Do we have a psychoanalytic understanding of supportive interventions?
by Brian Martindale, Honorary President EFPP
A central objective of the EFPP is to support the development of 'containing' networks of psychoanalytic psychotherapists and psychoanalysts whose focus of work is within public service frameworks. In most public services, psychoanalysis as an open-ended several times a week activity /technique is not available (in spite of the very large numbers who could benefit).
So the issues we grapple with are clarifying (to both ourselves and others) what contributions psychoanalytic ideas can make in these 'market place settings' and how they might overlap with and differ from other frameworks.
Supportive
interventions
Back in the 1950s supportive interventions were relatively derided by
psychoanalysts as separate and second best interventions to be performed
by other groups of professionals. This attitude started to changed when
it was found in the Menninger research (using audiotaped sessions), that
psychoanalysts conducting psychoanalysis were in fact offering supportive
interventions but consciously were unaware of this. Even more disconcerting
to the analysts at that time was the finding that patients were undergoing
analytically valid psychic changes from these supportive interventions.
Since then there has been an exponential increase of interest in the countertransference and in the processing of affect laden material in the mind of the analyst and concepts like holding and containing are part of everyday psychoanalytic language which I think are linked with notions of ego support and indeed development.
Psychotic
patients
Working with psychotic patients in the UK Health Service in recent years
has made me aware of the continuing need to keep thinking about this topic
of support and its complexity and its relation to interpretation. Support
is a word that is used very loosely, as if it were obvious what it is.
I used to think it meant something other than interpretation, yet I realise now just how vitally important interpretation can be as a support and affirmation of the experiencing self. By this I especially mean interpretations that reflect the 'therapists' attempt to put into words the patients or families conscious or preconscious experience(s) (of self or other). I think other mental health professionals will demonstrate their empathy by other means as well as words.
On the other hand, some supportive interventions may be deliberately aimed to help the psychotic patient or their family get a distance from their psychotic experience, through distraction, or engagement in some perhaps purposeful activity. We all know how helpful this can be for ourselves at times.
At other times, I have realised how dangerous and unsupportive it can be to not offer interpretations of unconscious material. However on reflection, I think that these situations are often when there is an unconscious belief that the other (e.g the therapist) cannot bear the material especially when this belief is not based on evacuation of the self but more on repeated external reality experiences.
A recent example was of a pregnant woman on a ward for three months who had not responded to antipsychotic medication, but whose psychosis almost literally melted when the family shame connected with the circumstances of the conception and the father was interpreted in the first family meeting.
So through this brief introduction, I am encouraging those of you interested in the topic to focus in on the notion of support and to be thinking of your work and the 'supportive' work of your colleagues who use non-analytic approaches.
Perhaps
we could
¨• try to describe support in its complexity, (eg what is being
supported and how)
¨• conceptualise it into different categories from a psychoanalytic
perspective
¨• examine what other models have to say about support
¨• try to clarify the conditions when support is a) containing,
b) facilitating of psychic development c) interfering with psychic development.
It seems that psychosis might be an especially interesting area in which to look at this topic. Perhaps we could review and recommend useful literature. Because psychosis brings us into contact with many other professionals it also offers us a chance to try to understand what 'we and they' are doing in both our psychoanalytic frameworks and theirs.
You will also notice that I used the word support in the opening line of this contribution. Perhaps if we understand more of what supportive elements are helpful to our patients development (and what are not) it might also offer some clues about how organisations can best support their own development.
I look forward with interest to reading your comments.
