Development Of Psychoanalytic Cases: Evaluation for Psychoanalysis and the Opening Phase

Adult Psychoanalytic Training (APT)
2018-19, 1st Trimester — Fridays, 1:45-3:15pm
Margaret Crastnopol, PhD


Welcome to this introductory class.

Each of the skills learned in this class will serve to further and deepen your analytic work, leading to increased patient retention and improved treatment outcomes.

We welcome your feedback as the class progresses.

Several reference books you may consider obtaining are:

  • Psychoanalytic Diagnosis, second edition, by Nancy McWilliams
  • Psychoanalytic Terms and Concepts by Burness E. Moore and Bernard D. Fine
  • Psychodynamic Diagnostic Manual, 2nd edition, by Lingiardi, McWilliams, and other authors

Learning Objectives

Our goals in this class are to help you to:

  1. understand qualities that distinguish psychoanalysis from psychotherapy both in theory and in practice
  2. understand what constitutes psychoanalytic diagnosis in particular, and how to make optimal use of it
  3. gain skill in determining what aspects contribute to recommending psychoanalytic treatment to a given individual, and which cases might be good beginning cases in psychoanalytic training
  4. consider factors involved in converting treatment from psychotherapy to psychoanalysis
  5. learn the foundations for the development of an analytic relationship early in treatment
  6. begin to conceptualize a patient’s “internal object relations” and “external object relations” as complementary aspects of the psyche that are the foci of analytic attention

September 7, 2018 — Psychoanalysis and Psychotherapy: The Difference

[48 pages]

Please read these articles with the following questions in mind:

What characteristics distinguish psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy from one another? Think about theoretical and clinical applications of these differences.

Gill, M.M. (1984). Psychoanalysis and Psychotherapy: A Revision. Int. R. Psycho-Anal., 11:161-179.

Kernberg, O. (1999). Psychoanalysis, Psychoanalytic Psychotherapy and Supportive Psychotherapy: Contemporary Controversies. Int. J. Psycho-Anal., 80(6):1075-1091.

Busch, F. (2010). Distinguishing Psychoanalysis from Psychotherapy. Int. J. Psycho-Anal., 91(1):23-34.

September 14, 2018 — Psychoanalytic diagnosis

[49 pages]

Please read the following with these questions in mind:

How does knowing the level of personality organization help the analyst to have a deeper understanding of the patient? In what way is the whole analysis an ongoing diagnostic process?

McWilliams, N. (2011). Ch2, “Psychoanalytic Character Diagnosis” in Psychoanalytic Diagnosis: Understanding Personality Structure in Clinical Process (2nd Edition), pp21-69.

September 21, 2018 — Assessment of patients for psychoanalysis and questions of analyzability

[42 pages]

Please read these articles with the following questions in mind:

What is “analyzability,” how valid is it as a concept, and how can we tell if somebody is analyzable, or why somebody isn’t? Does it depend on the compatibility of the prospective patient and the analyst?

Wilson, A. (1999). Analyzability Redux: From “Analyzable” to “Preparable for Analysis”. Ann. Psychoanal., 26:127-141.

Rothstein, A. (2006). Reflections on the Concept “Analyzability”;. Psychoanal. Rev., 93(5):827-833.

Levine, H.B. (2010). Creating Analysts, Creating Analytic Patients. Int. J. Psycho-Anal., 91(6):1385-1404.

September 28, 2018 — Assessment of Analyzability and Diversity

[55 pages]

Please read the following two articles with the following questions in mind:

What factors can have an important influence in the capacity for a specific patient-analyst dyad to engage in an analytic process?

Foster, R.P. (1993). The Social Politics of Psychoanalysis Commentary on Neil Altman’s: “Psychoanalysis and the Urban Poor”. Psychoanal. Dial., 3(1):69-83.

Moncayo, R. (1998). Cultural Diversity and the Cultural and Epistemological Structure of Psychoanalysis: Implications for Psychotherapy With Latinos and Other Minorities. Psychoanal. Psychol., 15(2):262-286.

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

October 5, 2018 — Converting from psychotherapy to psychoanalysis

[47 pages]

Midterm verbal evaluation.

Please read these articles with the following question in mind:

Which ideas would likely be helpful in considering converting a psychotherapy patient of yours to analysis?

Rothstein, A. (1994). A Perspective on Doing a Consultation and Making the Recommendation of Analysis to a Prospective Analysand. Psychoanal Q., 63:680-695.

Bernstein, S.B. (2010). Treatment Preparatory to Psychoanalysis: A Reconsideration after Twenty-Five Years. J. Amer. Psychoanal. Assn., 58(1):27-57.

Optional Reading

Stolorow, R.D. (1990). Converting Psychotherapy to Psychoanalysis: A Critique of the Underlying Assumptions. Psychoanal. Inq., 10(1):119-130.

October 12, 2018 — Analytic Sensibility—trust, appreciation, empathic attitude, background of safety

[46 pages]

Please read these articles with the following question in mind:

Considering that the analytic relationship is in constant development, what factors can you observe in yourself and intellectually learn that can facilitate your work with your analytic patient?

Meissner, W.W. (1996). Empathy in the Therapeutic Alliance. Psychoanal. Inq., 16(1):39-53.

Searles, H.F. (1977). The Analyst’s Participant Observation as Influenced by the Patient’s Transference. Contemp. Psychoanal., 13:367-370.

Schafer, R. (1979). The Appreciative Analytic Attitude and the Construction of Multiple Histories. Psychoanal. Contemp. Thought, 2(1):3-24.

Sandler, J. (1960). The Background of Safety. Int. J. Psycho-Anal., 41:352-356.

Optional Reading

Mitchell, S.A. (1998). The Analyst's Knowledge and Authority. Psychoanal Q., 67(1):1-31.

October 19, 2018 — The therapeutic action of psychoanalysis

[45 pages]

Please read these articles with the following question in mind:

How does learning of the historical and developing ideas about the therapeutic action of psychoanalysis assist you in understanding the journey that you are about to start with your analytic patient?

Strachey, J. (1969). The Nature of the Therapeutic Action of Psychoanalysis. Int. J. Psycho-Anal., 50:275-292.

Bromberg, P.M. (1996). Standing in the Spaces: The Multiplicity Of Self And The Psychoanalytic Relationship. Contemp. Psychoanal., 32:509-535.

Optional Reading

Loewald, H.W. (1960). On the Therapeutic Action of Psycho-Analysis. Int. J. Psycho-Anal., 41:16-33.

October 26, 2018 — The analytic situation/the treatment alliance/opening phase

[43 pages]

Please read these articles with the following questions in mind:

How can you establish the analytic relationship from the start? How do you secure the frame (i.e., frequency of sessions, “the golden rule/free associations”, scheduling, fees, “intrusion” of health insurance, confidentiality and disclosure, use of the couch, cancellation policy) and present it to the patient “analytically”? How can consultation assist you during this critical phase?

Brenner, C. (1979). Working Alliance, Therapeutic Alliance, And Transference. J. Amer. Psychoanal. Assn., 27S(Supplement):137-157.

Deutsch, H. Roazen, P. (1989). Technique: The Therapeutic Alliance. Int. R. Psycho-Anal., 16:427-431.

Jacobs, T. (1999). Chapter 2: On Beginnings: The Concept of the Therapeutic Alliance and the Interplay of Transferences in the Opening Phase. The Therapeutic Alliance, 17-33.

November 2, 2018 — Working with the internal object relations aspect of the psyche

[44 pages]

Please read these articles with the following questions in mind:

What constitutes an internal object relationship in analysis? How does the theory help you to keep in mind the relational dynamics taking place in the internal world of your patients, to listen, and to formulate your comments and interactions with them?

Sandler, J. Rosenblatt, B. (1962). The Concept of the Representational World. Psychoanal. St. Child, 17:128-145.

Greenspan, S.I. (1977). The Oedipal–Pre-Oedipal Dilemma: A Reformulation According to Object Relations Theory. Int. R. Psycho-Anal., 4:381-391.

Ogden, T.H. (1983). The Concept of Internal Object Relations. Int. J. Psycho-Anal., 64:227-241.

Optional Reading

Rosenfeld, H. (1983). Primitive Object Relations and Mechanisms. Int. J. Psycho-Anal., 64:261-267.

November 9, 2018 — Working with the relational/interpersonal aspects of the psyche (we could call it, “external object relations!”)

[51 pages]

Please read these with the following questions in mind:

What do you think about the idea that the emotional connection between the patient and the analyst “constitutes the most vital curative factor” in analysis? Do you understand the shifting from a predominant focus on the structures of the mind to a predominant focus on the analytic process and the ongoing construction of experience?

Bromberg, P.M. (2008). Shrinking the Tsunami: Affect Regulation, Dissociation, and the Shadow of the Flood. Contemp. Psychoanal., 44(3):329-350.

Stern, D.B. (2013). Relational Freedom and Therapeutic Action. J. Amer. Psychoanal. Assn., 61(2):227-255.

November 16, 2018 — Analysis of the transference/countertransference

[50 pages]

Please read these articles with the following questions in mind:

Why is it important to recognize and interpret the emerging transference? What happens to the patient-analyst relationship when the transference is correctly interpreted? Why is it important to recognize and use the understanding of the countertransference?

Gill, M.M. (1979). The Analysis Of The Transference. J. Amer. Psychoanal. Assn., 27S(Supplement):263-288.

Hirsch, I. (1998). The Concept of Enactment and Theoretical Convergence. Psychoanal Q., 67(1):78-101.

Optional Reading

Bálint, A. Bálint, M. (1939). On Transference and Counter-Transference. Int. J. Psycho-Anal., 20:223-230.