news, analysis, opinion for the psychoanalytic community issue 25 SUMMER 2018

On the Regulation, Psychoanalysis Churchill Psychodynamics Eldership, needs Research, and his of Boris Johnson and Analytic and Research needs Darkest Hour 4 and Brexit Work Psychoanalysis 6 8to leadership in the therapeutic world. 13It can appear that collaboration is taking These two polarised views of leadership place (and indeed in some instances of represent, as we might understand it, a course it is), but the refusal of the leader More Doing split where on the one hand we have the to take up authority and the unconscious good idealised (rather burdened) leader/ anxiety about tyrannical power, leads to parent figure and on the other the cruel the primacy of the individual clinician and Less authoritarian bad leader/parent figure. working in lone, idiosyncratic ways. This split, I suggest, perhaps represents a Sometimes in this situation the leader is generalised difficulty with authority and more “Guru” than “servant” but the guru hierarchy and I believe we can see this leader still offers little practical leadership split at work in many of our organisations. at all and is too busy thinking great Being Sometimes it seems to be expressed via thoughts! Of course, they may well be a lack of structure. We have institutions developing the technical and theoretical By Susanna Abse that have almost no structure, that resist aspects of our work and whilst this work what is felt to be “bureaucracy” and these is of vital importance, the “guru” leader Why we need to encourage and authorise our leaders can often be chaotic. Here the leaders can represent such a powerful position seem to hate their leadership role and feel in the mind of followers and accrue such very burdened by it. Correspondingly, we authority, they can stand in the way of have institutions where this split seems competent, active leadership which would to have led to authoritarian, hierarchical deal with administrative and corporate do not pretend to be a student I am hopeful that with good leadership structures where power is concentrated in needs in such a way as to move things of leadership theory, rather the tide will be turned but we’re going the hands of a very few. forward. these comments come from to need radical changes and leaders who my experience as a CEO and can inspire us with vision, courage and But let me extrapolate on the first side of Within the “no organisation organisation”, the other leadership roles I have taken commitment. And we’re going to have to I this split – the kind where the leader is institutional demands are negated and over the years. Also, these thoughts are change our attitude to leadership too. “servant” and where the use of authority this undermines potential collaboration shaped by my more recent role as an is avoided – I shall call this the “no around development and progress in Executive Coach working with leaders I was brought up with the idea that organisation organisation”! favour of stasis. and also by being a member of the leadership was neither something to be Executive of the BPC. These musings celebrated nor sought. Leaders, I was On the other hand, on the other side aren’t aimed at analysing the dynamics told, were usually far from benign and '…we’re going of the split, there are organisations of our organisations – there are many frequently self-interested narcissists. to need radical within the therapy world which seem good thinkers who have elucidated these There were notable exceptions of course classically authoritarian and hierarchical processes from a systems-psychodynamic and these were the self-sacrificing heroes changes and in structure. However, many of these perspective. Rather this piece focuses on (Gandhi was the example here). leaders who can have endless committees which seem to the need for leadership and why we seem appoint themselves and write their own to be struggling first to find leaders and What was valued in my family was the inspire us with rules and regulations. Lines of authority then when we do, we struggle to follow idea of “service” – being the servant was vision, courage are blurred and diffused with committees the leaders we have. “noble” being the boss definitely wasn’t. insisting on autonomy in order to carry As a woman, I felt very unsure whether and commitment.' out their work. Here too we see little There is no doubt that many of us are very taking up a leadership role and the change as the structures seem to exist to concerned about the state psychoanalysis authority that goes with it, was legitimate. The “no organisation” organisation will “preserve” rather than challenge, so even is in. In our psychoanalytic community I felt guilty and unworthy, so it took time usually have a clinician as the leader. This in this authoritarian structure, leadership there is a great deal of anxiety about and good mentoring to overcome these clinician may have been the founder or cannot lead in a classic “command and the future. Can psychoanalysis find inhibitions. perhaps is identified as carrying on the control” kind of way. In fact, there are its way in the 21st century? Are there founder’s legacy. There is little structure patients who want it? Are there trainees So, I came to my role as CEO of Tavistock and there are consistent attempts to Continues on page 2 who want to train? It seems clear that Relationships with two rather narrow avoid decisions that might have many of the psychoanalytic institutions models of leadership in my mind. Firstly, consequences which would affect are struggling to make the adaptations an idea of the leader as narcissistic and individual freedoms within the needed to be relevant to contemporary self-serving, seeking power for corrupt organisation. The leader may society. We are behind other modalities and base reasons; or secondly where be strongly identified with the in many ways – for instance we are leadership is a noble activity in which “servant as leader” mind set or still trying to gather a proper evidence the leader reluctantly agrees to accept may be unwilling to really base and we have a long way to go in responsibility and is in service to others. take on the responsibility tackling issues of diversity. We struggle Interestingly, I think these two notions of leadership at all. to be “business minded” and we have, are also quite prevalent in attitudes until recently, often failed to use modern marketing methods. These resistances to change appear to have led to an enduring decline. There are, of course some green shoots, and real possibilities for growth, particularly as Cognitive Behavioural Therapy (CBT) betrays its promise as a cure all. There is a growing awareness of the importance of good mental health in our society and also growing demand for talking treatments which should make for a favourable “operating environment” for the renewal of psychoanalytic treatments. NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 2

“The founder of psychoanalysis took We generally don’t seem to like fitting More Doing and Less Being leadership very seriously, both in his in with organisational structures; we theoretical work and also in his attempts, often ignore rules and directives; we are continued from front page sometimes successful and frequently dismissive of administrative requirements unsuccessful, to steer the movement and indeed we can be dismissive of that he founded away from schism, the administrators who are employed mysticism, quackery and dilettantism. to undertake these tasks. When I first Freud’s leadership ‘style’ inspired became CEO of Tavistock Relationships, great devotion among his followers, at and indeed from time to time over the times approaching deification; it also whole period of leading the organisation, demanded unquestioned obedience, every so often I would be condescended to something that led to the alienation by a colleague (usually ones who behaved and subsequent departure from the with no regard to institutional rules or fold of psychoanalysis of some of requirements) and asked if I was enjoying Freud’s most creative and original my admin job? This apparent ignorance disciples, including C. G. Jung, Alfred of the differences between the vital Adler, Otto Rank, Sándor Ferenczi and work of administration and the task of Karen Horney. Behind all of these leadership was indicative of, I believe, a painful separations, lay a questioning contempt for professional activity outside of Freud’s authority, something that the sphere of the consulting, seminar or conference room. Being a CEO was seen too many “leaders”. Shall we call this the developmental change and the leadership inevitably led to bitter disputes between by some as essentially a non-intellectual “Too Many Bosses Not Enough Leaders we need for it than this. But before we supporters and apostates. Instead of activity, which in their mind involved Organisation”? go on there is one further aspect of being viewed as scientific differences to boring bureaucratic procedures that they Kernberg’s ideas that I think are worth be resolved through rational discourse, felt often interfered or attacked the REAL What forces are at work here where we discussion, which is his comment that disagreements in psychoanalysis easily work of training or clinical work. either have ineffective leaders who do psychoanalytic theories of organisation came to be viewed as rebellions against very little or we have leaders who are have generally failed to think in depth the authority of the father figure of But where do these attitudes arise constantly undermined by structures that about leadership and about the kind psychoanalysis by his supporters and as from? In part I think it is to do with the work against change? of qualities needed to be a successful questioning of his infallibility by his required qualities of a psychotherapist. leader. Indeed, he suggests that thinking critics.” Whilst the institution may have provided Kernberg (2016) suggests that our training about the individual’s personality or the lights, the heating, the patient systems are to blame. He suggests that qualities is generally discouraged in the These tendencies towards a fear of and the fee, the psychotherapist must too much power and control has been psychoanalytic world and the emphasis questioning and challenging things are create their own domain; their own concentrated in the senior analysts – what is rather to think about systems and how still around of course. The continuing micro-organisation in which they are is generally known as the “training systems function and how psychological problem of the unresolved transference responsible for the management of the analysts”. Kernberg sees this as at the processes unfold in large and small groups. of the analysand towards their analyst case, the containment of the patient and heart of a malaise in our institutions and Whilst understanding of primitive continues to make “growing up” the boundaries of the setting. It is a big that this system has discouraged healthy processes in groups has, no doubt been difficult for clinicians in some of our responsibility and the very nature of the dissent which would bring new ideas and extremely useful in making sense of institutions. We could surmise that some activity demands considerable autonomy attitudes into organisations. Instead, he regressive tendencies in institutions, it of our malaise may indeed come from and a strong identification with the needs suggests that this system of creating an has in my view obscured the need to our “upbringing” in which the spirit of the patient and sometimes this feels elite of “training analysts” has enabled debate the importance of the personality of enquiry, the expression of difference much more compelling than the needs of a small group to accumulate power and of leaders, the kind of structures that and the pursuit of autonomy from the institution. create authoritarian structures in which promote good leadership and the required our teachers and supervisors has been ambitious aspirant psychoanalysts are qualities and skills needed for leadership. experienced as betrayal or a loss of faith, Further, most therapists do not become kept submissive and new trainees are rather than the ordinary natural process therapists to engage with institutions. infantilised. Perhaps some of these difficulties with of growing up and individuating. They are seeking in their work the leadership started with our founding profound intimacy and emotional I recognise some of this of course, but father (whatever your modality) – Freud. '…one thing that engagement that working with patients this version of training institutions is Freud, it seems, was a good old-fashioned offers. Most therapists have a strong not universal and I think there is more command and control leader and here I is commonly said personal need to care and support. They to our malaise and our difficulties with quote from Professor Yannis Gabriel – about managing wish to express and identify strongly with therapists is that loving, accepting and tolerant aspects of themselves and can have some difficulty it is like herding (despite the years of analysis) owning and cats!' creatively using their aggression. Because of this, leadership roles can present NA So, we’ve got some ideas about why the “loving therapist” with considerable leadership in our institutions can be over internal conflicts, as leaders must also be controlling but we are still left with the in touch with their aggression, and, in some circumstances, their ruthlessness in New Associations is published by Managing Editor Gary Fereday Contribute to New Associations trying to understand the chaotic and the British Psychoanalytic Council, Editor Daniela Pasquini We welcome your ideas for articles, dysfunctional nature of other institutions order to lead effectively. Suite 7, 19-23 Wedmore Street, Production Susan Rentoul reviews, and letters to the editor. – the “no organisation” organisations. London N19 4RU Illustrations Allen Fatimaharan In particular we are looking for Another aspect of clinical training can Tel. 020 7561 9240 Printer Blackmore reviews of cultural events, books What is going on there? Fax 020 7561 9005 and films with psychoanalytic also act against preparation for leadership. www.bpc.org.uk Views expressed in New Associations interest. If you would like to propose Many counsellors and psychotherapists [email protected] under an author’s byline are the a topic for a longer article (up to Here we must I think turn to the nature views of the writer, not necessarily 1200 words) please contact of therapy itself and both the personal work in modalities in which they Three issues of New Associations those of the BPC. Publication of Daniela Pasquini at: characteristics required to deliver it well strongly support their patient’s right are published each year in the views and endorsements does not [email protected] to “lead” the work. Training develops spring, summer, and autumn. constitute endorsement by the BPC. and to the day to day working practices Deadlines: The next issue of New that every psychotherapist is engaged the therapist’s ability to help the patient Subscriptions © 2018 British Psychoanalytic Associations will be published in in. If you talk to people attempting to be with themselves and to listen to UK annually (3 issues): £10 Council. No part of this publication September 2018. The deadline for their own experience. To achieve this Overseas annually: £16 may be reproduced, stored or article proposals is 30 June 2018. to lead psychotherapy or counselling transmitted in any form or by any Letters to the Editor should reach us organisations, one thing that is commonly the therapist must not be task orientated. means without the prior permission no later than 1 August 2018. In psychoanalysis this stance was best For insertion of advertising of the publisher. said about managing therapists is that it is materials contact: like herding cats! described by Wilfred Bion. [email protected] ISSN 2042-9096 Continues on page 4 NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 3

been designed to place the organisation So, there is much to be done to ensure Editorial more firmly in civic society, increase the the profession embraces leadership specificity of our aims and objectives and becomes better engaged with the and clarity around the respective roles external environment. The paradox of Council and the Board of Trustees. seems to be that while as a profession we It’s a necessary step to help enable seem to struggle with our own leaders, Leadership the organisation further to take up its our understanding and approach to the leadership role, with clear authority, human mind provides invaluable insight whilst at the same time ensuring the into leadership qualities of others – and the views and concerns of Member as the articles by Candida Yates and Institutions and Registrants are properly Lynsey Nicholls demonstrate through reflected in our work. their examination of Boris Johnson and future of the Winston Churchill. In her article examining regulation, eldership and analytic work, Helen Morgan explores the inherent dangers '…there is a strong profession of idealisation of the elders and the case for the associated tendency towards conservatism and preservation of the status quo. As she BPC to take up By Gary Fereday argues, there is a strong case for the BPC leadership in its to take up leadership in its regulatory role to ensure that the profession opens up to regulatory role to he concept of leadership the external environment that therapists ensure that the and patients live and work. and leaders has a '…if the profession profession opens complex relationship is to flourish then with psychoanalytic Research must surely be a crucial aspect up to the external psychotherapyT and is the theme of this it must embrace of that external environment and is edition of New Associations. explored in the article by Felicitas Rost. environment that leadership and In it, she powerfully argues the need for therapists and It seems at times to be a profession develop leaders the profession to embrace research whilst uninterested, suspicious even, of leaders at the same time arguing how research patients live with authority needs psychoanalytic thinking if it is to who are sometimes seen as self-promoting and work.' individuals either not to be entirely to lead.' find effective ways of overcoming biases. trusted or to be ignored whilst the ‘real Jessica Yakeley builds on this argument, exploring how some of the challenges of With such invaluable insight it is surely business’ of clinical work goes on. To avoid The reluctance to engage with, suspicion undertaking research have been tackled at time to support the development and this, some leaders adopt a position of the even, of leaders is something that can the Portman Clinic. authorisation of our profession’s leaders, ‘reluctant leader’, projecting an image often be witnessed across the profession. ensure we engage with the external of selflessly serving their colleagues only Reflection, challenge even, about whether The views of patients must also surely environment and avoid what Helen after reluctantly taking up the role, often a committee or a Board has the authority feature in our understanding of the Morgan describes as the dangers of seeking permission to make decisions. to make decisions can often dominate external environment. But, as the becoming ‘atrophied, marginalised and These are some of the issues Susanna meetings, concluding with the real issues conversation with leading patient seen as irrelevant in a modern world’. Abse tackles in the lead article. In it she being neither properly identified nor advocate, David Gilbert, suggests, the argues that if the profession is to flourish decisively tackled. Gary Fereday is the Chief Executive of profession still has some way to go to then it must embrace leadership and the British Psychoanalytic Council understand how we might do this in an develop leaders with authority to lead; as In March the BPC agreed to adopt new effective and collaborative way. she neatly puts it, we need ‘more doing Articles of Association and move to seek and less being’. charitable status. These changes have

Psychoanalytic approaches to therapeutic interventions have the potential to transform lives at the deepest levels and to provide understanding and insight into complex human interactions. PP NOW 2018 will explore and celebrate the recent evidence base for psychoanalytic work and showcase innovatory and cutting edge projects and services together with the various research methods used to validate their work that renew the discipline for the 21st Century. PP NOW 2018 is an all-plenary conference NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 4

More Doing and Less Being Politics continued from page 2

“Do not remember past sessions. The So, if we are to have effective leaders greater the impulse to “remember” what within our institutions what qualities do has been said and done, the more need to they need? Here again Kernberg (2016) On the resist it. … Desires for results, “cure” or helps us as he outlines the requirements even understanding must not be allowed for leadership to proliferate.’ (Bion, 1967a: 272-3.)” Psychodynamics “On the basis of my experience as Bion’s central idea here is that the psychoanalyst leader of groups (inc therapist must cultivate a “not knowing” therapeutic communities, medical of Boris Johnson state of mind in order to really be with director of psychiatric hospitals, and the patient rather than with a set of consultant to mental health institutions pre-learnt theories or ideas. He suggests I can attempt to describe the desirable that therapists need to be patient and personality characteristics for rational and Brexit borrows from the poet, John Keats the task leadership. First is high intelligence, idea of “negative capability” to describe which is necessary for strategic By Candida Yates a state of mind of continuous uncertainty conceptual thinking; second is personal rather than jumping to conclusions, honesty and non-corruptibility by the decisions and action. Obviously, this political process; third is the capacity “being rather than doing” approach, which for object relationship in depth, which arlier this year, Boris Johnson has become somewhat reified within is essential for evaluating others pier, Johnson had lost his touch and that used his much-trailed psychoanalysis, can be rather at odds with realistically: fourth is what might be his cachet as a popular politician was on Valentine’s Day speech to the requirements of leadership, where called healthy narcissism in the sense the wane. Johnson’s attempt to flirt with deliver his vision of how timely decision making and activity is of being self-assertive rather than self- Remainers was probably always doomed, the UK should come together, accept the effacing; and fifth is a sense of caution E and one suspects that his speech was necessary. Indeed, I would suggest this 2016 UK Referendum result, and look reification of negative capability has and alertness to the world rather than aimed more at shoring up approval ratings forward to all that life outside the EU has brought about a culture within some a naive credulousness, what someone I among his existing supporters. Research to offer. In the lead up to this speech, we institutions where acting is confused with once knew called justifiable anticipatory shows that since 2016, attitudes have were told that he intended it to reach out “acting out”. paranoia,” hardened on each side of the Remainer/ to Remainers, to reassure them that things Leaver divide in British public opinion, wouldn’t be as bad as they feared. He This stance can lead to difficulties in our I would add two further attributes – firstly, a split that reflects the polarised and urged them - in effect - to dust themselves profession with action and with decision a deep interest in improving things, highly emotive nature of contemporary off, accept ‘the will of the people’, and making. Problems are “thought about” not just preserving things. This means UK politics (Hobolt et al, 2018). A start all over again by embracing the and then “thought about” some more. noticing and minding when things aren’t psychodynamic analysis of emotional new landscape of a post-Brexit Britain Whilst we need reflective institutions going as well as they could, because investment in the Brexit campaign and (Johnson, 2018). And yet Johnson’s playful we do not need rumination. In my work that leads to an appetite and interest in its leaders allows us to understand the stab at political courtship, with its mock- as a leader and latterly as a consultant I innovation and change. And secondly, a powerful structures of feeling that shape psychological references to the problem of have seen a lot of poor meeting discipline competitive spirit with the capacity to use politics today. Johnson played a significant ‘Brexcosis’ failed to hit the spot, leading where the task is forgotten, rumination competitive aggression creatively! This role in rallying support for the ‘Leave’ some to argue that, like a fading music flourishes and then everyone is frustrated. links to an interest and engagement with campaign in the months leading up to hall act performing at the end of the the outside world and a wish to learn the Referendum. His decision to back the from others and compete for resources – '… a competitive funding, trainees, patients etc. spirit with the Finally, and perhaps most importantly capacity to use in our psychoanalytic world I think we competitive need leaders who remind us of our social purpose. We need people who have a fire aggression in their belly and an unashamed belief in creatively!' making a difference in the wider world, who can help us articulate and develop our So, we have perhaps these two very mission and who will galvanise us towards different kinds of activities – Leadership action and change. And leaders who are where decision making and action are not afraid to make psychoanalytic necessities and therapy where reflection practice the servant of, not the master of and staying with the feelings in the this task present are required. Leaders do need to reflect – they need to look right (back to Susanna Abse, Couple Psychoanalytic past experience), look left (to the future), Psychotherapist; Leadership Fellow, St look right again (to the present – now) George’s House, Windsor; Senior Fellow, and then they need to cross the darned Tavistock Institute of Medical Psychology; road! Winner of the BPC’s Outstanding Professional Leadership Award 2017 There are, of course, aspects of the training of therapists which are References Bion, W.R. (1967a) ‘Notes on memory and desire’. extremely useful in leadership. Listening Psychoanalytic Forum, 2: 271-280. to and offering containment to a staff Gabriel, Y. (2011) Psychoanalytic approaches group; being able to take the emotional to leadership. In Bryman, A., Collinson, D., Grint, K., Jackson, B. and Uhl-Bien, M. (Eds.), The SAGE temperature of an organisation and speak Handbook of Leadership: 393-405. London: Sage. to what is going on is very helpful, but the Kernberg, O. F. (2016) Psychoanalytic Education task of leadership does not end there – it at The Crossroads: Reformation, Change, and the Future of Psychoanalytic Training. Routledge: NY. must move to action and often very quickly. NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 5

leave campaign and ‘come out as an outer’ of transitional phenomena has, of late, to identify instead with the retro style and Telegraph column are often awash was taken after months of ‘indecision’ and been applied to the experience of relating of Johnson, can be seen in this broader with signifiers from an earlier era of ‘a huge amount of heartache’ (Johnson, to the objects of contemporary media and cultural context, but it is also framed by nation and empire, evoking a kind of 2016). popular culture (Bainbridge and Yates, the experience of social and economic Boy’s Own style of masculinity, often 2014), and the unconscious investments precarity. with some Winston Churchill references Johnson’s vacillations around the EU in Johnson as a psychological object of thrown in, to convey the threat posed by campaign hark back to a deeply flirtatious political culture is an example of how this From a psychoanalytic perspective, the ‘European powers’ to the border shores style of politicking rooted in his time as works. Winnicott’s theory of transitional this turning back also brings to mind of Britain. He conjures up a picture of the London Mayor, as I discuss elsewhere phenomena and cultural experience Christopher Bollas’s (1987, 1992) theory electorate as helpless infants faced with (Yates, 2014, 2016). Johnson continues to can be deployed to explore the public of object relating, where he contrasts the threat of an all-engulfing Brussels draw on the familiar, playful routines that fascination with figures such as Johnson. the ‘conservation’ of objects with their ‘Nanny’ who has lulled us into a passive worked so well for him during that period, The public interaction with him – or at potential to bring ‘transformation’. Bollas state of acquiescence, and he encourages which one might see as his ‘heyday’. All least the interaction with his persona develops Winnicott’s theory of transitional British citizens to ‘be brave’, to wake up this helps to shore up his power base as as a cultural object – often mirrors the phenomena to argue that just as we seek out of their slumber and imagine ‘an a potential leader in waiting, but, as his pleasurable dynamics of playing with a objects that may hold and reassure us, independent future’ (Johnson, 2016). prevarications around Brexit show, it is transitional object or toy, and Johnson’s providing a bridge between inner and not easy to square such ambition with comedic image helps this process along. outer worlds, we are also changed by However, as we have seen, one now can his public reputation. His flirtation with Aided by his appearance on various media those objects, as part of an on-going detect a number of tensions between voters on the theme of Europe provides platforms, including lively interactive process of transformation. Each time we Johnson’s comical Just William persona an example of his seemingly spontaneous, social networks, Johnson also seems experience an object, ‘subjectivity is newly and his role as a more serious politician authentic un-spun qualities that in very good at taking part in the game of informed by the encounter, its history who is currently the British Foreign the past have been key to his ability celebrity politics (Yates, 2014). altered by a radically effective present’ Secretary with ambitions to lead the UK to connect with the public. Johnson’s (Bollas, 1992, p. 59). after severing ties with Europe. More communication skills have been honed and more, as the contradictions of his over the years in various media settings, '…like a fading Nonetheless, as Bollas argues, alongside public persona are tested and his mask of and his celebrity status on television and music hall act the creative aspects of transformation, authenticity fails to convince, the public in political debates is such, that he is still there are also more defensive and grow impatient with his lack of integrity regarded by some as ‘political box office’. performing at the reactionary ways of relating, when objects and of being tantalised by the play of Johnson has constructed a persona as end of the pier, are used in the service of warding off his shifting political loyalties and policy a benign, old-school English eccentric, the risks, and we can extend this to think positions. Today, Johnson can no longer who refuses to identify with superego Johnson had lost about the losses that come with cultural profit from his performance as the popular figures of authority such as those who his touch.' change and the fragmentation of late politician as jester and instead, as an were eventually labelled in pejorative modernity which are also linked to the aspiring leader, must manage the hate and terms as the out of touch ‘metropolitan His apparent lack of deference to dynamics of Brexit (Yates, 2015). Bollas’s disappointment that increasingly comes elite’ following the Brexit campaign, or the establishment sits well with an discussion of the relationship between the his way as ‘faceless technocrats’ of EU leader, electorate who are increasingly cynical ‘conservation’ of objects and ‘malignant’ President, Jean-Claude Juncker’s ilk. and disenchanted with politics, and he moods is evocative when thinking about Candida Yates is Professor of Culture and manages to ward off any potential envy the mood of Brexit Britain. Bollas (1987, Communication in the Faculty of Media In the past, psychoanalytic studies of of his position as an elite politician by p.102) likens the ‘special state of a mood’ and Communication at Bournemouth leadership have focused on the processes representing himself as an un-impinging and the emotional work that takes place University, UK of fantasy around politicians as idealised figure that people can enjoy. Throughout within it, to that of a dream, as the mood parental figures, where the vertical the Brexit campaign, Johnson often works as an environment through which References structures of identification shape our appeared to gently mock the pomposity the emotional work of object relating Bainbridge, C. and Yates, C. (Eds.) (2014) Media and the Inner World: Psycho-Cultural Approaches to relationship to them as objects of the of those in the establishment who were takes place. He distinguishes between Emotion, Media and Popular Culture, Basingstoke: political imagination. Today, however, too negative and too often called on ‘malignant’ and ‘generative’ moods: the Palgrave Macmillan. western democracies are influenced by the authority of ‘experts’. By contrast, former is used as a way to block object Bollas, C. (1992) Psychoanalysis and Self Experience. London: Routledge. a loss of faith in the old structures of relating and is linked to an inability to Johnson’s very traditional English trait of Bollas, C. (1987) The Shadow of the Object: authority where the hierarchical Oedipal celebrating amateurism and of refusing work through the ‘unthought known’, Psychoanalysis of the Unthought Known. London: identifications in public life have been to take things too seriously, taps into his those aspects of history that have yet Free Association Books. Eaglestone, R. (ed.) Brexit and Literature. London: challenged by the social and cultural populist appeal, allowing him to associate to be properly processed and integrated Routledge. forces of late modernity. The increasing himself with a nationalist fantasy of (1987, pp. 100-101). At the collective Hobolt, S. B., Leeper, T. and Tilley, J. (2018) influence of social media across all levels ‘home’. In this rendition, the ‘England’ level, history is returned to and remains Emerging Brexit Identities. In: UK In A Changing Europe Report: Brexit and Public Opinion, p. 18. of society has also undermined the old in question is one that belongs to a less unmourned, as, for example, in idealised Johnson, B. (2018) Full Text: Boris Johnson’s Brexit symbolic order of paternal identification complicated and secure pre-globalised accounts of Britain’s place in the world as Speech. The Spectator. 14 February https://blogs. and often leads to more horizontal, age symbolised by flag-waving street a colonial power. spectator.co.uk/2018/02/full-text-boris-johnsons- ‘sibling’ structures of identification. brexit-speech/ Accessed 28 March 2018. parties, jammy dodgers and comics such Johnson, B. (2016) There is only one way to The popularity of Johnson’s playful as The Beano. And yet, in this realm, Bollas’s insights throw light on what we get the change we want and that is to vote to persona invites such fraternal rather than see within the hopes and aspirations of leave the EU. The Telegraph. 16 March. [Online] psychosocial and political relations were http://www.telegraph.co.uk/news/newstopics/ paternal identification, providing a perfect also underpinned by the values of empire those who wish to leave the EU – a desire eureferendum/12167643/Boris-Johnson-there-is- foil for perceptions about the ‘faceless and the injuries of ‘race’, gender and for some kind of positive transformation only-one-way-to-get-the-change-we-want-vote-to- authoritarian’ figures of the EU and the in the form, say, of greater sovereignty, leave-the-EU.html social class. Winnicott, D. W. (1953) Transitional Objects and ‘elitism’ of its governing bodies. With a desire to shape one’s own laws, remove Transitional Phenomena, International Journal of his teddy bear looks and public gaffes, The use of nostalgia as a defence unnecessary European regulations, Psychoanalysis. 34: 89-97. Johnson is for some a seductive figure – a develop a more sustainable eco- Yates, C. (2016) ‘Tuck Your Shirt in” it’s going to be against the losses and uncertainties of a Bumpy Ride: Boris Johnson’s Swerve to Brexit’. comical toy with whom the electorate can contemporary culture has been discussed environment and so on. Johnson’s upbeat In: Jackson, D., Thorsen, E. and Wring, D. EU play. Any notion of governance associated performance as the leaver’s champion Referendum Analysis 2016: Media, Voters and the at length in psychoanalytic and cultural Campaign. pp.53-4. Bournemouth University. with his role as a senior politician is thus studies, and the desire to turn back also may for some evoke such sentiments. Yates, C. (2015) The Play of Political Culture, undercut. taps into deep-rooted concerns about Nonetheless, the wish for transformation Emotion and Identity. Basingstoke: Palgrave change and of being ‘left behind’ by the in the Brexit campaign has often been Macmillan. Yates, C. (2014) Political Sport and the Sport of In some ways, Johnson’s image has forces of modernity (Yates, 2015). As underpinned by a mood of conservation Politics: A Psycho-Cultural Study of Play, the Antics allowed the electorate to identify with research shows, for many, such anxieties grounded in illusions of nostalgia for a of Boris Johnson and the London 2012 Olympic Games. In: Bainbridge, C. and Yates, C. (2014) him as a version of Winnicott’s (1953) played a key role in motivating them to Britain of an earlier era, when the old (Eds.) Media and the Inner World, Psycho-Cultural ‘transitional object’, providing a sense of vote to leave the EU, and Johnson’s image hierarchies were in place and where Approaches to Emotion, Media and Popular Culture. safety in an age of profound insecurity and leadership style resonates in that cultural differences were less pronounced. Basingstoke: Palgrave Macmillan. pp. 34-53. and crisis, thereby also illustrating the respect (Eaglestone, 2018). A cultural changing psycho-political dynamics of desire to look back, or at least to turn Whilst Johnson likes to talk in an upbeat fantasy in public life. Winnicott’s theory away from contemporary malaise and way about transformation, his speeches NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 6

Leadership and Governance Regulation, Eldership and Analytic Work

By Helen Morgan

ver the time since taking Winnicott proposes that the capacity to on the role of Chair in be alone is a crucial aspect of healthy 2015, I have come to know development and that this happens the work of the three through the infant being able to be alone committeesO that are responsible for in the presence of the mother3. As he carrying out the regulatory work of states: the BPC – Registration, Professional Standards and Ethics. This has led me Here is implied a rather special type to expand on earlier thoughts I wrote of relationship, that between the infant about when I was Chair of the British or small child who is alone, and the Association of Psychotherapists (BAP) mother or mother-substitute who is in on the relationship between matters of fact reliably present even if represented Governance and the analytic institution. for the moment by a cot or a pram or the At that time, we were all working towards general atmosphere of the immediate statutory regulation, a process which was environment. aborted when the coalition government (Winnicott, D.W. 1965, p.30) came into power in 2010. The BPC was then asked to take on the role of Winnicott is, of course, speaking of the Voluntary Regulator under the authority individual infant alone with its mother. of the Professional Standards Authority When he writes, albeit sparingly, about (PSA) and we now have considerable the paternal role he also hints at a notion experience of managing this function. of this ‘nursing couple’ itself being alone The following describes something of my in the presence of a third. This ‘third’ is thoughts on this work. the ‘other’ in whose presence the mother/ infant couple are alone. This ‘other’ has The Analytic Couple the dual role of protecting the couple Analytic work takes place within a from external impingements, but also container, a vas hermeticum. Working of intervening at times of stress in private practice one has the privilege between them. of being able to explore the therapeutic something which (though paradoxically) 'Working in relationship in a relatively uncluttered, For the sake of this discussion I suggest always implies someone else is there. protected, boundaried place and time. The it can be helpful to read the following (Winnicott, D.W. 1965. p.34) private practice free associating of the patient1, the reverie passage from Winnicott and replace the of the therapist2 and the play between term ‘infant’ with that of ‘the analytic How then, can the profession be one has the them can only happen in a space where couple’: organised so that it can be the facilitative, privilege of being confidentiality and privacy are secure and concerned and benign ‘other’ in whose trusted. The analytic couple must be alone It is only when alone (that is to say in presence the analytic couple can find able to explore for therapy to take place. However, in this the presence of someone) that the infant an ‘aloneness’ which allows them to the therapeutic aloneness each becomes vulnerable to the can discover his own personal life. The ‘rediscover the personal impulse’ rather other, and privacy can slip imperceptibly pathological alternative is a false life than the ‘pathological alternative’ of ‘a relationship into dangerous secrecy. The deeper, more built on reactions to external stimuli. false life built on reactions to external in a relatively intensive the work, the greater the danger. When alone in the sense that I am using stimuli’? This ‘other’ is made of a series of Boundaries may crumble, and unconscious the term, and only when alone, the infant concentric circles of colleagues (especially uncluttered, vengeful or erotic forces overwhelm, is able to do the equivalent of what in those in a supervising role), member protected, leading to the loss of the therapist’s an adult would be called relaxing. The institution and the regulating body. As empathic, ethical and analytical attitude infant is able to become unintegrated, to regulator the BPC itself is accountable boundaried place and resulting in retaliation and acting out. flounder, to be in a state in which there to our own regulator, the PSA, as well and time.' It is, therefore, also imperative that this is no orientation….. The individual who as to the law of the land, and our work has developed the capacity to be alone is is to manage the external demands and analytic couple are not alone. Whilst other professionals operate in a constantly able to rediscover the personal to ensure our systems and requirements more open forum so their work is publicly impulse, and the personal impulse is not foster authentic, trustworthy and available to be judged, the very privacy of wasted because the state of being alone is autonomous professionals able to bear 1 Or ‘client’. The term is also used to refer to this one makes evaluation a more intricate anxiety, hopelessness, powerlessness, to the couple or family where relevant affair. The analytic profession has existed not-know and yet to keep on thinking. 2 The term is used to include psychoanalyst, in relative isolation, containing within Jungian, analyst, psychotherapist or 3 The term ‘mother’ here refers to the primary it a number of theoretical approaches, counsellor caregiver NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 7

a variety of ‘truths’ each avowed by training institution is dominated by a average age of the profession and our multi-cultural society where matters of different groupings with historical and form of cabal, internally focussed and run difficulties in facing the decline, both of sexuality and gender are undergoing current conflicts between them. We have by Elders whose position seems to be a ourselves and that of others. a form of revolution, then training internal systems of professional authority matter of anointment. This can result in a curricula and post-grad events need to and responsibility, held by people who re-enforcement and amplification of such All systems have a tendency towards offer opportunities for all to undertake are assumed to know their craft. They an elevation as described by Colman and closure. A closed system is isolated, the work of addressing the racism are the ‘Elders’ who hold authority in leaves the analytic couple vulnerable to exchanging neither energy, matter and prejudice that arise within us as the realms of gate-keeping, assessment, the intrusion of the judgemental, shame- or information with its environment, individuals and in our institutions. Such teaching, etc. because of their experience inducing analytic superego. whereas one which is open maintains interventions will not always be welcomed and expertise. Having not had the sort its boundary but is able to interact with, and establishing ways of doing this need of oversight direct links to academia can Here the role of a regulator such as the and be changed by, the world outside discussion and thought if they are to be offer, the profession has been arranged BPC can be helpful as a container which of itself. We can think of the system’ as effective. However, given the history and hierarchically as an hermetically sealed requires greater openness and clarity analyst, the analytic couple, the member the tradition we inherit, I believe that system unaccountable to any external about training standards, assessment institution the BPC or the profession itself. good ‘Eldership’ has sufficient confidence body. The profession has, perhaps, itself procedures, ethical codes etc. Finding the Each can live in their own echo chamber in the value of the traditional to recognise been left too much alone for too long. right level at which to do this is not easy. guaranteeing they hear only what they it is strengthened by opening up to inputs On the one hand, behind this apparently already know. It takes active commitment from outside of itself, and it is this that The Ego Ideal and the rational process seethes a ferment of to work against this tendency towards good regulation can and should support. Super-Ego old and new battles over territory and closure, and the BPC as regulator, charged If we fail to do so then the analytic In his paper ‘The Analytic Super-Ego’ hierarchy with all the concomitant as it is with the demands of society, and couple becomes sealed off and isolated, Warren Colman refers to the similarity resentments and determined held on required, therefore, to face outwards as and analytic thinking generally becomes between analytic training and initiation to positions. A sort of ‘My-Elders-are- well as inwards, has an important role to atrophied, marginalised and seen as rites and the tendency this creates for better-than-your-Elders’ stand-off. play here. irrelevant in a modern world candidates to: ‘remodel’ themselves in the Historic and current conflicts rise up in image of their community’s ideal. The their most primitive form tearing into It is here where good governance Helen Morgan is a Jungian analyst and candidate’s ego-ideal is thus transformed the profession, the institution and the structures and a proper use of regulatory Chair of the BPC into an analytic ego-ideal to be monitored individual practitioner. On the other hand, requirements can be helpful in ensuring by an analytic super-ego identified with the analytic couple must also be protected that practitioners open up to input from References: the analytic community at large from invasion by an over-anxious system the environment in which we (and our Colman, W. (2006) The Analytic Super-Ego. Journal of the BAP. Vol 44 (2). (Colman, 2006, p.1) of regulation which has little capacity to patients) live and work. We all should Rycroft, C. (1995) A Critical Dictionary of trust this aloneness and wants to manage be making sure that we are familiar Psychoanalysis. 2nd Edition. London: Penguin. Rycroft’s Dictionary of Psychoanalysis and control it quite directly by intruding and up-to-date with research findings Winnicott, D.W. (1965) The Maturational Processes defines Ego Ideal as: ‘The self’s conception into it. both in our own profession and in other and the Facilitating Environment. London: Karnac. of how he wishes to be. Sometimes used related fields such as neuroscience. If synonymously with the super-ego, but A profession which relies too heavily on we are to be effective and available more often the distinction is made that its Elders will, inevitably tend towards to work with patients from a diverse, behaviour which is in conflict with the conservatism and a preservation of the super-ego evokes guilt, while that which status quo. I suggest it is more productive conflicts with the ego ideal evokes shame’ to shift the focus from that of ‘Elders’ (Rycroft, 1996, p.45) with all the implications of an idealised NEW aristocracy or elite, to the concept of Diploma in Psychosexual Therapy Colman goes on to say that…: ‘Eldership’ as a functional attribute ….idealisation and identification can or quality essential to any profession. create considerable difficulties if they Eldership includes the particulars of the Starting January 2019 craft, the theoretical framework, its moral remain unmodified. Since it is the job of This two-year course is designed to provide the super-ego to monitor and even police code, its wisdom. Whilst represented knowledge, skills and opportunities for clinical practice the ego in relation to the standards of the by certain individuals at any one time, in the area of psychosexual and relationship therapy. ego-ideal, the more idealised and therefore its ownership and development need It qualifies graduates to practice as psychosexual unattainable the ego-ideal becomes, the to be accepted as the responsibility of therapists in statutory and voluntary sectors as well as in private practice. more persecutory will be the functioning all members – including candidates in training. In the wider profession, in Taught by highly-experienced staff at an internationally-renowned institution of the super-ego (Newton, 1961).. with a 70-year history of teaching and research, the course is open to These pressures, in addition to those…. any analytic institution, and also in any qualified therapists and counsellors of any discipline. Teaching modules will arising out of the counter-transference individual practitioner, both functions be delivered on weekends (Saturdays and Sundays monthly in year 1 and to the patient’s distress, all contribute to of Eldership and of Governance need to Saturdays monthly in year 2). operate in respectful relationship to each a tendency to compensate for feelings of Content other. helplessness and powerlessness by elevating Students will be offered a containing environment in which to weave the psychoanalytic ‘parents’ into super- together theory, practice, self-reflective skills and group supervision. They powerful, magically effective, larger than Regulation, Eldership and will have the opportunity to develop critical thinking by means of written life beings. (Colman, 2006. p.5) the External World assignments, reading, discussion and assessed case work. The course will Like all other regulators, the BPC has also include seminars, opportunities for group work and role play, monthly case discussion/supervision groups and monthly self-reflective groups. It is inevitable that there is a degree of taken on a function on behalf of society idealisation of those who, after all, we as directed by the PSA. This function is Support from a personal tutor will be provided throughout the course, along with opportunities to undertake clinical work at an external placement to spend a great deal of time and money described as the ‘protection of the public’ broaden experience. training to become like. However, the and it means that we are working to In addition to training fees, students will be required to have an individual greater the gap between the ideal and the ensure that we minimise the possibility supervisor for clinical work from a Tavistock Relationships approved list of reality, the greater the threat of shame of malpractice and infringements of the supervisors in psychosexual and relationship therapy. and the harsher the super-ego response. If ethical code. We need good, well-regulated Full course details including clinical case requirements are available at the qualities of these Elders, the training trainings and the obligation that all www.TavistockRelationships.ac.uk. analysts, the supervisors, the teachers, clinicians present and discuss their work Fee: £5,900 are assumed but not defined, and the with colleagues as well as ensure they Venue: Tavistock Relationships, 70 Warren Street, criteria for assessing the various stages keep on learning throughout their career. London W1T 5PB of career development not explicit and And this is as essential for the ‘Elders’ as it transparent, then qualification and later is for the newly qualified, as complacency APPLY NOW: progress becomes a haphazard business and arrogance can be as dangerous as Tel: 020 7380 8288 of unknown factors and/or the benign inexperience – if not more so. This is an Email: [email protected] regard of those with power. Thus, the increasingly urgent demand given the www.TavistockRelationships.ac.uk NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 8

In that I agree with Jean Knox7 that it of an illusory hierarchy of evidence Theory and Pratice Today: Research is a “rather dubious ethical position” to that elevates RCTs above observational keep relying on ideological beliefs and studies13 is as restrictive as the claim that authority. I also think that the profession case reports are the only methodology of has a responsibility to its members in true psychoanalytic value. We might do providing opportunities for it to grow better in investing our anxiety-coloured Psychoanalysis and develop by questioning its concepts energies in building bridges between the and techniques in a systematic manner as various methodologies and employing well as in adapting to the various societal them in conjunction. If we are striving needs Research changes that are happening. It has been for the best approximation of finding the well established that we human beings truth, would we not do well by taking cannot rely on our own judgements given the perspectives of all three into account: and Research needs our tendency to seek confirmation of what the participant’s, the therapist’s and the we already believe and to over-estimate observer’s? Surely, shining light on one our own competencies9. Thus, as Fonagy4 perspective only would leave a looming reminds us, psychoanalysis, like any other dark shadow. Psychoanalysis discipline, needs another, an outsider who is not caught up in the transference and counter-transference processes, to become 'These figures By Felicitas Rost more scientific. speak of a

The dualistic view that psychoanalysis noticeable lack of s it fair to say that psychoanalysis than ever to raise the necessary funds. A is concerned only with hermeneutics a new generation and empirical research do not further concern is the increasing average not science, or is only idiographic speak in different dialects, age of psychoanalysts and decreasing not nomothetic, is most unhelpful, as of psychoanalytic but speak different languages number of patients seen (only 15% of the clearly it embraces and needs both. clinicians.' Ialtogether? In fact, it has even been members of the American Psychoanalytic There is no doubt that the evidence asserted that they descend from and Association (APsA) are under the age base for psychoanalytic treatments is In fact, many of the bridges have already belong to very different cultures. If so, 50, and the average number of patients growing. However, much more is needed; begun to be built as evidenced by the then this begs the question of whether seen is 2.752). These figures speak of a the profession has been very slow in adaptation of research trials to allow their diverging heritage forecloses the noticeable lack of a new generation of replicating trials and carrying out studies studying the complexity of the clinical possibility of any form of alliance. The psychoanalytic clinicians. It is indisputable with larger sample sizes that are needed to situation, the research participants and gulf between the two is striking, with that psychoanalysis is not blameless in strengthen and solidify it. It is important the treatment modality6. For empirical worrying consequences. What is needed finding itself in this perilous state of not to take the plug out of the bath findings to become meaningful, they need is a middle way, where neither imposes affairs. It has a history of insularity3 whilst the tap is running and to continue to be integrated into clinical practice. its tongue on to the other, but where both that led to a distancing from other accumulating that kind of evidence. RCTs Thus, the focus on mechanisms of change, can continue to hold on to their principles psychotherapies and disciplines, giving are equipped in answering important the incorporation of important moderator and values whilst gradually allowing them, as Peter Fonagy4 points out, “a place questions other research designs cannot and mediator variables, the importance 10 the effects of the encounter to shape at the table of evidence-based practice” provide, and anecdotal and published paid to therapy process as well as outcome a novel way of conversing and hence whilst finding itself on the side line. accounts of participating analysts shows are only a few examples of emerging gaining knowledge. As such, I argue that The profession’s scepticism of systematic that the fears and prejudices they had forms of research that psychoanalysis psychoanalysis needs research as much as research and reluctance to move beyond about the psychoanalytic process being has now at its disposal. Similarly, formal research needs psychoanalysis. single-case reports in providing evidence intruded upon, violated or even distorted qualitative methodologies have been for its theories and practice, has been a by the constraints of research – for developed that incorporate psychoanalytic Let me start with an illustration. Working serious problem. The argument made example always having a “third” in the principles of free association and the on the Tavistock Adult Depression by some that psychoanalysis would room when being recorded – were either importance of the dyadic researcher- Study (TADS)1, a pragmatic randomised thrive best when in “loyal opposition” unwarranted or could be worked with. I researched relationship and the dynamic controlled trial (RCT) investigating or when it is “optimally marginal”3 – or assume, the fear for some might be of a unconscious during the research interview the effectiveness of 18 months once- indeed the claim that the profession much more existential nature: the fear in the process of data analysis14, 15. Case weekly psychoanalytic psychotherapy need not to worry as “there will always of being proven wrong or of change. The study methodology, too, has undergone 11 for individuals suffering from severe, be patients who want and need an question is, as Mary Target highlights, important developments in that they treatment-resistant depression, I entered analytic approach and why there will whether psychoanalysts can be confident have become more systematic16, 17. The our communal kitchen one morning to always be therapists who need to learn and trust that any resulting change TADS serves as a good example of a find not one but three coffee machines. it”5 – I find difficult to comprehend. may not destroy the discipline’s firm research study that successfully managed I also noticed a variety of instant and As someone who believes about the foundation, but may instead allow for a to match both the complexity of severe, freshly ground coffee, a large container necessary integration of psychoanalytic creative adaptation. She underlines her chronic depression and the long-term of caffeinated tea and two family-size concepts into other psychological point by emphasising that Freud himself psychoanalytic psychotherapy by bottles of cola! What I suddenly woke up treatments as well as the survival of it was flexible and creative to change his combining a robust outcome trial with to was the realisation that investigating as a treatment model, I see the task at mind and model several times, and her formal qualitative research methodology particular complex human conditions and hand in needing to join the scientific plea to adopt such an attitude might be and clinical case studies. its treatment can impact the research in community as an active participant. As worth contemplating. particular ways. Bear with me – I will Jeremy Safran6 points out, it is there that The National Institute of Clinical return to this point shortly. the standards of practice are discussed Having said that, it is important to Excellence (NICE) is following a and implemented, and I believe being acknowledge the various limitations of restrictive model of science, and are in Since psychiatry broke away from part of it allows the profession to RCTs and to keep in mind that they are need of a re-visioning18. It needs to draw 12 psychoanalysis in the late 1970s, contribute directly to the dialogue and only one part of the research cycle . on a diverse range of evidence to inform treatments based on these principles negotiate the terms and conditions. But Other research methodologies are equally treatment recommendations, and research have become gradually less available. in order to do so, the profession needs important, and I never understood the efforts should be much more directed They continue to disappear from national to play the game following its existing need for such stern polarization as in towards what treatment works for whom treatment guidelines and are currently rules. But there is also another reason the case between empirical research and in what particular context and point in under enormous threat to remain a why psychoanalysis needs to engage psychoanalytic case studies. The particular time. However, there is also a serious lack treatment of choice in our national much more in systematic research. psychoanalytic concept of splitting of cohort or case control studies as well health service. Moreover, charities, such That is, like any other professional body helps me in trying to make sense of it as services and individual psychoanalytic as the Camden Psychotherapy Unit, offering a service to individuals who are - after all we are all prone to defensive practitioners who routinely collect whose crucially important effort is to suffering, it has a social responsibility reactions when feeling threatened or outcome data (and if you think that offer psychoanalytic therapy to those in respect to providing evidence of the perhaps persecuted by those wanting to there are not any meaningful outcome who cannot afford it, struggle more effectiveness of its treatment models. impose authority. The reinforcement measures available, please have another NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 9

search, and encourage the development of modalities. Time also plays a crucial substances, we, the researchers, clinicians with a real opportunity for new measures). Thus, whilst we need to factor in the consolidation of change after unwittingly tried to cope with the counter- creativity and progress. Whilst there is continue to challenge treatment guideline treatment ends and all psychotherapy transference, in particular the feelings a pressing need for the psychoanalytic developers and policy makers for their studies need to include a long-term of hopelessness and being tired of living community to engage, encourage and rigid adherence to and their continual follow-up. On another concrete level, that most of the TADS participants fund more research if it wants to survive, attempts of subordinating psychological psychoanalysis might remind the scientific experienced. One of the challenges the research community needs to engage treatment to medical science, the community about the crucial need to for every research study is to keep the with psychoanalysis to find effective ways psychoanalytic community needs to keep a position of equipoise, which attrition rate low, in other words to have of overcoming biases and to open up to engage with more research of all kinds. David Taylor21 likened to Bion’s concept as little missing data as possible as well become more meaningful, in-depth, and However, one might argue that research of ‘negative capability’ – the researcher as to have as few participants dropping all-encompassing needs psychoanalysis just as much. as much as the psychoanalytic clinician out as possible. The challenge lies in need to hold on to an impartial position finding a way of achieving that without Dr Felicitas Rost is the research lead That empirical research is reminded with regard to the outcome “whilst being coercing the participant in any way. at the Portman Clinic and President of of its biases and blind spots as well as prepared to be disturbed within limits” What psychoanalysis brings to it is an the Society for Psychotherapy Research keeping a constructive critical stance and tolerate uncertainty. The effect of the understanding of the various possible (SPR) UK towards its methods is a healthy scientific researcher allegiance and publication bias ways the researcher contributes to it attitude19. With that in mind, I would are serious problems that the research unconsciously. For example, the TADS References: agree that a position of psychoanalysis community is in need of addressing. participants’ belief that “nothing has 1. Fonagy, P., Rost, F., Carlyle, J., et al. (2015) 20 Pragmatic randomized controlled trial of “in opposition” might be advantageous. Most importantly, however, research in helped” and “nothing ever will help” was long-term psychoanalytic psychotherapy for However, the adoption of such a position its practical conduct would benefit from often palpable during research interviews treatment-resistant depression: the Tavistock Adult Depression Study (TADS). World is not exclusive to psychoanalysis, but the psychoanalytic understanding of and at some point we noticed we started to Psychiatry, 14(3):312-21. could also be inhabited by any therapeutic the impact of unconscious processes and feel similar: the doubts in the usefulness 2. Leonard, T. (2015) Why American approach. To my mind, research needs transference and counter-transference of the interviews we carried out became psychoanalysts are an endangered species. The psychoanalysis because of its unique phenomena. Let me now return to the more frequent, the near accidents in Spectator. 3. Safran, J.D. (2013) Psychoanalysis as the approach to understanding and engaging illustration I provided earlier. deleting precious recordings of therapy "Loyal Opposition" - Commentary on a paper by with the human mind. With sufficient or research sessions closer to realisation, Kenneth Frank. Psychoanalytic Perspectives, 10(2):350-62. time and space, psychoanalysis offers, and the forgetting of arranging follow- '…research needs 4. Fonagy, P. (2003) Psychoanalysis today. World as Target puts it, the unique experience up interviews recurrent. Whilst these Psychiatry, 2(2):74-80. of being “deeply known, progressively psychoanalysis experiences can be incorporated in the 5. Safran, J.D. (2006) Interview with Lewis Aron. uncovered while being held carefully in sense-making of patient qualitative Psychoanalytic Psychology, 26:99-116. 11 because of its 22 6. Safran, J.D. (2012) Doublethink or dialectical mind” . Whilst these experiences might interview data , inhabiting a thinking: a critical appreciation of Hoffman's indeed never be measured adequately11, unique approach psychoanalytic stance and supervision "Doublethinking" Critique. Psychoanalytic the particular psychoanalytic stance, provides a space to become aware of and Dialogues, 22:710-20. 7. Knox, J. (2013) The analytic institte as a psychic however, might help shape research to to understanding think about the possible parallel processes retreat: why we need to include research become more meaningful, in-depth, and and engaging with that can get evoked when studying a evidence in our clinical training. British Journal all-encompassing. On a concrete level, particular condition in order to help of Psychotherapy, 29(4):424-49. 8. Kahneman, D. (2011) Thinking, Fast and Slow. it might challenge the current trend of the human mind.' mitigate these challenges London: Macmillan. searching for and advocating ever quicker I strongly believe that diverging heritage 9. Lambert, M.J. (2017) Maximizing psychotherapy solutions, be it in the various efforts to I came to understand that by consuming does not foreclose the possibility of outcome beyind evidence-based medicine. exaggerated amounts of caffeinated Psychotherapy and Psychosomatics, 86:80-89. shorten questionnaires or treatment union, and that adapting to a different 10. Busch, F.N., Milrod, B.L., Rudden, M., et al. culture does not mean annihilation (2001) How treating psychoanalyst respond to psychotherapy research constraints. Journal of of one’s foundation or identity. What American Psychoanalytic Assessment, 49:961- psychoanalysis and research can offer 83. each other provides us scientists and 11. Target, M. (2010) Psychoanaltic psychotherapy now: where do we fit it? Psychoanalytic Psychotherapy, 24(1):14-21. 12. Roth, A. and Parry, G. (1997) The implications of psychotherapy research for clinical practice and service development: Lessons and limitations. Journal of Mental Health, 6(4):367-80. 13. Rowlins, M. (2008) De Testimonio: On the evidence for decisions about the use of therapeutic interventions. London: Royal College of Physicians (The Harveian Oration). 14. Wendy, H. and Jefferson, T. (2011) Doing qualitative research differently. London: Sage. 15. Werbart, W. and Levander S. (2006) Two sets of private theories in analysands and their analysts: Utopian versus attainable cures. Psychoanalytic Psychology, 23(1):108-27. 16. Stiles, W.B. (1993) Quality control in qualitative research. Clinical Psychology Review, 13:593- 618. 17. Willemsen, J., Della Rosa, E., Kegerreis, S. (2017) Clinical case studies in psychoanalytic and psychodynamic treatment. Frontiers in Psychology, 8:108. 18. McPherson, S., Rost, F., Town, J., et al. (2018) Epistemological flaws in NICE review methodology and its impact on recommendations for psychodynamic psychotherapies for complex and persistent depression. Psychoanalytic Psychotherapy, online. 19. Fonagy, P. (2013) There is room for even more doublethink: the perilous status of psychoanalytic research. Psychoanalytic Dialogues, 23:116-22. 20. Starr, K. and Aron, L. (2013) Deconstructing the psychotherapy/psychoanalysis binary – The case for optimal marginality: Commentary on paper by Kenneth Frank. Psychoanalytic Perspectives, 10(2):335-49. 21. Taylor, D. (2010) Psychoanalytic approaches and outcome research: Negative capability or irritable reaching after fact and reason? Psychoanalytic Psychotherapy, 24(4):398-416. 21. Holmes, J. (2014) Countertransference in qualitative research: a critical appraisal. Qualitative Research, 14(2):166-82. NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 10

required by commissioners into smaller aggression and disgust; that stresses the Theory and Practice Today: Research scale, more pragmatic research studies, for use of sexualisation as a defense against example naturalistic longitudinal outcome difficulties in forging and sustaining studies which measure chosen aspects of intimate relationships; and that the patient’s difficulties (e.g. depressive acknowledges the aetiological significance Implementing research symptoms) before and after treatment, of trauma or abuse, with dissociation a which may not fulfill the requirements of common response to such experiences. the ‘gold-standard’ methodology of the On the basis of these results, we propose in clinical practice: RCT, but are more easily implemented that in some cases, paraphilias are not just within clinical practice and may constellations of fantasies and behaviours, our experience at the nevertheless represent significant changes but may be considered diagnostically to in the patient’s psychopathology and be disorders of personality in their own Portman Clinic functioning. right. This clearly has implications for future assessment and treatment of Some of the complexities encountered these disorders. By Jessica Yakeley in researching psychoanalytic treatment concern questions of what constitutes Our vision for the future is to develop the change and how to measure this. One Portman into a research clinic, in which of our challenges at the Portman has every consenting patient participates in been finding a validated and widely used qualitative and quantitative research. measure that both describes our patients’ We are extremely fortunate in having n her article, Felicitas has violent patients. One of the most notable psychopathology and captures therapeutic appointed Felicitas in 2015 as our cogently argued for the psychoanalysts in this respect was Mervyn change within a psychoanalytic Researcher at the Portman Clinic. Under integration of empirical Glasser, whose conceptualisations on framework. One measure that we have her leadership we have developed an research with psychoanalytic violence and perversion, in particular found relevant, and have been using on all ambitious battery of clinician and patient Ipsychotherapy practice, not only to the notion of the ‘core complex’, which patients accepted for treatment since 2010, reported measures that we piloted on a ensure the survival of the psychoanalytic emerged from the violence research having persuaded our commissioners to few carefully selected patients currently community, but to provide a platform workshop which he developed and ran accept this as a Commissioning for Quality in treatment, and which we are now from which research and practice can for many years at the Portman, continue and Innovation (CQUIN) goal1, is the implementing with all consenting patients flourish through a process of mutual to exert a significant influence on our Shedler-Westen Assessment Procedure accepted for treatment. We have chosen enrichment. In this piece, I would like understanding of the psychic functioning (SWAP-200, Westen & Shedler, 1999). The these particular measures as they seemed to illustrate some of the challenges that of our patients and related challenges they SWAP is a psychoanalytically-informed to be the most appropriate in capturing she describes in implementing such present with in therapy. clinician-rated assessment of personality the diagnostic profile of our patients, research within an NHS psychoanalytic disorder as well as personality functioning. their psychopathology, changes in psychotherapy service, the Portman In more recent years we have been A unique strength of the instrument is its symptomatology, problematic behaviours, Clinic, and how to counteract experiences involved in a number of research ability to describe and quantify aspects of and personality traits through treatment, of imposition of commissioner-required projects. These include research by Rob internal experience central to personality as well as measuring the nature of the outcomes, measurements, and databases Hale, Stephen Blumenthal and Stan pathology, such as psychological conflict therapeutic relationship, the therapists’ that may seem irrelevant to clinical work, Ruszczynski at Ashworth High Secure or internal contradictions, representations countertransference experiences and by creating our own ‘evidence-base’ that Hospital in which they found that weekly of self and others, motives, and intentions. the patients’ own experiences of their is meaningful to both our internal and consultation to the staff increased the In a sample of 164 men with a range psychoanalytic treatment. We hope that external worlds. number of personal engagements between of paraphilic disorders and problematic this will in time give us sufficient data staff and patients; a qualitative study sexual behaviours referred for treatment to apply for research funding to conduct The Portman Clinic, part of the Tavistock that I did with Heather Wood where we to the Portman, our results to date show more rigourous studies, including an and Portman NHS Foundation Trust, interviewed patients to ascertain their that roughly two thirds of these patients RCT, on our treatment. This will clearly is an outpatient forensic psychoanalytic experiences of psychotherapy at the are diagnosable with traits of one or involve a lot of work but we feel very psychotherapy clinic in London offering Portman and their views on what changed more personality disorders as defined by fortunate in having Felicitas’ expertise assessments and treatment to children, and how; and research by Heather Wood the Diagnostic and Statistical Manual and previous experience of coordinating adolescents and adults presenting with and Stephen Blumenthal in offenders at of Mental Disorders (DSM-5), and one and researching the Tavistock Adult enactments of violence, problematic Grendon Prison Therapeutic Community third were diagnosable with categorical Depression Study (TADS) RCT, which has sexual behaviours, criminality and on the Implicit Association Test, in which DSM-5 personality disorders. These rates been one of the most important trials in delinquency. The Portman also offers they identified that an implicit association of problematic personality traits and recent years to demonstrate the efficacy of psychoanalytically-informed consultations, between violence and enjoyment (sadism) personality disorders are dramatically psychoanalytic therapy for depression. risk assessments, and teaching and is associated with offenders who are more higher in our sample than the prevalence training to professionals working in a wide antisocial, advancing our understanding rates of 6-10% found in epidemiological At the Portman Clinic we have a unique range of settings including health, the of risk. More recently we have become studies of personality disorders in the population of patients whose actions criminal justice system and social services, involved in a large pragmatic multi-site general population, both in the US and in harm themselves and others, provoke and is involved in a number of research randomised controlled trial, led by Peter the UK. outrage and rejection yet who suffer and studies. With this brief, the Portman Fonagy at University College London, have suffered deeply, and who deserve a effectively straddles two ‘cultures’, which is evaluating mentalisation-based The SWAP also generates scores for 12 better understanding of their pathology the culture of psychoanalysis and the treatment (MBT) for violent offenders trait dimensions, which were derived and the mechanisms through which culture of the modern NHS. On the one under the supervision of the National via factor analysis of the SWAP item psychoanalytic therapy may alleviate their hand, the Portman identifies with the Probation Service at 14 sites located set. In this study, we found clinically suffering. We hope that our continuing tradition and culture of psychoanalysis, within probation premises across England elevated scores for the trait dimensions research endeavours will go some way in which focuses on unconscious processes and Wales, a study which builds on a of Psychopathy, Hostility, Dissociation, achieving these aims, and will support and and intrapsychic change. On the other much smaller scale non-randomised study Oedipal Conflict and Sexual Conflict. inspire other NHS psychotherapy services hand, the NHS increasingly emphasises of MBT for ASPD that we initiated 10 These factors highlight features consistent to engage meaningfully in psychotherapy accountability, monitoring and evaluation years ago at the Portman Clinic. with the clinical model of paraphilic research of interventions, and the development of disorders which we find effective in an evidence-base to guide the choice of However, conducting a RCT such as the practice: a model that recognizes the Jessica Yakeley is a Consultant Psychiatrist treatment. MBT/ASPD study is a large enterprise association of sexuality with anxiety, in Forensic Psychotherapy and Director of requiring considerable expertise, the Portman Clinic, Tavistock and Portman The Portman has a longstanding coordination, staffing and funding, and NHS Foundation Trust; and a Fellow of interest in research, and some of the is very difficult to do solely by clinicians 1 CQUINs were introduced in 2009 to make a the British Psychoanalytical Society psychoanalysts who have worked here in psychotherapy services without the proportion of healthcare providers' income have developed and published innovations involvement of dedicated academics and conditional on demonstrating improvements in theory and technique in working researchers. A more realistic enterprise in quality and innovation in specified areas psychoanalytically with perverse and is to shift routine outcome monitoring of patient care. NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 11

2. Change how engagement is done – health services than previously. I think the In Conversation rethink engagement processes ‘re-humanising effect’ of creating spaces for difficult conversations about policy and 3. Support people’s capabilities to better practice could be beneficial to all sides. work together – develop the right skills As a professional, I run workshops in this space. As a poet, I want also to get into David Gilbert 4. Develop new opportunities for patients more creative forms of engagement. I am to influence decision making – create getting old and tired of the traditional new roles. NHS field. I have set up ‘Re-Verse’ – a programme of work and hopefully on Involving GF. Of course, in psychoanalytic another new organisation (I never learn!) psychotherapy the emphasis is on designed to use reading and writing partnership and long-term relationships poetry to heal relationships between staff Patients between clinicians and patients. How do and users. Maybe the future is poetical as you see the ideas being applied in the well as political. psychoanalytic field? Gary Fereday in conversation with David Gilbert, mental health GF. You clearly feel the profession has service user with over 30 years of experience both as a patient and a DG. I have seen many excuses in my some way to go. The BPC is seeing how lay leading public engagement practitioner. time for patients being marginalised involvement in our structures bring benefits from ‘engagement’. But the ones in the and I’m look forward to the organisation psychoanalytic field are often unique. building on this. But we have yet to work I was once told that a therapist had out how best to enable the views of patients cancelled appointments for their clients to help inform the development of the because a chair in a corridor had been profession. Do you think that patient moved and that this would ‘disrupt the involvement will eventually change services Jennifer-Anne who had choked to death ary Fereday. We therapeutic process’. So, no wonder some for the better? have known each other on her food while unsupervised after she clinicians think that one of their client’s professionally for many had left the psychiatric unit and gone being involved in discussions (let alone DG. On the whole patient and public to a nursing home. I thought of Dave years David. In that time, decisions!) about the way they practice engagement has changed little. The who had gone to his caravan and hanged IG have seen you passionately articulate would disrupt things. engagement ‘industry’ has largely focused himself and of Laurie who had drowned your experiences of being a mental health on inputs, activities and processes (the himself in a reservoir. All those deaths patient and the need for better engagement My hunch is that this is the psychanalytic methods of gathering data, how to capture had occurred away from the in-patient and involvement of patients. What brought profession’s problem, not the patients’. views, etc) over impact and outcomes. environment. I don’t think any of those you to this arena and what keeps you going? That it is more about power. I wonder The approaches and methods have used would have appeared as stats during who is projecting upon whom. As a former two main ‘styles’. The first is that of inspections and the unit would have ticked David Gilbert. Well, I will never psychoanalytic client, I doubt there would feedback: patients are invited to fill in the box on removal of ligature points. forget many years ago crying alone on a have been anything very disrupting if I questionnaires, attend focus groups, or psychiatric ward while under 24/7 suicide had gone to a focus group, participated tell their stories at board meetings. The watch clutching an old teddy bear and 'I keep going in a workshop or been part of decision- focus is what happened to them in the the kindness shown by staff (admin and making process. My serious point is that, past, the meaning of their data is left to clinical) and fellow patients that showed because of my if this is the way that psychoanalytic professionals to assess through their own me true partnership is possible. I keep admiration for psychotherapy draws its hard borders, lenses, based on their own assumptions going because of my admiration for fellow perhaps they need to be softened. This and often narrow institutionalised travellers who are working to raise the fellow travellers would be a fascinating discussion to thinking. The approach mirrors voice of patients and seeing the slow and who are working pursue. Maybe the BPC could hold an traditional medical paternalistic models – steady rise of a patient movement – one event on it? you tell us the symptoms, we will provide founded on the wisdom and insights of to raise the voice the diagnosis and treatment. It is stuck those affected by health conditions. of patients.' By the way, I worked with the Tavistock in child-parent mode. The second style is and Portman NHS Trust on its user ‘scrutiny’. Whenever there is a governance I also recognise the challenges we face. involvement strategy with their Chief GF. Powerful reasons, although I notice committee, an advisory group or the like, About twenty years ago, I was sitting on a Executive, Paul Jenkins, and their that you say we are seeing a ‘slow and the call goes up for lay representatives. But psychiatric ward with nothing to do – the wonderful user engagement lead, Anthony steady rise of a patient movement’. Are without clarity of role, support or training, lunch had been awful, the Occupational Newell. They have done great things and things really changing to bring a stronger the lay representative is expected to ‘bring Therapist had been sacked (so no activities have a thriving user engagement strategy. patient voice to the table? the patient perspective’ to the decision- that afternoon) and the ward seemed They seem to be able to overcome many making table. full of screaming folk. A doctor strolled of these challenges. DG. Patients can be true partners for onto our bay and gave a perfunctory nod I was once asked ‘so David, what do before gingerly pulling on the curtain improvement and change. They can help identify what matters, rethink 'I think the ‘re- patients think’. ‘What, all of them?’ I rail beside my bed. Even in my disturbed thought. In search of credibility and state, I could see his behaviour was odder problems, generate solutions, model better relationships, promote better decisions humanising leaning on what we know, we tell our than mine. I asked him what he was stories – half the people in the room doing: ‘Just checking to see if you could and improve practice. But, at the moment effect’ of creating I fear we are all hamstrung by bad applaud this ‘telling truth to power’ and do anything stupid’, he replied and then spaces for difficult the other half fall asleep (‘another patient walked back down the corridor. I was left habits. The way we think about patients’ contributions is stuck in a time warp, with an axe to grind’ or ‘personal agenda’ contemplating my suddenly increased conversations they mutter later in the corridors). Yet range of treatment options! our mindset constrained by an outmoded view of what patients can or cannot bring. about policy and if we arrive at the meeting brandishing data or outcomes, those that were awake Fast forward ten years and I was Head Moreover, the way we do patient and practice could be public engagement fails to have any real last time fall asleep and accuse us of of Patients and the Public at the ‘going native’. The consequence of failed Commission for Health Improvement, impact because it is outmoded and unfit beneficial to for purpose. In part, it was never designed representational mechanisms is that the then statutory health inspectorate. I all sides.' committees lapse into a default ‘us and was reading the National Patient Safety to bring real change, but to buffer it and maintain the status quo. If we really want them’ mode. Frustrated, marginalised and Agency standards on mental healthcare. Moving to mental health in general. solutions, this needs to change. I would unprepared ‘reps’ start finger-wagging or One of them was to decrease in-patient I am concerned that many staff are argue that the task is fourfold: fall silent. This is adolescent-parent style psychiatric suicides to zero by…. removing becoming unwell due to stress of the work engagement. all non-collapsible curtain rails! I was environment, resource and regulatory 1. Learn to value what patients can bring gobsmacked – talk about hitting the pressures. That they often have more in – see patients as partners target and missing the point. I thought of common with people who use mental Continues on page 14 NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 12

sayings accepted a reality without hanging their location. Naturally, meetings by On The Ground on to unrealistic expectations, they also videoconferencing are complemented by express a resigned attitude, which does face-to-face encounters. I am afraid that not demand change. Quite often I thought in the past the patience of AJA colleagues to myself – and on occasion I said it, ‘I gathered in AJA’s seminar room was tested wished you would mind’. Analytic therapy to breaking point when we faced yet Welsh Dragons, works towards change and the desire for a another technical hiccup. more liberated life. In contrast, the culture in North Wales is based on continuity and After I had qualified and become member Snowdonia tradition. To illustrate my observations, of AJA, I continued my own analysis with here are a few figures from my practice an analytic colleague by phone. Likewise, over the past two years. 11 of my patients for many years all my supervision was on Mountains and the were English, four were Welsh with the phone. Through my own experience English as their main language, two were and my increasing confidence in using European and only one was a predominant videoconferencing equipment, I started Unconscious Welsh speaker, all be it one who had lived to offer sessions online. Initially this was in an English-speaking environment for used in special circumstances only, such many years. as when poor road conditions prevented By Arthur Niesser patients from coming to the office. Living in a small community can raise Increasingly, however, I now work with problems of confidentiality. My office is a combination of face-to-face meetings next to the local primary school. I avoid and videoconferencing sessions. This n April 1995 I was on the train is the lack of funds. According to the session times, which start or end at the enabled some patients to have twice or home to Porthmadog in North Office of National Statistics, the county same time as the school opens or closes. even three-times weekly sessions. I am Wales after I had attended a of Gwynedd had the third lowest average Over 20 years ago, my wife and I went for still in the process of evaluating the effect conference in Edinburgh on wages in the UK in 2017. The median a rare night out at the local cinema, after of online work on the analytic process. Ipsychosomatic disorders. During a gross weekly earnings were as low as £421. we had managed to find a babysitter for I observe myself even more for my own conversation with fellow passengers one This makes longer term psychoanalytic the night. It was not before my wife and countertransference reaction and how of them remarked, ‘surely, there is no work so expensive that it is unaffordable I had snuggled up to one another that I engaged I am with a patient, who I can need for psychotherapy in North Wales’. for most residents. I therefore charge suddenly realised that my training patient see but who is not actually physically My reply was, ‘There is a lot of need but comparably low rates, for some patients was sitting right behind us! present. I watch out for manifestations little demand’. This assessment seems still not more than £25 per session. My of the unconscious, which might indicate valid. As a German national, I came to training patient was living on benefits at Right from the moment that I had moved how working by videoconferencing live in North Wales to marry my (English) the time and accordingly the fee for three to North Wales, I missed the contact changes the relationship. More recently wife. After I had completed my training as times weekly analysis had to be very low. to professional analytic colleagues. My I became particularly interested in the a general practitioner in Germany, I had GP colleagues often looked blank when effect on erotic transference. Online work obtained a psychotherapy qualification Another factor are long distances. My I tried to explain to them that I was guarantees a ‘safe’ distance, which at the under the training requirements of the geographically closest patient lives 23 working as an analytic psychotherapist. same time facilitates and hinders the German Medical Chamber. and I had miles away, the furthest 35 miles. Face- In all the years I only once received emergence of erotic transference and been working in my own psychotherapy to-face analysis more than once a week is a referral from a GP colleague. Over countertransference. I think that a lot practice in Germany until 1992. I had therefore impractical for most patients. time, though, I found other likeminded more research is necessary in this field. hoped to establish a private psychotherapy And finally, there are language and psychotherapy colleagues and I became My supervisor is invaluable for my way practice in Porthmadog and to make a cultural obstacles. According to the 2011 one of the founding members of PIG, of working. Then there are synchronistic good income from it, but this proved census, 65.5 percent of the population the Psychotherapy Interest Group. For events, when power cuts or service difficult. While working predominantly in Gwynedd are Welsh speakers. The years we met once a month for case disruptions occur just in the very moment as a GP, I completed my Jungian analytic language is of very high cultural value in discussions and presentations of general when the patient talks about a particularly training with the Association of Jungian this area. As a GP I only once experienced interest within the field of psychodynamic sensitive issue, as if the inner difficulty Analysts AJA) in London and I established outright hostility for not being able to psychotherapy. To this day I am the only manifested itself in the outer electronic a small private analytic practice. speak Welsh, but there is some reservation BPC registered therapist in North Wales. reality. to engage in an intimate trusting I am happy to say though, that a colleague One major reason to prevent potential relationship in a language that is regarded and friend, who cofounded PIG, is now in Modern Information Technology gave me patients from accessing psychotherapy as a threat to one’s own culture. the advanced stage of her training to be a the opportunity to serve as Chair of AJA Jungian Analyst. for the past four years, despite living so far There may be other cultural away from London. This position included and religious issues. The After I had completed my training and meeting analysts from other Jungian Welsh population in Gwynedd as a way out of professional isolation, organisations, particularly through the tends to live in traditional I pushed early on for AJA to purchase Umbrella Group, in which representatives communities with little audioconferencing equipment, which of London based Jungian societies come natural inclination to change. would allow me to participate in the life together regularly. I also got to know Most people have a network of AJA. Technically, the equipment was overseas colleagues through gatherings of family living locally and basic, but I could keep contact with my of the International Association for by and large, problems are analytic colleagues. Analytical Psychology (IAAP) and I am kept within the family. I involved in an AJA supervision project observed that talking about It came as a real breakthrough when for Ukrainian colleagues in training. conflicts within the family videoconferencing facilities were I am member of a supervision group was easily perceived as advanced enough to use them in group including a colleague in California. disloyalty. Furthermore, a settings. AJA members are now living Suddenly Porthmadog in North Wales retired Anglican vicar and in many different parts of the UK. The does not appear so insular any longer and good friend of mine pointed use of videoconferencing facilities has when, on a sunny day as today, I look out out that there is a belief that proven inclusive. Nowadays many out-of- of the window of my consulting room suffering is virtuous and leads London members attend meetings, which on to the Glaslyn estuary and the range to redemption. previously would have been inaccessible of Snowdonia mountains, I feel very to them. Council and various committees fortunate to live and work here When I worked as a GP, I work predominantly online. This is often heard expressions such important for a small organisation, which Dr Arthur Niesser is a Jungian Analyst as ‘oh, never mind’ or ‘grin can only exist through the committed in private practice and Chair of the and bear it’. While these participation of members, regardless of Association of Jungian Analysts NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 13

Cultural Review

Churchill and his

Darkest Hour way forward. Young, quoting Winnicott, Churchill had, in an earlier part of the states depressive position leadership film, described Hitler as ‘…that corporal, involves, an ‘acceptance of responsibility that boy, that… house painter!’ and later, By Lindsey Nicholls for all the destructiveness that is bound up somewhat misrepresents the passengers with living, with the instinctual life, and views to his outer cabinet – does he do this with anger and frustration’ (pg.432). to justify a decision he has already made? Bozalek (2014), using Tronto’s work on In the film we see Churchill falter in race, states that ‘In considering the power his decision to wage war upon seeing that racism confers on a majority group, oe Wright’s film ‘Darkest are presented to people that can then a telegram stating that 4,000 British she [Tronto] coined the phrase ‘privileged Hour’ covers the time period justify the actions that leaders take. men had been sacrificed in Calais. This irresponsibility’ by which she meant the between Winston Churchill Here he looks at a typology of problems, was portrayed as Churchill’s dark night ways in which the majority group fail being appointed as prime those that are ‘tame’ and those that are of the soul; in the film he is comforted to acknowledge the exercise of power, ministerJ (10 May 1940) to his famous ‘wicked’ (pg.1473). Problems which are by his wife and visited by the King thus maintaining their taken for granted speech in parliament, 4 June 1940, ‘… ‘tame’ require process solutions (he gives (George). Clemmy (Churchill’s wife) positions of privilege’ (pg.52). Was we shall fight on the beaches, we shall fight the example of timetabling trains) and says, while kneeling at his side, that he Churchill demonstrating his privileged on the landing grounds, we shall fight in those that are ‘wicked’ are complex and is strong because he has struggled, that irresponsibility when he stated the ‘policy the fields and in the streets, we shall fight intractable, solutions often lead to more he is wise because he has doubts and that was to wage war, the aim is victory’? Had in the hills; we shall never surrender…’. problems. Here he looks at the role of people trust him, testimony indeed for he understood the suffering he would Ending here, the film portrayed Churchill leadership in making decisions that may a depressive position leader. I wondered cause to the conscripted service men and as winning over a divided parliament involve a ‘collaborate process’ (pg.1473) what other influences gave him the women, and the city populations who and the nation, preparing them for the rather than providing answers. To this he seemingly overbearing moral authority to would have to withstand years of air rades inevitable battle with the menacing adds a third type of problems, ‘critical’ take a country to war. and bombing? German forces. The film highlights the (crisis) problems in which the leader needs choice that Churchill was given at that to take command and provide immediate There are two scenes in the film which There are three occasions during the film time; to begin peace negotiations with decisions as to what is to be done. There reminded me of Bozalek’s (2014) work when the camera leaves the intimacy of Hitler, which was endorsed by his war is no time to collaborate or deliberate. on ‘privileged irresponsibility’, one takes a close up to move away and upwards as cabinet, or to enter into a fight against Perhaps this is what the film ‘Darkest place in the toilet where Churchill calls if taking in the ‘bigger picture’. Perhaps seemingly insurmountable odds. The film Hour’ demonstrates, Churchill, a newly President Roosevelt to ask for help, and that is what we have with the film, a celebrates the decisions that Churchill elected prime minister, had a matter of the other is the aforementioned scene on backward look at a situation that was made and the power of his rhetoric in days to make a decision that would affect the tube. Bozalek, who draws on the work ‘critical’, that the leadership shown was gathering parliament and the ‘people’ the whole country, to go to war or to of Joan Tronto (1993) begins her chapter commanding and that Churchill did of Britain behind him to fight Hitler, make peace. with a quote; ‘One of the privileges of mobilise the common man through his ‘whatever the cost may be’. Is this film a the privileged is to be able to be oblivious oratory skills and stubborn self-belief. depiction of the true nature of leadership, To this typology of problems Grint (2005) to the life experiences of the subjugated’ Perhaps the cost of these decisions was or, is its success representative of the includes a social constructionist view (pg. 51). As Churchill states in the film, symbolically (under)portrayed by the longing for the kind of leadership that of leadership, suggesting that the way with some measure of pride, he has never women in the film, through the tears of stirs a country to unite against…the problems are explained to the public caught a bus, used the tube but believes Miss Layton (his PA) whose brother was enemy? can justify the actions leaders take, he he could ‘boil an egg’. Did the privilege killed in France, and Churchill’s wife who suggests that some problems are presented he had, related to his gender, class and states about herself, ‘Here is a woman to the public as if the solution offered education, give him a sense of entitlement who is always tired, she leads a life where 'Is this film a is inevitable. Grint does not imply that and self-righteousness that made his too much is required’. The film glorifies depiction of the all leaders attempt to manipulate the manner one of an imposing leader? Sure Churchill’s decisions and although it is public through using ‘spin’ but his work of himself and his decisions, impervious called ‘Darkest Hour’ it took many years true nature of does enable us to think critically about to the opinion of others because in his of war and loss before that hour ended leadership…?' how problems are ‘sold’ to the public as mind, they were of little consequence and needing leaders to act in a ‘command and their opinion did not count? What then of Dr Lindsey Nicholls is an occupational control’ fashion. Did Churchill manipulate the scenes in the toilet and on the tube? therapist and senior lecturer at University I have focused on some key moments in parliament and the public by saying of Essex the film where Churchill’s leadership he had ‘spoken to the people’? In the In the prime minister’s privy, Churchill could be understood with theory-in- film this was covered by an annoyingly calls Roosevelt for help, his voice falters References patronising portrayal of people on the as if he feels ashamed of the request. I Bozalek, V. (2014) Privileged irresponsibility. Moral mind, by using Grint’s (2005) thoughts boundaries redrawn: The significance of Joan on ‘problems, problems, problems…’ tube, obsequiously pleased to have their wondered if this was part of his colonial Tronto’s argument for political theory, professional (pg.1467), Bozalek’s work on privileged opinions sought by the prime minister. past and class legacy, that to ‘give’ was ethics, and care practice. Leuven: Peeters. to be seen as powerful, to ask for help Grint, K. (2005) Problems, problems, problems: The irresponsibility and Young’s (2003) social construction of ‘leadership’. Human relations, thoughts on depressive position This brings me to the work of Robert was to be seen as weak. Churchill was 58(11), pp.1467-1494. leadership. One issue I would not seek Young (2003) and his paper on the not portrayed as someone who asked for Tronto, J.C. (1993) Moral boundaries: A political argument for an ethic of care. Psychology Press. to question was Gary Oldman’s winning ‘depressive position’ (pg.431) leadership of advice from others, he told them what to do, and later through his speeches in Young, R.M. (2003) Lincoln, Mandela and the the 2018 Oscar for best male actor. Not Lincoln and Mandela. Young suggests that Depressive Position. Free Associations, 10(4), once during the film did I feel as if I was these two great leaders understood that parliament, told them what to think. Is pp.431-453. watching Mr Oldman act as Churchill. their decisions and actions would cause this the signature of a great leader or injury and death to many on both sides of someone whose privilege has occluded Grint (2005) offers a three stage the war, and they agonised over this loss their knowledge (or creative imaginations) understanding of the way problems of life while believing that it was the only of how ‘the other half’ lives? NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 14

Continuesd from page 11 Diary I’d argue that we are entering the third wave of patient power in healthcare For full event listings, visit the BPC's JULY politics. The early rights-based user and Event Calendar via their website: www.bpc.org.uk/events-calendar July 2 civic movement focused on accountability TAVISTOCK RELATIONSHIPS’ SUMMER gave way to a more institutionalised SCHOOL form of patient engagement focussing on MAY – JULY Tavistock Relationships, 70 Warren ‘feedback’ and ‘representation’ that aimed May 1 – July 17 Street, London W1T 5PB to improve quality. Now, we are starting THE POLITICAL MIND SEMINARS 2018 https://tavistockrelationships.ac.uk/ the see the emergence of ‘patient and – THE ROLE OF THE UNCONSCIOUS IN forthcoming-events/1127-summer- community leadership’ and what we bring POLITICAL AND SOCIAL LIFE schools-2018 as people individually and collectively. Sigmund Freud Lecture Theatre, Innovation and Evidence: This is giving rise to myriad forms of Institute of Psychoanalysis, 112a Shirland July 6 A Contemporary Vision engagement – ‘patient entrepreneurs’ Road, Maida Vale, London W9 2BT GROUPS IN ACTION – GROUP AWARENESS inventing apps, online fora to harness https://psychoanalysis.org.uk/civicrm/ FROM A CONTEMPLATIVE PERSPECTIVE With Jale Cilasun and Lawrence Ladden. collective voices, community and health event/info?id=686&reset=1 IGA, 1 Daleham Gardens, champions bringing in the marginalised, 3rd November London NW3 5BY peer support workers and patients/carers JUNE www.groupanalysis.org/ The British Library influencing healthcare design, research, June 2 EventsandWorkshops/ education and training. The old rules of SPIRITUAL EXPERIENCE: JUNGIAN EventsandWorkshops.aspx Speakers include: engagement are breaking down. People ANALYSIS AND THE VEDANTA [email protected] affected by mental health problems, want Speakers: Marcus West and David Sagar. to be trusted equal partners in their own Jonathan Shedler, Phd SAP – 1 Daleham Gardens, July 7 care, and perhaps more significantly in co- London NW3 5BY ATTACHMENT AND SPORT Stephen Grosz designing and co-delivering services. www.thesap.org.uk/sap-events With Arturo Ezquerro. IGA, 1 Daleham Gardens, Dr Eilis Kennedy June 7 London NW3 5BY '…we are entering ALCOHOLISM AND THE FAMILY www.groupanalysis.org/ Speakers: Sally and Henry Maybury of Dr. Sue Mizen the third wave of EventsandWorkshops/ the Lost Days Charitable Aid Trust. EventsandWorkshops.aspx Dr Felicitas Rost patient power…' Lecture Hall at 120 Belsize Lane, [email protected] London NW35BA Dr. David Hewison My current role as Patient Director (the www.thesap.org.uk/sap-events AUGUST first role of its kind) may usher in a and more! new model. At Sussex MSK Partnership June 8 KEEPING STAFF IN MIND: THE August 5 (Central), we have a clinical Director, PSYCHOLOGY, IMAGINATION AND THE managing director and patient director PSYCHOANALYTIC CONTRIBUTION TO MENTAL HEALTH WORK ARTS – SUMMER COURSE Psychoanalytic approaches to as the 'exec' team. My role is to ensure This symposium follows the publication of The Champernowne Trust with the therapeutic interventions have we keep the focus on what matters to a book, Psychoanalysis, the NHS, and C.G. Jung Club, London. the potential to transform lives at people who use our services, through hard Mental Health Work Today, edited by www.bpc.org.uk/events-calendar the deepest levels and to provide wiring the culture and systems to be more Alison Vaspe (Karnac 2017). understanding and insight into 'patient centred'. This includes having The Cassel Hospital, Ham Common, SEPTEMBER complex human interactions. a group of paid, supported and trained Richmond TW10 7JF PP NOW 2018 will explore and 'patient and carer partners' who have an www.routledge.com/mentalhealth/ September 11 SPOTLIGHT ON THE ARCHIVE – ALL celebrate the recent evidence influential role in both improvement and posts/13317 governance work. We are slowly getting ABOUT….ALMODOVAR base for psychoanalytic work and somewhere. Evening salon that explores the links showcase innovatory and cutting June 9 between cinema and psychoanalysis. SELF-CARE FOR THE WOUNDED HEALER edge projects and services www.theijp.org/film We can help reframe problems, bring Speaker: Alf McFarland. together with the various our insight to bear so as to develop new Quaker Meeting House, research methods used to September 28 solutions, shift policy and practice, change 40 Bull St, Birmingham B4 6AF validate their work that renew the ENGLISH SPEAKING WEEKEND discipline for the 21st Century. dynamics and model a new form of www.thejungiantraining.org.uk/ CONFERENCE 2018 collaborative leadership. This will help lecture2018-06.html Royal College of Physicians, PP NOW 2018 is an all-plenary accountability, transparency, quality and 11 St Andrews Pl, London NW1 4LE conference safety. But only if we are valued. June 29 WORKING WITH THE COUPLE NOVEMBER RELATIONSHIP THROUGH THE ADOPTION GF. David, thank you for being as candid PROCESS and outspoken as ever. I look forward to Tavistock Relationships, 70 Warren November 15 & 16 GAMES AND THRONES: THE SYSTEMS IN BOOK NOW! your thoughts generating lots of ideas and Street, London W1T 5PB responses WHICH WE LIVE https://tavistockrelationships.ac.uk/ ROYAL COLLEGE OF PSYCHIATRISTS IN www.bpc.org.uk forthcoming-events/1143-couple- SCOTLAND MEDICAL PSYCHOTHERAPY David Gilbert is Patient Director at relationship-through-adoption FACULTY CONFERENCE Sussex MSK Partnership (Central), Speakers: Rowena Davis, Marcus Evans, Director of InHealth Associates www. June 30 Molly Ludlam, Dr Christopher Scanlon. inhealthassociates.co.uk and blogs at www. BRITISH PSYCHOANALYTIC ASSOCIATION Atholl Palace, Pitlochry, futurepatientblog.com. He is Writer in (BPA) SUMMER SCHOOL 2018: BODY AND Perthshire PH16 5LX MIND, BEDFELLOWS? Residence at The Bethlem Gallery and More info: Queen Mary University, London his collection of poetry about coming [email protected] through mental health problems, 'Elephants www.eventbrite.co.uk/e/bpa-summer- (Fragile)', is available from Cinnamon school-2018-body-and-mind-bedfellows- Press. His views expressed here are his tickets-44333721354 personal views.

Gary Fereday is the Chief Executive of the British Psychoanalytic Council NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 15

News Letter to the Editor

Dear Editor, Politics series, focused on nationalism, ethnocentrism, racism and xenophobia A brief comment in relation to the both internationally and in a Norwegian SCoPEd politics, as opposed to the psychoanalytic context. In the recent years, post-Breivik politics, in Joanna de Waal's account and with a right-wing populist and racist of the PP NOW 2017 session Political party in government, the situation has Engagement with Andrew Samuels and deteriorated. In Norway hate speech has myself: "She was specifically critiquing become normalised under the banner ACP, BPC and UKCP Why are we doing it: Britain, in contrast to her own country 'freedom of speech'. The title of a one-day are jointly working on a of origin – Norway." It is true that, in conference I put on in Oslo in September groundbreaking project Counselling and psychotherapy are largely that context, I emphasized the distance 2017, 'Normalization of racism' captures a to set out the training regulated by professional bodies, a number between 'the elite' and 'the people'. serious problem which I will continue to requirementsB and practice standards for of which are themselves regulated by Though I perceive the degree of class- address in the years to come. counselling and psychotherapy. the Professional Standards Authority based hatred as specifically British, in (PSA) under its Accredited Registers contrast to more egalitarian countries, it Sincerely, Lene Auestad Many members will be aware of the programme. would be ironic indeed if I was heard as collaboration between BACP, BPC and idealizing Norwegian society. I have in Lene Auestad is an author, and a Doctor of UKCP. One of the most important The PSA sets minimum standards for a number of writings, and in previous Philosophy from the University of Oslo strands of this work is a project to organisations that hold a register in a conferences in the Psychoanalysis and map professional competencies for our health or social care profession, and professions. the focus of their programme is public protection. Consulting Room for Hire Here we give a brief explanation of what the work is, why we are doing it, and the The PSA-accredited registers in the field professional context in which it is being of counselling and psychotherapy each Central London. undertaken. has its own distinct standards of training Available from 3pm Monday, Tuesday, Thursday. and practice. There are also no agreed Close to Chancery Lane, Farrington, Holborn Tube stations. What the work is: common entry or training requirements to Soundproofed, analytic couch, two comfortable armchairs. enter the field. £240 per month, (£60 weekly) for any one day. No hourly rates. The Scope of Practice and Education Contact: Ms Despina Catselli for the counselling and psychotherapy This causes confusion for the public, [email protected] professions (SCoPEd) is a collaborative for clients/patients, for employers and project being jointly undertaken by BACP, commissioners of services about what BPC and UKCP. training and experience to expect when employing a counsellor or psychotherapist. The project is systematically mapping There is also confusion amongst those who existing competences, standards, training are considering training in this field as and practice requirements within there are disparate standards, with a wide counselling and psychotherapy. It is range of courses available at differing using an evidence-based approach to academic levels geared to different client identify the different and overlapping groups and professional roles, and sitting competences between them. within different qualifications frameworks

The initial mapping has been completed And why now… the professional and has now moved on to working with context: an Expert Reference Group. The Group comprises members who have been We are undertaking the ScoPEd project nominated by each partnership body, now because it is simply time to do this allowing equal representation of interests. work. There was complete agreement The Group has an impartial, independent between BACP, BPC and UKCP that a chair. proactive leadership role was needed in the development generic standards for the The Expert Reference Group will advance counselling and psychotherapy professions. the mapping process by consulting the The Department of Health recently held counselling and psychotherapy literature a consulation seeking views on proposals to ensure that gaps are identified and to reform the regulation of healthcare that further evidence is sought. This will professionals in the UK. While no one enable the Group to produce the final, knows where this will lead, we will be evidence-based competence framework. in a better place to navigate any future changes if we do this work now

GDPR is coming! The General Data Protection Regulation (GDPR) replaces existing data protection legislation in the UK. The BPC have put together a briefing that we hope Registrants will find useful when planning their individual compliance. The new legislation will be enforced on 25 May 2018. The briefing is available on the BPC web site at www.bpc.org.uk/resources/gdpr-briefing NEW ASSOCIATIONS ISSUE 25 SUMMER 2018 16

The Institute of Psychoanalysis invites applications from across the UK to The New Entry Scheme and New Entry Affiliates Scheme.

The New Entry Scheme is a pathway into training with The Institute of Psychoanalysis open to BPC registrants who have completed a Freudian Psychoanalytic Psychotherapy Adult training and have had a four or five times a week analysis with a member of the Institute of Psychoanalysis.

There are two entry points to joining the New Entry Scheme:

A) Direct entry for BPC registrants who meet all the criteria of acceptance.

B) Entry via the New Entry Affiliates Scheme which is for BPC registrants who do not yet meet all the criteria for direct entry, but would like to develop to that stage.

For further information please visit our website: http://psychoanalysis.org.uk/what-is-the-best- route-of-training-for-me/new-entry Or contact Katerina Tsami-Cole: Katerina.tsami-cole@ iopa.org.uk or 020 7563 5011.