Continuation of Opening Phase to Early Middle Phase

Fourth Year Adult Psychoanalytic Training (APT)
2020-21, 2nd Trimester — Fridays, 3:30-5:00pm
Diane Wolman, MSW
Scot Gibson, MD

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Introduction

This process class addresses the transition from starting the analysis (Opening Phase) to being solidly in the analysis (Middle Phase).  These “phases” are not sharply demarcated; rather, the terms are helpful markers for understanding the way into and through an analysis.

An analysis is a relationship, one that requires a high level of intimacy. The growth of this intimacy is one of the goals of the analysis, and this takes time and immersion (which is the main reason for the frequency of sessions in most analyses).  The analytic relationship takes place within a particular and special structure (the frame), which is carefully crafted to facilitate the necessary work.  The tension between intimacy and structure is where much of the important work of psychoanalysis happens, and it can encompass some of the most difficult areas to negotiate for both patient and analyst.

One of the major tasks in learning to be an analyst is to become comfortable within that tension.  You will become increasingly comfortable building the intimacy and also providing the structure, while holding on to the understanding of why both are important to the process.  As this understanding grows, psychoanalysis will increasingly make sense to you.  You will understand more of what is going to be created between you and the patient – at first in general terms, and increasingly in terms of what will grow between you and your specific partner in the analytic dyad.  As your ability to create the setting and provide the containment grows, you will grow increasingly confident in making a recommendation for analysis in the first place.  Your enthusiasm and hope for the analysis will be conveyed to the patient, and will itself become a part of the holding environment.

In working with patients analytically, you will rely on the frame, various theories and formulations about what is going on, as well as your affective responses to the patient. At times, when you and your patient are both having strong affective responses due to unconscious pressures, you and your patients will be involved in enactments.  Enactments, once feared as failure on the part of the analyst to deal with their countertransference, are now considered essential to the development of intimacy between analyst and analysand and to the “working-through” process that is central to psychoanalysis.

In the first part of this class, we will talk about some of the basics of what happens between analysand and analyst, in the co-created, interpersonal space that is often called the analytic field or the analytic third.  Later in the class, we will address some specific issues or dynamics that often need to be negotiated in an analytic relationship, including the use of psychotropic medications; the presence of somatic or behavioral issues such as eating disorders or addictions; or particular differences between the two members of the dyad (such as race, sex, or politics).

Another important goal of this class is to help you begin to write about your experience with psychoanalytic patients. We will use short writing exercises in class to help you into the process of writing about session material, culminating in a final session where we focus on the literature about psychoanalytic writing. At the last session, we will also ask you to submit a brief writeup of a clinical moment, which we will return to you with comment after the class ends.

Learning Objectives

1. By learning how to identify and work within and with elements of the analytic field, including the frame, enactments, and dreams, associates will be better able to successfully use these elements to engage their patients and help facilitate their growth.
2. By learning to navigate various features of the analytic relationship, including differences between the members of the dyad, factors external to the relationship, and the introduction or use of medications in the treatment, associates will be better able to respond to the dynamics enacted in these features in ways that move the treatment forward and allow patients greater freedom in their lives.
3. By writing about the analytic process, associates will develop a better understanding of how to formulate and communicate what is going on in the treatment, and thus will gain confidence in their work, which will lead to better outcomes for patients.

December 4, 2020 — Developing an Analytic Identity

Presenter: Diane Wolman, MSW

[37 pages]

What constitutes an analytic identity? Understanding that most of what goes wrong for people developmentally came about within the context of a relationship and it is through a relationship that healing can occur.  We are offering our patients our selves in a particularly analytic way that balances intense transference/countertransference feelings with the need for clear limits within a solid frame.

The reasons that brought you to analysis help you to understand why your patients are considering analysis and what their hopes and concerns might be.  You and your patients must tolerate the “extraordinary pain and narcissistic injury of learning to do something new.” Erlich asserts that while analysts always have to contend with the external pressures in their lives at every stage of our careers, that being an analyst in training does bring unique pressures to bear on the analytic dyad.  Shwaber beautifully explicates the reluctance we analysts can feel to take up such an important place in our analysands’ minds and why we might have a general tendency to shift away from the immediacy of the moment when we are with analysands.

As you’re reading, please think about times when you may have felt yourself pulling back from being emotionally present with a patient and why you think that you felt that way.

Erlich, J. (2003). Being a Candidate: Its Impact on Analytic Process. J. Amer. Psychoanal. Assn., 51: 177-200.

Schwaber. E.A. (1992). Countertransference: The Analyst’s Retreat from the Patient’s Vantage Point. Int. J. Psycho-Anal., 73: 349-361.