Crisis at Adolescence: Object Relation Therapy With the Family (Library of Object Relations)

Rating:
Summary: Essential reading for those who work with Families
Review: For me the most important unifying feature of this book was the issue of change in families. What sort of change are we aiming for and how are we going to bring it about? These are pressing questions for social workers, and are discussed in a helpful epilogue by the editor, Sally Box. This model of family therapy, which emphasises change from within, is in stark contrast to the facile prescriptions for behavioural change found in so many child protection plans. This view is not a theoretical preference, but a practical one. British psychoanalytic concepts have lent themselves particularly well to work with families. These influences have crossed the Atlantic in the work of the Scharffs and Zinner & Shapiro. The authors of "Crisis at Adolescence" acknowledge a debt to the work of Melanie Klein and her followers, particularly Wilfred Bion, as well as those analysts who have applied these ideas to groups and institutions. Klein's concepts of an unconscious world of internal objects and projective identification are particularly helpful in understanding the dynamics of family life. When a couple come together to form a family, each brings not only their objective experience of family life, but an unconscious world which has been so beautifully described by Joan Rivière as, "..A world of figures formed on the pattern of the persons we first loved and hated in life, who also represent aspects of ourselves.." If this internal world is filled with figures who are damaged or in conflict this is a source of what may be felt to be unbearable emotional pain. One way of dealing with this is by externalising the difficulties. The mechanism by which this takes place is projective identification, an unconscious phantasy that a part of ourselves can be split off and located elsewhere. However, as Bion points out, this phantasy can have a very real effect on the recipient. In some ways this is the familiar concept of the 'scapegoat', but Klein's concepts allow us to conceptualise family relationships in a more complex way, as the re-enactment of the internal conflicts and shared unconscious anxieties of the family members. In order to get in touch with these issues the psychoanalytic family therapist pays attention not only to what the family says and does, but also to their own experience of the family, their countertransference. This is described very clearly by editor Sally Box. (page 72), "The task of the therapist, then, is to be available to play a part in his patient's phantasy scenario, but rather than enacting the projections as he is implicitly invited to, it is to monitor his minute by minute experience in order to try and understand what part he is being required to play and to transform it..". The process whereby the transformation takes place can be understood in terms of Bion's concept of containment. The therapist receives the unbearable experience The therapist receives the unbearable experience and processes it in their own mind, so that it can be returned to the family in a 'detoxified' form. Hopefully repeated experiences of this sort will enable the family to internalise this containing function for themselves, and manage painful feelings which previously had to be split off and disposed of. It seems to me that this approach is more truly 'empowering' than those models of family work where the therapist stage manages structural change. The exploration of these possibilities makes fascinating reading,- Beta Copley's chapter, for example, on 'Introducing families to family work'. These types of decisions are often made by field social workers. The chapter on 'Making a space for parents' by Anna Dartington and Jeanne Magagna illustrates what powerful feelings are aroused for parents when their child is seen separately even under relatively benign circumstances. The sensitivity of young children to family dynamics is quite astonishing, and this may be an important route to getting in touch with feelings that are sensitive issues for the parents. There is a vivid example of this in the chapter by Margot Waddell, in which she describes how a very young baby monopolised the therapists' attention in a very similar manner to his parents. It was the therapists' comments on the child's behaviour which allowed the father to look at this aspect in himself. It is usually accepted without question that family therapy works best if there is more than one therapist. Yet the clinical material in this book illustrates the considerable demands that working in this way makes on the therapists' mutual trust and capacity for insight, particularly when examining the different countertransference feelings they pick up from the family. There is, however, a very refreshing chapter by Beta Copley on the advantages of being a single therapist. In view of the increasing number of small, single parent families that many of us are seeing, and shrinking staff numbers in many clinics, this approach seems to me to have a lot to recommend it, particularly if there is good supervision or a regularly meeting workshop. There is one chapter in this book which extends some of these ideas outside of families and into the professional network. 'Re-enactment as an unwitting Professional Response to Family Dynamics', by Ron Britton, describes how different professionals and even institutions can be drawn into a re-enactment of family dynamics. He shows how this re-enactment can serve as a substitute for 'realisation' or real change and development. As he puts it, the cast changes but the plot stays the same, and since the activity appears to be ongoing professional business it may be some time before the real situation is recognised. Anyone who attends child protection conferences will be extremely familiar with this phenomenon, often expressed through violent professional disagreements, inappropriate inertia or precipitate action.