What do patients want?

Psychoanalytic perspectives from the couch

Author: Christine A.S. Hill
Date of Publication: 2010
Publisher: KARNAC

What do patients want? is an important contribution to the literature on the Outcome of Psychoanalysis as it offers Qualitative Research from the patient’s perspective as well as offering sensitive clinical insights from the patient’s inner world and experiences on the couch. The author is a Clinical Psychologist and Psychoanalytic Psychotherapist who brings a broad professional base to her work and to the writing of this book.

This book is a beautifully written account of patients’ stories written up as a journey, paralleling the psychoanalytic journey itself. Dr Hill describes the analyses of 18 patients from how they began their analyses, through to the quality of their engagement, transference and countertransference experiences with particular emphasis on the paternal transference as well as of the termination phase. Through presenting patients’ narratives, this book enables the patient’s voice to be heard in a very honest and candid way highlighting both the helpful and sometimes unhelpful aspects of each person’s therapeutic journey.

Dr Hill defines the concepts she uses (transference, countertransference, interpretation and neutrality) in a well referenced and researched introduction and then later illustrates their usage with poignant clinical material.

The analysts’ personality characteristics, are also included in the discussion, together with the relevance of gender issues and third party influences as recurring themes throughout. When describing the impact the analyst’s personality has on the patient–analyst relationship, for example, the author reports “This has led to such diversity in the analyses to the extent that some patients are left at the end with an “extraordinary experience of having been liberated”, while other patients talk about a “mediocre stew experience”, or prematurely walk out after two years”.(p84) I think this a subject which has not received as much attention as it deserves and has an important place in a book focussing on patients’ narratives.

Of particular interest is the chapter on the paternal transference where themes of the “emotionally present” and “emotionally absent” analyst were explored. It was in this part of the book where I felt that the patients’ descriptions of the analytic relationship really came to life in their finding either a restorative space and a liberating father or the repetition of a punitive angry and abandoning father. It was satisfying to read a fuller version of the patients’ narratives in this chapter.

In the last few chapters the author draws together a number of threads and findings introduced earlier. She asks some crucial questions like what constitutes a good analysis, whether the patients interviewed would recommend analysis or not and draws attention to the mismatch between analyst and patient and the possible impasses that sometimes occur in the analytic relationship as a result of this mismatch.
I think this book is a well written and original text which offers an opportunity for clinicians to reflect on their own practices. I would especially recommend this book to the student of Psychoanalytic Psychotherapy and for those involved in the teaching and training of Psychoanalytic Psychotherapists and Psychoanalysts.

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