Book Review: Better Late Than Never: The Reparative Therapeutic Relationship

by Lorraine Price

Published by Karnac Books 2016 ISBN 978 1 7822031 9 3 Reviewed by Aisling McMahon

When I saw the title of this book, I was keen to read it. I have always been particularly interested in the potential for deep developmental work in longer term therapeutic relationships, and have been drawn to theorists who write about this work – some of my favourites being the writers from the British independent analytic tradition, or the object relations school, such as Fairbairn, Winnicott, Ferenczi, Balint, Bollas and Coltart, as well as Kohut’s self-psychology from across the Atlantic. I was pleased to see that Lorraine Price draws strongly from most of these writers in her book. While she writes from an integrative psychotherapy perspective, and is a member of IAHIP (Irish Association of Humanistic and Integrative Psychotherapy), Lorraine shows a strong affinity to psychoanalytic theory. In particular she focuses on the object relations school, and is keen to offer theories and insights from this tradition to fellow integrative psychotherapists who are working with early developmental needs with clients. She asserts that: “Modern integrative psychotherapy has an important relational tradition, but some of the significant concepts, which I consider necessary when working with clients with early relational trauma may have been insufficiently emphasised, lost or overlooked” (xviii).

This book is based on Lorraine Price’s PhD research which explored the experience of regression to dependence through qualitative research interviews with practising psychotherapists – these psychotherapists spoke about their own experience as clients, as well as their experience working therapeutically with clients. Lorraine’s research also involved a heuristic, reflexive element, including her own experience as client and therapist. The book is greatly enhanced by illustrative quotes throughout the text from Lorraine and her research participants. In this book, Lorraine offers an overview of selected psychoanalytic writings in relation to regression to dependence, followed by a focus on key areas in relation to this deep therapeutic work, such as working with shame and terror. She also pays close attention to sensitive issues within the therapeutic relationship, such as therapeutic touch and management of boundaries.

Lorraine defines regression to dependence as: “the concept that given the right environment, a person can return to their early developmental history and, through the unconscious process of the transference and countertransference, re-experience their early inchoate relationship within the therapeutic relationship” (166). She argues that psychotherapists need to be able to recognise a regressive process occurring in the therapeutic relationship, to understand the unmet needs being expressed, and to be willing to engage in the needed relationship, taking on some aspects of the original developmental relationship but also offering a more satisfying experience to facilitate repair and growth. To achieve this, she asserts that: “the therapist must be a safe, containing, holding, attentive and loving other” (167).

In going through a regressive dependency experience in therapy, the aim for the client is to: “have integrated split off infancy experiences, to have a narrative for the whole of the self, to be accepted by the self, and allow non-existence to become existence” (171). A tall order, and Lorraine makes it clear that the process of regression to dependence can be deeply frightening and disturbing for the client, involving going through an often lengthy experience of disintegration, which can feel psychotic at times, before achieving a new integration. This process requires strong holding by the therapist and I agree with Lorraine’s argument that this necessitates that the therapist has a good theoretical understanding of the processes involved, as well as a personal capacity to engage in this complex relational work. In addition to regular supervision and substantial personal therapy to enhance this capacity, Lorraine also believes that it is essential that the therapist has personally experienced a successful dependency relationship (either in infancy or in therapy) in order to have an experiential understanding of the depth and intensity of this therapeutic process.

I believe that this book offers a valuable review of selected psychoanalytic writings regarding deep developmental work in psychotherapy, and its weaving of experiential quotes through the theory brings the therapeutic experience to life. Lorraine’s reflexivity is strong in the book, and the reader is always aware of her personal and professional commitment to deepening understanding in relation to the complexity of therapeutic regression. She offers a useful discussion of the aware and responsible use of therapeutic touch and of more flexible boundaries when needed, in order to facilitate a new, healthier developmental experience for clients. My main criticism is that the book would have benefitted from tighter editing as there was repetition at times, with the same theoretical ground being covered in different places (for instance, the use of touch was discussed across two chapters), as well as some repeated quotes from theorists and research participants. I also would have liked more discussion of the difference between benign and malignant regression, as proposed by Balint, and the challenges we can experience as therapists in determining if a client’s therapeutic regression is healthy and timely, as well as in determining the difference between a client’s needs and wishes (as the latter may require empathic frustration rather than gratification). At a personal level, I was also disappointed that Fairbairn was only briefly referenced in the book, as I see his theory as fundamental to understanding early relational trauma/unmet needs and how psychic structure develops to defend the self from further disappointment or trauma in relationship. Lorraine does present some of Fairbairn’s theory in her chapter on ‘Terror: A sickness of spirit’ but she mistakenly ascribes his theory to Kalsched, a contemporary Jungian psychoanalyst who draws strongly from Fairbairn in his wonderful book, The inner world of trauma.

I think this book will be particularly interesting for psychotherapists who would like to develop their knowledge of psychoanalytic theory and it is likely to inspire an interest in further reading – the reference list in this book is a treasure trove. For those who are new to object relations theory and who are interested in learning more, I would suggest Gomez’s Introduction to object relations as a very accessible starting point. In addition, for those who are interested in integrating psychoanalytic theory with other modalities, I would recommend Kahn’s Between therapist and client as a very readable presentation of insights from both psychoanalytic and humanistic theory regarding the therapeutic relationship.

Aisling McMahon, D.Psych, M.Psych.Sc., is a humanistic and integrative psychotherapist and a chartered clinical psychologist. She works as a psychotherapy lecturer in Dublin City University (aisling.mcmahon@dcu.ie) and also has a small psychotherapy and supervision practice in West Dublin.

References:
Gomez, L. (1997). An introduction to object relations. London: Free Association Books.

Kahn, M. (1997). Between therapist and client: The new relationship (rev. ed.). New York: Freeman.

Kalsched, D. (1996). The inner world of trauma: Archetypal defences of the personal spirit. New York: Routledge.

IAHIP 2017 - INSIDE OUT 81 - Spring 2017