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Betty Joseph: Psychoanalyst and Klein disciple noted for treating the reluctant patient


The psychoanalyst Betty Joseph was the last survivor of a group of innovative clinicians who learned from Melanie Klein and her collaborators. Joseph developed Klein's ideas about "the inner world" and explored how and why patients may prefer to remain stuck with their symptoms, turning away from insight and help, in order to maintain a certain psychic equilibrium, however costly this might prove to the self.

Joseph was acutely interested in such matters; she wrote of patients who were "hard to reach", who preferred "chuntering" to facing their predicament or were addicted to psychic states of "near death" even as they may have appeared to be engaged in the work of recovery. She was renowned for taking up subtle aspects of the patient's manner of functioning that might have escaped others' ears.

Joseph's views, although admired, also aroused misgivings. Like Klein, she could give the impression that not to adhere to her approach was to do a lesser form of analysis: her rigour could be experienced as crushing or "precious", especially when badly applied by others. But she understood the novice's bewilderment, and she nurtured those in whom she saw potential. She set high standards: when told that she had qualified as a psychoanalyst, she wrote back to the relevant committee to say that she did not regard herself as ready. Complacency in the analyst was her bête noire.

Joseph's landmark publications are gathered in Psychic Equilibrium and Psychic Change (1989), which is best seen in the context of her larger career as teacher, supervisor, founder and convenor of a seminar that became something of a legend within the profession. Later renamed a "workshop", once her erstwhile junior students became eminences grises themselves, it ran nearly continuously for more than half a century. The atmosphere was convivial, searching, frank and sometimes rivalrous. She had a close working relationship with the psychoanalyst Michael Feldman, each acting as the other's editor or co-editor. If one could bear the discomfort of her criticism, Feldman observed in a moving speech at her funeral, it was possible to gain immeasurably from the experience.

Her lively seminars were routinely accompanied by copious quantities of panettone, among other edible reinforcements, along with coffee that the visitor was encouraged to drink with ample cream. She viewed modern health fads with irony; there was something in her house and her style that evoked another age. Her old friend, the poet and critic Al Alvarez, remarked fondly of the meals she served: "it was Anglo Jewish – Edwardian-French cuisine – grouse, steak and kidney pie, jellied eels, summer pudding." I recall a signature dish, circa 1972, involving chicken stuffed with grapes she had insisted on peeling and de-seeding.

A generous host and friend, Joseph was also a beloved aunt and great-aunt. She never married and had no children, but was comfortable in the company of the young. Like Klein and Hanna Segal, she regarded child analysis as an indispensable part of the toolkit in understanding the adult patient's mind. Sprightly and witty, she made living alone into something of an art. Towards the end her carer became exasperated when her charge kept disappearing, to concerts, the theatre and meals out. Joseph's zest, intelligence, lack of self pity and interest in the "crooked timber" of humanity made a powerful impression.

Born in Edgbaston in 1917, she was the second of three children in a secular Jewish family, her father an electrical engineer. She came to psychoanalysis via psychiatric social work. After studying and briefly working at the London School of Economics, analysis soon took pride of place. Joseph was sympathetic to communism, especially in her youth, but neither politics, literature nor ideology figured much in her writing, which was resolutely that of a clinician.

Joseph worked in wartime civil defence, at one stage driving a lorry, and worked with child evacuees (whose psychic dislocation, even trauma, she remarked, she only later fully came to appreciate). She began analysis with the Hungarian émigré, Michael Balint, and later with Paula Heimann, a key figure in the British psychoanalytic movement. Heimann, unlike Joseph, parted company with Klein.

Joseph qualified in 1949; it was, however, only in the 1960s and '70s that her distinctive approach became fully apparent. Hers was a highly attuned style of close listening and comprehension, and this capacity for paying precise attention to how the patient hears the analyst's interpretation – and what he or she then does with it – was to influence many of her contemporaries. Her explorations of such nuances and uncertainties bears some comparison with developments elsewhere in the humanities – detailed textual analysis for instance, with no recourse to knowledge of the author, in English literary criticism.

Joseph deftly showed in an analytic context how the medium is in part the message: the manner and form in which we talk, listen, respond (or fail to) can be as revealing as the actual content of what we say. She greatly encouraged fellow analysts to get their own ears much closer to the ground.

Such meta-attention – analysis of the analysis – could be of considerable service, enabling practitioners to see how they were unwittingly drawn into collusions, perhaps pulled into an unconscious drama instigated by the patient (or by the analyst's own preference for avoiding pain and difficulty). Joseph did much to show that the basis for psychoanalytical understanding lay as much, if not more, in grasping the "enactments" in the consulting room as in the patient's reports of the past or events outside. She liked to keep interpretations simple and direct. Where her friend Hanna Segal might attempt to talk directly of the deepest unconscious fantasy or draw more freely on patients' personal histories, Joseph preferred to stay close to the immediate situation.

A risk was that this style could become the be-all and end-all; Joseph clarified that she was not against "history" in analytic interpretations, but wary that it could be wheeled in too soon or distractingly. If she was renowned as a kind of miniaturist, a Jane Austen of clinical details, she was also alert to, and wrote eloquently about, what she and Klein called "the total situation" of the transference.

Joseph's work became an indispensible part of analytic education. Described as "the analyst's analyst", she was instrumental in disseminating Kleinian thought and technique to sceptical colleagues. She received many accolades, including the Sigourney Award of the International Psychoanalytical Association and a distinguished fellowship at the British Psychoanalytical Society.

Betty Joseph, psychoanalyst: born Birmingham 7 March 1917; died 4 April 2013.