Practical Psychoanalysis for Therapists and Patients

By Margulies, Alfred | International Journal of Psychoanalysis, June 2007 | Go to article overview

Practical Psychoanalysis for Therapists and Patients


Margulies, Alfred, International Journal of Psychoanalysis


Practical psychoanalysis for therapists and patients by Owen Renik New York, NY: Other Press. 2006. 179 p. Reviewed by Alfred Margulies, Cambridge Health Alliance, Psychiatry Dept, 1493 Cambridge St, Cambridge, MA 02139, USA - alfred_margulies@hms.harvard.edu

What do patients want?

Like salvoes across the bow, the opening sentences of this book put us on notice: By privileging insight over symptom relief, 'psychoanalysts [have] not only made themselves irrelevant to most peoples' needs, but, as many critics have pointed out, also compromised clinical psychoanalysis as a scientific investigative tool' (p. 2). Fighting words! This candid, polemical voice is familiar to us. It is the in-yourface- and-won't-go-away provocation that Owen Renik regularly puts to organized American psychoanalysis. The first chapter-and the book that follows-is really then a psychoanalytic manifesto, a call to arms. And, as a statement of belief and position, the details are working themselves out, moving in a trajectory whose arc we can discern. This then is a work still in progress-and it must be, because it reflects a whole field still in progress. This snapped into place for me as a discussant of a talk Renik gave a few years back when he asserted:

For me, the Hegelian concept of [a] progressive dialectical process is ... [most] relevant to psychoanalysis: instead of being in an eternal, complementary relationship to one another, contradictory propositions contend with one another until one of them prevails or until their contradiction becomes obsolete in [the] light of a new integration-the well-known juxtaposition of thesis to antithesis, leading to [an] eventual synthesis. (1998, p. 588)

Yes, and this describes how Renik situates himself, the big sweep of his work, and, of course, any responses (like this review). As a provocateur, Renik confronts our psychoanalytic culture and practices as implicit clinical theories, which, in the observing, are always more influential than written theory itself. And so his manifesto, too, is a next step, taking on not only our literature but also how we live in our clinical worlds. Renik knows this; he is reaching beyond the usual psychoanalytic community to 'psychoanalysis for therapists and patients.' Renik is aiming to influence our whole culture of theory.

I say 'culture' because 'theory' is more a matter of our community perception of what it is, than what our literature says it is. Indeed, our actual theory is seldom what we read about. Most of us don't know our theories that well-certainly in any systematic way-and we would be embarrassed if asked to list the principal features of our major schools. Rather, we first absorb theory impressionistically and in haphazard fashion, and our favored theorists become identified more with orientations and values that we ardently believe in-or that we vehemently don't. Our true and operative theories, then, are found in our community practices, which are the permissible standards of our local culture. This is 'lived' psychoanalytic theory, the unthought-known of our field, i.e. our accepted clinical customs that become our de facto theories. These customs themselves are shaped by a kind of natural selection, and, make no doubt about it, Renik is one of the selective pressures for American psychoanalysis.

Natural selection of theory and practice then takes place on the sequestered islands of our various psychoanalytic schools. These islands of clinical practice-like Chicago, New York, or San Francisco (or Paris, London and its neighborhoods)-have their own temperaments and styles; their own gurus, favorite journals, and conferences; their own economic realities; their own jargon and dialects. Moreover, these virtual islands of theory and practice are, for most of us, not really chosen, rather they are given, a part of our academic, existential thrownness. These weird regional mutations and life-forms of clinical work I think of as the 'Galapagos Island effect' of local theory and practice. …

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