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Event Series Event Series: Psychopathology II

Psychopathology II

March 20, 2020 @ 3:30 pm - 5:00 pm, Freud Classroom

Adult Psychoanalytic Training (APT)
2019-20, 3rd Trimester — Fridays, 3:30-5:00pm
Michael Pauly, MD


View Whole Syllabus

Introduction

Hello, and welcome to Psychopathology II: Borderline States.

Early analysts emphasized the fixed character structure of such “primitive” patients. It is my opinion that this fixed view is reductionistic and less clinically useful than a more flexible model whereby structures and defenses and emergent clinical phenomena are thought to be greatly influenced by the framing, containing, and holding capacities of the analytic situation and person of the analyst.

We will approach the affect-laden enveloping quality of the work with a focus on the developmental conditions and clinical manifestations of this psychopathology spectrum. This is rich, intricate, challenging, and at times uncomfortable work. Unbearable discomfort can lead to empathic failure and collapses of the space for thought on both sides of the relationship. We will emphasize how the analyst is affected by such patients, the various means by which disturbing experience is transmitted, and how these processes are a ubiquitous, inevitable, and potentially useful/reparative part of the analytic process.

Immersing oneself in the literature relevant to this psychopathology spectrum can lead to similar disorganizing affective states in the reader, accompanied by a reactive wish for a clearer more durable way of conceptualizing and organizing the material; a wish for more clarity where entropic disorganization often reigns. It is my hope that as a group we can cultivate the space to together metabolize the fragments and integrate the experience into a good-enough whole.

As you read through the articles for this class recall from psychopathology I Sugarman’s model for a neurotically organized mind consisting not of particular mental content but rather certain mental capacities (i.e. self-reflective capacity, capacity for affect regulation, capacity for narcissistic regulation, and internal conflict). We will make use of this to understand the struggles that characterize the phenomena that present in borderline states and states of narcissistic fragmentation / breakdown.

Learning Objectives

  1. The clinical associate, as a result of gaining greater knowledge of the hypothesized etiologies of borderline-level character disorder, will have a greater capacity to understand, empathize, and connect interpersonally with this clinical population, and thereby improve the odds of the treatment retention necessary for a positive clinical outcome.
  2. The clinical associate, as a result of gaining a greater understanding of and capacity to work with the intense transference-countertransference phenomena that develop when working with this population, will have an increased ability to assist their patient in reflecting on these phenomena, and thereby improve the odds of a positive clinical outcome.
  3. The clinical associate, as a result of gaining a greater capacity to work with collapses in reflective functioning under the weight of unbearable affect, will become more capable of assisting this population in such a way that they are better able to tolerate, regulate, and reflect on their affect states and associated triggers, thereby improving their defensive structures, self-understanding, interpersonal relationships, and overall life.

March 20, 2020 — Etiology

[39 pages]

37 pages of reading.

We will begin with Fonagy, Mancia, and Winnicott to highlight the relational – etiological factors contributing to the emergence of these character / self-disorders.

Fonagy, P. (2000) Attachment and Borderline Personality Disorder, Journal of the American Psychoanalytic Association. 48:1129-1146.

In Attachment and Borderline Personality, Peter Fonagy outlines how the caregivers’ reflective capacity impacts their child’s capacity for mentalization and the development of a secure attachment. He links these concepts with the idea that early trauma may result in a child’s inhibition of mentalization in an effort to avoid the pain of reflecting on their lived experience, thereby resulting in impaired reflective abilities and an impaired sense of self. Per Fonagy, these impairments may explain the link between childhood maltreatment and character pathology.

Mancia, M. (2006) “Implicit Memory and Early Unrepressed Unconscious: Their role in the Therapeutic Process (How Neuroscience Can Contribute to Psychoanalysis)” IJP, 87:83-103

In Implicit Memory and Early Unrepressed Unconscious…, Mauro Mancia proposes that that the affective pre-symbolic and pre-verbal experiences of the primary caregiver – infant relationship are stored in the implicit memory system and hence can be considered part of the unrepressed unconscious. He outlines how access to this material is present in the musical dimension of the transference and in dreams and that it is the analyst’s task to engage in a reconstruction of that which has been recorded but has yet to be thought / remembered.



Details

Date:
March 20, 2020
Time:
3:30 pm - 5:00 pm
Series:
Event Categories:
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Organizer

SPSI
Phone
(206) 328-5315
Email
info@spsi.org
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Venue

SPSI
4020 E Madison St, #230
Seattle, WA 98112
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Phone
(206) 328-5315
View Venue Website