Psychoanalysis On and Off the Couch

“After I had been practicing analysis for 50 years, I asked myself: What was the most important thing I learned in those 50 years? It took me a lot of time to learn the obvious: the patient is somebody else.”

Description: Dr. Harvey Schwartz welcomes Dr. Warren Poland, who is a psychoanalyst in private practice in Washington DC. Dr. Poland is a former editor of the JAPA Review of Books and he has been on the Board of The Psychoanalytic Quarterly for over 40 years. Dr. Poland was awarded the Sigourney Prize in 2009 and the JAPA Journal Prize in 2002. In addition to many articles, Dr. Poland has written two books, Melting the Darkness: The Dyad and Principles of Clinical Practice and his most recent work: Intimacy and Separateness in Psychoanalysis.

During this episode, Dr. Poland shares what it means to him to be vulnerable in this time as well as his sense of responsibility to others. He describes how the centrality of the recognition of the other gives rise to the recognition of aspects of responsiveness and separateness between people. His goal is to appreciate the patient as an other as well as for the patient to recognize his separateness.

Key takeaways:

[7:02] Dr. Poland shares his perspective with regard to the current crisis.

[9:33] Life can be terrifying for our species; all we can do is hope and work for the future.

[10:45] The future needs us.

[10:58] Dr. Poland talks about his analytic journey.

[12:58] What is like to be somebody else?

[16:33] ´There is a real person in there´.

[17:50] Dr. Poland talks about the obstacles that prevent truly engaging with a patient.

[18:40] Psychoanalysis is the discipline that studies the matters that the patient does not want to confront.

[20:30] The patient reads the analyst even better than the analyst does.

[21:50] Nobody lives outside the fabric of the human interchange.

[23:55] Dr. Poland shares a moment that describes his sensitive eye for people’s self-aggrandizing tendencies.

[27:07] Dr. Poland talks about how he deals with his patients that are struggling with financial situations.

[28:25] It is important that a patient is able to fire a doctor.

[30:35] If you want your patients to come back, tell them something they could use, and then they will want to come back for more.

[32:55] Dr. Poland dives deep into the fullness of conversation.

[35:46] What is human and humane is regard for the other.

[36:44] Dr. Poland talks about the intimacy about what is true without the fear of showing vulnerability.

[39:56] The core of conversation and vulnerability is the realization of reciprocity.

Mentioned in this episode:

IPA Off the Couch www.ipaoffthecouch.org

Recommended Readings:

Melting the Darkness: The Dyad and Principles of Clinical Practice, Dr. Warren Poland

Intimacy and Separateness in Psychoanalysis, Dr. Warren Poland

“Transformation is a kind of buzz word and it’s not just some economic and sociopolitical transformation. Indeed, it is about transforming the inner self as well and psychoanalysis is well placed to face these challenges.”

Description: Harvey Schwartz welcomes Armien Abrahams who is a Training Analyst at the South African Psychoanalytic Association. He is in private practice in Cape Town, South Africa. He has a special interest in the internal-external dynamics specifically regarding the legacy of Apartheid. He works in many areas, one of them is on setting up and providing affordable psychoanalytic services. He is the chairman of the Low Fee clinic structure which is part of the Psychoanalytic Institute. Armien is also very heavily involved in education and training.

In today’s conversation, Armien Abrahams shows his deep passion for his work, more specifically about that pivot point between the internal and the external worlds. He speaks of the power and the importance of meeting both at the same time - there is a great need for focus on the external disadvantages, burdens and challenges without losing awareness of the importance of the internal struggles that we all simultaneously face.

Key takeaways:

[4:35] How is South Africa managing the current crisis?

[10:50] The prohibition of buying cigarettes has triggered a black market.

[12:33] Psychoanalysis in South Africa.

[15:27] Psychoanalysis in South Africa consists of two different organizations SAPI and SAPA.

[17:20] Armien Abrahams talks about the switch to online sessions.

[20:15] Psychoanalysis provides the possibility of an inner journey.

[21:30] Armien Abrahams shares some clinical examples to illustrate how the transition to online sessions has been like with patients.

[25:10] The showing vs the wish to show.

[28:22] Armien Abrahams shares the challenges SAPI and SAPA are facing which do not outshine his passion for psychoanalysis.

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Mentioned in this episode:

IPA Off the Couch www.ipaoffthecouch.org

South African Psychoanalytic Association

“It's the people of the institute that are with us whenever we are doing our work, silently humming in the background. We are constituted by our colleagues.”

Description: Harvey Schwartz welcomes Dr. David Frank, who is a Training and Supervising psychoanalyst at the Psychoanalytic Association of New York (PANY) which is affiliated with the NYU School of Medicine. He is also currently serving as the Director and President of the Board at PANY, which is one of a number of IPA affiliated institutes in New York City. Dr. Frank is an assistant clinical professor of psychiatry at the NYU Langone Health Center, and he is also the Chair of the Medical Center Liaison between PANY and the NYU, Langone Health Center. In addition, he serves on the board of directors of the American Association for Psychoanalytic Education (AAPE) and is also a fellow of the American Board for Psychoanalysis.

All these activities describe only one aspect of Dr. Frank’s life as a psychoanalyst. Listening to today’s interview enables us to discover additional sides to him. Dr. Frank is an improvising musician - an aptitude that he exercises as the Director of the Institute orienting himself to new circumstances, to new tunes, tensions, and dissonances. Dr. Frank privileges the sense of psychoanalytic community which is the core of his success as a leader.

Key takeaways:

[5:40] Dr. Frank resides in New York and he shares his view about the current situation there.

[9:27] Dr. Frank, as Director of the Institute, shares his experience turning it into an online training program.

[13:05] The current moment became the subject of each of the classes.

[14:10] The challenge of keeping the value of the metaphor when there is a real and physical danger.

[15:31] COVID offers an opportunity to re-work all traumas.

[16:10] Candidates are using their own personalities and instincts to be supportive of their patients.

[18:08] The role of supervisors during the pandemic.

[20:01] The support and warmth of belonging to the psychoanalytic community.

[22:53] Psychoanalysis is a discipline and a practice that requires a community.

[23:10] Dr. Frank shares the shifts in his practice.

[25:28] Dr. Frank talks about a case example.

[28:45] Every analysis is different, the relationship between an analyst and an analysand is unique.

[30:09] What sustains Dr. Frank during these difficult times?

Mentioned in this episode:

IPA Off the Couch www.ipaoffthecouch.org

"I think people are feeling intimate in a way, strangers are feeling intimate, about what is important in life and what is important about what we leave behind. It is a very precious thing to be feeling and something we should hold on to."

Description: Harvey Schwartz welcomes Dr. Linda Emanuel for the second time to this podcast. On the first episode published in October 2019, Dr. Linda Emanuel shared that she began her career as an internist. She then trained as a psychoanalyst at the Chicago Psychoanalytic Institute and then continued working with dying patients in palliative care. She shares with the audience again in this episode her central notion of existential maturity. Her insights on this matter have never been so valuable than now when we are all living in uncertainty and facing death. Dr. Emanuel’s perspective as a palliative care psychoanalyst will shed light on the challenges we are facing.

Key takeaways:

[5:50] Dr. Emanuel talks about the meaning of existential maturity: a capacity that human beings have to come to terms with mortality.

[9:45] Existential maturity can come at any age and moment in life.

[11:42] How is to be an analyst among internal medicine doctors in palliative care?

[16:17] Dr. Emanuel gives her perspective about the current times during the COVID-19 crisis.

[20:18] The isolation of dying with COVID-19.

[22:18] Some people are coming into a new relationship with their internal objects while not having their external objects available.

[24:05] Dr. Emanuel shares clinical material.

[30:05] The present and the past coming together.

[32:31] Dr. Emanuel talks about how she is experiencing these times.

Mentioned in this episode:

IPA Off the Couch www.ipaoffthecouch.org

“The importance of inner ideas, fantasies, develop from the unconscious. Reality is important but not conclusive. We perceive and conceptualize reality with our unconscious. So let’s give the unconscious more than ever during this crisis its place, and keep the intention to listen to the unconscious with our patients.”

Description: Harvey Schwartz welcomes Dr. Cristina Escudero to today’s episode. Dr. Escudero is a psychologist and a graduate of the Madrid Psychoanalytic Association. She also has a Masters in Family Therapy and Group Dynamics, and works with adults, teenagers, and children. Dr. Escudero is a supervisor of therapists, teaches courses on psychoanalytic technique and also supervises therapists who work with foster children as part of the Basque Country therapeutic program.

Dr. Cristina shares her exquisite focus on what she calls “the intention to listen to the unconscious” which is her guiding principle in the face of trauma. It is not that she does not honor the current objective reality, but rather that in addition, she keeps her attention on listening to the unconscious before, during, and after sessions.

Key takeaways:

[4:30] Dr. Escudero talks about the common concern patients have regarding the economic situation in times of Covid-19.

[6:46] Our psychic structure is not complete.

[7:22] The importance of investigating the origins of the crisis.

[8:00] The human psyche is in crisis.

[9:01] The renunciation to omnipotence is part of the Oedipus Complex resolution.

[13:00] How the crisis intervenes in Dr. Escudero’s clinical work?

[13:34] Dr. Escudero talks about the intention to listen to the unconscious.

[15:39] The intention before and during the sessions.

[18:30] Libido is not in virtual sessions since many sensorial faculties are missing.

[20:05] Dr. Escudero shares clinical examples.

[28:37] Dr. Escudero talks about the resources that have been helping her cope with this crisis.

Mentioned in this episode:

IPA Off the Couch www.ipaoffthecouch.org

“In this period with the Coronavirus and even during the wars, I don’t think that the relationship between me and the patient is symmetric even if we have to face the same external dangers. The relationship continues to be asymmetric - I manage the treatment, I decide the setting, I continue to be the analyst.”

Description: Harvey Schwartz welcomes Dr. Yael Samuel who is a Training Analyst at the Israeli Psychoanalytic Society. Dr. Samuel works full time in private practice as an analyst in Tel Aviv and is a member of the training committee in charge of the new candidates, programs, and teaching. Dr. Samuel is also the Co-Founder and Manager of the nonprofit organization called Lechol Nefesh, “For Every Soul,” which is a program designed to bring psychoanalytic psychotherapy to a larger population of often psychotic patients. As part of this program for the past seven years Dr. Samuel has been managing a treatment unit in a psychiatric hospital. Dr. Yael Samuel is the Israeli Psychoanalytic Society representative to the Congress of French Psychoanalytic Speakers and works along with Harvey Schwartz on the IPA in Health Committee.

In today’s conversation, Dr. Samuel shares her unique Israeli perspective on facing this crisis, as Israeli analysts have faced many crises before as a consequence of the wars they have been through. She shares some dramatic examples of the prior trauma they had to deal with as analysts in the analyst-patient dyad.

Key takeaways:

[7:45] Dr. Yael Samuel talks about what life is currently like in Israel.

[9:12] Israeli people are used to obeying when it is time to protect themselves.

[11:25] Israeli people have an app that shows if you have been in contact with someone infected by COVID-19.

[13:07] The response of the analytic community in Israel to the COVID-19 outbreak.

[15:28] There are a lot of groups and forums organized by psychoanalysts.

[16:05] Dr. Yael shares how the transition was to working with patients in an online modality.

[17:19] Dr. Yael talks about a difficult moment she experienced in her practice with one of her patients.

[20:01] Struggles that may arise in phone sessions with different patients.

[22:18] Real vs metaphoric.

[23:20] Dr. Yael talks about her work on a unit designed for psychotic patients.

[25:50] Dr. Yael talks about the asymmetry in the relationship with the patient.

[27:50] Dr. Yael confesses to being less frightened by the COVID-19 infection than by the war.

[30:08] What sustains Dr. Yael during this current crisis?

Mentioned in this episode:

IPA Off the Couch www.ipaoffthecouch.org

“The feeling of strangeness because of the emptiness and the weight of the silence, the immobilization of everything. This immobilization is one of the signs of the traumatic situation in the psychic life - we can think of the dream of the Wolf Man.”

Description: Harvey Schwartz welcomes Dr. Bernard Chervet who is a psychiatrist and a Full Member and Training Psychoanalyst of the Paris Society of Psychoanalysis where he has served as President. Dr. Chervet has also served as a scientific secretary of the Congress of French-Speaking Psychoanalysts. He is a member of the European Group for the IPA Encyclopedic Dictionary, a member of the task force ‘IPA Constituent Organizations’, and a member of the Freudian Legacy Task Force. Dr. Chervet has devoted his life not only to institutional analysis but also to deep clinical analysis. Dr. Chervet has won many awards and published more than 240 articles, chapters, papers and books with a special focus on metapsychology.

In today’s episode, Dr. Chervet demonstrates his commitment to understanding the mind of his analysands and he does it in his French way, by bringing together theory with a deep understanding of the present and the past and how they relate to each other. Dr. Chervet shares his perspective on the concept of latency in the mind of the analysand when one is overwhelmed by trauma, and the role of the analyst as a facilitator, creating the capacity to pause, reflect and gain perspective.

Key takeaways:

[7:35] How Dr. Chervet listens to patients when both current and past trauma are present.

[10:43] The current context in France after 4 weeks of social isolation.

[13:38] The deprivation of freedom.

[13:55] Social and political context in France.

[15:07] The denial of the pandemic.

[18:06] People’s insecurity is increasing as a result of the high level of information they are receiving which is mostly not congruent.

[18:55] Traumatic neurosis and the importance of latency.

[22:05] The role of the analyst in creating the possibility of latency for the patient.

[25:55] Dr. Chervet shares a demonstrative case example.

[34:01] The analyst is the guardian of latency.

[37:45] The transition to online sessions is not a choice.

[38:40] The new setting: what has been lost and what has been won.

Mentioned in this episode:

IPA Off the Couch www.ipaoffthecouch.org

“When you have analytic training, the analytic attitude is internalized and you need to fit and keep it as well as being aware of when you lose it. As a result of this loss you will be receiving a sign from the countertransference. This is the motivation and passion for psychoanalysis.”

Description: Harvey Schwartz welcomes Dr. Virginia Ungar, who is a training analyst at the Buenos Aires Psychoanalytic Association where she lives and practices. Dr. Ungar specializes in child and adolescent analysis and is the former chair of the IPA’s Child and Adolescent Psychoanalysis committee and of the Committee for Integrative Training. In 2016 she was awarded the Platinum Konex Award for Psychoanalysis. She currently serves as the President of the International Psychoanalytic Association.

In today’s episode, Dr. Virginia Ungar shares how it is for psychoanalysts to move from an in-person to an online experience. She describes her personal experience of these changes, her clinical work and most importantly her leadership role in helping the international psychoanalytic community weather this difficult time.

Key takeaways:

[5:55] Dr. Virginia Ungar talks about the current situation in Buenos Aires.

[9:53] The transition in Buenos Aires from in-person to online sessions.

[13:42] All the psychoanalytic associations in Argentina started offering online services.

[15:19] Scientific meetings are held every week by Zoom.

[16:40] Dr. Virginia Ungar prefers to work on Zoom.

[17:36] The age as a factor for the adaptation to the virtual sessions.

[19:15] The challenge of the visual aspect.

[21:03] The absence of the physical presence of the patient is draining.

[23:15] All our inner lives are under threat.

[25:11] How does it feel to hold up the IPA?

[26:40] The IPA website is offering a section called “Stay connected COVID-19”.

[29:50] What sustains Dr. Ungar during these times of crisis?

Mentioned in this episode:

IPA Off the Couch www.ipaoffthecouch.org

IPA Stay Connected

Recommended Readings:

Analista y Paciente en Mundos Superpuestos, Pudget Janine

“There is not just one pandemic right now, there are really two concurrent pandemics. The first one is the pandemic of the virus, but the second one that is closely tied to the first is a pandemic of anxiety. I want to be really clear that I am not just using that as a figure of speech, I am actually quite serious about that, I think anxiety is reaching epidemic proportions and I think it has major consequences for how all of us and certainly how leaders of organizations of any size lead.”

Description: In times when we are all facing a crisis of unprecedented proportion, we are going change the focus of the podcast: we will now be interviewing psychoanalysts from all corners of the globe to discuss how their local communities are coping with this situation, how their clinical work has been affected by the situation, and how the internal worlds of both the analysts and the patients have been impacted by this virus as it touches both our real and imaginary fears. This is an opportunity to gain great wisdom, empathy, and hope.

Steven Rolfe welcomes Kerry Sulkowicz to today’s episode. Dr. Sulkowicz is the President-elect of the American Psychoanalytic Association. He is founder and Managing Principal of the Boswell Group LLC, a management consultancy based in New York since 1998. Kerry serves as a trusted advisor on people and culture to some of the world’s most well-known and respected CEOs and corporate boards. He is a graduate of Harvard College and the University of Texas Medical Branch and is now a Clinical Professor of Psychiatry at NYU School of Medicine, where he received the Distinguished Teacher Award. He also received the Edith Sabshin Teaching Award from the American Psychoanalytic Association. A passionate advocate for human rights, Dr. Sulkowicz is the past Chair of the board of Physicians for Human Rights, a global human rights organization that has shared in the Nobel Peace Prize, and serves on the Advisory Council of Acumen.

Key takeaways:

[5:21] Kerry Sulkowicz talks about the challenges the American Psychoanalytic Association and private practitioners currently face.

[9:08] The transition to virtual work has been exhausting for many practitioners.

[10:28] Kerry Sulkowicz talks about the current crisis in New York.

[11:57] It is a critical time for Physicians for Human Rights.

[13:30] Human rights violations have not stopped with the pandemic.

[15:16] Kerry Sulkowicz shares his long term vision for the American Psychoanalytic Association.

[16:40] Psychoanalysts share unique basic values.

[19:06] The effects of the absence of human touch.

[20:08] It is a golden time for psychoanalysis.

[20:55] Kerry’s approach for leaders of organizations.

[24:15] The denial of anxiety is on one extreme while panicking is on the other.

[25:13] The right amount of anxiety is actually highly adaptive.

[26:05] Leaders need to lead with their values.

[27:03] A quote on 1918 Spanish flu.

[29:18] The role of leaders is to give hope that is embedded in reality.

[31:05] How leaders can help their organizations.

[34:07] Leaders need to model the importance of maintaining social ties.

[36:50] Kerry Sulkowicz talks about the effects of anxiety on all of us.

Mentioned in this episode:

IPA Off the Couch www.ipaoffthecouch.org

“Our very specific analytic listening can be used to understand how this external terrible situation is reactivating their internal anxieties and for that we try to confine the suffering to the here and now of the phone call.”

Description: Harvey Schwartz welcomes Dr. Ana Catarina Duarte Silva to this episode. Dr. Duarte Silva is a psychoanalyst and a full member of the Portuguese Psychoanalytic Society and of the IPA. She is also past secretary of the Portuguese Institute of Psychoanalysis, where she gives seminars especially in the work of Winnicott. Dr. Duarte Silva also published in the journal of the Portuguese Psychoanalytic Society where she is chair of the working team. She lives in Lisbon, where she has a private practice since 1995.

In this conversation, you will hear about how countertransference is often limited by the pressing reality that we are all working under. In contrast, Dr. Duarte Silva shares a very rich case example where the patient having ‘no body’ in the office reverberates with his recognizing his childhood experience of feeling like a ‘nobody.’

Key takeaways:

[4:08] Dr. Duarte Silva talks about how Portugal is encountering this crisis.

[6:58] Dr. Duarte Silva shares the current state of the analytic community in Lisbon.

[8:50] In Portugal there is an open telephone line for people to call when they need to talk to an analyst.

[9:25] The relation between social isolation, loneliness, and fear.

[11:50] Dr. Duarte Silva talks about the transition from in-person to online sessions.

[15:25] The matter of soft community denial.

[17:20] Hypochondria

[17;52] Fear of loss and helplessness.

[18:15] The lack of the body and its interference in the analytic process via online.

[21:25] Dr. Duarte Silva shares clinical material.

[26:56] What keeps Dr. Duarte Silva going through these uncertain times?

Mentioned in this episode:

IPA Off the Couch www.ipaoffthecouch.org

Recommended Readings:

The Possibility of an Island, Michel Houellebecq