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- Convenor:
-
Nicholas Long
(London School of Economics and Political Science)
- Formats:
- Panels
- Stream:
- Medical
- Location:
- Magdalen Daubeny
- Start time:
- 21 September, 2018 at
Time zone: Europe/London
- Session slots:
- 2
Short Abstract:
This panel explores how both therapists and anthropologists can and do make sense of unexpected or unwelcome developments in the consulting room, and what these perspectives might contribute to cross-disciplinary debates about whether, how and why people can change.
Long Abstract:
Many forms of psychotherapy are premised on the notion that the language spoken and social relationships fostered in therapeutic encounters can transform the ways in which patients imagine, and thereby act in, the world. And yet every time a patient meets with their therapist, such claims are put to the test. While some encounters proceed as textbook exemplars of the therapeutic traditions that inform them, many do not. Sometimes, they fail outright. On other occasions, they unfold in unexpected ways: engendering transformation, but not of the kind, to the extent, or in the manner that the therapist might have anticipated.
Since psychotherapies are often inspired by psychological models that have also proven influential amongst anthropologists, ethnographic studies of therapeutic encounters that do not proceed as anticipated have the potential to make vital, critical, contributions not just to the field of psychiatry but also to anthropological theory. This panel thus explores how both therapists and anthropologists can and do make sense of unexpected or unwelcome developments in the consulting room. It invites papers that explore what therapists' handling of 'the unexpected' reveals about the emergent regimes of therapeutic governance in which they operate, that track how therapists' understandings of their practices' efficacy evolves in the wake of unexpected interactions, that debate the potential merits of such emergent emic perspectives for anthropological theory, or that develop etic explanations of the therapeutic unexpected which constitute original interventions into cross-disciplinary debates about whether, how and why people can change.
Accepted papers:
Session 1Paper short abstract:
This paper analyzes psychoanalytic trainees' doubts and uncertainties about the thoroughness of their own training analyzes and how this effects therapeutic outcomes for themselves and for their own analysands, paying particular attention to institutional constraints and contradictions.
Paper long abstract:
The "training analysis"—in which the psychoanalyst in training is him- or herself psychoanalyzed—is one of the three main pillars of psychoanalytic training. Unlike other types of non-training analyzes, the training analysis serves not only to encourage the analysand to explore his or her own personal and emotional orientations as fully as possible, but also to teach the prospective psychoanalyst how a proper analysis is to be conducted and to verify to the training institute that a candidate has in fact been psychoanalyzed. As a result, dual roles abound: the candidate is at once an analysand, but also a future psychoanalyst in training; the training analyst is at once an analyst who feels responsible for the care of her patient, but also a gatekeeper for the psychoanalytic institute. I examine how these conflicting roles and expectations affect the experience of the training analysis from the trainee's point of view, focusing especially on trainees' struggles with how open and honest to be about their own problems and conflicts and on the gaps many trainees experience between how they imagine an analysis is supposed to unfold and how their own analytic experiences actually do unfold. I explore how doubts and uncertainties generated by institutional constraints and contradictions affect therapeutic outcome for both trainees and for the people whom they analyze. I note that the gaps between normative expectations and personal experiences in training analyzes raise important questions about how psychoanalytic practice is taught and learned.
Paper short abstract:
Resurgent psychedelics-assisted psychotherapy is subject to contemporary scientific imperatives. Yet psychedelics are unruly, producing unpredictable experiences. By combining surprise and prediction, the skillful configuration of psychedelic therapy is able to shape wider spiritual practices.
Paper long abstract:
Amidst the proliferation of esoteric and occult practices and discourses in the global North, there has been a resurgence of scientific interest in psychedelic psychotherapy. Utilizing substances such as psilocybin, LSD and MDMA, university-based research trials are seeking to stabilize and optimize experimental systems that harness psychedelics in the treatment of clinical targets including depression, anxiety and addiction. Yet psychedelics are inherently unruly substances, producing experiences that defy prediction. The activity of support staff - variously known as 'therapists', 'guides' and 'monitors' - tends to be backgrounded in the writing up of scientific studies that foreground drug effects. The configuration of psychedelic psychotherapy is also influenced by legacies of understanding the psychedelic guide in an earlier wave of overground experimentation, models emerging from the illicit underground use of psychedelics, shamanic practices and biofeedback-based automation technologies under construction.
I draw on data collected during ethnographic stints with psychedelic researchers on the east coast of the United States from 2013-present, to demonstrate how psychedelic psychotherapy is being shaped around the very unpredictability of psychedelics. Weaving ethnographic data with theories of surprise (Sedgwick) and trickery (Taussig), I show how the mode of psychotherapy being provided celebrates the unexpected in ways that nevertheless manage to complement the narratives of predictability demanded by the agenda to medicalize psychedelic psychotherapy. In so doing, this highly singular model of psychedelic psychotherapy is authorized as 'scientific', enabling it to shape wider practices for producing and navigating altered states in the return of a new 'New Age'.
Paper short abstract:
When Ericksonian hypnotherapy is practiced in a developmentalist postcolonial context (Indonesia), it loses its capacity to accommodate certain unexpected forms of speech. 'The unexpected' can then render patients ambivalent towards hypnotherapy and therapists pessimistic about national development.
Paper long abstract:
Since the Indonesian Board of Hypnotherapy was founded in 2002, well over 24,000 citizens have trained as hypnotherapists, the vast majority of them aspiring to use their knowledge to serve their communities, contribute to national development, and be leading vanguards of the Jokowi government's proposed 'Mental Revolution'. Despite these noble intentions, however, hypnotherapists are often figures of great ambivalence. On the one hand, they are viewed ambivalently by the public, who suspect that hypnotherapy's apparent secular modernism may in fact be a front for sorcery. On the other hand, their own enthusiasm for transforming the Indonesian mindset can easily give way to a sneaking suspicion that the Indonesian population may in fact be irredeemably 'backward'.
This paper argues that both forms of ambivalence are consequences of unexpected twists and turns in therapeutic dialogue, the unsettling effect of which relates to the specifically Ericksonian character of the hypnotherapy taught by Indonesia's major hypnosis associations. Erickson argued that the most powerful way to reconfigure aspects of a patient's subconscious was by 'accepting and utilising' their core beliefs. In developmentalist contexts such as Indonesia, Ericksonian hypnotherapy is consequently haunted by the possibility that a patient's core beliefs will be 'backward', a possibility which can lead to forms of unexpected therapeutic speech that threaten the reputations of hypnotherapist and patient alike. Differences in political economy, and in resultant forms of subjectivity, therefore lead the very semiotic ideology that rendered Erickson's approach so effective in the United States to compromise its efficacy in Indonesia.
Paper short abstract:
This paper focuses on a small group of Ugandan psychotherapists and their efforts and challenges to establish psychological psychotherapy as a practice and academic discipline in Uganda.
Paper long abstract:
This paper focuses on a small group of Ugandan psychotherapists and their efforts, since the early 2000s, to establish psychological psychotherapy as a practice and academic discipline in Uganda. Based on interviews with these 'pioneers of psy', I discuss the different challenges they have faced in translating, appropriating and adapting psy-services in a country where they have hitherto been largely unknown. Drawing on different examples, I show how in the day-to-day practice often unexpected events take place which force the therapists to rethink the models they have learned from western textbooks. Through these ongoing creative processes of 'doing psychotherapy' new insights, and a distinctively Ugandan form of psychotherapy, are emerging.
Paper short abstract:
The objective of the paper is to focus on the role of neo-shamanic practices as a non-somatic therapy. We observed that inherently lengthy institutional psychotherapies are being replaced by a multitude of fragmented practices that may fulfill the duration of the conventional therapies.
Paper long abstract:
Healing might be regarded as one of the most relevant keywords capable of federating contemporary spiritualities in western societies.
The objective of the paper is to focus on the role of neo-shamanism spreading all over Europe through seminars and festivals as a non-somatic therapy. We observed that inherently lengthy institutional psychotherapies are being replaced by a multitude of fragmented practices that may fulfill the duration of the conventional therapies. The patient-practitioner, by the medium of concentration and visualization techniques, is invited by the neo-shaman to explore his/her inner-self and to heal it through the many figures populating the shamanic pantheon.
Distinctive elements of the neo-shamanic practices emerge: the patients follow different shamans in order to solve their psychological, emotional or existential problems and during the seminars the patients do not declare the reason for which they take part into the healing rituals.
By considering neo-shamanic practices as a kind of short and impromptu psychological therapies we can observe that they differ from classical ones under many aspects. The main differences that we have observed are: no specific bonds to any particular therapist, short and condensed sessions, no transfer or counter-transfer with the therapist, always changing settings, little or no time for the members of the group to introduce themselves or to explain the reasons of the participation, and finally, guarantee of the anonymity of patients.
Can we include these elements among the reasons when psychotherapy goes awry?
Paper short abstract:
This paper focuses on the nature and significance of the therapeutic relationship in psychological counseling in Sri Lanka with the broader aim of examining the social and political dimensions of this relatively recent and now increasingly common practice.
Paper long abstract:
Whereas in the past psychological counseling in Sri Lanka often evoked NGO-based services for war- and disaster-affected communities, today these services are available through public hospitals, private practitioners, local state agencies and not-for-profit organizations in rural and urban areas, reaching people of diverse class, ethnic, and religious backgrounds. In this context, scholars have raised concerns not only about the appropriateness of Eurocentric models in Sri Lanka but also about efficacy and quality, where counselors are not always formally trained and institutional oversight is not yet fully in place. However, while quality or efficacy are measured in terms of purportedly international standards and diagnostic tools, an ethnographic lens highlights what might matter to practitioners and clients apart from, or even against, those parameters. It reveals how psychological discourse emerges in particular contexts as a unique formation in relation to existing moral frameworks and socio-political realities. Focusing on counseling practice in one district of Sri Lanka's Central Province, I examine how practitioners and clients talk about the therapeutic relationship, asking what metaphors and values shape it and how it fits into broader frames of meaning such as "family" or "community." I further consider the forms of sociality counseling may engender beyond the therapeutic session and their transformative potential as collective care or action. This is part of a broader effort to understand the social and political implications of counseling in Sri Lanka against the grain of anthropological critiques that emphasize its depoliticizing and individualizing effects.
Paper short abstract:
In U.S. forensic psychotherapy, failures of empathy can be guides to therapeutic efficacy, and, in reverse, empathetic success may signal therapeutic failure, a situation we refer to as a "fallacy of care" as we ask what new ethical goals take empathy's place in the forensic therapeutic alliance.
Paper long abstract:
Contemporary person-centered psychotherapy typically considers empathy a requisite feature of the therapeutic alliance and, thus, effective treatment. However, empathy relates to care in altogether different ways in the practice of American forensic psychotherapy, suggesting a variable, dynamic, and counterintuitive relationship to ethical practice. Specifically, in this context, empathy risks a failure of the therapeutic alliance. Based on clinical case studies in a New England state psychiatric hospital, we ask how empathy illuminates therapeutic efficacy through its shortcomings, such that successful deployment of empathy indicates therapy gone awry, and vice versa. This paper will contrast two genres of failure - logical and ethical - that constitute what we call the "fallacy of care." A point of entry into medico-legal logics of the "therapeutic alliance," this condition also opens up spaces for alternative ethical languages and visions of care oriented to the concept of "radical genuineness." As a psychologist and an anthropologist, we approach clinical orientations to failure as at once orienting possibilities for care and highlighting the unique conditions of U.S. American forensic psychology. Ultimately, we argue that in a forensic inpatient context, empathy's care fallacy indicates that empathy can serve as a guide to effective practice precisely in the contexts in which it is no longer a goal.