Elective — The Body in Psychoanalysis: Inside, Outside, and In-Between

Fourth Year Adult Psychoanalytic Training (APT)
2023-24, 2nd Trimester — Fridays, 3:30-5:00pm
John Cardinali, PsyD
Babs Glover, MA LMHC


Introduction

Since Freud (1923) asserted that the “ego is first and foremost a body ego” (p. 23), psychoanalysis has been rooted in the premise that body and mind are inseparable, and that behavior is more than psychologically determined.  Psychoanalytic developmental theory provides models of how the mind, and sense of self, emerge from the dynamic interplay between the infant and the external environment, including body-to-body communication especially between the infant and the primary attachment figure.  Klein, Bion, Winnicott, Reich, Anzieu and others pick up Freud’s insight about the mind-body relationship and develop it further, Relational and intersubjective theorists have added further insight to our understanding of somatic communication and resonance throughout the lifespan.  The relationship between body and mind and the communication between bodies are both central to the experience of being alive.

Some authors have used the term bodymind (Aron, 1998; Harrang, Tillotson and Winters, 2022) to connote the inseparability of body and mind. In joining the words body and mind into a single word, we have both a visual and semantic representation of the oneness of body and mind. Despite the conceptualization of bodymind, until recently, psychoanalytic technique has continued to privilege verbal communication and interpretation as the primary mutative factors in psychoanalytic treatment.  Though the unity of bodymind and communication between bodies are central to our ongoing dialogue with patients, clinical attention to these factors has often been left undrawn.

In this seven-week course, we will explore psychoanalytic conceptions of bodymind in the development of self, in relations to others, and in treatment.  Stated slightly differently, we will consider the body as an object to others (including in sociocultural context), as an original source of subjective experience within ourselves, and lastly, as an object to ourselves.  We will also take up innovations in technique to account for our developing understanding of bodymind and body to body communication between patient and analyst. Throughout, we hope to stimulate your thinking about the embodied dimension of your work with your patients and make clinical reflections and examples from all of our work integral to our discussion and activities.

We are very much looking forward to learning together as a group.  A central aspect of this experience will be engaging with our bodies during our class meetings together.  We will be utilizing some experiential exercises to assist us in the process. To this end, we hope that each class member will make a concerted effort to attend each class in person.  We recognize this is a hardship for some and accept that in person attendance may not be possible for all or some of our class meetings.  That said, we believe that sharing the same physical space together is an important part of the learning experience for this class.

Learning Objectives

At the conclusion of this course, participants will be able to:

  1. Describe the evolution in psychoanalytic thinking about the role of the body in the development of mind.
  2. Formulate clinical material in terms of the domains of both the experienced body and the observed body.
  3. Make modifications in technique to account for body-to-body communication.

November 17, 2023 — Body of Work: The place of the body in analytic theorizing

[43 pages]

We begin our discussion of the body’s place in psychoanalytic thought and practice with the introduction and opening chapter of Lew Aron’s seminal book on relational perspectives on the body.  He provides us a brief overview of the distinctions between  the body from the perspectives of drive theory versus relational theory, and begins to elaborate central themes of the course:  the body’s role in the establishment of our self-representation, our experience of ourselves and our bodies as both subject and object, and the self-reflexivity that crucially mediates both positions.  Aron incorporates brief summaries of seminal theorists’ perspectives on the bodymind, e.g., Freud, Winnicott, Anzieu, Eigen, and Ogden, several of whom we touch on again later in the course.

Aron, L. (1998). “Introduction: The Body in Drive and Relational Models” in Relational Perspectives on the Body (L. Aron & F.S. Anderson, eds.). Hillsdale, NJ:  The Analytic Press, pp xix-xxxviii

Aron, L. (1998). “Ch1: The Clinical Body and The Reflexive Mind” in Relational Perspectives on the Body (L. Aron &; F.S. Anderson, eds.) Hillsdale, NJ: The Analytic Press, pp3-37.

December 1, 2023 — Mime is Money: Embodied subjectivity and embodied intersubjectivity; Mimesis in relating

[31 pages]

Sletvold comes to us from the tradition of Norwegian Character Analysis, which is heir to the work of both Freud and Wilhelm Reich.  Sletvold elaborates the Freudian perspective on the body and situates Reich, who pioneered the development of character analysis and centered the place of the body in his theory and work, at the core of the Norwegian perspective. Sletvold foregrounds the importance of embodiment in both subjectivity and intersubjectivity, argues for the centrality of body mimesis in the development of human relations, and introduces us to the mimetic approach to clinical reflection, which promises to deepen and broaden our understanding of our patients.

Sletvold, J. (2014). Ch6: “Embodied Subjectivity: Freud’s ‘Ich’ and the embodied self” in The Embodied Analyst: From Freud and Reich to Relationality. NY: Routledge (pp68-99).

Sletvold, J. (2014). Ch7: “Embodied Intersubjectivity: ‘You’ in mind” in The Embodied Analyst: From Freud and Reich to Relationality. NY: Routledge (pp68-99).

December 8, 2023 — I Wanna Rock With You:  Embodied desire and analytic eroticism

[43 pages]

Wrye’s perspective furthers our consideration of analysts’ and patients’ bodies as both subjects and objects, and foregrounds embodiment as central to psychological health and to the clinical experience. She urges us to embrace awareness of our own sensuous bodily responses to our patients’ material—our “body-based maternal erotic transference,” and extend what has historically been our focus on the oedipal, verbally-elaborated body to the preoedipal body of “sensorially lived experience,” from which our sense of aliveness emerges.

Writing some twenty years after Wrye, Elise also takes up the topic of analytic eroticism as a derivation of maternal eroticism and places it at the center of the analytic process.  Elise prizes analytic eroticism within an ethical frame as a crucial element in addressing developmental deficit and enlivening the intersubjective field of treatment.  She foregrounds emotionally embodied thinking and analytic vitality (as opposed to analytic neutrality) and elaborates the metaphor of dance to foster a felt sense of her clinical focus.  Elise argues for the analyst’s receptivity and engagement in a dance of vitalizing erotic energies as central to the patient’s experience of themselves as creative agents.

*The mid-term class evaluation will be conducted during this session. Please use these questions to facilitate your discussion: Midterm Evaluation Questions

Wrye, H. (1998). “The Embodiment of Desire: Relinking the Bodymind Within the Analytic Dyad” in Relational Perspectives on the Body (L. Aron & F.S. Anderson, eds.) Hillsdale, NJ: The Analytic Press, pp97-116.

Elise, D. (2021). “Moving from within the maternal: The choreography of analytic eroticism” in Vitalization in Psychoanalysis: Perspectives on Being and Becoming (A. Cooney, and R. Sopher, eds.) NY: Routledge (pp167-191).

December 15, 2023 — Sizing Us Up? or, Body Doubles: Analyst’s body as subject and object; Somatic reverie

[32 pages]

John’s article foregrounds unconscious aspects of living in or relating to the socioculturally stigmatized body, with particular attention to their emergence in the intersubjective field of treatment.  He offers us a clinical approach that addresses the ineluctable realities of both social context and bodily presence as they make themselves felt between patient and analyst and provides clinical vignettes demonstrating a way to address the unconscious levels of these realities without forsaking a focus on intersubjective emergence and the “dream” of the session.

Schoen argues that concrete surface elements of the analyst’s presence, such as our clothing and office décor—inevitably intertwined with signifiers around gender, sexuality, age, race, class, and so on—are often ignored, avoided, or overlooked as constructive aspects of the intersubjective engagement with our patients.  She argues that opening ourselves up to, and indeed inviting, the patient’s reactions to our physicality creates a space for the patient’s imaginative elaboration of physical aliveness.  Schoen addresses the analyst’s resistances to being seen and to engaging in what she describes as the “lived actualities of an erotic field” in the treatment.

Cardinali, J. (2023, unpublished). Stigmatized Body as Psychoanalytic Object. pp1-17.

This article will be distributed directly to the class members.

Schoen, S. (2023). The Patient’s Experience of the Analyst’s Physicality: It’s What’s on the Outside that Counts. Psychoanalytic Dialogues, 33:2, pp240-255.

January 5, 2024 — The Psychoanalytic Skin-ny

[24 pages]

Anzieu takes up the biological and psychical function of the skin to provide the infant the experience of a boundary between inside and outside, the sensation of both surface and volume, and confidence in the integrity of a bodily wrapping.  He defines the skin-ego as a mental image derived and internalized from the physical experiences of the interface between the surface of the baby’s body and that of its mother.  The internal fantasy of the skin ego allows the child’s developing ego to conceptualize itself as an ego containing psychical contents.

Wood foregrounds the importance of skin in the origins of self-representation and of problems in self-representation, including in the development of a sense of a reliable (or not) container for internal contents and adequate (or not) protection from external threats.  Wood applies his conceptualization of the skin function in an extended clinical example illustrating the unconscious psychic sequela of a patient’s congenital skin disorder, including its impact on the development of both her self-representation and her object relations.

Anzieu, D. (2016). Ch3: “The notion of a Skin-ego” In The Skin Ego. NY: Routledge (pp39-48).

Wood, P. (2014). Skin of Hate, Skin of Love. Psychoanalytic Social Work, 21:1-2, pp133-148.

January 12, 2024 — Head, Shoulders, Knees, and Toes: Dissociation and dis/embodiment

[28 pages]

Goldberg centers his article on the meaning given us through the sensory-somatic register of the body.  He builds on the Winnicottian ideas of indwelling and going-on-being to elaborate the experience of embodiment—living psychically in an actual body. Goldberg argues that it is through embodiment that we derive a sense of being and living vitally, and that without it we are left lacking access to the realness and aliveness of the self and the world.  He elaborates a clinical approach foregrounding the non-verbal psychosensory pattern language of the body and argues for the urgency of modifying technique where the patient presents with a fixed regime of disembodiment or dissociation and is thus dislocated from an interior emotional life.  Key to his approach is to engage at the level of shared sensoriality, noticing things in presentational form, rather than at the representational level.

 Like Goldberg, Cornell directs us to attend to the unlanguaged, sensory/somatic (i.e., subsymbolic) level of our patients’ experience.  His clinical focus is on the amplification of sensate, presentational elements of experience to foster the indwelling of patients who navigate life disembodied or dissociated from the fullness of a vital and direct connection between mind and body.  Cornell argues for early focus on the vertical (i.e., mind-body) axis rather than the horizontal (interpersonal) axis, to foster the communication between the patient’s mind and their disavowed body before attending to transferential material. He underscores the importance of analysts developing their capacities for somatic resonance, as distinct from countertransferential response.

Goldberg, P. (2022). “Embodiment, dissociation, and the rhythm of life” in Body as Psychoanalytic Object: Clinical Applications from Winnicott to Bion and Beyond (Harrang, D. Tillotson, and N. Winters, eds.) NY: Routledge (pp118-133).

Cornell, W. (2022). Wishing I Weren’t Here: Therapeutic Engagements with Disembodied States. Psychoanalytic Inquiry, 42:4, pp253-265.

January 19, 2024 — Lemme Hear Your Body Talk: Body-based interventions in work with trauma

[31 pages]

The reading authored by Solomon and Heide addresses trauma’s effects on the physiology of the brain, nervous system, and endocrine system. They distinguish more familiar “top down” clinical approaches from clinical approaches based on a “bottom-up” focus on what is happening in the patient’s body, and argue that ongoing attention to the patient’s body states is central to a biologically-informed treatment approach that facilitates the processing of episodic memories and the treatment of the physiological hyperarousal typical of trauma survivors. The article includes a description of EMDR and hypothesis as to the mechanism of its effectiveness in shifting brain function to address the sequelae of trauma.

Eldredge and Cole offer us an integrative approach designed to make psychoanalytically-oriented treatment more useful for people with trauma histories.  They argue that more effective treatments are realized by combining the traumatologists’ focus on working with bodily states with the analytic focus on transference and countertransference (including implicit procedural knowledge). Their article includes clinical excerpts detailing the technical approach involved in shifting away from interpretation and meaning-making (representational in nature) toward tracking the patient’s bodily states (presentational in nature).  The thrust of their engagement with patients becomes one of supporting shifts in the patient’s neural functioning, from a trauma-based fixed state to more flexible, better-regulated neural and brain functioning.

Solomon, E.; Heidi, K. (2005). The Biology of Trauma: Implications for Treatment, Journal of Interpersonal Violence, 20:1, pp51-60.

Eldredge, C.; Cole, G. (2007). “Learning From Work With Individuals With a History of Trauma: Some Thoughts on Integrating Body-Oriented Techniques and Relational Psychoanalysis” in Bodies in Treatment: The Unspoken Dimension (F.S. Anderson, ed.) NY: Routledge, pp79-102.