Andrea Greenman Ph.D. Spring 2018 NYU Post-Doctoral Program in Psychotherapy and Psychoanalysis Clinical Case Seminar Moments of Meaning: The Widening Scope of Interpretive Intervention What do we say to our patients and when do we say it? Contemporary psychoanalytic thinking has attuned us to the many non-verbal factors that fuel therapeutic action. We recognize the importance of relational elements which create an environment promoting self-regulation and the development of psychic structure, and have developed a heightened awareness about the factors that position relationship as moving back and forth between center-stage and backdrop in the therapeutic process. These insights have shifted our attention and provide new depth to our understanding of what facilitates change. For some patients, at some times, it is the sound and shape of speech itself that is important. For others, it is the relational give-and-take that is of central importance. In this current context, what role does interpretation play in the therapeutic situation? Does the content of our comments still deserve its privileged role in the psychoanalytic process? Speech continues to be a critical vehicle in its power to give shape and form to inchoate experience, and in its ability to create possibilities for meaningful meeting in clinical dialogue. Perhaps it would be most accurate to view the therapeutic action of interpretation as combining all these elements, and more. We ve thrown out any technical concept that suggests that one size fits all, so now what? Tailoring our interventions to best suit the needs of each unique patient requires unusual clinical dexterity and the capacity to work with a broad array of analytic techniques. This clinical case seminar will create an opportunity to discuss these questions in depth and detail as we review the widening scope of interpretive interventions verbal interpretations, interpretive action, and formulations that address conflict along with those that provide a holding, mirroring, or containing function. Students will be offered the opportunity to present clinical process material in depth with an eye toward following the interpretive matrix, and enhancing the scope of their interpretive techniques. We will follow the ongoing experiences of both patient and analyst, and attend to the factors that lead to the creation of a psychic space in which meaning and understanding evolve. Readings will be selected to represent divergent points of view along the contemporary psychoanalytic spectrum and offer a point of entry for our discussion of clinical material. A historical perspective will, on occasion, provide contrast with contemporary views. Learning Objectives Overall Learning Objective At the end of this course, candidates will be able to describe and effectively utilize a full spectrum of interpretive techniques. They will be able to determine when to utilize interpretive technique based on the patient s 1
manifestation of psychic conflict, and when to utilize techniques based on the patient s manifestation of selfdisruption. They will be able to contrast various interpretive approaches based on different theoretical perspectives as well as describe how historical developments in theory have led to enhanced interpretive interventions. They will be able to integrate consideration of diagnostic issues and how levels of integration require different interpretive techniques. Candidates will develop facility in presenting clinical process from their own work with patients and listen to their peers presentation with a view towards formulating effective and meaningful interpretive interventions. SECTION 1: INTRODUCTION One Technique Or Many? Pine, F. (2001) Listening and Speaking Psychoanalytically--With What in Mind? IJP, 82:901-916. Levin, C. B. (2011) The Analyst s Words and Wording: Do They Still Matter? JAPA 59:1221-1237. Learning Objectives: At the end of this class, candidates will be able to identify how the utilization of different theoretical approaches in psychoanalysis leads to the use of different interpretive techniques. Candidates will be able to recognize how the use of different theoretical languages promotes different forms of listening to patient material. Candidates will listen to the presentation of clinical material and identify their personal language. Something Deeper than Technique Poland, W. (2002) The Interpretive Attitude. JAPA 50:807-826. Loewald, H.W. (1979) Reflections on the Psychoanalytic Process and Its Therapeutic Potential, PSC, 34:155-167. 2. FORMULATING INTERPRETATIONS Historical Perspectives Arlow, J. (1979) The Genesis of Interpretation. JAPA Supplement 27:193-205 Strachey, J. (1934) The Nature of Therapeutic Action of Psychoanalysis. IJP 15:127-159. With Summary by Glen Gabbard. Bibring, E. (1954) Psychoanalysis and The Dynamic Psychotherapies. JAPA 2:745-770. Learning Objectives: At the end of this class, candidates will demonstrate familiarity with historical perspectives on interpretation and recognize how classical psychoanalytic theory determined what we might now consider classical interpretive technique, and when it is appropriate to make use of this technique. 2
Listening to Listening Faimberg, H. (1996) Listening to Listening. IJP 77: 667-677. Schlesinger, H. (1995) The Process of Interpretation and the Moment of Change. JAPA 43:663-688. Learning Objective: All interpretations are trial interpretations (Bion) and this class will focus attention on listening to the patient s reaction to the initial interpretive intervention. Where We Are Now Busch, F. (2015) Our vital profession. IJP 96:553-568. Ungar, V. (2015) The toolbox of the analyst s trade: Interpretation revisited. IJP 96:595-610. Learning Objectives: At the end this class, candidates will be able to identify contemporary shifts in analytic technique that may be in wide practice regardless of theoretical orientation of the practitioner. Levels of Interpretation Busch, F. (2000) What is a Deep Interpretation? JAPA 48:237-254. Roth, P. (2001) Mapping the Landscape: Levels of Transference Interpretation IJP 82: 533-543. Learning Objectives: Candidates will be able to identify and explain different levels of interpretation. Something More than Interpretation Stern, D.N., Sander, L.W., Nahum, J.P., Harrison, A.M., Lyons-Ruth, K., Morgan, A.C., Bruschweilerstern, N., Tronick, E.Z. (1998). Non-Interpretive Mechanisms in Psychoanalytic Therapy: The Something More Than Interpretation. IJP 79:903-921. The Boston Change Process Study Group. (2002) Explicating the Implicit: The Local Level and the Microprocess of Change in the Analytic Situation. IJP 83:1051-1062. Optional: Fonagy, P. (1999) Memory and Therapeutic Action. IJP 80:215-223. Learning Objectives: At the end of this class, candidates will be able to assess and discuss the factors that determine the effectiveness of an analytic process that may be universal to all theoretical perspectives and may not be communicable in interpretive language alone. Candidates will identify movement in clinical process. 3
3. Thinking about the Patient: Shifting levels One Patient, Many Moments Ahktar, S. (2000) From Schisms Through Synthesis to Informed Oscillation: An Attempt at Integrating Some Diverse Aspects of Psychoanalytic Technique, PQ, 69:265-288. Killingmo, B. (1989) Conflict and Deficit: Implications for Technique, IJP, 70:65-79. Learning Objective: Candidates will be able to identify how communications from different sectors of development may emerge in the analytic session and require different kinds of interpretive techniques. The Analyst s Internal Process Ogden, T.H. (1997) Reverie and Interpretation. Psa Quarterly 66:567-595. Coltart, N. E. (1986). Slouching towards Bethlehem or thinking the unthinkable in psychoanalysis. In The British School of Psychoanalysis: The Independent Tradition, ed. G. Kohon. New Haven, CT/London: Yale Univ. Press, pp. 185-199. Use of Countertransference ~~ Containment Gabbard, G. (1991) Technical Approaches to Transference Hate in the Analysis of Borderline Patients. IJP 72:625-636. Cartwright, D. (2010) Projective Identification, countertransference and the containing function Chapter 2 in Containing States of Mind: exploring Bion s Container Model in Psychoanalytic Psychotherapy. Hove: Routledge. Britton, R. (1998) Before and after the depressive position Chapter 6 in Belief and Imagination, London: Routledge. Learning Objectives: At the end of these classes, candidates will be able to recognize and verbalize how the analyst s internal process of reverie may be used to understand and further the analytic process. They will be able to recognize the importance of utilizing the analyst s internal experience in identifying transference and countertransference and in formulating relevant interpretive interventions. Candidates will discuss their ability to identify and utilize their own internal experience that is elicited in the course of listening to the clinical presentation. 4
4. Clinical Issues The Patient Who Will Not Tolerate the Analyst s Speech Coltart, N. (1991) The Silent Patient, PD 1:439-453. Bach, S. (2006) Confusion in the Analytic Hour, Chapter 6 in Getting From Here to There. Alvarez, A. (2012) Introduction, and Chapter 10 in The Thinking Heart, New York: Routledge, pp 1-6, 130-143. Learning Objectives: At the end of this class, candidates will be better able to contain and think about the anxieties generated in the analyst working with the silent or unintegrated patient. Candidates will be able to discuss how to utilize their internal experience to generate understanding when verbal processes of communication are impeded. Speaking Softly Pine, F. (1985) The Interpretive Moment, Chapter 11 in Developmental Theory and Clinical Process, New Haven: Yale University Press, pp. 148-159. Bach, S. (1985) Classical Technique and the Unclassical Patient Chapter 10 in Narcissistic States and the Therapeutic Process, New York: Jason Aronson. Learning Objectives: At the end of this class, candidates will be able to list and utilize extra-verbal factors that facilitate interpretive work with challenging patients. Candidates will apply this knowledge to class presentation of clinical material. Working with patients who don t attach Guntrip, H. (1975). My Experience of Analysis with Fairbairn and Winnicott (How Complete a Result Does Psycho-Analytic Therapy Achieve?). Int. R. Psycho-Anal., 2:145-156 Joseph, B. (1988) Object Relations in Clinical Practice, PQ 57:626-642. Learning Objectives: At the end of this class, candidates will be able to identify interpretive options to use with patients who reject attachment. and those who do not want to know Joseph, B. (1983) On Understanding and not-understanding: Some Technical Issues. IJP 64: 291-298. Britton, R. (1997) The Missing Link: Parental Sexuality in the Oedipus Complex, In The Contemporary Kleinians of London, Ed. R. Schafer, pp 242-258. 5
Learning Objectives: At the end of this class, candidates will be able to formulate and discuss how to utilize interpretive techniques to address the defense against knowing. Being Held in the Mind of the Other Steiner, J. (1993) Problems of Psychoanalytic Technique: Patient-Centered and Analyst-Centered Interpretations Chapter 11 in Psychic Retreats Pathological Organizations in Psychotic, Neurotic, and Borderline Patients. London: Routledge. Learning Objectives: Candidates will develop familiarity with patient-centered versus analyst-centered interpretations, and will recognize when clinical conditions dictate their use. Co-Construction of Meaning and Creation of New Mental Space: Levine, H. B. (2012) The Colourless Canvas: Representation, therapeutic Action and the Creation of Mind. IJP 93(3):607-629. Bach, S. (2006) A Mind of One s Own, Chapter 4 in Getting From Here to There, Hillsdale, NJ: The Analytic Press, pp 67-82. Harrison, A and Tronick, E (2011) The Noise Monitor : A developmental perspective on verbal and nonverbal meaning-making in psychoanalysis JAPA 59: 961-982. Learning Objectives: Candidates will recognize when change takes place through a close analysis of clinical process. 6