Raul Moncayo explores the relationship between Zen and Lacanian psychoanalysis

I wrote this book to help clarify some misconceptions about Zen and psychoanalysis and particularly to explore the relationship between Zen and Lacanian psychoanalysis. First, psychoanalysis and Zen are not worldviews or philosophy in the common sense of the words.  Psychoanalytic ideas are subject to critique and verification by the clinical practice between analyst and analysand. Zen also has to be confirmed within direct personal experience, the teacher-student relationship, and the relationship to the larger community.

Second, Zen and psychoanalysis are embedded within cultural contexts that emphasize different aspects of knowing and experience. Zen represents a traditional form of Eastern psychology and philosophy while psychoanalysis is emblematic of the Western enlightenment. Lacanian psychoanalysis represents a poststructuralist and Continental approach evolving out of the late twentieth and early twenty-first centuries.
Buddhism has been widely accepted and recognized within North American and English-American psychoanalysis, while European and Continental psychoanalysis has remained skeptical if not overtly critical of Buddhism. Despite Levi Strauss’ enthusiastic embrace of Buddhism, Heidegger and Lacan’s use of Zen and Mahayana Buddhism, many Lacanians and Lacanian psychoanalysts have remained uninformed about Zen Buddhism. Lacanians tend to view Buddhism as an ascetic attempt to eliminate suffering or desire and achieve happiness or Nirvana. Buddhism is viewed in this way despite the fact that Soto Zen arrived in Paris in the early seventies and from there spread to the rest of Europe. In fact, I began Zen practice in Paris in 1978 after already having studied Lacanian psychoanalysis for five years in Buenos Aires.
Freud believed that psychoanalytic treatment converts neurotic misery into ordinary unhappiness. In Sophocles play, Oedipus dies after being literally blinded by his own ignorance and with his heart/mind permanently injured for having married and lost his mother as well as killed the father that had aimed to destroy him. However, the self-knowledge he gained was henceforth transmitted from generation to generation as a way of preventing harmful repetitions of the complex drama. Psychoanalysis can prevent catastrophe and harmful repetitions, but does not guarantee happiness.
Soto Zen Buddhism is critical of ideologies of self-improvement and of using enlightenment for gain, either financially or otherwise. Neither desire, nor suffering, or happiness can be eliminated or attained because they are empty of inherent existence. Delusion, desire, and pain cannot be eliminated not only because they are empty but also because they contain their opposites: enlightenment, Nirvana, and happiness. For Lacanian psychoanalysis jouissance is both joy and pain, and without pain there is no gain. The symptom cannot and should not be eliminated but can be transformed into a sinthome and jouissance itself can be transformed into different types of jouissance that are no longer inconvenient or destructive. Finally, equanimity is not the same as “quietism” or nihilism. In Zen, activity, social and otherwise, is not reduced or transformed into stillness. Stillness itself is a form of activity, and at the core of activity lies stillness. Practice over-includes stillness and activity. Bodhisattva (enlightening being) practice includes both meditation practice and social practices and services. The historical encounter and disagreements between these two great traditions stands to be of great benefit to the future of both disciplines around the world.

Raul Moncayo, San Francisco, CA
Author of The Signifier Pointing at the Moon: Psychoanalysis and Zen Buddhism (London: Karnac Books, 2012).

Gavin Newby describes the development of Neuropsychotherapy, a new and emerging discipline

Within the broader world of psychology and clinical psychology, neuropsychology has had a reputation for being overly academic and assessment-focussed. When I joined the profession over twenty years ago, we had our elegant models of cognitive function and dysfunction, and the neurologists and GPs could expect long and complex neuropsychological assessments from us, which pin-pointed areas of difficulty. However, a casual observer might rightly wonder aloud, ‘So what? How does this help the distressed patient and their family?’
Over the last twenty or so years, the expectation has rapidly grown that clinical neuropsychologists will produce programmes of cognitive rehabilitation and help people re-integrate into their lives and societies. Most clinical neuropsychologists have always recognised the emotional havoc caused by an acquired brain injury – such as stroke, tumour, or trauma – and will have tried to adapt models of psychotherapy to deal with it, such as cognitive behavioural and personal constructs therapy. But it is only in relatively recent times that the discipline of neuropsychotherapy has begun to emerge from the shadows in its own right.
Whilst recognised models and systems of psychological therapy – including psychodynamic psychotherapy and analytic therapies – are important contributors to the development of this new discipline, there are a range of workers (including in the UK) who have gone beyond merely adapting these approaches and have developed their own systems and modes of neuropsychotherapy.
Our new book, Practical Neuropsychological Rehabilitation in Acquired Brain Injury, features a key chapter given over entirely to the concepts, principles and practice of neuropsychotherapy with acquired brain injury. Within the chapter, the reader is taken on a comprehensive tour of how to adapt models of neuropsychotherapy, and is invited to consider a helpful generic model of psychotherapy for brain-injured patients. A single case is presented and a range of treatments proposed, which embraces cognitive behavioural, psychodynamic psychotherapy, family/systemic, narrative and cognitive analytic therapy.
We hope that our exciting new book will act as a staging post in the further development of neuropsychotherapy.

Arturo Varchevker explains why we are all migrants from birth to death

Migration and its vicissitudes

The life cycle
The life cycle is an important framework that has been used and can be used by different theoretical perspectives and from various disciplines. The concept ‘life cycle’ was developed by Erik Erikson, in terms of chronological phases from infancy onwards, connecting the emotional and biological development of the individual and socio-cultural factors.

The psychoanalytic perspective focuses on the chronological age of the individual and his/her emotional development. From birth onwards the individual is expected to develop in order to deal with emotional and biological changes and external needs and pressures. The life cycle allows horizontal and vertical exploration of the individual’s present situation: the individual’s history (vertical) and their present emotional state (horizontal) and, in addition, the external and internal pressures coming from families, friends and socio-cultural contexts.

We decided to use the life cycle in our books on Trauma and Migration as we considered there to be significant differences at each stage of the life cycle. From birth onwards the individual is never alone or in total isolation; what is digestible by some may not be by others. To come to grips with the vicissitudes of life requires the capacity to work through the various stages of the life cycle. We wanted to draw attention to the complexities of these issues.

From a psychoanalytic perspective, the early years and early development in terms of attachment and separation are especially important in relation to future developments. How they are worked through will affect future developmental stages and conflicts. We have used an object relations approach developed by Melanie Klein and her followers, but we also stressed the importance of different contributions from a psychodynamic perspective. We also are aware that there are different ethnic, cultural, social and gender contexts which have an effect on the various phases of the life cycle. It is important to be aware of these contexts and their effect on the patient and on the therapist.

The theory of the Oedipus complex was developed by Freud, who considered it central in exploring and understanding the mind’s functioning. I want to underline the importance of exploring the variations of the Oedipus complex at different stages of the life cycle.
It is well-known that emotional difficulties or trauma in early childhood tend to be reactivated and affect the individual’s capacity to work through stresses that may appear at later stages of the life cycle. As I mentioned above, it is important to locate the stage of the life cycle when the individual is experiencing considerable anxieties or stress due to some form of migration or trauma, because the meaning of what is happening and how it is happening can be significantly different according to that stage.

Each stage confronts the individual with significant changes and often activates stress and anxiety. Basically, these stresses refer to conscious or unconscious awareness about the individual’s own life, in terms of biological, emotional and interactive situations. Of course there are external situations in life, and some quite stressful ones, and all of them can reactivate oedipal anxieties in a very intense way.
It is also important to emphasise that men and women will have different symptoms and responses to trauma and stress, due to the biological and psychological differences between them.  There are changes in their bodies, and in their lives according to external and internal expectations, which are affected by their emotional development and social and ethnic and religious backgrounds. For instance, an Asian adolescent living in the Eastern world will have a very different experience from an adolescent from the Eastern world living in an Asian country.  All this suggests a multiplicity of factors that activate and shape different aspects of the life cycle from birth to death.
Internal and external migration

The Bible refers to the first migration, when Adam and Eve were seduced by the tree of knowledge. When their eyes were opened, they were able to see that the materials that make up life are good and evil. Their acquired knowledge had a high price: leaving Paradise. ‘Paradise’, meaning that everything is provided in terms of goodness and pleasure.

Life confronts us with migration from birth to death. We can say that the baby inside the womb lives in a different world. It is a habitat that resembles a paradise where everything flows without an effort. To be born is to enter a world of early attachments and frustrations that require external and internal help to work through. Therefore, we can consider that the first migration occurs when the baby is born. Coming out of the womb is a form of migration into a different world.  Of course we sometimes long for a ‘paradise experience’ and on some occasions individuals can recreate illusions or delusions in which some form of paradise can be re-installed.
We can define migration in everyday language as a forced or voluntary move whereby the individual changes his or her habitat. How he/she leaves, lands, or is received play an important part in a successful outcome.
Migration is a complex phenomenon and I focused on certain aspects that I consider important from a psychoanalytic perspective. I consider migration from a dual perspective: the external change of habitat and the internal change of habitat or mental change. This mental change is connected to the vicissitudes that the external change brings about, but I also suggest that the concept of internal migration can be applied to the emotional conscious and unconscious changes and its vicissitudes associated to development. Internal migration is very much linked to different aspects of the Oedipus complex and when we consider a successful internal migration we are referring to the ability to work though the anxieties aroused by the Oedipus complex.
As I mentioned, to locate internal migration at different stages of the life cycle is important; especially if we want to find out its meaning and how they affect the individual’s capacity to deal with them.

Arturo Varchevker
‘At present, it has been estimated that over 200 million people are considered to be migrants. The reasons for having left their homes are wide-ranging: escaping from war, persecution, discrimination and exploitation, at one extreme; seeking better living conditions and opportunities for work, at the other. Some migrants end up having to perform jobs that are dirty, dangerous and degrading. For others, migrating can become a positive and creative experience, contributing to the economic growth of the new country and enriching societies through cultural diversity. In all cases, the changes profoundly affect individuals, couples and families.
Varchevker and McGinley have put together a collection of papers dealing, not only with external migration, but also with the consequences of internal migration. The individual’s life cycle is here used as a valuable frame for the understanding of those changes and their sequels. From a broad psychoanalytical perspective, the different authors included in this book describe the multiple problems presented by migration in its complex contemporary dimension.’
– Gregorio Kohon, Fellow and Training Analyst, The British Psychoanalytical Society

Self-Destruction, Heidegger, and Nature as a gigantic gas station

Brent Potter, author of Elements of Self Destruction, engages with the works of Wilfred Bion and Martin Heidegger to explore the sometimes horrifying manifestations of ‘mass hallucinosis’ in contemporary culture and our everyday lives.

A demented beehive

Early in my career during the 1990s, I recall occasionally looking up from my discussion with a so-called chronically mentally ill patient to look around the office. Invariably, there was outdated (usually 1970s-era) wall art, a desk lamp lighting the small room, a dead office plant in the corner and some abandoned dusty books next to the plant. The community mental health clinic where I cut my teeth was a massive, labyrinthine structure with an awkward combination of large cubical-laden expanses for clinicians and tiny consultation rooms. The clinic was the eighth largest employer in the county and each clinician had roughly 80-100 patients on his or her caseload. It reminded me of some kind of demented beehive abuzz with overworked, underpaid clinicians frantically running around completing paperwork, making copies and answering a backlog of voicemails. And the ‘patients’—always one or two screaming and/or throwing things in the lobby—wandering around, usually disoriented in the befuddling hall network. Supervisors and administrators wisely locked themselves in their offices or were otherwise quietly absent.

I think, in my eight years working there, I saw the clinical director twice. To add to the confused and confusing environment, the clinic had a 50% annual employee turnover. So, I may have seen a clinical director on more than two occasions but wouldn’t necessarily know. Patient suicides, clinician suicides, government cut-backs in spending, heartless human resources personnel; the patients’ chaos and the agency’s chaos seemed to reflect each other. It was Kafkaesque, as if the atmosphere itself was saturated with unwellness and us, collectively, attempting to give it shape and meaning. During this time, I asked my analyst what the real difference, if any, there was between the patients and clinicians. “Keys,” he answered quickly. “What?” I asked. “The clinicians are the ones with the keys to the building,” he said with a smile.

Where was the disease? I was reminded of Sophocles’ Oedipus Rex, where Oedipus “is the land’s pollution” and the polis is the body with the “pollution grown ingrained within.” Oedipus and the polis mutually reflect each other’s pathology. I realized early on that pathology is constructed and contextual. It is in this spirit that I wrote Elements of Self-Destruction.
In its pages, I attempted to show that the alleged diseases outlined in the DSM are contextual and meaningful phenomena. This stands in contrast to the (presently failing) hypothesis that such conditions are biological diseases centered in chemically imbalanced brain organs. Focusing in on the destructive capacity of the psyche, I utilized Bionian psychoanalysis and Heideggerian phenomenology as hermeneutic keys. While taking to heart Bion’s seminal contributions to psychoanalytic treatment, these tenets also hold true for aspects of our contemporary society. Psychoanalyst and Bionian scholar, Michael Eigen, points out today’s mass hallucinosis that has:

“become part of the cotton fuzz that makes for a kind of psycho-social soundproofing, dulling, numbing. Part of the hallucinatory nexus involves a mechanism reaching deep into infancy. In psychoanalytic language: “identification with the aggressor” … A strong leader or group identification finds alternate pathways for fears, hates, and criticism, often deflected towards a designated enemy … People in power intuitively know how to throw small bones for constituents to gnaw, keeping minds occupied, while grander destructive scenarios unfold … a hallucinated election. A hallucinated democracy … A hallucinated identity, a hallucinated life, a hallucinated death.”

Taking Bion’s notions of dynamic psychotic processes in psychic reality and applying them to social reality yields much. From this broader perspective, it is easy to see the hallucinatory spell cast in much of the world to be ‘successful’, to be ‘Number One’, to vanquish the ‘evil doers’, to establish a moral super-ego across the lands. A superficial (or no) sense of consequences is near to the essence of much contemporary psychopathic hallucinosis.

Martin Heidegger, following a phenomenological hermeneutic path, reached many of the same conclusions. He spoke of a world caught under the spell, a “delusion”, of unfettered control of the earth and its inhabitants as resources to be calculated, ordered and used.  The collective hallucinosis to which Eigen refers, Heidegger dubbed the Enframing, a mode of revealing the world where nothing appears in its essential character. It veils its truth as a presencing of Being by appearing as though it is a product of human making. We become convinced that the only mode of disclosing the world is through quantitative calculation.

“As soon as what is unconcealed no longer concerns man even as object, but exclusively as standing-reserve, and man in the midst of objectivelessness is nothing but the orderer of the standing-reserve, then he comes to the very brink of a precipitous fall; that is, he comes to the point where he himself will have to be taken as standing-reserve.”

Martin Heidegger
Heidegger asserts that once humankind is set upon this course of disclosure, the world becomes an “unworld” in which humanity engages in a “circularity of consumption for the sake of consumption.” In 1969 Heidegger used the image of Nature as a gigantic gas station with humanity at the pump—a disposable earth. Now, in 2013, we can see the haunting accuracy of this image.
Medard Boss, who was analyzed by Freud and studied under Heidegger, said, “today, people [are] horribly depressed by the meaninglessness and tedium of their lives. Suffering as they do, these people often try to drown out their desperation through addiction to work, pleasure, or drugs.” J.H. van den Berg suggests that the name neurosis is no longer an appropriate label to describe the disturbed human relations of our technological age. Placing neurosis in the realms of the individual and the anatomical ignores the underlying sociological character is illness. “No one is neurotic unless made neurotic by society. In a neurosis is an individual’s reaction to the conflicting and complicating demands made by society.”
Today, we have a plurality of selves. We possess a self for every group we belong to. Though we all suffer from this, the neurotic is unable to maintain a unified identity in various contexts. Van den Berg believes that it is more appropriate to speak of sociosis than neurosis. Our relationships are the pre-conditions of sociosis. This multitude of functional contexts cannot be quantitatively ordered so we lead a divided existence in a complex society. Those who can cope with these factors suffer the least.
So, quite briefly, these are some of the pathways explored in Elements of Self-Destruction, from the theoretical to the horrifyingly real manifestations in contemporary culture and as reported concretely from people’s own experience. Through these explorations, I hope to name some of the challenges of destructiveness and hope also to uncover a contextual pathway, open a path of the heart and mind, in negotiating this most difficult terrain.

elementsDestruction.jpg   35450

Dianna Kenny argues that infant intersubjectivity is primordial, not developmental

Dianna Kenny, author of Bringing up Baby: the Psychoanalytic Infant Comes of Age, presents the evidence against the standard assumption that infants are ‘merged’ with the caregiver at birth.


The intersubjective infant

In this short article, I hope to challenge readers to think about the evidence for the enthusiastic acceptance, if not passionate embrace in psychoanalytic circles, of the notion that early infant experience is undifferentiated, merged, and autistic-contiguous.

A number of psychoanalytic theories have suggested that babies pass through auto-erotic (Nagera, 1964), autistic, symbiotic (Mahler, 1967; 1972; Mahler, Pine, & Bergmann, 1975), autistic-contiguous (Ogden, 1989a,b), or fused or merged (Ogden, 2004) states, before emerging with a differentiated sense of self and other. This view has been constantly invoked over the past 100 years in both infant research and psychoanalysis and has never been put to rest (Alperin, 2001). Note the typical quote below that asserts that this position is taken-for-granted.

It is by now a commLeonardo Da Vinci. The Virgin, Infant Jesus & St. Anne (c. 1508).onplace of child psychology that in the earliest stage of life an infant and his mother cannot be seen as two separate individuals, but rather as a single unit, or dual unity, as Mahler (1963) calls it (Mohacsy, 1976, p. 501).

The psychoanalytic view that the infant is merged or undifferentiated requires clarification. Two concepts have potentially been conflated in this perception of the infant – those of “absolute dependence” or helplessness at birth, and the state of symbiosis, undifferentiation or merger with mother. It is possible for the infant to be in a state of absolute dependence with respect to physical and emotional survival at birth, while also possessing, as Klein has argued, and as subsequent infant research has demonstrated, rudimentary object relations and skills and capacities that render the infant, from birth, a co-constructing partner in the mother/baby dyad.

Recent scholarship has concluded that newborns are interpersonally competent (Morgan, 1997), and that nonverbal modes of communicating and experiencing form the basis for intersubjectivity in infancy (Beebe et al., 2003). Although sociality per se does not emerge until the second or third months of life, and is not directed specifically at primary caregivers until about five to six months of age, infants actively interact with their caregivers from birth in a process of reciprocal mutual influence. Infants are responsive to social referencing cues and adjust their behaviour accordingly (Carver & Vaccaro, 2007; Repacholi, Meltzoff, & Olsen, 2008).

Neonates also engage in active intermodal mapping (AIM), a process that unites perception with execution of a motor plan, which permits imitation from birth (Meltzoff & Moore, 1994) and beginning of “like me” perceptions, which form the basis for social cognition (Meltzoff, 2007a, b; Meltzoff & Brooks, 2008). By six weeks of age, infants show deferred imitation. When confronted with a non-responsive face, they will reproduce a tongue protrusion they had imitated 24 hours earlier, purportedly in an attempt to ascertain whether the passive face before them is the same as the face of the person whom they had imitated the previous day. Imitation rapidly becomes more complex, with cooing games indicating the presence of social expectations by two to three months of age (Caron, 2009).

Research also shows that infants in the first two months of life actively engage and negotiate with their mothers around their sleep-wake and feeding/eliminating cycles. Infants whose caregiver/infant relationship was disrupted after the first ten days of life showed dysregulation in the organisation of basic biological functions, leading to the conclusion that early regulation of biological functions is the outcome of mutual negotiation between the infant and his caregiver (Sander, 1988).

Thus, far from being fused, merged, undifferentiated or “radically egocentric” (Piaget & Cook, 1954), the infant enters the world with self-other equivalences that are innately specified and experientially elaborated (Meltzoff, 2007a, b). Intersubjectivity is primordial, not developmental. Varga (2011) concluded that “neonatal imitation reveals the equi-primordiality of our own sense of an embodied self and a sense of others…” (p. 631). Neonatal imitation, as embodied perception, is intersubjective (Gallagher, 2001). These abilities would not be present in either of the two conceptions of the psychoanalytic infant – one proposing a “selfless” state, and the other, Winnicottian, position proposing infant omnipotence.

Infants are interdependent and interactive with their caregivers from birth and are always already engaged with the intersubjective world. Systems of interaction build psychic structure, that is, internalized objects and representations of interpersonal interactions (see, for example, the work of Beebe and colleagues e.g., Beebe, Knoblauch, Rustin, Sorter, 2003). Bowlby’s (1973) “working model of attachment” and Stern’s (1985) RIGs (representations of interactions that have generalized) are two examples of psychic structure as it is currently conceptualized.

Further, the infant is born with the capacity to experience positive (rewarding) and negative (punishing) affects, which he encodes both neurologically and in memory. The infant is motivated to increase positive affects, decrease or manage negative affects, and minimize affect inhibition. These motivations enhance learning of environmental contingencies that lead to positive and negative affects and to organize behaviour to influence outcomes (Tronick, 2002; Tronick & Beeghly, 2011). Infants appear to be just as attracted to the expectation of a pleasurable outcome that accompanies success as they are motivated to avoid the negative affect experienced with too much incongruence, dissonance, or the inability to discover the contingencies related to outcomes, and adjust their own behaviour accordingly (Papousek, Papousek, & Koester, 1986).

Infants develop knowledge about themselves, their world, and their relationships non-verbally, non-symbolically and implicitly and use this knowledge in communicating with primary caregivers. Communicative competence precedes language. Indeed, “prior to language… the origin of mind is dyadic and dialogic; …adult intersubjectivity is built on infant intersubjectivity” (Beebe et al., 2003, p. 746). Many scholars, beginning with Freud (1900a) understood the profound impact of the child’s first emotional ties on subsequent development. Freud argued that “[t]he deepest and eternal nature of man… lies in those impulses of the mind that have their roots in… childhood…” (p. 247).

This implicit, embodied knowledge forms the basis of infant object relationships, which later become accessible in the transference of patients undergoing psychoanalysis (Lecours, 2007; Talvitie & Ihanus, 2002). Transference is understood to be the “process of actualisation of unconscious wishes… infantile prototypes re-emerge and are experienced with a strong sensation of immediacy…” (Laplanche & Pontalis, 1973, p. 455). While transference phenomena are important sources of evidence about infant states, this source must now be balanced against and combined with current empirical literature on infant development in a wide diversity of areas, including infant observation, ethology, behavioural genetics, attachment theory, cognitive development, and developmental neuroscience to formulate an empirically supported and nuanced view of newborn and infant capacities.

Dianna Kenny
Professor of Psychology, The University of Sydney.
Author of Bringing Up Baby: The Psychoanalytic Infant Comes of Age and From Id to Intersubjectivity: Talking about the Talking Cure with Master Clinicians (Karnac Books).



Reviews and Endorsements

‘In this book Dianna Kenny sets out to discover what remains of Freud in contemporary psychoanalytic practice. To do this, she engages us in an intensive dialogue with four eminent practitioners. While no four people can be said to be representative of an entire community of practitioners they are each distinctive and different with respect to their theoretical framework and the cultural milieu within which they operate. After the interviews, she lets them loose on a therapy transcript, which acts as a kind of Rorschach inkblot onto which they project their fantasies about the patient and the therapist. Before we meet the four clinicians, Professor Kenny sets the scene with an unusually lucid exposition of the core ideas of Freud and post-Freudian psychoanalysis. This is an heroic task to accomplish in two chapters but she achieves it with remarkable fluency. Inevitably some detail is missing but the core ideas are so clearly enunciated that these chapters alone will prove to be invaluable to any person seeking to navigate this complex and jargon-infested territory. The four interviews that follow are themselves outstanding exemplars of psychoanalytic enquiry. I cannot put it more clearly than Robert Stolorow, who said at the end of the interview “Your questions were very thoughtful and incisive.” It is clear that Professor Kenny had a plan that she brought to each interview. Her plan was informed by a close reading of the published work of each clinician and curiosity about how their ideas and approaches related to other strands of psychoanalytic thinking. However, she never allowed the plan to get in the way of the conversation and many of the questions were stimulated by the thoughts of the person she was interviewing. Indeed, there were times when the questions were as interesting and informative as the responses.

This is a scholarly work, with all the key ideas assiduously footnoted or referenced. The reader will have no difficulty further exploring any of the many thought-provoking fragments that the conversations weave together. However, it is much more than scholarly. There is an intimacy to the interviews, which enables each clinician to tell a very personal story. We are constantly reminded that an intellectual journey is shaped by life experience and not just by reading and ideas. For clinicians this is in part vicarious life experience through constant engagement with patients. However, through these interviews we also learn about formative personal life experiences such as the death of a spouse, working in an overburdened health system, or the search for a father. When it comes to the transcripts, each of the therapists adopts the position of the “master clinician” or therapy supervisor. Here we encounter something of the superego of each clinician. They are not always in agreement as to what the therapist might do better but they share what might best be described as a clear vision for how the work should proceed. Stolorow put it most graphically when he said in response to one of the therapist’s interventions, “The therapist is still pursuing a cognitive behavioural approach, which is not, at this point, helpful to the patient”. Each of the clinicians felt strongly about both therapist and patient and were emphatic in their advice-giving to the therapist which was motivated by an unwillingness to provide tacit endorsement of interventions that they considered less than ideal from their perspective. However, after the thoughtful and sometimes humble communication in the four interviews, the assumption of the role of expert came as something of a shock. There is a lot we can learn about therapeutic technique from the responses to the transcript. It also reminds us how strongly identified clinicians are with the patient and how little patience they can have with therapists, who struggle with their patients down difficult byways.

Those with a more academic orientation will especially appreciate Professor Kenny’s textual analysis of the responses of the four clinicians to the clinical transcript. She uses a formal text analysis program as well as a conceptual thematic extraction process to identify both the distinctive voices of each clinician and some of the communalities that lie behind these voices. This is an invitation to further research, which I suspect will be both stimulating and challenging for many readers. It is also the means by which Professor Kenny draws together some of the disparate strands that have emerged in the clinical discussions, and in the analyses of the clinical transcripts, to bring her work to a conclusion. I hope you enjoy this book as much as I have. It did not set out to provide you with a complete or fully integrated picture of contemporary psychoanalytic thinking; it does, however, provide you with an excellent overview. Furthermore, it will give you more than a glimpse into the world of the practicing clinician. It may also help you understand something Allan Abbass did not when he said “I don’t know what might be happening in psychoanalytic treatments that take so long . . . I can’t see the added value—the health dollar is so stretched.” Psychoanalysis may not be the most cost effective treatment but the conversations with Spielman, Holmes, and Stolorow do take us to where we might find some of the added value.’

Robert King, PhD, FAPS, Professor and Coordinator of Clinical Psychology, Training School of Psychology and Counselling, Queensland University of Technology

CABBY LAFFY: ‘We live in a highly sexualised culture, yet sexual issues are still shrouded in shame’


Sexual energy is potentially a free source of pleasure and ecstasy, with remarkable physical and emotional health benefits. In the UK, we seem much more liberalised than a generation ago, but there are also costs to our well-being, including high rates of sexual violence, sexual ill health, and the ‘side effects’ of chemicals in health and beauty products and the wide use of synthetic hormones.

We live in a highly sexualised culture where we are inundated with images of celebrity ‘sexy’ people, and lots of things to buy: fashions, lotions and potions to make us more ‘sexy’. We currently have concerns about our young people viewing pornography as a role model for adult sexual relationships, not understanding it is a fantasy world contrived to amuse and entertain adults. It is a world of a one-dimensional view of sex, where men have very large penises; women have very large breasts and where sex is mainly acts of penetration.

Many people feel a gulf between all this and their own tastes and preferences, their own sense of sexual self-esteem. Sexual issues are shrouded in shame. This silences us. Many think ‘everyone else seems cool, what’s my hang up?’ Discussing our current sexual culture needs to include physical and psychological health, and issues such as body image, cosmetic surgery, eating disorders, all of which take us away from our natural selves.

There are many areas around Sexuality in need of evaluation and healing. LoveSex offers a new model for us to explore what we think and feel about our own sexuality. It could be therapeutic for us all, to have a safe space to talk more openly, to blow out the cobwebs, and discuss how our sexuality could be honoured and really celebrated.

What do you think?

Cabby Laffy
Author of LoveSex (Karnac Books, 2013).


OLIVER JAMES: The England riots of August 2011


Why, not when?

Looking back on the theories offered to explain the riots of 2011, there was too much attention paid to the issue of why they occurred at that particular moment. Asking such a precise question was bound to lead to a plethora of factors being deemed significant, with a failure to identify which was more significant than the others.

The real question was ‘what were the conditions which made such a total loss of social control, expressed by looting, occur?’ That they happened in 2011 rather than the previous year or in 2012 was the wrong question.

The main factor

Of course there were many contributory factors, but by far the most significant was that we had become a nation of ‘shop till you drop’, It Could Be You, credit-fuelled consumer junkies. Widespread materialism (placing too high a value on money, possessions, appearances and fame – what I dubbed Affluenza) had been ramped up to such a degree that another question would be ‘why had there been no looting before?’

As the recession bit, money was getting tighter. For thirty years, first with Thatcherism, then Blatcherism, we had been encouraged to aspire, to believe that anyone could have anything or become anyone (even an ugly and unpleasant person could dream of winning Big Brother). There was a sense of entitlement to a widescreen TV and the sense that such a possession would make you fulfilled. What had been satirized as Loadsamoney in the eighties had ceased to be a joke. Being a loud-mouthed greedy person (otherwise known as the stereotypical American) had become highly valued. For five decades, we had been spending twice as much per capita on advertising to our population as mainland Europe, deliberately encouraging them to conflate real needs with confected wants.

The riots were inevitable

It would be wrong to claim that riots were inevitable. But it was hardly surprising to say the least when, one day, large swathes of the population who could not afford the consumer goods suddenly discovered that, if enough of them simultaneously smashed the windows of the shops and just took what they wanted, it was possible.

The biggest irony was that it took Right Wing journalists to point out that the population were only doing what the filthy rich ruling elite had been doing for three decades: the CEOs plundering their corporations, the MPs fiddling their mortgages and expenses, the politicians and civil servants hopping in and out of the financial services bed.

traders-are-probably-profiting-big-from-californias-gas-price-spike  london-looters-2011

Oliver James

Author of Affluenza; The Selfish CapitalistLove Bombing: Reset your Child’s Emotional Thermostat

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