What Makes Therapy Psychoanalytic?

Integrated Child & Adult Psychoanalytic Psychotherapy (ICAPP)
2020-21, 1st Block — Mondays, 6:30-7:45pm


There are many theories and schools of thought within psychoanalysis. You will be studying a number of different orientations over the next two years. You will undoubtedly notice how they overlap at time, or how they differentiate in important  ways at other times. However, the significance of the dynamic unconscious is fundamental to all, and we have chosen to focus on the ubiquity of the unconscious, and how we as clinicians can best serve the people who come to us, by respecting and listening to their unconscious as well as their conscious communication. This is a unifying concept in psychoanalysis, a foundational principle. And we chose to begin with an important aspect of what unites us as psychoanalytic clinicians.

We have prepared a syllabus that we hope you will find interesting and useful. We look forward to hearing your objectives for yourselves in beginning this program. We welcome feedback on the course and the readings as we proceed. This course and this syllabus are also dynamic undertakings and we are ready to respond to the group’s wishes and interests as we work together.

Learning Objectives

The following two learning objectives have directed our choice of topics and readings. At the end of the course participants will:

  1. be able to recognize and discuss the role and use of the unconscious in everyday life and in psychoanalytically informed psychotherapy. They will be able to listen for verbal and nonverbal unconscious communication, identify possible unconscious underpinnings of conscious choices and actions, and thereby increase their understanding of their patients' internal worlds (and their own in relation to their patients’), providing more options of how and where to intervene with patients.
  2. have a firm start in creating a safe and effective learning environment where ideas can be shared and explored, and discussions can be wide-ranging. A developing sense of safety will allow participants to intellectually support and challenge one another in a creative, dynamic, and respectful manner.

September 14, 2020 — Psychoanalytic Psychotherapy

[25 pages]

Historical and Cultural Context

Gaztambide draws our attention to how the psychoanalytic approach to psychotherapy developed in particular social and cultural conditions and illustrates how psychoanalysis continues to grow and adapt across contexts.

Gaztambide, D.J. (2012). “A Psychotherapy for the People: Freud, Ferenczi and Psychoanalytic Work with the Underprivileged”. Contemporary Psychoanalysis, 48(2): 141-165

September 21, 2020 — What makes therapy psychoanalytic?

[18 pages]

Recognizing the unconscious

McWilliams advocates for subjectivity in assessment, and introduces the concept of overdetermination. McDougall uses the metaphor of the stage to show the workings of the unconscious in each of our lives.

McWilliams, N. (1999). Psychoanalytic Case Formulation. New York: The Guilford Press. pp24-28.

McDougall, J. (1985). Theaters of the Mind. New York: Basic Books, Inc. Prologue, pp3-16.

September 28, 2020 — Listening and communicating – 1

[52 pages]

Listening to unconscious communication

McWilliams gives an overview of what it means to listen and talk as clinicians. Schwaber offers some common examples of how we all fall short of this at times. She suggests that being aware of this can help us listen anew.

In the Schwaber article, read pages 789-798. (Stop before “A Longer Example: Mr. A”.)

McWilliams, N. (2004). Psychoanalytic Psychotherapy. New York: The Guilford Press. pp132-142.

McWilliams, N. (1999). Psychoanalytic Case Formulation. New York: The Guilford Press. pp29-47.

Schwaber, E.A. (2005). The Struggle to Listen: Continuing Reflections, Lingering Paradoxes, and Some Thoughts on Recovery of Memory. Amer. Psychoanal. Assn., 53(3):789-810.

October 5, 2020 — Listening and communicating — 2

[33 pages]

Listening for unconscious conflict and defenses

McWilliams and Cabaniss give examples of some of the most well-know psychic defenses. Brenner gives a more detailed picture of how defense is related to conflict. Brenner’s definition of defense differs from McWilliams and Cabaniss, and paves the way to explain compromise formations – what Brenner believes comprises all of our psychic life, both healthy and pathological.

(Read just page 117 in the second McWilliams reading.)

McWilliams, N. (1994). Psychoanalytic Diagnosis. New York: The Guilford Press. pp96-100.

McWilliams, N. (1994). Psychoanalytic Diagnosis. New York: The Guilford Press, pp117-121.

Cabaniss, D. (2013). Psychodynamic Formulation. Oxford: Wiley-Blackwell. pp42-43.

Brenner, C. (1979). The Components of Psychic Conflict and its Consequences in Mental Life. Psychoanal Q., 48:547-567 (excerpts)

October 12, 2020 — Transference and countertransference

[25 pages]

The unconscious story that transference tells

Sandler describes the concepts of transference and countertransference and how a simple gesture is used to uncover meaning between the therapist and patient. McLaughlin’s clinical example, pulled from a longer article about enactments, shows how he came to recognize a patient’s unconscious communication within the transference dynamic. Instead of seeing this as an example of a ‘difficult patient,’ McLaughlin listens to his own unconscious and then uses that to hear his patient more clearly and speak with her in a way she can better hear.

(Just read pages 601-610 in the McLaughlin reading.)

Sandler, J. (1976). Countertransference and Role-Responsiveness. IRP, 3:43-47.

McLaughlin, J.T. (1991). Clinical and Theoretical Aspects of Enactment. Amer. Psychoanal. Assn., 39:595-614.

October 19, 2020 — Enactment and therapeutic action

[10 pages]

Being impacted by the dynamic unconscious and making clinical use of enactment

Maroda explores enactments as relational exchanges that open potential space for working deeply in therapy.

 Maroda, K.J. (2020). Deconstructing Enactment. Psychoanalytic Psychology 37(1): 8-17.

October 26, 2020 — Frame, safety and psychoanalytic attitudes

[35 pages]

Unconscious meaning in actions

McWilliams again provides a basic understanding of a psychodynamic frame. Abbasi’s case, while ostensibly focused on issues of religious and ethnic difference, brings to light aspects of safety and thoughtful frame adaptation.

McWilliams, N. (2004). Psychoanalytic Psychotherapy. New York: The Guilford Press. pp81-86.

McWilliams, N. (2004). Psychoanalytic Psychotherapy. New York: The Guilford Press, pp99-107.

Abbasi, A. (2012). A Very Dangerous Conversation: The Patient’s Internal Conflicts Elaborated Through the Use of Ethnic and Religious Differences between Analyst and Patient. J. Psycho-Anal., 93(3):515-534.

November 2, 2020 — Thinking beyond symptom removal

[38 pages]

Conscious and unconscious purposes and treatment goals

Ticho differentiates life goals (the change a patient wants from therapy) and treatment goals (what psychically needs to happen to free a person to reach their life goals). Vliegen considers the link between the capacity to play with words, metaphor and ideas and therapeutic progress.

Ticho, E.A. (1972). Termination of Psychoanalysis: Treatment Goals, Life Goals. Psychoanal Q., 41:315-333 (excerpts)

Vliegen, N. (2009). Two people playing together: Some thoughts on play, playing, and playfulness in psychoanalytic work. Psychoanalytic Study of the Child, 64:131-149.

Optional Reading

The Case for Psychoanalysis: Exploring the Scientific Evidence, John Thor Cornelius, MD.