Process: Middle Phase

Adult Psychoanalytic Training (APT)
2019-20, 2nd Trimester — Fridays, 3:30-5:00pm
Christopher J. Keats, MD


The Middle Phase is that period in psychoanalysis between the Opening Phase and Termination.

Learning Objectives

After this class students will be able to:

  1. discuss transference and countertransference as conceived in one person and two person analysis,
  2. discuss what is mutative in psychoanalysis, and
  3. understand when and how to use alternative models of therapeutic process and intervention.

December 6, 2019 — What is Mutative in Analysis

[28 pages]

See if you can connect Poland’s idea of the interpretive attitude to Busch’s concept of the capacity to represent, with examples if possible from your own clinical work.

26 pages of reading.

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 13, 2019 — Defenses and Interpretation

[35 pages]

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: 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?

34 pages of reading.

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 10, 2020 — Mutual Influence in Analytic Process

[19 pages]

Dan Kriegman is a co-founder of an ‘open source’ religion, ‘Yoism’; Glen Gabbard and Drew Westen attempt to integrate analytic thinking with neuroscience.

44 pages of reading.

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

Optional Reading

Slavin, M.O. 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):247-284.

(Optional but recommended.)

January 17, 2020 — Listening to Clinical Material

[43 pages]

Donnel Stern 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?

39 pages of reading.

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 24, 2020 — Transference and Countertransference

[47 pages]

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. Compare Fosshage’s ‘expecting rejection’ with Coen’s ‘thrall of the negative.’

45 pages of reading

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.

January 31, 2020 — Reverie and Subjectivity

[46 pages]

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?

44 pages of reading

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 7, 2020 — Introspection and Empathy

[51 pages]

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.’ Contrast the views of interpersonalists 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.

49 pages of reading.

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.

February 21, 2020 — Identity, Splitting, and Multiple Self-States

[55 pages]

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.

53 pages of reading.

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.

February 28, 2020 — Enactment

[40 pages]

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

38 pages of reading.

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 6, 2020 — Implicit Relational Processes

[76 pages]

Holly Levenkron offers 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?

36 pages of reading

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

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.)

March 13, 2020 — Therapeutic Change and Growth

[58 pages]

Jonathan Lear contrasts subjective and objective, but he makes a shift from normal usage. Describe that shift, and how it helps him come to the conclusion that the neurosciences will never replace analysis. Discuss the word ‘irony’ as Lear says is meant by Kierkegaard and Plato and show how Lear links this with psychoanalysis.

57 pages of reading

Lear, J. (2003). “Subjectivity, Objectivity, and Irony” in Therapeutic Action, pp31-88.