Members of the IIPT teleanalysis research group Caroline Sehon (Chair), and Janine Wanlass (Principal Investigator) presented preliminary findings from the first phase of the IPI-Westminster College research project along with their collaborators Tania Estrada Palma (Mexico) and Asbed Aryan, Ricardo Carlino, and Liliana Manguel, (Buenos Aires) at a panel chaired by Jill Scharff during the 49th Congress of the International Psychoanalytic Association in Boston, July 2015.
Jill Savege Scharff and Caroline Sehon
At the summer institute “Couple, Child and Family Therapy: Links from Theory to Clinical Practice” co-organized by the International Psychotherapy Institute (IPI) and the Department of Primary Education at the University of the Aegean, participants gathered from Greece, the United States, Canada, Israel, Australia, and South Africa to study together in Rhodes.
Led by David Scharff and Anastasia Tsamparli, the institute featured presentations by Greek and American child psychotherapists, couple and family therapists, and child analysts. David Scharff gave a theoretical and clinical introduction to object relations couple, child and family therapy to set the base on which the presenters built their talks. Janine Wanlass, Director of IPI, taught assessment of families and couples. Ionas Sapountzis, a Greek-American psychologist returning to his homeland, shared his Winnicottian approach to children with ADHD. Following her interest in field theory, Caroline Sehon gave a talk on decoding the links in families with psychosomatic difficulty. Jim Poulton of IPI-Salt Lake City gave a literature review of the concept of narcissism and illustrated its destructive effects in couple relationships. Greek colleague Dimitri Kyriazis elaborated on the destructive psychotic links in couple and families.
Jill Scharff outlined the history of the development of the concept of projective identification and why she has found it helpful in working with couples and families. Vali Maduro, Chair of the Couple, Child and Family program at IPI, took the concept of projective identification to the arena of the family where couples may project into their children. Norma Caruso addressed issues of sexuality and intimacy in couple therapy. In a related but very different presentation the summer institute host Anastasia Tsamparli spoke of the negotiation of sexual desire and the analytic third in couples. Dimitris Anassopoulos intrigued us with a highly complex paper on the analyst’s contribution to the intersubjective process.
We understood in discussions with our Greek colleagues that the economic situation is extremely uncertain. Many of them had lost patients that week and thought of canceling because of the crisis, but they came. As Americans we were buffered from the squeeze, since our credit cards backed by American banks were welcome whereas our colleagues’ could withdraw only 60 Euros a day or less. We were impressed by the Greeks’ willingness to confront the crisis and set it aside in order to learn.
In her opening speech of welcome, Anastasia said that although the crisis is humiliating, and everyone feels scared, we cannot succumb to feeling awful. We must keep on doing what we do, and keep thinking. Her clarity and strength of character was inspiring and set the tone for acknowledgement of the real crisis in the there-and-now and focus on the here-and-now of the learning process.
Participants new to IPI events were especially appreciative of the small group using the Group Affective Model (GAM) as a place to integrate professional cognitive apperception and personal emotional response to the material about couple, families and children. As foreigners, the group leaders worked through group transferences that reflected the apprehension felt by Greece towards privileged nations to create a secure holding environment where these charged affects could be voiced, thought about, and understood as they relate to family dynamics and cultural context.
For example, having heard presented a vignette of a couple in which one partner unconsciously evoked in the other a sadistic response, the small group related these unconscious pulls to similar forces in the troubled marriage of Greece and Europe.
Despite the tremendous uncertainty, anxiety and terror at this crucial moment in history, there was an impressive turnout. The quiet space to think away from turbulent Athens brought relief and pleasure, but also led to guilt and conflict about family members left at home burdened by worries, such as whether they would lose their jobs, or how the political machinations would ultimately be resolved.
Nevertheless, Anastasia and her colleagues managed to give the visitors a wonderful Greek welcome, with informal dinners, a rooftop party courtesy of the University of the Aegean, trips to the sea, and Greek dancing which having watched a performance we were coaxed into getting on the cement floor of the balcony to participate in this Greek expression of emotion.
The IPI contingent returned to America grateful for all our opportunities at home, and impressed by the generous spirit of our Greek colleagues. We hope to see our Greek colleagues again soon, if not in person, then when they connect to IPI’s couple therapy videoconference training program.
We’ve been fascinated this weekend at IPI by Dr. Björn Salomonsson’s account of his psychoanalytic treatment of infants with their parents. To develop an effective theory and technique for helping infants in distress we need to look beyond attachment research and developmental theory to include analytic theory and technique in our approach. It’s easy to believe that the analyst’s words communicate understanding to the parent. But Dr. Salomonsson believes that he can communicate directly with the baby. Many argue that you can’t analyze a baby because analysis is a talking therapy and babies can’t understand words. Others have argued that they do. But here it is important to distinguish between the lexical and the linguistic. True, babies do not understand the words but they respond to the patterns of the language, words, the rhythm of the speech, the affective tone, the authenticity and integrity of the analyst’s interest and reach the baby and give meaning to the experience. The analyst recognizes the baby’s distress, offers calm interest and concern, and conveys hope that the unmanageable distress can be understood and coped with through a process of co-thinking between baby and analyst and between baby and parent. The analyst recognizes the competence and responsibility of the baby to become a partner in the process of recovery.
– Jill Savege Scharff, M.D.
Caroline Garland presented a psychoanalytic view of grievance, a hatred directed at that which came between the child and the gratifying, ideal maternal object. This obstacle may be the individual Oedipal rival or the parental couple, engaged in intercourse from which the child is excluded. This hatred for the parental couple is then displaced onto the analytic couple because it is not the gratifying couple of fantasy based on longing to engage in the primal scene. The hatred may be directed at the patient and the analyst in the form of a masochistic attack on the patient’s capacity to benefit from analysis and a sadistic attack on the analyst’s capacity to be effective. Revenge for Oedipal betrayal may lead to loss of hope and a suicidal act that attacks the patient’s capacity to benefit and the analyst’s capacity to be effective, and fills the analyst with shockingly intense grief. Annihilation of the self can be preferred over life in the name of revenge.
—Jill Savege Scharff
Caroline Garland speaking today at the International Psychotherapy Institute on aspects of trauma described how the traumatized person experiences the present trauma in the light of past trauma. Defenses against anxiety have broken down and led to extreme distress because the good objects have not been strong enough to protect against reality which now feels immensely unsafe. The person loses a sense of a personal future. When family love and supportive action is not enough, the traumatized person who comes to a therapist needs the containment of analytic psychotherapy — not hugs and action. We do not treat the trauma with compensation or solutions to block the pain. We offer a relationship in which we agree to listen and take in and bear the patient’s fear and pain and contain our reactions of helplessness and emotional distress. We need the support of analytic theory and discussion with our colleagues as we work to contain the trauma past and present and help the patient restore a sense of meaning and purpose in life.
—Jill Savege Scharff
Anne Alvarez is interested in how thoughts are in dynamic relation and link together. Thoughts are highly active as people are. In health thinking is not static: it is always moving on; ideas can wait in line and do not disappear. Sometimes, however, our thoughts escape us and we feel frustrated if we can’t catch them. Other times we feel crowded by them. You cannot link thoughts together if the thoughts are not given weight. What gives weight to a baby’s thought is for it to be listened to and appreciated first by the primary objects and then by the baby herself. The curious baby has a thought, implements it, and takes pleasure in the resulting sense of agency. He also becomes aware of his thought having an effect on someone else’s mind. When there is too much disturbance thoughts cannot be thought, much less connected. When there is too much greed and impatience, the child in therapy does not take time to have his thoughts. Then the analyst needs to provide a container in which thoughts are held and can wait their turn to be thought.
Anne Alvarez looked back over her clinical work of years ago and found her technique at that time insufficient for reaching the terror and despair of tormented, vulnerable children. The interpretation of projections into the therapist as defenses against wishes or of transference as resistance might be useful for those who can hold in mind two thoughts and feelings and two people at once but for these children it is better to speak not of wish but of rightful need so that the children know you understand their need for rectification of deficit. For instance, the child who seems indifferent to the analyst might wrongly be thought of as omnipotently defending against need but Anne Alvarez points not to defense against need but to lack of interest because of having had no interesting or interested object to look up to. Once that child knows the therapist is interested in him, he can become interested and eventually find himself interesting.
Anne Alvarez acknowledges aggression ( how could she not when the child has just put her neck out of alignment) but she cautions against interpretive emphasis on the death wish. When a child becomes angry or horrendously anxious about a weekend separation, rather than say to the child “You are showing me that you want me to die” or “You are afraid that I will die” she suggests saying, “It’s hard to believe I will still be here on Monday”. I enjoyed her emphasis on looking for the good, reliable, interested, surviving object. The child can identify with that good object because the analyst relates positively to the child and to the stability of the therapeutic contact, and she welcomes the child’s identification.
Anne Alvarez is presenting today at IPI at the conference called The Thinking Heart (the same name as the title of her excellent book). Anne described three levels of therapeutic response — 1) explanatory, 2) descriptive, and 3) intensifying and vitalizing — depending on the state of mind of the patient. At the explanatory level the analyst makes an interpretation about what the patient is projecting into the analyst and why he needs to. At the descriptive level she describes what the patient feels and does not address why. Both these approaches involve addressing the patient directly as “you” but in some states of mind the patient experiences a “you” comment as persecutory. At the intensifying and vitalizing level, she simply says to the patient “it” is upsetting, acknowledging and sharing the experience without intrusion and without insisting on “you” and “I”.