Adult Psychoanalytic Training (APT)
2018-19, 1st Trimester — Fridays, 1:45-3:15pm
Judy K. Eekhoff, PhD
Kelly Lippman, LMHC
Table of Contents
Introduction
Welcome to our course on Child Development (Birth to age 5). This course is the didactic complement to the Year Two Infant Observation course and we expect to refer frequently to last year’s rich array of observations to illustrate and deepen our understanding of the concepts we will explore this trimester.
Sigmund Freud’s curiosity and theorizing about how childhood was linked to suffering and joy in adulthood led to the idea of developmental progression and therapeutic intervention. Early child psychoanalysis, developed by Melanie Klein and Anna Freud, and based in nuanced observation and clinical work, focused attention on the internal dynamics of infants and young children as well as the importance of their relational and social contexts. These foundational theorists set the stage for decades of observational research and psychoanalytic exploration, all of which has led to our contemporary understanding of attachment, developmental progression, affect regulation, object relations, projective processes and neurobiology.
During this class, we will examine this topic from a variety of vantage points with the goal of providing a nuanced and multilayered contemporary understanding of child development rooted in a historical psychoanalytic context. Throughout the course, we will apply our learning to the adult clinical situation.
Learning Objectives
This class will offer clinical associates a broad understanding of child development in the first five years of life. At the end of this course, associates will be able to:
- Assess the developmental experiences of their patients from a variety of perspectives and recognize how patterns of early experience dynamically affect the adult clinical situation.
- Apply their knowledge of internal working models of attachment, affect regulation and mentalizing capacity in order to listen more sensitively and respond and interpret more accurately to patients, which will enhance treatment persistence and outcomes.
- Recognize the effects of early relational trauma, better empathize with unbearable affect and receive and metabolize projective communication more effectively in order to facilitate improvement in patients’ reflective capacity, self-cohesion and affect regulation.
- Develop an understanding of the process of building representations in an internal world in order to better formulate patients’ material and improve treatment efficacy.
- Recognize relationships between projections, objects and introjects in patients’ internal worlds in order to listen and analyze relationships that generate meaning between internal objects and between the internal and external world.
September 7, 2018 — Origins of the Self
[18 pages]In this introductory session, we will begin to explore the question of how we become who we are. We will begin by considering the internal and external conditions that contribute to development of the child’s mind/body/self experience. The external family is the matrix for the child’s development. The child’s contribution to their development is the manner in which experience of the family is processed.
Required Readings: [53 pages]
Optional Readings: [11 pages]
Klein, M. (1958). On the Development of Mental Functioning. Int. J. Psycho-Anal., 39:84-90.
Winnicott, D.W. (1960). The Theory of the Parent-Infant Relationship. Int. J. Psycho-Anal., 41:585-595.
Stern, D.N. (1985). The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology. New York: Basic Books.
Read Chapters 6 (“The Sense of a Subjective Self I: Overview”), and 7 (“The Sense of a Subjective Self: II. Affect Attunement”), pp. 124-161.
Optional Reading
Winnicott, D.W. (1975). Through Paediatrics to Psycho-Analysis. The International Psycho-Analytical Library, 100:1-325. London: The Hogarth Press and the Institute of Psycho-Analysis.
Read “Mind and its Relation to the Psyche-Soma”, pp243-254.
September 14, 2018 — Ideas about Developmental Progression - Positions
[50 pages]Another way to think about development is as a three-dimensional spiral, one that begins small and ends wide. The movement occurs via a dialectical interaction between the three positions as originally conceptualized by Melanie Klein – the autistic-contiguous, paranoid-schizoid and depressive positions. All three remain active throughout life. This session will introduce progression as the interaction between internal factors that contribute to the generation of the meaning of experience.
Required Readings: [36 pages]
Optional Readings: [36 pages]
Ogden, T.H. (1989). On the Concept of an Autistic-Contiguous Position. Int. J. Psycho-Anal., 70:127-140.
Klein, M. (1946). Notes on Some Schizoid Mechanisms. Int. J. Psycho-Anal., 27:99-110.
Segal, H. (1979) “The Depressive Position” in Introduction to the Work of Melanie Klein, pp67-90.
Read pages 78-90.
Optional Reading
Pick, I.B. (1992). The Emergence of Early Object Relations in the Psychoanalytic Setting. New Library of Psychoanalysis, 14:24-33.
Riviere, J. (1936). On the Genesis of Psychical Conflict in Earliest Infancy. Int. J. Psycho-Anal., 17:395-422.
September 21, 2018 — Ideas about Developmental Progression - Stages
[42 pages]Mahler’s conceptualization of the separation-individuation process, particularly her ideas about rapprochement, development in symbolic representation, rupture and repair, affective attunement and libidinal object constancy continue to have relevance today. We will explore Mahler’s four subphases of separation-individuation and contemporary perspectives that integrate Mahler’s concepts with attachment theory.
Required Readings: [39 pages]
Optional Readings: [59 pages]
Mahler, M.S. (1972). On the First Three Subphases of the Separation-Individuation Process. Int. J. Psycho-Anal., 53:333-338.
Mahler, M.S. (1972). Rapprochement Subphase of the Separation-Individuation Process. Psychoanal Q., 41:487-506.
Bergman, A. Harpaz-Rotem, I. (2004). Revisiting Rapprochement in the Light of Contemporary Developmental Theories. J. Amer. Psychoanal. Assn., 52(2):555-570.
Optional Reading
Gergely, G. (2000). Reapproaching Mahler: New Perspectives on Normal Autism, Symbiosis, Splitting and Libidinal Object Constancy from Cognitive Developmental Theory. J. Amer. Psychoanal. Assn., 48(4):1197-1228.
Furman, R.A. Furman, E. (1984). Intermittent Decathexis—A Type of Parental Dysfunction. Int. J. Psycho-Anal., 65:423-433.
Seligman, S. (2016). Disorders of Temporality and The Subjective Experience of Time: Unresponsive Objects and the Vacuity of the Future. Psychoanal. Dial., 26(2):110-128.
September 28, 2018 — Attachment Theory
[66 pages]Attachment theory and research has helped us understand how infants are intrinsically motivated to preserve relationships with their caregivers, how disruption in primary attachment relationships creates vulnerability in cohesion, affective experience and ways of relating and how patterns of attachment create psychological structure. Listening to patients with an ear to attachment patterns and compromises allows an analyst to understand the underlying dynamics of a patient’s psychic structure and how to work with these dynamics in the clinical realm.
Required Readings: [57 pages]
Optional Readings: [46 pages]
Sroufe, L.A. (2017) Ch1, “Attachment Theory: A Humanistic Approach for Research and Practice Across Cultures” in Attachment Across Clinical and Cultural Perspectives: A Relational Psychoanalytic Approach, New York: NY. Routledge. pp1-24.
Slade, A. (2000). The Development and Organization of Attachment: Implications for Psychoanalysis. J. Amer. Psychoanal. Assn., 48(4):1147-1174.
Slade, A. (2014). Imagining Fear: Attachment, Threat, and Psychic Experience. Psychoanal. Dial., 24(3):253-266.
Optional Reading
Tronick, E. (2002). The Increasing Differentiation and Nontransferability of Ways of Being Together. J. Infant Child Adolesc. Psychother., 2(4):47-60.
Fonagy, P. (2001) "Key Findings of Attachment Research", from Attachment Theory and Psychoanalysis, pp19-46
Seligman, S. (2000). Clinical Implications of Current Attachment Theory. J. Amer. Psychoanal. Assn., 48(4):1189-1194.
October 5, 2018 — Affect, Regulation and Sense of Self
[60 pages]Understanding affective experience in an attachment context is central to understanding patients’ sense of themselves, their experience of feeling states and their experience of the analytic relationship. Recent interdisciplinary and neurobiological research efforts have emphasized the centrality of affect and patterns of mutual regulation in attachment processes and developing modes of self-regulation (or dysregulation).
Required Readings: [45 pages]
Optional Readings: [32 pages]
Pedersen, S.H. Poulsen, S. Lunn, S. (2014). Affect Regulation: Holding, Containing and Mirroring. Int. J. Psycho-Anal., 95(5):843-864.
Furman, E. (1992). On Feeling and Being Felt with. Psychoanal. St. Child, 47:67-84.
Beebe, B.; Lachmann, F.; Markese, S.; Bahrick, L. (2012). On the Origins of Disorganized Attachment and Internal Working Models: Paper I. A Dyadic Systems Approach. Psychoanal. Dial., 22(2):253-272.
Please read pages 261-268, beginning with heading “Early Interaction Patterns of Infant Procedural Forms of Self and Object Representations.”
Optional Reading
Fonagy, P. Target, M. (2002). Early Intervention and the Development of Self-Regulation. Psychoanal. Inq., 22(3):307-335.
Schore, J.R. and Schore, A.N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal 36:9-20. Handout by request [11 pages].
Eekhoff, J.K. (In Press) Affective Bridges Between Body and Mind. In Trauma and Primitive Mental; States: An Object Relations Perspective. Handout by request New York:NY. Routledge.
October 12, 2018 — Projection, Introjection and Identification I
[47 pages]Finding the self in the other requires the child to look for something. Young children discover the me and not me through their identifications with their parents and caregivers. This process requires a psychic movement out and a psychic movement in – much like breathing or the digestive process of taking food in, making use of what is good and then eliminating what is not.
This session will examine fundamental ways in which experience is accepted or rejected and how these accumulate for the development of a sense of self. In the beginning this process is very primitive and involves fragmented bits and pieces. Splitting processes predominate as a means of tolerating excessive stimulation.
Required Readings [44 pages]
Optional Readings: [28 pages]
Feldman, M. (1992). Splitting and Projective Identification. New Library of Psychoanalysis, 14:74-88.
Meltzer, D. (1975). Adhesive Identification. Contemp. Psychoanal., 11:289-310.
Alvarez, A. (2018). The Concept of the Internal Object: Some Defining Features. Psychoanal. Dial., 28(1):25-34.
Optional Reading
Sandler, J. Rosenblatt, B. (1962). The Concept of the Representational World. Psychoanal. St. Child, 17:128-145.
Sandler, J. Sandler, A. (1978). On the Development of Object Relationships and Affects. Int. J. Psycho-Anal., 59:285-296.
October 19, 2018 — Projection, Introjection and Identification II
[57 pages]As the young child relies so thoroughly on the whole person and personality of the caregivers, those caregivers become extremely important. In the first five years, the child’s concern for the other influences how the child learns and behaves. The child’s capacity to integrate and respond as a whole person – with good and bad traits – to loved others (Objects) with good and bad traits enables the child to elaborate and learn from experience. The child’s relationship to fear of loss will be explored.
Required Readings: [51 pages]
Optional Readings: [22 pages]
Ogden, T.H. (1984). Instinct, Phantasy, and Psychological Deep Structure—A Reinterpretation of Aspects of the Work of Melanie Klein. Contemp. Psychoanal., 20:500-525.
Seligman, S. (1999). Integrating Kleinian Theory and Intersubjective Infant Research: Observing Projective Identification. Psychoanal. Dial., 9(2):129-159.
Optional Reading
Alvarez, A. (2006). Some questions concerning states of fragmentation: unintegration, under-integration, disintegration, and the nature of early integrations. J. Child Psychother., 32(2):158-180.
October 26, 2018 — Psychic Reality and Mentalization
[65 pages]Language and symbolization enable increasingly more and more mental complexity, as well as an ability to tolerate emotional experiences via symbolization and the capacity to play. Caregivers help young children think about their own and others’ minds, creating a transitional space for play and reality testing. We will explore the concept of mentalization and how trauma can compromise mentalizing capacity and self-regulation.
Required Readings: [37 pages]
Optional Readings: [70 pages]
Fonagy, P. Target, M. (1996). Playing With Reality: I. Theory Of Mind And The Normal Development Of Psychic Reality. Int. J. Psycho-Anal., 77:217-233.
Fonagy, P. Target, M. Gergely, G. Allen, J.G. Bateman, A.W. (2003). The Developmental Roots of Borderline Personality Disorder in Early Attachment Relationships: A Theory and Some Evidence. Psychoanal. Inq., 23(3):412-459.
Optional Reading
Lichtenberg, J.D. (2003). Communication in Infancy. Psychoanal. Inq., 23(3):498-520.
Beebe, B.; Lachmann, F. (2002). A Dyadic Systems View. Infant Research and Adult Treatment, Hillsdale, N.J.: The Analytic Press, pp21-44.
Winnicott, D.W. (1971). Playing and Reality. London: Tavistock Publications. pp38-52
Klein, M. (1929). Personification in the Play of Children. Int. J. Psycho-Anal., 10:193-204.
November 2, 2018 — Dimensionality – Triadic Relations
[39 pages]The movement from one person to two person to three person relating is accompanied by an internal capacity to tolerate more than one thought and relationship at a time. We will discuss the contemporary idea of psychic dimensionality and its relationship to the early ideas of the oedipal situation. We will also explore how ideas of sameness and difference contribute to a capacity to think abstractly.
Required Readings: [38 pages]
Optional Readings: [13 pages]
Edgcumbe, R. Burgner, M. (1975). The Phallic-Narcissistic Phase—A Differentiation Between Preoedipal and Oedipal Aspects of Phallic Development. Psychoanal. St. Child, 30:161-180.
Alvarez, A. (1998). Failures to Link: Attacks or Defects? Some Questions Concerning the Thinkability of Oedipal and Pre-Oedipal Thoughts. J. Child Psychother., 24(2):213-231.
Optional Reading
Klein, M. (1928). Early Stages of the Oedipus Conflict. Int. J. Psycho-Anal., 9:167-180.
November 9, 2018 — Gender Development
[55 pages]The concept of gender identity development has undergone intense evolution in the past thirty years. We will explore the construct of gender as a process of self and body experience, differentiation, identification, disidentification, complementarity and the capacity for living with contradiction.
Required Readings: [48 pages]
Optional Readings: [45 pages]
Person, E.S.; Ovesey, L. (1983). Psychoanalytic Theories of Gender Identity. J. Amer. Acad. Psychoanal., 11(2):203-226.
Fast, I. (1990). Aspects of early gender development: Toward a reformulation, Psychoanalytic Psychology, 7:105-117
Benjamin, J. (1995). Sameness and Difference: Toward an “Overinclusive” Model of Gender Development. Psychoanal. Inq., 15(1):125-142.
Optional Reading
Tyson, P. (1989). Infantile Sexuality, Gender Identity, and Obstacles to Oedipal Progression. J. Amer. Psychoanal. Assn., 37:1051-1069.
Harris, A. (1991). Gender as Contradiction. Psychoanal. Dial., 1(2):197-224.
November 16, 2018 — Superego Development and Shame
[85 pages]As development progresses, differentiation of self and other and the developing child’s need to negotiate between their own wishes, ideals and their ideas and fantasies about the expectations of important others come under the structure of the developing superego. Affective tone and attunement have a significant effect on the superego. We will consider the superego’s function in affect regulation and the neurobiologic and relational aspects of shame.
Required Readings: [51 pages]
Optional Readings: [9 pages]
Tyson, P; Tyson, R. (1990). Development of the Superego. In Psychoanalytic Theories of Development: An Integration, New Haven: Ct. Yale University Press. pp 207-227
Schore, A.N. (1991). Early Superego Development: The Emergence of Shame and Narcissistic Affect Regulation in the Practicing Period. Psychoanal. Contemp. Thought, 14(2):187-250.
Optional Reading
Klein, M. (1948). A Contribution to the Theory of Anxiety and Guilt. Int. J. Psycho-Anal., 29:114-123.