Rezension zu Psychotherapeutische Tugenden
International Forum of Psychoanalysis
Rezension von Marco Conci
One of the first associations I had while reading Sandra Buechlers
precious book was represented by the concluding remark of the
address given by the sociologist Charles Johnson at the memorial
service for his very dear friend and colleague social scientist
H.S. Sullivan, held on February 11, 1949, which Helen Swick Perry
included in Sullivans anthology The Fusion of Psychiatry and Social
Science. »lt is one of the strangest paradoxes of our civilization
that the simplest human virtues and those which alone give us the
right to call ourselves civilized are precisely those which demand
the highest courage to translate into life and honest social
action«. It is not a coincidence that this attempt at integrating
human values (she calls them »clinical value«))!) into analytic
technique comes from a colleague trained in the Interpersonal
tradition (a psychologist, Sandra Buechler is Training and
Supervising analyst at New Yorks WA. White Institute), centered as
it is around Sullivans one-genus postulate and Fromms classical
wisdom (of Terences saying »Humani nihil a me alienum puto«). As a
matter of fact, the book represents volume one of the new book
series »Psychoanalysis in a New Key«, edited by Donnel B. Stern
(the present editor of Contemporary Psychoanalysis) for The
Analytic Press.
Two more voices, which must have significantly contributed to the
authors discovery of her own analytic identity, are those of the
late Stephen Mitchell and of the German poet Rainer Maria Rilke,
which we come in contact with through six quotations (three for
each of them) taken out of Hope and Dread in Psychoanalysis and
Letter to a Young Poet, which the author placed before her own
preface. What binds them together is the sense of curiosity,
humility, patience and courage, which substantiated their
approaches to psychoanalysis and literature, respectively. After
having given further credit in the preface to her peer supervision
group (her professional »family« for over twenty years), Sandra
Buechler introduces herself by telling us about her work with one
of her first patients (John), i.e. not only about the problems she
had treating him, but also about her present perspective on such a
treatment - with both of which I can well identify. Since, without
the benefit of much theory or training, the author was still able
to supply the affect
missing in the patients speech and life, she reveals to us that
what would actually change most, were she to treat him today, would
be »not so much what I would actually do but how I would think
about John and his treatment« (p.3). Crucial in this respect was
the role played in her training by her systematic study and contact
with H.S. Sullivans work, with particular regard to the feeling of
being helped, accompanied and guided by him in focusing and
directing the treatment.
But what helped her even more to transform her (our) human values
into »clinical values« - a transformation which well depicts the
authors professional evolution - was Izards emotion theory, i.e.
the theoretical frame which allows the author to consider the
therapists »aliveness« as the essential dimension of the treatment.
»Curiosity, hope, kindness, courage purpose, emotional balance, the
ability to bear loss, and integrity are aspects of our equipment
for sustaining ourselves. Together they form the par of our inner
resources - writes Buechler - that link all our experience being
human with our conduct o treatment« (p.6). In other words, this is
her answerk to the problem of how to elaborate the stresses of our
professional life (included, sometimes, our own training) and still
... remain alive, i.e. in contact with our own self, the principal
instrument of our work! Or, her answer to the way in which Steven
Mitchell used to formulate the problem of interpretation: more than
with the content the problem has to do with finding the right voice
to give expression to it. As a matter of fact, besides Sullivan and
Izard Buechler mentions, as a third major influence on her work,
Fromm and his concept of biophilia, i.e. his sense of purpose:
(»The analyst can bear the strain of doing treatment if she has a
strong enough sense of purpose« (p.8). And this is exactly what her
patient John had been able to mobilize in her, what the author
calls her »native passion«, whose further refinement through her
training and work experience represents the theme of this book.
Curiosity, a key ingredient of such a native passion, that is, the
factors which interfer with and elicit curiosity, thus represents
the theme of the first of the eight chapters which the author
dedicates to the human values which help us (»animate theory«
(p.9). Representing each session as »a theater of simultaneous
possibilities« (p.15), Buechler sees curiositys first function as
helping therapist and patient focus the material, i.e. clarify the
presenting problem and create a therapeutic context. By making the
strange familiar and the familiar strange, curiosity also promotes
the integration of self-states in each treatment participant. Of
course, the way in which Edgar Levenson expanded Sullivans detailed
inquiry in the direction of the question »Whats going on around
here?« also plays a role in this chapter. After mentioning Donnel
Sterns attention to the dimension of the »unformulated experience«
and Mitchells conviction about the necessity for the analyst to
take risks and to talk about them, Buechler concludes the chapter
expressing her belief that »to evoke the patients curiosity we have
to serve as catalysts, openly encouraging the patient to experiment
with new ways to relate to us« (p.29).
This is also one of the ways in which the therapist can inspire
hope, which is the theme of chapter two. From it I learned what the
author calls »hope for the wrong thing«, i.e.: »Not having hope
when it would be hope for the wrong thing preserves the possibility
that some day we will be able to hope for the right thing)« (p.35).
Since Joanna Greenberg described Frieda Fromm-Reichmann as
(»someone willing to do anything to help the patient see that life
is worth fighting for« (p.43), the theme of hope does appear in the
Interpersonal literature. Not only in Mitchells 1993 book Hope and
dread in psychoanalysis, but also in the less well known
Metamorphosis (1959) by Ernst Schachtel, who had emphasized hopes
role »as a galvanizing emotion, and not just as a cognitive
expectation« (p.45). Specific to the authors approach is her
capacity to show how hope, in terms of Izards emotional system, is
modified by the other motivating forces it accompanies, i.e. is
»shaped partially by avid curiosity and partially by the capacity
to be surprised« (p.46).
The starting point of chapter three, »Kindness in treatment«, is
the very special session that Sandra Buechler had had with her
training analyst, who took her out to lunch, instead of holding the
usual session with her, at a time when she was suffering due to a
major conflict with a senior faculty member an experience whose
impact, writes the author, »changes over the years as I reframe it«
(p.50). »Whether I remember it as an analysand, analyst,
supervisor, or teacher, the incident represents an act of kindness
to me. I believe it took some thought, effort and courage - writes
Buechler. Because the lessons I read from it multiply over the
years, my gratitude grows« (ibidem). At this point, after defining
kindness as »a treatment necessity« (p.53), the author shows us how
»many treatment records are also stories of kind sacrifices«
(ibidem). An example is the sacrifice of our own sense of pride,
which may occur - according to Buechler with Owen Reniks technique
of self-disclosure (cf. pp.58-59). Not to speak of the termination
phase of a treatment, and of the fact that (»ours is the only
profession that requires the total discontinuance of contact«)
(p.61). And these are only two of the twenty acts of kindness and
sacrifice that we as clincians frequently make that we find listed
at the end of the chapter!
After showing us - in the next chapter, »Promoting courage«) - how
much courage it takes to work with narcisstic and obsessional
patients, Buechler comes to the following inspiring definition:
(»The analysts courage is shown in interventions that balance the
need for tact with the need for truth, sacrificing neither« (p.72).
Courage helps us »find the way to be empathic and frank«, at the
same time (ibidem). As a matter of fact, given Sullivans and Fromms
tendency to err on the side of rashness, the author goes so far as
to give the philosopher Aristotle (fourth century B.C.) a
(»supervisory role« (p.75), in connection with his own definition
of courage as »the observance of the mean between excessive fear
and excessive rashness« (p.67; cf. his Nichomachean ethics). Very
interesting are also Buechlers ideas about courage in relation to
her theory of emotions, the handling of Daniel Sterns »now moments«
and the problem of training; their common denominator can be found
in the following very acute formulation: (»The internally
well-equipped analyst can show courage because she doesnt need a
success with the patient to prove herself« (p.83).
Sandra Buechlers particular voice, her particular way of connecting
what we bring as persons to our profession with how our basic human
constellation is modified and integrated into our professional
identity through our training and clinical work is what we
encounter, even more sharply articulated, in chapter five,
(»Manifesting a sense of purpose«. »In my own case, personal
›purposefuilness‹, including an expectation of movement, is a core
part of my personality, and I am sure - she writes - it influenced
my choice of profession. Looking back, I think it also played a
role in who I chose as my analyst and my supervisors . ... I
brought all of this to my analytic training, which profoundly
reinforced the need to have and to convey a sense of purpose. .. I
will never be able to separate - she concludes - the role of my
personal experience and character development from my early
professional work and later analytic training in forming the
analyst I have become« (pp.89-90).
Such an attitude profoundly shapes chapter six, (»Creating
emotional balance«: emotions and affects are not »beasts« to be
tamed by cognitive means, but have the power to modulate other
emotions and this is one of the most effective areas of our
clinical work, one of whose basic aims is to give the patient
»greater access to the power of his own emotionality« (p.118)! In
other words, putting her emphasis on the procedural or implicit
level of change, Buechler
considers the patients experience of how we handle and process
emotions as a fundamental part of our work. (»Patients watch us
lose our patience and regain it. They hear our frustration and see
our sorrow. They see us momentarily lose and then regain our
clinical spirit of inquiry. Like any other human being, all the
emotions affect us . ... Patients see us lost and sense how we bear
it. Intuitively they can feel what brings us joy and how that joy
sustains us« (p.123).
Further articulating her challenge of (»bringing our whole
awareness of what it means to be human into our work« (p.154), the
author tells us about her experience with the following two
dimensions of treatment: »Bearing loss« (chapter seven) and
(»Developing integrity« (chapter eight).
A final attempt to position herself in relation to the
interpersoanl tradition is what we find in the last chapter,
»Emotional use of theory«, where we find the following conclusion:
»Emotional balance has become more complex. Ideally, we would like
to have a Sullivanian sense of competence, a Frommian passion, and
a modern awareness of subjectivity,including our own. Is this
possible? Probably not. But I believe it is possible for the
analyst to strive toward balance ... face the inevitable moments of
imbalance, and palpably fight our own way back« (p.177).
As the reader can imagine, I found this book very fresh and
innovative. Together with Edgar Levenson (see back cover), I also
think that it represents an important enrichment and extension of
contemporary Interpersonal literature - centered as it is around
our ability to make the most out of being »all too human«. I also
hope that my detailed presentation will contribute to promoting its
circulation among our readers and to have the book translated into
their various languages. To find the words to describe, formulate
and communicate our own personal participation, i.e. our own
contribution to the treatment of our patients was what originally
brought Sullivan to develop his Interpersonal point of view and it
nowadays represents a shared ambition, need and task of the whole
analytic community.