IPI welcomes Antonino Ferro

Distinguished analyst Antonino Ferro, president of the Italia Psychoanalytic Association, opened our April Weekend Conference by presenting his unique approach to the clinical situation as a waking dream. The therapist receives unmetabolized proto-emotions generated in the here-and-now of the therapeutic relationship and contains them, first as a pictogram (image), until he/she can present them as a narrative. How does the therapist develop and enlarge the capacity to contain? This is the topic we will explore for the rest of this intensive weekend conference with our special guest, Antonino Ferro.

Antonino Ferro from Pavia near Milan teaching with IPI faculty member Jim Poulton of Salt Lake City
Antonino Ferro from Pavia near Milan teaching with IPI faculty member Jim Poulton of Salt Lake City

IPI February Weekend Conference

 Couple and Family Psychoanalysis Around the World

Monica Vorchheimer (BA), Mary Morgan (UK), Elizabeth Palacios (Madrid), Félix Velasco Alva (Mexico); John Zinner (Washington); Karen Proner (New York), Lin Tao (London and Beijing); and Susana Muszkat (San Paulo) who participate in an IPA working group chaired by David Scharff came to join IPI faculty and guests as presenters or discussants in couple and family psychoanalysis at the February core program weekend and its preconference day co-sponsored by IPI and the IPA working group.

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Photo 1. Weekend conference on couple and family psychoanalysis

 The weekend conference co-chaired by David Scharff and Janine Wanlass looked at difference and similarity in theory and practice around the world, and particularly at beginnings – beginnings of sessions, of treatments, new beginnings within treatments that became moments of change.

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Photo 2: IPI and IPA presenters

Back Row: David Scharff. Rich Zeitner (USA), Susana Muszkat (Brazil), Karen Proner (USA), Monica Vorchheimer (Argentina), John Zinner (USA), Lin Tao (UK and China), Jill Scharff (USA)

Front Row: Hanni Mann-Shalvi (Israel), Teresa Popiloff (Argentina), Mary Morgan (UK), Elizabeth Palacios (Spain), Delia de Cierda (Mexico), Yolanda Varela (Panama), Félix Velasco Alva (Mexico)

100 participants gathered to teach and learn about the differences among European, North and South American approaches to theory and practice of couple and family therapy.  We heard clinical examples that showed transference and countertransference noted at the beginning of contact and evolving over the months of treatment; difficulty in dealing with a hidden agenda in two beginning sessions; opening the space for discussion of trauma and shame in a consultation; how the initial conditions affected the outcome of a couple therapy; and ambivalence in making a first appointment as a displacement from ambivalence over reconnecting with a wife after renouncing an affair that gave the partners the illusion that they were stabilizing a marriage.

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Photo 3. Felix Velasco and Delia de Cierda (presenters) Lea Setton (session chair), Caroline Sehon (discussant)

We explored the value of theory and looked for similarities and differences among couple and family analysts around the globe.  We compared and contrasted projective identification (from British object relations) and link theory (from Pichon- Rivière in South America) as concepts applied to couple and family work.  We presented those theories as quite different, and yet it was hard to establish clear lines of difference because of individual variation in how our concepts are defined, both concepts being polyvalent.  We presented differences in technique in terms of how much data various analysts want to have before delving into process and how comfortable others are with waiting and not knowing versus intervening to be helpful, whether in a presentation or in a therapy session.  Some analysts prefer to ask about history in a routine manner, while others ask only at moments of affective exchange.  There was a trend towards seeing the South American approach as one more comfortable in the present moment, while the American one was seen as more data driven, more directive.

These differences were presented as culturally determined, and yet we noted individual variations within each culture.  In any case, I felt that our differences were far outweighed by our similarities in valuing containment of anxiety, invitation to inquiry, following the affect, interpretation, and above all, developing a therapeutic relationship and tuning in to the unconscious as the route to therapeutic action.   We presented cases in a variety of ways – case summary and overview of analytic process, process notes, and video – in order to provide various points of access for various learning styles.  Taken together the diverse methods of presentation and the varying ways of offering entry into therapeutic process, offered a more whole object for contemplation.  We’re looking forward to more collaboration between IPI and the IPA at the Congress in Boston 2015, and possibly before then in Buenos Aires.

Book Launch at IPI

Overseas guests Mary Morgan and Lin Tao were joined by local IPI faculty who had authored chapters in the new book Psychoanalytic Couple Therapy, edited by David and Jill Scharff, with the collaboration of David Hewison, Christel Buss-Twachtmann and Janine Wanlass, for the USA launch of this book, a joint effort by the International Psychotherapy Institute (IPI) and Tavistock Centre for Couple Relationships.(TCCR). The book is based on the jointly offered course given over the last four years by video link, which has had participants from the United States and overseas in the UK, Central America, Israel, South Africa, Turkey and Hong Kong.

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Photo 4. Chapter authors celebrating at the launch of Psychoanalytic Couple Therapy (left to right) Lea Setton, Yolanda Varela (Panama), Jill Scharff, David Scharff (USA) Damian McCann, Mary Morgan (UK), Mike Stadter, Janine Wanlass and Richard Zeitner (USA)

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Photo 5. Psychoanalytic Couple Therapy book

 

Comments about Psychoanalytic Couple Therapy:

  • “Shows the mental functioning of couples and families as fantasmatic organisms, the intertwining of intrapsychic and interpersonal levels, and the new frontiers opened by this approach.” Anna Maria Nicolo, President, Italian Society for Psychoanalysis of Couple and Family
  • “Numerous, lively, in-depth clinical examples which bring the couples and the clinical dilemmas to life” Joanna Rosenthall, Tavistock and British Psychoanalytic
  • “An updated, sophisticated approach to the diagnosis and effective treatment of the broad spectrum of couples’ difficulties.” Otto Kernberg, Past President, International Psychoanalytical Association

 

Book Review: Shrink Rap, by Dinah Miller, Annette Hanson, and Steven Roy Daviss

Scharff, J. S. (2013).  Book review of Shrink Rap.  In Psychodynamic Psychiatry 41(3): 473-477. Posted by permission of Guilford Press.

 Shrink Rap, by Dinah Miller, Annette Hanson, and Steven Roy Daviss, Johns Hopkins University Press, Baltimore, MD, 2011, 255 pp.

As a psychoanalyst, I was not drawn to the title of this book, Shrink Rap, or to its focus on psychiatry with barely a mention of psychoanalysis. As a psychiatrist, I was not drawn to it either, given I had already been immersed in psychiatry and had left it behind. Once into the book, I found plenty of useful information, and I quite enjoyed its survey of the field. This book, however, is not intended for professionals. It is for consumers of psychiatric services. A trade book! Surely an unconventional choice for an academic press, I thought, until I realized that Johns Hopkins Press includes similar titles in its catalogue. As an academic publication, Shrink Rap falls short in that, although there is an index, a list of further reading, and any research or literature drawn from is mentioned in the text, there is no bibliography as one might expect in a book from an academic press. Nevertheless, as a trade book, Shrink Rap is well written, well crafted, accurate, and forthright. In being clear, comprehensive, informative, and impartial, it is scholarly in its own way. True to their mission, the authors write as thoughtful friendly guides to the psychiatric system, respectfully explaining the competencies of various mental health professionals in relation to the book’s main focus—the practice of psychiatry from outpatient to inpatient setting, clinic to private practice, voluntary to involuntary treatment, severe mental illness to personality disorder. It interested me to read the book from the point of view of patients who face this array when they present with a problem, as well as from my own perspective as an analyst. Where would psychoanalysis fit in the scheme of things?

Written for patients and their families, Shrink Rap is a wealth of information, clearly presented. After years of experience writing a blog and creating podcasts, three Maryland physicians—Dinah Miller, a general outpatient psychiatrist, Annette Hanson, forensic psychiatrist, and Steven Roy Daviss, consultation-liaison psychiatrist and specialist in clinical informatics—know the needs and concerns of patients and their families and how to address them clearly and simply. Now they have distilled their collective wisdom and experience in this book. Readers can ask questions and post comments about the book and engage with the authors and other patients and families on the authors’ blog. The authors, who express their academic authority in a friendly professional voice, have constructed a really well written, easily accessible, reliable consumer guide with access to follow-up discussion. In short, Shrink Rap is a well-supported trade book, offered, however, by an academic press.

Accompanying the authors on this walk through the system are fictional patients. I always have a problem with this device because it cannot accommodate the movement of the unique individual unconscious. The “patients” are composites put to the service of representing types of illness such as attention deficit disorder, delinquency, depression, addiction to drugs and pornography, panic and eating disorders, bipolar depression, and schizophrenia, and illustrating various approaches by psychiatrists who vary from remote to effusive, respectful to exploitative. Patients and psychiatrists working in treatment demonstrate the strengths and weaknesses of the system, the therapeutic relationship, pharmaceuticals, and newer invasive therapies. At one end of the spectrum of satisfactory care, there’s Tara, her panic disorder treated successfully with drugs and weekly supportive and exploratory psychotherapy, and at the other end there’s Becca who bounces from one psychiatrist to another, feeling misunderstood, rejected, embraced, and eventually betrayed. There’s the fictive Brandt family whose members are given to suffer individually—Stuart from grief reaction, Jack with hallucinosis found to be caused by a brain tumor, rapid cycling bipolar disorder (that’s Becca), Richard addicted to pornography, and Frank who is simply in a developmental transition. Later we meet Mitchell who is receiving hospital care for relapsing schizophrenia, and orphaned, hyperactive Eddie who is followed from the juvenile justice system to his incarceration as an adult drug user and sex offender in a setting where at last he could develop into a responsible adult.

Shrink Rap is such an omnibus of information and possible scenarios that it is surprising to note a few omissions. The next edition might include telepsychiatry in which psychiatrists deliver quality mental health care direct to patients who live remote from specialist centers and provide consultation or supervision to their local physicians and therapists via videoconference. Perhaps the authors do not endorse this innovation, but it is a growing part of the field of psychiatry and therefore a significant omission. Conjoint therapies are also overlooked. Why, I wonder, did no psychiatrists recommend couple therapy for Richard and his wife, or family therapy for the whole Brandt family? Readers are not given enough information about the parents, the previous generation, and the current sociocultural setting to guess at the Brandt family unconscious that connects to individual psychopathology. There is little but a passing mention of psychoanalysis, the foundation for understanding human conflict that underlies symptoms. The authors do refer to the childhood history of each patient and its effect on perception and feeling toward the treating psychiatrist but they do not apply this knowledge fully in their clinical narratives. I regret that patients and their families cannot use this book to learn how their situation has arisen or how to work through to a better adjustment. To be fair, the authors do not claim to write a guide to self-help treatment, only a guide to the system. Their fictional patients and treatment situations do serve to illustrate what can happen to people who must traverse the ins and outs of psychiatric services. But the authors could have done more to encourage reflection on the patient’s self.

I appreciate that the authors are scrupulously and refreshingly honest. Their chapter featuring Becca and her troubled course of treatment with a series of psychiatrists—of whom none were quite right and one of whom broke professional boundaries to feed her own narcotic habit—is so chilling that they might have excluded it to save face, but they wisely left it in as a cautionary tale. They present and illustrate the ethics of psychiatry even-handedly, acknowledge ethical dilemmas candidly, and discuss questionable decisions in a nonjudgmental way, always recognizing the grey areas. They acknowledge areas of debate and controversy in psychiatry. Their examples show that any of the psychotherapies for mental illness take second place to the prescription and management of psycho-pharmaceutical agents, and they ac- knowledge that drug management earns the doctor much more money in 15-minute increments than can be made in a 50-minute therapy hour. The authors admit to not knowing. They confront ignorance and uncertainty in many aspects of this new and inexact science. They mention inadequacies among practitioners, limitations of research, discrimination in insurance reimbursement policy, and difficulties arising in diagnosis and treatment. They discuss the risks and benefits of a national health information data storage system. In short, they give an accurate, comprehensive, unvarnished overview of the medico-legal-psychiatric system.

Reading as a mature psychiatrist I came away with a refresher on areas of the field from which my subspecialty has taken me away. Reading as a psychiatry trainee, one would find Shrink Rap useful in that it provides a detailed, comprehensive view of the field, a description of many of the psychoactive drugs in use, and a nonjudgmental account of the three major forms of psychotherapy. Trainees who identify with the authors’ approach will come away with a broad perspective on issues in the field and a humane, respectful, ethical stance. They will be encouraged to develop curiosity about the emotional life of their patients and their histories, but they will not develop any analytic sensibility or deep understanding of the human condition.

Reading as a psychoanalyst, I was sad, but not surprised to note the tiny place psychoanalysis has in the mind-set of the general psychiatrist. Shrink Rap reflects current perceptions that drive psychiatric residency training and mental health insurance policy. Psychoanalytically informed treatment has been slow to subject itself to research because the psychodynamic therapeutic relationship is too complex to reduce to simple criteria ready for measurement, but attachment research and neuroscience are now showing how the therapist’s capacity for empathy, containment, and attunement provide conditions conducive to affect regulation and brain growth. Intensive psychotherapy, however, calls for a big investment of time and money by patient and therapist in training. Consequently, psychodynamic or insight-oriented psychotherapy, once the staple of psychiatry, is now less often prescribed than quicker, evidence-based, results-focused methods with circumscribed goals that can be subjected to quantitative research. As a psychoanalyst, having been an analysand myself, I know from professional and personal experience that an open-ended psychodynamic, interpretive approach that takes account of the dynamic unconscious and its effect on the therapeutic relationship offers insight out of which personal growth develops. But I do not find this value embodied in this book. Psychoanalysis receives a mention as an option for those who seek to know themselves better to fulfill their potential, especially as psychotherapists, but it is not fully described, illustrated, or applied to the discussion of vignettes.

Psychoanalysis is most visible by its absence in Shrink Rap. Reading this book is a hard lesson for the psychoanalyst and psychodynamic psychotherapist. It serves up a sharp dose of reality and a painful reminder of how society has come to view mental illness and the means to wellness.

 

Jill Savege Scharff, M.D.

6612 Kennedy Drive

Chevy Chase, MD 20815-6504

IPI and Westminster College Awarded Research Grant

Jill Scharff, Caroline Sehon, Janine Wanlass

The International Psychotherapy Institute  (IPI) and Westminster College are the proud recipients of a research grant award from the International Psychoanalytical Association (IPA) in support of our jointly conceived Research Grant Proposal on Teleanalysis.  This proposal, written by Janine Wanlass, Principal Investigator, was submitted to the IPA by Caroline Sehon, chair of the teleanalysis working group of the International Institute for Psychoanalytic Training (IIPT) at the International Psychotherapy Institute (IPI) on behalf of IPI and Westminster College, Salt Lake City.

Grant Recipients - Ellen Behrens, Janine Wanlass, Jen Simonds at Westminster College, Salt Lake City.
Grant Recipients – Ellen Behrens, Janine
Wanlass, Jen Simonds at Westminster College, Salt Lake City.

At the September meeting of the Teleanalysis Group, Janine Wanlass reviewed the history of the research grant proposal to the IPA.  She described learning about the IPA grant, gaining the interest and expertise of her colleagues Jen Simonds and Ellen Behrens at Westminster College, and discussing the collaboration between our group and Westminster College.  She then gave an overview of the study design.  The practice of teleanalysis – conducting psychoanalysis through the assistance of the telephone or other high quality video connection system – is described in case studies and anecdotal accounts but lacks an empirical research base.  The current study proposes development of a questionnaire to assess the frequency, format, rationale, experience, and scope of teleanalysis practice by IPA analysts.  Based on these research findings, a subset of analysts will be interviewed using a grounded-theory approach to further investigate analysts’ perceptions, experiences, and challenges in practicing psychoanalysis via the use of technology.  The findings from this mixed-methods approach will be presented with implications for current practice and future research.  For instance, we hope to expand our research to the study of psychotherapy via technology as another arm of the project. 

Janine explained that the grant money will be allocated against research expenses (such as data entry, translation of interview data, and computation) and that no researchers, interviewers, or interviewees will be paid for their participation in this study.  In response to interest shown by all members of the group, Janine stated that her next step will be to invite our group over the next couple of weeks to contribute ideas that would inform the questionnaire design. Janine looks forward to collaborating with the group, and to receiving direct and specific input from project participants along the way. We anticipate that it could take three to four months to design the questionnaire needed for Stage 1, obtain IRB approval, and pilot the questionnaire.  The award funds will be released as soon as we are ready to send documentation of IRB Approval from Westminster College to the IPA.

One IPA reviewer said, “This project is carefully planned and it promises to get data about teleanalysis which are not known up to now. Furthermore it is conducted in conjunction with two appropriate sponsoring institutions and with a group of experienced psychotherapeutic and psychoanalytical researchers. So it has a good basis…..”   IPI’s affiliation with Westminster College was a critically important factor in the success of this research submission, as it has been in many other clinical and educational aspects of training programs at IPI and Westminster College.

Robert Galatzer-Levy, chair of the Evaluation and Research Proposals and Results Committee of the IPA wrote that the IPI/Westminster College grant application “received a very high ranking in a highly competitive field. The grant will be funded in the amount of $5,000 to support your research project. This award reflects limitations in the funds available to support research.”   We are delighted with the amount of the award, because it corresponds exactly with the amount requested.  IPI Board member James Finkelstein expressed the view that the honor of receiving the award is much more significant than the amount of the award.  The IPI Board was unanimous in extending congratulations to faculty responsible for this successful submission.

Caroline Sehon complimented Janine Wanlass on her “hard work, keen analytical and research perspectives, and her collaboration with her research colleagues, Jen Simonds and Ellen Behrens, at Westminster College.”  Sharon Dennett, Chair of the International Institute for Psychoanalytic Training (IIPT), the analytic training program at IPI, thanked the teleanalysis group “for this considerable and productive work” and offered help in whatever way IIPT could provide support.
This is a tremendous accomplishment for all, and a testament to what can be achieved when a team of many individuals and two institutions came together, working at high intensity and lightning speed to meet a rapidly approaching deadline, all with the solid support of Geoff Anderson (IPI’s Director), Jill Scharff (co-founder of IPI, past chair of the teleanalysis group, and Board member) and David Scharff (co-founder of IPI and Board Chair), Doug Dennett, Sharon Dennett and Stan Tsigounis (IPI and IIPT at IPI), Colleen Sandor (Westminster College and IPI), and last but not least, Anna Innes, Executive Administrator of IPI.

 

 

IPI and IIPT at the International Psychoanalytic Association Congress in Prague

From Jill Scharff and Caroline Sehon

Betty Benaim, Doug and Sharon Dennett, David and Jill Scharff, Caroline Sehon, Yolanda Varela and Lea Setton (faculty of the International Psychotherapy Institute (IPI) and the International Institute for Psychoanalytic Training (IIPT) at IPI, and IPI-Panama faculty member and candidate Katia Paredes attended the International Psychoanalytical Association (IPA) Congress in Prague this summer. We met some IIPT adjunct faculty there too – Ira Brenner, Ted Jacobs, Otto Kernberg, Mary Kay O’Neill, Virginia Ungar, Vamik Volkan, and Rick Waugaman. The panel meetings were excellent, with proficient powerpoint and display of text .

Ricardo di Bernardi presenting Level 2 of the 3-level model on the process of change
Ricardo di Bernardi presenting Level 2 of the 3-level model on the process of change

Some of the small discussion groups were equally good, but others proved to be under-attended, although they had been fully subscribed. The Congress design was very good and the presentations were of high quality, especially the case reports and discussions.

Various roles of IIPT faculty members before and during the Congress

Sharon Dennett was busy with meetings for training directors and supervising analysts of IPA institutes in her role as Training Director of the Vermont Study Group. She also attended a pre-Congress workshop on initiating psychoanalysis. Sharon noticed that the IPA is making a big effort to translate and make accessible writings in multiple languages into English to give them a larger audience and to facilitate cross cultural communication among analysts from all regions.

Betty Benaim attended the Presidents’ Meeting in her role as Chair of the Panama Study Group, chaired by Marvin Margolis (USA). Betty found it a good opportunity to learn about the experience of psychoanalysis in other countries and to realize that the main goal everywhere is outreach to the younger psychologists to train them in psychoanalysis. She realized how much of what was being recommended is already being done in Panama where they have groups of young candidates. Ten years ago there was one analyst in Panama. Now there are seven, and soon a group of younger candidates will be graduating. Betty was also pleased that the schedule included small discussion groups, that being something that IPI members value so much.

David Scharff organized a pre-Congress workshop on behalf of the IPA Committee for Couple and Family Psychoanalysis, to which he was appointed in 2011 as chair following the death of Isidoro Berenstein.

Lin Tao listens as the group responds to his discussion of Felix Velasco’s case
Lin Tao listens as the group responds to his discussion of Felix Velasco’s case

Over a day and a half, three cases were presented from Mexico, Italy and Brazil, each had two discussants, and all of them generated lots of group discussion about couple and family dynamics — no-entry and spoiling defenses against the therapist as an intrusive, non-understanding object, collusive antilibidinal links and terror of entrapment in a couple relationship, violence as a desperate attempt at ending conflict, the therapist’s need to titrate optimal distance to avoid wounding the family with a psychotic core, and her provision of containment and space for thinking. Later in the week, David met with the committee (colleagues from Britain, Rome, Brazil, Mexico, Australia, Spain and China). Among other business concerning future directions, they discussed with great enthusiasm their participation in the February 6-9, 2014 IPI weekend, chaired by Janine Wanlass (Chair of Couple, Child and Family program at IPI) and David, when some of these international colleagues will travel to Washington to join IPI members in discussing the frame and the process of assessment and evaluation in couple and family therapy.

Jill Scharff organized and chaired a teleanalysis working group discussion at which Caroline Sehon presented a vignette to illustrate working in the transference in teleanalysis.

Caroline presenting, IPI faculty listening in the group
Caroline presenting, IPI faculty listening in the group

Participants included Mary Kay O’Neill, an IIPT adjunct faculty member introduced to Jill and the group by Sharon. Thanks to that meeting, Jill was invited to present on teleanalysis at the Post-Termination Workshop that Mary Kay chairs at the January meeting of the American Psychoanalytic Association. The lively discussion at the teleanalysis working group meeting served as a wonderful celebration of the newly published book Psychoanalysis Online (Karnac 2013), including chapters by IPI authors Mike Stadter, Karen Mohatt, Sue Cebulko, Jill Scharff (editor), David Scharff, Nancy Bakalar, Caroline Sehon, Betty Benaim, Yolanda Varela, Lea Setton, Geoff Anderson, Janine Wanlass, and IIPT adjunct faculty members Ernie Wallwork and Sharon Zalusky Blum.

Psychoanalysis Online: Mental Health, Teletherapy, and Training
Psychoanalysis Online: Mental Health, Teletherapy, and Training

 

A few highlights from some of the main IPA Congress panels and papers:

In “Tracking Transformations in Psychoanalytical Process: Unconscious and Explicit” Ricardo di Bernardi laid out the three-level model. Applying the model to vivid clinical material presented with empathy and precision by Michael Sebek (Czech Republic), Margaret Hanly (Canada) compared process notes taken at anchor points in the analysis in relation to a selected focus captured in the question, “How is the patient using the analyst at this moment?”

In “Mourning & Melancholia: After the Holocaust: A Psychoanalytic Exploration of the Deaths of Jean Amery, Paul Celan, and Primo Levi” panelists Samuel Gerson (USA), and Rachel Rosenblaum (France) explored why holocaust survivors who have written about the horrors they witnessed or experienced take their own lives in later years: The holocaust writer-survivor is a reluctant witness, caught between telling and not telling, until he decides to disclose the trauma — at which point he may perceive pain for the first time, and after speaking out, may identify the larger community as an indifferent world, and introjectively identify with it as a dead mother-object that ultimately turns against the self.

The Committee on Psychoanalysis and Culture tackled the challenge to psychoanalysis of virtual reality. Gerhard Schneider called us to become acquainted with the world of young people whose sense of time and self-concept and expression of intelligence is unfamiliar to older analysts. Drew Tillotson (USA) and Raquel Berman (Mexico) gave exquisitely relevant clinical material to illustrate the challenge to the frame, the erasure of time and space, the illusion of connection, and the use of a communication device as a psychic retreat or a bridge to mindfulness. Adela Abuela Garcia (Switzerland) asked whether, in this world of overstimulation and hyperacceleration, slow, careful listening can survive the demand of the urgent response.

In “Facing the Pain in Psychoanalysis With Severely Traumatized Chronic Depressed Analysands: New Ways in Conceptualization and Treatment,” Marianne Leuzinger-Bohleber (Germany) presented her research findings, showing powerful causal links between trauma and depression, and stated that “in the absence of trauma, genetic vulnerability is usually not enough to lead to depression later in life.” Discussant Otto Kernberg (USA, and IIPT adjunct faculty) advocated for worldwide, psychoanalytic research studies to investigate the links between neurobiological and psychodynamic etiologies for depression, and he underscored the tremendous value of an object relational way of thinking and working with individuals suffering from depression and trauma. Marianne will present research on trauma with her husband Werner Bohleber at IPI in Denver, October 18-20, 2013.

Ted Jacobs, IIPT adjunct faculty member, chaired a panel that he designed, The Analyst’s Pain: The Management and Utilization of Frustration, Rage, Despair, and other Troubling Affects in the Process of Analyzing. Ted assembled presenters from three separate countries and analytic traditions: Ilany Kogan (Israel), Bernard Reith (Switzerland) and Brian Robertson (Canada, IIPT adjunct faculty), and Caroline Sehon was the reporter. The panel examined the various kinds of pain that analysts and patients experience within the transference-countertransference field and explored the emotional wounds inflicted by the patient and potentially the analyst, not only within the analytic consultation room but also within the wider professional community. The panelists presented countertransference of various kinds – sadomasochistic feelings, helplessness, and sexual tension – and described unconscious enactments that contaminated the analytic field in disappointing and surprising ways that they then worked with in the service of advancing the analytic project. The audience joined the panelists in bearing witness to pain and distress in the heat of the analytic encounter and to the benefit of having battled the raw feelings that cut right to the core (For a detailed account, see Caroline Sehon’s report in the forthcoming Congress issue of the IJP).

Anne Alvarez (London and IPI guest speaker) gave a delightful interview about her theory and practice with children.

Ron Britton (London) received the IPA award for outstanding scientific achievement. Ron confirmed that he will come to Washington as IPI weekend distinguished guest speaker, October 17-19, 2014.

A glimpse of the new presidency of IPA

Stefano Bolognini (Italy) and Alexandra Billinghurst (Sweden) were installed as President and Vice-President of the IPA. Bolognini shared the overall vision of his presidency. Here are his priorities and a few lines from his speech:

1) Improved communication strategies

2) To revitalize the website

3) Education to the new generation of psychoanalysts

4) Children and adolescents

5) Rebuilding a bridge between psychoanalysis and psychiatry

6) Research

“Yes psychoanalysis has changed our lives as human beings, and this is something far too intense to be forgotten, or denied, or lost. Like a new complex instinct, this experience naturally leads us to provide listening, attunement, resonance, understanding, shared work, and interpretative formulation, from generation to generation. We are sustained by a tremendous wealth of research and theoretical clinical knowledge passed down for a century now. The positive resources that are available to psychoanalysis and to IPA are such as to allow us a feeling of well-founded personal regard for ourselves, our method and our future.” Stefano Bolognini, Prague, 2013.

Note: The IPA is trying to adapt to the future — catch the presidential speeches on You tube!

Around Prague

It wasn’t all work, of course. In various combinations, we went out to see the city and its extensive Jewish quarter,

Jewish cemetery
Jewish cemetery

enjoying its interesting architecture,

Katia at St. Vitus Cathedral
Katia at St. Vitus Cathedral

lovely river ,

Dennetts and Scharffs
Dennetts and Scharffs

first-rate international cuisine,

The Settons, Varelas, Scharffs and Betty Benaim
The Settons, Varelas, Scharffs and Betty Benaim

and wonderful music in exquisite chapels.

Organ concert at the Clementinum
Organ concert at the Clementinum

Boston July 22-25, 2015

The next IPA Congress has the intriguing title “Changing Worlds: the Shape and the Use of Psychoanalytic Tools Today.” In a very welcome letter of August 17, 2013, the new IPA president Stefano Bolognini and vice-president Alexandra Billinghurst apologized for the heavy-handed approach to maintaining confidentiality at the Prague Congress and promised to make amends to non-members by devising a better system for assuring confidentiality, by refunding part of the admission price, and by offering substantial discounts to non-members who attend the next IPA Congress. They believe that the IPA Congress should offer us all extraordinary opportunities to share in the excitement of new discoveries in psychoanalysis, meet analysts from every part of the world, interact and participate in debates, develop ideas with our colleagues, and see things through the eyes of analysts who may have very different approaches from our own. See you at the seaport in Boston, July 22-25, 2015.

DSM-V falls short

This recent article in the New York Times is an important admission by the psychiatric community that the notion of having the biological answer to mental illness is a myth.  What biological psychiatry is still missing is the important biological evidence that is revealed in affective neuroscience and developmental psychology about the underpinnings of the development of the unconscious relational self in attachment, affect regulation, and mentalization.  By looking for cellular level structure problems they are missing the idea that the human brain develops primarily after birth in a relational matrix.  It is encouraging to see a step back from the certainty that biological structure determines behavior and that there are deeper mysteries to yet be explored.

On the Derivation of the Word Therapist

Charles Ashbach, Ph.D., therapist in the Philadelphia area.

Faculty of the International Psychotherapy Institute (IPI)

Faculty of the Philadelphia Psychotherapy Study Center (PPSC).

E-Mail:  cashbach1@verizon.net.

            The training for psychotherapy by and large focuses, as it should, on the development of capacities within the therapist that enable him or her to make contact with the emotional and psychic-unconscious dimensions of the self and through this “self development” comes the capacity to be able to tune in and detect the unconscious of the patient’s mind, self and personality.  The development of empathy, intuition, patience, perspective, context, symbolism and the negative capability are all emphasized in helping a person prepare for the rewarding, though incredibly demanding profession of psychotherapist.  I want to share some thoughts I’ve come by in the study of our most demanding profession.

For some years I have been a member of a group of colleagues who have been studying the primitive dimensions of the human personality.  Not only through various schools and approaches within psychoanalytic psychology but also through myth, anthropology, sociology and the history of religion.  During that time I was fortunate to come upon the origin of the word therapist.  This occurred when a colleague of mine commented on a seminar he had attended and how the presenter made mention of the root of the English word therapist being the Greek word Therapon.  My colleague said it had to do with the master-slave relationship between a royal and his servant.

I was struck by this idea and my research revealed the Greek word Therapon described an individual whose job or role was to be an attendant, companion of lower rank, aide, minister, slave, servant or replacement committed to the willing sacrifice for a human master or supernatural deity.  It was used in the Old Testament to describe Moses’ relationship to his god, and was understood as “servant” of god.  I was especially impressed by the “sacrificial” aspect of the term when understood as “slave,” “servant” or “replacement.”  Further research revealed the use of the Therapon in Homer’s Iliad regarding the role of Patroclus.

In the Iliad, Patroclus, Therapon to mighty Achilles, takes up Achilles’ cause when he (Achilles) peevishly withdraws from the battle against the Trojans after an argument with King Agamemnon.  In that dispute Agamemnon demanded a certain public deference from Achilles as well as demanding that Achilles give up his beautiful female slave to Agamemnon.  Patroclus, recognizing the de-moralizing threat of Achilles’ withdrawal, put on his master’s majestic armor and went out onto the field of battle to fight the mighty Trojan warrior, Hector. Patroclus sought to save the day for Greece and to save Achilles’ sacred name.  Of course he did neither.  Hector immediately killed Patroclus and his death spurred the mighty Achilles to take us his weapons and defeat the Trojan army and drive them back behind the Walls of the city.

The point here is that the Therapon is prepared to sacrifice his, or her, life for the good of the master.  The implication being, that at the core of the human unconscious is a sacrificial component, an archetype if you will, that motivates an individual to take up a particular form of subjugation and sacrifice as their life’s work.  This seemed to be very important to reflect upon.

Heinrich Racker in his brilliant treatise on the role of the therapist, Transference and Countertransference (1968) writes compellingly about the unconscious need at the core of the therapist’s personality to rescue his or her own internal damaged objects.  He says we become therapists to repair and restore these precious objects in order to free ourselves from the responsibility and guilt of having let them down or aggressed against them.  Ultimately, Racker believes, that our metabolization of this guilt provides the path to become a competent, caring and realistic professional, empowered but limited, motivated but not manically so.  As Freud says that we must be careful not to seek cure at any price.  The goal of therapy, Freud says, is to offer the patient the awareness of choices and then ultimately to stand back so he or she can make the choices that define their life.

Racker seeks to remind us that it is the encounter with our unconscious that prepares us for the encounter with the patient’s.  It is our ability to acknowledge our limits and our vulnerabilities, our terrors and our dreams, that help us to offer this form of integration and humility to our patients.

In the work with the most difficult and demanding group of patients, those that occupy the class that Freud (1923) described as manifesting the “negative therapeutic reaction” (NTR), we frequently encounter the collision of our therapeutic self with the split self of the patient.  The patient’s self is split due to the operation of traumatic components that have driven that individual to both desperately seek help and simultaneously to resist help and the dreaded dangers of change and transformation.  We realize after some time and a great amount of suffering that the collision between these two aspects of the patient’s self means a great challenge to our therapeutic self.

With such patient’s there is a desperate need to see the self as “innocent” and the “victim” of circumstances.  These needs clash with their unconscious dimension of self-awareness that perceives the aggression and conflict that flows and has flowed from their self toward their objects.  This battle between their love and hate, that is their primordial ambivalence, is complicated by the attack of the super-ego that holds them in a dreadful state of moral judgment and condemnation.  Melanie Klein (1935) defines this moment as the crisis of the “depressive position.”  Often their only recourse is to projectively identify their dilemma into and onto the therapist and ask us to take their place on the sacrificial altar of their relentless self-judgment, punishment and guilt.

Here the battle between empathy and enmeshment is most acutely engaged.  The patient frequently feels that “if we loved them” we would take their place in their struggle with their bad-object conscience.  Other times they identify with the bad object and seek to have us offer up ourselves so that they may remain free and clear of any responsibility for the injuries to their love-objects.  In either the depressive or the paranoid version of the request, the patient is asking us to become the “scapegoat” for them.  It is here that we must be able to delineate the various sectors of their unconscious to help them to see what they are asking of us, and what their internal world of bad objects hold over their souls.  We might say at moments like these that are repeated over and over again, across a great span of time, that the patient is asking us to renounce our role of “therapist” and take on the role of Therapon.

Wilfred Bion (1970) says that the therapist must be able to “suffer” what the patient is tortured by in order to establish credibility with them.  He says we must be able to enter into an at-one-ment (atonement) with them in order to offer them the evidence that they are not locked away in the past position of abandonment or withdrawal being lived out in the transference.  As with all such states of identification, they are transitory.  Eventually they must be aided to see they are not the monsters they fear nor the angels they dream of.  Neither love nor hate will ever produce the desired outcome of integration, acceptance and most importantly, the mourning of the impossible dream lurking at the core of the self.

Our attention and attunement is to be directed toward the internal conflicts that are at the core of the patient’s problems and become projected on to and into the therapeutic relationship.  We can offer help that might assist them in solving their problem but we must not climb upon the sacrificial altar in their place.  Such sacrifice might meet the therapist’s unprocessed needs but does not lead the patient forward to be able to realize the complexity of their circumstances and the requirements necessary to achieve a productive separation and creative independence.

Notes.

Bion, W.  (1970), Attention and Interpretation.  London, Karnac, 1984.

Freud, S.  (1923), The ego and the id.  Std. Edition, Vol 19. , 48-59.

Klein, M.  (1935)  A Contribution to the Psychogenesis of Manic-Depressive States.  Int.J. Psycho-Anal, 16.

Racker, H.  (1968), Transference and Countertransference.  IUP, Madison, CT.

Michael Parsons and the Logic of Play in Psychoanalysis

By Yeshim Oz, MS, LMHP 2nd Year Student Core Program

As we come nearer to the IPI weekend in January, I became curious about the guest speaker, Michael Parsons. In the age of technology, it was not difficult at all to come across tens of articles written by him by just one click. (Ok, that is a bit of an exaggeration; you have to enter your username and password to use the fabulous Pep-Web). Since I am a child therapist and play is part of my life, one of his articles, although not a recent one stood out for me: The Logic of Play in Psychoanalysis (1999).

Although there is nothing extra-ordinary about the use of play in child psychotherapy, the idea of play in adult psychoanalysis might seem a little peculiar at first. However, in his article, Parsons demonstrates beautifully how play, with its paradoxical nature, is ever-present in psychoanalysis. “The paradoxical reality” he says, is “where things may be real and not real at the same time”. Isn’t it the essence of transference? When the patient experiences the analyst as the father or mother, it is true in the sense that the patient experiences it, but it is also an illusion. As Parsons reminds us, Klauber suggested that the therapeutic value of transference does not depend on resolving the illusion but on accepting its paradoxicality. This acceptance opens up a space for the therapeutic couple to do the analytic work without undermining the experience of the patient as a mere illusion. Where is the play element in here? Parsons says, ” the play element functions continuously to sustain this paradoxical reality”. The “as if” quality of play enables the patient -and the analyst as well- to think, imagine, and play with possibilities.

Parsons continues to explain the intricate connections between play, playfulness, humor and irony and stresses the spontaneity and the importance of the analytic frame. He gives excellent examples from clinical material that show how each of these aspects emerges spontaneously from the interplay between the patient and the analyst that would deepen the analytic process.

With all its seriousness, the article evokes in the reader a sense of playfulness, which might have been long forgotten, especially for those who work with adults. As far as I am concerned, it gave me a new understanding when thinking of my young clients who often express, silently or quite loudly, how magical the therapy room (a play framework- in other words) feels to them and to me at times. I am certainly more excited now than before for the January IPI weekend with the anticipation of a playful, humorous, yet serious work.

IPI Gala Award Dinner and Dance

IPI Hosts Gala Awards Dinner and Dance

Gala Dinner
The first International Psychotherapy Institute (IPI) Gala Awards Dinner and Dance took place on Saturday October 22, 2011 at Kenwood Country Club in Bethesda, Maryland.  The guest of honor was Jason Aronson MD, Premier Publisher of psychotherapy books and Co-Founder, IPI, and inaugural recipient of the David and Jill Scharff Award for contributions to mental health.  The dinner was held in Dr. Aronson’s honor and in appreciation of founding board and faculty members 1994-1996.  The event was organized by Gala Chair Sheri Rosenfeld and her committee Joanna Bienko, Anabella Brostella, Karen Greenberg, Jill Scharff, andLea de Setton.

Sheri Rosenfeld (left)
Sheri Rosenfeld, IPI Board Development Chair welcomed the guests to the IPI benefit  and handed over to Michael Stadter, IPI Founding Faculty and Board Vice-Chair, as Master of Ceremonies.

Michael Stadter

Gala Presenters
Michael introduced faculty to describe IPI’s community involvement. Caroline Sehon (Chair, IPI Metro Washington) spoke about the videoconference teaching program for therapists in remote areas.  Colleen Sandor (Co-Chair, IPI Salt Lake) attested to the value of IPI’s affiliation with Westminster College.   Carl Bagnini (Co-Chair, IPI Long Island site) his work with Latino fathers.  Lastly Vali Maduro (Chair, IPI Panama) and Anabella Brostella (Chair, Foundation for Healthy Relationships at IPI Panama) showed IPI-Panama’s film of work with Operation Smile plastic surgery programs to correct children’s congenital deformity, suicide prevention efforts, and programs for teenage mothers.
Books by IPI authors were on display for guests to browse.
Sharron Dennett with IPI Director Geoffrey Anderson
After dinner, in a short program to honor and thank colleagues and supporters, Geoffrey Anderson IPI Director, recognized the contributions of founding faculty 1994-1996. Pictured, from left, are Founding Faculty members Carl Bagnini, Yolanda de Varela, Charles Ashbach, Walton Ehrhardt, Sharon Dennett, Judith Rovner, Lea de Setton, Mike Stadter, and Michael Kaufman. (Not present: Kent Ravenscroft and Paula Swaner)

Founding Faculty Members
Chris Hill, Treasurer, IPI recognized the Founding and Inaugurating Board of IPI (then IIORT) 1994-1995.  Pictured are Kent Morrison, David Scharff (Founding Co-Director), Jill Scharff (Founding Co-Director) Jason Aronson (Founding Board Member, NYC). (Not pictured are Dennis Blumer, Yvonne Burne, Dickson Carroll, and Lorna Goodman.)

Founding and Inaugurating Board of IPI
Michael Stadter, Board Vice-Chair, IPI announced the inauguration of the David and Jill Scharff Award.  Drs. David and Jill Scharff are co-founders of the International Psychotherapy Institute.  They teach and supervise at IPI and IIPT and practice psychoanalysis and psychotherapy with children and adults, couples and families in Chevy Chase.  They spearhead IPI’s international outreach, our message carried in translations of their many books on psychoanalysis and psychotherapy in German, Italian, Chinese, Korean, and Russian.

Jill (left) and David (right) Scharff

Jason Aronson
David Scharff, Co-founder, Board Chair, IPI and Jill Scharff, Co-founder, IPI introduced the recipient of the award. Dr. Jason Aronson, a physician and psychoanalyst, founded and directed for over 35 years Jason Aronson Inc., the premier publishing company of highly regarded, professional, scholarly books by respected and gifted authors in the field of psychotherapy until 2003, when Jason Aronson became an imprint of Rowman and Littlefield.  In 1994, Dr. Aronson joined David and Jill Scharff as the third co-founder of IIORT, now called IPI, and has been a good friend to IPI ever since.  Dr. Aronson was the founder and editor-in-chief of the International Journal of Psychiatry.  He resides in New York City with his wife Alice Kaplan.  His daughter Jane and her family live in California.  
The Scharffs presented the award, an engraved tray, to Dr. Aronson who accepted it with thanks.  Dr. Aronson’s remarks began with gratitude and ended with an amazing act of generosity and inspiration when he announced his intention to come out of retirement in order to spearhead a publishing division at IPI for the creation of e-books to be distributed FREE to any mental health professional. Visiting professor Horst Kachele from Germany jumped to the podium to contribute the first book of the series.
A delighted audience rose to its feet in thanks and expressed its exuberance on the dance floor thereafter.

The Gala was a terrific success, both in terms of attracting support and in giving all our guests an enjoyable, entertaining evening.  Donations of table décor from Jonathan Willen, graphic design from Leanne Poteet, photography by Darin Del Rosario, and plant materials from American Plant Food were gratefully received.  With their help and the generosity of our guests, IPI raised $22,000 to support outreach programs. 

Acknowledgements

 

Helpers ($150-499)

Sharon Alperovitz

Dorothy and Larry Arnsten, Arnsten Foundation, in honor of Jason Aronson

Nancy and Richard Bakalar

Lawrence Birnbach, in honor of Jason Aronson

Jim and Elise Blair

Norma Caruso

Maria Checa-Rosen

Meg and Jim Cooper

Steven, Susan and Malka Drucker, in honor of Jason Aronson

Walt and Carol Ehrhardt

Bonnie Eisenberg, in honor of the Founding Faculty

Randy Freeman

Cleo and Michael Gewirz

Jeffrey Glindmeyer

Linda Hopkins

Michael Kaufman and Maria Ross

Chris Keats

Steven and Susan Levine

Jaedene and Chuck Levy

Doris and Scott Mattingly

Kent and Dale Morrison

Michelle Pfeifer

Mary Jo Pisano

Susan Plaeger

Eleanor Rosenfeld

Helen and Paul Schmitz

Eleanor and Arthur Siegel

Suzanne St. John, in honor of Charles Ashbach

Stan and Hilary Tsigounis

Wendy S. Wall, in honor of Jill and David Scharff

Kim and Judy White

Tappy and Robin Wilder

 

Friends ($500-$999)

Dennis and Tansy Blumer

Henri and Rachel Parens, in honor of Jason Aronson

Mr. and Mrs. Lewis Rumford

 

Supporters ($1000-$1499)

Lea Setton

Harold and Nancy Zirkin

 

Sponsors  ($1500-$2999)

Jason Aronson and Alice Kaplan

James Finkelstein and Laurie Ferreri

Sheila and Chris Hill

Hugh Hill and Sandra Read

Anna Innes and Charles Carter

Chuck Muckenfuss and Angela Lancaster

Michael Stadter and Jane Prelinger

 

Director’s Circle ($3000-$3499)

Jill and David Scharff

 

Angels ($3500 and above)

Sheri and Rob Rosenfeld

Caroline Sehon