What kind of therapist am I?

Allan Shafer, Psychoanalytic Psychotherapy Association of Australasia (PPAA)

Allan Shafer MA (Clinical Psychology) D Litt et Phil, has worked primarily as a psychoanalytic psychotherapist in private practice for over four decades. He has been involved in various PPAA state organisations’ training programmes as a teacher, supervisor and training therapist. Allan is a past Executive member of the Psychoanalytic Psychotherapy Association of Australasia, a past President and Director of Training of the Association of Psychoanalytic Psychotherapists of WA, a clinical member of and held various roles in the Victorian Association of Psychoanalytic Psychotherapists and, a founding member and past of President of Group Relations Australia. In addition to presenting seminars and lectures internationally, Allan has directed or consulted on the staff of over thirty group relations conferences in Australia and internationally.

To respond to the three key questions: Who are we as therapists when we work? How does my therapeutic work unfold? Why do I work this way? I must go back to the beginning of my formation as a psychoanalytic psychotherapist and reflect on the influences that shaped me along the way.

My passion for psychoanalytic thinking began in my teens but my early professional training was primarily in systems theory, which was popular in the early 1970’s. In the mid-70’s the Johannesburg Psychoanalytic Study Group came into being and my psychoanalytic formation began, deeply influenced by British Object Relations thinkers, including John Steiner, Michael Feldman, Isca Salzberger-Wittenberg, Edna O’Shaughnessy, Judy Jackson, Henri Rey and others. For many years in my early career as a psychoanalytic psychotherapist I was something of a devotee to Kleinian thinking. 

Soon after I migrated to Perth in 1987, I attended my first Tavistock-style group relations conference and discovered Wilfred Bion, who, in addition to his group relations work at the Tavistock, is – of course – a giant in post-Kleinian psychoanalytic thinking. Group relations has been a major contributor to my work in Australia and internationally, since it integrates systems and psychoanalytic thinking. But Bion’s ideas have significantly shaped my approach as a psychoanalytic psychotherapist, in addition to an appreciation of the systems in which we all live and work. The therapeutic dyad is, after all, a social sub-system.

Let me tell you a story, now, about more recent influences on my formation as the psychoanalytic psychotherapist I understand myself to be today.

A few years ago, a group of colleagues in Melbourne was engaged by Margaret Spelman, an Irish psychoanalyst, to write a chapter reviewing the book The Suppressed Madness of Sane Men by the psychoanalyst Marion Milner (1987). I had not been exposed to Milner’s work before. This was a contribution to a book aimed at resurrecting and drawing attention to the value of Milner’s relatively forgotten contribution to psychoanalysis, by an international group of psychoanalytic thinkers. The book, edited by Spelman and Leff-Raphael, has since been published under the title: The Marion Milner Tradition: Lines of Development. 

Milner reported in the book we reviewed that one of her child patients asked the question “What kind of Mrs Milner are you?” This evoked a similar question in our group – “what kind of therapist am I?” which is very pertinent to our work today in this event.

While reading Milner’s work I struggled with an overwhelming soporific state. Ultimately that state led me to understand better my own position on the therapeutic process and the creative process that it involves. In other words, I had a realisation about what it might mean to be overcome by a soporific state when reading her work. Especially since communication – verbal, somatic, psychic, artistic – is central to Milner’s work, particularly creative communication of the ineffable – so fundamental to the psychoanalytic endeavour. 

Milner highlights the failure of esoteric psychoanalytic language to meaningfully engage with the non-psychoanalytic world. I too, have struggled with this. Indeed, this has contributed to my questioning of Klein’s approach. The language of Milner’s early interpretations and some explanations – especially material that was heavily influenced by Melanie Klein – often seemed so remote from an ordinary understanding and from how ordinary people talk, that it seemed to me non-sense-making rather than sense-making. I was, for example, astonished at some of the meanings attributed to early childhood psychic experience and the related style of interpretations that Milner, influenced by, Klein made to very young children. 

Despite my antipathy, I was intrigued by Milner’s exploration of creative processes, especially her proposition about the power of the capacity to allow a unique symbol or idea to emerge from simultaneously held contradictory positions. My understanding of her ideas about the crucial function of reverie and absent-mindedness to make space for ideas to emerge and to be given symbolic expression in words and in drawings was profoundly useful and confirming of how I work. Allowing myself to explore my sleep-induced state had a value! An idea had emerged from it that I could apply.

Neville Symington’s work has also been a major influence on who I am as a psychotherapist. His ideas about creativity in the psychoanalytic process align with my experience of making use of the kind of soporific state I experienced when reading Milner. Symington, too, turns to reverie and a certain creative process as central to both psychoanalytic work and artistic creation. His description of a psychoanalytic state of mind resonates strongly with my understanding of what happens in therapy: ‘a state where the mind of one person is engaged with the mind of another in such a way that there is space for imaginative reconstruction…in the observer’ (Symington, 2005, p,10). Imaginative reconstruction is the essence of creativity. 

With Symington’s influence, I considered the impact of Milner’s work on my emotional state and saw that, as I read parts of Milner’s book carefully and only skimmed others, I might – in the spirit of the book - find a state of mind where unexpected ideas could emerge, despite the immense gravitational pull to sleep. Consistent with what I have alluded to, I was struck by her reference to ‘A place for absent-mindedness’, in light of the fact that while reading her work my mind often felt absent. She says:

… it requires a mental setting and attitude … a tolerance of something which may at moments look very like madness. … can we, in our so objectively-minded culture, come to recognize them as something to be used, in their right place? (1987 p.231).

So…what kind of therapist am I?

Reading Milner’s book stirred many thoughts in me about what kind of therapist I have been and am becoming. Reflections of this kind have been on my mind for many years now. For a long time, I had tried to adhere to what I now think of as rigid, sometimes quite punitive, ‘Kleinian’ orthodoxies. Nevertheless, some core object-relations ideas such as projective identification, and the defences of the paranoid-schizoid and depressive positions remain crucial aspects of my thinking.

Reading Wilfred Bion, who has become seminal to my work, I had often felt quite mad, and I had resigned myself to the realization that, while I often had no idea what he was writing about, I simultaneously often understood what he meant.  This was one of my first introductions to two ideas that now profoundly influence how I work: first, that creativity can emerge from states of ‘madness’; and second, that a new realization can evolve from contradictory ideas. 

I must both hold onto and let go of my mind. 

What is particularly relevant here is my capacity to tolerate the psychotic states (in Bion’s sense of psychotic) that are projected into me and with the help of other minds – like my writing cohort – to be able to think and to make important emotional discoveries.

Reading Milner’s ‘The Suppressed Madness of Sane Men’ had a related but not identical effect on me. I found the soporific states almost unbearable and a few times I was furiously ready to give up and resign from my collegial group with whom I was working to review this book. However, the capacity of the group to contain my feelings and my mindlessness helped me to find my mind and once again reminded me of Bion’s contribution to recognizing the importance of another mind to this process of creative consolidation of sense-making.

Milner’s ideas about the capacity to bear – indeed to be immersed in - madness and the potential for creativity to emerge, particularly out of contradictory ideas - was very meaningful to me; this was another way of articulating the kind of therapist that I hope I am constantly in the process of becoming. That is, one who - as Symington and Bion describe - finds a state of reverie with space for imaginative reconstruction. And one who offers a mind to another for their psychic survival.

Following these ideas, I believe that the psychotherapeutic process lies in the interpersonal domain. What is required in this state, is my capacity to bear powerful projective identification and to observe my subjective emotional experience, which David Armstrong refers to as the ‘proper object’ of psychoanalysis. (Armstrong, 2005) 

Therapeutic change – how does it occur?

My contention is that the inner act of freedom (as Symington, 1983, calls it) in the psychotherapist can produce a therapeutic shift in the patient and new insight, learning and development in the psychotherapist. This means that I must continually seek to create a space in my own mind, to think my own thoughts, under the emotional pressure of the clinical encounter. The function of interpretation is that it gives expression to the shift that has already occurred and makes it available to consciousness. 

This construction of how therapeutic change happens has led me to reflect – from my own experience as a psychoanalytic psychotherapist – on the state of mind I need to be in to work in this way. I describe this as a ‘psychoanalytic state of mind’ and I think it is a similar state of mind that enables many forms of creativity, as Milner described it.

In addition to this phenomenological position, I have also, through my extensive experience in group relations consulting, come to examine and to appreciate the related liminal space between my person and the role I am in when working as a psychoanalytic psychotherapist and also between me and you (the patient): the space in which this inner freedom in me is communicated to facilitate  therapeutic insight and change.

Armstrong puts it well when he asserts that the object of inquiry and the medium of inquiry in psychoanalysis are symbiotic. In other words, there is a relationship between me, the observer and that which is observed – especially insofar as emotional experience is concerned, and they are inseparable. I observe the patient, myself and the relationship between us through the vehicle of the emotional engagement that that relationship produces. The therapeutic dyad is a social sub-system which is mutually created.

I distinguish emotional engagement from emotional involvement which usually implies action or reaction aimed at reducing my own arousal and the patient’s. Emotional involvement entails a personal investment on the part of the reactor, unlike Bion’s imperative to ‘eschew memory and desire’. (An aspirational state!) This means differentiating my person from the role I am in and examining how my ‘person’ shapes the way I take up the role within the therapeutic sub-system.

This is a crucial boundary that I believe needs to be rigorously attended to. I like the way Maurice Whelan (1992) puts it when he says: ‘I am not going to treat you as any other “real” person would. I am not going to react and have my human needs realised through you. I am going to listen, attend, think and then speak (interpret).’ But I believe that my humanity and that of my patients must nevertheless never be lost.

So perhaps what kind of therapist I am – or continually aspire to be – is one who trusts his own mind; who examines his assumptions and the phantasies aroused by another; who appreciates the roles he is in or pressured into and has a valency for, and how he relates to these roles; one who recognises and explores the conscious and unconscious dyadic therapeutic relationship as a sub-system that is an element of the larger (unconscious) system of the external landscape; who can let go and hold on at the same time; who can be simultaneously immersed in sometimes mad and sometimes frightening states of mind and yet remain personally and interpersonally tethered in such a way that through what Bion would call ‘selected facts’, meaning can be made between two minds; but also one who retains a real sense of the humanity of both the patient and myself. This is the evolving and important challenge I unremittingly face in this work.

References.

Armstrong D (2005). ‘Names, thoughts and lies: the relevance of Bion’s later writing for understanding experiences in groups’. In Robert French (Ed.). Organisation in the Mind: Psychoanalysis, Group Relations and Organization Consultancy. London: Karnac. 

Milner, M (1987) The Suppressed Madness of Sane Men: Forty-Four Years of Exploring Psychoanalysis. London, Routledge.

Shafer AT (2014) Is there a psychoanalytic state of mind and how is it formed? Australasian Journal of Psychotherapy. Vol 32, No1 pp76-89

Shafer AT (2017) External landscapes/internal worlds: the politics of hate and anxiety. Paper presented at the PPAA Conference 2017: Things fall apart: the centre cannot hold.

Symington, N. (1983) The Analyst's Act of Freedom as Agent of Therapeutic Change. Int. R. Psycho-Anal., 10:283-291 

Symington, N. (2005). Where is the medicine of healing in psychoanalysis? Australasian Journal of Psychotherapy. 25,2, 6-22.

Whelan, M (1992) “What counts in the counting game?” Australasian Journal of Psychotherapy 11 (2), pp.41-54