Book review: Learning along the way: Further reflections on psychoanalysis and psychotherapy

 
by Patrick Casement

Published by Routledge 2019
ISBN 9781138343542 (pbk)

Reviewed by Maeve Dooley

In what he says will be his last book, Patrick Casement has drawn together a chosen selection of his writings and articles. In keeping with his personal and familiar style it is titled Learning along the way: Further Reflections on Psychoanalysis and Psychotherapy, and it weaves a colourful tapestry of key considerations for psychotherapy. Patrick Casement’s professional home is psychoanalytic but what he has to say echoes along the roads, streets and lanes of all psychotherapeutic approaches, knocking on doors to speak to those who wish to listen. Honest, forthright, courageous and with an undeniable passion for going to the depths of the developmental journey, Patrick Casement finds himself surfacing in this volume with some important perspectives, and casting a net around two particular questions. The first is “Why do we interpret?” (2). The generally assumed answer is to “… help to bring the unconscious of our patients within the reach of their conscious minds…” (2) but Patrick Casement also adds a concern that “… we may often be interpreting for our own reasons, seeking to demonstrate our own competence rather than staying longer with a more honest sense of not knowing, until other understanding might later emerge” (2). A second question he considers here is, might psychotherapy be leading to “Imprisoned minds”? He wonders if “…some patients experience a pressure for them to give up their own minds in order to accept some apparently better way of thinking?” (2). This later emerges in a similar way, as a concern for students in training.

Continuing on he guides the reader through the chapters, at times shining a light through the thin veils of some of psychotherapy’s struggles and uneasiness. Needless to say however, this is Patrick Casement, so we are not left to sit in any sticky swamps of resigned futility, but rather shown footholds and grips for those of us who choose to venture forward. He continues to generously offer us the resources of his learning and awareness from the depths of his own experience.

Throughout this book, Casement gently unpicks some of the seams of possible misalignment within the shape of psychotherapy in practice. He is, as ever, focused on the particular pattern suited to the individual client, led by their vision and need. There is no reckless ripping apart, no one size fits all. In his authentic, compassionate straight-talking style he offers us some of his chalk markings, alerting us to the bias, and leaving a clear outline for how we might further tailor effective practice.

I am a biased reviewer in that I like the ethos, approach and reflections of Patrick Casement, as I have done since first reading some of his books in the early 1990s. He embraces and supports a therapeutic world view that simply fits for me. I am captivated by his writing style as he describes and outlines with such clarity aspects like: the balance between ‘process’ and ‘procedure’; the primacy of ‘discovery’ in effecting long-term change; his devout willingness to meet the worst experiences with ‘non-certainty’ but with safe discernment. He reminds us in human terms about one of the most difficult yet most therapeutically important aspects of therapy – the therapist bearing with and surviving through the negative transference. He writes beautifully of the desire to provide a good experience in therapy and yet how this can, in effect, alienate the true needs of a client. In yet another chapter he takes us through the nuances of self-revelation by the therapist, again laying out the simplicity of its complexity, essentially evaluating from a perspective of therapeutic helpfulness rather than right or wrong – allowing us adjust the blinkers that can form around boundary holding.

Chapter 5 is titled ‘The Emperor’s Clothes: Some serious problems in psychoanalytic training’ (psychoanalytic could also read as ‘psychotherapeutic’ for the issues he raises). In this chapter there is a refreshingly frank review of difficulties related to training. Included here is a discussion on the power differential and the negative impact it can have on students. He describes the existence of institutional resistance and intransigence towards change, along with the apparent inability within some training schools to reflect on training/trainer shortcomings. Casement writes that there is “…a problem in how students are expected to learn within a context in which a particular way of thinking and of working, is often given priority over intellectual freedom and honesty” (43). Later he adds “It is so easy…to interpret some healthy persistence by the student as ‘being difficult’ or as ‘wishing to be treated as special’ … a symptom of some assumed pathology of the student” (46). In addition he writes to caution the newly qualified (and indeed all of us) against the danger of assuming that any amount of process work could protect against lapses into unconscious projection. At many levels we need to be aware of the ‘circularity of self-justification’.

In exploring therapies aimed at producing quick results to satisfy funding agencies and demands of systems, he speaks of how time limitations can often result in the suppression or changing of symptoms, and not the understanding or root resolution of them. While such therapeutic approaches may be effective at some levels, there is not enough time and relational ground for the client to safely explore deeper concerns, like the ‘worst in me’ or being ‘too much for other’, experiences referred to in his work with clients. In effect these self-perceptions may become better concealed and further rejected in such limited and pressured therapy structures. He later also describes how proper respect for the privacy of a client’s mind can be overlooked by intrusive demands of psychotherapy.

I cannot conclude without noting for the members of the IAHIP, that chapter 16 is a piece that was first published in Inside Out. It is a conversation between Therese Gaynor and Patrick Casement (Gaynor, 2010).

So, to conclude. This is most definitely a book to be recommended for students and experienced practitioners alike, as Paul Steinberg states on the back cover “Seasoned clinicians will be refreshed…”. Learning along the way: Further Reflections on Psychoanalysis and Psychotherapy inspires and energises from within its pages. Like a lighthouse in the rolling seas of difficulties and accomplishments, failures and successes, it gives us position. It also signals that what may help us gain safe passage is our awareness of possibility in unseen depths and shallows, guided by a compass that points to a magnetic north of always Learning…

Maeve Dooley is an accredited psychotherapist specialising in Jungian sandplay. She works from her private practice in Drogheda, Co. Louth.

Reference:
Gaynor, T. (2010). Patrick Casement in conversation with Thérèse Gaynor, Inside Out, 62, 54-66.