A Witness Breaks His Silence: The Meaning of a Therapist's Response to an Adolescent's Self-Destruction

I describe the case of a self-mutilating adolescent girl and my dilemma, as her therapist, about telling her parents about her self-abuse. I use two complementary, mutually enhancing relational theories of trauma—Ferenczi's (1933) and Davies and Frawley's (1994)—to help understand the minefield I was in. Davies and Frawley describe certain relational configurations that are typical of trauma victims. I believe that it is not only unavoidable but therapeutically vital for therapists to participate in these configurations so they can know the patient's experience in a personal way. It is also crucial that they be witnesses who provide recognition for the patient's pain and, in so doing, relieve the intolerable feeling of isolation that Ferenczi proposed was the most basic trauma. In addition, I discuss the observation that some people who have not been previously traumatized in any gross way manifest characteristics of trauma.     

Empathy—What One Hand Giveth,the Other Taketh Away: Commentary on Paper by Lynne Layton

In this commentary I support Layton's vision of psychotherapy as an unavoidably political practice. However, I caution against a belief in empathy as a primary means of motivating political activity. By sketching a brief history of the concept of empathy, I argue that it is a problematic concept that ultimately will not lead the profession to the type of progressive political practice Layton encourages it to undertake. Empathy preoccupies therapists and patients with inwardness, self-absorption, a modified but sometimes still present objectivism, and an apolitical vision trapped in the Cartesianism from which it originated. I suggest alternative terms to describe what therapists do when they believe they are acting empathically; offer philosophical, political, and socioeconomic reasons why therapists are reluctant to think in alternative terms; and make a link between those terms and a more effective, hermeneutic way of attending to the social realm. I conclude that empathy is not a natural, instinctive process that produces an automatic result and that what therapists mean by empathy is much more a culturally formed moral virtue than a technical skill; it is not a natural, instinctive process that produces an automatic result. Therapists, patients, and the society would be better served if we came to understand and appreciate the difference between virtues and skills, and confront the implications of that difference for both the politics of therapy and a therapeutic politics.     

Healing presence in the psychotherapist

Abstract

Throughout graduate school I felt compelled to become a fine psychotherapist. Implicit in that motivation was my curiosity about what makes a psychotherapist effective. My curiosity was inspired by my experience with one therapist who helped me activate profound transformation. After identifying intuitive inquiry (Anderson, 1998, 2000, 2004) as my research method, I explored that experience through meditation, reading, and conversation and eventually identified her healing presence as the core quality that differentiated her from other therapists I had known. Though technique and experience are important, I sensed that it was her healing presence that allowed her to use technique and experience skillfully. Throughout Cycle 1 of intuitive inquiry, the “text” that claimed me was my personal experience of her healing presence, her ability to be present, to connect with me, to see me, and even, to love me. Through intuitive inquiry, I was able to expand my understanding of the healing presence of a psychotherapist to incorporate the experiences of many others.     

Licensing Parents Revisited

Although systems for licensing professionals are far from perfect, and their problems and costs should not be ignored, they are justified as a necessary means of protecting innocent people's vital interests. Licensing defends patients from inept doctors, pharmacists, and physical therapists; it protects clients from unqualified lawyers. We should protect people who are highly vulnerable to those who are supposed to serve them, those with whom they have a special relationship. Requiring professionals to be licensed is the most plausible way of doing that. Given the overwhelming support for the licensing of these professionals, I find it odd that so many people categorically reject proposals to license parents. Although the relationship between a parent and her children is different in some respects, it is also relevantly similar to that between a professional and those she serves. To defend these claims, I show how and why the rationale for licensing parents parallels the rational for licensing professionals. I then ask whether such a program could be justifiably implemented. Finally, I describe and reject what I see as the flawed view of the relationship between parents and their children.     

Promiscuity in the practice of family therapy

Family therapy has continually confronted choices between polarized positions, each one taken up with zeal because it solved an old dilemma but eventually encountering its own limitations. In this article I suggest that we have evolved to a point where, instead of deciding which is better, we can focus on how to use theories, models and techniques as fluid and flexible resources for action in the therapeutic conversation. Doing so focuses our attention on how we can move in and out of various positions, including those that simplify issues and those that embrace complexity. In addition, our attention is drawn to the ways in which we can make choices between following a model as opposed to engaging in spontaneous dialogue. This promiscuous stance can help trainers and therapists answer questions concerning how we make decisions in therapy. Such promiscuity also positions us to confront our images and expectations of what it means to be a professional.     

Aesthetic Judgment and Perceptual Normativity

I draw a connection between the question, raised by Hume and Kant, of how aesthetic judgments can claim universal agreement, and the question, raised in recent discussions of nonconceptual content, of how concepts can be acquired on the basis of experience. Developing an idea suggested by Kant's linkage of aesthetic judgment with the capacity for empirical conceptualization, I propose that both questions can be resolved by appealing to the idea of “perceptual normativity”. Perceptual experience, on this proposal, involves the awareness of its own appropriateness with respect to the object perceived, where this appropriateness is more primitive than truth or veridicality. This means that a subject can take herself to be perceiving an object as she (and anyone else) ought to perceive it, without first recognizing the object as falling under a corresponding concept. I motivate the proposal through a criticism of Peacocke's account of concept‐acquisition, which, I argue, rests on a confusion between the notion of a way something is perceived, and that of a way it is perceived as being. Whereas Peacocke's account of concept‐acquisition depends on an illicit slide between these two notions, the notion of perceptual normativity allows a legitimate transition between them: if someone's perceiving something a certain way involves her taking it that she ought to perceive it that way, then she perceives the thing as being a certain way, so that the corresponding concept is available to her in perceptual experience.     

Interview with mara selvini palazzoli and giuliana prata

Abstract

As anyone who has encountered her in person or through her writings knows, Mara Selvini Palazzoli is an impressive woman. 1 found her to be powerful, attentive and, most of all, intellectually restless impatient with psychotherapeutic approaches that work slowly or not at all, with the reluctance of family therapists to undertake thorough training, and with my inability to understand immediately some of her explanations.

Giuliana Prata, in contrast, is quiet, stable, ready to supply the correct English word or to expand on one of Palazzoli's comments. She seems ideally suited to her job of conducting the intensive telephone interview required before a family comes to the Milan Family Institute.

Although I had corresponded with Mara Selvini Palazzoli before our interview in Milan on March 30, 1982, I had not sent her any actual questions. Nevertheless, showing a certain prescience, she launched into an answer to my first question before I had a chance to voice it! That question was: Would you talk about your evolution from psychoanalyst to family therapist to paradoxical therapist SEB     

Cross-Border Family Therapy: An Innovative Approach to Working with Latina Refugee Women in Therapy

In the era of transnationalism, family therapists working with immigrant women are provided with the space to be innovative in their search for alternatives to Eurocentric approaches. Doing so can help therapists to best serve working-class immigrants and refugees who arrive in North America to escape violence and poverty. The case presented in this article highlights the cross-border interconnectedness between a Salvadoran refugee woman in Canada and other people in her life. The woman's sources of resilience were her emotional and spiritual connections with her extended family and community members who lived in her country of origin and in the United States. Implications for practice are presented last.     

Final Insults & Other Family Matters

We didn't want to put her in a nursing home. Until the last minute, and even after that, we believed it could be otherwise. I'd plan to fly Mom down to stay with me. I painted the guest room and made lace curtains. My sister mentally arranged and rearranged the furniture in her apartment, converting the livingroorn into a bedroom for Mom. But in the end, our mother's dying overwhelmed us. She was so difficult, so unhappy to be dying, and not about to impart: words of wisdom and comfort from her deathbed. The medication, Dilaudid, made her very dark, like she used to get on alcohol. Mean things bubbled out of her mouth. When I came to take her home after her second stay in the hospital, she frowned at me and said, “You're not even the person I want to see.” I found it hard to believe it was just the drugs speaking.     

Mental Illness and Psychiatric Treatment Among Women: A Rejoinder to Johnson

In this reply to Johnson, it is suggested that her response to my paper is largely on ideological grounds. Johnson totally ignores the theoretical and empirical basis for the definition of mental illness that is used. She appears not to have read my paper carefully, for all the issues she raises have been dealt with in the paper. She does not seem to comprehend the problematic aspects of both feminist and traditional theory. Johnson does not appear to understand that traditional therapists do not blame the victim and that they also see the therapeutic process as resulting in maturation and growth. Her ideology also apparently makes her unable to see that she and I are in substantial agreement on many issues regarding the role of women.     

Recombinant values

An attractive admirer of George Bernard Shaw once wrote to himwith a not-so modest proposal: ``You have the greatest brain in theworld, and I have the most beautiful body; so we ought to producethe most perfect child.'' Shaw replied: ``What if the child inherits mybody and your brains?'' What if, indeed? Shaw's retort is interesting not because it revealsa grasp of elementary genetics, but rather because it suggests his graspof an interesting and important principle of axiology. Since the brainybut ugly Shaw and his beautiful but apparently dim admirer both fallshort of the ideal, she suggests that the best thing would be togenetically recombine his intelligence with her beauty. But what thenwould be the value of another genetic possibility: that of recombininghis ugliness with her stupidity? Underlining the prompted inference is afundamental principle of the theory of value which, perhapssurprisingly, has so far gone largely unnoticed in the ethicalliterature. I will call it the principle of recombinantvalues. It is the purpose of this paper to formulate the principle in a waywhich makes its content obvious and accessible; to motivate theprinciple philosophically; to both disentangle it from, and exhibitits relations to, principles of evaluative reasoning; to show howthis purely qualitative principle meshes with the infamous thesis ofadditivity of value; and finally, to use it to ground a rathersimple but quite general theory of the intrinsic value ofstates.     

In the Pursuit of Absence: Reimagining Early Loss within the Psychotherapy Relationship

In this paper I examine absence—absence as an internal relationship, absence as an enactment, absences characteristic of psychotherapy, absence as a theory, and absence as something people do to each other, including patients, therapists, families, and societies. To illustrate these ideas, I discuss my work with Gemma. When absence enters our relationship in a very present way, the powerful emotions that absence eludes come alive for us. Forced to confront my own absences, I begin doing a better job of holding her in mind, which ultimately helps her to hold me in mind and make better use of me.     

Donna Haraway's Cyborg Touching (Up/On) Luce Irigaray's Ethics and the Interval Between: Poethics as Embodied Writing

In this article, I argue that Donna Haraway's figure of the cyborg needs to be reassessed and extricated from the many misunderstandings that surround it. First, I suggest that we consider her cyborg as an ethical concept. I propose that her cyborg can be productively placed within the ethical framework developed by Luce Irigaray, especially in relationship to her concept of the “interval between.” Second, I consider how Haraway's “cyborg writing” can be understood as embodied ethical writing, that is, as a contemporary écriture feminine. I believe that this cyborgian “writing the body” offers us a way of both creating and understanding texts that think through ethics, bodies, aesthetics, and politics together as part of a vital and relevant contemporary feminist ethics of embodiment. I employ the term “poethics” as a useful way to describe such a practice.     

Parents as therapeutic agents: The usefulness of filial therapy in a community mental health center

Filial Therapy, a program training parents as play therapists for their own children, has been found an effective part of the functioning of a child unit in a community mental health center. The basic philosophy and principles of Filial Therapy are identified. The use of parents as therapists is viewed as consistent with the growth of the community mental health movement and the concept of treating the context in which the child resides. The structure and flexibility of this model are delineated to provide the reader with a basis to introduce Filial Therapy in his/her own setting.     

The size-constancy of underwater swimmers

The size-constancy of divers was measured by requiring them to adjust the distance between two disks of unequal size so that they appeared phenomenally equal. In clear water divers showed greater constancy-ratios than on land. In murky water, where visibility was reduced by suspended particles, constancy-ratios were the same as, or less than, on land. It is suggested that these effects may be due to changes in apparent distance: in clear water objects appear nearer through refraction, but in murky water they appear further away because of the distance cues provided by the visibility gradient.

The orientation of the display, or of the diver's body, did not affect constancy under water, though it does on land. It is argued that the effect on land is due to visual and proprioceptive cues which are absent in the water.     

Melanie Klein and Envy: A Static Totalitarian Script or a Sample of our Protean Theories? Commentary on Paper by Joye Weisel-Barth

I agree with Joye Weisel-Barth's main point. But I regret her impression that Klein “monopolized” envy. In the world of ideas, a concept cannot be appropriated as if it has been bought. We acknowledge the originator, but the concept belongs to our collective heritage. It is open at all hours and there is no entry fee. Quite apart from this, Klein's concept is not simple. I have discussed elsewhere the conflicting currents in her paper on envy and questioned traditional views. But even for Klein herself, envy is never isolated. It is always in a dynamic conflict with love. To my mind, Klein's envy was loaded with a further responsibility: to remind us of the worst in our nature. If we accept the full humanity of our patients, we must remain receptive to their cruelty as well as their love. In my own thinking, envy has a subtle relationship with admiration and is ever shifting on a spectrum, from a point of positive emulation to a point of destructive attack. Lastly, I enjoyed Joye's clinical work. But I expressed deep concern about the paedophilic activities disclosed by the patient.     

The complaining client and the troubled therapist: a discursive investigation of family therapy

In this paper I examine two important issues for family therapy research. I attend to the concept of complaints, highlighting the conversational structure they take in a family therapy setting. I do this by outlining how clients construct their complaints and examining how the family therapist receives them. Data is taken from a corpus containing four different families and two different therapists, and is subjected to discursive analysis in order to provide a rich analysis of not just what is happening in the talk but how it is happening. I conclude that complaints are not received as useful to the therapeutic process, despite their constructed importance to the client, and therefore there are wider implications for therapy and professionals more generally, particularly implications for multi-agency communication.     

Tools for Change

Abstract

This paper discusses the ways in which one may incorporate political action into a client's therapy process so the client may incorporate it into her/his life. A framework for defining this as ethical, therapeutic and necessary to the client is presented. A number of suggestions for helping clients and therapists to become more politically active, as well as vignettes demonstrating how this might work with clients in the therapy process are provided.     

REASONS AND REASON REVISITED: ANOTHER REPLY TO MORRISON

In a previous article, Katherine Morrison (1999) argued that in my book Back to Reality: A Critique of Postmodern Theory in Psychotherapy (Held, 1995) I failed to accept the "strictly epistemological" aim of the narrative therapy movement. In the present article she reiterates the same objections, and adds the new criticism that I perceive epistemological oscillations in the writings of narrative therapists where there are none. In my present response I summarize my prior response to Morrison's (1999) critique (Held, 1999a), and I then respond to her new objections by showing how the conflation between epistemology and ontology that she attributes to me reflects her own confusion rather than mine.