The Healer’s Bent: Solitude and Dialogue in the Clinical Encounter (Book Review)

Author:  McLaughlin, James T.
Publisher: The Analytic Press
Reviewed By: Harriet Basseches, Winter 2008 (Vol. XXVIII, No. 1) pp. 50-52

James McLaughlin’s book follows his personal and professional history to create a memoir cum psychoanalytic know-how practicum. It was edited by William Cornell. The chapters include material spanning the many decades of McLaughlin’s working career as a psychoanalyst, dating back to the Second World War. However, the book was compiled at the end of his career and is full of wisdom born of sometimes painfully acquired experience. His journey and evolving point of view are etched clearly on the pages. The reader has the sense of being in the presence of a very thoughtful, sincere person who has earnestly tried to do his very best. Although I myself did not know him personally, I feel confident that he would strike anyone who met him as a genuinely fine person. Regretfully, he has died since the writing of this book, and I have lost the opportunity to meet this admirable colleague.

To characterize his theoretical position, he might be called a self psychologist wrapped in a Freudian cloak. His own words, expressed in the preliminary acknowledgment forward of the book, capture his sensitivity to narcissistic issues when he comments: “…it may be better to name no names lest omission be felt as a slight.”(p. vii-viii) And in that same section, his volunteering of what might be called his mantra portrays his balanced devotion to his patients: “AIM-INHIBITED LOVE” (p. viii, capitalization and italics in the original text).

The twelve chapters of the book are divided into four sections: The first, an unnamed introductory section of four chapters; the second, entitled “What was Wrought: Self-Analysis;” the third, entitled “What was Sought: Nonverbal Communication,” and the fourth, entitled “What was Thought: The Dialectics of Influence.” I found the first part of each of these subheadings distracting, although the subheadings successfully illuminate certain basic concepts dear to McLaughlin. Putting aside each dramatic opening phrase, they do catalogue important ideas for McLaughlin of what goes on in the analytic experience: the crucial value of self-analysis; the significance of the body and its movements to the analytic work; and the ever-present intersubjectivity.

The title of the book also requires mention. The main title—The Healer’s Bent — refers to McLaughlin’s belief that his work as a psychoanalyst was a “calling” and stood in identification with a medical doctor father who was lost to him 6 weeks into his infancy—a father who died while administering to the community in the time of a flu epidemic. The second part of the title—Solitude and Dialogue in the Clinical Encounter— portrays the intertwining of his personal experience with his understanding of his analytic work. McLaughlin relays the many hours he spent in solitude, mulling over elements of analytic hours that disturbed him. He recounts the time spent alone, particularly when in mechanical activity, gardening or building a lattice fence, or even painting, during which he would suddenly come upon an insight into the meaning of some analytic element of a session. Each time the new thought would direct him to recall some relevant aspect of his own history that made comprehensible the troubling aspect of what was going on in the session. These epiphanies would emerge unbidden from unconscious processes, not intentional thought about the work, so that he came to prize those times of self-analysis as critical to his work as a psychoanalyst. In passing, I mention that the artistic work was painting bird forms on eggs. Examples of the eggs are shown on the cover of the book: They are spectacular! This was a man who obviously had many talents, and his patients were fortunate that he chose to integrate his capacities into a career as a psychoanalyst.

From the introductory chapters we learn that Dr. McLaughlin was raised in a large Irish Catholic family, all the other children girls, by a mother who was at once both devoted and demanding of high standards and periodically depressed following the death of her husband. McLaughlin apparently grew up fearful that his own aggression might harm someone, a concern that reverberates in his adult professional work. We also learn of his early psychoanalytic training in Philadelphia and his further psychoanalytic experience as a graduate and later training analyst working in Pittsburgh. He describes the early training as leading him to an understanding (later abandoned) of his role as being authoritarian, superior, the expert, focused on helping the patient see his/her infantile conflicts. These descriptions lend support to the picture of the cold, silent, unmoved, aspiring-to-be a blank screen analyst. If McLaughlin had not taken such pains to describe his need to rid himself of so much of his early training, I would be skeptical that such rigid technique existed; rather I would consider it as an exaggerated stereotype —a myth.

Dr. McLaughlin, however, is explicit in his portrayal of his slow evolution away from his early ego psychological training roots to his later more flexible approach. In his later work, he continues to claim Freud’s centrality, but it is a personally defined interpretation of Freud. He leaves behind the all-knowing stance to focus increasingly on what the patient is telling him and what the interaction produces in both patient and analyst. Along with this development, he describes his two analyses. The first is an analysis with a male analyst in the more rigid Freudian mold, which the author, nevertheless, acknowledges was greatly beneficial. The second analysis was with a female analyst, whose theoretical orientation and manner more closely resembled that of Evelyne Schwaber’s patient-focused approach. He explains that as a result of this second analysis, he was able to become more comfortable with his feminine identifications, and to consolidate a profoundly different way of working analytically.

In his many clinical examples he returns repeatedly to the mutuality of the process: his awareness of how his behavior with the patient is induced by his own resonance with the patient’s behavior and conflicts that have awakened unresolved facets of his own early (and later) conflicts. When he is able to pin point the matter in his on-going self-analytic activity, impasse dissolves and new clarity in the treatment is reached. He stresses his willingness, at such times, to take responsibility for his errors in what he considers mutually induced enactments. As mentioned above, McLaughlin feels strongly that there is, in the psychoanalytic endeavor, mutual influencing that goes on throughout the work and is crucial to conceptualizing what is going on. From this position, he expands the meaning of countertransference (a term he does not actually like). In a first step his thinking embraces the earlier derived, narrowly understood, meaning of countertransference as the intrusion of the analyst’s own conflicts—not just infantile conflicts but conflicts throughout the life cycle—getting in the way of the analysis. He then adds a dimension of mutual enactment that makes the countertransference—or as he calls it, the transference responses that each member of the analytic dyad experiences and responsively enacts—into a path to understanding the patient. With this shift, he creates a more contemporary definition of countertransference.

It is important to mention his interest in the body and the expressiveness of the body as unconscious communication. For a period of time, he attempted informal research during the sessions to try to see if particular body movements correlated with the words that were spoken. Although he abandoned the effort to do this systematically, he continued to be convinced of the power of the bodily actions to express meaningful emotional content of his patients. Because their actions were often out of patients’ awareness, he worked with his observations in a highly circumspect way. Sometimes the results were strikingly useful, while at other times his attention to body language caused shame filled reactions in the patient and painful disruption to the alliance. His honesty, transparency, and willingness to acknowledge his errors (in this case not only to patients but to his audience of readers) reflect his courage and perhaps his masochism. The intent of his revealing self-reflection is the hope that his honest reporting will provoke further psychoanalytic understanding.

Another brave disclosure that he makes is of his willingness to touch the patient in a non-sexualized way if the occasion has important meaning. I found his view refreshing and open. Yet, as with so many of his ideas, I also felt a twinge of concern that in the hands of a less skilled practitioner, or one with less integrity or greater pathological conflicts, the occasions for touching could potentially be misconstrued or even harmful.

McLaughlin speaks about the analyst’s dumb spots, blind spots, and hard spots as forms of blindness that impede the work. He defines the dumb spots as deriving from ignorance, the blind spots as coming from the analyst’s conflicts. The hard spots he sees as the blindness that comes from the analyst listening from a fixed position, as in theoretical preconception, that inhibits the analyst’s ability to hear the validity of what the patient is saying and therefore keeps the analyst from being with the patient.

I will close with a comment on who might benefit from this text. First, of course, those studying psychoanalytic technique can learn much from McLaughlin. Second, the relational analysts might find McLaughlin’s packaging of Freudian conflict theory more acceptable, no less than modern Freudians might see relational ideas in a fresh light. Here is an opportunity to see a successful interweaving of relational ideas with more traditional Freudian thought.

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