Book reviews
schechter, Kate. 2014. Illusions of a Future: Psychoanalysis andtheBiopolitics of Desire. Durham: Duke University Press. 288 pp. Pb.: $23.95. IsBN: 9780822357216.
The role of psychoanalysis and psychotherapy in shaping the modern and then the postmodern/neoliberal self has been the subject of much debate in the social sciences. Following Foucault and Nikolas Rose, much attention has been paid to the way in which analysts and therapists become technicians for the creation of particular kinds of subjectivities. Less attention has been paid to the subjective self-shaping of therapists themselves and the processes by which a particular kind of personhood is cultivated as the tool through which other persons can be reshaped. James Davies' excellent ethnography of psychoanalytic training at one of London's most prestigious institutes is a notable exception. Schechter's new monograph describing the changing nature of the Chicago psychoanalytic community marks a valuable addition to this short list.
Schechter's main focus is on the effects of neoliberal reforms upon the relationship between analyst and patient and subsequently upon the self-identity of the psychoanalyst herself. In the post-war years, conventional long-term psychoanalysis was often the only form of mental health intervention available and it was supported largely through medical insurance programmes. This meant that the analyst was able to maintain what she might consider to be an appropriate distance from the patient who could become emotionally dependent upon the analyst in order for the therapist to interpret their transferences of unresolved childhood traumas on to the analyst. In recent decades, however, health insurers have moved towards a financially driven desire to limit analysis or replace it with quicker, cheaper and more "evidence based forms of therapy. As a consequence, the ability to do "proper" psychoanalysis of at least four sessions a week has dwindled, as few private patients can afford such regular commitment to long long-term analytic work. The psychoanalysts have gone from a position of self-appointed superiority over other therapists to one of anxious self-doubting, constantly questioning whether or not they or their colleagues are "really" doing analysis anymore, or are "just" doing therapy instead when they are seeing patients over a short term or at weekly intervals. When the psychoanalyst becomes increasingly openly dependent on her patients for whatever number of sessions she can convince them to commit to, then what does this dependence do to the relationship that classical analysts liked to cultivate of one-way dependency of the patient upon the analyst and her interpretative skills?
This question of the relationship between patient and analyst is at the heart of the problems that analysts face in the world of neoliberal accounting that seeks to discipline the analyst as much as it seeks to use the analyst as a tool to discipline others. By removing the analyst's financial independence, it makes the analyst dependent upon the patient in a manner that throws the nature and meaning of the analytic relationship into doubt. Schechter describes how these changes have led many Chicago psychoanalysts to focus more on how the analytic relationship itself is the factor leading to therapeutic change: a shift in focus that is viewed with considerable scepticism by many who argue that it is the interpretation that they can offer from a position of expertise in the course of long-term intensive psychoanalysis that is central. Schechter does a good job of describing the ways
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in which the rise of the relationship, 'can best be understood through an examination of the organiational contexts of its emergence' (p. 5), by which she means the neoliberal reforms of insurance-provided healthcare in the USA.
There would be a danger in pushing this analysis too far, however. Although Schechter illustrates well how Chicago psychoanalysts have been driven to query the importance of the analytic relationship versus analytic interpretation, in creating a "relational" and "neoliberal" form of psychoanalysis, the move towards the relational and away from expert interpretation has a long history in psychotherapy more generally. It is, for example, the central tenet of Roger's development of "person-centred" psychotherapy in the 1940s. Roger's break from the idea of therapist as expert interpreter and his proclamation that the quality of the therapeutic relationship was the fundamental factor not only predates the schisms going on amongst contemporary Chicago psychoanalysts, but it has been immensely more influential on how therapy is practiced, Rogers being widely regarded as only second in importance to Freud in the history of psychotherapeutic practice. It may have been the influence of neoliberal reforms that pulled some classically trained analysts down from their Olympus of interpretative expertise, but it would be a mistake to draw from this the conclusion that the move to the relational more generally is simply an opportunistic adaptation to changing forms of economic governance. Likewise, although Schechter does an excellent job of outlining how neoliberal reforms have led to an intensification of the relational in this particular therapeutic community, it is easy to construct a picture that might view this as the exception rather than the rule. The introduction of National Institute for Health and Care Excellence (NICE) guidelines governing the availability of mental health support in the UK are often derided as being part of a neoliberal restructuring of government health services in the UK. Furthermore, one of the main reasons for that criticism, from advocates of psychodynamic and person-centred forms of therapy alike, is that their desire to promote short term, cost effective and allegedly "evidence based" forms of therapy, leads to a stranglehold for therapies such as Cognitive Behavioural Therapy (CBT), in which relationship is downplayed in favour of the implementation of a toolbox of techniques designed to fix the patient's faulty thought patterns in the course of six sessions.
None of this should detract from the excellent job that Schechter has done in this book of outlining the changing self-perception of this particular analytic community and how those changes are intimately tied in with the changing political, economic context within which they operate. For anyone interested in exploring new angles on the meaning of contemporary psychotherapy or neoliberal subjectivity then this well-researched and intellectually provocative book will be a valuable addition to the debate.
KEIR MARTIN
University of Oslo (Norway)
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