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Brian Martindale (Honorary President EFPP): The Therapist's Influence on the Process and Outcome of Psychoanalytical Psychotherapy. Clinical & Research Findings.

Crossing the Divide - Cyprus

The divided city of Nicosia was the venue for this - the 4th adult section conference of the EFPP. The setting of a conference can be experienced in retrospect as having been in the foreground or background. I am sure that for most participants, Nicosia and Cyprus itself will have shifted backwards and forwards into focus, because this was a most successful conference in a most fascinating setting. It is therefore difficult to know where to start my account.

To avoid giving the false impression of the EFPP as a mask behind which lies a club for international explorers, I will start with the content of the conference itself.

The choice of theme

It seems to me to be a sign of the EFPP's maturity that the section decided on this theme. There is so much discussion about differing theoretical approaches in psychoanalysis and psychoanalytic psychotherapy, and about the patient's role in eliciting the countertransference. Yet in spite of much research indicating that therapist variables independent of theory are of the greatest importance, it seems to be much more an implicit topic for discussion and debate rather than an explicit one at conferences. I suppose there is one main reason for this: the sensitivity of personal exposure. In well conducted trainings, it is hoped that many personal matters will be clarified in the course of analysis and supervision, but this begs the questions of how therapist variables can continue to be considered as matters of psychoanalytic interest for open discussion.

The style of the conference

The conference was organised along the now traditional lines of the EFPP, with plenary sessions in the morning followed by small discussion groups and the afternoon being devoted to workshops and paper presentations in smaller groups.

I nearly always hear how much appreciated are the small group discussions that follow the plenaries in EFPP conferences. They allow for a great deal of digestion of the main plenary lecture or else to pursue some related theme. This is the main place where professional exchanges happen between persons from different countries and fantasies challenged or reinforced about differing schools and cultures of psychoanalysis and psychoanalytic psychotherapy. This conference was no exception.

The plenary lectures

Any thoughts that - by beginning with the clinician's theory (and its impact on the analytic process) - we were witnessing a resistance to the conference theme were rapidly dispelled. Professor Joachim Küchenhoff from Basle gave a brilliant paper looking at many aspects of the influence of the therapist's theory on the analytic process and of the influence of the analytic process on the analyst's theorising. Demonstrating the thoroughness of his understanding of Bion, Winnicott and Derrida amongst others, he certainly assisted us in dispelling any thoughts that the plurality of psychoanalytic theories detracted from the scientific status of psychoanalysis. He also mitigated any guilt that some may have about wanting to understand more thoroughly other theories than those we are familiar with.

On Saturday there were two plenary presentations. Maria Ponsi from Florence certainly focussed on the conference theme with her attention on the subjectivity of the analyst, and resolutely did not allow this to remain hidden behind the concept of countertransference. She then focussed on the 'collaborative' process in analysis. She described an impasse in the treatment of a borderline patient who behaved as if 'in a bunker' on the couch. Ponsi described the restitution of the collaborative work following the move to the face to face position. Ponsi observed that in this situation the subjectivity of the analyst was more closely exposed to a much greater range of the non-verbal ways in which the patient expressed herself. She felt this gave a better and more accurate source of understanding / realisation of the sort of object relationship being established, from which more fruitful verbalisation followed.

Claude Smadja from Paris gave a detailed account of his very different view of the evolution of Freudian theory and technique and of their intertwining. This particular framework formed the basis of his conceptualisation of 'The healing work of a practising psychoanalyst/ psychotherapist" and he describe to us his detailed clinical work and his thinking processes with a 35 year old patient with a life threatening somatic disorder. This was a very compact paper that merited a great deal of careful reflection.

On the last morning of the conference, a large number of participants were up in time following the energetic and clearly vitalising Greek dancing of the gala evening to hear Margot Waddell from London. With her background in literature and neo-Kleinian psychoanalysis, Margot Waddell focussed especially on the crucial role of the modern dream-interpreter to bring 'to move the sleeping images of things towards the light' (Dryden). She described two young male patients and brought her rich and moving understanding of both their dreams and her young patients struggles (in these cases often terrors) within the analytic relationship to/ not understand themselves (as revealed in these dreams) especially when this was reviving early breakdowns in emotionally dependable relationships that were affecting their contemporary development.

As all our high quality speakers indicated in their own way, minds can develop only as much as it is possible to register new impressions, feelings and thoughts and not to split them off. I would like therefore to convey something quite painful without having a solution. It is my shared experience with many persons especially at conferences with participants from many different languages, that we do not yet know how to make best 'use' of the talented main speakers that we attract. It is common knowledge to educationalists that even in a familiar tongue, a minimum of useful information is retained beyond about twenty minutes of a traditional lecture. In the much-appreciated small discussion groups, it is clear that it is by and large mainly aesthetic experiences of the plenary lecture have been registered and very little of the rich content. I do hope that this 'fact' can be registered and thought about and that it will encourage some experimentation and sophisticated research on any changes. Certainly it is a possible way by which the EFPP could extend its already excellent reputation for the quality of its conferences and further cross the divide between speaker and listener.

Afternoon choices
Maybe because a good number of participants took some holiday before or after the conference, the afternoon papers were mainly well attended. For the purposes of this report, I will convey my own frustration at not being able to be in more than one room at once, when I mention just some of the themes that were presented. It is certainly clear that presenters were generous in their preparedness to discuss the effect of particular personal situations on their therapeutic work. Thus the therapist's pregnancy, serious illness, own dreams, writing an autobiographical book that patients had read, the therapists gender, difficulties in separation were all topics that were keenly discussed. In addition the overwhelming conditions of torture, sexual abuse, forced migration and death were all considered from the point of view of the therapist's subjectivity and countertransference and how these interrelated with the therapeutic process.

I found myself having a transcultural experience of being in a group, mainly intended to register the experience of being in a mutli-cultural, multi-lingual group and discovering our different ways of coping or not coping with this over the space of two 90 minute sessions.

I was especially pleased that there were sessions on more formal research (as well as other forms of research into the conference theme). This is a new and important area being included in our conferences now and vital for our future. Important research papers were given on therapist's own attachment characteristics, the degree of commitment to the work and the patient and their effect on outcome. Most important too is the effect on therapy of residents conducting Psychoanalytic Psychotherapy who are in supervision but not in analytic therapy.

The Cyprus context

For those of us who have been involved with the EFPP for some time, this conference was a particularly moving occasion. This was because it was about the time of the foundation of the EFPP, that Psychoanalytic Psychotherapists colleagues from Greece (some of whom had played a prominent part in the early days of the EFPP), started also to travel regularly to Nicosia. Some offered seminars and supervision, others offered therapy to aspiring psychoanalytic psychotherapists. A couple of years before the conference, following the first graduations, the Cyprus Association for Psychoanalytic Psychotherapy Studies (CAPPS)became a full member of the EFPP and now has some 40 students. Many congratulations were offered to all those involved over these years for the tremendous achievement. This has occurred in the context of Cyprus only having had a University for very few years and only now opening a department of psychology. The Cyprus organisation is certainly now well established on the local map, confirmed by the fact that the Minister of Health and the Vice-Principal of the University opened the conference and gave genuinely appreciative and knowledgeable introductions. In this context it was important that there were a number of presentations from Greek Cypriot colleagues.

Congratulations

Particular congratulations are in order for Evangelos Papanikolaou from Cyprus (chair CAPPS) and Dimitris Anastasopoulos from Athens who chaired the organising committee for all their attention to detail in their care of the conference and all the participants. The conference was held at the comfortable Nicosia Hilton. The conference facilities, accommodation and the swimming pool were all very welcoming ( I only heard the Portuguese complain that the pool was not warm enough)! The local committee made excellent arrangements for both accompanying persons and participants. Margareta Mörner and her colleagues on the scientific committee deserve every praise too for the rich scientific programme.

Lunchtime arrangements were made for visits to the University in the old part of Nicosia near the wall, as well as receptions in the museums in the evenings and excellent advice as to where to best eat 'Mese'. The friendly atmosphere of the conference is best conveyed by the fact that the minute the dancing started at Gala Dinner on the last evening, it was hard work to find a space on the dance floor until the early hours. The author was not the only one who had to disappear to change his shirt.

Crossing the Divide
So this was a memorable conference. It was memorable in a sobering way for the barbed wire that straddles the city and the island -separating Greek Cyprus from Turkish Cyprus. Sadly there was little evidence of the possibility of any reconciliation in this generation. The conference was memorable for the transition from a very wet, windy and expensive Britain to a beautiful mountainous inexpensive island with warm sea and mountains and very friendly hosts.

It will be memorable for our Cyprus colleagues (together with their Greek partners) in crossing onto the international map as a recognised psychoanalytic psychotherapy organisation. Most of all it was memorable for the crossing of the divide from the usual public focus on the patient back to the therapist. The conference was a brave and successful attempt to face the painful facts of it being our own strengths and limitations that play a crucial part in determining the outcome in psychoanalytic therapy.

 


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last modified: 2001-07-25