The Craft of Psychodynamic Psychotherapy The Craft of Psychodynamic Psychotherapy ANGELICA KANER AND ERNST PRELINGER JASON ARONSON Lanham • Boulder • New Ylwk • Torollto • Oxjiml Published in the United States of America by Jason Aronson An imprint of Rowman & Littlefield Publishers, Inc. A wholly owned subsidiary of The Row man & Littlefield Publishing Group, Inc. 4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706 www.rowmanlittlefield.com PO Box 317 Oxford OX2 9RU, UK Copyright© 2005 by Jason Aronson Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher. British Library Cataloguing in Publication Information Available Library of Congress Cataloging-in-Publication Data Kaner, Angelica. The craft of psychodynamic psychotherapy I by Angelica Kaner and Ernst Prelinger. p. em. Includes bibliographical references and index. ISBN 978-0-7657-0372-9 1. Psychodynamic psychotherapy-Philosophy. 2. Psychodynamic psychotherapy Methodology. I. Prelinger, Ernst. II. Title. RC489.P72K36 2003 616.89' 14~c21 2002038501 Printed in the United States of America QTM 'C:7 The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences-Permanence of Paper for Printed Library Materials, ANSI/NISO Z39.48-1992. Contents Preji1ce: The Spirit of This Book vii Acknowlet(~1nents IX Introduction Part 1: Inner Life and Adaptation Individual Psychological Work 21 2 Impediments to Individual Psychological Work 26 3 Adaptation 28 4 Psychodynamics 35 5 Character 52 Part II: Creating a Room of One's Own 6 The Therapist: Her Personal Experiences and Qualities 75 7 Wobbly and Brittle 79 8 Early Learning 81 9 Later Learning 87 10 The Frame 90 11 Setting Up a Practice 100 Part Ill: Opening the Door 12 The Patient 115 13 First Encounters 120 14 The Therapeutic Match 123 15 The Therapeutic Understanding 126 16 The First Therapy Session: Setting a Tone 132 17 The First and Only Hour 147 18 The Initial Version 158 19 The Therapeutic Formulation and Agenda 161 20 Widening the Conversation 165 Part IV: The Dynamic Interplay 21 Resistance and Anxiety 171 22 A Frequent Clinical Situation 177 23 Transference 182 24 Countertransference 193 25 Clinical Neutrality 198 26 The Therapeutic Alliance 205 Part V: The Nitty Gritty 27 What Does a Therapist Actually Do? A Starter Kit 211 28 Listening 213 29 Beginning and Ending Sessions 251 30 Making Comments 255 31 Being Silent 262 32 Interpretations 266 33 Working Through 274 34 Termination 278 Part VI: Ingredients of Change 35 Active Elements in Productive Psychotherapeutic Work 295 36 Meditation 299 References and Recommended Readings 301 Index 305 About the Authors 313 Preface The Spirit of This Book There are things down there still coming ashore. Never make the mistake of thinking life is now adjusted for eternity. It gets into your head-the certainty, I mean-the human certainty, and then you miss it all ... -Loren Eiseley, "The Snout," from The Immense ]oumey In the beginner's mind there are many possibilities, but in the expert's there are few. -Shunryu Suzuki, Zen Mind, Beginner's Mind Loren Eiseley's essay, "The Snout;' is a meditation upon the evolution of man. An anthropologist and naturalist, Eiseley writes of nature still busy with ex periments, still dynamic, and not through or satistled because a Devonian tlsh, what he calls the Snout, managed to survive oxygen-starved pools "to end as a two-legged character with a straw hat." He goes on to say that there are things still brewing in the oceanic vat. There in the ooze, unnoticed in swamps and along the tide tlats, fish climb trees and "ogle uneasy naturalists who try un successfully to chase them back to the water:' He says that it pays to know this. From a different tradition Shunryu Suzuki speaks of beginner's mind. The mind that is tree of learned, perhaps overlearned, routines: open, vast, capa ble of seeing things afresh and new. It is an attitude of doubt, of receptivity, of possibility, "always ready for anything." Suzuki says that with beginner's mind vii viii PREFACE: THE SPIRIT OF THIS BOOK we look out over limitless meaning and "can really learn something:' Our challenge is not to lose beginner's mind. As with the evolution of the struggling fish there are no preset paths or guarantees in the psychotherapeutic journey. We may have a well-reasoned hypothesis or just a hunch, but we really don't know what will come ashore. The influences on human psychological development and adaptation are as manifold and wide ranging as those on the physical. What happens along the way is often better grasped in retrospect, in case conferences, individual su pervision, or unexpectedly as one walks alone in the woods or down the pro duce aisle. As much as we are taught, as much as we employ theory, any theory, we must be sure to remain gracious hosts to mystery, our inevitable compan ion. It is with this spirit of openness so eloquently expressed by Suzuki and Eiseley that we present this book. In attempting to put forth a somewhat co herent view of psychotherapy we have been mindful not to coerce parts into place, thereby falling into the seductive arms of intellectual closure. The process of writing has asked us to reckon with pieces that don't fit together quite as neatly as we would like, with questions for which we don't have easy answers. And, of course, what we have left out, by design or ignorance, is far greater than what we have included. But if the joints of this work are not seamlessly linked, neither, we like to think, are they arthritic or fixed. After all, the survival of psychotherapy, both the practice and the writing of it, requires of the psychotherapist a flexibility of thought and feeling. It requires an open ness to experience, as well as a willingness to face the uneasy challenges of puzzlement and uncertainty without having to chase them back to the water. -A. K. and E. P., New Haven, Connecticut Acknowledgments First of all we would like to express our gratitude to the Division of University Mental Hygiene at the Yale University Health Services, and especially to Lor raine Siggins, its director. We learned a great deal there from our colleagues, students, and patients and had the good luck to teach in the seminar Theory of Psychotherapy. We also derived much benefit from the reading and helpful suggestions of Rosemary Balsam, Michael Groner, Naomi Kaner, Sidney Phillips, Stanky Possick, Jane Prelinger, Rosemarie Prelinger, and Joan Wexler. Finally, we wish to extend our heartfelt appreciation to Olga Kaner and the late Nathan Kaner for their unwavering encouragement and support. ix