Psychopathology

Transcription

1 Psychopathology /1 Psychoanaytic Pespectives on Psychopathology I Dr. Schneier 12/8 Psychoanalytic Perspectives on psychopathology II Dr. Schneier 12/15 Obsessional Defenses Dr. Notarfrancesco 12/22 Obesssional Defenses Dr. Notarfrancesco 1/5 Masochism I Dr. Jacobson 1/12 Masochism II Dr. Jacobson 1/26 Hysteria I Dr. Schneier 2/2 Hysteria II Dr. Schneier 2/9 Narcissism I Dr. Sagi 2/23 Narcissism II Dr Sagi 3/2 Narcissism IIII Dr. Sagi 3/9 Clinical Case Correlation Dr. Gutman 3/16 Paranoid States of Mind I Dr. Sagi 3/23 Paranoid States of Mind II Dr. Sagi 3/30 Depression Dr. Busch 4/6 Affect-Its Expression and dys-expression I Dr. Bookstein 4/13 Affect-Its Expression and dys-expression II Dr. Bookstein 4/20 Affect-Psychoanalytic Approaches to Depression Dr. Bookstein 4/27 PSA Struggle with Trauma Dr. Lindy 5/4 Trauma- Reinterpretation of Data Dr. Lindy 5/11 Trauma-Dissociation and the Question of Multiple Personality Dr. Lindy 5/18 Perverse Structure and Phenomena I Dr. Kulchycky 6/1 Perverse Structure and Phenomena II Dr. Kulchycky 6/8 Clinical Case Correlation Dr. Notarfrancesco

2 Psychopathology Course Class 1 December 1, 2014 Psychoanalytic Approaches to Psychopathology I Dr. Schneier Lemma, A. An Overview of the Schools of Psychoanalysis: Theory and Practice, Chapter 1, (pages 15 53), in Lemma, A. (2006), Introduction to the Practice of Psychoanalytic Psychotherapy. Wiley Study Questions: 1. Alessandra Lemma gives an overview of Classical Freudian theory, Ego Psychology, Kleinian Object Relations Theory, The British Independent School/ Object Relations, Self Psychology, Intersubjectivity, and Attachment Theory. Class discussion will center around how each of these theories conceptualizes what goes wrong with patients and results in psychopathology. Strenger, C. The Classic and the Romantic Vision in Psychoanalysis, IJP, (1989) 70: pp Study Questions: 1. What is the essence of psychopathology in conflict models, and in deficit models? To what degree is generalizing theories into conflict models and deficit models useful in conceptualizing core elements of psychopathology? Do you agree with the authors grouping Freud and Klein together as conflict model theorists and Kohut, Balint and Winnicott together as deficit model theorists? Where would Attachment theory fit into this grouping? 2. What do you think of the author s conclusion that many analysts consider patients psychopathology from both conflict and deficit perspectives? Seminar 2 Psychoanaytic Pespectives on Psychopathology I Dr. Schneier Kernberg, O. Aggressivivity, Narcissism and Self Destructiveness in the Psychotherputic Relationship Yale, 2004; Chapter 1 1. What are the levels of Personality Organization described in this paper? 2. What do you think of the construct of psychodynamic lines which extend across the three levels of personality organization? How well do you feel this succeeds as a way of describing personality disorders? 3. Why is it important to identify levels of personality organization? 4. What other factors beyond developmental dynamics influence a patient s level of personality organization?

3 5. How does Dr. Kernberg s theory of personality organization inform the analyst s technique in working with patients? 6. How is analytic techniques fundamentally different with neurotic vs borderline personality organization? 7. How is Dr. Kernberg s theory useful in conceptualizing psychopathology? Joseph, Betty On Understanding and not Understanding: Some Technical Issues 1983, International Journal of Psychoanalysis, 64: What are the forms of psychopathology that are being described in this paper? 2. What is crucial to the analysts understanding of patients who are operating from within the paranoid/schizoid position? 3. Describe the analysts use of transference and countertransference in identifying psychopathology and in intervening on it? 4. Can you think of examples of patients whom you have treated who are operating in the paranoid/schizoid or depressive position? 5. How does the concept of psychopathology in Kleinian theory (as elaborated here by Betty Joseph) compare to that elaborated by Dr. Kernberg in the prior paper? 6. What is the difference in the levels of abstraction in the two theories of psychopathology? Coen, Stanley The Sense of Defect, 1986, JAPA, 34: What is the sense of defect being described in this paper? 2. What does Dr. Coen believe constitutes the core element of psychopathology leading to patients sense of defect? 3. How does Dr. Coens concept of the sense of defect relate to psychic deficit; how does it relate to psychic conflict? 4. Can one have a model of psychopathology which includes both conflict and deficit? 5. How does such a model(s) inform psychoanalytic technique? Lecture 3 Obsessive Defenses in Analysis, I. : Classical models. Dr. Notarfrancesco Freud, S. (1908). "Character and anal erotism. S.E. 9: Keep in mind through these 3 classes on obsessive defenses in analysis, that we're considering how to work with all patients' defenses against affects. You'll see throughout this course that affect intolerance, is a formidable problem; therefore, we examine it in various ways. Freud finds a way to explain the development of character which is, an early model for psychic development. This is much more important than the vicissitudes of the anal libidinal drive. Again, try to identify with Freud as he struggles to develop a psychoanalytic model of childhood development

4 (1913). "Disposition to obsessional neurosis." S.E. 12: With the concept of pregential organization of libido, Freud's developmental model moves toward "choice of an object". Organization links with sequential development, here of anal-erotic and sadistic-anal impulses. Exaggerated fears of hostile aggression will play a significant role in all your analysands. This is why we examine this in detail. Freud, A. (1966). "Obsessional neurosis: a summary of psychoanalytic views presented at the Congress". Internat. J. Psycho-Anal., 47: While Anna Freud summarizes 1960's thinking about obsessionality, can you find where she opens the door for concern with attachment, separation, loss and destruction? What do you think of her model of precocious ego and superego development? Do you want to modify the classical model of obsessionality? Nagera, H. (1976). "Obsessional neuroses as a facade". Obsessional Neuroses: Developmental Psychopathology, New York: Aronson, Chapter 3 pp An attempt to preserve the classical view of the obsessional by subsuming and integrating other conflicts as subsidiary. How well do you think he succeeds?. Optional Reading Fenichel, O. "Obsession and compulsion." The Psychoanalytic Theory of Neurosis, Norton, 1945, chapter 14, pp An encyclopedic summary of classical views on obsessionality. I will summarize it, but if you review it, note his ideas on superego defense: provocativeness; use of witnesses; "automatized pseudo-morality"; superego harshness and unevenness. Think about magical defenses against magical destructiveness. Focus on problems of analyzing the obsessionalcwhich extend to the obsessional side of everyone. Abraham, K. (1919). "A particular form of neurotic resistance against the psychoanalytic method." Selected Papers on Psychoanalysis, New York: Basic Books, 1953, pp Note how clearly, for 1919, he understands narcissistic defenses against needing and valuing another person, especially as compounded by envy, while still seeming intolerant of them. Seminar 4 Obsessional Defenses in Analysis, III.:Contemporary theoretical revisions. Dr. Notarfrancesco

5 Shapiro D. (1965). "Obsessive-Compulsive style" In: Neurotic Styles, New York: Basic Books, Chapter 2, pp Even though you may have read this previously, this is a terrific description of obsessional fear of spontaneous feeling leading to willingness to surrender to another person's control or domination. Shapiro helps you feel empathically what it's like to be in the room with wth obsessional side of patients. Character rigidity aptly describes the affective constriction of the obsessional. Asseyert, H. (2002). "The Exclusion of the Other: A Clinical Contribution to an Object-Relations Theory of Obsessional Defense" Internal. J Psychoanalysis, 83: The author is describing an obsessional mechanism in the form of a particular type of object relation? Can you describe this object relation. How does this object relation keep the patient from forming identifications? What is the purpose of avoiding identifications? What types of anxieties does this obsessional mechanism serve to defend against? As we have discussed with certain hysterical mechanisms, the author makes the point that while his case example is of a Borderline patient, this obsessional mechanism may occurr in individuals with a range of psychic structures. Can you think of patients you have seen who use such a mechanism? Optional Reading: Shapiro, D. (1981). "Rigid Character and Obsessive-Compulsive Rigidity". In: Autonomy and Rigid Character, Chapters 3 and $, New York: Basic Books, pp Brandchaft, B. (2001). "Obsessional Disorders: A Developmental Systems Perspective" Psychoanalytic Inquiry, 21: Seminar 2 Hysteria I Dr. Schneier Freud, S (1908): Hysterical phantasies and their relation to bisexuality. S.E. 9: Zetzel, E. (1968): The so-called good hysteric. Int. J. Psycho-Anal. 49: Easser, R. & Lesser, S. (1965): "Hysterical personality: A re-evaluation." Psychoanal. Q. 34: Laplanche, J. (1974): "Panel on hysteria today." Int. J. Psycho-Anal. 55: Optional Review the Dora case if you would lkike Freud, S. (1905): Fragment of an Analysis of a Case of Hysteria

6 Study Questions: 1. How has Freud s theory of the pathogenesis changed from 1901 when Dora was written (case was published in 1905) to 1908 when he published Hysterical Phantasies and their relation to Bisexuality? 2. What is the phenomenology that Easser and Lesser and Zetzel are looking at as they define hysterical character in the 1960 s?. What elements make for hysterical character? How is this different from hysterical neurosis? 3. What prompted these authors to examine the spectrum of hysterical characters and break it down. What is the role of oedipal conflict? What is the role of preoedipal conflict? How are the two related? 4. What is the relationship of instinctual development and object relations for these authors (Easser and Lesser, and Zetzel)? 5. What do you think about the debate about the desexualization of hysteria as this is elaborated in the Laplanche paper? 6. How do you imagine incorporating preoedipal developmental dynamics into theorizing about oedipal conflicts? In what ways does this or does it not change the relevance of sexuality? Seminar 4 Masochism I Dr. Jacobson Review quickly: Freud, S. (1923). The ego and the id. S.E. 19, chapter 5, pp Freud, S. (1919). A child is being beaten. S.E. 17, pp Freud, S. (1920). Beyond the pleasure principle. S.E. 18, pp Freud, S. (1924). The economic problem of masochism. S.E. 19, pp You will already have read these papers in the first year Freud course, and we will not discuss them in detail in class, but rather refer back to them in our discussions of other papers, so simply skim them to refamiliarize yourself with the basic points of each paper. Brenner, C. (1959) The masochistic character: genesis and treatment. JAPA 7: Berliner, B. (1958). The role of object relations in moral masochism. PQ 27: Seminar 6 Masochism II Dr. Jacobson Joseph, B. (1982). Addiction to near-death. International J. Psychoanal., 63: Stolorow, R.D. (1975). The narcissitic function of masochism and sadism. IJP 56:

7 Optional: Cooper, A. (1988) The narcissistic-masochistic character, in Glick, R.A. and Meyers, D.I., eds., Masochism: Current Psychoanalytic Perspectives, Analytic Press. Kernberg, O. (1988) Clinical Dimensions of Masochism. JAPA, 36: Seminar7 Hysteria I Dr. Schneier Freud, S (1908): Hysterical phantasies and their relation to bisexuality. S.E. 9: Zetzel, E. (1968): The so-called good hysteric. Int. J. Psycho-Anal. 49: Easser, R. & Lesser, S. (1965): "Hysterical personality: A re-evaluation." Psychoanal. Q. 34: Laplanche, J. (1974): "Panel on hysteria today." Int. J. Psycho-Anal. 55: Optional Review the Dora case if you would lkike Freud, S. (1905): Fragment of an Analysis of a Case of Hysteria Study Questions: 1. How has Freud s theory of the pathogenesis changed from 1901 when Dora was written (case was published in 1905) to 1908 when he published Hysterical Phantasies and their relation to Bisexuality? 2. What is the phenomenology that Easser and Lesser and Zetzel are looking at as they define hysterical character in the 1960 s?. What elements make for hysterical character? How is this different from hysterical neurosis? 3. What prompted these authors to examine the spectrum of hysterical characters and break it down. What is the role of oedipal conflict? What is the role of preoedipal conflict? How are the two related? 4. What is the relationship of instinctual development and object relations for these authors (Easser and Lesser, and Zetzel)? 5. What do you think about the debate about the desexualization of hysteria as this is elaborated in the Laplanche paper? 6. How do you imagine incorporating preoedipal developmental dynamics into theorizing about oedipal conflicts? In what ways does this or does it not change the relevance of sexuality?

8 Seminar 8 Hysteria II Dr. Schneier Bollas, C. (1987): The psychoanalysts and the hysteric. The Shadow of the Object Kohon, G.(1984) Reflections on Dora.: the case of hysteria. IJP 65:73, 1984 Yarom, Nitza, A Matrix of Hysteria, IJP, (1997), vol 78, pp Optional: DeFolch, T. Eskelinen (1984): "The hysterics use and misuse of observation." IJP. 65: Bollas, C. (2000) Hysteria. Routledge. Chapters 2 (13-26), 4 (pp and 14 ( Brenman, E. (1985): "Hysteria." Int. J. Psycho-Anal. 66: Study Questions: 1. In each of the three papers, what is the hysterical phenomenology that the authors are identifying? 2. To what extent has this changed from the papers from the 1960's and to what extent has it remained the same? 3. What is Kohon's concept of 'divalence'? What do you think about his theory and about his notion that hysteria is specific to femininity? Is there a way to incorporate male hysteria into his theory? 4. What do you think of the way in which Bollas uses the concept of 'conversion' compared to Freud's concept of the term? 5. In what ways does the hysterical mechanism (which is a particular types of object relations) described by Bollas serve as resistances to analysis? Do you find this a useful way in which to think about hysteria? What has happened to the role of sexuality according to Bollas? 6. Yarom attempts to conceptualize Hysteria across three dimensions: gender/sexuality, repression and conversion as they are understood in modern psychoanalysis. She elaborates on central tenets of Freud s original concept hysterical symptoms, and concludes that one may evaluate hysteria across these original three dimensions. The three dimensions extend across different levels of personality structure or organization. How well do you think her matrix of Hysteria succeeds in explaining common attributes of healthier and sicker patients

9 with hysterical defenses 7. Do you feel that these authors add anything to your way of assessing and/or working with hysterical defenses? Seminar 9 Narcissism - Dr. Sagi Freud, S. (1914). On Narcissism. S.E. XIV: Cooper, A. M. (1989). Narcissism and Masochism: The Narcissistic-Masochistic Character. Psychiatric Clinics of North America 12(3): (republished The Narcissistic-Masochistic Character. Psychiatric Annals 39(10): , October 2009) Stolorow, R.D. (1975). Toward a Functional Definition of Narcissism. Int. J. Psycho- Anal. 56: optional: Pulver, W.E. (1970). Narcissism: The Term and the Concept. JAPA 18: Seminar 10 Pathological Narcissism I - Dr. Sagi Abraham, K. (1927). A particular form of neurotic resistance against the psycho-analytic method (1919). in Selected Papers. London, Hogarth Press. Riviere, J. (1936). A contribution to the analysis of the negative therapeutic reaction. Int. J.Psycho-Anal. 17: Rosenfeld, H. (1964). On the Psychopathology of Narcissism: A Clinical Approach. Int. J. Psycho-Anal. 45: optional: Reich, A. (1953). Narcissistic Object Choice in Women. JAPA Reich, A. (1961). Pathological Forms of Self Esteem Regulation. Psychoanal. Study Child. 15: Seminar 11 Pathological Narcissism II - Dr. Sagi Kernberg, O. (2004): Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship: New Developments in the Psychopathology and

10 Psychotherapy of Severe Personality Disorders Yale University Press. Chaps. 3 & 4 (pp ) Kohut, H. (1977): The Restoration of the Self. New York: IUP. Chap.2, Kohut, H. (1979). The Two Analyses of Mr. Z. Int. J. Psychoanal., 60:3-26 Recommended further readings for narcissism (selections of relevant historical and contemporary clinical texts) Akhtar, S. (1996). Someday.. and If Only.. Fantasies: Pathological Optimism and Inordinate Nostalgia as Related Forms of Idealization. JAPA, 44: Akhtar, S. (2000). The Shy Narcissist. In: Changing Ideas In A Changing World: The Revolution in Psychoanalysis. Essays in Honour of Arnold Cooper, Karnac Books Bion, W. R. (1958). On arrogance. Int. J. Psycho-Anal. 39: Bolognini, S. (2008). Reconsidering Narcissism from a Contemporary, Complex Psychoanalytic View. Int. Forum Psychoanal., 17: Burstein, B. (1973). Some Narcissist Personality Types. Int. J. Psycho-Anal. 54: Chused, J.F. (2012). The Analyst's Narcissism. JAPA, 60: Faimberg, H. (2005). The Telescoping of Generations: Listening to the Narcissistic Links between Generations. London and New York: Routledge. Gitelson, M. (1954). Therapeutic Problems in the Analysis of the Normal Candidate. Int. J. Psycho-Anal. 35: Goldberg, A and Kohut, H. (1978). The Psychology of the Self. New York: IUP. Green, A. (2001). Life Narcissism, Death Narcissism. London: Free Association. Green, A. (2002). A Dual Conception of Narcissism: Positive and Negative Organizations. Psychoanal. Q., 71: Grunberger, B. (1979). Narcissism: Psychoanalytic Essays. New York: International Universities Press

11 Jacobson, E. (1959). The "Exceptions" An Elaboration of Freud's Character Study. Psychoanal. Study Child, 14: Jacobson, E. (1975). The Regulation of Self Esteem. Psychoanal. Study Child, Jones, E. (1913). The God Complex: The Belief that One is God and the Resulting Character Traits. in Essays in Applied Psychoanalysis, Vol II London: Hogarth Press, Kernberg, O.F. (2007). The Almost Untreatable Narcissistic Patient. JAPA, 55: Kernberg, O.F. (2008). The Destruction of Time in Pathological Narcissism. Int. J. Psycho-Anal., 89: Kohut, H. (1971). The Analysis of the Self. New York: IUP. Perelberg, R.J. (2004). Narcissistic configurations: Violence and its absence in treatment. Int. J. Psycho-Anal., 85: Reich, W. (1933). The Phallic Narcissistic Character. in Character Analysis Touchstone Books: Simon and Schuster, Rosenfeld, H. (1971). A Clinical Approach to the Psychoanalytic Theory of the Life and Death Instinct: An Investigation in the Aggressive Aspects of Narcissism. Int. J. Psycho- Anal. 52: Steiner, J. (1993). Psychic Retreats: Pathological Organizations in Psychotic, Neurotic, and Borderline Patients. London: Routledge Steiner, R. (1989). On Narcissism: The Kleinian Approach. Psychiatric Clinics of North America 12(3): Tartakoff, H. (1966). The Normal Personality in our Culture and the Nobel Prize Complex. in Psychoanalysis, a General Psychology ed. Loewenstein, etc: IUP, van der Waals, H. (1965), Problems of Narcissism. Bulletin of the Menninger Clinic 29: Wylie, H.W. (1974): Thread in the Fabric of a Narcissistic Disorder. JAPA 22: Seminar 12 Clinical Correlation Dr. Gutman Seminar 13 Paranoid States of Mind I Dr. Sagi Freud, S.: Psycho-Analytic notes on an autobiographical account of a case of paranoia (Schreber Case) S.E. XII.

12 : A Case of Paranoia Running Contrary to the Psychoanalytic Theory. S.E. XIV : Some Neurotic Mechanisms in Jealousy, Paranoia and Homosexuality. S.E. XVIII. Optional: Klein, Melanie. "Contributions to the psychogenesis of manic depressive states,(1935)" in Love, Guilt and Reparations Delacort Press, 1975 Kernberg, O. "Paranoid Regression and malignant narcissism, in Severe Character Disorders Yale University Press, 1984, pp Seminar 14 Paranoid States of Mind II Dr. Sagi Blum, Harold: "Paranoia and beating fantasy: An inquiry into the psychoanalytic theory of paranoia." JAPA. 28: , Auchincloss, E.L., Weiss, R.M.: "Paranoid Character and the Impossibility of Indifference." JAPA 40(4), 1992 Cooper, Arnold: Paranoia: a part of most analyses. JAPA 41(2): , 1993 Seminar 14 Affect: Its expression and dys-expression I Dr. Bookstein Krystal, Henry.:Affect Tolerance. Annual of Psychoanalysis, 3: , Coen, S.: Negative acting on how to help patients (and analysts) bear the unbearable. JAPA 45: , 1997 McDougal, J (1984): The Adis-affected patient: reflections on affect pathology PQ 53:386 Seminar 15 Depression Dr. Busch Rado S: The problem of melancholia. Int J Psychoanal 9: , 1928 Chapter 2 of Psychodynamic Treatment of Depression, by Busch, F. et al, 2004 with recommended reading: Freud S: Mourning and melancholia (1917), in The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol 14. Translated and edited by Strachey J. London, Hogarth Press, 1957, pp

13 Jacobson E: The psychoanalytic treatment of depressive patients, in Depression and Human Existence. Edited by Anthony B. Boston, MA, Little, Brown, 1975, pp Seminar 16 Affect: Its expression and dys-expression II Dr. Bookstein Gabbard, G.: Love and lust in erotic transference. JAPA 42(2): , 1994 Stern Gloria: Anxiety and Resistance to Changes in Self-concept. In Anxiety as Symptom and Signal. Edited by SP Roose and RA Glick Joseph, Betty: Different types of anxiety and their handling in the analytic setting: In Psychic Equilibrium and Psychic Change, pp , Seminar 17 Affect: Its expression and dys-expression III Dr. Bookstein Chused, Jusith. (1991):The evocative power of enactments. JAPA 39: Anderson, Maxine. (1999): The pressure toward enactment and the hatred of reality. JAPA 47: Ivey, G. Enactment controversies: a creitical review of current debates. IJP 89: 19- Seminar 18 Affect: Psychoanalytic approaches to depression Dr. Bookstein Seminar 19 Psychoanalytic Struggle with Trauma Dr. Lindy Readings Freud: Heredity and the aetiology of the neuroses (1896), S.E. III Freud, 1897, Letter 69, S.E. vol. 1, p Makari, G. The seductions of history: sexual trauma in Freud s theory and historiography. Chapter 1: pp in The Seduction Theory in its Second Century. Hood, editor, IUP, 2006 Ferenczi: (1949). Confusion of tongues between the adult and the child. Ijp 30: Optional: Simon, B. (1992). Incest- see under Oedipus complex. JAPA 40:

14 Seminar 20 Trauma - Reinterpretations of the data Dr. Lindy Russell, P (1998) The role of paradox in the repetition compulsion, in Trauma, Repetition and Affect Regulation (ed. By J.G. Teicholz and D. Kriegman) Fonagy: Living the experience of childhood seduction (1998). Paper presented at the Symposium of the Journals of the PEP CD-ROM AThe seduction hypothesis: one hundred years later@ 1 st March 1998 Davies, J. (1999), Getting cold feet, defining Asafe-enough@ borders. PQ, 68: Seminar 21 Trauma, Dissociation and the Question of Multiple Personality Dr. Lindy Readings; Shengold, L. A view of severely traumatized patients, in Good, M. The Seduction Theory in the Second Century, pp Brenner, C On trauma, perversion and multiple personality JAPA 44: , Howell, E. The Dissociative Mind. Chapter 1, pp Seminar 22 Perverse Structure and Phenomena I Dr. Kulchyky Readings: Kernberg, O. (2004) Perversion, perversity and normality in Aggresivity, Narcissim and Destructiveness in the psychotherapeutic relationship, pp Seminar 23 Dr. Kulchycky Perverse Structure and Phenomena II Stein, R. Why perversion? False love and the perverse pact. IJP 86: , 2005 Purcell, S. (2006) The analyst's excitement in the analysis of perversion. IJP., 87: ?????

15 Seminar 24 Clinical Case Correlation Dr. Notarfrancesco Moises Rabih, Body as stage for criminal acting out, Int Jouranal of Psychoanalysis 1991.