Valentine's Day Musings

"When the satisfaction or the security of another person becomes as significant to one as is one's own satisfaction or security, then the state of love exists" (Sullivan, 1940)

“Such mutuality, however, seems clearly an ideal, not a normative practice. No matter how mature and healthy, all love relationships are characterized by periodic retreats from mutuality to self-absorption and demands for unconditional sensitivity and acceptance.” (Mitchell, 1984)

Among its other important components, I still contend that the analytic relationship is one of love. And as Mitchell notes, and Benjamin reminds us, it is almost impossibly difficult to hold for long the tension between mutual recognition and negation of the other; instead we are always falling to one side (usually negation). This realization of how easily we fall, I think, is in sharp contrast to Orange and Levinas putting the (suffering) other above ourselves, making psychoanalysis, with this impossible ideal, once again the impossible profession. I think that love might just be in the striving, not the success, to recognize the other.

Is Addiction Inherited?

This past week the media (National Public Radio, BBC World News, for example) picked up a story from Science that addiction might be hereditary, based on a study out of Cambridge, UK, of 50 pairs of siblings, where one sibling had a cocaine addiction and the other did not, yet both had similar changes in the brain (in areas of impulse control). The conclusion that these similar brain changes indicate inherited traits may overlook the discovery that experience changes brain anatomy, chemistry, and function. As such, it might be equally plausible to conclude that siblings were similarly exposed to parents who were unavailable, misattuned, or abusive in ways that caused the brain to develop as seen in the touted study.

In the TBIPS course on Repetitive Painful States, in which a portion of the course is devoted to addiction, we consider the possibility that addictive behavior (whether substance abuse or self injurious such as cutting) is a way to manage untenable beliefs and affects. Having gone unrecognized and misunderstood, or worse, as often is the case, having had one’s reality attacked and one’s spirit nearly extinguished, a child is often without the opportunity to learn to regulate one’s impulses. Does this not affect the developing brain? [This is not to say that the myriad possible ways a child's brain might develop is not constrained by genetics.]

We go even further in class, presupposing that new experience in relationship with the analyst, repeated and protracted, also begins to change brain anatomy and function, encoding experience in such a way that impulse control is gradually developed, not by prohibition of behaviors, but by the shared experience of accepting a patient’s reality, bearing painful affects together, and reconfiguring belief systems about the self and the self with others. Differing with most treatment modalities for addiction, I expect that it would be a further misunderstanding of an analytic patient to base treatment on the contingency of abstinence while the patient has yet to have help with painful affects and untenable beliefs.

Mitchell's Developmental Tilt

This semester the TBIPS first year class is reading Mitchell’s Object Relations Theories and the Developmental Tilt. In it, Mitchell asks (doubts) whether so many diverse theories can go under one theory called Object Relations. But, more importantly, he notes that many Object Relations theorists maintain allegiance to the Freudian drive-conflict model (whose sine qua non of neurosis according to Freud is the Oedipus complex) by simply placing relational issues developmentally earlier than the oedipal stage. He asks, is Object Relations just an extension of drive theory? Or is it altogether new, substituting drive discharge as motivation and the structural theory (ego, id, superego) of mind with object-seeking as motivation and with relational configurations, “relations with others, past and present, real and imaginary” (mental representations of part/whole objects, in Object Relational terminology, and how they interact with each other) as the makeup of the mind?

Mitchell sees assimilation of Object Relations theory into drive theory as mixing apples and oranges. He says that assimilating Object Relations, through what he calls the” developmental tilt,” into drive theory risks designating lifelong needs of relationship as pathology:

“these innovations have been introduced into psychoanalytic theory via the developmental tilt; consequently, the dynamic issues they depict tend to get characterized as infantile, pre-oedipal, immature, and their persistence in later life is often regarded as a residue of infantilism, rather than as an expression of human relational needs extending throughout the life cycle.”

Mitchell believes contrivances such as regarding “relational issues as prior to drive issues”, were required by ego psychologists (who privilege drive and defense, ie the structural conflict model) in order to assimilate Object Relations. Mitchell does not conceive that relational issues “emerge sequentially over the course of early infancy, becoming progressively resolved” but says they instead persist throughout life.

Furthermore, the developmental tilt risks, Mitchell contends, infantilizing patients by casting the analytic relationship in an infant-mother dyad:

“…instead of conceptualizing these dimensions of the analytic relationship as providing the patient with a richer, more complex, more adult kind of intimacy that his previous psychopathology allowed him to experience, the developmental tilt leads to a view of these dimensions essentially as developmental remediations…”

Consequently, spontaneous gestures as evidence of new relationship (such as Balint’s somersaulting patient) are viewed not as a ‘forward edge’ [Tolpin], but as a regression to the old and are pathologized: their “evidence later in life is regarded as a regressive residue of very early disturbance.” When Object Relations theory is “positioned via classical theory” through the developmental tilt, psychoanalytic “interaction is collapsed into mother-infant terms.” Similarly “the need for tenderness throughout life”… is collapsed “into the infant's need for tenderness from the mother … depicted as regressive, unresolved residues from earliest childhood” [and] “depicted as [the] …only developmental forum in which such needs make sense.”

Mitchell agrees with contemporary theorists on the importance of the real relationship, as well as of what is new:

“the analytic relationship has been understood as more and more of a real and new relationship than previously. For Freud, the relationship with the analyst was a re-creation of past relationships, a new version struck from the original "stereotype plate" (Freud, 1912). The here-and-now relationship was crucial, but as a replication, as a vehicle for the recovery of memories, the filling in of amnesias, which cured the patient. Contemporary views of the analytic relationship tend to put more emphasis on what is new in the analytic relationship. The past is still important, but as a vehicle for understanding the meaning of the present relationship with the analyst, and it is in the working through of that relationship that cure resides.”

I find I agree with Mitchell’s ideas, especially the need for relationship and tenderness being lifelong (just as Kohut posited a lifelong requirement for self object experiences) and can dust off my previously long constrained (anonymous, abstinent) self to participate with my patients in the therapeutic endeavor toward new experience co-creating new ‘templates [Herzog].’

Mitchell, S.A. (1984). Object Relations Theories and the Developmental Tilt. Contemp. Psychoanal., 20:473-499.

Mutual Recognition in a Fly Bottle

The Tampa Bay Institute for Psychoanalytic Studies, Inc boasts two Study Groups, each every other week, one on Relational Psychology, alternating Fridays with Self Psychology. For several years now I have been looking for places where the two psychologies happily marry. In the past month our discussion groups have seen the rocky courtship of Self and Relational psychology in the papers found in 2010 IJPSelfPsychology by Donna Orange with commentaries by Jessica Benjamin, Philip Ringstrom, and Malcolm Slavin.

It was Orange in Recognition as: Intersubjective Vulnerability in the Psychoanalytic Dialogue who first seems to misrecognize recognition by characterizing the relational usage of the term to mean “demand”ing that the patient deal with the subjectivity of the analyst. She writes that most of her patients who “come from families where they were excessively required to validate the parent’s experience...become adults excessively attuned to the needs of others...The last thing these patients need…is an analyst who is preoccupied with a therapeutic agenda to get patients to recognize her as a subject.” [I am under the impression that most relational therapists would see the capacity for intersubjectivity (to recognize an Other as a subject) as a result of treatment, not a requirement for treatment, and that Orange has overstated her characterization.] Orange goes on to advocate for the use of empathy [called mutual attunement these days by Self psychologists trying to find their way to a two-person psychology] to find our way into the patient’s predicament (Wittgenstein’s fly bottle) and to stay close to the patient’s experience in order to help the patient find a way out. Orange utilizes “close emotional attunement” to access the patient’s emotional experience “through verbal and nonverbal conversation where we establish and identify together the nature and rules of a particular language game [Wittgenstein]…” [what, I think, relational therapist would call negotiation] .

I was very pleased with Orange’s response to Ringstrom, Benjamin, and Slavin, for she humbly admits to her misrecognition. While I agree that the psychoanalytic endeavor strives to hoId the patient asymmetrically central, I still do not understand Orange’s Levinasian inclination to put herself below, instead of on par, with the patient. (She intimates throughout her writings that this is a personal relational template for her.) I also wonder why, when using Winnicottian ideas so often, Orange would place “destruction” outside her language game (perhaps she wants to safe guard from confusion her own term “world-collapsing”). And, moreover, why not become familiar with the language games of other schools, holding more lightly the theories of her own camp, and "stretching" toward pluralism?

Benjamin, I think, writes with a greater clarity than Orange, perhaps unencumbered with arabesques of philosophical side leaps, and explicates the usefulness of an analyst with her own subjectivity who “assumes a reality independent of the patient’s worrisome anxieties about having to be a caretaker for the analyst…[T]he analyst, being a subject in her own right, means she is the one who can take care of herself and regulate herself…” The patient is not re-traumatized by the “demand” to take care of and regulate, as the patient once did for the parent, the analyst.

Ringstrom wonders if Orange does not idealize [perhaps holding less than lightly] empathy (in much the same way classical analysts idealized anonymity, abstinence, and neutrality) because, when empathy fails, as it inevitably will, Orange does not offer alternative ways in, and out of, the fly bottle. Ringstrom offers an alternative: enactment. “Enactments allow access to self-states that are typically coded in implicit procedural memory…” Orange eschews Hegel [also a misrecognition, or being willfully obtuse, or merely a failure to enter Hegel’s language game?]: “…we should give up the search for the Hegelian self-conscious subject, with its implied demand for the other to re-cognize and create it.” And she eschews use of the term dialectic, preferring the term dialogic. Ringstrom, I think, describes a lovely dialectic that even intersubjective self psychologistslike Orange might recognize when he, using Benjamin’s inevitable negation, writes “assertions of self that take the other for granted (negation) often result in ruptures that force awareness (recognition) and often precipitate repair (mutual recognition).”

It is Slavin who stands easiest in the spaces between Self and Relational psychologies, balancing the tension between the two as he gives in his clinical example an elegant use of his subjectivity to meet the patient in her experiential world. His vignette describes how, in admitting his disinclination to be with the suffering of his patient, he paradoxically reaches the patient. Orange added her own vignette of a time when she, too, self disclosed her own failure to go into the fly bottle with her patient. She says about this disclosure, “I had given her what she needed to recognize me so that I could recognize her…” This, I think, is where Orange marries the relational subjectivity with self psychology’s empathy (neither the exclusive purview of the other, though often mischaracterized as if it were, as Orange did) and recognized that sometimes empathy allows us, consciously or unconsciously, to recognize that what the suffering other needs from us in this moment is our subjectivity.





Orange, D.M. (2010). Recognition as: Intersubjective Vulnerability in the Psyc... Int. J. Psychoanal. Self Psychol., 5:227-243.
Benjamin, J. (2010). Can We Recognize Each Other? Response to Donna Orange. Int. J. Psychoanal. Self Psychol., 5:244-256.
Ringstrom, P.A. (2010). Commentary on Donna Orange's, “Recognition as: Intersubjective Vulnerability in the Psychoanalytic Dialogue”
Int. J. Psychoanal. Self Psychol., 5:257-273.
Slavin, M.O. (2010). On Recognizing the Psychoanalytic Perspective of the Other... Int. J. Psychoanal. Self Psychol., 5:274-292.
Orange, D.M (2010). Revisiting Mutual Recognition: Responding to Ringstrom, B... Int. J. Psychoanal. Self Psychol., 5:293-306.

Herzog and Shifting Relational States

On the morning of January 14, 2012, Dr. Bruce Herzog presented to the Tampa Bay Psychoanalytic Society, Inc his 2004 paper Reconsidering the Unconscious: Shifting Relational States, Activators, and the Variable Unconscious. “The unconscious is not a fixed structure, … thus what is conscious in one state of mind can become an unconscious entity in another… When an event is encoded into memory, it occurs within the specific relational state that is active at the time. …Hence, what I am conscious of at any particular moment has much to do with the relational state that I am in.” [When I read this paper a few years ago, these statements of Herzog’s were a kind of eureka moment for me: what he wrote had made profound sense (with a forehead slapping “Of course!’) and yet I had not heard it articulated that way before.]

Herzog continues: “… each relational state has its own particular consciousness and unconsciousness. …In any individual, the unconscious is in no way fixed, but is rather a continually changing phenomenon. I have chosen to name this the variable unconscious. … The notion of a variable unconscious proposes that people, when shifting from state to state, have a level of awareness and unawareness that shifts along with them. The unconscious is no longer considered a fixed phenomenon, but is something that moves and adjusts according to what state one is in. A shift to a new relational state can grant access to certain affects, memories, and relational behaviors that may have been previously unconscious [inaccessible].” Herzog calls his concept of shifting relational states, activators and the variable unconscious: template theory.

Herzog gracefully utilizes both traditional interpretation and relational theory: “…it is not only an interpretation’s content, but … the act of interpreting [italics added] can trigger a shift to a new state that can give rise to a different awareness.” [Here I like the integration of interpretation itself, its content making conscious what was heretofore unconscious, with the act itself having meaning separate from the meaning of the content. This deconstructs somewhat the privilege heretofore given to narrative interpretation, and insight, as a mutative power.] One aim of psychoanalytic treatment has always been to increase the capacity for self reflection, in Herzog’s terms, to activate a reflective state and increase the frequency of its activation. In treatment this can allow access to previously disavowed self states or to newly co-created (in therapy) self states.

I particularly liked finding new ways to consider transference, repression, interpretation, and the goals of treatment: “The transference might be seen as the activation of a particular relational state, and the interpretation could be seen as a means to help the patient organize the procedural (non-verbal) elements of the [that] state into symbolic thought (Herzog 2001; see previous post). The entire process serves to improve the reflective capacity of the individual, by allowing the current relational state to be consciously apprehended, understood, and modified - from within an overriding reflective state established in the analysis.” And where “repression comes in the form of disavowal of certain relational states …
What’s reported to the analyst is limited to what can be accessed in the state the patient is in when seeing the analyst.”

Herzog concludes: …”my patients [are] shifting through relational states, moving between the various possibilities within their relational repertoire, and having each state of mind containing its own unconscious elements… Pathology in the individual comprises rigid denial of the existence of parts of the self, whereas emotional health involves a general awareness of all parts of the self and controlled, flexible movement between them. …The analytic dyad’s growth-promoting behavior and ability to comment on the relational changes that are being fostered will lead to the development of a new repertoire of more functional relational behaviors, and a capacity to recognize and access them.”

I thoroughly enjoyed my day with Bruce Herzog, a presenter who embodies what he says, thereby providing the best educational experience: when procedural learning accompanies the symbolic or spoken lesson. I did regret that Dr. Herzog often chose to put aside for the day, leaving unexplored, the contribution the analyst makes to a shift in a relational template, and thereby, momentarily, eschewing elaboration of a two-person psychology.

Repulsion in the analyst

In the afternoon session of “A Day with Bruce Herzog” on January 14, 2012, Dr. Herzog presented to the Tampa Bay Psychoanalytic Society, Inc.: Repulsion in the Analyst and its Impact on Empathic Capacity, a paper that is remarkable for Herzog's willingness to discuss something many therapists are loathe to admit. His candor about times when he was disgusted or disdainful and how he traversed these therapeutic impasses was compelling.

Herzog believes “For an adequate therapeutic process to occur there must be islands of empathic contact, which requires some matching of relational premises [1] between the analyst and patient.” and that “greatest empathic connection takes place when the relational premises of patient and therapist are best aligned. [I think of how much easier it is to love a friend than an enemy.]

Patients may come to us expecting rejection or disdain while simultaneously hoping for something different. There are other times when revulsion is in accordance with the patient’s point of view [empathy?], and serves to collude with a patient so that neither discusses something they find unacceptable. Herzog encourages us: “As long as there are enough instances where there is a concordance of relational premises and behaviors in the dyad, sufficient areas of contact for a ‘good enough’ empathic connection can be established.” He emboldens us: “The therapist first needs to know that empathizing with the patient will not harm him [him the therapist].”

While this may be so, it is, of course, I think, incumbent upon the analyst to seek, to struggle, assiduously if need be, to find the point of view of the other. Sometimes there seems to be no common ground, sometimes empathy fails us, and we are left then to negotiate explicitly a way to be together without common ground. Sometimes this negotiation can only come to the table through the other side of an enactment.


[1]“ ‘Relational premises’ refer to the many innate relational assumptions that are applied by an individual to interpersonal circumstances. These assumptions amount to belief systems that we hold about the functioning of, and our place within, relationships. We often assume that others share our relational premises; this is not always the case and can be a cause of considerable conflict…”

Happy Birthday Paul Cezanne

Paul Cezanne (1839-1906)


The father of modern art, Paul Cezanne paved the way for Cubism, and both Matisse and Picasso credited Cezanne as “the father of us all." Born in a provincial, southern French town in Aix-en-Provence on January 19, 1839, Cezanne endured early maltreatment from, and rejection of his artistic endeavors by, his tyrannical father. Nonetheless, Cezanne defiantly chose his own way in painting with passionate colors, and eventually deliberately distorting his subjects by painting multiple perspectives in one painting (later to be exaggerated by Picasso in Cubism), deconstructing the laws of painting.

Cezanne’s early paintings depicted murder, rape, and nudity, conflicts about sexuality, entwined with violence (e.g. in “The Murder,”
where a woman holds down another woman who is being stabbed by a man. [Did Cezanne blame his own mother for not intervening or mitigating father’s dictatorial impingements?] Cezanne’s father remained contemptuous of Cezanne. A loner with many fears and phobias, Cezanne hid his private endeavors, his painting, and his mistress (later his wife) from his fearsome, cold father. Cezanne himself both feared intimacy and was easily enraged. Personally he could not stand to be touched and he was disturbed by the nudity of female models.

Eschewing the human body (nude), Cezanne would paint landscapes, still life with voluptuous fruit,
portraits, and bathers, the latter reminiscent of his youth with Zola. Frightened by women models, he tyrannically controlled his human subjects, like his son and wife. He fantasized about murdering his family of origin, upon whom he felt completely dependent, but often used them as models. Cezanne identified with Wagner’s struggles in “Tannhauser” (1861) between spirituality and sensuality. In an homage to Wagner, he painted his sister at the piano playing Wagner while his mother (darned), but his father was painted out of the picture.

Hiding his professional and private life from his father, upon whom he relied for financial support, Cezanne was encouraged by his childhood friend Emile Zola, whose boyhood bathing expeditions would later inspire portrayals on canvas (“The Bathers”--
misshapen nudes, ambiguous in their hermaphroditic bisexuality). Cezanne would follow Zola, the great French writer, to Paris. There he met Monet, Pissarro, and Renoir, and he discovered the Louvre. Finding at last, amongst great works of art, a relational home, he spent hours copying masters of the past, ancient sculptors, and Rubens. But Cezanne’s artistic talent, while supported by the Impressionists of his day, was ridiculed by Parisian haute culture and the press, and his work considered depressing and violent.

This rejection must have painfully resonated with his father’s disregard. Mocked by the critics, by the public, and even by Zola, who used Cezanne as the inspiration for the artist in his novel L'Oeuvre, which described the unsuccessful artist Claude Lantier and his ineptitude with women and painting, Cezanne felt betrayed, never spoke to Zola again, and retreated to Provence. Cezanne, an outsider when visiting Paris and his work artistically incoherent to his provincial neighbors, spent most of his life as a recluse there.


At the first Impressionists exhibit in 1874 he had not been well received. To the late 19th Century his works looked flat. Like contemporary psychoanalysts who strive to balance foreground and background, another characteristic of Cézanne's paintings is the equal treatment of every part of his canvas. Not only is a flattened space created by the integration of the foreground and the background, but neither dominates the other. Cezanne painted dozens of views of Mont Sainte-Victoire
from his family home Jas de Bouffan, the "Home of the Winds," with abstract sky-mountain-earth in a single solid structure, the tree in the foreground appears to merge with the image of the mountain in the background.

A Conversation With Bruce Herzog: Relational Templates

When the Tampa Bay Psychoanalytic Society, Inc offers a day-long program with a guest psychoanalyst, one of my favorite parts of the day is the early morning, intimate, small group “Conversation” with the expert speaker. On January 14, 2012, Bruce Herzog discussed his very accessible ideas about relational templates.

Repeated behavior becomes a relational template, and becomes procedural. He defines relational template as “an internalized relational pattern that has been learned through repeated exposure and applied to interpersonal circumstances throughout life”[1] and may be “activated” by specific, contextually-driven interactions. (Unlike Stolorow’s ‘invariant organizing principles’ which implies cognitive, relational templates are behavioral. Herzog‘s “relational expectancies” are more akin to the former. A relational expectancy includes an automaticity that assumes a relationship to be a certain way.)

Multiple templates exist, each with its own variable unconscious, and are hierarchical, the most frequently activated ones being the most accessible. He notes “a stockpile of templates waiting to be mobilized when needed”[2] The analyst can track shifts in relational states (often accompanied by a shift in affect), e.g. when a negative transference appears. Clinically, the analytic relationship offers the opportunity to encode new ways of being in relationship, new templates. For example, when a patient, long holding the expectancy to be ignored or misunderstood, finds that the analyst does not meet her/his expectation, a new template is encoded and now joins the repertoire of multiple relational templates. Herzog notes that each of us has the capacity throughout life to continue to grow and change when our expectations are confounded in this way.

Herzog prefers the term ‘template’ for its simplicity; Preferring ‘relational template’ to the unwieldy 'projective identification,' Herzog nonetheless notes that Klein described something useful to the clinician. For example, where Kleinian analysts might say a patient had projected disavowed sadism into the analyst and so now the analyst is feeling angry at the patient, Herzog would say simply that a sadomasochistic template has been activated.

Like an attuned parent who gives words to experience, thereby adding to the child’s comfort, mastery, or joy, Herzog says “naming and explaining” helps a patient. But, he notes, it is not simply content which is mutative, but that we bother to say something at all, for, along with tone, prosody, etc, this is also a procedural interpretation, the non-symbolic part of the verbal interpretation. [See his 2001 paper]

Patients may activate templates in the therapist just as analysts’ behaviors also activate patients’ templates. The therapist has certain capacities (e.g. what s/he can give) while the patient has certain capacities too (e.g. what s/he can take). In template theory, provision might balance expectation; it is as if the analyst is saying, ‘Even though you ask something of me in a way that makes me want to withdraw from you, I know you need it and so I will provide it.’ Having in the past been accused of being a ‘provision-ist,’ Herzog retorts that the accuser might be a ‘frustration-ist’ and recalls how Kohut advocated “optimal frustration” and Bacall, “optimal responsiveness.”[3]

Herzog finds that perhaps his foremost goal in treatment is to enjoy his work, which means enjoying his patient, which means the patient, perhaps for the first time, is enjoyed (thereby creating a new relational template). Herzog also reminds us that each therapist must ‘survive’ (in Winnicottian terms). He also seeks to find something he can love in every patient. [It is perhaps these final sentiments with which I most agree.]






[3] Bacal and Herzog (2000). Optimal Responsiveness and the Use of Specificity Theory
in Clinical Practice, Presented at the 23rd Annual International Conference on The
Psychology of The Self, Chicago, Ill.

Herzog, B. (2001). Procedural Interpretation and Insight: The Art of Working Between
the Lines in the Non-Verbal Realm. Presented at the 24th Annual International
Conference on The Psychology of The Self, San Francisco, Ca.

[1,2] Herzog, B. (2004). Reconsidering the Unconscious: Shifting Relational States,
Activators, and the Variable Unconscious. Presented at the 27th Annual
International Conference on The Psychology of The Self, San Diego, Ca.

TBIPS COURSE REGISTRATION Form Spring 2012

Program Offerings First and Third Year
2011-2012

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.

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

Please be aware that the TBIPS Board has recently decided that all tuition scholarships (for Semester II and after) will be 'work study' where the student or candidate will volunteer for one hour per semester to TBIPS (nothing strenuous: typing, attending planning meetings, errands) for every $50 of scholarship monies the student receives (eg, if you receive $100 off of your tuition, then you will volunteer for two hours in that semester).
Spring Semester 2012

First Year Courses Semester II

Introduction to Psychoanalytic Concepts Part II (16 weeks)
The second part of this course will provide a strong foundation in theory. Contributions from major theoretical predecessors from Ego/Structural and Drive, Objects Relations, Interpersonal, and Self Psychology, and how these influence Relational, and Intersubjectivity clinical engagement will be discussed, as well as Affect Regulation, and Attachment Theory.
Instructor: Lycia Alexander-Guerra, MD, with guest faculty.

Meets Wednesdays 700pm-830pm at 14043 N Dale Mabry Hwy Tampa, FL 33618.
February 1, 8, 15, 22, 29; March 7, 14, 21, 28; April 4, 11, 18, 25; May 2, 9, 16, 2012.
Fee: $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take fourth course).

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.

Meets Wednesdays 345pm-515pm at 14043 N Dale Mabry Hwy Tampa, FL 33618.
February 1, 8, 15, 22, 29; March 7, 14, 21, 28; April 4, 11, 18, 25; May 2, 9, 16, 2012.
Fee: $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take fourth course).

Human Development (16 weeks)
Participants will supplement and re-configure Freudian and Mahler's ideas with infant research, attachment theory, contributions from Benjamin, Stern, Bowlby, WInnicott, and others. Instructor: Lycia Alexander-Guerra

Meets Wednesdays 525pm-655pm at 14043 N Dale Mabry Hwy Tampa, FL 33618.
February 1, 8, 15, 22, 29; March 7, 14, 21, 28; April 4, 11, 18, 25; May 2, 9, 16, 2012.
Fee: $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take fourth course).

Third Year Courses Semester II Spring 2012

Painful Repetitive States (16 weeks)
This course explores how early paradigms of self and self with others become encoded and then repeated in self injurious behaviors, addictions, and psychosomatic symptoms. We will discuss the therapist's frustration in working with people who have these particularly intransigent symptoms, as well as ways to engage this world of patients in an effort to co-create new ways of being together.

Meets Wednesdays 215pm-345pm at 300 S Hyde Park #240, Tampa, FL 33606
February 1, 8, 15, 22, 29; March 7, 14, 21, 28; April 4, 11, 18, 25; May 2, 9, 16, 2012. (note, first year may conference call in from 14043 N Dale Mabry)
Fee: $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take fourth course).

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
Meets Wednesdays 345pm-515pm at 300 S Hyde Park #240 Tampa, FL 33606
February 1, 8, 15, 22, 29; March 7, 14, 21, 28; April 4, 11, 18, 25; May 2, 9, 16, 2012.
Fee: $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take fourth course).

Trauma III (8 weeks) and Gender III (8 weeks) (must register for both)
The Trauma course revisits Freud's seduction theory and is contemporized by the works of Van der Kolk, Davies, Boulanger and others.
Instructor: Peter Rudnytsky
Meets Wednesdays 530pm-700pm at 300 S Hyde Park #240 Tampa, FL 33606
February 1, 8, 15, 22, 29; March 7, 14, 21, 2012
The Gender course looks at postmodern views of gender, its construction, and the loss and mourning of paths not taken.
Instructor: David Baker
Meets Wednesdays 530pm-700pm at 300 S Hyde Park #240 Tampa, FL 33606
March 28, April 4, 11, 18, 25; May 2, 9, 16, 2012
Fee for Trauma and Gender Course (taken together as one course): $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take a fourth course).

Registration for first year courses Spring Semester 20I2
Name________________________________________ Degree____
License #_______State___
Address________________________________City_______________State___Zip______
Email address________________________________
Request long distance learning ____(yes)

Spring Semester 2012: Registration deadline January 19, 2012

______ Intro to Psa Concepts II (16 weeks) Wednesdays 700-830pm
_______ Clinical Case Conference (16 weeks) Wednesdays 345-515pm
______ Human Development (16 weeks) Wednesdays 525-655pm

_______ Painful Repetive States (first year may add as option) Wednesdays 215-345pm

_______Total Payment Enclosed

Mail this copied registration form with check (and CV if first time registrant) to:
TBIPS, Inc 14043 N Dale Mabry, Tampa, FL 33618
refund policy (85% 7 days before classes begin)


Registration for third year courses Spring Semester 2012
Name________________________________________ Degree____
License #_______State___
Address________________________________City_______________State___Zip______
Email address________________________________
Request long distance learning ____(yes)
Spring Semester 2012: Registration deadline January 19, 2012
______ Repetitive Painful States (16 weeks) Wednesdays 215-345pm
______ Clinical Case Conference (16 weeks) Wednesdays 345-515pm
______ Trauma and Gender (each 8 weeks) Wednesdays 530-700pm
______Total Payment Enclosed

Mail this copied registration form with check (and CV if first time registrant) to:
TBIPS, Inc 14043 N Dale Mabry, Tampa, FL 33618
refund policy (85% 7 days before classes begin)

Pathological Accommodation

Last month at our Tampa Bay Psychoanalytic Society, Inc meeting, I found myself literally jolted by a concept. Many of our speakers have left indelible ideas and memories within me, but this notion explored on a November Saturday morning struck me as profound and clear and pervasive. Dr. Shelley Doctors elucidated the psychological process called "pathological accommodation," in which a person, likely from infancy onward, learns essentially to erase him- or herself in order to have a relationship with an important other. In other words, a child grows up knowing that in order to maintain a relationship with a caregiver, he or she must deny longings, feelings, and opinions that reside authentically within: "I will accommodate to you, my mother, so that I can have a relationship with you and thereby survive, but I do so at the cost of my very self and its development. I will do this because to be rejected by you, I fear, will be the very end of me. So, this is my choice, the lesser of two evils, between having no self and having nothing at all."


The Impact of Pathological Accommodation

It was not the idea of pathological accommodation per se that rocked me, but rather, the developmental course that this may take in one's life. Authors Brandchaft, Doctors, and Sorter1 describe these possible trajectories:

The child may attempt to preserve and protect this core of individualized vitality at the expense of object ties by determined non-conformism or rebellion. That is a path of isolation and ultimate estrangement. Alternatively, the child may abandon or fatally compromise his central strivings in order to maintain indispensable ties. That is the path of submission. Or the child may oscillate
between these two . . . Depression becomes the dominant affect in a person whom such a conflict has become chronic and internalized. It signals the loss of hope where no synthesis can be found between intimate connectedness with important others and the pursuit of a program of individualized selfhood. (p. 56)

It is deep within this quandary where I see many precious people. Those who disconnect relationally may do so because they have come to the conclusion that the price tag surrounding personal connections, especially intimate ones, is simply too high: it requires a submission of self-ness, authentic personhood. Those who remain in unhappy intimate situations may do so because they have concluded that it is better to have a relationship that is smothering and controlling (or abusive), than to disconnect from it and risk alienation or worse. And the third group: those who cannot be at peace in isolation or stultifying relationship. These try one approach until the pain of their current dynamic overwhelms them and then they flee---either into nonconformity in a brave attempt to find and hold onto their own voice, or into a painful intimacy in an attempt to feel less alien, less disconnected from.

Perhaps as you read about this process, you might identify with it, if only to some degree; perhaps you have noticed themes in your life not altogether different than the process of pathological accommodation. Coming to a point in life where you dare to believe that you can indeed have relationships that are mutual and reciprocal, that do not require a forfeiture of self, is not only a life-changing moment, but a life-giving one.

Steve Graham, PhD

1. Brandchaft, B., Doctors, S., & Sorter, D. (2010), Toward an Emancipatory Psychoanalysis: Brandchaft's Intersubjective Vision. London: Routledge.