Ryan - Psychoanalysis and class: the psychic landscapes of inequality

First published 2017
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2017 Joanna Ryan

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ISBN: 978-1-138-88549-3 (hbk)
ISBN: 978-1-138-88551-6 (pbk)
ISBN: 978-1-315-71540-7 (ebk)

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This book has evolved over many years of practice, discussion and engagements of various kinds. I would like to thank the participants in my research study, and all the patients and supervisees whom I have had the privilege to work with. The Tavistock Institute of Medical Psychology funded some of my research. I have benefited greatly from being a Visiting Research Fellow in the Department of Sociology, Goldsmith University of London, in 200408. An Honorary Research Fellowship in 2016 in the Department of Psycho social Studies, Birkbeck, University of London, has helped me complete this book. I have gained much from my involvement with The Site for Contemporary Psychoanalysis and the critical and innovative psychoanalytic thinking that it enables.

Sheila Ernst, who died in 2015, had been a long-term companion in many of these journeys through psychoanalysis and politics, and an inspiring internal presence through the writing of it. I owe much to the stimulation and support of Vic Seidlers friendship, breadth of knowledge and critique over many years. Im hugely grateful to Ruth Petrie for invaluable editorial input into the whole book, and for her consistent and sustaining friendship. Madelyn Brewer has read many chapters and provided thought-provoking comments, as have Sue Einhorn, Marion Gow, Julian Lousada, Allegra Madgwick, Marie Maguire, Janet Sayers and Vic Seidler. My long-standing womens group has been a constant source of support and challenge. Thanks to Marion Gow and Angela Kreeger for initiating a Laplanche study group. Casey Ryan has been invaluable in patiently helping me navigate the IT demands of the twenty-first century, as well as in his support and encouragement. Aaron Brown has been consistently concerned for my work and well-being, as have many other friends and family. Thanks also to Riccardo Steiner for his engagement and encouragement. I am immensely grateful to the NHS, and especially my GP, Dr Sanders, for their essential ministrations over the years. Margaret Mellor has done some essential copy-editing.

Excerpts from Extrusion and disavowal, previously published in Sitegeist: A Journal of Psychoanalysis and Philosophy (2009), are reprinted with kind permission of Karnac Books.

Portions of Class is in you, previously published in British Journal of Psychotherapy (2006), are reprinted with permission from John Wiley and Sons.

Portions of Class is in you in Thinking Space: Promoting Thinking About Race, Culture and Diversity in Psychotherapy and Beyond , edited by Frank Lowe (2013), are reprinted with kind permission of Karnac Books.

Lynne Layton, Laurence Spurling, Penny Crick and Teresa Mulvena have allowed me to quote from unpublished papers.

Here I explore how the dynamics of therapy relationships may be inflected by class, based on my own research and the contemporary writings of others. Dimen argues that class has powerful unconscious resonances such that: The fault lines of class and other hierarchies show up systematically in transference and countertransference (Dimen, 1994: 79). Whitman-Raymond describes how fraught with anxiety the elucidation of class in clinical work can be. She asks: How can clinicians begin to talk about the pain of our class limitations and class exploitation as they are experienced, and at times replicated, in the clinical setting? (Whitman-Raymond, 2009: 440). This chapter provides many diverse examples of how therapists do often do this, within various class permutations, and sometimes fail to do so. I show how different therapists conceptualise and work with class issues, and the barriers to this.

I asked the therapists in my study (Ryan, 2006/2013) to describe in some detail their clinical work with two patients, one working class, and one middle class, as this was perceived by the therapist and/or in accordance with patients self-ascriptions where these were present. They were asked to select cases where they were aware there were class issues, either for their patients or for themselves in relation to these patients, or both. It became apparent that prior preparation for this part of the interview was advantageous, and I sent guidelines to all subsequent interviewees outlining possible topic areas and questions. This is unusual in qualitative research but reflects the reality that to ask therapists to talk in detail about their clinical work does entail thought and preparation. They were asked to provide some general background to their descriptions of their work with each patient, their understandings of class issues for that patient, and any class-related aspects of the transferencecountertransference that they perceived. I would at times ask for more elaboration, or sometimes suggest links to other parts of the interview, if appropriate. The interviews were psychoanalytically informed, in the sense that all parties were experienced in psychoanalytic modes of self-reflection and thinking, and the topic was clinical work.

Most therapists readily located examples of work where they felt class was an issue of some kind. The exception was K, who said of her NHS work: I did obviously have working-class patients there, but I dont think class is what I was thinking about , and I dont think Id have mentioned it in an assessment.

Many of the interviews were highly charged, and it was as if we had embarked on unusual discussions. The therapists accounts were a mixture of what they were felt were class issues for particular patients, and also of how they felt class played out in the interface between the two of them. B asked: Does the social class appear in the transference and how would the analyst hear it? a highly pertinent question that puts the onus as much on the therapist as on the patient. Here I illustrate some class-related transferences and how these therapists heard and responded to them.

In what follows, the data from the interviewees from lower middle-class backgrounds is combined with the data from those from working-class backgrounds, as much of their material, both biographical and professional, contained similar concerns and was distinctively different from that of the middle-class interviewees. This generated four possible pairings of therapist and patient as regards class: two with a class difference and two with a similarity. I did not start out with any assumption about dividing the research material up in this dichotomised way, but the subsequent analysis of the transcripts did suggest that with the two possible pairings with class differences there were distinctive themes, and there was almost no overlap between these. That talk about class can readily default to the binaries of working class and middle class, the haves and have-nots, or us and them, indicates the intensity of emotion and projection at play and the powerfulness of social divisions and inequality, even if this does not always correspond to more complex or differentiated realities. Class issues of many different kinds were reported in all combinations. Here I have selected some detailed accounts and described others more briefly.