New Book
Rank and Freud, 1920
The Letters of Sigmund Freud and Otto Rank: Inside Psychoanalysis
E. James Lieberman and Robert Kramer,. eds.
Johns Hopkins University Press, January 2012
To order: 800-537-5487 Mention code NAF for 25% discount.
Posted 01.06.2012 at 11:32 pm | Have your say →Tagged: History, Philosophy
What I learned from Otto Rank
Tommy Schmitz, who I met on the Ernest Becker Foundation list, recorded and edited 11 interviews with me about Rank. The result is here. He elicited relevant matters long dormant, for which I am grateful. While Rank never did couples therapy, his concern with the here-and-now and with ethical aspects of all human interaction has been a major influence that I’m still trying to clarify. Thank you, Tommy. –Jim
Use the link below. The interviews range from 10 to 20 minutes. Your feedback is invited!
http://www.box.com/s/7t6ookilxufftvhb5pzf
Posted 01.27.2012 at 11:29 am | Have your say →Tagged: Therapy
What is Rankian Therapy?
Otto Rank was not interested in founding a school or a method and it may be presumptuous to say that one is a Rankian therapist. He taught and wrote; his students and allies were called “Rankian.” Here is one such therapist’s approach. I liked working with couples and families as well as individuals, and introduced a structured approach to the process for psychiatry residents. It is designed to teach people how to elicit positive responses in important (and conflict-prone) relationships.
START WITH A GENOGRAM
A five-minute introduction helps settle people on the first visit. I use a simple family tree–parents, siblings, children. Include key information on religion, education, occupation, health status. Keep it to five minutes per person, no details. This sets the tone of unbiased inquiry, structured, easy conversation, useful in first visits in all forms–individual, couple, family.
Elicit positive responses through WARM QUESTIONS. W. Robert Beavers, M.D., defines warmth in No Single Thread: Psychological Health in Family Systems, Jerry Lewis, et al, NY: 1976.
“Human warmth is human need, honestly expressed, with a recognition of the limits of the other person.” Many people confuse warmth with “giving”—which often leads to a virtuous sterility and emotional starvation. (p. 78) The idea is to help someone ask for something and receive a “yes” from the other. The request must be for something small but meaningful that is within the power of the partner (or parent, child, friend) to grant. The asker’s expressed need, though small, is significant, so he or she is vulnerable (hence warm)–gratified by the responder’s “yes,” hurt by a “no.” The therapist or mediator will follow up at the next visit to see if the wishes were granted, and then conduct a second round. Here is a structured example.
THE REQUEST-OFFER EXCHANGE
Helping Couples Change. Richard B. Stuart. NY: Guilford, 1980.
“The Caring-Days Technique” (p. 197-202)
What would you like your partner to do as a means of showing that he or she cares for you? [Requests must be positive; specific; “small,” i.e., daily; and they must not have been part of recent acute conflict].
“Think of something you can ask your partner (or parent, child, sibling) to do this week that will please you, and that is small enough that you are pretty sure that the other person will agree to do it.” The exercise tests empathic accuracy, personal efficacy, and optimism. Sometimes the therapist has to moderate. A man asks his wife for sex. “Is that a small thing?” says the therapist. It isn’t, and the request is harsh, cold, not warm. A wife says, “I can’t think of anything to ask him.” She is too angry, hurt, or self-protective. The relationship can’t go anywhere if she can’t think of anything she wants from him that is both do-able and desirable. The exercise reveals where the two people stand and how they communicate their needs–or fail to. “I’d like to go for a walk together for 20 minutes once or twice this week.” “I’d like to get a baby sitter and go out to that movie I’ve talked about.” “I’d like to get a hug when I come home from work.” Well, a hug may not be much to ask, but is may be pro forma. You can’t request an emotion, but you can create a situation to elicit one.
DIAGNOSTIC WORKUP AND TREATMENT PLAN
With Rank in the background–he stressed the importance of the actual relationship in the present–I note Salvador Minuchin’s principle that to diagnose a family, you push it to see which way it moves, and Steven Wolin’s approach emphasizing strengths and resilience, not pathology.
A four-session evaluation begins and ends with a couple session; in betwee are with confidential individual sessions with each partner. This is modeled after the Masters and Johnson couple sex therapy evaluation of the 1970s. I use some active interventions, and make comments/interpretations/suggestions in the individual sessions with two caveats to the client: 1) Don’t use an idea unless you are comfortable with it; anything adopted reluctantly because the therapist said so will fail. 2) Don’t quote me. I keep confidences and I want to be free to speculate or float an idea without worrying about this being shared. Quoting the therapist to the absent partner is mischief or sabotage. If you want your partner to know how I would handle a situation, ask me in a couple session.
I view the relationship of two competent adults as a 50-50 proposition until proved otherwise. Each partner is asked to focus mainly on his/her own 50%. I am interested in hearing criticism of the partner without dwelling on it. Change is enhanced by individual sessions, since a person can be more open/vulnerable if the loved one (and chief critic) is not in the room. Couples decide on both the frequency and type of session: when both want a couple session it has priority. In most cases, couple sessions become less frequent as the therapy takes hold, and they can do the couples work without me.
CONFIDENTIALITY
If you do individual as well as conjoint sessions—often a good idea—you must keep information compartmentalized so as not to disclose material from an individual session to anyone else. Even if you are told “it’s OK” or “I have no secrets,” it is NOT your right or responsibility to do this. If you encounter a secret inimical to progress (ongoing affair, addiction, fiscal cheating, criminal behavior, STD) you can encourage the individual to resolve it, reveal it (not as important), or both. Otherwise you must change the format of therapy lest you become an accessory to deception in which couples/family therapy becomes a sham or a cover up.
–E. James Lieberman, M.D.
GWU Dept of Psychiatry September, 2000; updated July, 2011
Tagged: Therapy