I’ve been thinking about narcissism lately and ended up watching Now, Voyager yesterday and selected excerpts form the Alien films this morning. None of this ran together in the way I have just written it until I began writing the words ‘narcissistic feed’, but there we go.
Narcissism isn’t necessarily a bad thing: thinking about what you like to eat, wear, say and do; if I didn’t I would, in an awful sense, disappear. There’d be nothing of me on show and no return from that in the world to give me a sense of having a life that’s mine. Of course narcissism can be overdone and, from time to time, most of us overdo it – unless we underdo it, which I might come to at another time: underdo as in written our of life or written over someone else, no doubt a particularly egregious narcissist. We forget that we don’t actually know better than other people, or that we know them half as well as we might imagine. All kinds of narcissism rely on a feed from the outside world, from the kind of ‘that’s a nice hat’ comment to the more disturbing ‘you’re mine’ behaviour which characterises those egregious types I mentioned.
If you want to see what happens when narcissism becomes a difficult thing watch what happens to Charlotte Vale, or the crew of the Nostromo in Alien. Narcissists take a dim view of those around them trying to assert themselves: it interrupts the feed. Charlotte or Kane could have stayed in their cabins, but instead they went looking for adventure.
Differentiation, the move from a ‘we’ to an ‘I’, recognising the other, will always in some way be worrying (not being comfortable as an ‘I’ leaves you feeling anxious). You know you’ve got a problem when someone insists on ‘we’, not necessarily if they get worried about the ‘I’ … we all do that.
The ‘I’ demands a leap into the unknown unless I believe, secretly, we really are always a we, inseparable and conjoined. Wilfred Bion wrote about Experiences in Groups, not ‘experiences of groups’. Groups are an experience rather than an entity – as The Three Musketeers would have done well to remember.
I got worried about something like this yesterday. When I was a boy hooked on watching Sunday afternoon matinee films Now, Voyager had only existed for thirty years … rather like the relationship between now and another film I love: Withnail and I. And so I was reminded that I am 50 again. The ‘we’ of Tom Tomaszewski, me in all of my incarnations, still hasn’t quite become used to this ‘I’, the 50-year old one.
I love reading but I find it very hard to read most psychotherapy journals, especially the ones circulated by accrediting bodies such as UKCP. What could be an opportunity for me to engage with other people wondering what it is that constrains them, or affects them and exploring how they proceed from there … often ends up with me feeling like I’ve arrived at Checkpoint Charlie with the wrong papers.
If I’m going to think about the limits of psychotherapy I have to begin by looking at the limiting effects of psychotherapists, whenever they get together. It doesn’t have to be that way, but generally that’s how I have found it. Psychotherapy seems to be a refuge for numbers of people who might have imagined themselves, in another life, as an artist, a doctor, a philosopher, a scientist or perhaps (if they’ve had enough therapy) a prison guard or a better parent.
But reading, for example, the latest edition of the UKCP gazette I remain unsure how aware its writers are of the negative effect of their … professionalism. There’s so much attempted mastery: attempts to inflict expertise on the reader that remind me of a scene from Nicholas Monsarrat’s The Cruel Sea in which gulls pick over the dead floating on the ocean surface after a horrible incident with depth charges.
Mastery is a force to be resisted. If I want philosophy I will turn to someone who can at least tell me deconstruction isn’t about taking things apart; or that the preface to Hegel’s Phenomenology of Spirit might be a good thing to read before putting pen to paper for the UKCP gazette. If I want to know about creativity I’d like to speak with someone who’s made something that a lot of people find exciting. If I want to understand neuroscience I’d like to meet with someone who has more than a fleeting acquaintance with Niels Bohr.
If I feel I am in the domain of psychotherapy I’d like to look outward and see these expert categories approaching to greet me. They might have arrived here, in psychotherapyland, but they came from somewhere else. And I might go and pay them a visit at home some time, too … even if I end up realising we live in the same place … but that’s getting a little more complicated than I intended here, when I just wanted to write something about what seems to be happening to a profession I love being part of, but forever seems in search of a soul.
Psychotherapists can be experts in the unknown, but we need to understand that some people have spent most of their time thinking about the things this particular category of expertise is likely to conjure up. And I’d like an introduction to those things: never to be a told a psychotherapist knows best.
I love psychoanalytic thinking. It’s imaginative, it can take me and other people to surprising places, and it’s somehow at one with the world in ways that other kinds of thinking don’t seem to be. Psychoanalysis seems on the side of poetry and mystery, ever the best ways of trying to get a feel for life, whereas other forms seem, at least to me, catastrophically limiting.
Unfortunately it’s also a ready defence for half-wits and clowns. It’s easy to mistake psychoanalysts for intellectuals. Some intellectuals enjoy psychoanalysis, but very few of them are psychoanalysts. Psychoanalytic thinking offers a kind of quick-sand for the insecure, sucking them in to a world where nothing is at it seems and there’s always an opportunity to state the obverse rather than the obvious.
Psychoanalysis can offer security as long as you don’t need it.
Possibly the problem is in the word ‘thinking’. Psychoanalytic practice involves being in a ways that don’t dissociate thinking from feeling. They become something else.
Once upon a time acronyms perhaps seemed exciting, of the future, nothing to do with stuffy formalised conversations or over-long names. I dread them. Every one I see seems dissociated from what it represents … schools and colleges whose names are reduced to admissions friendly locator scripts; medical interventions and psychiatric conditions that do nothing to help me remember they concern lives. ADHD as like a chemical compound, a thing in itself, rather than a way of describing manic levels of activity. Acronyms take the sting out of death without even the awful dissonance of a euphemism: PAS, DAS, VE, AS, ASFRA, or EDAS. They root me to whichever institution holds the upper hand in deciding what needs to be done in response to some form of human activity. If you want to know about ADHD look in the DSM. Abandon acronyms. They’re on the side of death and tyranny.
I wanted to write something about becoming fifty when it actually happened, back at the beginning of October. But October’s been like a berth on a clipper crossing the Pacific sometime around when my grandfather was born (1857). October, an uncomfortable bunk in the year 2016, one of the ships sailing me through time. Years can be like boats. There are many non-scientific ways of thinking about time travel: friendships, lives, things which have happened and the echoes or ripples that carry forward.
Afterwardsness … I’m not particularly fond of Freud as a psychologist, not in the prescriptive sense of x + y = neurosis z, as some might have him, but as someone who thought about life I find him irresistible. His notion of nachträglichkeit, often translated as ‘afterwardsness’ might be one of the best boats of all.
Sailing on, I’d like to mention a discovery I made today. I was reading about the wonderful Jean Laplanche (who appears, incidentally, in Agnes Varda’s film ‘The Gleaners and I’ talking about winemaking and psychoanalysis), whose thoughts about the enigmatic signifier I may owe much of a career to, when I cam upon a startling reference to a seminar he gave in Kent in 1990. I was startled because as far as anyone connected to my training at the University of Kent was concerned, Laplanche was a non-person, not even a mystery, but one of those figures teachers and trainers seem never to have heard of. I shrugged, inwardly and outwardly, but always felt this unawareness was a little like the kind of unawareness we each sometimes cultivate in relation to a kind of tricky problem. Laplanche was joint editor of what’s become the standard encyclopaedia of psychoanalysis and, internationally, a figure something like The Pet Shop Boys might be to anyone with an interest in music (Orthodox Psychoanalysis, for all of its all its apparent esotericism, has something of the spirit of Take That).
And there, as I read about Jean Laplanche, was a reference to a paper, ‘Psychoanalysis, Time and Translation’ delivered in 1990 to the first year of students completing my then newly established training. Laplanche wrote a book called ‘New Foundations of Psychoanalysis’ and there he was, in at the start, the foundations, of a training that later seemed incapable of recognising him.
There’s a story in all this, if I ever get the time to look into it.
I mention it here in relation to my becoming 50 not specifically out of pique but to show maybe something of what I mean by echoes and ripples from the past. I find something out and it seems to be an intersecting, me and Laplanche catching up somehow … somehow.
If you read me much you’ll know I tend to think a lot of things come to us indirectly, rather like the ball in a pinball machine. I used to play one of those at a caravan park near Newhaven where the ball even went down a hole later to appear randomly from one of many other holes in the machine. In life we don’t see the paddles or the curves of pins; or the strange electronic mushrooms or the jump pads (I imagine there are more correct technical terms). Sometimes we can’t even see the arc or the angle of something as it approaches: it simply lands.
I began by saying I wanted to write something about being 50, but it seems that’s still on its way.
I imagined picking up the phone and talking to someone dead about Donald Trump. Someone who hasn’t been around for a while. My mother would be good: as much as anyone she used to surprise me with her instinct for where to look if you really wanted to see what was going on. I’m sure she’d find it hard to conceive of Trump, as he’s known today, continuing to run for president without clowns running wild in the streets. The madness has to be visible somewhere if Trump isn’t going to put on makeup and a wig and start threatening children with a chainsaw.
People often write about change in psychotherapy. Fewer people seem to write about how changes are noticed and acted upon, especially in clinical teams. This piece is written for people working in teams and tries to suggest a few things about accountability among clinical groups.
When you see something that you believe someone has missed it can feel alarming. (I’ve heard it can also be gratifying.) There’s a kind of noticing which can either be constructive or divisive, depending on how it’s approached, and it goes like this: someone (a therapist, a counsellor, a nurse; let’s not get too hung up on titles right now) is responsible for a client, perhaps something goes wrong or a situation deteriorates, or nothing seems to be happening, and another person is invited in (hopefully by the first person) to take a look at that client as well. I’ve experienced this from both sides.
At worst, the person being called in might see what they call negligence. Negligence happens and is probably as likely as ever to happen now, although I won’t get into that here (if you’re interested, I imagine all would be revealed rather quickly if you watched Ken Loach’s latest film and then read some Adorno on administrative culture). More often I imagine that what might be regarded by the second person as having been ‘missed’ by the first person has actually been subject to one of, broadly speaking, three kinds of process.
The first person may have been aware of what has been ‘missed’ but chosen to approach it in a way that does not seem immediately obvious to the second (process one); or it could have been seen and not considered as important as the second person believes it to be (who may or may not be right in believing this – either way, this is process two); or it could have been become perceptible as a result of the way the first person has worked, but remained undetectable, immediately, to him or her, such are the defences at play (process three).
There’s much I would say about the first two categories of process listed above. It’s the third, however, that I want to say some more about here. If you have some kind of affinity to what’s usually called ‘psychoanalytic’ work then the third category is possibly one that you never let slip out of mind. But I think any experienced clinician, in fact anyone who’s had the regular experience of joining in with work someone else has begun, might recognise that some things will never be immediately perceptible to the people who begin to make them knowable.
Good clinical work is work from which something emerges over time. This calls for a kind of continuity in which accountability is isolated, as far as possible, from blame – where it’s sought after by the person accepting it, rather thrust upon them as part of a move to account for what apparently hasn’t happened, with no acknowledgement of ‘yet’.
The idea that clinical work can predictably happen in the time we would like to allocate to it is of course most seductive. Given the ways in which clients live their lives, how treatment is paid for, and how therapists work it’s almost too much to bear, to think that the most useful thing in someone’s treatment may be happening only unrecognisably so. But holding onto the idea that perhaps something hasn’t happened yet, and that some clinicians are going to complete what they see as their work without perhaps feeling with their client the greater sense of achievement that comes with a life ‘turning around’ calls for a rare and special kind of collaborative work.
Supervision and cooperation must hold strong without starting to become steely. Experience needs to be contained without being restricted or constricted; growth needs to happen while being shaped as little as possible by containing forces (directive work needs at some point to give way to a client finding his or her own direction).
Plato (the Timaeus), Heidegger (Was heißt Denken?, 1954 [What is Called Thinking?, trans. 1968]), Bion (Container and Contained, 1962) and Derrida (Sauf le Nom, 1993 [On the Name, trans. 1995]) wrote about this. Still, it seems somehow to so often become forgotten.
And of course I am not suggesting that certain other important things be forgotten, like looking closely at what is evident to everyone involved and making sure certain parameters are not exceeded: the ones written into the ethical codes we subscribe to and the bottom lines relating to the forms of treatment or engagement we begin. It would be a mistake, however, to believe these things are always decided beforehand, in another place, such as a room inhabited by a UKCP ethics committee. Things begun in those places have a life of their own, too.