Clinical Seminar Review: Clinical Reflections.

19^th May 07. UCD Earlsfort Terrace.

Reviewed by Mary de Courcy

Facilitated by the Irish Analytical Psychology Association, 24 practising psychotherapists met with Susie Orbach in a drafty pathology lab in UCD Earlsfort Terrace on 19^th May 07. Coinciding with UCD’s day of departure from ‘the terrace’, we assembled in a disused lab alongside rolls of pink bubble wrap, boxes of defunct computer equipment and the attendant smell of old university buildings. Amidst such disorder, I mused that in practise the work of psychotherapy is seldom where we expect it to be.

Susie Orbach, a petite figure clad in black with bright red jacket buttons and matching nails began the morning by speaking about the democratization of therapy; the move since World War 2 from seeing clients as treatable objects and the therapist as a psychic surgeon, to the 1990s therapeutic approaches of affects, distractions and feelings. Issues of transference and counter transference as expressions of the client’s struggles have developed into the view that the therapeutic relationship is crucial, and that therapist and client influence each other. Susie spoke of the issue of gifts from clients as potentially seductive, manipulative or devious. While she suggested such gifts could be interpreted as the client’s effort to provoke or disrupt the therapeutic space, the group wondered whether they might in fact be the client’s attempt to thank the therapist for what has been received in therapy. In the move towards the democratization of therapy, she encouraged us to consider our own therapeutic responses, actions, absences and structures. She wondered whether we can trust our reflective processes to contain the potentially scary places into which difficult emotional therapeutic relationships can bring us.

Moving from disjointed therapeutic relationships with their political, religious, philosophical and theoretical underpinnings, Susie began to speak of connections and disconnections with the body. Eating disorders were described as an expression of early psychic disorder and a way of using the body to describe the client’s relationship with parents. For instance, keeping the body small is a way of avoiding responsibility, of staying in control and of expressing an internal dilemma.

My sense of curiosity was being actively challenged by the time of the mid-morning move towards coffee. I realised I had been sitting opposite a green running stick figure pointing towards the exit. I was distracted by the vast array of footwear; sandals, trainers, boots, bare feet, laced shoes, strappy high-heels. Had I heard anything new? Fresh air, coffee and chat beckoned.

With hopes of a more interactive speaker/ group assembly I somewhat reluctantly returned for the second part of the morning. Susie then spoke of some of her own counter transference body responses; feeling dandruff-covered, anger, nausea, feeling lost, inadequate, envious, and an irritated, ‘what’s her problem?’ reaction to an elegant, attractive, female client with an eating disorder. Key words of mistrust, disconnection, parental struggle and internal rupture floated around the room. A participant’s query about the role of therapeutic interpretation was met with Susie’s unease and another wordy cul de sac. The hum of electricity intermingled with heavy words and unspoken sounds. Many practitioners sat with fingers over their mouths, caught perhaps in unconscious intensity, yet illustrating frustration, irritation, boredom and disconnection.

As the ‘Being Human’ theme, interspersed with Kleinian and Freudian references, was outlined by Susie, the struggle in the room was palpable. The struggle of not hiding alongside a sense of collusion with the repeated split towards words and away from feeling was tangible. Attempts to concretise by participants in the midst of the disconnection yielded little development of connection. I found it curious but unsurprising that the moment we began to touch on something solid, it was split off. For instance a brief connection with possible themes like the 1970s fear of drugs mirroring the current Western fear of food, or emotional illiteracy manifesting in body destruction, resulted in a brief struggle and then split. A collective unconscious anxiety about control?  Group/ family unease with unresolved food issues in the room? Group collusion about not connecting with historical or familial difference?

The morning had started with World War 2, a war not historically familiar to most participants, but clearly pertinent to Susie who mentioned her one-generation, Jewish ancestry. It ended on a disjointed, puzzled note with clinical minutiae being detailed by some participants, attempts to chew over the material and an outcome of boredom, frustration and irritation. Counter-transference in action? Probably, but also a desire for something more solid and nourishing to sustain us in our clinical work. Amidst such disorder, I remembered that in practise the work of psychotherapy is seldom what we expect it to be.