Intersectionality, Social Context and the Co-Creation of Clinical Experience

Intersectionality encompasses a number of dimensions including race, ethnicity, nationality, immigration status, gender and gender identity, sexual orientation, socioeconomic class, religion, ability, age and the way in which these aspects of the self are lived in a particular social context. In this six-session class, we have chosen to focus attention on current psychoanalytic ideas about race, ethnicity and the intersection of multiple aspects of identity in the United States. We are operating from the perspective that these dynamics are present in every clinical encounter, whether or not they are consciously experienced or addressed and whether or not the analyst and patient experience themselves as similar or different from one another (along multiple axes).

At the conclusion of this course, we hope that you will read and engage with theory, clinical material and our institute with a deeper understanding of racial trauma and a deeper curiosity about layers of identity – your own and those of your patients. We have chosen articles that we hope will spark discussion and engagement. We welcome you to talk with us about your experience in class as we proceed.

In a recent presentation to the New Center for Psychoanalysis, Anton Hart noted that the idea that individuals could eliminate “blind spots” is inconsistent with psychoanalysis. In his words, “we are all blind to aspects of ourselves and if we are able to become aware of our pervasive blindness and more receptive to the presence of our biases we will be better able to persist in deep and uncomfortable conversation and listen with less chance of inflicting our biases on others.” As instructors, our hope is to encourage self-reflection and genuine engagement. We also hope our discussions will allow us to be more conscious of how power arises and can be misused, whose experience tends to be centered, whose experience may be marginalized and how this affects how we relate as colleagues and with our patients.

The Relational Psychoanalytic Orientation

As part of the SPSI curriculum for the classes you’ve taken thus far, you’ve been exposed in some depth to traditional one-person psychoanalytic theories, including the original versions of drive psychology, ego psychology, self psychology and American and British object relations theories. Though these psychoanalytic schools of thought vary considerably, one thing they have in common is that they place great, if not exclusive, emphasis on the presumed internal workings and vicissitudes within the individual mind. All of these theories moved psychoanalysis in important directions: ego psychology toward an increased appreciation of the individual’s defense mechanisms, as well as (to some degree) the role the environment plays in shaping and influencing ego development; self psychology toward a greater understanding of a grandiose self, narcissistic injury, and therapeutic empathy or empathic failure; and, object relations theory, toward elaborating the inner object world, involving the interaction among internalized representations.

While some members of the traditional schools of psychoanalytic thought implicitly moved psychoanalytic theory toward a two-person psychology (especially W.R.D. Fairbairn, Donald Winnicott, Hans Loewald, and selected others), contemporary relational theories have taken the most decisive and radical turn toward a two-person model.

A major shift credited to the relational psychoanalytic orientation is that it moved psychoanalytic theory away from the near exclusive study of the individual mind or psyche, toward the interaction between two “real” people, the patient/client and the therapist or analyst. The term “relational psychoanalysis” was originally coined in the 1980s by Stephen Mitchell, Jay Greenberg and their colleagues at the Post-Doctoral Program at NYU. In this seminar, we’ll cover an array of authors that we view as representative of the relational tradition. Relational authors argue that personality emerges out of the matrix of early formative relationships with parents and other significant figures. An important difference between relational theory and traditional psychoanalytic thought is in its theory of motivation, which assigns equal if not more importance to the quality of relatedness between an individual and his/her interpersonal surround, rather than focusing on the vicissitudes of inborn instinctual drive.

Relational psychoanalysis is associated with such concepts  as social constructivism (e.g., Irwin Hoffman, Donnel Stern); enactment (e.g., Owen Renik, Lewis Aron, Antony Bass) and countertransference (e.g., Epstein & Feiner, Karen Maroda ). What all of these authors have in common is that they tend to view transference and countertransference as co-creations carved out of the psychoanalytic dyad of patient/client and analytic therapist. Contrast this to traditional theories that view transference as residing within the patient, which is then projected or displaced onto the analyst. Also, while the earlier traditional analytic theorists tended to view countertransference and enactment primarily as “errors” on the part of the analyst, occurrences that would negatively affect the treatment process, relational authors view them—and indeed, the analyst’s subjectivity in generally—as inevitable, unavoidable, and potentially not a hindrance but an aid to the analytic process when properly worked with. That is, relational analysts are more likely than traditional analysts to view countertransference as the product of the analyst’s own ongoing subjectivity in interaction with the patient’s psyche. As such, it is a highly informative source of information about the patient and the analytic process per se. Those associated with the relational orientation tend to approach the work with a spirit of greater egalitarianism between patient and analyst. The relational style of interpretation aims to be experience-near, eschewing traditional  interpretations that can at times be intellectualized, stilted, and/or authoritarian-sounding (e.g., see Stephen Mitchell’s writings). When treating patients/clients, relational psychoanalysts recommend a mixture of judicious and disciplined restraint and a degree of spontaneity on the analyst’s part. Relationally-oriented psychoanalysts decry the traditional sole focus on interpretation, cognitive insight, and free association; they believe that the analytic relationship itself has a large impact on the analytic process and outcome, and that interpreting its development is an additional “royal road” to the unconscious, along with dreams and one’s fantasy life.

The relational perspective and its interpersonalist precursors were the first major psychoanalytic approaches to be influenced by feminism and postmodernism. In addition, queer theory and postcolonial critique have influenced the evolution of relational thinking. Consequently, one of the defining features of relational psychoanalysis is an appreciation of the role of culture and subcultural differences in shaping mental life, one’s sense of self, and interpersonal relationships. Variables such as gender, race, ethnicity, class, and sexuality are understood to be necessary considerations in theory building and conceptualization of an individual patient and the treatment process itself. Some authors make such consideration explicit, while for others it is implicit given the emphasis on the “matrix” in relational theory.

A word of context about the design of this course in its 2021 iteration.  It can take three or more years of continual coursework in a “contemporary” institute—all of it devoted to the relational literature and its contributors– to fully understand, appreciate, and be able to apply this orientation’s thinking to one’s clinical understanding and practice.  Here at SPSI we have only one dedicated course, of only 11 sessions, in which to accomplish a sturdy and substantive overview of all this material. So we have to be realistic about the constraints involved.

In part because of this, a few of the assigned readings on certain topics will be summary condensations (always, though, from the seminal thinkers themselves!) of the main viewpoints associated with the topic. These readings may not feel quite as gripping as others—for one thing, they may not dive into a particular clinical illustration–but we are assigning them in order to be sure certain bases are covered in your understanding. We are glad to offer additional, more targeted readings to help deepen your engagement with any particular theorist or idea, according to your personal level of interest—just let us know if you’d like further suggestions.

We may share some study questions with you in advance of the class sessions, to help organize and guide your thinking as you engage with the assigned papers throughout the trimester. If the readings end up feeling especially dense for a given week, we will decide and let you know a week or two in advance what to concentrate on for that particular class session.

We look forward to hearing your reactions to these readings and to our inputs as instructors.

Psychopathology I: Neurotic-Level Personality and Symptom Disorders

Welcome to Psychopathology I: Neurotic-Level Personality and Symptom Disorders.

We have chosen to organize this course to first convey an understanding of the developmental underpinnings of neurotic character organization and to then explore the related intrapsychic and interpersonal (including transferential-countertransferential) manifestations of neurotic-level psychopathology.

The following are the types of questions we hope to explore throughout the course:

  • What is implied by the term neurotic character?
  • What is it that one looks for in the consultation period that differentiates between neurotic and the less organized structures that underlie borderline / psychotic characters or states?
  • What are the developmental / relational experiences that may have facilitated or hindered the psychic achievements that characterize a neurotic level organization?
  • What are the predominant conflicts and / or defenses that characterize the various diagnostic categories within neurotic-level symptom or character presentations?

Discussion of clinical material is essential in bringing to life and making personally relevant the concepts we will be exploring. Hence, we strongly encourage you to bring vignettes and short process-notes to class.

Development III: Adolescence

Welcome to our seminar on Adolescence. This course begins with pubescence and ends with late adolescence and emerging adulthood. The aim of this course is to familiarize you with the central developmental challenges associated with early, middle, and late adolescence, as well as emerging adulthood. In addition, throughout this seminar, we will explore how to understand adolescent pathology. The readings draw from a combination of classical and modern articles.

Our aim is also to provide you with an understanding of the manifold interacting elements that influence psychological development during the adolescent years. We intend to discuss the concepts of adolescent sexuality, drive resurgence, object removal, formal operational thinking, identity consolidation and several special issues and challenges in the psychoanalytic treatment of adolescents. Our hope is that this seminar will enrich your work with adults. Indeed, many of you who treat adults may find yourselves confronted with individuals who, from a developmental perspective, have not completed certain adolescent tasks.

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.