"The Emperor’s New Clothes," review of Patrick Casement's article

Patrick Casement, psychoanalyst and author of several books and numerous papers on clinical technique, most famously: On Learning from the Patient.

In The Emperor's New Clothes, Patrick Casement discusses power dynamics in psychoanalytic training that can patronise, pathologise and, ultimately, even dismiss students. Psychoanalytical theory is capable not only of drawing into the light, but also of eclipsing the reality of the person in its projection. What Casement describes in terms of group dynamics and narcissistic projection are issues that are common to all institutional trainings -- including schools (for children) -- and, potentially, in all relationships, so we can all learn something from his article, whether we are working with clients, students, children, or simply being with each other in daily life. 

​​Casement says, “…projection comes into play in the services of narcissism…”. If we are unguarded and unaware we risk walking in illusion and not seeing or giving space to the reality outside of ourselves and our “group”, be that a psychoanalytic society, training committee, or, I would add, staff-room friendship group, or beyond. It is the power dynamics of exclusion, of fascism (as I have written about elsewhere), to which we are all prey since it is an easy place for us to go to in our (unwitting, secondary personality) narcissism and insecurity. Casement shows how this is possible, and even normal, when we are inattentive.

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Challenged to summarise his wisdom and teaching in a paragraph, Casement wrote the following,

While listening to a patient, there are some questions which I am putting to myself. What might the patient most need me to hear in what they are communicating to me at this moment, whether in word or silence, or in the quality of their presence? What can I say that could open up some exploring of this? What might I then be contributing to the analytic space and process? Could this then lead to creative playfulness or might it just lead to some confrontation or compliance? Am I merely applying insight from preconception or am I opening up a joint exploring towards some fresh understanding, which could be arrived at along with the patient? Am I trying to analyse from some position of assumed understanding, or am I truly open to arriving at some insight along with the patient? Am I actually open to learning with my patient at this moment or am I slipping back into trying to interpret from theory and from other experience?

(available here: pep-web.org/search/document/PPTX.038.0082A ) which illustrates Casement's approach to his work.

Casement’s focus in The Emperor's New Clothes is the particular area of psychoanalytic training schools, and the danger of students being evaluated based on their character rather than on their competence. He says “students are expected to learn within a context in which a particular way of thinking, and of working, is often given priority over intellectual freedom and honesty.” Casement believes this wouldn’t happen in a university to such an extent, so he sees a problem that may be inherent in psychoanalysis itself. I’m not sure how different a university setting is to a psychoanalysis training school, or how similar or dissimilar psychoanalysis schools are to psychotherapy trainings, but I certainly recognise what Casement is describing from the trainings I have attended myself, in the realms of therapy and spiritual direction. But, and this may undermine Casement's main point, I have also witnessed these dynamics in universities and schools, too. I have witnessed these same dynamics being enacted by therapists towards clients, and by teachers towards children in school. Always with devastating results.

​Issues arise, according to Casement, when all problems, dissatisfactions, challenges and conflicts raised by the student body are seen as being rooted in transference and regression. In fact, there is a reality outside of transference and we will not necessarily be meeting that reality if we do not accept that disagreements, challenges, and other issues arising might not necessarily be solely addressable by the student in their process. 

Along with Casement, we can surely say (like in so many spheres of life) problems “might occasionally be genuine and not necessarily an indication of pathology…”. Furthermore, problems can also be iatrogenic, a direct result of malpractice in training or therapy itself, in which case it is not pathological to feel disturbed by them! Being disturbed by mistreatment is not pathological, "but it can be pathological to accept it.” This is where the quote “…projection comes into play in the services of narcissism…” comes into force, because trainers, being human, with inner insecurities, have their own process, defences, projection and transference, and the human being will use such defences in the service of their own protection -- to protect themselves from criticism, feelings of failure, or material consequences in terms of professional status and standing. Failure to keep these forces in check is a failure to face reality, and the consequences for the student (or client) may be serious and extensive.

The consequences are also there for the person, or people, doing the projecting, as they risk mis-interpreting, and mis-diagnosing the reality of the situation and getting stuck in speculative closed loops, vicious circles.

“Wild analysis in committee” is the name Casement gives to a situation where a student is analysed by trainers in committee, “almost as if the student were the committee’s patient”. This happens without the permission, the knowledge, or the participation of the student/patient. Casement says, “there is always a risk [then] of assumptions being made that may go unchecked…" These are assumptions "...that may later be treated as if they were facts, which can lead to decisions being made upon an insufficiently firm foundation.” Casement says this way of working is so common in training committees that it is taken to be the norm, and tends to go unchallenged.

Casement describes a training environment where students are "infantalised," and where they “risk being pathologised if they are too vigorous in challenging either what is being taught or the ways in which things are being done in the training.” This almost inevitably encourages an atmosphere where students feel anxious not to ‘raise their heads above the parapet’, and feel it is “foolhardy to risk it all for the sake of one’s own intellectual integrity” by speaking up or showing their true self in all their difference. It might not be the right 'fit' for the training programme. In this environment, there will be a fear of what will be said behind students' backs... might a “healthy persistence [be recognised as a student] ‘being difficult’ or as ‘wishing to be treated as special’, and then—by a simple act of pseudo-interpretation—external problems, with which a student may be needing practical help, can be regarded as merely a symptom of some assumed pathology of the student [which] would then require no further action, except maybe for the student’s training analyst to attend to the complaint as if it were some ‘acting out’.” Reaching out, then, leads to more pain, not actual help (understanding and support).

We all need to be watchful of ourselves becoming convinced by our own theories —“a closed system that can become immune to external challenge” — but the especial leverage... or power... that therapists have is the inference that they “know the patient better than the patient knows themselves.” It is a "power" shared with religious people such as priests, and with teachers and parents with children.

The wrong help, or lack of help, that comes out of this speculative analysis by committee (or any other place that speculative analysis takes place), is likely to result in the student being “less able—not more able” to take care of themselves, leading to a “false self development rather than to something more resilient and clinically useful”. Casement uses analogy from Winnicott in how to support a mother with baby, in order to actually help, rather than interfere and make things worse, because “it is not surprising to find a student’s clinical work being affected” by levels of anxiety “about how the supervisor is going to view their clinical work [so] that they begin to feel watched in the session… [and feel] paralysed when… with the patient.” Casement says, ‘these intrusive influences are not sufficiently taken into account” when making assessments of students.

Inevitably, “the narcissism of any analyst is that which most frequently persists beyond the training analysis, or most readily returns after it”, so Casement encourages us all to “be more consistently aware of our own part in the difficulties that we have with those around us, including our analytic colleagues and students”, especially when we have 'finished' therapy. He cautions us to not fetishise neutrality or other psychotherapeutic techniques and devices. Ie, to not be so limited by the structures and theories of the therapy that we are unable to “[step] outside of the usual boundary of the analysis [and training structures] when it is necessary” in order to adequately meet the human being in all their needs, experience, knowledge and strength, in reality. “It may thus become possible for training analysts to be more ready to acknowledge that they do not necessarily always know best and be more open to those occasions when they could actually be getting things wrong…”

In this way, we may be less reliant “on an illusion of sureness", "more alert to the seductiveness of ‘wild analysis in committee’ ”, and more able to be present with the discomfort of differences and disagreements in ways of thinking. Wild analysis, especially when it is in committee, can be damning and impossible to escape. To avoid all this is something Casement says we must do for ourselves, because “it is likely that others will see through our self-deception more readily than we will ourselves,” hence the title of the article. There is information to be learned from each other, things we might have missed!

One thing I particularly like about Casement's writing is that he sees the power and importance of bottom-up movements in hierarchal systems. Every person inside a system, every part inside a person, has a channel to keep open for life to flow through it, and we can all step up in some way towards keeping that system truly alive. Casement says it's important not only not to be a "yes-man" to authority but also for the authority to make genuine space for disagreement and dispute. Diversity and inclusion are key in enabling free movement of the spirit, life force, through the body. We can't shut out any parts without blocks entering the system, blinding us to directions that bring systemic health; blinding us even to the potential for change. Like a sail boat on the sea, adjusting her sails to the wind direction and speed, an organisation (/therapeutic relationship/friendship/family...) finds a balance in direction and discernment with the tensions brought naturally by the life and difference of its members, opening ourselves up to new horizons through the otherness of what we don't already know. Difference is a gift we can use, an energy, like wind upon our sails, to follow and move in healthier directions, towards inclusion, love and acceptance, and away from rigidifying stagnation of our comfort zones, be those personal or organisational.
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​By Ruthie Baigent, 22 November 2024

The Emperor’s New Clothes, was published by Patrick Casement 22/02/2005 and is available here: www.tandfonline.com/doi/full/10.1516/58N3-PXKL-PDGE-VLXA

Comments and thoughts will be gratefully received!