The Southeast Florida Association for Psychoanalytic Psychology
A Local Chapter of Division 39 of the American Psychological Association
Psyche & Sol - Fall 2011, Volume 17, Issue 2
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President's Message: When does self-disclosure become inescapable? - Lori Prince, LCSW
As I sit down to write the SEFAPP President's column, I realize Fall is approaching quickly. Fall means three fourth's of my year as SEFAPP President has past and I am amazed and filled with mixed emotions. We have some terrific conferences and programs coming up and I hope that you will review the calendar contained within our newsletter.
I am so proud of the work of SEFAPP and the numerous events and accomplishments throughout the year. I am honored to serve with an outstanding Board of dedicated, intelligent and responsible board members who have put relentless hours and efforts into our events and projects.
For me personally, it is been an interesting and challenging year, and after giving much consideration to self disclosure, I have decided to do so. After the SEFAPP election but before my term started, I experienced two life changing events. I was blessed and thrilled to marry my partner and soul mate and begin our life together as a married couple. However, two weeks before the wedding, I was diagnosed with thyroid cancer. Shortly after the wedding, I had to face surgical intervention followed by a specific type of in-patient radioactive radiation ablation of remnant tissue.
I work in a very large healthcare system as Director of the Employee Assistance Program. While I do not see patients in psychoanalysis, I do practice and think psychodynamically and have a deep appreciation for the importance of a therapeutic relationship/ alliance, and understanding of the transference /counter-transference issues that emerge in our work.
I am used to the "hospital environment". I treat many employees, some of whom have come to see me when they faced cancer and needed to become "patients” in the very healthcare system that we work for. Now here I was, facing the same daunting task, becoming an involuntary member of the "Big C" club (C=Cancer) at the time of my life when I should have been off on my honeymoon. Now I was a patient in the very system where I work and treat employees.
This healthcare system is rather large with ten thousand plus employees and I do not typically know any of them before I meet them on a professional basis. Now however, I had some major dilemmas:
1) What do I tell (if anything) about my expected absence? It now was no longer going to be a two week vacation, but a more prolonged medical leave of absence.
2) Can I really ask some of the individuals I know on the "in" who really is the best surgeon for me?
3) Might I end up being taken care of by someone whom I have had a therapeutic relationship with?
4) How am I going to manage any transference/counter-transference feelings when someone comes to see me with a similar diagnosis?
5) Do I move forward and accept the SEFAPP presidency or do I ask for a replacement before my term starts......Will I do a "good enough" job?
I will tell you I am and have been back at work for some time now. My experience (some of which was unexpected) has led me to read the literature and try to further understand dilemmas of disclosure to patients and colleagues when a therapist faces possible life threatening illness.
Nancy Kahn (2003) pointed out that “According to the literature, each analyst’s own subjective experience, idiosyncratic to the combination of the psychology of the analyst, the course of her illness, the patient, and the analytic process, determines whether or not self disclosure becomes inescapable.”
Barbara Pizer (1998) coined the term “inescapable self disclosure” after her experience with breast cancer and her belief that failure to disclose would be more disruptive to her patients. She described this self disclosure as “the analyst’s action resulting from the presence in the treatment situation of a circumstantial event whose disruptive properties in the mind of the analyst can be handled only by verbal acknowledgement”. She felt that to not disclose and discuss the changes (i.e. wearing a wig after chemotherapy) was to ignore the elephant in the room.
When I returned to work, I had to adjust to physical changes and symptoms as well as manage my own anxiety about illness. My illness has a very good prognosis and therefore I reassured myself there was little need to disclose. I returned to work in between surgery and treatment so there were some patients who merely thought I had taken a vacation and did not express any curiosity or sense any changes. I felt relief when seeing new patients: I simply felt relieved at being able to avoid any issues related to my changes.
There were other patients whom I had been involved in their care on a much deeper level and when asked I advised them I had been on a brief medical leave and that I was “fine”. I agree with Kahn as she discussed her unconscious agenda of maintaining her own security and wondered whether this type of reassurance was just as importantly done to quell my own anxiety.
Philip (2004) pointed out that “the seriously ill or dying therapist, who has access to his or her deeper thoughts, feelings, fantasies, and dream content is preoccupied with a multitude of doubts and anxieties reflecting every developmental level. ... Disclosure can feel a lot like exposure and silence can feel like a burden.”
It is imperative that the therapist seek support and supervision so that any disclosure is for the patients benefit and the therapist is adequately prepared for the questions and emotions that follow. I chose to deal with my illness by reaching out to colleagues and friends for support and consultation.
Dewald (1992) used his experience with illness to consider the multiple meanings and reactions that occur in both patients and analysts. Dewald recognized his own level of denial stating “The realization during my recovery phase that this had occurred to me and I had been helpless to do anything about it forced upon me the recognition that I had previously considered myself invulnerable to illness or disability.” Upon his return to work, he was faced with the question of how much factual information to provide, how his level of disclosure would vary based on his assessment of each of his patients, as well as the question of how extensively can and should the patient be helped to deal with the conscious and unconscious reactions to the analysts' illness.
I personally encountered two issues that I had been unprepared for. Firstly, as a result of my surgery and treatment, I experienced one of the possible side effects: a left-sided vocal cord paralysis. As a result, my voice was hoarse and strained and I experienced difficulty with power and projection. At times, I was more exhausted than usual and worried my patients might feel I was not fully there for them. Could I still be a calming presence at the same time I struggled? As the day wore on, the symptoms were more noticeable and impossible to mask. Some patients were aware that I was out on medical leave, relieved when I reassured them of my good health, and definitely aware both of the struggles and improvement in my voice.
An additional surprise encounter I experienced occurred during an initial session with a new patient that was seeking support and counseling secondary to family issues. Midway through the session she looked straight at me and asked “You have thyroid cancer don’t you?” I wondered “Was it my voice or scar that gave it away?” At that moment, I chose to answer the question directly rather than explore why she asked. I cannot adequately defend why I did that other than to say I was shocked and answered directly. “Yes”.
She then answered “I know, I was one of the people that took care of you during surgery.” In retrospect, I believe because she saw me as vulnerable and a survivor, she believed I would understand her specific issues and concerns.
Buechler (1995) wrote about hope as inspiration in psychoanalysis. She asked "Does the analyst's hope for the patient, or for himself, somehow communicate itself to the patient, infecting or instructing him? I don't believe it is, specifically, the analyst's hope that engenders hope in the patient, but the analyst's whole relationship to life. The patient observes the analyst's struggle to make sense of things, keep going in the face of seemingly insurmountable obstacles, and retain humor and courage in situations that seem to inspire neither. The analyst stumbles, reacts without self-hate, and works to recover. The analyst is willing to work hard. She is honest without being crippled by shame. She wants to live even the most difficult moments. She doesn't shrink from what is ugly in herself or the other. She is more interested in growth than in being right, more curious than self-protective. She can be wounded but refuses to be made dead. While in part this attitude may provide a model, and it may be contagious, I think that what mainly creates hope is the patient's experience of finding a way to relate to such a person. For many, this task requires substantive changes, alterations in all components of the emotion system. The deepened curiosity and joy, the lightened envy and hate that results engenders hope."
While I did not choose to become ill, nor did I choose to disclose for my benefit, I have come to accept that should my health worsen, should a patient become aware of my struggle, I will choose to face it as openly and honestly as I possibly can and hopefully demonstrate my ability to have faith, persevere and overcome adversity.
My experience has led me to continue my interest and ponder questions. Had I adequately thought about or prepared for the day that I may not be able to work? Although I thought I had always given sufficient attention to matters of treatment termination, I now realize that I avoided any thoughts about premature termination due to unforeseen illness within me. I had only considered family crisis or illness of others that might derail me for a period. I realize my level of denial about this possibility was higher than I imagined.
I have chosen to share with you my experience primarily for two reasons: 1) If you have not yet considered planning for unforeseen illness and impact upon your work, I encourage you to give this some consideration and advance planning, and 2) my experience has brought me an even greater appreciation for psychoanalytic communities that provide opportunities for friendship, belonging, support, scientific discussion, consultation and recognition of the importance of the patient/therapist relationship. When faced with illness I not only had the support of family and friends, but numerous colleagues both at work and through our wonderful SEFAPP community.
References
Abend , S. (1990), Serious illness in the analyst: Countertransference considerations. In: Illness in the Analyst, ed. H. J. Schwartz & A.L.S. Silver. New York: International Universities Press, pp. 99-113.
Buechler , S. (1995), Hope as inspiration in psychoanalysis. Psychoanalytic Dialogues 5: 63-74.
Cristy, Barbara, L. E.. Journal of the American Academy of Psychoanalysis, 2001; v.29 (1), p33-43
Dewald , P. A. (1982), Serious illness in the analyst: Transference, Countertransference and Reality response. Journal of the American Psychoanalytic Association 30 : 347-363
Kahn, N. (2003), Self Disclosure of Serious Illness: The Impact of Boundary Disruptions for Patient and Analyst Contemporary Psychoanalysis 2003 v39 (1) p51-75
Morrison , A. (1997), Ten years of doing psychotherapy while living with a life-threatening illness: Self-disclosure and other ramifications. Psychoanalytic Dialogues 1997 v7 (2)225-241.
Philip , C. E. (1993), Dilemmas of disclosure to patients and colleagues when a therapist faces life-threatening illness. Health Soc. Work, 18
Pizer , B. (1997), When the analyst is ill: Dimensions of self-disclosure. Psychoanalytic Quarterly. 66: 450-469.
Editor's Column - Antonio R. Virsida, Ph.D, ABPP
Again, full of interesting and informative articles and columns, this issue begins with Lori Prince’s President’s Message on a topic all therapists, at one time or another, face and deal with personally and clinically with patients; our serious illnesses. Lori refers to several references by therapists who have experienced serious illnesses.
She points out that disclosing her illness to patients was a painful process and further that we cannot rely on “one size fits all.” If and how we disclose our illnesses to patients has to be guided by who our patients are, and the context of the treatment.
Regarding SEFAPP business, Aaryn Gottesfeld’s Treasurer’s Report is indeed good fiscal news for SEFAPP. With a closing balance in July of $14,621.52, SEFAPP is in the best ever financial position. She also reports that this year’s fundraiser netted $1,811.00. Cathy Stamm-Kaufman, Chair of the Fundraising Committee, reports on the pleasurable and profitable afternoon of food and drink at our seventeenth annual Freud Amongst the Arts. Len Ferrante, our Membership Chair informs us that our membership numbers are up which, of course, helps our financial bottom line. Lisa Schulman, our President-Elect and Chair of the Scientific Program Committee, along with help from Marshall Fenster (who has been temporarily chairing the Continuing Education Committee) offers us a 2011-2012 calendar of events. Comprehensive summaries of four of our excellent Scientific Meetings and a Symposium/Brunch are provided by Emily Krestow.
As usual, Linda Sherby offers a sensitive look in her column, Clinical Vignettes, at her work, many years ago, before her psychoanalytic training, with a patient who rejected all of Linda’s caring intentions and clinical efforts. Something we all have experienced, pre-or post-psychoanalytic training.
I provide an update on the Southeast Florida Institute for Psychoanalysis & Psychotherapy (SEFIPP). We have five new students enrolled in our Introduction to Psychoanalytic Thinking: Theory and Practice. Because each of the students live and work long distances (one is from Naples) from where SEFIPP’s classes are usually held, Imperial Point Medical Center in Ft. Lauderdale, the two classes per week will be by way of group video conference. The once monthly Clinical Case Process Seminars will be attended, in person by students and instructors. For information about SEFIPP either contact me at arvirsida@aol.com or check out our programs in detail at www.sefipp.com.
With the permission of Division 39’s newsletter, The Division Review and the Editor, Davi Licthenstein, Ph.D. we are re-printing a review by Andrea Celenza, Ph.D. of a book by Karen Maroda, Ph.D. entitled, Psychodynamic Techniques: Working with Emotion in the Therapeutic Relationship.
Reprinted here with permission of Division 39’s President, William MacGillivray, Ph.D., A.B.P.P. is last month’s Division 39’s online newsletter, InSight entitled, “Psychiatry and Big Pharma: Waiting for the Perp Walk to Begin” is a powerful, hard hitting and frightening (for all psychotherapists) piece about pharmaceutical houses’ big money, along with psychiatry’s joint efforts to transform mental health treatment into the first, last and only mental health treatment, particularly through their pervasive advertisements. Bill cites several articles about the economically-driven influence peddling of pharmaceutical houses on university departments of psychiatry and how some of these departments and heads of psychiatry benefit by payments and donations of huge amounts of money from pharmaceutical houses.
In addition, we have a piece, by Connie Galietti, J.D., Executive Director of the Florida Psychological Association (FPA) about Blue Cross/Blue Shield of Florida, who has contracted with New Directions Behavioral Health to manage their mental health benefits. Surely to reduce fees and reimbursements from previous payments to PPO providers to psychotherapists by 25% to 55%, this action represents another threat to the financial well-being of psychotherapists. Hopefully, psychotherapists will join together to fight these intrusions into, and devaluations of, our practices. Further information about this BC/BSFL action is available on tbe FPA’s website.
Along different, but related, lines, we are publishing by Todd Essig, Ph.D., with his permission, from his regular column in the online Forbes Magazine an interesting article entitled, “The Battle of the Bachmanns’ Bull: We’re All Culture Warriors Now.”
Finally, in a recent issue of Psychology Today there is an article by Molly Knight Raskin, “The Idea that Wouldn’t Die.” It is now posted on the Internet at www.psychologytoday.com/articles/201105/the-idea-wouldnt-die. Check it out. It’s a great example of the kind of information that we need to be presenting to our non-psychoanalytic colleagues and to the public on a regular basis.
Please let us hear from you about what you’d like included in Psyche & Sol and send any articles you’d like us to consider publishing to sefapp@gmail.com.
Clinical Vignettes - "The Locked Door", Linda B. Sherby, Ph.D., ABPP
It has been over thirty years since she sat across from me in my newly opened, dingy, windowless office above a toy store. I have seen countless patients since then, some whose names and stories I remember, others who have faded into oblivion.
But none are clearer to me than Margaret Eisenberg, a 19 year old student in Middle-Eastern studies, with curly brown hair framing her round face, an olive complexion, and oh so wide, strikingly brown eyes. It is those eyes I remember most, those eyes that stared at me with venom, defying me to say anything of meaning, warning me to keep my distance. But I couldn’t. Despite her anger, despite her defiance, despite the gauntlet she threw down in almost every session, Margaret’s eyes reminded me of a terrified doe caught in the headlights of a car. I knew that it was my job to save her.
Margaret’s anger and underlying terror was more than understandable given the harsh and neglectful treatment of her childhood. Although much of her history has grown dim for me over the years, there is one incident that remains emblazoned in my memory like an image from a bad movie. As a young child, one weekend she developed an excruciating pain in her abdomen that left her bent over in pain, refusing all food. Her father, an oral surgeon, did nothing to help her. Her mother, a teacher, insisted that she stop demanding attention. Instead, they exiled her to the basement of their home so that she would not disrupt the rest of the family. Then, on Monday morning, Margaret’s mother half carried, half dragged her daughter to the pediatrician’s office. She had a burst appendix and barely made it through the surgery alive. How could Margaret not be angry about such treatment? And how could she not be terrified underneath, a child at the mercy of such cruel and neglectful caregivers. But I offered an alternative. I could rescue this poor, defenseless doe. I could show her that not everyone was like her parents. She would take sustenance from me and would be saved. Much to my surprise, Margaret did not react as I had anticipated. Rather than welcoming my attempts to be the kind, giving caretaker, she responded with scorn and contempt. Entirely at a loss, I tried harder, my voice softer, my understanding greater. I was met with rage and those huge, defiant eyes. Probably no more than ten years older than Margaret myself, I remember being speechless the day she screamed at me, “I always have trouble with older women!”
Unfortunately this was not an impasse that was ever to be resolved. I was still several years away from my analytic training, several years from reading about transference, and several years from even hearing the concept of the negative therapeutic reaction. I had not yet realized that love was not enough. I did not yet understand that Margaret was intensely tied to her negative internalized objects and that relinquishing those objects would be a long, slow, laborious process.
I wonder now how Margaret fared in her life. Did she marry an abusive man? Is she working at some university as a Middle-Eastern scholar? Is she on the frontlines somewhere, embroiled in the Israeli-Palestinian conflict? I also wonder how we would be today as an analytic dyad. I still see her as a deer in the headlights, fending off terror with rage. But I now know that I would have had to work with that rage in the transference, understanding that identifying with her angry objects felt far safer than experiencing herself as the helpless, dependent child. And to really resolve the impasse, we would have needed to look at how Margaret’s unwillingness to allow in my kinder, gentler voice was her way of avoiding the pain of mourning the loss of her past internal objects. We would have needed to closely examine each interaction as it occurred, anticipating defensive rage following upon the slightest movement towards connection. Could she have dealt with her terrifying helplessness as a child at the hands of such capricious caretakers? Could she have mourned her need for those caretakers and moved beyond her defensive anger? Those are unanswerable questions, some of many that we as therapists must live with.
Fundraising Update - Freud Amongst The Arts, May 15, 2011, Cathy Stamm-Kaufman, LCSW
This year we had our 18th annual Freud Amongst the Arts Fundraiser on Sunday, May 15th, 2011. The brunch was held at the Mustard Seed Bistro, in Plantation FL. The celebration was a big success!
We honored Bernard Chodorkoff, Ph.D., M.D., Joan Chodorkoff, Ph.D., and Jacob Slutzky, Ph.D., with the 2011 "Robert Storch Memorial Distinguished Psychoanalyst" Award. Our own President, Lori Prince, L.C.S.W. was awarded the 2011 "Renee Zevon-Steinberg Friend of Psychoanalysis" Award.
The food was delicious, and was delivered with warm hospitality. We all enjoyed having the time to socialize with our colleagues. Matt Prince and his musical colleague accompanied our brunch with delightful Jazz music. We also had a fabulous Silent Auction. Artists from the Rebel Drop-in Center generously donated their beautiful works of art. Richard Steinberg's daughter, Liz, also generously donated a painting of Freud. Other auction items included gift certificates, jewelery, restaurants, and sports memorabilia.
Thank you to all of our generous donors and patrons for making this a great success. A special thanks to Hans Heubel for enabling us to receive the beautiful and heart-felt art work. I want to thank our President Lori Prince for her constant support and ideas. Finally, I want to thank my committee for their months of hard work, commitment of time, and playful spirit in putting this event together.
Conference Summaries - June 2011, April 2011, February 2011 and September 2010, Emily Krestow, Ph.D.
June 11, 2011 - Psychoanalytic Perspectives on Adoption
Presented by Kerstin Kupfermann, M.A., D.E.S., Linda Gunsberg, Ph.D., David Kirschner, Ph.D. and John LaValle,Ph.D.
Our thanks to Kerstin Kupfermann for bringing together four exceptional presenters in addition to an incredible film. This all day conference had three parts, each one informative and moving, as well as quite diverse. The morning program opened with the powerful film “Roots” by Zara Phillips. It underscores the life-long impact of being an adoptee. Adoptees and their spouses are interviewed, and we hear one woman state “the big issue – fear of abandonment – is always with me.” The fear of being given away again never left her. For another, there is loss of a bloodline, and grief at this: I’m given to a stranger and how should I feel about that? ” Indeed lineage is important: just ask the adoptive child who is given the school project of a family tree. We hear how finding birth parents is necessary and leads to healing, with a concomitant physical feeling of being “more grounded into the earth.”
After the film, Linda Gunsberg PhD presented the inner world of the adoptee in regards to 1) the concept of the ghost kingdom, 2) closed and open adoption with respective effects on development of the child, and 3) case presentation of an international adoption.
The Ghost Kingdom is where unknown family members reside. The Ghost Kingdom is absolute: one set of parents is all good, the other all bad. Who else resides there besides the adoptive parent(s) and the baby? There is the birth father, possible siblings and dead siblings, the bond between birth mother and child which is considered the real self of the adoptee. This bond between birth mother and child remains frozen in time. Adoptees report being in much fantasy time regarding birth parents. Each adoptive child must come in contact with the ghost family. In the course of treatment this is necessary. The Ghost Kingdom when split off, leads to genealogical bewilderment, low self-esteem, sense of guilt..
The adoptive family must be educated: when there is a mixed family of biological children and adoptive children, there is resentment of the biological children as to why the adoptee needs to seek out the biological family. The adoptive parent must respond actively and openly to the ghost kingdom, and validate the search for biological family.
Open Adoption There are four types of open adoption, from the most restrictive in which open adoption is limited to just receiving pictures and information about child, to the most open in which there is a plan to continue meeting. When an adoptee does not have access to birth parents or information, as in closed adoption, lower self-esteem, sense of guilt, loss of power directing one’s own life is a given. Gunsberg believes that all adoptees need to find birth parent, and advocates opening of records. Reunions that don’t go well still serve a purpose - the process of search or reunion, in itself, leads to increased sense of control over life. It must be kept in mind that there is an original loss of control – when first given up for adoption. Finding the biological parent results in increased sense of control, a sense of power that occurs when directing one’s own life, and identity cohesion. Adoptees are driven to search; tenacity is a common factor. Research finds that why they were relinquished is not as important as genealogical knowledge.
As for the case presentation, it raised all the above issues. A child ten years of age was brought to her for therapy. Born to a family in China, this was a child destined to be adopted out. A girl and not firstborn, the birth mother felt it was not good a idea to bond, so during first 7 months, various family members took care of her. Nevertheless, she was breastfed by the birthmother. The transfer of this baby to the single mother, occurred at the airport in china, while asleep. Child woke up on the plane and screamed all the way to the US. Screaming was thus in cellular memory of the child, on a preverbal level. Her symptoms included barking like a dog, neighing and prancing like a horse. The ghost kingdom included all the biological family members as well as the adoptee mother’s own ghost Kingdom.
On Gay Adoption: The second presenter of the morning, John Lavalle, PhD, gave a personal account of adoption as a man in a committed gay relationship. He and his partner were present at birth of their child, a girl.
There is little literature of gay men and adoption. Gay men believe in the world of heterosexualism, that heteros make the best parents. They have Internalized homophobia. Therefore, they believe they don’t deserve to be parents; they take in the belief that gay men are defective and not fit to be a parent. Therefore believing that women make better mothers. John LaValle and his partner had a woman friend stay with them first week, happily finding she wasn’t needed. This internalized homophobia by gay men themselves (as well as the community) is the greatest obstacle for gay men to adoption.
It was a very open and moving personal account of their daughter who enacted her greatest fear which was to be given up again, and how it was skillfully handled in the end.
The afternoon presenter was David Kirschner, PhD, whose work involves criminal adoptees in high profile serial murder cases, such as the infamous David Berkowitz. By exploring extremes, one can learn so much about the average. He explores Identity issue of “splitting,” a lack of genetic expectancy, self/parental image confusion and clinical dissociation in these cases. Dr. Kirschner presented Brandon who shoots father in face and stabs him 15 times, stabs mother 10 times, and kills sister whom he loves. Yet claims to not remember these acts. Dr. Kirschner considers this to be dissociative amnesia.
From his discussion and evaluation of these extreme cases, he presents the following results in their words: *I suffered a profound loss before I was adopted. *Just because I don’t ask about my birth family doesn’t mean I don’t think about them. *Talk to me about my birth family. I would never bring this up. I wouldn’t hurt them by asking. * My unresolved grief and loss may surface, attacking you. *If I knew my genetic content I’d be content .
Thus the security of the adoptive parent is a crucial factor. Denying the ghost kingdom is dangerous, and results in an unstable identity. During adolescence , when there is a metamorphosis in search of unique identity, these children do not have the safety net of genetic expectancy, that is, knowing where you come from. It is reasonable to expect that a lack of genetic expectancy guarantees stress and hardship, and failure. However, he took care to point out that he is talking about approximately 10% of adoptees.
The general consensus coming out of the conference is that children should know immediately, and, yes, when preverbal. The child is not too young to know. The two month old experiences loss as well. Children can handle the truth; it is far better knowing than not.
Adoption is always the elephant in room.
April 19, 2011 - Making a Difference in Patients' Lives: Emotional Experience in the Therapeutic Setting
Presented by Sandra Buechler, Ph.D.
Sandra Buchler delighted us and enriched us with her clinical understanding of what changes people in treatment. What is it that therapists do that makes a difference in peoples’ lives! How do we help people profit from life experience? How do we inspire hope?
The answer, she feels, is how we conduct therapy: She uses three concepts: contrast, challenge, and relational content:
*Contrast is built into our role. If you have an assumption all your life, you don’t know you have that assumption. The analyst is the contrast that provides that knowledge, by being a new object, a new experience, rather than a transference experience. Both people are participants: observer changes participant, participant changes observer.
*Being a challenge means openly encouraging experimentation with life. Thus the analyst is a catalyst for life change. Curiosity is encouraged. Curiosity is there from birth, so the question is how to capitalize on it, actualize it, or to remove what is blocking it. A little shift towards curiosity changes the whole system.
*Relational State involves Active Empathy – as well as curiosity. Which self state in the patient do we empathize with. A caveat is to separate out Active Empathy from just feeling the affect, nor does It require an effort to recover from this affect. Active Empathy involves learning something about the patient on a deep level – through affect.
So, over all, she believes how we conduct treatment involves the thoughtful use of words: poetry is an economy of words, and so is interpretation an economy of words. Interpretations involve the collaboration of the patient, and what we feel is information includes counter transference.
Dr. Beuchler considers her ideas an “Emotion Theory.” Emotions form a system in the human being.; either they don’t feel alive, or feel too much intensity of feelings. Differing from drive theory, she believes that emotions are our primary motivator. Curiosity, for example, is both an emotion and a motivator. I personally love the concept of the curative power of curiosity. What a benefit when the patient becomes more curious in therapy!!! When curiosity is absent, so is the absence of feeling alive. Other “emotions” discussed include shame, grief/loss, joy, anger, courage, hope. All positive, but can be distorted into negative. For example, anger is an engine for life, hope is an emotion that can drive people forward, courage is the mean between excessive fear and excessive rashness. Joy is the universal antidote. It can modulate our emotions. The question to ask ourselves, to the patient: why is it not there. What is blocking it. Joy is in being human.
Treatment is a dialogue about what it means to live. It is to assist in an expansion of the range of emotions. This does not change their lives, but changes the outcome.
February 27, 2011 - Psychiatry, Psychology and the Patient: How the Triangle Works
Presenters: Bruce Saltz, MD and Lisa Schulman, PhD
The response of the audience, including feedback, reflected the exceptional quality of this presentation, and demonstrated the interest in and appreciation of collaboration of triangle members: patient, pharmacotherapist and psychotherapist. Often referred to as “split therapy,” this treatment modality has a great chance of success when there is awareness of issues of transference and countertransference among all participants. This presentation involved just such a clinical case, Mrs. X.
Dr. Bruce Saltz posed thought-provoking salient questions, among them: should drugs be avoided unless essential to a favorable outcome? Should psychotherapy be advised to all patients, or only to those who say they want to look for the cure, not a band aid? Does the patient infer that the need for medication is proof that he cannot handle his symptoms without it, or expects positive outcome by virtue of its presence? Are unrecognized countertransference conflicts on the part of the psychotherapist at work, that is, specifically, are there competitive feelings between practitioners of winning or losing the debate over medication’s role in the treatment. Let us ponder, he states, that if outcome in psychotherapy is indeed connected to the establishment of a therapeutic alliance, why would it not also apply to the pharmacotherapist?
Dr. Lisa Schulman presented models of collaboration: Robert Langs, MD who warns against breaches to the two-person relationship; psychoanalytic psychiatrists who would not participate in a dual role as the dual role works against the psychotherapy process; contemporary models which view value working collaboratively in the treatment of eating disorder patients, addiction and anxiety disorders, depression and character disorders. Destructive practices exist, such as in a busy public clinic where administration encourages signed prescriptions left to be filled in by other mental health care workers and given to patients, and where the triangle is not acknowledged. Dr. Schulman sums working triadically with the following statement: “When the treaters’ relationship is characterized by mutual respect and open communication, the triangular transferences can be anticipated and understood.” A working alliance!
Mrs. X was referred to Dr. Schulman by Dr. Drourr, an Internist. Mrs. X had multiple medical problems including a TIA and many food sensitivities, and was on several medications. Nevertheless, in contemplating a referral to a pharmcotherapist, she worried that in creating a split treatment, she might be experienced as detracting from the psychotherapy, cause the patient to fear being seen as sicker, or perhaps experience the referral as a rejection (among other possibilities).
Considering all factors, Dr. Saltz was brought in by Dr. Schulman. They had prior experience together: sharing depressed patients, patients lacking in agency, prone to medicalize their complaints, passive and dependent, and prone to vanishing under the weight of a spouse who was complicit with the idea of there being only one mind in the marriage. In the case of Mrs.X.,a complicating factor was a husband who drinks. Overriding theme was of not feeling understood by almost everyone. One example of the benefit of the shared treatment was that there was discussion as to who would be the best to bring the husband into treatment, thus constructing a second triangle of patient/husband/treating participant.
An exciting addition to the Symposium Brunch was the attendance of Dr. Drourr in the audience - an expansion of the original triad of patient/psychotherapist/psychiatrist. Dr. Drourr commented that she is now privy to information that greatly expanded her knowledge of Mrs. X.
I end with Dr. Saltz’s thought: split therapy is healthful, successful and rewarding to all participants when properly executed.
September 25, 2010 - Understanding Love and Hate in the Therapeutic Relationship: Theoretical Considerations and Clinical Implications
Presenters: Donna Bentolila, LCSW, PhD, Linda Sherby PhD, ABPP, Emily Krestow, PhD, LMHC
We don’t have to go far to find talented and experienced writer/analysts. Both Linda B. Sherby, PhD, ABPP and Donna Bentolila, LCSW, PhD, are clinicians practicing here, in Boca Raton, Florida. They presented stimulating thought-provoking papers, addressing the theoretical and clinical implications of working effectively with the intense and inevitable emotions of love and hate. I was in the enviable position of being the discussant for both papers.
Dr.Bentolila’s presentation centered on an analytic understanding of how love and hate intertwine and function within the analytic transferential relationship. Emphasis was given to the need to conceptualize love and hate as grounded upon the function of the Third, a Lacanian concept. It was argued that the need for analysts to refer to the thoughts and feelings of the analytic patient in reference to the Third remains pivotal if we are to facilitate and advance the work of analysis within the Freudian tradition. In my discussion, I chose to focus on one of the cases presented, which demonstrated what happens when love and hate are uncoupled: hate becomes all consuming. Intense feelings of the patient engender intense feelings in ourselves, and can throw the analyst off center. Or as Lacan would say, excludes the Third. This was an example of uncompromising honesty on an analyst’s part. In the process of unconsciously identifying with the patient’s projected vulnerabilities, she also lost the analytical self and led to her search for what was temporarily missing. In Dr. Bentolila’s words, “when we have access to the Third, we gain knowledge on the deeper logic between analyst and patient during analysis.”
In Dr. Sherby’s paper we are privy to an intimate experience in a consulting room in which we listen to how an analyst feels about her patient. She presented a detailed clinical case of a disturbed young woman she treated for five years, one of the most tumultuous cases of her career. An intense connection from the beginning: the patient emphatically decided that Dr. Sherby would be her analyst despite serious practical considerations and would allow nothing to stand in the way of her objective. Dr. Sherby, in turn, drawn to the patient’s underlying fragility covered by a defensive and defiant toughness, was immediately hooked. Dr. Sherby, saw the patient as frightened, confused and child-like, terrified by her own vulnerability and struggling to keep her psychotic thoughts at bay. Described as a mutual “falling in love,” the other extreme, hate, was destined to erupt. Intense feelings of love and hate continued throughout the treatment, necessitating that the analyst remain steadfast in her commitment to the patient and able to withstand and survive the storms of rage and disruption. It was the intensity of the love and hate in this relationship that served to facilitate the patient’s growth.
It is a rare treat to have access to how two analysts work with intense feelings. It demands self-analysis, requires uncompromising honesty about one’s own countertransference, to say nothing of the ability to withstand raw expressions of rage and hatred. Both papers provided rich clinical material, assisting attendees in their own struggles with love and hate in the therapeutic setting.
(Thanks to Dr. Sherby and Dr. Bentolila for help with this review)
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Treasurer's Report - Aaryn Gottesfeld, M.S.
The Treasurer’s Report published in the last edition of Psyche and Sol reported on the organization’s much improved financial situation. I am pleased to convey that SEFAPP’s financial situation has remained stable and healthy over the last six months and we are in a much better place than we were one year ago. As we near the end of Summer 2011, SEFAPP’s account balance is $14,621 - just over $10,000 higher than it was at the end of Summer 2010.
The Freud Amongst the Arts Fundraiser was a great success with a net profit of $1811.00. 20% of the profits ($362.00) are being donated to the Veterans Project of South Florida, and the remainder will be divided equally between SEFAPP and SEFIPP ($724.00 each). The much improved account balance, as well as the profits from FATA are accomplishments that put us in a secure financial position as we commence the 2011-2012 season.
|
|
Income |
Expenditures |
End of Month Balance |
|
February 2011 |
$6,575.36 |
$3,319.68 |
$12,886.46 |
|
March 2011 |
$1,531.97 |
$1,849.79 |
$12,568.64 |
|
April 2011 |
$1,640.26 |
$3,042.26 |
$11,166.64 |
|
May 2011 |
$3,283.95 |
$2,515.26 |
$11,935.33 |
|
June 2011 |
$6,032.55 |
$2,492.27 |
$15,475.61 |
|
July 2011 |
$1,400.64 |
$2,254.73 |
$14,621.52 |
Membership Report - Leonard J. Ferrante, Psy.D.
We are happy to report that as of September 1, 2011 SEFAPP has added 20 new members to its growing list of mental health professionals and students. We anticipate that the membership standing at 110, which has steadily remained above 100, may increase this year due to the solid calendar of upcoming workshops and events and the gaining popularity of our affiliation with our training institute, SEFIPP.
For those of you new to SEFAPP and who have thus far renewed, please encourage your colleagues to join as well. We do not want anyone to miss out on SEFAPP’s exciting calendar of events this year and the next, which is packed with great topics and speakers. I recommend that you check the SEFAPP calendar if you have not done so already in order to plan ahead. Remember, as a member of Division 39, and for an additional nominal annual fee, you can have access to a wide range of psychoanalytic journals at your fingertips through the internet. Click here for further details. We look forward to another exciting year and warmly welcome the following 20 new members:
Anais Alvarez
Mayra Alvarez
George Baaklini, M.S.
Carole Cakov, Psy.D.
Sarah Coleman, Ph.D.
Amanda Countryman, M.S.
Felicia Einhorn, LCSW
Laura Essen, LCSW
Karen Forberg, LCSW
Tina Goodin, Ph.D.
Judy Gotthoffer, LCSW
Ellen Helman, LCSW
Jeffrey Huttman, Ph.D.
Tania Koolik, Ph.D.
Alexandra Lonc, MSW
Elizabeth Menard
Barbara Pepper, Ph.D.
Jeffrey Perlman, Ph.D, LCSW
Stephanie Wasserman, Ph.D.
Bette Ann Weinstein, Ph.D.
Yours truly,
Leonard J. Ferrante, Psy.D.
Chairperson
2011 - 2012 Calendar of Events (dates subject to change)
September 17, 2011…………………………………………..SEFIPP Scientific Meeting: “Interpretation, Interruption and Self Disclosure: Complementary Ways of Relating in Psychotherapy”; Presenter: Antonio R. Virsida, Ph.D., ABPP; Discussants: Martin Schulman, Ph.D. and Richard Steinberg, Ph.D.; Memorial Regional, Hollywood
October 23, 2011……………………………………………………Sunday Symposium Brunch: No Time To Think: Maintaining a Psychoanalytic Practice in a Culture of Instant Gratification, Multi-tasking, and Quick Fixes; Presenter: Tina Goodin, Ph.D., ABPP, Home of Linda Sherby, Ph.D., ABPP, Boca Raton
November 12, 2011……………………………………………All Day Scientific Meeting: Building Connections, Repairing Ruptures: A Self Psychological Approach to Couple Therapy; Presenter: Carla Leone, Ph.D.; Memorial Regional, Hollywood
December 11, 2011………………………………………………..Sunday Symposium Brunch: Film Presentation and Discussion on the movie “Doubt”; Presenter: Len Ferrante, Psy.D. (location TBA)
January 28, 2012………………………………………………….All Day Scientific Meeting: Technologically-Mediated Relationships: All the Way from Treatments Online to Cybersex and Online Porn; Presenter: Todd Essig, Ph.D.; Memorial Regional, Hollywood
February 12, 2012……………………………………..Sunday Symposium Brunch: The Unspoken Pleasures of the Psychoanalyst; and the Question: Why Are They Unspeakable?; Presenter: Michael Shulman, Ph.D. , Home of Barbara Lurie, LMFT, Delray Beach
March 10, 2012……………………………………………………..Scientific Meeting: Analyst’s Subjectivity and Difficulty with Self-Care; Presenter: Adrienne Harris, Ph.D. ; Memorial Regional, Hollywood
April 29, 2012…………………………………………………………….Sunday Symposium Brunch: Themes of Attachment: Understanding the Relationship Between Working Mothers and Their Nannies; Presenter: Aaryn Gottesfeld, M.A., M.Phil.; Discussant: Debra Stein, Ph.D., Home of Barbara Lurie, LMFT, Delray Beach
May 19, 2012………………………………………………………………Freud Amongst The Arts (Venue TBA)
Special Report: SEFIPP Update - Antonio R. Virsida, Ph.D., ABPP, SEFIPP President
The SEFIPP BOD is very satisfied with their hard work. SEFIPP has six new students who have enrolled in the Introduction to Psychoanalytic Thinking : Theory and Practice first year program. The students are Karen Forberg, LCSW, Savianne Maharaj, Psy.D., JoAnne Nuccio, L.M.H.C., Thomas Unsworth, L.M.H.C. and Stephanie Wasserman, Ph.D. The program consists of two one and one half hour weekly courses, one on theory and one on clinical process and technique for three trimesters, beginning on September 15. In addition, once monthly two-hour Sunday clinical process seminars are held, in which faculty and students present and discuss cases. These in person monthly seminars are held at Imperial Point Medical Center and each of the seminars will be taught by different local faculty members.
Because all of the students live far distances from SEFIPP’s usual class site, Imperial Point Medical Center, the weekly courses will be taught by way of video conference. This broad based first year program introduces students to all psychoanalytic models, from Freud to contemporary Relational, Neuroscientific, and Intersubjective theories. The courses are structured in modules. For example, the first five classes of the theory and process courses of the year, introduce Freud’s models of the mind, Ego Psychology and North American Object Relations and the first two Sunday clinical process seminars are led by two instructors who work from this theoretical perspective.
On Sunday, September 11, 2011 SEFIPP, held in the Private dining Room of Imperial Point Medical Center, 6401 N. Federal Highway, 33308 an appetizer and beverages Reception and Orientation for new students, BOD members, Local Faculty and anyone else who is interested in learning about the training programs.
Wanting to expose our students to the wide range of psychoanalytic theories, we also want to expose them to a wide variety of instructors. So, Visiting Faculty members, including, Jon Auerbach, Ph.D., Helen Banta, Ph.D., F. Diane Barth, M.S.W., Marilyn Charles, Ph.D., ABPP, Todd Essig, Ph.D., Benjamin Kilborne, Ph.D., Susan Kolod, Ph.D., Dorienne Sorter, Ph.D., Steven Tublin, Ph.D. will be teaching theory and clinical process classes from their particular theoretical perspectives this year. We have many other Local and Visiting Faculty members who will be teaching our second, third and fourth year courses in the psychotherapy and psychoanalysis training programs.
In addition, SEFAPP and SEFIPP have agreed that one SEFAPP scientific meeting each year will be presented by a Local Faculty member. In September, 2010, Linda B. Sherby, Ph.D., ABPP presented a paper on Love and Hate in the Therapeutic Setting, which was discussed by Donna Bentolila, L.C.S.W. and Emily Krestow, Ph.D. On September 17, 2011, I am presenting a clinical paper on my unconventional work with an unconventional patient. The presentation is entitled, Interpretation,Interruption and Self-Disclosure: Complementary Methods of Relating in Psychotherapy. My paper will be discussed by Martin Schulman, Ph.D. and Richard Steinberg, Ph.D. In September, 2012, Max Harris, Ph.D. and Stefan Pasternack, M.D. will present papers on neuroscience, psychoanalysis and psychotherapy. The panel is entitled, Keeping the Brain in Mind in Psychotherapy.
In January, 2012 SEFIPP will offer another nine monthly classes in our Contemporary Psychodynamic Psychotherapy Seminars series. For information on this upcoming program and our training programs in psychotherapy and psychoanalysis, as well as viewing a listing of our distinguished Local and Visiting Faculties, go to our website, www.sefipp.com or contact the coordinator, Richard Steinberg, Ph.D. at rstein1426@aol.com.
Active and vital, SEFIPP is pleased that we are contributing to SEFAPP and the education and training needs of local mental health professionals.
Veterans Project of South Florida 
With the increase in young men and women returning from war in Iraq and Afghanistan with post traumatic stress disorders and multiple mental health issues, and the lack of adequate services for these veterans, SEFAPP and The Florida Psychoanalytic Society has created "The Veteran's Project of South Florida", offering free mental health services to Iraq/Afghanistan soldiers and their families in the South Florida community.
If you are interested in finding out more, please contact us below:
| Name | Phone | |
| Cristina Virsida, Administrator | 877-783-2748 | veteransprojectfl@gmail.com |
| Frederic J. Levine, Ph.D., Co-Chair | 305-669-8948 | fredlev@gmail.com |
| Richard Steinberg, Ph.D., Co-Chair and Intake Coordinator for Palm Beach County | 561-393-1439 | rstein1426@aol.com |
| Emily Krestow, Ph.D., Intake Coordinator for Broward County | 954-929-4199 | ekrestow@aol.com |
| Jill Hartog, LCSW, Intake Coordinator for Miami/Dade County | 305-274-0018 | jillhlcsw@yahoo.com |
Article Reprint: Psychiatry and Big Pharma: Waiting for the Perp Walk to Begin - William A. MacGillivray, PhD, ABPP, Division 39 President
Reprinted with permission by Division 39
Much heat has been expended debating the relative merits of psychoanalytic work versus other approaches, especially CBT. While research and theory is of undoubted importance in better defining quality and success in psychotherapy, the more enduring threat to independent practice of psychoanalysis and psychoanalytic psychotherapy does not come from CBT practitioners, or even CBT researchers, however dearly we may resent their current hegemony in academia. I submit it that any successful practicing clinician, regardless of orientation, works with resistance, transference, unconscious processes, dissociated affect, repressed memories, as well as habits, symptoms, cognitive distortions and so on, regardless of what labels describe these concepts. Working psychotherapists often have far more in common in their understanding and approach than research would suggest. ... Click here to read the full article.
For more on this latest controversy, read the article from 9/13/11: "How An Ethically Challenged Researcher Found A Home at the University of Miami", Paul Thacker, Contributor, Forbes Magazine
Article Reprint: The Battle of the Bachmanns' Bull: We're All Culture Warriors Now, by Todd Essig, Forbes Contributor
Originally printed by Forbes Magazine. Reprinted with permission.
Congresswoman Michele Bachmann Both history and legend track a significant throng of eager spectators following the Union army from Washington DC towards Manassas in Prince William County, Virginia to watch the Battle of Bull Run. They fully expected July 21, 1861 would be a glorious adventure; they were going to witness the southern rebellion quickly end while picnicking on a hill. As we know, things did not turn out that way; the battle was lost and the tragic war did not end quickly. And, less obviously but more relevant for the current moment, history has also shown they were not really spectators at all but full participants in what would become an all encompassing nationwide war. ... Click here for full article.
Special Article: Blue Cross-Blue Shield of Florida, by Connie Galietti, Esq., Executive Director, Florida Psychological Association
Psychologists participating as Blue Cross Blue Shield of Florida Providers began receiving letters in late July advising that their contracts were being terminated effective 11:59 pm on November 30. A company called New Directions Behavioral Health, LLC will begin managing the PPO business on December 1, 2011, and the HMO business on January 1, 2012.
New Directions followed up by sending application materials to providers, directing them to respond within 15 days. The contract provided by New Directions contained some terms that the Florida Psychological Association (FPA) found to be very concerning.
FPA immediately took action by contacting the American Psychological Association Practice Organization, which assisted in composing a letter to Insurance Commissioner Kevin McCarty, and CFO Jeff Atwater. The letter voiced our many objections to the terms of the contract, including the timeframe in which the materials were to be returned.
FPA received a response from Office of Insurance Regulation (OIR) on August 17. According to OIR, BCBSF is working with New Directions to effect several changes to the provider contract, including:
- Changing the choice of law forum from Missouri to Florida.
- Clarifying that a patient in a PPO can receive treatment from a nonparticipating provider and pay the out-or-network charges, or a patient in an HMO can receive treatment from a nonparticipating provider, but there will not be any coverage.
- Clarifying that New Directions cannot dictate the scope of practice of a participating provider.
According to OIR, ND will send out a letter to providers clarifying the contract terms. ND does not intend to enforce the 15-day deadline referenced in the original letter, giving providers more time to review the contract and make an informed decision.
All we can do now is wait to see what the new contract states, and respond accordingly. We can assure you that this continues to be an issue of great importance to FPA and we will work with our colleagues in psychiatry and at the national level to advocate for providers and patients. We encourage all licensed psychologists and other BC/BS mental health professionals to join us so that we can strengthen our voice.
Please visit our website www.flapsych.com to view the correspondence with OIR and to find updates on the situation.
Connie Galietti, Esq., Executive Director, Florida Psychological Association
Book Review: Psychodynamic Techniques: Working with Emotion in the Therapeutic Relationship
Author: Maroda, Karen J.
Publisher: Guilford, 2009
Reviewed By: Andrea Celenza, PhD, Divison Review, January 2011, pp. 274
Reprinted with permisson by Division 39
Written at a time when training in psychodynamic psychotherapy is nearly nonexistent, Karen Maroda's book Psychodynamic Techniques: Working with Emotion in the Therapeutic Relationship is a profoundly needed corrective for a wide range of clinicians and academics. Maroda has integrated current findings in psychological, psychosocial, attachment/developmental and neurophysiological research with the emerging empirical literature on the efficacy of long-term psychodynamic psychotherapy. Her timing is impeccable! Psychodynamic psychotherapy is almost impossible to find in graduate school curricula; derived as it is from psychoanalytic principles, it can be argued that until psychodynamic clinicians submit to the gods of empiricism, the craft will continue to be viewed as an antiquated (albeit charming) piece of literature. Maroda's book is destined to play a crucial role in grounding psychodynamic theory in empirical demonstrability and practical utility, serving as the basis for any thorough-going clinical technique. This book serves as one of the few linchpins that just may resituate psychodynamic theory as the cornerstone of sound clinical theory and technique. Click here for full article.
The Southeast Florida Association for Psychoanalytic Psychology ♦ Email: sefapp@gmail.com
Phone/Fax: (954) 597-0820 ♦ Administrative Office: 101 Mint Hill Drive, Cary, NC 27519
