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.

zurück zum Titel