Summer 2024: An Omnium Gatherum

Introduction:

Can it have been eight months since I last posted on here? It is not for lack of materials, as you shall presently see! I read as greedily and voraciously as ever, rapidly eviscerating some books while with others slowly meandering through them repeatedly as I soak in their wisdom.

Instead, I have been busy with all the usual aacademic and clinical duties, and all spare energies have gone into writing not one but two books of my own this year. With one of them done, I have come up for breath and can say something brief about both (before reviewing books devoured this year to date). 

1) The first has morphed in my mind countless times. But now it has coherent shape, and would have been done this summer but for the unexpected instrusion of book #2, noted below. This first book will be more 'meditative' (for lack of a better word) and gives me a chance to develop some things I have been thinking about for thirty years now. The tentative title is On Being a Psychiatric Monk. It develops ideas my beloved Nina Coltart first laid out very sparingly, especially her notion of "bare attention" which the clinician must constantly cultivate.

Such a notion was drawn from her immersion in Buddhism, about which I have hitherto been ignorant. But she inspired me to start reading Mark Epstein's books, two of which I have now finished and want to re-read: first was Thoughts Without a Thinker: Psychotherapy from a Buddhist Perspective. This was followed by Going to Pieces without Falling Apart: A Buddhist Perspective on Wholeness.

In thinking about "bare attention," I returned to a fascinating woman I first read about in the early 1990s: Simone Weil. She has a very rich essay "Attention" that I read in Gravity and Grace. For context to Weil's essays I read The Subversive Simone Weil: A Life in Five Ideas by Robert Zaretsky (University of Chicago Press, 2021).

2) This second book of mine, which I had neither plans nor foreknowledge of, came roaring out of nowhere in the late spring, part of it decided upon simply by gathering the lecture notes I use for my Introduction to Psychotherapy/Counseling class every year. In that class I have had the students read a number of books (especially those of Lou Cozolino and Nina Coltart) and articles, especially those of Jonathan Shedler and Nancy McWilliams. But I decided I could write my own book not only as a short, accessible, suitable text for my students, but also (and here I must cite Kristian Kemtrup for this inspiring idea) as a rejoinder to the increasing number of right-wing critics of psychotherapy, of whom some American journalist named Abigail Shrier is most prominent just at the moment with her Bad Therapy: Why Kids Aren't Growing Up. Her book advances many of the usual romantic and reactionary fantasies ("chosen traumas" as Vamik Volkan calls them) about our present moment but it also, importantly, advances criticisms of the field of psychotherapy some of which deserve to be taken seriously. So that is what I spend the first chapter of the book doing: responding to, and in many cases agreeing with, Shrier about the many practices that constitute bad therapy. 

Nobody likes a scold, however, so I spend the rest of my book unfolding a more compelling vision of what psychotherapy could and should be like largely inspired from Winnicott's argument that “psychotherapy has to do with two people playing together.”

Here is the Table of Contents:

Introduction:

I: What Good Psychotherapists Do Not Do

II: What Good Psychotherapists Are and Do:

III: What Good Psychotherapy Requires: a Frame

IV: What Good Psychotherapy Requires: Psychologically Minded Patients   

Conclusion

Brief Annotated Bibliography

Acknowledgements.

I have been unable to decide on title for this book. There are four contenders at the moment, none of which I am entirely happy with. Your feedback, and additional suggestions would, dear reader, be gratefully appreciated:

A Short Guide to Finding a Good Psychotherapist Psychotherapy: A Playbook for Patients, Students, and Clinicians Psychotherapy: A Playbook for Patients and Professionals Alike On Not Giving Blow-Jobs to Stick Figures on White Boards: And Other Tales of Psychotherapy Gone Awry

Right. Now to briefly go through some of what I have been reading this summer in the hope that it might be useful to others:

Clinical Readings:

Having previously read two of her books, especially The Analyst's Vulnerability, which I wrote about here, I was eager to read another of Karen Maroda, and this July read Seduction, Surrender, and Transformation: Emotional Engagement in the Analytic Process. I began with her chapter on the use of touch in psychotherapy, of which I am not an advocate at all, while she came very carefully to moderate her previously negative views, too. But the richest part of the book is her reflection on how all psychotherapy is "grief work," to use that almost pedestrian phrase.

Self-Examination in Psychoanalysis and Psychotherapy: Countertransference and Subjectivity in Clinical Practice by William F. Cornell came out from Routledge in 2018. Perhaps this book might be useful for beginning students unaccustomed to self-examination and drawing on counter-transference reactions, but I found it very thin gruel.

That was also my reaction to The Language of Change: Elements of Therapeutic Communication by Paul Watzlawick (Norton, 1993). Much better books on this topic exist including Paul Wachtel's Therapeutic Communication: Knowing What to Say When and, even more than that, Leston Haven's invaluable Making Contact: Uses of Language in Psychotherapy, which I wrote about at length last summer and find myself returning to often.

Having been so taken by Haven's book, I decided I should read more of his. Reader, I was not impressed, but that is okay for I have long been aware that authors of more than one book usually have a dud or two in the mix. Thus I was rather disappointed by the thinness of A Safe Place: Laying the Groundwork of Psychotherapy (1989) and Coming to Life: Reflections on the Art of Psychotherapy (1994). Slightly more edifying were Haven's chapters in The Real World Guide to Psychotherapy Practice, eds., Alex N. Sabo and Leston Havens (Harvard UP, 2000).

Critical Analyses of the Field of Psychotherapy:

Because I am a neurotic academic anxious not to repeat what others have said before me, and even more anxious to ensure all my bases are covered, I decided, in writing the second of my books noted above, I had to look at recent critiques of psychotherapy from those within the field, and so I read and almost entirely agreed with Enrico Gnaulati's Saving Talk Therapy: How Health Insurers, Big Pharma, and Slanted Science are Ruining Good Mental Health Care.

Advancing Psychotherapy for the Next Generation, eds., Linda L. Michaels, Tom Wooldridge, Nancy Burke, and Janice R. Muhr (Routledge, 2023) deserves the widest possible audience for it publishes the results of one of the largest and best studies of what patients want and benefit from in psychotherapy. A study of this size has not been seen, as far as I know, since the 1995 Consumer Reports study. Here's a hint totally unsurprising to practicing clinicians: patients want to be listened to at depth to explore the dynamics of their minds and relationships. They do not want worksheets, breathing exercises, chakras, and the whole farrago of fatuities one so often encounters today.

Some Winnicott (of course):

I own all but one of Christopher Bollas's books so when he published another one recently I was of course going to get it: Essential Aloneness: Rome Lectures on DW Winnicott. Regular readers and re-readers of Winnicott, as I am, will not find a lot of new material here, but this book would make the best brief introduction to Winnicott I know of. It is cogently and compellingly written based on lectures which Bollas gave decades ago and, strikingly, did not feel the need to alter for publication. There is a freshness and liveliness to each of the short chapters.

This is one of those books I did not--could not--devour and eviscerate, but instead had slowly to read and re-read, and I expect I will go back to regularly: Steven Cooper, Playing and Becoming in Psychoanalysis. He picks up on Winnicott's argument, quoted above, about psychotherapy being a place for play to ask what that looks like. Happily Cooper does not give definitive answers to that question but writes in such a way as to invite the reader to imagine his or her own thoughts on the question, noting that you can never play with each patient in exactly the same way. (Another book on this theme of playing was a total disappointment--virtually worthless.)

Books Useful for Training or Recommending to Students:

If you are trying to teach your students or supervisees about the centrality of the working alliance, then this is a book to have in your back pocket: The Therapeutic Alliance: An Evidence-Based Guide to Practice, eds., Christopher J. Muran and Jacques P. Barber (Guilford Press, 2010).

In May I was asked to do some training for local clinicians on working with psychotic disorders, and just a few days before I did so, a brand new book arrived, which I tore through at the time but really must go re-read to benefit from. It is very rich and compelling: From Breakdown to Breakthrough: Psychoanalytic Treatment of Psychosis by Danielle Knafo and Michael Selzer (Routledge, 2024).

A Little Sex:

I still cannot overcome my dumbness to say anything about two books Avgi Saketopoulou. The first of these is her just staggering work Sexuality Beyond Consent, which I read back in mid-January. I have tried writing about it several times, but to no avail. She has forced me to re-think things in ways I would never have expected or been prepared to until quite recently.

The second is one she co-authored with Ann Pellegrini: Gender Without Identity It took requires more commentary than I can make here. Perhaps some day...

Speaking of sex, because I work with sex offenders clinically I ordered Brett Kahr's Who's Been Sleeping in Your Head: The Secret World of Sexual Fantasies to see what some of the international research says about types, themes, and prevalence of various fantasies. Kahr's book is very workmanlike. (A friend tells me he is currently enjoying one of Kahr's other books: Coffee with Freud.)

A Bit of Bromberg and Bach:

Once I take a liking to an author I usually have to devour all his or her works. So in January of this year I ordered the remaining books of both Philip Bromberg and Sheldon Bach that I did not own. I've read chapters in each of them, but hope to finish them by Christmas.

Non-Clinical Reading:

How boring it would be only to read books in one's field! Thus not all my reading is clinical: I confine that to daytime and weekday reading.

Bedtime and weekend reading lately has consisted of many other books (especially those about the canal systems of England and Wales, a curious obsession I cannot explain), including Adrienne Rich's poems, and Charles Moore's splendid Margaret Thatcher: The Authorized Biography, vol.3: Herself Alone. Though I found her politics repellent then as now, I was fascinated by her fierce and contradictory character and perhaps allowed myself a bit of a crush on her as I watched her final year in office when I was a teenager briefly toying with a possible career in law and politics. Moore is a much more judicious commentator and elegant writer than I was expecting, and the book, while a bit over-laden with detail sometime, is very gripping. Having finished the final volume, I'm about to go back and read the first.

Prior to finishing the Moore biography, I read the second of Steven Kotkin's studies of Stalin, Stalin: Waiting for Hitler, 1929-1941. Among its many virtues is its careful attendance upon and wise reflections on historiographical principles used and abused in telling the story of Stalin, who has been the subject of a myriad of biographies, some of which I have read.

Traveling this summer I perused used bookstores in North Carolina and West Virginia, and found Harry S. Truman, written by his only child Margaret. It's a charming biography of one of the most compelling men to occupy the White House. This has made me determined to re-read David McCullough's Truman, which I first read twenty years ago. Recently two new books about him have emerged which I may eventually read.

Truman's exact contemporary and man of similar temperament and politics, Clement Attlee, was the subject some years back of John Bew's splendid book Clement Attlee: The Man Who Made Modern Britain. These two men nearly alone of all politicians in the last century remind me that not all political leaders are mendacious, malevolent, and repellent creatures.

I am part-way through the very dense Early Auden, Later Auden: A Critical Biography by Edward Mendelson.

Once that is done, I will start another biography I found on my travels this summer: Jacques Lacan by Elisabeth Roudinesco. If you don't know Roudinesco's works, you should. Her Freud: In His Time and Ours is one of the best single-volume biographies of the great man (less idealistic and more gritty than Peter Gay's book, and far less officious, of course, than Ernest Jones' authorized three volumes) while her Why Psychoanalysis? is a short apologia which avoids special pleading.

With the academic year beginning Monday, time for reading and writing sharply diminishes and so it may well be December before I have time to pop back on here, but who knows....

Betty Joseph on Psychic Change

As so often happens, my friends on Twitter [some insolent rabble in the gallery: "He has friends?"] convince me finally to read people of whom I have been aware, often for decades, without having actually read their works. In this case, it was a quotation from Betty Joseph. Finding it compelling, I ordered, and have now read, Psychic Equilibrium and Psychic Change: Selected Papers of Betty Joseph, eds. Michael Feldman and Elizabeth Bott Spillius (Routledge, 1989).  

Joseph lived to nearly 100, dying just a decade ago after a very long clinical career in England. (A short biographical sketch is available here.) My first analyst in Canada was a Kleinian and I vaguely recall her mentioning Joseph at one point but I never investigated farther. 

The Hard to Reach Patient:

Like all collections, Psychic Equilibirum is uneven. It contains papers originally published as far back as the late 1950s. Every chapter is fairly brief and follows a standard format. I perused the table of contents and decided, after reading the editors' introduction, to jump around, beginning with the chapter that first grabbed me most strongly, viz., no.5, "The Patient Who Is Difficult to Reach." I have at least one such right now and whenever I read a chapter like this--or any chapter by clinicians citing their own case material--I always hope (surely I am not alone in this?) that what they describe will be exactly what my patient is like so that, at last, I can stop thinking and reading and wondering and working to figure out the treatment they need, and instead copy the example cited by this manifestly masterful clinician. Thus does one see the very real attractions of manualized therapy!

But, of course, my patient is at least 90% different from Joseph's. (And thus does one see the massive limitations of manualized therapy!) So I ended this chapter somewhat disappointed, to be honest, finding it only partially useful. (That is also true of much of the book: I found only 2 or 3 chapters particularly useful, but read all of them, and found threaded through each and every one a common theme, noted below.)

But then, trying (at risk of sounding pious or sycophantic, both of which I abhor) to reflect over the whole chapter by means of a kind of reverie, which 'method' I learned from reading the great Thomas Ogden, I put the book down and stared across the coffee shop and out the window to the river, and found myself focusing on nothing in particular but allowing my mind to range back over the entire chapter as it tried to weave in one case in particular. At that moment I came to a rather startling insight about what now seems to me a technical mistake or perhaps an 'enactment' I have allowed to happen. I was aware of what I was doing, and thought it justified, but now in light of Joseph's chapter I see differently.

What, in particular, provoked this small epiphany? There are three lines in the chapter that were bracing to me.

First, she begins by talking (as others I have read would later do--I think in particular of Christopher Bollas here) about those patients eagerly proffering "pseudo-cooperation aimed at keeping the analyst away from the really unknown and more needy infantile parts of the self" (p.76). That latter phrase--more needy infantile parts--especially struck home and inched me toward greater understanding of a case in which my countertransference imagery has been utterly plagued for months with nothing but images of my cradling my (adult) patient as a babe-in-arms. 

This first line of Joseph's I immediately linked up with a passage a few paragraphs later in which, continuing the theme, Joseph speaks of the really needy part of the patient needing "the experience of being understood, as opposed to 'getting' understanding" (p.79). That, of course, echoes one of her contemporaries, Frieda Fromm-Reichman, and the latter's famous observation that the patient needs an experience, not an explanation. Here I came uncomfortably close to a second acknowledgment of a near-mistake in a case in which I have sometimes found, in my impatience, doing what Joseph warns against: offering 'an explanation,' a thing, rather than an overall experience--and doing so prematurely, in a way the patient could not use at the time. 

In doing so, I am now rebuked not just by her, but also by a passage of Winnicott I have not always heeded. In "The Aims of Treatment" from 1962, he speaks of the necessity of "economical" interpretations, rightly warning that "I never use long sentences unless I am very tired. If I am near exhaustion point I begin teaching." In my case it's not just a moment of exhaustion but also sometimes of frustration which I have done a poor job of controlling. At such a moment I lapse into professor and academic mode, giving a paragraph-length explanation, an understanding, an interpretation: these rarely go over well. 

At the very end of the chapter in the third passage of Joseph that I found challenging, she advises that with patients hard to reach, we must keep our interpretations, our understandings, "immediate and direct" (p.87; her emphasis). In other words, she explictly says, do not offer some kind of historical explanation or interpretation, linking together themes or events from years or months or even weeks past: stick closely to what is going on in that moment in that session in your consulting room. Here is where (as she'll make clear elsewhere in the book) Bion is handy: abandon memory of past events and sessions, and a desire to escape the present moment, and instead plunge right in to your immediate experience of and with the patient, and they of you. (Bion's famously difficult and confusing counsel is examined in a bit more detail here.)

I admit this--discussing what is happening in the moment--was enormously hard for me to do for a time, but working with borderline patients has in essence forced me to do it. I remember very clearly the first time, with enormous trepidation, I attempted it and how it proved to be so pivotal to treatment. Once I figured out my own idiom for doing it after that, and became (in part thanks to my own analyst) much more comfortable with the risks I felt I was running in doing this, it has begun to flow more easily now. I think the key for me was once again Winnicott. In that most invaluable of essays, "The Use of an Object," he helped me to see that I could allow patients to bring their rage out into the open of the immediate moment and try to destroy me but that I would not in fact be destroyed. 

The Patient Addicted to Near-Death:

The other outstanding chapter in this collection is "Addiction to Near-Death." Here she refers to patients engaged in "a type of mental activity consisting of a going over and over again about happenings or anticipations of an accusatory type in which the patient becomes completely absorbed." (In my experience this is characteristic of certain obsessional-compulsive personality styles, about whose treatment I wrote in some detail here.) For such patients their "seeing of the self in this dilemma [as] unable to be helped is an essential aspect." 

As a Kleinian, Joseph mentions projective identification and splitting in every chapter, and here notes that the splitting characteristic of these patients is such that "the pull towards life and sanity" (p.128) is projected almost entirely into the clinician. (I have found myself in this position but, being an ignorant fool at least once a day, rather blithely told myself--here vaguely calling to mind some exculpatory aphorism of Yalom--that it was simply me being "the bearer of hope" until such time as the patient could be more hopeful.....except they never assumed one bit of that burden, and acidly disdained any expressions of hope!) 

Joseph returns to this later in the chapter, speaking in more forthright terms than in many other chapters as she speaks of this splitting, and the clinician taking up the role of one who is hopeful about and pushing for change, as being a "collusion" in which a "major piece of psychopathology is acted out in the transference." If you are put into this position of bearing the hope and desire for change then "the patient constantly is pulling back towards the silent kind of deadly paralysis and near-complete passivity" in significant measure to avoid having to recognize and deal with their own "ambivalence and guilt" (p.136). 

The "patient's apparent extreme passivity and indifference to progress" is based in part on, and heavily reinforced by, the fact that "the near-destruction of the self takes place with considerable libidinal satisfaction." These patients enjoy the "deeply addictive nature of this type of masochistic constellation" (p.128). At the chapter's end, she will return to this in graphic terms, speaking of the patient as having "withdrawn into a secret world of violence, where part of the self has been turned against another part" and where "this violence has been highly sexualized" (p.137).  

A word is here introduced by Joseph, giving an excellent definition to a term I first encountered I don't know where some time back: chuntering. The chuntering patient goes "over and over again in some circular type of mental activity" that consists of endless grumbling, complaining, fault-finding. Sometimes, however, such chuntering is silent: Joseph mentions those patients who, passively and silently, will destroy whatever you are doing, apparently listening to your thoughts but all the while mocking them with silent contempt.

Given such powerful libidinal rewards for their self-destruction, it is no wonder that working with such patients is going to be very difficult. Joseph ends this chapter with no clear or simple fixes, saying simply that "it is very hard for our patients to find it possible to abandon such terrible delights for the uncertain pleasures of real relationships" (p.138). 

Once more the only thing Joseph counsels is taking a "moment to moment" approach in the session, monitoring the changes in transference (which for her is never static, never fixed, never permanent, but a live thing, a dynamic, living, changing experience) and counter-transference.  As a result the same behavior can have a difference transferential import: Sometimes the patient may be engaged in what appears to be chuntering, but doing so out of real psychic pain at some legitimate thing they need you to know about; at other times they may be trying to drag you into a masochistic enactment. You need to get clear as to which is which, and these can even shift within the same session.

Finally: What is the Change We Seek?

If it is hard for these patients to change, which patients find it easy? For Joseph the answer is itself easy: none. Nobody finds it easy to change for we are all shot through with ambivalence and conflicting desires, and all our struggles--whatever they are--are bound up with our personality structures (a point so helpfully made more recently by Jonathan Shedler and Nancy McWilliams, inter alia). Our personality defenses, Joseph notes here, are "very tightly and finely interlocked elements" (p.193). To change even one thing is to risk a cataract of other changes, and thus to provoke multiple defenses at every step: this is the theme of Joseph's fourteenth chapter ("Psychic Change and the Psychoanalytic Process"), the last on which I shall comment. 

How might we define change? What are its hallmarks? Here Joseph is very reluctant to get into details or to over-promise. Indeed, throughout this book one gets the sense that she is in constant, unwavering control of her omnipotent and omniscient desires, never overpromising or indulging in messianic fantasies about dramatic changes. 

"Moment-to-moment shifts and change" in the transference is what we should be paying attention to, Joseph says, without much regard for anything outside it. If such changes happen, then we are permitted to "hope" that such are "eventually going to lead to long-term, positive psychic change. I do not think that the latter long-term psychic change is ever an achieved absolute state but rather a better and more healthy balance of forces within the personality, always to some extent in a state of flux and movement and conflict" (p.194). This last sentence, to my mind, sounds very much like Philip Bromberg avant la lettre. (This chapter was originally published in 1986, a dozen years before Bromberg's Standing in the Spaces, an outrageously rich collection I hope to finish and write about next week. Bromberg cites this passage of Joseph's on p. 272.) 

From here Joseph expands somewhat outward, first noting what Freud said about change ("where id was, there ego shall be") before adducing what Klein added to this, and then, in sum, writing that psychic change consists in "greater integration between ego and impulses, love and hate, superego and ego" and that as an analysand moves toward greater health, this will be seen in an ability "to bear both his love and his hate at the same time and towards the same person. His perception of human beings then becomes more real, more human....This step, or rather, minute series of steps, forward and backward, towards integrating love and hate, brings with it momentous changes within the personality." (This theme of taking up love and hate will find powerful expression in Glen Gabbard's book of that name.)

Such changes may be seen in a greater ability to acknowledge and not flee from "guilt and concern" for others as we come to "take responsiblity" for our "own impulses" and how we may have harmed or attempted to destroy the objects of our life. If we take such responsibility, "there opens up the possibility of feeling for and repairing the object. With this there is also relief and a deepending of emotions" (pp.194-95). All of these changes emerge, Joseph stresses again and again, not in grand Damascus-like moments of blinding conversion, but often in the very minute, moment-by-moment changes in the transference, where it all begins; and if it doesn't begin here, it will never begin. 

This is a humbling note on which to end, but a salutary one. If we are always looking for external affirmations and grand signs of change and progress, we may risk overlooking, perhaps even disdaining, the quotidian ones in the transference.  We need to be content eating bread and butter as a regular diet rather than lusting after prime rib every day. 

We also need to be comfortable recognizing that the mind, Joseph says in conclusion, is a scene of perpetual conflict--even when progressing in the 'right' direction. If we leave our patient pretending otherwise, even as they progress in change and grow in freedom, then we have returned them to a very primitive form of splitting which, to Joseph, is anathema. 

Sexualities and Identities:

It is the fate of collections to be often wildly uneven, and that is true with Sexualities: Contemporary Psychoanalytic Perspectives, eds. Alessandra Lemma and Paul E. Lynch (Routledge, 2015), xiii+244pp. There are two outstanding chapters, and two very good chapters; and then a great deal of other material some readers might find interesting or helpful but I did not. 

I read this book first for general interest, then because I work with adult and adolescent sex offenders ordered by the courts into treatment, and finally because I am working on an essay about the erotic in transferences and counter-transferences. 

I begin with Part III, "Homosexuality" and the first essay in this section by Peter Fonagy and Elizabeth Allision, "A Scientific Theory of Homosexuality." To my mind, this is the most outstanding essay in the book both for the cogency of the writing and for the challenging arguments it offers. The entire chapter--or at least the first half of it--plays something of a trick on the reader who, under that title, is led to expect something the authors very severely put to the question in the chapter's second half. That is, the first part is a brief review of the history of attempts to conjure up a theory of homosexuality (that history has recently been treated more expansively, but not entirely successfully, in a book I discussed here). 

Fonagy, of course, is the founder of the tradition of mentalization-based therapy, about which see here and here. He has also published on possible connections between infantile experiences and attachment, and the development of sexuality. 

With Allison, the burdern of the second half of their co-authored chapter is introduced and encapsulated by the claim that "normal sexual desire is inherently unknowable....Part of the essence of desire is that there is something anti-conceptual, something indefinite and unknowable about it" (p.133). This, in turn leads to one of the other major claims by these authors: "neither homosexuality nor heterosexuality are 'normal' and...neither can be an identity."

I rather imagine that both claims will immediately set some teeth on edge, but both are for me so straighforwardly obvious and true they cease to require additional argumentation. 

These claims are not, of course, entirely original to these two authors. Adam Phillips, for one, has argued something similar about the inherent unknowability about sexual desire and identity, especially in his 1997 book Terrors and Experts, where he has repeatedly noted that "there is nothing like sexuality...for making a mockery of our self-knowledge. In our erotic lives, at least, our preferences do not always accord with our standards." Later in the book he continues by arguing that "from a psychoanalytic point of view, nobody can know about sexuality" in part because "we are never one thing or another, but a miscellany. (For how long in any given day is one homosexual or heterosexual, and can you always tell the difference?)" 

The, uh, desire to have definitions and identities clearly nailed down is, Phillips suggests, an expression of our "wish to be defined [which] is complicit with the wish to be controlled." Additionally, the ham-fisted insistence on clear and sharp definitions runs the very real risk that "too much definition leaves too much out." Too much definition, in other words, undermines mystery and freedom alike. 

This, too, is very similar to what Fonagy and Allison argue: "the essence of desire is its indefiniteness." Indefiniteness means that we can have no legitimating theories of human sexuality, and these authors end their essay by suggesting that such theories in the past have functioned in an anti-mentalizing fashion, shutting down the ability to think about ourselves in ways that take account of our complexity and messiness: "it behooves us to be suspicious of ourselves when our wish for simplicity begins to override out respect for the complexity of subjective experience that our patients engender and bring with them in relation to their experience of their sexuality" (p.135). 

Anyone who has done clinical work for more than a week will immediately realize the profound truth of that last statement. And it shows up in several other essays, as well, including the moving and somewhat melancholic "Intimacy and Shame in Gay Male Sexuality" by Paul E. Lynch: "the beauty of working with patients instead of theories is that they are not so determinedly insistent on conclusions about their own sexuality, and are more often trying to find some way to make sense of themselves, their bodies, their pains and pleasures, and their relationships" (p.146). (Briefly towards the end of his chapter, Lynch suggests that "transgressive sexual behaviors may be an enactment or embodiment of un-represented, un-symbolized, or unformulated early experience," a theme that Adam Phillips has also briefly touched on, and before them both found in the works of Robert Stoller, including Perversion: the Erotic Form of Hatred.)

Earlier in the collection, Mary Target suggests that "fully expressed adult sexuality, regardless of dominant gender identity or orientation, incorporates unconscious bisexuality and bluring of the gender role of self or other." All of these authors, of course, are merely echoing what Freud first postulated in his infamous 1905 Three Essays on the Theory of Sexuality:

Since I have become acquainted with the notion of bisexuality I regarded it as the decisive factor, and witout taking bisexuality into account, I think it would scarcely be possible to arrive at an understanding of the sexual manifestations that are actually to be observed in men and women.

Lynch's claim about un-represented forms of sexual desire and behavior shows up in the last two chapters of this collection, the first written by Avgi Saketopoulou, who has also recently published Sexuality Beyond Consent, which I hope to read over the Christmas break. Her chapter here is entitled "On Sexual Perversions' Capacity to Act as Portal to Psychic States that Have Evaded Representation." 

She grapples with the continued use of the word "perversion," before arguing that we might retain it because it "captures the phenomenology of sexuality that blends anguish and/or pain with pleasure." Those who work clinically, as I do, with patients whose desires have been judged (often by courts, but sometimes by parents or themselves) as perverse and illegal know well this unique, and uniquely difficult, blend of anguish and pain: the desire that is unwanted, that has brought such trouble and left a streak of such devastation, is also a desire not without a certain frisson. Rather than condemn all such desires a priori and totally, we must, if we are to be of any help clinically at all, recognize that in some cases there may be real attempts to grapple with things that were unthinkable to the developing mind. As she puts it, "some sexual perversions...may be understood as proto-attempts towards figuration" (p.214). In the process of trying to figurate such experiences and desires, we must, she concludes, "always be aware" that some things are "eternally inaccessible to us, impossible to bring into knowable experience." Once more those with even modest clinical experience will at once recognize this as true.

Finally, Heather Wood concludes the book with her "Working with Problems of Perversion," and takes a much more practical approach, showing how many and how often perversions function as defensive measures to keep at bay the ever-threatening peril of intimacy and its possible engulfments. Drawing on Glasser's earlier work, Wood argues that "sexual perversions have very little to do with sex...but are about the use of sexualization as a defence to deal with primitive terrors in relationships" (p.224).  Such terrors include an uncertainty about whether the patient's own aggression can be controlled in a relationship or whether it will give rise to sadism and destruction. 

Wood also offers some helpful counsel about working in the transference with such patients, and dealing with counter-transference reactions. Many of us are anxious about sexualized transferences, and perhaps even more sexualized counter-transferences (a topic I'm writing a paper about just now), but she calmly suggests that if we keep in mind her claim above--that sexualization is a defense mechanism like other defenses--it should help us be less anxious about it. We must still, however, examine closely our own reactions as well as the transference to see whether they are about: control? sadism? anxiety? intrusion? seduction? taming a frightening object? fear of abandonment? a defense against destructive urges? a desire for merger which is intolerable and must be defended against? 

In some cases, Wood suggests, after the above forms of sexualization have been worked out, one occasionally might then begin to see less defensive sexual feelings emerge toward the clinician: "it may be important that these feelings are tolerated rather than viewed as defensive if true integration of sexuality and dependency are to occur" (p.228). 

This note has only touched on some of the essays in this rich collection. Anyone interested in sexuality and psychoanalysis will want to have this book on their shelf. 

Creative Engagement in Psychoanalytic Practice: Further Thoughts

(I wrote and published this on 9 September 2023; but learned colleagues on Twitter, especially Jayce Long and Kristian Kemtrup--always gracious interlocutors from whom one learns much--offered an important challenge to my principal critique of Markman and I saw at once how right they were, and how their argument about reading Markman's ideas of surrender through Emmanuel Ghent's crucially important treatment of the topic makes brilliant sense, largely dissolving my difficulty. I have therefore amended the review at the place noted below.)

Introduction:

I'd never heard of this author until perhaps May, and, perusing the book on Amazon, found myself mildly interested. But I then I reviewed a mss for Routledge this summer and agreed, as always, to take payment in books; and so, to get to the total amount allotted to me, I (somewhat diffidently) put Henry Markman's Creative Engagement in Psychoanalytic Practice onto my list of desired books.

Wow. Did I ever severely underestimate the wisdom in this book and the grace of its author. If one can judge the import and impact of a book by the intensity and extent of the marginalia (underlining, double-underlining, starring, check-marking, uncharacteristically promiscuous use of exclamation points, and writing commentary up and down the page) it inspires then Markman's book is at moderate-to-severe flood stage, not quite drowning in suitably green (is anyone else quite so weird as to coordinate the colour of their ink relative to the colour of the book's cover?) ink from my second-favourite fountain pen of all times, but close to it.*

For me the impact of this book is twofold: it has forced--is forcing--me to rethink some things, though I do not know if in the end I will be in complete agreement (in other words, questions remain, and the chief of those are to be found below); and then there is much of the book that confirms and strengthens the argument for certain "techniques" that I (a nobody of very minor achievements) have more or less just found myself falling into doing, without ever seeing these cited or taught anywhere. (Perhaps some of them have been repeated by me as a result of being unconsciously imprinted on me by both of my psychoanalysts?)

The contents of this book are impressive indeed, and the writing is usually excellent; but what is the most outstanding feature of all is the manifest modesty of the author. Given the title we might have expected some "creative" fireworks and some preening by the author of how unique his methods of engagement are. But in fact what the author proposes seems to me a sort of engagement that bears strong resemblances to Winnicott and Ogden and their offering of "ordinary good enough" care for the patient. (In a time when even the basics of psychotherapy seem to have been utterly degraded or never taught, I mean that as very high praise.) 

The biographical sketch at the bottom of the back cover only gives us the bare minimum. Inside, and very casually, the author also tells us he is a trained psychiatrist with wide and extensive experience in numerous settings. He has obviously read widely--Freud, Bion, Ferenczi, and Winnicott are the major interlocutors here but there are several others I had not heard of but am now seeking out. All this learning is worn very lightly, with the result that the book is a near-miraculous production: it lacks any indulgence in jargon or theoretical defensiveness. When reading it, I thought quite sincerely: Jonathan Shedler would approve of this book, for he has often--rightly--lamented how needlessly obscure much psychoanalytic writing is, a failing that Shedler totally avoids in his wonderful article "That Was Then, This Is Now: Psychoanalytic Psychotherapy For The Rest Of Us," copies of which I now give to our interns and my students. 

In addition to the clarity and cogency of the prose, this book also succeeds in demonstrating its independence of thought without being ostentatious or obnoxious about it. In at least two places it quietly makes a reference to "orthodox" thought or practice...and then even more quietly steps away from that with ample justification for independence of mind and practice. (In this he reminds me of nobody so much as Nina Coltart.) The book borrows, adapts, creates from across the various "schools" of analytic thought, intertwining all this with winsome reflections on the author's own clinical and personal development, and illustrated with material from his patients. Therein lies the creativity suggested in the book's title, which is not at all any sort of radical heterodoxy as far as I can see but instead a gentle pursuit of its own path.

In short, the miracle of this book is, I daresay, that even those with little or no clinical background could pick it up and immediately get a sense of how psychoanalysis and psychotherapy unfold with Markman, gaining insight into not just the patient's struggles, but how Markman is present with and attuned to them in far-reaching ways. 

The Contents:

Right. Down to business. I shall only comment on select chapters, leaving readers to encounter the others for themselves. My commentary is driven largely by the need to continue metabolizing this book, and also to air some real questions I have. 

The Importance of Play:

The author begins very promisingly when he recounts his early clinical experience with adolescents, and how this "changed how I worked with adult patients: I became more playful" (p.13). This, of course, is a very Winnicottian theme I greatly welcomed here. 

Equally influential was his own experience as an adolescent patient who found his analyst had a "warm, calm, and capacious presence" and this was a key part of the "transformation" he experienced: "I strongly felt his loving care" (p.14). 

This theme of love shows up in the first chapter: "Love is expressed in our desire to know, understand, and recognize the singularity of a patient in a deep way that fosters intimacy." This should not, he cautions, lead us into a facile belief about needing nothing more than love. "In fact, ongoing serious emotional work and self-interrogation are needed by the analyst" (p.23).

The Importance of Authenticity:

Ch.2 focuses on the authenticity of the clinician. Its epigraph is a well-known saying of Bion's about "the analyst you become is you and you alone." This, in turn, is a theme picked up by Ogden, as I noted here. Markman notes that authenticity and spontaneity are not license to do and say what you want--there is no "wild analysis" here. Everything is in service of our "care and empathic understanding of our patients" (p.46). 

On Embodied Presence and its Obstacles:

Ch.3, on embodied presence, opens by drawing on French thought--Marcel and Merleau-Ponty in particular. The former's thought on disponibilité has clearly captured Markman's imagination: "putting oneself at another's disposal" is the translation he prefers. This leads into a discussion of how one manifests such availability through presence in the session. Though he does not cite her and appears unfamiliar with her work, Markman reminds me here of Nina Coltart's reflections on "bare attention." Here he also briefly invokes Ferenczi on the "language of tenderness." 

There are, as the author recognizes here and elsewhere in the book, "emotional obstacles," as he calls them, to maintaining presence with our patients--and a fortiori a presence of tenderness one assumes. Here is the first of several discussions about such obstacles. In especially difficult cases, we may lose our sense of emotional equilibrium and thus struggle to maintain presence and attention. This is fairly commonplace, but the author presses the point to its (to my mind) most troubling extreme: those times when "we can be taken over by the patient's emotions and states, losing our analytic place, becoming ill with the patient for some time as described by Borgogno and Bollas" (p.67). 

On Going Mad with Our Patients: How Much and How Far? And: How Helpful? 

Others have also written of this, including Harold Searles and Philip Bromberg: what does it mean to say that with some patients you have to be willing to let them drive you at least a little bit mad? Markman argues that allowing yourself to get a bit sick, to go mad with the patient, can be "possibly...curative." (That adverb is bearing rather too much weight for me! And Markman never returns to this point to offer the fuller argument I think it very much deserves.) 

Lest this quickly degernate into idealism and omnipotence, and all the dangers inhernet in those two, Markman later on explicitly recognizes that "we cannot fully make up for the deprivations in our patient's childhood. A 'basic fault' remains. There is a limit to how much we can repair or restore in the patient" (p.85). Our acceptance of this "basic fault" (as Balint called it) can help the patient mourn it. 

How do we do it, and how does it help? Markman continues: "What use do we make of these emotions that help the patient? Paradoxically, by not resisting these states, by surrendering, relaxing, and living within them (i.e., containing them), we restore presence in ourselves and for the patient". Very similar language shows up again later on p.86, raising the same questions for me once again.

His use of "containing" here takes him into a brief excursus on Bion's use of that phrase, and Markman clarifies that containing = metabolizing. You take something in and contain it, and do not often give it back to the patient, at least not in the form you received it. Sometimes you may need to hold on to it permanently. 

This chapter's introduction of the importance of surrender and relaxation is discussed in detail in the next chapter, "The Analyst's Work of Surrender and Mourning." I read it the first time and felt almost stricken into silence. A few days later I re-read it, sent some comments about it to friends, and then tried to read more. Even now, my third or fourth tour through this chapter, it feels deeply challenging.

Markman says here that effective therapeutic presence requires "surrender ('internal relaxation') and mourning. Mourning is the struggle to give up and let go of attachments that protect yet constrict us--attachments that do not allow for openness to the patient's inner world, being with and living within their experience. This is not the scary prospect it may sound when contemplated directly and abstractly like this, Markman suggests: "we are permeable to the emotions of others, at times even before they are aware of their own feelings" (p.77). So we may be "surrendering" in some ways without making a fuss of it. He brings in Bollas and Borgogno on this point, suggesting that such surrendering is, in essence, the greatest and most intensive form of empathic identification with the patient. 

The Importance of Self-Forgetfulness:

This is not facile surrendering. Though Markman is not explicit on this point, he does seem quietly to recognize the risks and costs when he writes that "surrender is the necessary first emotional step. We give up the hard and clear boundaries that separate us from the patient, we give up our sense of control and surety....Mourning is the actual emotional work of letting go of such attachments that block surrendering" (p.82). A little later he is explict in seeing that such surrender and mourning brings with it "two painful states--loneliness and alterity." 

Why do this? A little later Markman again brings in Gabriel Marcel's thought to argue against being "'encumbered with one's own self'." There is, I would add here, a lovely and lively freedom that comes from being forgetful of one's own self (in, of course, non-masochistic ways). I think this is very much what Coltart had in mind in speaking (ascetically, I would argue) of "bare attention," attention that is forgetful by and of the clinician's self. Such an approach not only frees oneself up to do deeper and more effective clinical work, but to do so in a way, I would suggest, that allows for you to be used, used up, and even destroyed, as Winnicott put it in his profoundly important essay on "The Use of an Object," without suffering as much "collateral damage" in the process.  

On the Uses and Abuses of Masochism (updated):

On this question of masochism--about which he has authored a chapter elsewhere--Markman differs from Maroda later in the book when he outright says "we need to surrender to the particular and intense needs of the patient that may feel self-depriving, even masochistic" (p.192). 

Markman appears to justify this masochistic surrender by returning to Ferenczi, who apparently wrote that "'transformation of the patient depends unequivocally on the willingness of the analyst to be transformed in and by the analytic process'." (p.198) But Ferenczi says nothing here about masochistic surrender, and on this point I was initially unconvinced and somewhat disconcerted by this argument. I do wish Markman had developed this point in more detail.  

But after discussion with colleagues, noted above, much of my anxiety here is reduced by being reminded by them of Emmanuel Ghent's crucial distinction between surrender, on the one hand, and masochistic submission on the other. (Ghent, "Masochism, Submission, Surrender—Masochism as a Perversion of Surrender," Contemporary Psychoanalsis 26 [1990] :108-136.). I am inclined to give Markman the benefit of the doubt here, and thus to read him through Ghent and thereby feel much less anxious about his idea of surrender. But the remaining issue is: Ghent is nowhere cited in Markman's book--not in the text, notes, bibliography, or index!

Collapse of the Therapeutic Space?

Another important and somewhat disconcerting question Markman does not entertain here or anywhere in the book so far as I can tell is whether this process of surrender and mourning, leading to such intense indentification with the patient, does not carry the very real risk of collapsing the therapeutic space. There must, as Ogden has put it, be room for the "third." But the strong emphasis on mourning and surrender--which in the main I find deeply compelling and refreshingly challenging--almost seems to make the therapist too passive in some ways, perhaps too closely identified with the patient. 

Instead, I am far more comfortable with the kind of "split mind" that Nina Coltart advocates than I am with an emphasis on mourning and surrender that seems (unless I have severely misread this book) to run unnecessary risks of minds merging, as it were--of overidentification with the patient. (I am not opposed to surrender at all--this I long ago learned from Winnicott theoretically, and practically from my own psychoanalysis. And I firmly believe mourning is always a crucial component of therapeutic work with everybody.) In her words, we must at any moment in a session be engaged in:

sharply focusing, and scanning; complex involvement in feelings, and cool observation of them; close attention to the patient, and close attention to ourselves; distinguishing our own true feelings from subtle projections into us; communicating insight clearly, yet not imposing it; drawing constantly on resources of knowledge, yet being ready to know nothing for long periods; willing the best for our patients and ourselves, yet abandoning memory and desire; a kind of tolerant steadiness which holds us while we make innumerable, minute moral decisions, yet steering clear of being judgmental (Slouching, p.119). 

To his credit, Markman entertains some brief consideration of the dangers of the approach he advocates, but only much later in the book. On p.146, he briefly mentions the risk of "a narcissistic misuse of the patient." He also stresses (something Andrea Celenza does in her excellent book, discussed here) that we can never, ever forget the inescapably and profoundly assymetrical nature of our relationship with our patient. This must always be kept in the forefront of our mind, and we must always "interrogate our own actions and states of mind as our own responsibility....We are never off the hook, and that is a good thing" (146-47). 

On Acknowledging our Own Needs of the Patient:

Markman also introduces an admission rarely encountered--Karen Maroda being the only obvious exception I know of: "unconsciously we need things from the patient." Inter alia, we "seek in our work reassurance of our goodness, capacity to repair, narcissistic needs for love, and early omnipotent feelings of power and control" (p.82). What he does not say here--but later reflections invite one to go on to this speculation--is whether some clinicians also need to feel the pleasures of masochism. 

I do not wish to end on a quarrelsome note, for I have found this a deeply right book in almost all of its instincts, and deeply convicting in many ways. The author has written in a powerfully compelling way about some crucial, and crucially neglected, topics in clinical work today, including the centrality of mourning in diverse forms (which Nancy McWilliams also reminds us of). 

In sum this is the very rich sort of book one feels wholly inadequate to metabolizing on one, or even the first several, sittings. I will doubtless pick it up profitably many times in the months and years ahead. 

___________

* You naturally wonder: what is the most favored of all times? My favourite pen is a purple Krone from decades ago, so grand it travels in an enormous velvet case only slighly less posh than that which the Crown Jewels presumably travel in. Moses himself wanted to use it to write the 10 Commandments, but God told him He was giving it to me instead. Of course--to allay your further wondering--this pen is charged with purple ink. I inherited it from a dear friend upon his death the day after Christmas in 2010. 

Credo: I Believe in What, Exactly?

I'm going to let you in on a couple of secrets from my previous life that bear directly on this book I shall be reviewing.

First, those of us with some scholarly background in religious studies and theology (especially its Christian variants) tend to hear the word credo and immediately have a set of fairly specific and rather clearly defined associations and connotations come to mind. In typical usage, a credo ("I believe" in Latin) is a very succinct and often dense statement comprised of propositions establishing belief on frequently contested points of doctrine. In some versions, after laying out the positive claims, a series of anathemas follow, establishing what beliefs are to be explicitly rejected as heterodox. 

In the book under review we have almost none of this at all. Given that we are talking about psychoanalysis and the authors are all analytically trained, it would be rather queer to find such statements being proffered too categorically for psychoanalysis, of course, seeks always to question definitive claims and probe what lies beneath the lust for certainty. 

While there are, as the eminent historian Jaroslav Pelikan and others demonstrated, many versions of such creedal statements within just Christianity, the most common example still in use today is the Nicene Creed, as it is usually called, though its fuller title is the Niceno-Constantinopolitan Symbol of Faith, reflecting the fact that the statement begun at Nicaea I in 325 was amended and added to at the first council of Constantinople in 381. Unlike the word "creed" and cognates, "symbol" in Greek is less a carefully and cogently constructed series of propositions but instead often translated as that which is thrown together.

I'm going to suggest straightaway that had the editor or contributors to this volume, Psychoanalytic Credos: Personal and Professional Journeys of Psychoanalysts, ed. Jill Salberg (Routledge, 2022) been aware of the etymological history I've just so roughly sketched, they would have called their volume Psychoanalytic Symbols of Faith or something along those lines instead of using the word credos, which promises a type of statement, and a corresponding level of certainty in its propositions, very nearly entirely absent from this volume. That is not a fatal flaw but merely a rather minor mismatch between title and contents. (Perhaps, they might reply, the subtitle, especially with its use of the word journeys, gives cover here, as indeed it does, for many authors seem to have written not tight compact creedal essays, but meandering autobiographical sketches, many of them quite banal and of very limited interest.) 

The second secret I shall let you in on also comes from my scholarly life organizing international conferences, editing two academic journals, and also being editor of scholarly collections and proceedings, several of which I have published. In every case, one often begins with a dream list of contributors, but then has to settle for those who actually say yes and show up. Roughly 15% will say yes and then drop off the face of the earth; roughly 35% will say yes and hold you hostage while they wickedly blow past all deadlines and may eventually get their submission to you months or even years after deadline; and the rest will usually be professional and accommodating in working with you to submit decent materials on time. The resulting collection, of course, is invariably going to be very uneven and even the most ruthless editing I could provide could never totally smooth it out entirely. Such is the fate of all collections. 

Sometimes it is fairly well accepted (though should not be) that especially "big names" may agree to give a paper or make a submission to your journal or book, but it will be some paper they've recycled four times already and couldn't be bothered publishing, or the paper was not really top-drawer stuff, but because of their status in the field they can pawn off second-rate materials and people will gladly take them because, of course, you want their name in your publication, and they know you want their name. Thus they send you some such material--not their best stuff because it may be incomplete, or the sources haven't been updated since they first gave the paper in 1998, or they wrote in sloppy haste--and you accept it even though it doesn't quite fit your focus. 

Similarly, if the "big name" really should be in your book or conference program--else people will sneer How could you publish on gravity without asking Newton for an essay?--but does not want to write something original, or finds you insufficiently important enough to think of writing something fresh for your focus, they may condescend to let you have a paper previously published that, they think after two seconds, clearly fits your focus (but doesn't really). Again, being glad to have this person, you will snatch up the previously published paper and include it in your collection even though it doesn't quite fit your focus.

There are, then, a number of prominent people in Psychoanalytic Credos who fit into this category. These essays, if not previosuly encountered, may be profitably and perhaps even enjoyably read here. I shall not name names nor pay them any attention in what follows.  

Rather, I am content to highlight a half-dozen chapters that offered some excellent insights. 

The first of these--it will come as no surprise--is Nancy McWilliams' chapter "Credo: Psychoanalysis as a Wisdom Tradition." I am, of course, greatly indebted to McWilliams, as I showed here. If I were the editor here, I'd have sent her chapter around to other contributors as a model of what to write: she begins with some autobiographical reflections and then, in a section labelled Credo, tells us how she believes psychoanalysis to be a wisdom tradition, and what that means. 

A central feature of her article, not encountered much elsewhere in the book or the wider literature, is that "much of the healing in analytic treatment seems to me to be essentially a grieving process...and deep acceptance of what cannot be changed" (p.74). What she does not say on this point, but clearly implies, is that such grieving can be a conduit to greater liberation and even to some change not possible until and unless grief happens first and is really worked through. 

The very next chapter is by the British analyst Michael Parsons. He gives us two gifts. The first is to remind us that "to be an analyst...is to lay oneself continually on the line," that is, clinicians (if they are to do what he calls "transformative" work) must "have their own psychic life at stake in an analysis." Only, he says, if you can tolerate this will you have the potential to be both changed and to help your patient change. (This theme is taken up in a later chapter by Lewis Aron, who suggests "the biggest thing getting in our way is that we're afraid to be bad objects, we're afraid to just let ourselves out.")

Parsons ends his chapter with a very striking suggestion: what if we conducted supervision or case consultation in a freely associative manner? How might this help the supervisor, supervisee, and patient? 

Jessica Benjamin (about whom I wrote a bit here) has a wonderful chapter which opens with the ringing declaration that "if psychoanalysis were a religion, I would be not only a practitioner but also a theologian"! She launches into a discussion about Winnicott on uses of an object, and the non-retaliatory stance of the clinician whose failures of the patient and ruptures in the alliance can be "developmentally necessary." 

She also draws on Emmanuel Ghent's celebrated distinction between submission and surrender to note that if the patient has to surrender to the clinical process, so too does the clinician, and the latter's surrendering first is a salutary model for the anxious patient to see that they are not alone (even if the level of surrender is, she notes, assymetrical).

To my mind, the best chapter in the book is, by far, Steven Cooper's "Credo: Playing and Becoming in Psychoanalysis." There is a refreshing candor in what he reports of how he talks to patients with great modesty:

"I have faith in your ability to grow even if I don't always know how to facilitate that. I believe that there is something unique about this setting and the two of us trying that can be useful. I would like to become useful in helping you with the process of becoming who you are." 

Cooper says that the key way he attempts to help patients is through play, which he learned from Winnicott, and about which published a book last year, Playing and Becoming in Psychoanalysis. 

Therapeutic play, Cooper argues, should help the patient to develop "elasticity," a term he borrows from Ferenczi. None of this should be thought easy; we cannot be seduced by the word 'play' into thinking of it as something facile. Instead Cooper says that "finding new forms of play is immensely messy and challenging" (p.106). Some of the challenge comes from patients who "hold on to bad, sometimes persecutory objects rather than feel alone or helpless." Only if they can play with you can they perhaps come to surrender those objects.

Echoing McWilliams, Cooper says that "the play of mourning" is crucial: "limit and mourning are just as constitutive of play as more frequently described forms." Mournful play, though, can facilitate movement "from the chains binding the self to an internal object toward new experiences with self and other" (109). 

Play is ultimately a form of love, Cooper briefly notes, quoting Hannah Arendt (who was herself writing about Augustine of Hippo) who said that love consists in saying "I want you to be." Play is useful here insofar as it expresses "the wish to appreciate the patient as he or she is." 

The last chapter I will note here is from Ken Corbett, "Credo: So Our Lives Glide On." He foregrounds the importance of freedom, drawing here on Freud (and not, as I expected, on Fromm) in several striking ways. Part of the freedom of the clinician, he suggests, is to not know, to not intrude with one's knowing too soon, and certainly to not talk too much: "too much talking is akin to wind drag, and slows the patient down" (p.162). 

He then links his discussion of freedom to "the eroticism of coming into existence" through periods and experiences of "libidinal turbulence." These striking phrases are not developed in any depth, alas, no doubt reflecting the limitations of a word count in a volume such as this. 

There are a few gems in almost every chapter of Psychoanalytic Credos, but I will not drag this on with more talking!