Jeremy Holmes - Attachments: Psychiatry, Psychotherapy, Psychoanalysis: The selected works of Jeremy Holmes

Attachments: Psychiatry, Psychotherapy, Psychoanalysis

For three decades Jeremy Holmes has been a leading figure in psychodynamic psychiatry in the UK and across the world. He has played a central role in promoting the ideas of John Bowlby and in developing the clinical applications psychiatric and psychotherapeutic of attachment theory in working with adults. Drawing on both psychoanalytic and attachment ideas, Holmes has been able to encompass a truly biopsychosocial perspective. As a psychotherapist Holmes brings together psychodynamic, systemic and cognitive models, alert to their vital differences but also keenly sensitive to overlaps and parallels.

This volume of selected papers brings together the full range of Holmess interests and contributions. The various sections in the book cover:

an extended interview covering Holmess career and philosophy as a psychodynamic psychiatrist;

juvenilia sibling relationships, the psychology of nuclear weapons and the psychodynamics of surgical intervention;

psychodynamic psychiatry: integrative and attachment-informed;

a psychotherapy section in which he develops his model of psychotherapeutic change;

heroes biographical pieces about his major influences, including John Bowlby, Michael Balint, David Malan, Jonathan Pedder and Charles Rycroft;

ephemera brief pieces covering such topics as frequency of psychodynamic sessions and fees.

Attachments: Psychiatry, Psychotherapy, Psychoanalysis The selected works of Jeremy Holmes will be essential and illuminating reading for practitioners and students of psychiatry and psychotherapy in all its guises.

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, Storrs The Art of Psychotherapy, Exploring in Security: Towards an attachment-informed psychoanalytic psychotherapy and The Therapeutic Imagination: Using literature to deepen psychodynamic understanding.

Attachments: Psychiatry, Psychotherapy, Psychoanalysis

The selected works of Jeremy Holmes

Jeremy Holmes

First published 2015

by Routledge

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and by Routledge

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Routledge is an imprint of the Taylor & Francis Group, an informa business

2015 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

Catalog record for this book has been requested

ISBN: 978-0-415-64422-8 (hbk)

ISBN: 978-1-315-76208-1 (ebk)

Typeset in Sabon

by Book Now Ltd, London

CONTENTS

24 In praise of low intensity psychotherapy

When my stalwart Routledge editor, Kate Hawes, invited me to contribute to her World Library series I was of course delighted, and gratefully accepted her offer at once how could one not? But the experience of reviewing my work over 40 years can it really be that long? has not been entirely comfortable. For a start I seem to have been saying much the same things over and over again. My leitmotiv list runs roughly as follows: diseases, psychological and physical, arise in the context of relationships, past and current; narrative approaches must stand alongside so-called evidence-based practice if something vital in our medical culture is not to be lost; psychiatrists need to take account of unconscious as well as the more overt aspects of the mind; gut feelings, aka transference and counter-transference, influence the doctorpatient relationship no less than its rational purposes, and need to be aired and examined; psychotherapists need Bowlby as much as Freud; psychotherapy integration is the way forward for our discipline. One might ask why it is necessary for psychodynamic psychotherapists to bang these recurring drums. Is there an inherent resistance to the uncomfortable message of the unconscious? Is the instrumentalist quick-fix zeitgeist against us? Or is it that ongoing verities need constantly to be discovered anew by each generation of practitioners? All of these possibilities, and others, are considered in the chapters which follow.

Another challenge, in trying to select pieces which show at least some traces of originality, has been to pinpoint what my specific contributions have been. Such as they are, they consist mainly of little phrases and bons mots: the idea of optional illness as an aspect of general medicine; autobiographical competence as a mark of psychological maturity; contrasting strategies for therapists depending on their patients attachment styles as story-making (ambivalent attachment) or story-breaking (avoidant ditto); mentalising as the ability to see oneself from the outside and others from the inside; and finding a vantage point from which to view feelings and relationships as a therapy goal. Stepanskys (2009) answer to the decline of psychoanalysis is a wistful advocacy of optional marginalisation, a distinct if necessarily adjunct role in the medical pantheon. Discussing his book at a seminar at the Anna Freud Centre, a colleague pointed out that Holmes appears as a footnote in Stepanskys analysis. Perhaps my overall contribution could be described as a footnote to a footnote to footnote!

Even that is perhaps preferable to total obscurity. But, more seriously, lest all this self-deprecation be deemed no more than inverted narcissism, these reflections have usefully served to remind me that I am not primarily a theoretician, a system-builder, a researcher even, and certainly no guru. I remain a clinician psychotherapist with minor academic leanings. My contribution, such as it is, flows, therefore, from the skills and purposes of psychodynamic practice. These I group under four headings, each of which goes some way to explain what I have been doing and not doing in the writings collected herein and elsewhere.

First, there is the therapeutic stance itself, the so-called analytic attitude: a knights move position; fluid, orthogonal to action; looking from the aforementioned vantage point (safe, yet blessed with vision) at roles and assumptions; commenting; refusing to be pinned down, pigeonholed or categorised; in search of what cannot being said, or maybe even thought. This necessary indeterminacy cascades down through the roles. Despite Freuds attempt to compare psychoanalysis with surgery, as a psychiatrist one cannot, in my view thankfully, without some sleight of hand be a proper doctor, a diagnoser and a curer of illness. One is always primarily a wounded healer, face to face with the sufferings of the other, trying to understand and transcend them in the context of an evolving life-story. Similarly, as a psychotherapist one does not fully embrace the mores and habits of psychiatry always interested more in the therapeutic relationship and its meanings than, as a colleague mock-ironically used to put it, in stamping out mental illness. Perhaps controversially, I believe the same stricture applies to ones role as a psychotherapist. While psychoanalytic theories are embraced by some as absolute truths, I prefer to see them as provisional heuristics, to be viewed with a degree of affirming scepticism.