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.
