Psychoanalysis On and Off the Couch

"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.

"From such accounts [of Polish atrocities] we can see how incredibly emotional and how incredibly pleasurable it could be on the social level, not only for the people involved, but for the whole group, and we can really see how violence on others becomes the core of social identity, of the national identity. We tend to think about committing violence as anti-social, and that Eros is the only force that brings us together. We can't see here how eroticized violence or sexualized violence might do it as well. After so many years of research, we don't really have to ask the question: how is it that people can do such things, or how can people become murderers on a social level, on a group level? I'd say that the more interesting question we may ask is how did the murderers stay people and stay citizens? How could after committing such crimes in plain sight of the whole group, how could that group remain a stable group? How could a community of murderers and bystanders to the violence - what is the social glue that brings them all together? I would say that eroticized violence is one of the main aspects, one of the main elements of creating a closed identity based on denial of humanity of the other."

Episode Description: We begin with acknowledging the phenomena of bystanding in the presence of extreme violence. The slaughter of neighbors by neighbors notoriously occurred in the Rwandan genocide and in the Polish Holocaust, which is the focus of Jan's research. He posits that the psychoanalytic concept of perversion best captures the denial and split-off excitement that characterizes bystanding - 'one eye open, one eye closed'. He challenges the possibility of observer's indifference, documents the ever-present knowledge that neighbors have of the history of their neighbors, and discusses the experience of 'ghosts' inhabiting the homes of forgotten/remembered neighbors. We distinguish between being a bystander and a witness, and the state of mind "We will not forgive you for what we did to you." We close with our sharing the difficulty of listening to this material and how he managed this over the years of his research.

Our Guest: Jan Borowicz, PhD, is a certified psychotherapist and candidate in psychoanalytic training in Polish Psychoanalytic Society (IPA). He is a Member of Holocaust Remembrance Research Group in the Institute of Polish Culture, University of Warsaw, Poland. He is interested in cultural memory, psychoanalytic theory, and Holocaust studies. He published two books in Polish on history and memory of the Holocaust. Recently, he published his first book in English, Perverse Memory and the Holocaust: A Psychoanalytic Understanding of Polish Bystanders (2024), in which he explores the deep implications of witnessing mass violence and extermination.

Recommended Readings:

Jessica Benjamin, "A relational psychoanalysis perspective on the necessity of acknowledging failure in order to restore the facilitating and containing features of the intersubjective relationship (the shared third)", International Journal of Psychoanalysis, vol. 9, iss. 3, 2009.

Jan Borowicz, Perverse Memory and the Holocaust: A Psychoanalytic Understanding of Polish Bystanders, trans. Mikołaj Golubiewski, Routledge: London and New York, 2024.

Stanley Cohen, States of Denial: Knowing about Atrocities and Suffering, Cambridge: Polity Press, 2001.

Samuel Gerson, "When the Third is Dead: Memory, Mourning, and Witnessing in the Aftermath of the Holocaust", International Journal of Psychoanalysis, vol. 9, iss. 6, 2009.

Grzegorz Niziołek, Polish Theatre of the Holocaust, trans. Ursula Phillips, London: Bloomsbury Publishing and Instytut Teatralny im. Zbigniewa Raszewskiego, 2021.

Probing the Limits of Categorization: The Bystander in Holocaust History, eds. Christina Morina, Krijn Thijs, New York: Berghan Books, 2019.

Joel Whitebook, Perversion and Utopia: Studies in Psychoanalysis and Critical Theory, Cambridge, Massachusetts: MIT Press, 1996.

My conversation with Sudhir Kakar took place five weeks before his untimely death on April 22nd.

"Freud obviously is very brave and courageous to accept that the world is inadequate and that my desires will never be sufficiently fulfilled. My question - is this in fact the case? I think that everyone has had some kind of spiritual experience, some more than others and in many different contexts, not just religious ones. Spiritual experiences contradict Freud's notion of common unhappiness and the idea of the world as inadequate. What reason do we have to assume that all such common experiences are simply false, that they are based on some kind of false consciousness? Rather, I believe that the inadequacy lies in our own awareness rather than with the world. The world allows for many experiences that would be highly adequate yet we block them - what we call the mundane world is much more enchanted than we think it is."

Episode Description: We begin by considering the embodiment of one's cultural imagination - "one's mental representation of culture" - into one's unconscious mind. Sudhir describes different early child-rearing practices and invites the question about their influence on our later inner lives. He shares with us his early idealization of Freudian/Western ways of thinking and his later development, which returned to the enchanting aspects of his Hindu youth. We discuss the similarities and differences between a Judeo-Christian-based psychoanalysis and one founded on a Hindu imagination. We consider the different notions of God, ritual, and illusion. He distinguishes an 'autonomous person' from a 'communitarian person' and describes the pleasures and burdens of each. We close with his sharing his lovely psychoanalytic origin story connected to his meeting Erik Erikson and discovering "I want to be like him."

Our Guest: Sudhir Kakar was a psychoanalyst, scholar, and writer. He had been a Lecturer and Visiting Professor at Harvard University, Visiting Professor at the Universities of Chicago, McGill, Melbourne, Hawaii, and Vienna, Fellow at the Institutes of Advanced Study, Princeton, Berlin, and Cologne, and was on the board of Freud Archives. He had received the Kardiner Award of Columbia University, Boyer Prize for Psychological Anthropology of the American Anthropological Association, Germany's Goethe Medal, Tagore-Merck Award, McArthur Research Fellowship, and Order of Merit of the Federal Republic of Germany. `As 'the psychoanalyst of civilizations', the French weekly Le Nouvel Observateur listed Kakar in 2005 as one of the world's 25 major thinkers. Sudhir was the author/editor of 20 books of non-fiction and six novels. His books have been translated into 22 languages.

Recommended Readings:

Kakar, Sudhir -

The Indian Jungle: Psychoanalysis and Non-Western Civilizations, Karnac. June 2024

The Capacious Freud, in F. Busch and N. Delgado eds.The Ego and the

Id 100 years Later. London: Routledge 2023

Re-reading Freud's The Future of an Illusion in Hindu India, in O'neill & S.Akhtar.eds.On Freud's the Future of an Illusion. London: Routledge, 2018

The Analyst and the Mystic Chicago: University of Chicago Press, 1992

Psychoanalysis and Eastern Spiritual Healing Traditions, J. of

Analytical Psychology,48(5).

Shamans, Mystics and Doctors: A Psychological inquiry into India

and its Healing Traditions. New York: A. Knopf, 1982.

Mad and Divine: Spirit and Psyche in the Modern World. Chicago: U. of

Chicago Press, 2009

"Psychoanalysis landed in Finland in the 50s; before the Second World War there were one or two persons familiar with psychoanalysis. In the 50s, psychoanalysis got a lot of interest in Finland but then there was no possibility of training in Finland. The pioneers went abroad, some to Sweden and some to Switzerland. They picked up the theoretical preferences in the new countries and new institutes - the IPA Associations mainly were from people studying in Sweden and coming back to Finland and creating the IPA association. The Therapeia Institute consisted mainly of people studying in Switzerland and got a lot of influence from existential psychoanalysis and Jungian psychoanalysis… I tend to side with Lee Grossman [link below]; I guess the theoretical theories reflect more the character - when you listen to a case presentation of course people present them differently depending on their theoretical background, but in the consulting room I am not sure there is that much difference."

Episode Description: We begin with acknowledging the value of meeting and learning from analyst colleagues from around the world. We discover both similarities and differences in both the challenges and pleasures of this work. In Finland there was a government-mandated change in the structure of training in psychotherapy and psychoanalysis starting in 2012. The anticipatory anxieties were considerable. There was input from the university on issues of curricula, research opportunities, and improved pedagogy. The fears of loss of meaningful autonomy proved to be mostly fears - not realized. We also discuss the origins and current state of psychoanalysis in Finland. We close with a few words of the pervasive role of sauna in Finnish life and the ways it manifests in analyses.

Linked Episode:

Episode 135: Technique is Character Rationalized with Lee Grossman, MD (Oakland, Ca.) – IPA Off the Couch

Our Guest: Jan Johansson is a psychologist and a training and supervising analyst at the Therapeia Institute in Helsinki, Finland. Currently, he's working as a psychoanalyst in private practice in Helsinki. In addition, he supervises psychotherapists and psychoanalysts. He has been interested in issues concerning psychoanalytic training for the last decade and a half. Currently he is the chair of the board of the Institute, while also being a member of board of the Therapeia Society. He also was a member of the Executive Committee of the International Federation of Psychoanalytic Societies 2014 - 2022. He is interested in promoting the multitude of psychoanalytic voices; while being trained within an object-relational frame, he doesn't identify exclusively with any particular theoretical frame of reference.

He lives in Espoo, a neighbor city of Helsinki with his wife. After languishing in the darkness of the Finnish winter from October to mid-March, in the summer they enjoy the light and the white nights at their summer-house at the seaside, heating their sauna everyday and swimming in the Finnish Gulf.

Linked Episode:

Episode 135: Technique is Character Rationalized with Lee Grossman, MD (Oakland, Ca.)

Recommended Readings:

Grossman, L. (2023): The psychoanalytic encounter and the misuse of theory. New York: Routledge.

Kernberg, O.F. (2016). Psychoanalytic education at the crossroads: Reformation, change and the future of psychoanalytic training. New York: Routledge

Reeder, J. (2004). Hate and love in psychoanalytic institutions: The dilemmas of a profession. New York: Other Press.

Tuckett, D. (2005). Does anything go? Towards a framework for the more transparent assessment of psychoanalytic competence. Int J Psychoanal. 86: 31–49.

Tuckett, D., Amati Mehler, J., Collins, S., Diercks, M., Flynn, D., Franck, C., Millar, C., Skale, E., Wagtmann, A-M. (2020): Psychoanalytic education in the Eitingon model and its controversies: A way forward. Int J Psychoanal. 101: 1106 – 1135.

"My interest is to rather than continue with the psychoanalytic tilt which has tended to try to find the words - to find the areas of the analyst that has words to engage with these states and then help the patient transform these states into something thinkable and communicable. [In contrast] my interest has been to take the patient where they are; it's kind of a radical way of saying 'meeting the patient where they are', and find our way and lend ourselves to engaging with them in their own idiom, using Bollas's term, in their own way of being and to find ways to be with them that don't necessarily rely on talking about things and making things known."

Episode Description: We begin by considering patient's non-represented mental states and their manifestation in somatic and motoric registers. Robert describes his understanding and approach to clinically engage those who "barely experience continuity of the self or subjectivity in themselves or others." He recommends 'companioning' with them. This entails not trying to "move the patient out of these regressed areas into greater relatedness ...but to welcome these other dimensions and their full expression within the analytic space." We consider the role of enactive engagements, the non-verbal vs the pre-verbal and 'radical neutrality'. He presents a case where the patient and analyst shared music, food and not discussed emotional intimacy between them that he felt was vital to enable the patient to emerge as a 'real person'. We close with speaking of Robert's professional history of working early on with psychotic individuals and finding that his approach enabled them, often to their surprise, to feel heard. He also describes his attunement to the experience of being an 'other' that emerged from his growing up as an 'other' - a Jew in London.

Our Guest:

Robert Grossmark, Ph.D., ABPP, is a psychoanalyst in New York City. He works with individuals, groups, and couples. He is on the teaching and supervising faculty at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis, The National Institute for the Psychotherapies Program in Adult Psychoanalysis, The National Training Program in Psychoanalysis, National Faculty Member, the Florida Psychoanalytic Center and lectures at other psychoanalytic institutes and clinical psychology training programs nationally and internationally. He is an Associate Editor for Psychoanalytic Dialogues. He is the author of The Unobtrusive Relational Analyst: Explorations in Psychoanalytic Companioning and co-edited The One and the Many: Relational Approaches to Group Psychotherapy and Heterosexual Masculinities: Contemporary Perspectives from Psychoanalytic Gender Theory.

Recommended Readings:

Grossmark, R. (2024) The Untelling, Psychoanalytic Dialogues. In press.

Grossmark, R. (2019) The anguish of fatherhood, Psychoanalytic Perspectives, 16 (3), 316-325.

Grossmark, R. (2023) A child is being murdered: A contemporary psychoanalytic treatment of a compulsion to child pornography, Psychoanalytic Psychology, 40: 25-30

Bach, S. (2011) Chimeras: Immunity, interpenetration and t he true self. Psychoanalytic Review, 98(1): 39-56

Winnicott, D. W. (1974). Fear of breakdown. International Review of Psycho-Analysis, 1(1-2), 103–107.

Bollas, C. (2011) Character and interformality. In C. Bollas, The Christopher Bollas Reader (p. 238-248)

Ogden, T.O. (2017) Dreaming the analytic session: A clinical essay. Psychoanalytic Quarterly, 86: 1-20.

Stern, D.B. (2022) On coming into possession of oneself: Witnessing and the formulation of experience. Psychoanalytic Quarterly, 91: 639-667

Symington, N. (2012) The Essence of psychoanalysis as opposed to what is secondary. Psychoanalytic Dialogues. 22, 4, 395-409

"The first line treatment for adolescents with anorexia now is family-based therapy typically, which involves helping the parents facilitate the refeeding of the adolescent. So, I was working with the patient in that way and found it to be helpful and useful, but was consistently struck by the neglect of the patient's inner life, and found, at least based on my experience with many patients, that while you could get some symptomatic relief, if you didn't, in some way, address the deeper dynamics, the aspects of the patient's personality organization that drove the disorder, that were implicated at the disorder, there was a way that the patient would snap back to their old behaviors over time, that deeper change and a deeper understanding of what was going on was really necessary; and so that's been kind of evolution from my work over the past ten years from my first book, which was about anorexia in males, and tried to present a kind of Integrative understanding of that phenomena, increasingly over time I've become more and more interested in the deeper kind of analytic thinking that we can bring to bear on this kind of suffering."

Episode Description:

We begin with a description of the common contertransferential pull to intervene behaviorally in the face of repetitive self-destructive eating disorder symptoms. This intention can inform but not compel the clinical decision as to the indicated treatment of choice for someone at any particular moment. Behavioral and pharmacologic treatments can be important in softening the pressure of eating disorder symptoms. They do not, however, give an individual access to their interoceptive life, from which these disturbing self-preoccupations emerge. We discuss the challenges of working with those who have limited capacities for mentalisation and as a result, live out their inner lives somatically and motorically. Immersive treatment leads the clinician to experience these proto-affects in one's own body and in one's own ruminations. Tom discusses alexithymia, typical family structures, and the presence of the 'abject' experience in the lives of these patients. He presents a disguised case of a patient who was able to work through both the early struggles and later neurotic aspects of these conflicts analytically. We close with his sharing with us his vision for the future which includes more integration between the dynamic and adynamic approaches to these challenging patients.

Our Guest: Tom Wooldridge, PsyD, is Chair in the Department of Psychology at Golden Gate University as well as a psychoanalyst and board-certified, licensed psychologist. His first book, Understanding Anorexia Nervosa in Males, was published in 2016. His second book, Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak, an edited volume in the Relational Perspectives Book Series, was published in 2018. His third book, Eating Disorders (New Introductions to Contemporary Psychoanalysis), was released in 2022. His fourth book, co-edited with Burke, Michaels, and Muhr, is entitled Advancing Psychotherapy for the Next Generation: Rehumanizing Mental Health Policy and Practice. He has also written a novel about the process of psychotherapy, Ghosts of the Unremembered Past, additionally released as an audiobook. He is a Personal and Supervising Analyst at the Psychoanalytic Institute for Northern California and a Training Analyst at the San Francisco Center for Psychoanalysis. He is on the Scientific Advisory Council of the National Eating Disorders Association, Faculty at the Psychoanalytic Institute of Northern California (PINC), the Northern California Society for Psychoanalytic Psychology (NCSPP), the William Alanson White Institute's Eating Disorders, Compulsions, and Addictions program, and the San Francisco Center for Psychoanalysis, and has a private practice in Berkeley, CA.

Recommended Readings:

Williams, G. (1997). Reflections On Some Dynamics Of Eating Disorders: 'No Entry' Defences and Foreign Bodies. International Journal of Psycho-Analysis., 78, 927-941. Brady, M.T. (2011). Invisibility and insubstantiality in an anorexic adolescent: phenomenology and dynamics. Journal of Child Psychotherapy, 37(1), 3 – 15. Bromberg, P.M. (2001). Treating patients with symptoms – and symptoms with patients: Reflections on shame, dissociation, and eating disorders. Psychoanalytic Dialogues, 11(6), 891 – 912. Petrucelli, J. (2015). 'My body is a cage': Interfacing interpersonal neurobiology, attachment, affect regulation, self-regulation, and the regulation of relatedness in treatment with patients with eating disorders. In J. Petrucelli (Ed.). Body-states: Interpersonal and relational perspectives on the treatment of eating disorders. (Psychoanalysis in a New Key). New York: Routledge. Sands, S. (2003). The subjugation of the body in eating disorders: A Particularly female solution. Psychoanalytic Psychology, 20(1), 103 – 116.

Wooldridge, T. (2021). Anorexia nervosa and the paternal function. Journal of the American Psychoanalytic Association, 69(1), 7-32.

Wooldridge, T. (2018). The entropic body: Primitive anxieties and secondary skin formation in anorexia nervosa. Psychoanalytic Dialogues, 28(2), 189 – 202.