Book Review: Integrative Perspectives

A few chapters into my first reading of this curious book, I found myself feeling rather perplexed; less than half-way through, I had become distinctly confused. After some careful thought, I decided to imagine that the tag to the title was "a kaleidoscope of perspectives" rather than the one that actually appears on the cover and thereafter I proceeded through the rest of the book happily. Admittedly, it is flagged clearly enough that we are to expect ideas discussed from integrative perspectives (plural) rather than a (singular) integrative perspective, but this nicety still falls short of offering an uncontroversial description of the material included. In her introduction, the editor notes that 'the book was designed with trainee psychotherapists in mind' (p. 7) and I shall return to query how well this cloth has been cut to suit at the end of my review.

For this volume, the editor has brought together eleven papers that describe and discuss different experiences of 'the therapeutic frame' (she is also the author of one of these). Many contributors note the origin of this phrase in a 1952 article by the psychoanalyst Marion Milner; in their engagingly written chapters, John Beveridge and James Pollard independently offer concise traces of the heritage of over half-a-century's deliberate psychotherapeutic endeavour, aspects of which she referenced so neatly in it. Different authors imbue the metaphor with different contents, as is only to be expected, but it is not until Greg Madison's chapter - the penultimate - that we are first forcefully reminded that we have been thinking about a metaphor all of this time (the opening paragraph of his conclusion clears the air like menthol, in a most welcome way). While mentioning language, in addition to the three authors mentioned so far, Nick Zinovieff's paper appealed greatly in terms of clarity and elegance.

I shall quote two short passages to move us from considering language style to issues of material content:

Heteronomy is concerned with alterity, and whereas the egocentricity of autonomy is concerned with self-interest, heteronomy is concerned with difference and recognizes the absolute otherness of the Other. (Smith-Pickard, p. 139)

The weakening of ego defences and of secondary-process functioning - facilitated by thestructure itself of the analytic setting, and in particular by its temporal arrangements - gives way not only to a freer expression of unconscious material but also to a more primitive experience of time and relationship to it. (Sabbadini, p. 197)

The freedom with which each of these authors moves to express his ideas within a particular technical vocabulary causes me to stumble. Assuming that Einstein's exhortation to make things "as simple as possible, but not simpler" has been heeded already, then these instances and many more like them form the basis of me wondering whether the topics themselves are all well suited for inclusion in a text intended to appeal to psychotherapy trainees, integrative or otherwise. What topics are covered? Four of the authors take as their main theme their experience of providing therapeutic meetings in particular settings. These contexts are not very varied, in that all are located in NHS centres (one author discusses his work in GPs' surgeries, the others consider their hospital-based practices). What were the reasons for not including a wider range of the situations where therapists commonly work, if the site-specific nature is revealing? Prisons, schools and crisis drop-in centres all come to mind quickly as places where something about their social or political context may impact upon the experience of people meeting there for therapy. Other papers consider specific dimensions of our work as therapists which are indexed by the frame metaphor: the experience and meaning of open-ended contracts, making use of unplanned contact, managing responses to unexpected illness, making sense of therapists' urges to alter their usual practice boundaries with particular clients. Three "generalist" contributions complete the book, one of which is deliberately modality based (written by one of the two attachment-based psychoanalytic psychotherapists whose work is included) and the other is written from the perspective of being a client in therapy (this account is brave in its frankness). The most general chapter is the editor's, in which she touches upon a range of points which others will later develop in their contributions. Is this a satisfactory mix? Not really. To my way of thinking, too many of the contributions are actually too specific, whether that surfaces in terms of context or modality (seven of the authors share an interest in analytic thought and this informs their papers). It seems unremarkable for a psychoanalyst to conclude his paper on time and timelessness noting a core feature of his work is that 'analyst and analysand alike commit themselves to share the same space for a regular and limited period of time - say 50 minutes a day, five days a week - over an unlimited number of years.' (p. 202). I expect that interesting things appear in this frame which may not be seen easily in others, but such a bald restatement of how psychoanalysis proceeds is not likely to help many trainees. This paper might usefully have tackled head-on how the experience of timelessness is provoked differently or not at all in less frequent work, and how to manage this accordingly.

If feeling partisan, the readers of this journal may be pleased to note that the chapters contributed by the "existential representatives" in the authorship line-up are relatively strong. Each benefits from being clearly written, and I find that these authors take care to remind us consistently that attention paid by therapists to frame considerations is purposeful: these inform the stage on which we meet the others who are temporarily our clients and our ability to find one another there is crucial to our work together. Clarifying this imperative further, Smith-Pickard identifies the notion of a 'portable frame' (p. 137), a pretty self-explanatory idea which I am sure I will find fruitful to reflect upon from time to time in the future. The self-avowedly existential practitioners are not the only ones to refer to existential resonances in their work, perhaps not surprisingly, given the way in which frame matters speak at the micro level of the macro "givens" which existential philosophers have long drawn to our attention. For example, here is a gem of an idea tucked into Beveridge's chapter: The 'fifty-minute hour' already carries a communication that, in therapy, even an hour is not an hour, so the practitioner cannot be 'everything'; they will always disappoint.' (p. 162). It is an assumption shared by all of the authors that it will be useful for clients to recognize in rich detail the impact of encountering life's boundaries and no perspectives are included which attempt to critique the validity of existential psychotherapy as a project. From the other side, so-to-speak, there many, many examples of what could be called a 'short-circuiting' of experience to concept; I had to squint unexpectedly hard and often in an effort to see through the words back to the phenomena I think they were intended to identify.

To close, I shall return to the question of how appealing this book is likely to be to its intended readership. As will now be evident, I encountered too many missed opportunities here to find that hit its declared target convincingly. Where are papers on the radical revisions to framework proposed by Lacan or Langs for example (both mentioned by different authors in passing and thinking only of interesting psychoanalytic thinkers not represented)? None of the chapters are unworthy of publication and readership as articles in relevant journals, but their presence side-by-side does not lead to the steady accumulation of ideas that their appearance as a book might be expected to achieve. Trainees will find an interesting collection of experiences and ideas recorded, but these alone do not offer a balanced introduction to help them progress their thinking on this important topic in a systematic fashion.

Brinley Yare