The Southeast Florida Association for Psychoanalytic Psychology
A Local Chapter of Division 39 of the American Psychological Association
Psyche & Sol - Summer 2010, Volume 16, Issue 3
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President's Message - Marshall Fenster, Psy.D.
We all know the critical importance of attachment, affiliation, and community. Scientific research confirms this but we know its truth in our hearts from our personal experience and our experience with our patients. We all need a sense of belonging with other human beings. This is as true in our psychotherapeutic work as in any other aspect of our lives. I believe that being a part of a psychoanalytic community is key to creating a stable foundation for our psychoanalytic work, which can be intense and isolating in a private practice setting, and that the importance of a psychoanalytic community cannot be overestimated.
The Southeast Florida Association for Psychoanalytic Psychology is my psychoanalytic community. As are many of our members, I am a transplant. I came to Florida from New York nearly 17 years ago leaving a rich, vibrant, and satisfying psychoanalytic environment for what my analytic friends thought was exile in a psychoanalytic desert. My background as a Jew and a Buddhist, where the concepts, respectively, of congregation/minyan, and sangha, are essential, had ingrained in me the importance of community and therefore I did fear psychoanalytic isolation. But, happily, this was not to be. There was a local chapter of the American Psychological Association’s Division of Psychoanalysis (Division 39), SEFAPP, which at the time, for a psychologist, was the only game in town. Upon my arrival, I contacted the chapter representative to Division 39, Antonio Virsida. Tony welcomed me, took me to lunch, and introduced to me to SEFAPP and other analysts and I quickly found an analytic home in Florida for which I will always be grateful. What I found in SEFAPP back then, which is unchanged today, is a multi-disciplinary organization dedicated to psychoanalysis as a whole, with members of every psychoanalytic theoretical orientation from Freudians and Ego Psychologists and Lacanians, to Relational Analysts and Self Psychologists. SEFAPP is a group of clinicians with strong personal analytic positions but who are open to dialogue, usually with a touch of humor, and not with the typical animus that their theoretical orientation has the lock on psychoanalytic ‘truth’. Although it has happened, very seldom does one hear those solemn words “that’s not psychoanalysis”. SEFAPP members prefer to focus on what we all have in common and not on our differences.
Despite the difficulties and problems of any organization, I like to think of SEFAPP as what John Fiscalini referred to in a special issue of Contemporary Psychoanalysis on ‘The Ideal Psychoanalytic Institute’ (2009, Volume 45, number 3) as “a community of clinicians”. While SEFAPP is an interest group, not an institute (we do have a sister organization in SEFIPP which is a psychoanalytic institute), we still strive to represent the ideals that Fiscalini wrote about - to be “a clinical home, a center of social experience, a hub of mutual support, safety, solace and hope…[that] sustains and protects its members growth…[and] strives to deepen and broaden the analysts understanding of analytic inquiry – to stretch his or her capacity to work in this rewarding but often vexing ‘impossible profession’” (p.328).
A psychoanalytic community is essential not only for our own personal work and growth, but because psychoanalysis continues to be under attack, of late particularly in the media, and its future viability and survival is at stake in a fast-paced, immediate-gratification, non-reflective culture. Yes, there has been a lot of good news. The ‘Freud Wars’, led by critics like Frederick Crews, are mostly over. Within the field, there is a much accepted broader definition of Psychoanalysis and a burgeoning pluralism. Research in neuroscience by people such as Alan Schore and Jaak Panksepp are giving new credence to psychoanalytic concepts. Jonathan Shedler in his recent article “The Efficacy of Psychodynamic Psychotherapy” in the American Psychologist (2010, Vol. 65, No. 2, 98-109) reports, based on meta-analysis, the empirical evidence that Psychoanalytic Psychotherapy works and has had treatment benefits that equaled or exceeded other treatments such as Cognitive-Behavioral Therapy. However, the bad news for psychoanalysis persists. There are still very powerful forces aligned against psychoanalytic ideas. Mary Beth Cresci, the current President of Division 39, has written in a column in Psychologist-Psychoanalyst about what she calls “the sport of couch bashing” (Volume XXIX, No. 4 Fall 2009) reviewing recent attacks in the media on psychoanalysis, and even clinical psychology, based on the push for ‘evidence based treatment’, for example, in Sharon Begley’s Newsweek column of October 12th, 2009. Furthermore, at the Division 39 meeting in Chicago in April, from which I recently returned, there were many reports on the current efforts by insurance companies to eliminate psychoanalytic psychotherapy from insurance reimbursement. We have also been our own worst enemies for as Paul Stepansky writes in his book “Psychoanalysis at the Margins” (Other Press, 2009) the turf wars, and intolerance amongst the different branches of psychoanalysis about what is or is not psychoanalysis continue unabated and are parts of the marginalization of psychoanalysis.
So what does this mean to you? Since you’re reading this, you have some level of interest or commitment to psychoanalytic psychotherapy and/or the principles that underlie psychoanalytic thinking. Perhaps your practice is going fine. You make a good living. You have good contacts, a strong referral base and you don’t deal with insurance or managed care. You discuss difficult cases with your close colleagues, perhaps in a peer supervision group, and don’t feel the need for an organization for support or to fight the battle for psychoanalysis. But, if you believe in psychoanalytic ideas, in the benefit to your patients of psychoanalytic treatment, it is imperative that we join together and fight the forces allied against us. Our psychoanalytic organizations - on the local level it is SEFAPP, on the national level it is Division 39 - have responsibilities to their members and as members we have responsibilities to our organizations and to psychoanalysis as a whole. I apologize for my hyperbole, but Benjamin Franklin famously said “we must all hang together or assuredly we will all hang separately”. If that is too strong a metaphor for our current psychoanalytic situation perhaps Rabbi Hillel’s saying is more appropriate: “If I am not for myself then who will be for me? And if I am only for myself what am I? And if not now when?
On the local level, if you are not a member of SEFAPP, join. If you are a member, attend our events. Get involved in the organization. Join a committee. Volunteer one hour a week to be a therapist for the Veterans Project of South Florida, a collaborative effort of both SEFAPP and The Florida Psychoanalytic Society, which provides pro-bono mental health services for veterans of the Iraq and Afghanistan wars and their families. Present a paper or discuss a movie for one of our Sunday Symposiums. SEFAPP, in our desire to be your psychoanalytic home, has listened to you, our members. We frequently update and improve our website which provides networking and referral sources with our searchable directory and member’s activity area to post your professional news and events. We provide stimulating educational presentations. In the past, we have had renowned speakers such as Neil Altman, Jessica Benjamin, Jay Greenberg, James Grotstein, Otto Kernberg, Donnel Stern, and Nancy McWilliams to name just a small fraction of our distinguished presenters. We sent out a survey to learn more about your interests and have acted on your request for more clinically relevant programs. We recently had Arietta Slade talk about Attachment and Mentalization; and Brian Johnson on Neuroscience and Addictions. We have scheduled upcoming events such as working on issues of shame with Benjamin Kilbourne, for December 4th, 2010; a seminar on eating disorders with Jean Petrocelli on January 29th, 2011; and on April 9th, 2011 Sandra Buechler will speak about making a difference in patient’s lives.
We welcome any help, any idea or even criticism. To create a more responsive organization we want to hear your thoughts even on what you don’t like. We take your views very seriously even if we cannot always accede to them. For example, we’ve had complaints about the location of our presentations and realize it is very difficult for those of you who live far away to attend some of our events. However, due to our financial constraints, particularly as a not-for-profit organization, our hands are usually tied. We tend to use Memorial Regional Hospital in Hollywood because thanks to Lori Prince, our President Elect, who works at the hospital, we get the space, and breakfast, for free. But we are continually on the look out for other affordable venues for our presentations. As Richard Steinberg, our Past President detailed so well in his last president’s message in Psyche and Sol (Winter 2009) “we’re making progress”.
For a larger sense of community, join Division 39. It is open to all no matter your background or degree. On the national level this is one of the premier psychoanalytic organizations. As part of your membership you will receive the journal Psychoanalytic Psychology, and have the opportunity at a reduced fee to have access to the ‘Pep Web’ of psychoanalytic articles. Attend the yearly spring conference. Next year the conference is in New York City from April 13th to 17th, with the topic “How We Matter: Psychoanalysis in the 21st Century” and the keynote speakers are Lewis Aron and Neville Symington. There you can participate in one of the highest quality psychoanalytic conferences. You can be amongst over 1000 attendees and really immerse your self in presentations and discussions on the cutting edge of psychoanalytic ideas. The division is currently starting a new project called the Division 39 Fund to promote psychoanalysis, re-define it in the media, and to encourage and support programs in education, research and service to advance the profession. At the time I’m writing this SEFAPP’s Board of Directors is considering donating to this fund and I hope we will have voted to do so by the time you are reading this issue of Psyche & Sol. I have personally donated to this fund and urge all of you, if it is at all financially possible, to do so, for they are fighting for all of us and the future of psychoanalysis.
I thought I would end this message with a reminder of what it is that psychoanalytic psychotherapy offers, why we must fight for it, and a reason to have hope for the future. Lewis Aron, seemingly off the cuff, in an interview he gave to Jeremy Safran published in Psychoanalytic Psychology (2009, Vol. 26, No. 2, 99-116) made the following meaningful and eloquent statement.
“We listen to people in depth, over an extended period of time and with great intensity. We listen to what they say and to what they don’t say; to what they say in words and to what they say through their bodies and enactments. And we listen to them by listening to ourselves, to our minds, our reveries, and our own bodily reactions. We listen to their life stories and to the story they live with us in the room; their past, their present and future. We listen to what they already know or can see about themselves, and we listen to what they can’t see in themselves. We listen to ourselves listening. Psychoanalysis is a depth psychology, which means we listen in depth and teach our students to listen. Whatever managed care says, and whatever drugs are prescribed, and whatever the research finding, people still want to be listened to in depth and always will. That’s why there will always be patients who want and need an analytic approach and why there will always be therapists who need to learn it” (p.116).
Editor's Column - Antonio R. Virsida, Ph.D, ABPP
This issue of Psyche & Sol is my third, my one-year anniversary as editor and my twenty-third year as a SEFAPP member. For me, SEFAPP is better than ever, thanks to the hard work, Ala the Oakland Raiders of old, “commitment to excellence” of our Administrator and Managing Editor, Cristina Virsida and our Board of Directors (BOD).
As our long time Membership Chair, Leonard Ferrante, Psy.D. informs us in this issue we are 111 members strong and have a significant number of new members. In his President’s message, Marshall Fenster, Psy.D. speaks to the important functions of SEFAPP as a clinical and professional and personal home for himself and for members. He draws us together, recognizing the value of personal and professional affinities, as well as the importance of united psychoanalytic organizations in today’s troubled, if not hostile mental health market place. And, finally, he reminds us of the enduring and unique personal and human enterprise called psychoanalytic psychotherapy.
Linda Sherby, Ph.D., A.B.P.P. offers us another, but different, touching scenario in her piece, Clinical Vignettes. She not only illustrates how we listen with a “third ear,” but in some sense, the compassion-driven occupational hazards and pains of listening to what people say about themselves in social situations.
Royce Jalazo, Psy.D., our guest Transference/Countertransference Corner contributor, offers a unique glimpse into her experience of the culture and mind of law enforcement officers, their relationship to their psychological struggles, and to her, as a psychologist, who seems to threaten their efforts at equilibrium. Her piece speaks to the value of speaking in the other’s idiom as a way to respond to their sense of anxious difference and make contact.
Polly Young-Eisendrath, Ph.D. has given us permission to re-print her two book reviews originally published in Volume XXVIII, No 3, Summer issue of the Psychologist-Psychoanalyst. She reviews Phillip Bromberg’s book, Awakening the Dreamer: Clinical Journeys and Joseph Schacter’s, Transforming Lives: Analyst and Patient View the Power of Treatment.
The article by Donna Bentolila, L.C.S.W. entitled, Acting-Out and Passage into Action: Clinical and Theoretical Considerations offers us a Lacanian look at how patients’ actions, in and out of the treatment setting, represent un-symbolized communications. Ms. Bentolila usefully distinguishes acting out and passage into action, the latter of which is a dangerous attempt to flee the world.
Treasurer, Aaryn Post Gottesfeld, M.A. reports on the financial status of SEFAPP and the Chair of our 17th annual fundraising event, Freud Amongst the Arts (FATA), Cathy Stamm-Kaufman, L.C.S.W. summarizes this year’s successful and fun-filled event. We awarded Frederic J. Levine, Ph.D. and Richard Steinberg, Ph.D., Steering Committee Co-Chairs of the Veterans Project of South Florida-Strategic Outreach to Families of All Reservists (VPOSF-SOFAR) with SEFAPP’s annual “Distinguished Psychoanalyst” Award for their commitment and tireless work on the VPOSF-SOFAR. We also awarded Barbara Lurie, Ph.D., L.M.F.T. our “Friend of Psychoanalysis” Award for the generous use of her home for our Symposium Brunch Series on many occasions.
Emily Krestow, Ph.D. summarizes SEFAPP’s three most recent Scientific Meetings. I report on the status of the Southeast Florida Institute for Psychoanalysis & Psychotherapy’s (SEFIPP) innovative training and education programs and contribute an article entitled, Tradition, Immigration Assimilation and the Marginialization of Psychoanalysis in the U. S.: The Old, the New and the Newer Orthodoxies, Part I-The Power of Theory and the Theory of Power. In this piece, I examine the role of early politics and economics in the development of psychoanalytic theory and practice in the U. S. This issue is rich, enlightening and informative and we welcome contributions from SEFAPP members. Please send your contributions to me at arvirsida@aol.com.
Clinical Vignettes - "The Locked Door", Linda B. Sherby, Ph.D., ABPP
Although we think of clinical vignettes as occurring only in our offices, there are occasional life experiences that capture a therapeutic moment, a therapeutic understanding, but one that cannot be explored because the person is not our patient. The following is such a moment, one that I have carried with me for over twenty years.
She opened the door, smiled, and in her crisp English accent, invited us into her home. My husband embraced her. She laughed uncomfortably and tried to inch away. But he held on and she relaxed into his arms. I looked at them entwined, amused by their differences. They were not, in fact, related by blood. She was my husband’s stepsister, the daughter of his mother’s second husband. She was half his size in height, and almost twice his size in girth. She was younger than my husband, but looked at least 10 years his senior. Perhaps it was her stark white hair or her dress: the calf-length blue and green pleated skirt, the starched white blouse covered by a mousy gray cardigan, and the black lace-up shoes like my grandmother used to wear. Perhaps it was the English accent which conjured images of the Queen Mum. But she was definitely not royalty. She was Molly, a retired lollipop lady – that’s British for school crossing guard – a marginally middle class widow who lived in one of the poorer suburbs of London. We had come to visit her for the Christmas holidays. I kissed her on the cheek and told her I was pleased to meet her.
She invited us into the house she rented from the city, a house both homey and meager. The living room was dwarfed by a red and black tweed, overstuffed couch with matching recliner, as well as by the floral carpet long faded by time. The kitchen was pint-sized with non-existent counter space and a refrigerator so small that daily shopping trips were a necessity. The bathroom had a tub with an overhead hot water heater that had to be fired up before each use. And then, of course, there was the absence of central heating. I could never warm up, particularly since Molly had generously insisted that we take her larger, more comfortable bedroom which unfortunately had no heat supply whatsoever. This was Molly’s castle, a castle where she had lived for many years.
Molly was delighted by our visit. Not only did she get to see her relatives from America, she also had a whirlwind adventure for one week. When we discovered how far Molly lived from everyplace and how infrequently the trains ran, particularly during the holidays, we had little choice but to rent a car. So Molly got to travel in luxury, visiting her grown children and their families, as well as other relatives in style. We took her to the theatre and to restaurants she could never have afforded. It was our pleasure to watch her enjoy.
The last evening before our departure we bought a bottle of Scotch and sat sipping it in Molly’s living room. She was not accustomed to drinking and soon said that she felt “a little tipsy.” We began to talk more openly about ourselves – my husband’s unhappiness in his first marriage, my estrangement from my father.
“I’ve never really felt close to anyone,” Molly said suddenly.
“Not even your daughter?” I asked, surprised.
“No, not really,” she replied matter-of-factly.
A heaviness settled over the room. There seemed nothing else to say. We said our goodnights shortly thereafter. I huddled close to my husband, wanting more than just the warmth of his body.
The next morning began as though nothing unusual had happened.
“Did you sleep well?” I asked conversationally.
“No,” she replied. “I had a very frightening dream. I dreamt that someone was trying to get into my house. They were trying to take off the doorjamb so that they could get in. I was afraid.”
I looked at Molly and knew she didn’t understand the meaning of her dream. I wanted to hug her, to tell her it was okay to let people in. That people weren’t dangerous. That we weren’t dangerous. But I couldn’t do that. I didn’t really know Molly. I wasn’t part of her life. And we were leaving. I could offer her nothing. I said nothing.
Special Article -Acting-Out and Passage into Action: Clinical and Theoretical Considerations, Donna Bentolila, L.C.S.W.
Very early into the elaboration of psychoanalytic theory, Freud (1901) addressed the importance of faulty actions, such as parapraxes, slips of the tongue and lapses in his remarkable study, The Psychopathology of Everyday Life. We know that such mistakes were no mere “ accidents “ and that they were at the core of neurotic formations, obeying a logic that was unconscious and revealing of one’s desire.
I will address a spectrum of what we could refer to as” disturbances in the motor sphere”, in which we can include serious acting-outs, and passage into action, both of which can be encountered in severely disturbed patients. In such cases, the sphere of movement derives either from an action that is untimely, hastened, or at times, intensely violent. We know that sometimes there is no other way to say something that is not being heard or cannot be heard, than through action. Action is generally used when someone to whom a communication is addressed, is simply not listening. The fact that the action is addressed to this Other, speaks of a need for this Other to listen, and take its place as interlocutor, so that the truth can be said, and the seemingly “ crazy and irrational actions”, understood. As analysts, we believe that the more someone can speak about the unspeakable, and be listened to, the less they will feel compelled to act it out. That is why, psychoanalysis grants such a central place to the function of speech and language, giving someone who comes to see us, the right to speak for herself. It is important to underline that either in acting- outs or passage into action, just as with “ faulty actions”, these type of behaviors carry an important nucleus of “truth”, only that the patient is constricted to the use of these behaviors in instances where words are no longer trustworthy or useful to convey experience, since the symbolic order, which is the one that guarantees an individual’s connection to social relations, language, and history, has been crushed, is unsafe or lacks the resources to name or recognize the trauma.
Defining Acting-Out and Passage into Action: an Examination of their Differences and Similarities:
We could claim that all acting out behaviors, when they take place inside the treatment, involve a communication to the analyst. It is a way if hinting to her, that she has missed the target. Acting out could be understood as an attempt by the patient to push the analyst into reordering the nature of his or her interventions into a more symbolic level. We can claim that all such behaviors are symbolic communications, an attempt made by the patient to be represented by language and to be heard. If we look up the definition of Acting out according to the dictionary, we will find: “….To represent ( as play story, a story in action, as playing a role on the stage, as opposed to reading.” The acting out then, would involve two moments: 1) a story that has been represented, but has failed in it’s purpose; 2) thus, it necessitates a second moment, as if someone would say: “….I am going to show you what this is about, we are going to represent it, to display the scene.” Therefore, it is very important to notice that the scene is supported by a text, that it has a symbolic support. What this means, is that the analyst is compelled to “read between the lines “, and exercise the function of “intelligere”, of figuring out what this is about. An acting out sustains a speech that was not articulated, a verbalization that was not spelled out, but one that begs for interpretation in a far more urgent way than a symptom does, due to a variety of reasons: 1) the degree of depersonalization that severe acting outs entail; 2) the gestures of self destruction; 3) the impulsive handling of time in which the patient experiences an urgency that forces her to go to the edge or do something desperate; 4) the request to the analyst to help her reintroduce to the field of speech that which had been cast out and left unspoken; 5) acting out expressions are reversible. There is the possibility of a return to the symbolic dimension, from where it was expelled (a hope structurally unavailable when a passage into action has been accomplished).
Acting out behaviors can have two possible outcomes: 1) it can push the patient into a “ passage into action”, whereby the patient tears himself apart from the scene of the world, either in a self destructive manner or destructive of others. Such acts are irreversible in nature; 2) it can push a patient into engaging in the symbolic process of analysis in an effort to gain knowledge from the unconscious, and hopefully, if the treatment works, to rescue their subjectivity.
Passage into Action:
In his Seminar, on Anxiety, Lacan (1962/1963) proposed a structural distinction between “ acting outs” and “ passage into action.” While the former implies that the patient acts out because she is subjected to a puzzling question and seeks an answer, the latter is described as an attempted solution, a flight from the scene of the world, which ends in the form of suicide or criminal act. How does this come about? Let us say that we can distinguish two moments in the structure of the passage into action: 1) the period in which a patient begins to drift more and more into the place of the unspeakable catastrophe and becomes increasingly identified with a state of despair, helplessness, worthlessness, hopelessness or nothingness. Such cases in which narcissistic supports begin to crumble and disappear, necessarily involve a deepening identification with a devalued and worthless object, with the entrance into a zone where there is no way out and someone is more at risk of trying to “ do” something to make this stop. So, how can we operate clinically with such situations when faced in our clinical practice with the risk of a passage into action? The first parameter to consider is to have strong transference alliance, or to develop one as a first priority. Secondly, in cases when a patient begins to experience suicidal or criminal ideation, with a strong affective component, we know that we have to take them seriously, and a sign that this is registered in the analyst is when we feel worried or concerned. Thirdly, we have to allow the patient to unfold his phantasies, allowing the phantasies to “ speak,” as it were (which means that often times , the therapist has to bear some things that are quite dramatic in the transference) so that the patient can eventually do something else with it. In this regard, it is very important that the therapist promote in every way, the patient to speak about what is on his mind, particularly when what is not spoken about is some unbearable trauma, objectified position or a mourning process, in order for the patient to be able to articulate, “ the scenes that take him to the edge of the abyss.” In order to help this process, it is crucial to preserve the continuity of the narrative, so that the therapist can be inside the scene and become part of it. As part of this effort, there are some technical interventions such as calling a patient when they have missed a session, asking them to attend their sessions, attending their calls, adding an extra session, in short, actively sustaining the transference. We could add to this, the need to request a psychiatric consultation, involve the family, and in some cases, the need to undergo a psychiatric hospitalization. Fourthly, the therapist needs to attempt to produce a cleavage, and allow the patient, if possible, to de-identify from this worthless, crazy, dead or rejected object, so that the self can be rescued, together with the self esteem and any threads of the desire to live. Lastly, let us examine another important indicator, which is the relationship to time. Anxiety, anguish and desperation are part of a dialectics of affects in relationship to the patient’s capacity to wait without falling apart. In the case of anxiety, the patient seems placed in a “longing for the missing object”, anxiously awaiting it, at times, unable not to overeat, over drink or medicate oneself. In the case of desperation, we can concern ourselves that a patient might be at the edge of an act that could expel him from the scene of the world. Desperation is defined both as a state of great recklessness brought about by a sense of urgency and anxiety, but also, by a state of hopelessness. When someone is caught in a place where they feel that there is no way out, no light at the end of the tunnel, one can be dominated by this impervious urgency to precipitate the end, and the risk of a passage into action is imminent. We can claim that in such cases, where the end is accomplished in a suicidal passage into action, there is a maximum effect of loss of self, which takes place as the effect of a trauma that has been impossible to mourn, and therefore has crushed all subjectivity and hope. We know that it is all the more difficult to mourn a trauma which has been repudiated by the social order, or by the family environment, thus preventing a patient, a combat veteran, or a people, from ever being able to forget it. The death or crime that is un-acknowledged by society prevents the mourning process and the possibility of working through the trauma. With such patients, there might be a need to find ways in which the trauma may be recorded in the social order, so that the mourning process not be aborted ahead of time and the losses can be mourned.
References
- Bentolila, D. (2004). The Burning Actuality of Trauma: Reflections and Psychotherapeutic Implications. In Press.
- ________. (2007). Passage into Action: A Lacanian Perspective on Serious Acting-Out. Typescript.
- ________. (2007). Trauma and the Failure to Mourn. Typescript.
- Freud, S. (1901). The Psychopathology of Everyday Life. S.E., Volume VI, pg.291
- _______. (1914). Remembering, Repeating and Working-Through. S.E. Volume XXII, pg. 145
- Lacan, J, (2006). Introduction to Jean Hyppolite’s Commentary on Freud’s Verneinung. In, Jacques Lacan Ecrits. The First Complete Edition in English. Translated by Bruce Fink. W. W. Norton.
- _______. (1962/1963). Seminario de la Angustia. Paidos. Official Version, text by Jacques Alain Miller.
- Lunger, V. and Nadel, S. (2000. )Acting-Out y Acto. Escuela Freudiana de Buenos Aires.
Conference Summaries - Emily Krestow, Ph.D.
Alan Sugarman, Ph.D. - Fostering Mentalization: An Integration of Relational and Structural Approaches in Child Psychotherapy
On December 5, 2009, SEFAPP's Scientific conference featured Alan Sugarman, Ph.D. who has integrated two theoretical models, Ego Psychology and British Object Relations Theory. He, different than the prevailing idea that children lack the capacity to develop insight, finds that children develop insight, and that insightfulness is related to the capacity for mentalization - an important mental function through which we are able to recognize and appreciate that we and others have inner lives. The child develops an awareness of mental life, of emotions, of mental content, and the ability to be reflective on the inner workings of his/her own, and others' minds.
How is mentalization derailed in the developing child? This capacity to mentalize is vulnerable to internal conflict and insecure attachment, and hence no well developed capacity to mentalize. Fostering mentalization then, he believes, is at the heart of psychoanalytic change. It is the attainment of insightfulness, not knowledge of conflicts that is the cure. Therapy promotes the appreciation in the child that he/she has an inner life, and must learn the importance of his or her mind which takes place in the relational space of therapist and child.
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Dr. Sugarman describes play therapy in which this emphasis on process rather than content ultimately leads to self-reflection. Phantasy play is a crucial way of learning to process. Focusing on, interpreting and accepting the child's wished-for self representations is similar conceptually to Kohut's notion of interpreting the leading edge, meaning the desire for self-representation and accompanying affects rather than the trailing edge or warded off affects and disavowed self representations. Addressing these dynamics inside, outside of the play and in the child's life, the desires, fears, internal prohibitions lead to understandings without being overwhelmed by feelings. How does play therapy go from action oriented to play, to phantasy in play and then to insight? Within the play words are put to feelings. Mental representatives are being built and serve to bind, and make anxiety tolerable, which enables the child to think about problems. He believes that the therapist can stay within play the whole course of therapy and bring about benefits. But the capacity to reflect is maximally sustained by getting outside of the play. Remarkable cases were presented, but here is one that succinctly demonstrates the process in which the newly developed capacity to mentalize comes under stress due to termination of therapy, and how he responds to this:
A 6 ½ year old girl, in third year of treatment wanted to terminate, and termination was negotiated. She then wanted to go to the bathroom to clean the holes in her ears so they wouldn’t get infected. He reminded her of how she avoids feelings of what might happen to her in her leaving Dr. Sugarman. They together now are remarking on her history of somatizing - an understanding that will help her when he is no longer there. Thus, this child came to understand how her mind functions, allowing her to focus on her inner life and regulate her feelings. Dr. Sugarman’s interpretation of the child’s action and somatization makes the unconscious conscious. Insightfulness and thus mentalization are reinforced; explicit, reflective capacity and processing are fostered and developed.
Arietta Slade,Ph.D. - Attachment, Mentalization and Fear: Their Role in the Clinical Process
On February 27, 2010 SEFAPP's all day conference featured Arietta Slade, Ph.D. She elaborated on the concept of mentalization which was originally introduced by Peter Fonagy. Interestingly, it was from a different theoretical perspective as Dr. Slade integrates contemporary psychoanalytic and attachment theories.
From this perspective, she accords fear a greater value than present day theories. it is an essential element of attachment theory. If attachment needs are regulated, as determined by parents, emotions will be managed internally. When a parent is both the source and solution of the fear dilemma, attachment disorganization follows, and the exploration of the internal and external worlds stop.
She described the work with mothers and babies in a mentalization-based program for high risk mothers, infants and their families, called Minding the Baby. Clinical examples were given of children, but it is important to realize that mentalization works with adults, something that Dr. Sugarman had emphasized as well. The results are the same: the more trauma the less likely to be a good mentalizer.
Dr. Leonard Ferrante’s presentation of an adult case, in the afternoon, demonstrated the theme of Dr. Slade’s presentation: the role of fear, and as it relates to attachment. This case was of an intelligent but powerfully traumatized woman who, with difficulty establishing trust, not surprisingly exhibited a strong negative transference. She suffered from a chronic state of fear in her childhood, experiencing her mother as very rejecting. Her earliest memory was of the mother’s out-of-control threatening and violent behavior. With the devastating loss of a father during her formative years, she was left unprotected by a mother who turned a blind eye to later sexual abuse.
Dr. Slade described the woman in this case as the classic example of preoccupied and unresolved attachment, having inchoate negativity, and unregulated intensity of feelings. From an attachment point of view, her mother failed to protect her, leading to an utter failure of her defenses, with intensity of phantasies of inner rage. Having suffered abject fear, her feelings are concrete entities. With an abusive parent the child has to be careful, she must modulate her presentation. That is, she must keep affects minimized in order to maintain closeness to the caregiver. It is a strategic way of managing fear. This woman could not mentalize in the face of difficult affects, and had no mentalization as to the aggression. It was thus for Dr. Ferrante to be the reflective or mentalizing clinician. And he demonstrates fortitude in staying with this difficult case, helping her develop a reflective stance. The mentalization approach for this case is to facilitate wondering, as well as to promote autonomy. Ultimately, the higher the reflective capacity, the more likely the child or adult is to be secure.
Brian Johnson, M.D. - Addictions and Relatedness: A Neuropsychoanalytic Approach to Treating the Addicted Patient
On April, 17, 2010, Brian Johnson, M.D. presented his approach to treating addicted patients. A psychiatrist, addictionologist, psychoanalyst and neuroscientist, Dr. Johnson integrates neuroscience and a psychoanalytic model of the mind expanding and enriching treatment approaches to these badly suffering patients.
Neuropsychoanalysis, a developing wing of psychoanalysis, also returns us to Freud’s original field of neuroscience. Both ask, “What drives people?” Dr. Johnson describes addictive behavior as a self destructive and ruthless drive to engage in behavior that is known to harm, to even kill. He spoke of patients who cry because of their craving and have frequent "drug dreams." Making the point that drugs and alcohol are not only psychologically and biologically addictive, the use of drugs changes the pathways in the brain,leaving neurological imprints further enforcing cravings. Drugs and alcohol are always on their minds and in their brain pathways.. The pleasure principle has been overridden, which was presented as the basic thrust of the conference. Neuroscience tells us what lies beyond the pleasure system. While the pleasure system runs on endorphins and has to do with opiate receptors, drugs that replace naturally produced endorphins produce addiction.
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What does this have to do with relatedness? Dr. Johnson's thesis is that drive, as a pathological phenomenon, itself is unrelated. Relatedness is a pleasure seeking motivation which is organized by becoming tuned to a certain kind of a person - through a thousand minor events: a look, smells, movements, etc. Dopamine receptors are involved in our affective remembering and cathexis requires a drive system to remember whom one likes. But drugs overtake the neural pathways, and motivations for relatedness are supplanted by the compulsive motivations to obtain chemical substances. The brain is changed by these addictive drugs which cause lack of relatedness. If dopamine receptors are blocked by drug action, then one doesn’t develop partner preferences. Also, hormones modulate the system. Oxytocin helps with bonding (e.g., after sex, it increases). Block oxytocin and partner preferences are blocked as well.
Therapeutically, the patient must learn to inhibit behavior in order to override the drive system. Since the craving system and dream system share the same pathway, and drug dreams are a sign of physical addiction, unconscious cravings can be made conscious by the recognition of the meaning of these dreams, as a manifestation of continuing irrational urges to use. I have read elsewhere, that drug dreams may help patients stay sober, for the onset of craving is accompanied by the onset of recurrent dreams.
Each of these three conferences were gems. Yes, you can miss one and still benefit. But taken together, they provide us with a wealth of theoretical and clinical information to enhance our practices. And, our Scientific Meetings yet to come in 2010 and 2011; Benjamin Kilborne, Ph.D. on shame on December 4, 2010, Jean Petrucelli, Ph.D. on eating disorders in January, 2011, Kenneth Corbett, Ph.D. on gender development and identity and Carla Leone, Ph.D. on couple therapy are sure to further enrich us.
Transference/CounterTransference Column - Royce Jalazo, Psy.D.
A Therapeutic Ear to the Wall
My work as a police psychologist for a local police department began quite unexpectedly. Having passed the months-long selection process that included a rigorous background investigation into my character, I would soon find myself riding along with officers on their routine patrols. These in vivo experiences of their work were made possible to give me a deeper understanding of their police officers’ job tasks and the inherent challenges. They would inform my treatment as one of their employee assistance program psychologists.
My new part-time job seemed like a dream come true, but it was not going to be without its challenges. Notwithstanding the daunting task of bringing the abstract and sometimes seemingly absurd concepts of psychoanalytic psychology to people who tended to think more concretely, I would have to traverse the in-groups versus out-groups mentality that was sure to be found in this paramilitary organization. What I did not learn at the interview was that the ride-alongs would involve a test of my character, usually coming very early on in the shift, and my passing or failure of them would result in my assignment to one of these groups.
There were other negatives to be dealt with. I was a woman entering a predominantly all-male profession with a ‘good-ole-boy’s-club mentality.’ “You’ll be introduced as ‘Royce’ and not ‘Doctor’,” I was told. “The man you are replacing retired. He was always referred to as ‘Doctor-so-and-so’ over his twenty-something year career with our department and never by his first name, but you are different. He was an older man with white hair –you are a woman. Also, know that you will be considered an ‘asshole’ until proven otherwise,” I was further informed. The person providing me with this background information was attempting to be helpful, not hostile.
I had been warned. I was certain to encounter negative transference. To appreciate this, one must understand the psychology of a law enforcement officer. In the United States, there exists ‘The Blue Wall of Silence,’ an unwritten rule among police officers to claim ignorance whenever another officer is suspected of doing something wrong (Westmarland , 2005). This long-held tradition in police-work extended itself to remaining silent about one’s own troubles.
To some, I was seen as an immediate threat, someone attempting to knock on this wall and get them to admit their psychological difficulties, and thus risk being seen as weak and possibly unfit for duty. The stage was set for automatic suspiciousness of me as a “company spy,” which I combated by openly discussing it with humor (e.g., “Yes, speak clearly and slowly into the tip of my ballpoint pen, please.”).
For me, on the surface, this gig was my way of “taking care of my Id,” as McWilliams (2004) would refer to it, a chance to properly sublimate all of the pent-up energies that got created as a result of having to sit still in the consulting room for many hours per day and endure my patients’ traumas and other distress. I am psyched on these days.
There was also my own negative countertransference. Perhaps it resonates with any moment in my past during which I may have felt potentially unsafe in the presence of others who had much more power than I –to feel vulnerable, afraid. After all, I am not the one with the badge and gun here. I was not unfamiliar with guns, though.
So each of us felt vulnerable for different reasons. I would have to remain aware of this while I sought to make in-roads. Just how does one get to the soft gooey center of a police officer? It is certainly not by trying. There is a paradoxical effect here. If one acts interested in breaking down barriers and “getting inside” then it serves to evoke stricter defenses against opening up. If one simply casts-off the role of healer and steps wholly into their world, respect and credence are garnered, walls come down quite naturally and the therapeutic work begins. I would do whatever was necessary to make myself appear less like a psychologist and more like them.
On one particular afternoon, I was to ride in one of our county’s more crime infested districts. I was looking forward to it. I knew that there was certain to be some action. It beat sitting around with a radar gun writing tickets and feeling bored for hours. I always looked forward to plugging license plate numbers into the crime computer database. As I climbed into the very young officer’s car, I excitedly told him, “I’m gonna run tags,” and I swung his laptop over to the passenger’s side of the patrol car. Seconds later, the cab was filled with the presence of a third companion who monotonously chirped, “Name clear (ding!). Registration clear (ding!)…” I found that checking license plates had the same quality as playing the slot-machines. Feeding it tag numbers and waiting for the dings versus whoops that alerted us to a violation was akin to dropping my quarters in and waiting for the fruit-symbols on the reels to align into a perfect match. The variable-interval schedule of reinforcement was quite addictive.
We had been joking a bit about the presence of a psychologist in a patrol car, when suddenly, getting serious with me, the officer both informed and inquired of me, “Hey, there is a gun in the glove box. If I get into it and someone goes for my gun; you shoot them, okay?” He quickly scanned my face for what appeared to be any hint of fear or insincerity in my response and continued, “Are you okay with that?” and stared at me with what seemed liked masked worry.
Recognizing that this was my defining moment, without uttering a word, I opened the glove box, grabbed the gun, and proceeding to pull the Glock from its holster. It was a bold move meant to demonstrate that I was not afraid of guns and that I would take swift action if necessary. My movements were halted by the cautious officer’s hand that stopped mine. Knowing that Glocks do not come with manual safeties, he shoved it back into the glove-box while sputtering, “Whoa… h-h-hey… let’s just leave it in the holst—“
“And, I’m ‘gonna kill ‘em. You okay with that?” I replied calmly, leaning ever so slightly forward toward him, locking my gaze onto his and trying my best to refrain from looking too eager or afraid.
The cop sat back (or maybe was taken aback) and his facial expressions unfolded into a mixture of gratification and disbelief. The result was a compromise formation of a cautious half-smile as he mulled-over the notion that a psychologist, a therapist, a healing professional would actually be alright with killing someone.
“Really? You would be okay with that?” he checked me out again.
“Yep, really,” I reaffirmed my stance with him and gave him my logic, “If I don’t, he will kill you.”
Having pled my case fully, I turned my attention back to my police slot-machine and entered another tag: “Name clear (ding!). Registration clear (ding!). (WHOOP! WHOOP!) LICENSE INVALID! (WHOOP! WHOOP!)"
“Hey, what? Wait. Where is that?!” the officer cognitively pulled himself out of his reconciliation with my psyche, and turning his attention to the task at hand, swung his laptop back to its rightful place on his side of the patrol car.
I could see him scanning the readout as he took-in the same compelling information that I had just moments ago. As soon as the two matching fruit shapes in his eyes aligned into ‘jackpot’ I pointed at a car up in the distance. “Right there,” I oriented him further and continued, “driving on a suspended license,” I reaffirmed. I pulled my extended arm back to grasp my seat belt as I felt my body sinking heavily into its seat back by the G-forces created from the high-speed acceleration of our vehicle in that direction.
“Hey! Wouldn’t it be cool if we had a hit on a stolen car tonight?” he glanced quickly in my direction and asked me, allowing his half-smile to fully blossom into glee.
“Yeah, cool,” I validated him, smiling back, and sneaking a look at the glove box holding the gun that made me feel safer and more in control of my own fears of victimization.
“So… Doc… I wanna tell you some stuff… okay? Is it okay if I call you ‘Doc’? This is confidential, right?” he went on.
References:
McWilliams, N. (2004). Psychoanalytic Psychotherapy: A practitioner’s guide. New York: Guilford Press.
Westmarland, L. (2005). Police Ethics and Integrity: Breaking the Blue Code of Silence. Policing and Society, Volume 15, Issue 2 June 2005 , 145 – 165.
Treasurer's Report - Aaryn Gottesfeld, M.S.
In preparation for writing this report, I looked back at the treasurer’s report published one year ago. At that time the account balance hovered around the $13,000.00 to $14,000.00 range. Our account balance has slowly declined throughout the last year, so that it now hovers around the $7,000.00 to $9,000.00 range. Several of our events were not as profitable as we had hoped, and two of our events incurred losses. This being said, as you can see from the chart below, our balance has remained somewhat stable over the last several months.
On a brighter note, income from membership renewals has been steady, and the Freud Amongst the Arts fundraiser was a success, raising $2274.02 to be split between SEFAPP and SEFIPP. Members of this organization and the community donated generously and we are greatly appreciative of everyone’s support.
SEFAPP currently has a balance of $8440.09 which is approximately $5,000 less than June 2009. The President and Board of Directors are aware of this downturn, which given the current economic climate is unsurprising. Our goal is to increase profitability over the 2010-2011 season and restore the funds lost in the last year.
|
|
Income |
Expenditures |
End of Month Balance |
|
December 2009 |
$5442.88 |
$2104.86 |
$7276.00 |
|
January 2010 |
$5455.06 |
$5472.25 |
$7258.81 |
|
February 2010 |
$1872.19 |
$1876.86 |
$7254.14 |
|
March 2010 |
$3450.00 |
$3517.39 |
$7186.75 |
|
April 2010 |
$3450.00 |
$4227.35 |
$6409.40 |
|
May 2010 |
$5453.00 |
$3769.78 |
$8092.62 |
Membership Report - Leonard J. Ferrante, Psy.D.
As membership Chairperson, I am happy to report that our membership has climbed to over 110 with the addition of 23 new members from the professional disciplines of medicine, psychology, social work and mental health counseling! I would like to offer a warm welcome to:
Maria Artime, Student
Amarylis Barbosa, Student
Glenda Bates
Silvina Belmonte, LMHC
Robin Benjamin, LCSW
Enrique Casero, Ph.D.
Laura Cohen, Ph.D.
Lawrence Cohen, Ph.D.
Mercedes Cubillan
Gloria Fraggetti, Ph.D.
Pamela Garber, LMHC
Nonie Griscom, LCSW
Patricia Jaegerman, Psy.D.
Rebecca Klasfeld, Student
Laura Kreiger
Lorena Lechter, LMHC
Allison Levine
Roslyn Malmaud, Ph.D.
Robert Moran, M.D.
Valeriya Sharova, M.D.
Julie Shuman, Psy.D.
Ann Toback Bair, LCSW
Susan Turner, LMHC
I want to remind our members and inform our new members that you can advertise your professional services and notices at no cost via SEFAPP’s website and that you have access to our networking and referral resources via SEFAPP’s online searchable directory.
Moreover, I encourage you to consider participating on one of our numerous committees in which you can offer your ideas, creativity and expertise to foster the growth of SEFAPP and promote its identity throughout and beyond the tri-county area. Your participation on a committee also allows you the opportunity to develop a more in-depth professional and personal relation with other SEAFPP members. If you have interest in one of our many committees or would like more information, please feel free to contact me at psyd@bellsouth.net.
On behalf of SEFAPP, I want to thank you for your support. I look forward to meeting you all and wish you a happy, healthy and prosperous year.
Sincerely,
Leonard J. Ferrante Psy.D.
Fundraising Report: Cathy Stamm-Kaufman, LCSW
SEFAPP'S 17th annual fundraiser, Freud Amongst the Arts was held on May 14th, 2010, at the Ft. Lauderdale Culinary Institute-Chef's Palette Cafe and Grill. The event was very successful, with approximately 60 people attending. Accompanying the delicious food, fabulous wine, and wonderful service, was our President-Elect’s son, Matt Prince, and his colleague playing delightful Jazz music.
During the evening, we honored Frederic J. Levine, Ph.D. and Richard Steinberg, Ph.D. (photo left, by Marion Tarasuk) with the "Robert Storch Memorial Distinguished Psychoanalyst" Award for their work and inspiration in launching Veterans Project of South Florida- Strategic Outreach to All Families of Reservists (VPOSF-SOFAR). The result of a true and effective collaboration between SEFAPP and the Florida Psychoanalytic Society, Fred and Richard both have distinguished careers beyond their work as Co-Chairs of the VPOSF-SOFAR Steering Committee.
Barbara Lurie, Ph.D, L.M.F.T. received the "Renee Zevon-Steinberg Friend of Psychoanalysis" Award. Over many years, Barbara has frequently and generously offered her comfortable and gracious home for SEFAPP's Sunday Symposium Brunch Series. These individuals were recognized for their longtime support of SEFAPP and SEFIPP, as well as their outstanding service to the local community.
Shirley Malove's artist sister, Helen Moody created a stunning Freud portrait which we auctioned. We also had a delicious rendition of the painting in the cake that Lisa Schulman, Ph.D. donated. Numerous other treasures were donated for our raffle, made all the more exciting by Board Member Leif Weig, M.Ed.
It was an evening of great camaraderie. Much fun was had by all! I wish to thank my committee members, Emily Krestow, Ph.D., Richard Steinberg, Ph.D. and Leif Weig, M.Ed. for their hard work, creativity, and support in putting this event together. I would also like to thank our President, Marshall Fenster, Psy.D., President-Elect Lori Prince, L.C.S.W. and all of our Board Members for their support.
Special Report: SEFIPP - Antonio R. Virsida, Ph.D., ABPP
Over the last few months, SEFIPP’s Curriculum Committee developed, and the BOD approved, three innovative and integrated training programs. Helen Banta, Ph.D., Chair, and members, Max Harris, Ph.D., Emily Krestow, Ph.D., Arnold Z. Schneider, Ph.D., A.B.P.P., Linda Sherby, Ph.D., A.B.P.P., Richard Steinberg, Ph.D. and Scott Winfield, L.C.S.W. designed a one year program, Introduction to Psychoanalytic Thought: Theory and Practice (IPTTP) which can stand alone or serve as the first year of the two year Training Program in Psychoanalytic Psychotherapy (TPPP) and/or as the first year of the four year Training Program in Psychoanalysis (TPP). The revised curriculua, training requirements and admissions process offer three “user-friendly” options of training and education for a variety of interests among mental health professionals. The announcement of the Introduction to Psychoanalytic Thought: Theory and Practice was recently mailed and emailed to SEFAPP members and 1,500 mental health professionals in the tri-county area. We already received three inquiries from mental health professionals who are seeking full psychoanalytic training and are hopeful that more enrollments for the one, two or four year programs will follow. This program structure is different and separate from SEFIPP’s Contemporary Case Seminar Series that meets monthly for nine months. These programs will be offered in the Fall of 2010.
The courses of the IPTTP first year program, include one theory course and one clinical process/technique seminar, each 1-1/2 hours long, meet once weekly and provide an overview of different psychoanalytic schools of thought. In addition, a monthly two hour clinical process seminar is offered, led by different faculty members who will present their own clinical work. Enrollees may also present their clinical work when they want some supervision. All enrollees in the IPTTP will be evaluated by instructors during the first year, and those who want to proceed to the two year TPPP or the four year TPP will be reviewed by the Progress and Evaluations Committee to determine their suitability to continue. This modification of usual admissions procedures allows faculty members to become more familiar with applicants than allowed by the usual three or four admissions interviews.
The curricula of the two year TPPP and the four year TPP are broad based, covering the wide range of psychoanalytic thinking and clinical approaches. Designed to give students an appreciation of the historical and political development of psychoanalytic theories and practices, these 1-1/2 hour courses are also paired and meet weekly. The Curriculum Committee members worked long, hard and creatively to develop these innovative programs.
For further information and details about SEFIPP’s program offerings and/or a copy of SEFIPP’s catalogue, CLICK HERE. You may also contact our Administrator, Cristina Virsida at sefipp@gmail.com or (954) 597-0820.
Veterans Project of South Florida Update - Richard Steinberg, Ph.D.
Would you like to help children, spouses and other family members of soldiers? Help soldiers cope with reintegration and the traumas suffered in war? Impact the community in learning to ameliorate sense of isolation, loss and stress in families and soldiers impacted by the wars? Then, volunteer for our vital project by calling Cristina Virsida, Project Administrator toll free at (877) 783-2748 or veteransprojectfl@gmail.com. You can also contact our Co-chairs directly, Frederic Levine, Ph.D. at (305) 669-8948/fredlev@gmail.com, and Richard Steinberg, Ph.D. at (561) 393-1439/rstein1426@aol.com. We particularly need child therapists and outreach workers, who are willing to attend gatherings of vets and families in support meetings and other events.
Recently, Matt Mascitelli, MA attended a support gathering of solders on leave and their families in Hollywood, FL interfacing with them and other agency personnel to let them know about our program services. We have learned that both the soldiers and families, as well as those who work with them are a somewhat closed society. It takes time, respect for their culture, and a willingness to learn, to be accepted as a trusted resource.
Through the efforts of our volunteers like Matt and Royce Jalazo, Psy.D., who in May presented a program about supporting kids and families from deployment to reintegration, at the Sandpiper Elementary School in Sunrise, FL, we are establishing VPOSF/SOFAR volunteers as professionals who are accessible, caring and a valuable resource. Over 60 teachers and administrators participated in the workshop at Sandpiper where there are 63 children of actively serving/returning soldiers in the military.
With grant funds received through the Florida BrAIve fund and The American Psychoanalytic Association (greatly due to the efforts of Fred Levine, Ph.D.), we have also been able to sponsor outstanding training programs under the direction of Antonio Virsida, Ph.D., our Director of Training.
On January 30, 2010, Washington Post reporter Christian Davenport talked about the history and current operation of the National Guard. He drew from his experiences as an embedded reporter with a National Guard unit and his 18-month follow-up with the soldiers, upon which he based his book “As You Were: To War and Back with the Blackhawk Battalion of the Virginia National Guard”. Also speaking were Stephanie Lincoln, LMHC, Director of Psychological Services for the Florida National Guard, Gary Hodgson, Family Assistance Coordinator for the Florida National Guard and former Marine, and Elisabeth Slater, Ph.D., Executive Committee Member of SOFAR in Boston.
On March 20, 2010 Jonathon Shay, MD, Ph.D., noted author on the traumatic effects of combat in Vietnam and internationally acclaimed psychiatrist, specializing in the treatment of Vietnam veterans presented his ideas about character. Other contributors were Francoise Davoine, Ph.D. and Jean-Max Gaudilliere, Ph.D., known for their work on intergenerational trauma. Rounding out the program was Daniella David, M.D., a psychiatrist on the PTSD unit at the Miami VA.
On June 8th, 2010, Ana Eriksen, MD, our Director of Child and Adolescent Services, appeared on the local NPR radio show “Topical Currents” along with Dr. Shay, Fannie Cocalides, LCSW and Harry Zayas, a veteran of the Iraq War. In addition, we have co-sponsored with the Palm Beach Returning Behavioral Health Task force, conferences on PTSD, TBI and special issues facing women veterans.
As you can see from this brief update, from providing free treatment, to sponsoring educational programs, to consulting with community agencies, we are busy! Please come join us in any one of these activities by calling or e-mailing us at veteransprojectfl@gmail.com. We welcome your participation in our vital community service project.
Richard Steinberg, Ph.D.
Co-chair VPOSF/SOFAR
Steering Committee Members: Frederic J. Levine, Ph.D., Richard Steinberg, Ph.D., Antonio R. Virsida, Ph.D., ABPP, Emily Krestow, Ph.D., Ana Eriksen, M.D. and Jill Hartog, LCSW.
Special Article - Traditions, Immigration, Assimilation and the Marginalization of Psychoanalysis in the U.S.: The Old, the New, the Newer and the Newest Orthodoxies - Part I - The Power of Theory and the Theory of Power, Antonio R. Virsida, Ph.D., ABPP
I’m listening to NPR's Morning Edition one Monday morning before this Thanksgiving holiday on my way to work, I’m struck by the first in a series of interviews with chefs who were either born in other countries or whose parents immigrated to the U.S. Michael Psilakis, a well know New York City chef and owner of the restaurant, Anthos, whose parents were born in Greece, is speaking about the disjunction between family and cultural identities, and about how family cultural identities were preserved in his childhood home by way of foods prepared and eaten. Asked by the interviewer if turkey was prepared for the Thanksgiving meal, he replies that while his mother did cook turkey, everything else on the table was “Greekified,” by which he meant that all the dishes and accompaniments were classic Greek dishes. Further, more central than turkey to the meal, was a spit roasted whole baby lamb prepared by his father. These immigrants definitely placed their Greek stamp on the Thanksgiving celebration and it became their own.
Two of the loves in my life are food and psychoanalysis. A third is in my identification with my grandfather born in Asturias, Spain and my father, aunt and uncle who were first-generation U.S. born. I immediately and fondly think of how my family preserved their Asturian heritages at Thanksgiving, all holidays, and every day meals. Our thanksgiving table included turkey, but the rest of the foods were “Asturiafied” with an Austurian bean and collard greens soup, an egg and lemon smothered baked red snapper , lamb and beef. Then my thoughts turned to psychoanalysis, which emigrated to the U.S., originally by U.S. physicians who visited Vienna and studied for brief times with Freud, and then by a wave of immigrant refugee psychoanalysts from Vienna and Berlin.
This article is about how this trans-cultural migration affected the transmission and evolution of psychoanalytic thought, training and politics in the U.S. Perhaps some history about the Thanksgiving Day observance may be applicable to the main thesis of this article. While the Thanksgiving Holiday is thought of in the U.S. as a quintessential North American celebration of the harvest and giving thanks to God, indigenous nations all over the world have harvest celebrations that start from very old traditions. (Dow and Slapin, 2006). In the U.S., the English settlers and the Native American tribe of the region, the Wampanoag, had harvest celebration traditions. So the coming together of two peoples to share food and company was not foreign to either. However, the visit that by all accounts lasted three days was most likely one of a series of political meetings to discuss and secure a military alliance.
Neither side trusted the other. The Europeans considered the Wampanoag soulless heathens and instruments of the devil. The Wampanoag had seen Europeans steal their seed corn, abduct some of their tribes people to Europe and enslave them and rob their graves. It is quite unlikely, contrary to popular myth, that either group referred to this feast/meeting as “Thanksgiving” (Dow and Slapin, 2006). Wikipedia (2009) and the Encyclopedia Britannica (2008) are consistent in their chronology of later development of Thanksgiving Day in the U.S. Briefly, in 1789, George Washington proclaimed the first formal national Thanksgiving Holiday to be in October. Abraham Lincoln, in 1863, in the middle of the American Civil War, proclaimed a national Thanksgiving Day to be celebrated on the last Thursday of November. Toward the end of the Great Depression and before our entrance into World War II, Franklin D. Roosevelt established Thanksgiving to be on the next-to-last Thursday in November.
Roosevelt made his plan clear. An earlier Thanksgiving celebration would give merchants a longer period to sell goods before Christmas. At the time, advertising and selling Christmas goods before Thanksgiving was considered inappropriate and disrespectful. The founder, Fred Lazarus, Jr., of Federated Department Stores, later Macy’s, is credited with convincing Roosevelt to push “Franksgiving,” as it was called by critics, back a week to expand the shopping season. Although cultural traditions like Thanksgiving that have been mythologized and held dear, they have long been significantly influenced, if not organized by threat, power and economics. Psychoanalysis, too, has not been immune to these economic forces and influences through generations of reverent practitioners, upholding believed theoretical and clinical traditions. In fact, psychoanalysis may very well be like a country whose citizens, none of whom are natives, do not want their traditions changed by immigrants, while at the same time, immigrants must by definition, in order to find their own place, emphatically put their personal/cultural stamps on the dishes served up. The question is not only what foods are prepared, but how much of what foods and recipes are acceptable, palatable. The question is who can lay claim in the psychoanalytic and mental health market place to being the true authority, with the true traditions and with the right to advertise, promote and sell their foods and recipes to the public.
Immigration from one country to another is a complex and multi-faceted psychosocial process with significant and lasting effects on an individual's identity (Akhtar, 1995), not the least of which are profound losses. Immigrants often come to the U.S. in the face of severe personal and cultural traumas in their country of origin. This was certainly true of the wave of psychoanalysts who fled Vienna and Berlin during WW II. Coupled with a renewed opportunity for freedom, psychic growth and self expression, came gross and subtle cultural and characterological conflicts, in some ways similar to the effects and internalization of their traumas.
So, what psychoanalytic foods were prepared and served up by the first generation of psychoanalysts in this country as opposed by those immigrant analysts from Austria and Germany, most of whom were Jews seeking refuge here from the Holocaust?
The analysts who comprised the first U.S. psychoanalytic society and institute, the New York Psychoanalytic Society (NYPS) and the New York Psychoanalytic Institute(NYPI), begun in 1931 were dubbed the “anointed” Kirsner, (2000). Sandor Rado, was brought from Berlin by Abraham Brill, the U. S. born founder of the NYPS, and Clarence Oberndorf, similarly U.S. born. Both of these latter psychoanalysts held firm, contrary to Freud's acceptance of “lay analysts,” to the policy that analysts should be medically trained. This is an example of the selectivity of all orthodoxies. They considered themselves Freudian in theoretical and clinical regards, but not in political and economic regards. It is important to note that, in the U.S., medical education and the practice of medicine were unregulated until the 1910 Flexner Report (Eisold, 2000). Reforms in training requirements, curricula, standards of accreditation and licensing did away with the proprietary schools, quacks and charlatans.
Now with governmental regulations and fewer medical practitioners physicians and their organizations became small capitalists, controlling admissions, fees and the practice of medicine rather than being the victims of capitalism (Eisold, 2000). This history of the development and establishment of authority in medicine influenced the attitudes of physicians and were precursors to questions of authority in psychoanalysis. These analysts strictly controlled the theory and practice of psychoanalysis, as well as, admissions and organizational membership.. Nevertheless, early on splits occurred among the faculty at the NYPI, owing more to “arrogant and contemptuous” (Kirsner, 2000) power struggles, than to theoretical differences.
In 1941, that control and rancor led Karen Horney, Clara Thompson and three colleagues to storm out of a NYPS meeting. The walkout was a response to a vote that evening to disqualify Horney as an instructor and training analyst (Eisold, 2000). In1945 the Columbia University Center for Psychoanalytic Training and Research in the College of Medicine, Department of Psychiatry was established with Sandor Rado as the head.
During the late 1930s and early 1940s many refugee analysts fleeing Hitler, headed from Vienna and Berlin for New York and London. These immigrant analysts were a significant financial threat to many N.Y. analysts, all of whom were New York state licensed physicians in contrast to the immigrant European analysts. The late 1930s and early 1940s were difficult financial times, with the transformation of the Great Depression into World War II. Many U.S physician analysts were drafted into military service, and the remaining New York analysts often refused to sponsor European analysts in this country, in fact, encouraging those who did arrive in N.Y. to re-locate to other metropolitan areas. Despite pressures to leave N.Y.C., one-third of the European analysts remained in N.Y., often residing and practicing in upscale neighborhoods on Park Avenue and near Columbia University (Kirsner, 2000). The NYPI, the most powerful and influential institute of the American Psychoanalytic Association (APsaA), was successful in outlawing European analysts, by passing a resolution requiring that a “training analysis” was necessary to become a member of the APsaA. Since many of the European analysts had not had such analyses, they were ineligible for membership, and for ascendance to the authority of training analysts. However, after an intense struggle, the International Psychoanalytical Association (IPA), of which the APsaA was a prominent member, influenced the APsaA to accept as members, European “lay” (meaning not licensed as physicians) analysts who were members of the IPA. European analysts, brought up in the heady tradition of Freud's legacy, believed in psychoanalysis as a way of life, and not as a guild (Kirsner, 2000). European psychoanalysis was viewed by European analysts as superior to U.S. psychoanalysis, likely because they had identified with Freud's position that psychoanalysis was not to “become the handmaiden of American psychiatry.”
European immigrant analysts thought of themselves (as might any immigrant) as citizens of their European countries they wanted to preserve. What they had upon immigrating was a powerful belief and identification with that which they knew and valued, their ethnic/cultural heritage and their identities as psychoanalysts who were the real “anointed.” They were the real and direct descendants of Freud. They were from a tradition begun by Freud that eschewed national considerations and therefore expected to be welcomed as training analysts in the U.S. psychoanalytic community on the basis of their pedigree and IPA member status (Kirsner, 2000). This thinking assumed that being a training analyst was a qualification of universal status instead of a particular position or function within a specific institute (Arlow, 1994, cited in Kirsner, 2000).
Interestingly, it was the European inner group of analysts and their direct analyst descendants who took over the NYPI for the next forty years. Many of these analysts and their descendants were titans of U.S. psychoanalysis, and included the likes of Heinz Hartmann, Ernst and Marianne Kris (the daughter of Oscar Rie, Freud's closest friend, colleague and tarok partner), Rudolph Lowenstein, Edith Jacobson, Annie Reich, Robert Bach, Kurt and Ruth Eissler, Otto Isakower, Margaret Mahler and Hermann Nunberg. For those analysts who took over, the NYPI became the repository of a new cause, the stamping of U.S. psychoanalysis with their European/Freudian identities as formulated in Europe.
The majority of these formerly humanist, left wing, liberal and socialist European analysts, rather quickly adopted the U.S. policies about the necessity of a medical degree to become a psychoanalyst, and, of course a training analyst. Ironically, both of these policies, were originally put in place by U.S. analysts to exclude the European analysts, who adopted the same policy requirements. Their sense of liberalism and social causes may have been disjointed by the urgent necessity and trauma of leaving their homes and emigrating to the U.S. owing to Hitler, the persecution of Jews and the Holocaust.
Finding that they now possessed “the power,” they seemed to identify with the aggressor. Perhaps consistent with Freud’s thesis in Group Psychology and Analysis of the Ego (1922), the super ego, politics and hierarchical structure of the group replaced individual morals and ideal values. The NYPI under their leadership, became the temple where the psychoanalytic truth resided, where the Grail naturally came to rest, was kept, and truly preserved by the high priests.
Much of what was handed down as psychoanalytic truth and wisdom by the first U.S. analysts and then the European analysts and their descendants, had its origins in power, economics, and much like today, the threat of immigrants to the established power hierarchy. As always, “insider” and “outsider” were in conflict. However, the European analysts found their way to shift the balance of power by identifying with the aggressor and assimilating the U. S. psychoanalytic cultural and economic rules to suit their own narcissistic and financial motives. Parts of Freud’s authoritarian control of the psychoanalytic movement were preserved in the U.S. Psychoanalysts in the 1930s, the NYPI and the APsaA occupied psychoanalysis and made psychoanalysis a province of medicine. Subsequent efforts to colonize the rest of the country and maintain their beliefs, which were held and enforced by the psychoanalytic titans and governors were successful well into the 1980s. Since then, psychoanalysis been guided by a disguised belief in self serving orthodoxies and fundamentalisms.
Within psychoanalytic oral history, anecdotes about the inflexibility of orthodoxy abound. In the late 1950s, Hans Loewald, an early U.S. object relations thinker who grew up in Europe, and studied philosophy before medicine, was trained in the the ego psychology tradition. He was invited to speak at the NYPI and was disrespectfully and openly dismissed because of his then unorthodox ideas. Several years later, Donald Winnicott was invited to speak at this same institute and he was similarly treated. He later suffered his fourth heart attack and died. Some say that he, a rather gentle man, was so distressed by the hostility of his hosts that he suffered the fatal heart attack. Other anecdotes suggesting disguised political, as well as economic motives were witnessed by me. Ten to fifteen years ago I attended a panel on psychoanalytic training at a Division 39 Spring Meeting. The panel members were of the “newer orthodoxies,” meaning Relational, Object Relations, Intersubjective and Interpersonal psychologists, some had recently founded institutes. One panel member, a psychologist/psychoanalyst from the William Alanson Institute (WAWI) in N.Y.C., I asked about the rationales for WAWI requiring a training analysis with appointed analysts. Her response was that they wanted to insure that their candidates had an Interpersonal analysis so as to continue the tradition of their particular psychoanalytic way of thinking. I also recall the Division 39, 1992 Philadelphia Spring Meeting that featured Jacob Arlow as a keynote speaker. I overheard several psychologist/ psychoanalysts, perhaps feeling powerful after the anti-trust lawsuit victory in 1987 against the APsaA and the IPA, eagerly anticipating challenging, even bashing and discrediting Arlow. Interestingly and ironically, Arlow was not among those physician analysts who opposed the inclusion of non-physicians in training. But he was a premiere proponent of ego psychology. And perhaps that difference, as well as the fact that he was a physician, made him an easy target.
I had a similar experience during another Division 39 meeting where Roy Schafer was a keynote speaker and presented clinical material to illustrate a theoretical idea. Audience members not only challenged his understanding and interpretation of the clinical material, but they were disrespectful in repeating, and to my way of thinking, hammering their own, different views.
It was power and economics that ultimately changed the professional landscape of psychoanalysis and who was acceptable for training in the U.S. First, there was the 1986 anti-trust lawsuit brought by four psychologist members of the Division of Psychoanalysis (39) of the American Psychological Association (APA), that resulted in the change in the admission policies of institutes of the APsaA. The second powerful economic shift was brought by the declining application of physicians to psychoanalytic training programs owing to the rise of more lucrative and simpler biological psychiatry, that led institutes of the APsaA and free standing institutes in the U.S., in attempts at self survival, to accept psychologists, social workers and other mental health professionals . We, like others before us in psychoanalysis, and in the culture at large, seem driven by a closed system of anxiety, xenophobia, narcissism, retaliation and desire to ascend to power by claiming new theoretical authority. We’re setting the table, bringing new dishes and claiming that the dishes, tables and chairs are ours exclusively, while giving dismissive nods to the traditional dishes. These economic and power motives seem disguised by new and newer popular theoretical orthodoxies that make us right and righteous. Psychoanalysts in the U.S have, as it is probably true to varying extents in other countries tried to be the unique owners and purveyors of psychological truths. Perhaps one exception to this owner frame of mind was in war torn, combat and destruction weary, Great Britain, who had discourse between Kleinians and Anna Freudians, which resulted in the Independent Object Relations school of thought.
In our attempts to surpass the heritage of “outsider” in U.S. psychoanalysis and gain admission to the wealth and prestige of the U.S psychoanalytic culture/nation, we have assimilated the motives of our forbearers and overvalued our differing, and often minority, psychoanalytic ideas and lineages.
I venture, but not too far out on a limb, to say that Chef Psilakis' recipes have mostly his Greek heritage stamp, as did my family’s recipes. And, like immigrant family members sitting around the Thanksgiving table, either traditional or culturally varied to be consistent with our new views, we need to be aware, “that the largest concentration of psychoanalytic patients in any one place at any one time is at a psychoanalytic meeting” (Prince, 1999, p. xxii). Further, that largest concentration of psychoanalytic patients at any one time are psychoanalysts of a particular theoretical orientation.
Perhaps this is an applicable allegorical example of the power of cultural identifications, in breeding and fundamentalism which actually strengthens, literal or figurative, immigrants and numbers recruited to their organizations (Sorenson, 2000).
What does this all mean about what some psychoanalysts called the “revolution” in U.S. psychoanalysis? Is it truly a “revolution,” with transformative operating principles and values? Or is it an old “revolution,” disguised in newer theoretical garb, wherein the oppressed, disenfranchised and disadvantaged psychoanalysts have gained power, influence and wealth, and are enjoying their apparently non-traditional meals, laying claim to the tables and chairs, at similar traditional restaurants as their forbearers?
In Part II, in the next issue of Psyche & Sol, I'll further explore the questions of literal and figurative immigration and the impacts of believed psychoanalytic truths, as related to the transmission of ideas in the mental health marketplace and within psychoanalytic training institutes and organizations. Part II will cover the halcyon years of psychoanalysis in the 1950s through the mid 1960s, and struggles within the U.S. to maintain the definitions of psychoanalytic identity with the threat of new ”immigrants” from three sources: biological psychiatry, the uniquely U.S. interpersonal psychoanalysis of Harry Stack Sullivan, Erich Fromm, Frieda Fromm Reichman, and Clara Thompson, and U.S. university psychology departments who considered themselves superior because they laid claim to being empiricists and behavioral scientists. In part III, I'll examine the more “contemporary” theoretical trends, the politics and economics of the newer and newest orthodoxies, including Relational and Intersubjective psychoanalysis, the so called “evidence based” psychotherapies, undergraduate texts and the practice and business of pharmaceutical house sand psychopharmocolgists, to which many psychologists aspire.
I believe that psychoanalytic theoretical/clinical evolutions and modifications are significant, important and clinically useful. Rather, I am attempting to examine how the influences and expressions of the politics of power and economics within psychoanalysis have affected and been affected by the mental health marketplace. I believe as Robert Prince (1999) said, “ rumors of our death are greatly exaggerated” and, “we will survive the psychoanalytic movement.” However, we are seriously wounded. I believe that our survival and prosperity are best served by recognizing, reflecting on and trying to revise the beliefs, attitudes and behaviors within our own discipline that have contributed to the “rumors of our death,” and keep us fighting as “outsiders,” who feel compelled to become “insiders”, so that we can rejoice once more in the “halcyon years.”
References
- Akhtar, S. (1995). A third individuation: Immigration, identity and the psychoanalytic process. J. Amer. Psychoanal. Assn.,43, 4, 1051-1083.
- Dow, J. and Slapin, B. (2006). Deconstructing the Myths of “The First Thanksgiving.” Oyate Web Page.
- Eisold, K. (2000).
- Freud, S. (1922). Group psychology and the analysis of the ego. S.E. Hogarth Press, London
- Kirsner, D. (2000). Unfree Associations. Process Press Ltd., London, England.
- Prince, R. (Ed.) (1999). The Death of Psychoanalysis: Murder? Suicide? Or Rumor Greatly Exaggerated?. Jason Aronson, Inc., N.J.
- Sorenson, Thanksgiving Day. (2008). Encyclopaedia Britiannica.
- Thanksgiving (United States). (2009). Wikipedia Foundation, Inc.
ARTICLE REPRINT: Psychologist-Psychoanalyst, Volume XXVIII, No. 3 Summer 2008
Awakening the Dreamer: Clinical Journeys by Philip Bromberg. Mahwah, NJ: Analytic Press, 2006; 236 pp ., $55.00.
Transforming Lives: Analyst and Patient View the Power of Treatment, by Joseph Schachter. Lanham, MD : Jason Aronson, 2005; 200 pp ., $40.00.
Book Reviews by Polly Young-Eisendrath, PhD
A Welcome New Pragmatism
Is it possible to find a new 
perspective in psychoanalysis that is both useful and original? If you’re like me, you might not be optimistic. Sometimes I avoid reading accounts of “new” trends in the professional literature because they seem either too arcane and idiosyncratic or simply new bottling of perfectly good old ideas (best left in their old bottles, in my view). But, if you’re longing for something new and helpful, and you’re generally inclined toward thinking in “relational” terms, then you’ll be happy with two new books: Awakening the Dreamer: Clinical Journeys by Philip Bromberg, and Transforming Lives: Analyst and Patient View the Power of Psychoanalytic Treatment by Joseph Schachter. They are both well written and innovative, challenging us to think in new ways. They both come from well respected and highly skilled clinicians who have been in the profession long enough to see trends come and go. And yet, these two seasoned writers and thinkers are likely to shake up your psychoanalytic reading group (they did mine) because they introduce views and methods that may forever change your approach to practice if you take them seriously.
Intersubjectivity and Analytic Inquiry
Both authors claim that a contemporary relational approach requires a new kind of theorizing, as well as new ways of working. Our theories now have to account for the fact that both members of the therapeutic dyad are truly and deeply affecting each other, moment to moment. Neither analyst nor patient can hide behind a mantle of authority in relation to their live experiences in the consulting room. In Bromberg’s model, the via regia of therapeutic change is bringing into awareness what was previously defensively or affectively dissociated. This can be accomplished through interpreting dreams or working with affective enactments in the consulting room; he prefers the latter. To be deeply helpful in the process of finding meaning in such expressions, the analyst must reveal her or his own subjective and intersubjective experiences in such a way that “the disclosure is more one of sharing than covert indoctrination designed to look like sharing” (p. 134). Along these lines, Bromberg challenges his reader:
I argue that the analyst’s experience as a real person is not only inevitable, because it is not something under his control, but is necessary. Why? Because the analysts’s experience while with his patient is linked to his patient’s experience as a part of a unitary affective, cognitive, and interactional configuration that is at once subjective and intersubjective. Some aspects of that configuration are dissociated in each person and must be processed jointly in the immediacy of the analytic interaction to achieve cognitive symbolization through language. (p. 131)
Bromberg recommends a new clinical method that fits with his theory of a unitary interactive field: “I assert not only that the analyst’s self-revelation is permissible but that it is a necessary part of the clinical process if the therapeutic efficacy of analytic treatment is to be most enduring and far-reaching” (p. 132). Building his theory of mutative change on the foundation of working through enactments, Bromberg believes that the effective analyst is self-revealing in the service of therapeutic transformation.
What are the guidelines or boundaries for such self-disclosures from the analyst? Mainly, self-disclosures should not be motivated by a desire (revealed or hidden) to change the mind of the patient. Instead, the analyst shares his or her ongoing experiences as a way of clarifying and opening up the process of intersubjective discovery and negotiations, especially in reflecting on enactments that have taken place in the analytic relationship.
The classical model of psychoanalysis assumed that the mind of the patient was separate from the mind of the analyst. The analyst’s self-revelations were understood to intrude on the autonomy or subjectivity of the analysand; indeed, such self-disclosures would be understood as enactments themselves (typically bringing into expression something that was preconscious or unconscious in the analyst and should be kept hidden).
Generally, the patient’s subjective experiences were considered “pure” if the analyst didn’t speak or otherwise reveal his or her subjectivity. Now we know, from myriad findings in research on emotional communication that affective messages are being sent all the time when people are together, whether or not they are speaking.
From Bromberg’s perspective then, “intrusiveness” on the part of the analyst means interfering with the process of intersubjective discovery and negotiation. The analyst’s silence (if it is a refusal to communicate something being felt) can easily be as intrusive as a knee-jerk formulaic interpretation is. According to Bromberg, the analyst intrudes when he or she is unwilling or unable to allow his or her subjectivity to be modified in response to the patient’s experience. If the analyst is stubbornly, perhaps “strategically,” protecting the sanctity of her or his mind, the analyst may be shirking responsibility. Effective therapeutic self-revelation is motivated by the desire to be influenced by the patient’s feedback and reactivity, but not to dominate the patient either directly or subtly. And the patient’s feedback is always to be taken seriously in the ongoing discovery process.
When Patients and Analysts Speak About Treatment
Joseph Schachter’s revolutionary book, TransformingLives, presents extensive clinical data (some from patients themselves) that illustrate and demonstrate the validity of many of the claims made by Bromberg. Schachter, as editor and originator of this unique volume that gathers together writings from therapists and their patients about psychoanalysis, asked seven very different kinds of analysts to report on seven patients that they had seen in an extended treatment. The analysts range from classical Freudians through various nontraditional approaches. Schachter remarks at the outset, “Evidence suggests that the analyst’s personal qualities and values as well as his or her technique may influence the treatment.” (p. 4)
For this reason, he asked a wide range of types of analysts to contribute, including “men and women, training analysts and non-training analysts, Americans and Europeans, heterosexuals and homosexuals, Democrats and Republicans, and, last but not least, people who vacation in the mountains and people who vacation by the sea” (p. 5). While he gives us the names and credentials of the contributors, he separates them from their case material. And so, we read their cases with additional interest and curiosity because we are unable to categorize their approaches through typical analytic stereotypes or other biases. Additionally, five of the seven analysts asked their patients if they would like to contribute a report of their own to the paper. Four of the five patients agreed and their contributions make this book a special opportunity to examine what is perceived as effective from the patient’s point of view.
For my part, I believe, as Owen Renik has asserted (see pp. 149-150 in Schachter for a fuller discussion of this issue), that eventually we must include our patients’ accounts of their treatment in our psychoanalytic literature if we are to understand its effectiveness. While asking patients for a narrative response to their treatment may seem to pose ethical concerns, not asking also poses ethical concerns. Schachter’s book is a step forward in taking up the discussion of such concerns from both sides.
What we see in several of the patients’s accounts in Schachter’s book proves the points that Bromberg makes about the significance of enactment, repair, analyst self-revelation, and the affective intersubjective engagement. For instance, a 28-year-old patient called Andrew says,
I have gotten to the point in therapy that I can sense a process of rebuilding, reconstructing, my life in such a way that I am able to live fully. My problems have always been that I am afraid of life, of people, of people who may be better than me, of people criticizing me and realizing my weaknesses, my inferiority.” (p. 141)
Praising his analyst for helping in tangible ways with his relational problems with women and in his work, Andrew further says,
What I think has facilitated the process is my analyst’s extreme active engagement in each session. He does not play the passive analyst, allowing me to simply talk and offering no direct commentary. Because the point of the treatment is to figure out how to change the way I deal with situations that occur on a daily basis, it has been extremely helpful to me that my analyst shares with me his own life experiences and how he has dealt with them. . . Our sessions take the form of a dialogue. Because I know more about him, I have a better understanding of where his input is coming from, and thus I understand it as emanating from a person with certain characteristics and life experience, not merely from a body of psychoanalytic knowledge. I am dealing less with someone who represents an ideology that posits itself as truth and more with a person who can critically relate his own experiences to my own. (p. 142)
If the effective analyst is someone who does not represent “an ideology that posits itself as truth,” but is more of “a person who can critically relate his own experiences” to the patient, then such an analyst must be open not simply to reflecting on subjective and intersubjective events in a session, but revealing his own experience.
Schachter’s book, however, has a different aim than Bromberg’s. Bromberg’s is a collection of clinical essays that convey in often subtle and poetic terms a new relational method for doing psychoanalytic psychotherapy, with an emphasis on affective engagement between patient and therapist. Schachter, on the other hand, has written and edited a volume that makes a broad and popular appeal to readers who may not know much about psychoanalytic psychotherapy, but are interested in it for themselves as potential patients. It is a book that can be recommended to someone who is considering entering analytic psychotherapy. I have lent out this book to friends who knew little about analytic treatment and they found it very useful.
In a final succinct and incisive chapter, “Discussion and Conclusion,” Schachter summarizes what he takes to be the reasons that psychoanalytic psychotherapy and psychoanalysis are uniquely effective in bringing about lasting change in patients. They are the following: interpretation, construction of a personal narrative, and modification of habitual relationship patterns. And then he looks at the seven successful (or mostly successful) cases reported in his book. What are the common curative elements in these cases, Schachter wonders. As he relates them, they reflect exactly what Bromberg talks about in his recommendations for using enactments as the via regia (filled with potholes and bumps, as he says): mutual fondness between patient and analyst; moments of mutual intense feeling; and being able to express anger toward the analyst (p. 172-173).
Bromberg would seem to concur,
No matter which school of thought organizes one’s basic stance, the inherent structure of the analytic situation—the inevitable tension between the treatment frame and the human relationship—pulls for relational collisions. Enactments are what we count on to make the analysis of transference possible; it is only when seemingly unresolvable treatment crises emerge from enactments that we even question the role played by the relational collisions in the therapeutic action of psychoanalysis. (p. 95)
Reading these two books side by side and discussing both in a small reading group, I gained a great deal in courage and understanding. Bromberg’s book assembles a whole new way of thinking about what we are doing within the therapeutic relationship—a way that accounts for momentto-moment affective contact in our attempts to interpret transference and countertransference. There was a lot of argument, in my reading group, about the basic thesis that Bromberg puts forth: that enactments and self-revelations of the therapist are necessary components for therapeutic change. There was disagreement, even anger, with Bromberg’s stance. Then, when we read the seven cases in Schachter’s book, especially the five patient reports, we found evidence that reinforced Bromberg’s points. Moreover, Schachter’s account of what was curative in the cases further highlighted the significance of the affective communication and honesty in the consulting room.
But neither of these analysts is recommending that psychoanalytic therapy become a food fight with each person making subjective claims in unconscious or conscious opposition. Both analysts are highly respectful of the therapeutic framework or set-up that protects the relationship and allows for reflection, mental spaciousness and interactive play or humor. Both believe that interpretations, when they are alive and responsive to what’s actually happening in the room are transformative. And yet, each author in his own way is recommending a whole new perspective on what psychoanalysis means and how it is defined. If you believe that we need a new lens and some new methods to develop a “two–person” psychology that is theorized as interdependent and shared, then I highly recommend that you read these two books side by side. It might be even more fun to read them with some colleagues and talk about how they impact all of you in your clinical work. I guarantee it will be a lively and revealing conversation.
Polly Young-Eisendrath
pollye@comcast.net
Reprinted with Permission, July, 2010
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
