Psychoanalytic Thinking in Occupational Therapy E-Book

Lindsey Nicholls

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 561

Veröffentlichungsjahr: 2012

Beschreibung

Divided into three overarching themes, theory, application and research, this cutting edge book explores the influence of psychoanalytic theories on occupational therapy practice and thinking. It incorporates a new conceptual model (the MOVI) to guide practice, which uses psychoanalysis as a theoretical foundation for understanding therapeutic relationships and the ‘doing’ that takes place in clinical practice.

Using practice models and incorporating many clinically applied examples in different occupational therapy settings, this introductory text to psychoanalytic theory will appeal to students and practising clinical and academic occupational therapists worldwide and from different fields of practice from paediatrics and physical disability to older adult care and mental health. 

• The first book in fifty years to concentrate entirely on a psychoanalytic approach to occupational therapy
• Distills cutting edge theory into clinically relevant guidance
• Features clinical examples throughout, showing the links between psychoanalytic theory and occupational therapy practice
• Written by an experienced international team of authors

Leseprobe

Contents

Cover

Title Page

Copyright

Foreword by Sheena Blair

Foreword by Paul Hoggett

Acknowledgements

Chapter 1: Introduction

Finding our Way

Finding the Words

Conclusions

References

Section 1: Psychoanalytic Theory Interwoven with Occupational Therapy

Chapter 2: The ‘Therapeutic Use of Self’ in Occupational Therapy

Conscious and Unconscious Communication

‘The Important Thing is to Connect’

Client-Centred Practice in Occupational Therapy

Concerns with Client-Centred Practice

The Illness Narratives

A Story without Animals

On not Liking a Patient

On Becoming a Therapist

Conclusions

References

Chapter 3: An Occupational Therapy Perspective on Freud, Klein and Bion

Introduction

Freud (1856–1939)

Free Association, Free-Floating Attention

Transference

The Unconscious

Klein (1882–1960)

Play

The Internal Object and the Inner World

Projective Identification

Bion (1897–1979)

Thinking Thoughts: Learning from Experience

The Container-Contained Model

No Memory, No Desire

Conclusions

References

Chapter 4: The Function of ‘Doing’ in the Intermediate Space: Donald Winnicott and Occupational Therapy

Introduction

Inhabiting the Intermediate Space

Adding doing to the Transitional Space

Conclusions

References

Chapter 5: Beyond Bowlby: Exploring the Dynamics of Attachment

Introduction

Beginning with Bowlby

Towards Well-Being

Restoring Occupational Well-Being

Assisting Caregiving Awareness

Conclusions

References

Chapter 6: Re-Awakening Psychoanalytic Thinking in Occupational Therapy: From Gail Fidler to Here

Introduction

The Lasting Concepts Introduced by Fidler: Occupation and Relationship

The Unconscious: Fear and Fascination

Psychoanalytically Trained Occupational Therapists

Changes in Psychoanalysis Itself

An Enlarged Field: From the Fidler Approach to the Development of the MOVI

The Transformation Process: Standing in the Spaces with Anna

Choice as a Fixed Part of the Structure of the Setting: Valeria

The Importance of the Therapist's Feelings: The Therapy Process with Lucia

Conclusions

References

Section 2: Psychoanalytic Occupational Therapy: A Relational Practice Model and Illuminating Theory in Clinical Practice

Chapter 7: MOVI: A Relational Model in Occupational Therapy

Introduction: How MOVI was Developed

What is MOVI?

Specific Characteristics of MOVI

The Components of MOVI

Conclusions

References

Chapter 8: Let the Children Speak

Introduction

Could Freud be Responsible?

Was Mum or Dad the Culprit?

The Language of Unnamed Emotions

The Malleable Mind

The Toxic Narrative

Let the Children Speak

Conclusions

References

Chapter 9: Working with Difference

Learning from the Other

Employing the Split Position: Evoking Admiration and/or Fear of Contamination

Apartheid: The Exploitation of Difference and the Personal Price of Racism

Avoiding Difference: A Need for Fusion

Containing Difference: Finding Oneself in Relation to the Other

Some Further Thoughts on Working with Difference

Conclusions

References

Section 3: Further Psychoanalytic Thinking: Research and Training

Chapter 10: Psychoanalytic Thinking in Research

The Regeneration of Psychoanalytic Theory in Social Science

Psycho-Social Research Methods

Interviews, Interpretation and Ethical Endeavours

Learning from the Participant

Conclusions

References

Chapter 11: Understanding the Use of Emotional Content in Therapy Using Occupational Therapists' Narratives

Introductory Considerations

Part 1: The Lived Experience of MOVI

Part 2: The Emotional Significance of Objects in Therapy

Part 3: Closing Reflections on what we Learned from Listening to Therapists' Narratives

Conclusions

References

Chapter 12: Training Experiences to Develop Psychoanalytic Thinking

Introduction

Using Analytical Psychodrama for Teaching

Conclusions

Learning from Baby Observation

Conclusions

Afterword

References

Chapter 13: The Relational Space of Supervision

Introduction

The Traditional Role of Supervision in Occupational Therapy

The Psychodynamic Influence to Supervision

The Landscape of Possibility

Reflective Practice

The Supervisory Space

Considering Boundaries in Supervision

Enlightening the Supervisory Process: The Means by Which the Client is Brought to Supervision

On Reflection

Conclusions

References

Index

This edition first published 2013

© 2013 by John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Psychoanalytic thinking in occupational therapy : symbolic, relational, and transformative / Lindsey Nicholls…[et al.].

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-65586-3 (pbk. :alk. paper)

I. Nicholls, Lindsey.

[DNLM: 1. Occupational Therapy–psychology. 2. Psychoanalytic Theory. 3. Psychotherapy. WM 450.5.O2]

616.89′165–dc23

2012027805

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover images: © iStockphoto/tuja66

Cover design by Sandra Heath

Foreword

From the day that I first learned about the work of Azima and Azima (1959) and Fidler and Fidler (1963) whilst undertaking my occupational therapy course in the mid to late 1960s in Glasgow, I was captivated. This work sought to explore and understand the meaning of what we do as human beings and how participation in occupational therapy could offer another means of communication. The Fidlers also contributed one of the first and most comprehensive approaches to activity analysis. I was fascinated by the links between psychoanalytic thinking and the practice of occupational therapy and was lucky enough in my early practice to work in a unit which was underpinned by the principles of group psychotherapy and the importance of the milieu. Forty-five years later, I am equally engrossed by the ideas offered in this text.

Over the years, I have reflected countless times on how the ideas, concepts and principles have informed my understanding and work, whether that was in practice, education, management or research. Historically, there has always been a sustained adherence to this way of understanding human beings within the occupational literature. Contrary to the popular view of some occupational therapy theorists who considered that therapists who thought and practised in this way would lead to the demise of the profession, I maintain that this form of thinking enhances our repertoire of knowledge and skill. I endorse the view that is taken in this book that occupation is symbolic, relational and transformative, and to facilitate understanding of this we need to refer to the seminal work referred to in this text.

This is a courageous book. It bravely runs counter to contemporary discourse of health and social care and reminds us of what it is to be a therapist by attending to multi-layered communication and containing distress. Therapy is characterised by providing emotional safety and containment. Often engagement with occupation provides that safe space to begin to explore difficult issues. Throughout, the book strives to help the reader develop their own sensitivity to others through the provision of vignettes and this both helps deepen professional reasoning and links theory with practice. This is the crux of good educational practice and enables readers to risk reflecting upon and considering their own interactions with others. It is also courageous in adhering to the principles and mores of psychoanalytical thinking instead of the more popular notion in occupational therapy literature of psychodynamic thinking.

The writers have outlined the links between psychoanalytical thought and the practice of occupational therapy in a developmental way by revisiting seminal works from both occupational therapy and psychoanalysis. Additionally, they have offered a specific model to infuse practice with a celebration of the therapeutic use of self and the pivotal contribution of emotion and relationships in the lives of human beings. The text covers work from childhood to later adulthood and reveals how this way of working with people can facilitate the development of an emotional language and enable emotional shifts to occur. It also covers how work of this nature can revitalise supervision and develop organisations in a positive way. The final chapters of this text concern psychoanalytic thinking in research and this reveals how there has been a regeneration of interest in the contribution of psychoanalytical thinking within social science. As such the book unites theory, practice and research.

I have found this a refreshing text with the authoritative signature of stimulating the occupational imagination to creatively work with the unconscious. It encourages practitioners to strive to understand internal life, whether as a therapist, educator, researcher or manager. While it may only be possible for a small number of occupational therapists to directly practise in this way, what this book offers is a way to enhance professional reasoning, deepen understanding of the meaning of occupation and contribute to mental health and well-being.

Dr Sheena E. E. BlairDip COT, M Ed, Ed D, FHEA, FCOT

Foreword

In the UK today we are experiencing a crisis in the quality of our care services with scandal after scandal surfacing in our hospitals, our residential homes and day services. In Europe, for two decades now, welfare services have struggled to develop under successive waves of management reforms which, under the banner ‘getting more for less’, have sought to increase the productivity of the public services. I think it is clear now that whilst in some cases we may have increased the volume of throughput, it has been largely achieved by a real decline in the quality of care. The danger is that as the OECD economies seek to regenerate private affluence on the backs of public austerity, the quality of care is something that will be seen as something we can no longer afford.

The appearance of Psychoanalytic Thinking in Occupational Therapy is therefore very timely. For here is a book which has the courage to proclaim that quality counts and that ultimately the only guarantee of quality lies in the richness of the relationship that emerges between the professional and the client. I deliberately use the unfashionable word ‘client’ rather than ‘service user’ because the latter has become a degraded term, a piece of ‘carewash’ (like greenwash) which actually covers up the lack of care which now seems to accompany the bizarre mish-mash of centralised control, micro-management and breakdown of real accountability which makes up our increasingly fragmented welfare system. The concept of ‘client’ (still used by architects, solicitors and many other professions) has those connotations of dignity, respect and status that we urgently need to rediscover to challenge the lack of care presently taking place.

Psychoanalytic Thinking in Occupational Therapy is unashamedly humanistic. It puts the humanity of the client at the forefront of the professional agenda – their emotions, frailties, eccentricities, strengths and mysteries. Indeed it pours out of the many vignettes and case studies that are such a marvellous feature of this book. Whilst the authors show great confidence in their use of psychoanalytic terms, they do so in a way which illuminates rather than reduces the humanity of their clients. This is how the psychoanalysis I love should be used – to enliven, to ‘move’ and to make you think, the opposite of jargon or dogma.

In contrast to the regimented, risk-averse and prescriptive techniques which have come to dominate our thinking about professional practice, the authors of this book offer an entirely different way forward. Can we afford not to move in the direction they point to? So much of our accounting these days is preoccupied with short-term efficiencies that the long-term costs of failing to think systemically pile up all around us. There are signs all about us that the citizen is no longer prepared to surrender public welfare on the altar of economic austerity. We do indeed deserve more. The kind of practices outlined in this book should lie at the heart of a welfare society, one which values human and non-human relations as intrinsic goods rather than means to an end.

Professor Paul HoggettCentre for Psycho-Social Studies, University of West England

Acknowledgements

We would like to thank our clients, colleagues and students for their sincerity, patience and commitment to work that can only truly be done in the spirit of collaborative inquiry.

1

Introduction

Lindsey Nicholls, Julie Cunningham Piergrossi, Margaret Daniel and Carolina de Sena Gibertoni

There is a saying for people who plan to undertake the long-distance walking route known as the ‘Way of St James’: it states that the Camino de Santiago1 begins when you first think of it. That is how the book began; we began to think of it. Since 2006 we have exchanged our thoughts in emails and initial writings, and used a process of peer editing to learn from each other and produce this book. We have found ways to meet in person and listen to each other's presentations (at Brunel University Master Class events and international conferences in 2009, 2010 and 2011), and this had led to our connecting with many other occupational therapists who have been using (i.e. thinking and working with) psychoanalysis as a theory and method within their clinical practice.

It has been a rich and rewarding time where each of the authors, at different times and/or in relation to certain specialist topics, has taken the lead. Although we come from diverse professional and personal backgrounds, we share a conviction in the importance of using psychoanalytic theory in occupational therapy. In this we have been good companions and learnt much from each other's clinical work and theoretical discussions. This book is a result of our collaborative desire to make this work available to scholars and clinical therapists, to form a wider ‘community of practice’ (Wenger, 1998), where new projects, clinical discussions and writing can emerge.

At its heart the book discusses the work that we have practised, learnt, thought about and carry within as we engage with clients, students and colleagues. Our hope is that the book will provide a basis for serious study by therapists who are interested in psychoanalytic theory and may have begun their own journey into the internal landscape of the emotional understanding of people and what they ‘do’.

There are 13 chapters in all (including this one) and the book has been divided into three overarching themes; theory, application and research. The first section takes the classic psychoanalytic theories (e.g. Freud, Klein, Bion, Winnicott and Bowlby) and considers their influence on occupational therapy practice and thinking. The second section is devoted to an explanation of a psychoanalytic occupational therapy model (MOVI) and this is followed with further discussions of psychoanalysis in clinical occupational therapy practice. The final section describes research methods and projects that have incorporated psychoanalytic thinking in occupational therapy.

Each chapter could be read as an extended case study but we hope there is sufficient cross-reference between the different contributions to make for a coherent whole. In many ways it has been hard to choose the order of work for the linear structure that the book offered. The core of the book lies in understanding MOVI (Chapter 7), an occupational therapy model, and we would suggest that readers develop a duel vision where MOVI can be held in mind as they refer to the earlier chapters on Freud, Klein and Bion (Chapter 3), Bowlby (Chapter 5) and the therapeutic use of self (Chapter 2).