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Editorial – Special Edition: Psychoanalytic Theories and Therapies

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Petra Bueskens, The University of Melbourne 

 

This edition of PACJA promises an eclectic and exciting collection of articles under the broad theme of psychoanalytic theories and therapies. What characterizes these different articles – the first three in particular – is an analysis of analysis or, in Jon Mills’ terms, an internal critique of psychoanalytic theories and therapies. This critique from within is important; it is part of the process of scholarly and clinical reflection and revision and yet, as Mills describes, it is so often fraught.  While critique from outside psychoanalysis is predictably dismissive, faulting psychoanalytic concepts such as the unconscious on their lack of empirical evidence or theories such as infantile sexuality on their apparently preposterous and fantastical qualities, critique from within tends to be fractious and lead to splits within and across schools.  

The first three papers share a theme of critique from the inside. Leading the charge is John Mills whose article “Fine-Tuning Problems in Relational Psychoanalysis: New Directions in Theory and Praxis” urges a rethink on the key tenets of relational psychoanalysis, the prevailing orthodoxy in North American psychoanalysis, especially the emphasis on relationships at the expense of drives. For Mills this is philosophically untenable, committing us to logical fallacies. In particular, the idea that you can separate relationships from drives “… is unfathomable and ultimately indefensible because you cannot have relationships without a body”. Synthesising these two positions, Mills urges for a more integrated understanding that makes use of both classical drive theory – in particular Freud’s idea of the unconscious as an opaque yet influential force – and its more recent relational revisions. In terms of therapy, however, Mills falls decidedly on the relational side, although here again we see a synthesis, this time of philosophy and psychoanalysis, in his articulation of therapy as “a way of being” and indeed a “liberation struggle”.  For Mills, “[k]now thyself!  the Delphic decree is the psychoanalytic motto.”  This means that we can only take the patient as far as we ourselves have gone committing us as therapists to the pursuit of (self) knowledge and growth. By implication, we cannot treat with techniques alone but rather with a developed, dynamic, reflective, attuned self.  For Mills, the self is the tool par excellence of therapy.

Dianna Kenny’s article “A brief history of psychoanalysis: From Freud to fantasy to folly” furnishes us with another insider critique – hers concerns the obfuscating language (and concepts) of some contemporary psychoanalytic theorising and, together with it, the splintering of theory into a cacophony of voices.  Kenny makes the compelling, if polemical, case that psychoanalytic theory is “fragmenting”.  In particular, she takes umbrage at the use of arcane, speculative concepts that lack a basis in empirical research – a characterisation she identifies as “metaphor gone mad”. Again, we see a clash of paradigms between more hermeneutic psychoanalytic theories and therapies and those based on empirical research (for a recent analysis of this controversy see Wallerstein, 2014).  While for me, the two are not mutually exclusive – that is, the poetry and the science of psychoanalysis can co-exist – Kenny urges for a more empirically based theory and practice. For Kenny theorising without empirical foundations leads to flights of intellectual fancy and a tendency toward unintelligible verbosity. Moreover, “failure to achieve consensus with respect to basic concepts compromises not only the scientific status of a discipline, but also, in the case of psychoanalysis, its therapeutic practices.” As part of her critique Kenny makes a call for continuity between Freud’s original insights and current theory and practice.  Kenny speculates that perhaps “the common denominator” that binds psychoanalytic practice “is the empathic availability of the therapist”.

Peg LeVine’s article, “Classic Morita Therapy: Advancing Consciousness in Psychotherapy” opens the critique out further with a focus on the field of nature itself. Here we find an explicit tension with the anthropomorphic view that consciousness (including its archaic cousin the unconscious) resides exclusively within human beings with LeVine, elaborating on the work of Japanese psychiatrist and contemporary of Freud Shōma Morita, suggesting that consciousness runs through all life and indeed through all phenomena. Herein lies the transformative potential of therapeutic change.  LeVine reviews the key insights of Morita in the context of 20th Century psychoanalytic and philosophical thought suggesting that an anthropomorphic and western centric paradigm prevails at the cost of a richer account of consciousness that can be found in the Zen tradition. Therapeutic interventions are undertaken not only through talk and reflection but also and primarily through awareness of and connection with daily rhythms, the seasons, plants and animals. In LeVine’s terms, “In Morita therapy, we do not use the mind to open the mind – rather we close the mind so that the body is primed for infusion of consciousness that runs through Nature, metaphysically”.

Denis O’Hara’s article “The self: reflective, relational, and embodied” resonates with LeVine’s article insofar as his analysis of the contiguous nature of self, memory and embodiment demonstrates that “the self” is an integrated system whose capacity for reflectivity is contingent on a free movement between awareness and experience. For O’Hara the self is composed of reflective, relational and embodied dimensions that act in concert to produce “indwelt awareness”. Disruption through trauma and/or ruptured attachment produces a tear in the fabric of self inhibiting reflective function and, in turn, a sense of integration. O’Hara takes us on an excursus through psychodynamic theories of memory demonstrating the interplay between episodic and semantic memory.  Context and, in particular, secure attachment remains critical to the formation of a meaningful inner world and personal story. In the case of trauma there is a collapse in episodic memory – or the capacity to make meaning of events – and a concomitant focus on impingements shutting down the “stream of consciousness” between experience and awareness. O’Hara explores the clinical implications of secure relationships and their pivotal role in the healthy self-system, including in the repair of self. Healing and change is therefore reliant on a secure therapeutic relationship. It is this that provides the foundation for the re-emergence of episodic memory and, in turn, the capacity for reverie and reflectivity.

In the non-refereed section, we are fortunate to have nuanced and engaging contributions from psychiatrist and maternal mental health specialist Anthony McCarthy and award winning journalist and author Anne Manne. McCarthy explores the personal meaning of miscarriage in “Who can call herself a mother?”  through case studies from his clinical practice, exploring the subtle psychological calling to be a mother and the work that is done first in imagination. What does it mean, then, to have one’s journey to motherhood disrupted at this point through the loss of the foetus? Is one still a mother? Can one call oneself a mother? This central question is explored by McCarthy in an article that shines with clinical wisdom and empathy.  When I first heard this paper in oral presentation form at the Motherhood and Cultures conference at Maynooth University in Ireland (2015) it made me – and many others in the room – cry such was its poignancy, especially against the backdrop of Ireland’s continued repression of women’s reproductive rights.

Anne Manne provides us with a compelling account of narcissism in her article “Look at Me! The Rise of Grandiose and Vulnerable Narcissism under Neo-Liberalism.” Manne explores the two presentations for narcissism with reference to Anita Brookner’s novel Look at me (1982) identifying the well-known grandiose narcissist and a lesser known more vulnerable narcissist (sometimes underneath the grandiosity, sometimes its own personality constellation).  Drawing on the metaphor of the artichoke, Manne describes the dual nature of narcissism first identified by Akhtar (1989) spiking the world with self-aggrandizement and exploitation, while concealing “a tender kernel of insecurity on the inside”.  As a personality profile, the covert narcissist is thin-skinned, and vulnerable; here the prevailing theme is fragility while “shame, especially bypassed (unacknowledged) shame” is an integral part of the problem. This latter type of narcissism has been discerned from the more hermeneutic work of psychotherapy case studies rather than large clinical trials. “One possibility [for this]”, contends Manne, “is that … the more thin-skinned and vulnerable narcissist, whose defences fail [may]… end up on the psychotherapist’s couch, in the winter of their own discontent”. 

Manne explores the childhood context of narcissistic personality disorder, making fruitful connections with research on attachment and attunement (in particular the work of Allan Schore and Daniel Stern) drawing out the psychosocial implications of emotional deprivation. From here, Manne moves into the wider issue of the political economy of late capitalism – what is increasingly referred to as neo-liberalism – examining the parallel rise in narcissism and decline in empathy  – what she calls “narcissism’s nemesis”.  Manne suggests that neo-liberalism is both cause and consequence of rising levels of narcissism with its ruthless cuts to jobs and welfare, rising cost of living and extreme emphasis on individual achievement. 

In this edition of PACJA, as in previous editions, we have another commissioned literature review. This review is Cadeyrn Gaskin’s, The effectiveness of psychoanalysis and psychoanalytic psychotherapy: A literature review of recent international and Australian research. Gaskin finds “tentative support for the effectiveness of psychoanalysis in the treatment of patients with some depressive, anxiety, and personality disorders.”  Although only a small number of studies were included in the review (given the stipulation for Australian specific content), the research indicated that the effects of long-term psychoanalytic psychotherapy may endure long after the termination of treatment. This research supports a range of recent empirical studies by Jonathan Shedler (2010), Peter Fonagy (2015) and Falk Leichsenring, Frank Leweke, Susanne Klein and Cristiane Steinert (2015) demonstrating the effectiveness of psychoanalytic and psychodynamic psychotherapy.

In addition to our articles and literature review, we have a rich array of book reviews.  Susie Elliot reviews Sue Gerhardt’s 2nd edition of her 2004 best seller Why Love Matters (2015) synthesizing extant research in neuroscience on the critical importance of secure attachment in infancy and early childhood with implications for psychotherapists. Fiona Giles reviews Rosemary Balsam’s Women’s Bodies in Psychoanalysis (2012), a collection of essays spanning twenty years of work on the critical importance of expanding our theoretical and clinical frames to include women’s reproductive and sexed bodies. Aleksandra Staneva reviews Nancy Chodorow’s Individualizing Gender and Sexuality (2013), another collection of essays over 20 years refining Chodorow’s expert synthesis of the sociological and the psychoanalytic outlining her more recent preference for “clinical individuality”. Elizabeth Day reviews Relational psychotherapy, psychoanalysis and counselling: Appraisals and reappraisals (2014) examining the relational turn inside psychoanalysis and its philosophical roots beyond. Tony Talevski reviews Josette ten Have-de Labije and Robert Neborsky’s Mastering Intensive Short-Term Dynamic Psychotherapy (2012) building on the classic work of Habib Davanloo (1980) outlining the theory and practice of  Intensive Short-term Dynamic Psychotherapy. Hugh Crago reviews Helen Gerondis’ Why Am I So Angry? My Search for the Truth (2013) an exploration of therapy from the client’s perspective in the context of her struggles with body image and eating disorders.

This is a rich and eclectic collection of articles and reviews in this fourth edition of PACJA.  I hope you enjoy reading it as much as I have enjoyed putting it together.

 

References

Akhtar, S. (1989). Narcissistic personality disorder: Descriptive features and differential diagnosis. 
          Psychiatric Clinics of North America, 12, 505-529.

Brookner, A. (1982). Look at me. London: Triad Grafton.

Davanloo, H. (1980). Short-term dynamic psychotherapy. New York: Jason Aaronson.

Fonagy, P., Rost, F. Carlyle, J. McPherson, S., Thomas, R., Fearon, P., Goldberg, D, Taylor, D.
          (2015). Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for
          treatment-resistant depression: The Tavistock Adult Depression Study (TADS). World
          Psychiatry
, 14, 312–321.

Leichsenring F., Leweke F., Klein S., & Steinert C. (2015). The empirical status of psychodynamic
          psychotherapy – an update: Bambi’s alive and kicking. Psychotherapy & Psychosomatics,
          84, 129-148

Motherhood and Culture: International and Interdisciplinary Conference (2015, June 15-17).
          Maynooth University, Co. Kildare, Ireland. Retrieved from https://www.maynoothuniversity.ie/
          motherhood-culture-conference

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist,
          65
, 98-109. doi: 10.1037/a0018378

Wallenstein, R. (2014). Psychoanalytic therapy research: A commentary. Contemporary
          Psychoanalysis, 50(1-2), 259-269.


 

 

 


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