Making Contact: Leston Havens on the Uses of Language in Psychotherapy

People for whom I have very great respect, and from whom I have learned and continue to learn much, have said very laudatory things about Paul Wachtel's book Therapeutic Communication: Knowing What to Say When. I have read it twice, and recommended it to students and interns albeit diffidently because I was sure I must have missed a great deal in the book because of my general dimness, laziness, or both. 

And yet, on both readings--three years apart--it has struck me as unnecessarily dense and prolix, needlessly complicated in places, and in want of more ruthless editing. The writing style is also entirely forgettable--it has little charm and even less humour. Does it have valuable things to say? Without doubt. Have I learned from it? Certainly. Does it fill a gap in the contemporary literature? Yes. 

But does it allow itself with some facility to translate memorably into clinical practice? No, it does not, at least for me.

Along comes a book treating the same issue but doing so in a way that is much briefer, written with greater cogency and accessibility, and occasionally has subterranean shots of sarcasm and the driest of dry humour, which we all know is the best kind. That book makes itself almost immediately clinically useful: it is by the late Harvard psychiatrist Leston Havens, Making Contact: Uses of Language in Psychotherapy (Harvard UP, 1986). 

Additional virtues abound in this book: the author name-drops almost never; his intellectual fireworks (as seen, e.g., in the use of jargon) are non-existent; the apparatus is very minimal and does not distract from the text; and he is that rarest of clinical writers in that his vignettes from sessions are usually a half-dozen lines at most. (I suspect I am very odd in finding it vexatious when clinical writers put acres and acres of session notes to illustrate one brief point. Others may benefit from this but I rarely do.)

The book consists of four chapters along with an introduction, the gist of which is that patients, being human, come in wearing disguises and leaving parts of themselves deliberately outside the door--absent, in effect, both consciously and unconsciously. Language has to find a way to outwit both of these phenomena. In order to find the other, the missing other, one employs the language of empathy, a succinct definition of which is given early on: 

empathy is best measured by the therapist's attempting inwardly to complete the patient's sentences. The more closely the therapist can match what the patient then says, the closer he is to the patient (p.19). 

Empathy will get broken down into different types as Havens proceeds through the book. These will then need to be deployed at the right time depending on what the patient presents with, and where they are with you in treatment. 

I: Immitative Statements: 

One begins with these. Havens says they are sometimes called 'doubling' as "in psychodrama and work with children." They consist simply in the therapist "speaking out loud for the patient," especially one who seems very lost, depressed, or to have little developed sense of self. Examples (there are many others):

Issue:                                                    Statement:

Fear:                                                    "Where does one find the courage?"

Doubt:                                                "How can I decide?"

Depression:                                        "What hope is there?"

Dominated:                                        "I have no rights." 

The utility of such statements is that they do two things: they demonstrate that the therapist is with and understands the struggles of the patient, but the therapist is also at something of a remove or a distance, which is important especially early on treatment when trust is not yet fully established and having someone close may be threatening. As Leavens puts it nicely, "the goal is to comfort by our presence, not to startle by our prescience" (28). There are echoes of Winnicott here, it seems to me, in his well-known call for patience in the therapist: "It appalls me to think how much deep change I have prevented or delayed...by my personal need to interpret. If only we can wait, the patient arrives at understanding creatively and with immense joy, and I now enjoy this joy more than I used to enjoy the sense of being clever."

In addition to foreclosing on the ability of the patient to get there before you, untested empathic statements can also be an imposition, Havens says, in forcing the patient to feel what you are feeling or what you feel the patient should feel. Instead you must create room for the patient to feel how and whatever they do. Thus in response to a patient's memory of being forced to eat what he hated because his mother dominated him, Havens said "I have no rights," an immitative statement that, the patient later said, made him realize: Havens is like me, and he also wants me to have rights.

II: Empathic Exclamations:

a) Nonverbal Sounds:

Havens says there is a whole range of these from simple to complex. The simplest of them are not words at all, but "nonverbal utterances" or empathic sounds, which "form an important supplement to what is usually considered the language of emotion, namely facial expression" (42). In 1986, when Havens published this book, he could not of course have forseen the rise of telehealth where, especially on the phone (less so in my limited experience on video calls), such sounds become vitally important. 

I admit I was gratified to read this section because I have found myself rather unselfconsciously making a number of these sounds as a patient is talking. In my experience the benefit is that they do not interrupt or prevent the patient from speaking. They convey not just interest but indeed empathy, but potentially many other things as well. In Havens' words, empathic sounds typically convey "ascent, protest, contentment, outrage, or sorrow." He gives an example of a patient weeping: while acknowledging that sometimes he, too, feels like weeping, what he finds himself instead doing is uttering "brief, low cries." 

b) Adjectival Exclamations:

These are what he also calls "translation statements" as you translate into words the feelings in or behind the story the patient is telling you. Such statements/exclamations are by definition very brief:  

Pain:                                     "Terrible!"   or    "How awful" 

Joy or Victory:                    "That's wonderful!"

Shock:                                   "Good God!"

If the shock strikes the therapist especially strongly, Havens--anticipating something Fonagy would recommend decades later, as I noted here--says you should freely request "Give me a moment to take that in" (p.44). Fonagy says the same thing: when you lose your ability to mentalize, you need to pause the session until you can recover. I've done this several times, especially with borderline and manic patients, and it is very helpful. 

Additional benefits are to be found in using these statements and sounds, chiefly that they can outwit the patient's defenses. They can also "normalize" (my word) what often feel like illegitimate feelings or a great deal of ambivalence in the patient. This is often the case early in treatment--or sometimes well into treatment--when "that rough beast, its hour come round at last, slouches toward Bethlehem to be born" in your presence for the first time. The patient tells you something they have not uttered to another living soul, and have scarcely allowed themselves to think, or feel much about. 

I find this especially in those who have been abused as children and do not, on first telling, know exactly what they are feeling, and whether they have the right to feel anything critical, hateful, or rageful in response to the abuser, especially if that person is still a part of their life. To these I often find myself saying something like "No wonder you were pissed!" (I deliberately use that language after a patient has told me that "We weren't allowed to swear" or "We got into trouble for cussing." My doing so conveys, without drawing too much attention to itself, that such language is fine with me. More important, of course, as Havens recognizes, it gives legitimacy, often for the first time, to the inchoate rage and hatred now heaving into view. 

c) Complex Empathic Statements:

All the statements and sounds Havens lays out for us have the twofold job of getting close to the patient and seeing the world from their eyes but not crowding them out or making them uncomfortable by your getting too close. Such statements as

"No one understands"

or

"No wonder you were frightened" 

have a way of accomplishing this twofold task. A "no one" statement "reconnoiters the field of blame," Havens says, while "no wonder" statements clear it. 

"Wonder" statements are very powerful in several ways, the author continues. As I suggested above, patients may have very covertly allowed themselves only the slightest bit of wonder at what happened ("was this normal? Should I be feeling like this?"), before shutting it down. Your use of such statements legitimizes the wonder and brings it out into the open. "No wonder" statements, Havens says, are a "denial of denial." If the patient has denied himself the right to feel something, your saying "No wonder you hate him!" now allows him to begin doing exactly that--if he chooses. That is an additional benefit here: you are not imposing what you feel, or what some abstract standard of feeling might insist the patient feel: you give them freedom and room now to feel something previously heavily warded off. 

No wonder statments can later on be supplemented or even supplanted by what havens sees as stronger expressions of empathy: "It is natural" statements. 

d) Bridging Statements:

In patients who are "supine" or who have hardly been allowed to live or develop a robust sense of self by parents or other overly dominating figures, or who are so severely depressed that there is little life in them at the moment, or who are heavily conflicted by their conflicting feelings (here I think of patients with obsessive-compulsive personality disorder--not OCD--about whom see some excellent resources here) you need to use bridging statements. These allow you to share the conflict around conflicting feelings, to be ambivalent with the patient in his or her ambivalence. They also, as he says later in the book, function as a form of "noninvasive closeness in which the patient has someone present on his own terms" (p.85).

Again using military metaphors (as Freud did in one of his most important papers, "Remembering, Repeating, and Working Through"), Havens says that in such patients you are entering a state of civil war, and you have to form a "provisional government" to deal with on the patient's behalf: "the seat of governance is found in an unexpected place: the patient's reaction to his own behavior." Precisely to the extent the patient finds his own behavior baffling or terrifying you have material to work with. (Here I am mindful of later developments in motivational interviewing in which you "roll with the patient's ambivalence.") By wading into an internally conflicted patient, the therapist gives both sides permission to acknowledge each other and begin talks toward integration.

Bridging statements to use here include "God knows": 

"God knows you must have wanted to escape from them!" (This, he says, lends support to the desire to get away while also subtly acknowledging problematic ties of authority holding the patient back.)

Another version of this to use is "God forbid you should try to escape." This, of course, is spoken "sarcastically" (p.62). In uttering it, you come alongside the patient in her desire to escape and to tell off the domineering authority figures. 

e) Causal Extensions:

One should not--I hope this is obvious to seasoned clinicians--use questions to demand of such patients as above "Why didn't you leave?" Those are very counter-productive approaches. Instead, Havens recommends causal extensions:

"If I say 'Why didn't you call?' I am judgmental, inquisitive, and assume that the patient knows. On the other hand, if I say 'You must have had some good reason for not calling,' I put myself with the patient and extend that empathy investigatively."

The above is, he says, a longer version of "no wonder" statements, but it does more work and opens onto a potentially longer line of inquiry. 

III: Good Management:

Later in the book, having fully convinced us of the need for all of the above, Havens then "rights the balance," as it were, by introducing some contrary factors to watch for. (On the very last page, he will later speak of "disciplined passion" so that your statements of empathy are not "empty display.") Here he says--in something that made me think immediately of Nina Coltart's open advocacy of the therapist always operating in "two minds"--the therapist cannot just be a tap pouring out empathy constantly. "Therapists must cultivate attitudes sharply opposed to one another," he bluntly puts it, reminding us that we have to enter into the patient's world via empathy, but we also cannot be "taken in" too much by that, losing our distance, our neutrality, our abstinence, our ability to mentalize. (There is little of clinical utility in my thinking empathy requires me to hate the patient's alcoholic mother or abusive husband as much as she does.) 

Remember, Havens says: "the object is the establishment of a working distance" (p.95) and both parties in the room have to be aware of the other and at the appropriate (and sometimes changing) distance from each other. If you collapse that distance and space--if there is, in Ogden's well-known terms, no room for an analytic third--then one has to wonder if any real work is going to get done. What will likely replace the work is some extended collusion-cum-enactment, and whom does that help? 

The Therapist's Authority:

Maintaining distance and space, however, does not mean a retreat to a preserve of therapeutic authority. Finding the balance here is, Havens freely acknowledges, one of "exquisite difficulty" (p.103). You need to likely have a greater sense of authority at the start so the work can begin, but as it progresses you need to relax that so that the patient does not come to be dominated by you, but to discover more freedom with and through your work together. (Havens is preaching to my choir here for I have long had in mind Erich Fromm's insistence from decades ago that in time a therapist has to be abandoned precisely so the patient's freedom can continue to expand, even by "disobeying" the therapist.) 

On Being Wrong and Acknowledging It:

One way Havens recommends doing this--and I was gratified to find I've just sort of fallen into doing this myself long before reading the book--is by your "willingness to be wrong" (p.105) and your inviting the patient to share whatever they feel, including critical or angry feelings towards or about you. Of course, merely telling the patient they can do this often cuts little ice. Instead, the author says think of what you have to do with frightened children: you yourself volunteer to go up to the barking dog and pet it, thereby revealing to the child that it is okay to do so. (Merely insisting "Go on--he won't bite you! Pet him! Come on!!" of course rarely works and often makes the child more upset.)

Another way to do this (which I have done) is to begin a session with an apology. I had let a patient, on a provisional basis, do something in session for about six weeks that I would not normally have encouraged and do not allow others to do. It became a ritualized part of the session and I half-forgot that it was supposed to be provisional. One weekend I realized it had long outserved whatever modest purpose it had and was now proving to be harmful to our work together. So I began the following session with an apology for letting it go on so long and explaining how I thought it was hindering the work. This so startled the patient that I saw a completely different, much more playful and emotionally fluid side of them that day, and slowly, haltingly, without any further encouragement from me, they began to venture more independent thoughts in session, and to disagree with me. I was delighted.

Projective Statements:

Additional ways to do this are by means of "projective statements." These put the "therapist's fallibility forward first" and reveal an example of your "happy receptivity" to being corrected.

One way I have found to do this is by using some version of the following prefaces:

"I could be wrong about this......."

"This may sound really off the wall, but I'm wondering if....."

"I really don't know if this is the best word for it, but I can't think of another at this point." (This often gets the patient thinking for a better one, and very often it is better and we happily agree on it.)

Havens suggests the utility of these projective statements with erotic and loving transferences, and his example of how to handle these is extremely close to the way that Andrea Celenza (as we saw here) recommends: by saying "You love me and naturally want me to love you." That normalizes things and goes some way to balancing them. But then you follow up with "Would that I could! Would that work made room for them both!" (p.107).

Counter-Assumptive Statements:

The goal here is to shake assumptions without getting drawn into a long debate about them. (They are especially useful if you find yourself caught in what I would call the agonies of an idealizing transference.) In brief, you do this by taking the patient's expectations and then "throw a dash of salt on those expectations" (p.115). Such disconfirming responses might include (only well after a solid alliance has been established!) saying "Yes, I know: you're a real idiot." Here you are sarcastically siding with the patient's inner prosecutor and the shock of your sarcasm, if done well and at the right moment and in the right way, can jolt them out of agreeing with that prosecutor. (I have done this many times and can report that it is very effective.)

I will pass over sections on counter-projective statements and others in the interests of wrapping this up.

Idealizing and Mirroring and Loving:

Some of the richest material in the book, for me, comes in the last chapter, and here again I thought of work with OCPD patients in particular. This leads Havens to reflect on the place of ideals and the therapist's use of what he calls Performative Statements: "the power of performatives is based on the therapist's authority and on the patient's need to be loved. Such statements evoke and then transform the need to be loved" (p.162). 

Havens gives the example of a deeply conflicted patient with internalized hateful objects that attacked the self, inhibiting a healthy self-love. So Havens sided with the kind, gracious aspects of the patient he saw, and called those out for attention, affirming them. The very "performance" of such affirmation ipso facto strengthened the kindness in the patient and allowed him increasingly to love that part of himself to the point he did not need external affirmation of it after a while. (As he puts it later in the book, "the therapist who finds something to admire in the patient creates the state of being admired.")

Such admiration is needed above all in those patients the author calls "supine." But once admired and loved--and my experience confirms this--they discover some inner resources and strength, so that the need to be admired does not become prolonged or pathological, but leads to real and important independent growth in a capacity for love and corresponding decrease in self-hatred. 

In the End, Love: 

This leads Havens into a very important clarification in the book, worth quoting in full and ending this review with:

Freud's cure through love did not mean any happy result that might spring from the love of a therapist for his patient. Quite the reverse....The cure through love...depends upon the therapist's finding in the patient a quality that can be admired, hoped, or wished for. It is the 'recognition of a promise.'

Psychoanalysis and Christianity

Prologue:

A tedious bit of autobiography: since 1990, when I was in gr. 12 first reading Freud and Jung and trying to decide, first, what I was to study at university the following year (psychology? theology? history?) and, second, whether to pursue clinical and then analytic training in Montréal, or priestly ordination into the Anglican Church of Canada, I have lived my life at the intersection of theology and psychoanalysis. When I went on sabbatical in 2018, my project was to finally write the book I had been carrying around in my head for nearly thirty years at that point, then tentatively titled "Theology After Freud." (Events intervened and I turned my sabbatical project to writing Everything Hidden Shall Be Revealed: Ridding the Church of Abuses of Sex and Power, where Freud features very prominently and unapologetically throughout). 

I may yet write that book, though increasingly with a much different focus. Some of its materials have in the last decade worked their way into lectures on the relationship between theology (especially Orthodox and Catholic theology) and psychoanalysis that I have gladly given before academic and ecclesial audiences in England and Wales, Canada, and in several places across these United States. A version of that lecture is available here as a podcast.

The other development in 2018 that swayed me against writing my book on psychoanalysis was the appearance of the most powerful theological engagement of Freud I have ever read. The Spanish psychotherapist and Jesuit Carlos Dominguez-Morano (who has published many books in his native tongue, few, alas, having been translated into English) published Belief After Freud: Religious Faith Through the Crucible of Psychoanalysis. That book is, and remains, a stunning work of far-reaching criticism of the most prominent manifestations of the massive psychopathology at the heart of Catholic Christianity. I could only salute the author's penetrating insights and great courage in writing a much more forceful book than I would have attempted. If you read nothing else on this list, read, mark, and inwardly digest this book. The Catholic Church would be a far less objectively disordered and sadomasochistic institution if Dominguez-Morano's proposals were taken at all seriously, which they won't be. (I wrote a bit about him for the Jesuit periodical America, and in more detail at an old blog.) 

If you read Morano and then want to read more in this area, I have, over the last three decades, read as many books about religion and psychoanalysis as I can lay my hands on--with many more to read! What follows are a few notes on disastrous books to avoid, a few that are "good enough," and a rare few that our outstanding. 

Books Fit for Burning:

Previously I noted on here one book that, had it been edited and published properly, would have been a handy collection to have. But it was so shoddily produced it's not fit for reading and the publisher should be ashamed to have foisted such slop on us. 

The other book is one I can only think of as psychotic: by that I mean Bion's theory of psychosis as the severance of all meaning-making links and possibilities for rationality and reality-testing. I cannot in all honesty discern any sort of rational purpose to the book as it staggers around vomiting out incoherent statements unconnected to any sort of discernible purpose--or to each other. The Freud who features here, and the "arguments" made, bear no relationship to reality. There is of course no end of attacks on Freud, and almost all of them are at least generally coherent (see, e.g., Frederick Crews), but this book could not even manage to rise to the level of childish diatribe. 

Mediocre Treatments:

Beyond such egregious examples, there are plenty of books in which others might quite rightly find value but I found to be very thin gruel indeed. Most of them were written in too general a way, and often very poorly edited. Under this heading I include Christianity & Psychoanalysis: A New Conversation, eds. Earl D. Bland and Brad D. Strawn; and Marie Hoffman's sprawling Toward Mutual Recognition: Relational Psychoanalysis and the Christian Narrative. Her premise and methods were good but the execution very poor. Other books along these lines could be mentioned but need not detain us further. 

Good General Treatments:

If you are new to the area, then a 30,000-foot overview provided by one of the great scholar-clinicians and social critics of the last century, Erich Fromm, is a good place to start: Psychoanalysis and Religion was originally delivered as part of the Terry Lectures at Yale. Like all Fromm's books, it is written at a very general and accessible level. (I discuss Fromm in a bit more detail here but keep meaning to get back to him at some point.) 

A more advanced but still general treatment may be found in William Meissner, the Jesuit psychiatrist and psychoanalyst I wrote about in my America piece, who authored several decent books, including Psychoanalysis and Religious Experience.

Two other collections merit mention: Soul on the Couch: Spirituality, Religion, and Morality in Contemporary Psychoanalysis, eds. Charles Spezzano and Gerald Gargiulo is decent. Even better is Psychoanalysis and Religion in the 21st Century: Competitors or Collaborators? ed. David M. Black.

Ana-Maria Rizzuto's Works:

The Argentine-born but American-educated Catholic psychiatrist and psychoanalyst remains too little known, in my view, but deserves to be for her first book in 1979, The Birth of the Living God, which was based on fascinating and highly original research with psychiatric inpatients and their internalized God objects. 

Then her 1998 book Why Did Freud Reject God?, published by Yale, is the most careful and respectful such treatment yet published of a topic that almost always sees authors descend to the level of puerile polemics and "pseudo-mentalizing" (to borrow a phrase from Fonagy). 

Only recently has Rizzuto come in for some attention in this decent collection: Ana-María Rizzuto and the Psychoanalysis of Religion: The Road to the Living God, eds. Martha J. Reineke and David M. Goodman.

Winnicott and Religion:

Back when I taught undergraduates theology, I came across the works of the scholar and Jungian clinician Ann Ulanov, author of such books as Finding Space: Winnicott, God, and Psychic Reality as well as Primary Speech: A Psychology of Prayer (which my students loved). 

Stephen Parker has written an unexpectedly excellent monograph (I say "unexpectedly" because works like this are often ploddingly dull, having all the vices of a doctoral dissertation and none of its virtues), Winnicott and Religion, which is very much worth your time if you love Winnicott half as much as I do. Winnicott, as always, has a lovely and useful phrase to describe his own relationship to the Methodism and Anglicanism in which he was reared: traditions to "grow up out of." That phrase admits of wider application today if much research (e.g., Stephen Bullivant's important new book Nonverts: The Making of Ex-Christian America is to be believed on declining practices. 

Highly Specialized Scholarly Monographs:

Under this heading I put two dense but worthwhile works: Peter Tyler's The Pursuit of the Soul: Psychoanalysis, Soul-making and the Christian Tradition; and then Marcus Pound's Theology, Psychoanalysis and Trauma. Pound's book has the virtue of making some of Lacan accessible--a figure whom I otherwise find needlessly and vexatiously obscure so much of the time (though I did find something useful in him as I argued here). 

One of the best books I have read is Pia Sophia Chaudhari's Dynamis of Healing: Patristic Theology and the Psyche. I discussed its virtues and interviewed her about it here. 

Let me end with a new book I forgot to mention in a recent post on On Bare Attention: it is a book by Paul Marcus entitled Psychoanalysis as a Spiritual Discipline: In Dialogue with Martin Buber and Gabriel Marcel. The book is a bit choppy in execution, but it draws out useful material from its two named interlocutors. I read some of Marcel and Bueber in writing my M.A. in moral philosophy at the end of the 1990s (when I read rather a lot more of Alasdair MacIntyre and Emmanuel Levinas, whose "ethics of the face" and critique of abstraction I still teach to my students). 

Marcus seems to suggest in this book that for people who both find themselves "ecclesially homeless" (to use a phrase of Stanley Hauerwas) or "deconstructing" their faith, or otherwise alienated from religious institutions, and are clinicians or interested in psychoanalysis, then the analytic tradition offers both insights and "disciplines" similar to ascetical practices found in Judaism, Christianity, and Buddhism. This allows him to say that "psychoanalysis can reasonably be conceptualized as a spiritual/moral venture." As such, it has practices of "communion" (to borrow a term from Marcel) or what Marcus calls "the five essential elements of psychotherapeutic support--presence, holding, caring, challenging, and confirming."

 

Psychoanalysis and Religion

It is an infelicitous duty sometimes to warn people about books and their problems, but in this case I do not mind doing so as the publisher in question is one that is notorious for charging some of the most outrageous prices of any academic publisher. In exchange for that, one might hope--indeed, one would rightfully expect--that any book such a publisher produced would be flawlessly edited and smartly presented, but neither is the case with Early Psychoanalytic Religious Writings, eds., H.N. Malony and E.P. Shafranske (Brill, 2021), ix+181pp.

The book is an anthology of excerpts from various first-generation analysts, including Freud, Karl Abraham, Fromm, Sandor Rado, Ernest Jones (whose chapter is sophomoric and supercilious and certainly does not bear reprinting), and Wilhelm Reich. The editors offer an opening and concluding chapter, the latter itself being a reprint of an earlier publication.

Apart from the Oskar Pfister chapter, which reproduces his reply to Freud's The Future of an Illusion, most of the other chapters are such truncated abbreviations of the originals that they offer very little substance. This is certainly true of the excerpts of Fromm and Abraham, inter alia.

The other really vexing and inexcusable problem is that Brill has clearly sacked all its copyeditors, and as a result this book is littered with the most embarrassing sorts of typos, grammatical solecisms, and formatting flaws. Just to give a few examples: in some places, references are made that do not show up in footnotes or the bibliography; in several places periods are missing, so that sentences are smashed together; and in too many places to count, spelling errors abound, including most egregiously on the same page where in at least one instance a name is repeated three times, each of those times in a different spelling! Other howlers could be noted. In short, this is intolerable for a slender book costing nearly $90--and not even containing much original content, either. 

That said, the one redeeming feature here--for those who have not encountered him earlier--is that Pfister is always a delight to read, and his chapter here reminds one of the close relationship he had with Freud and his family for nearly three decades. Pfister, for those who do not know, was a Swiss pastor who not only saw no opposition between Christianity and Freud, but praised the latter as an invaluable critic of the former, saying of Freud that "you fight religion out of religion" and in so doing engage in a "smashing of idols." 

On this latter point, Adam Phillips develops it to such effect in his superlative short collection of essays, On Kissing, Tickling, and Being Bored: Psychoanalytic Essays on the Unexamined Life. And this point is not original to Phillips. Before him, in his Terry lectures at Yale in the 1960s, Paul Ricoeur had already highlighted the anti-idolatry uses of Freud which Christians should embrace and extend to their own tradition.

Oskar is not above twigging his friend Sigmund by noting that Freud's fellow Jew, Jesus of Nazareth, had "practiced psychoanalysis 1900 years before." But Pfister ends by noting that Freud is in fact following Jesus very closely when both of them are "united in a strong faith, the credo of which says: 'The truth will make you free'" (p.148), a quote from John's gospel that Erich Fromm will also use in the same way in his book Beyond the Chains of Illusion: My Encounter with Marx and Freud. 

In Praise of Frieda Fromm-Reichmann

Gail Hornstein's lovely biography of Frieda Fromm-Reichmann convinced me that I must also read the latter's Principles of Intensive Psychotherapy, which I have now profitably done. In reading this latter work, I had constantly to remind myself that it was written in the 1950s (she died in April 1957)! It was astonishing to me at every turn how much of contemporary practice and current concerns she anticipated and was already engaged in. I will say more about this later. Let us begin with To Redeem One Person is to Redeem the World: the Life of Frieda Fromm-Reichmann for it is a moving, elegant, and gracious study of the life of someone who remains too little known even today. 

This biography, whose compelling title is Talmudic in origin, takes us to the beginnings of Fromm-Reichmann's life in Germany where we get some crucial insights into her early family dynamics that seem--so Hornstein suggests several times, and convincingly--to have played no small part in shaping her career choice and actual clinical practice. Fromm-Reichmann was the sort of person who seems almost effortlessly to have put the needs of others ahead of herself. 

After her move to America, she finds in Chestnut Lodge in Maryland what seems an almost Providential appointment so well suited for her unique gifts and limitations. It is hard, in reading of the uniquely free, creative, unrestrictive environment around the Lodge in the interwar and immediate postwar years, to restrain at least a touch of nostalgia for what seems a less straitened time before the orthodoxies of a strict Freudianism, or later a strict behaviorism and cognitive-behaviorism, set in. 

When I picked up Hornstein's biography I expected that Frieda's marriage to her very famous first (and only) husband, Erich Fromm, would occupy more of the stage than it does. At least in Hornstein's telling the marriage--much of it lived in different countries--seems to have come rather quietly to a relatively mutual and amicable end, and Frieda does not seem to have bothered herself with romantic partners again, though Erich of course did at least twice more. (Erich has been the subject of at least three biographies that I know of. I think the Lawrence Friedman one, The Lives of Erich Fromm: Love's Prophet, excellent.)

I cannot do justice to the rest of the Hornstein biography so I will not try here. Let me instead reiterate my warmest recommendation that you read it. You will not be disappointed. I know I will leave it on my shelf in order to be able to come back to its riches and delights at some point in the future. 

Let us now turn to Principles of Intensive Psychotherapy, which is--quite frankly--far better written than I expected. Fromm-Reichmann's style is not at all what is sometimes derided as Teutonic prose: leaden, verbose, impenetrable, abstruse. Quite the contrary: she is succinct (more so in the first half of the book, admittedly), cogent, and constantly supplying practical illustrations and applications based on her own long clinical career. 

In addition, while clearly downplaying her own personality and unique contributions, one nonetheless gains throughout the book a considerable glimpse into the person of Frieda Fromm-Reichmann, and it is an attractive one. In fact, several times I thought of Peter Rudnytsky's observation about another clear, practical, cogent, and wonderful clinician I admire hugely--viz., Nina Coltart, whom I discussed here at length. Of Coltart he noted that

In reading the work of a psychoanalytic author, there is one question that I think we should ask ourselves above all others: would I want to be in analysis with this person? Is this someone I would trust to probe the innermost recesses of my psyche and with whom I would be likely to have a genuinely therapeutic experience?

One feels something quite similar in reading about Fromm-Reichmann, and with Rudnytsky one can also answer these questions in the affirmative. 

It seems that much of her Principles reflects and retains her very considerable debts to, and her desire for expanding the insights of, Harry Stack Sullivan, which is no small thing for he is often confined to a footnote in recounting the history and intellectual development of psychoanalytic theory. In this regard, FFR and HSS alike rise and fall together. 

They are clearly yoked in this book, and by the end of its brief introduction it is clear that FFR is a strong proponent of HSS's interpersonal theory. Indeed, upon finishing her thoughts here mine immediately turned to Winnicott: "there's no such thing as a baby!" With DWW, HSS, and FFR, one could thus insist "there's no such thing as a solitary patient who does not come into one's consulting room trailing a long line of entanglements with parents, siblings, authority figures and others." And this patient's interpersonal challenges will, of course, show up in the transference and counter-transference. 

Anticipating by many decades the contemporary research that has shown, time and time again, how crucial the therapeutic alliance is to the success or failure of therapy, Fromm-Reichmann opens her book by insisting that "the first prerequisite for successful psychotherapy is...respect...[for] the mental patient" (xi). Such patients come, she notes, seeking not just insight, but also symptom relief and possibly personality change of some sort. 

FFR made her bones, as it were, and her name treating psychotics and schizophrenics especially. From this she makes a striking comparison I've not heard before but whose logic makes sense to me: When it comes to the question of dreams, she notes that they "and psychotic productions are actually analogous" (xiii). We will return to the question of dreams late in the book, noted below. 

If it was Yalom who made famous and widespread the recognition of the importance of paying attention to the here-and-now in the psychotherapeutic relationship, it was FFS who anticipated him by decades: already by p.4 of Principles she is insisting that we must pay serious and regular attention to "the reality of the actual experience between therapist and patient in its own right."

This takes us to her second chapter, explicitly focused on the role of the "doctor" in the therapeutic relationship. Here she issues a welcome and forthright reminder that no therapist or doctor worth his or her salt will be trying to impress a patient with his technical brilliance or intellectual prowess or theoretical genius, all of which she regards as displays of "irrational authority" (17) that will set therapy back, not advance it. (In a similar way and for similar reasons, at the end of the book, she stoutly insists that the doctor should not give advice for that infantilizes the patient.)

Much as I have more recently heard the great Adam Phillips regularly remind us (especially in his Unforbidden Pleasures), FFS was, in the 1950s, insisting that the therapist must resist "fantasies of omniscience" and illusions of "perfectionism" (18). This must go hand-in-hand with the humble admission of mistakes, which we now know, thanks to decades of research after her death, is a key part of sustaining and repairing the therapeutic alliance. (On the question of the alliance I have recently found Jeremy Safran's book Negotiating the Therapeutic Alliance: A Relational Treatment Guide very insightful and helpful.) Such admission of therapeutic mistakes, Fromm-Reichmann helpfully reminds us, really must be done "in a matter-of-fact and nonmasochistic manner" (20). Therapists, confessing missteps, do not need to lose control of their own masochism and turn themselves into penitential flagellants!

Chapter three is where I detected what I take to be the clearest and closest influence of her sometime husband, Erich Fromm. She notes here that the therapist must be free enough to stand above and at some remove from the pressures of conventional thinking and "authoritarian values" and their demands for obedient conformity. They must also help their patients do the same thing if that is what the patient wants. To do so, she continues a little later, requires in the therapist "mature love" based on "stable self-respect." 

Chapter V, "The Initial Interview," begins by reminding us (again, decades ahead of this becoming a commonplace!) that "psychotherapy is a mutual enterprise, if not a mutual adventure" (45). In other words, Fromm-Reichmann is quietly moving beyond what is often called the one-person psychology of classical analytic approaches into the two-person and inter-personal approaches that would not really become mainstream, at least in America, until forty years after her death. 

Again, in the 1950s FFR was ahead of the modern fixation on having goals for therapy, which she explicitly addresses a number of times. For her these seem to have been very important for she was operating--as a striking footnote on p.61 called me up short to see--in an era before the Diagnostic and Statistical Manual of the American Psychiatric Association had been invented--much less ballooned to the massive thing it is today (about which its sometime editor, Allen Frances, has had some critical things to say in Saving Normal). Later (p.143) FFR notes the importance--which seems standard today--of regular review of treatment plans to avoid therapeutic drift. 

Returning, late in the book, to the topic of dreams Fromm-Reichmann again says several very useful and striking things, starting with: "Dreams are frequently used by the sleeper as a means of conveying something to the therapist which the patient has been incapable of conveying while awake" (163). More strongly still, she goes on to note that "the mental operations of the sleeper frequently excel in wisdom and insight those which he is capable of accomplishing while he is awake" (169). (I know this to be true from the very first dream I had back in the fall of 1994 immediately upon entering into psychoanalysis. Fromm-Reichmann, a little later, notes that you should always pay attention to the first dream in therapy for it often indicates the central struggle of the patient's life, and its theme will recur in therapy.)

She goes on, in the same practical and hands-on way she uses throughout the book, to offer an approach to dreams which very much accords with my own as both patient and therapist: the challenge of interpretation. Here she says that "the greatest source of help in this endeavor is the patient's own associations to his dreams." This, as an analysand, I found invariably helpful to decoding most--but not all--parts of dreams that would otherwise have been rather recondite in meaning. 

If there are--and frequently this is the case--parts of dreams that prove elusive to association and interpretation alike, she recommends a useful tip: have the patient tell the dream a second time, and this time, as therapist, pay very close attention to any alterations in the second re-telling for such alterations are very likely "deserving of the therapist's special attention." In the end, it is not necessary, she says, to interpret every detail of every dream. 

Overall, Principles of Intensive Psychotherapy holds up astonishingly well. Yes, the language (almost always "the doctor" or "the psychiatrist") is sometimes stilted and perhaps overly formal, and not all the details in her chapter on interpretation and its techniques would be widely practiced today. But overall a book that has now been in print for over sixty years remains fresh and challenging, reflective of the wisdom of an extraordinary woman whose therapeutic endeavors with some of psychiatry's sickest patients would prove redemptive indeed. Let that be counted unto her as righteousness, and may her memory continue to be blessed. 

Robert Abzug on Rollo May

It is always melancholy for me when I reach the end of an exceptionally good book, but my consolation is that if I leave it on my shelf long enough, I can come back to it again in a few years time and enjoy its riches anew. This I will do with a fascinating biography that was melancholy for me in a second way: it took me back to a time when there seemed to be a closer, richer relationship between psychology and theology (as well as existentialist philosophy) than obtains in most places today. 

That relationship was lived by Rollo May, whom I first encountered almost thirty years ago as an undergraduate in psychology with a strong interest in theology, especially in its mid-century existentialist manifestations which I had explored in the last year of high-school when a generous French teacher (who very much saw himself as a soixante-huitard and thus indulged his contempt for rules and routine) gave me the entire semester off from class provided I show up on the last day in June after having written him a final paper on existentialism. This I gladly did, and so availed myself of the opportunity to read a lot of Paul Tillich--in English--and then Sartre and Camus in French. 

The following year, as an undergraduate, I read at least one of May's books as I recall: Love and Will. (I also read Will and Spirit: A Contemplative Psychology by his half-brother, the psychiatrist Gerald May.)

May is now the subject of Robert Abzug's brand new book, Psyche and Soul in America: The Spiritual Odyssey of Rollo May (Oxford University Press, 2021), 432pp. 

I finished this biography about a month ago on a lovely early summer evening on my patio. It is superbly written and a real treat to read. Abzug has an extremely deft touch in knowing how much detail to give about May's fascinating life and how much contextualization the reader needs without in either case overwhelming one with an excess of details. One would expect no less of so seasoned a scholar who is now professor emeritus of history at the University of Texas at Austin. 

Following standard practice, I e-mailed Dr Abzug some questions and was delighted when he agreed to my request for an interview about his new book, His thoughts are below. 

AD: Tell us about your background

RA: I grew up in a suburb of NY City, went to Harvard as an undergraduate and then to Berkeley for graduate school, both degrees in history. I was raised and remain a reform Jew by belief and tradition, though of course writing about May (and before that about 19th-century Protestant reformers) deepened my sense of the power of Christian faith and influence.

AD: What led you to writing Psyche and Soul in America: the Spiritual Odyssey of Rollo May?

RA: I tell the story of meeting Rollo in the Preface of the book, but the short answer is 1) After having taken Erik Erikson’s course on the life-cycle in college, I began to have an increasing curiosity about psychology and psychotherapy, one that had already been reflected in my first two books but only as a non-jargony use of what I would call a psychological aesthetic. 

Also, while in graduate school, had taken an external seminar in the latest psychoanalytic developments at the San Francisco Psychoanalytic Institute. And, of course, being in the Bay Area between 1967-1977, I was in a culture awash with therapeutic visions of the world. That said, it was only the accident of meeting Rollo that I became interested in writing about May and, for that matter, seeing some of the history of psychotherapy and religion through the lens of his life. Of course, the experience of knowing him and his world of friends and concerns for the last eight years of his life proved richer than I could  have imagined.

AD: I first read May in the 90s as an undergrad in psychology who also had an interest in theology, especially the existentialists like Paul Tillich. Tell us a bit about the long-term and hugely important relationship Tillich and May had. 

RA: The early 1930s were key in setting May’s future. First, while still in Europe as a missionary teacher, he encountered, and I would say “converted,” to psychoanalysis by taking a seminar in Vienna with Alfred Adler. That put a certain shape on his spiritual quest but didn’t end it, and when he returned to the U.S. he enrolled at Union Theological Seminary in New York. 

Tillich meanwhile had just escaped arrest by the Nazis by being invited to teach at Union, which he started to do in 1934. He and Rollo met early on in that year, and it began a relationship that was intellectual, spiritual, deeply personal, and lasted for the rest of Tillich’s life (he died in 1965). That relationship is certainly a central theme of Psyche and Soul in America. The mentorship of Tillich for May is clear, but it was something of a two way street. That is best indicated by the fact that Hannah Tillich asked May to deliver the eulogy at his first burial in East Hampton, NY, where the Tillichs had a summer home, and his reburial at the park named in his honor in New Harmony, Indiana.  

AD: May was also influenced by Freud, Adler, and Rank. But Adler seems to have been especially important. Tell us a bit about his relationship to and influence upon May. 

RA: Paul Tillich and Alfred Adler came into May’s life at a crucial period in his life, where his spiritual searching needed greater guidance and inspiration. Adler certainly had a life-changing influence on May, giving him a new way of envisioning the world and the possibility of a new profession. 

But Adler died in 1937, only four years after May met him and aside from a few friendly and important encounters in New York, the two didn’t really have the same sort of relationship as May did with Tillich. Nonetheless Adler’s ideas formed a compelling basis for his exploration of Freud, Jung, and Rank. 

But May told me that in the end he found other first generation analysts and later American neo-Freudians like Harry Stack Sullivan and Erich Fromm more powerful than Adler in their sense of complexity of the human condition and intellectual reach.

AD: You note (p.54) that May for "remained all his life wedded to obsessive self-scrutiny." That certainly comes through in your biography down to the last years of his life. What lay behind such an obsession?

I was about to say, “that’s a question for his analyst,” but let me give you two answers. First of all, I think his sense of spiritual devotion, which as it developed was truly a relationship with Tillich’s “God beyond God,” one which a therapist might call, insufficiently, OCD, made him investigate and judge his every action. This compulsion was historically not unusual among what Max Weber called “religious virtuosi,” and May was certainly of that breed. 

But I think more important was that he had the genius to build a theory of therapy based in many ways on his somewhat perhaps narcissistic but very productive contemplation of self. In short, these ongoing themes that provoked incessant self-questioning were in fact the well from which he drew much of his best work.

 AD: Part of May's project, you write (p.114), was "marrying the insights of psychoanalysis with the eternal quests of religion in a manner meaningful to the modern reader." Given how popular his books were, it seems he was successful in this endeavor in one way, but I'm wondering in another way about the kind of reception his books received in the professional psychoanalytic community. Did you come across reviews of and reactions to his works by psychoanalysts, and if so can you give us an idea of what they were?

RA: From almost the beginning, he saw as his mission in life the spiritual counseling of individuals, whether in the first instance through religion and later through psychotherapy, but perhaps most of all by educating an interested public through his writings. This was true when he first started publishing books that implicitly or explicitly saw a crucial interaction between the spiritual and the therapeutic (The Art of Counseling of 1939 and The Springs of Creative Living from 1940), the latter being a main selection of the Religious Book Club. It remained true even after he shed the theological trappings of Protestantism for a spiritualized existentialism.

Much of the answer to your question about his impact on therapists and reviews of his books is as much the ever-changing nature of psychology, psychiatry, and psychoanalysis as it does with the specific contents of one May book or another.  

AD: In early 1940 or 1941, you write (p.135), May began an analysis with Erich Fromm. I've been re-reading Fromm for the last two years and amazed at how well some of his insights stand up three quarters of a century after his English-speaking debut. Tell us a bit about the influence of Fromm on May that you see.

Another very interesting question.

I think there was some influence, though some of the most important ideas about the world and culture were transformed in May’s work from neo-Marxist thought to existential thinking, for instance living in a culture where not so much through the transformation of society but rather the resistance of self an authentic sense of the world might emerge. 

Nonetheless, there can be no question that Fromm influenced May, especially in those early years of analysis before the post-tuberculosis restart of the analysis. And certainly, by reading Fromm’s Escape from Freedom, he got a new and materialist view of an idea that he was already familiar with from reading the late Victorians and conversing with Tillich: the notion that both faith and community had been in decay for some time and that these trends had deleterious effects on the ability of individuals to “be” themselves. In that general sense, May joined with Fromm and others of the postwar era—David Riesman, William H. Whyte, John Kenneth Galbraith, and others—each in their own way critiquing the conformity, consumerist values, and general weakening of individual autonomy.

AD: I sometimes wonder if the existentialist movement in theology and psychology alike has been largely left behind, but then you trace out the burgeoning relationship between an older Rollo May and a then-young and upcoming Irvin Yalom, who is still with us after an astonishingly prolific career. Tell us a bit about that influence of May on Yalom.

RA: As Irvin Yalom has said many times, it was his reading of May’s Existence (a collection of essays from European therapists) introducing an existential framework to psychoanalysis and psychotherapy that inspired him to follow a psychiatric and analytic path. Later, when they got to know each other, I believe each helped the other in imagining the possibilities of existential psychology. However, there were differences. Yalom was a doctor, taught at a prestigious university medical school, pioneered group psychotherapy, was a self-declared atheist, and was a successful novelist. Rollo May was many things but none of those. In short, while they came together on existentialism, their careers and commitments were strikingly different.

AD: May's relationship to Christianity waxed and waned over the decades--from being a pastor and preacher early on to falling away it seems and then to returning to attending church later in life as an Episcopalian (p.331). Where, in the end, do you see May's life in relationship to Christianity?

RA: I think it is fair to say that past the early 1950s, at which point the formal church was no longer part of his life, he nonetheless lived a life imbued with the values he gained within the Protestant church culture and retained an abstract but real sense of what he called “infinitude.” His attendance at the Episcopal church in Tiburon in the 1980s had more  

AD: For those new to May and wondering where to begin, do you have, say, your top three favorites of his writings? What would you recommend beginning with for those who want to discover May today?

RA: My top three for getting to know May’s work would be Man’s Search for Himself (1953), Love and Will (1969), and The Courage to Create (1975), which is short, fits creativity into a vision of society, and as usual is clearly and compellingly written. And I would also suggest reading May’s introductory chapters in Existence (1958), an edited introduction to the possibilities of merging psychotherapy with existential thought. These are marvelous explanations of the power of existentialism. I might add that since the book’s publication, I have received any number of emails, some quite lengthy attesting to the influence May’s ideas had on their lives, and the three I recommended were ones that most often came up in our exchanges.

AD: Having finished this biography, what are you at work on now--new works in the pipeline?

I am still catching my breath but have thought about a short book based upon some lectures I have given recently about the practice of spiritual life in America, both in and out of formal denominations and traditional ritual practice. One element I wish to explore is the impact of religious and cultural pluralism on individual and group spiritual practice.

AD: Sum up your hopes for the book, and who especially should read it.

RA: Most of all, I hope to restore Rollo May’s place in the history of public intellectual life and, indeed, allowing readers to grasp the significance of his work to contemporary society and thought and inspire to engage with his ideas. As a biographer, I have also tried to write as “intimate” a biography as the sources allowed in order to provide readers with an account of May’s life that conjoins the public and private, as well as the unconscious and conscious—that is, brings an understanding that the origins of significant public lives lie in unique and often less than ideal sojourns. 

As for a readership, my hope is that psychologists open to a broader view of their profession as well as all who in one way or another were affected by May’s writings would profit from it. Yet, I also hope that those too young to know of Rollo May first-hand but who are in need of a broader and deeper sense of life somehow find the book and seek out May’s own attempts to offer roads to a richer life.