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Chapter Two Part Two – Methodology - Page 52
psychoanalysis, group analysis and ethnography. The contribution of each of these
fields will now be set out in turn, and then some previous inter-weavings will be
outlined so that this one can be set in context.
Psychoanalysis
There is a range of theoretical orientations to psychological therapy. These orientations
are themselves constructed on differing philosophical bases. One example of a
classification would be into psychoanalytic, humanistic, cognitive-behavioural and
systemic approaches. 3 Although some approaches seem more naturally suited to
particular clinical problems (behavioural approaches to the treatment of specific
phobias, for example, and exploratory approaches to existential difficulties), key
determinants of outcome include client factors (including pre-morbid adjustment and
motivation for change) and therapist-client matching. In my own practice, I have come
to work from a psychoanalytically-informed perspective (Bion, 1959, 1967; Freud,
1900/1953; Hinshelwood, 2002; Klein, 1946; Matte-Blanco, 1988; Meltzer, 1967;
Ogden, 1994, 1999; Sandler, Dare, & Holder, 1973; Symington, 1986; Winnicott,
1971). Briefly, this involves consideration of the unconscious of the patient, accessed
principally through the intersubjective relationship with them. The aim is to enable a
transformation of the inner world of the patient so that they have greater choice in their
lives and access to an expanded range of repertoires of response. As Hinshelwood so
aptly puts it:
3 Such classifications can be problematic, but I hope that the above array is clear. Historically in Western
Europe and the USA, psychoanalysis was an early paradigm, opposed first by behaviourism (followed
decades later by cognitive-behaviourism) (the challenge based on the perceived lack of empirical
evidence for the efficacy of psychoanalysis as compared with these approaches), then by humanistic
approaches from another perspective (that challenge based on the apparent disregard by psychoanalysis
for what it means to be human, and in turn to be with another human in distress), and subsequently by
systemic approaches from a third perspective (based on the need to attend to the systemic context of
behaviour and experience as well as their individual manifestations).