Lucila Rodriguez of Agnese, Director of GUIAS, hostess of Dr. Kraemer during your stay in Buenos Aires

 

From the "Cathedral" of London psychoanalysis, a renowned consultant speaks of his experience "systemic-kleinian" with families. Their original and disruptors views were developed in this exclusive interview with Systemic perspectives by the Dr. Sebastian Kraemer of the Tavistock Clinic, during his visit to Buenos Aires.

S. KRAEMER. -Want you speak first of the Tavistock?

C. DES CHAMPS. -Yes, then I'll ask questions about your specific work.

S.K. - The Tavistock is the only public dedicated to psychoanalysis, England clinic because psychoanalysis, you know, it is generally a private practice, but the Tavistock is exclusively public, the Government pays the salary of psychologists, psychiatrists, etc. Almost all the work is or is related, for psychotherapy psicoanalítica… in the past twenty years have developed systemic groups in the Department of children. Well, I was not from the beginning, then was a student of medicine, but I think that one or two people from there went to New York and, for one reason or another, they began to train people in family therapy, and there were major conflicts because they used videos and camera Gesell, and people wondered: "How can you do this?" "Patients have fantasies about the video and the camera". Well, they did it, moved on, and currently have a great prestige in the training in family therapy.

C.D.ch. -This comes from United States or...?

S.K. - As I see, since 1977 when I am with them doing family therapy have various influences: Virginia Satir, Harry Aponte, Salvador Minuchin, Luigi Boscolo and Gianfranco Ceccin of Milan, that was my education, from structural to systemic, family therapy begins to be respected in the Tavistock. In the children Department, where I am a psychiatrist, there is a large group of family therapy, the systemic group, and a large group of psychoanalytic psychotherapists.

C.D.ch. -They work with families also?

S.K. - Not much, mainly working in individually. They also work with families but not in a strategic way, they work with the countertransference, etc. I think that the psychoanalytic in the children Department Group is very interesting because they are mainly training psychotherapists in children, there are several disciplines, social workers, psychiatrists, psychologists, continue to Melanie Klein.

C.D.ch. -do Melanie Klein?

S. k. - Yes, these are the two main parties in that the children's Department is divided: Klein on one side and family systems on the other. What is interesting is that both work in the "here and now", you know, Klein is no historicist, that is important, and what I see as most interesting from my experience is that these two traditions work well together, and have much to offer each other, although the styles are different. The kleiniano style is serious, there are not many laughs, but it is very inmediato… is not a historical reconstruction. We have a small group of psychologists, social workers, trained working agreement with… well, really "makes what can!","Yes, makes what can!". I think it is a good way of working if you can harmonize with each other, so that we do not have a school of thought in this small group. You were here overnight? (Refers to consultations that made Dr. Kraemer during your stay in Buenos Aires, in the framework of its educational demonstrations at the Institute guides - group University of Exchange, interaction and assistance in Mental Health-). Well, the morning and afternoon the three cases I showed were individual therapies. In the end, all finished as individual therapies, and for my this is perfectly systemic; Finally, individual therapy is correct in these cases and that's not anti-systemic, because systems include individuals and the work you do with them.

C.D.ch. -Interesting, but tell me more about Melanie Klein and the systemic.

S.K. - I think the answer is that I do not at the same time. In the here and now systemic are looking at people and how it relates to each other; in the here and now kleiniano you are looking at yourself, obviously the transfer is more active in the fourth, and if you're the patient and the therapist myself, I'm thinking all the time what you're thinking about me, when working in this way I feel uncomfortable, I transpired, because the patient is interested in me. But when I do family therapy they are not interested in me, are happy to answer my questions, but I can assure you that they are interested in them. It is different, but we are always talking about the present, of course, you can ask questions about the story, etc., but the main therapeutic force is what the people are thinking now, what they think about each one of them. That's another thing that connects Melanie Klein with… "melanosistémica" therapy is the emphasis on the thinking of problems and feelings. I think that from w. Bion, he was patient of Klein, was famous for his work with groups, although it left him in 1948 and continued doing individual psychoanalysis... and his contribution, as I see it from the outside, is how people think, how he thinks about his feelings, but how to think. Similarly, if you talk to a family on each of them, in a systemic way, I prefer to ask "What think?" on MOM and dad, more "Does that feel?".

C.D.ch. -Why?

S.K. - Because the feelings are something private and people can't explain what they feel, they say "good", "bad", "cold", "warm", but if you stared them what they think you are going to get their views, and this is something typical of humans, you can not ask an animal what they are thinking, but you can imagine asking an animal how it feelsa cat could say frightened, comfortable, but there is no point asking him what he thinks. I believe that the traditional view of the therapy around the world is good that…, you have a person with particular feeling, cries and that's it, cries for his mother and gets better. I think that it is not therapy, I think therapy is when you think about what you feel and when you have an experience, the therapeutic is new thinking, emotional, thought and I think that this is the basis for a change in any kind of therapy, cognitive experience.

C.D.ch. -in systemic therapy uses the redefinition, what do you think about this technique?

S.K. - As I understand it, the redefinition is the basis for all therapies. The redefinition takes place both psychoanalysis and systemic family therapy. When someone has a confusing experience, about himself or another person, redefining torna least confusing what's new. I mean, it may be more confusing, but it is new. I think that to make it therapeutic must be related to unconscious fantasies, i.e. do not agree with any kind of redefinition, it has to do with the relationship, and correct redefinition is approaching the fantasies of the same way both in psychoanalysis, structural, strategic, systemic therapy, even though the therapist do not know, from my point of view, we are all psychoanalysts although we do not use the transfer, or other psychoanalytic techniques, do it... I'm not talking about the MRI, I think that they are genuine behavior therapists, I am not sure to understand his work, but I think in other therapists I know, Minuchin, Palazzoli, Haley, etc., represent a new understanding of the relationship, so that I can combine my understanding psychoanalytic and systemic thinking.

C.D.ch. -When you talk of unconscious, fantasies does mean that you're looking those fantasies for the work?

S.K. - No, that's the difference technique in psychoanalysis consists in seeking these unconscious fantasies, what I say is that in systemic family therapy these unconscious fantasies are mobilized, but are not wanted, and this is the important point, we speak of experiences but we try not to locate us in the heart of another person, we say directly: and why I think that systemic therapy is a redefinition of psychoanalysisbecause you have a new perspective on an old idea, and of course the method is different, although I believe that the principles of the therapy are the same. So it's a different position, a different activity, different feelings, but I think the effect is the same.

C.D.ch. -is interesting, because I think that Bateson or Milton Erickson did not think about it.

S.K. - I think not. And the reason why I think that they did not is because psychoanalysis in the United States.UU. It is quite primitive, conservative, expensive, they don't have psychoanalysis resolved by the State, the Tavistock being public is more flexible, is one reason, but I also believe that the English school is more creative, perhaps because it has more mixture between Melanie Klein and Anna Freud and all those that followed them, Bion, Winnicott, Balint, etc. Many of them were in Tavistock, e.g. Bion and Balint, Winnicott not. For some reason the English school is more creative, more spontaneous. Winnicott and Withacker have much in common, but in general American therapists do not know too much about English psychoanalysis; Haley, in particular, when speaking about psychoanalysis is talking about fantasies that he has, believe have no much idea of what psychoanalysis in its modern practice.

Of course, through his books on psychotherapy one realizes that understands well what it is.

C.D.ch. -When you talk of modern psychoanalysis what you are referring?

S.K. - Well, I speak of psychoanalysis I know in London.

C.D.ch. -do Tavistock?

S.K. - Tavistock and…

C.D.ch. -psychoanalysis in the here and now...

S.K. - Yes, probably is a combination of many things, psychoanalysis kleiniano that is here and now, the Middle group, Winnicott, Balint, etc., which is more flexible, more played (in the sense of game NT), Jungian psychoanalysis is quite developed in London, my analysis Jungian, was my father was Jungian, so I find it natural to have different influences in my own work.

C.D.ch. -You have a very open mind.

S.K. - Yes, as an anthropologist. But here you also see how Zurich jungians are different from the London, all this evolves very differently from the original ideas, Freud would not recognize what is happening in London now, and Jung would not recognize. The other day was reading Freud was not considered a good therapist, but Klein was brilliant, gifted, natural. I think that this is an important distinction, the American tradition is Freudian, more rigid, intellectual cautious and… medical!, this is the treatment, vos so tomás and I'm going to talk about you and your past, what do now... well... the kleinian tradition is more... surprise, more shocking, a good intervention kleinian is irresistible, is very simple, you cannot preventIt is very obvious.

C.D.ch. -How are the interventions?

S.K. - well... on the envy for example. Klein was much concerned about the envy, as a destructive force. If you say someone is hungry for something, that is a jealous State, it is that he is envious of you. If it is true can not escape from eso… is so obvious to be envious. Here you have something well live, which is either immediate redefinition.

C.D.ch. -then if you say that all therapists redefine, not you agree with the stance of some theorists or therapists on a single truth.

S. k. - I believe in the concept of truth, I believe that each map is more or less true, which means that it is also more or less false. What I mean is that a redefinition may not be any redefinition, must be related to some experience.

C.D.ch. -A patient experience.

S.K. - Yes, indeed an experience of the heart, and therefore believe that the psychoanalytic base is important, because it refers to what people experience in their bodies. Last year I was thinking that psychoanalysis is really about the holes in the body. This is something shocking, think in terms of children intellectual experiences, because I believe that Freud's last contribution was to reduce these symptoms or ideas to childhood experiences, and somehow, plays this, although from another angle, and I do not believe that to ignore, but I doubt any family therapist allowing recognition of his psychoanalytic basis, but remember that Palazzoli and his colleagues were trained in the United States.UU. in psychoanalysis.

C.D.ch. -What are the goals of therapy from your perspective?

S.K. - I am looking for the main task, which is not that people are well, but find out what I have to do; and what I have to do sometimes is very little. Winnicott,

and I'm talking about a psychoanalyst, not a systemic, wondered what was the minimum needed to do with children. So I think that goal, rather than therapy, as the clinical activity is discover what needs to be done. I never have a goal, because this seems too ambitious, as wanting to do everything

best. I simply have a task…tap

C.D.ch. -A small task?

S.K. - A small task, for example, with an alcoholic to stop drinking today, tomorrow is another day, work with what needs to be done now, and at the end the "now," I wonder who consult what we do then, and then we are tomorrow or in a month.

I like to dismiss me immediately of the clinical situation, to force me to think why should see again, to avoid becoming an addict patients. Clinical work is addictive, it becomes to see patients while one does not want it to, why?, always wonder why have to see again? This is dangerous of psychoanalysis, generates repetitive meetings and addiction to therapy. One of the main contributions of the brief and systemic therapy is the refusal to continue

indefinitely.

C.D.ch. -is attractive to hear this from someone that is in psychoanalysis, is going to cause much impression in the Argentina.

S.K. - Well, remember that I am not psychoanalysis, my work is based on psychoanalysis, I am not a psychoanalyst. Respect to psychoanalysis but I have no psychoanalytic goals, me not too involved with my patients, while my colleagues analysts do. But… of course I care for my patients, and sometimes I wake up in the middle of the night.

C.D.ch. -meeting about the small task similar to the model of the MRI.

S.K. - Yes, I think that it is the case. They ignore the relations from the emotional point of view, are interested in games, but not in the families... I I resist the term family therapy, it is a trap, perhaps don't need to make it, prefer to think in systems, as I said before, I do family therapy if I am forced, try to find what the emotional connection between carrier of the symptom and the family, which of course in my case involves a child and his family.

C.D.ch. -do you're referring to the role of the symptom?

S. k. - absolutely, I think in terms of sacrifice, I took of Palazzoli, is sacrificed the boy tries to help, salvar… and this idea is not popular among therapists in short, Steve Shazer dislikes for nothing; I think he is naive, is brilliant but I think it is naive, I think that it ignores one of the most powerful to change paths, devotion and loyalty of children towards their parents, I believe it is a thrust in all therapy: what do the guys for their parents, is a secret, a fantasy: "I can save my parents", but not must say them because they will tell me who you you think you are? "."

C.D.ch. -Looking in general, do you for the sense of the symptom?

S.K. —Exactamente, la idea freudiana es que el síntoma tiene un significado y creo que los terapeutas sistémicos han cambiado la palabra significado por "función". Creo que esta diferencia se hace para evitar pensar en alguna alianza con el psicoanálisis. Tengo esta idea irritante de que la terapia familiar está en lucha ética con el psicoanálisis, y tiene que probar que es más nueva, más poderosa y que no tiene nada que ver con Freud, pero no es así.

C.D.Ch. —¡Esto va a ser chocante para los terapeutas sistémicos! Bueno, creo que ambas opiniones, sobre el psicoanálisis y la terapia sistémica van a causar un gran impacto. Es difícil ver esto en la clínica, una orientación lineal, que busca etiología, y otra circular, que no lo hace…

S.K. —Pero el significado no es etiología, trabaja como un accesorio psicoanalítico activo, la transferencia no es lineal, es circular, entre vos y yo; qué pensás de mí, qué pienso yo de vos, qué es lo qué vos pensás que yo pienso de vos, etc.

C.D.Ch. —Si permanecés en el presente…

S.K. - Yes, but also we use transfer to gather information about the past. I think transfer is a system, it is a present system, is that you think that I am me...What I mean is can not necessarily carry out both forms of work together, because they have different modes, but intellectually I have no problems in access to both forms, and even use them at different times, but in a particular situation, you have to define where they are working; of course, it is easily acceptable the countertransference is always acting, anyone that reflect on itself can accept that there are influences of others. But I distinguish between an interpretation from the transfer and a systemic interpretation.

C.D.ch. -You Trabajás with what the consultant brings or looking for something more?

S.K. - Well... think that this distinction is a fantasy, which is a false polarization, because the client requests something, and is engaged in negotiations with the "seller" and after half an hour the client is asking for something else, I think that work in the consultation of brief therapy is to actually change the nature of the problem, I feel well in a consultation that demands half an hourthree quarters or an hour to find out why the customer is there.

C.D.ch. -You Trabajás usually in three or four sessions?

S.K. - Well... Yes, sometimes work with less sessions. I work in a hospital there and also try to do it as soon as possible, and often with the longest possible range, two months, three months, I don't know why, I do not want to be involved, they should be involved with each other.

C.D.ch. -You Trabajás with tracking?

S.K. - Yes, send them a questionnaire six months or a year after the last meeting, it is a very simple questionnaire, they have to indicate whether the problem was better, much better, without changes, worse or much worse.

C.D.ch. -... the problem you defined with them.

S.K. - Not I wonder what, only "the" problem, I send to the family and they decide what the problem, then I wonder: have you had any problems? I send an envelope with the estampilla…

C.D.ch. -They respond?

S.K. - More than half, invalid statistically but it satisfies curiosity, if no answer back them send saying "forgiveness but not reached us your response, perhaps can send it again", PEAR is headed to the clinic not to the therapist, which is an important point, because I think that responsible for the therapist feelthus do not feel obliged to say that they are fine.

C.D.ch. -What most read?

S.K. - Leo more psychoanalysis, having done so for more than ten years with systemic therapy, now I think I have the systems in the blood and I run no risk of losing them, then I can now read what you want, history of the Argentina. My wife wants to be a psychoanalyst, gonna analysis every day, so I have to also read psychoanalysis seriously, this helps me to think again about psychoanalysis, in fact I continue my own analysis, which ended four years ago.

C.D.ch. -You you think that it is very important for the therapist to make analysis?

S.K. - I really think that Yes, I believe that you can have a richer contact with the people...

C.D.ch. -You Deseás add something?

S.K. - I am very grateful for having had the opportunity to express what I think.

C.D.ch. -the grateful we.