I write as the febrile, volatile and divisive public mood that we experienced in relation to Brexit appears to be partially replicated by the anxiety associated with the corona virus. Both have engendered an atmosphere of fear of (external) contagion. A primary anxiety which takes the form of an externally malign, and highly infectious, danger which is concurrently both imagined and real. What we witness at these times are the (re)appearance of developmentally early defence mechanisms such as splitting and projection and their siblings – grandiosity, denigration, scapegoating and contempt. Needing at this time to move from a culture, and conversation, which privileges the ‘we’ over the ‘I’, how can we avoid recourse to the threatening ‘they’? How can a more thoughtful, relational, self-reflective culture endure when public discourse privileges a developmental ‘race to the bottom’, an appeal to one’s base emotions. What role can psychoanalytic understanding and practice have in a world which seems, in its manifest content at least, to favour divisiveness, rancour and unprocessed emotionality? Additionally, at a time when we are asked to self-isolate and avoid interaction with others to avoid contagion (whilst simultaneously recognising our fundamental need for each other), what place can the relational occupy? What kind of therapeutic conversations do we want to have – or are possible – in our contemporary culture? This forms a central question in this issue of Psychodynamic Practice.
Our opening paper is a conversation between Nick Barwick and Adam Phillips which was the 2019 Birkbeck Counselling Association’s Autumn Talk. Entitled ‘Brexit, nationalism, populism: Where are we now? How did we get here? Where are we going?’ the discussion ‘takes psychoanalytic thought beyond the consulting room into the realms of (the) social, cultural and political.’ A reminder that there is such a thing called reality that we process through our own personal and social scripts. The consequences of living in real, and metaphoric, ‘gated communities’, or what others have described as ‘tribalism’ or ‘echo chambers’, are named, and the ensuing struggle to listen to, hear, and engage with views with which we disagree is discussed. In our currently volatile atmosphere, concepts such as ambivalence, doubt and uncertainty, as well as a certain thoughtful reciprocity, the capacity to mentalise, and the ability to entertain and engage with contradictory ideas – all central to the psychoanalytic project – are difficult positions to maintain and articulate. The upholding of these central psychoanalytic themes – as well as the capacity to bear loss, entertain ambivalence and mourning, and the acceptance and importance of vulnerability – have become problematic, and denigrated as signs of weakness in the public sphere. On the other hand, the conversation suggests that states of conviction, currently seemingly highly prized, can act as forms of self-cures, while potentially having a less than positive effect on the wider community. The importance of valuing and engaging with ‘difference, different voices, conflicting voices and compromise’ is highlighted since the psychodynamic framework addresses, and is mindful of, the engagement with ideas, emotions (and people) we may not find comfortable or agree with. Arguably these qualities are not in the current ‘zeitgeist’ or valued in contemporary discourses. In Phillips’s words we need to engage with the ‘not me’s’ as a way of escaping our echo chambers which restrict – rather than facilitate – our roles as citizens. We need to remind ourselves of that ‘fundamental belief in inter-dependence; that actually there is no such thing as autonomy, or isolated independence and so on; that there is a multi-dependent world.’ It is unfortunate that we need a virus to remind us of that. Managing to contemplate this is the work of both the consulting room and the wider civic – or political – sphere. The conversation stresses the dangers of reality being excluded from our consulting rooms and how culture, particularly if toxic, encourages certain forms of relating which can become malign and destructive. What is the role of the clinician in these circumstances?
The paper offers both a developmental and social context for understanding our current civic turmoil – and also a positive view of what we, as psychodynamic practitioners, can offer both our patients and more generally the cultural debate. I, for one, was very taken with the suggestion that ambivalence should be taught in schools to aid the ‘avoidance of splitting, and the wish to live a comparatively non-paranoid life.’
Mary Lynne Ellis ‘Dissenting colleagues; power, alienation, vulnerability’, our second paper, also explores a contemporary theme in finding a link between past upheavals in psychoanalysis – the Freud/Klein controversies during the 1940’s and 1950’s – and current cultural and professional controversies. The paper gives a fascinating account of how organisational, professional and clinical dynamics are shaped by social and historical contexts. Then, as now, we need to be mindful of transgenerational transmitted professional anxieties so as to pay attention to our own, and our colleagues, ‘.vulnerabilities, which can lead to benign and … creative and mutually enhancing professional relationships which allow for critical questioning and differences.’
We are always vulnerable to treating people who disagree with us as objects and not as three-dimensional figures with strengths and weaknesses. The challenge in fraught times is of accepting vulnerabilities and differences which apply both inside and outside the consulting room, as well as between ourselves as clinicians and in our professional organisations. The paper calls for the privileging of collaboration over competition between us in our profession and in the wider culture. The paper suggests that the profession has in the past used ‘pathology in colleagues who challenge dominant discourses to bolster power and disempower others’, while contemporary ‘cancel culture’ brings up the question of ‘whose voice do we want to deny and why – what is it that we ourselves are afraid of?’
It goes on to highlight the parallels between past controversies and contemporary ones, not least the fact that both past and present exist in a ‘marketplace....which is competitive and ruthless’ where theoretical/clinical differences may be exacerbated by competition over patients and income and where trainings exist in a culture that encourages competition (and denigration) between therapeutic modalities. This culture inhibits creativity, thoughtful reflection and enquiry which we, as psychodynamic practitioners, need to preserve and espouse.
‘The effectiveness of psychodynamic career counselling: A randomized control trial on the PICS program’ by Andrea Caputo et al. is a quantitative study of psychodynamic career counselling which suggests that a protocol led, psychodynamically informed, group model may well lead to a more relational, and informed, approach to career choice and progression. The paper suggests that while we are being led to believe that we choose careers on purely rational, conscious (and increasingly economic) grounds, the psychodynamic paradigm reminds us of the importance, and value, of being mindful of unconscious factors in the choice of careers. Equally, the paper suggests that ‘psychodynamic approaches to career counselling have mostly focused on inner motives, drives, and related … variables, without carefully considering the economic, social, and cultural contexts of individuals, thus failing to integrate issues of the intra-psychic (subjective dimension) and the external world (labour market)’. Internal and external reality coexist and inform and influence each other.
While a psychoanalytic framework for career counselling has potentially a lot to offer, the paper contends that it currently lacks a coherent model for its application. Through the introduction of a five-session group career counselling programme, the author suggests that participants become more mindful of their motivations for various career choices and this enhances their ability to make the search for a career/job more informed and thus more satisfactory and durable. This is facilitated by the relational aspect of the dynamic group process which encourages a relational, rather than an individual, perspective. Interestingly, this structured group model, involving dynamic group processes and understanding, suggests that career choices maybe enhanced by understanding the part that reparation plays in the process particularly when linked with the depressive position and its relational outcomes. It offers a model for enhancing career choice while being mindful both of the intrapsychic and external factors influencing these decisions.
Our Open Space papers, while concerning themselves with a somewhat different demographic, highlight similar themes.
Mannie Sher’s ‘Group Relations Event: The experience of being seventy years or older’ is a fascinating account of a group relations event held at the Tavistock Clinic as part of the Tavistock Festival marking the seventieth anniversary of its establishment. Using the framework of a group relations event, it offered the opportunity for people to reflect on, and address, achieving ‘three score years and ten.’ Issues concerning visibility, the re-emergence of Oedipal anxieties in an interestingly different form from earlier phases in life (not least in relation to septuagenarians’ attitude to work), time and generational succession, were all in evidence and were underlying themes of the three-day event. Developmental issues surrounding dependence/independence appeared to encourage familiar preoccupations from adolescence, with correspondingly similar, if age different, anxieties, as did the participants concern about their physicality and changing bodies. Loss was a major issue and the importance of narrative – telling a story – appeared to be particularly important for participants as it arguably is for therapeutic conversations at any age.
Developmental repetitions, no less powerful for being age specific, were much in evidence and Sher’s paper vividly conveys that the process of ageing offers another opportunity to revisit lifelong developmental challenges, and reinforces the analytic notion that every developmental achievement comes with both gains and losses. Both the dynamic process and thematic content of the event convey a real sense of the ageing process but also demonstrate how similar developmental issues that we have confronted throughout our lives need to be reworked in a differing temporal context. Time is of the essence. Back to the future indeed.
Our second paper in the Open Space section of the Journal, ‘The traumatic potential of nursing home admission’ by Linhardt and Viode, complements the first. While social care has been in the headlines of late, discussion has tended to focus on the economics and practicalities of, amongst other issues, nursing homes for the elderly. Linhardt and Viode discuss the psychological aspects of admission into nursing homes, viewing the process as a form of trauma involving issues of ‘identity and existential meaning’, where developmental issues of independence/dependence are again paramount. However, unlike other developmental stages, in old age, losses start to outweigh gains. Fascinating case studies reveal how traditional defences against frailty, old age, and dependence, are overwhelmed, and resemble a specific form of trauma which ‘hinders psychic and cognitive functioning’, making the processing of these experiences more problematic and challenging. Deficits in the capacity to symbolise add to the difficulties experienced by the elderly in these situations. The authors suggest that involving the person in aspects of their own admission, as well as being mindful of specific individual character traits, and of ‘... the subject’s internal representations of the institution’, can be helpful in making admissions less traumatic.
Our book review essay is devoted to the difficult issue (both to acknowledge and work with) of the erotic transference and counter transference . Viewing erotic vitality as a creative, rather than destructive, process, and part of the psychoanalytic encounter, the author helps us understand how this might elicit a thoughtful and constructive clinical conversation within the profession, rather than something rarely talked and experienced as a secret vice, fused with guilt and shame.
Other reviews include a contemporary view on psychodynamic therapy and practice; the use of ‘poetics of experience’ where the body, metaphors, myth, and folk tales become intersubjective means of communication; gendered, religious and national grief and bereavement in Palestine; Islamic thought and psychoanalytic thinking; a reconsideration of the work of Bion, and Winnicott’s concept of ruthlessness in the context of the decolonisation project in South African universities.
As editors we trust that this issue will help readers to take their minds off a preoccupation with current events and remind us of (non self-isolating) therapeutic and social interactions which might be possible in these increasingly fraught times. We hope the papers will reinforce the importance of the relational and emphasise the kind of conversations, both inside and outside our consulting rooms, that the psychodynamic paradigm makes possible.