Roy E. Barsness - Core Competencies of Relational Psychoanalysis: A Guide to Practice, Study and Research

This part covers:

• the research behind the Core Competencies;
• efficacy of the models;
• the history of relational psychoanalysis.

This part has been designed to offer the reader four points of entry into learning the Core Competencies:

• one-line naming of each Core Competency
• a brief introduction to each Core Competency
• properties of each Core Competency, offering categorical bullet points taken from the qualitative research that describes it;
• an in-depth essay on each Core Competency.

This part covers current issues relevant to contemporary practitioners, including:

• relational ethics;
• the brain and psychoanalysis;
• sexuality and gender;
• cultural considerations;
• self-care.

This part offers the reader a critique and a counter-critique of Relational Psychoanalysis, offering theoretical constructs that will continue to need revision, conversation, thoughtfulness, and thoroughness in order to continue to advance our field.

A supervisee with tears in her eyes says: I get so annoyed with myself. I constantly feel that I cant get this. I cant do what you do; I cant get to the metaphors, the underlying meanings, the process instead of the content, the What the hell is going on here anyway? question that you always encourage me to consider. I just cant think quickly enough.

She pauses, But what keeps coming back to me is that the only way to understand and assist my patient is through immersion into my own affects and experiences of my patient. I have to feel her to know her.

That is the only way. I respond, Yes.

We are quiet for a while as we consider the magnitude of what this involves. As we begin to speak, we acknowledge that indeed it is our selves that serve as the conduit, the midwife, the window to the deep of the other as we attend to what is being called up through the depth of our own being.

In relational psychoanalysis, it is expected and inevitable that the treatment will re-evoke aspects of the very experiences that contributed to early developmental difficulties (Beebe and Lachmann, 2014, p. 68). Slavin and Kriegmann argue that the evocation occurs within both patient and analyst, and therapeutic action is found in a mutual influence process suggesting that the therapist has to be changed by deepening her awareness of her own struggles that are parallel in some way to those of the patient, [Slavin, refers to this as] embodied simulation (Beebe and Lachmann, 2014, pp. 7374).

As you have read the preceding chapters, you have seen that the shibboleth of neutrality has been replaced by the principle of authenticity, privileging a heightened attention to the mutual intersubjectivity of the therapeutic encounter. In these chapters, we have come to see that the main instrument we have in our efforts to understand is our empathy, the main delivery system of our empathy is our person (McWilliams, in this volume), and Schore (2014) sums it up:

that the core clinical skills are right brain implicit capacities, including the ability to empathically receive and express bodily based nonverbal communications, the ability to sensitively register very slight changes in anothers expression and emotion, an immediate awareness of ones own subjective and intersubjective experience, and the regulation of ones own and the patients affect. All techniques sit atop this relational substratum .

(p. 394, italics added)

We are a long way from the days of abstinence, neutrality, and anonymity, when the self of the analyst was expected to be absent from the encounter. Now the analysts own personhood, the use of the self, is seen as central to change and transformation for the patient. There is no hiding or dissociating from countertransference reactions. In fact, as Bion has noted, the patient always knows what the analyst is thinking, and that this is the price the analyst pays for being an analyst (in Ferro, 2006, p. 661). The subjectivity of the therapist is central to understanding unconscious material, the structure of the intrapsychic and the patients interpersonal world. We no longer live in the myth of being unseen and unknown as helpful for the patient. Rather, we are required to pay disciplined attention to our thoughts and emotions and to have a keen awareness and acceptance of our deep emotional states and dissociations, in order to situate ourselves non-defensively, when activated by our patients fragilities and pathologies.