An Intersubjective Mentalization-Based Primer

Rezensionen / Stimmen

'In Empathy as Competence, Johann Steinberger, rooting his work in intersubjectivity, resonance, and mentalization theory, understands and portrays empathy not just as a talent, but as a skill. Equally important, Steinberger presents the method he has devised to teach this crucial skill. The practice of empathy, in other words, does not necessarily require that the student of empathy already be gifted in this respect, which means that Steinberger's method, Affect Resonance Therapy, can be very widely taught. In taking this step, and doing the research to establish it, Steinberger broadens the empirical demonstration of psychoanalytic conceptualizations in a way that serves as a model for all such work, and simultaneously offers not only mental health professionals, but all healthcare workers, and even practitioners in other fields, such as education, a means of meaningfully contextualizing the understanding of persons.'

Donnel B. Stern, Ph.D., William Alanson White Institute, New York, U.S.A

'Our social fabric and well-being depend on the essential care provided by healthcare workers. As I write these words, the global population is struggling with the effects of the coronavirus. We are in the grips of a pandemic and healthcare workers are as susceptible to the virus and its associated anxieties as the patients they treat. The pressures they face are enormous. Societal expectations of healthcare workers, and the responsibilities they experience, create a constant emotional burden, even as they work to relieve the physical suffering of the individual patients under their care.

In his important new book, the psychotherapist and educator, Johann Steinberger, demonstrates that our emotional well-being is manifestly complex and always exists in relationship to other people. The emotional lives of healthcare workers, or of anyone else for that matter, can only be understood if we appreciate the social contexts that bind us together as human beings. We are all fundamentally emotional and social in nature. This basic precept raises some important questions: How do healthcare workers relate to the humanity of their patients, or to their own emotional experience? How might a greater emotional awareness improve not only patient care, but also the lives of healthcare workers themselves?

And what kind of educative process can instill emotional understanding, given the prevailing emphasis on cognitive knowledge and biomedical research? The societal crises we face today, from pandemics and rapid climate change to repressive and authoritarian regimes, surely provide good reason to attend to our emotions. This book asks us to engage with our emotions and recognize how they manifest themselves in our everyday and professional lives. But this is neither easy nor straightforward to do. We often do not know what we are feeling, and our current system of medical education neglects the centrality of emotional life.

Steinberger demonstrates that in order to achieve emotional awareness and possibilities for emotional regulation, we need first to understand how we interact with others and the world around us. To this end, he lays out a carefully planned and practiced program of training that teaches us to reflect on and understand emotionality - to mentalize our emotions - and thus, to learn from and deepen our emotional lives.

Affect Resonance Training is a thoroughly and wonderfully interdisciplinary book. It is both scholarly and highly readable, a work that combines history and theory, with evidence-based practice and training models that draw upon ongoing qualitative and quantitative research. Above all, this book seeks to render psychoanalytic ideas relevant for the present, and to invigorate an approach to medical and therapeutic education that moves beyond cognition and embraces the reality of our emotions, in all their richness and complexity.

This book is both an introduction to an essential training course in the emotions and a vital reminder of the importance of psychoanalysis at a time when psychotherapy is increasingly dominated by cognitive and behavioral approaches.

Steinberger provides a wide-ranging and rigorous introduction to an essential body of psychodynamic theory and practice, from mentalization to intersubjectivity and relational psychoanalysis. In this sense, the book's purpose is twofold: to provide a new and specific emotion-focused model of education for healthcare workers called Affect Resonance Training or ART; and to outline a contemporary and cutting-edge psychodynamic perspective on emotional life and well-being.

Steinberger's work will resonate with readers in myriad ways. As a University Professor, teaching in the Faculties of Education and Psychiatry, and as a practicing psychoanalyst with hospital experience, Steinberger's book brought home for me the challenges and opportunities we face today. How do we think and practice, be it as healthcare workers in today's medical system, or as individual clinicians interacting with our patients? For example, young psychiatrists are increasingly educated only in the biomedical model and receive limited exposure to therapeutic forms of patient care. The important, but often outdated psychodynamic models that once held sway in psychiatry, have been overturned in favor of psychopharmacology, a formal diagnostic process and biomedical research.

The patient, who was long defined as the one who suffers, has been increasingly transformed into a medical object that can be measured and assessed. As a result of these changes, today's psychiatrists-in-training are often ill prepared to understand the emotional dynamic of the healing relationship with their patients. Nor are they prepared to understand their own emotional lives or how the emotions shape what they perceive, understand and do with their patients.

How can today's educative system prepare heathcare workers to appreciate the empathic process or their emotional relationship with their patients? For Steinberger, the solution to this dilemma is clear: >> New perspectives are needed in the education of upcoming generations, moving away from cognitive meaning and towards developing psychological meanings and new forms of psychological understanding. We attach great importance to technical progress and the pursuit of change in cognitive experience. We attach less importance to our psychological development [...] The creative basis for future generations will be found in attitude and in psychological understanding.

When we empathize with another person, we may relate differently to them depending on how we perceive and understand the patient's pain or suffering (see Luhrmann, 2000). When psychiatrists are schooled in diagnosing and prescribing in a biomedical setting, they learn to see their patients in terms of categories of illness, defined by specific brain functions and psychological symptoms. But what of their patient's lived experience, the way that an illness is felt, or can shape the trajectory of life? In order to understand and empathize with a patient's lived experience, it is necessary to move beyond categories, functions and symptoms, to grasp the experience of suffering at the heart of their struggle. This requires a different kind of relationship. It requires seeing the patient as a person, someone who is more alike than different. Empathy, the ability to think, see or feel oneself into the place of the other, plays a crucial role in this humanizing process.

The traditional medical model, with its emphasis on universalization and objectification, tends to neglect our embeddedness in the social world. As Steinberger points out, the consequences are far reaching: >>Unser derzeitiges Wissenschaftsverstaendnis loest sich von der Person und versucht, deren Gedanken und Theorien zeit- und ortsunabhaengig darzustellen [...].<< In response, Steinberger develops an educative model that seeks to foster awareness and appreciation of the social and cultural contexts that shape emotional life. It is essential to understand human experience in the contexts in which it takes place (Frie & Coburn, 2011).

This is particularly relevant for understanding emotions. Viewed from a developmental lens, patterns of emotional interaction between a child and its caregivers unfold in specific sociocultural contexts and historical trajectories and give rise to interpersonal frameworks and implicit meanings that shape subsequent emotional experiences. Viewed from a contemporary psychodynamic perspective, our emotional lives are a central dimension of all human experience and fundamentally relational and sociocultural in nature.

Steinberger's book seeks to overcome and question the overarching contemporary emphasis on cognition. In the process, it teaches us how to engage with new and different forms of emotional awareness. Affect Resonance Training is written to help professionals concerned with the crucial task of training tomorrow's healthcare workers. This book is equally relevant to practicing therapists and students because it provides an essential guide to a growing and important body of work on mentalization. Clear and comprehensive, reaching the expert and novice alike, Steinberger's careful and sensitive study is both necessary and inspiring.'

Roger Frie, PhD, PsyD, R.Psych, Professor of Education, Simon Fraser University, Affiliate Professor of Psychiatry, University of British Columbia, Vancouver, Canada

'We have known for decades that the relationship, as perceived by the patient, is key to outcomes in psychotherapy. We also grasp the contributions of the therapist's capacity for empathy to that relationship. But are we constrained to select trainees with higher innate capacity for empathy, or can it be taught? Johann Steinberger has made a significant step in the project outlined in this book to answer this question. He is a major contributor to the recent move towards unpacking the tools, interventions, and therapist qualities that matter, by showing us how to go about increasing one of these-- empathy. Kudos to Dr. Steinberger for this excellent book.'

Stewart Kiritz, PhD, Clinical Assistant Professor, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Clinical Assistant Professor Emeritus, Department of Psychiatry and Behavioral Sciences, Stanford Medical School, California, U.S.A.