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Psychodynamic Psychotherapy in South Africa: Contexts, Theories and Applications, Edited by Cora Smith, Glenys Lobban and Michael O Loughlin.

Psychodynamic Psychotherapy in South Africa: Contexts, Theories and Applications, Edited by Cora Smith, Glenys Lobban and Michael O Loughlin.

Johannesburg: Wits University Press, 2013. ISBN 978-1-86814-603-1

Introduction

In Psychodynamic Psychotherapy in South Africa: Contexts, Theories and Applications the editors, Cora Smith, Glenys Lobban and Michael O'Loughlin, state that the book is focused on 'how psychodynamic psychotherapy, as well as psychoanalytic concepts and theories are practised and applied in the context of contemporary South Africa' (p. 1). Situated in the context of post-apartheid South Africa, with its 'extraordinary legacy of apartheid, the legacy of institutional violence, the complexities of gender and the lingering presence of unsymbolised intergenerational trauma' (p. 274), the book is intended to 'provide the readers with an experience of the current debates, clinical issues, therapeutic practice and nature of research that is representative of the work being done in South Africa' (p. 1). As such, the editors state that they will not focus on either practice or theory, but aim to explore all the different ways in which psychoanalytic theory may be relevant to the South African context.

The book is structured into three main sections. The first section 'Subjectivity and identity' includes three chapters in which practicing psychotherapists give first-person accounts of how they have drawn on intersubjective psychoanalytic theory to negotiate the racialised histories of themselves and their patients in the psychotherapeutic context. In the second section, entitled 'Traumatic stress', the two chapters deal respectively with four case studies 'representative of the ways in which psychoanalytic concepts and ideas are applied in child psychotherapy' (p. 77) in the South African context, and a discussion of what psychodynamic perspectives contribute to the understanding and treatment of trauma. The third section, 'Social issues,' includes chapters on indigenous healing, intimate partner violence, serial murder, HIV-orphans and their caregivers, ending with a chapter on genealogy, memory and history.

An overview of psychodynamic psychotherapy in South Africa is certainly timely, with the last book of this kind being Reflective Practice: Psychodynamic Issues in the Community (edited by Swartz, Gibson & Gelman) which was published in 2002. Indeed, one of the strengths of the current book lies in the diversity of its topics and approaches. In beautifully written and theoretically sophisticated chapters the reader is exposed to many different ways in which various psychodynamic theories are applied in the South African context. As is the case with many edited books, this breadth has resulted in what can be regarded as a compromise in coherence, some unnecessary overlaps and a few significant gaps. Contributors were obviously given a lot of freedom in terms of what they wrote and how. This means that the chapters do not explicitly speak to each other. Unlike, for example, Dimen's (2011) powerful collection of 'psychoanalytic stories', With Culture in Mind, where discussants link the stories in explicit ways, it is left to the reader of this collection to make the comparisons and connections. The individual contributors seem to share underlying assumptions that issues of subjectivity and identity are always present (even if implicitly), subjectivity and identity are always shaped by social issues (or social discourse) and the social issues described (e.g. violence, murder, HIV, race and gender) are implicated in trauma. These shared assumptions may mean that dividing the book into sections (subjectivity and identity, traumatic stress, social issues) was not necessary.

Contexts

All the contributors contextualise their work by situating it in postcolonial post-apartheid South Africa, describing in more or less detail racial divides and trauma in the present and the past. It seems clear that the connecting factor is not simply that this is a book about psychotherapy in South Africa; it is a book about how South Africa enters each and every psychotherapy, psychological intervention or research project that South African psychologists conduct in this country, but also when they work elsewhere (see Lobban's chapter about being a psychologist in New York City). 'Where is South Africa in your consulting rooms?' asks Deborah Posel, renowned sociologist, of a group of psychodynamic psychotherapists after a case presentation at a recent conference. The various contributions found in this book powerfully illustrate how each interaction with a community, each research encounter and every psychotherapeutic relationship becomes 'a microcosm of the larger socio-cultural context' (Esprey, p. 47) or, in the words of Altman (2004, p. 807), 'History on the large-group social level and history on the individual, dyadic, or small-group level may reflect each other. '

Theories

Although not explicitly stated by the editors in the introduction, the implicit model for the whole book is a theoretical pluralism that is consistent with contemporary postmodern psychoanalytic theories such as intersubjective psychoanalysis and relational psychoanalysis. Lobban and Smith (both editors of the book), in their respective chapters, discuss how and why these approaches are particularly relevant to the South African context, but also what the limits and dangers of such approaches are. While quite a few of the contributors situate themselves within relational psychoanalysis or intersubjective psychoanalysis, others clearly align themselves with more traditional psychoanalytic theories. Psychoanalytic thinkers referred to include Freud, Klein, Kohlberg, Kernberg, Kohut, Winnicot, Bion, Bollas, Butler, Brombert, Benjamin, Wallerstein and Ogden, to name just a few. A metatheoretical framing in the introduction to the book would perhaps have helped readers navigate this complex terrain.

Applications

A wide array of applications is described in this book. There are very traditional individual case studies (Swartz, Esprey, Smith, Ivey, Sideris, Hemp, Del Fabbro), group therapies (Hemp), research (Sideris, Del Fabbro), consultancy work (Hemp), political critique and political activism (all authors). The book thus powerfully illustrates how psychodynamic theory has the potential to be relevant to contemporary South Africa, both as practice and as critique.

In terms of psychodynamic practice and technique, the book succeeds in showing that psychodynamic psychotherapists can work in more traditional ways with individual patients and families, but they can also offer techniques for supporting and consulting with activists and organisations working with disadvantaged and vulnerable groups (see also Gibson, 2000; Gibson & Swartz, 2000; Lazarus & Kruger, 2004; Maw, 2000; Pillay & Lockhat, 2001), using psychodynamic ideas to help activists and community workers to think about and contain their anxieties about work which can be felt to be 'demanding, frightening, chaotic, and ultimately unattractive' (Gibson, 2000, p. 240). More importantly, however, the book clearly illustrates that psychoanalytic theory is relevant to contemporary South Africa, because of its potential to bring about political and social change through its understanding of systematic structures of misrecognition and omission (Kruger, 2006). O'Loughlin begins his final chapter about memory and silence with a poem by Don Mattera (p. 242):
   Gone.
   Buried.
   Covered by the dust of defeat--or so the conquerors believed
   But there is nothing that can be hidden from the mind.
   Nothing that memory cannot reach or touch or call back.


The book is written largely by white middle-class academics and private practitioners living and working in urban South Africa. Their work is juxtaposed with that of a white American and a Eurasian South African living and working in urban USA. All contributors, however, write with acute political awareness, with most of them foregrounding their own subjectivities, also specifically their whiteness. For instance:

My skin colour spoke before I could open my mouth (Hemp, p. 222)

Throughout my life ... I have had a feeling akin to what Bion terms 'nameless dread' (O'Loughlin, p. 245)

My skin immediately and irredeemably marks my privilege ... I am a perpetrator (Swartz, p. 22).

They write insightfully about the impact their whiteness has on their work with black patients and with black communities. They claim that their whiteness leads to denial and disavowal:

Shhh ... don't tell anyone there is an umlungu in the room (Hemp, p. 222).

and enactments, sometimes of a strange kind:

Most of the time I dealt with the difference by trying to deny it--engaging and immersing myself in the culture of the community, eating slaaiwatwat (a traditional township fast food) from the local spaza shop with the clinic staff (Hemp, p. 222).

Swartz uses the concept of interpellation to 'name the (political) process by which subjectivity is hailed into being' (Dimen, 2011, pp. 5-6), a process leading to denial, disavowal and enactment. Esprey explains this process as follows:
   These social conditions map onto a deeply ingrained
   consciousness of how we see ourselves as subjects in the
   world, and when this is re-evoked in the therapeutic
   setting, the therapist is overwhelmed by aversive affects
   and is unable to think. In these moments we are subject not
   only to a dynamic unconscious, but also to social discourse
   (p. 45).


The analytic third, 'a dynamic of recognition and mutuality' (Swartz, p. 26), becomes impossible. In the words of Benjamin (2011, p. 49):
   ... the discursive practices ... are parts of selves, as crucial
   to any interactions as any part-selves that engage in the
   analytic dyad. We now see how so much that appears to
   happen against the backdrop of this 'social third' is actually
   constructed by its shapes and shadows--that even if we are
   able to see around and beyond it, we cannot undo its
   powerful staging effects because they are the very stuff of
   which our meanings and intentions are made.


It is a striking feature of this book that the patients, research respondents, groups and communities are mostly black. Except for one white Afrikaner serial killer, all subjects are either black or not identified by race. Given that all the contributors (psychotherapists, practitioners, and researchers) are white (except for Lobban, who was classified white, but is genetically Eurasian), the book becomes an uncomfortable reflection (maybe even an enactment) of one of the more unfortunate realities of South African psychology: that the field is still dominated by white psychologists, despite the dire and urgent mental health needs of black impoverished people and communities.

Being a white practitioner, academic and author myself, employed at an institution with a notorioius historical connection with apartheid and white privilege, also trying to write about black patients and research respondents (see for instance, Kruger, 2012; 2014a; 2014b), I would have liked the editors to explicitly discuss this constellation of contributors and subjects, the complex reasons for this constellation and the potential dilemmas associated with such a constellation. The lack of discussion feels a bit like Hemp's 'Shhh ... don't tell anyone there is an umlungu in the room' (p. 222)--in this case, 'umlungus' in the book. In other words, while the topic of white psychotherapists writing about black patients in South Africa is certainly one warranting a book in itself, it becomes problematic if the fact of this constellation is not highlighted. The editors, who certainly would not have intended this, may be suspected of unconsciously 'turning a blind eye' (Esprey, p. 33) to the (white) 'elephant in the room' (Esprey, p. 49), being complicit in the 'disavowal and avoidance' (Esprey, p. 42) that the individual writers describe and manage to make visible in their chapters. It would have been helpful if the editors addressed Swartz's (p. 17) important question more directly: 'is empathy (in the Kohutian sense)--the oscillation between two subjectivities--possible when difference confers a fluid, shifting but ever-present other on every encounter?' The individual contributors do argue and convincingly show that, with careful self-reflection, good psychodynamic skill, thoughtful linking and some robust playfulness (Swartz's very evocative grounding principles for 'the shift from interpellation into traumatic discourses to the construction of a working analytic third', p. 27), empathy is indeed possible.

Several contributors also point out that, to quote Esprey, '(e)ven in same-race dyads where there is a 'resonance of alikeness', the potential for racially based enactment occurs' (p. 47),. What the book does lack, making it unrepresentative of psychoanalytic psychotherapy in South Africa, are contributions reflecting on how 'events in the social domain make their way into the clinical setting' (Layton, Holland & Gutwill, 2006, p. 1) in the case of same-race dyads.

The editors note that '(a) key characteristic of the book is the insistence of the authors in locating their work self-reflectively in their own socio-historical and socio-cultural origins ... and the ways in which the racial divide, the legacy of institutional violence, the complexities of gender and the lingering presence of intergenerationally transmitted trauma make their presences felt in the therapeutic process' (p. 274). The varying levels of self-reflection in the different chapters seem to be informed by the foci of the various contributors, and thus can be deemed to be totally appropriate. We have several chapters where there is extensive reflection on self and history (Swartz, Lobban, Hemp, O'Loughlin), and others in which contributors situate themselves in terms of race and gender (Esprey, Ivey), but some, equally powerful, in which there is minimal self-reflection (Smith, Eagle, Sideris, Del Fabbro). It is therefore important to ask in which circumstances and to what extent self-reflection is necessary in psychological work and writing? For instance, Swartz suggests that an awareness of 'my own gendered and raced history' is one of 'the grounding principles' for shifting 'from interpellation into traumatic discourses to the construction of a working analytic third' (p. 27). The collection as a whole implicitly raises a question which is very prominent in contemporary psychoanalysis, but also in psychological research in general: when and how should the researcher or clinician become part of the analytic field and reflect on their own subjectivity?

In a recent review of the last 70 years of psychoanalytic literature, Kumar (2012) concludes 'that psychoanalytic scholarship has very little to say directly about poverty or the poor' (p. 1). Despite the exciting work of some contemporary psychoanalysts (see for instance Altman, 2009, Dimen, 2011; Javier & Herron, 2002; Layton et al., 2006), the dearth of literature on poverty is even more striking in the field of psychoanalytic psychology than in psychology as a discipline. Javier and Herron (2002, p. 161) state: 'analysts are more likely to work with people of different genders and ethnicities than with the poor because of the class difference and its accompanying economic limitations which keep the patients who live in poverty out of the analyst's usual practice.' In this book, too, contributors seem to be more comfortable writing about race and gender than about class and specifically poverty. Layton et al. (2006) states that 'Mental health professionals are increasingly challenged to consider the place of class and politics in unconscious and conscious life' because, as argued by Zizek (as cited in Layton et al., 2006), 'when class and capitalism are excluded categories of analysis, their omission allows for the successful functioning of mainstream political thought' (p. 1). Perhaps an edited book on the psychodynamics of poverty in South Africa is called for?

Conclusion

This is a book that is authoritative in terms of the issues that it addresses, the questions that it raises and the gaps that it exposes, even though it may not be entirely representative of 'psychodynamic psychotherapy in South Africa'. A representative book would have been an impossible task indeed. It is, on the one hand, a book about how South Africa enters the consultation room when white psychodynamic psychotherapists work with black patients or research participants of different socio-economic backgrounds in South Africa, thus exploring 'how events in the social domain are making their way into the clinical settings' and 'how they are entering into the transference/countertransference relationship' (Layton et al., 2006, p. 1). As such, the book is in conversation with a growing contemporary international psychoanalytic literature 'locating the psychic and the social in a single clinical moment' (Dimen, 2011, p. 2). Such moments, whatever their content, serve 'as opportunity and means to reflect on that familiar binary of mind versus culture, on the relationship between internal and external, psychic interior and socio-political surround' (Dimen, 2011, p. 2).

On the other hand, it is also a book that vividly and in different ways illustrates the relevance of contemporary psychodynamic theory for South Africa by discussing why and how psychodynamic theory is useful when we think about our most challenging mental health issues, such as trauma, violence and the HIV-epidemic, but also about more general issues such as healing, race, gender, identity, memory and history. The implicit argument is that, while thinking psychoanalytically about specific mental health problems is crucial, psychoanalytic thinkers can also contribute to social change by addressing 'the severance of social links, the denial of memory, the erasure of generational and ancestral wisdom, and the rupture of genealogical continuity' (O'Loughlin, p. 262).

Despite the problems discussed above, this book represents a powerful and multifaceted attempt at addressing 'the holes, the openings, the breaks, the breaches, the cracks, the spaces, the pauses, the silences, the interruptions and the lulls' (Kruger, 2006, p. 3) in the practice of psychodynamic psychotherapy, but also in South African society as a whole. It is also a unique addition to a growing international literature concerned with more politically and socially relevant psychodynamic theories and applications. As such, it will become essential reading for psychotherapists, psychologists and activists working in South Africa.

References

Altman, N. (2004). History repeats itself in transference-countertransference. Psychoanalytic Dialogues, 14(6), 807-815.

Altman, N. (2009). The analyst in the inner city: Race, class and culture through an analytic lens. London: Routledge.

Benjamin, J. (2011). Facing reality together: Discussion of 'the social third'. In M. Dimen (Ed.), With culture in mind: Psychoanalytic stories (pp. 49-63). London: Routledge.

Dimen, M. (2011). With culture in mind: Psychoanalytic stories. London: Routledge.

Gibson, K. (2000). The emotional experience of working with troubled children: A psychodynamic approach to organisational consultation. In D. Donald, A. Dawes, & J. Louw (Eds.), Addressing childhood adversity (pp. 225-243). Cape Town: David Philip.

Gibson, K., & Swartz, L. (2000). Politics and emotion: Working with disadvantaged children in South Africa. Psychodynamic Counselling, 6(2), 133-153.

Javier, R. A., & Herron, W. G. (2002). Psychoanalysis and the disenfranchised. Counter transference issues. Psychoanalytic Psychology, 19(1), 149-166.

Kruger, L. (2006). Not mastering the mind: Freud and the 'forgotten material' of psychology. Psychoanalytic Psychotherapy in South Africa, 14(2), 1-12.

Kruger, L. (2012). 'Vrot kolletjies.' (rotten spots): Reflections on shame, silence and enactment in psychotherapy with impoverished clients. Psychodynamic Psychotherapy in South Africa, 20(2), 1-32.

Kruger, L. (2014a). The 'slow violence' of poverty: Notes of a psychoethnographer. In C. S. Van Der Waal (Ed.), Cape Winelands, wealth and work: Transformations and social process in the Dwarsrivier Valley. Durban: UKZN Press.

Kruger, L. (2014b). The whales beneath the surface: The muddled story of doing research with poor mothers in a developing country. Health Care for Women International. Special Issue: Women and Health in Africa, 1-12.

Kumar, M. (2012). The poverty in psychoanalysis: 'Poverty' of psychoanalysis? Psychology & Developing Societies, 24(1), 134.

Layton, L., Holland, N. C., & Gutwill, S. (2006). Psychoanalysis, class and politics: Encounters in the clinical setting. Sussex: Routledge.

Lazarus, J., & Kruger, L. (2004). Small meetings: Reflections on the application of psychodynamic thought in community work with low-income South African children. Part 1: Reflections on the literature. Psycho-analytic Psychotherapy in South Africa, 12(1), 48-73.

Maw, A. (2000). The consultation relationship: Reflections on a psychological consultation partnership. In L. Swartz, K. Gibson, & T. Gelman (Eds.), Reflective practice: Psychodynamic ideas in the community (pp. 57-72). Cape Town: HSRC Press.

Pillay, A., & Lockhat, R. (2001). Models of community mental health services for children. In M. Seedat, N. Duncan, & S. Lazarus (Eds.), Community psychology: Theory, method and practice, (pp. 87-106). Cape Town: Oxford University Press

Swartz, L., Gibson, K., & Gelman, T. (Eds). (2002). Reflective practice: Psychodynamic issues in the community. Cape Town: HSRC Press.

Professor Lou-Marie Kruger obtained a M.Soc.Sci. (Political Studies) from the University of Cape Town (1989) and a M.A. and Ph.D (Clinical Psychology) from Boston University (1996). She completed an American Psychological Association accredited internship for Clinical Psychology at Massachusetts Mental Health Center, Harvard Medical School (July 1995 June 1996). She co-ordinated the postgraduate programme in Clinical Psychology and Community Counselling at Stellenbosch University in South Africa for 13 years (2000-2012) and is currently still teaching and supervising in the programme. In her research, she focuses on the emotional worlds of low-income South African mothers, utilising mainly psychoanalytic, feminist and postmodern theoretical frameworks.

Lou-Marie Kruger

Stellenbosch University
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Author:Kruger, Lou-Marie
Publication:Psycho-analytic Psychotherapy in South Africa
Article Type:Book review
Date:Mar 22, 2014
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