Fourth Year Adult Psychoanalytic Training (APT)
2022-23, 1st Trimester — Fridays, 3:30-5:00pm
Stan Case, LICSW PhD
Judy K. Eekhoff, PhD
Table of Contents
Introduction
Freud wrote that the ego is “a precipitate of abandoned object cathexes” that “contains the history of these object choices,” although he continued to believe that intrapsychic drives are the primary determinants of personality and psychopathology. To Fairbairn, who coined the term object relations theory in 1941, and Klein, infants were more than drive-satisfying—they are born object-seeking and object related. Klein elaborated the internal world, a complex system of internalized object relations based on early phantasies and anxieties in intensely personal relationship with the primary object. While Klein acknowledged the reality of external trauma, she tended to see bad objects as internally derived. Winnicott, drawing on his experience with healthy mother-infant dyads, tried to bridge the interpersonal and the intrapsychic. Attachment research has confirmed that mental disorders of adulthood develop in earlier relationships, both fantasied and remembered. It has also confirmed that infants are object related from birth and do not begin life in an autistic state as Mahler and Tustin once thought.
Bion’s ideas expanded the analytic field exponentially; as Ogden writes, his concept of dreaming “is our profoundest form of thinking and constitutes the principal medium through which we achieve human consciousness, psychological growth, and the capacity to create personal symbolic meaning from our lived experience.” Just as to Winnicott (1960) “There is no such thing as an infant [apart from the mother],” to Bion (1961) “the human unit is a couple; it takes two human beings to make one.” “Just as Winnicott shifted the focus of analytic theory and practice from play (as a symbolic representation of the child’s internal world) to the experience of playing, Bion shifted the focus from the symbolic content of thoughts to the process of thinking, and from the symbolic meaning of dreams to the process of dreaming.”
Bollas (1987) has distinguished between two kinds of transference, one involving the patient and their objects, the other involving the receptive capacity by which the analyst facilitates the creation of new internal objects and self experiences. In the first we serve as a transference object, in the second we serve as a new (or developmental) object. Object related ideas have enriched our understanding of the “social unconscious” and collective forms of othering. When Freud’s focus shifted from the seduction theory to fantasy-based neurosogenesis, sexual trauma got marginalized. Ferenczi (who was Melanie Klein’s first analyst, and who was exiled by orthodox Freudians) focused on the impact of the actual incest and abuse. He expanded the concept of introjection to that of “intropression” (1932), to describe an externally forced introjection. Bion’s seminal explorations of group phenomena in the 1940’s provided a foundation for current psychoanalytic authors about group schisms, ostracisms, parasitic and persecutory processes. Further, he believed that external group processes reflected the internal world.
Bion wrote that each of us contains a “group self,” pitting what he termed our innate “socialism against [our] narcissism” (1961). Gonzalez (2020) proposes that the collective psyche involves not just “individual object relations, but relations of one-to-many.” Layton (2018) anchors her ideas on Freud’s and Bion’s ideas about disavowal and lying and on Klein’s concepts of guilt and reparation. Dajani (2020) draws on the cultural implications of Winnicott’s theories. She and Anton Hart enlarge Winnicott’s radical ideas about listening to the patient. Green and Skolnick base their insights about systematic racial oppression on Bion’s conceptualizations about groupthink and Klein’s paranoid-schizoid positions. Fakhry Davids bases his reflections on racism on British object relational theories such as Rosenfeld’s about malignant narcissism and Steiner’s on psychic retreats.
Just as this field keeps growing, we look forward to growing with you as we reflect on these readings together. Although we both regretfully need to teach remotely this term, we will keep you informed about if/when that could change.
—Judy and Stan
Learning Objectives
At the end of this course candidates will be able to:
- Describe the fundamental concepts and techniques of BOR theory.
- Demonstrate more capacity to recognize the analytic process through the here and now transference-countertransference experience.
- Encounter the complexities of emotional experience as known through primitive protection mechanisms and defenses.
- Formulate an analytic frame informed by a British Object Relations perspective to enhance clinical outcomes.
September 9, 2022 — Bion’s Theory of Thinking
[34 pages]Bion extended Klein’s concept of projective identification to include a normal communicative, not just an evacuative, defensive function. He revolutionized psychoanalysis with concepts such as container-contained, maternal reverie, alpha-function, beta elements (raw emotional sensations), nameless dreads, and bizarre objects. He focused on the capacity to think and on the mind’s capacity to attack its own thinking functions. In this early writing on psychotic processes which dominate the neurotic part of the personality, his concepts are Kleinian. Excessive projective identifications which split, penetrate or engulf their objects, hateful of links between objects in reality, leave one surrounded by “bizarre objects” when these projections return, laden with aspects of the external object into which they were projected.
Ogden outlines four principles of mental functioning on which Bion built his theory of thinking (by which Bion meant both thinking and feeling). “Dreaming” for Bion is a form of thinking, the way in which we achieve consciousness, psychological growth, and create personal symbolic meaning from lived experience. We “dream” ourselves into existence. The four principles are our needs: (1) to know the truth, (2) for two minds to mentalize our most disturbing thoughts, (3) to develop our capacity for thinking in order to work on disturbing emotional experiences, and (4) to dream in order to grow psychologically.
Bion, W. (1957). “Differentiation of the Psychotic from the Non-Psychotic Personalities.” IJP 38:266-275
Ogden, T.H. (2009). Ch. 6 “Bion’s Four Principles of Mental Functioning” in Rediscovering Psychoanalysis. N.Y.: Routledge. pp90-113
September 16, 2022 — The Body as Psychoanalytic Object
[22 pages]Ester Bick was the founder of the use of infant observation in the training of analysts and therapists at the Tavestock, London. She used her observations to formulate a theory regarding the function of psychic skin. Psychic skin holds the emerging self together, allowing cohesion and accumulation of learning and meaning. Her ideas were profoundly influential in London, although she did not write very much. These ideas added a great deal to Object Relations theory and technique. Before knowing Bion, she explored the idea of containment. Some terms found in current literature on psychopathological processes use her ideas of second-skin formation and adhesive identification. She also noticed the impact a lack of psychic skin produced in therapy, such as impasses which resulted in dead-ends and looping. Her focus was more on object relations than on the cognitive symbolic functions of thinking and language.
My papers explore the role of the body in the development of a subjective sense of self. I link the development of Self with both Bick and Bion’s work. Bion explored the processes involved in the accumulation of meaning via relationship. He always looked for the precursor to thinking. It is not only that we use our minds to think: sensory and perceptual experience initiate the birth of a mind. Bion’s famous phrase, “thoughts without a thinker” turned some basic assumptions about thinking around. We need a mind in order to cope with thoughts. Proto-mental experience originating in the body becomes useable after being organized by the mind. Sensations and images cohere to create internal structure and organization via emotional relationship. For me, and here is the influence of Bion, emotions are already representations that lead to symbolization. These are embedded in the body. Psychopathology arises when the mind and the body are dissociated, which occurs in early trauma. Mind and body together organize experience so as to reduce the infinite experience of reality.
Bick, E. (1968). “The experience of the Skin in Early Object-Relations.” IJP 49:484-486
Eekhoff, J.K. (2020). Ch. 8 “The Body as a Mode of Representation” in Trauma and Primitive Mental States: An Object Relations Perspective. London & NY: Routledge. pp94-111
Eekhoff, J. (2022) The Organization of Experience (developmental chart)
September 23, 2022 — Klein-Bion: developments in theory
[20 pages]Joseph describes how the earliest object relations and defensive organizations can be lived out in the transference, alongside and beyond what the patient is saying. How patients act on us, and try to get us to act out with them, may transfer total situations, in addition to specific anxieties, from infancy. How we are being used, beyond the use of words, is communicated through our countertransference.
Meltzer summarizes how Klein expanded Freud’s instinctual theories of development with her theory of an internal world, its geography as real as that of the outside world. She focused on the self’s emotional growth from part- to whole-objects, both loved and hated, in bodily-anatomical terms. Bion emphasized the evolution of the capacity to think, described the mind’s capacity to attack its own thinking functions, and on the links between objects. Both Klein and Bion initiated a change in the way the body is instrumental in the development of the mind, shifting to the idea of instinct rather than drive.
Joseph, B. (1985). Transference: The Total Situation. Int. J. Psycho-Anal., 66:447-454.
Meltzer, D. (2009). Ch. 3 “The Klein-Bion expansion of Freud’s metapsychology” in Dream Life. Perthshire: Clunie Press, pp36-47.
September 30, 2022 — Interpreting In or About the Transference
[30 pages]The degree to which the Self coheres and is integrated is a measure of mental health. Clinical experience has negated the idea that we have one unified self. Instead, analysts realize that a self consists of many selves, all of which influence the emotion and the action of an individual. This is different than having parts or aspects. Most contemporary analytic theories accept the idea that that which is not accepted or repressed, is split off and projected out into a receiving ‘other’. Such splitting and projection are deeply unconscious and raise new questions about interpretation or what Feldman names as description of the process. He is questioning the familiar analytic techniques of interpretation – the ‘why’s’ and the ‘what’s’ of description and explanation. He suggests these techniques may actually collude with the patient’s defenses against unbearable emotion and be ‘experience-far’ instead of ‘experience-near’. Brown emphasizes the implicit intersubjectivity in evolving Kleinian literature following expansions of Klein’s more intrapsychic emphasis in her concept of projective identification. Bion included the subjective experience of the analyst with the capacity to become the patient’s projected phantasy. Argentinian analysts contributed the notion of the shared unconscious of the analytic couple.
Feldman, M. (2007). “Addressing Parts of the Self.” IJP 88:371-386
Brown, L.J. (2010). Klein, Bion, and Intersubjectivity: Becoming, Transforming, and Dreaming. Psychoanalytic Dialogues, 20(6):669-682
October 7, 2022 — Bion and Winnicott: Radical Reformulations
[54 pages]*The mid-term class evaluation will be conducted during this session. Please use these questions to facilitate your discussion: Midterm Evaluation 2019-02-13
Britton explores and exemplifies Bion’s concepts of container and contained which he developed in the 1950’s. He characterized containment as providing a sanctuary for being safely bounded in space as well as providing meaning. He defines and elaborates on different kinds of containment including malignant and perfect containment, each of which obstructs psychic growth.
Eshel describes the radical shift from Freud and Klein initiated by Bion and Winnicott. This shift is away from an experience-far analysis – that is an intellectual description of what happened – to an experience-near analysis. In doing so, she relies heavily on Bion’s later work where he explores working outside the realm of projective identification. This coincides with a shift from a one-person analysis to a two-person analysis. She links this to a focus on ‘being.’ This is a focus on the unknown as it emerges between two people and makes Psychoanalysis an experiential treatment. An experiential treatment enables us to work with autistic, psychotic, and borderline states. It happens in undifferentiated states of mind that are an aspect of health. In this, Eshel approaches what Bleger (1967/201113) named symbiosis. It is present throughout life and speaks to the interdependence between intimates.
Britton, R. (1998). Ch. 2 “Naming and Containing” in Belief and Imagination: Explorations in Psychoanalysis. N.Y.: Routledge pp19-28
Eshel, O. (2017). “From Extensions to Revolutionary Change in Clinical Psychoanalysis: The Radical Influence of Bion and Winnicott.” Psychoanalytic Quarterly 86(4): 753-794
Case, S. (2007). Book review of J. Grotstein’s book: A Beam of Intense Darkness—Wilfred Bion’s Legacy to Psychoanalysis, Correlations Newsletter
October 14, 2022 — Engaging Trauma
[17 pages]Emotional links to others organize our experience. We attune unconsciously and automatically with whomever we are with. When we do this, we use our own internal organizations to attribute meaning. These patterns or configurations of emotional linkages are multiple and are called upon depending upon the immediate call and response of the relationship. Persons who have suffered early trauma defend against relationship by retreating into autistic bastions (Baranger & Baranger) where they deny their need of others. Yet, a link to the other is always present. Working in the immediate here and now of the analytic hour enables us to observe and name the relationship as it presents itself. It is interpreting the transference very differently than Freud would have, for it is recognizing the present that originated in the past. This emotional link between patient and analyst is what makes working with very disturbed patients possible.
Eekhoff, J. (2015). “The Silent Transference: Clinical Reflections on Ferenczi, Klein, and Bion.” Canadian Journal of Psychoanalysis, Vol. 23(1) 57-73.
October 21, 2022 — Winnicott: Othered Selves and Objects
[34 pages]If a mother is not good-enough and repeatedly ignores the child’s spontaneous gesture, substituting her own experience, the infant complies and develops a false self. It hides and protects the True Self, the creative and real self, from exploitation and annihilation.
The capacity to be alone is an achievement and a sign of emotional maturity. Derived from experiences of being alone as an infant in the presence of the mother, the capacity to be alone depends on the existence of an internalized good object–the introjection of an ego-supportive environment.
Dajani builds on Winnicott’s psychoanalytic explorations in social, historic and cultural dimensions. She proposes two ideas: with bi-cultural patients we must keep in mind that for the immigrant (1) the new culture is a prosthetic, artificial extension of the body and the mind, and that (2) hatred towards the lost person or place, like Freuds insight about self-hatred in the melancholic, leaves a festering sense of self-loathing.
Winnicott, D.W. (1960). “Ego distortion in terms of true and false self” in The Maturational Processes and the Facilitating Environment. London: Hogarth Press (1965), pp140-152.
Winnicott, D.W. (1958). The Capacity to be Alone. Int. J. Psycho-Anal., 39:416-420.
Dajani, K.G. (2020) Cultural determinants in Winnicott’s developmental theories. Int J Appl Psychoanal Studies. 17:6-21
October 28, 2022 — Bion on Groups
[42 pages]Bion in Experiences in Groups (1961) described primitive defenses used by groups to defend against individuals’ protomental anxieties. Using defenses including splitting, idealization, projective identification and magical thinking, groups become more than an aggregate of individuals, bypassing critical judgment by allowing assumptions to pass as statements of fact. These basic assumption groups are the ‘fight-flight’ group, the ‘pairing’ group, and the ‘dependent group.’ These group members bond by finding a common enemy, by worshiping an omnipotent group leader or group ‘bible,’ and/or exalting an idealized oedipal couple who will deliver a messianic hope. But when organized to think logically and capable of learning from experience, the group evolves into a sophisticated ‘work group.’ Bion felt that each of us contains a ‘group self,’ pitting what he termed our innate ‘socialism against [our] narcissism.’ He regarded the therapeutic couple as a pairing group, which includes an omnipotent fantasy of giving birth to a savior or a messianic idea.
Green and Skolnick, influenced by the Tavistock group relations model in Britain, base their insights about systematic racial oppression on Bion’s conceptualizations about groupthink and Klein’s paranoid-schizoid positions. Our rapidly changing world which has brought diverse groups closer together has also stirred inter-group paranoia, hatred, and envy. Groups split into factions to avoid painful self-knowledge while denigrating the other. Referencing Bion’s thoughts about the Tower of Babel myth, they observe our human tendency to strive for omniscience, as symbolized by building the Tower of Babel, instead of learning together from shared experience, which is a depressive position achievement.
Schneider, J. (2015). “Bion’s Thinking about Groups: A Study of Influence and Originality.” Psychoanalytic Quarterly 84(2):415-440
Skolnick, M. & Green, Z. (2004). Ch. 6 “The Denigrated Other: Diversity and Group Relations,” in Group Relations Reader 3, pp128-143
November 4, 2022 — Exclusion: Internalized and Externalized
[50 pages]Fakhry Davids builds on Rosenfeld’s concept of the pathological organization and Steiner’s ideas about psychic retreats. Coming from a fixed infantile part of the self which felt robbed of its omnipotent narcissism, the pathological organization resorts to self-idealization and destructive narcissism. With ruthless envy toward the more dependent, object-related part of the self, its brutality disguises itself as a benevolent savior, whose “false promises,” he says, “are designed to make the normal self of the patient dependent on or addicted to his omnipotent self, and to lure the normal sane parts into this delusional structure in order to imprison them.” Steiner’s psychic retreat is a psychic organization which, in between the paranoid schizoid and depressive positions, avoids contact with reality. Only after the analyst has been induced into an enactment, emotionally disturbed, and recruited to play a role in maintaining the patient’s pathological equilibrium, can he or she become more aware of its impact and meaning.
Steiner, J. (2008). “Transference to the Analyst as an Excluded Observer.” IJP 89:39-54
Davids, M. Fakhry. (2011) Ch1, Introduction. in Internal Racism: a Psychoanalytic Approach to Race and Difference, pp1-16
Davids, M. Fakhry. (2011) Ch2, A Clinical Study of a Racist Attack. in Internal Racism: a Psychoanalytic Approach to Race and Difference, pp19-36
November 11, 2022 — Levels of Listening
[25 pages]Alvarez describes analytic listening from three main vertices: motivation or the “why” something is done, description or the “how” something is done, and the most controversial method when working with extremely traumatized patients who are operating with deficits in development as the “wake-up” call or vitalizing. We might name this name this, as does H. Levine, as the “hey you”. Such vitalizing interventions do what the mother does with an infant, that is – the calling of the other into existence. The listening stance of the analyst determines what the analytic dyad pays attention to. This itself is a powerful intervention, enabling each member of the dyad to attend to and become conscious of unconscious processes and beliefs.
Britton differentiates psychic levels of the both the mind and the body and the impossibility of knowing the internal world. He says, “Belief gives the force of reality to that which is psychic, just as perception does to that which is physical. Like perception, belief is an active process and like perception it is influenced by desire, fear, and expectation; and just as perceptions can be denied, so beliefs can be disavowed.” (p. 19) His assertion is that analytic listening to the precursors of action—in this instance, to the beliefs underlying evaluation of reality enables the analyst to be present to unconscious motivations and defenses against change.
Britton, R. (1995). “Psychic Reality and Unconscious Belief.” IJP 76:19-23
Alvarez, A. (2010). “Levels of Analytic Work and Levels of Pathology: the Work of Calibration.” IJP 91:859-878
November 18, 2022 — Primitive Terrors and Protective Mechanisms
[43 pages]Primitive trauma can result from premature exposure to separations and losses experienced by the infant at a somatopsychic level. Untransformed by a mind that can mentalize them, unbearable and unborn states of mind turn to primitive mechanisms for psychic survival. Protective maneuvers such as autosensual cocoons, enactive memories, body memories, and memories in feelings encapsulate or evacuate the terror of a catastrophic psychological birth.
Mitrani, J. (1995). “Toward an Understanding of Unmentalized Experience,” in A Framework for the Imaginary. Northvale, N.J.: Aronson pp205-247