Monday, September 30, 2013

2013-2014 Film Series “Children and Trauma” kicks off on Sept 29 with The 400 Blows
     According to philosopher Janoff-Balman (1992) parents are charged with instilling 3 basic assumptions in their beloved children: 1) that the world is benevolent; 2) that the world is meaningful, and 3) that the self is worthwhile.  Psychoanalyst Eric Erikson noted that infancy, if the baby’s needs are attended to in a timely and good enough fashion, is the time a child learns a sense of basic trust, and that this early attunement is the most fundamental prerequisite of mental vitality. This sense of basic trust developed from the loving care children receive from their caregivers enables them to be content with themselves, with relationships, and with the world, and contributes to these three basic assumptions, that the world is benevolent, the world has meaning, and I am worthwhile; I have a right to be here. By providing for the child’s basic physical and emotional needs, parents contribute to the child’s sense of self and self worth.

    Traumatic life events impact our basic assumptions, our sense of trust, and our self esteem. Chronic neglect and disregard or mis-attunement and misrecognition are considered traumatic for they assault the child’s assumptions about the world and the self in the world. The self, necessary to sustain relationships with others, is undermined as is the belief that there is meaning to human experience. The child’s faith in the natural or divine order of things is violated, which can lead to a state of existential crisis. Children thus injured must then work hard to find divertissement from their existential anxiety, their sense of meaningless and sense of worthlessness. Their ability to participate in Society in a way that brings joy and allows them to share themselves with the world is vitiated. Without love, acceptance, being enjoyed, and engaging in mutual recognition—all which give meaning to life-- a child is at risk for cynicism and alienation; a child might feel unlovable, unacceptable, incapable of joy, and feel he does not deserve a place in the world.

Director Francois Truffaut like Doinel was an unwanted child. His mother gave him up to his grandparents for the first years of his life. He found solace and meaning in cinema. The famous final shot of the 400 blows is the face of Antione Doinel,  a restless boy who seems to beseech the audience with questions like’ where do I belong?’ and ‘what do I do now?’

Saturday, September 28, 2013

Subjects, subjectivization, subjugation

Because Elise Snyder, founder of the China American Psychoanalytic Alliance, had been in Tampa last week discussing cross-cultural psychoanalysis (the pearl there being that every encounter is, to some extent, cross cultural) the paper Communicating across Boundaries, Building Crosscultural Bridges by Patrizio Campanile caught my eye. This led back to its main paper I Had Twenty-Five Piercings And Pink Hair When . . .”: Adolescence, Transitional Hysteria, And The Process Of Subjectivization. Neither paper was what I expected but both led to a very interesting discussion in the Friday afternoon TBIPS Study Group. 

Campanile got us to thinking about subjects in the psychoanalytic sense (as the center of experience with one’s own agency, will and desire) and subjects in the historical sense, under the will of the monarch. Subjectivization is the process of becoming a subject in the psychological sense, but to do so includes subjugating, if you will, multiple aspects of one’s self, a multiplicity of self states, under the rubric of a one self. Campanile notes this includes for the adolescent integrating, getting control over, subjugating one’s changing body, as well as, for the rest of us, other aspects of the self, such as our dreams when sleeping, over which we have little control. Symbolization, such as language, or giving words to experience, gives us the sense that we can organize things over which we have little, if any, control. 

I was reminded of people I have treated who have Tourette’s Syndrome and who tic and utter without the will to do so. They have told me that it is like there is an alien other who resides inside over which they have no control. It takes a huge amount of energy to postpone these involuntary movements and utterances until they are at home in private and then Tourette’s explodes, leaving them even more exhausted. Because Campanile’s papers use the traditional language of drive theory, the group mused about sexual urges being sometimes experienced as involuntary and alien. If psychoanalysis aims to allow richer, fuller human experience, then disavowal of ourselves as sexual beings is a denial in search of a cure.

Campanile, P (2012)  “I Had Twenty-Five Piercings And Pink Hair When . . .”: Adolescence, Transitional Hysteria, And The Process Of Subjectivization. Psychoanal Q, 81: 401-418.

Tuesday, September 24, 2013

Candidates discuss effect patients have on them

In discussing Slochower’s ‘hateful borderline patient’ paper one candidate, Dimitris Tsiakos, summarized as follows:

The patient who maintains an intensely and unremittingly hostile stance toward the analyst inevitably evokes strong countertransference feelings… It might be suspected that the patient who finds it necessary to relentlessly attack the analyst has failed to develop confidence in his capacity to make a real impact on a real object, and probably also deeply doubts the possibility of receiving a genuine response from the object. Such a person has failed to internalize a stable, alive object world. In this sense, the hateful borderline patient may be attempting to establish a relationship with an object who is alternately experienced as external, and thus capable of destroying and being destroyed, and as a projected aspect of the patient's own hate. 

The last line here, speaks well to Winnicott’s ideas of the necessity of the analyst’s survival, and to the paradox in the transitional space of playful relations between what is real (external) and what is fantasy. Tsiakos goes on:

I have found that many times a borderline patient tries to involve me within his sadomasochistic pattern by making me adapt from one the strict - authoritarian figure that holds the frame and for the other by scaring me to impose something that make him angry…. There is a big question between the necessary patience of the therapist in terms of tolerating the hostile and angry feelings in order to transform them into introjected representations and the collusion to a "masochistic" state where he [the analyst] is forced to tolerate any kind of behavior [from the patient].

thereby bringing up a very important discussion about ‘When does survival cross the line to masochism?’  This very line is different for each dyad, of course. No matter where the line, an analyst may make use-- sometimes, to avoid enactments, must make use-- of feelings evoked by the patient so as to better negotiate the relationship between the two, and to help the patient, and analyst, see the impact and the projective identifications more clearly.

This very question came up at the most recent, local Society meeting when the guest speaker noted that her patient, from Europe, continued to insult Americans, including the analyst, and American education. Having been repeatedly disparaged for over a year with these invidious comparisons, the analyst finally asked him why he did not just go back to Europe then. A couple of ego psychologists in the audience seemed quite pleased that the patient got his comeuppance and that the analyst had put an end at last to the patient’s sadistic behavior. Had the analyst heretofore been masochistic? Had she felt abused and felt that she had to take it? She thought so. The analyst’s self protection is an important part of the treatment for both analyst and patient. And it is to the analyst’s feelings we look when locating the ‘line’ (dare I say "red line"?).  To wait to address what was going on between them may indeed have been masochistic (I was not there) on the analyst’s part but, unless the question was in playful paradox where both participants knew the analyst meant-and-did-not-mean banishment, her question may also have been perceived as retaliation, a failure to survive, as if she had ‘had’ it and now needed to say so. Failure to survive runs the risk of not engendering a capacity for concern but instead further relegating the patient's aggression to the Not-me.

Some kinds of self protection, just as is our masochism, are more costly than others.  Sometimes it models behavior that a patient might choose to consider for himself. If we withdraw by not explicitly addressing what is going on between us, that, too, is a failure to survive.  Once, when a patient was yelling his aspersions, I got an instant headache. Not one prone to headaches, I found it distracting. I told the patient it was important he continue saying what he needed to say, but, because I had a headache, I would appreciate he tell me in a reduced volume, which he did, seething his insults through his teeth. My headache dissipated soon after and I could listen again.  

A good outcome might be when, later, we may come to know that the patient's paramount intent was not to attack us, but was part of the process of finding us and communicating their desperate need to do so (find us). Regardless of how and in what circumstances we grapple with survival and masochism, Slochower lets us know how very difficult relentlessly attacking patients can be, as well as speaks to theories that help vitiate our failure to survive.

Fosshage, too, offers food for thought when he re-conceptualizes the classical distortion model of transference as a patterning to organize experience, assimilating or accommodating new with the old. The classical model seeks to resolve transference via interpretation and sees transference as a product solely of the patient’s psyche. Contemporary models recognize the co-creation of transference-countertransference in which each participant brings and triggers unique aspects of the self and other.

Slochower, J. (1992). A Hateful Borderline Patient and the Holding Environment. Contemp. Psychoanal., 28:72-88.      
Fosshage, J.L. (1994). Toward Reconceptualising Transference: Theoretical and Clinical Con... Int. J. Psycho-Anal., 75:265-280.

Saturday, September 21, 2013

Cross Cultural Psychoanalysis: Elise Snyder speaks to the Tampa Bay Psychoanalytic Societ

Not only were we posed this morning with the most provocative of questions about security –far beyond our wildest concerns about confidentiality and sufficient to make all in the audience a bit paranoid –oh wait, you’re not necessarily paranoid if it is really happening—but we were also exposed to a charming, lively, cosmopolitan speaker, Elise Snyder, MD, founder of CAPA (China American Psychoanalytic Alliance). Snyder definitely thinks outside the box!

She reminds us that all analyses are cross cultural in some ways: boys grow up in a different culture than girls, young people in a different culture from their aged analysts. Moreover, when analysts assume their cultural experience is similar to their analysands, they may take for granted a certain mutual understanding of references— and so fail to explore what is meant by a certain reference— such that less analysis may be going on. When CAPA analysts ask their Chinese patients to explain (their different culture), more exploration about the inner life of the patient may actually be taking place.

An analyst’s fantasy about the inscrutable Asian may lead to questions of analyzability. Whether an American, white analyst working with an African-American analysand, or a NYC, Jewish analyst working with a non-Jewish Midwesterner or Southerner, we are each confronted with the Other, with alien-ness. But psychoanalysis, after all, is concerned with meaning, not with external form. One cannot think that learning about a particular other'd culture is sufficient to understand one’s patient: Is our patient’s thinking or behavior culturally normative or is it peculiar to the patient? If we know about ancient Chinese culture, is this as relevant to Chinese students, supervisees, and analysands as knowing that the USA burns (burned) witches at the stake?

Negotiating how to be with one another is of the same significance in similarly cultured analytic dyads as it is with cross culture analyses. Snyder actually put it this way: “When a patient and analyst speak the same language, the analysis is over.” In other words, we have sufficiently negotiated a meeting of the minds such that the skills we have garnered here between us can now be applied in a good-enough fashion in the world at large.

Tuesday, September 17, 2013

A new first year class commences

Some institutes start training with the historical beginning of psychoanalysis, but at TBIPS—because what is taught first is often best learned—we jump right in with the  contemporary view and bring Freudian, Kleinian, Kohutian and others’ concepts in as we go along, comparing and contrasting their contributions. A couple of useful papers we start with are from Aron (1991) and Hoffman (1983). From the get go we challenge the idea that the analyst is the arbiter of reality and distortion, that the analyst could possibly remain anonymous, and that transference emerges solely from the intrapsychic life of the analysand. In this way we can begin with a focus on the analyst’s personhood. We ask the candidate -student to inquire about her/his own subjectivity: Who are we and why did we choose this profession? By delineating contemporary and classical views on ideas such as transference, countertransference, and anonymity on day one we can from the beginning define and reconfigure the vocabulary we use to describe our professional experience.   

Aron juxtaposes classical concepts with contemporary ones. In teaching Aron’s paper in the beginning course Introduction to Psychoanalytic Concepts it is important for the students to place this paper in the historical context of the Freudian tripod of abstinence, neutrality, and anonymity, and of Freud’s technique of making what is unconscious conscious via interpretation. Classically, only the contents of the analysand’s mind were of interest (referred to as a one-person psychology), but as Aron notes, just as children are interested in the minds of their parents and in what their parents think of them, so, too, do analysands take an interest in their analysts’ minds and attitudes. What analysands fantasize, perceive, discern, or know implicitly about their analysts is also something important to make explicit as this information, too, reveals the mind of the analysand and facilitates the “inevitable and essential part of how patients begin to think more psychologically” (p. 36).  An important aspect of making the unconscious conscious is to bring into awareness and articulate the patient's denied observations, repressed fantasies, and unformulated experiences about the analyst. Transference acts not just as carrier of infantile wishes, and defenses against these wishes,  but patients also inevitably and persistently seek to know the minds of their analysts, not only because they want to turn the tables on their analysts defensively or angrily but also, like all people, because they want to and need to connect with others, including their analysts.

Subjectivity is a sense of one’s own agency, one’s self as the initiator of thought, the source of will and desire. The analyst’s subjectivity will greatly influence, both explicitly and implicitly, the work co-created by analyst and analysand. Just as patients can not entirely know themselves, neither are we the authority on the accuracy of our patients' perceptions of us. Just as patients learn about themselves from us, so we learn, often uncomfortably, about ourselves from patients. Both importantly inform the work we do together.

Hoffman’s paper more directly sets the historical context for us. Right away the question is posed: What is difference between classic and contemporary views? Re: transference, Hoffman notes the classical idea:
           unfounded ideas, … neurotic, intrapsychically determined fantasies about the therapist …a distortion of reality (p.392) 
and notes that transference can instead be seen as
              a selective attention to and sensitivity to certain facets of the analyst's highly ambiguous response to the patient in the  analysis. (p 409)
Likewise, Hoffman casts a new light on objectivity:
             "objectivity, " [is] the tendency which is inclined towards understanding more than enacting  (p 413; 414).
Hoffman notes the inevitable influence (dialectical, by the way) known implicitly by the analysand, that the analysand has on the analyst’s so called objectivity:
the analyst in the analytic situation is continuously having some sort of personal affective reaction that is a response to the patient's manner of relating to him. What is more, every patient knows that he is influencing the analyst's experience and that the freedom the analyst has to resist this influence is limited (p.411)
This is a lot for the beginning analyst to think about, but well worth her/his consideration.

Hoffman’s (1983) paper: The Patient as Interpreter of the Analyst's Experience. (Contemp. Psychoanal., 19:389 -422).

Sunday, September 15, 2013

The Logic of Play

TBIPS’ Relational Study Group is reading a very interesting paper this fall by Shachaf Bitan
[Bitan, S. (2012). Winnicott and Derrida: Development of Logic-of-Play. Int. J. Psa., 93:29-51.] Bitan writes, “Winnicott [In Playing and Reality (1971)] was concerned with play as a special form of experiencing and being in the world” and that creative living is “playful relations between opposites...”  The logic of play is “both a conceptual framework for theoretical clinical thinking and a space of experiencing in which the therapeutic situation is located and to which it aspires.” Winnicott viewed the “[t]herapeutic encounter … as a playful space in which analyst and analysand continuously exist…” and Bitan proposes that the logic of play is “the basis for the therapeutic encounter….crucial…for two-person psychology.” He says that both Winnicott and Jacques Derrida, eschewing dichotomy, viewed oppositions as paradox, peacefully coexisting (Derrida), playfully coexisting — not complementary or contradictory. Furthermore, says Bitan, “Winnicott and Derrida emphasize playfulness as an inherent element of experience and language.”

Bitan thinks that the therapeutic situation becomes a playful space when two subjects are not starkly distinct, but coexist peacefully. He considers play as “an ongoing movement” rather than something to be examined, both a frame and infinite possibility. Play is paradox, both real and created, what Bitan calls ‘finding’ (in externality) and ‘founding’ (as in a foundry, manufacturing, that is, created, as in fantasy).  In play, it is not necessary to resolve discrepancies or close gaps (just be mindful of them, allowing them to be “respectfully associated with each other”). Bitan notes that [Cartesian] logic is an attempt to control reality, and that this logic limits possibility. For Derrida meaning comes from identity and difference “through a repetition that is already penetrated with difference…. Each pole is revealed to be contaminated by its opposite, thus being itself paradoxical or, more accurately, playful…” (Bitan tells us that Derrida does not use the term ‘paradox’ because it inherently carries two violently clashing, contradictory poles; Derrida prefers peaceful “inter-coexistence.” ) And where does this ‘contamination’ occur: in play –where neither opposition is defensively negating the other—in the transitional space of not ‘either/or’ but ‘and.’  “In playful relations (Bitan’s italics) oppositions coexist and interpenetrate each other, such that they are no longer ‘certain opposites’. Within the logic of play, dichotomous oppositions become interpenetrated by each other…The playful movement suggests an ongoing process of found-ing of meaning through a dialogical discourse with an-other.”

Tuesday, September 10, 2013

TBIPS Open House September 10, 2013

Psychoanalysis is predicated on two main ideas: that the brain-mind has unconscious/non-conscious functioning and that relationship hugely influences brain-mind. Traditionally in psychoanalysis the unconscious –with its contents of repressed material, relegated to unawareness by conflict between our wishes and what society demands— was emphasized, and called for the technique of making conscious what was heretofore unconscious through the use of interpretation. This technique privileges left brain: language, free association, understanding, insight. Neuroscience now tells us how non-conscious implicit cues, especially right brain procedural and automatic organizing of experience, actually play a greater part in communication than the explicit use of words. What we do and feel is encoded in the brain based on salience and grouped by like affect and experience. Both intrapsychic conflict and interpersonal experience contribute but salience is, in part, greatly determined by the context of relationship.

Because we now understand the brain to be plastic— that is, constantly changing with its dendritic connections branching anew and being pruned— and that its neuronal pathways are influenced by experience, psychoanalysis offers an immersion experience of a deep and protracted relationship in which brain change can occur, a relationship of implicit acceptance and welcome, as well as cognitive understanding made explicit. New experience in the context of such a psychoanalytic relationship helps override, if you will, the brain’s default position of fear, self-loathing, depression, and other self states that vitiate a creative and enriched life. 

Training in psychoanalysis fosters an analytic attitude that strengthens the clinician’s capacity to think about relationship and conflict, to survive the vicissitudes of intimacy, to be with the other, and to maintain a growth promoting experience for both analysand and analyst. This strengthening of understanding and relationship promotes a commitment in both parties to the work. Practitioners find their attrition rate decreases and satisfaction in work and outcome increases. The better one becomes at helping, the more people will seek your help. Psychoanalysts also report a very high rate of job satisfaction and stay in practice longer than the average mental health professional. It's a win-win.

Wednesday, September 4, 2013

2013-14 Film Series "Children and Trauma"

Tampa Bay Institute for Psychoanalytic Studies, Inc
                                   in conjunction with
Tampa Bay Psychoanalytic Society, Inc.
   the 2013-2014 Film Series                

“Children and Trauma”

Psychoanalyst Ernest Becker: "[the child is] routinely punished for dirtying a tablecloth, spilling on the floor, for losing a sock: the message he gets is that he is less valuable than these things, that things are truer than subjectivity, that order takes priority over spontaneity, that outsides and surfaces are more vital than insides and depths."

DATE:             Sundays, monthly (see specific dates below)
TIME:              200pm-500pm
LOCATION:      Auditorium, 13919 Carrollwood Village Run
                         Tampa, Florida 33618
CHARGE:         $2 donation (includes popcorn and soda)
Informal and convivial afternoon viewing, then discussing a film. Facilitators for each film discussion include an academician (film, humanities) and a psychoanalytic clinician.

Film Title
Academic Discussant
Clinical Discussant

September 29, 2013          
The 400 Blows               
Silvio Gaggi                         
Lycia Alexander-Guerra

October 20, 2013               
Kersuze Simeon-Jones      
Diane Hahn

November 24, 2013           
Stand By Me                  
Scott Ferguson                   
Michael Poff

January 26, 2014               
Hope and Glory             
Armond Aserinsky             
Linda Berkowitz

February 23, 2014             
The White Ribbon         
Margit Grieb                       
Kate Lamson

March 23, 2014                 
Pan’s Labyrinth              
Madeline Camara               
Paulina Robalino

April 13, 2014                    
The Virgin Suicides       
Dana Plays                          
Stacie Lauro      

May 4, 2014                      
Warm Spring                 
Adriana Novoa                    
Loren Buckner