Tuesday, February 05, 2008

The Narcissism of Small Differences

Entry for February 4, 2008:

On Saturday night, over dinner at a small French bistro in Islington, Georgia Lepper referred to Freud’s phrase, “the narcissism of small differences”. She meant to include firstly the emphasis on differences among different psychodynamic approach, and the consequent in-fighting there. But as a psychotherapy researcher and long-time SPR member, she was also referring to the way in which all the different major approaches to therapy tend to focus on what makes them distinct rather than what they have in common, which was also a key theme of Peter Fonagy’s presentation to UKCP.

But after reading today about an exchange between a couple of people I know, I find myself growing increasingly weary of attacks by some classical person-centred therapists on people like me, and in this case on a friend who was attempting to equally affirm both classical nondirective therapists and others like me who don’t display sufficient ideological purity. This seems to me to be an example of what Freud was referring to. Increasingly, I believe, it is an attitude that we can’t afford anymore. It is also a problematic mode of being that I also have often fallen into, especially when I had tried to promote PE-EFT by claiming it as a distinctive and unique approach.

But the thing that bothers me the most about the whole debate is how it is conducted almost entirely at the purely conceptual level, without us actually looking at each other’s practice. I want to paraphrase Husserl: “Back to the videos themselves!” I don’t think we should talk about nondirectiveness or process differentiation or client deference without specific reference to recordings of actual therapy sessions.

The Social Anxiety Therapy Development group has started playing each other’s video and audio recordings (so far it’s just Mick and I, but we’re looking forward to others joining in as well). Based on this limited experience, and others that I have had over my career, I want to hypothesize that, among experienced, qualified therapists, when we look at each other’s actual work, we are going to see several things:
-First, we will see much that we recognize in common in each other’s work;
-Second, we will see responses, phrases, even words that we wouldn’t necessarily have thought to use but that might be a good idea to try in the right context;
-Third, we will see and recognize the other therapist’s (or our own) humanness and fallibility;
-Fourth, we will see places where we might have preferred to have said something different.
But even here I am going to predict that it will usually be the case that our preferred response would have led in the same direction, or in a somewhat different but not necessarily better (or worse) direction. So it seems to me that only rarely will we see a place where what we would have said or done would have been clearly better than what the therapist we are watching said or did; and here we are generally recognizably within the boundaries of our own human fallibility. By this I mean: Perhaps we had something better to say at this particular moment, but someplace else the opposite would likely to be the case. To pretend otherwise is to risk Freud’s narcissism of small differences, and to generate endless fruitless and divisive debate in a time when our energy is desperately needed elsewhere, such as in doing research to justify and improve our practice.

1 comment:

Julie said...

Hello Robert,

this is my first visit to you Blog or for that matter any Blog.Really enjoyed reading it.

I just wanted to say that I do whole heartedly agree with you. Looking for what we share rather than what divides us will ultimately serve therapists better. The problem is that to let go of what are percieved as certainties demands a certain confidence and flexibility and I certainly find with my students who are training as psychodynamic counsellors that even discussion around common factors in therapy can cause anxiety. This, understandably can be experienced as a threat to their developing sense of their therapist identity. Students enrol on courses because they expect to become a particular brand of therapist and then discover that it is about becoming themselves - growing into a way of being - rather than being made into a particular sort of therapist. This difficult process can sometimes strengthen the desire for rules and techniques. Therefore the desire to be psychodynamic is often greater than the desire to look for what is shared amongst therapists.

I really enjoyed John Rowan's model in his book The Future of Training .. (I have written a review on this which has recently been published in the European Journal of Psychotherapy) - in which he proposes that we should categorise therapists by what they do rather than orientation e.g. Instrumentalist, Centaur etc. In his model I would certainly see my practice as having more in common with the humanistic therapists in the Centaur group rather than the CBT therapists in the Instrumentalists section.

On my PGDIP course we did a days digital recordings of role play sessions last week. I am increasingly disatisfied with just audio recordings. So I have been trying to work out for some time now who we could begin video taping students - the logistics of the building - which is too small is all that is stopping me at the moment and the fact that I need to re-write that part of the course. But it has to happen. Although we are a long way from student placements allowing video taping as some still won't allow audio recording. The only way I can see the video taping of client sessions happening at the moment is if we had a research clinic.

I have mentioned your HSCED presentation as SPR UK conference last March. It was amazing to see an excerpt of a real session presented at a conference. In many ways it is logically such an obvious thing to do but amazing because so few therapists have the courage to do it.

So, if it is possible, I look forward to being able to show you some of my/our video recordings with you sometime in the future and seeing how much is shared.

Very best wishes

Julie Folkes-Skinner
Course Director, PGDIP/MA Psychodynamic Counselling, University of Leciester