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bookREVIEW: Therapist and Client

A Relational Approach to Psychotherapy

Patrick Nolan
Wiley-Blackwell 2012
(Paperback) pp206

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Reviewer Jane Edwards

Nolan begins and ends his short, but I felt important, book by reflecting on how the roots of therapy can be found in ordinary human contact. He evidences this with descriptions of his own mother, whose intuitive skill at dispensing ‘plain, empathic counselling’ to her customers in the family corner-shop, are remembered as ‘warm and friendly yet businesslike.’  Nolan obviously learned much at her side, as the same description could also apply to the warm, empathic tone and friendly, straightforward style he uses here to effectively convey at times complex theoretical ideas. In his foreword Peter Stratton suggests that ‘if he (Nolan) were being grandiose, (this book) could be claimed to be a universal conceptualization of all interpersonal therapies’.  Thankfully Nolan never comes across as grandiose; instead I was left with the impression that his motivation was a modest desire to share generously how his work over the years has developed into a personal relational theory integrating both mind and body.  He says that this book ‘aims to set out vital elements of the therapeutic relationship (where) no one theory applies exclusively since therapy in each case is different, and requires us to tailor the way we work, fitting therapy to our individual clients.’ (p159)

While reading I was frequently reminded of other wise words, generously dispensed by the many experienced therapists I encountered during my training, that enabled me to keep my faith in the ‘muddled thinking’ and paradoxical tension that is required of an integrative therapist. I also remember a casual conversation I had with another student on a psychodynamic foundation course who, when hearing my training was integrative, related that she had been advised by her tutors that she should consider pursuing a range of further courses, but at all costs avoid an integrative training!  This left me mildly bemused, while also managing to find that soft underbelly of doubt I imagine most therapists of the integrative persuasion carry around with them. Integration is not an easy calling; sometimes I’ve found myself longing for the authoritative certainty of a single-school training.   An ongoing challenge for all therapists, but I would have thought particularly when newly qualified in integration, is to find our own words to describe what we do.  Indeed, the advice of my Course Director, delivered in her harsh New Yorker’s twang remain etched in my memory – “You’d better know how to talk about this stuff or you’re gonna look foolish – you can’t just say it’s the relationship, you gotta know why it creates change, and be able to explain it!”  This is what Nolan achieves here – lucidly without unnecessary jargon.

The first section describes the caregiver-baby relationship as the basis of inter-subjectivity, and relates it to the therapeutic dyad. More recent developments in infant research and neuroscience, (Bebbe, Schore, Stern) are used to support the theories of Bowlby, Winnicott, Trevarthen et al, focusing on the subtle interplay of mutual regulation and attachment. Case examples of a handful of his clients are threaded throughout to illustrate theory, often using bracketed italics to highlight specific points or interventions. From here Nolan moves on to the idea of ‘the third’ (Ogden) or the potential space where creativity and play become possible. Unsurprisingly Winnicott forms the basis of the ideas in this chapter, but I found Nolan’s confidence in the therapeutic use of play, and excellent examples of different kinds of play in action, far more accessible than any direct reading of Winnicott I’ve attempted.  I ended the chapter feeling emboldened and able to give myself permission to play more in my work. Nolan then describes how inter-subjectivity, or ‘reciprocal mutual influence’ is the constant focus in his client work before linking this to what he calls ‘the relational body-mind.’  This chapter provides an excellent overview of bodywork (Reich, Lowen, Bodella, Totton and Staunton are some that are mentioned) reminding us that there are ‘two bodies in the room, not two talking heads’. The philosopher Merleau-Ponty is quoted: ‘My body is the fabric into which all objects are interwoven … the physical, sensing body is the essence of our existence, providing the basis for contact with the self and other.’ (p109)

What Nolan calls the five modes of Experience, Function & Expression – body sensations, emotion, cognition, imagination, movement/motor activity – are then introduced: he describes how we must attempt to attend to all five aspects of our clients, while maintaining Bion’s notion of ‘no memory or desire’. Nolan applies these theories specifically in the following chapter to traumatized and what he calls ‘fragile’ clients, highlighting the importance of ego strengthening and grounding to avoid re-traumatising and overwhelming. The final chapter is a firm reminder that play and creativity are not achievable without the safe containment of the frame and contract, and here Nolan leans towards a psychodynamic approach when insisting that a thorough assessment is a vital element of any ongoing treatment. Throughout the book Nolan finds many ways to describe the art of therapy, often using sailing metaphors very aptly; for example: ‘We tack our way through therapy, zigzagging, reversing, and circling, sensing our way not to a clear location, but to a destination of achievement in journeying together.  The progression becomes visible mainly in hindsight.’ (p191) He ends entreating his readers to develop their own individual style, describing how his training and knowledge now combine with the confidence of practice and his character to form his own style of therapy.

If I were to have a grumble it would be that I would have liked Nolan to have been more explicit about language, because at times I was unclear whether or not he chose to communicate his counter-transference to his clients, and if he did, what words he used to convey these complex feelings.  But this is but a small quibble about an otherwise near perfect little book. In my opinion it deserves a large readership, and in particular I would urge that it be read by all recent graduates of integrative trainings as an inspiration and encouragement to them as they ‘head out into unchartered water,’ as Nolan might say.

Jane Edwards is a UKCP registered Integrative Psychotherapist in private practice and co-founder of Londonpsychotherapynetwork.