Kleinian Psychotherapy

 

Melanie Klein, a Viennese psychoanalyst came to England in 1926. She shared Freud’s belief that our infancy and childhood hold the key to the psychological problems we experience as adults. However, unlike Freud, who formulated his theories about the conscious and unconscious experiences of childhood by interpreting the stories told by his adult patients, Klein actually studied how children behave and how they develop. She was particularly interested in the way children play and in their worries and fantasies.

The result is that, although Kleinians see their theories as rooted in Freud’s, their way of thinking is different. Like Freud, they see psychological difficulties as the consequence of childhood experiences, but they see them as stemming more from our environment and our conflicts and less from our frustrated instinctual desires.

My friend Jo is in therapy with a Kleinian. By her own choice she sits in a chair, face to face with her therapist rather than lying on a couch with him seated behind her. In therapy sessions she says whatever comes into her mind, and the therapist comments and interprets. He tends to evade direct questions, particularly those about himself: he is more likely to comment on why she asked the question than to answer it.

Jo is completely addicted to her therapy. She has been going for 30 months and she would do anything rather than miss one of the four sessions she has each week. She pushes all her open-ended commitments into therapy-free days and even arranges her holidays to coincide with those of her therapist.

Part of the attraction of therapy is that Jo unloads all her mental garbage in the sessions. Sometimes she saves up things that she wants to tell her therapist, but much of what she says in a session will be triggered by his comments and interpretations of what she says.

Jo will often tell the therapist about situations in which she feels she has behaved extremely badly, or where somebody has behaved badly towards her. He helps her to see that when she thinks of her actions and thoughts in black and white – as extremely bad or extremely good – it gives her an excuse not to do anything about them. If everything is either perfect or irredeemably bad, there is nothing to be done. When she can see that, like most other people, she is not desperately bad, but has room to improve, she feels she can get things under control.

This shift between a self-centred view of the world, in which we see things in black and white, and a more sophisticated view where we can see shades of grey and other people’s points of view is a fundamental part of Klein’s theory of development, says Margot Waddell, a Kleinian psychoanalist who works at the Tavistock Centre in London. The views are known as the paranoid-schizoid position and the depressive position respectively. The names have nothing to do with mental illness – they are simply the Kleinian terms for these ways of thinking about the world.

The link with development is clear to see. A young baby has a completely self-centred view of the world. His mother exists only for him, she is the source of food and warmth. When she is not there he feels her loss. Only gradually does he become aware that she is a person in her own right and that she has her own needs and has relationships with other people.

This theory of developmental positions provides a good framework for dealing with states like narcissism, and envy, both of which can be very difficult in relationships Waddell says. Envy can be very important: some people always begrudge other people their happiness. They would rather console a friend who has suffered a catastrophe than congratulate one who has had a success, she says.”

Jo was neither envious nor narcissistic before she went into therapy: she just felt unfulfilled and dissatisfied with her life. However, because Kleinians see therapy as a way of helping the client go through normal developmental processes by learning more robust ways of looking at the world, they are not limited to dealing with people like Jo. They can work with patients who are quite badly disturbed and with children and adolescents.

Contacts and further information Kleinian therapy is very much a UK thing. The British Psychoanalytical Society web site has information about low-cost private treatment schemes for those who cannot afford the full cost. The Tavistock Centre provides intensive and non-intensive therapy for children and adolescents, and non-intensive therapy for adults on the NHS.

Tavistock Centre Tel 0207 435 7111; http://www.tavistockandportman.nhs.uk

British Psychoanalytical Society http://www.psychoanalysis.org.uk/ Phone (0171) 580 4952

For a detailed exposition of Kleinian and post-Kleinian ideas try “Inside Lives, Psychoanslysis and the Growth of the Personality” by Margot Waddell, Duckworth 1998

 

 Posted by at 19:27