For anyone wanting to understand how psychoanalytic psychotherapy works from within the consulting room, this book is brilliant. Whilst telling the intimate and detailed stories of work with her patients (who have all consented to her doing so, of course), Dr Luepnitz also draws on and elucidates complex psychoanalytic concepts from Winnicott, Freud, and Lacan, without it feeling tacked on or dryly pedagogical.
It is quite clear that these concepts are no longer cloistered within psychoanalytic circles. I am sure that most experienced practitioners, of all psychotherapeutic types, are fully aware of and sensitive to the ‘transference’, ‘splitting’, and ‘projective identification’ dynamics (to name a few…) that arise in their therapeutic work.
But what I think makes this book so special is how it demonstrates how psychoanalytic work not only brought to light and labelled these processes, but how the bulk of its therapeutic power lies in directly working with and through those processes as they arise within the therapeutic encounter. Dr Luepnitz guides us through not only what happened in her work with her patients, but also gives us the most admirable and diligent example of self-reflexivity by the therapist. Nothing she felt, said, or did, with her clients was left un-considered. And we see in each example, especially, how precisely that care and thought that she gave these experiences was what lead to the therapeutic ‘breakthrough’ and resulted in significant benefit to the patient.
For an example, with a Black female patient called Pearl, Dr Luepnitz finds herself wanting to break her policy of requiring patients to pay for missed sessions, with the thought: ‘How can I charge this poor black woman?’, but with reflection she then realises that this was more of a counter-transference problem on her behalf, a ‘simple rescue fantasy,’ and not one that she should act on, for the mutual benefit of both parties. I will quote at length now, as I don’t think these dilemmas could be worded more clearly:
‘As we have seen in other cases, a “resistance” to making the unconscious conscious belongs to the therapist as well as to the patient. For both, there is a yes and a no, always. I saw my not charging Pearl as a bit of resistance to doing the work. That is, sensing that Pearl was expressing anger or resentment through her no-shows, I nonetheless chose to let them pass, rather than invite her criticism. It was an act of self-protection. […] All therapists at some moment with every patient construct a kind of protective lining to shield themselves from what is going on in the patient’s head. One wants to know and yet also does not want to know… Unique to psychoanalytic training is the emphasis on disciplining oneself to face rather than disavow one’s resistances.’ (193-194)
Undoubtedly, and as she herself admits at the beginning, the limitation to this case-study approach is that she’s only describing the ‘positive cases’. It is unlikely that someone who got no benefit from her treatment and had a terrible experience would then agree to her publishing the details of their analysis. So, this book doesn’t go any way in proving or even supporting the idea that psychoanalytic psychotherapy is better or worse than any other kind. But I think we all have much to learn by seeing such honest and detailed therapeutic work between such a remarkable analyst and her equally remarkable patients.