Just a brief post to let you know that Radio Drama Revival, one of the longest running and most popular radio drama podcasts (also an on air radio show) have been kind enough to rebroadcast my radio sitcom ‘Choices‘. Although host Fred Greenhalgh disagrees with calling it a ‘radio sitcom’. Judge for yourself!
Here’s the plot synopsis…
Ainesh Sharma is an under confident, over intellectual Indian-Irish twenty something. Ainesh has always been a victim of circumstance; working jobs he didn’t enjoy and failing to live up to his potential. Now, sacked from his factory job and thrown out of home by his disappointed parents, Ainesh is forced to train as a psychotherapist. His course is in ‘Choosing Therapy’, the philosophy that we choose our own destiny, and that everything that happens is our fault. With nowhere to stay, Ainesh is forced to live with two of his bizarre classmates. We follow him as he learns whether there really is such a thing as choice, and if so, how he can make his own destiny.
Choices was funded by the Broadcasting Authority of Ireland, and originally produced for Dublin City FM. The show starred Katie McCann, Aishlinn O’Byrne, Kieran Roche and Dylan Jones, and was produced by Heather MacLeod.
Last year Radio Drama Revival also rebroadcast our ambitious 2012 on location production ‘Any Other Dublin‘. Both Dublin and Choices are available as podcasts on iTunes (and in the listings of pretty much every other podcatcher), if you’d prefer to check them out in episodic format!
This is a review written back when I was studying psychoanalysis. These articles critiquing psychodynamic texts proved pretty popular (I’m assuming with students, or practicing psychoanalysts) when I initially posted them. Having recently uncovered a couple that had never made their way to the web, I thought why not release them. Hope you find them useful / interesting, despite the rather dense academese.
Inside lives (Waddell, 2002) attempts a phenomenological object relations account of psychological development, from infancy to advanced age. Margot Waddell considers the stages of life as states or meta-positions (Waddel, 2002, pp 8), contingent and dependent on earlier developmental negotiation, rather than inevitable developmental milestones. These states represent individuated matrixes of attitude and biological development, in which the positions articulated by Klien and others shift in the context of emotional and intellectual development, external stressors and interpersonal relations. The book examines the impact of biological changes, family of origin, adolescent affiliation, adult individuation and finally the difficulties of coping with degeneration and impending mortality. Continue reading “Inside Margot Wadell – Book Review: Inside Lives”→
‘Psychodynamic Techniques’ (Maroda, 2010) is an attempt to offer a set of ‘culture bound’, historically situated clinical techniques, increasing the ability of psychotherapists to emotionally engage with their clients. Maroda suggests that it is within the affective space of the ‘real relationship’ (Gelso, 2010), that change takes place in psychotherapy, and that by expanding the intercommunicative emotional literacy and affective availability of psychoanalysts, deeper change can be facilitated; especially with extremely damaged and vulnerable clients. The author focuses on practical concerns, from the development of the collaborative working alliance and breaking ‘lulls’ in client engagement, to issues of countertransference revelation and the delicate balance of relating congruently with clients, whilst protecting them from damaging or sadistic expressions of anger or erotic interest. For Maroda, genuine therapeutic practice involves honest engagement with countertransference, both positive and negative. Maroda encourages therapists to expand their range of emotional availability and sincerity within the therapeutic encounter; arguing that it is better to risk mistakes and ‘mended failures’ (Abram, 2007), than to maintain a superhuman veneer of complete acceptance or masochistic impermeablility.
The Book’s Usefulness for Therapists
Maroda’s practical and specific applications of technique provide a clear and consistent perspective, applicable across therapeutic orientations. She argues for a degree of engagement with clients that pre-dates the contemporary mental health fixation with disorder and labelling. Maroda’s specific examples are frequently both novel and theoretically neutral. She provides guidelines for the timing and nature of interventions that are client centred and growth oriented. Maroda provides a blueprint for a ‘here and now’ (Yalom, 2011) emphasis in psychoanalysis that supports rather than detracts from clients lived experience and explorations of past trauma – by attending to how ‘repetitive patterns’ of pathological / self destructive relationship behaviour are revealed in the countertransference. This elucidation of the dynamics of diagnostic countertransference is a helpfully specific and comprehensible explanation of an obtuse and intangible phenomenon.
Maroda, like Patrick Casement, provides a practical guide for the ‘good enough’ therapist, by demonstrating how owning up to her misunderstandings and unhelpful emotional interventions ultimately enabled deeper collaboration in the therapeutic process. This presents both a tremendous challenge and opportunity to therapists, who may fear appearing incompetent or abandoning the veneer of expertise.
The book recommends a less conflict avoidant approach, erring on the side of honest affective engagement with revelations of negative countertransference (once a trusting relationship has been established), in the understanding that owning and correcting subsequent mistakes in treatment may itself facilitate client growth. This is situated in a broader engagement with the reality of the emotional encounter in general, and the use of ‘breaches and repairs’ as methods for transforming mistakes to opportunities for increased client (and therapist) self awareness.
Much of the detail of Psychodynamic Techniques is concerned with the practicalities of navigating the emotional disclosure Maroda advocates, balancing client needs, containment and congruent emotional engagement, whether in the context of therapist anger, erotic counter-transference or simple boredom. Maroda addresses directly the dangers of client exploitation where lack of engagement with (or over indulgence of) negative counter-transference encourages reaction formation and boundary breaking.
What use would you make of it as a practitioner?
Maroda’s detailed recommendations about the appropriate (client directed) levels of empathic expression, how to employ questions and interventions, the utility of goal setting in therapy etc, are usefully specific, without being overly prescriptive. For me they help to structure a mental map of therapy as a progressive process, rather than a series of single encounters.
Maroda keeps client interests at the centre of the therapeutic process – acknowledging that some clients may not wish to tolerate the iatrogenic suffering involved in depth work. Her descriptions of healthy regression (and it’s differentiation from malignant decompensation) provide a compelling narrative of the process of reintegration of split emotions and repressed traumatic experiences. While her acknowledgement of the role therapists can unconsciously play by failing to provide adequate containment / boundaries (with specific examples from her own cases), is informative: For example, examining how the seductive / abused client can unconsciously recreate in their therapist the feelings of ‘powelessness’ and ‘anger’ they experienced in childhood. Addressing the issues surrounding containment with borderline clients, Maroda outlines a method rooted in understanding of the underlying deficits involved, employing ‘reverie’ and appropriate emotional responses, with a measured understanding of the more extreme emotional sensitivity and acting out typical of BPD.
Maroda acknowledges that therapists will inevitably feed into the countertransference, but that this can direct the therapeutic process rather than derail it. Her suggestion that client resistance or therapist distaste may be the inevitable result of a clash of incompatible ‘patterns of relating’ (Maroda, 2010, pp35) , is a humbling reminder that not all client-therapist pairings are a good fit.
I find Maroda’s psycho-educative approach attractive – especially within the boundaries that she develops in Psychodynamic Techniques; i.e.: teaching social norms and providing constructive feedback in response to expressed client need, or in anticipation of common process. This provides a structure for clients who might be left at a loss by the tabula rasa of less responsive psychoanalysis, without imposing theory or inflexible methodology. Maroda is particularly strong in navigating between reinforcing client dependence, and providing support where needed, and here her case examples are particularly helpful.
I found her elucidation of potential re-traumatisation in the phenomena of ‘kindling’, a novel and important element of understanding regression as a therapeutic process. Maroda’s specific advice about how to hold regressing clients, especially those with attachment disorders, is highly applicable in the clinical setting.
Similarly, Maroda’s techniques for tentative client-directed challenges provide a specific guide as to how to tailor interventions. She demonstrates how to assess the efficacy of interventions as they are received, and how to transform missteps into opportunities for deepening the therapeutic relationship. Here she accords with contemporary conceptions of reactance (Dowd & Seibel, 1990) as indicative of therapeutic misdirection, rather than defensive resistance. Admirably she seeks to reduce the role omnipotence of the therapist, by removing the screen and revealing to clients (in so far as is therapeutic) the developing insight of her internal supervisor (Casement, 1995). Maroda closely examines the boundaries surrounding disclosure, and outlines clearly the differences between serving a therapist’s needs and their client’s.
Maroda subscribes to the Winnecottian ideal of the therapist as model of ‘good enough’ functioning / parenting, ‘failing well’ (Abram, 2007), both in order to transcend inevitable misunderstandings in interpretation, and ultimately to provide a model for depressive social functioning. Here Maroda ties her recommendations into published research, rather than case studies alone, something often lacking in psychodynamic texts.
If you were writing this book, what would you add/subtract?
Maroda’s opinion, that therapists should refer clients they dislike or find dull, is appealing, though perhaps not entirely practical – especially in ‘front line’ care provision. Perhaps an acknowledgement of the different treatment scenarios at work in ‘real world’ managed care could have been useful.
Maroda frequently roots her expectations of client’s potential recovery in their past ability to form secure attachments / relationships, and their historic ability to change. While these are likely strong predictors of the success of person centred psychoanalysis, it might have been useful to examine alternative treatments like Adult Attachment Therapy (Lopez & Brennan, 2000) for clients with deep trauma and attachment disorders. Similarly, an examination of the family and individual resilience factors (Hawley & DeHaan, 1996) that differentiate developmental experiences might reveal useful approaches to the amelioration of otherwise untreatable clients.
Maroda assures us that therapists need not be over worried about misdirecting clients, as they are less vulnerable to imposed change than we imagine. I feel she goes too far in this regard, ignoring the liability of client behaviour / discourse revealed by research into the demand characteristics of various psychotherapies (Kanter et al, 2004), and historic abuses like ‘recovered memory syndrome’ (McElroy & Keck, 1995). While clients do possess a tendency toward authentic change, it is demonstrable that this can be misdirected by wilful manipulation or well intentioned conditioning.
Less seriously, Maroda reveals a distaste both of casual drug use (relative to moderate alcohol use) and ambiguous sexual relationships (Maroda, 2012, pp54), that betray a puritanical intolerance.
Maroda’s account of the process of interventions becoming ‘automatic’ lacks an understanding of proceduralisation (Binder, 2004), a basic process in learning that explains how deliberate behaviours gradually become pre-conscious schema. Linking this with a ‘dual process’ account of cognition (Slife et al, 2001) and behavioural economic research into innate cognitive biases (Gigerenzer & Todd, 1999), might provide a more useful understanding of how client’s learned pathological attachment patterns can be neuroplastically ‘re-wired’ through the kind of corrective emotional experiences Maroda advocates.
Any other comments?
In stark opposition to Patrick Casement (Casement, 1995), Maroda falls on the ‘good model’, practical intervention side of the debate in psychotherapy, between passive listening and interpretation on the one hand, and facilitation and ‘helping’ on the other. Her willingness to adopt aspects of other therapeutic approaches, like congruence (from person centred therapies) or behavioural strategies and goal setting (from CBT) is a heartening change from more strictly psychodynamic texts. Her belief that change occurs through “incremental emotional experiences” rather than insight, accords with contemporary neuroscientific research into synaptic plasticity and the practicalities of habit formation (Bennett & Nelson, 2010), and to me represents a more humane and pragmatic psychoanalytic approach. This is reflected in Maroda’s understanding of borderline clients as affectively and cognitively impaired rather than wilfully destructive (Maroda, 2010, pp153) However I do question whether a less directive collaboration in the exploration of values, goals and interpretations might be preferable to the ‘advice’ that Maroda recommends in response to genuine client requests (Maroda, 2010, pp64).
Does the book meet its objective?
Overall Maroda succeeds in delineating a variety of techniques derived from clinical experience and illustrated with vivid case histories, that outline a growth orientated, less asymmetrical psychoanalytic relationship. Tacking therapy as a series of stages or challenges, Maroda remains consistently practical and readable, redefining the ‘good enough’ therapist for our less prescriptive time. Finally, Maroda’s pragmatic, psychoeducative approach tallies with client efficacy research (McLeod, 2011), in creating a collaborative and emotionally honest template for depth work in psychotherapy.
Abram, J. (2007). The Language Of Winnicott: A Dictionary of Winnicott’s Use of Words. UK: Karnac Books.
Bennett, S., Nelson, J.K. (2010) Adult Attachment in Clinical Social Work: Practice, Research and Policy. USA: Springer.
Binder, P. (2004). Key Competencies In Brief Dynamic Psychotherapy: Clinical Practice Beyond the Manual. UK: Guilford Press.
Casement, P. (1995). On Learning From the Patient. USA: Routledge.
Dowd, E. T. (1990). A Cognitive Theory Of Resistance and Reactance. Implications for Treatment. Journal of Mental Health Counselling, Vol 12(4), pp 458-469.
Gigerenzer, G., Todd, P.M. (1999). Simple Heuristics That Make Us Smart. UK: Oxford University Press.
Gelso, C. J. (2010). The Real Relationship In Psychotherapy: The Hidden Foundation of Change. USA: APA Books.
Hawley, D.R., DeHaan, L. (1996). Toward a Definition of Family Resilience: Integrating Life-Span and Family Perspectives. Family Process. Vol 25(3), pp 283-298.
Kanter, J.W., Kohlenberg, R.J., Loftus, E.F. (2004). Experimental and Psychotherapeutic Demand Characteristics and the Cognitive Therapy Rationale: An Analogue Study. Cognitive Therapy and Research. Vol 28(2), pp 229-239.
Lopez, F. G., Brennan, K. (2000). Dynamic Processes Underlying Adult Attachment Organisation: Toward an Attachment Theoretical Perspective On The Healthy and Effective Self. Journal Of
Counselling Psychology. Vol 47(3), pp 283-300.
Maroda, K. (2010). Psychodynamic Techniques. USA: Guilford Press.
McElroy, S.L., Keck, P.E. (1995). Recovered Memory Therapy: False Memory Syndrome and Other Complications. Psychiatric Annals. Vol. 25(12), pp731-735.
McLeod, J. (2011). Qualitative Research In Counselling and Psychotherapy. UK: Sage.
Can there be a more reliable indication of stupidity than the phrase ‘everything happens for a reason’? But if we play the game of presupposing a shape or interconnection to life, this play space connects us to the real – the shared experience of illusion. This game allows us to act as though our lives had weight, to act as though the universe possessed meaning in relation to us, to the you and I (and I in you) of this moment. This is the game of faith, not in the nebulous other, but the dreamlike meaningful coincidence that Jung called synchronicity.
Alan Watts used to ponder, when confronted with cruelty or stupidity, ‘Oh how interesting the form Buddha has taken for me today!’ The form Buddha has taken for me today is precisely the ‘third space’ of the transitional phenomena D.W Winnicott speaks of as the birth place of play, culture, and the emergence of self; the transition space between the inner world of drive, and the outer world of succor / dukkha. In other words, the real.
The patient of psychoanalsysis becomes the parapraxic analysand, the subject of analytical psychology arrives at each session brimming with archetypal dreams and so on. All the players have their scripts in the dramaturgy of the therapy session. This being the case, we see that psychoanalysis (and indeed clinical psychology) isn’t archaeology of the mind so much as the construction of a creationist theme park. But if we play the game of presupposing it is not… Then we all become Lacanians.
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