Book Review: Making Sense Together: The Intersubjective Approach to Psychotherapy

By Heather Lee Kilty & Barbara Dewar

Dewar, B., & Kilty, H. (spring, 2006).
Book Review: Making Sense Together. OSP Newsletter PrOSPect. Vol. 13, No. 2.

Making Sense Together: The Intersubjective Approach to Psychotherapy.
Peter Buirski and Pamela Haglund, 2001
Jason Aronson Inc. $53.50

Reviewed by Barbara Dewar and Heather Lee Kilty

Authors Buirski and Haglund have created a superb introductory text related to intersubjective theory and practice. This valuable contribution to the psychotherapy literature provides an overview of the basic fundamental concepts, ideas and therapeutic applications of intersubjective relational therapy. Experienced and novice practitioners are provided with rich, clinical illustrations that make the intersubjective come alive.

In his forward to the book, Robert Stolorow, co-founder with George Atwood of the Intersubjective approach in psychoanalytic psychotherapy applauds Buirski and Haglund for “providing a superb introductory text presenting the basic ideas of intersubjective theory in clear, down-to-earth language.” (p.xii). Stolorow describes intersubjective theory as a “dialogic exploration of a patient’s experiential world” (p.xii).
In exploring the intersubjective interactions of both the client and the therapist, Buirski and Haglund highlight the fact that, “A central organizing concept of intersubjective theory is that our experience of ourselves is fundamental to how we operate in the world” (p.1).

Drawing from the salient writers in the field such as Beebe and Lachmann (1992); Brandchaft (1983); and Stolorow and Atwood (1992), Buirski and Haglund provide a guide to the intersubjective self, a self that is comprised of the sum of all our subjective experiences. According to this theory, earlier relationships with caretakers provide the organizing principles from which we unconsciously operate in all our subsequent relationships. However, if we develop an understanding of the meanings of our early experiences, we may no longer be destined to repeat the past.

Following from this, it is the dialogue between the therapist and client that assists the client to make sense of early experiences. Through the intersubjective relationship – that is, where the subjective world of the client and therapist interface, new meanings are created. Old meanings are transformed into new effective ways of being in present relationships.

Buirski and Haglund suggest that the therapist’s basic tools for making meaning are through the empathic-introspective stance, and through attunement to their client’s experiences. The empathic stance is a way of listening until mutual understanding is reached, as it can be assumed that the therapist is fallible and will only come to understand the clients’ subjective world through varying amounts of dialogue. “Affective attunement refers to the therapist’s abilities to perceive correctly and respond meaningfully to various qualities of a patient’s subjectivity” (p.50). While the writers definitely value empathy, they see it limited more to a listening stance with the goal of attunement. For example, in a case study about Brad a 40-year old male, they illustrate how his therapist conveys an understanding of his experience. Brad speaks about his girlfriend by saying, “It’s this over and over and I’m suspicious of everything she does at this point.” The therapist responds, “It’s hard to trust her” (p. 203). As this example illustrates, they stop short of a full development of the concept of empathic engagement.

To continue with the same case study, Brad’s organizing principle was that he had “considerable difficulty integrating what he considered the good and bad aspects of himself and others” (p. 203). He could not accept his own anger. The therapist helped Brad to come to understand that his anger made sense in the context of his childhood. This client continued through dialogue and reflection to make sense of his world with the therapist. Eventually, he became less afraid of his anger, accepted his past with new compassion, and recreated how he could live in his present.

In this example, the therapist demonstrated another core principle of the intersubjective approach, in that old meanings are not seen as pathology arising from conflicts, but as strivings for health, even though they may appear ineffectual in current relationships. Although in agreement with the striving for health concept, the reviewers question the complete elimination of the traditional psychoanalytic conflict-defense model, in the sense that mutuality of engagement in the intersubjective relationship often involves meaningful engagement in conflict and defensiveness on the part of both the therapist and the client.

Each period text in psychotherapy moves the field and its practitioners forward in thought and in practice, and this text is no exception. For example, the intersubjective approach as described herein redefines the notion of transference. Instead of being seen as projection of childhood conflict on to the therapist, the transference is redefined as, “the assimilation of the analytic relationship into the thematic structures of the patient’s subjective world” (p. 90).

The authors of Making Sense Together also make a distinction between clients who effectively use the therapist as a self-object, and those who use the therapist as an antidote for painful invariant organizing principles and behaviours. They stress that the supervision of psychotherapy candidates should follow the same conceptual model used as the intersubjective approach between client and therapist. As teachers and supervisors ourselves, we were a bit disappointed that the text didn’t go further in the development of this concept.

In spite of some underdeveloped themes, both reviewers believe this engaging text is a must for any psychotherapist or therapist in training who want to better understand the Intersubjective model. Ongoing discoveries and reflections will be made with clients and students mixing the essential ingredients of the experiential together with the concepts offered in this text to test if clients and therapists do make intersubjective sense together.