Therapist

Exploring the landscape of the mind an introduction to psychodynamic therapy

Book Review

Exploring the Landscape of the Mind: An Introduction to Psychodynamic Therapy

by Janet Lee Bachant, Ph.D.

(2019) New York, NY: IP Books, 223 pages, $35.00.

Reviewed by Kenneth Barish, Ph.D.

Beginning psychotherapists face a daunting and unsettling task.  Patients consult us for varied and complex problems – an amalgam of acutely painful feelings, chronic self-doubt, recurring anxious and depressed moods, traumatic life experiences, self-destructive behaviors, and unsatisfying personal relationships – that they have often lived with for many years.  As therapists, we need to decide, from among the many things that patients tell us, what are the origins (and persistence) of their difficulties in living?  What kind of understanding can I offer?  Where do I begin?  What do I say?

Janet Lee Bachant has written an excellent introduction to a psychodynamic understanding and therapeutic approach to these clinical problems.  Exploring the Landscape of the Mind is not a dry recitation of theories and controversies in psychoanalysis or psychotherapy. Bachant wants to teach us to be better therapists, and she succeeds admirably.  Throughout the book, she pays special attention to the problems of working with patients who have suffered complex developmental trauma. Her understanding of trauma draws from important clinical and neuroscience research (Van der Kolk, 2005; Ginott, 2015).

For Bachant, psychodynamic therapy is defined by our commitment to understanding patients’ inner experience and our effort to facilitate the emergence of latent meanings and unconscious processes.  She begins with a review of the fundamental values that make therapy possible.  Most of these values are universally acknowledged as essential requirements for all psychotherapy, the shared humanistic foundation of our work: valuing the influence of the past, respect, curiosity, non-judgmentalness, empathy, genuineness, the ability to accept limits, flexibility, courage, hope, the creation of a setting of safety, and the importance of psychotherapy as a collaboration.

Bachant explains the basic frame of the therapeutic relationship in psychodynamic psychotherapy – an invitation and encouragement of free association by the patient (a rare form of emotional honesty) and the neutrality of the therapist. The therapist’s neutrality (often misunderstood) protects the therapeutic process and “holds the treatment through the stresses and storms of analytic work.” She offers an understanding of essential psychodynamic concepts: fantasy, transference/countertransference, resistance, and multiple functioning.  Bachant defines each of these concepts broadly, not only as they apply to the unique setting of psychotherapy, but as basic principles of mental life.  Fantasy, Bachant teaches, is an organizing activity of the human mind and a “window to our soul.”  Transference and resistance are also defined broadly.  Bachant emphasizes the adaptive function of resistance, a “guardian of psychic equilibrium,” useful and necessary at an earlier time in patients’ lives, “to be welcomed rather than dreaded, ‘befriended’ rather than pushed away.”

Bachant then provides an organizing framework for listening from a psychodynamic perspective. These chapters are perhaps the most original contribution of the book. For Bachant, psychodynamic listening is “fundamentally listening with the heart.”  She identifies seven modes of therapeutic listening, what she calls “listening for the footsteps of the past.”  These are: listening for content; listening for feeling; listening for defense; listening for organization; listening for transference/countertransference; listening for meaning; listening for enactment; and listening for organization.  Bachant’s description of these modes of listening (and her practical advice) will be enormously helpful to beginning therapists, enabling them to hear “many layers of meaning in how patients communicate with us,” forms of communication that are continuously and simultaneously present in the therapeutic interaction.

In a final section, Bacchant offers clinical wisdom about the effect of trauma on development (“like a virus that invades the body’s cells”) and how to help patients change their relationship to childhood trauma and adversity – by learning to identify triggers, develop a new narrative of trauma, and take more effective action in their lives.  She wisely notes that change comes in small steps and helps us recognize and encourage small changes that patients make in how they relate to their feelings, new ways of relating to self and others that minimize the power of emotional hijacking.

Throughout the book, Bachant is non-dogmatic and quietly, but persuasively, integrative.  She warns us against simple generalizations and one-dimensional understanding.  She is able to capture the complex, multi-layered nature of the therapeutic interaction, and she avoids the (usually false) dichotomies that are so common in our field.  Bachant’s understanding of psychotherapy is guided by the principle of multiple function:  “As we do psychotherapy, we need to keep in mind that every action, every thought, every feeling, every experience a person has is determined by multiple forces“ and “when it comes to explaining human experience, every understanding is by definition a partial understanding. Exploring the Landscape of the Mind is a book of “both/and” not “either/or.”

I have some differences of emphasis from Bachant in my understanding of therapeutic listening and mechanisms of change.  Bachant recognizes the importance of empathy (which she traces, as do many others, to nonverbal communications between mothers and infants) and her therapeutic work is deeply imbued with empathy.  She expresses some caution, however, about the danger of over-identification with patients, “where the boundary between patient and therapist blurs.”   Although this concern is appropriate, I would place greater importance on empathy, both as a mode of listening and as a profound therapeutic process in its own right.  Empathy is continuously present in therapy, guiding the therapeutic interaction in both large and small ways, not only in our direct empathic statements to patients, but also in the subtle, often unconscious, adjustments we make in response to patients’ nonverbal communications.  Empathy is our therapeutic GPS, letting us know when we have taken a wrong turn or gone subtly off course (Barish, 2018).   I would also have liked even more discussion of listening for feeling and the centrality of affect in the therapeutic process. (See, for example, Zellner et al., 2011, on emotions as “command systems” of the mind, and Lotterman, 2012, on affects as “a psychological center around which…other elements… are organized, like a force field.”)

These small differences, however, do not diminish my enthusiasm for what Bachant has accomplished in this book. Bachant has done a great service to the field of psychotherapy, including non-psychodynamic psychotherapy. Any therapist, of any persuasion, who reads this book will be a better therapist. Exploring the Landscape of the Mind should be read by students at the beginning of their training as well as by experienced therapists, when we need to take a step back and reflect on our daily clinical experience, and refocus our attention on overlooked aspects of the complex, challenging, and compassionate work that we do.

References

Barish, K. (2018). How to be a better child therapist: An integrative model for therapeutic change.  New York: W. W. Norton.

Ginott, E. (2015). The neuropsychology of the unconscious: Integrating brain and mind in psychotherapy.  New York: W. W. Norton.

Lotterman, A. C. (2012).  Affect as a marker of the psychic surface. Psychoanalytic Quarterly, 81, 305-333.

Van de Kolk, B. (2005).  Developmental trauma disorder.  Psychiatric Annals, 35: 401-408.

Zellner, M. R., Watt, D. F., Solms, M., & Panksepp, J. (2011). Affective neuroscientific and neuropsychoanalytic approaches to two intractable psychiatric problems: Why depression feels so bad and what addicts really want. Neuroscience and Biobehavioral Reviews, 35, 2000–2008.

Kenneth Barish, Ph.D. is Clinical Professor of Psychology at Weill Cornell Medical College.  He is on the faculty of the Westchester Center for the Study of Psychoanalysis and Psychotherapy and the William Alanson White Institute Child and Adolescent Psychotherapy Training Program.  He is the author of How to Be a Better Child Therapist: An Integrative Model for Therapeutic Change (W. W. Norton, 2018) and Pride and Joy: A Guide to Understanding Your Child’s Emotions and Solving Family Problems (Oxford University Press, 2012). Pride and Joy is winner of the 2013 International Book Award and the 2013 Eric Hoffer Book Award.

$35.00

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From the Introduction:

Psychotherapy is an adventure into uncharted territory — the landscape of the mind. Beginning a treatment takes us on a journey into the unmapped interior of a person’s soul.  We do not know what awesome vistas, formidable obstacles and strange inhabitants we will encounter.  But we do know that the exploration of the self is the path to finding answers to some of life’s greatest personal mysteries such as “How did I become the person I am?” “How can I solve the mystery of my problems in living?” “What do I really want?” and “Who am I?”  Psychodynamic treatment is akin to the great voyages of discovery in which significant danger is faced but the rewards of discovery outweigh the difficulties of the journey (Levin 2017). On all such encounters, each participant has a role to play and together they embark on an adventure that has no equal.

Uncovering complex mental processes (many of which are unconscious) in the context of an ongoing, intimate relationship is the core of psychodynamic therapy.  This work demands intellectual understanding, emotional connectedness and ideally a sense of humor to keep things in perspective. Doing psychotherapy tests patient and therapist alike, asking them both to deal with fears, tensions, losses, acceptance of limitations, exposing the self and maintaining a focus on the growing edge of development despite inevitable setbacks and disappointments. But it also provides a ground spring of authentic relatedness, an interest and commitment to knowing a person’s internal life. The understanding generated by psychodynamic psychotherapy is unrivaled. Shedler (2010) reports the recurring finding that “the benefits of psychodynamic therapy not only endure but increase with time” as contrasted with non-dynamic therapies whose gains decay over time (p. 102-3).  Students have captured the essence succinctly: “It goes deeper.” “It goes to the heart.”

 

The primary function of this book is to help the reader begin a voyage of discovery.  While every person’s path will be different, there are steps each of us can take to understand the minds of others and thereby to organize our own.   The techniques developed in this book focus primarily on the ordinary processes of mental organization, processes that are determined by the interaction of biological, emotional and interpersonal factors during the child’s early years. In addition to addressing how normal development informs psychodynamic technique, this book also highlights the long-term effects of adverse emotional experiences on the child’s mental functioning. These experiences are much more common than originally thought and have pervasive negative effects on development and emotional health. Van der Kolk (2005) has suggested a broadening of the concept of trauma to include the effects on mental life of what many have come to describe as developmental trauma disorder, complex developmental trauma, relational or interpersonal trauma, disordered attachment and other terms that signify the long term consequences of emotional adversity on mental development. I will use these terms interchangeably in this book.

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