Making Sense Together: The Intersubjective Approach to Psychotherapy (Book Review)

Author:  Buirski, Peter and Pamela Haglund
Publisher: Northvale, NJ: Jason Aronson, 2001
Reviewed By: Elizabeth L. Shane, Fall 2001, pp. 52-53

Perhaps an appropriate way to begin a review of Buirski and Haglund’s Making Sense Together: The Intersubjective Approach to Psychotherapy is with a subjective vignette. Beginning the text, I found myself distracted by the knowledge that my personal relationships with both authors would bias my critique. I wondered if my praise might be lavish and criticism muted to avoid jeopardizing these relationships. Less easy to acknowledge was an uncomfortable mix of feeling jealous of their creative success, and a sense of both trepidation and exhilaration about “grading” a former professor and a peer. Making Sense Together helped me understand that from the intersubjective perspective, this is exactly as it must be: there is no escaping subjectivity.

What immediately distinguishes Making Sense Together from other books on psychoanalytic theories is the authors’ elegant use of language to communicate their ideas. In parallel process to the psychotherapy relationship they espouse, their considerable talent in using clear prose unburdened by jargon invites the reader to make sense of this therapeutic approach with them.

As Buirski and Haglund elucidate, one of the givens of intersubjective theory is that subjectivity necessarily informs all that we do. This theory holds that any view of a person, event, or thing without distortion by personal feelings or prejudices is not possible. While we can call into question and assign relative importance to the various components that make up our perspective, these influences cannot be eradicated. Nor should they be. It is from our earlier lived experience that we develop subjectivity and return to each new interpersonal situation bringing these patterns of experience.

“Buirski and Haglund proclaim early in the text that the emergence of intersubjective theory “is the basis for a theoretical revolution in psychoanalysis:” This assertion means that the personal ways in which we have come to view and experience ourselves, both privately, within our skin, and as we move among others, are all that can be understood through the psychoanalytic dialogue (p. 4)”

What is radical here is the authors’ call to overthrow the traditional focus of psychoanalytic inquiry. They dismiss the value of a pre-existing theoretical framework, replacing assumptions about the universality of psychosexual conflicts and development arrests with a focus on intersubjectivity, “the complex field that is created when two or more individuals with their unique subjectivities come together” (p. 4). Thus, the concepts, terms and inferences of intersubjective theory grow out of the moment-to-moment experience of others and ourselves within a relational matrix of bumping subjectivities. Like a Venn diagram in motion, relationships are comprised of separate subjectivities dynamically interacting with overlapping influences.

Of great value for beginning therapists and seasoned clinicians alike is the author’s use of meaningful illustrations and clinical examples to distinguish the intersubjective approach to therapy from both traditional and contemporary psychoanalytic schools. The authors utilize their breadth of psychoanalytic knowledge synthesized from years of teaching and supervising in graduate and post-graduate academic settings and clinical practice. Indeed, their rethinking of standard psychoanalytic terms brought me up against my own somewhat inflexible patterns of organizing clinical data. They disentangle concepts like “interpretation” and “empathy” from the restrictive meanings rooted in psychoanalytic theories inferring an “objective” reality. As the authors state “one cannot derive objective reality from subjective experience” (p. 134). What is evident throughout this book is Buirski and Haglund’s keen use of language that illuminates the congruence between intersubjectivity theory, the concepts used to describe it and the therapy grounded in this perspective. Expanding its application to psychotherapy supervision underscores the complexity of factoring in multiple subjectivities.

The intersubjective approach to psychotherapy begins with unique assumptions and inferences:
  • Striving for health spurs much of human behavior,
  • Problems are seen as adaptive solutions to a complex system 
  • Affect is a prime organizer of experience 
  • Subjectivity emerges within the intersubjective context of early repeated experiences of emotional attunement and misattunement with caregivers 
  • These early lived experiences develop into personalized schema we prereflectively employ to manage interpersonal relationships

Buirski and Haglund elegantly assert that the goal of intersubjective therapy is to make sense together. Stated differently, therapy aims to “illuminate the underlying organizing principles from which the behavior derives, not modify the behaviors” (p. 32). The target of therapeutic action is the patient’s unfolding subjectivity. Change is inferred to occur as the result of the therapist/patient dynamic mutual influence in understanding the latter’s early organization of experience and replications in present relations. The authors define the therapist as an active participant in articulating the patient’s subjective experience of being understood, and regularly providing attuned responsiveness to the patient’s affective states. By serving to disconfirm historical patterns of relating, therapy stimulates new meanings to previous relationships and creates new expectancies for future ones: “Repeated experiences over time of feeling understood by her therapist would promote greater self understanding, integration of affect, and an enhanced sense of self-cohesion and self-esteem” (p. 87).

The authors point out in Making Sense Together that, by definition, subjectivity entails individuality of perspective. Therapy from an intersubjective perspective will be characterized to a degree by the interactions of specific personalities of the therapeutic dyad. So it is that I comment on this text influenced not just by my personal connections with the authors but from my individual life experiences and relationships, and clinical training and work.

I found Buirski and Haglund’s dismissal of developmental imperatives problematic. The authors alternately rely on and reject the value of universal developmental sequences or stages. Granted that subjectivity entails particularity and therefore, by definition, excludes the notion of everyone without exception. However, subjectivity as comprised of repeated experiences of differing emotional quality within the caretaker-infant dyad seems to infer a developing sense of relatedness, individualistic or not. That development, the variance of which is influenced by singular characteristics of the particular pair is nonetheless configured within a matrix of physical, cognitive and emotional maturational milestones. Indeed, Buirski and Haglund seem to infer as much when they refer to “developmentally formed unconscious organizing principles” (p. 124). Future exploration of the biology of subjectivity would more solidly ground their position.

In addition, I found the authors reliance on the traditional term “patient” oddly reactionary. Given the irreconcilable divide between the intersubjective approach to psychotherapy and the medical model from which the term derives, I wonder if that word so pregnant with theoretical inference can ever be given new meaning.

Reviewer Note

Elizabeth L. Shane, PsyD is a licensed psychologist treating children, adolescents and adults in Denver. In addition, she provides assessment and treatment for homeless youth at Urban Peak Shelter.

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