Core Competencies of Relational Psychoanalysis

A Guide to Practice, Study and Research

Roy E. Barsness

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781315437750
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

Core Competencies of Relational Psychoanalysis provides a concise and clearly presented handbook for those who wish to study, practice, and teach the core competencies of Relational Psychoanalysis, offering primary skills in a straightforward and useable format.

Roy E. Barsness offers his own research on technique and grounds these methods with superb contributions from several master clinicians, expanding the seven primary competencies: therapeutic intent, therapeutic stance/attitude; analytic listening/attunement; working within the relational dynamic, the use of patterning and linking; the importance of working through the inevitable enactments and ruptures inherent in the work; and the use of courageous speech through disciplined spontaneity.

In addition, this book presents a history of Relational Psychoanalysis, offers a study on the efficacy of Relational Psychoanalysis, proposes a new relational ethic and attends to the the importance of self-care in working within the intensity of such a model. A critique of the model is offered, issues of race and culture and gender and sexuality are addressed, as well as current research on neurobiology and its impact in the development of the model. The reader will find the writings easy to understand and accessible, and immediately applicable within the therapeutic setting. The practical emphasis of this text will also offer non-analytic clinicians a window into the mind of the analyst, while increasing the settings and populations in which this model can be applied and facilitate integration with other therapeutic orientations.

Core Competencies of Relational Psychoanalysis is inspired by Barsness' students; he was motivated to create a primary text that could assist them in understanding the often complex and abstract models of Relational Psychoanalysis. Relevant for graduate students and novice therapists as well as experienced clinicians, supervisors, and professors, this textbook offers a foundational curriculum for the study of Relational Psychoanalysis, presents analytic technique with as clear a frame and purpose as evidenced based models, and serves as a gateway into further study in Relational Psychoanalyses.

Part I
Current Research and History of Relational Psychoanalysis

Chapter 1
Core Competencies in Relational Psychoanalysis

A Qualitative Study

Roy E. Barsness

Freud (1912) compared psychoanalysis to the game of chess where “only the opening and closing of the game admit of exhaustive systematic description … and that the gap left in between can only be filled in by the zealous study of games fought out by master hands” (p. 342). He says this about rules:

I bring them forward as recommendations without claiming any unconditional acceptance for them. The exceptional diversity in the mental constellations concerned, the plasticity of all mental processes, and the great number of the determining factors involved prevent the formulation of a stereotyped technique, and also bring it about that a course of action, ordinarily legitimate, may at times be ineffective, while one which is usually erroneous may occasionally lead to the desired end. However, these circumstances do not prevent us from establishing a procedure for the physician which will be found most generally efficient.

(p. 342)

Freud ultimately settled upon the primary techniques of the “ethic of honesty” and “free association”, with the primary goal of providing insight through the interpretation of transference, defenses, and resistance, and with the end goal that the ego gain sovereignty over id impulses and superego constrictions.

Though this tradition has been challenged since psychoanalysis began—in particular the role and the authority of the analyst and the intersubjectivity of the analytic work—by such theorists as Theodore Ferenczi, Erich Fromm, Frieda Fromm-Reichmann, Karen Horney, Irwin Singer, Harry Stack Sullivan, and Clara Thompson, it eventually grew into a movement in the 1980s. In Chapter 3 in this volume, Adrienne Harris effectively charts the evolution of the relational movement and its shift away from a one-person drive theory towards intersubjectivity, mutual influence, and interaction. This re-positioning opened the windows to other traditions “derived from constructivism, critical theory, post-structuralism, feminist philosophy, sociology, linguistics, narrative literary criticism and deconstructionism” (see Mills, Chapter 17 in this volume), arriving at what I call a psychoanalytic ecumenism. This union offers a mixture of the diverse elements from the richness of all of psychoanalytic theory, philosophy, and culture, inviting a new analytic discourse of interactionism and mutual influence extending our practices beyond insight and interpretation.

As one would expect, this new understanding of the self as socially, politically and culturally constructed, muddied analytic technique. Indeed:

As relational theory has evolved, it has increasingly emphasized multiplicity in the encounter: multiple interpretive frames that might be relevant, multiple self-states from which to speak and to address, and multiple meanings that might plausibly be assigned to the patient’s and the dyad’s experience. Taken together, these render the notion of a unitary, proper technique, as it has been traditionally understood, problematic.

(Tublin, Chapter 4 in this volume, p. 72)

As relational psychoanalytic theory has reworked historical models through a perspectival lens, the rules for practice have become less clear. As relational theorists turn from insight as the primary order of change to the reworking of early trauma within the therapeutic dyad, new techniques and clinical skills are required. With this in mind, a qualitative research study was conducted to determine fundamental techniques or competencies that can provide a working framework for contemporary analytic practice. This chapter reports the results of that research.

Why Study Psychoanalytic Technique?

The genesis of this study emerged from years of teaching a year-long graduate course in relational psychoanalysis. In addition to this yearlong course, students are enrolled in several other courses in systemic, developmental, and object relations theories. They are also involved in an intensive three-year practicum/case conference training program focusing on issues of transference/countertransference, establishing the therapeutic frame, and exploring narrative as well as practices in intervention. However, encountering their first internship and introduced to their first patient, they report feeling like “a deer caught in the headlights.” One year, a student raised her hand and with a tenor of lament stated, “I have all this theory, but I don’t know what to do.” As students were now being exposed to evidenced-based models, some ready to sign on because it was comprehensible and immediately applicable, while the analytic theories remained obscure, inaccessible and the practice of it “squishy,” I felt a call to some action. Consequently, I decided to work more intentionally in translating and communicating rich and complicated psychoanalytic theory into how we actually practice.

I began by mapping my own mind as it operates within the clinical hour. In this mapping, I began to see a pattern in how theoretical constructs and psychoanalytic knowledge occurred in actual practice with my patients. The pattern went something like this. The patient would stimulate some thought and/or affect in me, I would begin to consider this stimulus from developmental, early object relations, transferential/countertransferential affective, and cultural perspectives, while considering defensive structures, interpersonal relations, and how the narrative unfolded. I metabolized these relational and affective complexities with questions such as, “What the hell is going on here anyway?” or “What is the feeling or thought trying to express?” Furthermore, I attended, as best I could, to countertransference reactions, understanding them not only as something of my own, but as a stimulus and a means of access to the inner workings and interpersonal world of the patient. I simultaneously imagined ways I could articulate my experience to the patient, mindful of the possible effect it might have upon our relationship. As I had earlier in my practice adopted a particular stance of courageous speech/disciplined spontaneity (see Barsness and Strawn, Chapter 12 in this volume), I was aware that in speaking honestly and openly about what I was experiencing within the analytic relationship, misunderstandings, ruptures, and enactments would befall us. Therefore, I did my best to consider the consequences in expressing my experience, aware of the cost of entering into the “fray” and the effort required in “working through” difficult dynamics. Having mapped my own mind and finding it helpful to me as well as in teaching and supervision, I decided to advance the study of my own “map” by constructing a qualitative study “mining the minds” of seasoned analytic clinicians.

Prior to launching the study, however, I had to contend with my own reluctance to codify technical principles, easily indentifying with many in the analytic community who view the analytic experience as “unformulated technique,” believing that what we do is intuitive, automatic, and organic. Though this may be true, I think it is also true that each analyst has their own internal guidelines—they simply are not articulated. For example, I think we “know” we listen in a particular way different from other disciplines and we “know” we engage our patients differently. The question is: how do we do this?

Secondly, my draw to psychoanalysis was essentially a spiritual calling. I understand our vocation as an invitation into the sacredness of the human encounter where change and healing occurs by calling to the depth of each person within the encounter. The nature of the human condition, the fluidity of the self and our relationships, is not categorical. So to label, categorize, or define scientifically this unique relationship, I found unsettling.

However, with the echoes of Freud in my mind, “that these circumstances [should not] prevent us from establishing a procedure for the physician which will be found most generally efficient” (Freud, 1912, p. 342), and recalling the value of science as an intellectual and practical effort to systematize and make sense of the world through observation and experiment, I realized there did exist an intellectual and systemized ritual to my work that could be documented. I believed this was true for every analyst, and therefore set out to determine through research a baseline of fundamentals identifying the commonalities in our work. As is true in all research, these standards or Core Competencies are not the final word. However, these findings, I believe, do offer an important foundation that assists in fostering change in our patients’ lives, and will hopefully encourage further research and dialogue.

It is also my hope that in building a bridge between theory and practice, understandings of theory will be less compromised. For example, I have found that students/supervisees can be loose cannons, misunderstanding theories such as mutual recognition, intersubjectivity, or disclosure as a means to irresponsibly spout off whatever is on their mind. I have also noted that when interpersonal conflict and entanglements occur within the treatment, rather than working it through, the therapist will often defensively “hide” behind diagnosis or interpretation. Often, if these ruptures are pursued, they are “repaired” by blaming the patient or by offering pseudo-apologies to avoid the ensuing conflict. Therefore, I hope that by having a set of guidelines informing and guiding theory, the integrity of a relational psychoanalysis can be maintained.

The overall purpose of this study is to:

• develop foundational competencies for the study and practice of relational psychoanalysis;
• offer a gateway into the study of relational psychoanalytic theory;
• address the concerns of what Freud (1912) referred to as “therapeutic ambition” and Greenberg (2001) referred to as “psychoanalytic excess,” offering a framework as a guide for practice;
• offer analytic “techniques” with as clear a frame and purpose as evidenced-based models.

Method

A qualitative research study was conducted using in-depth interviews of 15 psychoanalysts identified with contemporary theories of relational psychoanalysis. To analyze the data, Grounded Theory Analysis (GTA) was chosen because, much like psychoanalysis, GTA is “emergent, is broadly constructivist and subjective, relying a great deal on hermeneutics while recognizing the importance of scrutiny and careful analysis” (Rober, Elliott, Buysse, Loots, & De Corte, 2008, p. 407). Similar to psychoanalysis, GTA seeks to let the data speak, while recognizing that the researcher and participant co-construct these data and, to some degree, the analysis. In GTA, the researcher repeatedly asks: “What is going on here?” “What are the core issues that are at stake?” “What is trying to be worked out?”

Grounded Theory Analysis was originally developed by Glaser and Strauss in 1967 as a method to assist in developing theory, grounded in data systemically gathered, organized, and analyzed. It is a method that does not assign prior assumptions to what is under study to prove or disprove, but seeks to gain a sense of central themes indicating a particular model or idea constructed from the data, and grounded in the participant’s lived experience: “The generated theory explains the preponderance of behavior in a substantive area with the prime mover of this behavior surfacing as the main concern of the primary participants” (Glaser & Holten, 2004, p. 13). In applying GTA, I discovered an uncanny similarity between analyzing the data and how I work with my patients. Concepts such as co-construction, open-mindedness, patterning, and linking are common to both Grounded Theory and psychoanalysis. These methods outlined by Glaser and Strauss (1967), Strauss and Corbin (1998), Glaser and Holten (2004), Charmaz (2006), and L. Belgrave (personal communication, 2015), include:

simultaneous involvement in data collection and analysis; constructing analytic codes and categories from data, not from preconceived logically deduced hypotheses; using the constant comparative method which involves making comparisons during each stage of development; advancing theory development during each step of data collection and analysis; advancing theory development during each step of data collection and analyses; memo-writing to elaborate categories specify their properties, define relationships between categories and identify groups; sampling geared towar...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of Contributors
• Acknowledgments
• Organization of This Text
• PART I Current Research and History of Relational Psychoanalysis
• PART II Core Competencies
• PART III New Frontiers
• PART IV A Critique
• Permissions
• Index