Deepening the Treatment: Transference, Countertransference and Enactments

Integrated Child & Adult Psychoanalytic Psychotherapy (ICAPP)
2021-22, 2nd Block — Mondays, 6:30-7:45pm
Donald Schimmel, PhD

Introduction

The development of the capacities in the Learning Objectives for this course  will result in enhanced patient retention and clinical efficacy.

Additional Reading

Aron, L. & Atlas, G. (2015) Generative Enactment: Memories From the Future. Psychoanalytic Dialogues 25:309-324

Schwartz Cooney, A. (2018) Vitalizing Enactment: A Relational Exploration. Psychoanalytic Dialogues 28:340-354

Renik, O. (1993) Analytic Interaction: Conceptualizing Technique in Light of the Analyst's Irreducible Subjectivity. Psychoanalytic Quarterly 62:553-571

 

Learning Objectives

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

  1. develop a therapeutic stance that is most conducive to deepening psychoanalytically-informed treatments,
  2. recognize the centrality of the enacted dimension of treatment, which occurs alongside the verbal dimension of treatment,
  3. address more challenging transference and countertransference configurations in treatment, and
  4. assess key clinical decision points from the standpoint of their impact on the depth of the treatment.

November 15, 2021 — Countertransference

[32 pages]
This is a handout listing criteria for assessing whether a treatment is psychoanalytic.  Many of the items listed will be part of our discussion during the course of the block on Deepening the Treatment.  Feel free to peruse this at your leisure; we’d be happy to answer questions or elaborate whenever it arises.

Maroda, K. (1991). Introduction & Ch1 in The Power of Countertransference. Chichester, NY: Wiley. pp1-32.

November 22, 2021 — The Treatment Relationship; Provision and Negotiation

[27 pages]

Mitchell, S. (1993). Ch7, “Wishes, Needs and Interpersonal Negotiations” in Hope and Dread in Psychoanalysis. pp175-201.

  1. Within the classic psychoanalytic model, how does Mitchell characterize the psychoanalytic relationship?  What is the “fundamental rule”; and what is mean by “abstinence”? What does he identify as the two major problems with this model?  (pp. 176-177)
  2. What is the difference between ego-needs vs instinctual-wishes? How does Mitchell suggest we make the distinction in the clinical moment? (pp 178-180)
  3. Note Mitchell’s point about continual negotiation.  Did you ever agree to a request and regret or resent it later?
  4. Regarding requests made by patients/clients, what does Mitchell mean when he says, “In short, the process itself is more important than the decision arrived at.”  What does Mitchell name as most crucial as the analyst decides what to do?  (pp, 195-196)

November 29, 2021 — Frame and Spontaneity in Treatment

[25 pages]

Hoffman, I.Z. (2001) Dialectical Thinking and Therapeutic Action in Ritual and Spontaneity in the Psychoanalytic Process, pp193-217.

  • What are different names for the poles of the dialectic Hoffman is describing? (p. 200, 208)
  • What does Hoffman name as the key abstract principle in guiding the therapist’s responses to the patient, given the ongoing dialectic he proposes?  (p. 199)
  • Have you had the experience of responding to a patient “prescriptively,” at either end of the dialectic, and wondered about it or felt uncomfortable about it later?  (p. 197)  Have you ever had the experience of realizing you have used an empathic stance with a patient in a way that you think, upon reflection, may have been more self-protective than therapeutic? (p. 197)
  • What is it that Hoffman believes gives the therapist’s mutuality or personal expressiveness particular significance to the patient?  (p. 204)
  • Does Hoffman’s clinical example bring to mind an experience of your work with a patient that you would be willing to share with the class? (pp. 204-214)

December 6, 2021 — Enactments

[37 pages]

Katz, G. (2014), Ch4-5 in The Play Within the Play: The Enacted Dimension of Psychoanalysis. pp37-48.

  1. What does Katz mean by “dual dimensionality?” (p. 38)
  2. How does Katz describe the process of therapeutic action with regard to the enacted dimension of treatment? (p.40)
  3. What are the two systems of memory and how do they relate to the dual dimensionality Katz is describing? (p.41)
  4. How does Katz define “experiential insight,” and how does he distinguish this from “an experience with a new, ‘better’ object? (pp.47-48)
  5. Katz describes two vignettes that illustrate enactment. What were the enactments and what does Katz say was enacted in each? (ch. 5)

Wachtel, P. (2008), Ch10, “Enactments, New Relational Experience, and Implicit Relational Knowing” in Relational Theory and the Practice of Psychotherapy, pp220-244

  1. What is the distinction between procedural and declarative memory? (p. 239) How do these memory systems map on to those which Katz describes?
  2. What is “implicit relational knowing,” according to the Boston Process of Change Study Group? (p. 241)   How is this expressed or revealed in the therapeutic relationship?  (Can you think of examples from your work with patients?)
  3. What is the “something more than interpretation” that is required for deep therapeutic change to occur, and which we provide for our patients? How does this occur? (pp. 240-242)
  4. What does Eagle argue is necessary for change in the dimension of the patient’s procedural knowledge? (p. 242)   How does this bear on the question of verbal interpretation, according to Eagle and Wachtel? (p. 243) What is meant by the “music” of the therapeutic material? (p. 243)

Optional Reading

Jacobs, T.J. (1986). On Countertransference Enactments. J. Amer. Psychoanal. Assn., 34:289-307.

December 13, 2021 — Enactment, Relationality and Self-Disclosure

[40 pages]
I have attached a handout on varieties of self-disclosure.  Please give it a quick read; it’s intended as way to  “prime the pump” with regard to our discussion on self-disclosure in the clinical setting.
Please feel free to use the study questions and handouts in whatever way you find most helpful. Our intention in providing them is to  highlight what we think are the most salient parts of the readings, and allow you to formulate questions for things that might seem unclear.

Maroda, K.J. (1998). Enactment: When the Patient’s and Analyst’s Pasts Converge. Psychoanal. Psychol., 15(4):517-535.

  • What are some essential elements of the definition of enactments? (p. 519)
  • What is the primary danger of enactment Maroda focuses on? (p. 522)
  • According to Maroda, what is the primary goal for the therapeutic use of enactment? (p. 530)
  • According to Maroda, what actions on the part of the therapist are most effective, when the patient has stimulated emotions in the therapist that replicate what other significant people feel or have felt toward the patient? (p. 531)
  • What does Maroda do if a patient observes, and she believes, that she has “started” an enactment? (p. 534)

Wachtel, P. (2008), Ch11, ”Confusions about Self-Disclosure” in Relational Theory and the Practice of Psychotherapy, pp245-265

  • How do you respond to a patient when he or she asks you where you went on vacation?  What if the patient asks, “Did you have a good time?” or “Did you go with your family?” (p. 250 & 257)
  • In discussing therapist disclosure Wachtel says that mistakes can be made by either disclosing or not disclosing.  In light of this, what is his recommendation for how the therapist/analyst should proceed? (p. 250 last paragraph).
  • How do you feel about disclosure of the therapist’s outside life?  Have you ever disclosed something about your outside life to a patient?  Upon reflection, did this prove productive/destructive?

January 3, 2022 — Racial Enactments

[31 pages]

Leary, K. (2000). Racial Enactments in Dynamic Treatment. Psychoanal. Dial., 10(4):639-653.

  • According to Leary, what feelings are racial enactments likely to provoke in the analyst?
  • Leary says that “racial experience may have something in common with what Stern (1997) called unformulated experience.” What does she mean by this?
  • The author states that it is “inevitable” that each of us will drift into racial enactments at one time or another. What does she suggest is the best way to work with patients when racial enactments do transpire?
  • What does Leary think is the most common racial enactment we clinicians fall into?

Suchet, M. (2004). A Relational Encounter with Race. Psychoanal. Dial., 14(4):423-438.

  • Suchet references Leary’s statement that race occupies a transitional space in the therapeutic process. What does this mean, and how is it represented in Suchet’s treatment of Sam? (pp. 429-430)
  • Name some of the oscillations of multiple subject positions that may be constellated between analyst and patient around the issue of race. (pp. 431-432)
  • What does Suchet describe as some of the causes and effects of using whiteness as the universal norm? (pp. 432-433)
  • What is the central idea of Helms’s work that Suchet elaborates upon in her reflections about the underlying dynamics of her work with Sam? (pp.433-434)
  • Suchet quotes Helms and Cook as arguing that “race and culture critically influence every aspect of the therapeutic process.” How does Suchet describe her work evolving in the years since her treatment of Sam? (pp.435-436).

Optional Reading

Gaztambide, D.J. (2021). Do black lives matter in psychoanalysis? Psychoanalytic Psychology, 38(3), 177-184.

January 10, 2022 — Working with Anger

[47 pages]

Hall, J.S. (1998). Ch7, “Tolerating the Patient’s Rage” in Deepening the Treatment, pp157-178.

Read only pages 157-163 and 171-178. (Skip the clinical example in the middle of the chapter.)

  • What is the essence of the test the patient is giving the therapist, with regard to the patient’s rage and anger?  (pp. 163, 172)
  • What actions on the part of the therapist constitute passing the test, according to Hall?  (throughout, and pp. 175, 176-177) What actions on our part might result in our not passing the test? (throughout, and pp. 161, 163)
  • What are some markers for progress in the treatment, according to Hall?  (pp. 160)
  • Note Hall’s formulation of rage as resistance:  what is being resisted, according to her? (p.160)

Maroda, K. (2009). Ch8, “Confrontation and Countertransference Anger: Overcoming the Therapist’s Aversion to Conflict” in Psychodynamic Techniques. NY: Guilford Press. pp179-203.

  • According to Maroda, under what circumstance will she directly confront a client’s behavior? (pp. 183-184)
  • What is your view of Maroda’s confrontation of Charles on page 190?

Optional Reading

Casement, P.J. (1991). Ch7, “Analytic Holding under Pressure” in Learning from the Patient, NY: Guildford Publications, Inc. pp129-139.

January 17, 2022 — Mistakes, and Psychoanalytic Companioning

[55 pages]

Gilhooley, D. (2011). Mistakes. Psychoanal. Psychol., 28(2):311-333.

Stop reading at the beginning of the Discussion section on page 322.

Study Questions:

  1. What are some of the potential “paradoxical effects” of ruptures, mistakes and misunderstandings? (pp. 312 and 314)
  2. What are the dynamics of failures of recognition, according to Benjamin? What restores the relationship in cases of failures of recognition?  (p. 312)
  3. How would you describe Gilhooley’s general protocol for a corrective or restorative response to a mistake? (pp. 316-322)

Grossmark, R. (2018). The Unobtrusive Relational Analyst. NY: Routledge. Ch3, “Psychoanalytic Companioning” pp54-75

Study Questions:

  1. With the term “psychoanalytic companioning,” Grossmark describes a kind of engagement with the patient that differs from the familiar mode of verbal/intellectual relating. How does he define psychoanalytic companioning?
  2. Grossmark suggests it is necessary to work “in the companioning register” with specific patients and/or self-states. What are some of the self-states for which the standard verbal engagement might not be useful?
  3. Grossmark uses the imagery of darkness and light to illustrate the particular ways of relating for which he advocates. What is his recommendation to clinicians invoking darkness and light?

Grossmark, R. (2018). The Unobtrusive Relational Analyst. NY: Routledge. Ch4, “The eloquence of action” pp76-85