“The Therapeutic Imagination: Using Literature to Deepen Psychodynamic Understanding and Enhance Empathy”
Author: Jeremy Holmes
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Jeremy Holmes (2014) offers here a book, rich with the wisdom of an experienced clinician, that celebrates the imagination as an essential component of the psychotherapeutic process, using examples from literature to provide insight into important aspects of clinical work. He argues that literature and psychodynamic therapy share an “aesthetics” based upon a “paradoxical combination of security of form with creative uncertainty and exploration” (p. x), and says his goal is not so much to use psychoanalytic concepts to explain literature, but rather the reverse – to bring “artistic insights to bear on clinical work” (p. xii).
Literature is useful to clinicians, according to Holmes, for, like the psychoanalytic frame, it marks off a privileged space for a complex play of interactions that can, if things go well, lead to a greater capacity to understand the mind (both one’s own and that of another). Like therapy, in other words, literature, in staging encounters with otherness, promotes the ability to “mentalize,” to think about the other thinking, to become “mind-minded.” The links Holmes posits here between the literary and the psychotherapeutic imagination allow him to claim, in an undeclared nod to Freud, that “literate therapists . . . make better therapists” (p. ix).
Holmes asserts that his book has a practical orientation and structure, each chapter addressing a specific clinical problem, “using literature to extend its range of reference and reverberation” (p. x), in order to help therapists enhance their therapeutic empathy, understanding, and skill. But Holmes also acknowledges important theoretical, literary, and philosophical commitments—principally to attachment theory (he has written several earlier books on the subject), which, I will suggest, despite occasional gestures toward the very different theoretical models of Freud, Klein, and Lacan, informs his use of literature throughout.
Holmes also acknowledges a significant debt to English Romantic writers and to the tradition of German philosophical idealism that informs some of their work. Coleridge, in particular, is an important touchstone for Holmes, the central figure in a lineage he traces back to the philosophy of Kant and Schelling, and forward to a tradition of psychoanalytic thinking that includes Sharpe, Bion, Winnicott, Rycroft, Britton, Ogden, and Ferro. While he provides little detail on the complex vicissitudes of thought within this lineage, Holmes associates it with a Romantic idealist philosophy that “celebrated mind as an autonomous sphere in which, in the imagination, all things are possible” (p. 162). The imagination becomes here a supreme creative power which rivals that of nature, and even of divinity.
The imagination is thus the mental faculty that makes possible the creative or therapeutic event. It disposes the mind to attend to what has not yet come into presence, and allows the poet or analyst to re-present the raw materials of experience in ways that break free of old constraints and open onto new possibility. The clinical encounter is here conceived as an opportunity for spontaneous reciprocal exchange within the safe structure of the analytic frame, an exchange which, however asymmetrical, serves as the basis for the possibility of mutual understanding and the creative transformation of negative relational patterns. In its emphasis on playful reciprocity as the vehicle for the emergence of new relational harmonies, the clinical situation is for Holmes not unlike the Romantic poet’s encounter with nature as represented by the metaphor of the aeolian harp in Coleridge’s famous poem, according to which the harp, producing music in response to an inspiring breeze, is like the poet’s receptive mind, which, stirred into action by changing perceptions of the natural landscape, engages in a process of thought, reflection, and creative expression (p. 7).
It is not difficult to see how this model of poetic creativity, based as it is upon principles of reciprocity, affective resonance, and communicable meaning, offers an attractive basis for understanding the therapeutic process according to a particular strand of the psychoanalytic tradition that culminates in attachment theory. Like the reading and writing of literature, the practice of psychotherapy is understood to be a dialectical process that leads, by way of mutual recognition and understanding, to new synthesis or resolution. For Holmes, however much this process may be complicated by obscurity, disruption, or failures of meaning, the therapist can go forward “secure in the knowledge that a resolution will emerge, given time and attentiveness and faith” (p. 173; see also p. 59). Few clinicians would deny the usefulness of this model for understanding a significant dimension of the therapeutic experience, and it captures an important aspect of the phenomenology of literature as well. But it also has limitations. I will come back to this.
The book has four parts. Part I, “The Poetics of Psychotherapy” begins with a chapter—Holmes calls it “a manifesto” for the whole book— that lays out a “model of ‘the therapeutic imagination’ underpinning clinical encounters” (p. xiii). According to Holmes, the clinical encounter involves a therapeutic sequence in five stages: “primary attachment,” “reverie,” “logos,” “action,” and “reflection” (p. xiii; pp. 7-8). Holmes illustrates this sequence with a moving scene from George Eliot’s novel Daniel Deronda, in which the title character rescues a young Jewish woman from suicide. The second chapter, also central to the overall argument, places “the process of discovery” (p. 16) at the heart of therapeutic work.
The remaining chapters of Part I offer readings of several poems, each tracing a movement toward some kind of resolution. A poem by Robert Lowell, for instance, demonstrates how, like the analytic transference, the figure of metaphor, by establishing a link between disparate realms of experience, facilitates “pattern-recognition” and a movement toward “coherence” and “integration” (pp. 32-41). And Wordsworth’s “Ode on Intimations of Immortality” is used to illustrate a movement from grief to consolation, as an experience of loss gives way to a redeeming sense of an underlying continuity. For Holmes, literary language carries an implicit promise of “wholeness”: although fraught by ambiguity, disruption, and obscurity, the literary and clinical experience of language is underwritten by a faith in the possibility of reconciliation, resolution, and unity.
In Part II, “Psychotherapy and Narrative,” Holmes shifts away from poetry to consider the relationship between forms of prose narrative and the therapeutic process. The basic argument is that psychological health depends on an ability to dismantle constricting stories in response to new experience, to allow the narrative of self-understanding to develop within a dialectical movement between “fluidity and form” (p. 78). This dialectic of “story-making and story-breaking” (p. 78) is what allows the patient to revise the rigid narratives by which she has tried to account for herself, and to find more accommodating stories that can express new or unformulated experience, or give containing narrative form to unruly experiences of trauma.
In the following chapter, Holmes makes the broad claim that all novels have an “underlying emotional structure” (p. 86) and movement—from the presentation of a problem, to explication and modification, and finally to resolution or accommodation—and argues that it resembles the general sequence of the therapeutic process. The final chapter in this section offers an oedipal reading of the central character in Jane Austen’s Emma. But Holmes also expands the scope of his argument here, moving beyond the psychological analysis of character to present a political critique of the insulated worlds of Austen’s fictional Hartfield and of psychoanalysis itself, which he says must look outside the “park walls” (p. 99) to respond to the ethical demands presented by social inequality and injustice.
Part III, “Psychotherapeutic Approaches to Psychiatric Diagnoses,” deploys selected works of literature as illustrations of specific diagnostic conditions: anxiety (Wagner’s Siegfried), dissociative splitting (Stevenson’s Dr. Jekyll and Mr. Hyde), grief (Milton’s “Lycidas,” Tennyson’s In Memoriam, and Donne’s “A Valediction: Forbidding Mourning”), and narcissism (Ovid’s rendering of the Narcissus myth and Wilde’s The Picture of Dorian Gray). Finally, Part IV, “‘Only Connect’: Psychotherapy and Psychiatry,” argues for an integration of art and science, and for a psychodynamic therapy with roots in Freud and in literary culture that will serve to mitigate the limitations of what he calls a “diagnostically-oriented managerial psychiatry” (p. 161).
No one could fairly claim that Holmes lacks ambition. His book is copious, far-ranging, richly suggestive, and generically various. Holmes makes a passionate argument for the central role of the imagination in clinical practice, and the personal, political, and professional values that inform his work deserve our respect.
The book also has some limitations. For one thing, while he briefly acknowledges that his project has precursors, Holmes neglects to place his work clearly in the context of the long tradition of psychoanalytic criticism beginning with the classical readings of literature by Freud (1900), Jones (1976), Maria Bonaparte (1949), and others, continuing with ego psychological efforts to develop a theory of art (Kris, 1952), archetypal interpretations of literature and myth (Frye, 1957; Jung, 1976), object relational aesthetics (Klein, 1975; Winnicott, 1989), through to structural and post-structural criticism, which includes marvelous readings, for instance, of complex transferential phenomena set in motion by Poe’s “The Purloined Letter” (Derrida, 1975; Johnson, 1977; Lacan, 1972), and by Henry James’ “The Turn of the Screw” (Felman, 1977). While Winnicott and Klein figure prominently in Holmes’ argument, it would be helpful to delineate their theoretical positions on psychoanalytic aesthetics in relation to other figures in this tradition, whose assumptions, methods, and goals are widely various, and often starkly opposed.
In a gesture of winsome humility, Holmes states early on that he claims “no literary sophistication or expertise,” and admits that his selections, which come mostly from the “mainstream English literary canon,” reveal the limitations of his “class, generation, and ethnicity” (p. xii). Indeed, with the exception of three women and one Peruvian, all of the literary texts cited by Holmes are by white men. To be fair, however, Holmes compensates for the rather restricted cultural range of his selections with a nice sensitivity to matters of class, race, and gender as they arise in several of the works he discusses, as well as with his urgent plea for psychoanalysis to open itself more fully to the harsh realities of social inequality.
But Holmes’ relative innocence in literary matters also leads him to make some questionable general claims, as when, for instance, he declares that “the business of poetry is to generate truthful and beautiful images” by which—and here he cites Hannah Segal—lost objects may be “reinstated” in the mind (p. 51) While literature may indeed perform this consoling function, one could equally argue that literature is a verbal practice of singularities that works to suspend and resist the comforting resolution suggested by such substitutions—or, to put it another way, that whatever else it may be, the work of literature, bearing within itself irreducible traces of absence, is always also an act of mourning without end.
Elsewhere, Holmes makes an untenable distinction between poetry and prose, aligning poetry with what he sees as the liberating power of raw sensory experience, and prose narrative with an organizing function that “contains, reassures, [and] soothes” (p. 80). But the powerful effects of sensory immediacy in, say, Woolf’s Mrs. Dalloway (1925), the uncanny effects of Hoffmann’s “The Sandman” (1982), or the confounding effects of Beckett’s prose works (1955), which put the very categories of “character” and “plot” in radical question, are sufficient to disable this distinction. Holmes also associates poetry with the “primal” experience of self and other in the pre-Oedipal dyad, and prose with the triangular dynamics of the Oedipal phase. In this pairing, poetry is concerned with “primal contact and communication with the object,” while prose addresses experiences of rivalry, loss, power, and time (p. 65). But we need not look to prose for literary explorations of these issues, as Shakespeare’s sonnets (Booth, 1977), or Milton’s portrait of Satan in Book 4 of Paradise Lost (Elledge, 1993), well attest.
Holmes states at the outset, we recall, that “rather than using psychoanalytic ideas to illuminate the arts,” his project “aims in the opposite direction, bringing artistic insights to bear on clinical work” (p. xii). It is true that Holmes marshals the imaginative resources of literature to challenge certain reductively “scientific” approaches to clinical work. But apart from its uses in this general polemic, Holmes draws on literature not to put pressure on the concepts of psychoanalysis, but rather to provide allegorical confirmation of these concepts. Psychoanalysis, that is, remains the dominant discourse, while literature serves for the most part only to illustrate its insights. This is most evident when the critical readings tip into rather heavy-handed translation of a literary passage into the jargon of clinical psychology, as happens, for instance, in his discussion of the scene from Daniel Deronda: “At the end of his ‘assessment interview,’ we see Deronda align his imaginative identification with the girl, and his formulation (‘suicidal, alone, in need of Maenad-like feminine succor’), with the referral possibilities” (Holmes, 2014, p. 11); or when Ovid’s mythic characters are used to exemplify psychological types, and treated as patients with psychological histories: “Narcissus and Echo could be seen as typifying the avoidant and ambivalent strategies. As her son was the product of a rape, Liriope may have had difficult feelings about Narcissus from the start” (p. 150).
One could turn the axis of this critical strategy to show how Holmes’ literary examples may be deployed to disturb the very psychological formulas used to interpret them. Deronda’s rescue of the Jewish Mirah, for instance, stands in the plot as an allegory of Deronda’s later discovery of his own identity as a Jew, and of his destiny as a savior of the Jews. In this sense, the sequence of the novel’s plot may be understood to lie implicit in the “imaginative identification” that Deronda establishes with Mirah in this scene—the kind of identification that for Holmes serves as the basis for the therapeutic sequence. But the complex narrative strategy that leads to the revelation of Deronda’s identity in the novel works to undermine the very concept of identification that allows the plot to move towards its “resolution.” A consideration of identification as the positing of an illusory equivalence could usefully complicate our understanding of the straightforward roles played by Deronda and Mirah in Holmes’ account of their “therapeutic” encounter.
Or again, Conrad’s Heart of Darkness, which gets only a brief paragraph in the longest chapter of the book (on attachment), is used by Holmes to illustrate the dialectic of “form” and “fluidity” in the making and re-making of stories. This way of framing the relevance of the novel to Holmes’ argument suggests a rather benign understanding of its narrative as a progressive formal accommodation of the unruly flux of Marlow’s experience on his journey upriver. But this overlooks the role of Kurtz, who functions in the novel as a figure for the tragic kernel at the heart of human experience, an unrepresentable horror that refuses accommodation in narrative form, and that resists and annuls any movement toward dialectical resolution.
Holmes’ model of the literary and therapeutic imagination depends upon a Romantic philosophical idealism and a theory of attachment that defines the clinical encounter according to a measure of resonant reciprocity and a faith in the possibility of relational harmony. The series comprised by the terms “unity,” “wholeness,” “coherence,” “interconnectedness,” “resolution,” “synthesis,” “reciprocity,” “consolation,” “reparation,” and “understanding” sounds the keynote of the book. It is a series defined by a principle of (imaginary) equivalence. What this approach obscures, in my view, is the radical alterity at the heart of human subjectivity, a discordant otherness that refuses to be harmonized by the logics of reciprocity, of correspondence, or of opposition resolved in a dialectic leading to new synthesis. It is a vision of human subjectivity suggested by the Freudian unconscious, the Lacanian Real, or the enigmatic signifier of Laplanche . This notion of an irreducible otherness or untranslatable remainder as constitutive of the human subject is, I think, what leads Laplanche to make the provocative charge that attachment theory is “a war machine against psychoanalysis” (Laplanche, 2011, p. 16).
Literature is itself testimony to this dimension of human subjectivity. While literature does indeed invite us to establish symbolic equivalences and make imaginative identifications, it also troubles these hermeneutic actions—each text in its singular way—by putting a resistance in play, by suspending the movement toward meaning and reference. We could point, for instance, to the way Mallarmé (Caws, 1982), in calling attention to the linguistic signifier, disturbs the interpretive movement from rhetoric to cognition; to the way in which Célan’s poetry (2001) generates a force of destruction against the German language which is its vehicle; or to the fictions of Kafka (Glatzer, 1971), which repeatedly stage the failure of readings that strive for symbolic equivalences.
But these are merely more dramatic examples of an aspect of literary writing that appears, I would argue, in all works of literature, including those of Coleridge, Wordsworth, and Keats. It is that aspect of literature, we could say, that disturbs all “reference and reverberation.” Kafka (1977) captures one sense of what this may mean in a letter to Oskar Pollak dated January 27, 1904: “I think we ought to read the kind of books that wound and stab us. If the book we are reading doesn’t wake us up with a blow to the head, what are we reading it for? . . . we need the books that affect us like a disaster, that grieve us deeply, like the death of someone we loved more than ourselves, like being banished into forests far from everyone . . . A book must be the axe for the frozen sea inside us” (p. 16).
Cite This Article
Thurn, D. (2015, September). Using imagination and literature to enhance therapeutic abilities: A book review [Web article] [ Review of the book The therapeutic imagination: Using literature to deepen psychodynamic understanding and enhance empathy, by J. Holmes]. Retrieved from http://societyforpsychotherapy.org/book-review-the-therapeutic-imagination/
Beckett, S. (1955). Molloy, Malone dies, the unnamable. New York, NY: Grove Press.
Bonaparte, M. (1949). The life and works of Edgar Allen Poe. London, England: Imago.
Booth, S. (Ed.). (1977). Shakespeare’s Sonnets. New Haven, CT: Yale University Press.
Caws, M. A. (Ed.). (1982). Stéphane Mallarmé: Selected poetry and prose. New York, NY: New Directions.
Célan, Paul. (2001). Selected poems and prose of Paul Célan (J. Felstiner, Trans.). New York, NY: Norton.
Derrida, J. (1975). The purveyor of truth. Yale French Studies, 52, 31-113.
Elledge, S. (Ed.). (1993). John Milton: Paradise Lost (2nd ed.). New York, NY: Norton.
Felman, S. (1977). Turning the screw of interpretation. In S. Felman (Ed.), Yale French studies, 55/56, 94-207.
Freud, S. (1953). The interpretation of dreams. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vols. 4-5, pp. 336-368). London: Hogarth Press. (Original work published 1900)
Frye, Northrup. (1957). Anatomy of criticism: Four essays. Princeton, NJ: Princeton University Press.
Glatzer, N. (Ed.). (1971). The complete stories of Franz Kafka. New York, NY: Schocken Books.
Hoffmann, E. T. A. (1982). The Sandman. In R. J. Hollingdale (Ed. & Trans.), Tales of Hoffmann (pp. 85-125). London, England: Penguin. (Original work published 1817)
Johnson, B. (1977). The frame of reference: Poe, Lacan, Derrida. Yale French Studies, 55/56, 457-505.
Jones, E. (1976). Hamlet and Oedipus. New York, NY: Norton.
Jung, Carl. (1976). Symbols of transformation (R. F. C. Hull, Trans.). Princeton, NJ: Princeton University Press.
Kafka, F. (1977). Letters to friends, family, and editors (R. Winston & C. Winston, Trans.). New York, NY: Schocken Books.
Klein, M. (1975). Infantile anxiety-situations reflected in a work of art and in the creative impulse. In Love, Guilt and Reparation and Other Works, 1921-1945 (pp. 210-218). New York, NY: Free Press.
Kris, E. (1952). Psychoanalytic explorations in art. New York, NY: International Universities Press.
Lacan, J. (1972). Seminar on “The Purloined Letter.” Yale French Studies, 48, 39-72.
Laplanche, J. (2011). Drive and instinct: Distinctions, oppositions, supports and intertwinings. In Fletcher (Ed.), Freud and the sexual: Essays 2000-2006 (pp. 5-25). Astoria, NY: International Psychoanalytic Books.
Winnicott, D. W. (1989). Playing and reality. New York, NY: Routledge.
Woolf, V. (1925). Mrs. Dalloway. New York, NY: Harcourt, Brace, & World.