Dr. Noreen Giffney works as a psychoanalytic psychotherapist in private practice. She also provides supervision to clinical practitioners conducting research in the fields of psychoanalysis and psychotherapy. She is a tenured lecturer in counselling and psychotherapy at the University of Ulster in Northern Ireland. She has published extensively on psychoanalysis, gender and sexuality studies, and cultural studies. She is particularly interested in the writings of the psychoanalyst Wilfred Bion, the impact of psychosocial factors on work in the consulting room, and the clinical usefulness of non-clinical case studies for psychoanalytic practitioners becoming more self-reflective about the countertransference experience in the clinic. She is the convener of Psychoanalysis +, an interdisciplinary initiative that brings together clinical, academic and artistic approaches to, and applications of, psychoanalysis.

You are involved in the clinical application of psychoanalysis in your work as a psychoanalytic psychotherapist. Could you say something about your background and what led you to train in this area?

I’ve always been interested in how we make meaning of our experiences, particularly those situations in which our external environment intrudes on us and throws us off kilter. How does the mind process experiences that are too much to bear, especially as it can’t undo those experiences and also can’t get away from itself? What I’m referring to here is the phenomenon of trauma. The term “trauma” is a small word that stands in for the enormity of an overwhelming experience too painful for the mind to comprehend. I first became interested in the subject of trauma and its aftermath when I was writing my doctorate in medieval studies, long before I trained or worked clinically in the field of psychoanalytic psychotherapy. The focus of my research as a medieval historian was to examine the violent invasion by the Mongols, a nomadic army from Mongolia, of Christendom and the Rus’ principalities (now Eastern Europe and Russia) during the mid-1230s/early 1240s.[1] While reading the various accounts of the invasion, I began to wonder about the emotional impact of such a violent onslaught. I was interested in tracing the impact of trauma, how trauma worked psychically (in terms of the mind, the individual) and socially (within the context of the community, the group). While people got on with the day-to-day business of their lives after the invasion, what did they do with the psychological disturbance of such a shocking environmental intrusion? I found that the affective disturbance resounded in their writings: in their dramatic use of adjectives and verbs, adverbs and nouns, and above all, in writers’ evocative and highly visual descriptions of the Mongol perpetrator. An elevation of feeling was contained within such articulations.[2] It wasn’t until I began to work as a psychoanalytic psychotherapist that I gained a deeper understanding of how each individual deals with trauma in their own way, but whatever our minds do to try to expunge it, it continues to bubble away and leak out of our unconscious in ways we cannot predict or control—in our feelings and thoughts, in how we behave and relate, in our bodies.

This interest I had in examining the thematic of trauma and its representation led me to seek out analytic tools to help me to trace and unpick the intricacies of different discourses coming at the same experience from multiple vantage points. I needed an approach that would facilitate me reading historical texts closely. I used a literary framework to help me to undertake close textual analyses of a number of thirteenth-century historical source materials, and drew on theories such as monster theory, feminist theory, postcolonial theory, queer theory and psychoanalytic theory.[3] So, my work has been, since the beginning, interdisciplinary. By the end of my doctorate, while still interested in closely reading texts, my passion for theory had overtaken my interest in medieval studies.[4] What grounds me in my work is a commitment to theory: how theories form, develop, and can be used to help us to be more capacious in our thinking about ourselves and our relation to the world around us. While I love reading theory as a literary genre in itself, it is the performative aspects of theory that draw me in again and again. When I read this piece of theory what does it do to me? How does it affect me and change me in ways that might appear to be subtle yet have the potential to open up whole new vistas of thought? How does it make me more reflective? How does it open up a space between me and whatever I’m thinking about in order to help me to reflect on the topic and my relation to it? Theory’s usefulness lies in its potential to open up the kaleidoscopic potential of a topic. I’ve also always been interested in searching for ways to open up a space in order to explore a theme from multiple perspectives. Employing multiple theories is one way of accomplishing this. Another more satisfying way is to bring many different people together to explore the same theme. 

Before working clinically, I spent many years researching and writing about psychosocial discourses of desire and their relation to the identities we choose or are assigned and the impact of both on our lived experience. I also did a lot of work tracing the discourses underlying the development of theoretical fields of study organized around sexual identity categories.[5] I was actively involved in convening events in Ireland on theories of sexuality.[6] A long-term collaboration with philosopher and theorist Michael O’Rourke during this time enriched my own theoretical research in the field of sexuality studies. Some of the events I organized formed part of The(e)ories: Critical Theory & Sexuality Studies, which I convened with O’Rourke from 2002 to 2013, while others were independent initiatives or collaborations with other people. While doing this, I became more and more interested in psychoanalysis.[7] After many years of collaborating with people within and outside Ireland, I realized that it was the collaborations themselves—working with individuals as we brought together our different thinking and writing styles—that I enjoyed most of all. I was drawn again and again to write, edit, teach, and organize events with others because it was what I found most productive for my own thinking and development. Reflecting on this in terms of clinical practice: the opportunity to collaborate with another person in a therapeutic setting is an enormously rewarding experience. The focus becomes the process itself rather than a set goal: while clients of course have goals, they shift and change over the course of the treatment.

When I began to make enquiries about clinical training, I initially considered the Lacanian tradition, because it was through Sigmund Freud’s and Jacques Lacan’s writings that I first came to psychoanalysis.[8] I love Lacan’s concepts: the object a, the sinthome, the signifier, jouissance, the real, the imaginary, the symbolic. I’ve also gained a lot from reading Lacan’s interlocutors, people like Bruce Fink, Dany Nobus, and Darian Leader.[9] But it was reading Melanie Klein’s work[10] that led me to choose the clinical training program offered by the Department of Psychiatry at Trinity College Dublin because of the course’s emphasis on the Kleinian tradition.[11] Klein’s work was a revelation to me. Her writing completely bypasses the intellectual, the logical, and the rational, and goes straight for the viscera. In her refusal to engage with psychical defenses like intellectualization or rationalization, she makes contact with parts of the reader that are usually left untouched by a piece of writing. In doing so, she offers the reader an affective experience that was unlike anything I had felt before in my reading of theory.

Could you say something about the status of psychoanalysis as a clinical practice in Ireland?

There are a number of different traditions of psychoanalysis operating in Ireland so it’s more accurate to speak of psychoanalyses: contemporary Freudian, Kleinian, Independent, Lacanian, Relational, and Jungian. Each tradition has its own distinctive understanding and development of Sigmund Freud’s ideas. All of them share a fundamental belief in the unconscious, its inaccessibility, as well as its dynamism and impact on how we think, feel, and behave. Practitioners work with individuals and/or groups, and with adults and/or children and adolescents. There are specialist trainings to work with different client groups and in different ways—for example, with adults or children and adolescents, and with individuals or groups. There are specific trainings offered for different traditions—for example, Kleinian, Lacanian, and Jungian—and a number of clinical organizations accredit psychoanalytic practitioners’ work: the Irish Forum for Psychoanalytic Psychotherapy (IFPP), the Irish Forum for Child and Adolescent Psychoanalytic Psychotherapy (IFCAPP), the Irish Group Analytic Society (IGAS), the Irish Analytical Psychology Association (IAPA), the Association for Psychoanalysis and Psychotherapy in Ireland (APPI), the Northern Ireland Institute of Human Relations (NIIHR), and the Irish Psycho-Analytic Association (IPAA). The Irish government is currently in the process of regulating the profession of psychotherapy, so it is not known yet how that will impact on the work of psychoanalytic psychotherapists.[12] 

As regards psychoanalytic training in Ireland, the training I completed was in the Kleinian and Independent traditions. This involved four years of clinical training, followed by a further two years of working as a fully-qualified psychoanalytic psychotherapist in order to become a fully-accredited practitioner. After accreditation, it’s necessary to do further professional development training by attending clinical supervision, courses, conferences, seminars, and reading groups. Many psychoanalytic practitioners continue to attend personal analysis for years after training requirements have been completed. The program I trained in required attendance at clinical and theoretical lectures, personal analysis multiple times per week, an analytic group for the first two years, an infant observation of a baby in her/his own home environment on a weekly basis for the first two years, and a clinical observation in a psychiatric hospital in the third year. Further to that, upon taking on clients in the second year of training, I was required to attend clinical supervision on a weekly basis.

Psychoanalytic practitioners tend to undertake clinical training after they have trained in another area first. People come from prior careers, such as psychiatry, the creative and performing arts, nursing, occupational therapy, teaching, science, community development, business, physiotherapy, law, sport, psychology, research, dentistry, social work, counseling, religious vocations, and so on. This makes for such an enriching experience in the classroom and in further professional training events. After training, some people continue on in their prior careers incorporating the skills and experience they have gained from their clinical training, while others go into clinical practice full- or part-time in public, private, or community settings. The Irish state doesn’t fund psychoanalysis, so most practitioners work in private practice, in which case the client pays for their treatment directly. The few practitioners who work in state-sponsored services often do so as psychiatrists, psychologists, nurse practitioners or counselors. They might draw on their psychoanalytic training to help them to think about their work with clients, but the main focus in Irish mental healthcare is on shorter-term and often fixed-term treatments. Having said this, full-time employees of state-sponsored services often retain some leeway in being able to offer treatment on a longer-term basis in certain instances.

While there are a number of psychoanalytic clinical practitioners in Ireland who publish their writing in journals, edited collections, and as monographs in Irish and international contexts, there is no integrated psychoanalytic research community active in Ireland at the moment. There are pockets of research going on in different contexts, but it tends to be tradition-specific rather than focused on the furtherance of psychoanalysis more broadly as a discipline. Some names include Margaret Boyle Spelman, Olga Cox Cameron, Joanne Conway, Tom Dalzell, Michelo DelMonte, Cormac Gallagher, Rik Loose, Patricia McCarthy, Ian Miller, Gerry Moore, Patrick Nolan, Toni O’Brien Johnson, Carol Owens, Medb Ruane, Florencia Shanahan, Ross Skelton, Eve Watson, and Rob Weatherill. There are a number of clinical practitioners who have completed PhDs, are currently embarking on doctoral research, or are considering doing do. So, while there is an appetite for research among clinical practitioners, there are no formal administrative structures in place in Ireland at present to facilitate this work, such as the university performs in the case of academic research. There are also very many clinicians who do not publish but who are highly experienced psychoanalytic practitioners. Many of these people are involved in training future generations of psychoanalytic psychotherapists as training analysts, clinical supervisors, and lecturers. Further to this, I think it’s important to keep in mind that while we’re fortunate to have the writings of Sigmund Freud, Melanie Klein, Wilfred Bion, Donald Winnicott, Jacques Lacan, and others, there are a great many clinicians whose insights we are not privy to, due to the fact that they chose or choose not to publish.

Psychoanalysis tends to be split into many specialized traditions in Ireland and there is not much dialogue between the various traditions. If psychoanalysis is to develop as a discipline and a treatment modality in the long term, I think practitioners will have to come together to form stronger links to work together in difference. While specialization is important, particularly when discussing clinical technique, there are a number of areas within which psychoanalytic practitioners could work together: most pressingly, to raise awareness of the effectiveness of psychoanalytic treatments among the mental health professions, the general public, and government service providers. I believe the field of psychoanalysis would also benefit from us mining our collective resources to establish and develop a society that could act as an administrative interface, with a premises for use by members. Within that space, specialized trainings and meetings could continue alongside one another, with some cross-pollination in interdisciplinary reading groups or continuing professional development courses. Some of this work is currently being done by the Psychoanalytic Section of the Irish Council for Psychotherapy (which includes the IFPP, of which I’m a member), the APPI, the Irish Circle of the Lacanian Orientation-New Lacanian School (ICLO-NLS), and the Irish School for Lacanian Psychoanalysis (ISLP),[13] but I think a more structured approach is needed. For example, the Psychological Society of Ireland (PSI) seems, from the outside at least, to bring together a number of different traditions of psychology (for example, counseling, clinical, organizational, behavioral, and educational), as well as clinicians and academics, to foreground the importance of psychology as a discipline and a treatment modality.

Could you elaborate on the research you have been involved in doing in the field of psychoanalysis?

My research in psychoanalysis can be divided into three areas: 1) the writings of the psychoanalyst Wilfred Bion, 2) psychosocial discourses of sexuality and their impact on clinical practice, and 3) the clinical usefulness of non-clinical case studies. Bion’s writings have as their aim the facilitation of self-reflection on the analyst’s role and function in the therapeutic session.[14] His work has been significant in the development of clinical practice and particularly in setting down how the analyst should manage memories and desires they might experience in their countertransference during the session. Bion’s concern is what it takes to facilitate the analyst experiencing the session as fully as possible. While Bion’s work is difficult to read, I believe this difficulty is necessary, because his writings cannot simply be read but must be felt. Bion refuses the reader the intellectual satisfaction of mastering the text and moving quickly on, instead demanding from his readers a deep, visceral engagement with the experience of not knowing and not understanding. This state induces both anxiety and frustration. I have explored the ways in which Bion’s writings are indispensable for psychoanalytic psychotherapists becoming more self-reflective about our theoretical and clinical practices.[15] My concern has been with how a careful reading of Bion’s writings can facilitate us becoming more aware of our countertransference during the session, including its usefulness for thinking about how, when, and why we make interpretations to clients.[16]

I’ve recently completed a co-edited book entitled Clinical Encounters in Sexuality: Psychoanalytic Practice and Queer Theory, which has been published by Punctum Books in New York.[17] The book is the result of a long-term collaboration between Eve Watson, a Lacanian psychoanalytic practitioner, and myself.[18] It opens up a space between clinical psychoanalysis and queer theory in order to explore psychosocial discourses of sexuality and their impact on work in the consulting room. The central questions guiding the book are as follows:

1. What are the discourses of sexuality underpinning psychoanalysis, and how do they impact on clinical practice?
2. In what ways does sexuality get played out for and between the psychoanalytic practitioner and the patient?
3. How do social, cultural and historical attitudes towards sexuality impact on the transference and countertransference, consciously and unconsciously?
4. Why is sexuality so prone to reification?[19]

Divided into three sections, the book begins with a series of six chapters by queer theorists on key themes relevant to psychoanalysis and queer theory: identity, desire, pleasure, perversion, ethics, and discourse. The second section features responses to the chapters in section one by fourteen psychoanalytic clinical practitioners from a number of traditions of psychoanalysis: Freudian, Kleinian, Relational, Lacanian, Jungian, and Independent. The third section features seven further responses to the chapters in sections one and two. These responses are by clinical and academic writers whose work draws both on psychoanalysis and queer theory. Eve Watson and I frame the book in the introduction, written by me, and the afterword, written by her. We were fortunate to obtain permission from the Turner Prize-nominated artist Karla Black to reproduce a photograph (taken by fine art photographer Ruth Clark) of her sculpture There Can Be No Arguments as the book’s cover image. Medb Ruane, an art critic and Lacanian psychoanalytic practitioner, has contributed a piece reflecting on her encounter with the cover image. The book is designed to be performative in style, with the aim being to facilitate the reader, in their reading encounter, to reflect on their own views on sexuality and how such views might be impacting on their work in the clinic.

My current clinical research project is a monograph entitled Developing Clinical Insight Using Non-Clinical Case Studies in Psychoanalysis and Psychotherapy: Visual Culture and the Transference and Countertransference Experience. The book develops on from pieces I’ve written on psychoanalysis and film.[20] It takes as a given that clinical case studies, vignettes, and process notes are central in the clinical training and ongoing professional development of psychoanalytic psychotherapists. One or other of these might be brought to the teaching situation by the clinical lecturer or trainee or the supervisory meeting by the supervisee or supervisor. The book explores the clinical usefulness of incorporating non-clinical case studies and vignettes into the clinical training and further professional development training of psychoanalytic psychotherapists. I focus on case studies drawn from visual culture, particularly film but also creative arts practice. The book attends to the ways in which non-clinical case studies can facilitate psychoanalytic practitioners becoming more receptive to clients’ material, in helping them to develop more of an awareness of their countertransference experience during the session, as well as its usefulness for the timing and delivery of interpretations to clients. I also think about the usefulness of visual culture texts as a way to explain and illustrate clinical concepts to trainees, as well as how they can provide a starting point for discussions with clinicians on clinical themes before broadening and deepening the conversation. Above all, visual culture texts offer each of us an opportunity to be with our own thoughts and feelings while watching a film or visiting an exhibition, after which we can tease out the intricacies of our individual and collective thoughts and feelings as a group during clinical discussions.

You have been developing an initiative called Psychoanalysis +. What is it, and how does it develop on from your previous work in academic research?

I founded Psychoanalysis + in 2013, at the same time that The(e)ories was winding down. I’ve used Psychoanalysis + to integrate the various skills and experience I have in the areas of clinical practice, event management, and academic teaching, research, and writing. It’s an interdisciplinary initiative that foregrounds psychoanalysis as a clinical practice and a theoretical tool for tracing the unconscious dynamics underpinning occurrences in cultural, societal, and political contexts. It also takes psychoanalysis itself as a signifier or object to be wondered about and questioned. It has a commitment to psychosocial and psychocultural work, and seeks to serve a bridging function between the clinic, the academic institution, and the arts and cultural sphere. And so, Psychoanalysis + brings together individuals interested in clinical, theoretical and artistic approaches to, and applications of, psychoanalysis. This is because psychoanalysis exists in an interdependent and mutually enriching relationship with the cultures and societies within which we as clinical and theoretical practitioners find ourselves. The “+” in the title gestures towards the fact that psychoanalysis is always more than itself. In other words, psychoanalytic practitioners have always drawn on and incorporated insights from other clinical and non-clinical fields into our work—for example, literature, psychiatry, music, neuroscience, art, psychology, mathematics, medicine, philosophy, nursing, classics, social work, film, theatre, and so on. Psychoanalysis is thus always, can only be, interdisciplinary. The space between “psychoanalysis” and “+” also recognizes the gap needed for productive things to happen which cannot be known in advance. The “+” also symbolizes an openness to new possibilities and collaborations.

Thus far, Psychoanalysis + has included a series of collaborative and interdisciplinary projects, publications, events, and podcasts in Irish and international locations, including Film: In Session (Psychoanalysis & Film) in Filmbase, Dublin in 2013-2014; Melancholia in the National Museum of Decorative Arts and History in Dublin in 2014; Conducting Psychoanalytic Research for Publication at University College Dublin in 2015; The Clinical Usefulness of Wilfred Bion’s Writings for Psychotherapists at Birkbeck, University of London in 2015; Affect and Melanie Klein at the Affect: Memory, Aesthetics and Ethics Conference in Winnipeg in 2015; Cinematic Encounters with Violent Trauma and Its Aftermath in Science Gallery Dublin in 2016; Sexuality, Identity and the State in the Irish Museum of Modern Art, Dublin in 2016; and The Artist/Analyst Is Present: At the Interface between Creative Arts Practice and Clinical Psychoanalytic Practice as part of the Irish Psychoanalytic Film Festival in the Irish Museum of Modern Art, Dublin in 2017.[21] Hundreds of people have taken part as speakers or delegates in events, some of which were organized by me solely while others were convened in collaboration with other people from clinical, academic, and artistic spheres.[22] I have used a variety of formats for different events and sometimes within a single event: seminar, workshop, lecture, informal response, open discussion, structured discussion, art performance, roundtable discussion, installation, symposium, screening, reading group discussion, and public conversation. The events have engaged a broad range of clinical and non-clinical disciplines and art forms, including psychoanalysis, psychotherapy, film studies, literary theory and criticism, philosophy, history, gender and sexuality studies, art history and visual culture, creative arts practice, curatorship, sociology, race and ethnicity studies, forensic psychotherapy, neuroscience, horror studies, and clinical, counselling, and social psychology. My aim has been to create a space where clinicians, artists, and academics can come together to have an experience together and to think and talk about that experience. Psychoanalytic clinical practitioners learn so much from the experience of reading psychoanalytic theory, undergoing analysis, attending clinical supervision and courses and so on, but we also learn from those who do not practice psychoanalytically and those who do not practice clinically at all but who have skills and expertise in other areas.

What, for you, is the most pressing issue for clinical psychoanalysis?

Psychoanalytic practitioners work in a clinical world of manualized approaches and short-term and fixed-term therapeutic treatments, which sometimes promise quick results. This is because short-term and fixed-term treatments tend to work by relieving symptoms rather than tackling their underlying causes, which takes much longer and can only be arrived at when the person is ready, which is different for each individual. The descriptor “evidenced-based” has become intermingled with certain therapeutic modalities, with the result that there are a litany of clinical articles published every year extolling the benefits of “x” number of sessions by practitioners following “x” set of interventions. Data is collected from clients who complete, among other tasks, questionnaires designed to measure clinical efficacy and outcomes. Cognitive Behavioral Therapy (CBT), developed by the psychiatrist Aaron Beck, has become, for many, the bête noire of psychoanalysis.[23] The two have been pitted against each other with psychoanalytic practitioners often aligning themselves against CBT. There is a lot of resentment at the space taken up by CBT and envy of its influence among healthcare professionals. A split has been increasingly enacted in which either psychoanalysis is all good and CBT is all bad or vice versa. This binary is unhelpful. They are two very different approaches, both of which have benefits for different clients and at different times.

A challenge is how to continue offering a psychoanalytic treatment within the socio-economic context I outlined above, where funding pressures may be in conflict with the clinical assessment of client needs. There’s no one approach to addressing this difficulty. Some clinicians have engaged in the discourse of evidence-based practice, undertaking their own research into the effectiveness of psychoanalytic treatment and presenting their findings in clinical journals in the fields of psychiatry, psychology and psychotherapy.[24] Some clinicians have drawn on and adapted psychoanalytic theories to develop manualized and/or shorter-term or fixed-term treatments, which are evidenced-based. Examples include Transference-Focused Psychotherapy (TFP), Mentalization-Based Treatment (MBT), and Dynamic Interpersonal Therapy (DIT).[25] These approaches bring psychoanalytic concepts together with theories of development, attachment, and psychopathology and more direct, cognitive-styled interventions in the consulting room. Some clinicians forego working in state-sponsored agencies, instead devoting themselves to private practice work. Some psychoanalytic practitioners, in public and private settings, apply their training and experience to working on a shorter-term or fixed-term basis with clients.[26] Whatever approach psychoanalytic practitioners take, it is important to continue to have confidence in psychoanalysis as a treatment modality in and of itself, as well as to allow for it to underpin the development of new therapeutic treatments that may be effective for certain client groups.

Psychoanalysis is a slow process. It does not follow a pre-ordained trajectory. There is no set goal in mind. There is but the client, the analyst, the consulting room, and the analytic frame. Each person is understood as an individual. We all work through the process in our own time, at our own pace. How long a treatment will last or what will emerge cannot be known in advance. This can be difficult when someone is in pain and wants it to go away or to stop. It takes great perseverance to undergo a psychoanalytic process. It can be a painful experience. It cannot expunge pain or undo painful experiences. No therapeutic process can do that. Psychoanalysis has great respect for a person’s psychical defenses and symptoms; they have enabled a person to get to where they are today. Psychoanalysis does not seek to relieve symptoms but interacts with the underlying dynamics that give rise to symptoms in the first place. To seek to remove a symptom without addressing the underlying dynamics that gave rise to that symptom serves only to activate the unconscious to produce another symptom in its place. To attempt to weaken a psychical defense before the person has the psychical space to experience whatever the defense has been protecting them against results in the shoring up and strengthening of the defense to deflect the persecutory experience that is too much for the person to bear.[27] It is delicate work that cannot be rushed. Instead of taking away clients’ experience of pain, which is impossible, they are offered an opportunity to develop a capacity to suffer their pain rather than self-medicating, repressing it, or splitting it off. This is facilitated through the psychoanalytic frame, which opens up a space for this slow but ultimately rewarding and worthwhile work. It is the analyst’s responsibility to keep a space open—concretely in terms of the physical space of the consulting room and symbolically in terms of their mind—to hold and contain the client as they open up areas of themselves that bring anxiety, pain, relief, and joy.

Acknowledgements

Thanks to Nicole Murray for her comments on an earlier draft of this interview, and to Joe Valente for inviting me to contribute to this special issue of Breac. Many people have welcomed me into the psychoanalytic community in Ireland in different ways and at different times. They include Margaret Boyle Spelman, Fran Burns, Olga Cox Cameron, Fionán Coyle, Sheena Eustace, Joanna Fortune, Mary Logue, Ian Miller, Liz Monahan, Ann Murphy, Berna O’Brien, Toni O’Brien Johnson, Pauline O’Callaghan, Anne O’Leary, Carol Owens, Mary Pyle, Silvia Roncalli, Medb Ruane, Michelle Sludds-Hickey, Caríosa Walsh, Marie Walshe, Eve Watson and Rob Weatherill. Each and every person’s welcome has been vitally important to me as a person and to my professional development as a psychoanalytic psychotherapist.