Integrative Psychotherapy Books
English language books by Richard Erskine may be ordered from Karnac Books at
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A Healing Relationship:
Commentary on Therapeutic Dialogues
By Richard Erskine
Published by Phoenix Publishing House, 2021
Reviewed by JAMES SWEENEY
The metaphor Richard Erskine chooses for this book is the Japanese art of Kintsukuroi. This art is about repairing broken pottery with precious metals so that what emerges from this process is something beautiful and different. A crucial aspect of the metaphor for me is that the breaking of the pot is key to the changes that take place and all the parts have a place, as well as the ‘breaking ’itself. This is a beautiful description of the process of psychotherapy and is the canvas for the dialogue into which Erskine invites the reader.
This book arose from requests from colleagues and practitioners who wanted to know more about what Erskine says to his clients; his process and thinking around his clients and around his interventions, and what influences those interventions. In his own words, ‘This book is about a relationally focused psychotherapy, how I work and why.’ (2021, px).
Thus transcripts in the book are interlaced with Erskine’s commentary on his client, the possible processes, his process, his thinking around his interventions and what he is seeking to achieve. What I also noticed as I read is his deep empathic engagement with his clients; using his terminology Inquiry, Attunement and Involvement which is brought to life in his work and his writing about that work.
The book sets out to be a dialogue with the reader and aims to engage us, the readers, in discussion with ourselves and others regarding the subject of, ‘developmentally based, relationally focused integrative psychotherapy’. Erskine brings three full transcripts of his work with three different clients who were the clients of three colleagues. He also brings in a transcript of his conversation with one of his colleagues about the session he had had with that colleague’s client.
The book does not set out to be a comprehensive review of the theory of Integrated Psychotherapy, for that Erskine directs us to four of his other writings: Beyond Empathy (Erskine, et al., 1999); Integrative Psychotherapy: The Art and Science of Relationship (Moursund and Erskine, 2004); Integrative Psychotherapy in Action (Erskine and Moursund, 2011); Relational Patterns, Therapeutic Presence (Erskine, 2016)
The initial four chapters give a context and background to the rest of the book. Chapters five, six, and seven contain full transcripts of the sessions, referred to above, together with his commentary. Chapter 1 sets out his reflections on ‘relationally focused psychotherapy’ and discusses the principles and therapeutic tasks of this psychotherapy; the importance of the healing relationship that acknowledges, validates and normalises clients ’process in a non-pathological way. This is a relationship that values the clients ’ ‘creative accommodation ’to manage their experience.
Chapter two, ‘Discovering relational psychotherapy’, speaks of Erskine’s own journey into relational psychotherapy and his experience of this journey. This seems to me, to bring to the fore the impact of ‘profound disruptions in significant relationships’ (Erskine, 2021, p6) while growing up. It also talks of authors who influenced his approach to a ’developmentally based, relationally focused psychotherapy. ’
Chapter three explains how Erskine practices relational psychotherapy exploring the central concept of attunement and in the next chapter he talked about the significance of ‘relational-needs’. For Erskine ‘attunement ’includes the therapist’s responses to the clients’ relational-needs as they become figural in the therapeutic relationship.
These first four chapters set out the context for the heart of this book which is about how, in practice, Erskine works with his clients. What I appreciate about chapters five, six, and seven was Erskine’s attention to his client’s story which is summed up in his comment, ‘I know nothing about this client’s inner experience. ’Hence the importance of Inquiry and his attention to his client’s experience. I also appreciated his capacity to use the relationship to guide his interventions in addition to his diagnosis. In these chapters, I saw how he applies what he has set out at length in his other writings. I like his openness to being curious, to acknowledge the relational possibilities. Through his observation and attunement to the impact of his interventions he readily engages in the repair of the relationship where the intervention may not be therapeutic. His openness to own his process in this illustrates the depth of his engagement and relationship with his client.
A key part of my own learning in my reading of this book was not about learning how Erskine works in the sense of what he said or how he understood or used a piece of theory but was more about his approach to and his process around, his client. This was expressed meaningfully for me when he said:
‘I have often found that the intersubjective process of psychotherapy is more important than the content of the psychotherapy. The important aspects of the psychotherapy are embedded in the distinctiveness of each interpersonal relationship, not in what we consciously do as a psychotherapist, but in the quality of how we are in relationship with the other person. The essential factor in a healing relationship is not about “what we do” but “how we are” in the relationship. ’(Erskine, 2021, p4)
In the final chapter, ‘A collegial dialogue’, Erskine talks of the enriching process of dialogue, and includes a discussion with the therapist about the client who features in chapter seven. In this chapter he widens his reflections on his work. What I particularly liked about this chapter was how it was organised; there are references in the transcript of the dialogue to the transcript of the particular piece of work with the client. This helped me reflect and integrate both aspects of the work; that is, therapist-client and therapist- interested other which resulted in rich reflections on the work.
I personally enjoyed this book and it helped me to reflect on how I work relationally. I consider the book is important for all those who want to reflect on the process of their own work. I also believe Erskine’s openness around his work, his feelings, his thinking, his capacity to reflect on himself, the relationship and his client, will be very helpful for those who sometimes see their own struggle within the process with their client as reflecting negatively on themselves rather than seeing the struggle as the very stuff of the therapeutic journey.
References
Erskine, R., Moursund, J. and Trautmann, R. (1999). Beyond Empathy: A therapy of contact-in relationships. New York: Brunner-Routledge.
Erskine, R.G. (2016). Relational Patterns, Therapeutic Presence: Concepts and Practice of Integrative Psychotherapy. London: Karnac.
Erskine, R.G. (2021). A Healing Relationship: Commentary on Therapeutic Dialogues. Bicester: Phoenix.
Erskine, R.G. and Moursund, J.P. (2011). Integrative Psycho- therapy in Action. London: Karnac.
Moursund, J. and Erskine, R.G. (2004). Integrative Psychotherapy: The Art and Science of Relationship. Boston: Cengage.
JAMES SWEENEY PTSTA (P), PGCert (HE), has a Research Masters in Counselling Studies. James is a Fellow of the Higher Education Academy and was formerly Treasurer, UKATA Council, and Chair of the Research Committee.