Introduction to the Practice of Psychoanalytic Psychotherapy by Alessandra Lemma
Alessandra Lemma is a consultant clinical psychologist in the Adolescent Department at the Tavistock Clinic and in the Psychology Treatment & Assessment Service at Camden & Islington Mental Health and Social Care Trust. She is also an honorary senior lecturer in clinical psychology at University College London. She is trained as an adult psychoanalytic psychotherapist.
This book has been largely inspired by teaching psychoanalysis to trainee clinical psychologists and other clinicians from different mental health backgrounds, who were often approaching psychoanalysis with little knowledge or experience of it.
Even so, many were primed to be critical of it on the basis of prior learning or exposure to psychoanalytic interventions that had been experienced as unhelpful. I approach the subject matter in this book largely with this audience in mind, remembering some of the questions my students have put to me over the years and the criticisms they have voiced. The book is intended primarily as a practical, clinical text for workers in the mental health field who are relative newcomers to the practice of psychoanalytic therapy.
It does nevertheless assume a core background in one of the mental health professions, clinical experience with patients and a degree of familiarity with the practice of psychotherapy and/or counselling more generally.
Teaching psychoanalysis has helped remind me that when we are trained psychoanalytically it is all too easy to forget that our practice is based on so much that is taken for granted, and on the idiosyncrasies of our own personal analytic experiences with training therapists and supervisors, that it is unsurprising when the newcomer to it finds the ideas confusing and the theories difficult to translate into practice.
Teaching is indeed a salutary experience – unless we teach the converted – since it forces us to revisit cherished assumptions. It has taught me to beware the dangers of overvalued ideas, though I am sure that while reading this book you will come across several ideas with which I am all too reluctant to part company.
A word of caution is called for before embarking on this book -I am a synthesiser. In this book, I have traded specificity for generalities and subtle differences in theoretical concepts for common strands between the many psychoanalytic theories that are available. It will thus probably disappoint if you are in search of sophisticated critiques of particular metapsychologies or of the philosophical underpinnings of psychoanalysis.
This is not the aim of this book. Rather, my efforts are directed at developing a guiding, yet always provisional, framework for my own clinical work, based as it is on my understanding of theory and on what “works” in my own clinical practice. To this end, I draw on several psychoanalytic theories as I have yet to come across one model or theory that can satisfactorily account for all my analytic work.
In this book I am concerned with articulating my “private” clinical theory (Sandler, 1983) and its implications for technique. In some of the chapters I summarise some of the ideas that guide my work as “practice guidelines”. These are not intended to be in any way prescriptive but merely reflect my own attempt to make explicit how I approach my interventions, and to share the technical teachings that my own clinical supervisors have imparted to me over the years. This book pools together these experiences into a working framework that is inevitably personal and evolving.
In light of this, I can make no claims that what I do and what I have written about is empirically sound, but I have endeavoured, wherever possible, to anchor my practice in the empirical research that I am familiar with.
Because this is an introductory text at the end of each chapter, I have made some suggestions for further reading which will help extend the study of the concepts and ideas presented. If approaching this book with little prior knowledge of psychoanalytic ideas, it will probably be more helpful to read it sequentially as each chapter relies on an understanding of concepts discussed in the preceding chapter.
In this book I will outline key psychoanalytic concepts as they relate to practice guided by the psychoanalytic model that I espouse, namely, an object relational model. In doing so, I am clear, however, that the interventions that I experience as consonant with this model and that lend some coherence to my clinical work are, for the most part, awaiting empirical validation. I am all too aware too that my interventions could be justified by a diverse range of psychoanalytic theoretical orientations.
While I cannot take any credit for the ideas that I shall refer to, I do take responsibility for the way they inform my practice and how I present them in this book.