-downs which have found their way into popular culture
such as `neurotic', `psychotic', `narcissistic'. But within psychoanalytic
psychotherapy these are theoretical technical terms referring to states
of mind (which should, in any event, have no place in any therapeutic
encounter). They are no more inherently pejorative than, say, technical
terms in medicine or any other occupation including family
therapy. However, this is not to say that therapists cannot use these
terms pejoratively. Hate can get into almost anything (even positive
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connotation) and should be recognized as such. So what I am saying is
that psychoanalytic psychotherapy is at times inherently painful but
not inherently blaming.
Blame of others and blame of self are, though, regular aspects of
the human condition (corresponding to what Klein (1952) calls the
paranoid schizoid state of mind which we have all experienced and
can all experience again in times of duress). The progress of psychoanalytic
therapy is a movement from blame through tolerance and
understanding of painful states of mind to greater acceptance of self
and others.
I believe the attempt to avoid parent blaming has led some parts of
family therapy culture to almost give up on any theories of family
processes. Lynn Hoffman's recent book (2002) outlines her journey to
an almost completely non-theoretical position. What is left is intuitive,
poetic and warmly supportive. Knowing seems to be removed
through fear that it will be used in an authoritarian and fault-finding
manner. But don't families wish us to know some things they don't
know? (What I should add perhaps is that a therapist with Hoffman's
extensive experience can never be short of knowing. Intuition is not a
personality trait but based on layer upon layer of experience built up
over many years.) My own view is that knowing and not-knowing
need to be held responsibly in a careful balance and I would identify
with Glen Larner's (2000) thoughts on this.
I think this disabling fear of blame in families does not come
primarily from our theories but from elsewhere ­ a conviction in
many parents and children that they are bad and blameworthy, and a
fear that inevitably the therapist will come to see this and their terrible
secret will be out. Parent blaming is real and damaging but exists not,
I think, primarily in our theories but in the continuous and secret
conscious or unconscious attacks that parents make on themselves and
then, understandably, try to get rid of. Of course, these self-attacks can
be assisted by popular knowledge of processes of attachment and the
developmental importance of maternal and paternal care in general
but twisted to be used against the self. But is, for example, a
postnatally depressed mother blameworthy when her child develops
a primary insecure attachment? She might be convinced this is the
case but I do not know of any psychoanalytic or family therapy theory
that would agree. Instead, in such a case, our theories should assist in
a search for a compassionate understanding of the complex internal
and external relational processes that underpin and support the
depression.
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In short, acknowledging, understanding and challenging painful
self-blame seems to me to be far more helpful than trying to rid family
therapy of its theoretical base or projecting its fears of pathologizing
into psychoanalysis.
5 Psychoanalytic psychotherapy is not primarily about working with history
The idea that analytic psychotherapy is preoccupied by history used to
be a boundary marking misunderstanding during the time when
structural and strategic family therapy models were prominent, since
these took no interest in historical issues. I include it now because of
its significance in understanding some important theories of change
in analytic psychotherapy.
Although there may be some enquiry into history during a brief
assessment stage, psychoanalytic work commonly relies on experiential
changes in the context of the here-and-now relationship with the
therapist. However, one sign of a good enough therapy is the
development in the patient of an emotionally coherent narrative
history. But this is generally a good side effect of change rather
than the main focus of the work.
Many people who suffer as adults seem to have little or no sense of
personal history. Often there is an idealized view of childhood (`It was
perfecť) or a dismissive view (`It was just like everyone else's'), or
there is little that has been processed into autobiographical memory
(`I can hardly remember anything before I was 9'). Children with the
least attuned parents tend, when they grow up, to become parents
themselves with a limited or dismissive emotional history. This
dismissive style in parents is, from attachment research, strongly
associated with insecure attachments in their children ­ especially
insecure avoidant attachments (Main et al., 1985).
A sense of history results from a process of reflection in oneself or
with others. Many patients have had very little opportunity for this as
children or as adults. Even persons apparently preoccupied with
aspects of their history often have important elements missing as,
for example, in melancholic grief reactions in which the lost person is
idealized and hated aspects of the same person are turned unconsciously
against the self.
For Christopher Bollas (1987), for example, the unconscious is the
place for memories of the earliest experiences of care, but the term
`memory' is being used differently to the usual vernacular meaning. It
is not something recalled from the past but current and alive. I think
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the crucial idea here is Freuďs view that the unconscious is timeless.
Regression in the transference allows these timeless memories to be
accessible for thought. In the weeks leading up to a summer break a
patient may re-experience vividly the rage and upset of childhood
abandonment. The memory of the abandonment is relived and the
therapist is experienced as the longed-for but hated object or other.
However, alongside memory ­ now made conscious ­ is reverie ­ the
capacity of the therapist and thinking parts of the patient to bear,
accept and make sense of the feelings, perhaps for the first time.
Through these here-and-now experiences, timeless unconscious
memory (in which the patient always has, always is and always will
be abandoned) begins to turn into a capacity for a bearable personal
emotionally coherent narrative. The patient may then be able to say,
`I know where this feeling comes from ­ iťs history'. It no longer
needs to be associated so strongly with events or relationships in the
present.
6 `Separation' in psychoanalytic psychotherapy is a technical term used to
signify the start of a new capacity for relating rather than to signify the
withdrawal from relating or the end of a relationship
The postmodern philosopher Jean-Franc¸ois Lyotard (1988) writes
about disputes ­ he calls these differends ­ that can never be resolved
since the protagonists are, without realizing it, using the same words
to mean different things. The term `separation' is, I believe, the cause of
a differend between family therapy and psychoanalytic psychotherapy.
In this active misunderstanding in some parts of family therapy, the
goals of separation and individuation in psychoanalytic psychotherapy
are seen as equated with Western (or more specifically North American
male) values of rugged individualism. At its most stereotyped the
image that comes to mind is the production of John Wayne and Clint
Eastwood characters ­ separate, independent, needing no one.
Attached to this misunderstanding is therefore an accusation of
cultural insensitivity. Evidence from Asian cultures (in which issues
of personal autonomy are said to be managed very differently) is often
used to show that separation is a Western cultural preoccupation.
(What I would say is that becoming an individual is a universal issue
but mediated differently through cultural variation.)
Once again, I think the non-intuitive nature of technical terms in
psychoanalysis has played an unhelpful role. Who, without prior
knowledge, would guess that the Kleinian term `depressive position'
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(Klein, 1935) refers to the capacity to relate to the other as a separate
person in a respectful manner in which there can be a meeting of
needs not based on manipulation or a distorted view of their otherness?
The achievement of separation in analytic psychotherapy is not
to go it alone but to be capable of participating in relationships based
on mutual care and respect. Western cultural individualism of the
lonesome cowboy type would be seen, not as a model of psychological
health but, more likely, as an example of destructive narcissism in
which the individual denies and turns against his own need of others
and instead uses other people in a ruthless manner.
A key idea in psychoanalysis is that projective identification is a
defence against separation. In analytic psychotherapy the therapist
from the patienťs perspective quickly comes to be experienced as a
remarkably familiar figure. This is the result of transference. The
therapist is not perceived as a separate person but, in unconscious
phantasy, as aspects of internal relationships based more or less on the
experience of earliest important parental relationships. This very
helpful process is of course facilitated by the therapist taking some
care not to reveal too much of herself to the patient. (However, the
cold, unresponsive, blank-screen analyst is, I believe, mostly a myth.)
These internal relationships are then re-created between the patient
and therapist but can then be talked about.
The therapist can feel a powerful ­ although often subtle ­ pressure
to become like the projected aspect ­ perhaps an ideal mother who
will see this patient as special above all others. But the patient is
effectively relating not to the therapist but to part of his self. Excessive
projective identification outside the therapy room is therefore seen as
a barrier to understanding and respecting the needs of the other as a
person in his own right.
Projective identification thus involves the use of the other. In this
theory, a partner or a child can be the repository for disowned aspects
of the self and this can form a very stable interpersonal defence
affecting the life chances of both the person projecting and the person
projected on to. The other is used ­ not experienced as a separate
being with an equivalent centre of self. The task of psychotherapy is to
help the patient to understand that what he perceives is part of
himself. This is referred to by the terms `withdrawal of projection' and
`integration'. The therapist begins to be experienced more realistically
and it is often a warm period in the work where genuine concern and
love for the other can flourish. It is also usually a time of substantial
systemic shifts in the other significant relationships of the patient. This
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process is often called experiencing the other as a whole object ­ the
depressive position ­ in Kleinian terminology.
Winnicott (1965) calls this the stage of concern and I also find the
terminology of Jessica Benjamin (1999) ­ an American analyst and
feminist ­ very useful. She describes this process as moving from
object relatedness to subject relatedness. The other can now be seen as
a subject in his or her own right. This point of separateness is thus the
beginning of a non-exploitative kind of relating.
Summary
This concludes my six things worth understanding. I have covered
issues of diversity, authoritarianism, terminology, blame, the place of
history, and the question of separation. Now, in summary, let me
reduce all of these points down to one. Psychoanalysis has, for twentyfive
years or more, too often been a denigrated object for mainstream
family therapy. There are many signs that family therapy no longer
needs to do this. I am hopeful that each therapy culture can
increasingly see the other as interesting, diverse and neither ideal
nor bad. In other words, I hope that there is now sufficient separation
to have a relationship.
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