Education and psychoanalysis.

The school year is coming to an end here. Not only will I move some of the child patients I see to an earlier time in the day but I am reminded of ways education research informs what I do in the consulting room. For example, in 1964, Robert Rosenthal experimented with what would happen if teachers believed that certain students as reflected on their testing were poised to have a dramatic rise in their IQ. Even though these students had been randomly chosen, and no such test actually predicted who would have a rise in IQ, it turned out that teachers treated these supposed identified students so differently, with the expectation that these students were smart, that, lo and behold, IQs for these differently treated students rose! Teachers’ expectations of these kids really did affect their students’ performance. How was this possible?

We psychoanalysts might think of implicit relational knowing. It turns out that the teachers’ moment to moment interactions with these students changed. They gave these students who were expected to succeed more attention with smiles, nods, and touches, and gave them more time (to answer questions), feedback and approval. So how get teachers to change their expectations? Robert Pianta at the Curry School of Education (UVA) found teachers’ beliefs about students and about what is effective teaching were more likely to change if— through coaching and videotaping of their teaching –teachers changed their behavior rather than if teachers took a course on how to change expectations.

All this got me to thinking about how we behave with patients. Do we have the expectation that they can make a richer life for themselves or do we share too much of their hopelessness? Do we implicitly, and sometimes explicitly, communicate our hope, or despair? And, if so, do we reflect on how we implicitly communicate— through gesture, tone, facial expression— our expectations? Pianta’s work does not make me think that CBT is the way for me of working with patients. Instead it confirms the power of experience and procedural learning that we offer when we do long term treatment with patients. Both studies confirm for me the power of right brain experience over left brain cognition or insight. They say to me that living the experience in the deep immersion of a psychoanalytic relationship changes brain networks.

In addition, one of my favorite contributions from education, and elsewhere, is the idea of constructionism. It recognizes that people construct their own understanding and knowledge of the world, and their place in the world, through the very things we utilize in psychoanalysis: experience and reflection upon experience. Through assimilation and/or accommodation (Piaget) we reconfigure or create our own knowledge. Like teachers in the classrooms, therapists encourage patients to reflect on and talk about what they do and about what they understand about their experiences. While the teacher might have the answer, or the therapist an idea, both encourage the student, or patient, respectively, to find their own answers, encouraged sometimes by the way we formulate our questions or musings, particularly in helping to question the self and the self’s strategies to learn or grow. Rather than a passive recipient of knowledge, we encourage students/patients to actively engage in curiosity and in negotiation and co-creation of reality and emotional truth. 

Register now for Fall 2013 Courses at TBIPS

Program Offerings

2013-2014

About our Program: TBIPS is a professional community which embraces pluralism and a comprehensive contemporary view of psychoanalysis within the context of a mutually respectful and open learning atmosphere.

We invite you to:

·         Deepen and develop  your clinical skills

·         Join  colleagues  to network and share practical issues

·         Enroll in an individual class, or

·         Enroll in a training program

     Two year certificate program in Psychoanalytic psychotherapy

     Four year certificate program in Psychoanalysis

Courses: Classes are open to mental health professionals with an interest in psychoanalytic ideas. The courses may be taken independently, but, in order to optimally elaborate concepts, we suggest that you enroll in the full semester.  Immersion through training (courses, personal treatment, and supervision) allows the richest outcome.

Distance Learning:  Long distance learning options available through use of conference calling or Skype video conferencing.

Fall Semester 2013

First Year Courses

Introduction to Psychoanalytic Concepts I (16 weeks) A foundation of psychoanalytic frame, attitude, relationship will preface the clinically useful contributions from the various schools of thought. We will emphasize an analytic attitude and building/negotiating relationship, and discuss subjectivity, implicit communications, the unconscious, how to listen and respond, as well as major concepts of Freud, Klein, Winnicott, et al. Clinical material, to be provided by all participants, will be used to illustrate concepts.           

Wednesdays  8:30am-9:45am   Sep 18, Sep 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20,  Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014                    

Fee: $250 for a single course; $200 if enrolled in full semester.

                                        

Clinical Case Conference (16weeks) This course is designed to support the clinician’s work and offers opportunity to integrate clinical material with psychoanalytic concepts, including ethics, and ways to deepen the psychoanalytic process, with a focus on the therapist’s self reflection, the clinical relationship, and ways to facilitate what is mutative for the patient. Attendees are encouraged to present case material.    

 Wednesdays 10:00am-11:15am    Sep 18, Sep 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20,  Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014                    

Fee: $250 for a single course; $200 if enrolled in full semester.

Practical Analytic Subjectivity (16 weeks) Designed to develop in the clinician an increased capacity to negotiate the analytic frame, including fees and frequency, as well as increase the capacity for curiosity in the patient for a deeper psychoanalytic experience. Also included will be emphasis on self care of the clinician.   

Wednesdays 11:30-12:45pm    Sep 18, Sep 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20,  Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014                    

Fee: $250 for a single course; $200 if enrolled in full semester.

                          

Registration deadline                         

If you are to receive a subscription to PEP (psychoanalytic electronic publishing), registration deadline for all application material, registration form, and payment is August 12, 2013.   

REGISTRATION FORM: 

Fall Semester 2013

First Year Courses

______ Introduction to Psychoanalytic Concepts I

               Meets 16 Wednesdays 8:30-9:45am  

               (Sep 18, 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20, Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014)                                      

               Fee: $250 for a single course; $200 if enrolled in full semester

              

_______Clinical Case Conference

                Meets 16 Wednesdays 10:00-11:15am

                (Sep 18, 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20, Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014)                  

                Fee: $250 for a single course; $200 if enrolled in full semester

               

_____ Practical Analytic Subjectivity

              Meets 16 Wednesdays 11:30am-12:45pm

              (Sep 18, 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20, Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014)                                       

              Fee: $250 for a single course; $200 if enrolled in full semester

             

______  Requesting Work Study scholarship (up to $300 for work provided, up to six hours)

                (write in amount you need deducted from payment)

                reduction of tuition by (circle one: $50  $100,  if taking one or two courses)

                reduction of tuition by (circle one:  $50  $100 $150  $200  $250  $300, if taking three courses)

_______Total Payment Enclosed (one course: $250; two courses: $500; three courses: $600)             

refund policy (85% 7 days before)

Name________________________________________ Degree____ License #_______State___

Address_____________________________________City_______________State___Zip______

Email address________________________________  Request long distance learning ____(yes)

Must Send Along With (Or After) Application Material (go to tbpsychoanalytic.org)

Mail form with check payable to TBIPS (and CV if first time registrant) to TBIPS, Inc   13919 Carrollwood Village Run, Tampa, FL  33618

Fall Semester 2013

Third Year Courses

Couples Therapy  (16weeks)    This course will examine the ways in which development informs our clinical work with adult  patients.  Life events and developmental transformations throughout the lifespan will be explored in terms of their relevance for adult treatment. Papers will be paired with clinical material. We will address major developmental concepts in this course.   (16 weeks)        Instructors: differ each week and include instructors such as David Shaddock and Carla Leone:  

Wednesdays  2:00pm-3:15pm   Sep 18, 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20,  Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014                    

Fee: $250 for a single course; $200 if enrolled in full semester.

                                         

Clinical Case Conference  (16weeks)    This course is designed to support the clinician’s work and offers opportunity to integrate clinical material with psychoanalytic concepts, including ethics, and ways to deepen the psychoanalytic process, with a focus on the therapist’s self reflection, the clinical relationship, and ways to facilitate what is mutative for the patient. Attendees are encouraged to present case material.     Instructor:  Susan Horky

Wednesdays  3:30pm-4:45pm   Sep 18, 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20,  Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014                    

Fee: $250 for a single course; $200 if enrolled in full semester.

Practical Analytic Subjectivity III (16 weeks)  This is a peer group format which emphasizes analysts' subjectivity and countertransference, positive and negative feelings of the therapist, and ways our subjectivity facilitates or impedes the analystic process.    Instructors: Lorrie Gold and Susan Horky

Wednesdays  5:00-6:15pm        Sep 18, 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20,  Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014                    

Fee: $250 for a single course; $200 if enrolled in full semester.

                          

Registration deadline                           

If you are to receive a subscription to PEP (psychoanalytic electronic publishing), registration deadline is August 12, 2013.   

      

REGISTRATION FORM:

Fall Semester 2013  

Third Year Courses

______ Couples Therapy  Meets 16 Wednesdays 200-315pm  

               (Sep 18, 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20, Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014)                                              

               Fee: $250 for a single course; $200 if enrolled in full semester

               Registration  deadline  August 19, 2013

   

_______Clinical Case Conference  Meets 16 Wednesdays 330-445pm

                 (Sep 18, 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20, Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014)                    

                 Fee: $250 for a single course; $200 if enrolled in full semester

                 Registration  deadline  August 19, 2011   

______ Practical Analytic Subjectivity III   Meets 16 Wednesdays 500-615pm

                (Sep 18, 25, Oct 2, 9, 16, 23, 30, Nov 6, 13, 20, Dec 4, 11, 2013, Jan 8, 15, 22, 29, 2014)                    

                Fee: $250 for a single course; $200 if enrolled in full semester

               Registration  deadline  August 19, 2011

______  requesting scholarship (write in amount you need deducted from payment)

                reduction of tuition by (circle one: $50  $100,  if taking one or two courses)

                reduction of tuition by (circle one:  $50  $100 $150  $200  $250  $300 $350, if taking three)

_______Total Payment Enclosed  (one course: $250; two courses: $500; three courses: $600)  refund policy (85% 7 days before)

Name________________________________________ Degree____ License #_______State___

Address_____________________________________City_______________State___Zip______

Email address________________________________  Request long distance learning ____(yes)

Mail form with check made out to TBIPS (and CV if first time registrant) to TBIPS, Inc    13919 Carrollwood Village Run, Tampa, FL  33618

Happy Birthday, Siggy

One hundred, fifty-seven years ago today, little ‘Siggy’ was born to a young, beautiful mother and an aging father. Sigmund Freud (b. May 6, 1856) would grow up to be the father of psychoanalysis. He would give us both a way of conceiving of the mind, by emphasizing the Unconscious, and a technique for accessing it, free association. It was from his self analysis, especially of his dreams, that he developed the latter, and wrote his magnum opus The Interpretation of Dreams (1900).

A lot in psychoanalysis has changed since fin de siècle Vienna. While Freud conceived of the mind as monadic, a closed energy system pressing for the discharge of the libidinal and aggressive drives, contemporary psychoanalysts now recognize that the mind develops within, and is continually influenced by, an interpersonal context. Freud in 1923 posited the structural theory of the mind and a dynamic unconscious where the id, ego, and superego were in constant conflict. Today, additional motivations, including intersubjectivity and attachment, are privileged. Dissociation seems as prevalent, or more so, than repression of conflictual material.

In Vienna, Freud advised abstinence, neutrality, and anonymity to avoid the pitfalls of the heightened psychological intimacy engendered in the therapeutic situation. Today we recognize the inevitability and usefulness of intimate (not physical) involvement with patients and how enactments, if reflected upon, aid the psychoanalytic process.  Freud conceived that relational patterns are ‘transferred’ from previous important relationship figures onto the analyst, and today we also make use of the real and unique components in the therapeutic relationship. Perhaps one of my favorite ideas of Freud’s is that patient’s and analyst’s unconscious speak to one another, something now confirmed by neuroscience research and elaborated in ideas about implicit relational knowing.

Freud catapulted us into a great adventure, and thus we are exploring a vast, unknown frontier. Psychoanalysts report high job satisfaction and an unparalleled professional longevity and for these we are grateful. So HAPPY BIRTHDAY, Siggy!

Attachment Theory And Therapy

As classes at the Tampa Bay Institute for Psychoanalytic Studies, Inc approach the Spring semester’s end next week, I reflect back on the Second Year’s course in Attachment and Affects. Attachment theory, pioneered by John Bowlby, is a relational theory that conceptualizes an innate human motivation to be connected with others. Crying, clinging and proximity are behaviors infants and toddlers have adapted to remain safe and secure. When parents respond in an attuned fashion, children can use the secure base from which to explore the world. Therapists, too, strive to co-create a safe place which allows better for exploration of interiority. Moreover, human beings require management of their affects, and emotional regulation starts out in the caregiver-infant dyad, where mutual regulation, then infant self regulation can develop. Affect regulation is seen as a necessary component to optimal growth and development. Theorists differ: intersubjectivity may allow for attachment within which there is affect regulation; or, conversely, attachment may allow for intersubjectivity within which emotional regulation is achieved.

Humans throughout life struggle to balance our longings for connection with our striving for autonomy. In traditional psychoanalysis, ‘freedom’ usually meant freedom from dependence, and [masculine] autonomy was privileged over [feminine] connectedness. Dependency, as in human infancy, creates conflict and engenders humiliation. The ubiquitous dilemma is the striving to be connected in dialectical tension with the striving for independence, or as Benjamin might describe it, the tension between recognition (contact and connectedness) and negation (the illusion of omnipotence and control). 

Attachment Theory promotes understanding of how affects foster communication and build relationships, positing ways that early attachment, separation, and loss influence subsequent capacities (and behavioral styles) to form bonds with others, including the therapeutic dyad. It recognizes that development is relationship-based and contextualized, and that affective sharing affects self- and mutual regulation. Patterns of attachment are universal, though they may differ in relation to different caretakers, by culture, or even depend on particular self states. Many contemporary psychoanalysts see attachment, with it concomitant object seeking and need for relationship (to have recognition, to share affectivity), as primary to development. The need for attachments exists throughout life and its presence does not necessarily constitute regression.Though therapists may facilitate the recommencement of patient development, we need not conflate patient-hood with infancy. Relational patterns, developed early in life, are carried forward into the therapeutic relationship and therapy may help a patient reevaluate the expectation that everyone is as unreliable, disinterested, or dangerous as the patient’s parents might have been. 

Happy Birthday. Harper Lee

Today is the birthday of Nelle Harper Lee. She is 87 years old and the author of the Pulitzer Prize winning, autobiographical novel To Kill A Mockingbird (1960). Her only novel was published when she was thirty four years old.  Her story is told through the eyes of a young girl (6-9 years old) Scout Finch, who refused to be boxed into dresses and etiquette by her aunt, and who often spoke first with her fists as she righted school yard injustices. Scout understands the injustice of racism, which turns human beings into the Other, a not me.

To Kill a Mockingbird was adapted to film by Horton Foote. Gregory Peck’s Oscar winning portrayal of Atticus Finch, an American icon and moral benchmark of American integrity as the small, Alabama town lawyer who defends Tom Robinson, a black man falsely accused of raping a white woman, became the greatest film hero of the 20^th century.  Lee’s older sister Alice practiced law at her father’s firm till she was 100 years old. Lee’s actual father A. C. Lee had “genuine humility” and was purported to have been, like Atticus Finch, “soft spoken, dignified, and did the right thing.” He gave Harper Lee her first typewriter, which she shared with her next door neighbor and playmate Truman Capote, depicted in her novel as Dill Harris. In the 1930’s, they were considered an odd pair in Monroeville, AL, she with her tomboyish ways, Capote leaning toward his feminine side.

Lee’s feat of writing the world through a child’s eyes and with a wisdom beyond her years has rarely been matched. Lee’s novel precedes the Civil Rights Act and for a young, white, Southern woman to write herself into the shoes of a black man was, as Oprah Winfrey noted, “pretty damn brave.”  In To Kill a Mockingbird, Atticus tells Scout, “You never really understand a person until you consider things from his point of view, …until you climb into his skin and walk around in it.”

Certainly, that is an analytic attitude. We strive to understand our patients and, to do so more fully, we must dislocate ourselves momentarily from our own point of view and “climb into the skin” of our patients. Kohut called this empathy, and in the most difficult of moments, we struggle to stay empathically immersed, moving to right ourselves again when we fail. From the patients’ singular misery, we may not seem able to fight their fight, but we hope patients know we are in their corner.

Starting out, for the beginning therapist

I like to discuss with third year psychiatry residents starting their out-patient clinical year of psychotherapy what we hope do together with our patients.  We may strive to aid the patient in reconfiguring organized experience in order to free the patient enough to tolerate new ways of experiencing and understanding. Our job may be to provide a ‘good enough’ therapeutic space to allow the ineffable, the unremembered, or the as yet unformulated to come into being in the space co-created between therapist and patient. It goes without saying that we bring to the consulting room our respect for the other person and for their uniqueness as well as an analytic attitude which includes open inquiry. We guard as sacred the confidentiality of all that the patient entrusts to us. We provide a safe enough environment for the approximation toward an authentic self  by being open with the loving openness of the lover or parent who cannot wait to hear or see what comes next, open to the unknown, the unknowable, and to uncertainty.

Discussing with a patient what it is like to be in the room with the therapist and to be invited, even expected, to discuss feelings and fantasies, especially in the here and now moment, may be the first time the patient has ever experienced such deep, untruncated interest or experienced an opportunity to talk in such a way. The patient is assessing (unconsciously, non-consciously, and consciously) what may be addressed and what must be left unknown and unsaid, based, in part, upon the implied capacity of the therapist to tolerate, accept, and embrace the most untenable aspects of the patient’s (and therapist’s) self.

It is incumbent upon us to initiate negotiation between us and the patient about how we plan to work together. Some patients will come with the hope of realizing particular goals, some very specific: ‘I want to stop throwing things when I get angry’; some general: ‘I want to be happy.’ While you cannot guarantee an outcome, you can vow to attempt to explore (via attunement and open inquiry) and experience (through inevitable enactments) together what it is that troubles the patient.

Psychiatric therapists will struggle personally between their medical role as an authority and their responsibility to offer an authentic self to the experience. Both the struggle and the offering have therapeutic potential for therapist and patient alike and make for more meaningful and enriching use of the process.

I ask the psychiatry resident to consider: Do I have faith that earnest and authentic leaning to understand is salubrious in itself, even if I, as yet, fail to comprehend what is going on? Can I respect and empathize with this patient’s suffering, even if the problems include drug addiction, pedophilia, or some other behavior beyond my comprehension? How do I open myself to the sufferings of people with whom I have difficulty empathizing? Can I bear the patient telling her/his fears even when they intimate that I am untrustworthy or have failed to help the patient feel safe or more open? And we commiserate: it’s a tough job.

War Photojournalist and psychoanalyst of like minds

Two years ago today, war photojournalist Tim Hetherington, who, along with journalist and co-director Sebastian Junger, was nominated for a 2011 Oscar for their 2010 documentary Restrepo about American soldiers in Afghanistan, was killed in Misrata, Libya, during the civil war, having bled to death at the age of 40 after a mortar exploded.  In recounting, on NPR’s Morning Edition on April 18, 2013, a conversation Hetherington had with his father, Junger said that Hetherington defined “rich” as having “the power to determine your future.”  This got me to thinking about what psychoanalysts strive toward, that is, facilitating people toward greater freedom to determine their emerging lives. In covering war, Junger notes a “moral awareness” in making a living telling stories about people dying, which sometimes weighed heavily. Therapists, too, have a ‘moral awareness’ that we make our livings off the suffering of others. War correspondents can comfort themselves that stories must be told, just as we therapists can. Additionally, I think, and as the brave survivors of Monday's Boston Marathon proved, running toward suffering is the best hope to relieve it.

In an interview on Wed April 17, 2013 by Daniel D'Addario in Salon, Junger said of Hetherington, “Tim …was trying to understand the human experience, … engaging people in conversations and trying to tell their story, ... trying to get the experience and connect with someone.” I think this aptly describes what relational psychotherapists do as well. Also, when Junger described his own job, “I think you definitely have a need for feeling comfortable with feeling overwhelmed and in over your head, and the challenge of that is frightening, but also very stimulating. I think there’s a feeling of specialness, like I’m doing a special job that most people don’t do…”, I recognized that I, too, feel that way about my job.

Junger, whose latest documentary Which Way is the Frontline from Here?, which includes footage shot by Hetherington, and which aired on HBO two nights ago, said of his colleague Hetherington, “ [H]e really was an astonishingly open-spirited person.” And regarding the impact of photojournalists, “He broadened the sense of what’s possible.”

Christianity and Psychoanalysis

Max Harris discussed, over dinner, some interesting and intersecting antipathies within religion and within psychoanalysis. He stated that the battle waging within modern Christianity is over who we are: Are we defined by what was put into us, that is, original sin, as many evangelicals believe, or is who we are in relation to God defined by a process we co-create with God, where we are ‘lured’ into a relationship with God through love?  The latter, thus, incurs upon us a certain responsibility in our moment to moment actions.

The current debates in psychoanalysis move along similar lines. There are the traditionalists who define mental life via conflicts brought into play by drives (libido and aggression), that is, by what is put inside us by virtue of being born. Contemporary analysts advocate for the inclusion, perhaps the emphasis, of the relationship between therapist and patient and its co-creation by both. Likewise, here, too, more responsibility is incurred.

The Christian god may have more in common with the Freudian analyst of objectivity and anonymity. Where they diverge from the contemporary relational analyst may be around the idea of authority.  The Christian god is omnipotent and omniscient; the contemporary analyst is fallible and dependent on the analysand for meaning making.  The Christian god reveals, mandates even, the correct path; the relational analyst walks hand in hand with uncertainty, as does the patient with the analyst.

Nonetheless, both the endeavor of psychoanalysis and that of a relationship with the Christian Jesus require a leap of faith: that we are in this together no matter what, and that an abiding love means we are accepted for who we are, no matter what, imperfections and all. And as Max, a psychoanalyst and former minister, noted, his calling was the saving of souls, just no longer through the ministry.

Neuroscience and Psychoanalytic therapy

In his talk How Understanding Some Neuroscience Can Increase Empathic Attunement on April 13, 2013, Max Harris, PhD presented to the Tampa Bay Psychoanalytic Society on ways neuroscience informs our clinical work. We now understand that mother’s right brains develop their babies’ right brains, in regulation of emotions and coordination of intentions. It is hopeful to know that psychotherapy, too, confirmed by neuroimaging, also can modify neuronal networks. This is due to the plasticity of the brain, and brought about partly through modification of dendritic branching (growth of new connections or pruning of older ones). New experiences rearrange neural networks!

Relational Trauma can come about from abuse, neglect, or chronic misattunement. Trauma, through the HPA (hypothalamic-pituitary-adrenal) axis, can decrease blood flow to the hippocampus and increase it to the amygdala, such that language and context are decoupled from  sensory and procedural memory, and dissociation can ensue. (Trauma can also turn genes on and off via methylization.)  Dissociated experience, often a result of dysregulation of affect, of the patient or the analyst may be communicated through a co-created enactment. This dyadic dissociative process can vitiate reflective function.   The therapist , using self regulation, can serve as ‘container’ (Bion) in helping to regulate patient affect.

Because there are cortical (cognition) connections to the subcortical limbic system (emotions) and limbic connections to the gut (with its chemical messengers the same as some neurotransmitters) and body via vagal nerve, Harris reminded therapists to attend to facial and bodily expressions and right brain, nonverbal  communications, including one’s own.  Mirror neurons may also be a mechanism by which we can feel our way into others’ experience. Harris enumerated three aspects of empathy:  Reflective, Affective, and Intersubjective: the thinking about experience through reflective function, mentalization and theory of mind; vicarious affective matching where one feels oneself into the experience of another; and the intersubjective, where therapist and patient negotiate experience through shared dialogue. Empathic attunement, then, relies on the social right brain, mirror neurons, the parasympathetic and enteric systems’ emotional experience, as well as on the left prefrontal cortex’s reflective function. 

Survival, then gratitude in a Thank you Poem

WInnicott wrote of survival in his 1969 The Use of an Object paper. Survival for the mother or the analyst attacked by the baby or the analysand, respectively, means neither withdrawing nor retaliating. One analysand put it this way.

Thank you for allowing to express disdain for you without taking offense, without crumbling or acting childish.

Thank you for allowing me to express contempt without making me feel wrong. 

Thank you for allowing me to express disgust without retaliating.

Thank you for allowing me to hate you without making me feel ashamed, bad. 

Thank you for allowing me to be me and not throwing a guilt trip on me for doing so.

Thank you for allowing me to grow.

Thank you for allowing me to express my feelings.

Thank you for being you.

Thank you for showing me it's ok to be imperfect.

Thank you for teaching me how to withstand forces that want to rip me apart.

I want you as a friend, not an analyst.

I want you as an analyst, not a friend.

I didn't know you could be both.

Thank you for accepting me as I am, and all the hell that comes with that.

Thank you for letting me hate you.

Thank you for no strings attached.

Thank you for no conditions. 

Thank you for no retaliation.

Thank you for love.

Thank you for your patience as I try to share my pain, find who I really am.