Fostering the therapeutic alliance: Recognizing autonomy’s dialogical antecedents

ABSTRACT

This paper presents a reconceptualization of autonomy as the iterative realization of one’s capacity for “effective self-definition,” that is, possessing a sense of clarity and coherence in “who I am,” and exercising the decisional and volitional ownership over my life that this engenders. This process is “Relational,” wherein people’s interpersonal interactions have a deep and pervasive influence on their ability to recognize and exercise their autonomous capacities. This Relational understanding of autonomy is contextualized within the field of addiction rehabilitative practice. Addiction is a pathology that progressively and insidiously undermines autonomy – producing a number of negative consequences that present themselves along a “continuum of pervasiveness.” In order to most fully foster rehabilitation, therapeutic alliances should to be attentive to facilitating autonomy’s dialogical antecedents. Here, interpersonal recognition can help clients to more fully recognize their own autonomous resources – enabling them to embark on their rehabilitative journey and achieve broader autonomous living. This paper concludes by proposing ways that practitioners can manifest their recognition of their clients’ autonomy within the therapeutic encounter.     

Discussion of “I’mprovisation–Therapists’ Subjective Experience during Improvisational Moments in the Clinical Encounter”

The first part of this article discusses Romanelli, Tishby, and Moran’s qualitative research on the impact of training clinicians’ “skill-sets” derived from improvisational theater. Categories of experience were discerned from the data, along with findings of the impressive positive effects from the training on the clinicians’ ability to better respond to unpredictable “improvisational moments” in psychotherapy. The second part elaborates on how the authors' research represents a welcome addition to a larger conversation about how drama theory “puts” “flesh and blood” on the “bones” of Relational Metapsychology, which entails theories of process and change, rooted in an information theory based epistemology in contrast to Freud’s archaic and deeply flawed Metapsychology ensconced in a psychic energy theory epistemology. Finally, the authors’ lends to advocacy for clinical training in drama and improvisation being added to clinically based curriculums.     

Contributors

Abstract

This paper studies the interaction of the clinical theories of two major British theorists, Melanie Klein and Donald Winnicott. Through three clinical examples, we see how the “Klein-Winnicott dialectic” operates in a significantly developmental fashion to advance and fulfill clinical work. Winnicott’s “object survival” is looked at in developmental conjunction with Klein’s “mourning” as a primary clinical and developmental process. This interaction also captures the essence of working with the aggression of a self that has been traumatically disrupted within its early development. This paper demonstrates how such work leads to the assimilation and grieving of primal object loss, evolving into a “developmental mourning process.” This developmental mourning includes the working-through of an “abandonment depression” in the character-disordered patient. A clinical example in a 1989 essay on “psychic pain” by Betty Joseph is used to set up the clinical challenge of going beyond the symptomatic clinging behavior of developmental arrest, into full psychic birth as a separate other, an Other who can relate to an Other. Conclusively, the subjective visceral affect noted and monitored in its clinical dimensions here is that of human “heartache,” which can also include regret.     

Investigating Psychology and Transcendence

Psychology has not fully engaged with the possible reality of transcendence, spirit, or the divine, largely due to unexamined assumptions that prevent taking religious experience and transcendence seriously. Eugene Long’s reflections on experience and transcendence, key ideas from hermeneutic philosophy, including Brent Slife’s conception of “strong relationality,” Peter Berger’s analysis of modern dilemmas and “many realities,” Louis Dupré’s discussion of an ingrained “objectivism” that has long colored and probably distorted Western philosophy, theology, and the social sciences, and Vaclav Havel’s suggestion of a “need for transcendence” in a postmodern world roughly cohere and go a long way toward dismantling the “encapsulated self” that must either reject transcendence altogether or reach it only by way of a blind and indefensible “leap” out of the modern situation.     

青少年对广告的态度及影响因素

通过对北京城八区11所中学的730个有效样本的研究分析,作者发现,北京青少年对广告的总体态度比较消极, 40.2%的青少年表示不喜欢广告, 27.9%中立,只有31.9%喜欢广告;此外,61.6%的青少年表示不信赖广告,24%中立,仅14.5%的青少年表示信赖广告。在对广告信念的因子分析中,青少年对广告“决策信息”功能表示基本肯定;对广告的“娱乐”、“购买体验”和“个人伤害”结果表示基本否定。此外,人口统计变量与广告总体态度以及各个因子之间有一定的关系。因此,要改变青少年对广告的消极态度,企业营销者需要从产品质量、广告表现形式、广告诉求内容等多个方面加以改善和提高。     

Pitfalls on our “New Royal Road”: Commentary on Paper by Joyce Slochower

In discussing Joyce Slochower’s paper “Going Too Far: Relational Heroines and Relational Excess,” (this issue) the author welcomes its self-critical emphasis, suggesting that analysts from all schools of thought benefit more from noticing the risks and pitfalls in their own approach—thus becoming able to improve their own clinical work—than from polemically highlighting what is faulty in other, competing approaches. Such polemics run a risk of their own: turning our theoretical homes into theoretical fortresses, and blocking richer communication among analysts. He shares the concern about some specific attributes of relational and intersubjective clinical work but relates many of the issues raised by Slochower to tensions and dilemmas present in older models of the analytic relationship as well, offering examples from the work of Freud, Ferenczi, Balint, Winnicott, and Racker.     

Commentary on “Night Cries: A Rural Tragedy” by Tracey Moffatt and Discussion of “States of Exile and Marginalization” by Gillian Straker

This is an excerpt of the work that I presented in Sydney last May at the International Association for Relational Psychoanalysis and Psychotherapy Conference “From the Margins to the Centre: Contemporary Relational Perspectives” in my capacity as discussant of Gill Straker’s work, which included the viewing of the film Night Cries by Tracey Moffatt. I focused on the relationships that are characterized by abuse of power, by inequalities that define interpersonal relationships, and by the type of trauma that ensues from them and on the ways and possibilities to find a way out, a method to reconcile with the victims.     

Vitalizing Enactment: A Relational Exploration

Drawing from her extensive work with deeply disturbed children Alvarez (2012) theorized a form of intervention termed “vitalization” in which the analyst actively reaches out to contact and “reclaim” her most inaccessible patients, engaging them in the world of emotions and relationships. In this paper I consider Alvarez’s ideas through the lens of Relational thought, reconceptualizing vitalization as a unique form of enactment that can draw the analytic dyad from deadened impasse into enlivened contact. In vitalizing enactment embryonic affects, hopes, and longings find expression and are potentiated for patient and analyst alike. This is a view of enactment as a progressive and creative lived experience, rather than an unconscious collision to be survived and symbolized. I contextualize vitalizing enactment in relation to Alvarez’s original formulations as well as relevant contemporary theories and present a clinical vignette to illustrate this paper’s themes.     

Ecology in mind,mindful practices

In many areas of writing and social practice it has become commonplace to think of people and organizations as having content-specific characteristics (e.g., traits, attitudes, structures), and as conducting internal and external processes (intra and interpersonal, intra- and inter-organizational...). The approach taken here is very different. Relational processes form the “starting point”, these being viewed as the medium within which social realities and learning are socially constructed. More precisely, relational processes are said to construct (1) people and things and (2) relations-as social realities. It is suggested that relations very often are constructed as being between separate and opposed entities; these being viewed as relations of “either/or”. However, relations also may be constructed as “both/and”, which invites a view of learning as participation by treating self and other as joined. It is this participative or ecological view that is explored here. An ecological view invites serious consideration of ways of relating that are: diverse-rather than homogenized; slow-rather than fast; and capable of constructing deep knowledges, e.g., that are less closely tied to conceptual language and to a disembodied sense of “I”, “outside” of nature. Discussion briefly points to some mindful (mind-full) practices that embrace, for example, self-reflecting ways, reflection on frames and questions, and reflection on conceptual ways of knowing.     

Contexts,Polarities, and Pluralism. Discussion of Slochower’s “Going Too Far: Relational Heroines and Relational Excess”

In her searching paper “Going Too Far: Relational Heroines and Relational Excess,” (this issue) Slochower finds the potential for excess as inherent in any psychoanalytic theory. I argue that context is key in understanding this phenomenon within relational psychoanalysis; what she describes may not be the case for other theories. The beginnings of relational theory as a movement, generational and radical, could lead to therapeutic overconfidence or certainty around countertransference insights and disclosures. Slochower sees an abundance of certainty in this stance, as well as pressure for premature mutuality. As a complement or balance to this intense mode of interpersonal engagement, Slochower elaborates her own work on holding, wherein the analyst “brackets” her experience and respects the patient’s need for privacy and nonimpingement. Uncertainty is an affirmative stance in letting the patient’s inner life come into being. There are a number of polarities in Slochower’s paper—between mutuality and privacy, certainty and uncertainty, and in the origin story of relational psychoanalysis between relational and classical theories. I argue that pluralism offers a path forward from polarities to a rich complex world of multiple possibilities and recognition of different minds and theories.     

Influence of personal therapy on learning and development of psychotherapeutic skills

The aim of the present study was to investigate psychodynamic psychotherapists’ experience of the influence of personal therapy on professional growth during training with a focus on the acquisition of knowledge and the development of psychotherapeutic skills. Thematic analysis was conducted on interviews with former students (N=10) at two training institutes for psychoanalytic psychotherapy. The resulting theme “professional subjectivity” indicated that personal therapy was experienced as having a positive effect on learning and growth of professional skill by facilitating the development of a theory- and knowledge-based professional subjectivity, a personally founded, professional attitude. Important elements of this development are “shared experience,” “personal influence,” and “knowledge integration.” The emergence of professional subjectivity proved to be an important factor in terms of professional advancement for future psychotherapists. Finding and relating to their own subjectivity was crucial in the process of developing a personally founded, professional attitude in the clinical work.     

Working Class Masculinity: Keeping Gay Men and Lesbians out of the Workplace

Recent survey research suggests that heterosexuals’ attitudes toward lesbian and gay rights have become more progressive. However, we find in our research that negative attitudes and barriers against gay men and lesbians in workplaces still remain. Our project represents one case study of hidden animosity toward homosexuals, which varies from “overt disgust” to “don’t ask, don’t tell” policies that reinforce negative attitudes toward gay men and lesbians. As such, we contend that attitudes toward lesbian and gay rights are not becoming more progressive; instead various methods of discrimination are increasingly being used to exclude gay men and lesbians from the workplace. We argue that White working class men have constructed and maintained a form of White male solidarity, a collective practice directed toward women, People of Color, and non-heterosexuals that maintains racism, sexism, and homophobia in the local, national, and global context.     

PEAK关系训练系统：孤独症语言障碍康复的新方法

PEAK (Promoting the Emergence of Advanced Knowledge, 促进高阶知识涌现)关系训练系统是全球首个同时整合了斯金纳的《言语行为》和后斯金纳主义的“关系框架理论”, 促进孤独症谱系障碍(Autism spectrum disorders, ASD)患者的语言、学习、社交等核心技能发展的语言行为评估训练系统。截至2018年底, PEAK关系训练系统由以下4个模块组成：直接训练模块、泛化模块、等价关系模块、功能转化模块。每一模块依据难易程度分别设置了184个目标能力的评估方法及训练课程。已发表的多项实证研究表明, PEAK关系训练系统打破了《语言行为里程碑评估及安置程序》(Verbal Behavior Milestones and Placement Program, VB-MAPP) 对ASD患者进行里程碑评估时出现的“天花板效应”, 有望比VB-MAPP提供更全面、高阶的语言行为评估体系。此外, PEAK关系训练系统表现出的评估工具的信效度良好、多项效果研究显著、实践中易操作等特性, 使其不仅适用于专业人员教学, 未来在ASD患者家庭干预模式中也有潜在的应用价值。     

Be Fair,Your Employees Are Watching: A Relational Response Model of External Third‐Party Justice

There is growing theoretical recognition in the organizational justice literature that an organization's treatment of external parties (such as patients, community members, customers, and the general public) shapes its own employees’ attitudes and behavior toward it. However, the emerging third‐party justice literature has an inward focus, emphasizing perceptions of the treatment of other insiders (e.g., coworkers or team members). This inward focus overlooks meaningful “outward” employee concerns relating to how organizations treat external parties. We propose a relational response model to advance the third‐party justice literature asserting that the organization's fair treatment of external parties sends important relational signals to employees that shape their social exchange perceptions toward their employer. Supporting this proposition, in two multisource studies in separate healthcare organizations we found that patient‐directed justice had indirect effects on supervisory cooperative behavior ratings through organizational trust and organizational identification.     

If all acts of love and pleasure are Her rituals,what about BDSM? Feminist culture wars in contemporary Paganism

Since the 1970s, some religious practitioners of the contemporary Pagan movement (a.k.a. Neo-Paganism) have embraced spiritual BDSM, or “sacred kink,” as a spiritual discipline relating to their tradition. The “sex wars,” debates around pornography, prostitution, and sadomasochism, have appeared in the history of Wicca and contemporary Paganism. Pagan feminists have brought theological questions to the same debates. They have focused on the Wiccan Rede (“harm none”) and the affirmation of pleasure in Doreen Valiente’s Charge of the Goddess that states that, “All acts of pleasure are [the Goddess’s] rituals.” While support for BDSM has become the dominant public perspective in twenty-first-century Paganism, the movement’s late twentieth-century history includes instances of anguish as individuals wrestled with their personal sexual desire and their feminist principles.