Practicing Intersubjectively (Book Review)

Author:  Buirski, Peter
Publisher: Rowman and Littlefield
Reviewed By: Peter Kaufmann, PhD, Winter 2006, pp. 33-34

The major point for me of Peter Buirski’s book, Practicing Intersubjectively, was brought home while I was teaching. Like Dr. Buirski, I was brought up as a Freudian and have evolved, through different incarnations, into an intersubjective systems practitioner. In this postmodern age of psychoanalysis, I have been interested in integrating contrasting perspectives, however disparate, in an effort to create a balanced approach (as well as to achieve some hard-won self-continuity). Consistent with this spirit, I was presenting an article written by an eminent Freudian to my students, a group of avid intersubjectivists, in which the author was arguing that the therapeutic action in his case could be explained by intersubjectivity theory. He convincingly maintained that his overall attitude towards the case, which had been implicit in his interpretations and other interventions, had accounted for the therapeutic success. A good integration, right. Yes, but... my observant students cautioned, he didn’t fully appreciate how the context had contributed to the patient’s experience and the therapy process. What about the therapist’s delay in beginning the treatment, his privileging of sexuality and the Oedipus Complex, his avoidance of direct comforting? Didn’t these factors impact, didn’t they reflect unexamined aspects of the therapist’s subjectivity, including isolated-mind assumptions, which skewed and limited the process. Yes, I affirmed, my eyes opened wider to the distinctness and uniqueness of the intersubjective systems perspective.

My students’ critique captures the emphasis of Buirski’s writing. In this compilation of articles, he repeatedly demonstrates how practicing intersubjectively involves considering how the context is affecting people’s experience and that this approach cannot be integrated with perspectives which maintain isolated-mind assumptions. He simply asserts, “that whatever emerges clinically can be understood only as a phenomenon of the field consisting of both participants” (p. xviii). Writing with a range of collaborators, he practices intersubjectively in two principal ways. He reconsiders Freudian cases from his intersubjective systems perspective and he applies this perspective to cases which reflect a range of current social concerns, including racism, prejudice and trauma. The net effect is
bracing, causing me to pause (much as my students’ critique did) and rethink many situations in terms of a consistent and thoroughgoing consideration of how context (present and past) impacts on experience and behavior. Have you deconstructed enough, really identified all the assumptions you are bringing into a situation and how they affect it? (Just think about the assumptions you are bringing to your reaction to my review so far.)

In reinterpreting Freudian cases, Buirski contributes to the literature on comparative psychoanalysis. Reviewing Silverman’s case of Miss K. (Silverman, 1987), he effectively shows how Silverman’s isolated-mind assumptions about Oedipal sexuality and masochism and his unexamined countertransference frustration lead him to retraumatize Miss K. during a therapeutic impasse and reinforce her tendencies toward pathological accommodation. Reconsidering Freud’s famous case, The Wolf Man, Buirski and Haglund convincingly demonstate that Freud’s assumptions about sexuality and his own self-object needs in relation to Pankejeff prevented him from appreciating Pankejeff’s developmental needs and his unresolved mourning. This chapter leaves you with a wistful sense of what the Wolf Man¹s treatment might have been if Freud had appreciated the yearning and the dread of loss which lay behind Pankejeff’s “obliging apathy.” (To top off his intersubjective critique of Freudian approaches, Buirski presents an interview in which his use of a structural theory approach inflicted narcissistic injury and evoked considerable defensiveness while his shift to an intersubjective stance enabled the subject to became more organized and self-reflective.)

In applying intersubjective systems thinking to a range of current cases, Buirski not only addresses socially relevant concerns, he also indicates how a “collision of subjectivities” in treatment is frequently necessary to facilitate change. By using the term, “a collision of subjectivities,” Buirski is referring to a process in which the therapist presents a person with an alternative view of themselves which challenges their characteristic perspective. This challenge is part of the two-fold process of making people aware of their assumed organizing principles and helping them to develop alternative ones. In two of the cases, the therapists enabled the person to change by implicitly and explicitly challenging her view of herself as worthless and defective. One young woman, a trauma survivor who had been violently mugged, could only truly process the impact of the trauma after she had challenged her historical view of herself as being invisible and disposable and come to value her emotional experience. In appreciating the co-determining impact that organizing principles have on experience, Buirski effectively balances his emphasis on the role of context. These case presentations then, can serve as a useful answer to some critics of intersubjectivivity who I have encountered who try to dismiss this approach as being too environmentalist. As a further example of this balance between context and organizing principle, Buirski and Ryan analyze how a woman’s tendency to be prejudiced in certain contexts reflects her vulnerable self-organization, with her resorting to prejudiced attitudes serving multiple self-protective and self-restorative functions.

Buirski rightly places Practicing Intersubjectively in the theoretical tradition established by Stolorow et al., with their emphasis on understanding development and treatment in terms of the interaction and mutual influence amongst the involved subjectivities. This book represents a rich application of the intersubjective systems perspective to a wide range of clinical situations, helping to ground clinicians who may find some of the intersubjectivity literature too abstract or philosophical.

I’d like to end with a final note to tweak, but certainly not to collide, with Buirski’s overall contribution. In delineating what distinguishes intersubjective practitioners from therapists who espouse other perspectives, Buirski asserts that intersubjectivists are distinguished by what they do not say or do, rather than by what they actually say or do. Aware of the relativity of their perspective and seeing their patients as ultimately striving towards health, they avoid taking an objectivist stance and they eschew pathologizing. Here, I think, Buirski is only partially correct. In understanding and intervening from an empathic stance, which is informed by assumptions about people’s striving towards mental health and need for affect attunement, as well as other so-called developmental experiences, the intersubjective systems therapist does do many things, which reflect particular preconceptions. Many of these assumptions reflect the self-psychological orientation which intersubjective systems theory retains. So, we too are implicated in our treatment processes. In his many case examples, Buirski stresses the beneficial therapeutic impact of practicing these assumptions. But are there detrimental effects too in particular cases, especially in cases which don’t go so well? In the evenhanded, deconstructionist spirit of intersubjectivity, it would be interesting to consider problematic cases in which practicing intersubjective assumptions could be seen as having negative effects. Possibly a project for Dr. Buirski’s next book? Until then, keep Practicing Intersubjectively.

Peter Kaufmann is faculty and supervisor at the Institute for the Psychoanalytic Study of Subjectivity (IPSS) and the National Institute for the Psychotherapies (NIP). He is in private practice in New York City.

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