Presentations from Conference ‘Embodied Intersubjectivity in the Clinic’ with Shaun Gallagher

Presentations from Conference ‘Embodied Intersubjectivity in the Clinic’ with Shaun Gallagher


Conference Invitation >>

Conference in London - 26/4/15

See the Invitation for conference background and leaflet, as well as biographies and comments from the panelists.
Conference Invitation >>
Preparatory Materials >>

Preparatory Background Reading

This page below contains all the conference presentations (as text or PowerPoint), including introductory notes by Michael. Follow the green button for all the preparatory materials, including some synopses of Shaun's writing, distributed before the conference.
Preparatory Materials >>

Shaun Gallagher: "4E cognition in therapeutic settings"
(4E = embodied,  embedded,  enactive,  extended)

Shaun's presentation in PDF format

‘Embodied Intersubjectivity’ – Preparatory Notes by Michael Soth

Questions inherent in our theme ‘Embodied Intersubjectivity’

What are our ideas/concepts of ‘mind’ and how two ‘minds’ understand each other and relate? What notion of ‘mind’ is implicit in our practice and in our way of being and thinking?

What role does our bodily experience play in our ‘mind’ process? What are our implicit assumptions about the body-mind relationship?

Burying Cartesian dualism?

One way of phrasing the significance of our theme today is to think of Shaun’s ideas on embodiment and intersubjectivity as helping us put the final nail into the coffin of Cartesian dualism and bury it.

But why should we be bothered by ideas that were formulated 400 years ago, by Descartes who lived 1596 – 1650? Or, to put it the other way around: how come his ideas are still sufficiently influential in how we think and practice psychotherapy today, that we need to bother critiquing them?

How does Descartes live on in our therapy practice today?

The more we think of the mind as embodied and embedded, the more sense it makes that

  • a) our 'individual mind' is embedded in cultural contexts,
  • b) these cultural contexts go through an epigenetic evolution throughout history,
  • c) with historically evolved aspects of 'mind' being carried from generation to generation (like transgenerational trauma),

There is a straight historical line of conflict (between 'rational' and 'irrational', between 'mind' and 'body') from Descartes and the enlightenment, through the romantics to psychoanalysis (Freud being equally committed, or let's say: torn apart between, science and soul - he won prizes for literature, not medicine!). That conflict continues, and it is not too far-fetched to say that we are also still embodying and embedding Descartes, as one of the pillars of one polarity in that conflict, in how we work and how we think about our work. So here is a psychotherapeutic transgenerational accusation of how Descartes interferes in our practice today:

The transgenerational embodied and embedded mind

As psychotherapists we understand more profoundly than much of the rest of the culture how our experience of mind is socially constructed and shaped by our early formative experience – my mind is shaped by the company of other minds and by the social context in which it first emerges – that’s the upshot of modern infant research as neuropsychoanalysis – (Allan Schore) and short of neuroplasticity, that’s the mind I’m lumbered with for the rest of my life.

And Susie has been influential in spreading the recognition that the same applies to our experience of ‘body’ – our bodies are socially constructed, manifesting currently in a painful epidemic: the obsession towards perfecting a virtual body co-exists with a loathing of the actual body; the body as a fashion accessory, an objectified advertisement of Self rather than an incarnation of self or a subjectifying psychosomatic process.

In Western culture, secure embodiment, rather than being implicit, must often be earned. To feel alive and connected to one's own body is an achievement that goes against the cultural grain. (Susie Orbach: Acquisition of a Body)

We can take a step further and rather than thinking of mind and body separately as socially constructed, we combine the two and think about how the relationship between mind and body is shaped and moulded and conditioned by the social context in which it emerges and develops.

The transgenerational replication of dis/embodiment

What Winnicott called our experience of “psyche indwelling in the soma” is something we cannot take for granted in the modern world. So if we call what Winnicott is talking about our subjective experience of ‘embodiment’ (which is our lived experience and awareness of inhabiting our bodies, not just the mere fact that we ‘have’ a body and ‘are’ a body), then we can say that the degree of ‘embodiment’ or ‘disembodiment’ we experience – the relational matrix of our bodymind system - is something that gets transgenerationally handed down to us and that we “find ourselves thrown into”.

The way my reflective mind handles and holds my spontaneous experience tends to parallel the way I was handled and held as a child.

The way my reflective mind handles and holds my spontaneous experience tends to parallel the way I was handled and held as a child. The way I was related to as an emerging bodymind subjectivity in early development is the way I relate to spontaneous and emergent processes now.

Perceiving, feeling, breathing, thinking, relating via ‘character’

That means that the way we are able to consciously talk about (to perceive, to think and reflect and use language to describe) our experience of our mind or bodymind or embodiment is always already pre-structured by our developmental experience which is a prior ‘given’. As psychotherapists we understand that our thinking is circumscribed and limited by what Christopher Bollas calls the ‘unthought known’, or Body Psychotherapists might say that we perceive, feel, breathe, think and do everything else (speak, vote, have sex, eat, etc) from within ‘character’ – our life history and biography organising (or traumatically frozen into) our bodymind.

The same thing is true for the way we live the self-other relationship: we relate to others from within ‘character’ – from within the established blueprints, survival mechanisms, scripts, schemas, RIG’s (Daniel Stern: representations which have been generalised), internal object relations, affect motor schemas, etc. or as Nick calls them: engrams.

Nature via nurture (after a book with that title by Matt Ridley)

So as an extension of Shaun’s book title, we could say: our (past) bodymind character shapes our (present) mind – the somatised (bio-neuro-psycho-socio) history of our emergent bodymind shapes our emergent bodymind now [I mean: right now].

For practical therapeutic purposes, we phrase the same thing more psychologically and say, in object relations terms: we have internalised our family’s bodymind narrative, and are carrying them as flesh-and-blood embodied internal objects into our being and relating and mental processes now. Or better: these family relationships structure our sense of self and our bodymind experience of being, thinking, reflecting and relating now.

culture –> family –> bodymind formative years –> bodymind now = culture shapes the bodymind -> body shapes the mind

Descartes in your consulting room

One way of phrasing the point of the conference: down that transgenerational chain of influences like endless dominoes, Descartes still structures our self-experience and bodymind process and self-reflection as therapists.

The oversimplified narrative, vilifying Descartes as the originator/exacerbator of existential split and disembodiment goes something like this: since the ‘Enlightenment’ we Westerners get conditioned/socialised into a dualistic/Cartesian universe which we therefore find ourselves thrown into as very real in our first-hand phenomenological experience. That experience is then accurately reflected in dualistic thought processes, dualistic philosophies and beliefs. And then we try to deal with the painful fall-out from the isolation and alienation we experience within that dualistic presumption using counterproductive dualistic tools.

To phrase it in the Cartesian language of CBT (who quite happily use his paradigm and don't have nearly half as much trouble with Descartes as we have): Cartesianism has become a culturally dominant faulty thought that functions as a self-fulfilling prophecy, creating transgenerational traumatic disembodiment.

This is relevant for psychoanalysis and psychotherapy because – as I have suggested - psychotherapy has a dualistic 'birth trauma': having been born into the zeitgeist of the late 19th century, psychotherapy still carries the legacy of the kind of Cartesian assumptions which Freud’s time took for granted down the generations into our current therapeutic theories, approaches and practice – reflected in the idea of the ‘talking therapies’ and the ‘talking cure’.

The struggle to overcome Cartesian dualism

So we have good reason to question and try and get beyond Cartesian dualism. As Shaun points out, most of cognitive science these days agrees in principle that Cartesian dualism is now dead, after ruling the roost for most of the 19th and 20th century. Atwood and Stolorow, the originators of the intersubjectivist psychoanalysis have been explicitly attacking the Cartesian ‘myth of the isolated mind’.

Cartesianism is not that easy to escape

However, as those of us who have been battling with and against the body-mind split and disembodiment, or with and against the ‘myth of the isolated mind’, have found over the years - in Shaun’s words: “Cartesianism is not that easy to escape.”

What is ‘dualism’? What’s the alternative?

Dualism is when we absolutize and reify phases in a differentiating self-organising process into abstract, static, linear antagonistic categorical opposites. The opposite of dualism is Yin-Yang: antagonistic AND complementary – a systemic field and process understanding (in psychology, the closest notion would be Jung's enantiodromia - having gone towards the extreme at one end of a polarity, it turns into its opposite).

The fallacies of anti-dualism

Many who oppose and critique dualism fall into the opposite trap, what I call 'anti-split holism'. But countering dualism with more dualism is like putting out a fire by adding more fuel. We are not going to get beyond dualism by categorically opposing it, e.g. ...

  • countering the body-mind split with anti-split holism (idealisation of the body, reversal body-over-mind – "lose your head, come to your senses", bodymind unity)
  • countering classical one-person-psychology with dogmatic two-person psychology (or exclusive 'medical model' stance with categorical 'anti-medical model')


Dualisms affecting psychotherapy

The two main relationships that suffer from acquiring a static, linear, dualistic rather than a systemic, holistic process conception are:

a) mind-body relationship – body-mind split versus bodymind unity

b) doctor-patient relationship – therapy as treatment versus therapy as relationship

[Some of you may know that my own ‘resolution’ to these traditional polarisations is to think of them as paradoxical, never static, never finally resolved, but in constant, self-organising dynamic process (which I tried to summarise in a condensed hand-out “The ‘Birth Trauma’ of Psychotherapy and the Deconstruction and Transcendence of 19th-century Dualisms (2004)”).]

The Cartesian mind: the brain-in-a-vat

For the sake of simplicity, let me summarise the Cartesian mind in an image (which Shaun discusses frequently when summarising the various branches and approaches of cognitive science): the brain-in-a-vat:




When we operate from that image and presumption, a tricky existential question arises:

How does one isolated brain-in-a-vat ever connect with and understand another brain-in-a-vat?

‘Mentalising’ as the key to ‘mutual recognition’?

The answer is ‘mentalising’ – my mind forming a theory of the other mind. And some of Shaun’s writing explicitly contradicts and critiques the main approaches in the cognitive sciences that form the basis of ‘mentalising’ (‘theory theory’ and ‘simulation theory’). Psychoanalysis has, of course, its own influential version of ‘mentalising’ (Fonagy & Target), which many of us who are thinking about intersubjectivity and relational perspectives, have been strongly relying on over the last 15 years, in order to understand the developmental achievement of ‘mutual recognition’ - a key notion in relational psychoanalysis).

So, for us, one important question is: to what extent does Shaun's critique apply to the psychoanalytic version of ‘mentalising’, too?

The mind equals the brain?

The other tricky implication of the brain-in-a-vat is that thought is then, of course, completely independent from body and material reality (which is precisely Descartes’ starting point and what Shaun’s book “How the Body Shapes the Mind” is formulated to challenge). Much of modern neuroscience has this emphasis on the brain, and it is one of the frontiers of consciousness studies to distinguish between brain, mind and consciousness.

The body-oriented traditions are organised, of course, around the intuition that mind emerges via the body, a principle that we work with experientially (as well as assume as a philosophical foundation).

Post-Cartesian versions of the mind

There are a variety of diverse and overlapping approaches and attempts to reconceptualise the mind as enactive and extended and embodied and embedded.

embodied mind: in philosophy one of the main most comprehensive formulations is by Merleau-Ponty (which Shaun refers to extensively)

embedded mind: various versions which see the mind as embedded in social contexts and socially constructed

extended mind: various versions of this throughout Shaun’s writings (see also

enactive mind: see “Enactive intersubjectivity: Participatory sense-making and mutual incorporation” by Thomas Fuchs & Hanne De Jaegher

systemic intersubjectivist psychoanalysis: Atwood and Stolorow

Dan Siegel: “the mind is an embodied and relational process that regulates the flow of energy and information.” the mind is an embodied and relational process that regulates the flow of energy and information.

Principles of post-Cartesian meta-psychology:

1. body and mind are not separate (the body shapes the mind - extended and enactive mind - interactive rather than exclusive observer stance)

2. the two minds are not separate (two coupled bodyminds in cycles of co-regulation and disrupted co-regulation)

3. perception and behaviour are not separate (body schema: innate intermodal connection between visual and motor behaviour)

Questions, questions …

Even if as practitioners we 'believe' in these principles, we are then landed with several difficulties:

1. if 'mind' is extended and enactive (i.e. not clearly separate in each individual, but extending across body-brain-environment), how do we explain agency and intentionality? Jean will address that conundrum of 'agency'.

2. because we find ourselves thrown into dualism and Cartesianism (culturally, socialised into language and narrative communities), we appear to be operating within dualism (as if it's fundamentally ‘real’) and certainly many clients operate within dualisms (as if they were fundamentally ‘real’); even if we don't 'believe' that in essence human beings have to function like that, in practice we find that they do.

3. so a more embracing and realistic perspective to take might be to ask: how does the conflict between the Cartesian and post-Cartesian aspects of our being relate to each other in our experience, both in the client and in ourselves and the relationship?

4. if there is no separate, individual 'mind' (in the head, bounded by my skin), and everything happens within the ‘intersubjective manifold’ (Gallese) in self-organising cycles of enactive and extended 'mind' spontaneously, before reflective reasoning has a chance to kick in, on what basis do we reason and reflect and have agency as therapists?

Werner Prall 'My Body'? - A Caveat

Let me begin by misappropriating, mangling even, a famous saying from Lao Tzu's Tao Te Ching: the body that can be spoken is not the true body. Meaning that, when we speak of the body, it is always the body of language, inserted into a network of symbolic signification, i.e. a body that is already alienated from the alive thing that lives us. If it wasn't so cumbersome I'd be tempted to always put 'the body' in quotation marks to emphasise that this is the body as far as we speak about it, the body which, by the time it is 'mine', is not, strictly speaking, body anymore, not the animal side of us, as it were (nature also being sadly beyond us once we have become the cultured beings we human beings are). Lacan, in order to highlight this point, distinguishes between the unorganised organism of the neonate and the body as we tend to think of it. This is not 'only semantics' – it constitutes, in my mind, the heart of the problem of the body for us.

Mind gets established only at the price of a disjunction between it and the body of which, as I have said, it is an effect. By the time I am able to say I have a body, or, as many may prefer, I am a body, or, even better, I am my body I am in fact separated from it. I guess I want to claim it precisely because I sense that I have lost it. We become subjects only when we/our bodies become objects for ourselves and as we realise we/they have always already been objects for others. This disjunction, or loss, accounts for a lot of the problems we face, both in ourselves and in the consulting room.

For Freud the body and the ego (the I) are closely related; we could say they come into existence only in tandem. As he famously wrote in The Ego and the Id: 'The ego is first and foremost a bodily ego; it is not merely a surface entity, but is itself the projection of a surface' (1923, p26). If we think of the ego as located inside a psychic skin separating what is inside and outside, what is mine and not-mine, then there is also a point of identification of that body as 'me'.

But having already distinguished (as the founding moment of psychoanalysis, we might say) between the conscious and the unconscious mind, and later, between the ego and the id, now the ego's identification with the body – me in my body, my bodily me, the man in the mirror – leaves something out, if not behind. The ego is not only juxtaposed to the outside world and the other who confronts it, there is something of the body which itself has become other to it. Freud called this the drive, Lacan the Real of the body. One way of illustrating this is to point to trauma (as Freud has done in Beyond the Pleasure Principle): we can be overwhelmed by something originating in the body, our body can drive us mad, it can kill us! (And it will...)

Freud defines the drive as 'a measure of the demand made upon the mind for work' (1905, p168, added 1915); and the means with which we work over mentally what comes at us from the side of the body are primarily linguistic. Language, however, which I receive from the other (or the Other in Lacan) always precedes me. Thus it is in two senses really that I receive my body from the other.

The other is always before me. Lacan illustrates this point by evoking the scene in which the small child first recognises itself in the mirror: this is me! The ego identifies with the image of the body it sees in front of itself. This image exceeds in integration the actual experience of the body and is set up as ideal, an ideal the identification with which is confirmed by the other: yes, my lovely (or not so lovely), this is you! This moment of identification is thus at the same time a moment of alienation. Self-recognition is always also mis-recognition ('méconnaissance').

Other psychoanalytic theorists stress that it is not only via language, and not only via the image that our bodies receive their shape from the other. Handling – e.g. feeding, washing, tickling, hugging, restraining etc etc, the whole complex never-ending 'dance' that is performed in the nursery world of the small child – forms the way its body comes into being whilst the desire of the (m)other is being inscribed upon it. The child learns how the body is meant to enjoy and to express itself from others who are, of course, only partially conscious of their own desires (a point central to Laplanche's thought). Using a striking image Lear writes how parents are patrolling the boundaries of the erogenous zones of their offspring setting limits to what can be expressed and enjoyed (2005, p80). From Laplanche's perspective what is at stake here is not just the transmission of social norms but the confrontation of the child with the 'enigmatic messages' of the the parents' unconscious desire. The body-ego thus emerges between the organism and the other, or, to put the same thing differently, between the drive and language (Verhaeghe 2001).

It is part of the problem that many psychoanalysts have with the newer so-called relational schools that something essential gets left out if we forget about the drives. (Maybe we come back to that in our discussion.)

We are conceived by the other who is always before us, we receive our being, and our body from them – and I am speaking here, to repeat, not just of the physical body. Whilst we are in this sense always already alienated from an original or true self, a notion which I think we can only nostalgically dream up with hindsight, we better identify with this existence offered to us if we want to be a human, that is a social being at all. We can always put the details of this identification into question later in life – there is, thanks to Freud, psychoanalysis!

Where does this leave me in relation to the binary choice between mind-body dualism or BodyMind unity? Neither is right, in my view. To reject Cartesian dualism, as I think we must, does not lead us (back?) onto the happy fields of unity – a grave disappointment to romantics! Whilst mind is a manifestation of the body, just as 'the body' is a manifestation of mind, this does not mean there are no divisions. Clinically these often appear as a chasm between mind and body – as in the hysteric conversion syndromes, eating disorders, body dysmorphia etc; but I think this division is better understood as one between 'body' and body, or – is this the same thing? – between aspects of the mind. Importantly, however, I think of this division as structural; i.e. not only as an accident of personal history, but as constitutive of us 'embodied' human beings.

One more comment, re: embodiment. I have put this in inverted commas here, for reasons I will briefly outline. I may be the only person present who thinks speaking about embodiment is puzzling, even misguided. The definition, I looked it up in the Oxford Dictionary, since I needed a bit of support here:

a tangible or visible form of an idea, quality, or feeling: she seemed to be a living embodiment of vitality.
• [ mass noun ] the representation or expression of something in a tangible or visible form: it was in Germany alone that his hope seemed capable of embodiment.

It’s something akin to incarnation, the manifestation in the flesh of something ideational. I think to make sense of the idea of embodiment one has to presuppose the division one is trying to get rid of. Am I embodying the idea of me, which would, in that case, be primary? I don't think so.

I am not embodied. If anything my body is en-I’d, or, maybe better, minded.

Unless I got this wrong.


Freud, S. (1905) Three Essays on the Theory of Sexuality. SE 7.

Freud, S. (1923) The Ego and the Id. SE 14.

Lacan, J. (2002 [1966]) Ecrits. New York/London: Norton.

Laplanche, J. (1999) Essays on Otherness. London/New York: Routledge.

Lear, J. (2005) Freud. London/New York: Routledge.

Verhaeghe, P. (2001) Beyond Gender. New York: Other Press.

Mirror neurons and embodied simulation

1.Theory of Mind (ToM)

What children “are acquiring in developing ToM is an understanding of patterns of action in which they are already participants”
Astington 2002

“Meaning, understanding and rationality arise from and are conditioned by the patterns of our embodied intersubjectivity.”

Johnson 1987

2. Embodied simulation

We do not need to translate another’s actions into a mental representation - we know what it means directly through the activation of our own mirror neuron
system and the same motor and intentional pathways in our own brains that correspond to the intentions and actions of the other. This does not just apply
to motor actions but also to emotional intention.

“Both observation and imitation of the facial expression of emotions not only activate the same facial muscles but also activate the same group of
brain structures.”

Carr et al. 2003

3. Empathy

‘feeling with’: the observer’s emotions reflect affective sharing and imitation

‘feeling for’: the observer’s emotions are inherently other-oriented and so give rise to empathic concern and mentalization

“Through introjection, an analyst perceives a patient’s unconscious processes in himself and so experiences them long before the patient is near
becoming conscious of them.”

Fordham 1996

4. Mathieu Ricard and colleagues:

empathy training increased negative affect and brain activations in regions associated with empathy for pain

compassion training could reverse this negative effect and augment positive affect and increased activations in a different network

5. Two types of mirror neurons

Strictly congruent mirror neurons
respond to identical observed and executed actions and may be critical to imitation.

Broadly congruent mirror neurons
respond to non-identical observed and executed actions and so create in the observer the complementary action to that of the other person.

6. Countertransference rooted in embodied simulation processes

The birth of shame lies in ‘not being able to evoke an empathic response in the other’ (Mollon, 2002)

Therapists need to learn to work with both their concordant and complementary countertransference experiences, rooted in the embodied simulation processes
of the mirror neuron system.

Birgit Heuer: Embodied Being and Intersubjectivity in the Consulting Room


My presentation covers the two themes of this day: body and intersubjectivity. The first part of my talk addresses the body, in terms of two very different ways of approaching it. When I trained as a body-psychotherapist, in the late seventies, body-work was known as a ‘fringe therapy’, and we were very aware of its marginalized status. All that has changed, of course, and the body has been increasingly received by the analytic approaches. For instance, all International Jungian Conferences now include body-movement workshops, and techniques such as cranial osteopathy are increasingly recognized. The bodily dimension features in Jung, and several Jungians have addressed it. However, the analytic clinic tends to employ the body chiefly as a carrier of meaning.
Conversely, I want to suggest that we need to distinguish between the body, and the actual experience of being embodied, for speaking of ‘the’ body suggests an object in the mind, whilst body as being evokes its very experience. I shall thus discuss embodied being and, in addition, frame it as a developmental capacity.

Training in two modalities, in my case body-therapy and Jungian analysis, exposes a therapist not only to different theories, but also to differentclinical values. In body-psychotherapy, the experience of embodied being is recognized and fostered, in other words it is an implicit clinical value. Conversely, mainstream analysis does not seem to register being-based experience in its own right, except negatively as part of dissociative or borderline pathology. One of my concerns is to introduce what might be called being-based values to the analytic clinic. Whilst it is useful to think about the body symbolically, or it may be emancipatory to theorize it socio-politically, the people who come to see us might need help in strengthening their very capacity to be. It is therefore important to articulate the distinct qualities of embodied and being experience.

The second part of this presentation considers intersubjectivity and its relevance in clinical work. In the context of a doctoral thesis, I have conducted research into the relational aspects of the clinical hour. I have researched clinical case histories, using textual and narrative analysis, and come up with the relational messages and attitudes implicit in clinical writing. Even at first glance, terms such as resistance connote the language of military conflict, and indicate a conceptual frame, which is oppositional in structure. My textual research indicates a tacit pre-clinical dimension with implicit attitudes and views which are very different from the benign values of clinical theories. In order to bridge this gap, I have coined the term relational sensibilities, which frames the relational qualities of exchanges in the consulting room.

Like embodied being, a parameter of relational sensibilities is an experience-near way of conceiving things. It provides a foil for assessing the relational qualities of communications from therapist to patient, which usually are not reflected upon. In the analytic approaches, we are currently at what has been termed ‘the relational turn’ of analysis. This has involved much rethinking of ‘the’ therapeutic relationship, similar to the analytic reception of ‘the’ body I mentioned earlier. Both are helpful developments, however, they are not conceived in a way that is sufficiently experience-near. Parameters such as relational sensibilities focus awareness on the subtle qualities and relational messages of how we speak to our patient in the consulting-groom, an aspect that tends to be overlooked.
Supervision, for instance, ordinarily includes intricate reflection on our patients’ processes, as well as consideration of transference and counter-transference dynamics, but it is unlikely to encompass the subtle relational messages of our own tone of voice, body language, facial expression and the words we use. These, however, are the chief carriers of communicating relationality, and we need experience–near concepts, such as relational
sensibilities, to be able to think about them. Otherwise we risk grafting new relational theories and ideas onto old relational sensibilities.

Embodied being

I shall now return to my first theme, embodied being. Is it possible to define the experience of embodied being? This seems akin to catching a butterfly.
As a quality of experience, being needs to be evoked rather than defined. For this purpose, I would like to invite you to imagine the state we enter just before falling asleep. We become more and more relaxed, perhaps more aware of our body, aware of some of its tensions too, aware of thoughts and feelings left over from the day, before letting go and drifting off into sleep. We are relaxing, yet aware and this is an example of abeing-based state. We are linking with our being. Something similar happens in meditation, where awareness and being come together not as awareness of but awareness in being.

In body-psychotherapy, close attention is paid to both body-impulses and spontaneous, involuntary movement. They may guide the theme of a session, which then arises out of the patient’s being experience. Conversely, the aims informing the analytic clinic, at present, centre on making meaning and relating.
Experience on a being-level is not usually valued in itself, and clinical accounts tend to reduce them to their meaning. As others have noted (Plaut 1993), clinical accounts tell us what it said, rather than how it is said, in tone of voice and body-expression, nor do they tell us how a comment might impact on our patient’s embodied being. Somatic experience tends to be reduced to its archetypal or symbolic aspects which emphasizes knowing and minimizes embodied experience. The idea of somatisation, for instance, implies bodily expression is valued less than its verbal equivalent.

I think it important to positively include the dimension of being. This enables us to perceive our patients’ states of being and their embodied experience. Making meaning then is complemented by linking with one's being and deeply experiencing ‘what is’.

Amongst analytic approaches, Winnicott’s developmental theory stands out in conceiving being as a capacity acquired in infancy. His model describes the intricate ways in which we might learn to experience ourselves embodied. Here the dimension of being features in its own right, rather than as an aspect of the developing mind. Winnicott describes three stages of development, which are termed integration, personalization and object-relating (Winnicott 1945, 1962). For reasons of time I cannot deepen this today, except to say that, in Winnicott, embodied being is a recognized both as a quality and a capacity. However, this does not automatically render it a clinical value. In analytic clinic practice, there is still a gap between ‘the body and the living experience of embodied being. My conclusion for the moment is that there is a unique clinical expertise offered by the body-therapeutic approaches to do with embodied experience which analysts might avail themselves of, to deepen our own learning and enable that of our patients.

Relationality – Intersubjectivity

I shall now return the second of today’s subject’s intersubjectivity and relationality.

I have briefly mentioned my textual research of clinical case material which reveals a tacit, generic pre-clinical dimension that impacts on the relational qualities of the clinical hour. This dimension, I have termed clinical paradigm. Clinical Paradigm is a notion developed through the critical philosophy of science of the previous century, Foucault (1970), Habermas (1968), Kuhn (1962) and Polanyi (1968, 1975). These philosophers concur in arguing a dimension which precedes and pre-constitutes scientific undertakings, irrespective of empirical or hermeneutic methodologies. This dimension contains views and values which may be summed up as a tacit and generic pre-clinical bias. This is important because my research indicates it is largely this tacit pre-clinical dimension which influences relational sensibilities in the consulting room. Importantly, such sensibilities are not guaranteed by an approaches’ theoretical outlook, nor by its clinical theories, however emancipatory or helpful, for the actual, yet subtle, relational ‘feel’ in the consulting-room often differs considerably. Sensibilities register in the tone and language therapists use, and in their non-verbal communications. My research indicates, relational ‘feel’ is determined by a therapeutic approaches’ implicit attitudinal bias, and this is researched by analyzing the language and narrative employed in clinical accounts.

As therapists, we are induced into specific sensibilities during training, which express the underlying views and values of our approach, which trainees are required to identify with. Such views, though, are pre-clinical in nature, for they contain ontological and socio-political views, as well as weltanschauung. Importantly, they are largely learned without words, yet become bound up with what is regarded as professional competence. As a result, practitioners with alternative views, or those wishing to innovate, may easily be viewed as lacking in professional competence, when the issues at hand are actually about making changes to pre-clinical bias. This indicates that pre-clinical bias is a highly political issue. At the same time, from the perspective of the philosophers mentioned, no therapeutic approach is without bias, but it is important to become aware of it, for the qualities of the relational ‘feel’ in the consulting-room are directly related to pre-clinical bias.

I would like conclude on a different note, though. My research indicates in the analytic clinic we lack positively substantiated notions of health, for it is currently conceived through the negative, or as absence of pathology. This has led me to propose an alternative pre-clinical basis, termed deep positivity, which is another political issue. Deep positivity addresses the lack of publicity, both in the press and society at large, of information, which strongly suggests a world-view, where positive dynamics might be much more prevalent, than we are currently led to believe. Thus positive stories are not regarded as newsworthy, and research like Steven Pinker’s (2011) on the significant decrease of violence over time is marginalized. Deep positivity is able to assert a more hopeful outlook that concurs with Pinker. In my experience, such views foster calm and confidence, which are empowering, for overwhelmed and terrified citizens are likely to be
either more passive or extreme.

In addition, the notion of deep positivity frames the difference of relational exchanges which revolve around power as distinct from those informed by love. This enables understanding racism, sexism or fundamentalism as acts of relational transgression, by directly or indirectly asserting power over another. Conversely, in Levinas (1986), whose philosophy has recently emerged in psychotherapy , the otherness of the other is sacred. Situating the holy in otherness adds a spiritual layer to relational sensibilities. Sensibilities which emphasize the principle of love as distinct from that of power, and include love of otherness, are then politically relevant.

In the psychotherapeutic clinic they inform a re-envisaged pre-clinical dimension which enables deepened awareness of subtle relational processes, catching them up, where necessary, with helpful or innovative theoretical ideas. One way of translating this is to conceive our patients’ otherness as sacred, rather than conceiving their otherness through what might be wrong with them, i.e. pathology. However, this does not mean we have to relinquish analytic maps of the psyche which have been honed over more than a century. The points made are specific to analytic clinical practice. Considering this from the point of view of relational sensibilities and implicit notions of otherness is an important step towards adjustment. To end on a traditional Jungian note, in the language of the grail myth, the transformative question ’what ails you’ gently recedes, and re-emerges as ‘what heals you?’


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By |2017-06-09T20:22:47+00:00July 5th, 2015|Michael's Psychotherapy CPD Blog|0 Comments

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