Monday, December 26, 2011

I.H. Paul's Letters to Simon - The Reluctant Psychoanalyst Reads a Professional Classic

Recently there was a meeting at my institute between various faculty members and a group of young, enthusiastic psychiatric residents and psychology graduate students.  The topic was: How should the students learn about psychoanalytic approaches to treating clients/patients?  We thought about various things that had worked in the past: analysts presenting their cases or teaching classes about basic psychoanalytic concepts, but when someone suggested a book club, the energy in the room picked up.  And then, as we discussed various books that we could read, it was clear that there was a special place in the hearts of the analysts for a book by I.H. Paul (1973): Letters to Simon.

Letters to Simon is modeled after C.S. Lewis’ Screwtape Letters.  Lewis was writing to Christians – warning them as it were – by presenting a series of letters from a wise and avuncular devil to a neophyte who was just learning the craft of temptation (I have posted about an imaginary meeting between Lewis and Freud here).  Paul writes to his – presumably imaginary - nephew, Simon, a neophyte therapist just learning the craft.  In Paul’s book we do not read the correspondence of the student – we know about it only from the references to it in the master's letters. 

We were all excited to recommend Letters to Simon, it held an important position in each of our development and, as the leader of the resident group characterized it, we seemed so attached that she did not recommend asking to borrow our texts – we valued them that highly.  That was true, but we also were somewhat concerned about how well the book had held up.  It was written at a different moment in the development of psychoanalytic theory.  It was a time when psychoanalysis was in vogue – and a time that predated some important developments in both psychoanalytic theory and technique.  So when we agreed to read the book together, it was with some trepidation and some anticipation that I picked it up.

Simon’s letters were still warm and clearly written.  They do, indeed, have a time bound perspective – but from that perspective they clearly articulate good psychoanalytic technique and provide an articulate rationale for that technique.  Simon’s perspective is that the intent of Psychotherapy (he referred to his particular perspective by this handle, though I think it describes the dominant, middle of the road psychoanalytic thought at the time he was writing) is to increase the autonomy of the client/patient.  To this end, the job of the therapist is to be as unintrusive as possible – to assiduously avoid suggestion – and, instead, to offer interpretive help when that is available, and silence when it isn’t.  This creates a picture of the analyst that is still dominant in New Yorker cartoons – a silent, all knowing, but somewhat stilted, formal and unavailable therapist isolated behind a couch offering pronouncements.

The book is longer and denser than I remembered it.  Despite its informal tone and format, there is quite a bit of challenging material between its covers.  It also failed the primary test that I have for technique-based texts: it did not evoke any current patients that I am treating.  So it was with some trepidation that I approached the book club.  I spent time, somewhat defensively, preparing to help them understand why this book was so important to the development of the analysts in the group, to explain how we have developed since then, and to promise to look for books that were more current and likely to be more relevant to their experience.

So, imagine my surprise when the group – a small group, it met during the holidays, maybe that has something to do with it – was very excited about the text.  They found it to be a reassuring, avuncular voice just as we had a generation earlier.  They were taken by the model and appreciative of it.  As neophyte therapists, they found it very useful to have a clearly articulated model – a handbook, as it were, of what it is that they are to do in the therapy session.

I now realized why the book had failed my test of a good technique article - the focus is not on clients/patients and their experience, but on the experience of the analyst/therapist.   While I found that distracting, these novice therapists found it helpful to have a clearly articulated set of rules, just as the analysts with whom we had met earlier had found it orienting.  But, these rules were not the current rules of engagement.  They work best with a very narrow range of clients – really the most healthy ones – and they lead to certain limits in treatment outcome – clients/therapists become more comfortable with their inner worlds, but they can also become too autonomous – taken with themselves, they have trouble relating well to others.

So, now concerned about the opposite end of the spectrum, I took the position that, while the students clearly were finding the book helpful, its position was not the only one – and was not a particularly current one, and I maintained that they ought to think about what this technique, as articulated would promote – autonomy (as advertised) – but what might be lost in pursuing this – a sense of the relationship between the therapist and client and the ways in which articulating that relationship – being more real and present with the client/therapist – could lead to therapeutic outcomes that would influence more than just the capacity of the client/patient to be comfortable with their own thoughts, but also to move towards being more comfortable being in relationship with others while also being connected with their own thoughts.

The students, for their part, ended up comparing two of their teachers and the conflicting approaches that these teachers offered – one represented, more or less, by the book, and the other represented, more or less by my corrective.  This led to a conversation about the tension between the two positions, the virtues of both, but also the limits and concerns associated with each.  Hopefully I was able to inhabit an avuncular space that helped these novice therapists continue the process of developing the skills that are part of this complex but also very human art.  And next month we will read something much more contemporary – Wearing my Tutu to Analysis and other stories...

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