The Therapist's Therapy

When psychoanalysis came to Canada, it retained more of its European and originally Freudian ideas and practices in some respects than it did when it came to the United States. One glaring example of this is in training requirements: Americans until recently required medical training before application to analytic training; Canadians never did. 

When I was an undergraduate in psychology in Ottawa in the 90s seriously contemplating analytic training, I knew I was not cut out for, nor did I have any interest in attending, medical school. Fortunately, following the model Freud first put forth in The Question of Lay Analysis, I knew there was an open path for me, allowing me to combine my scholarly interests with the clinical: I would obtain a doctorate--whether in history, psychology, religious studies, or possibly philosophy was not clear to me then--and then train as an analyst at the institute in Montreal. Many others had done this before me and it was long since commonplace in Canada as across most of Europe and elsewhere. In that book, Freud in fact spoke of the ideal analyst as being neither a priest nor a physician but a "secular pastoral worker," a very curious phrase which was, and remains, inspiring to me. 

The other requirement, of course, universally adopted--even in the US--was that analysts had first to be analysands, and thus undergo a training analysis. 

Moreover, Freud recognized very late in life, in "Analysis Terminable and Interminable," the need for ongoing treatment. Freud has reassuring words when he counsels that "Every analyst ought periodically himself to submit to analysis, at intervals of, say, five years, without any feeling of shame in so doing." (One of the things I admire about Nina Coltart, is her regular reminders throughout her books of the need for analysts and therapists to go back into therapy even occasionally or to "get a bit of supervision" as she puts it flatly if the counter-transference is getting out of hand or other difficulties arise.) 

Since returning to the clinical field more recently, and this time in the United States, I am frankly amazed not just at how long it took American institutes to admit more than just physicians, but to a broader phenomenon across the entire mental health field and outside of analytic institutes: the lack of any sort of requirement for personal therapy on the part of those who train to be therapists in other programs--clinical social workers, mental health counsellors, etc. 

I am aware, having read more than a few stories of abuse, that the requirement for therapy necessitates very careful handling so that it does not end up reinforcing certain existing ideological prejudices or power structures while hiding behind clinical concerns. Not unlike certain professors holding up their doctoral students because of "political" disagreements with other members of the jury (which I have seen first hand), certain analysts could hold up certain trainees as being "insufficiently analyzed" or "resistant" when in fact these trainees just disagreed with their analyst, or were more inclined to, say, a Kleinian or Adlerian or Freudian approach that did not sit well with their supervisors. 

So there are dangers to be avoided, but avoiding them is far from an insurmountable problem. This returns me to my original question, phrased in the following words in the introduction to a very absorbing, richly researched, and important book on an unjustly neglected topic: Jesse D. Geller, John C. Norcross, and David E. Orlinsky, The Psychotherapist’s Own Psychotherapy : Patient and Clinician Perspectives (Oxford University Press, 2005). Here in their introduction these authors ask how and why is it that "in most European countries, a requisite number of hours of personal therapy is obligatory in order to become accredited or licensed as a psychotherapist" but "in the United States, by contrast, only analytic training institutes and a few graduate programs require a course of personal therapy" (p.5)?

Much of the rest of this book--a collection of essays from people in many countries and operating from a variety of traditions--seeks to begin to look at the frequency of, resistance to, and unique aspects uncovered in, the psychotherapy undertaken by those who are themselves therapists of some sort, noting that "many important questions about the psychotherapy of psychotherapists have not been answered or even asked by empirical investigators" (7). 

I was especially interested in a chapter by the late Harry Guntrip on being in analysis with Fairbairn and Winnicott, two of the most important figures in the British object-relations school that I have read the most about and for whom I have enormous respect. For Guntrip, the trauma of losing a brother at 3 was "softened up" by his 2 analyses but not solved: that happened after. In this, he seems a perfect illustration of something Adam Phillips said when he noted that "The cure can begin only after the treatment has ended." One can certainly debate that, but I have found it very true in my own life. 

By this I think we must include the realization not only that the analysis itself helped directly, but it also gave one the skills to carry on a regular self-analysis and create what Fred Busch called a "psychoanalytic mind."

Guntrip, Fairbairn, and Winnicott--and more recently Phillips--remain hugely important and valuable to me in very large part because they illustrate how valuable a "psychoanalytic mind" is to avoiding the dangers of rigid ideological thinking, including those too attached to one theoretical orientation! As Guntrip puts it, theory can be "a useful servant but a bad master, liable to produce orthodox defenders of every variety of the faith" (63). 

So this book varies across theoretical persuasions, but is able to draw some generalizations, noting, e.g., that "therapists enter personal treatment an average of two to three times during their careers—and probably for and during developmentally propitious crises." What is curious to me is the further reporting that even as therapists enter their own therapy, with, presumably, some self-awareness into the dynamics of resistance that they themselves see in their own patients, they cannot resist these dynamics when they are the patient: "Directly and indirectly, all of the therapist-patients in this book reported that no matter how intellectually prepared they were to collaborate, they could not 'resist resisting'" (6). 

That resistance may keep some from entering therapy, which I would regard as a great pity. More than that, I would have to wonder: how much (to speak in a Kohutian way) of a usable self do you have available for your patients whom you hope to treat in therapy? If you are one of those blessedly free but vanishingly rare people with enormous reserves of the self available, and few to no traumatic memories to work through, then praise God. But for the rest of us, the answer to the question of the psychotherapist's own psychotherapy should be: "Yes, please, let us have some more!" 

Clinical Work with the Amish

I was greatly edified to meet and talk with a local clinical psychologist, Dr James Cates, who has done a lot of pioneering work with the Amish of northern Indiana. Some of that is detailed in two of his books, starting with Serving the Amish: A Cultural Guide for Professionals (Johns Hopkins University Press, 2014), 256pp. 

Cates has another book set for official release, also from Johns Hopkins University Press, next month. I have contacted him and he has agreed to a blog interview about forthcoming Serpent in the Garden: Amish Sexuality in a Changing World (JHUP, 2020, 224pp).

About this book the publisher tells us this:

The Amish offer a startling contrast to the postmodern view of sexuality and gender roles. After the sexual revolution of the 1960s, mainstream American culture never looked back. Meanwhile, the Amish never looked forward. In twenty-first-century Amish communities, heteronormative sexuality is still based on a unifying principle: an understanding of sexuality as emerging from a divine plan. In the eyes of the Amish, sex is squandered by those who embrace it as hedonistic or who carve out a sexual identity that moves them away from that singular, God-given purpose. But this communal emphasis on sex for procreation does not mean that the Amish do not possess a complex range of sexual identities and opinions.

In Serpent in the Garden, clinical psychologist James A. Cates breaks new ground in the study of Amish sexuality by examining this shrouded, rarely discussed subject. The first book to bring Amish sexuality into primary focus, this volume argues that, because the Amish are a sexual minority, queer theory is the ideal framework from which to observe their views on sex, sexuality, and gender. The book offers a broad view of sexuality in Amish culture that includes the challenges that gays and lesbians face in the community, as well as an exploration of Amish gender roles, their views toward intimacy, their responses to cases of child sexual abuse, and the role of fetishes among the Amish. Cates draws from multiple perspectives and years of research on the Amish themselves. He also looks at pushback against alternative behaviors or identities, as well as Amish success in keeping mainstream values at bay.

With this book, Cates establishes Amish sexuality as a topic worthy of professional attention. Offering readers a more sophisticated understanding of the Amish and of sexual expression among cultures, Serpent in the Garden will appeal to scholars working on gender and sexuality, the Amish, and social service professionals who serve the Amish community.

Constructing the Self and Reality: An Interview with Jason Blakely

I've earlier noted the advent of this fascinating and important new book, which I read with great interest. The author, Jason Blakely, kindly agreed to an interview about it. Here are his thoughts:

AD: Tell us about your background

JB: I am a political philosopher by training. While studying for my PhD in political science at UC Berkeley I became fascinated by basic questions of how to think about human agency and the explanation of behavior. I currently teach at Pepperdine University in Malibu

AD: What led to your writing We Built Reality: How Social Science Infiltrated Culture, Politics, and Power?

We Built Reality attempts to turn the tables on mainstream social science by reading psychology, sociology, political science, and economics as forms of meaning-making or hermeneutic creation. This reveals many surprising things about these disciplines—perhaps the most arresting being that they are forms of world-making and intimately tied to the story of our time.

On a more personal level, the earliest seeds of this book go back almost fifteen years to when I was a graduate student at Berkeley. At that time the human sciences were an urgent and controversial topic on campus with many rival schools of thought participating in the debate. 

For one thing there was still a strong living institutional memory of Michel Foucault having spent time at Berkeley. Foucault’s research agenda and style of thought inspired many philosophers on campus, including Judith Butler and Wendy Brown who were both formidable presences. 

In addition, philosophers coming out of the analytic tradition of linguistic analysis—like my advisor Mark Bevir and committee member John Searle—were thinking intensely about philosophy of action and social ontology. They were joined by phenomenologists including Alva Noë and the legendary Heideggerian philosopher Hubert Dreyfus. There were also world-class interpretive social scientists like Robert Bellah and Paul Rabinow. In the midst of these very different thinkers I found myself trying to gain my bearings. This book is still the fruit of coming to terms with the debates over the human sciences at Berkeley, specifically from within the hermeneutic tradition.

AD: Your introduction seems to be building a case that what Alasdair MacIntyre almost 40 years ago memorably called the “systematic misinterpretation” of the social sciences has only become more widespread. Is that a fair view of where we are now? And if so, what has led us to this moment where what MacIntyre almost gleefully mocked in his inimitable way has actually gotten worse?

JB: Yes, we are certainly awash in naturalistic approaches to both the study and governance of human beings. At the same time very few working social scientists openly avow philosophical naturalism. This appears to be a bit of a paradox. But it is partly resolved when one recognizes that social science operates in our societies as a form of authority with attendant social practices—it is a kind of power.

MacIntyre was enormously insightful in this respect. I have written elsewhere about how MacIntyre in the 1960s participated in the British New Left, which included figures like Charles Taylor, Stuart Hall, and E. P Thompson. This group was far ahead of its time and saw deeply into the technocratic tendencies of our culture and politics.

One reason for the persistent dominance of these naturalist and often pseudo-scientific schools of thought is precisely that they are embedded in practices and institutions. They are not foremost or even chiefly disembodied or ideational. Indeed, actual research agendas—like behaviorism, sociobiology, geno-politics, cognitive psychology, neoclassical economics—tend over the long term to implode under their own contradictions. But both the ethical attraction of naturalism and the practices of arranging institutions by claiming a top-down science of management persists. So there is a deeper strata of meaning that orients people to this scientistic way of thinking even as specific theories come and go.

AD: Your introduction speaks of how “social science can undergo a strange metamorphosis in our societies and become its opposite, ideology and superstition” (xiv). This is a wonderfully bracing claim that I think it exactly right, but I also think it might raise a few eyebrows, so perhaps you might unpack it a bit for us.

JB: One of the insights of hermeneutics is that human agency is marked by the ability to take on and embody theories. We have the potential in certain respects to become more like our theories. This is in stark contrast to the natural sciences. A sunflower exists in some isolation from the theories of botanists. Not so with human beings. Our social scientific theories can build new worlds and practices of selfhood.

In the book I call these “double-H effects.” A clear example of this that is at least passingly familiar to most people is the case of Marxist theory and its relationship to the social and political reality of the Soviet bloc. But what we fail to recognize is this is true of many of our social, psychological and political theories. Modern societies have many ways of inhabiting social scientific theories. They can become blueprints for institutions, inspiration for types of self, beliefs guiding practices, and so on.

AD: You also go on in the introduction—and indeed throughout the book—to document how “social science rarely simply neutrally describes the world, but rather plays a role in constructing and shaping it” (p.xv). Give us a couple brief examples of this if you would.

JB: One example I cover at length in the book is what I call “homo machina” versions of selfhood in psychology. I think there are various streams of popularized or vulgarized psychological theory that are embodied through the self-help genre. 

Self-help in our society is not just some eccentric or distasteful literature that intellectuals should consider unworthy of attention. Self-help is central to the cultural life of many people in our society. In some cases, it encourages its readers to build a kind of ethical self that treats private emotional life and relationships with others as a kind of mechanics. In other instances, it reinforces managerialism in the workplace and government.

A second example that receives extended treatment in the book is “homo economicus” or a form of selfhood that vulgarizes and inhabits a kind of ethical identity derived from the idealized models of neoclassical economics. This is the whole phenomenon of a neoliberal self but viewed as a popular or folk tradition as evidenced in cultural artifacts like Freakonomics or Fredrich Hayek’s more popular writings. I think there is a highly complex and interesting relationship between the mathematized abstraction of economic modeling and these supposedly lower, vulgar forms. My book suggests that a hermeneutic or interpretive approach helps us see the complex philosophical, social, psychological, and political linkage points.

AD: You introduce an interesting phrase and concept, “double-H effects” as when you speak of how “Double-H effects make social science profoundly unlike the natural sciences” (p.xxviii). Tell us a bit more about what you mean by these effects.

A double-H effect happens when our interpretation of reality penetrates our identity or social practices. Our attempt to interpret reality then has the potential to radically alter or change that reality. Often times this can have inadvertent and unexpected consequences. Or at least that’s one of the cluster of theses advanced by the book. 

The double-H effect is one route into understanding the radically different ontology that is characteristic of political reality. If you can see that double-H effects can happen among self-interpreting, linguistic creatures like ourselves but not other beings then you are a long way down the road to grasping what differentiates the social sciences from the natural sciences.

AD: Perhaps it’s only because I’ve been immersed in Fromm and Adorno the past six months, but I hear regular echoes of them in your introduction and again in chapter 6 when you speak of the abuses of authority and power that lurk behind certain claims of social science. Is it part of your argument in the book that scientism is in significant ways authoritarianism in disguise?

Perhaps there is some repressed influence there. Certainly Adorno was mandatory reading with a number of the critical theorists who taught me at Berkeley. Nonetheless, I tend to think of myself as working instead within the humanism of Gadamer, Charles Taylor, and others. My problem with Adorno and the Frankfurt School more generally is what I perceive as a tendency to slide into overly structuralist conceptions of politics that neglect human agency and local cultures.

In terms of the relevant form of political power I prefer the term technocracy as denoting rule by experts. I prefer this term because I think technocracy can and does combine with any number of ideological traditions—authoritarian, socialist, liberal, communist, feminist, ecological, fascist, etcetera. 

Hermeneutic philosophy of social science can do damage to any political tradition that relies very heavily on technocracy. It can do so through the backdoor so to speak—unmasking the way it has an inadequate philosophical anthropology. Hermeneutics does critical, eliminative work while also allowing for a certain amount of political pluralism. Technocracy is off the table philosophically speaking but then the question is what is the strongest remaining humanism?

AD: You reference the psychologist Phillip Cushman on the empty self that shows up in consulting rooms, and this puts me very much in mind of the Anglo-American literary scholar and psychoanalyst Christopher Bollas who in the late 1980s started writing of what he calls “normotic illness,” the chief symptom of which is the “blank self” which denies having any sort of unconscious or inner life at all and tries desperately to conform to an external construction of compliant citizen and cheerful consumer. I’m wondering if the origin of such selves is not also a deliberate creation, much as you say “the very discovery of economic man was part of the creation of economic man. Perhaps it would be best to say that free-market economists did not unearth the world but helped to contrive it” (p.43)? It seems to me that the wild popularity of pop psychology and the self-help books you discuss plays a huge role here in creating these vacuous selves of exceedingly shallow inner life?

Yes, that is an excellent observation. I am interested in what you are saying and delving deeper into it. In the book I do suggest that self-help has a long historical genealogy extending to Thomas Hobbes and machinist notions of selfhood developed in the early modern period. This is not to say Hobbes was a self-help writer which would, of course, be insanely anachronistic.

But I do suggest in the book that there is a cultural history that serves as an important background to individuals thinking about themselves along these flattened and shallow tendencies we see in self-help. An entire set of anthropologies is assumed by the self-help genre—a certain stance towards relationships, depression, happiness, efficaciousness in careers, charisma in social groups. It flattens the potential poetic depths of human inner life. Edgar Allan Poe is replaced by a kind of car manual for driving the road of life. This is, in fact, the replacement of one poetics for another. It is not actually the discovery of the “real” mechanics of being human.

AD: There’s a very interesting article in a recent New York Review of Books on the uses and abuses of the “scientific method” by late-19th and early-20th century Anglo-American industrialists to maximize efficiency and productivity at their factories. You note several times that such a “method” is itself a creation, and not a singular one: “Although philosophers generally reject the idea of a single, unified scientific method, the notion has gained a grip on the popular imagination” (p.73). Why does such a singular conception have such a popular appeal?

This is an important question that probably evades a single or reductive sociological answer. Different people have different reasons for falling into the thrall of method and ethnographies would need to be conducted to capture the relevant tales. At a general level Charles Taylor’s work on sources of the self is probably about the best answer we have at the moment in terms of the broad philosophical and historical outlines. One might also consider how an obsession with controlling reality through the fixed steps of a method shares some family resemblances with prescientific cultures and their use of magic. Granted the actual semantic content of the modern cult of method is very different from magic as it is part of a set of meanings only made possible by the scientific revolution. I suggest all that in the book. One antidote to this bewitchment by method lies in Aristotle’s conception of arete or skilled human action. This is one of the many things I learned from the Heideggerianism of Dreyfus and his students on Berkeley’s campus—the relevance of Aristotle via phenomenology to contemporary philosophy of action. The notion that you can ever become truly excellent at a practice by simply carrying out a fixed set of steps or a method is a myth.

AD: Loathe though I am to give any aid or comfort to people today protesting efforts to contain a pandemic, I do nonetheless wonder if the reason some of the less densely stupid among them are so objectionable (refusing masks, demanding the “right” to go to bars, beaches, etc) is because they recognize in some inchoate and clumsy way, as you put it, that “many people who believe they are doing science are in fact doing ideology” (p.84). What prevents scientists from seeing this and guarding against it?

I am also distressed by the lack of thoughtful attention paid to scientists in our society on questions ranging from epidemiology to climate. Nonetheless, many people in our society do intuit however haphazardly and self-destructively that scientific authority is too often overstepping its bounds. We are not very good at discerning the limits of scientific authority. I believe that in addition to poor education in science this is tied to the crisis of the humanities and the liberal arts. 

Not enough citizens—be they laypeople or scientists—appreciate the centrality of interpretation and stories to our shared political life. They do not see that while the natural sciences should be respected in terms of our understanding of the physical world, this remains philosophically distinct from the stories and narratives that structure our lives. All public policy incorporates some story that includes a highest set of goals or aims. There can be no expert science of these stories. They remain accessible to laypeople and scientists alike and so are rightly subject to democratic deliberation and contestation.

Unfortunately, there is a tendency to replace genuine democracy and open discussion over our stories with technocratic management. Often specialist languages and jargon are used to block out ordinary people from the political process. An example of this covered in the book is the response to bailing out the banks as “too big to fail” after the 2008 economic recession. When this happens genuine, deliberative democracy is replaced by a form of managerial society that claims the name “democracy” but in fact represents something very different. The resultant backlash can create a situation where rightful scientific authority and technocracy are confused with one another. We are currently living through the steep costs of the chaos born of that confusion.

AD: You open your chapter 5 (pp.89-90) by reminding us of the deadly effects of scientism on Eric Garner. In 2020, we would add to his name that of George Floyd and others. Your point here is that “scientism had revamped the dominant mode of American policing,” leading to “racialized, authoritarian, and militarized dimensions of this massive shift in policing culture” (p.99). Can you unpack all this a bit for us?

Thank you for this question. For personal reasons I felt the deaths of George Floyd and Eric Garner very profoundly. While studying technocracy I noticed that violence is exercised in a very strange way in our societies. We have a highly theorized, rationalist form of justifying the exercise of force. There is a certain discourse and culture of dispassionate science that informs everything from our use of drones in the Middle East to our deployment of militarized SWAT teams in poor and brown neighborhoods.

In the chapter on policing, I trace the way that a set of social scientific theories spearheaded by political scientists like James Q. Wilson and Charles Murray helped rationalize and justify the militarized police tactics of the law and order movement. Policing practices like zero-tolerance, stop-and-frisk, and racial profiling all received elaborate theoretical articulations several decades ago. These theories often developed seemingly colorblind concepts like “disorder” and the statistical analysis of criminality that when enacted within the American political context had highly discrepant racial outcomes. 

The new racial caste is far subtler than Jim Crow. The theories and practices normally do not explicitly state racial distinctions. Instead, there is an elaborate set of theoretical and practical developments that are de facto racialized. They appear to be mere colorblind “sciences” on the page, but in practice they are tied to the mass incarcerations outlined so vividly by scholars like Michelle Alexander and Elizabeth Hinton. My contribution here is to focus on the discursive role of the social sciences and the double-H effects involved in building a world which has seen a great increase in authoritarian and militarized police tactics. Such tactics once in place, as we are now discovering, can later be deployed on people regardless of color or social class—journalists, protestors, political opponents—are all now coming under the shadow of a form of authoritarian policing first waged on poor racial minorities in American cities.

AD: Cognitive psychology comes in for scrutiny at several points in your book (and not a moment too soon in my view!) as do psychiatry, psychopharmacology, and the ideologies undergirding them all. Though you didn’t address this directly, I want to press on you an example I am especially leery of thanks in part to the outstanding and hugely important work of people like Jonathan Shedler: the predominance of “evidence-based” claims in psychotherapy—especially the dominance of cognitive-behavioral manualized treatments today so that therapy patients can be rushed through a treatment in a dozen or fewer sessions. That phrase “evidence-based,” it seems to me, is too often an example of everything you describe in this book—scientism in action and an ideological masquerade. Am I wrong?

No—I am highly sympathetic to your point. I think you are right and there is a lot to learn and explore further in these domains that my book leaves untouched. Furthermore, we are only scratching the surface when it comes to the possibilities of a new hermeneutic psychology. At the philosophical level, a frequent problem with manualized therapeutics is the repression of the interpretive features of human agency. Yes, we can still learn much from the different techniques developed by therapists as well as from psychologists who have taken a more medical approach to mental health. But we need to be very careful to not eliminate or hide the hermeneutic features of human life. The particular meanings, beliefs, and cultures that inform an individual life are also essential to mental health.

Unfortunately, my sense is that many of the dominant modes in psychology are reductive in just this way. They operate on the basis of an inadequate anthropology. We need to recover the way that human emotional life is always constituted or completed through the medium of meaning and culture. We are meaning-making creatures and any adequate psychology or therapy needs to have this fact about us firmly in view. This is something that I think psychotherapy—for all its flaws and tendencies to sometimes veer into naturalism—retains more deeply than many other paradigms of psychology. Yes, sometimes the meanings themselves are ahistoricized or crammed into silly just-so stories from, say, the Greek mythological past. But nonetheless psychotherapy is one school that houses the potential to address the complexity of human meaning making—its memories, identity formation, repressions, and stories. I will not say it is the only school of psychology that holds this potential. But it has retained interest for me for this reason.

AD: I was glad to read that “Gary Greenberg argued that uniformly treating depression and anxiety as diseases contributed to an ideological agenda in which a sense of malaise or discontent with a reigning social-political order was stigmatized” (p58). I think this stigmatization is exactly right, and is certainly born out by the very strong criticisms advanced in a powerful recent book, Marxism and Psychoanalysis: In or against Psychology by the Mexican clinician and scholar David Pavón-Cuéllar who seems to despair entirely of American ego psychology in this regard. I’m wondering about one possible reason for this, which you seem to hint at: research funding, much of which comes from governments and pharmaceutical corporations, both with vested interests in buttressing the “reigning social-political order.” Is that an assessment you would share?

Again, I am sympathetic to your suggested line of thought. Although I also think it is important to see the bottom-up features of psychological culture. Part of the point of the chapters covering psychology in the book is to suggest that there are folk naturalisms, so to speak. These folk naturalisms are cultures of scientism that emerge out of particular identities. The wild popularity of the self-help genre that we have been discussing is a vivid example of how the problem is not simply imposed top-down by a particular class onto another class. Without negating it, the hermeneutic picture is more complicated than power exercised by one group on another one. In other words, many people are not simply coerced or bamboozled into this kind of psychological practice. They find it ethically attractive. So the depth of the problem lies deeper in the culture.

AD: If so, one possible way beyond this—and almost everything else your book describes, if I am reading it rightly—comes only at the very end of your book when you ask “Where are the new humanists?” Well, where are they?! Do you see any examples on the horizon we should be paying attention to? How do you (or do you?) see a revival of humanists and the humanities today in playing a part in rightly recovering the role of hermeneutics that you discuss several times in the book?

Humanistic culture still exists in beleaguered pockets in our society. I was taught by heroic humanists beginning in public school in Colorado. I had teachers of literature who conveyed to me that an irreplaceable form of human knowing was opened up by literature and poetry. They spent a great deal of time impressing on us the importance of Shakespeare, Zora Neale Hurston, Gabriel García Márquez, Jorge Luis Borges, James Joyce, and others. Later as an undergraduate at Vassar College I was the beneficiary of tremendous humanistic learning in the ancient Greeks, the history of philosophy, various world literatures. The liberal arts are also frequently safe havens of humanistic understanding.

As many people are beginning to recognize, one major problem is that humanistic study is not only being largely defunded but characterized as useless and a waste of time by a society sick with economistic modes of being. We have lost a sense of the profound value of interpretation for democratic and political life. I do not view it as coincidental that our current crisis of democracy and failure to read political reality in America—everything from “fake news” which is also a problem of political literacy to the inability to properly identify authoritarian politics—coincides with the crisis of the liberal arts. We Americans are unable to read our own political situation very well. We do not know what we are living because we are effectively bad readers and interpreters of culture and politics. This is a problem of education. We need to pursue more radically than ever before the right of all citizens to a humanistic education—to the arts worthy of free persons. How different would our society look if its poorest members also received the lavish gift of the liberal arts and a humanistic education?

AD: Sum up the book for us and your hopes for it. Who especially should read it?

I hope in the course of this interview, and through your excellent questions, the general outlines of my project have become a little clearer. As for my hopes for the book, I think that books are strange things. Once you write them they have their own destiny. This is because books only retain relevance through readers. They leave the author behind, so to speak. I hope this book is helpful not merely to intellectuals but also to tenacious citizens interested in how we arrived at our current predicament. I feel a particular affinity for all those amateur lovers of history, politics, philosophy, and literature. The liberal arts are not some bizarre, inaccessible hobby reserved for the rich like yachting or polo. The art of interpretation is central to how well we weather the coming storms. The book was written for other humanists and particularly those who are still willing to learn something new. I have had a number of young people contact me since the book was published and say they found it exciting. This is very gratifying. If an egalitarian humanism linked to American democracy is ever going to happen it will have to be attractive to up and coming generations. They will need to desire and pursue it. That desire must be awakened.

AD: Having finished We Built Reality, what projects are you at work on now?

I have been slowly working for several years on a genealogy of naturalism and a historical-philosophical recovery of humanist sources.

Thank you for such an intelligent and thoughtful interview.

Creating an Analytic Mind

Some discussion on Twitter this week with Jonathan Shedler and others about what we hope patients will be left with after therapy is over put me in mind two books I often find myself returning to. (Shedler deals handily and powerfully with the old and tiresome slanders that psychoanalytic/dynamic therapy are somehow less effective and less "evidence-based" than the CBT methods seemingly so beloved by governments and insurance companies today. See the invaluable articles at his website above, but also see this new book which I am looking forward to reading.)

The first is by Adam Phillips, who, like Shedler, is always worth reading. I have read all but one of Phillips' books, and would be hard-pressed to rank them, but if I had to, then On Kissing, Tickling, and Being Bored: Psychoanalytic Essays on the Unexamined Life would probably be in my top three, if only for its essay "Psychoanalysis and Idolatry," which I drew on in my own recent book on the sex abuse crisis in the Catholic Church. 

Anyway, Phillips has a lovely little aphorism in this book: "The cure can begin only after the treatment has ended." One can certainly debate that, but I have found it very true in my own life. As Luis Izcovich has recently argued, psychoanalysis leaves lasting "marks" in certain often distinguishable ways--a point stated even more dramatically by François Roustang almost forty years ago now. 

The second book that came back to mind this week is by Fred Busch. I read it several years ago, but it pays re-reading. He argues very much in favour of the idea that psychoanalysis and analytic therapy should leave the person with a re-structured mind as a permanent and positive after-effect: Creating a Psychoanalytic Mind: A Psychoanalytic Method and Theory (Routledge, 2013). 

Busch writes in a low-key manner with a refreshing lack of ideological rigidity, jargon, or hubris. He interpolates passages from well-known literary works with short case-studies from his own practice to illustrate what he means. This is a rewarding book that pays re-reading. 

As he recounts in the introduction to this book, Busch is something of a pioneer in psychoanalytic technique and training, being one of the first clinical psychologists to be admitted in the 1970s to psychoanalytic training at an American institute. (This restriction has never made any sense to me. I grew in Canada, underwent analysis there, and planned to finish a doctorate in the humanities and then embark on a training analysis at the Institute in Montreal. I was able to do this because unlike American institutes, those in Canada, the UK, and parts of Europe and elsewhere, generally have had no problem following Freud's recommendations in The Question of Lay Analysis.) 

As he looks over the course of an analysis, Busch understands it to consist of three phases:

1) The first phase is when the patient comes to be familiar with his own inhibitions and restrictions that keep him from living: until the patient can wonder about his lack of wondering, wondering is not possible. This phase, later in the book, is called one of self-observation. 

2) The middle phase of an analysis is the beginning of a "psychoanalytic mind," that is, learning to observe one's own mind and its sequence of free associations. Such a psychoanalytic mind is necessary if the analysis is to bear long-term sustainable fruits in one's life. It is necessary, that is, if the patient is to be freed from the "slavery of repetition compulsion" and instead freed to "think about thinking." Later in the book Busch calls this phase one of self-reflection. (In my experience this ability to "think about thinking" has remained a constant and constantly valuable gift bequeathed by analysis.) 

3) The terminal phase of an analysis consists of a deeper psychoanalytic mind more completely free from deceptions in understanding one's associations with greater veracity. Here the analysand can "play, muse, reflect, and interpret her own associations." This phase Busch later calls self-inquiry. 

Classically, it was thought by some that the main goal of an analysis was insight into the contents of the unconscious.  But for Bush, "the process of knowing is as important as what is known." Here Busch pioneers a different goal for analysis, giving greater emphasis to the patient gaining an understanding of how his mind works and how it affects him. Busch suggests the freedom of a psychoanalytic mind, with a process of knowing in addition to what is known, may be of greater long-term benefit.

This, it seems to me, is a very noble goal for a clinician to work towards: not merely to leave a patient with certain tips or techniques that may come in handy in some future struggle, but to help in the creation of a mind that can now think much differently. And one thing that newly recreated mind will likely have--dare we say should have?--is an awareness of its ongoing need for the help of others. Here I would return to Freud in noting that the creation, and nourishing, of such a mind is never going to be complete, but will require perhaps ongoing or perhaps periodic work. As he says in his "Analysis Terminable and Interminable": "Every analyst ought periodically himself to submit to analysis, at intervals of, say, five years, without any feeling of shame in so doing. This is as much as to say that not only the patient's analysis but that of the analyst himself is a task which is never finished." 

In conclusion, I would simply note that Busch has a new book coming out in November which I am looking forward to reading. The publisher tells us this about it: 

In this first-of-kind book, senior psychoanalysts from around the world offer personal reflections on their own training, what it was like to become a psychoanalyst, and what they would like most to convey to the candidate of today.

With forty-five personal letters to candidates, this edited collection helps analysts in training and those recently entering the profession to reflect upon what it means to be a psychoanalytic candidate and enter the profession. Letters tackle the anxieties, ambiguities, complications, and pleasures faced in these tasks. From these reflections, the book serves as a guide through this highly personal, complex and meaningful experience and helps readers consider the many different meanings of being a candidate in a Psychanalytic Institute.

Perfect for candidates and psychoanalytic educators, this book inspires analysts at all levels to think, once again, about this impossible but fascinating profession and to consider their own psychoanalytic development.

Beginnings in Psychotherapy

As the days of August tick rapidly by, and the fall semester looms on the horizon, I am eagerly reading any number of books that I can get my hands on, including Mary Jo Peebles-Kleiger, Beginnings: The Art and Science of Planning Psychotherapy (Analytic Press, 2002). Both the title and the timing are apt as I am beginning a clinical practicum later this month, and am very excited about that. 

The book has many good insights, though in my reading of it these are largely confined to the first six chapters. 

Begin as You Mean to Go On:

The author begins with what might seem obvious, but can get overlooked: If therapy is to end properly it must begin properly. She notes that what goes on in that first hour very often communicates our theory, our views of patients and their problems, and how the process will play out.

She reiterates what I have seen said time and again in many books in the past year: the role of the therapist's personality and our "competence, hope, and humanity...will minister strongly (or, some would argue, more strongly) than the particular modality we eventually select" (p.1).

Wearing Diagnoses Lightly:

I have seen others whom I respect note that one cannot and must not be hidebound about diagnostic labels. Peebles-Kleiger says that one may often start with a diagnosis, but one can equally start with a case formulation--a narrative that goes beyond symptoms and causes to be grounded in history of relationships, taking a wider view. I very much incline towards this latter. In any event, one must recognize, as she rightly puts it, that "no system of diagnosis is fully comprehensive....diagnosis is ongoing" (p.4).

Early on, her approach is to put together a clear picture of the patient that takes account of and has some idea of:

1) History, including that of relationships
2) Patient's capacity for forming the therapeutic alliance
3) What functions do the symptoms serve?
4) What is psychological cost of change?

Having accounted for these, one can proceed to step 5): Form what she calls a "blueprint" for treatment that focuses on "connection, focus, joint activity, prioritization, and choice" (13).

Later on she offers further recommendations on the taking of a patient history (cf. Nina Coltart, discussed elsewhere on this blog, about the huge importance of getting this done as comprehensively as possible early on), noting that it is best to take history "which flows out of the investigation of current emotions, behaviors, and ideas" (52). Indeed, some of those current emotions and behaviors will show up in the consulting room, and careful observation of the patient and his or her activities will often give clues of an historical nature which should then be examined together. E.g., she refers to a patient who always came precisely 15 minutes late to every session. This obviously had a history behind it needing to be explored, as they did. 

The Therapeutic Alliance:

In her second chapter, Peebles-Kleiger offers a helpful reminder that the alliance is beginning to be formed (or thwarted!) the moment you walk into the waiting room and make eye contact with the new patient for the first time. Here and throughout your entire time working together, she says that "respect, even reverence, is the order of the day" from first greeting patients to the end of their treatment. I like that "reverence" here for each person's unique dignity. 

She notes something often seen in other books based on wide-ranging research: building the alliance repeatedly shows the crucial importance of the therapist's "ability to show empathy, sincerity, and unconditional acceptance of the patient" (16). This allows her to note, moreover, that other
"research has documented that if a patient feels accepted, understood, and liked by the therapist early in the relationship, then therapy tends to be successful" (14). This, she says, is pantheoretical. 

She differs--rightly in my view--in not following early psychoanalytic techniques and requirements aimed at "curbing spontaneity and remaining unresponsive" because doing so  "could actually have a negative impact on the relationship" (17; cf. Coltart again). She does, however, agree with the formative experience and expectation--going back to the early days of psychoanalysis--that insisted on the therapist also being in therapy, if not as a prerequisite then as a concomitant to his or her own clinical practice: "There is empirical evidence for a positive correlation between having had personal therapy oneself and being better able to facilitate a positive alliance in treatment" (23). (I am, frankly, amazed that this is not still a widespread requirement today of prospective clinicians.)

Naked Logic:

I really liked her counsel to avoid appearing or trying to be some kind of aloof expert handing down recommendations from on high. This is not original to her, of course, but goes back at least to Carl Rogers. In any event, she rightly says that transparency in the therapist's thinking--taking off the outer later to see the logical gears working underneath--can be very important. This "invites the patient to be a diagnostic partner and to reason along with you. The end result is that the patient not only knows how a particular treatment recommendation was arrived at, she also feels that she helped critique and shape its construction" (22). Such collaboration helps the alliance.

Goals and Treatment Plans:

As someone whose entire experience thus far has been psychoanalytic, I found her third chapter, Focus, helpful. She begins by noting that some people (I confess I incline towards this) are suspicious of too much attention on focus, on goals, on treatment plans because they fear this will undermine the capacity for spontaneity, creativity, and above all free association. To us she says it may be helpful to see our role as similar to a personal trainer: advocating for a repeated focus on attaining certain goals for improvement in the patient's life. She says that the research is clear: focus and goals across modalities are key to successful therapy. And, she insists (though this needed much more development), focus and goals are not at cross-purposes with free associating. Nor are they aimed only at symptom relief. You can be doing several things at once in therapy. 


The author's sixth chapter, What Material Is Important?, poses some important questions and offers some not terribly original answers that are nonetheless still important to underscore. 

One of the really obvious things she says to pay attention to is "repetition (of phrases, themes, behaviors, sequences, mannerisms, emotions).... The more repetition the more attention is warranted" (p.69). I have learned this from reading the great child therapist and psychoanalyst Adam Phillips over the years, but I first learned it from what is perhaps my favourite of Freud's technical papers, "Remembering, Repeating, and Working Through." 

In addition, do not fail to note strong emotions, idiosyncrasies, and especially dramatic losses of control or wildly singular behaviors--even if they only occurred once and were never repeated, they may offer a deep vein of significance to be explored. 

Jumping, finally, to Peebles-Kleiger's nineteenth chapter, on the Psychological Costs of Change, I found much gratifying material here, too, which reflects my own attempts at rethinking "resistance." I've come to the view that resistance must be seriously respected, not merely scorned as something to be gotten rid of, or around, as quickly as possible. This, too, comes out in Freud's paper mentioned above: the resistance plays a role, and the clear-eyed clinician must try to see what role that plays. As Peebles-Kleiger notes here, symptoms can be bothersome but also productive and useful. Some symptoms may protect from grief or hold anger in check. Some may be resistant to change until and unless (as Winnicott might say) the patient learns that it is okay to hate the therapist. 

Though she doesn't mention him here, I had another of Freud's works in mind here, the centenary of which is this year: Beyond the Pleasure Principle, with its controverted theory of the death drive and the less controverted and I think more clinically abundant phenomenon of the repetition compulsion. The repetition of symptoms, and of resistance, must be examined and taken seriously by, inter alia, asking what the plan is for their replacement. As she notes, lots of therapy without such a plan will falter: you can't remove something and leave nothing in its place for most people. You must replace something pathological with something adaptive. 

Anyway, such were some of my thoughts in reading Mary Jo Peebles-Kleiger's useful book, Beginnings: The Art and Science of Planning Psychotherapy