Reflections of the IPI Weekend Conference by Dra. Iraira Butcher 

Be Thoughtful and Act: Confronting Racism Inside and Outside of Our Minds
Reflections of the IPI Weekend Conference by Dra. Iraira Butcher 

 

After finding much needed containment in the approximately biweekly town hall meetings with IPI and after the recent escalation in my frustration due to my inability to find a space to explore racism and discrimination in my country of residence, I was more than eager to participate in IPI’s weekend conference with the appropriate title of Be Thoughtful and Act: Confronting Racism Inside and Outside of Our Minds. I constructed a fantasy around my expectations for the conference thinking along the lines of Michael Jackson’s song, Heal the World. This fantasy held me through the latest rejection that I experienced when trying to explore these topics within an institution. In fact, the fantasy grew bigger and then frightening due to my ever-growing thoughts that I was going to be met by the persecutory resistance that has plagued the human race.

But I was pleasantly mistaken.

As I sat with an international community of analysts, psychotherapists, students, mothers, fathers, sisters, brothers, daughters, sons, whites, blacks, Hispanics and Asians, but most importantly, with human beings, to listen, to explore, to analyze, to learn and to understand, I quickly realized that part of the task that millions of human beings have set out to do, inside and outside of IPI and inside and outside of our minds, is to find, pull out and to deconstruct ideologies that have been so deeply rooted, in the DNA, in the unconscious, in the culture, in the psychic structures of humans of all backgrounds but also in the overall society that was built off of slavery, that as K.Vaughans’ said, gave birth to racism.

But it has proven to be a difficult task.

This brought to mind the fear of annihilation. As a black woman born and raised in Brooklyn, New York, I understand that, contrary from what some theorist may say, this particular fear of annihilation is something real and it continues to live strong, throughout an entire life, to include transgenerational , within afro-descendants and the other oppressed communities all over the world. But again, in contrast to what others may say, this fear of annihilation is not a fantasy, it is in fact a reality as it was eloquently exhibited by Dr. B. Greene’s reading of the thoughts written out by a black, COVID-19, frontline New York City Doctor during the weekend conference.

But it goes both ways.

The fear of annihilation is also experienced in the white community both as a fantasy as well as a reality. What I witnessed and experienced during this conference, within the white participants, either because of race or lighter skin color, is a collective shame and guilt not only for what was done in the past by them or their ancestors but because of their inability to deconstruct the ideologies that were imbedded in their unconscious, that was floating in their pre-conscious and that were ignored while in their conscious. In other words, the shame, guilt and resistance related to the difficulties in examining their own psychic functioning, in particular within members of the psychoanalytic community, the examination of their ego. It is important to note here that if therapists are unclear and untouched within themselves, it is more likely than not that there will be a parallel process within their patients.

But it is painful.

Our psychic structures are filled with defenses to counteract and to resist the pains that are associated with, in this case, racism. A few that were highlighted in the conference were denial, repression, projection, displacement, rationalization, reaction formation and intellectualization. Aside from defensive mechanisms, the conference brought forth a space to explore psychoanalytic theory and its strong attributes for understanding racism. Thoughts were discussed in abundance and emphasized such as K. Vaughans’ considerations on education and African Americans in the USA (school to prison pipeline), B. Greene’s and H. Wolfe’s personal and clinical contributions to intersectionality of racism and sexism, E. Hopper’s research and developments on social unconscious, M. Klein’s schizoid-paranoid and depressive positions, S. Freud’s views on mourning, D. Winnicott’s work on cultural experience and many others.

But, as expected, these discussions opened up many more unconscious doors.

The groups, both large and small, encouraged the participants to view racism from distinctive perspectives. This task stimulated me to examine my internal and external worlds thus allowing me to look more at the reality of the situation, which includes the fact that racism and discrimination is a painful topic with limited language to use as expression when describing it as it relates to oneself and to the other, internally and externally, individually and socially and particularly in the white communities. Semi-successful attempts were made to define or redefine terms such as microaggression, whiteness, white privilege and racism in and of itself, by including aspects such as greed, exploitation, narcissism, avoidance, loss, control, secrecy and many others.

But the reality is that there is no real plan to continue to address this topic in the future.

Interestingly enough, the topic of dreams and nightmares was introduced on the last day by C. Ashbach as a means to find ways to unlock the secrets that are kept inside of our unconscious by the resistance associated with addressing and confronting racism. There is no surprise that I had a dream and I was able to share it in my small group. The only thing that I could and can remember of the dream was that my mother was running for President. After exploring my own associations, that included the reality of the fact that we are in one of the most important elections in history, I determined that I saw partial objects in my mother such as my 14-year-old daughter, the resilience and perseverance that my mother had and that was passed down to me and that now I am passing down to my daughter. I was and am clear that, for one, my mother is deceased. Additionally, my mother could not run for President due to the fact that though she was a citizen of the USA, she was born in the Republic of Panama. I was and am clear that because of my career path, I could and can but do not want to run for President. I was and am clear that my daughter can in fact run for President, especially because of all of the opportunities that my husband and I, a black couple, are able to provide to her. It is important to note here that opportunities include psychoanalytic treatment, high quality education, a nuclear family that includes both parents and overall stability. What I didn’t know and realized after an interpretation by C. Ashbach was that I am very visible in the dream not by way of running for Presidency in its literal sense but by way of running the race to uplift the races as a leader. My question of where do we go from here still produces disorganized thoughts, however, one thing is extremely clear and that is that, through listening, as stated by B. Votaw, and partnerships like those produced by the community created in this weekend’s conference, will be the only way to move forward.

Cheers to hope.

participants in the October 2020 weekend: Be Thoughtful and Act-Confronting Systemic Racism Inside and Outside our Minds

Recent IPI Faculty Publications

Change across a completed analysis assessed using a modified Three-Level Model

Jill Savege Scharff & Pat Hedegard

The authors present their design for a clinical teaching exercise to study transformation in psychoanalysis. They chose a completed analysis from which to select the sessions retrospectively so that the clinical review exercise would not influence ongoing analytic process. The co-authors selected three tranches of clinical material, a few years apart, to be presented by the analyst. They studied the material with colleagues in the impressionistic manner of traditional clinical review, and then subjected it to more systematic examination, using a modified application of the Three-Level Model (3-LM) for assessing change. Their prediction was that the use of the 3-LM model could amplify the clinical impressions of the individual analyst and provide a way of being more specific about the changes, if any, that had occurred, and arrive at which theories best explained those changes.

The authors gratefully acknowledge the participation of colleagues who engaged in the exercise, the generosity of Paul Koehler, MSW, Charles Ashbach, PhD, and David Scharff, MD, who shared their responses to the three tranches of case material, and the analysand who gave permission for the use of her clinical material.

https://doi.org/10.1080/0803706X.2020.1743879


The use of a simple writing task to enhance psychoanalytic education

Jill Savege Scharff & Caroline M. Sehon

The authors describe a simple recurrent writing task called the “Two Page Paper Exercise,” designed to enhance candidates’ learning of analytic theory and technique. They set this task in the context of other analytic institutes’ writing programs and show that this exercise is unique. Their educational philosophy is that, as candidates confront multiple perspectives in contemporary psychoanalysis, this writing task develops their ability to conceptualize, reflect on their learning, integrate affect and cognition, and express their ideas to others in written form and in discussion with peers. The candidate group develops cohesion that reduces writing anxiety. As individuals they develop a writing habit that supports the eventual duty to develop the field of psychoanalysis through publishing. The authors present raw data from candidates’ writing for readers to make their own assessment of the usefulness of the task as a measure of candidates’ integration of learning, development of analytic sensibility and synthetic capacity, and communication of experience and ideas to others.

The authors gratefully acknowledge the generous contributions of Flora Barragan, Ryan Garcia, Stefanie Minen, Andi Pilecki, Matthew Rosa, and Karen Sherwood of the International Institute for Psychoanalytic Training.

https://doi.org/10.1080/0803706X.2020.1718751

Some thoughts about the transition to an online weekend conference  

Jill Savege Scharff

Because of physical distancing to combat COVID-19, the International Psychotherapy Institute (IPI) moved its April weekend conference on sex and gender and its student graduation ceremony from the usual site in Rockville to IPI’s 1000-capacity Zoom room online.  I thought it was a good decision, and I planned to be there.  I had attended a number of online Town Halls and was quite used to seeing all the attendees in their electronic squares in gallery view across multiple screens, or a large image of a single person in speaker view.  However, in the week before the conference, I was still thinking of scheduling enough time to drive up to Rockville.  I was still anticipating meeting colleagues in the flesh.

Once the conference began online, I resonated with comments about what people were missing – the time after the session to meet and greet in the hallways, the pleasure of embodied presence, giving a hug, comforting someone who had lost a friend or loved one.  Electronic social time was scheduled but was barely used.  Once these aspects were acknowledged and mourned the large group seemed able to work.  Members got used to entering their requests to speak on the chat, and the co-chairs held the center, monitored the chat and called upon participants to speak during the discussion periods. One member spoke of his hatred of physical deprivation and of having to look at his colleagues in their little boxes.  It reminded me of the Pete Seeger song written by Malvina Reynolds, “little boxes just the same.”  But each person seemed far from the same to me.  The variety of backgrounds and size of image within the frame reflected the personality of the person within.  To me, the online setting offered one great improvement.  Instead of looking at the backs of heads as people addressed the speaker or the panel in the Rockville hotel, I was looking at faces, and I could see everyone perfectly.  Although it is a 2-D image, the speaker view brought me very close to a real live person, perhaps because of the size of the image, but more likely because of the affect being expressed.  We broke into assigned small groups five times during the weekend, each group using its facilitator’s own Zoom room number, and that worked well.

People speak a lot about being fatigued by the effort of being online all day.  I felt fine on Friday.  By Saturday the relentless pace had got to me.  I needed to take part of the afternoon off to relax, get some exercise and fresh air.  I missed a presentation that was important to me, and then a small group.  Missing those was a loss I had to take because the conference schedule was too tightly packed for me and for many others.  During the conference, I got an email announcement of a conference that was to have been in Panama in October would now happen online instead. I had intended to go because of wanting to work with my colleagues in Panama, but now I faced a choice: do I want to attend a conference online in three languages?  I tried to tell myself that it will be easier to listen to just the English translation without having to tune out the language of the presenter and the interference from other headsets, and cheaper than traveling to Panama.  But for me it would be so much less enjoyable because of my particular attachment to the place and the people.  If this notice had not come in the middle of a packed conference schedule, might I have responded with more enthusiasm?

This bears on the decision I must make about attending the APsaA conference in June, now also online.  IPI’s director is asked to help ApsaA plan for that transition.  It is an honor for IPI to be recognized as having experience in reaching across a distance.  So, I should want to attend, but I am not drawn to it.  What had drawn me to IPI’s event was the subject matter, the conference design, and the object relations analytic perspective.  The weekend was organized on a theme, with participants studying, responding, discussing and developing the theme.

On Sunday, the conference had its first technical glitch.  The director worked feverishly but with an outward appearance of calm as she put in place an alternative gathering place.  Reminded of the old days with frequent technical problems when IPI teaching was frequently interrupted on the old Polycom system, David Scharff felt that current participants now knew what he and those early classes had put with.  Someone offered him “technology empathy”.  Since the director and many of those leading the current day’s events had experienced those days too, they rolled with the punches.  On this occasion, the host-administrator was locked out of the IPI Zoom room.  She could not reach the Zoom representative to arrange for a new number.   It was explained that Zoom had scheduled an update unknown to us.  The director and the administrator worked together like lightning to inform 72 participants of a switch to the director’s own Zoom room number.  The conference start was delayed by 15 minutes to allow everyone to log on, and the schedule was quickly adjusted in consultation with the conference co-chairs and session co-chairs.   We saw a fine example of grace under pressure.  The ensuing case presentation and discussion proceeded smoothly thereafter.

Last came the graduation.  The convenience of the online venue meant that lots of family members and friends from far away could attend. Faculty described the qualities of individual graduates from IPI’s psychotherapy and psychoanalytic training programs.  Students spoke of their experiences of pain, challenge, perseverance, passion, and reward. Lots of congratulations and praise for work well done was mixed in with sadness of leaving behind group members to whom people had become close over two  to four years.  Some were laughing at silly skits.  Others were in tears at the beauty of a song that captured saying good-bye to a friend who would be missed.  True, this graduation was devoid of physical copresence, but there was no lack of affect.  The closing ceremony felt like a salute to psychoanalysis, to a vibrant, sturdy organization carrying on in spite of the corona virus, a demonstration of the life force over COVID-induced death anxiety.

Changes in Frames: COVID-19 and Teleanalysis

 April 2020

 

Yolanda Varela, PhD, President, IPA Panamanian Association of Psychoanalysis (Provisional Society); supervising analyst, IPA; supervising analyst and graduate, APsaA International Institute for Psychoanalytic Training.

 

Thoughts arising at Town Hall Meeting:

Changes in Frames: COVID-19 and Teleanalysis

 

With so many countries under lockdown to flatten the curve of the COVID-19 pandemic, the frame of life and work has completely changed.  Analysts who always conducted analysis in their private office, now are forbidden from traveling, and must stop practice or continue to see their patients in virtual space, each connecting from their own home. As always, crises bring opportunities for new experiences for us and for our patients.  I would like to address my experience under three headings: the use of teleanalysis, the early anxieties that are stirred in the patient, and early anxieties that are stirred in the analyst.

 

The use of teleanalysis

Unlike some of my colleagues who had never engaged in technology mediated treatment, I had experience to draw on.  I had already completed a personal analysis with an ApsaA certified analyst, and much of it was necessarily conducted using the telephone at first, and later using Voice over Internet Protocol with web camera.  I had had a full analytic training too — but not one that was approved by ApsaA.  Then FEPAL (Psychoanalytic Federation of of Latin America) authorized ILAP (Latin-American Institute of Psychoanalysis) to offer psychoanalytic training in Central America, as a global outreach project of the International Psychoanalytic Association.  When ILAP arrived in Panama, one of its requirements was that analytic graduates like me who had already completed a personal analysis would have to do an extra 200 hours of condensed analysis “in-person”  that is, traveling to the city where our analysts lived, or meeting in Panama with an IPA authorized analyst newly immigrated to Panama.

 

In order to meet the new requirement, I would do the extra hours.  I decided to travel to the United States to resume with my analyst, but what I chose to do with the extra time in analysis was to focus on what is not represented in me, on my early anxieties.  To address these effectively, I decided to continue my required in-person analysis with four-times-a week videoconference technology mediated sessions between trips to the United States.  For me, analysis “in-person” continues to be the preferable one, but at no time were transference and countertransference aspects lacking in the technology-mediated portions of the treatment.  In fact, it was the change in the frame that evoked the very early anxieties and enabled me to analyze them.  This experience gave me confidence in the use of teleanalysis.

 

Now I am analyzing my own patients in Panama in traditional, in-office analysis.  Occasionally I am asked to do teleanalysis.   For this, I establish new rules.  First, I use the most secure and stable platform (in my case ZOOM) and I don’t let the patient decide the platform.  Before each session, the patient receives a link to access the session with a password that only the patient knows.  I explain to analysands that they should look for a private place, where they can recline, similar to the office couch, with the camera on one side and behind them, simulating my position inside the office.  I greet them with the usual greeting, they recline and lose eye contact with me, but if they turn their head back, they will be able to see me.  I think we should stick to rules for technology mediated treatment that are similar to those in use for treatment in the office.  Beyond these arrangements to secure the external frame, I also shift my internal frame.  It was José Bleger’s article on the psychoanalysis of the frame that helped me to develop my technique in teleanalysis, and so help my patients. Bleger asks us to analyze what lies hidden behind the traditional, well-established frame.

video camera

Early anxieties of the patient

During the past three weeks in quarantine because of COVID-19, I have been transitioning my in-office patients to technology mediated psychoanalysis and psychotherapy.  Because of social distancing to fight the COVID-19 pandemic, analysands usually treated in the office must now set up a private treatment space of their own choosing.  At first, the sessions are dominated by worries about getting sick, the loss of social contact, and being trapped at home with children while trying to work. Behind the emphasis on COVID-19 lies the loss of the analyst’s physical presence and the loss of a safe office, which now seems like a uterus from which the patients were extruded.  Having to see the analyst on the screen, and put up with the times that the image freezes as well, the analysand feels as if the analyst is removing affection.  These fears of loss of response and loss of love result from early fears related to the dead mother.  Fears of viral invasion echo fears of the mother’s death drive, drowning the patient’s desire for life.  Feelings of hopelessness, helplessness and lack of trust in agencies that are supposed to protect us (hospitals, government, Ministry of Health) reflect early attachment insecurities, and convey transference to the analyst as an unreliable object.  With the change in frame from in-office analysis to teleanalysis, I have been able to observe the expression of very early anxieties in analysands who were previously seen only in the office.

 

Anxiety of the analyst

Freud’s warnings about the dangers of changing the frame of analysis are echoed by our own psychoanalysts, supervisors and colleagues, especially when confronting any change from the traditional in-office setting to the teleanalytic setting. Teleanalysis is frequently regarded as a transgression. The transgenerationally transmitted superego will have to be somewhat pacified to understand the current situation as a necessary and effective adaptation that brings us the possibility of continuing to work and of countering the guilt of not being able to do more for our patients, a problema that Eizirik pointed out in a recent IPA webinar.  Patients come to us with a fear of death and we receive them with our life drive.  To support our life drive, we need to pursue our own pleasure and part of that  is our work. We will have to continue to be linked to life, taling with colleagues in Town Hall meetings like this, keeping in touch  with friends and family, accepting and not denying reality, but without being suffocated by it.

CORE Student Reflection on French Psychoanalysis

In preparing to write this blog on our recent weekend exploring French Psychoanalytic thought and its contribution to understanding psychotic and borderline states, I found myself worrying about using too many “I” statements in my reflections. This urge to avoid writing “I” too many times in this composition, I think speaks to the theme and tone of this past weekend. Alain Gibeault described Freud’s theory of psychosis as de-cathexis from worldly objects and the psychotic terror of being engulfed or consumed by an object. Additionally, he discussed the concept of “the blank,” a space between matter and nothingness. We then watched a recording of an institutionalized patient, François, describe murdering an elderly woman, Jeanette, whom he had cared deeply for. He described Jeanette and himself being up on separate pillars with “something growing up between us.” I was struck by the terror of this image, being alone on a pillar, surrounded by the blank, with something terrifying growing up between François and Jeanette.

This material along with Dr. Gibeault’s discussion of psychodrama led into our small group discussions. During our group affective learning, fear and safety and their relation to individuals, patients, our group, and IPI were central themes. As the group went on, I felt myself feeling strangely disengaged and detached.  Initially, I defended myself as bored.  However, upon reflection, like François I was gripped by a psychotic fear of vulnerability, of being engulfed by the group or by IPI.  I too, had in a sense de-cathected from the horror of the material and was existing in the blank.

I’d like to say that the psychodrama of our small group facilitated my re-cathexis with the material, but I found myself struggling to stay focused on Saturday as well.  On Saturday afternoon, a colleague in the CORE program gave a fascinating presentation on a boy that he had been working with. The presentation was rich with symbolic meaning and beautifully captured the theme of terror of being engulfed that was running throughout the weekend. During one of the sessions presented, the boy was playing with a dollhouse. The presenter described this patient arranging the dollhouse in such a way that there was a “sealed off room, full of drawers” upstairs. For the second time during the weekend, I was struck by the rich imagery described by a patient. During plenary, themes of fear and violence were discussed. The ambivalence concerning feeling for and treating psychotic patients, like François, and recognizing the horror of the acts that they sometimes commit. Jill Savege Scharff brought up confronting gun violence, hate crime, toxic partisan politics, and climate change that are terrifying realities of our daily lives. It was during this dialogue that the image of the “sealed room, full of drawers” popped back into my consciousness.

I wonder if my feelings of detachment and the theme of unease that seeped into the weekend conference acted as a defense against the sealed room, full of drawers inside of all of us. I began to think of these drawers as full of rage, panic, lust, and violence, terrifying emotions/drives that are walled off inside me, but in reality would take little to provoke. In relation to my small group: would these terrifying affects/emotions kill my group? In relation to psychotic or borderline patients: does the fear of violence or panic in myself incline me to split them off as different and distance myself from them? In thinking about the didactic material or engaging with IPI: am I de-cathecting at times and existing in the blank in order not to experience frightening emotions? This weekend spent thinking about French psychoanalysis and psychodrama provided the opportunity to think about borderline and psychotic states and the terrifying moods and affects associated with those states as positions along a continuum on which we are all precariously perched.

 

Thomas Ringwood Jr., NP –  1st year student in 2-year Object Relations Theory and Practice Program (CORE) December 1, 201

Analytic Student Reflection on French Psychoanalysis

During the November 8th through 10th weekend of 2019, the International Psychotherapy Institute hosted the French psychoanalyst Alain Gibeault. French analytic writing is often criticized by British and American analysts as overly abstract, lacking in clinical detail, and often difficult to follow; nonetheless, Dr. Gibeault’s presentation, particularly the video recordings of his patient Francois – a man who was legally committed to mental health treatment following his murder of an elderly woman during a psychotic break – gave us a first-hand look at how French psychoanalytic thought can be applied in the treatment of people with overwhelming psychotic terror. In Francois’s case, psychodrama was used by Dr. Gibeault and his colleagues to provide a mediator for the patient to begin to make sense of his otherwise unrepresentable mental state.  Rather than applying direct interpretation in an analytic dyad, which is the usual clinical approach in most psychoanalyses, Dr. Gibeault and his team allowed Francois to choose characters among the hospital staff to play out, in real time, the dramas that were occurring in his mind. That part of Francois that killed an elderly woman in his psychosis was re-presented to Francois in a session of psychodrama by an ‘actor-therapist’ who improvised a murderous old woman that Francois ran into while riding on a commuter train.  In another session, Francois’s brother was depicted as a carefree, somewhat envious character with whom Francois could interact – and at as much distance as the mediation of the psychodrama would allow. In this way Francois could experience aspects of murderous rage and envy, as represented by the actor-therapist, rather than having to own it as a direct aspect of himself.  In other words, rather than attempting to understand and interpret to Francois the unconscious derivatives of his intense envy and murderous rage in a two-person analytic relationship – an approach that Dr. Gibeault believed would probably be too overwhelming for Francois given his inherent engulfment and fusion anxieties that lay at the heart of his psychosis – the mediation of the multiple actors in the psychodrama allowed Francois to begin to think about his experience in a way that he could tolerate.

As I reflect on this particular weekend at IPI, I find myself drawn to the idea of the Group Affective Model as a kind of psychodrama.  The Group Affective Model – or GAM group – is a unique aspect of training at IPI that brings to life, much like in psychodrama, the often very complex theoretical and clinical material that participants are trying to digest.  Though not itself a “therapy group”, participants in small GAM groups of between four and let’s say ten individuals, are nonetheless encouraged to bring in their own affective material, often derived from their personal lives or immediate experiences of the weekend. By interacting in this way the GAM group works to understand, as a group, the different facets of the material under discussion. As such, what is learned at an IPI weekend is never only theoretical. Rather, it comes to life in some form or another as a memorable emotional experience from which any and all of the members of the group can learn – each in their own way. Given that this weekend was on the terror of non-representative states and the defensive use of psychosis as a way of negotiating the horror of experiencing psychic “nothingness”, it is not surprising that groups would get in touch with psychotic aspects of themselves as a group.  It was so in my own GAM group as well as in others’ groups that I had heard about.  This is not something to be concerned about as much as it is an opportunity to think about, particularly après coup – in the context of the theoretical material being presented over the weekend.

In thinking about the GAM group at IPI, I am also reminded of Dr. Gibeault’s discussion of the necessity of “the director” of a psychodrama (or of a GAM group, or even of an institute as a whole) as a representative of the ‘thirdness’ – or the analytic third – of the group.  The director serves as a container and a mediator, a kind of Perseus’ shield between the raw experience of group members and their distance from the material under discussion. With a good enough “director”, the experience of the psychodrama can be mediated in a way that makes it possible to appropriately reflect upon what is occurring in order that it can be learned from as an experience.  Obviously, there is nothing quite so good as a “good enough” anything. In that way, we struggle, as indeed we did once again this past weekend, to understand the ideas presented during the weekend in the context of our own unique clinical experience as well as in ourselves in ever new and enriching ways. Taken in its entirety, this was once again my experience of an IPI weekend – and one that will remain as my own experience in the learning group of analytic training at IPI over the last several years.

 

Matthew H. Rosa, M.D. – 4th Year Analytic Candidate

Alain Gibeault speaking at IPI, Saturday November 7, 2019

True to the traditions of French psychoanalysis, IPI’s visiting guest speaker Alain Gibeault, formerly secretary general of the IPA, bases his theory and clinical practice on the metapsychology of Freud. He approaches the first interview with a new patient with four questions in mind.

  1. What kind of meeting is appropriate for this patient — psychoanalytical or something else?
  2. What indications are there that a psychoanalytic approach to treatment could be useful?
  3. How do patient and analyst work together in this interview?
  4. What has triggered the request for help?

Gibeault’s intention is to explore the conscious, pre conscious and unconscious layers of the mind. In keeping with Freud’s topographical approach, he assesses the psychic functioning, faces the emotional storm, and contains the affect that arises as he works to open a psychoanalytic space, giving access to the unconscious and tracing the structural connections between superego, ego and id.

When treating the psychotic patients he sees in a clinic attached to a hospital, Gibeault, inspired by Lebovichi who introduced psychodrama to France, expands his psychoanalytic technique by including a team of seven psychodramatists (a luxury we can hardly imagine in the USA).  He also arranges for a psychiatrist to treat the patient as well, keeping medication, follow up, risk assessment, and medical responsibility separate from the psychoanalytic perspective.  The point of the profusion of therapists is to spare the patient the threat of engulfment by a single object.  Instead, the transference is spread laterally among psychoanalyst and psychodramatists and the task of containment is shared by the team. The introduction of such a third in this way reduces the threat and diminishes the defense of splitting as a defense against engulfment or intrusion by the single therapeutic object.

Neurotic patients can symbolize their distress and keep it internal and so we can treat them in private practice.  Psychotic patients cannot do that and so they need a hospital setting and a team approach that includes psychodrama to create for them an external image for contemplation.  These patients can address this externally created image more easily than trying to use words to reach insight, while dealing with the stress of looking at a single therapist.  The psychodramatists take on the characters assigned to each of them by the patient but they do not wait for role induction.  They spontaneously react in ways that do not try to recreate the patient’s experience. Instead they offer something different.  This construction of something new in the third reduces the dissociation from which the psychotic patient suffers.  Unlike Klein who teaches us to interrupt the negative transference in the first session, Gibeault recommends that we must respect idealization and only later interpret aggression. Only then is it possible to interpret the negative transference — which must be done before termination can be possible.

 

Submitted by Jill Scharff  Saturday November 9th

Alessandra Lemma: The Effect of the Internet on Sexuality and Identity

Jill Savege Scharff, October 5, 2019.

I am here at the International Psychotherapy Institute weekend conference Technology and Ethics in Treatment and Training: Best Practices. I am sitting in the audience of 60 people at a hotel conference room while the guest speaker talks with us via proZoom. It is now Saturday October 5, 2019. There on a large screen is Alessandra Lemma, Fellow of the British Psychoanalytical Society and Consultant-Clinical Psychologist at the Anna Freud Centre for Childrenand Families, Honorary Professor of Psychological Therapies at the School of Health and Human Sciences at Essex University, and Visiting Professor, Psychoanalysis Unit, University College, London. She is presenting on the impact of Internet pornography on development. We can see and hear Alessandra. She can see us in general and can hear each one in particular who comes to the microphone and web camera to speak to her. When she moves away or looks down we may miss the end of a word, and she may have to ask us to repeat a word, but by and large we can follow her talk. Some of us would rather interact with her in person, but she lives in London and cannot spare the time to travel here for a weekend conference or for one lecture. This way we are deprived of her actual physical presence but not of her humanity. We have the gift of her presentation, and we get to interact with her and her ideas. And we get to know her as a presenter beyond our experience of her as a writer from reading her book The Digital Age on the Couch. Technology isn’t perfect but it gives access to her knowledge. So what am I taking away from her talk?

I learn that Internet pornography, which obviously fundamentally interferes with sexual desire and development in adolescence, is now leading to sexual dysfunction in young people of the digital generation. Why is this happening in this age of enlightenment about sexuality? They spend their life online and pornography is not only regularly available but also jumps out at them. Ready access to pornography stimulates desire and leads to the delivery of instantaneous satisfaction. There is no need of delay. Under normal circumstances desire experiences a delay before there is the delivery of satisfaction. But in internet pornography there is no need of a journey towards gratification all because it is already there. This collapse of time and space incurs a stultification of psychic development. Psychic development requires delay of gratification, which leads to psychic movement across time, the unconscious mind at work developing its representations of desire and its gratifying objects of satisfaction. Furthermore, pornographic images do not only receive existing fantasies but also project other people’s fantasies violently into the viewer’s body and mind where they take over, creating a “not-me” experience and foreshortening the consolidation of sexual identity.

What makes an adolescent vulnerable to exploitation by pornographic images on the Internet? Alessandra suggests that we need to look backwards to the kind of infancy when an endless sensory, erotic experience occurs without the cognitive resources to make sense of it. Then it falls to the mother to reflect the sexuality of the infant and give the infant time to make sense of it. She delays gratification, which gives the body time to organize its response and fulfill its role as the link between desire and satisfaction, self and other. She develops cycles of frustration and satisfaction that shape the infant’s rhythms, which later underpin the expression of desire in later stages of development. When she fails to do this, the child develops an incoherent mental representation of the body.


Then in adolescence there is a desperate search to find a mirror that will reflect the sexual self accurately and confirm the adolescent’s sexual identity. In the pre-Internet era this was provided by peer groups and teen media during the infinitely lengthy waiting period that was adolescent sexual awakening. Now however the adolescent has been bombarded by sexual imagery in childhood and is now driven to look for reflection in the “black mirror” of the handheld device. The upside is that easy availability of such online mirroring brings a benefit of inclusiveness for those whose sexual proclivities place them in minority groups. The downside is that the adolescent looking for this type of reflection and peer affiliation stumbles upon an orgy of intoxicating sexual possibilities that re-create a view of the primal scene, now constantly open for access. Like an infant in an endlessly sensory state of being, the adolescent does not have the ego development to deal with the overstimulation alone. What is needed is the care and responsiveness of a living breathing other person.

Young people who look for instant, impersonal gratification do not know the value of the work of desire. When they are locked in to a habit of getting aroused and gratified online instantly, they feel that they triumph over desire. In fact they are killing desire. They do not recognize its value in creating movement towards the other. They do not know to wait for that. Learning to derive pleasure from waiting requires psychic work towards maturation. As therapists we can offer a reflective mirror and a relationship that will help these adolescents recover desire, experience anticipation, wait for pleasure, and ultimately enjoy a sexual experience with a partner.

 

And what about us? How is our digital learning experience different from that of the porno-addicted adolescents? Obviously this is not porn. We are watching and looking at an image, but our desire is for the gratification of learning. It is not a solo activity, and it is not hidden. True, Alessandra arrives the click of a mouse but she appears by careful selection and mutual arrangement. But in this case, there actually is delay between desire and delivery. We have been waiting to work with Alessandra Lemma since April two years ago when she was with us for a whole weekend. She could not offer that amount of teaching and travel given other commitments at this point in her life. So we signed up for the conference on technology and ethics at which she would speak by Zoom. We knew to expect a technology-mediated lecture: It does not intrude on us unbidden.

Looking at the screen and listening to Alessandra is not immediately gratifying: In fact it is slightly frustrating as we strive to catch every word. The image on the screen is inviting but not overstimulating. Yes, the content of the presentation is inducing desire for more, but we share the experience with others in a group setting. With technology, we get to “be with” Alessandra again, sharing with colleagues her brilliant ideas, empathy and responsiveness, and outstanding clinical technique.

In Remembrance: Alice Brand Bartlett, Ph.D.

 

Alice Brand Bartlett, PhD

1950-2019

 

 

Dear Faculty, Students, & Friends of IPI,

Alice Brand Bartlett was a beloved adjunct faculty in the International Institute of Analytic Training, a sensitive and thoughtful supervisor, a supportive mentor, and a valuable friend to many of us at IPI. She died on July 13, 2019 from ovarian cancer. Those of you who knew Alice can rightly imagine that she was lively until the very end, fighting to survive and to continue in a profession she loved so passionately.

Alice was born on October 27, 1950 in Carrollton, Missouri. She pursued an MS in Library Science and became Chief Librarian of the Menninger Professional Library. At Menninger, she held many prestigious posts, including Associate Dean in the Menninger School of Psychiatry. She went on to pursue training as a psychologist and psychoanalyst, at the Fielding Graduate School and Topeka Psychoanalytic Institute, respectively. The American Psychoanalytic Association affirmed her status as a Training and Supervising Analyst in 1996. We all benefitted from her library science expertise, as she became Board Director for the Psychoanalytic Electronic Publishing database (PEPWEB), awarded the Sigourney Award in 2018. Just before her death, she served as Director of the Greater Kansas City Psychoanalytic Institute.

While all these accomplishments speak to her intelligence, generative contributions, and respected place in the field of psychoanalysis, most of us knew Alice as kind, compassionate, humorous, spunky, and a bit irreverent. She was devoted to her patients and mentees, as is evident in the way she approached the end of her work with them, conveying genuine care and respect and regretting the loss her death would impose. For IIPT, she was one of our most active adjuncts, facilitating clinical case consultation, providing supervision and analysis, and serving on the ethics committee.   We miss her already!

Alice leaves behind her husband Tom and many friends and family. A public memorial service will be held on Saturday, August 17th at 11:00am at the Chapel in Mount Hope Cemetery (17th and Fairlawn). In lieu of flowers, please make memorial contributions to The Greater Kansas City Psychoanalytic Foundation, Greater Kansas City-Topeka Psychoanalytic Center, 1000 E. 24th St., 4E-53, Kansas City Missouri or Col. Potter Cairn Terrier Rescue.

The Contribution and Influence of Enrique Pichon Riviere

Lea Setton and David Scharff

 

David Scharff steps back into presenter mode this morning. He is talking about Pichon Rivière’s concept of el vinculo, translated as “link”.  David is excited to have found a theory that goes beyond Freud who sees development as instinctually driven, linear and predestined in the individual, and beyond object relations theory which sees development arising from the need to relate expressed in internal relationships being built in interaction in external relationships to Pichon Rivière’s more encompassing view of individual and group, self and society. Pichon Rivière focused on the area between two people as well. David tells that Pichon Rivière described the link as a feature of the inside, the outside and the area in between, all connected with experience of previous and future generations on the perpendicular post of a cross and connected to social and cultural associations in the present on the horizontal arm of the cross.  We can imagine the link as a network of connections, an endless, interlocking dynamic ring spinning around in space and along time, and it is into this link people are born, and which they change and are changed by as they express their needs for love, safety, nurture and knowing.

IPI faculty prepare for the weekend’s work with guest Joachin Pichon Rivière

 

Introducing Joachin Pichon Rivière, social psychologist and organizational consultant (and son of Enrique), David announced that in tomorrow morning’s open lecture, Joachin will present Pichon Rivière’s concept of the link in what he called “operative groups” (work and affiliate groups) in institutions.

Jim Poulton weekend cochair asks a question responded to by Lea Setton, David Scharff (presenters) and Karen Greenberg (session chair) on the panel and Joachin Pichon Rivière in the audience.

Until then, we are following Lea Setton’s application of Pichon Rivière’s theory in family therapy.  She shows how a family suffers from a major loss. Various family members from time to time become the spokesperson or the symptom bearer for the family wide loss in the present and its reverberations in past trauma and predictor of fears of future failure and shame. Over the years, the family engages with the analyst as the depositary for the family legacy and potential. Their therapy follows a spiral process in which the analyst relates to the symptom, the existent fixed pattern of reaction, makes interpretation which creates a disruption, after which the family enters an emergent pattern with new possibilities for reaching understanding and transformation.