Abstract
Professor Russell Meares has devoted his professional life to developing and explicating the process of effective psychotherapy, with a particular interest in borderline personality disorder. The first edition of The metaphor of play was published in 1992. This new edition, published in 2005, constitutes a substantial rewrite.
Meares anchors his treatment method in a developmental theory of mind. The ideas of turn-of the-century psychologist and philosopher William James about the nature of human consciousness are integrated with the findings of modern neuroscience and contemporary human developmental psychology.
We are invited to consider differing levels of information processing within the brain–mind system. There are automatic responses, in which we act without any awareness of the mental processes that have motivated our actions. In more complex states of consciousness we are – at the same moment that we are thinking, feeling and acting – aware of the self that is having those thoughts, feelings and behaviours. This form of consciousness is vital to flexible mental functioning, and to the process of psychotherapy. Autobiographical memory develops within this form of consciousness, and lends a sense of familiarity and understandability to new experiences. Each new moment of experience, although it is fresh and unique, is also familiar and recognizable through being embedded within this expanded form of consciousness.
Meares argues that a relative failure to develop this expanded form of consciousness, or the tendency to lose it under certain circumstances, explains many of the clinical disturbances that afflict our patients. Therapy aims to develop, within the therapeutic dialogue, the capacity for this form of consciousness.
The therapist does not ‘make the unconscious conscious’ through interpretation. Indeed, argues Meares, the act of interpretation is liable to set up a form of relatedness incompatible with the desired form of consciousness. The goal for Meares is not the explanation, but the emergence of the expanded form of consciousness.
The book is at times a demanding read. Some students of psychotherapy may prefer a book that simply states what needs to be done and how to do it, just as the suffering patient often wants to be told simply what is wrong and how it will be fixed. According to Meares, however, psychotherapy cannot be reduced to a programme of technical procedures. A particular form of conversation must be established in which the subjective experience of the patient becomes visible to both. This form of consciousness cannot be established when patient and therapist converse in a manner of teacher and pupil.
The book is divided into three parts: development; disruption; and amplification and integration. As Meares draws together disparate fields of knowledge it is not always easy to see where he is going, particularly in the first section. Perseverance is well rewarded as the text comes increasingly to life with clinical examples, and the threads of the model weave into a cohesive whole.
In my opinion The metaphor of play is a profoundly important book by one of the greatest contemporary thinkers and researchers in the field of psychotherapy.
Dougal Steel
Christchurch, New Zealand
© 2007 Dougal Steel