December 1st, 2013

“Listening with Purpose: Entry Points into Shame and Narcissistic Vulnerability”

“Listening with Purpose: Entry Points into Shame and Narcissistic Vulnerability”

By Jack Danielian and Patricia Gianotti

Rowman & Littlefield Publishing Group, 2012, Lanham, Md.

 

Application of psychodynamic therapy examined

Reviewed by Paul Efthim, Ph.D.

Few contemporary writers have tackled clinical work with shame and its vicissitudes as thoroughly as Jack Danielian and Patricia Gianotti in their new book, “Listening with Purpose.”

Based in southern New Hampshire, psychologists Danielian and Gianotti have built careers practicing, teaching and supervising psychotherapy. They saw a need for a training manual that helps clinicians move beyond quick fixes by deepening their understanding of how psychodynamic therapy works in a way that can be applied to a variety of treatment approaches. The result is a well-written book that illuminates the interplay of shame, narcissistic vulnerability and dissociation.

The authors ground their model on the theoretical contributions of Karen Horney along with more recent relational, inter subjective, and self psychological perspectives. Writing in the 1930s, 40s and 50s, Horney framed characterological problems not as fixed “disorders” but rather as dynamic “solutions” which are amenable to therapeutic intervention. She was several decades ahead of her time in moving beyond intrapsychic phenomena to include interpersonal and systemic factors in her views of human behavior.

Danielian and Gianotti organize their approach around a quadrant system with axes that represent the dialectic tensions between conscious and unconscious elements of the personality and between ego-syntonic versus ego-dystonic elements. Shame and its derivatives occupy a central place in their view of characterological vulnerabilities, leading to parts of the self being split off from contact with other internal parts. Rigid or compulsive behavior patterns (such as perfectionism, addiction, self-defeating behavior) may indicate splits that function to sequester shame away from conscious awareness, but at great psychic cost.

How do we detect and address such internal splits? One way is by tracking the clinical process in a moment-to-moment fashion that requires close listening to how we experience ourselves as well as our clients in the course of treatment. What is not being said? Are we colluding with something important but disavowed? Along these lines, the authors describe the goal embedded in the book’s title: “Listening with purpose involves improving our subjective ability to hear how disappointments and ruptures are defended against through levels of dissociation that have resulted from compensations against unacceptable feelings of shame and vulnerability.”

Drawing on phenomenological inquiry, the authors demonstrate how to create “entry points” that gently penetrate defensive patterns to open up space for reflection and curiosity. They also take up complex questions relating to the pacing of the therapeutic process, the timing of interpretative comments and how to assess progress over time.

Several book chapters describe how to recognize and work with shame affect, trauma-related issues, and transference. We learn how working with transferential dynamics can feel quite fuzzy in the minds of even seasoned clinicians, who may feel compelled to avoid taking up these issues in the treatment. Danielian and Gianotti provide generous session material illustrating how to work with these and other challenging issues. They add even more value by including transcribed case consultations with trainees and moment-to-moment commentary on process recordings. Many chapters close with additional question-and-answer dialogues with trainees.

The tone of the book captures the warm and collegial manner of two senior clinicians eager to share their wisdom with a broad audience. The writing is clear and most concepts are well-defined. Not a manual for newbies, this highly recommended work will be accessible to most clinicians familiar with psychodynamic theory and also is sophisticated enough to appeal to seasoned practitioners.

Paul Efthim, Ph.D. is a licensed psychologist in private practice in Brookline, Mass. He holds a faculty appointment at the Boston Institute for Psychotherapy and is a candidate at the Massachusetts Institute for Psychoanalysis.

By Paul Efthim PhD

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