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Book review for Del Loewenthal and Andrew Samuels, Relational psychotherapy, psychoanalysis and counselling: Appraisals and reappraisals

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Elizabeth Day, Australian College of Applied Psychology

 

If you were to succumb to the temptation to read this book by its cover, you might find it a fractal experience. We know that authors do not always have command over the choice of cover for their book, certainly with the larger publishers like Routledge. But whoever did choose the cover has nailed it.

What you see beneath the title is a hyperreal coloured photographic image of three people standing on a beach. On the left is a white man dressed in white trousers, a grey t-shirt and sun hat. His gaze is toward the sea. He is holding the hand of a woman of colour who is wearing a white bikini. Between them is a white man dressed in white trousers and shirt. He has an arm around the woman’s lower back and they are kissing. The image is arresting, from the perspective of relationships and overdetermined signs. 

What is going on? Are the two men in relationship, with one of them making a bisexual turn? Is the man dressed in all white the woman’s fantasy, as she and her (other) male partner hold hands before the ocean?  Is there an act of betrayal in this arrangement of handholding and kissing and, if so, by whom? Or is this a representation of straightforward polyamory? What does the juxtaposition of the woman, semi naked, with men fully clothed indicate about their relative positions of power? Are they feeling oceanic by the sea? In this fraught interpretive space fantasy is indistinct from object reality. On the face of it conceptual analysis cannot solve it. Whose fantasy, whose gaze, could determine the answers to the question of meaning posed here?

The overdetermined signification of the cover is replicated through this multi-authored collection of cases and arguments about relational psychotherapy, psychoanalysis and counselling.  

The book includes contributions from luminaries of the field including Susie Orbach, Lewis Aron, the editors, Del Loewenthal and Andrew Samuels, and other leading thinkers and practitioners in psychotherapy, psychoanalysis and counseling.

In a stimulating mix of theoretical conceptualizing and case material, contributions look at relational practice through self/other boundaries in the intimate clinical exchange; mutual influence of therapist and client/patient/analysand; therapist self disclosure; the use of silence empathy and forgiveness; social theories of power; and the“magic” (Loewenthal, p. 1) that renders the clinical process transformative.

In his opening chapter Loewenthal cuts to the chase about the indeterminacy of the key term of the book: “what perhaps is being spoken about by  ‘the relational’ appears in the nooks and crannies that the particular theory can’t reach, beyond conceptual totalizing – and even beyond pluralism.” (p. 6)

The book presents British perspectives on the  “relational turn”, with a few international voices from New Zealand, the USA and Israel. It is divided in two parts: “Mainly celebrations”, comprising chapters that celebrate the relational, with a wide range of interpretations of just what relational practice is; and “Mainly critiques” including chapters that critique the practice or the very idea of a “relational turn”. The editors thereby aimed for a “spirit of tough-minded dialogue” (p. 3). Although the common factors research (Duncan, Miller, Wampold & Hubble, 2010) has not been integrated as significantly yet in psychotherapeutic scholarship in Australia, it seems to have influenced the work of these contributing writers, if only implicitly.

The Index reassuringly notes the presence of Buber, Husserl, Levinas; the entry for “empathy” sits comically alongside “empty signifiers”, “evil” alongside “existentialism”, “hate” alongside “Heidegger”. I was looking for entries for “field”, “field theory” or “relational field”, though, because the phenomenon of “the field” – a “totality of mutually influencing forces that together form a unified interactive whole” (Yontef, 1993, p. 297) – is so integrally related to relational process across a number of disciplines that it is almost impossible to conceive of relationship occurring without the constellating of a field, whether it be an ontological, energetic or theoretical phenomenon (Day, 2016; O’Neill, 2008; Parlett, 2005). Its explanatory force regarding the transformative potential of therapy is worthy of attention, as it conceives of the relational not simply as social, empathic and interpersonal, but as a substrate that operationalizes intersubjectivity and the transformative potential. I was disappointed that this was missing from all contributions, a critical absence in a broad discussion about what constitutes “the relational”.

Aron’s honest assessment of his own understanding of “relational” hints at why there are still significant gaps in the critical discourses forming around the term and its clinical practices. In his recollection “relational psychoanalysis” emerged from New York in the 1980s. “There was never any question, within the circles in which I was associating, that this burgeoning of interest in relational theory and practice was a development within psychoanalysis rather than outside it.” (p. 93). Clearly the many modalities under the umbrella terms of psychotherapy, psychoanalysis and counselling need to get relational with each other, and attune to the broader transactional field.

He problematises this history and Tudor picks up on it to provide a wider lens for viewing the specific instance of relational psychoanalysis within the broader field of relational psychotherapy, whose origins he identifies in Jessie Taft and subsequently Carl Rogers (p.195). Citing humanistic origins for the relational does not settle the questions, for, to go with Rogers is to ignore the phenomenological method applied explicitly or implicitly in much relational therapy. This would lead us at least to Heidegger, before him, Husserl, and before him Kierkegaard, to Merleau-Ponty and to Levinas. Or do we step back to the ancients, to Greece, or further back to the Vedic texts?  Is the relational drawing us to a renaissance of the axial paradigm?

Neither origins nor foci are settled questions in this still emerging domain of clinical practice. The collection provides a range of approaches to relational work. For example, Nodelman in “The primal silence” presents an exemplary case study of relational work (preverbal, including enactment of a dramatic birth history) with a client with cerebral palsy.  She describes the “silence” as “co-constructed with implicit meaning that was the result of analyst/client interaction” (p. 47) after a year of work together. “At times it seemed as if ‘silence‘ in and of itself and/or my bodily presence represented a primary substance (Balint, 1968) that sustained and preserved for Stephen his continuity of being” (p. 48).

Intersubjective psychoanalysis is represented in which analysis becomes part of the field of enquiry, not standing separately from it. This tension may be why the relational is characterized as a “turn”, in some psychoanalytic circles; something that works “against” the main mode in order to alter it. Yet wider clinical circles have deployed the relational as an inherent practice orientation and have a productive framework both theoretical and practical for working with the relational field.  Some of this is taken up amply in the second half of the book, given over to critiques of the relational.

Loewenthal (chapter 12) on the question of a relational ethics aligns with Levinas, asserting heteronomy (the other comes first) over autonomy (me first), as the ground for clinical wellbeing. This approach requires us “…from and through our relationships, to be just in the moment with another” (p. 150), and represents a distinct challenge to an overheated knowledge system that mistakes atomization and measurement as the apex of knowledge. 

Carmeli and Blass (chapter 10) seem to take relational literally in a social sense in order to critique the relational turn. Parker (chapter 11) also critiques from a reductive interpretation of relational, positing left activism at the opposite end of the spectrum from relational therapy.  And yet, aside from its implicit democratization of the therapist client relationship, the relational in its philosophical rather than social sense neither aims at normalizing a client nor coercing them into socially constructed subject positions.  Its radicalism is not based on any assumed content, or what relational looks like, but rather in its absence of intentionality or design toward a client. The capacity to “be with” following Heidegger “to embody” following Merleau-Ponty and/or to “be for” the other following Levinas, is arguably more structurally transformative and foundationally radical than the content-based activism of a social movement, precisely because it does not serve up full signifiers for the patient, or, in other words, a faitaccompli subject position.  Samuels shares a little of this frustration in his epilogue, in which he brings the client into view as the missing signifier in the field of signs.

The collection does not aim to formulate a type and form of the relational. Rather, it conjoins diverse therapeutic voices across the relational spectrum.  And it sets up the voices into celebrations and critiques of relational practice. This is a useful dialectic that never produces its third term a resolution to the uncertainties of the definitional limits of “relational” – deliberately so, given the multiplicity of voices. The risks of not taking allegiance with a unified theory and process for relational practice are evident, as are the risks of boring down into a settled definition that generates a set of skills and falls immediately into a pre-relational and experience-far expertise model of therapy. Articulating ways that the term “relational” can be applied to benefit or undermine psychotherapy Loewenthal muses, “Perhaps Heidegger’s …  ‘being with’ is one alternative, if one could then stop it becoming a technology” (p. 4). If only.

References:

Day, E. (2016).  Field attunement for a strong therapeutic alliance: A perspective from relational gestalt
          psychotherapy. Journal of Humanistic Psychology. 56(1) 77–94.

Duncan, B. L., Miller, S. D., Wampold, B. E; & Hubble, M. A. (Eds.). (2010). The heart & soul of change:
          Delivering what works in therapy (2nd ed.).Washington, DC: American Psychological Association.

O’Neill, B. (2008). Relativistic quantum field theory: Implications for Gestalt therapy. Gestalt Review,
          12(1), 7-23.

Parlett, M. (2005). Contemporary gestalt therapy: Field theory. A. Woldt & S. Toman (Eds.), Gestalt
          therapy: History, theory and practice
(pp. 41-65). Thousand Oaks, CA: Sage. 

Yontef, G. (1993). Awareness, dialogue and process: Essays on Gestalt therapy. Gouldsboro,
          ME: Gestalt Journal Press.