Relational Psychotherapy, Psychoanalysis and Counselling

Appraisals and reappraisals

Del Loewenthal, Andrew Samuels, Del Loewenthal, Andrew Samuels

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317683568
• Edition: 1
• Topic: Psicologia
• Subtopic: Consulenza psicoterapeutica

Is therapy's relational turn only something to celebrate? It is a major worldwide trend taking place in all the therapy traditions. But up to now appreciation of these developments has not been twinned with well-informed and constructive critique. Hence practitioners and students have not been able to engage as fully as they might with the complex questions and issues that relational working presents. Relational Psychotherapy, Psychoanalysis and Counselling: Appraisals and reappraisals seeks to redress this balance.

In this unique book, Del Loewenthal and Andrew Samuels bring together the contributions of writers from several countries and many therapy modalities, all of whom have engaged with what 'relational' means – whether to espouse the idea, to urge caution or to engage in sceptical reflection.

Relational Psychotherapy, Psychoanalysis and Counselling: Appraisals and reappraisals presents clinical work of the highest standard in a way that is moving and draws the reader in. The more intellectual contributions are accessible and respectful, avoiding the polarising tendencies of the profession. At a time when there has been a decline in the provision and standing of the depth therapies across the globe, this book shows that, whatever the criticisms, there is still creative energy in the field. It is hoped that practitioners and students in psychoanalysis, psychotherapy counselling and counselling psychology will welcome this book for its cutting edge content and compassionate tone.

Part I Mainly Celebrations

1 The Magic of the Relational? An introduction to appraising and reappraising relational psychotherapy, psychoanalysis and counselling

Del Loewenthal

DOI: 10.4324/9781315774152-1

Is the ‘relational turn’ in psychoanalysis, psychotherapy and counselling something to celebrate? Half of the chapters and case studies in this book do just that. They show why there is now a widespread realization that the therapy relationship runs in both directions, is mutual, and involves the whole person of the practitioner.

The other half of the book consists of a set of respectful challenges to and critiques of the current consensus that relational therapy is definitely a ‘good thing’. The uncritical reception of relational ideas is a growing problem for the field. Is it really a question of ‘It’s the relationship, stupid!’?

We hope the advantage of this unique book will be that it brings together in one volume both an account from British perspectives of the relational turn and also critiques and discussions of that turn. A special feature of the book is that two relational psychoanalysts (one from the US and one from Israel) comment in depth on the British authors in the Part I ‘Mainly celebrations’ chapters, and two relational psychotherapists (one from the UK and one from New Zealand) critique in the Part II ‘Mainly critiques’ chapters. Thus we aim for the spirit of tough-minded dialogue permeating the book.

There is a growing interest in relational therapy (Greenberg & Mitchell, 1983; Mitchell & Aron, 1999; Safran & Muran, 2000) as well as research on relating in psychotherapy (Birtchnell, 1999) and relational research (Loewenthal, 2007). For some, the ‘relational’ is most apparent in the psychoanalytic traditions of Freud, Klein and object relations theories as well as Jung; however, the increased interest in relational psychotherapy also includes a whole range of humanistic, existential, integrative and other approaches.

Importantly, there is growing international recognition of the research evidence (Beutler & Harwood, 2002; Luborsky & Auerbach, 1985), which suggests it is the relationship that is the most important factor in facilitating a successful outcome in psychological therapy. Furthermore, following the pioneering work of those such as Stephen Mitchell (1988), there is the emergence of such organisations as The International Association for Relational Psychoanalysis and Psychotherapy.

But what, then, of the different theories in the psychological therapies, regarding questions of the ‘relational’? Do they make any difference? For example, do notions of object relations help or hinder? Is relational psychoanalysis really any different? Does the notion of learning relational skills just lead to further alienated inauthenticity in the name of authenticity? How can it be that, for some, interpreting the transference is a form of persecutory violence, whereas, for others, it’s an ethical responsibility? Does naming a therapeutic modality as relational increase the possibility of a more human and fruitful approach or is it really an inappro-priate, unhelpful demand from the therapist, brought about from what is lacking in the therapist’s own life? So, is it helpful to link psychotherapy with the name ‘relational’? In particular, isn’t there a danger of putting characteristics to the word ‘relationship’ and making it a technology where we talk about ‘the’ relational, ‘relationality’, etc.? Perhaps Heidegger’s (1962) ‘being with’ is one alternative, if one could then stop it becoming a technology.

Yet, what I hesitantly term ‘relational learning’ does seem to have vital intrinsic qualities. How many readers’ favourite, and their children’s favourite, school subjects have consistently changed as their teachers have changed? What is it then about the relationship that makes the difference? Perhaps it’s magic! Whatever it is, perhaps it needs to remain mysterious – for as Merleau-Ponty (1956) wrote, once you take away the mystery, you can take away the thing itself.

Does, potentially, Polanyi’s (1983) ‘tacit knowledge’ come closest to describing what happens through the relational in therapy? If so, it is not something that can be taught and learned by either trainee psychological therapists or patients/clients. But might it be imparted and acquired? So, should we attempt a definition of the relational, or does its tacit, perhaps magical qualities make this too problematic? Hargaden and Schwartz (2007), who edited one of the two special issues of the European Journal of Psychotherapy and Counselling from which this book has evolved, identify what they consider to be key elements of relational psychotherapy:

• The centrality of the relationship
• Therapy as a two-way street involving a bi-directional process
• The vulnerability of both therapist and client is involved
• Countertransference is used, not merely as information but in thoughtful disclosure and collaborative dialogue
• The co-construction and multiplicity of meaning

Hargaden and Schwartz (2007) suggest that relational psychoanalysis usually tends to be regarded as a distinctive contemporary American contribution to psycho-analysis, emanating from the interpersonal (Washington) school of psycho-analysis associated with the psychiatrists Harry Stack Sullivan and William Alanson White. White in particular was instrumental, in the 1920s, in questioning the classical Freudian perspective, insisting that psychosis was capable of being treated psychodynamically with Freud’s techniques. In the 1970s, a group of analysts (including Stephen Mitchell and Jay Greenberg at the William Alanson White Institute in New York) began to explore extensions of Sullivan’s interpersonal psychoanalysis and what has become known as relational psychoanalysis emerged from this grouping.

Hargaden and Schwartz (2007) contend, however, that the relational perspective has in fact deep European roots that began with Eugen Bleuler, at the Rheinau Hospital for the Insane just outside Strasbourg. Bleuler maintained the possibility of relating to and understanding the utterances of the deeply disturbed people that he was to call schizophrenic. Hargaden and Schwartz (2007) see the tension between instinctual and relational approaches to mental distress as inherent in Freud’s writings and, additionally, the work of Donald Winnicott, Ronald Fairbairn and John Bowlby is viewed as central to object relations and attachment theory – a development in Europe closely intertwining with the developing relational approaches in the US.

There is the belief that there are significant humanistic routes to relational psychoanalysis (Hargaden & Schwartz, 2007) including the work of Carl Rogers. Two films – The Right to Be Desperate and Anger and Hurt – show Rogers working with a man who was very ill and a victim of racism. In these films, Rogers works with a deep concentrated listening that is described as benign, yet intense and with a great warmth and depth of intellect. Hargaden and Schwartz (2007) regard this type of listening as very skilled and deeply empathic, whilst also retaining the therapist’s subjective sense of self. This is viewed as the essence of a relational approach to working with clients.

If we then think that as psychological therapists we can actually be helpful by focusing on relationships, what are we actually looking at relationships between? Following Malan (1999), we might think it is the relationship between the patient/client and the psychological therapist; and/or the relationship between the patient/client and those around the client; and/or the relationship between the patient/client and significant others in their past.

However, if one were to return to William James (1890), a founding father of psychology (psychologists, never mind psychotherapists, might benefit in reading the original), one would find that he speaks about relationships in three different ways: first, the relationships between things, which would include the relationships between person and persons (this is ‘intersubjectivity’); second, the relations between persons and materiality and environment (termed ‘inter-materiality’) and third, what I would like to briefly explore here: the relationship between person and method (called ‘intermethodology’).

So, what may be particularly important is the relationship between the psychological therapist and their particular mode of working. For different modes of working probably evoke thoughts, feelings and behaviours of different orders. What James (1912) attempted to knock on the head was the traditional belief that methods usage only implicates the intellect by stating that passion, taste, emotion and practice cooperate in science as much as in any other practical affair. This radical empiricism is in contrast to the traditional belief that methods function independently of the total personalities who use them. This raises such questions as the potential suitability of the individual psychological therapist to carry out a particular therapeutic approach, as well as the effect of the professional training on the person.

With ideas of radical empiricism, developed from James, what is being suggested here is, first, an interest in the relationship of the person who is the psychological therapist with the particular method/school of psychotherapy they have chosen and what qualities it brings out in the therapist that are helpful and unhelpful for the therapeutic endeavour. Second, there is the question as to what else the particular modality method allows, perhaps despite itself, to percolate through beyond its self-contained, detached professional posturing. Here, we might see what the spaces between our method give rise to. In the case of psychological therapies, we attempt to give names to what happens in such spaces as ‘transference’ and ‘countertransference’, ‘letting the other person know how they make us feel’. But 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.

So, might we wonder what the relationship is between our distinguished contributors to this book and the methods they are putting forward; what qualities has it brought out in them which are helpful or unhelpful to their patients/clients and indeed themselves and to what extent do these methods allow something magical to happen? Also, to speculate to probably the extreme, is it possible that these different psychotherapeutic methods have really come about in order to deal with different types of ‘psychopathologies’ in people who are psychological therapists, enabling the therapist to be able to sit there for 50 minutes, minimising the damage their ‘psychopathology’ might do to the patient/client, whilst hopefully enabling something quite other to go to work and heal?

Perhaps a further advantage of having all these different approaches presented in this volume is that you, as the reader, may be able to modify your approach to the one that best suits your particular ‘psychopathology’! Of course, here, as elsewhere, with so many different approaches provided in the psychological therapies, there is also the additional advantage of being able to project onto other approaches aspects of ourselves which we have not worked through, and which may not be able to be contained by our particular theorising!

What I have attempted to open up are questions regarding whether relational psychoanalysis, psychotherapy and counselling are ‘cutting edge or cliché’. I think we are very fortunate in this book to have leading authorities in this field respond to such questions from different perspectives.

In Chapter 2, Susie Orbach discusses ways in which the complex shape of wanted (and feared) forms of relating by an individual analysand emerge in the therapy relationship. Orbach argues that in the reconfiguring of the meaning of the therapy relationship, the analyst is not an outsider, observing the impact of the analysand’s various forms of longing and defences, but is inevitably drawn into and is an active participant in the relational field. Therapeutic neutrality and therapeutic stance are therefore reconceptualized, as are other issues that could be considered contentious, such as the blank screen, self-disclosure, the analyst’s use of the countertransference, interpretation, power in the therapy relationship, dependency and money.

Following this, in Chapter 3 Jane Haberlin presents her clinical paper tracking episodes in a long, intensive therapy with a patient who felt haunted, both by her dead sister and by a part of herself, which led a parallel life. The chapter illustrates what relational therapy might look like in the consulting room through the lens of key themes such as bi-directional influence of patient and analyst, intersubjectivity and working with disassociation at relational depth.

Marsha Nodelman presents the case of Stephen in Chapter 4, ‘The Primal Silence’. Marsha revisits her work with Stephen, a man in his mid-forties with cerebral palsy, to underline the significance of non-verbal analytic work as an essential vehicle for therapeutic action when the patient’s dramatic birth history is enacted within the therapeutic relationship. The work with Stephen highlights the reciprocal processes of mutual influence and mutual regulation within the therapeutic dyad when altered and primitive states of consciousness cannot be formulated or communicated verbally.

In Chapter 5, William F. Cornell addresses the understanding of the analyst’s/ therapist’s vulnerabilities within the therapeutic process and the intimate potential of the therapeutic relationship. The author stresses the awareness of the therapist’s personal vulnerabilities in addition to the more common conceptualizations of countertransference. Case material is presented to illustrate the complex questions of self-disclosure and the intimate nature of therapeutic practice when viewed from a relational perspective.

Judith Anderson in Chapter 6 uses qualitative research based on interviews to explore how psychoanalytic practitioners may perceive forgiveness and argues that they see it as important, and sometimes at the heart of the psychoanalytic endeavour. In so doing, Judith acknowledges that forgiveness is a complex subject with cultural, religious and political associations and further explores how analytic thinking has enriched what is essentially a concept determined by religions and cultures. Judith concludes that the development of the capacity to forgive requires consciousness and empathy, for both self and other, and appropriate metabolizing of aggression.

In Chapter 7, Susan Cowan-Jenssen discusses the topic of mortality in the consulting room. Susan reviews some of the literature concerning how we make sense of our awareness of deat...