Opinion

DISCUSSION PAPER ( 2 ) PRESENTED TO THE CPJA ON NOVEMBER 28TH by ALAN LIDMILA ( EXECUTIVE MEMBER OF THE CPJA AND MEMBER OF THE HALLAM INSTITUTE OF PSYCHOTHERAPY )

CPJA Discussion Statement: Parameters of Practice/2

We need to address the question ‘what is it we do?’ (and what is it we try not to do). Because it may be unclear, and therefore requires redefinition. This short paper seeks to delineate core principles of psychoanalytic practice, based in a reliable theoretical model that has evolved over time.
Essentially, it is a concrete restatement of our ‘flag statement’ (revised 2012) that in simple but meaningful terms may be listed as a series of principles of practice as follows:
• Rhythm (translation: key arrangements around time, frequency, and regularity, typically longer than shorter, based in an understanding concerning, among other factors, infant development);
• Regression (trans: also concerning time and the importance of early or past experience ,including as re-experienced, possibly re-enacted, in the therapy setting);
• The Unconscious (trans: mental operations , perhaps determining behaviour, not immediately apparent, the meaning of which may be accessed through language, dream and symbol);
• Setting/Frame (trans: the therapeutic space, involving the above, as well as, crucially, attention to boundary and abstinence, as far as possible intellectually, and certainly physically);
• Language and Thought ( trans: the epistemophiliac impulse, aka the desire to know – and fear knowing – as investigated, facilitated and understood , quintessentially, via language and speech);
• Interpersonal Relationship ( trans: the inter-subjective relationship/s between therapist and client, often involving multiple objects of a transferential and countertransferential nature, that may come to be identified and recognised by means of insight and interpretation);
• Supervision ( trans: therapist normally has recourse to the ‘3rd position’ of supervision, wherein there is located some authority of the model, in addition to managing this position internally).

It therefore follows, as distinguishing features of p-a practice, that normally or typically, we do not advise, and try to be judicious in our use of creativity. We are also cautious about, if not actually prohibit, forms of acting-in, which may include touch, extra-sessional contact, or excessive dosages of expertise, sermonising or prescriptions. We may utilise short-term dynamic approaches, but we do not consciously adapt our approach by wandering into territories best occupied by other modalities. We try not to succumb to pressures for a ‘quick-fix’, or be seduced by the fantastic, whether ‘new idea’ or latest toy.
This statement is really a reprise, in edited form, of my thinking of twenty years ago,* which was what many jobbing analytic therapists thought anyway, and what most should be thinking now! Some things do not need to change, for the sake of change. Notwithstanding my claimed adherence to the above rubric, over 25years I have become, subject to client or pathology, relatively more flexible, responsive and creative in my personal style. But, I suggest, it is within, not beyond the pale

DISCUSSION PAPER (1) PRESENTED TO THE CPJA ON NOVEMBER 28TH by ALAN LIDMILA ( Executive Committee Member of CPJA and member of The Hallam Institute of Psychotherapy )

Paradigms of Practice/1

CPJA 1

By way of introduction, let me tell you a short tale. Twenty-five years ago today, a few of us were trying to get all the band to play.. So, in this actual venue, a meeting was held, probably long forgotten, with the title: ‘The Making of Analytic Psychotherapy – Varying Perspectives’. H.W (a fellow-conspirator at the time)and I were invited to contribute and my offering was entitled :’ The Emperors Clothes – looking again at analytic paradigms’ At the time, we barbarians spoke for the fringe, unsanctified analytic tribes, those unblessed by metropolitan hegemonic holy waters.
There has always been a debate as to what properly constitutes psychoanalytic practice. In alliance with elements of The Guild, AGIP & other ‘liberal’ organisations, we were trying to widen, indeed diversify the range of organised p-a practice in what were pre-UKCP days, in a field that was very exclusively organised in ritual, incestuous obeisance around The Institute. Hence the sub-title on that day. It is a longer tale, but one not only for the archive: history, like food, repeats.

Now, looking for an apposite phrase in very different times I consider plus ca change , plus c’est la meme chose but, things are not quite the same, even if the comment underscores what is often ironic about apparently progressive change, and signifies the importance of history, taking a ‘ long view’ regarding a current zeitgeist, or any uncritical conformity to the flavour of the day..
At that time, as now, sub-texts,politics, are at play. Then, the ‘radical’ tendency was to widen the net, extend the brief, allow in some of the Barbarians from the outer encampments (not a wholly altruistic move, as this would in turn strengthen a power base, assist economic imperatives, in squabbling London town houses).Yet change is ironic, and dialectic, and often unintended; my comments today suggest other consequences in psychotherapy culture ,and in turn a response that is now, necessarily, more ‘tradical’ than radical !

To briefly explain this shift. Now, we inhabit, in wider culture as it impinges on psychotherapy culture, different, but not necessarily progressively better times. Leaving aside the problematic ‘regulatory mind’, we almost over-subscribe to values of ‘inclusivity and diversity’, which may have undesirable consequences as far as a homogenous, clearly differentiated psychoanalytic model is concerned. Ironically, the old guard, zealous keepers of the flame, upped sticks to form a higher temple elsewhere, leaving a vacuum, fertile for doubters, to ‘develop’, deconstruct, or maybe dismantle the integrity of the model – a model already under external threat in Nice Times. (I note tendencies, by the way, not conspiracies!).

The confidence in the model seems to have wavered for some, who as a result, have experimented, with techniques, derived from other models. This is not necessarily ‘adapt and survive’, any more than any crisis is nuclear – it is more like anxiety, or at worst panic. There are two interacting factors:
Adaptive responses to external pressures in form of NICE, IAPT, contractions in NHS and trainings, coincident with a translation of the ideology of diversity into shifts in practice technique, so as to resemble a more mixed portfolio, some more strings to the practitioner bow, because, well, we need to reflect and embrace diversity, rather than anything that whiffs of exclusiveness, elitism, even specialism. I am suggesting there is evidence of muddled, if well-meaning thinking, which has contributed to doing a disservice to a confidently held psychoanalytic paradigm. Thanks.

A century on, Freud’s melancholia remains the psychological condition of the lost soul. Which is why psychoanalysis has become the modern form of exorcism

” I believe in ghosts. I live with them all the time. But it wasn’t always the case. Foolishly, I used to pretend they didn’t exist, that the dead stayed dead, that they had no purchase on my life. But now I speak to them all the time and they speak to me. I have photographs of them on my study wall. And I have even come to love them, in a strange kind of way. But I don’t call them ghosts. I call them memories, many half buried, many faintly conceived. For one of the surprising things unearthed for me by the extraordinary chemistry of psychoanalysis was the continuing presence of my ancestors. Ghosts are psychological unfinished business, often associated with unprocessed pain.

It is exactly a hundred years since Sigmund Freud set pen to paper to write his ground breaking paper Mourning and Melancholia. Published in 1917, Freud distinguished between two responses to loss: mourning, when the object of loss is clear and obvious, and thus can be emotionally processed; and melancholia, a state of being in which one is affected by a loss that one is unable to name. Melancholia is, as it were, a loss that one doesn’t realise has been lost. And because one cannot properly name this loss, because it exists in the psychic shadows, one cannot go through the process of mourning it properly. The pain goes unburied. So it hangs around and continually haunts you. This state of melancholia is often associated with depression.

It was four years ago last Monday that I resigned from St Paul’s Cathedral. Dealing with the emotional fallout led me back to therapy. Initially, I thought the subsequent depression was to do with something obvious like a loss of ego-status or a life-crisis that had yet to be properly worked through. But as the lens widened, something unexpected came into view. My ancestors came to these shores escaping persecution. Many were central European refugees fleeing tsarist pogroms. And as Jews were being gassed in Nazi Germany, my family were desperately seeking to re-build their lives, searching for normality and acceptance. And for some, the best way to do this was to forget the past and to blend in. My dad became a Christian. I became a priest. Unconsciously, it was the ultimate way not to talk about what had happened. But theologically, it was the ultimate betrayal  not to talk about what had happened. And yet, for me, the dead refused to stay dead. The Jewish talking cure, also invented by a man running away from his religion, returned to me these buried presences and invited me to walk among them again: my great-grandfather Louis, working for the Jewish Board of Guardians looking after “swarms” (cf David Cameron) of desperate refugees in the East End; his brother Samuel, with his Anglican-looking dog-collar, but leading the Princes Road synagogue in Liverpool.

And yet, for me, the dead refused to stay dead. The Jewish talking cure, also invented by a man running away from his religion, returned to me these buried presences and invited me to walk among them again: my great-grandfather Louis, working for the Jewish Board of Guardians looking after “swarms” (cf David Cameron) of desperate refugees in the East End; his brother Samuel, with his Anglican-looking dog-collar, but leading the Princes Road synagogue in Liverpool. They both changed their names from Friedeberg. And, interestingly, they were both of Freud’s generation.  For me, only by re-membering the dead would melancholia be converted into plain old mourning. My healing was to be found among the ghosts.

The year before Freud was writing Mourning and Melancholia, the fascinating ethnographer Shlomo Ansky was writing his own Jewish ghost story called The Dybbuk and subtitled “between two worlds”. In Jewish mythology, the dybbuk is a dark lost soul, suspended in some intermediate state between life and death. For a secular socialist like Ansky, his story was an expression of mourning for a religious culture that was collapsing both around him and inside him. The Jewish faith was something he rejected and yet needed at the same time. “My life was broken, split, torn,” as he put it. Freud invented psychoanalysis and Ansky wrote about ghosts. But they were doing a similar thing: resurrecting the half-dead, thus to give them a proper burial. Freud’s melancholia is the psychological condition of the dybbuk, the lost soul. And psychoanalysis is a form of exorcism. So, yes, I believe in ghosts. My sanity depends upon it. Happy Halloween. ” Giles Fraser

A Putney debate on changing the constitution of CPJA?

Andy Cottom

Back in 1647, towards the end of the Civil War, members of the Parliamentarian forces met by the banks of the Thames at St. Mary’s Church in Putney to discuss the make-up of a new constitution for England. Many of the speakers there were members of the Levellers movement who sought universal suffrage – One man, one vote. Read this entry →