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Sister Mary: A Story of a Healing Relationship,
by Nini Herman,
Whurr Publishers Ltd, London, 1999.
Reviewed by Chris Wood
This book is divided into sections written by Nini Herman herself and sections written by her patient Sister Mary. The central part of the book is that written by Sister Mary herself and it tells the story of her abuse as a child and her subsequent therapeutic relationship with Nini Herman in adult life. A significant part of the therapeutic exploration of her own history involved the production of a series of paintings. These paintings are commented upon by both the patient and by Nini Herman towards the end of the book. It is a matter of mild disappointment to me as an art therapist that the paintings and these commentaries are placed towards the end, almost as an afterthought. Herman tells us that the paintings were made at times when Sister Mary was unable to speak of what she had experienced: it would have been very interesting to have seen some thoughts about the place and function of the paintings integrated within the story of the therapeutic relationship.
The book opens with a promising quotation taken from Guntrip’s paper ‘Schizoid phenomena, object relations and the self’:
It could be that the slowness of psychotherapy is not only due to the inherent difficulty of the problem, but also the possibility that our psychodynamic interpretations have been missing something vital. Everything in a given field cannot be seen from one point of view, and often a change of viewpoint leads to a deeper understanding (Guntrip, 1977, p. 171).
This seems to promise some discussion of technique (perhaps particularly in relation to the art making) and this discussion is not forthcoming. However the genre chosen by Herman does not allow for much theoretical speculation within the story itself.
There is a growing genre in the present period of accounts of therapy by former patients. Herman in her introductory pages points to the famous historical examples by Freud’s patient HD and Wininicott’s patient Margaret Little, neither of these accounts are preceded by introductions penned by either Freud or Winnicott. There is something a little uncomfortable then about them being offered as examples, even before her own patient has had the chance to begin. That Herman opens the book with three chapters of her own, leaves little doubt as to how the reader is intended to perceive the story, but it also means that the reader is presented with a hybrid. The book is neither case study nor patient account.
The power of the therapist in introducing therapeutic stories is clear and it is not something about which I can or would wish to single out Nini Herman. In case studies the power of the therapist and their persuasion is always evident, this is not surprising given the extent to which they open the therapist’s work to public scrutiny. Joint presentations by therapist and patient (whether oral or written) can have a similar tendency for persuasion (although perhaps they require still more courage to make), but when they are done well they can be educational. With this jointly presented story I am unsure what is being presented: Sister Mary’s part of the account is innocently deferential to her ‘Lady’ therapist and it sometimes seems that Nini Herman is a little romantic and grandiose about her practice.
Sister Mary’s account of her experience and her memories of being a naive participant in therapy is interesting and I think, moving. Her frequent sense of imminent danger, a fear of emptiness and personal catastrophe is reminiscent of the fears described by people with a history of psychosis, although her condition is not one of psychosis. Her account of painting what she feels when fear makes her mute is simple and clear. The paintings seem to have enabled her to articulate more of her experience, although it is not very clear how Nini Herman worked with them. It may be that Herman herself said too much about the paintings, nevertheless Sister Mary appears to have come to her own understanding of them,
And as the trapdoors and the shutters of my mind stayed open a little longer each time I brought another painting, I would listen while Nini helped me to make some sense of the meanings they might hold. Gradually the terror minimised and an understanding grew that I was no longer that helpless unprotected child and need to longer run or hide (Sister Mary in Herman, 1999, p. 52, my italics ).
Throughout the book I think Nini Herman protests too much about her tendency for not being obedient to a sense of practice technique. Although I’m sure many therapists would recognise how they themselves stray from what Herman terms ‘obedience’, she offers us too much rhetorical self justification about not following some notion of technique. This is again uncomfortable, as are generalisations about clients who have been abused and about the level of articulation in modern life.
If we return to these individuals’ dysfunctional families – the culture that they came from, we find one thing in common, which is a striking poverty of language of the emotions. Now, to some extent, this is nothing unusual. A dialogue today often consists largely consists of ‘you know what I mean’ (Herman, 1999, p. xxii).
My own experience is that the access to international multimedia on almost every street corner has massively widened the range of articulation for the vast majority of people, although admittedly it is not all delivered in received pronunciation and possibly some individuals (maybe Sister Mary) have remained cloistered.
One of the most startling examples of straying from technique is the introduction given by Nini Herman to Sister Mary in order that she could have a meeting with her husband Josef Herman and their daughter. This meeting which took place in the artist’s studio and involved a wide ranging discussion about Sister Mary’s paintings and about art in general, seems to have been nourishing and successful. For me it is reminiscent of some of the best examples I have seen of social psychiatric practice, having been fortunate enough to work in the psychiatric teams of psychiatrists like Alec Jenner and Jim Gomersall. In one sense perhaps this helps me think about how a book like this might be read, not within a strict framework of psychoanalytic psychotherapy, but within the frame of good social psychiatric practice. This is necessarily more wide ranging and liberally pluralistic but it can usefully involve the insights of psychoanalytic psychotherapy. However even within a psychiatric setting Herman’s practice would be unusual, but certainly her idea of inviting her patient to bring paintings to their sessions seems to have dated from the time when she had supervised a team of art therapists in the psychiatric hospital in west London where she had worked for a number of years.
My thoughts about the paintings and the separate sets of comments upon them made by patient and therapist, carry with them a feeling of respect that their creation is acknowledged as an element of the relationship which enabled them both to move through a period of being stuck. However it would have been interesting to read a record of their dialogue about the paintings, because the separate accounts are too much like lists and they leave it unclear how the paintings functioned within the relationship. Also Herman suggests that whereas Sister Mary’s account of the paintings ‘return pristine to the original here and now situation’ (p. 77-8), her own ideas ‘evolved in relays over many sessions and were further elaborated with hindsight’ (p.78). Whereas I recognise Herman’s description of the changing significance of an image over time, I think that the patient’s awareness of the changing of significance is particularly important and unfortunately Sister Mary’s retrospective view of the images is not included. I find the explanation given by Herman to be unsatisfactory, because it implies that Sister Mary can not even after three years think in an undisturbed way about her paintings. It is not I think as Herman implies, evidence of the paintings being hot-wired to the unconscious, although they clearly have aspects which seem less than conscious.
The concluding chapter presents Nini Herman’s reflections about what is needed in order to help patients with disturbed and abusive backgrounds. Her thoughts are wide ranging and they will be recognised as materials which are regularly chewed over by hard-pressed clinicians. She argues against a notion of bad psychotherapeutic practice ‘the faceless therapist’ and against excessive interpretation which threatens the patient’s sense of reality. She advocates instead a therapy of corrective parenting. She suggests that spontaneous interventions can be pivotal, with the example given of a psychiatrist who drives their patient in the middle of the night to check the reality of fears about the death of both parents. She describes bad psychiatric practice as invoking punitive regimes.
Whereas she acknowledges that the public sector can not provide 5 times a week psychoanalysis (also acknowledging the constraints upon financing this in the private sector), she wishes to propose that such patients need more than once weekly sessions and that for some patients the work needs to be open-ended. Her ideas about reaching a wider range of the many clients who have a disturbed history include expanding training programmes. She would propose a more inclusive range of entry criteria for those trainings which offer some understanding of the less conscious aspects of human difficulty.
Whereas I have some sympathy with most of these proposals, I do not think her manner of proposing them is politic. Her final paragraph rails against the ‘echelons of science which still tend to launch missiles of ridicule and abuse at psychoanalysis’ (p. 102). I do not think this helps practitioners or the great majority of patients in the public sector who might benefit from an inclusion of the more progressive aspects of psychoanalytic insights within public services. Herman’s reliance on spontaneous interruptions of technique will as she rightly anticipates make many whom she might want to convince, regard her work with suspicion. Also to not acknowledge in 1999 the more legitimate aspects of the movement calling for evidence of effectiveness is in one sense the political abandonment of the vast majority of public sector clients and the insights which psychoanalysis and psychotherapy might bring to them.
It is evident that Herman cares deeply about Sister Mary and that she was moved to present their joint story in a readable and respectful vignette, but it remains a particular account with very particular relevance. I think there are numerous examples of this sense for her of the particularity of the relationship:
And it strikes me, more fully, as the months since working on our project run by, how exceptional that soul of hers must be to have drawn form me, in my turn, responses – the like of which I have not been drawn into before (1999, p. 91).
Finally it seems to me that it is hard to generalise her findings because of the very particular way in which Herman has chosen to describe the relationship.
Guntrip, H. (1977) ‘Schizoid phenomena, object relations and the self’ International Psycho-analytic Library, 77, p. 171.
Chris Wood is
Course Director for Art Psychotherapy at the Centre for Psychotherapeutic
Studies, School of Health and Related Research at the University of
Sheffield. She also works for the mental health services in Sheffield
(Community Health Sheffield) as an art therapist.