Learning Along The Way: Further Reflections on Psychoanalysis and Psychotherapy*
Patrick Casement; beloved mentor, teacher, supervisor, and influencer of psychoanalytic clinicians worldwide, shares some of the thoughts engaged in his latest book.
Stimulated by my unexpected reprieve from a near-fatal cancer, I began to put together my thoughts about psychoanalytic practice in a brief synopsis 1 .
That recall of my clinical thinking re-kindled my enduring passion for this thing called
psychoanalysis
, especially after having ended my clinical practice with patients when I turned seventy.
So it did not take much prompting from a supervisee for me to realize that it might be worthwhile if I were to collate those of my writings that had been scattered between various journals and my own archive. This would offer a useful presentation of my clinical thinking, formed as it has been over the past fifty years.
We have much to learn as we prepare for working in analysis, so it feels reassuring when we begin to recognize some of what we have been learning about when we begin seeing patients.
As we build up our clinical experience we may begin to develop a confidence, even a sense of sureness, as we proceed upon our way. But there are hazards in that sureness. We may develop a sense of preconception, seeing what we expect to find. As a result, we can become caught in a partial blindness, whereby we fail to see the unexpected, and whatever does not fit with what we may imagine we are finding.
Dr Klauber, my second supervisor, used to remind us that it takes at least ten years to become a psychoanalyst after training. It takes time to find our own way.
There is an irony in this because we are usually trained to accept the ways of working that we learn from others. And, of course, we need as much help as we can get as we start the daunting task of working with our patients. But whatever way we work at first, it is to be hoped that we may eventually find ways of working that have the greater authenticity in our being true to ourselves rather than borrowing too much from others.
A balance is required since it is in continuing to explore different ways of working and different ways of listening, that we remain open to considering more than one way of thinking so that we might better understand what we are hearing from our patients.
Alongside this, that openness has stirred some uncomfortable questions about the state of psychoanalytic training. I wonder whether some training analysts might be hiding behind their assumed rightness in how they work? In particular, how do those responsible for training deal with times when things are going wrong? How often might it be that training problems come to be regarded as due to the pathology of a candidate, without attention being given to any contribution to such problems that might come from the 'emperors' responsible for the training?
There are other questions too. 'Why do we interpret?' It might seem to be assumed that it is mainly through interpretation that we help to bring the unconscious of our patients within reach of their conscious minds, as Freud had been advocating. But we may often be interpreting for our own reasons, seeking to demonstrate our own competence rather than staying longer with a more honest sense of not knowing, until other understanding might later emerge.
And perhaps yet another is, “to what extent does our practice of psychoanalysis free the minds of our patients, or do some patients experience a pressure for them to give up their own minds in order to accept some apparently better ways of thinking?” Such 'imprisoned minds', a rarely addressed clinical issue, are more to the fore of thought because of the perspective offered by years of training.
There are also constants and we should continue to attend to the ways in which we may be intruding upon the analytic process, through what we are putting into the analytic space. I am practising with trial identification with the patient, in the session, and considering this as part of all internal supervision. For, to be more truly in tune with each clinical moment, we need to be able to follow closely the interactions between ourselves and our patients; all of this being more immediate than anything we can take into our consulting rooms from supervision or from clinical seminars, or from our reading.
Of course, many know that my own learning from patients has been prominent in all I have done and written about. But I now have also been learning from my work with supervisees. And I want to make clear that in all of my practising with clinical moments, I had been practising as much for myself (for other times) as for my supervisees. That is why I dedicated this, my final book presenting the core of my clinical work and writing, to them.
Book launch recording....
1 Now published and titled “Ways of working” in the International Journal of Psycho-Analysis, 2017, Vol 98(6): 1813-1815.
Patrick Casement is a retired analytic psychotherapist, psychoanalyst and training analyst with the British Psychoanalytical Society.
He is the author of several seminal texts that have become required reading on many counselling and psychotherapy training courses. His first book On Learning from the Patient (1985) was an international bestseller and introduced the concept of the ‘internal supervisor.
* From the Introduction to LEARNING ALONG THE WAY, Routledge. Adapted in collaboration with Patrick Casement.
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