Looking Back
I wrote my first book mainly to sort out my own thinking on the subject of psychoanalysis, not knowing whether it would ever be accepted for publication and not showing it to any publisher until the manuscript was complete. However, once published, this book seemed to catch a wave of interest amongst many who were ready to think afresh about analysis and the clinical practice of psychoanalytic therapy. Fifteen months later Harry Karnac told me that it had become his best selling book in his 40 years of being a specialist bookseller, a fact that he used to mention in his lecture on that subject.
Getting into writing that first book happened almost by chance. The title came into my mind, late one night, when I was not even thinking of writing. My mind then raced through the previous twenty years and it became clear that learning from the patient captured exactly my main clinical interest throughout that time. I knew immediately that this title would not let me go. I would have to write on this theme.
I had come to realize that patients are often giving us unconscious cues when we are getting things wrong. For instance, they may criticize someone else when they are unconsciously feeling critical of us. Similarly, they may point to someone else who gets things right, or who does a thorough job, when they are feeling that we may be failing them in these respects. They are also responding to much more than just what we say but to how we are saying it.
In order to process what was happening between a patient and myself I learned to enter into a dialogue with my own thinking in the session. Ideas from someone else often seemed to get in the way, especially when a supervisor or a seminar leader had indicated how he/she thought I should be interpreting.
I was looking for fresh understanding with patients rather than offering interpretations that had been arrived at from books or supervision, or from other clinical experience. In that task, what helped me most was the process I call internal supervision, an important part of which has been trial identifying with the patient in the session. This has often helped me to find several different ways of seeing what might be going on, and more than one way of trying to speak to it. I believe that when we try out different possibilities, from the point of view of the patient, we are in a better position to choose what to say and how to say it. This can help us to arrive at understanding within the process of a session and in ways that relate more clearly to a particular patient at that particular time, rather than giving interpretations that can easily become analytic clichŽs.
In supervising others I recalled times when I had come across mothers in social work who had felt undermined by experts telling them how they should mother their babies. It was from this observation that I developed the notion of the nursing triad, with a parallel in the supervisory triad, by which a mother or a therapist needs to feel supported by someone who believes in them as mother or as therapist, rather than feeling put down by someone presenting themselves as the _better_ mother or the _better_ therapist.
The title I initially chose for my second book was The analytic Space and Process. I think that the title eventually decided upon, Further Learning from the Patient, may have led to that second book being somewhat overshadowed by the first, as if it were merely offering "more of the same", whereas it is actually moving on from the first book to consider other issues - relating to the analytic space and process.
A very useful question for me has been: "Who is putting what into the analytic space?" This has often helped me to recognize when there is a risk that the process of a session could be taken over by what we put into the analytic space. Quite often this indicates as much about what is in our mind as it may indicate what could be in the patient_s mind. It is then not surprising to find how often patients relate to us in terms of what we have unwittingly revealed about ourselves through how we speak to them. Some patients also take on the thinking of their analyst, whether or not this is a true expression of themselves.
In noting how some analysts work I came to be concerned about the ways in which the analytic process can become circular and self-proving rather than leading to genuinely new understanding for the patient. So it was natural that my mind turned to the issue of Learning from Our Mistakes which, I believe, can help us to get back on course when we have been getting things wrong. In this book I re-visit the case of my burned patient, my work with her having been a major focus in my first book, sharing with the reader how that extraordinary analysis had unfolded as a result of my not holding her hand.
I have often worried that we sometimes speak from a position of sureness, which can seem like certainty, with the result that when something has been going wrong it is often the other person who is regarded as being at fault - not the analyst or therapist. Unfortunately, once we have ended our analysis we are all liable to slide back into projecting onto others the faults we no longer wish to find in ourselves. It can also happen that we begin to see ourselves as apparently knowing better than others. But we do not always know better.
Learning from Life was written after I had retired from taking patients. It was only then that I felt free to be autobiographical. In sharing aspects of my own life I am hoping this may encourage others to find, in their own lives too, much that can help to enliven their understanding and their clinical practice. It is not only from books that we can discover the extraordinary power and relevance of psychoanalytic understanding. It is from life as it unfolds, outside the consulting room as well as in it, that I have learned so much that has helped to bring analytic thinking alive for me. This learning from life has also helped me to temper some analytic thinking with common sense, something which can be overlooked once we get caught into the zeal of analytic "certainties".
Getting into writing that first book happened almost by chance. The title came into my mind, late one night, when I was not even thinking of writing. My mind then raced through the previous twenty years and it became clear that learning from the patient captured exactly my main clinical interest throughout that time. I knew immediately that this title would not let me go. I would have to write on this theme.
I had come to realize that patients are often giving us unconscious cues when we are getting things wrong. For instance, they may criticize someone else when they are unconsciously feeling critical of us. Similarly, they may point to someone else who gets things right, or who does a thorough job, when they are feeling that we may be failing them in these respects. They are also responding to much more than just what we say but to how we are saying it.
In order to process what was happening between a patient and myself I learned to enter into a dialogue with my own thinking in the session. Ideas from someone else often seemed to get in the way, especially when a supervisor or a seminar leader had indicated how he/she thought I should be interpreting.
I was looking for fresh understanding with patients rather than offering interpretations that had been arrived at from books or supervision, or from other clinical experience. In that task, what helped me most was the process I call internal supervision, an important part of which has been trial identifying with the patient in the session. This has often helped me to find several different ways of seeing what might be going on, and more than one way of trying to speak to it. I believe that when we try out different possibilities, from the point of view of the patient, we are in a better position to choose what to say and how to say it. This can help us to arrive at understanding within the process of a session and in ways that relate more clearly to a particular patient at that particular time, rather than giving interpretations that can easily become analytic clichŽs.
In supervising others I recalled times when I had come across mothers in social work who had felt undermined by experts telling them how they should mother their babies. It was from this observation that I developed the notion of the nursing triad, with a parallel in the supervisory triad, by which a mother or a therapist needs to feel supported by someone who believes in them as mother or as therapist, rather than feeling put down by someone presenting themselves as the _better_ mother or the _better_ therapist.
The title I initially chose for my second book was The analytic Space and Process. I think that the title eventually decided upon, Further Learning from the Patient, may have led to that second book being somewhat overshadowed by the first, as if it were merely offering "more of the same", whereas it is actually moving on from the first book to consider other issues - relating to the analytic space and process.
A very useful question for me has been: "Who is putting what into the analytic space?" This has often helped me to recognize when there is a risk that the process of a session could be taken over by what we put into the analytic space. Quite often this indicates as much about what is in our mind as it may indicate what could be in the patient_s mind. It is then not surprising to find how often patients relate to us in terms of what we have unwittingly revealed about ourselves through how we speak to them. Some patients also take on the thinking of their analyst, whether or not this is a true expression of themselves.
In noting how some analysts work I came to be concerned about the ways in which the analytic process can become circular and self-proving rather than leading to genuinely new understanding for the patient. So it was natural that my mind turned to the issue of Learning from Our Mistakes which, I believe, can help us to get back on course when we have been getting things wrong. In this book I re-visit the case of my burned patient, my work with her having been a major focus in my first book, sharing with the reader how that extraordinary analysis had unfolded as a result of my not holding her hand.
I have often worried that we sometimes speak from a position of sureness, which can seem like certainty, with the result that when something has been going wrong it is often the other person who is regarded as being at fault - not the analyst or therapist. Unfortunately, once we have ended our analysis we are all liable to slide back into projecting onto others the faults we no longer wish to find in ourselves. It can also happen that we begin to see ourselves as apparently knowing better than others. But we do not always know better.
Learning from Life was written after I had retired from taking patients. It was only then that I felt free to be autobiographical. In sharing aspects of my own life I am hoping this may encourage others to find, in their own lives too, much that can help to enliven their understanding and their clinical practice. It is not only from books that we can discover the extraordinary power and relevance of psychoanalytic understanding. It is from life as it unfolds, outside the consulting room as well as in it, that I have learned so much that has helped to bring analytic thinking alive for me. This learning from life has also helped me to temper some analytic thinking with common sense, something which can be overlooked once we get caught into the zeal of analytic "certainties".
By Patrick Casement
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