The emperor's new clothes: A study of narcissism and delusional greatness,denial, splitting and projection in a centre for people facing the challenge of HIV and AIDS

Abstract

Last January I began work as an untrained volunteer counsellor at a drop-in centre for young adults in London. It was the first time I had done any counselling with adults, though I had worked with children, and I found myself to be extremely anxious. I was acutely aware of my untrained and inexperienced status, not to mention any other flaws in character and health I might possess, and acutely concerned about whether I could possibly discharge my responsibilities to any client who might come to me for help. I was in therapy myself, but it was not clear to me how this could help me on the spot, so to speak.     

‘Knowing all this just makes it harder’: Psychodynamic Ideas on the Frontline

This paper was given as the fifth Annual Ellen Noonan Counselling Lecture on 12 July 2011 and retains some of the spoken style of the lecture. The theme pursues an aspect of Ellen Noonan’s thinking, in that she always valued equipping students with learning they could take back into the workplace rather than purely training clinicians. The paper addresses both the usefulness and potential difficulties of providing front-line workers with psychodynamic insight. It might appear self-evidently worthwhile to offer staff in the caring and educational professions greater understanding of the roots and meaning of the difficulties faced by their clients and of the dynamics involved in working with them. This paper, while stressing the immense value of such awareness, looks at what can be problematic about it, both for staff and their employing agencies. It also describes ways of addressing such issues, both at an individual and organisational level.     

“‘WE' AND ‘THEY'”: WHY MUST WE ENGAGE IN CROSS-CULTURAL CONVERSATION?

This article contains the principal ideas that I presented in four different sessions at the IRAS 2022 conference, on the theme “‘We' and ‘They’: Cross-Cultural Conversation on Identity.” Focusing on the central topic, the article begins with (i) the contents of my opening lecture; followed by (ii) a broad outline of the concerns discussed in my book, Cross-Cultural Conversation: A New Way of Learning, intertwined with glimpses of the intellectual journey that led me to CCC, delivered in the Book-discussion session; (iii) a summary of the main ideas about the importance of meeting of religions today, which formed the background for the CCC Panel discussion on religion, where I was in conversation with spokespersons of five world religions; and (iv) my comments on how science–religion dialogue can help promote a sense for human solidarity by combining knowledge with wisdom, in the concluding session.     

Reflections on a psychiatric placement

Abstract

During a seminar last year, I was teaching a group of counselling students on the subject of depression. One of the students asked me what I thought of referring a depressed client to a psychiatrist. I replied that in my opinion it was better to keep a person out of the psychiatric services as much as possible. This was an opinion I began to reconsider over the course of a six-month psychiatric placement, undertaken as part of an analytic psychotherapy training.     

Catalysts for psychic change: Perspectives from contemporary psychoanalysis

This paper was given as the inaugural ‘Ellen Noonan Counselling Lecture’ on 3 July 2007, at Birkbeck College, University of London, and I have retained some of the spoken style of the original lecture. Since the 1960s, psychoanalytic models of change and growth have in themselves undergone radical changes. The aims of psychoanalytic and psychodynamic work are now less tied to a model of ‘health’ or ‘normality’ and more linked into processes that enable people to keep developing throughout life. The lecture examines some of the new theories of psychic change and growth from the contemporary Independent, Lacanian and post-Kleinian schools of psychoanalysis and, using clinical illustrations, explores the implications of these new theories for psychodynamic practice.     

A Psychotherapist Retires

Abstract

This article reflects on a year of my personal experience as I prepared to retire from my psychotherapy practice of 40 years. While aware that this might be a poignant experience for bothmyself and my clients, my own surprising emotions and dreams demanded that I pay attention to myself. By acknowledging my feelings I was able to direct sensitive attention to the clients' feelings of loss and sadness. Finding the balance between the sadness that filled the therapy room and my own enthusiasm for what awaited me outside that room, was not a simple task     

Balint's Influence on Contemporary Psychoanalytic Theory and Practice

Invited by the Psychoanalytic Psychotherapy Study Center in New York to lecture on my book Michael Balint: Le renouveau de l'Ecole de Budapest, Toulouse, Erès 2000, I first gave my personal and analytic motivations for writing this book. Then I stressed Balint's original contributions to analytical theory and practice: the object relation combined with the theory of instinct, the development of the infant, adolescent and even of old age, the basic fault, archaic defenses (such as ocnophilia and philobatism), as well as his idea about analytic treatment with its phases of regression and "new beginning". His style and his discretion in treatment and mainly the responsibility he recommended to the analysts seem to me very important not to forget. I have shown him as Ferenczi's heir and how he continued his work. His clinical approach and his style are evoked to alert contemporary analysts--who sometimes just know his method to train general practitioners through the Balint group--that they have been influenced unbeknown to them.     

Reply to critics

ABSTRACT

In this reply to critics, I reply to Stephanie Leary’s, Kris McDaniel’s, Tristram McPherson’s and David Plunkett’s articles on my book Choosing Normative Concepts. One central theme in the replies concerns what is the best strategy for the so-called ardent realist when it comes to responding to the challenge I present in the book. Another central theme concerns the criticisms of my characterizations of what normative concepts and normative properties are.     

Learning and teaching (briefly)

This paper was given as the Annual Ellen Noonan Counselling Lecture on July 2012 and retains some of the spoken style of the lecture. It uses examples of Ellen Noonan’s work to examine aspects of the process of teaching and learning psychodynamic practice. The difficulties of how to embed theoretical knowledge with its clinical application are discussed and the question of what are the key skills of the self-reflective practitioner is raised with reference to whether, and how, they can be taught or learnt. It is suggested that part of this process consists in helping students, and their teachers, to be more comfortable with not knowing, a concept that is both counter intuitive and counter cultural. From this aspects of contemporary therapeutic practice, with specific reference to psychodynamic short-term therapy, are addressed. The paper looks at the ambivalence felt by many psychodynamic clinicians towards working within a short-term paradigm in current workplace settings and how this might be addressed. The paper discusses the intrinsic qualities of a psychodynamic short-term approach and its relation to contemporary therapeutic modalities. It is suggested that the increasing managerial culture, leading to the ascendance of protocol driven, manualised and structured therapies, represents an attack on the relational and must be challenged.     

Use of narratives and collage in the exploration of the self and the meaning of a career

ABSTRACT

A methodological challenge during my doctoral research led me to use collage to reflect upon my own life and career. The insights it allowed me into the relationship between who we are and what we do led me to conclude that such methods can also illuminate these connections for clients of career counselling. In this paper I argue that such constructivist approaches allow the examination of that psycho-social space within which career is shaped and understood, allowing access to both the conscious and unconscious meaning made of a career and life story. I further argue that in times of increasing complexity such methods will be an important tool for career counsellors to meet the holistic needs of clients.     

You Must Have Thought This Book Was About You1: Reply to Daniel Dennett

Daniel Dennett's review 2 of my book, Human Nature and the Limits of Science, 3 was apparently conceived as part of a multiple review, anticipating an author's response, so I am grateful for the opportunity to satisfy this expectation. Indeed, Dennett uses this excuse to justify devoting his own contribution to responding to those parts of the book directed explicitly at his own work, leaving other imagined reviewers to take care of other issues. Since he has things to say about most of the topics in the book he evidently interpreted this remit widely, in fact taking the book as “presented as an antidote of sorts to [his] own world view” (p. 482). Let me begin, therefore, by reassuring Dennett that, while I certainly had some critical things to say about some of his views, the book most certainly was not intended as an ad hominem attack. The nine pages (out of 187) on which his work is cited fairly accurately reflects the extent to which his views figured in my thinking. Curiously, his ire seems most strongly aroused by my assault on his views on free will in which, apparently, I agree with nearly everything he says and, worse still, fail to cite him at all.     

Total Recall: Treating Chronic Mental Illness as a Memory

The ideas outlined in this paper developed from three separate strands of my work as a therapist treating older people. Firstly, I was concerned with reducing the number of patients not benefiting from therapy. In keeping with Pinquart et al.'s (Am J Psychiatry 163:1493–1501, 2006) recent meta-analytic survey concerning the use of psychotherapy and medication, 50% of the depressed patients treated by my team failed to respond adequately. Secondly, the ideas grew out of my attempts to determine why different therapies with older people have often been shown to have equivocal beneficial impacts (Davies and Collerton, J Ment Health 6:335–344, 1997). Thirdly, I was interested in integrating the relevant neuropsychological features, particularly memory, into my therapeutic work. These three strands have led me to propose a pan-theoretical model of distress based on memory functioning and existing information processing perspectives (Teasdale and Barnard, Affect, cognition and change: Remodelling depressive thought, 1993; Power and Dalgleish, Behav Cogn Psychother, 27:129–142, 1996).     

Journeys through the valley of death: multimethod psychological assessment and personality transformation in long-term psychotherapy

The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) is based on the assumption that an in-depth understanding of clients' underlying emotional, personality, and interpersonal patterns will facilitate their treatment. In this article I show how such an understanding can be achieved through multimethod psychological assessment, and how useful such information can be in long-term psychotherapy with high-achieving, successful clients who struggle with forming and maintaining intimate relationships. Such treatments are extremely difficult, because when these clients attach to their psychotherapists, many of them temporarily become more symptomatic. I illustrate these points with a detailed account of my long-term therapy with a resilient but highly traumatized young man. Repeated use of the Minnesota Multiphasic Personality Disorder-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and Rorschach with my client helped guide us in our work, and also helped create an important therapeutic "opening" into the underlying traumatic material. This and other experiences have convinced me that it is extremely useful for psychologists to have training in both assessment and psychotherapy.     

Writing qualitative research — A gathering of selves

This paper is a reflection and discussion on the integration and personal development that may occur when we use ourselves in heuristic research, particularly in the process of writing. It focuses on my writing about a study I undertook with two of my ex‐clients who are brothers, and their journey towards healing, and on their experience of our counselling relationship as part of that journey. As their counsellor, and the main researcher, my story inevitably intermingles and overlaps with theirs. My ‘selves’ as woman, survivor, client, counsellor, researcher (and numerous other selves) and their selves as survivor, man, client and researcher (and many others) are impacted by the collaborative, experiential nature of the work. Issues faced in the writing of a book about the research (Etherington, 2000), such as self‐disclosure and reclaiming my voice, parallel many of my own issues as a client and my clients' issues.     

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.     

‘Adolescent fantasies and the horror-film genre‘: The freud museum 1995 spring conference

Abstract

As I walked towards home across Waterloo Bridge, having left this conference in its apt setting of the National Film Theatre, I realized I had attended the day from two points of interest: firstly, from my professional position of working in a university counselling service where I encounter adolescents and their ‘phantasies’ regularly. Only the other day a young student I had been seeing started the session by telling me she had seen the film Interview with the Vampire the night before, had been sick at the end, and then casually ‘threw up’ to me that she did not think she would need to go on seeing me.     

Reflections on intersections between cognitive and social psychology: A personal exploration

I appreciate the opportunity offered by the editor to reflect on the relationship between cognitive and social psychology. This topic has interested me my entire professional life, because I was admitted to graduate school to study social psychology and then eventually migrated to cognitive psychology. The organization of this paper is as follows: I first relate my (somewhat puzzling) personal experiences that led me to wonder about relations between cognitive and social psychology. I suggest that, for many topics, the placement of a topic of study in one field or the other is arbitrary. Next I selectively review some common historical influences on the development of both fields, ones that have made them similar. Both grew from common seeds, which include Gestalt psychology as it became applied to a wider array of topics, experimental psychologists becoming interested in attitude change during and after World War II, and Bartlett's famous book on Remembering: A study in experimental and social psychology. Next I review some research from my lab that picked up themes from Bartlett's work and that, in some aspects, combines cognitive and social approaches. I also discuss the issue of memory conformity or the social contagion of memory, and conclude with thoughts about how social and cognitive psychologists might collaborate on an exciting new arena, creating empirical studies of collective memory. Copyright © 2010 John Wiley & Sons, Ltd.     

The difficulty of understanding a borderline patient

SUMMARY

For much of the time during my work with Mr A, a borderline patient whom I saw for twice-weekly psychotherapy over a period of one year. I had difficulty understanding and communicating with him. I felt despairing and impotent and that therapy was not progressing at all. A few weeks prior to termination a shift occurred and I realised that there had been some improvement in Mr A's functioning. Although I was aware that behind the polite façade was an angry, disturbed man, I felt that he was a little more in touch with reality than he had been at the beginning of the treatment.

In this paper I will focus on the factors that contributed to my difficulty in understanding and communicating with Mr A. I will also attempt to account for his apparent improvement.     

Bulletin Board

Abstract

When psychotherapy is viewed as shared reconstruction, there are implications for both clients and therapists. My clients become sources of expectations, myths, thought, and feelings about themselves and their therapists. I, as therapist, become a source of intentions and reflections, with capacities for self-awareness and abilities to construe my clients and their constructs, languages, and metaphors. Both participants in psychotherapy can then be seen as involved in reconstruction through the sharing and rebuilding of narratives. It is the life stories of clients that are likely to be more changed in therapy, but my life stories and my stories about the therapeutic process are also open to change