Reviewer: Brad McLean
We are now approaching 30 years since the beginning point of what has been called the ‘relational turn’ in psychoanalysis and psychotherapy. Given that relational theory has embedded itself as a predominant meta-theory informing much of modern psychotherapy, it seems that it can hardly continue to be called a ‘turn’ anymore.
The widely-used metaphor of the relational sensibility being a binding orientation holding together diverse practitioners under the one ‘tent’ means that rather than a turn, relational theory is more a relatively straight highway linking a broad church of practitioners from diverse schools of psychotherapy.
Such inclusivity comes with a variety of challenges, particularly for trainees. I myself know from experience that many people I meet professionally who describe themselves as relational do not practice in the way I do, and I am sure, having met me, they feel the same way. With so many practitioners considering themselves relational and having background training in a host of diverse psychotherapy and psychoanalytic modalities, what binds relational practitioners together? And how is their clinical practice distinct from their original training? Where is the common ground? Indeed, the notion of systematising and categorising technique for relational practice is considered antithetical to some practitioners who valorise the unique therapeutic dyad, believing each therapeutic coupling is unique and beyond codification. But these sorts of positions don’t help clinicians learning to practice and they leave trainees floundering. While ‘not knowing’ is profoundly relational as a position, it can be very confusing. Surely how relational clinical practice is taught hinges on clarity about exactly what relational analysts and psychotherapists do in their work?
In the opening chapter of Core Competencies of Relational Psychoanalysis, the book’s editor, Professor Roy Barsness, explains how, in response to his students’ confusion about the complexities of learning to work relationally, he began to reflect on his own practice with clients to address key questions about what relational psychoanalysts and psychotherapists actually do. His description is too detailed to recount here, but it is a very coherent explanation of the steps he follows, and immediately resonates with its detailed analysis of the complexity of working in this way as a clinician. It’s a worthy pursuit and opens this excellent book, which addresses some of the fundamental questions outlined above.
Barsness’s ‘mapping’ of his own clinical practice, he explains, was the genesis of a qualitative study involving interviews with 15 experienced relational psychoanalysts with the objective of eliciting detailed information about “how the mind of a relational psychoanalyst functions in the actual therapeutic moment to discern if there is a set of principles or practices that can serve as guideposts in the practice of our work” (p.10). Study participants were asked to reflect on a number of aspects of their clinical work, either generally or in relation to a specific clinical encounter in the previous day.
Using a complex process of grounded theory analysis of the material collected in the 15 hour-long interviews, the author arrived at a collection of core competencies. These competencies include therapeutic intent, therapeutic stance/attitude, deep listening/immersion, relational dynamic (i.e. the there and then and the here and now), patterning and linking, repetition and working through, courageous speech/disciplined spontaneity and, finally, love.
An exploration of each of these competencies forms the body of the book (chapters four to eleven) which are authored by leading and very recognisable academics and clinicians in the field. For example, Nancy McWilliams writes chapter five on the therapeutic stance/attitude, Lewis Aron explores the relationship between past and present in chapter seven, and Karen Maroda explores repetition and the process of working through in chapter nine. Each of these chapters are immersive, stimulating, and sharply written. The authors take on the task of illustrating these specific competencies theoretically and through case material bring each particular competency alive for the reader, and taken as a whole these chapters bring clarity to what is unique about the clinical work.
Despite their richness, exploration of the core competencies through the chapters above is only part of what this book offers in its four sections. The first section, ‘Current Research and History of Relational Psychoanalysis’, offers a detailed outline of the qualitative study discussed above by the book’s editor. Additionally, this section includes a comprehensive chapter outlining the evidence base supporting psychoanalytic psychotherapy, which challenges long-standing misconceptions about the lack of evidence for its treatment effectiveness. A final chapter in the first section, authored by Adrienne Harris, historically contextualises the emergence of the relational perspective as a critique of classical theory and covers, among other things, the emergence of two-person psychology, the concept of multiple self-states, developmental and ‘emergent function’, and the positioning of relational theory as a radical field theory.
Section three of the book could be considered an exploration of the meta-contextual issues informing relational work, and includes chapters addressing the role of culture, gender, and sexuality, among other issues. It examines the ethical complexities of relational work and the vital area of practitioner self-care, and also includes an important chapter on the right brain in psychoanalysis, written by the eminent Professor Allen Shore.
Finally, section four of the book has both a critique of relational psychoanalysis by Professor John Mills and a postscript contributed by the current president of the International Association of Relational Psychoanalysis and Psychotherapy, Steven Kuchuck, penning a gentle rebuttal of Professor Mills, who takes a highly critical position on an array of issues associated with relational theory and practice in his chapter. It’s a chapter the editor could have left out of the book, but is an important inclusion for providing a full survey of the terrain.
Having trained as a psychotherapist in a program grounded in relational theory and practice I have to admit that the experience was at times disorientating and, if I am completely honest, theoretically confusing on the one side and simultaneously exciting, generative and paradoxically coherent on the other. This book would have helped because of its sharpness and clarity as it cuts through the labyrinth-like body of relational literature. Not only is it practical and well-structured, but in my view this book has the potential to offer a blueprint for training, research and professional development specific to the practice of relational psychoanalysis and psychotherapy.
Brad McLean is a relational psychotherapist based in Sydney, Australia. He can be contacted at email@example.com.