Advances in Relational Psychotherapy

This presentation offers a synthesis of perspectives drawn from British Kleinian theory and American relational psychoanalysis focusing on our understanding of the function of guilt within the psyche, why people so readily hurt each other, and the role of reparation as both a defense against the burden of guilt and as a demonstration of love to the injured person. Neil Altman suggests that relationalists tend to follow the Kleinian idea that guilt arises from “hurting the one you love”, but see both the hurt and the love as socially constructed, in a dialectical relationship to each other. Altman elaborates these themes through a case study. Here we see two people, each struggling with the guilt that arises in ruptures, impasses and enactments, and struggling toward the kind of repair that makes one feel that goodness and badness can co-exist. The case pivots on his realisation that an enactment has grown out of his own childhood trauma.

Video lecture with transcript – 23 mins

Interview / Q&A with Dr Neil Altman

Video interview – 14 mins

In this conversation, Shoshi Asheri will present a clinical encounter which illustrates how the invisible bonds that pre-exist between therapist and client can be utilised therapeutically, if dared to be felt by both therapist and client.

Together, she and Roz Carroll will discuss the complex notion of ‘Felt Participation’ as a navigating tool in the invisible field of connection and dissociation between therapist and client. They will explore their understanding of the potential that sits in the paradoxical tension between the therapist as a person and the therapist in their role, and the creative edge arising from staying with a moment to moment embodied lived experience.

The discussion then opens out into the broader question of how to foster in trainee psychotherapists the capacity for embodied relating and improvisation side by side with the capacity for reflexivity. Finally they will consider the importance and the complexity of creating a therapeutic culture that democratises the power relationship.

Video lecture – 1 hr 14 mins

In this presentation, Jessica Benjamin explains her conceptualisation of the ‘third’ and its application to psychotherapy. She regards the creation of thirdness as an intersubjective process that is constituted in early, pre-symbolic experiences of accommodation, mutuality and the intention to recognize and be recognized by the other; it is a relationship of mutual recognition in which each person experiences the other as a ‘like subject’ yet has a distinct, separate centre of feeling and perception. In contrast to the notion of the intersubjective as a system of reciprocal mutual influence, the term ‘third’ is used by her to convey the representation of a potential relationship that we use to break out of the reciprocal lock of complementarity.

Video lecture – 15 mins

The therapeutic relationship at the heart of this paper revolves around the special language that developed between Akela, a young Egyptian born married woman, and Doris Brothers – her American analyst. On entering therapy, Akela not only lacked a sense of belonging to a place or nationality but she was also deeply confused about her professional and social life. Despite this, she quickly developed the sense that she belonged with her analyst even though, superficially, they appeared to have many differences. This talk describes the unfolding of a therapeutic relationship from dislocation to connection that is utlimately enriched by a strong and mutual sense of twinship. The analyst’s own relational past and her capacity to recognise an enactment stemming from her interpersonal history is significant in the success of the therapeutic process.

Video lecture with transcript – 35 mins

This presentation is an exploration of a particular theme in relational psychoanalysis: who does the work. It is possible to think of the analyst as engaged in a struggle to grasp the patient’s internal life, Muriel Dimen argues. However, this struggle does not belong to the analyst. It belongs to the patient. Here, she does not mean that the analyst should not struggle. Rather, that the work of analysis is about patient’s relation to themselves. Insofar as it focuses on the analyst-patient relationship, it does so in order to foster the patient’s understanding of their inner life. Inevitably, this self-knowledge draws both analyst and patient into their social situations, their cultural constructions of themselves, and the distribution of power within and outside the consulting room. These ideas are illustrated by two engaging case studies.

Video lecture – 57 mins

Maria GIlbert presents a relational approach to supervision in which she focuses on the co-creation of an effective learning environment for the supervisee. The aim of the supervisory process is to encourage curiosity and reflexivity in the interests of a creative learning process. She highlights the importance of attuning to the uniqueness of each supervisory and therapeutic encounter.

Video lecture – 51 min

The question of a theory of analytic change is approached in this talk through a consideration of analytic impasse. This phenomenon is considered in the light of the analyst’s character formation, the relation of analytic vocations to early attachment, and object ties in the analyst leading to problems with omnipotence. Impasse, Adrienne Harris suggests, is tied to various processes and defenses that shape and contribute to the analyst’s countertransference. Analytic change is considered here in the context of theories of nonlinear development, models of speech practice, and mutative action, explored here through case material and biographical detail.

Video lecture with transcript and slides – 1 hr

Although the Relational Movement represents a huge paradigm shift, Nancy McWilliams – having been trained in the tradition of Kohut and Sullivan – initially felt that certain relational ideas were already active in classical psychoanalysis. She later became aware of the extreme rigidity in which some colleagues had been trained, and which contributed to the genesis of the ‘relational turn’. The new honesty about the analyst’s true feelings, and the inevitability of enactments, recognition of therapeutic change via the processes of repair and meta-communication were – she argues – a remarkable development leading to important advances in technical skills. Dr McWilliams discusses her vision for a more fully integrated school of psychotherapy that combines relational skills, self-psychology, an understanding of character and a diagnostic model that allows for psychopathology, based on a platform of sound research, offering an illuminating picture of the current state of the field.

Audio lecture – 38 mins

In this presentation, Jeremy Safran describes how he faced a sudden incapacity to empathise with a long-term patient – a relational breakdown which resulted in intense and conflicting emotions for both. He identifies this as an enactment, “the repetitive interactional patterns between patients and their therapists that reflect their unique personal histories, conflicts, and ways of relating to the world”. These interactional patterns, he suggests, can be very destructive, obstructing therapeutic progress and potentially re-traumatizing the patient. At the same time, they afford a tremendous opportunity for therapeutic change if they are worked with in a constructive fashion. Dr Safran describes the multifaceted inner and interpersonal skills that therapists require to facilitate this type of collaborative exploration, emphasizing the importance of the therapist’s inner work. He suggests that mindfulness is an essential skill for the therapist’s own affect-regulation and their capacity to work through and talk about internal processes in a meaningful, therapeutic fashion.

Video lecture with transcript and slides – 55 mins

Andrew Samuels describes the history of relational psychoanalysis as rooted in the transformative social and political movements of the twentieth century. He suggests that the civil rights movement, feminism, gay liberation and radical student politics formed  powerful influences on the clinical values and ethics of the relevant generation of relational psychoanalysis. Though analysis is not a crude relationship of ‘equals’, Andrew suggests that egalitarianism is the key historical factor. In common with other relational psychoanalysts, Andrew questions the use of the terms ‘object’ and ‘subject’, and the ubiquity of ‘the infant’ in the discourse of traditional object relations based psychodynamic psychotherapy. In the UK, Samuels thinks, relational psychotherapists are engaged in an ambitious project to go beyond ‘schoolism’, working out a pluralistic synthesis of many routes to relationality. He ends by speculating on future developments.

Video lecture – 40 mins

We are used to the idea that trauma in the past interrupts our capacity to grasp the present. But present or recent trauma can have a similar dissociative effect on our capacity to experience the more distant past. Contemporary trauma can rob the past of its goodness, leaving one feeling as if the past is gone, dead, separated from the present. The vitalization of the present by the past or the past by the present requires that experiences be linked across time. These links are created, in both directions, via categories of experience characterized by shared affect (Modell 1990, 2006). Such categories are created, in turn, by metaphor; and the construction of these metaphors across time requires that one be able to occupy self-states in both the past and the present that can then bear witness to one another. Trauma can result in the dissociation of these self-states from one another, leading to a disconnection of present and past.

Video lecture with transcript – 24 mins

Witnessing Across Time: Accessing the present from the past and the past from the present – PART II

Video lecture and transcript – 41 mins

Just as the child’s original attachment relationships make development possible, it is ultimately the new relationship of attachment with the therapist that allows the patient to change. Our ability to provide a secure base will largely depend upon our own attachment history – and our relationship to that history. To set the stage for exploring the impact of our own psychology, David Wallin will discuss how therapists can attempt to generate a secure base and in the process help their patients to deconstruct the attachment patterns of the past, to construct new ones in the present, and to integrate previously dissociated experience.

Video of lecture with captions – 36 mins

Enactments, mentalizing and developing a mindful stance with the patient

The healing potential of the therapeutic relationship is ultimately determined by the interaction between the attachment patterns of the patient and those of the therapist – which often emerge from a history of trauma. Failing to attend to the impact of our own attachment patterns, we usually repeat them, often compromising our efforts to create a secure base. By contrast, recognizing the hand of our past in the present can loosen its grip, while also revealing the ways in which own attachment patterns and those of the patient are meaningfully related. David will discuss how our attachment patterns shape not only how we relate but also what we know-sense, feel, think, and remember. Such patterns can be sources of insight (we know others most deeply on the basis of what we know about ourselves) but also of impasse (our ability to know others will be limited by what we are unable or unwilling to know about ourselves).

Video of lecture – 16 mins