The Therapeutic Imagination

Using literature to deepen psychodynamic understanding and enhance empathy

Jeremy Holmes

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781134752386
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

Use of the imagination is a key aspect of successful psychotherapeutic treatments. Psychotherapy helps clients get in touch with, awaken, and learn to trust their creative inner life, while therapists use their imaginations to mentalise the suffering other and to trace the unconscious stirrings evoked by the intimacy of the consulting room.

Working from this premise, in The Therapeutic Imagination Jeremy Holmes argues unashamedly that literate therapists make better therapists. Drawing on psychoanalytic and literary traditions both classical and contemporary, Part I shows how poetry and novels help foster therapists' understanding of their own imagination-in-action, anatomised into five phases: attachment, reverie, logos, action and reflection. Part II uses the contrast between secure and insecure narrative styles in attachment theory and relates these to literary storytelling and the transformational aspects of therapy. Part III uses literary accounts to illuminate the psychiatric conditions of narcissism, anxiety, splitting and bereavement. Based on Forster's motto, 'Only Connect', Part IV argues, with the help of poetic examples, that a psychiatry shorn of psychodynamic creativity is impoverished and fails to serve its patients.

Clearly and elegantly written, and drawing on the author's deep knowledge of psychoanalysis and attachment theory and a lifetime of clinical experience, Holmes convincingly links the literary and psychoanalytic canon. The Therapeutic Imagination is a compelling and insightful work that will strike chords for therapists, counsellors, psychoanalysts, psychiatrists and psychologists.

Part I The Poetics of Psychotherapy

1 The therapeutic Imagination

George Eliot and Daniel Deronda

DOI: 10.4324/9781315879826-1

Imagination is defined in the Oxford English Dictionary (1973) as ‘that faculty of the mind by which we conceive of the absent as if it were present’, illustrating this with Shakespeare’s oft-quoted (Williams and Waddell 1991) credo (put into the mouth of Theseus in A Midsummer Night’s Dream):

And as imagination bodies forth

The forms of things unknown;

The poet’s pen

Turns them to shapes, and gives to airy nothings

A local habitation and a name.

(Shakespeare 1911/1962)

If, as Barratt (1984) suggests, psychoanalysis is in essence a ‘negative dialectic’, i.e. a discipline whose starting point is absence (cf. Green 1997; Gurevich 2008), concerned with that which is unconscious, repressed, dissociated, split off – as Conan Doyle might have put it, a discourse of the dog that didn’t bark – then imagination is a key psychoanalytic capacity. The collaborative job of patient and analyst is to conjure up, capture and transform what is missing, or conspicuous by its absence, from the patient’s mental life. The starting point of this chapter is the idea that the means by which this is achieved is through harnessing the imagination in specific and systematic ways.

Shakespeare’s Theseus points to some important aspects of the workings of the imagination. First, like the unconscious, it is impersonal – an ‘it’ rather than an ‘I’ – bodying things forth rather than purposively thinking them up. Second it is corporeal, being both in and of the body, especially, but not exclusively the visual system; imaginative activity starts with a quasi-bodily feeling or half-glimpsed ‘form’, or image, in the mind’s eye. Third, there is an intimate relationship between this embodying process and language: the ‘pen’ of the poet transforms ‘forms’ unknown into definite ‘shapes’, places and names.

Theorising imagination can be traced to a coherent intellectual framework, but one that tends to be downplayed in today’s clinical and political climate. Its origins lie in the German romantic tradition which predates, but undoubtedly influenced Freud, which also has its own independent lineage in Anglo-Saxon culture. This in turn has fed back into the British contribution to psychoanalytic thought and practice.

The roots of imagination as a construct lie with Kant, Schelling and German Romanticism (Watson 2010). Coleridge introduced these ideas into the Anglophone world (Holmes, R. 1999), transforming them in his own idiosyncratic way. They were developed psychoanalytically by Sharpe (1940), Bion (1962), Winnicott (1971) and Rycroft (1985); and more recently by Britton (1998), Ogden (1997), Turner (2004), Ferro (2012) and Waddell (1998). These authors clearly draw on pre-1914 Freud (Barratt 1984, 2012) where the romantic impulse of The Interpretation of Dreams and the development of free association technique were still to the fore. In addition, I suggest that there is a Coleridgean tradition which contributes to their thinking in a separate line of intellectual influence. Rycroft (1979, p. 167), for example, saw it as his aim to ‘marry the thinking of Freud and Coleridge’.

What then is the ‘therapeutic imagination’? The related phrase ‘clinical imagination’ is not new (e.g. Havens 1982; Dimen 2001; Rustin 2001). The purpose of adding a definite article, capitalising the concept and broadening from ‘clinical’ to ‘therapeutic’ is to suggest – in a spirit which might perhaps be seen as anti-imaginative – that imagination can be systematised and anatomised, and that it provides a useful framework for thinking about the components of psychoanalytic activity in the consulting room.

Jung saw an aim of psychoanalysis as fostering its patients’ ‘active imagination’ – whether through daydreaming, painting, writing or other artistic activities (cf. Holmes 2012b). Within the Anglo-Saxon tradition the phrase is the medical/psychotherapeutic analogue of ‘the poetic imagination’ (Weir 1996). Psychoanalytic writers compare the poetic transformation of experience into words with a similar process in psychoanalytic sessions. A key lineage runs backwards from Bion’s injunction to the analyst to be ‘beyond memory and desire’, through Keats’ ‘negative capability’ – the ability to be remain in doubts, mysteries and uncertainties – to Coleridge’s ‘willing suspension of disbelief’. Full play of the imagination entails temporarily bracketing off veracity-testing; in the world of the imagination anything goes – and needs to be allowed to – if the necessary ‘dream work’, in its wider sense, is to be given free reign.

Bion picks up on the Coleridgean notion of poetic ‘reverie’ and uses this to describe the analyst’s state of unprejudiced receptiveness, reborn in Ogden’s idea of ‘dreaming the session’. The animating notion is that of the capacity of the analyst, like the poet, to allow thoughts and feelings spontaneously to arise within her; to transform these imaginative stirrings into gesture and words which can be put to therapeutic use; and thereby to help the patient better understand his unconscious thoughts and feelings. Poetry and therapy both, represent a ‘raid on the inarticulate’ (Eliot 1954, p. 31).

But psychotherapy is not poetry; as Britton rightly says, the analyst who explores ‘his own psychic reality while attributing it to the patient … has forfeited his role of analyst’ (Britton 2003, p. 103). Therapeutic imagination, while sharing some features of poetic imagination, has a distinct identity and structure of its own. It can be thought of as a general process informing clinical encounters, whether medical, psychiatric or psychotherapeutic. In addition to reverie, it comprises a number of other components which feed into, and flow from, the act of reverie. These can be divided into a five-part sequential structure. The first step, following Bowlby, might be called primary attachment. Reverie, the poetic analogue is next. Then, Coleridgean again, comes logos. These are then followed by action and reflection. This cycle repeats itself in a ‘fractal’ way in both micro-moments of the session, as an overall trajectory for whole sessions, and for on-going periods or ‘passages’ of a therapy.

Daniel Deronda

Before developing these ideas in more detail, let us look at a specific example, taken not from the consulting room, but the literary canon. In George Eliot’s last great novel, Daniel Deronda (1876/1986), the eponymous hero rescues a young woman from suicide – which might be seen as one of the ultimate justifications for psychotherapeutic work. Eliot was fluent in German and would have been fully conversant with German Idealist and Romantic ideas. This, I suggest, forms the philosophical background to her account of a proto-psychodynamic encounter and suicide rescue (cf. Rotenberg 1999; Waddell 1989).

This Romantic connection is tangentially referred to when Eliot states that Deronda, a beautiful young man, ‘bore only disguised traces of the seraphic boy “trailing clouds of glory”’ (Eliot 1876/1986, p. 225) – an explicitly Wordsworthian/Coleridgean reference to the former’s Intimations of Immortality (cf. Chapter 5). Deronda chafes against his formal and narrow education:

He longed now to have the sort of apprenticeship to life which would not shape him too definitely, and rob him of the choice that might come from a free growth … Deronda’s demerits were likely to be on the side of reflective hesitation …

(ibid. p. 220)

Free growth and reflective hesitation might be seen as desirable antecedents of a career as a psychotherapist.

The story begins in London. One evening while rowing on the Thames, Deronda notices a slim dark girl at the river’s bank, whose

‘eyes were fixed on the river with a look of immovable statuesque despair’.

Momentarily, their eyes meet:

‘he felt an outleap of interest and compassion towards her’.

Then he reflects ruefully on his reaction: perhaps it is just because she was beautiful that she excited his interest. But no:

‘I should not have forgotten the look of misery if she had been ugly and vulgar’

he says to himself. He rests on his oars in a state of ‘solemn passivity’. Reaching the bank, he

‘enters a state of ‘half-speculative, half-involuntary identification of himself with the objects he was looking at’, wanting to ‘shift his centre till his whole personality would be no less outside than the landscape’.

(ibid. p. 228)

Suddenly he sees the girl preparing to plunge herself into the river. Quickly he sculls across, and ‘speaking but very gently’:

‘Don’t be afraid …You are unhappy … Pray, trust me … Tell me what I can do to help you’.

She responds and reminds him that she had heard him singing earlier. He replies:

‘But I fear you will injure yourself staying here. Pray let me carry you in my boat to some place of safety.’

Daniel realises that the girl has stirred a chord in him, evoking thoughts of his own mother, about whom he knew nothing:

‘The agitating impression this forsaken girl was making on him stirred a fibre that lay close to his deepest interest in the fates of women – “perhaps my mother was like this one”’.

She enters the boat (his surrogate consulting room), and he rows: ‘they went along swiftly for many minutes without speaking’. For Daniel: ‘his first impression about her, that her mind might be disordered, had not been quite dissipated: the project of suicide was unmistakable …’. He longs to begin a conversation, but abstains, ‘wishing to encourage the confidence that might induce her to speak first. At last she did speak’:

‘I like to listen to the oar’

‘So do I’

‘If you had not come I should have been dead by now’ …

Deronda was mute: to question her seemed an unwarrantable freedom…

‘I want to know nothing except what you would like to tell me’.

‘This morning when the light came I felt as if one word kept sounding within me “Never, never!” But now – I begin – to think’ her words were broken by rising sobs – ‘I am commanded to live …’.

Deronda takes her to the house of a family friend whose mother and sisters he knows will look after her. In the cab the story of the Maenads comes to mind. How:

… outworn with their torch-lit wanderings they lay down in the marketplace, and the matrons came and stood silently around them to keep guard over their slumbers … He could trust the women he was going to for having hearts as good.

Finally Deronda thinks about his experience, while the author reflects on that refection:

… how to make sure that snatching from death was rescue? The moment of finding a fellow-creature is often as full of mingled doubt and exultation as the moment of finding an idea.

This episode may seem somewhat remote from the analytic consulting room. But the image of the river provides a perfect metaphor for the flux of experience – the stream of consciousness – that is the medium of psychotherapy. Deronda aligns himself with the force of the river to direct his boat, to drift, or rest, as the situation demands – a metaphor comparable to Freud’s rider-horse image for the relationship between the conscious and unconscious self (Freud 1900). The fluidity of character Deronda both seeks and is affected by is thereby instantiated. Like Shakespeare, his ‘… nature is subdued/to what it works in, like the dyer’s hand’ (1911/1962, Sonnet 111).

The first vector of therapeutic imagination – here Deronda’s – is the clinician’s alignment or attachment to the person in need of help or cure. The elements of this include: eye contact; an excitation of focus and attention; an ‘active passivity’; identification and a partial dissolving of the self into the object. Next comes reverie: the therapist allowing the process of connection with the other to flow through him, as through an aeolian harp, and to activate its chosen heart-strings. These ‘melodies’ inevitably also reflect the therapist’s own deepest themes – for Deronda the search for the missing mother, which, it later turns out is the girl’s mission too; her suicidal despair reflects a feeling that this is unattainable.

Next comes logos, the ‘poet’s pen’: putting experience into words. Here, like the good therapist, Deronda holds back, creating a potential space into which the girl can speak. Only when she makes a seemingly irrelevant comment ‘I like to listen to the sound of the oar’ does he r...

Table of contents

• Cover Page
• Halftitle Page
• Title Page
• Copyright Page
• Dedication Page
• Table Of Contents
• Preface
• Acknowledgements
• Part I The poetics of psychotherapy
• 1 The therapeutic imagination: George Eliot and Daniel Deronda
• 2 Discovery: Seamus Heaney and Marcel Proust
• 3 Non-discursiveness: Robert Lowell
• 4 Repair: Hugo Williams
• 5 Loss: Wordsworth’s Ode
• Part II Psychotherapy and narrative
• 6 Attachment and narrative: Conrad’s Heart of Darkness
• 7 Change: Llosa’s Aunt Julia
• 8 Society: Evelyn Waugh and Jane Austen
• Part III Psychotherapeutic approaches to psychiatric diagnoses
• 9 Anxiety: Wagner’s Siegfried
• 10 Splitting: Stevenson’s Dr Jekyll and Mr Hyde
• 11 Grief and loss: Milton, Tennyson and Donne
• 12 Narcissism: Ovid and Wilde
• Part IV ‘Only connect’: psychotherapy and psychiatry
• 13 Meaning v. mechanism: Forster’s Howard’s End
• 14 Toughness v. ‘wetness’: Armitage
• 15 Facts v. feelings: Abse, Olds, Holub and Larkin
• Postscript
• References
• Index