Process: Continuation of Opening Phase to Early Middle Phase (with Introduction to Psychoanalytic Writing)

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.

Development of Psychoanalytic Thought and Theory

 

At the conclusion of this course we hope that each clinical associate will feel a personal connection from Freud to their own place in the classroom at SPSI, including a broadened perspective on their identity as psychoanalysts in 2020. We will study major transition points between schools of thought, including the social and historical context that may have influenced shifts in thinking.

We will move from the Anschluss in 1938 (when Freud was forced to move to London) which occasioned the diaspora of psychoanalysts from Vienna, Berlin, and Budapest, out to London, the United States, and South America. We will first look at these early analysts and their theories, spanning roughly 1938-1960, including “The Controversies” and early middle school in London, psychoanalysis in France and South America, and, in the States, the neo-Freudians, ego psychology, object relations.  Next we will circle back through the regional and historical movements into a next generation, roughly 1960- 90, and look at self-psychology, attachment theory, relational thought, and intersubjectivity.

Throughout our learning together, we hope to ground theory in the capacity to consider “otherness”. Psychoanalysis emerged from a marginalized intellectual culture, Judaism in Central Europe. It could be argued that Freud set the groundwork for a more inclusive climate by advocating for lay analysts, women psychoanalysts, and offering ground-breaking ideas about sexuality. We hope to look at the shifts over time and consider the stereotype of a USA-centric psychoanalysis that can privilege power, class, and exclusion.

Along the way we encourage you to consider why you like or dislike a theory, where you feel an affinity or a prejudice, how you practice now, and how you envision your future practice. We encourage you to wonder about why theory is valuable or not, how is it clinically useful and how it can be limiting. And we hope that you will feel the aliveness and vitality of where you sit at SPSI; that you are now a new branch in the family tree of psychoanalytic thinking.

For further study:

Texts that offer accessible and overarching theory and history of psychoanalytic thought:

  1. Auchincloss, E. (2015). The Psychoanalytic Model of the Mind. American Psychiatric Publishing.
  2. Makari, (20–). The Revolution of Mind
  3. Mitchell s. and Black, M (2016). Freud and Beyond: A History of Modern Psychoanalytic Thought, 2nd Edition. Basic Books, NY.
  4. Black Psychoanalysts Speak. Video. PEP

Psychoanalysis in Seattle: http://www.historylink.org:

  1. George “Mike” Allison
  2. Edith Buxbaum, PhD
  3. Pinel Foundation Psychiatric Hospital, 1948-58
  4. Douglas Winnett Orr, Father of Seattle Psychoanalysis

Theory: Self Psychology

Welcome to our course on Self Psychology. Our objective is to create with you, a safe, stimulating and dynamic learning environment. We will be exploring the central theoretical foundations and the contemporary theories of Self Psychology, and their application to clinical practice. In addition, we will apply these concepts to contemporary issues such as racism, antisemitism, trauma and the gaslighting of America by Donald Trump. We will read some of the original works by the founder of Self Psychology, Heinz Kohut, as well as scholarly articles by contemporary Self Psychologists.  In the final class, we will be watching the film, “Reflections on Empathy,” which was Heinz Kohut’s final presentation before he died a few days later. We wish to provide with a diverse experience, which will stimulate your interest and curiosity in Self Psychology.

Self Psychology Definitions

Bipolar Self

Introduction to Psychoanalytic Listening

Hello and welcome. It is my pleasure to welcome you to the first trimester of your first year at SPSI and to your first class meeting.

The Psychoanalytic Listening course is a preparation for the mixed Continuous Case Conference classes you will be attending every trimester over the next four years of didactics and continue attending till your graduation, after you complete the course work. Starting the Winter trimester of this year, you will be in a Case Conference every term comprised of  some clinical associates from your own cohort and some from the cohorts ahead of you. In those classes, one clinical associate will present throughout the trimester and the rest of the classmates will discuss the case in order to learn to listen-to-learn, discuss what they hear, formulate what may be going on with the patient presented and within the analysis, and learn from each other. This course is structured slightly differently.

One aspect of this course is the review of some concepts that are useful in listening to clinical material and in formulating a case. Analytic listening differs from ordinary listening in a variety of ways and takes place on multiple levels. It is the cornerstone of what we do in our interaction with patients and it is an essential part of the analytic stance. Towards that end, at the beginning of each class meeting, I will review some analytic concepts we can keep in mind as we hear one of you present your work with a patient of your choice.

Unlike case conferences in the future where one clinical associate will present throughout the trimester, during this class each person will present for only one or two weeks. We will set up the presentation schedule during our first meeting. Because there are more of you than weeks in the trimester, only some of you will be able to present. Even though we will only have time for one of you, all of you please give some thought to presenting during part of our first meeting on 9/11/20.

The majority of our class time during the trimester will be spent hearing one of you present your work with a patient while the rest of us listen. Our group discussion of the case may include transference, countertransference, developmental themes, motivations, affective themes, conflicts and defenses, attachment styles, enactments, verbalized and nonverbal cues that give us clues about the analytic process, and how we envision responding to the patient.

A case conference is not a forum to be competitive, critical of each other’s work, or demonstrate how clinically astute we are. Neither is it meant to be supervision of the presenter’s work. Case conference is the opportunity to hear each other’s thoughts about a case, about the unfolding process, to think about alternative ways of understanding the interaction between the patient and the analyst, and to contemplate a variety of ways one could respond analytically.  It is an opportunity to think out loud clinically. Our job as a group is to attend, notice, get confused, ask questions, wonder, share, formulate, think flexibly, be humble, and be open to differing views. We have to remember that the presenter and the patient are doing us all a big favor by generously sharing their process with us to benefit our learning.

We will go over the ground rules together during the first class meeting such as strict confidentiality, not discussing the clinical material outside the classroom, etc.

Another goal of the course is to start developing your individual identity as an analyst and your identity as a cohort by getting to know and trust each other. Your support for and collaboration with each other as you go through your training is the main ingredient in determining how well you learn, what your educational experience will be like, and how you form your analytic identity as a clinical associate and a graduate analyst. How we listen, hear, and respond to each other in this course will take you closer to that goal.

An implicit aspect of your years at SPSI as clinical associates and later as faculty is that you all come to this endeavor with a wealth of professional and life experiences. You have a lot to offer as well as to learn. Respecting and utilizing each other’s varied backgrounds, experiences, expertise, and viewpoint will make this course richer for all of us.

The fact that we are not in a room together in person adds, by now, a rather familiar challenge to our interaction. To help us all participate and engage in the process, I may call on specific people to hear their views on what we are discussing. This is an invitation rather than pressure for you to speak. Please feel free to decline and speak at a time of your choice.

I like to start each class I teach by reading a poem. Sometimes I am fortunate enough to locate a poem that has direct relevance to what we discuss and sometimes I am not. Regardless, hearing a poem read out loud and giving it some thought as a group is likely to put us all in a more receptive and reflective mode.


I have consulted the following materials in preparing for this class.

  • Abbasi, Aisha. (2012). A very dangerous conversation: The patient’s internal conflicts elaborated through the use of ethnic and religious differences between analyst and patient. International Journal of Psychoanaysis, 93(3): 515-534.
  • Akhtar, Salman (Ed.). Listening to others. Lanham: Jason Aronson (2007).
  • Akhtar, Salman. Psychoanalytic listening. London and New York: Routledge (2013).
  • Arnold, Kyle. (2006). Reik’s theory of psychoanalytic listening. Psychoanalytic Psychology, 23(4): 754-765.
  • Atlas, Galit, Aron, Lewis. Dramatic dialogue. Routledge, London and New York. (2018). (Chapter 3: Dramatic Dialogues. Chapter 7: At-one-ment, mutual vulnerability, and co-suffering).
  • Cooper, Steven H. (2017). The Analyst’s “use” of theory or theories: The play of theory. Journal of the American Psychoanalytic Association (JAPA), 65(5): 859-882.
  • Egit, Esin. (2020). ”I’ve never been that traditional domestic Turkish woman”: Self, culture, and the dissociative mind. Contemporary Psychoanalysis, 56:1, 57-86.
  • Ehrlich, Lena Theodorou. (2004). The analyst’s reluctance to begin a new analysis. JAPA, 52(4): 1075-1093.
    and
    Ehrlich, Lena Theodorou. (2013). Analysis begins in the analyst’s mind: Conceptual and technical considerations on recommending analysis. JAPA, 61(6): 1077-1107.
  • Felman, Shoshana. (1982). Psychoanalysis and education: Teaching terminable and interminable. Yale French Studies, (63), 21-44.
  • Fosshage, James L. (2011). The use and impact of the analyst’s subjectivity with empathic and other listening/experiencing perspectives. Psychoanalytic Quarterly, 80(1): 139-160.
  • Fosshage, James L. (2011). How do we “know” what we “know”? And change what we “know”. Psychoanalytic Dialogues,21 (1): 55-74.
  • Freud, Sigmund. (1958). Recommendations to physicians practicing psycho-analysis. In: J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 12, pp. 111-120). London: Hogarth Press. (Original work published 1912).
  • Grossmark, Robert. (2018). The Unobtrusive relational analyst and psychoanalytic  companioning. In De-idealizing relational theory. London and NewYork: Routledge. (2018).  (Read with Maroda, 2020),
  • Hanoch, Esther. (2006). The loudness of the unspoken: Candidates’ anxiety in supervision. Psychoanalytic Perspectives, 3(2): 127-146.
  • Harris, Adrienne.  (2007). The house of difference: Enactment, a play in three scenes. In Relational Psychoanalysis (Vol. 3 New Voices. 81-95)
  • Heimann, Paula. (1950). On counter-transference. International Journal of Psychoanalysis, 31:81-84.
  • Hoffman, Irwin Z. (1996). The intimate and ironic authority of the psychoanalyst’s presence. The Psychoanalytic Quarterly, 65:102-136.
  • Holmgren, Bengt. (2005). Reports and brief communications: Two ways of listening to the patient. Scandinavian Psychoanalytic Review, 28(2): 110-114.
  • Ivey, Gavin. (2000) A listening-formulating model for psychoanalytic psychotherapy. Psychotherapy, 37 No 1, 22-35.
  • Kaufman, Judith. (2006). Candidates’ anxiety in supervision: A discussion. Psychoanalytic Perspectives, 3(2): 147-157.
  • Kitsen, Jane. (2008) Listening to people who do not speak: attachment, communication, and meaning in working with disabled adults and children. Attachment: New directions on psychotherapy and relational psychoanalysis. Vol 2, March 2008, 56-61.
  • Langs, Robert. (1978). The listening process. New York: Jason Aronson.
  • Lister, Elena; Kravis, Nathan; Sandberg, Larry; Halpern, Jeffrey K.; Cabaniss, Deborah L., and Singer, Meriamne B. (2008). “I write to know what I think”: A four-year writing curriculum. JAPA, 56(4); 1231-1247.
  • Luiz, Claudia. (2018). The making of a psychoanalyst. London and New York: Routledge.
  • Makari, George, and Shapiro, Theodore. (1993). On psychoanalytic listening: Language and unconscious communication.JAPA, 41:991-1020.
  • McLaughlin, James T. (1991). Clinical and theoretical aspects of enactment. JAPA, 39:595-614.
  • McWilliams, Nancy. Core competency two: Therapeutic stance/Attitude. In Roy E. Barness (Ed.), Core competencies in relational psychoanalysis. Routledge: London and New York. 2018.
  • Maroda, Karen J. (2020). Deconstructing enactment. Psychoanalytic Psychology, 37(1); 8-17. (read with Grossmark, 2018)
  • Pizer, Stuart. Core competency three: Deep listening/Affective attunement. In Roy E. Barsness (Ed.), Core competencies of relational psychoanalysis. Routledge: London and New York. 2018.
  • Safran, Jeremy (2011). Theodor Reik’s “listening with the third ear” and the role of self-analysis in contemporary psychoanalytic thinking. Psychoanalytic Review, 98(2), April 2011.
  • Sandler, Anne-Marie. (1988). Comments on therapeutic and counter-therapeutic factors in psychoanalytic technique. Bulletin of the Anna Freud Centre, 11:3-13.
  • Schwaber, Evelyne Albrecht. (1996).  The conceptualization and communication of clinical facts in psychoanalysis: A discussion. International Journal of Psychoanalysis, 77:235-253.
  • Schwaber, Evelyne Albrecht.  (2005). The struggle to listen: Continuing reflections, lingering paradoxes, and some thoughts on recovery of memory. JAPA, 53(3): 789-810.
  • Tummala-Narra, Pratyusha. Considering culture from a psychoanalytic perspective. In Roy E. Barsness (Ed.), Core Competencies in Relational psychoanalysis. Routledge: London and New York. 2018.
  • Winnicott, Clare. (1964). Development towards self-awareness. Unpublished lecture included in: Kanter, Joel. (2004). Face-to-face with children: The life and work of Clare Winnicott. London: Karnac.

Human Development: Child Development I (Birth to Age 5)

Welcome to our course on Child Development (Birth to age 5). This course is the didactic complement to the Year Two Infant Observation course and we expect to refer to last year’s rich array of observations to illustrate and deepen our understanding of the concepts we will explore this trimester.

Sigmund Freud’s curiosity and theorizing about how childhood was linked to suffering and joy in adulthood led to the idea of developmental progression and therapeutic intervention. Early child psychoanalysis, developed by Melanie Klein and Anna Freud, and based in nuanced observation and clinical work, focused attention on the internal dynamics of infants and young children as well as the importance of their relational and social contexts. These foundational theorists set the stage for decades of observational research and psychoanalytic exploration, all of which has led to our contemporary understanding of attachment, developmental progression, affect regulation, object relations, identity formation, projective processes and neurobiology.

During this class, we will examine this topic from a variety of vantage points with the goal of providing a nuanced and multilayered contemporary understanding of child development rooted in a historical psychoanalytic context.  Throughout the course, we will apply our learning to the adult clinical situation.

The Origins of Psychoanalysis and Freud’s Legacy, Including Evolving Ethics of Psychoanalysis

Welcome to our course on The Origins of Psychoanalysis and Freud’s Legacy.  Our objective with this course is to assist you in appreciating the foundations of psychoanalysis, i.e., how psychoanalysis began and how it has evolved.  During this seminar we will also make reference to, and encourage, discussion of how the theory and practice of contemporary psychoanalysis has changed since Freud.  The course readings are divided between a biography of Freud and his original writings.  We have selected chapters for you to read from Peter Gay’s classic book, Freud: A life for Our Time.  And, to compliment these biographical chapters, we have included many of Freud’s original writings from The Freud Reader edited by Peter Gay.

The texts are:

  1. A Life for Our Time, a biography of Sigmund Freud by Peter Gay, W.W. Norton & Co., Inc.; originally published in 1988.
  2. The Freud Reader edited by Peter Gay, W.W. Norton, Inc., 1989.

Starting Psychoanalysis: Opening Phase

Developing psychoanalytic cases is part of the foundation of our work as psychoanalysts.  In this course, we will discuss how to develop analytic cases from the first phone call through the early opening phase.  We will work together to help you define who is analyzable by you.  I will help you explore your own feelings about taking patients into analysis.  You are welcome to share your feelings with your cohort or keep them private.  I will give you the tools to help you establish your own psychoanalytic frame.  You will begin to learn the basics of the opening phase of psychoanalysis.  We will also discuss including people of color in our practices during this very important historical movement.

Since you are adult learners and practitioners, please collaborate with me and stop me whenever you need clarification. Develop your own tools for learning.  My role is to assist you so that you can learn psychoanalytic theory and technique in a way that benefits your practice.

British Object Relations

Hello and welcome to British Object Relations (BOR).  We have arranged this course with classical and contemporary writers from BOR theory to provide a rich introduction to this material. We want to give you a sense of what it is, from which we can then understand and explore its developments and its critiques. BOR is a theory born from creative and political controversy.  It is also a living theory in so far as it continues to evolve with many branches evolving from the same trunk.   In addition to the classical writers, we will explore BOR in Mexico, Central and South America and how theory interacts within a culture and context to make its own developments.

As this is a Theory course, our discussions will come alive with your clinical material.  We hope to invite your questions, arguments, half-thoughts and to deepen our conversation.

Psychopathology II: Borderline States

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.