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 Honour of D.W. Winnicott on the 50th Anniversary of His Death

Last week marked the 50th anniversary of the death of D.W. Winnicott. It seems with each passing year I find myself reading more of him, and benefiting in deeper ways from his many rich and often unusual insights. (I have an essay coming out this week that draws on him.) So I wanted to repost these reflections from last November so that we may continue to honour him in the best possible way: by reading him. 

Before you do that, you could do worse than to start here with this moving and fascinating reflection from his wife on how DWW understood death and wrote about the prospect of his own death. I have read it three times now and continue to learn different facets of him and of their marriage. His prayer "Oh God! May I be alive when I die" is one that repays careful reflection. (I will, in fact, have an essay about it coming out probably next month.) 

I recently noted an essay of D.W. Winnicott that I found very insightful. Now the BBC has published excerpts from various talks by, and about, Winnicott. It is a charming retrospective and will only take 10 minutes of your time. Have a listen here. 

I have not read all of Winnicott by any means, but my debts to him are noted in the above-linked piece and in other essays here (discussing his thrilling 1947 essay "Hate in the Counter-Transference") and here. 

For those who have the money and inclination, Oxford University Press recently published the entire opera omnia. 

For those who might find it useful, let me recommend a few individual books by and about him. There are many more, of course, but these are the ones I have read and in some cases re-read several times. 

For biographies, there are two I have read (and others I have not but hope to). The first is by Adam Phillips, titled simply Winnicott. It is one of Phillips' earliest publications, and is a relatively simple and straightforward book without some of the literary flourishes so common in his more recent books. 

The second is by Dodi Goldman, In Search of the Real: The Origins and Originality of D.W. Winnicott, published in 1989. It's somewhat more intellectually expansive than Phillips but generally complementary to his book. 

The Chicago Psychoanalytic Institute had a library sale a year or two back, and I was very glad to get my hands on Through Paediatrics to Psycho-Analysis: Collected Papers. That is a very rich collection despite the somewhat off-putting title. 

Next to this, his Playing and Reality is perhaps one of his most noteworthy books.

Winnicott's Home Is Where We Start From is somewhat mixed, but there are some good essays in there. 

Additionally, I'm only part-way through Psycho-Analytic Explorations, but it has many good essays in it, especially those on the uses of silence.

Though a bit dated now, Judith Hughes' Reshaping the Psychoanalytic Domain: The Work of Melanie Klein, W.R.D. Fairbairn, and D.W. Winnicott is useful for the wider context, and for showing the very important relationships between all three who, each in their own way and also together, form so much of the British object-relations tradition. I am always happy to see Fairbairn get some attention after his decades of more or less solitary Scottish labours in Edinburgh, far from the London scene where Winnicott and so many others made their name. Fairbairn's early essay on schizoid personalities remains one of the most illuminating things I have read on that score. 

Finally, I have started, but not yet finished, Stephen Parker's Winnicott and Religion. So far it's rather good, though not earth-shattering. Winnicott seems to have been comfortable, in that rather vague and pragmatic British way, being part of the Church of England though he was not especially demonstrative of it, least of all in his writings. 

On this score, one final book on my list to read: Ann Belford Ulanov Finding Space: Winnicott, God, and Psychic Reality. I confess to never having heard of Ulanov (a New York-based Jungian analyst and academic) until almost exactly a year ago when I interviewed Pia Sophia Chaudhari about her recent and fascinating book, Dynamis of Healing:  You may read that interview here. 

Vamik Volkan on Racism and Group Psychology

I'm delighted to be able to report that on the weekend I received two books, one of which I have read: Vamik Volkan, Large-Group Psychology: Racism, Societal Divisions, Narcissistic Leaders and Who We Are We Now (Phoenix, 2020), 144pp.

When I saw the book was forthcoming earlier this year, I wrote to Dr. Volkan about an interview, and he has kindly consented. I'm putting questions together for that now and will post his thoughts as soon as I have them.

The other book the publisher kindly sent to me is a biography of Volkan: Ferhat Atik, A Psychoanalyst on His Own Couch: A Biography of Vamık Volkan and His Psychoanalytic and Psychopolitical Concepts, published not quite a year ago. I'm eagerly looking forward to reading it not least because even the bits and pieces of Volkan's life that I have read (some of which he shares in the moving introduction to the group psychology book noted above) are moving and fascinating indeed. 

In the meantime, let me also point you to at least a couple of other books. I first came across Volkan's work when I was doing research on ISIS about five years ago. For those who read their online propaganda magazine Dabiq, as I did in detail, you quickly saw that there were manifold and many uses and abuses of Crusades history. Trying to puzzle through what was going on led me first to Charles Strozier (a Harvard historian, Lincoln scholar, and psychoanalyst in New York City, and author, inter alia, of the invaluable biography of Heinz Kohut, the well-known Chicago psychoanalyst). 

Strozier had edited the collection The Fundamentalist Mindset: Psychological Perspectives on Religion, Violence, and History. That book, valuable in itself, also introduced me to Volkan, whose work on religious-political conflict in the Balkans and elsewhere has been very helpful in trying to understand the ISIS mindset, as well as Ukrainian Catholic and Russian Orthodox religious conflicts in the twentieth century, about which I have a book coming out late this year.

For those new to Volkan, he has been very prolific, so knowing where to begin might be daunting. Might I suggest you begin with the book I first found so valuable? That was his 1998 book Bloodlines. In it I first encountered Volkan's key ideas of "chosen glory," "chosen trauma," and "time collapse," all of which have been very revealing when applied to some of the religious and historiographical conflicts I have studied and written about. More recently, and in a similar vein, there is his 2013 book Enemies on the Couch: A Psychopolitical Journey Through War and Peace.

Stay tuned for the interview, and further discussions of Volkan's new book on group psychology. 

Hearing Voices and/or Hearing God?

At the Other Place, you can read a notice of a new book I'm looking forward to getting my hands on: Hearing Voices and Other Matters of the Mind: What Mental Abnormalities Can Teach Us About Religions by Robert N. McCauley and George Graham (Oxford University Press, 2020), 280pp.

Spirituality and Therapy

One recent change I have noted since I began in psychology in 1991 is that the openness to and even basic awareness of the role that "spirituality" plays has grown very considerably in the last decade or so. A book just released this week will continue to break down the once-traditional hostility between psychology (especially psychoanalysis) and religious and spiritual practices and traditions: 
Spirituality in Mental Health Practice: A Narrative Casebook, eds.,Miriam Jaffe, Widian Nicola, Jerry Floersch and Jeffrey Longhofer (Routledge, 2020), 226pp. 

About this book the publisher tells us this:

This key text presents an accessible and diverse exploration of spirituality in mental health practice, broadening the definition of spirituality to comprise a variety of transcendent experiences.

Chapters include a brief history of the tensions of spirituality in mental health practice and consider a range of emerging topics, from spirituality among the elderly and energy work (Reiki), to spirituality in addiction recovery, incarceration, and hospice work. The book offers a close examination of the limits of the medical model of care, making a case for a more spiritually sensitive practice. Rich case examples are woven throughout, and the book is paired with podcasts that can be applied across chapters, illuminating the narrative stories and building active listening and teaching skills. Suitable for students of social work and counseling at master's level, as well as practicing clinicians, Spirituality in Mental Health Practice is an essential text for widening our understanding of how spiritual frameworks can enrich mental health practice.

Neville Symington on The Making of a Psychotherapist

I spent several happy days in early 2018 at the Cincinnati Psychoanalytic Institute and their library, which I had the run of. There I had the first chance to begin to read some of the many works of several people, including the Anglo-Australian therapist Neville Symington, who has recently died. 

Part of my interest in him is for a book I'm working on that will look, in part, at the question of psychoanalysis and religion, especially Christian theology. Symington was for a time a Catholic priest before leaving the Church, marrying, undergoing analysis, and then training to become a therapist, first in London (where he was connected to the justly celebrated Tavistock Clinic) and later in Australia. He has many interesting insights on the analysis-religion relationship, and most of them are constructive if not positive, but we will not get into those here. 

In any event, I've been meaning to read more of him, and recently had a chance to read his The Making of a Psychotherapist (Routledge, 1997). Herewith some thoughts on that.

Symington notes early on that the goal for this book is to show "a psychotherapist in the making, so both the strengths and errors of the psychotherapist are laid bare for the reader to scrutinize. I hope that this might help psychotherapists who are trying to learn, as I am." And with commendable candor Symington, several times in his mini case-studies, does describe interactions with a patient that were not always productive and positive, and how he handled them, and what he learned from them. 

The first part of the book is, in my view, much richer than the second. By the second he seems to forget the rather sharp distinction he posited early on between psychotherapy and psychoanalysis, and the second half of the book is almost entirely focused on classical analytic issues and concepts.

Having recently written appreciatively about what I've learned, and am learning, from Yalom, I noted that Symington early on in this book takes issue with the notion of therapy providing corrective emotional experiences (which Yalom talks about in his chapter on interpersonal group therapy, where he notes that many of his insights originate with Harry Stack Sullivan and Franz Alexander). Such experiences, along with the therapist's empathy, are not in themselves sufficient to provide lasting healing according to Symington. 

Inner Creative Emotional Act:

Instead, he writes, "my own belief is that healing of a lasting kind is the product of an inner creative emotional act. This act is essentially free and cannot therefore be imposed upon the patient" (xvi). 

I was struck by this insofar as it rings true to my own experience as a patient, and describes my own approach to working with people. A lack of imposition was, and is, the largest part of my attraction to, benefit from, and continued defense of psychoanalytic therapy: it seems to offer maximum freedom to the patient and to resist imposing things on him or her. Some of the key insights I took from analysis came from that kind of inner emotional act. Does that mean they were singularly and solely mine, and that the analyst or therapist plays no role? Of course not.

Psychotherapy and the Moral Life:

Ch. 1 opens with the ringing declaration: "Psychotherapy means healing of the soul." This then leads into a brief discussion of Viktor Frankl and from here into an extended discussion about the "moral element to mental distress" which is not always entirely clear. I think what he is saying here--and it comes out more clearly at the very end of the book--is that none of us can escape certain judgments about the good life, and so even though we may try to preserve a certain level of neutrality with patients, nonetheless each claim about what constitutes "healthy" or "adaptive" or "appropriate" behavior or thought is ipso facto a moral judgment. It may, Symington seems to suggest, be profitable to be more explicit about this, especially with those patients who are asking explicitly moral, metaphysical, or existential questions. 

Of course, such engagements must be nicely judged to avoid moralizing or moral imposition. As Symington recognizes, 

If the psychotherapist does not understand the moral element to mental distress, then the patient will superficially sigh with relief but, at a deeper level, go away disappointed. There is no doubt that the theoretical models with which the trainee psychotherapist is equipped during the course of his training are essential tools of the trade. But of equal importance to this knowledge of theory is knowledge of when and how to apply it-which tool to use for a particular job.

Process Your Own Mourning and Melancholia:

Symington does not shy away from noting several significant challenges a therapist must continue to face. At the end of ch. 3 he says that the therapist's "task is to reach his own feelings," especially "feelings...[of] pain and loneliness." Why should any of us want to do that? The answer is quite simple: doing so is a win-win for both people in the relationship: "If... he reaches his own feelings, it frees the patient and favours his emotional development." This is not a one-and-done kind of thing, but, Symington says, an on-going task throughout the therapist's life. 

Take Courage!

Later in the book he recognizes that this task of the therapist recognizing his own feelings of pain and loneliness requires courage or, as he says, "moral fortitude is an essential quality in a psychotherapist if he is to endure the pain that reaching those feelings entails. In other words, moral courage is needed to deal with mental pain."

Keep Your Imagination in Good Working Order:

In ch. 4 Symington notes that very often "patients come to see us when things have broken down and when their lives no longer hold meaning for them." In such a situation many of them will "place implicit trust in the psychotherapist's ability to help them rebuild their world." A therapist will be useless at doing this "unless the imagination of the psychotherapist is in a healthy, functioning state." I know such arguments make some people very nervous, especially if they have been led to believe there is a manual for everything so that imagination becomes otiose. And I think Symington would be the first to agree that this, too, must be finely judged so that the therapist's imagination does not run riot, indulging in what Freud would call "wild analysis." 

Symington comes to this point a little later in the same chapter, when he says that it "is important that the psychotherapist should freely exercise his imagination while in the process of determining the most appropriate treatment programme for the patient." As he goes on to recommend, some of this can begin even "at the initial assessment interview" when, "as the patient is allowed to talk freely" the therapist then "relaxes into an inner attitude of free association," a process that "will frequently lead him to the area in which the patient has the greatest difficulty."

Your Office Matters!

In a separate, longer post sometime down the road, I will bring in some of the research I did this past semester on the arrangement of a therapist's office. That research, as it turned out, revealed that common arrangements (sometimes in textbooks referred to as the SOLER set-up) are very under-theorized and based more on assumptions.  There are gaps in the research here which are nonetheless covered over by common assumptions many people seem to copy almost mindlessly--chief among them that one must always sit squarely facing the patient. Knowing this, I was greatly cheered to read that Symington is also aware of the power of the environment to be (or not to be) "conducive to the free exercise of the imagination.... The interior decoration of the psychotherapy rooms and the whole psychotherapy department will, in itself, play an important part in both the activity of psychotherapy and the enjoyment of the results." 

Can You Paint Your Patient?

At the end of ch 4, Symington, who has written elsewhere about the British analyst Wilfred Bion, quotes the latter in a way that uses a really striking image: "When you have seen a patient, instead of going and writing up the session, why not instead go and make a painting of the next session." I can't paint (or draw) worth a damn, but I like this image in part because of what it seems to imply about the relatively freer mode of painting vs. the tendency to feel one has locked something down in writing, especially if one also happens to be, as I am, a longstanding academic editor with a ruthless intolerance of sloppy writing. 

But sometimes ruthlessly cogent writing can be its own kind of prison, and we need to break out of it at least to some degree. One of the many valuable lessons I have learned from Adam Phillips is that people may often come to therapy precisely when they feel the stories of their life have been too tightly, narrowly, pathologically written--by themselves and others--and need help finding a freer, newer story to inhabit. 

But the search for alternate or freer stories is always going to be challenged, perhaps most of all by ourselves. As Symington recognizes on this point, the process of therapy is a constant battle against patients who want to be cured but, at the same time, do everything in their power to avoid mental pain. Much effort, a good deal of it unconscious, will be spent trying to steer the therapist away from the patient's areas of pain. This, of course, has been known from the beginning when Freud saw resistance emerging almost minutes after a patient settled onto the couch for the first time. He wrote about it, and later his translator and sometime analysand Joan Riviere did also in her essay on negative therapeutic reaction. 

Sometimes the Complaint is Justified!

Symington is helpful in noting that not every bit of negative feedback from the patient is just projection or pathology. Sometimes they are right to be critical. As he says, the psychotherapist needs a finely tuned sensitivity in order to distinguish between the negative transference and straightforward justifiable negativity--as when, e.g., the therapist has been an ass or made a major mistake. 

The Importance of Neutrality:

For people personally inclined towards, and professionally trained in the practice of, empathy, it may be difficult to realize that one can go too far in trying to take the patient's side or in accepting uncritically what s/he tells you. This, I think, is especially tricky in cases of massive trauma. In such cases, Symington quotes Jung "'The patient does not feel himself accepted unless the very worst in him is accepted, too'." This has to be a comprehensive acceptance of the love and hate, the ambivalence, the admirable and despicable parts of the self. 

But Symington (and others I have read) is very clear in noting that acceptance must be contained within a broader neutrality of sorts. As he says, if the "psychotherapist puts himself entirely into the shoes of the patient and bases his understanding on the patient's own point of view, excluding all else, he will do nothing to solve the patient's basic problem." That is because, he continues, the patient comes to us in the first place "because his own point of view had not solved his problem. To be able to solve it, he needs the point of view of the Other."

Approaching Termination:

Many people have turned their hand to the question of when a therapy might be ended, or what signs or criteria one might use in judging whether a patient is approaching a terminal phase in the treatment. Symington also has done so in this book, noting two primary criteria which he regards as "particularly good indicators of whether emotional maturity has been achieved. These are the capacity to bear criticism and the capacity to manage confrontation."

But termination is not the end--far from it. As Adam Phillips has said, "the cure can only begin after the treatment has ended." (That may be more true for classical psychoanalysis than psychotherapy, but it seems to me that if either is good and worthwhile, its long-term effects will continue to be manifest almost if not daily. I certainly believe it to be in my own life.) And termination can leave in place certain skills that allow the patient to negotiate future struggles. As Symington notes in the book--with some hesitation--far from being in a crisis when you go to therapy, going to therapy is itself a crisis. If it is successfully survived, then this becomes a rich and significant source of strength to prevent collapse in future crises.

One final note here on the theme of termination, drawn from a fascinating book I read several years ago: Fred Busch's Creating a Psychoanalytic Mind: A Psychoanalytic Method and Theory. 

In that book, Busch divides the therapeutic relationship (as many do) into 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 consists in learning to observe one's own mind and its sequence of free associations. Such a 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. 

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