This training day, as I understand it, has the aim of exploring individual therapy from both family therapy and psychoanalytic perspectives. I believe that implicit within this is also a wish to understand the possible connections between family therapy and psychoanalytic psychotherapy in broader terms.

It is interesting to reflect how times change. I doubt that such a training day would have been held in this country even 5 years ago. In fact, with some exceptions such as the seminars organised at the Tavistock by John Byng-Hall I think the chances of finding such a training day would have been remote any time in the last twenty years. Twenty-five years ago however the odds, I believe, would have been higher. The first issue of the JFT in 1979 shows that the interest in psychoanalytic ideas in family therapy was strong with both the editor and half the contributing authors having analytic interests. At that time the developments in object relations theory and group analysis in this country were well placed to make a major contribution to family therapy thinking. And at the same point in UK family therapy history, structural and strategic family therapy models - which were implacably opposed to psychoanalytic thinking - had yet to achieve their sweeping dominance of most of the 1980s. When these models in turn were superseded – at least in the mainstream – by Milan and especially post-Milan second order family therapy there was no return to a dialogue with psychoanalytic colleagues despite the original Milan associates being analytically trained.

What has now shifted in the therapy world to make dialogue (and, therefore, this kind of event) more possible?

Here is a brief list of changes in family therapy, psychoanalysis and in the philosophies of knowledge contributing, I believe, to this shift in context.

• Family therapy is more securely established and does not need to draw such clear distinctions with its neighbours. (Professionalisation and the UKCP are relevant factors in this country.)
• "Systemic" is no longer a single overarching theory (or metanarrative) for family therapy now that family therapy has incorporated narrative and social constructionism and other big ideas which are not obviously related to systems theory.
• Working with an individual is more acceptable in family therapy for the same reason.
• Family therapists are now becoming as interested in internal processes as they are in interactional ones.
• Attachment theory and infant research is a growing bridge between family therapy and analytic psychotherapy.
• Understanding, not-knowing, reflexivity and making sense together are common reference points.
• Postmodernism explicitly or implicitly makes the drawing of tightly boundaried therapeutic models less supportable.
• Psychoanalytic ideas continue to expand beyond the consulting room.
• Psychoanalytic psychotherapy is more pluralistic.
• And there are specific major developments - especially in American psychoanalysis -which, to some extent are either parallel to or complementary to those of family therapy e.g. relational psychoanalysis, intersubjectivity theory and narrative developments.

I’ll now say something briefly about my own involvement with family therapy and psychoanalytic ideas. I initially trained and worked as a Probation Officer in the late 70s and early 80s. I was aware during this period of family therapy as an exciting development but – working then in the South Wales Valleys - one that was always happening elsewhere. I recall trying to read two books neither of which I finished – Peoplemaking by Virginia Satir which I couldn’t get on with (I think that her model came strongly out of her warm extrovert personality and the American human potential movement) and a book edited by Sally Box and colleagues at the Tavistock called "Psychotherapy with Families" which I’m sorry to say I didn’t have sufficient prior knowledge to understand.

In 1984 I moved to Swindon Child Guidance Clinic as a social worker and in 1986 undertook an introductory training with John Carpenter and Andy Treacher in structural-strategic family therapy here in Bristol. I found Minuchin’s work especially his co-written book with Charles Fishman "Family Therapy Techniques" inspiring. (I still think of this as one of the most remarkable books in family therapy.) But also in 1986 I began a weekly personal psychoanalytic psychotherapy which continued throughout the remainder of my family therapy training at the Institute of Family Therapy. The IFT training had by this stage mostly dropped psychoanalytic ideas from its syllabus but I was fortunate to be supervised by Arnon Bentovim and Sebastian Kraemer both of whom have strong psychoanalytic interests and this helped in bringing together in my mind these otherwise disparate influences of analytic therapy and systemic training.

I also found it helpful to bridge this gap by reading backwards into the literature of family therapy of the 1960s and 1950s including ideas which had not made it across the Atlantic, (I would especially mention the contextual therapy of Boszormenyi-Nagy) and I researched as far as possible the ideas of projective identification in families which has a rich if somewhat scattered literature. I began to see a few parents for individual work from 1988 as part of a supervision group inside Swindon Child and Family Guidance Centre meeting weekly with a supervisor who was a psychoanalytic psychotherapist. This group lasted for eight years and was remarkably helpful. I was supervised by Sally Box for a year and then was part of a weekly case discussion group which she ran at the bbridge Foundation. In 1996 I began the adult training at SIP which I completed in October last year.

The other influence I would like to mention is a North American Psychologist Lois Shawver, who I met through internet discussion groups which I participated in from around the mid-90s until about a year ago – the most recent being the Postmodern Therapies Forum. She and others in these groups introduced me to the unsettling ideas of Wittgenstein, Foucault, Lyotard and Derrida.

One thing I have learned from those Forum discussions is the slipperiness of language and the need to carefully define terms. I’ll now explain some of the definitions I am using today. In this country psychoanalysis when used as a clinical description generally refers to 5 times per week work undertaken by those who have qualified in a small number of training establishments. Psychoanalytic psychotherapy generally refers to work of a frequency of 1-3 sessions per week and is a training offered by a broader number of training institutions. This distinction doesn’t exist in the same way in America where both are called psychoanalysis. I think there are differences between the two (especially noticeable between once per week and five times per week) but these are not easy to tie down. Psychoanalysis also has a non-clinical meaning when used to refer to academic interests in these ideas. These are prominent in discussions of social and cultural theory.

Today, I will use the word psychoanalysis to refer broadly to all clinical and non-clinical applications of psychoanalytic ideas and I will try to use the term psychoanalytic psychotherapy (and to ring the changes) analytic psychotherapy or psychoanalytic therapy to refer predominantly to clinical work with individuals.

I’m using the term family therapy in a broad inclusive manner to encompass a loose collection of ideas drawn largely but not exclusively from three major theoretical roots psychoanalytic, systemic and narrative / social constructionist. Perhaps I should add at this point that I don’t identify myself as a psychoanalytic family therapist. Rather, I prefer to see myself as an eclectic family therapist who feels that psychoanalytic ideas have much to offer to family therapy.

I’ll shortly move onto my five things worth understanding. (In fact since I agreed the title with Jeremy there has been some slight inflationary pressure and the number of things I think worth understanding has risen to six.) I’ve chosen these to try to correct some common misunderstandings about individual psychoanalytic psychotherapy which are implicit and active in family therapy. I notice these all the time because they make me wince but if I am with a family therapy audience I notice that other people often don’t wince - such misunderstandings being accepted - and therefore not noteworthy - within some parts of family therapy culture. Here’s an unusually explicit example from a chapter by Gergen and Kaye (1992) in the book Therapy as Social Construction.

I should add that I think this is, on the whole, a useful book and that I find social constructionism - aside from versions that appear to indicate that there is no reality outside of our constructions of the world - challenging and helpful.

I used the term active misunderstandings earlier and by this I am referring to the effect of these beliefs. (Or - in postmodern jargon – how these beliefs perform.) They seem to function to position psychoanalysis as a discredited outsider. For example, in the above quote – through making psychoanalysis the authoritarian and brainwashing "other" it becomes self-evident that the reader should stand firmly on the constructionist side of the constructionist / psychoanalytic border (the side marked "moral high ground"). This form of rhetoric both reinforces the constructionist territory and reassures those within it that they don’t need to worry so much about authoritarianism. The implicit messages are "We’re not like them", "Relax, you’re one of the good guys" and "Don’t go over there – they’re so bossy and controlling!". So, in my view, these misunderstandings help to create an identity for family therapy an "usness" defined by the "themness" of psychoanalysis. These processes are common to all groups and cultures and occur also from time to time within family therapy. (For example, 1^st order vs. 2^nd order, narrative vs. systemic.) Psychoanalysis call this splitting, Bateson called it schismogenesis and Foucault, from a different angle refered to the disciplinary power of discourse.

But why bother to understand more – why should psychoanalytic psychotherapy be of interest to family therapists? I’ve got three points:

• Therapists have, I believe, a primary duty of care not to be analytic or systemic or narrative but to be helpful. (I’ll only note here that this term is necessarily loosely defined at this point since helpfulness can’t be defined independently of those seeking help.) But helpfulness, I think must be a higher ethic than professional identity. I believe that some clients or patients can be best helped by psychoanalytic work. (I also believe the opposite – that individual psychoanalytic therapy is not useful for everyone.) Misunderstandings may act as a barrier to helpfulness and, on the basis of this argument, are then unethical if recommending a different form of therapy would be more helpful.

• Misunderstandings may prevent family therapists from making use of personal therapy. I think there is much more to each of us than we can possibly know but regardless of our state of self-knowledge and of our avowed therapeutic model we are involved with families with all aspects of ourselves – even (and sometimes especially) the ones we would prefer to keep hidden. One factor I might have mentioned earlier in renewal of dialogue between family therapy and psychoanalysis is the number of family therapists who first came to understand these ideas through the experience of being patients and found themselves incorporating these ideas in their work. Bebe Speed, Glen Larner, Carmel Flaskas all come to mind.

• Active misunderstandings continue to waste useful resources for family therapists and those they work with. Indeed since psychoanalysis is interested in the-self-in-the context-of-relationship (rather than the fully interior self of some misconceptions) it is difficult to see how such ideas could not be relevant to family therapists.

So after this long preamble I am ready to give you the full title of this paper;

Six things worth understanding by family therapists about psychoanalytic psychotherapy which require revision of key misunderstandings embedded within family therapy culture which in turn have helped define the boundary and "goodness" of family therapy by positioning psychoanalysis as the denigrated "other".

You can see, perhaps, why I chose the shortened version to go on the publicity.

I’m using the term culture to refer to the ideas and practices of both family therapy and psychoanalytic psychotherapy. The core identity of any culture looks clearer from the outside and from a distance than from inside. (Imagine, for example, trying these days to offer a brief definition of family therapy.) As we know, the best way to understand any unfamiliar culture is to avoid the kind of homogenising talk that gives rise to stereotypes.

I think a good analogy is that of visiting a city. Cities tend to be characterised by what they have at their centre and it takes a while to discover the variation that exists around the centre in different communities and in the suburbs. Indeed it would be impossible to tie down the complexity of a city such as Bristol.

The centre of psychoanalysis is the idea of a dynamic relationship between the conscious mind and unconscious mind. But how these terms are defined and thought about will vary a good deal within the culture. There are variations for example between groups of those considering themselves Freudians, Kleinians, Independents, Jungians, Self-Psychologists and Relational Psychoanalysts. But within each of these groups there are also differences. For example, the Independent Group was formed initially as a section of the British Psychoanalytic Society by those who did not want to identify themselves closely with the followers of Melanie Klein or of Anna Freud. But within this group are found those who are eclectic or those with a strong interest in attachment theory or perhaps those who are strongly influenced by particular figures such as Fairbairn or Bollas.

And while the ideas of each of these larger groups were once fairly distinct, the passage of time, the fading of Freud’s vision of psychoanalysis as a science, a less idealised view of the pioneers of each group, a greater acceptance of not-knowing are all factors leading to blurring of the edges and mixing of ideas. The ethos of the Severnside training here in Bristol is perhaps quite common – an eclectic training that recognises differences between all groups but believes that what they have in common is greater than the differences. The tendency these days of most trainings - even those not calling themselves eclectic - is for greater pluralism.

As with family therapy there are also national differences in the way their cultures of psychoanalysis and psychoanalytic psychotherapy has developed. The work of the post-Freudian Jacques Lacan is most identified with French intellectual modernism and postmodernism. Most developments in the work of Anna Freud have taken place in North America – ego psychology. This tends to give less emphasis to the role of both external relationships and internal relationships (in the way that object relations theory has developed in the UK). This in turn has been the context for the counter-development of a strong relational model in the US – intersubjectivity theory. This so far has not been much taken up by UK psychoanalytic psychotherapy which has its own relational model (object relations theory) and a growing interest in attachment theory.

Family therapy’s fear of authoritarianism in psychoanalysis is closely linked to the second order movement in family therapy and more recently to the ideas in the narrative and social constructionist therapies of what might constitute modernism (as opposed to postmodernism). In these discussions psychoanalysis is seen as one of the chief examples of modernism.

In this active misunderstanding at its most stereotyped, the analytic psychotherapist, is an expert on the human mind. He or she knows first and knows best the truth about the patient. This is because the analyst knows how to read the Rosetta Stone of the patient’s unconscious and gradually the therapist conveys these hidden truths to the patient in a series of interpretations. A more postmodern view of this might say that the therapist and his or her psychoanalytic culture come to colonise the patient. (This is close to the Gergen and Kaye quote that I mentioned earlier.) This way of positioning psychoanalysis as "other" took over from the belief in psychoanalysis as linear (rather than circular) which was prevalent during so called "first order family therapy". And what could underline this power difference more than having the patient lay down on a couch and the therapist outside of the line of the patient’s vision sitting up?

I remember being so convinced by this view of analytic psychotherapy prevalent in late 1980s family therapy that I was rather surprised by my therapist listening very carefully, wishing to understand what I thought and felt. Interpretations tended to be offered by her quite tentatively and seemed generally to invite further thinking or dialogue rather than to present some final truth. I began to wonder if she might be a bit of a maverick. In fact I was a little disappointed that more wasn’t done for me.

Analytic psychotherapy if it is to be of any use depends in forming an alliance (or what family therapists might think of as working collaboratively) with the thinking capacity of the patient. (Sally Box (1994) characterises psychoanalytic therapies including psychoanalytic family therapy as, primarily, a space for thinking.) Even in very regressed states of mind (and by regression I’m referring to the idea of a patient re-experiencing a relational fantasy or memory in which the therapist powerfully represents some aspect of the patient’s internal world of relationships) - there is usually an observing and thinking part of the patient alongside that of the therapist.

It is, of course, possible to tell patients what to think, it is not uncommon for patients to want to be told what to think but it can never be therapeutic. There are, frankly, times when the idea of being able to change people instrumentally – (as 2^nd order family therapy calls it) by telling them what to think and do is quite appealing. If only change was that easy. The same psychological issues may come up scores of times and be talked about in many different ways but the moment of change is not one in the power of the therapist. It is not even a direct product of collaboration – although there can be deep mutual satisfaction when something has been worked out together over a long period of time. In the end the patient arrives at the particular emotional truth on their own. It is an achievement of the patient.

I would argue that analytic psychotherapy is possibly the least didactic therapy. The learning – or probably it is better to say unlearning and new learning - depends largely on the patient’s experience in the analytic relationship. I think a very good description of this experiential psychic change is found in Bateson’s ideas on "binocular vision" and "news of a difference". For example, a woman patient of mine, scapegoated as a child and trynanised and sexually abused by her father, is so convinced that I will shout at her if she is ever late for a session that she makes elaborate arrangements for this never to happen despite having to travel by bus. Inevitably, one day the bus is delayed and she is late and sits (feeling very hot) silently waiting for me to begin raging at her. This is explored a little and after a while she explains that she knows it is true that I am not furious with her. She knows this from the tone of my voice (although it is the case that I do feel slightly needled.) At the same time, she says, it still feels true that she expects me to rage at her. Both things now seem possible whereas before an angry internal part of her was firmly, in fantasy, located in me. Some certainty has been dislodged in her by this new experience.

Later in the work her very hot feeling is replaced by the beginnings of fury with me and a stronger sense of her entitlement to protest and to fix her own boundaries as she comes to take back this attacking aspect of herself which for years has been routinely projected into others.

I would like to briefly say something else about family therapy’s fear of authoritarianism which seems not just to have maintained the boundary with psychoanalysis but to have underpinned the first-order – second order split. I think there is now dangerously unhelpful levels of fear in family therapy not simply of authoritarianism but of holding any specialist knowledge.

This in turn, I think, is based on a partial reading of postmodernism. Basically the postmodern critique says that reality or truth can’t be captured or fully represented in language. There may be many descriptions that can give an account since reality gives quite a degree of wriggle room. Family therapists have begun to worry that, if this is the case, their knowledge can overpower the self-constructing power of those who are seeking help. There is instead great hope placed in re-storying, co-construction and building new narratives. But this in effect reduces all experience to language and is not what postmodernism says. It also, as Carmel Flaskas (2002) notices in her recent book, offers a very fluid notion of the self which is at odds with everyday experiences of what it means to be a person in which a sense of identity (even a denigrating one) is held onto tightly for fear of something worse – a sense of personal dissolution.

But the most important point about postmodernism is I think the one made by Steven Frosh (2002). Postmodernism shows the limitations of language in capturing reality – that there is a point in therapy in which available words dry up – we are left then with our other pre-linguistic human capacities of experiencing the other or as Alice Miller puts it – witnessing. This is not to say that new ways of representing (or symbolising) some of this experience cannot be found but we are more frequently at the edge of our capacity for words than the constructionist-narrative turn in therapy recognises.

My other concern, linked to this, is that too much hope in the capacity for re-storying leaves too small a role for the task of bearing painful feelings in family therapy. One can simply construct a less painful story. (Should feelings – like rage for example ever be externalised. I don’t think so.) But I am hopeful that narrative as it has been taken up in the UK is quite strongly influenced by John Byng-Hall’s interest (from attachment theory research) in emotionally coherent stories. These are narratives that incorporate a living history of emotional experience. And I was certainly heartened to read Lynn Hoffman’s (2002) fascinating "Intimate History" of family therapy which despite steering well clear of anything psychoanalytic in family therapy ends with a great respect for the possibilities of unconscious emotional communication (although using different words).

The culture of family therapy is, I think, distinct from that of psychoanalysis in one way which is in its use of technical terms. Family therapy with its ethos of radicalism seems constantly to be re-inventing itself, splitting off from its past every few years. Each new movement carries new terms and one characteristic of those family therapists who have been around for some time is that they begin to grumble that the new jargon simply re-cycles old ideas - "old wine in new bottles". I won’t say too much about the merits of this argument but will simply use it as a point of contrast with the opposite tendency in psychoanalytic terminology.

Terms in psychoanalysis tend to be conserved so that the same term can be stretched over the years to mean several different things. A good example is that of countertransference which – in Freud’s original view was simply the unconscious reaction of the therapist to the patient and was seen as a complicating factor in understanding the patient and, therefore, rather a nuisance. Later countertransference became seen as potential information not solely about the therapist, but about the patient via projective identification. (Some aspect of the patient being created in the mind of the therapist.) In relational psychoanalysis the same terms are used differently again. Here the therapist is not seen as reacting to the patient’s unconscious but each are seen as interacting at both conscious and unconscious levels – in other words as a system. So transference and countertransference might here be defined as all that which is in the mind of patient and therapist respectively but in the context of the relationship with each other. Some writers such as Donna Orange (1995) have suggested a new term co-transference for this.

Many of the most useful terms in psychoanalysis do not intuitively yield up their meanings. Some exceptions are Winnicott’s idea of emotional "holding" and Bion’s "reverie" but terms such as Klein’s "paranoid schizoid position" and "depressive position" – in many ways crucial to understanding contemporary psychoanalytic thinking - seem almost perversely non-intuitive. (I’ll return to these terms later.)

Primary to clinical training is the training analysis or training therapy typically 3-5 times per week therapy for a minimum of five years. The experience of being a patient is central to the training and theoretical teaching supports this. Reading about projective identification is hard going and baffling. In contrast discovering as a patient that what one is attributing to the therapist or others is actually something of oneself can be shocking but also compelling and unforgettable.

All told this makes acquiring knowledge of psychoanalytic ideas very difficult through reading alone. I say this not to put anyone off from reading but to help explain why terminology is often opaque and hard going.

The terms "parent blaming" and especially "mother blaming" have become, I believe, crucial and powerful boundary markers in some parts of contemporary family therapy – and function in the same way as the terms "linear", "first order", "modern", "expert". In a recent conversation with a very experienced family therapist - he talked about transgenerational issues in families and then as an automatic aside apologised that this might sound rather blaming.

Terms like "mother blaming" – which I call "badges of shame" only operate in a disciplinary manner if they remained unexamined. I would like to re-consider the assumption that psychopathology is "just blaming" through an analogy.

A woman breaks her right leg and is taken to casualty complaining of considerable pain. The Doctor mindful of the dangers of pathologising decides not to call attention to the damaged leg at all but to concentrate on strengths and says "But you have such a good left leg. Have you considered hopping."

Of course in this example the patient will soon re-direct the doctor back to the damaged leg – the doctors knowledge about pathology is in tune with the patient’s view of the matter. The knowledge of pathology is not therefore experienced as a problem. In fact one would say that the doctor would not be able to discharge his or her duty of care without a detailed knowledge of how the body can suffer and a willingness to attend to this suffering. And a concentration on strength of the undamaged leg would probably have been experienced as neglectful and dismissive.

A more complex problem is presented in analytic psychotherapy. Here attempts by the patient to feel better may lead to unbearable aspects of the self being projected outside and into others. The therapist’s knowledge of these processes is not going to be received immediately as helpful and may well be experienced as persecutory and blaming.

There is no doubt that psychoanalysis contains some potentially good put-downs which have found their way into popular culture such as, "neurotic", "psychotic", "narcissistic". But within psychoanalytic psychotherapy these are theoretical technical terms referring to states of mind. They are no more inherently pejorative than say technical terms in medicine or any other profession. However, this is not to say that therapists can’t use these terms pejoratively. Hate can get into almost anything and should be recognised as such.

So what I am saying is that psychoanalytic psychotherapy is at times inherently painful but not inherently blaming.

Blame of others and blame of self are, though, regular aspects of the human condition (corresponding to what Klein calls the paranoid schizoid state of mind which we have all experienced and can all experience again in times of duress). The progress of psychoanalytic therapy is a movement from blame through tolerance and understanding of painful states of mind to greater acceptance of self and others.

The attempt to avoid parent blaming has led, I think, some parts of family therapy culture to almost give up on any theories of family processes. Lynn Hoffman’s recent book shows I think a fascinating journey to an almost completely non-theoretical position. What is left is intuitive, poetic and warmly supportive. Knowing is removed through fear that it will be used in an authoritarian and fault-finding manner. But don’t families wish us to know some things they don’t know? (What I should add perhaps is that a therapist with Lynn Hoffman’s history can never be short of knowing – intuition is not a personality trait but based on layer upon layer of experience built up over many years.) My own view is that knowing and not-knowing need to be held responsibly in a careful balance and I would identify with Glen Larner’s (2000) thoughts on this in a recent JFT paper.

I think this disabling fear of blame in families does not come primarily from our theories but from elsewhere – a conviction in many parents and children that they are bad and blameworthy and a fear that inevitably the therapist will come to see this and their terrible secret will be out. Parent blaming is real and damaging but exists not, I think, primarily in our theories but in the continuous and secret conscious or unconscious attacks that parent’s make on themselves and then, understandably, try to get rid of. Of course these self-attacks can be assisted by popular knowledge of processes of attachment and the developmental importance of maternal and paternal care in general but twisted to be used against the self. But is, for example, a postnatally depressed mother blameworthy when her child develops an insecure attachment? She might well think so but I don’t know of any psychoanalytic or family therapy theory that would agree. Instead our theories should assist in a search for an understanding of complex internal and external processes which underpin depression.

In short, acknowledging and understanding painful self-blame seems to me far more helpful than trying to rid family therapy of its theoretical base.

This is my extra thing worth understanding. It used to be a boundary marking misunderstanding during the time when structural and strategic family therapy were prominent, since these models took no interest in historical issues. I include it now because of its importance in understanding some important theories of change in analytic psychotherapy.

Although there may be some enquiry into history during a brief assessment stage psychoanalytic work commonly relies on experiential changes in the context of the here and now relationship with the therapist. However, one sign of a good enough therapy is the development in the patient of an emotionally coherent narrative history. But this is generally a good side effect of change rather than the main focus of the work.

Many people who suffer as adults seem to have little or no sense of personal history. Often there is an idealised view of childhood - "It was perfect", or a dismissive view "It was just like everyone else’s", or there is little that has been processed into conscious memory "I can hardly remember anything before I was nine". Children with the least attuned parents tend, when they grow up, to become parents themselves with a limited or dismissive emotional history. This dismissive style in parents is, from attachment research, strongly associated with insecure attachments in their children – especially insecure avoidant attachments.

A sense of history results from a process of reflection in oneself or with others. Many patients have had very little opportunity for this as children or as adults. Even persons apparently preoccupied with aspects of their history often have important elements missing as, for example, in melancholic grief reactions in which the lost person is idealised and hated aspects of the same person turned unconsciously against the self.

For Christopher Bollas (1987), for example, the unconscious is the place for memories of the earliest experiences of care. But the term "memory" is being used differently to the usual vernacular meaning. It is not something recalled from the past but current and alive. I think the crucial idea here is Freud’s view that the unconscious is timeless. Regression in the transference allows these timeless memories to be accessible for thought. In the weeks leading up to a summer break a patient may re-experience vividly the rage and upset of childhood abandonment. The memory of the abandonment is relived and the therapist experienced as the longed for but hated object or other. However, alongside memory – now made conscious – is reverie – the capacity of the therapist and thinking parts of the patient to bear, accept and make sense of the feelings perhaps for the first time. Through these here and now experiences timeless unconscious memory (in which the patient always has, always is and always will be abandoned) begins to turn into a capacity for a bearable personal emotionally coherent narrative. The patient may then be able to say "I know where this feeling comes from – it’s history." It may be triggered by events in the present but it more properly belongs to the past.

The postmodern philosopher Lyotard writes about disputes - he calls these differends - that can never be resolved since the protagonists are, without realising it, using the same words to mean different things. The term "separation" is, I believe, the cause of a differend between family therapy and psychoanalytic psychotherapy.

In this active misunderstanding in some parts of family therapy the goals of separation and individuation in psychoanalytic psychotherapy are seen as equated with western (or more specifically North American male) values of rugged individualism. At its most stereotyped the image that comes to mind is the production of John Waynes and Clint Eastwoods - separate, independent, needing no-one. Attached to this misunderstanding is therefore an accusation of cultural insensitivity. Evidence from Asian cultures (in which issues of personal autonomy are said to be managed very differently) are often given as evidence that separation is a western cultural pre-occupation. (What I would say is that becoming an individual is a universal issue but mediated differently by cultural variation.)

Once again, I think the non-intuitive nature of technical terms in psychoanalysis has played an unhelpful role. Who would guess that the Kleinian term "depressive position" refers to the capacity to relate to the other as a separate person in a respectful manner in which there can be a meeting of needs not based on manipulation or a distorted view of their otherness. The achievement of separation in analytic psychotherapy is not to go it alone but to be capable of participating in relationships based on care. Western cultural individualism of the John Wayne type would be seen not as a model of psychological health but an example of destructive narcissism in which the individual denies and turns against their own needs of others and instead uses other people in a ruthless manner.

I’ll try to give some sense of this movement towards the separation of the depressive position. A key idea is that projective identification is a defence against separation. In analytic psychotherapy the therapist from the patient’s perspective quickly comes to be experienced as a remarkably familiar figure. This in effect is the result of transference. The therapist is not perceived as a separate person but, in unconscious phantasy, as aspects of internal relationships based more or less on the experience of earliest important parental relationships. This very helpful process is of course facilitated by the therapist taking some care not to reveal too much of themselves to the patient. These internal relationships are then recreated between the patient and therapist but can then be talked about.

The therapist can feel a powerful - although often subtle - pressure to become like the projected aspect – perhaps an ideal mother who will see this patient as special above all others. But the patient is effectively relating not to the therapist but to part of themselves. Excessive projective identification outside the therapy room is therefore a barrier to understanding and respecting the needs of the other as a separate person.

Many of you may have experienced the situation of the family who are referred in a situation of urgency by a GP or a teacher where the parents seem not to be ready to engage in work but to complain about the failure of the agency or any agency to help them over the years. "No-one has ever tried to help" – they may say. But reading the file may give a very different picture with therapy repeatedly terminated by the family. This sort complaint is often strongly and genuinely meant but the process is not engagement but projective identification in which the therapist and agency are required to carry the sense of failure of the parents. One can feel used by this and may wish to push the failure back especially if other agencies have also been recruited into denigrating our efforts.

Projective identification thus involves the use of the other – a partner or a child can be the repository for disowned aspects of the self and this can be a very stable interpersonal defence affecting the life chances of both the person projected and the person projected into..

Here I think the use of the psychoanalytic word object is highly relevant – the other is used – not experienced as a separate being with an equivalent centre of self. The task of psychotherapy is to help the patient to understand that what they are perceiving is part of themselves. This is referred to by the terms withdrawal of projection, integration. The therapist begins to be experienced more realistically and it is often a warm period in the work where genuine concern for the other can flourish. It is usually a time of substantial systemic shifts in the other significant relationships of the patient. This process is often called experiencing the other as a whole object – the depressive position – in Kleinian terminology.

Winnicott calls it the stage of concern and I also find the terminology of Jessica Benjamin (1999) – an American analyst and feminist very useful. She describes this process as moving from object relatedness to subject relatedness. The other can now be seen as a subject in their own right. This point of separateness is thus the beginning of a non-exploitative kind of relating.

This concludes my six things worth understanding. I have covered issues of diversity, authoritarianism, terminology, blame, the place of history, and the question of separation. Now, in summary, let me reduce all of these points down to one. Psychoanalysis has for twenty-five years been a denigrated object for mainstream family therapy. There are many signs that family therapy no longer needs to do this. I am hopeful that each culture can increasingly see the other as interesting, diverse and neither ideal nor bad. In other words, I hope that there is now sufficient separation to have a relationship.

David Pocock

15.5.03

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