Lewis Aron and Karen Starr
Routledge Relational Perspective Book Series
Reviewer Brad McLean
Recently, a psychiatrist told me he had attended an education seminar on resistant depression at which an eminent colleague told a room full of psychiatrists that in addition to pharmacotherapy he now recommends clinicians refer a selection of their more challenging cases to a psychodynamic practitioner. Somewhat surprised, the psychiatrist told me that just four years ago, at a meeting on the very same topic, led by the same psychiatrist, the recommendation was that in addition to pharmacotherapy, those same resistant cases be referred for CBT.
This might be a statement about the challenges of treating resistant depression or, possibly (as I like to imagine in something of a hopeful projection or phantasy) it is a subtle but positive sign that analytic thinking and its clinical application is in ascendance. It’s also likely that I am making too much of the tale. Given my own views about the value of psychodynamic thinking, I struggle to understand why so few in the mental health professions see what I see.
But there are more positive signs. I’m buoyed by the diversity of clinicians with whom I attend a weekly psychodynamic psychotherapy course – nurses, psychologists, psychiatric registrars and body therapists – who while learning about psychoanalytic thinking seem to share the positive experience of reading brilliant papers from the great analytic writers. It is writing that carries such richness and depth yet a freshness that makes the work feel not only applicable but to also very contemporary – as if the authors had a crystal ball and knew the issues us therapists would be facing many decades on.
I am also encouraged by the growing number (and diversity) of attendees at meetings held by the Sydney Chapter of the International Association of Relational Psychoanalysis and Psychotherapy. I might be optimistic but there is sense that things are shifting away from cognition and towards the domains of relationship (both internal and external) and subjectivity as destinations worthy of attention and clinical focus.
A number of scholars have reflected that the last 30 years, away from the glare of the centre stage lights, a fertile refashioning of analytic ideas has been underway. Leading relational analyst Jeremy Safran outlined this argument well in an essay published last year on the New York New School’s digital publication Public Seminar entitled The rise, fall and possible resurrection of psychoanalysis in the United States Safran argues here that the marginalization of psychoanalysis had led to engagement with it by researchers, clinicians and theorists with more intrinsic (ie non-establishment) motivations and that while this has served to keep psychoanalysis on the margins, it has allowed innovation (and integration) to flourish. The result has been a transformation of psychoanalysis towards a more contemporary and ‘intellectually vital’ field that integrates thinking from a broad church of social, political and neurological sciences and from the worlds of philosophy and ethics.
So if the opportunity to re-emerge is to be seized what does the post-modern analytic world need in order for it to come out of the cold? What advice should be followed to usher in a new and exciting era in which greater valence is given to psychodynamic theory and its practical integration across the ‘therapies’ and in the broader field of mental health? A careful analysis (I use the word advisedly) of the recent A Psychotherapy for the people: towards a progressive psychoanalysis by Lewis Aron and Karen Starr could provide a roadmap for that future. This incredibly scholarly work emphasizes that salvation may necessarily involve the excising of analytic loftiness, a democratization of its thinking and a return to the genius of Freud and his ideal of making psychoanalysis accessible ‘to the people’.
Lewis Aron, Director of the New York University post-doctoral program in psychoanalysis and psychotherapy and Karen Starr, a candidate in the NYU program and an independent scholar and author in her own right, offer an intensively researched socio-cultural and historical exploration of the binaries, dualities and splits that have defined the life-course of psychoanalysis in this challenging but thought provoking volume.
The authors chart a course through the historical binaries through which psychoanalysis has defined itself in opposition to others (especially psychotherapy) and examines the socio-historical terrain traversed along the way, ending with a plea for a progressive ‘psychoanalysis for the people’ that is flexible, adaptable and connected to other ideas.
Its message builds as the book evolves, taking the reader though the social, religious and cultural influences that shaped the emergence of psychoanalysis, into eminence in 1950s American medical culture and through to its austerity, cloistering and ultimate disenfranchisement from the mainstream of mental health care, swept aside by biological psychiatry and cognitive psychology as they seized control of mental health culture. The book argues that rather than being a victim of circumstances, psychoanalysis did this to itself.
The binaries explored in the book are numerous. They include racism, homophobia, gender politics, authoritarianism, the medical model and many others that serve to reveal where psychoanalysis has ended up, how it separated itself from psychotherapy and, importantly, how the field can embrace an inclusive new vision to take psychoanalysis into the future. This vision of an inclusive psychoanalysis, embracing ‘otherness’ and accepting reciprocal influence is likely to be its one shot out of obscurity.
The highly regarded psychoanalyst Donna Orange, in an essay that simply and skillfully described the book’s content and sensibility as critical to the survival of the psychoanalytic tradition, said:
“Suppose we consider ourselves more simply psychotherapists than otherwise, working in the service of the other. What the other needs from us for healing determines our response, within our limits, and what clinical wisdom we have learned so far. We may have grown up influenced by various traditions but we need not view these as religious denominations to defend as orthodoxies….Why not learn everything we can from everyone?” (Orange, 2014:54-66)
I highly recommend this book as a way of digesting the socio-political and cultural dimensions of psychoanalysis that tell the story of both its strengths and weaknesses.
Brad McLean is a psychotherapist based in Sydney, Australia. He can be contacted at: www.bradmclean.com.au
Orange D (2014) A psychotherapy for the people: towards a progressive psychoanalysis by Lewis Aron and Karen Starr A book review in International Journal of Psychoanalytic Self Psychology 9: 54-66.