Process Facilitation in Psychoanalysis, Psychotherapy and Social Work Process Facilitation in Psychoanalysis, Psychotherapy and Social Work elabo- rates a differential theory of therapeutic engagement with full reference not only to psychoanalysis and to psychotherapy but also – surprisingly – to social work. When contemporary social work with the marginalised achieves mutual construc- tive collaboration, social workers characteristically notice an unfolding process. Could this correspond to the ‘analytic process’ of psychoanalysis? Sylvia O’Neill seeks to explain theoretically, and to illustrate clearly in prac- tice, just how a quasi-autonomous therapeutic process becomes established. The theory underpinning the book is Jean-Luc Donnet’s conceptualisation of the establishment of the analytic process in psychoanalysis through introjection of the analytic setting. Donnet designates the psychoanalytic setting as the analytic ‘site’. O’Neill proceeds to trace, by means of detailed clinical discussion, the analogous process by which a viable therapeutic process can become established through created/found discovery and introjection of the relevant ‘site’ or setting in psychoanalytic psychotherapy and in social work. Amongst the most important elements are the practitioner’s internalised theoretical principles. The book demonstrates that unconscious introjection figures more impor- tantly in effective therapeutic engagement than a conscious therapeutic alliance. An important corollary for social work is that, contrary to popular myth, no prior psychological-mindedness is required. The differential theory of Process Facilitation in Psychoanalysis, Psychotherapy and Social Work is equally rele- vant to psychodynamic counselling. Sylvia O’Neill is a psychoanalytic psychotherapist practising privately in Edinburgh and in the NHS in Glasgow. She trained in psychotherapy at the Tavistock Clinic after practising social work in Melbourne and London. Her pub- lished research interests include therapeutic engagement, autistic pathology, male anorexia and professional cultures. Process Facilitation in Psychoanalysis, Psychotherapy and Social Work Sylvia O’Neill First published 2019 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business 2019 Sylvia O’Neill The right of Sylvia O’Neill to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Names: O’Neill, Sylvia, 1946- author. Title: Process facilitation in psychoanalysis, psychotherapy and social work / Sylvia O’Neill. Description: New York : Routledge, 2018. | Includes bibliographical references and index. Identifiers: LCCN 2018004796 (print) | LCCN 2018013381 (ebook) | ISBN 9780429490651 (Master) | ISBN 9780429955556 (Web PDF) | ISBN 9780429955549 (ePub) | ISBN 9780429955532 (Mobipocket/ Kindle) | ISBN 9781138591080 (hardback : alk. paper) | ISBN 9781138591097 (pbk. : alk. paper) Subjects: LCSH: Psychotherapy. | Psychoanalysis. | Social case work. Classification: LCC RC465.5 (ebook) | LCC RC465.5 .O54 2018 (print) | DDC 616.89/14—dc23 LC record available at https://lccn.loc.gov/2018004796 ISBN: 978-1-138-59108-0 (hbk) ISBN: 978-1-138-59109-7 (pbk) ISBN: 978-0-429-49065-1 (ebk) Typeset in Times New Roman by Swales & Willis Ltd, Exeter, Devon, UK To Fionnuala who believed in a book not yet written Contents Acknowledgements xiv Introduction 1 The wider context 3 An overview 5 PART I ‘Lines of advance in psychoanalytic therapies’ 9 1 Lines of advance, then and now: continuum, or radical break? 11 Freud addresses an international congress 11 A reading of ‘Lines of advance in psycho-analytic therapy’: the prominence of analogy 12 Psychoanalytic application: a form of analogy 16 ‘Psychoanalytic therapy’: an inherent ambiguity 17 ‘You sits and you listens: that’s all I can say’: psychotherapy and social work 17 2 Donnet’s concept of the analytic site or ensemble 21 Modell and Donnet: the role of the psychoanalytic setting 21 Freud and the noble game of chess 22 Donnet: from analytic site to analysing situation 23 Overcoming the obstacles to understanding Donnet 27 Thirdness and the third position 28 Discovering an element in the analytic site: a clinical vignette 29 The term ‘ensemble’ as an alternative to ‘site’ 31 Summary 31 viii Contents PART II The site in psychoanalytic psychotherapy 35 3 Juliana and her faithless boyfriend: the psychotherapy site in a twice weekly psychotherapy 37 The ‘psychotherapy site’ in psychoanalytic psychotherapy: the case of Juliana 38 Pre-history: encountering elements of the site at the pre-treatment stage 38 Treatment: unpromising beginnings? 38 Thirdness 39 The decisive encounter with the element corresponding to the fee 40 Consequences of introjection of the site: Juliana confronts her oedipal illusion 42 Conclusion 44 4 The psychotherapy site in a once weekly therapy: the dark world of incest 46 Carl: early discovery of some elements of the psychoanalytical psychotherapy site 46 Further discoveries of elements of the psychotherapy site 49 On the brink of metamorphosis: two decisive encounters 50 Creativity and the ‘rules of the game’ 52 Modality and setting (site): supporting the patient’s unconscious collaboration in his treatment 52 5 Thraldom to narcissistic objects: the psychotherapy site in a three times weekly therapy 56 Velia: finding a way to begin 56 Images of the psychotherapy site in the first three months: from school to oriental herbalism 56 Finding how free association works 58 Discovery of some other elements of the psychotherapy site 58 Freedom to make the site one’s own 58 A place where evacuated contents are contained 58 Therapist neutrality 59 A gradually stabilised timeframe 59 Approaching the point of watershed 60 The fee: a session having an encounter with a more stabilised frame 60 Discovering the representation of bodily states and ownership of them 61 Contents ix Inferring from a new level of depth that the site as a whole has been introjected 62 First session of the week: a vivid description of a nuclear catastrophe 62 Second session of the same week: exploring back in time 63 Comment 64 The move from two sessions per week to three, and to use of the couch 65 A session, after the change, with opposing images of the site 65 The site as firm ladder 66 The final months 66 A subjectivising process 67 Conclusion 67 6 Satish’s weekend: drama on the stage of external reality 68 Psychotherapy and external reality 68 André Green’s discussion of projective actualisation of the primal scene 68 An illustration taken from a patient in psychotherapy 69 Case illustration: Satish 69 One year on: a hinge-point 70 A session at 14 months 70 Discussion 71 Gradual elaboration 72 Partial recovery of a partially repressed memory: trauma at age 13 73 Repair of the breach in the stimulus shield 74 Conclusion 75 PART III The site in social work 77 7 Miss M: the site in social work with a vulnerable adult 81 An eviction crisis in outer and inner reality: the case of Miss M 81 The preliminary phase: an eviction crisis 82 Referral 82 The initial meeting 82 The second interview: weekly casework proposed 83 Formulation: an outer and inner eviction 83 Phase I: ten months in the negative transference 83 Daily realities: job, rent, officials 83 The element of the comical: the intrusion into the toilet 84 Negotiating the obstacle to the mourning process 85 Crisis: terrors of the baleful maternal ghost 85 x Contents Phase II: a year in the positive transference 86 Emergence of the positive transference: a sheltered workshop review 86 Mourning, essential depression and the depressive position 87 The treatment contract and the ‘therapeutic alliance’ 88 Phase III: integration 88 Accounting: a checking up 88 Bread-and-butter pudding: resolution of grief and mourning 89 The man on the building site 89 A transitional object: the TV-licence money 89 Termination and after . 90 The social work site 90 A unique ensemble of elements 90 Specifying some elements of the social work site in the case example 91 Transformation of the relation to the social work site 92 Conclusion 94 8 Engaging families ‘mired in deep distress’ 96 Goodness of fit 96 An intensive family support project 99 Re-stating the defining issue: allegiance to the logic, ethics and specificity of the social work method 101 Allegiance to the site means allegiance to the social work frame of reference 102 Conclusion 104 9 A question of allegiance to the social work frame of reference 106 Agency function as a part of the social work frame of reference 106 Case example I: a mother speaks of an unsafe edifice on the stairs 107 Case example II: a foster child builds a spaceship cocoon: social work, or therapy? 109 Background 109 The visit