Adult Psychoanalytic Psychotherapy (APP)
2018-19, 1st Block — Mondays, 8:00-9:15pm
Scot Gibson, MD
Table of Contents
Introduction
The goal of this class is to give you a beginning framework for your own understanding of psychoanalytic theory and thought.
"Psychoanalytic Theory" is an enormous, sprawling body of thought and ideas, which has been aggregating over the last 123 years (or longer, depending on how you count), and learning it is a long-term process. There is no one single, definitive interpretation of this body of work, and the job of the psychoanalytically-informed therapist is to continually take what they learn (from both theorists and from their patients) and add it to their own personal synthesis.
In this class, we will hit a few of the "high points" or important nodes among the branches and schools of thought. Each class, or part of a class, devoted to particular figure or set of ideas will necessarily be a very cursory and incomplete discussion -- really only a taste of each line of thought. My hope is that by having this broad, partial overview, you will be able to more readily make connections, comparisons, and contrasts among the various thinkers and ideas as you study them in more depth in subsequent classes.
These connections are important, because along the history of psychoanalytic thought, each new idea has been built upon the ideas which came before it, and the newer ideas often carry (implicitly or explicitly) a useful critique of the prior ways of thinking. Thus, by following the historical progression of ideas, you can see the strengths of the new theory, and the limitations of the older theory that the newer one was hoping to address. This can help you understand both theories more fully.
In the process of creating their own ways of practicing, individual therapists will often gravitate to one or two areas of the larger world of psychoanalytic theory that particularly suits them. For instance, a therapist might say "I'm a self psychologist", or "I mostly work within an object-relations framework, with some influences from the relational world." Regardless of what pieces you put together to create your own practice style, having the larger picture of how everything fits together will bring greater understanding and richness to your practice.
September 17, 2018 — Introduction
[16 pages]LaFarge, L. (2017). From “Either/Or” to “And”: The Analyst’s Use of Multiple Models in Clinical Work. J. Amer. Psychoanal. Assn., 65(5):829-844.
This is a recent article from a major psychoanalytic journal which discusses the use of theory, including the “personal core theories” that individual therapists and analysts work from, and how new theoretical ideas get assimilated (or not). I think she begins to get down into the nitty-gritty of how theory shapes our listening. To quote: “It is a truism of psychoanalysis that theory should never be in the foreground of the analyst’s mind in the clinical moment, but that at the same time an analyst cannot listen analytically without theory in the background of her thinking.”
September 24, 2018 — Freud and His Followers (through Ego Psychology)
[56 pages]Mitchell, S.A.; Black, M.J. (2016) Ch1, “Sigmund Freud and the Classical Psychoanalytic Tradition” in Freud and Beyond: A History of Modern Psychoanalytic Thought (2nd Edition). Basic Books, New York. pp1-22.
This book is an excellent primer on psychoanalytic theory, very readable and clear. Stephen Mitchell is widely considered to be one of the founders of the modern relational movement in psychoanalysis, and as such is one of the great figures of the field. This chapter summarizes the basics of Freud’s work.
Auchincloss, E. (2015) Ch8: “A New Configuration and a New Concept: The Ego” in The Psychoanalytic Model of the Mind. American Psychiatric Publishing. pp129-143.
Auchincloss, E. (2015) Ch10, “Conflict and Compromise” in The Psychoanalytic Model of the Mind. American Psychiatric Publishing. pp167-185.
These chapters are from a reference work which we will be using often this class. The chapters summarize what I think are the most clinically relevant areas of ego psychology — the Structural Model; the concepts of ego function and ego adaptability; and the concepts of conflict, defense, and compromise formation.
In this book, Auchincloss does a reasonably nice job of putting complex ideas into readable, digestible, encyclopedic form. She can be a bit dry, and she has a very ego psychological slant on psychoanalysis which sometimes colors her generalizations and her readings of other theories. She continually talks about “the psychoanalytic model” as if it were a unified theory of some sort, and not a collection of often disparate models. Despite these fairly minor criticisms, I find this to be a very useful reference.
Optional Reading
Colombo, D. (2012) Ch1 "Freud and His Circle.” in Textbook of Psychoanalysis, 2nd Ed (Gabbard, Litowitz, and Williams, Eds.) American Psychiatric Publishing, pp3-17
Daria Colombo, who used to live in Seattle (she now lives in NYC) and is on faculty at SPSI, did a nice job here of condensing a LOT of history and theory into a readable chapter.
October 1, 2018 — Melanie Klein and Object Relations
[46 pages]Erwin, E. (2002) “Kleinian Theory” from The Freud Encyclopedia: Theory, Therapy, and Culture. Routledge, New York and London. pp305-309.
Auchincloss, E. (2015) Ch11, “Object Relations Theory” in The Psychoanalytic Model of the Mind. American Psychiatric Publishing. pp189-217.
These two reference articles should give you a good overview of the salient points of Kleinian (and others’) object relations theory. The article from The Freud Encyclopediagives an overview of Melanie Klein’s theory, while the Auchincloss goes into other theorists’ elaborations of object relations theories. (The Meltzer chapter below, though, should help you understand why it is important.)
Meltzer, D. (2009) Ch3, “The Klein-Bion Expansion of Freud’s Metapsychology” in Dream Life. Karnac. pp36-47.
Meltzer is a wonderful, passionate, and very direct writer, and in this short passage he walks the reader from Freud, through Klein, and into the ideas of Klein’s successor Wilfred Bion. As he does so, he make it clear why the Kleinian revolution was necessary, and the crucial change in emphasis that her and her successor’s ideas brought to psychoanalysis. This chapter was one of the most important texts that I read as I was becoming a psychoanalyst, and reading it gave me an “aha” moment about object relations that helped me understand that theory like nothing else ever did.
Optional Reading
Clarkin, J.F.; Yeomans, F.E.; and Kernberg, O. (1999) Excerpt from Ch1 "The Nature of Borderline Personality Organization" in Psychotherapy for Borderline Personality: Focusing on Object Relations, pp1-17
Otto Kernberg, who has been writing since the 1960s to the present day, is a great synthesizer. He has created a particular take on psychoanalytic theory which is an attempt to bridge ego psychology and object relations theories. He has been very influential especially in America, as the Psychoanalytic Diagnostic Manual (PDM), which was created in part to counter the reductionist methods and philosophy of the psychiatric DSM, is based largely on his theoretical system. His Transference-Focused Psychotherapy (TPP) is a psychoanalytically-based, manualized therapy for borderline personality disorder which has been shown to be superior to other treatments (including dialectical behavior therapy) in several ways. I think of him as one of the last, and one of the most useful, of the classical “old-guard” psychoanalytic thinkers.
October 8, 2018 — Winnicott and the Independents
[51 pages]Parsons, M. (2009). An Independent Theory of Clinical Technique. Psychoanalytic Dialogues, 19:221-236.
NOTE: Read ONLY through the paragraph which finishes at the top of page 223, which ends with the line “…rather than on how they exemplify general principles.”
This brief snippet of a larger article explains how and why the group of analysts known as the “Independent Group” formed within the British Psychoanalytical Society. I’m not sure what I think of Parson’s larger point about “Independent Theory” as a sort of theoretical open-mindedness, but I appreciate his short history. Prominent analysts from the Independent Group (sometimes called the “Middle Group”) were D.W. Winnicott, John Bowlby, Michael Balint, Masud Khan, Marion Milner, Ronald Fairbairn, and Paula Heimann.
Phillips, A.(1988) Excerpt from Ch3, “War-Time” in Winnicott. Harvard University Press. pp72-76.
Phillips, A. (1988) Ch4, “The Appearing Self” in Winnicott, Harvard University Press. pp98-127.
These two readings, a chapter and another small snippet of another chapter, are from a biographical work on Winnicott by the psychoanalytic writer Adam Phillips. I think he does a very nice job of describing many of Winnicott’s contributions to psychoanalysis. The shorter snippet is a description of Winnicott’s famous “Spatula Game,” an exercise which he used to evaluate the behavior of infants with their mothers. (What would be called a “spatula” in a doctor’s office in Britain would be called a “tongue depressor” in the US.)
Optional Reading
Winnicott, D.W. (1960). The Theory of the Parent-Infant Relationship. Int. J. Psycho-Anal., 41:585-595.
Winnicott, D.W. (1953). Transitional Objects and Transitional Phenomena—A Study of the First Not-Me Possession. Int. J. Psycho-Anal., 34:89-97.
Winnicott, D.W. (1949). Hate in the Counter-Transference. Int. J. Psycho-Anal., 30:69-74.
I’ve included these three optional articles as good representatives of Winnicott’s own work. Unlike many psychoanalytic theorists, Winnicott’s writing is very clear, direct, readable, and relatively jargon-free. It’s worth noting that on Pep-Web (the widely used database for psychoanalytic articles) these are the three most popularly referenced articles on the entire database.
October 15, 2018 — Kohut and Self-Psychology
[25 pages]Shane, M.; Shane, E.; Gales, M. (1997) Excerpt from Ch2, “Essential Features and Origins of the Model” in Intimate Attachments: Toward a New Self Psychology. pp10-16.
Auchincloss, E. (2015) Ch12, “Self Psychology” in The Psychoanalytic Model of the Mind, American Psychiatric Publishing. pp219-236.
Heinz Kohut, originally from Austria, was based in Chicago. He wrote several influential papers through the 1950s and the 1960s which culminated in his landmark 1971 book The Analysis of the Self. Originally conceived as an elaboration of Freud’s work, his ideas fostered a new major school of psychoanalysis. Self Psychology described a new theoretical construct, the self, which had its own developmental trajectory, its own contributions to healthy function (including self-esteem, ambition, and ideals) and its own set of potential pathologies (most notably pathological narcissism). Self Psychology also developed a new set of clinical techniques for the clinician to employ, based on empathic attunement.
The Auchincloss, as usual, will give a workable overview of the salient points of Self Psychology. The excerpt from Shane, Shane, and Gales is basically a short list of the major features of the theory by practitioners who are themselves prominent Self Psychologists.
October 22, 2018 — Attachment Theory
[52 pages]Holmes, J. (2001) Ch 1-3 in The Search for the Secure Base: Attachment Theory and Psychoanalysis. Brunner-Routledge, London. pp1-34
Attachment theory has become increasingly important in psychoanalysis, though it used to be considered a separate field. Holmes’s book, now 17 years old, was written as an attempt at helping bring the two together. The first three chapters, presented here, provide a good summary of John Bowlby’s attachment theory and how it has come to be important for psychoanalytic thought.
Fonagy, P. (2000) Attachment and Borderline Personality Disorder, Journal of the American Psychoanalytic Association. 48:1129-1146.
This is a good, straightforward account by Sir Peter of his theory of mentalization and reflective function (which derive from child/infant research and from Bowlby’s attachment theory), the importance of these capacities in the development of the child, and how they are used in his treatment for borderline personality disorder.
Fonagy, along with his frequent co-author Anthony Bateman, have developed their theories into a manualized treatment called “Mentalization-Based Treatment”. Click here for a link to the standard reference for this therapy.
October 29, 2018 — The Relational Turn
[37 pages]Maroda, K.J. (1999) Ch1, “On Seduction, Intellectualization, and the Bad Mother: Underlying Assumptions in Psychoanalysis” in Seduction, Surrender, and Transformation: Emotional Engagement in the Analytic Process. The Analytic Press. pp11-47.
Karen Maroda is a clear, no-nonsense writer from Wisconsin, and a leading thinker in what is known as ‘the relational turn’ in psychoanalysis. This book is a bit of a relational manifesto, and the first chapter hits many of the important theoretical points of the relational movement: the emphasis on emotions over intellect in the analytic relationship; the use of enactments; the use of self-disclosure; and the absolute necessity of emotional engagement on the part of the analyst.
Optional Reading
Benjamin, J. (2004). Beyond Doer and Done to: An Intersubjective View of Thirdness. Psychoanal Q., 73(1):5-46.
Jessica Benjamin is one of the most prominent figures in the relational world, as well as in feminist psychoanalysis (the two areas have much overlap). This article, one of her most cited, develops her idea of mutual recognition – ‘a relation in which each person experiences the other as a “like subject,” another mind who can be “felt with,” yet has a distinct, separate center of feeling and perception.’ The article also introduces the idea of thirdness, which is a frequently encountered idea in relational literature.
November 5, 2018 — Sexuality and Queer Theory
[29 pages]Lemma, A. (2013). The body one has and the body one is: Understanding the transsexual’s need to be seen. International Journal of Psychoanalysis 94:277-292.
Alessandra Lemma (biography) is a fantastic writer and thinker on gender, sexuality, and psychoanalysis, and this article is no exception. Her extremely thoughtful and sensitive presentation of her transsexual patient’s struggles with embodiment really brings the concept alive. It’s yet another example of how a thoughtful, curious approach to non-normative trends in human experience can illuminate important concepts in all human experience. Here, her work to understand this particular transsexual person’s struggles and vicissitudes with embodiment and with being seen by another can open up the concepts of embodiment and exhibition for all cases. To quote: “The plight of the transsexual exposes in possibly the most extreme manner the developmental challenge we all have to negotiate and to which we all find compromise solutions, namely how to transform the body one has into the body one is, or, to use a Winnicottian (1970) term, how to ‘personalize’ it.”
Corbett, K. (1993). The Mystery of Homosexuality. Psychoanal. Psychol., 10:345-357.
Corbett wrote important, groundbreaking articles on homosexuality during a time when the field was changing from “gay as pathology” to “gay as normal variation.” Academics and activists had been critiquing psychoanalytic theories of sex, gender, and sexuality for decades, but what was different about Corbett and other authors from this period (like Kenneth Lewes, Mark Blechner, Ralph Roughton, Muriel Dimen, Adrienne Harris) is that they critiqued psychoanalytic theory from withinpsychoanalysis, by bringing in new viewpoints, and showing how a better understanding of sex, gender, and sexuality would enrich psychoanalysis as a whole. Corbett here theorizes the intersection of sexuality and gender in male homosexuality as a new type of masculine/paternal identification which must incorporate both active identification with the father and passive longing for the father, as opposed to older theories which postulated a solely passive/feminine/maternal identification and thus left analysts mystified at any signs of masculinity in homosexual men.
Optional Reading
Herzog, D., (2015) Ch1, "What happened to psychoanalysis in the wake of the sexual revolution?" in Sexualities: Contemporary Psychoanalytic Perspectives, eds A. Lemma and P.E. Lynch, pp19-40.
Herzog (biography) does a nice job here of going over some of the history of sexuality within psychoanalysis. Note her description of how psychoanalysts changed their theories to keep from having to acknowledge their own biases and conflicts — if we were putting psychoanalysis itself “on the couch”, we could consider this “defensive” use of theory as a form of analytic resistance.
Chodorow, N.J. (1992). Heterosexuality as a Compromise Formation: Reflections on the Psychoanalytic Theory of Sexual Development. Psychoanalysis and Contemporary Thought, 15:267-304.
This article is an examination of the way in which historical biases against homosexuality and other non-normative sexualities kept many basic concepts in psychoanalysis (such as “heterosexuality”) under-theorized. As Chodorow says in her abstract: “Subjecting our accounts of heterosexuality to scrutiny gives us a greater sense of its contours and of the questions we still need to ask in order to understand heterosexuality as well as we understand other sexualities.”