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29 avril 2012

ah ces présentations de cas ! Michael Randolph

Allez un peu d’anglais, de cet élégant anglais de Michael Randolph, qui vous méduse en vous rappelant le principe des médecins que laisser faire la nature parfois représente la meilleure solution – principalement quand il ne s’en trouve pas d’autre à disposition.

Un peu de modestie et d’humour, et la référence à ce Cozolino qu’il nous invite à lire, qui démontre que le cerveau assisté par une bonne relation saine et attentive peut des merveilles. Certes, le cerveau, et l’âme dans tout ça, la bonne âme de Sé Tchouan ?


Michael Randolph

Unreliable case studies

By Michael Randolph

There is a case to be made out for reliably unreliable case studies, i.e. ones that are based on far too little information coupled to a somewhat feverish imagination. The case is that all case studies are anyway basically unreliable in that they present a twice or thrice filtered view of a patient/client in psychotherapy: They filter the present, past and future massively in or out by the choice of verbatim reporting, edited reporting or charged description; the patient’s view of things is sometimes, though very rarely, heard, as in Irving Yalom’s Every Day Gets a Little Closer but, although a courageous and welcome innovation, it doesn’t mean we grasp what we might really want to grasp; the therapist’s conceptual references may and do clarify some things whilst systematically obscuring others; the whole idea of conveying the reality of a psychotherapy in a study is a resoundingly dubious one, though there is no better learning material, no more inspirational humus to allow our growth as practitioners.

Below there is an upbeat text about modern psychotherapy I found while ordering a book from Amazon. I agree with almost all of it in the sense that I hope and assume that these things are basically true, basically realisable. From time to time, however, I run across something that, taking these hopes and assumptions as my baseline, gives me pause for thought, sometimes a long pause. I think it could enrich our clinical awareness to exchange these, not so radically uncommon, exceptions or, possibly, surprising therapeutic meanders which end up reconnecting in some way with mainstream expectations. Attached and further below find my pump-priming two-page starter. Lots of my colleagues never write anything because they worry about conveying something as comprehensive as it is comprehensible or they worry about their five-book bibliography.

There’s a lot of thought, feeling and synthesis-provoking experience out there which practitioners occasionally mutter about wanting to share with someone, preferably in the privacy of their own home, and which never gets to illuminate the trade. Pity. Short and sweet, with as few disclaimers as possible and no obligation to conclude with any plausible foresight, it could even form the basis of a one-off review.


After over a century of the ‘talking cure’ helping people with their mental suffering, we finally are able to shine a light on the physical, neurological basis for the changes that happen in the brain after a prolonged therapeutic interaction between patient and therapist. Louis Cozolino is an excellent teacher and with great ease and clarity shows how the brain changes as a result of experiences, both traumatic and healing. He explains how it can become a strong and integrated organ that regulates our emotional states and focusses us towards our goals, if the person it inhabits has a successful experience of attaching securely to the caretaker.

He also illustrates the damage that the brain suffers when deprived of the needed opportunity for a secure relationship. Fortunately our brains are able to change given new experiences. This ‘plasticity’ is what allows us to learn new things at any age, by growing new neurons and new pathways between them and prior structures. The author illustrates in great detail the regulatory architecture of the brain, and how psychotherapy when based on a trusting, safe and emotionally significant relationship helps the rational left brain sooth and modulate the affective right hemisphere, and the cortex in general to exert top down inhibition of the emotion generating limbic system. Excellent and highly recommended.

Z’s profile

By Michael Randolph

In a 5 day group psychotherapy workshop in the spring, both L. and especially Z. seemed to be in shock at the prospect of self-induced disaster, seemingly mediated, encouraged or accelerated by their experience in psychotherapy. They were apparently mesmerised by the perspective of an unavoidable smash-up. The equally appalling prospect of accepting a posteriori radical impotence in the face of the destructive cunning of wilful neglect, in Z’s case, or the grim fate of the worn-out plaything in L’s did not appear even remotely envisaged as an option by these two relatively young adults (27 and 32 respectively).

Here is a plausible outline of her situation reconstructed from the hints put out by Z: Z.’s mother was an intellectual, a university literature teacher whose husband, Z’s father, humiliated her by rapidly directing all of his emotional intensity back on to his family of origin after their marriage and disgraced her by fulfilling her overbearing parent’s prophecy that hers was a lousy choice of a husband. She revenged herself by being, whenever she didn’t forget herself, ostentatiously uncaring for and uninterested by his offspring, her children. She also strove to label him, an occasional festive over-imbiber, an alcoholic to their children and to the world, thereby consigning him to the slag-heap of the weaving Slovakian working-class drunk.

Z. rapidly, in primary school already, totally appalled by the girls’ baroque world of friendship-negotiation and betrayal, found a durable boy-friend. After four years, presumably aided by the fact that the boy couldn’t really understand what his purpose was, she dumped him and felt intense euphoria at this decision which “resolved everything”. Not long after she started another relationship which also lasted four years and whose demise was the occasion for another ride int