Middle Phase

Second Year Adult Psychoanalytic Training (APT)
2021-22, 2nd Trimester — Fridays, 3:30-5:00pm
Katherine Weissbourd, PhD


Introduction

The Middle Phase is that period in psychoanalysis between the Opening Phase and Termination. This class will offer a broad overview of theories and techniques, with a focus on clinical practice. Please be prepared to bring in relevant examples from your clinical work.

December 3, 2021 — What is mutative in analysis

See if you can connect Poland’s idea of the interpretive attitude to Busch’s concept of the capacity to represent. Do you find one or the other of these more helpful as you develop your analytic practice?

Pages: 26

Poland, W.S. (2002). The Interpretive Attitude. J. Amer. Psychoanal. Assn., 50(3):807-826.

Busch, F. (2013). Changing views of what is curative in 3 psychoanalytic methods and the emerging, surprising common ground. Scand. Psychoanal. Rev., 36(1):27-34.

December 10, 2021 — Defenses and interpretation

Russell begins with the classic Freudian theory of the repetition compulsion. Although the language is traditional, the overall perspective is one of maintaining a therapeutic relationship as a source of security and emotional contact, so that traumatic repetition can be relinquished.

Reed then presents two approaches to this:  Ferro wants to stay right with his patients, constructing a narrative that keeps them engaged as they develop an understanding of their inner states. Arlow remains focused on the patient’s internal conflicts between wish and defense. His stance is interpretive, and keeps more of a distance between the minds of the analyst and the patient. When is each approach useful, and why?

Pages: 34

Russell, P. (1998) The Role of Paradox in the Repetition Compulsion in Trauma,Repetition, and Affect Regulation; The Work of Paul Russell, pp1-22

Reed, G.S. (2015). Visions of Interpretation: Ferro’s Bicycle and Arlow’s Home Movie Screen. Psychoanal. Inq., 35(5):465-477.

January 7, 2022 — Transitional space in psychoanalysis

Drawing from the contributions of both Anna Freud and Melanie Klein, as well as his own work with children, Winnicott formulated a theory of technique that incorporated mutual influence and the co-construction of the therapeutic environment. His work has been very influential in the Independent Tradition (Middle School) in British psychoanalysis. These papers address the strong countertransference feelings that can be evoked in psychoanalytic work, as well as the need to make space for new and creative experiences in treatment. Do you find Winnicott’s use of the emotional experience of the caregiver and the infant useful for your clinical work? How do you understand transitional space in the analytic relationship?

Pages: 22

Winnicott, D.W. (1947). Hate in the Countertransference in Through Paediatrics to Psycho-Analysis: Collected Papers.  New York: Brunner-Mazel (1992) pp.194-203.

Winnicott, D.W. (1975). Through Paediatrics to Psycho-Analysis, Ch17 “Transitional Objects and Transitional Phenomena”, pp229-242

January 14, 2022 — Listening to clinical material

Donnel Stern represents the interpersonal perspective that was developed at the White Institute. He identifies 3 models of therapeutic action that are used in psychoanalysis: interpretive, developmental/provisional, and mutual influence. Can you identify each of these approaches in the clinical material presented in Steven Stern’s description of a challenging clinical case? What are the strengths and weaknesses of each kind of intervention?

Pages: 39

Stern, D.B. (1996). The Social Construction of Therapeutic Action. Psychoanal. Inq., 16(2):265-293.

Read pages 268-288 only.

Stern, S. (2014). A 9-Year Analysis With a Connection-Resistant Patient: Theory, Reality, and the Messiness of Therapeutic Action. Int. J. Psychoanal. Self Psychol., 9(3):179-192.

January 21, 2022 — The analyst’s subjectivity

Kohut’s classic paper on introspection and empathy introduced the phenomenological perspective of self psychology, which would be developed in his book The Analysis of the Self, published in 1971. As Teicholz asks: how can we use our subjectivity in our work, while at the same time keeping our responsibility to help the patient at the forefront of the analytic exchange? And, if patient and analyst are truly equal partners, why should the analyst feel responsibility to protect and provide for the patient in any privileged way? Discuss ‘normative inequality.’ How would you contrast the views of Teicholz with the idea in Kohut’s article that ‘the analyst, to the extent that he is a transference figure, is not experienced in the framework of an interpersonal relationship but as a carrier of unconscious endopsychic structures’?

Pages:49

Mid-term evaluations should be conducted in the closing minutes of your classes today. This is a discussion that should be allowed at least 10 minutes, but no more than 30 minutes. No written records are necessary.

Midterm Class Evaluation Discussion Questions

Teicholz, J.G. (1998). Chapter 16 Self and Relationship: Kohut, Loewald, and the Postmoderns. Progress in Self Psychology, 14:267-292.

Kohut, H. (1959). Introspection, Empathy, and Psychoanalysis—An Examination of the Relationship Between Mode of Observation and Theory. J. Amer. Psychoanal. Assn., 7:459-483.

January 28, 2022 — Transference and countertransference

Strong feelings are mobilized in analysis on both sides of the couch, both positive and negative. These authors come at this problem from differing vantage points. What are the pros and cons of Fosshage’s ‘expecting rejection’ and/or Coen’s ‘thrall of the negative’?

Pages: 45

Coen, S.J. (2003). The Thrall of the Negative and How to Analyze it. J. Amer. Psychoanal. Assn., 51(2):465-489.

Fosshage, J.L. (2007). Searching for Love and Expecting Rejection: Implicit and Explicit Dimensions in Cocreating Analytic Change. Psychoanal. Inq., 27(3):326-347.

February 4, 2022 — Perspectives on analytic process

Glen Gabbard and Drew Westen offer a pluralistic approach to therapeutic action. Rather than continuing a debate about “interpretation vs. relationship”, they embrace a broad view of techniques and strategies, conscious and unconscious, influencing change in treatment. Slavin and Kriegman develop a model of treatment based on the belief that conflict is inherent in the analytic relationship, as both parties are impacted by their individual subjectivities. How do you incorporate multiple perspectives into your work?

Pages: 44

Gabbard, G.O. Westen, D. (2003). Rethinking therapeutic action. Int. J. Psycho-Anal., 84(4):823-841.

Slavin, M.O. and Kriegman, D. (1998). Why the Analyst Needs to Change: Toward a Theory of Conflict, Negotiation, and Mutual Influence in the Therapeutic Process. Psychoanal. Dial., 8(2):247-273

Pages 274-284 optional but recommended.

 

February 18, 2022 — Reverie and subjectivity

How much should we rely on our own subjectivity as a guide to the unconscious processes of our patients? Here are two examples of the role that reverie and countertransference can play in our work. Can you think of times when your thoughts have led you to a new insight about a patient? Or perhaps, as Jacobs discusses, a sign of blindness or confusion? How do we make the best use of our subjectivity?

Pages: 44

Ogden, T.H. (2004). The Analytic Third: Implications for Psychoanalytic Theory and Technique. Psychoanal Q., 73(1):167-195.

Jacobs, T.J. (2001). On Misreading and Misleading Patients: Some Reflections on Communications, Miscommunications and Countertransference Enactments. Int. J. Psycho-Anal., 82(4):653-669.

February 25, 2022 — Identity, splitting, and multiple self-states

Bromberg’s writing introduces two important concepts that are valuable in treating trauma. The first is dissociation, and its manifestation as multiple self- states, as they impact analytic process. Secondly, he highlights the role of dialogue, both internal and interpersonal, as playing a curative role in reducing dissociation and denial. Can you think of ways that dissociation impacts your clinical experience? The second article addresses a child’s gender identity struggles as an expression of self, and how analysis can support identity formation.

Pages: 53

Bromberg, P.M. (2003). One Need Not Be a House to Be Haunted: On Enactment, Dissociation, and the Dread of “Not-Me”—A Case Study. Psychoanal. Dial., 13(5):689-709.

Saketopoulou, A. (2014). Mourning the Body As Bedrock: Developmental Considerations in Treating Transexual Patients Analytically. Journal of the American Psychoanalytic Association. 62 (5): 773-806.

March 4, 2022 — Enactment

Is enactment part of a containing process or antithetical to containment? Does Ted Jacobs’s paper shed light on this question? Try to bring examples of enactment as you understand it from your own work.

Pages: 38

Ivey, G. (2008). Enactment Controversies: A Critical Review of Current Debates. Int. J. Psycho-Anal., 89(1):19-38.

Jacobs, T.J. (2001). On Unconscious Communications and Covert Enactments: Some Reflections on Their Role in the Analytic Situation. Psychoanal. Inq., 21(1):4-23.

March 11, 2022 — Implicit relational processes

Holly Levenkron provides a good introduction to the important work of the Boston Change Process Study Group. She then provides a critical review of the ways that implicit relational process resembles, and differs from, relational psychoanalysis. How do “sloppiness” and “enactment” resemble each other? How are they different?

Pages: 36

Levenkron, H. (2009). Engaging the Implicit: Meeting Points between the Boston Change Process Study Group and Relational Psychoanalysis. Contemp. Psychoanal., 45(2):179-217.

Read pages 179-202 only.

Boston Change Process Study Group (2005). The “Something More” than Interpretation Revisited: Sloppiness and Co-Creativity in the Psychoanalytic Encounter. J. Amer. Psychoanal. Assn., 53(3):693-729.

Read pages 702–715 only.