There's a paradox in clinical practice. I get to know people very well, but they can never be my friends. This bothered me at first, but it doesn't so much any more. If there were any way of being friends, then the work we do together would become unbearable, and therefore impossible. It's a sacrifice we mutually make to make it possible to do something useful. It's a loss I've accepted.
That's a quote from a new psychoanalytically informed blog Working Through (the author of which I met while in New York recently). I recognise the dilemma he's talking about - less that clients can never be "friends" but more how difficult it can be to have a normal social life if you are a therapist. You can't drop into the local pub on a Friday night and have a casual chat about your week's work...Confidentiality is primary and those conversations are kept for Supervision. As a result most therapists I know only talk about the work with other therapists and this can make for a self referential system that is on one hand supportive and on the other unhealthy at the same time.
Having said that it was a real treat for me to attend the regional meeting of ISPSO in New York and to join psychodynamically orientated colleagues for a day and a half while we talked about the work in our own shorthand and in a way that allowed me to "breathe". I find these oportunities essential punctuations in my working year that remind me about my motivation, orientation and interests. They allow me to go back into other systems and not feel as isolated. The loneliness of the long distance consultant is eased for another 12 months at least!
Woody Allen and Dick Cabot discuss psychoanalysis...
You know, I never know with Allen as to whether he's found psychoanalysis helpful or not. His creative output has certainly been going around in circles telling the same story for years - maybe he really should ask for a refund?
Meanwhile, what about some insights from Dr Niles Crane? (His song, Hit the Couch, kicks in after 4 minutes of great comedy!).
One of my favorite shows on TV is called "Intervention" on A&E, which is about the struggles of people dealing with addiction. On the show, families stage interventions with the addicted member of the family in order to get them to seek help and change their ways. One of the principles that is encouraged is not only that the person is willing to change and get help, the family needs to come together in order for the change to work.
I haven't seen this particular programme on this side of the pond but am familiar with the concept - Travis applies the thinking to organisational change processes and suggests that there needs to be a healthy "family" and a desire for change if this process is to work effectively in organisations. He goes on to say:
The dynamic of the workplace, whether it be a team, group, division, or whole organization, has to be in a healthy state for the organization to undergo serious and permanent organization change. It is almost a paradox that in order for change to be successful, there must be some level of stability in terms of relationships, communication and culture before the instability of change takes place.
This got me thinking about the way in which interventionists are used - the 3Cs Counsellors, Consultants and Coaches. Very often (not always) the 3Cs are called in when an individual is perceived to be "unhealthy"...the 3Cs are marshalled in the service of keeping the organisation healthy by splitting off the unhealthy individual to be made more healthy externally and reimported once s/he is sorted out. To take Travis's example above (and addiction is a great example of a systemic approach) there are other questions to be asked about what work the individual does on behalf of the system and how the system itself contributes to and informs how the individual behaves within it. Increasingly I am working with client organisations to feed back into the system the dynamics that emerge within the coaching relationship and this is having significant impacts. The contract with the individual respects the content of the discussion but also makes space for the overall themes to be explored in the context of the whole system and as such is fed back as organisational intelligence.
I'm taking the opportunity here in New York to catch up with some colleagues who practice in a similar way to myself (not a lot of us back in Ireland!). Over lunch this week I had a fascinating conversation with one colleague about how consultants (particularly those of us who are psychodynamically inclined) participate in listserves. The impulse if you're a psychodynamic consultant is to wonder about the question or dilemma rather than answer a question. Very often in business settings it's that ability to step back that generates interesting material - don't take the obvious for granted etc. But when a group of consultants gather on a listserve there is often more energy devoted to exploring the question rather than offering an answer.
This got me thinking about the power of interpretation. A consultant is given, and accepts tremendous power in organisational systems to interpret what others can't make sense of. How that interpretation is done can be a very creative endeavour - but ultimately it's the interpretation that a consultant is being hired to offer. The permission that is sought and received to interpret is a delicate negotiation. When a group of consultants gather in virtual space to converse it can be a different matter - the jump to interpret is somehow assumed rather than negotiated and this makes me rather uncomfortable because I think this needs to be made explicit. I may ask a question of you as a colleague but that's not the same as inviting you to interpret as a consultant.
Ultimately this is a boundary issue which arises all the time in work settings - am I interpreting from a coaching? counselling? consulting? perspective? Am I throwing my weight around to show how smart I am? Am I endeavouring to close down any difference in the discussion by using my interpretative authority to say it "as it is"?
The lunch time discussion offered so many interesting perspectives that I'll be ruminating over them for quite some time to come - but it has made me consider the explicit and not so explicit ways I negotiate with clients and colleagues and the assumption of authority which each brings.
Both the patient and the analyst are the recipients of these side effects, of all the things said and implied and unintended and alluded to as the patient speaks as freely as he is able, and begins to understand the ingenuities of the censorship he imposes on himself…Psychoanalysis, essentially, is an attempt to redescribe the whole notion of concentration (Side Effects, p.xi).
Phillips’ suggests that you can only be distracted if you have a plan and in attending to the distractions our plans (ones we may not even be aware of) are revealed. So when people ask me “how I work” and “what I do” I refer them to Phillips because his accessible interpretation of psychoanalysis (and indeed, pscychodynamic approaches to working in general) make sense of the ways in which my interest is captured by “oddness” and incidents and issues that somehow “don’t fit in”. Working below the surface of organisations and with people, means drawing clients attention to their plans – the ones that are unspoken and unconscious. Very often those unconscious plans derail the conscious ones and getting to the heart of that difference (very often exposing it for the first time) is the key to unlocking blockages in the system.
If I am working with a group then there’s the “group” plan; the conscious plans of the individual members of the group and the myriad unconscious plans of the group that nobody may be aware of. Add to this the consultant or coach’s plans – conscious and otherwise and there’s a lot going on. All of these agendas are organised in different ways depending on the life stories of participants and the organisational system in which they work. It’s complex work and finding the right time for a client to hear an interpretation of what’s going on is also an important factor in the mix.
So distractions and interruptions are very welcome intrusions into my work space because they help reveal the agendas and plans of a group and as such are such fantastic resources to work with. Phillips also talked about anxiety – and how anxiety leads people to try and engineer pleasure – distractions may be part of that coping mechanism…so attending to distractions generally means we are getting closer to the issue at hand. But pleasure is such an ephemeral thing – can we engineer pleasure? Phillips doesn’t think so – at one point he talked about dinner parties and how we can’t engineer the perfect dinner party – we can only create the context in which it might happen - therefore anxiety – the calcuation of pleasure is the bridge and negotiation between pain and pleasure and as such a wonderfully rich place to begin to understand our fears and desires in a business context.
I’ll leave the final word on this one to Phillips:
If someone were to invent a drug – say, in this context, a psychotropic drug, one that is designed to improve people’s mental health - and to say that the point of this drug, the whole value of it was its unpredictable side effects, there would be a public outcry. (Side Effectrs p. xii)
The full interview with Adam Phillips (in which yours truly is heard asking about collusion among psychoanalysts and about Woody Allen) is available as an audio download at the NYPL website. Pic of Phillips and Holdengräber from NYPL.
The following is the short paper I prepared for the Irish Business Women's Conference in Mayo last week called "Anyone for Pizza?". As it turned out the paper wasn't presented because I offered the time slot for an extended Q & A with delegates It is available as a PDF download by clicking here. (The paper has also been added to the Library on the main site).
Do any of these sound familiar?
You’ve a business idea that’s been cooking away in your head for years..you have an opportunity to make it happen but can’t seem to take the leap…it just doesn’t seem to be the “right time”.
You’ve decided to go it alone as a self-employed person after years of thinking about it .. there’s more work than you can handle and you need to employ someone .. just before you hire that assistant all that work seems to dry up and suddenly there’s no need for anyone else.
You’ve worked hard on the diet, cross-trained, spinned, walked miles and cut back on the carbs…you’re 5 pounds from your goal and you decide to celebrate – anyone for pizza?
If any of these sound familiar then meet your inner saboteur. Self-sabotage is more common than you think and most of us have a familiar set of fears in our head that steps in right at the moment when we want to make a change, take a risk or do something different and very often sends us off track.
But if we’ve worked so hard, harboured those dreams and really want to be different – why on earth do we stop at the last hurdle? What possible function could an inner saboteur have? There’s a long answer and a short answer (let’s look at both). The short answer is – we decide that the saboteur’s voice is the more sensible view - the long answer is – well … let’s meet the F Words.
When is enough enough? San Francisco based Psychoanalyst Dr Owen Renik says
The profession is in a great decline, and I predict the decline will continue. The reason for it, and the reason a corrective is needed now, is that although psychoanalysis began in a spirit of open-ended inquiry, with an orientation above all to be helpful to the patient, it took on a self-perpetuating guild mentality that was its ruin. The possibility is still open to reverse the decline, but it will be necessary to escape the clutches of an establishment that, unhappily, has increasingly gotten away from the original scientific enterprise.
He goes on to say
There is a tendency among psychoanalysts to pursue self-awareness as a goal in itself, rather than a means to an end. Originally, the idea was that the self-understanding that arose as a result of psychoanalysis was unique and impressive and valid because it afforded relief from symptoms that were otherwise impossible to treat.
If you don’t require that self-awareness be validated by symptom relief, there are two destructive consequences. The first is scientific. You have no independent variable to track; you set up a circular situation in which it’s the analyst’s theory that determines what is found in analysis. Many critics of psychoanalysis have recognized this.
The points he raises are interesting in themselves, but they also relate to any kind of inter-personal and professional relationship – when is enough enough? And what kind of methodologies do you use to determine if you your intervention is (a) appropriate? (b) working? or (c) past its sell by date? There is always the temptation to keep clients wanting more. I don’t see coaching in particular as an endless process. There comes a time when you have to say goodbye – often times it’s the coach who has to determine that if a client appears to be too reliant on their coaching process and reluctant to move on and it's sometimes the case that a client is ready to move on long before a coach or consultant is willing to let go.
Renik goes on to say
You should have a criterion for judging whether the outcome is satisfactory, which leaves you free to judge by trial and error. If the treatment seems sufficient, you stop. You can always resume the therapy when and if there’s a need. What might also happen along the way, you might become aware of other things that then you define as symptoms, and you want to address those. Let’s say you have trouble dating, for example. We discover when we look into it that you have trouble asserting yourself, and that applies in a number of areas, including your work life. So we go on, until you are able to make progress there. If you’re not having symptom trouble after that, there’s no reason to keep analyzing stuff. That’s it. You’re done.
I think the same is true of any kind of coaching or consulting, particularly if it’s a one to one relationship and where the identity of the consultant gets tied up with the assignment. If the job is done, it’s done and it’s time to move on – dealing with the personal nature of ending and rejection is something that consultants need to integrate into their practice. I know when I was working as a therapist I had regular supervision where I addressed endings and beginnings on a regular basis. Now that I’m consulting I try to build in some kind of formal ending process with clients – be that a review or other – to mark the transition.
But as Renik says –
there’s no reason to keep analyzing stuff. That’s it. You’re done.
I've just returned from Stockholm where I attended the International Society for the Psychoanalytic Study of Organizations annual symposium. The symposium is an opportunity for those of us working in a psychoanalytic way with organisations to meet and share knowledge about this area of practice.
There were numerous interesting papers and one in particular on a group relations conference conducted via the internet caught my attention. I have to admit to being mystified by how a group relations conference that didn't deal with the territory (i.e. cyberspace) would work. The consultant presenting the case paper bravely stepped into the project and fed back his experiences of how it was managed and conducted. The detail of that isn't of particular interest here. But what did interest me is how systems-psychodynamics needs to be applied to working on the web. There is a whole body of literature at this stage (particularly from psychology and systems thinking) about operating and working on line which I think systems-psychodynamics needs to attend to and build on, not merely replicate. Working on the web seemed to be a very new idea to many people who were at the conference and to some extent mirrors my experience of therapists and consultants who work psychoanalytically, many of whom have a sometimes neurotic attachment to being "in the room" and privilege this as the primary way of generating the transference. (As an interesting aside, of the 14 people who attended this workshop only 2 of us were women...I'm not sure what that means but the gender imbalance was more pronounced here than at any other event I attended).
Some of the thoughts that occurred to me about this..
1. The web doesn't exist - it is a wonderful manifestation of the collective unconscious - everywhere and nowhere at the same time.
2. The web is a boundary less space and many of the conversations (particularly in the wake of the Kathy Sierra incident) about placing boundaries on it have resulted in strong reaction and an acknowledgement that formal rules simply won’t work in this space which means it’s ripe for persescutory experiences and a regression to primitive drives.
3. The only thing that stops any of us committing an “offence” online is our own conscience or sense of what is right and wrong. So our internalised boundaries and how those boundaries are negotiated and made meaning of, are of primary importance in this space.
4. The absence of the social clues that assist us make meaning of, and interpret, relationships offline are absent online so this heightens the transference and counter-transference in a way that can be persecutory. This is why I’m mystified as to how a group relations conference that doesn’t address the territory can operate with integrity in this space.
5. When a conference finishes we have our experiences of the people who attended and how we entered into relationship. When contact online ends we have that, minus the physical presence of people but we also have the written correspondence. What happens to the text afterwards? And how are boundaries around text negotiated? We all know that once something is out there in cyberspace it is never coming back so the archiving function of the web is something that has to be looked at?
I'd love to hear from any psychodynamically informed practitioners working online about their own experiences of this area..
Ernie is a 37 year old single male (?) muppet with borderline intellectual functioning (vs. ADD?) who presents with a chief complaint of a "silly squeek" when he plays the saxophone.
The patient is self-referred to Mr. Hoots, a wise psychotherapist & jazz musician, with a full practice (a "busy bird") who is experienced in a number of psychotherapeutic modalities.
After a brief period of observation, Mr. Hoots identifies the source of the squeek: Ernie is holding his support rubber duck while trying to play the saxophone. Mr. Hoots points out this maladaptive behavior pattern to Ernie and identifies corrective measure for him ("put down the duckie"). Despite repeated behavioral directives, Ernie is not able to follow through with Mr. Hoots' treatment recommendations and the issue of compliance is raised. Frustrated, Mr. Hoots uses self-disclosure as a psychotherapeutic maneuver, telling Ernie, "I've learned a thing or two, through years of playing in a band, it's hard to play a saxophone with something in your hand!"
Ernie remains resistant to Mr. Hoots' interventions. In the video rendition of the psychotherapy, during the Put Down The Duckie refrains, Ernie is shown to be participating in group psychotherapy with a number of celebrities (Madeline Kahn, Danny DeVito, Paul Simon, Wynton Marsalis, & Jeremy Irons) who all instruct and encourage Ernie to Put Down The Duckie while modeling the appropriate behavior of playing their instruments without a squeeky support animal.
Acknowledging the failure of these behavioral interventions, Mr. Hoots turns to a more psychodynamic understanding of Ernie's persistant dysfunctional behavior. Addressing the separation anxiety which prevents Ernie from parting with his duckie, Mr. Hoots reassures Ernie that he does not need to permanently part from his duckie, and adding a cognitive component, he takes Ernie through stages of imagining progressively more difficult forms of seperation ranging from putting the duckie in his pocket, to sending him off on a train, and finally to flying duckie off on a rocket! With his internal conflicts identified, his fears exposed, rehearsed, and allayed, Ernie is at last able to Put Down the Duckie in what is truly a successful psychotherapy.
Whereas all human sciences advance towards the unconscious only with their back to it, waiting for it to unveil itself as fast as consciousness is analysed, as it were backwards, psychoanalysis, on the other hand, points directly towards it, with a deliberate purpose - not towards that which must be rendered gradually more explicit by the progressive illumination of the implicit, but towards what is there and yet is hidden.
M Foucault (1970) The Order of Things: An Archaeology of the Human Sciences, Vintage Books, New York, NY.
in
GABRIEL, Y. & CARR, A., (2002) Organizations, management and psychoanalysis: an overview. Journal of Managerial Psychology, 17, 5, 348 - 365.
Different points of view about psychoanalytic education and theory can be grouped, I think, into two categories. One camp argues that psychoanalysis must be safeguarded from those who would debase it by using the name to include therapies that are scheduled for less than three times per week. The other camp argues that psychoanalysis is, as Freud himself defined it, the use of the concepts of transference and resistance to understand the unconscious and especially unconscious affects, wishes, prohibitions and fears. Who is right?
She then adds
People who have sought psychoanalytic training have complained of being excluded as not good enough or smart enough to do psychoanalytic work. Those who are excluded then turn around and denigrate the group that excluded them. It should be no surprise to a sophisticated audience to learn that excluding people does not make them friends. But psychoanalysts have been doing such excluding for over a century. How do we get away with it? I think that we get away with it because we have a very valuable technique that speaks to people’s hearts and minds in a way that no other technique does.
I'm not a psychoanalyst but my work (therapeutically and organisationally) is all about the transference - the issues Ms Richards raises are of course relevant to any professional association or group, As the old Irish saying goes - the first thing on the agenda of any political party meeting is 'the split'. She is arguing for more fluid boundaries between the rigid definitions of who is and who is not an analyst - suggesting that an understanding of the transference process is the key component of the practice.
For both the practical reason that we want to continue the field of psychoanalysis and our own analytic practices and the theoretical reason that transference and resistance are the firmest foundation for analytic understanding, I think we need to welcome our colleagues who practice at different frequency from ourselves as fellow psychoanalysts and welcome ones.
I like the idea of people practising at 'different frequencies' as ourselves and I would suggest that not all types of therapy are suitable for all kinds of people - neither is one type of therapy necessarily the right answer for somebody at each stage of their journey. The article is the text of a presentation she is making at a conference The Future of Psychoanalytic Education to be held in New York at the beginning of December and the post also has a number of very considered comments (you can register to comment at the bottom of the sidebar on the right). I'm looking forward to reading more at this site and if any readers know of other psychoanalytic/psychodynamic blogs that aren't on my blogroll, please let me know.
There is an outdated idea, based on superficial appearances, that a patient’s sufferings result from a kind of ignorance, and that if only this ignorance could be overcome by effective communication . . . a recovery must follow. But the illness is not located in the ignorance itself, but in the foundation of ignorance, the inner resistances that are the cause of the ignorance and continue to sustain it . . . If knowledge of the unconscious were as important as those inexperienced in psychoanalysis believe it to be, then all you would need for a cure would be for the sufferer to listen to lectures or read books. However, that would have about as much impact on neurotic symptoms as distributing menus would have on hunger during a famine.
A story is told of Alfred Adler, one of Freud's early followers, who once interviewed a prospective patient at great length, taking a detailed family history, and getting as elaborate an account as possible of what the man was suffering from. At the end of the consultation, Adler asked the man, "What would you do if you were cured?" The man answered. Adler replied, "Well, go and do it then." That was the treatment. As in Jack and the Beanstalk, and in many fairy stories, there is a serious problem and a piece of magic; this magic makes strange things possible. The magic is there to show how poor our sense of possibility always is. Jack's beans make him full of beans; they make his world huge. And they show him, as a taste of things to come - living happily ever after with a beautiful princess - that very small things can get bigger and lead you into unexpected and unusually satisfying places. Small boys are not Freudians, but they know that they have their own beanstalk, and that it takes them away from life at home.
The story says that being sensible only gets you sensible things. And whatever else growing up is, it is an initiation into the sensible.
And the Freudian reading of the fairy tale evolves into a fascinating essay on how our desires and our sense of possibility (known to us as wishes when we are children) are turned into sensible options as adults and invariably wished away rather than acted upon.
I'm preparing a workshop for a group of psychotherapy students on 'contemporary issues in psychotherapy' and am interested in unravelling assumptions (well some assumptions) about therapy being useful and a good idea so if anyone would care to contribute some thoughts I'd be really interested...I'm particularly interested in the cultural and political aspects...I won't say any more for now - comments and email would be welcome. I'm hoping Johnnie, Mark, Mike and a few others might chip in?
Robbins' photographs grace an article in the March 6 edition of the New York Times in which Penelope Green asks What's in a chair? The article is an exploration of the physical spaces in which therapists work and she asks a number of interesting questions - what is the impact on a patient's therapeutic process when the sessions take place in a therapist's house? or when the decor or arrangement of the room gives something away about who the therapist 'really is'?
Few therapists today would contend that it’s possible or even desirable to present oneself as a true blank slate, with an office and treatment style utterly free from personal influence. And so the conversation now centers on degrees of influence and revelation: is a family photograph too much? What about the family dog?
The real question that's not addressed in the article is - why are some therapists (and for this read consultants, coaches etc) so grandiose that they think they can control the patient/client's transference? There's a difference between flaunting one's personal life in the face of clients and bringing oneself fully into the room/relationship. The physical presence we create says as much about us as practitioners as the psychological and emotional one. What's absent from a room says as much about someone as what's present. I don't have a lot of time for practitioners who angst about controlling clients' emotional and unconscious lives with the subtle (and sometimes not so subtle) inference that the therapist or consultant's 'real life' is somehow split off and unimportant in building a working alliance. A therapist's life is not a contaminating quality. As a therapist and consultant I work with who is in the room and with what is presented in the room - consciously and unconsciously. I am not and neither do I believe I have the right to attempt to be in control of the client's experience of me. I wonder how many therapists and consultants are really comfortable in a space where the free reign of a client's unconscious is unleashed in the room?
Co-incidentally? Psychoanalyst and writer Adam Phillips is the subject of the Guardian's Writers' Rooms series in which he talks about the physical space he has created in which to write (his consulting room has been photographed many times for various interviews).
The annual meeting of ISPSO takes place in Philadelphia between 20 and 22 June this year. The title of this conference is Meaning and Motivation at work. If you are interested in how organisations 'really work'; and are curious about how emotion and unconscious processes influence how and what gets done then this gathering of consultants, managers and academics is the place to be. Before the main part of the proceedings there are four days of professional development workshops (16 - 19 June) open to anyone to attend. The questions being covered this year include:
How does one effectively market psychoanalytic work?
How does photography introduce new power into understanding organizations?
When consulting or coaching assignments involve working through impasse, what methods can encourage transformation?
What can organizations do to build resistance to corruption in their work?
There are any more fascinating topics - so if you are in the Philadelphia area and are curious about a psychoanalytic approach to working and organising check out the full schedule here.
There's more information about ISPSO here and the full conference schedule is available here.
Wandering around cyberspace this week looking for interesting podcasts to take with me on the flight to New York at the end of the week brought me to these conversations with Adam Phillips. In BBC Radio 4's Open Book Phillips talks about his most recent book Side Effects and in this shorter clip he talks about Going Sane. There's a longer interview with Phillips recorded at the New York Public Library in May of last year here.
About Psychotherapy
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