C-1: Continuity of Relatedness After The End of Treatment: Moving Beyond the Roadblocks of Psychoanalytic History

Transcription

1 C-1: Continuity of Relatedness After The End of Treatment: Moving Beyond the Roadblocks of Psychoanalytic History Adam Kaplan, PhD Sheldon Meyers, MD Jane Jordan, PsyD Psychoanalysis has strived to provide innovative and creative methods of navigating and understanding human experience. But the very theoretical innovation that once opened new pathways of understanding can become, over time, an intrusion into the fluid nature of clinical practice. This paper follows the evolution of a treatment to a stage where the clinician felt abandoned by theory. While attempting to remain afloat in the turbulent waters of mourning and death, it became difficult to recognize how a psychoanalytic conception of the termination process could help facilitate a quality of relatedness in an increasingly complex system. At the start of treatment the patient was a college student presenting with many of the struggles that are often a part of a young person s transition from familiar structure to unknown territory. The diagnosis of an ultimately fatal disease within the first six months of treatment changed not only the nature of the therapeutic relationship, but the relationship of the therapist to the patient s family. The larger intersubjective system that has become an understood yet somewhat invisible element of any treatment suddenly became a concrete reality including family members, doctors, other therapists, hospital rooms, and the family home. As the work progressed, it became increasingly apparent that while the focus remained on the needs of the patient, the treatment relationship was not one of one patient/one person, but a much larger tumultuous system of subjectivities. Psychoanalytic theory remained a stabilizing and adaptable tool for helping the patient with end of life issues. But as the overall context of the treatment shifted the clinician felt increasingly unaided in his efforts to establish a relatedness with the entire family that felt consistent with the emotional realities of the evolving system. The night of the patient s death the therapist was with him and his family in their home. Perhaps this event, more than any other, thrust the background quality of intense connection between the therapist and the family into the foreground. It was a moment that, once again, dramatically altered the intersubjective field of the work. This contextual shift left the therapist adrift, as present-day theory did not seem up to the task of helping him consider how the challenge of terminating could or should be approached. At the conclusion of my presentation the participants will be able to more fully conceptualize their self within a larger intersubjective system and consider how this understanding informs establishing greater continuity of relatedness after the end of treatment. The participant will also be able to critique the theoretical and cultural factors within psychoanalysis that can stand in the way of conceptual and clinical growth.

2 C-2: Owning My Thrownness-Into-Others: Extending Intersubjective-Systems Theory Perspectives On Experiences of Personal Ownership and Individuality Presenter: Discussant & Malcolm Slavin, PhD Discussant & Peter Maduro, PsyD, PsyD, JD Malcolm Slavin, PhD This paper/presentation draws on Heidegger (1927) and extends Stolorow s (2009 & 2010) recent intersubjective systems studies of the experience of self. It shows that a person s sense of distinctive selfhood, or individuality, is enriched when he owns the affectivity associated with his thrownness : the feelings of powerlessness evoked by those features of his existential situation over which he has utterly no say or control. Focus is placed on the person s ownership of his perceptions of, and emotional reactions to, the developmentally critical human relationships of attunement and/or malattunement into which his emotional life is thrown --i.e., delivered outside of any consent, agency or control on his part. The person s thrownness into his particular attuned and/or malattuned caregiving relationships is termed his thrownness-into-relationship. Thus, the person s ownership of his distinctive perceptions and affective reactions to his thrownness-into-relationship expands and enriches his sense of individuality. I explain that a person s ownership, or disownership, of his thrownness-into-relationship is facilitated, or obstructed, as the case may be, by caregivers attuned or ill-attuned receptivity to the person s distinctive views and feelings about, first, his emotional interactions with his primary caregivers past and present, perhaps especially hurtful ones, and, second, his helpless existential deliverance into this relational context. Finally, I contend that psychoanalytic theories must strive towards an ever more rigorous and refined contextualism --one that is capable of further illuminating the phenomenology of contextualism. Educational Objectives: 1. By the end of this paper/presentation, the audience would better understand the value of using philosophical phenomenologies, like that of Heidegger (1927), in the elaboration of psychoanalytic phenomenology and explanation, including especially the phenomenology and understanding of selfhood --or, better, self-other-worldhood. 2. By the end of this paper/presentation, the audience would better understand the respect in which enriched experiences of distinctive selfhood, or individuality, entail not radical differentiation from other but instead constitutive otherhood and worldhood. Instead of the individual as radically distinct from other, the individual is viewed as embedded in other (and world).

3 C-3: Can We Say It Is a Coincidence That the Patient Does Well? Discussant & Koichi Togashi, PhD Margy Sperry, PsyD In this paper the author attempts to explore how and in what sense a patient and an analyst subjectively experience an analytic process as contingent or necessary, and to describe the therapeutic effect the experience has on an analytic process in which analyst and patient allow themselves to view the therapeutic process as contingent. Through discussion of the case vignette of a female patient with whom the analyst slips into an intersubjective disjunction, the author concludes that contingency and necessity are significant terms through which patient and analyst together make sense (Orange, 1995) of their emotional experiences. The author emphasizes that a traumatized person or a relational organization easily falls into a dualism between contingency and necessity, and that a traumatized system is perturbed when an analyst and a patient allows themselves to confront the possibility that any phenomena could be both contingent and necessary. The author finally suggests that contingency and necessity have to do with a person s sense of being human. Educational Objectives: At the conclusion of the presentation, participants will have a better conceptual grasp of the clinical significance of contingency and necessity. They will have an understanding of their complex relationship, and they will be able to describe how a traumatized person slips into the dualism and how the traumatized system can be perturbed.

4 C-4: George Atwood s Radical Engagement," Posttraumatic Development, and Necessary Delusions Doris Brothers, PhD Susan Lazar, MD Eileen Paris, PhD, PsyD What allows development to resume after severe trauma? What do delusions tell us about the reality of self? This paper explores these provocative questions with reference to George Atwood s understanding of madness as explicated in his recent book, The Abyss of Madness. It also makes use of a delusional experience of the author s, which served restorative functions in the aftermath of severe trauma. Two clinical examples, are presented to illustrate how Atwood s concept of radical engagement makes for posttraumatic development. Educational Objectives 1. At the conclusion of my presentation, participants will be able to discuss George Atwood s concept of radical engagement. 2. At the conclusion of my presentation, participants will be able to describe the restorative functions of delusional experience. 3. At the conclusion of my presentation, participants will be able to explain how radical engagements between therapists and patients promote posttraumatic development.

5 C-5: How the Empathic Process Heals A Microprocess Perspective Richard Geist, EdD Sanford Shapiro, MD Susan Mitchell, MA Kohut struggled tenaciously for many years with his ambivalent attitude toward empathy s potentially curative effect. In his final lecture, Kohut clarified his belief that empathy per se is a therapeutic action in the broadest sense His premature death, however, prevented him from formulating the specific and myriad ways that empathy contributes to the healing process. Contemporary self psychologists continue to debate whether and how empathy may contribute to the healing process, but these discussions tend to be more theoretical than clinical. Rarely discussed or articulated are the experience near clinical questions of how the therapist or analyst actually enters another s subjective world, how he allows the patient into his own world, and how empathy impacts intersubjective healing processes in any given therapeutic session. This paper delineates, from a microprocess perspective, how empathy contributes to healing. I attempt to formulate an intersubjective definition of empathy as a mutual analytic process, describe empathy s general contribution to psychic healing, present a verbatim analytic hour in which I endeavor to remain embedded in an empathic process and then, through a progressive discussion of that hour, enumerate more specifically how empathy benefits the healing process. At the conclusion of my presentation, the participant will be able to: 1. Describe an intersubjective view of the empathic process 2. Explain how empathy contributes, both generally and specifically, to the healing process 3. Apply one s understanding of the empathic process to deepen an analytic hour

6 C-6: Alone in the Mirror: Twins in Therapy Barbara Klein, PhD, EdD Julia Davies, PhD Lisa Bialkin, JD, LCSW Alone in the Mirror: Twins in Therapy chronicles the triumphs and struggles of twin as they separate from one another and find their individuality in a world of non-twins. The text is grounded in issues of attachment and intimacy, and is highlighted by Dr. Barbara Klein s scholarly research, clinical experiences with twins in therapy, and her identity struggles as a twin, all of which allow her to present insights into the rare, complicated, and misunderstood twin identity. She presents psychologically focused real life histories, which demonstrate how childhood experiences shape the twin attachment and individual development, and she describes implications for twins in therapy, their therapists, and parents of twins. Unique to this presentation are effective therapeutic practices, developed specifically for twins, and designed to raised the consciousness of parents as well. Participants will find the practices and insights that are presented extremely useful, whether they use them to communicate with twin patients and family members, or if they are part of a twinship themselves. At the conclusion of the presentation these educational objectives will be understood. 1. Participants will be able to explain how the two primary attachments twins share affect their development as individuals in a non-twin world. 2. Participants will be able to analyze the twin attachment in order to make a treatment plan for psychotherapy. 3. Participants will be able to describe five common problems of twins in therapy.

7 C-7: Hermeneutics of Suspicion or Hermeneutics of Trust? The Complexity of Theory Choice in Psychoanalysis Ernesto Vasquez, MD Sandra Kiersky, PhD Marina Amore, PhD, PsyD The Hermeneutics of Suspicion and the Hermeneutics of Trust are incompatible psychoanalytic attitudes. The Hermeneutics of Trust must become our fundamental working attitude for it captures more precisely "the spirit and practice of relational psychoanalysis" with all its elements, especially its ethical clinical sensibility and sense of vocation, which can radically transform why and how we work. Theory choice in psychoanalysis is a complex matter. At the conclusion of my presentation, the participant will be able to: 1. Explain the differences between the Hermeneutics of Suspicion and the Hermeneutics of Trust as interpretive mind-sets adopted as fundamental working attitudes. 2. Explain five considerations to be made in the complex matter of choosing a psychoanalytic theory.

8 C-8: Living Truthfully Under Imaginary Circumstances: The Impact of Improvisation in Psychoanalysis Discussant & Arthur Gray, PhD Alan Kindler, MBBS FRCP Improvisation in psychoanalysis has heretofore been defined by a theater games model in which the emphasis is on a creative exchange of dialogue. In this paper, I expand the concept of improvisation by drawing on the contributions of Sanford Meisner. Two improvisers maintaining affective engagement characterize his model. He described this process as living truthfully under imaginary circumstances. Clinical case material illustrates how a Meisner improvisation can be applied to circumstances in which the analyst is pushed beyond familiar analytic comfort zones. In such situations, his improvisation provides the analyst with an additional resource with which to respond to these challenging moments in ways that facilitate increasing intimacy between patient and analyst. I spell out how a Meisner improvisation impacts therapeutic action in psychoanalysis. Educational Objectives 1. At the conclusion of my presentation, the participants will discuss and understand what a Meisner improvisation is. 2. The participants will also discover and discuss how a Meisner improvisation can be relied on to engage complex challenging moments that occur in an analysis. 3. The participants will understand and discuss how a Meisner improvisation contributes to therapeutic action.

9 C-9: Oren Builds A House Discussant & Iris Golomb-Haalman, PhD Jacqueline Gotthold, PsyD The therapy process with Oren, a seven years old boy whom arrived to therapy mainly due to his oppositional attitude, is portrayed in details. Oren, and many other children like him, pass as a regular kid to adults, yet is perceived as different by children his age. He doesn t play-pretend, has difficulties adapting to changes and his social skills are impaired. Also excels academically, he can t use language to cope with emotional distressed. During the sessions, by mainly building things, Oren goes from withdrawing, rejecting the therapist, building walls around him in the most concrete way, to interacting, collaborating, enjoying closeness and intimacy, and caring. Is it worthwhile? Is it enough? The growing awareness and interest among the psychoanalytic community, in treating people and kids characterized with Asperger or similar social and mentalization deficits, opens the way to gaining better understanding regarding the possible developmental and therapeutic processes that can be expected, including seeing the great affection that can develop in such relationships. Educational Objective: At the conclusion of my presentation, the participant will be able to discuss possible therapeutic processes and outcomes for psychotherapy with Aspereger or other similar socially impaired kids; to notice diagnostically sub-threshold people that might have gone unnoticed till then, Recognize some of the counter-transference and enactments that might occur in such a treatment, to describe some of the developmental implications to the parent-child relationship and hence to the child ability to experience himself as caring and loving; and to inquire the difficulties and possibilities of using metallization and mutual regulation in relationships.