Loss, Mourning, and Termination

Integrated Child & Adult Psychoanalytic Psychotherapy (ICAPP)
2021-22, 4th Block — Mondays, 6:30-7:45pm
Ann De Lancey, PhD


Introduction

I am excited to join you in reflecting on the issues of loss, mourning, and termination. These topics hold some of the most profound and basic issues that we as humans face: issues of existence and non-existence, life and death, love and loss, human and clinical limitations.  Analytic wisdom on facing and dealing with all losses (developmental steps, transitions, separations, relationship endings, injury, illness, aging, termination, and death) is rich and varied. Some of the most moving ideas about what is helpful and mutative involve the processes of interpretation, internalization, transformation, and creation. A relatively recent ontological shift reflects a fundamental commitment to the principle of being and becoming in the experience rather than epistemological exploration.

Reading

When you engage with each article, try to let yourself float into the experience the words, stories, and images spark in you. What dreams (night or day) do they engender? What pictures form in your mind? What movies do they call forth? What associations? Personal memories? Anything goes. Please jot down (or hold in your mind) at least three of these associations that you have to the article.  (I have only assigned one article with the exception of the last meeting. I’d rather we go deep and free with one paper than two. For the last meeting I also have assigned a YouTube seminar, which you can just listen to as a podcast. You may want to listen to that sooner, as it addresses the issue of who we are as a person/citizen and the relationship between the role we had in our family and the person we are now.)

Process

I’d like for us to try to create a space for us to inch our way into what each of us feels and thinks about losses, how to best get through them, deal with them, learn from them, grow from them. What in your bones do you feel is mutative? I would prefer, rather than a heady conversation about theory X or Y, that we ground ourselves in what each of us believes from our personal experience, our own self-reflections and therapy, clinical work, observation, these readings and our discussion.

Let’s see what wisdom our individual and group unconscious sheds on these existential issues. Let’s leave room to sit with your own feelings of being together over this course and the last two years. What do you mean to one another? How has it been to be learning from one another? What role have you taken in this cohort, this seminar? How does that compare to the role you have had in your family of origin? How have you taken in one another and this learning? Where do you want to go?

Goals

One major issue I’d like for us to wrestle with is the question of the relative merits of epistemic knowledge and experiential knowledge. L. A. Paul writes, “… Experiences, as I shall discuss them, have two ways of being transformative. They can be epistemically transformative, giving you new information in virtue of your experience. And they can be personally transformative, changing how you experience being who you are. Some experiences may be epistemically transformative while not being personally transformative, like tasting a durian for the first time. Some experiences may be personally transformative without being epistemically transformative. “

What is your theory and conception of best practices in dealing with loss? And how do you sit with it with someone other than one’s own race, culture, background, privilege?

Learning Objectives

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

  1. name two or three formulations of mourning and melancholia
  2. describe two contemporary psychoanalytic ideas about racial dissociation and racial enactments
  3. describe two useful clinical approach to minimize racial enactment of avoidance or race and racial differences
  4. cite several aspects of our vulnerability working with loss and endings
  5. name three modes of change and growth as one faces loss of any kind
  6. describe the arc of ideas about what is mutative in facing a loss
  7. name three new pieces of information about various aspects of loss, including the experience of loss and change in diverse populations
  8. develop one’s own idea of what is mutative

Clinical Impact of the Knowledge or Skills Gained

Clinicians will:

  1. have a greater ability to name, tolerate, and put into perspective their patients, and their own, feelings about defenses against loss, endings, mortality
  2. be able to face their own losses, endings, and mortality with a greater sense of peace and tranquility
  3. open themselves to varieties of loss including developmental, cultural, racial, minoritarian, etc
  4. enact more creative responses to loss

April 11, 2022 — Mourning and Melancholia Reconceived Racially

[22 pages]

Freud’s paper, “Mourning and melancholia”, (1917), Standard Edition, 14, 237-258 is, of course, the classic analytic paper on loss. Greatly oversimplifying, if one can mourn a loss and take the “shadow of the object” into one without self-reproach, one can avoid melancholia, depression. Weaving in critical race theory and building upon Freud’s and other’s conceptions of mourning and melancholia, David Eng and Shinhee Han explore what they describe as processes of racial melancholia and racial dissociation in U.S. society. Immigration, assimilation, and racialization all involve losses that are not just difficult to mourn but often socially disavowed. They contend that these dynamics are often reproduced and reenacted in the consulting room, rendering Asian Americans either as invisible or as “model minorities.”

Eng, D.L. & Han, S. (2019). Racial melancholia: Model minorities, depression, and suicide. In Racial Melancholia, Racial Dissociation: On the Social and Psychic Lives of Asian Americans. Durham, Duke University Press, pp34-55.

April 18, 2022 — Mourning and Melancholia Reconceived Developmentally through the lens of Klein, Bion, post-Bionian, and field theory

[19 pages]

As is Freud’s “Mourning and Melancholia,” Melanie Klein’s paper “Mourning and its Relation to Manic-Depressive States” is another classic paper. Margot Waddell, unlike Klein, Bion, and many post-Bionian writers makes Kleinian and Bionian thought more accessible. This chapter captures the processes of mourning, loss, and growth in late adolescents and adults using literature.

Waddell, M. (2002) Late adolescence: Fictional lives in Inside Lives: Psychoanalysis and the Growth of the Personality. London; Karnac, pp175-193.

April 25, 2022 — American Independent Psychoanalysis: Being Centered Upon

[10 pages]

Loewald is one of the most beautiful and thoughtful writers in the analytic cannon. Donna Orange, also a good writer, swoops through some of Loewald’s most famous writing. Loewald’s ideas on internalization (very developmentally based) address some of the most important psychological processes around dealing with loss and growth. In one of my favorite passages in analytic literature he says, “The child begins to experience himself as a centered unit by being centered upon.” *

Orange, D. (2014). What kind of ethics? Loewald on responsibility and atonement. Psychoanalytic Psychology. 31, 560-569.

Reference

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

May 2, 2022 — Grief

[29 pages]

Sandra Buechler’s central impetus is the criticality of the emotional experience of both patient and analyst for emotional change. She integrates emotion theory and interpersonal psychoanalysis. She is more open than most analysts about her own emotional life. Grief has been an enduring theme running throughout all her writing. In this paper she develops her vision of loss as an “ever-present, ongoing human experience, concretized and made manifest by a death.” P.148.

Buechler, S. (2008). Grief. Making a Difference in Patients’ Lives. Emotional Experience in the Therapeutic Setting. New York: Routledge, pp137-165.

May 9, 2022 — Endings

[50 pages]

These two papers present versions of a termination process, each also including process material. Cooper writes from an object relations/relational position and Knafo from a more relational home. Pick one reading, whichever appeals to you.

Cooper, S. (2009). Familiar and Unfamiliar Forms of Interaction in the Ending Phases of Analysis, Psychoanalytic Dialogues, 19(5):588-603.

Knafo, D. (2015). Beginnings and endings: Time and termination in psychoanalysis. International Journal of Psychoanalysis. 26, 1-34.

May 16, 2022 — Incalculability of Endings

[16 pages]

Dodi Goldman raises the tension between accountability and desire, treatment and experience. Pulling from literature, philosophy, Freud, Winnicott, and Bion he raises the question of the incalculability of endings.

Goldman, D. (2010). Parting ways. In J Salberg (Ed.) Good Enough Endings: Breaks, Interruptions, and Terminations from Contemporary Relational Perspectives. New York: Routledge, pp241-256.

May 23, 2022 — Psychoanalytic Witnessing and Experiences

[10 pages]

Bruce Reis engages with his patients at deeply unconscious levels and opens doors in his own heart and those of his patients to reach into the mysteries of life. His intellectual span includes Freud, Searles, Winnicott, de M’Uzan, Bion, Ogden, and Spezzano.  In his 2020 book he introduces the notion of “psychoanalytic witnessing,” an experience of enactive witnesses.” He has in mind “an intersubjective concept that is based less on the notion of transforming an experience than transforming the patient’s experience of an experience.” (Reis, 2020, 59, 67). As you read his essay on termination see whether you can imagine yourself into such an experience with your patients or your analyst.

Reis, B. (2010), “Afterwardness and termination” in Good Enough Endings: Breaks, Interruptions, and Terminations from Contemporary Relational Perspectives, Jill Salberg, ed., pp213-222.

Reference

Reis, B. (2020) Performative and enactive features of psychoanalytic witnessing: The transference as the scene of address. Creative Repetition and Intersubjectivity: Contemporary Freudian Exploration of Trauma, Memory, and Clinical Process. New York: Routledge, pp57-72.

June 6, 2022 — Transformations

[21 pages]

Atlas and Aron lead us into the world of transformative experience, moving us from objects of fate to agentic subjects. They explore how we unconsciously anticipate and rehearse for that future. We land in the world of the “prospective function.” “We look forward to, anticipate, envision, and construct future possibilities.” There is also commentary on the transformative function of analysis.

Atlas, G. & Aron, L. (2018) Ch2, “The Prospective Function” in Dramatic Dialogue: Contemporary Clinical Practice, pp21-41.

Listen to Shapiro, E. R. (2021). Why do I have to do this? Institutions, integrity, and citizenship. OFEK Guest Lecture June 6, 2021.