Psychoanalysis On and Off the Couch

"The Holocaust seems to me to be the paradigmatic case of the acting out of unconscious fears, fantasies and projections onto another group that has ever occurred. It is the place therefore for psychoanalytic concepts in understanding anti-Semitism and racism more generally. Particularly in this context and thinking about Nazism and Nazi perpetrators is crucial, especially given what for me is so interesting about this is not just thinking as a historian and how can I borrow psychoanalytic ideas to enrich the thing I am interested in explaining. Also, because the history of psychoanalysis is bound up with this history. It’s why I cited Fenichel and Loewenstein - the idea of psychoanalysis as this ‘Jewish science’, of the emigrates all persecuted by Nazism and how they restarted their lives in the US or elsewhere, the grappling with the German psychoanalysts after the war, the conflicts in the International Psychoanalytic Association after the war - these are all part of the history of the Holocaust. For me, this combination of the history of psychoanalysis as an endeavor, plus the usefulness of psychoanalytic concepts in trying  to explain this phenomenon in the first place is a hugely enriching conversation.”

Episode Description: We begin with outlining the tension within the 'complemental series' where external events and intrapsychic registration of those events are both contributors to psychic difficulties. This applies to early as well as later life traumas. Dan's book invites us to additionally consider the conflicting psychoanalytic contributions to the question of what enables survival. All research points to the essential dimension of luck in enabling survival in concentration camps. As a historian he fleshes out the contrasting viewpoints of analysts Eddy de Wind and Viktor Frankl as they each describe what they felt were the essential psychological qualities that contributed to survival. De Wind and others point to a state of stupor, also characterized as estrangement or dissociation, as an essential state of mind to facilitate surviving in overwhelming circumstances. He shares with us why he as a historian feels that an analytic way of thinking is essential as "history without psychoanalysis cannot access aspects of the human experience that elude rational thought - and there are sadly many."

Our Guest: Dan Stone, PhD, is Professor of Modern History and director of the Holocaust Research Institute at Royal Holloway, University of London, where he has taught since 1999. He is the author of numerous articles and books, including, most recently: The Holocaust: An Unfinished History; Fate Unknown: Tracing the Missing after World War II and the Holocaust; and Psychoanalysis, Historiography and the Nazi Camps: Accounting for Survival. He is also the co-editor, with Mark Roseman, of volume I of the Cambridge History of the Holocaust. Dan chaired the academic advisory committee for the Imperial War Museum London’s redesigned Holocaust Galleries (opened in 2021) and is a member of the UK’s Advisory Group on Spoliation Matters.

Recommended Readings:

Martin S. Bergmann and Milton E. Jucovy (eds.), Generations of the Holocaust (New York: Columbia University Press, 1982)

Werner Bohleber, Destructiveness, Intersubjectivity, and Trauma: The Identity Crisis of Modern Psychoanalysis (London: Routledge, 2018)

Matt Ffytche and Daniel Pick (eds.), Psychoanalysis in the Age of Totalitarianism (London: Routledge, 2016)

Dagmar Herzog, Cold War Freud: Psychoanalysis in an Age of Catastrophes (Cambridge: Cambridge University Press, 2017)

Emily A. Kuriloff, Contemporary Psychoanalysis and the Legacy of the Third Reich: History, Memory, Tradition (New York: Routledge, 2014)

Dori Laub and Andreas Hamburger (eds.), Psychoanalysis and Holocaust Testimony: Unwanted Memories of Social Trauma (London: Routledge, 2017)

Steven A. Luel and Paul Marcus (eds.), Psychoanalytic Reflections on the Holocaust: Selected Essays (New York: Ktav, 1984)

Dan Stone, Psychologists in Auschwitz: Accounting for Survival (lecture at the German Historical Institute,( London, 11 July 2024): 

“The historian [of the vineyard] gave us regular feedback on what she was finding, and she also brought in oral historians to take our own life histories. There's also a psychoanalytical point to be made here - you can take refuge in this scholarly exercise, going into archives and finding out things that happened hundreds of years ago, you can all too easily remove yourself from that: ‘This is what happened long, long ago’. But all of us on this farm, we had all lived through Apartheid. The oral historians who wanted to participate, we met over many sessions in my living room and the oral historians asked each of us who volunteered to participate to tell our stories of our lives and it was a real revelation to me. Despite my abstract awareness, the actual concrete listening to people who I was getting to know as individuals, to hear one after another account of the grinding poverty of what it actually is like to be a poor black farm worker in South Africa under Apartheid." 

Episode Description: Mark shares with us his original intent to make a "citizen-sized contribution to the reconstruction" of South Africa through redressing the inequalities that formed a basis of his family's vineyard. He describes going through a painful process of enlightenment where good intentions themselves were insufficient to honor the historical processes that lived inside the owner and the tenant farmers who have been on the land for generations. Psychoanalytically informed, he consulted a historian and archeologist to, along with the farmers, dig into both the land and the lives of all involved. This led to a rebalancing of the pride/shame dynamic that had existed in the owner/workers. When faced with the inevitable question, "Must I give the farm back?" Mark discusses what he felt was the difference between ‘self-interest’ and ‘selfish-interest’. He shares with us the efforts he took to enable the workers to become landowners, to become educated and also to become discoverers and messengers of their historically rich cuisine and music. He also details the ‘not so happy ending; of these efforts as his farm has struggled financially under the burden of these considerable costs and government corruption. Things have turned around of late and there is reason to be optimistic for the long-term flourishing of his vineyard and his “citizen sized” contribution to the well-being of those with whom he works.

Our Guest: Mark Solms, PhD is a member of the British Psychoanalytical Society and the American and South African Psychoanalytic Associations. He is Director of Neuropsychology at the Neuroscience Institute of the University of Cape Town. He is an Honorary Fellow of the American College of Psychiatrists. He has received numerous honors and awards, including the Sigourney Prize. He has published 350 scientific papers, and eight books, the latest being The Hidden Spring (Norton, 2021). He is the authorized editor and translator of the Revised Standard Edition of the Complete Psychological Works of Sigmund Freud (24 volumes) and the forthcoming Complete Neuroscientific Works of Sigmund Freud (4 volumes).

Recommended Reading: 

Solms, M. (2015) Psychoanalysis in Pursuit of Truth and Reconciliation on a South African Farm: Commentary on Gobodo-Madikizela. Journal of the American Psychoanalytic Association 63:1147-1158

"I think it is very interesting to open a debate and talk about this impact of the culture, this epoch, in the subjectivity and never losing the internal work within psychoanalysis, within our consulting room. So when I  quote the Lacanian way of saying the ‘declination of the father's name’, I am talking about these times, this epoch, in which the reference  and the subjectivity fails in respecting what we can call ‘the authority’. But ‘the authority’  means not authoritarian systems - it is the law, it is the possibility of symbolization, and it's the way of being free too, because without some limits you cannot be creative, you cannot be open to symbolization. We are talking about how the ‘other’ is working in this new social environment and how this evanescence of the father’s name is part of a situation that leaves open to the death drive." 

Episode Description: We begin with recognizing the aspects of chaos that surround us  in the real-world. Gabriela takes us from there into the chaos that often lives internally. She then addresses the clinical space which allows for its emergence through the dyad. She speaks of the evanescence of the father's name, authority vs authoritarianism, the 'halo of metaphors' and the nature of the analyst's 'open form' of clinical engagement. Gabriela describes analytic cure as "step by step, so that love and not revenge for pain predominate." She shares with us her early life involving her child analysis, her study of architecture and her now working as an analyst and a painter.

Linked Website: Gabriela Goldstein 

Our Guest: Gabriela Goldstein, Ph.D. Past President of APA (2020-2023). Training analyst of Argentina Psychoanalytical Association (APA), and the International Psychoanalytical Association (IPA) and FEPAL. Doctor Ph.D in Psychology (Universidad del Salvador). Books include The Aesthetic Experience, Writings on Art and Psychoanalysis, and Art in Psychoanalysis. Co-author, among others, of the APA book Dreams and Perception APA Editorial and the book Dear Candidate Fred Busch edit. She has won the Mom-Baranger prize for best monograph in Psychoanalysis with The Aesthetics of Memory, Freud at the Acropolis and won the A. Storni prize for conceptual contributions in Psychoanalysis with Transience, or the Time of Beauty. She has served on many IPA and APA committees including the IPA and Culture Committee since 2007.

In addition, Gabriela is both an architect and a painter. Since 1985 she has taken part in solo painting exhibitions in Argentina as well as collective exhibitions in museums, art galleries, and cultural centers in Italy, France and Germany. She lives and works in Buenos Aires.

Recommended Readings:

Baranger, W. y M. (2012). La situación analítica como campo dinámico. Revista de Psicoanálisis. 69(23), pp. 311-352

Bush, F. (editor) (2021) Dear Candidate: Analysts from Around the World Offer Personal Reflections on Psychoanalytic Training, Education and the Profession. Routledge. London and New York.

Freud, S. (1919) “The Uncanny” The Standard Edition of complete psychological works of S. Freud, V 17

Goldstein, G (2013) Art in Psychoanalysis, A Contemporary Approach to Creativity and Analytic Practice, Karnak-IPA 

Goldstein G. (2022): “La no respuesta del Otro: algunas cuestiones sobre la cura” Revista de Psicoanálisis de la Asociación Psicoanalítica Argentina, LXXIX-3-4

Goldstein, G (2022): “Los misterios de la creación: Entre cuerpo y cultura”, Revista Uruguaya de Psicoanálisis ( on -line 135)

Mc Dougall, Andre, J., De M´Uzan, Et all,(2010) El artista y el Psicoanalista Ed. Nueva Vision

Winnicott, D.W. (1978). Winnicott, D.W., Green. A, Mannoni, O, Pontalis; J-B y otros 

Winnicott, D. W. (1974): “Fear of breakdown” Int. Rev. of Psychoanalysis. (1974) l, 103

“I was very interested in the unspoken thoughts and feelings of the patient because I think one of the things about free association is that in the beginning most of what's going on with the patient is unsaid.  As the analysis evolves more and more of the unspoken becomes spoken and more of it becomes at the center of the analytic space. I wanted to show the evolution of the unsaid. At the beginning of the book, the unsaid is more than the said, and then it evolves as the analysis goes on.” 

Episode Description: We begin discussing Roberta’s first career as a sociologist which she described as an effort to disengage from her self-focused ruminations. She pursued psychoanalytic training after receiving her PhD in sociology. She also continued as a writer of both fiction and non-fiction. Both genres represented her personal as well as other-oriented reflections. Her book Our Time is Up is likewise a combined memoir and novel – she both is and isn’t the young woman 'Rose' whose analysis with ‘Joan’ forms the essence of this work. She reads sections from the book that describe her first meeting with her analyst as well as when the analyst’s illness is introduced into their treatment. The book concludes with 'Rose' saying, “Frida Kahlo said about Diego Rivera, ‘He took me shattered and returned me in one piece, whole.’ I could say the same thing about Joan.”

Our Guest: Roberta Satow is a practicing psychoanalyst in Washington, CT; a senior member of the National Psychological Association for Psychoanalysis and Professor Emerita of Sociology at Brooklyn College and the Graduate Center of the City University of New York. In addition to her non-fiction books Gender and Social Life and Doing the Right Thing: Taking Care of Your Elderly Parents Even if They Didn’t Take Care of You, she has written two novels, Two Sisters of Coyoacan and Our Time is Up. Dr. Satow also writes blogs on Psychology Today and psychology.net.

Recommended Readings:  

Roberta Satow, Our Time is Up, IPBooks, 2024.

Roberta Satow, Two Sisters of Coyoacan, 2017. Roberta Satow, Doing the Right Thing: Taking Care of Your Elderly Parents Even if They Didn’t Take Care of You (Tarcher/Penguin 2006). Roberta Satow, Psychology Today Blog. Roberta Satow,  Psychotherapy Blog Roberta Satow, A Case of Severe Penis Envy: The Convergence of Cultural and Individual Intra-Psychic Factors, Journal of the American Acad. of Psychoan. October 1983.

“There was a lot of dilemma, and I wasn't able to definitely deal with the sudden knowledge of my cancer and to be able to impart that information in a more containing and structured manner so that my patients can be held even in that situation. But the consciousness was there about how to go about it. Whenever I was asked by the patient directly, or if the necessity arose where the hospital needed to impart the information, I did agree later that they can let them know about the cancer situation, and the patient can connect to me directly. When I was in a better stage, I knew how to deal with it, but that was months later. I found that the honest submission was more helpful for me and for the patient because when certain larger than life events happen, it probably connects us in a more humble way to the community - that the analyst as healer is not supreme above all of this, and who can also be affected with such aspects of life." 

Episode Description: We begin with honoring the clinical difference between fantasies of physical vulnerability from real life mortal danger. Jhuma shares with us her medical journey that entailed suddenly receiving a diagnosis of cancer. She was immediately hospitalized and faced with, among other challenges, the question of how to inform her patients. She describes her fragility and uncertainty and the various engagements she was able to arrange. We discuss the meanings of "honest submission," patient's curiosity, and their aggression and tenderness towards her. She elaborates on the presence of the Hindu notion of an afterlife and her post-hospital awareness that “the clinical becomes vast" - this refers to the importance of bringing analytic sensibilities to the many venues that are 'off the couch'. We close with her sharing clinical vignettes demonstrating how even real-life current trauma can meaningfully awaken a patient's awareness of their forgotten painful past.  

Our Guest: Jhuma Basak is a Training & Supervising Psychoanalyst of the Indian Psychoanalytical Society and member of the International Psychoanalytical Association. She holds a Ph.D. in Psychology from the Kyushu University, Fukuoka, Japan. She has specific interest in culture & gender in psychoanalysis. She has publications in Japanese, Italian, French and Spanish. Over the past 20 years, she has presented at various IPA Congresses, along with the Keynote for the 53rd IPA Congress in Cartagena in 2023. Other presentations were at the Washington Baltimore Centre for Psychoanalysis, Hakuoh University, and Kyushu University. She is the co-editor of the book Psychoanalytic & Socio-Cultural Perspectives on Women in India and editor of Sculpting Psychoanalysis in India – Sudhir Kakar. Jhuma has been the past Co-Chair of the Asia Committee on Women & Psychoanalysis and continues to be its consultant. 

Reading List:

Bernstein, Stephen (2024): The Making of the IPA Podcast: Psychoanalysis On & Off the Couch. Psychoanalytic Inquiry, Vol.44. No.2, 166-177.

Fajardo, B (2001): Life-Threatening Illness in the Analyst. Journal of the American Psychoanalytic Association. 49:569-586.

Feinsilver, David (1998): The Therapist as a Person Facing Death: The Hardest of External Realities and Therapeutic Action. International Journal of Psychoanalysis, 79: 1131-1150

Fieldsteel, N. D. (1989): Analysts' expressed attitudes toward dealing with death and illness. Contemporary Psychoanalysis, 25 (3): 427-432 o 

Halpert, Eugene (1982): When the Analyst is Chronically Ill or Dying. Psychoanal. Q., (51):372-389.

Kitayama, O. (1998) Transience: Its Beauty and Danger. International Journal of Psychoanalysis 79:937-942.

Masur, Corinne (ed) (2018): Flirting with Death: Psychoanalysts Consider Mortality. Routledge.

Rosner, Stanley (1986): The Seriously Ill or Dying Analyst & the Limits of Neutrality. Psychoanalytic Psychology, 5(4), 357-371

"In my own two analyses, I had observed such transformations for me in a very impressive way. I started my own analysis after the traumatic death of my sister when I was 22 years old. At that time, I had a breakdown, and I suffered from severe depressive and psychosomatic symptoms and sleep disorders but also from terrible nightmares that haunted me almost every night. Fortunately, my two analyses did change my depressive and psychosomatic symptoms, but what was at least as important for me, subjectively, was the change in my dreams, including the manifest dream content. The nightmares became less frequent; I was hardly in the position of an observer anymore but actively involved in the dream event. I was less alone in the dream but accompanied by people close to me and was more often able to solve the problems and conflicts which arose in the dream. In addition, the dreams were no longer predominantly characterized by fear and death anxiety but a whole range of emotions emerged. Towards the end of my second analysis, I will never forget that I had the only dream of my life from which I woke up because I was laughing out loud." 

Episode Description: We begin with acknowledging the ambivalence that many analysts have towards research. It is seen as distant from the sharing of subjectivities that draw many to our field. Marianne honors the unique transference reliving and then remembering that is central to the analytic encounter and from that position suggests ways that it can be researched. She presents a patient whose manifest dreams were studied over the course of treatment along with his sleep laboratory data. She notes how the stability of the analyst's presence is essential but not sufficient to maximize therapeutic benefit. We discuss the role of theory, the controversy over approaching the veridical past and the seductions of simplified treatments. Marianne closes by sharing her deep respect for the unconscious and how psychoanalysts are living in "rich times of pluralism."

Linked Episode: 

https://ipaoffthecouch.org/2019/07/13/episode-10-refugees-germany-psychoanalysis/

Our Guest: Marianne Leuzinger-Bohleber, Prof. Dr. phil, director of the Sigmund-Freud-Institut in Frankfurt Germany (2001-2016), professor for psychoanalysis at the University of Kassel, Senior Research Fellow at the University Medicine in Mainz. She is a training analyst of the German Psychoanalytical Association (DPV) and the International Psychoanalytical Association (IPA). She has served as the Chair of the Research Subcommittees for Clinical, Conceptual, Epistemological and Historical Research of the IPA (2001-2009), Vice Chair for Europe of the Research Board der IPA (2010-2021); Chair of the IPA Subcommittee for Migration and Refugees 2018/19 and since then member of the committee. She received the Mary Sigourney Award 2016, the Haskell Norman Prize for Excellence in Psychoanalysis 2017, the Robert S. Wallerstein Fellowship (2022-2027) and the IPA’s Outstanding Scientific Achievement Award, 2023. Her research fields are clinical and extra-clinical research in psychoanalysis, psychoanalytic developmental research, prevention studies, interdisciplinary dialogue between psychoanalysis and literature, educational sciences and the neurosciences.

Recommended Readings:

Leuzinger-Bohleber, M. (2008): Biographical truths and their clinical consequences: Understanding ‚embodied memories‘ in a third psychoanalysis with a traumatized patient recovered from serve poliomyelitis. International Journal of Psychoanalysis 89: 1165-1187.

Leuzinger-Bohleber, M. (2015): Working with severely traumatized, chronically depressed analysands. In: The International Journal of Psychoanalysis Volume 96, Issue 3, June 2015, Pages: 611-636.

Bohleber, W., Leuzinger-Bohleber, M. (2016): The Special Problem of Interpretation in the Treatment of Traumatized Patients. In: Psychoanalytic Inquiry 36: 60-76, 2016.

Fischmann, T., Ambresin, G., Leuzinger-Bohleber, M. (2021): Manifest dreams in psychoanalytic treatment. A psychoanalytic outcome measure. Frontiers in Psychology, doi: 10,3389/fpsyg, 2021.678440.

Leuzinger-Bohleber, M., Donié, M., Wichelmann, J., Ambresin, G., & Fischmann, T. (2023). Changes in dreams - the development of a dream-transformation scale in psychoanalysis with chronically depressed, early traumatized patients. The Scandinavian Psychoanalytic Review, 46:1-2, 82-93. doi:10.1080/01062301.2023.2297116

Fischmann, T., and Leuzinger-Bohleber, M.: Dreams, Memories, and Trauma—A search for transformations in psychoanalysis (in press).

"I don't know what to do about this because we do have to use clinical material. It's the best tried and true method in which to inculcate analytic thinking in our students and supervises. On the other hand, we are so indebted to our patients and their trust in us and our responsibilities as ethical practitioners not to divulge their privacy. Principles are what we're trying to teach, we're not trying to teach people, we are not trying to teach that person, the case is not what we are teaching, but the principles in the case." 

Episode Description: We begin by acknowledging the tension between our commitment to patient confidentiality and our need to learn, teach and advance our field through the sharing of intimate information. We discuss the difference between using clinical examples to reveal particular individuals as opposed to illustrating principles in psychoanalysis. Barbara describes the well-known case of a famous author whose analyst revealed identifiable details of his analysis in a publication. She shares why she feels that co-writing with one's analyst about one's treatment is problematic - "it stretches the concept of co-construction to a clinical breaking point." We consider how presenting a patient publicly impacts the analyst's interiority and lives on in the treatment. We close with recognizing the challenge of confidentiality and appreciating "the insuperable predicament posed by the mutually exclusive imperatives of protecting patient privacy and educating the next generation, as well as ourselves. Remembering that ego ideals are only approximations is our most effective balm."

Our Guest: Barbara Stimmel, PhD, is an adult and child psychoanalyst in New York city where she has practiced for the past several decades. She teaches and supervises widely and has contributed to psychoanalytic journals as well as editing and contributing chapters in several books. She has also presented papers, discussion groups and workshops in the wide world of psychoanalysis. She has held offices in psychoanalytic institutions on the local, national, and international level.  Barbara is involved at Mt. Sinai Medical Center in New York, where she sits on committees, has taught residents, and serves on the Palliative Care team.  She is on the President’s Council of Sanctuary for Families, an organization devoted to women and families surviving domestic violence and trafficking. She also sits on the Shakespeare Council of The Public Theatre in New York.  This diversity of interests is reflected in the variety of topics within psychoanalysis and psychotherapy about which she has written, presented, and taught.  In some sense, confidentiality is part and parcel of any clinical topic, regardless of theory and patient population.

Recommended Readings:

Crastnopol, M. (1999). The analyst's professional self as a third influence on the dyad: When the analyst writes about the treatment. Psychoanalytic Dialogues,  9,  445-470.

Gabbard, G. O. (1997). Case histories and ««confidentiality»». International Journal of Psycho-Analysis,  78,  820-821.

Gabbard, G. O. (2000). Disguise or consent? Problems and recommendations concerning the publication and presentation of clinical material. International Journal of Psychoanalysis,  81,  1071-1086.

Kantrowitz, J. L. (2004a). Writing about patients: I. Ways of protecting ««confidentiality»» and analysts' conflicts over choice of method. Journal of the American Psychoanalytic Association,  52,  69-99.

Kanwal, G. (2024) To Reveal or not to Reveal, That is the Wrong Question: Thoughts about Clinical Writing in Psychoanalysis. Psychoanalytic Quarterly 93:135-156.

Stein, M. H. (1988b). Writing about psychoanalysis: II. Analysts who write, patients who read. Journal of the American Psychoanalytic Association,  36,  393-408.

Stimmel, B. (2013). The Conundrum of Confidentiality.  Canadian Journal of Psychoanalysis,21(1):84-106

"During the whole course of your [psychoanalytic] training, you are laying on the couch and have your personal analysis and beforehand you don't know where it will lead you. You start to discover corners of your unconscious psyche which you don't want, which you are not so eager to explore. This accompanies you during the whole course of  training, always confronted with your own psyche and with not-yet-discovered areas of your internal world -  this is really an adventurous journey. And  you do the same with your patients. It is not that you treat diseases with certain symptoms, but you delve deeply into their souls and this is a shared enterprise. Doing psychoanalysis you are confronted with your own psyche, you are confronted with the psyche of the patient too. This confronts you with surprises, sometimes deep anxieties and terrors that you’ve never known beforehand. So I think the comparison of psychoanalytic training of starting a journey with a sailing ship into the vast areas of the ocean, it’s a good example, you will never know exactly what will be the next day or what you will be confronted with." 

Episode Description: We begin with recognizing two aspects of psychoanalytic training - the adventurous and the immersive. These aspects, in addition to the many challenges in the training, can offer the unique opportunity to come to know the depths of the human experience. We discuss the various theoretical models currently available and how they can both enrich and distract from the core competencies that allow for a depth treatment. We consider whether different types of patients need different types of interventions, the centrality of neutrality, and the value and impossibility of free association. Eike addresses the unfortunate conflation of abstinence and unfriendliness, and we consider the clinical moment of receiving a gift from a patient.  We close with his sharing his psychoanalytic journey that began in mathematics and then to medicine and then to psychoanalysis.

Our Guest:

Dr. Eike Hinze is a psychiatrist and psychoanalyst in Berlin. He did his psychoanalytic training at the Berlin Karl-Abraham-Institute and works in his private practice. At present he is chair of training in the institute. One of his main areas of interest is the psychoanalytic treatment of elderly patients. For decades he has been active in the training of future psychoanalysts. For more than 15 years, he has been working in the Board of the Psychoanalytic Institute for Eastern Europe the objective of which was the development and furthering of psychoanalysis in Eastern Europe. He is co-author of a recently published book studying commonalities and differences between different styles of performing psychoanalysis.

Recommended Readings:

Ch. Brenner (1982) The Mind in Conflict. International Universities Press. New York.

F. Bush (editor) (2021) Dear Candidate: Analysts from Around the World Offer Personal Reflections on Psychoanalytic Training, Education and the Profession. Routledge. London and New York.

Ferro (2002) In the Analyst’s Consulting Room. Taylor & Francis. New York.

E. Hinze (2015) What do we learn in psychoanalytic training? Int J Psychoanal 96:755-771.

J.-M. Quinodoz (1993) The Taming of Solitude. Routledge, London and New York.

J.-M. Quinodoz (2004) Reading Freud. A Chronological Exploration of Freud’s Writings. Routledge. London and New York.

D. Tuckett, E. Allison, O. Bonard, G. Bruns, A. Christopoulos, M. Diercks. E. Hinze, M. Linardos, M. Sebek (2024) Knowing What Psychoanalysts Do and Doing What Psychoanalysts Know. Rowman & Littlefield. Lanham. Boulder. New York. London.

“I would love for the psychoanalytic world to re-embrace some of these adjunctive treatments that get to non-ordinary states of consciousness in order to enhance psychoanalytic treatment, and that includes psychedelics. The other thing I'd like to see is, I think psychoanalysts are extremely well suited to use psychedelic-assisted therapy in a non-harmful way. I really believe that without an ongoing treatment relationship that these medicines are not going to be quick fixes. There’s an article in the Substack blog, Ecstatic Integration, about an Israeli man who had an MDMA treatment for chronic post-traumatic stress disorder and it's a very interesting read, and it really does speak to the crucial aspect of having an ongoing therapy relationship while we use these medicines. I want people who are in the analytic field who are trained right out of the box to provide these containers to be more involved in the psychedelic field. For the psychedelic field I think sometimes I wish they would be a little more humble, a little less zealous about the efficacy, and a little more concerned about what could happen that's harmful. I also think the psychedelic field, for some reason, has not embraced psychoanalysis as a major tool to enhance the medicine." 

Episode Description: Charis begins by discussing her inspiration, attributed to Maimonides, for always seeking new understandings to enhance her care of patients. We also begin with a caution - any time we introduce a frame change in clinical work, we must carefully attend to our countertransference to determine the factors that are contributing to our actions. That said, we should be careful to not use our carefulness to rationalize inhibitions to thinking and acting creatively. Charis describes her thinking underlying her decision to introduce ketamine with a particular patient as well as the process of the ongoing psychotherapy. We discuss the practical aspects of this procedure, the risks, the changes in the patient, and the importance of an ongoing psychotherapy to serve as a productive holding and processing space for this work. She concludes with her recommendation to the analytic world to be more open to such adjunctive approaches to therapy and to the psychedelic world to be more modest in their assumptions of its healing ability.

Linked Webinar and Article: 

/g/Communications/Ees4tjM0U1lEtzEkVrUmDjgBmH9Vd6wgap_-Z-7BJVXNDw?e=h8Afay&referrer=Outlook.Win32&referrerScenario=email-linkwithembed">https://ipaworld.sharepoint.com//g/Communications/Ees4tjM0U1lEtzEkVrUmDjgBmH9Vd6wgap_-Z-7BJVXNDw?e=h8Afay&referrer=Outlook.Win32&referrerScenario=email-linkwithembed

https://www.ecstaticintegration.org/p/successfully-treating-c-ptsd-with?utm…

Our Guest: Dr. Cladouhos is a child, adolescent, and adult psychiatrist and psychoanalyst practicing in Boston, Massachusetts. She is on the faculty at the Tufts University School of Medicine and in the Boston Psychoanalytic Institute's adult and child analytic training programs.  She is the course director of an experiential elective for first-year medical students at Tufts called The Healer's Art: Rekindling the Heart and Soul of Medicine and established a pilot retreat program (First Aid for Physicians) through Tufts Medical Center to address physician burnout. She is trained in EMDR and Deep Brain Reorienting, has completed the first phase of MDMA training through MAPS, and has a certificate in Ketamine Assisted Psychotherapy from the Fluence Center for Psychedelic Training in New York. She is a member of the International Society for the Treatment of Trauma and Dissociation's Special Interest Group on psychoanalytic contributions to the treatment of trauma and dissociation.

Recommended Readings: 

Jeffrey Guss (2022) A Psychoanalytic Perspective on Psychedelic Experience, Psychoanalytic Dialogues, 32:5, 452-468, DOI: 10.1080/10481885.2022.2106140 

Fischman, Lawrence G. Knowing and being known: Psychedelic-assisted psychotherapy and the sense of authenticity. 09/20/22. Frontiers in Psychiatry. pp.1-36 

Lawrence G. Fischman (2019) Seeing without self: Discovering new meaning with psychedelic-assisted psychotherapy, Neuropsychoanalysis, 21:2, 53-78, DOI: 10.1080/15294145.2019.1689528

Dahlberg, Charles Clay. LSD Facilitation of Psychoanalytic Treatment: A Case Study in Depth 

Aaron D. Cherniak, Joel Gruneau Brulin, Mario Mikulincer, Sebastian Östlind, Robin Carhart-Harris & Pehr Granqvist (2023) Psychedelic Science of Spirituality and Religion: An Attachment-Informed Agenda Proposal, The International Journal for the Psychology of Religion, 33:4, 259-276, DOI: 10.1080/10508619.2022.2148061

Orbach, S. There Is No Such Thing As A Body. John Bowlby Memorial Lecture: British Journal of Psychotherapy. 20 (1) 3-15 2003

Orbach, S. Body Part 2: Psychoanalysis’ Discomfort with Touch. British Journal of Psychotherapy. 20 (1) 17-26.2003.

Essentials of informed consent:

Power Trip: Cover Story New York Magazine. Lily K Ross and David Nickels 

“What is it like to be a clinician with a patient who either comes because they're going to be dying or it happens in the treatment -  what is it like for the clinician? It's lonely in a way because there is a lot of parallel with what the patient is going through. To me, and as a field, I would like to think we could talk about this and write about it. My peer group at the time was terribly important to me - colleagues, people that basically would be with me in this. But in the end I was the one that went alone to the service at the funeral home and I went to my patient's luncheon, not to have the lunch but to talk to the family, and then I left - I didn't stay for the lunch, I thought that might be a little intrusive. There's nothing really to read about, talk about, pick somebody's brain about how do they experience this in their work or I don't really understand why we've been so quiet about this in our work.” PW

“You mentioned about being alone in it, and there is a way in which it's very true. I think a large part is that not many of our colleagues have had this experience. But on the flip side, maybe because I’ve worked with so many patients and I’m beginning to notice a certain consistency, but I've also had such an experience of close intimacy with these patients. There's a closeness that is to be had particularly in analytic work and work over time - but it happens quite quickly in the work with dying patients, and in that regard, I felt less alone in my work. In some ways in the rest of our work, because we maintain a careful distance in a way, a boundary with the patient, a frame - I feel with the dying patients, I feel like both of us are more in the room together.” MM

Episode Description: We begin with acknowledging the tension that exists between the literal and metaphoric aspects of the analytic relationship and how that is highlighted in the face of physical illness in either party. We focus on patients' illnesses both as they present upon initial consultation and when they develop in the course of treatment. Mark describes his years of work with cancer patients, and Peggy shares her experience with an analysand who, in the 6th year of her treatment, developed a terminal illness. We consider the emotional challenges associated with making home visits, the meaning of 'boundaries', feelings associated with fees, and the shared experience of love between patient and analyst. We consider the ways that the analyst’s affective intensity may also be associated with earlier and feared illnesses in their own life. We close with considering the difficulties that our field has in honestly communicating this aspect of the heart and soul of psychoanalysis.

Linked Episodes:

Episode 23: A Psychoanalyst Encounters the Dying – Discovering ‘Existential Maturity’

Episode 40: How Psycho-Oncology Informs an Approach to the Covid-19 Crises with Norman Straker, MD

Our Guests:

Mark Moore, PhD, is a clinical psychologist and psychoanalyst who works in private practice in Philadelphia. He was the Director of Psychological Services at the Abramson Cancer Center at Pennsylvania Hospital from 2004-2014 where he supervised psychology interns and post-doctoral fellows during their psycho-oncology rotation and provided psychological services to cancer patients and their families. He is also currently a co-leader for a weekly doctoring group for neurology residents at Penn Medicine. He was the Director of the Psychotherapy Training Program from 2014-2020 at the Psychoanalytic Center of Philadelphia, where he currently teaches courses on Writing, Assessment, Core Concepts, and a comparative course on Psychotherapy and Psychoanalysis. He was a recipient of the 2020 Edith Sabshin Teaching Award from the American Psychoanalytic Association, and he runs a monthly teaching forum for faculty at his institute. Dr. Moore’s clinical work focuses on health issues, notably chronic illness, losses, and life transitions associated with cancer, and the fear of dying. He has written several book chapters on topics including the concept of harmony in Japan, cultural perspectives on lying, conducting therapy outside the office, the experience of bodily betrayal in illness and aging, the experience of shame across the adult lifespan, and more recently about friendship. 

Peggy Warren, MD, is a psychiatrist and psychoanalyst in Boston. Originally from Chicago, she danced professionally with Giordano Dance Chicago from ages 15 to 21, which created a lifelong interest in the effects of creativity and mentoring on human development. Fascinated by cell biology, she received a master’s degree in microbiology from Chicago Medical School and then an MD from Rush University. In medical school, she was chosen to be an Osler Honor Fellow in Pathology/Oncology, where she was first exposed to dying patients. Awarded the Nathan Freer prize for excellence in a medical student at graduation, she used the prize money to buy the Complete Works of Freud and began to learn about the power of the unconscious. After completing residency training in psychiatry at Massachusetts General Hospital, she pursued analytic training and graduated from the Boston Psychoanalytic Society and Institute. She was on the teaching and supervising faculty of the MGH/McLean psychiatry residency program for 30 years, the Boston Psychoanalytic faculty for 20 years, and won the teaching award from the Harvard Medical School MGH/McLean residency program in 2010. She has given talks on “Vaslav Nijinski: Creativity and Madness,” was a discussant with Doris Kearns Goodwin on Abraham Lincoln and depression, lectured on the effect of twinships on siblings, was a discussant in the “Off the Couch Film Series,” (Boston Coolidge Corner theater), a case presenter “On the Dying Patient” at the 2017 American Psychoanalytic meetings, and is a faculty member of the American Psychoanalytic Association’s annual Workshop on Psychoanalytic Writing. She has been in private practice in Boston as a psychoanalyst for 38 years.

Recommended Readings:

Bergner, S. (2011). Seductive Symbolism: Psychoanalysis in the Context of Oncology. Psychoanalytic Psychology, 28,267-292.

Emanuel, L. (2021). Psychodynamic contributions to palliative care patients and their family members. In H. Schwartz (Ed.), Applying Psychoanalysis to Medical Care. New York: Routledge. 

Hitchen, C. (2012). Mortality. New York: Hatchette Book Group.

Minerbo, V. (1998). The patient without a couch: An analysis of a patient with terminal cancer. Int. J. Psych-Anal., 79,83-93.

Norton, J. (1963). Treatment of a Dying Patient. Psychoanalytic Study of the Child, 18, 541-560

Didion, Joan: The Year of Magical Thinking. Vintage/Random House, 2007

Jaouad, Suleika: Between Two Kingdoms: A Memoir of a Life Interrupted;

Random House, 2022.

Bloom, Amy: In Love: A Memoir of Love and Loss;Random House, 2023.