Downloaded by [New York University] at 12:48 14 August 2016 THE THERAPEUTIC IMAGINATION Imaginative play is a key aspect of successful psychotherapeutic treatments. Psychotherapy helps clients get in touch with, awaken and learn to trust their creative inner life, while therapists use their imagination to mentalise the suffer- ing other and to trace the unconscious stirrings evoked by the intimacy of the consulting room. Working from this premise, in The Therapeutic Imagination Jeremy Holmes argues unashamedly that literate therapists make better therapists. Drawing on psychoanalytic and literary traditions both classical and contemporary, Part I shows how poetry and novels help foster therapists’ understanding of their own imagination-in-action, anatomised into five phases: attachment, reverie, logos, action and reflection. Part II uses the contrast between secure and insecure nar- rative styles in attachment theory and relates these to literary storytelling and the transformational aspects of therapy. Part III uses literary accounts to illuminate the psychiatric conditions of narcissism, anxiety, splitting and bereavement. Based on Forster’s motto, ‘Only connect’, Part IV argues, with the help of poetic examples, that a psychiatry shorn of psychodynamic creativity is impoverished and fails to serve its patients. Clearly and elegantly written, and drawing on the author’s deep knowledge of psychoanalysis and attachment theory and a lifetime of clinical experience, Holmes convincingly links the literary and psychoanalytic canon. The Thera- peutic Imagination is a compelling and insightful work that will strike chords for therapists, counsellors, psychoanalysts, psychiatrists and psychologists. Downloaded by [New York University] at 12:48 14 August 2016 Jeremy Holmes worked for 35 years as a Consultant Psychiatrist and Medical Psychotherapist in the NHS. He is currently Visiting Professor at the University of Exeter, UK, and lectures nationally and internationally. Recent publications include The Oxford Textbook of Psychotherapy, Storr’s The Art of Psychotherapy and Exploring in Security: Towards an Attachment- Informed Psychoanalytic Psychotherapy. This page intentionally left blank Downloaded by [New York University] at 12:48 14 August 2016 THE THERAPEUTIC IMAGINATION Using literature to deepen psychodynamic understanding and enhance empathy Jeremy Holmes Downloaded by [New York University] at 12:48 14 August 2016 First published 2014 by Routledge 27 Church Road, Hove, East Sussex BN3 2FA and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2014 Jeremy Holmes The right of Jeremy Holmes to be identified as author of this work has been asserted by him 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 Holmes, Jeremy, 1943– The therapeutic imagination : using literature to deepen psychodynamic understanding and enhance empathy / Jeremy Holmes. pages cm 1. Imagery (Psychology)–Therapeutic use. 2. Imagination–Therapeutic use. 3. Psychoanalysis. 4. Psychotherapy. I. Title. RC489.F35H65 2014 616.89′14–dc23 2014002652 ISBN: 978-0-415-81957-2 (hbk) ISBN: 978-1-138-78949-4 (pbk) ISBN: 978-1-315-87982-6 (ebk) Typeset in Times New Roman by Wearset Ltd, Boldon, Tyne and Wear Downloaded by [New York University] at 12:48 14 August 2016 To my patients – who have taught me so much Downloaded by [New York University] at 12:48 14 August 2016 This page intentionally left blank Downloaded by [New York University] at 12:48 14 August 2016 CONTENTS Preface ix Acknowledgements xiv PART I The poetics of psychotherapy 1 1 The therapeutic imagination: George Eliot and Daniel Deronda 3 2 Discovery: Seamus Heaney and Marcel Proust 16 3 Non- discursiveness: Robert Lowell 28 4 Repair: Hugo Williams 43 5 Loss: Wordsworth’s Ode 52 PART II Psychotherapy and narrative 63 6 Attachment and narrative: Conrad’s Heart of Darkness 65 Downloaded by [New York University] at 12:48 14 August 2016 7 Change: Llosa’s Aunt Julia 86 8 Society: Evelyn Waugh and Jane Austen 89 PART III Psychotherapeutic approaches to psychiatric diagnoses 109 9 Anxiety: Wagner’s Siegfried 111 vii CONTENTS 10 Splitting: Stevenson’s Dr Jekyll and Mr Hyde 115 11 Grief and loss: Milton, Tennyson and Donne 128 12 Narcissism: Ovid and Wilde 134 PART IV ‘Only connect’: psychotherapy and psychiatry 159 13 Meaning v. mechanism: Forster’s Howard’s End 161 14 Toughness v. ‘wetness’: Armitage 171 15 Facts v. feelings: Abse, Olds, Holub and Larkin 174 Postscript 181 References 183 Index 193 Downloaded by [New York University] at 12:48 14 August 2016 viii PREFACE The rationale for this compilation is the link between literary and psychody- namic aesthetics.1 Books and consulting rooms may seem very different domains – although few of the latter are book- free – but novelists and poets can be helpful to psychotherapists in a number of ways. First the voices of literary giants, if suitably harnessed, lend authority and a species of validation to psycho- therapeutic ideas. Second, literary examples provide case-illustrations without the attendant difficulties of confidentiality and non- generalisability. Third – and here is the main focus of this work – there are parallels between the literary and the psychotherapeutic imagination, so that understanding literary creativity can enhance psychotherapeutic skilfulness. Literate therapists, I suggest, make better therapists. This theme is explored in the introductory chapter, which is an extended ‘con- versation’ between Freud, Coleridge and George Eliot. I argue that psychoana- lysts particularly interested in creativity and spontaneity, of whom Bion is an outstanding example, were drawing on a pre- psychoanalytic tradition with roots in German Romanticism, translated into the Anglo- Saxon world by Coleridge, Keats and Wordsworth. The use of literature in psychoanalysis is far from new. Freud was deeply versed in the Western cultural tradition, drawing freely on art and literature – but, oddly, not music – to illustrate and buttress his arguments. At the kernel of his theories lies the Oedipal myth; without Sophocles there could have been no Freud, and no psychoanalysis; Ernest Jones (1948) famously ‘analysed’ Hamlet in Oedipal terms. The psychoanalytic literature is replete with psycho- Downloaded by [New York University] at 12:48 14 August 2016 literary magpies drawn to glittering examples from the canon. Among con- temporary analysts Ogden (1999), Wright (1991, 2010) and Britton (1998, 2003) have been particularly skilful in their use of literary examples. Williams and Waddell (1991), and Canham and Satyamurti (2003) have specifically linked psychoanalytic and literary thinking. This book is in that tradition, but with two distinct features. First, its orienta- tion is unashamedly practical. The author has a workaday background in psych- iatry and psychodynamic psychiatry, and brings psychoanalytic ideas to bear on the quotidian world of the clinic and public health settings. Each chapter ix PREFACE addresses a particular clinical problem, using literature to extend its range of reference and reverberation. A second distinctive aspect derives from attachment theory (Holmes 1993/2013, 2010) as a significant psychodynamic voice. I am reaching here for three-way links between evidence- based understanding of parent–infant interac- tions, the processes of literary creativity and therapeutic efficacy. What ‘good’ parenting, good literature and mutative therapy have in common is the paradox- ical combination of security of form with creative uncertainty and exploration, dubbed by Feeney and van Vleet (2010) as the ‘exploration paradox’ in which adventurousness and secure attachment go hand in hand. A hallmark of sensitive parenting is ‘partially contingent mirroring’ (cf. Beebe et al. 2012) – the capacity of parents to respond to and imitate their chil- dren’s ‘gestures’, physical and later verbal, but to take them one step further, leading the child in turn to expand on her parent’s elaborations, and creating a vibrant interpersonal field, ‘third’ (cf. Ogden 1994), or transitional space, dis- tinct from the contributions of either party. Vitality and innovation – Winnicott’s (1971, p. 39) ‘creative living’ – flow from this balance between non- controlling structure and boundaried playfulness; rhyme without replication. Acquiring the capacity to inhabit this world, and to turn it to therapeutic advantage, is the essence of psychotherapeutic training, a life-long process in which assimilation of theory and active practice inform and nurture one another. Mentalising or ‘mind-mindedness’ is a mark of security-creating relation- ships (Meins et al. 2001; Allen et al. 2010). We can never see directly into the mind of another person. Good parental care entails imaginative identification with her children on the part of