IPI’s Annual Scharff Award lecture by Otto Kernberg

Posted on October 7, 2024 by Melonie Bell

Friday September 10, 2024, noon-2:00 pm ET on Zoom

Jill Scharff

I am sitting at my Zoom screen, along with 341 colleagues each at their own computer stations, waiting for the IPI Director Caroline Sehon to introduce Otto Kernberg speaking to us from his country home. Behind him are shelves of decoys, beautiful birds, bringing nature and art into relation with psychoanalysis. Now in his later years, Otto is still vigorous, his extraordinary breadth and depth of knowledge undiminished by age. A wonderful support to David and me and a friend to IPI and IIPT, Otto stood by during our development in the controversial and lonely space of introducing innovative distance education in analytic thinking for psychotherapists and designing analytic training for candidates far from an analytic training center. With Otto’s help and letter of support, IIPT, viewed for years as unacceptable to both APSA and the IPA, was approved as the 33^rd APSA institute, during the presidency of Bill Glover. Acceptance for the comparable effectiveness of teleanalysis and distance education is still a problem for the IPA, but IPI with APSA’s blessing is devoted to continuing work online, in person, and in hybrid environments to build a global distance learning psychoanalytic learning community in real time. The Scharff Award Lecture will always be online, always free, and inclusive of all clinicians and students of mental health.

Otto Kernberg lectures via Zoom September 2024

Otto is beginning his lecture “Conflict and Controversy in the Field of Psychoanalytic Technique”. Used to hearing about the dynamic unconscious, we are surprised to hear Otto focus on the everyday functioning of the operational unconscious that is not dynamic. In the first few years of life, the original conflict is between affects evoked in pre-bonding, bonding, attachment, desire, frustration, and separation. Avoiding life-threatening alone-ness, the infant is consciously aware of conflict between love and hate, and then dissociates into opposite libidinal and aggressive segments of experience to defend against the underlying conflict has become unconscious. Surely, Otto is pointing to the drives not as fundamental but as breakdown products of object relations in the early years.

Turning to theories of neural structure, Otto revisits Panksepp’s seven affect systems – Seeking/ Expectancy, Rage/Frustration, Fear/Anxiety, Lust/Sexual Desire, Care/Nurturance, Panic/Grief, and Play – and ties them to the relevant neural organizations and their locations in the brain. The seeking system is intentional, scanning for survival and generating excitement and erotism. When that is thwarted by threat and curtailed freedom, frustration sets in and give rise to rage. The fear response secures proximity to a secure base and protects against destruction by predators. Lust is gender specific, associated with oxytocin release which in men drives assertiveness and sensitivity to visual stimuli and in women favors bonding and values feeling understood in intimate relations. Panic/Grief responses are stimulated in terror of separation from mother, in situations of social rejection and threats of disaffiliation. The play of childhood become the social joy of adulthood. These affect systems in the limbic system irradiate to the prefrontal cortex where they acquire their content and cognitive meaning and are integrated in perception, memory, imagination, introspection, and self-awareness. Each affect is experienced in relation to the affects of others, and so there develops an image of the self, the other and the affects that connect them in life and are built into psychic structure as internal object relationships. Where there are heightened contradictory affects and symbolization is weak, lack of cortical control releases a diffuse trauma response.

This takes us to a section on clinical technique, beginning with Freud’s free association, evenly suspended attention, and neutrality (in which feelings of abandonment are not gratified but are analyzed) and Bion’s being without memory and desire. With these in place, the analyst is in a position of concerned objectivity from which to stay out of (or recover from) conflicts, observe transference displacements into the outer world, and transform countertransference into transference analysis and interpretation of unconscious object relationships, thereby helping the patient move between dyadic and triadic situations. Otto reviews specific foci for analysis – dreams, repetition compulsion, somatization, negative therapeutic reaction based in unconscious guilt and envy, and analysis of the analytic field. He pauses to warn against the use of cognitive, emotional and environmental supportive measures because those interfere with reaching primitive levels of experience, so essential to recovery. The termination phase takes us back firstly to paranoid-schizoid anxieties then to depressive operations, stimulated by imminent loss of the analytic relationship, and so analysis of the termination is the final effort in analysis of the analytic field. Moving from psychoanalysis to psychotherapy, Otto mentions his specialty, the treatment of personality disorders, for which he has developed his signature method of Transference Focused Psychotherapy, with attention to transference specific to each type of personality disorder.

We are covering a lot today, and people are lining up in with electronic hands in their Zoom windows to ask another question, but the time is coming to a close. Otto’s exposition so freewheeling, the grasp of his knowledge so wide and the thrust so deep, that there is no way to capture it fully in these few words— you had to be there! Suffice it to say, thank you, Otto, for an amazingly erudite lecture and generous discussion of contemporary conflicts in psychoanalysis.

IPI Program Graduates

Posted on May 1, 2018January 18, 2019 by Melonie Bell

Congratulations to our IIPT (analytic) graduate Michele Kwintner and our Core (object relations) graduates, and our clinical consultation program graduates.

cake

Suzanne St. John and Karen Fraley announce the names of the Clinical Consultation Program graduates.

Caroline Sehon (IIPT chair) Michelle Kwintner (graduate) and Janine Wanlass (IPI Director)

Two Year Core Students preparing for their last weekend small group as a cohort (Henriette van Eck, Kelly Seim, Steven McCowin, Christie Dietz)

The graduates acknowledge the support given to them by their group leader (Lorrie Peters)

Core graduates present their group leader with a blanket made of patchwork saris.

Posted on August 3, 2015January 18, 2019 by Melonie Bell

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 49^th Congress of the International Psychoanalytic Association in Boston, July 2015.

A Group Dynamics Approach to Understanding America’s Current “Collapse”

Posted on April 2, 2009 by Melonie Bell

By Charles Ashbach, Ph.D.

In 1921 Sigmund Freud published his famous monograph Group Psychology and the Analysis of the Ego. Driven by the madness, savagery and destruction of the First World War, he set about expanding psychoanalytic principles to explain the dynamics of social cohesion. It’s worthwhile that the original German title of the work was better translated as “Mass” or “Horde” psychology than “Group.”

In a similar way this essay will attempt to apply the principles and understanding developed by both Freud and Bion to help explain the social-psychological processes that have brought the United States to a condition of near “collapse” and economic “crisis.”

Freud combined his study of the libido with the mechanism of identification to explain how a group of separate and heterogeneous individuals combine to form a common emotional bond and construct a cohesive social system capable of a wide range of both creative and destructive acts.

He observed that it was through a process of introjective identification that individuals, sharing a common purpose, need, or function, were able to constitute a psychological group. Each individual internalized the image of the central leadership figure, experienced in the unconscious as a representative of the father. This process of common connection and investment of the leader had the effect of allowing all members of the group to now possess a common love object.

Furthermore, and most importantly, the installation of the leader’s image inside the individual’s super-ego-ideal created a common conscience and experience of morality. The leader, now functioning as the ideal, brought about a revalued narcissistic sense. Ideals and aspirations of the leader, and his ideology, become central to the individual member of the group. A single love object, shared conscience, and unified ideal combine to provide the members of the group a common sense of reality and purpose. Out of the many, the One was formed: E Pluribus Unum.

The common features possessed by each member, create a kind of psychic “gyroscope,” make cohesive social action possible. At the same time the homogenization of the values, beliefs, and ideals of group members leads to a decrease of diversity, complexity, and reality testing. The sense of oneness, which generates feelings of inclusion, connection, and safety works against the freedom of thought, feelings, difference, and doubt.

Once unified under a common banner the group must face the task of dealing with the aggression that is the consequence of human ambivalence. Splitting and projection are the prime mechanisms used to place the dangers of love and hate into the external, non-group environment. In fact, one of the central functions of any group is the discovery or creation of “enemies” in order to define and solidify boundaries and contain threats to the common ideal.

The feeling that a “group” exists, apart from the members who make it up, reveals the massive regression that is the consequence of sharing a common conscience and ideal. The group’s cohesion places demands on the individual members to maintain their sense of identity in the face of its homogenizing force. The pressure to define what is “true” by what is “shared” is intense and on going.

In the 1950’s Wilfred Bion offered a series of important developments in the theory of group formation and dynamics. Rather than locating the central group conflict in the Oedipal complex and family “romance” as Freud did, Bion sought the deeper dynamics of the group in the primitive emotional and phantasy experiences characteristic of the infant’s earliest connection to the mother.

For Bion, this meant the anxieties of attachment and the dangers of annihilation preceded concerns about competition and castration. Specifically, psychotic anxiety and dread were now posited as the core dynamic force that the group had to encounter and resolve.

Bion considered the group-as-a-whole to be the primary object of concern for the members of the group. While the leader provided structure and organization, the group as “mother object” provided the true source of comfort and protection against the dangers and challenges that the members faced.

The group as common object is created by the membership through a process of projective identification, not, as Freud thought, through introjective identification. In essence, each member places varying elements of the self within the group-object and then internalizes that “created” entity.

Leader, group-as-a-whole, and member now are seen to exist in a complex field that is constituted to protect the psyche and emotions of each member through a complex structure where phantasy and reality are continually acted upon, at the deepest levels of unconscious experience, to insure the maintenance of the group’s central illusion or ideology.

Bion then added a crucial concept to group dynamics. Not only is the group formed, but the members are able to use it to create a common phantasy condition, shared, unconsciously and anonymously, by all members of the group. This common “disposition” or attitude followed the group’s need to protect its narcissistic cohesion and sense of shared reality. Bion called this regressive condition the group’s basic assumption.

He felt that embedded in human nature were three organizing paradigms that provided the primary forms that collectives arrange themselves in to function and survive: Dependency, based upon the infant at the breast; Fight/Flight, based upon the paranoid and delusional experience of a threat to the integrity of the group; and Pairing, which had to do with phantasies of the primal scene and the conception of a child who would realize the wish for an omnipotent Messiah.

The basic assumption state is a regressive state, in flight from reality and dedicated to maintaining both a sense of primitive object relating and an experience of narcissistic wholeness and invulnerability. The term ‘basic assumption’ may sound as if it contains rational or conscious considerations, but actually it is an aspect of the depth unconscious, closer to psycho-somatic states, and centered on the most primitive emotional and phantasy elements.

In the basic assumption mode the ego’s function of reality testing is subordinated to the group’s primary task of affirming delusion: we are all good and pure; our leader is all loving and all knowing. Therefore another common state of group experience is required for the members to maintain connection to reality in order to adapt, think, change and grow. This mode of group structure and function Bion calls the work group.

The work group is in constant oscillation with one or more of the basic assumption states as the group deals with the challenges and demands of internal and external reality. Members reclaim their individuality in the work group, and yield it when they become the unthinking agglomeration of the basic assumption group.

The basic assumption state reveals a different definition and understanding of leadership. Rather than the leader imposing his or her idea, ideals, or vision on the members, Bion sees the membership selecting one particular individual because of that person’s susceptibility to carrying out the phantasies and emotions central to the operative basic assumption state.

The Group’s “reaction” to the catastrophe of 9-11

Having presented this overview of group dynamics, it is my contention that we can better think dynamically and symbolically about how the group, the United States, has gotten itself into the terrible set of circumstances it now faces. The problems of the group’s fear of “terror” and the worries about “collapse” and “depression” seem best illuminated by Bion’s paradigm of the basic assumptions.

The psychological effects of the tragedy of 9-11 included the shattering of the nation’s sense of invulnerability and of the absolute sense of safety of the American homeland. Those internal experiences and beliefs evaporated as surely as the steel and concrete of the Towers were immolated in those terrible fires.

As clinicians we’re aware that trauma results when events violently exceed the expectations, boundaries, and experiences of an individual. The fall of the Towers and the shock of the unknown pushed the group toward of state of overwhelming dread and disorientation. The group’s regression into the basic assumption state of Fight/Flight was the defensive adaptation to fend off the fragmenting anxieties and dread generated by these unprecedented events.

The regression was quickly revealed by the country’s stated goal of waging a war “on terror”—not on terrorists, not on para-national groups, but on terror itself. If any therapist had a patient present for treatment with the stated goal of destroying terror, per se, we would be taken aback and suggest that the person consider coming in 3 or 4 times a week to help them through their crisis.

At the national level we started organizing our resources and might to destroy a ghost, demon, or chimera. Billions, no trillions, of dollars and thousands of our soldiers have been sacrificed on the altar of this crusade against “terror.”

The Flight/Flight basic assumption allows for the mobilization of enormous states of aggression in a condition of “innocence.” Further, the normal moral structure that prohibits members from committing violence, “thou shall not kill,” is superseded by the revalued group conscience, “thou must kill.”

The enormity of the trauma caused the group to split itself. We became the “good and innocent” victims and the “terrorists” became the evil perpetrators. So much trauma, anxiety, and guilt was generated that no process of national reflection was possible. Therefore no reflection about the complex geo-political, economic and military circumstances that provided the context for the attacks was possible. The idea of guilt surfaced, but only in the form of accusations by fundamentalist preachers blaming the country for its “sins.”

To this day, no significant discussion of our feelings of guilt and responsibility has occurred, and no thorough process of finding meanings in all of this suffering and chaos has emerged. When the good object is lost, the absence is filled with the presence of the bad object, and doubt becomes persecutory.

Might we unconsciously fear that some angry deity punished our attempts to build our version of the Tower(s) of Babel and this catastrophe was the manifestation of the deity’s ire and dismay?

The group, in its manic movement into Flight/Fight mode, sought and seemingly found the moral high ground that then was used as a platform to engage in any behavior or action we deemed justified by the extent of our trauma. The group reshaped its morals and ideals in light of the trauma and in light of the need for guilt-free vengeance.

Since we sought to destroy internal objects in the guise of external enemies we created a deep sense of confusion and disorientation. To show how “good” and “grateful” we were as members of the basic assumption group, we idealized all those who protected us, and all were called “heroes.” The endorsement of leadership became total. In spite of the obvious and shocking deficiencies of President Bush, the group embraced him and reinforced his power to continue to lead us in our Fight/Flight state.

While many now criticize and lament President Bush’s failed and tragic leadership, we would do well to keep in mind the group’s creation of him to fulfill our basic assumption needs. Bush was our dummy; we, the collective, were the ventriloquist. As we now seek to assign blame, our collective responsibility lies hidden, lurking in the shadows of our indignation.

The absence created by our flight from reality was filled systematically with all forms of distraction, stimulation, and charade. Not the least of which was the creation of a war. War served both the need to attack our actual, external enemies, but, more importantly, to contain the sense of inner badness by projecting it into the enemy. In this phantasy mode, war was also a means of offering up sacrifice to the angry “god” who “punished” us on 9-11. On that altar we destroyed billions from our treasury and thousands of our children. It is no accident that soldiers are described as infant-ry.

The economic bubble that was created can now be seen to contain a manic action that would encourage consumption as an antidote for the grief, guilt, and confusion that has never left the American psyche. We should probably think of all of this manic economic behavior, especially the housing “bubble” and the middle class’s use of credit cards, as a kind of air-bag deployed to protect us from banging into the hard edge of the reality lurking in our collective unconscious.

Certainly the madness of the banks, with their abandonment of economic and fiscal reality, has to be seen in the shadow of the overall flight from the stress, conflict, and suffering that the group was avoiding. The use of the word “depression” seems to be a symbolic means of introducing the group’s real problem, guilt over the injury or destruction of good objects, into the national psyche. As yet we have not been able to approach the depressive position that might allow us to re-claim our responsibility for the madness and destruction we have authored.

Eventually, the group, like manic individuals, ran out of its perverse energy and crashed. The seven plus years of running from the internal threats and demons finally became too much for the group. It seems that the group had literally and figuratively depleted itself. Once we heard the clarion call of Obama’s vision of reality, hope, and justice, we began to contact some of the deeper layers of grief, guilt, confusion, and shame. Though, certainly, the sense of imminent Messianic transformation shows the group shifting from the Fight/Flight to the Pairing basic assumption.

In Pairing basic assumption the group believes that two individuals or forces will come together and create a “messiah” who will come from the future to save us in the present. Of course, the messiah must never be allowed to show up because his, or her, presence would disrupt the hope for magical transformation with the demands for actual work, change and responsibility.

Messiahs are almost always killed before they attempt to fulfill their mission of transforming some basic aspect of human nature. Probably it is better to see the death of the Messiah than to see the death of the dream that humanity can be fundamentally altered by the power or message of one individual. We can easily think of JFK, Martin Luther King, Bobby Kennedy, John Lennon, Malcolm X as representatives of that pattern.

Obama’s ascent seems to mark a recovery of the group out of the basic assumption state and toward the work group. His emphasis on equity, justice, thought, reality and lucid articulation represent the functions of the work group; while at the same time the yearning for Messianic magic seems to be the embodiment of both Dependency and Pairing. Somehow all will be solved for us, and Obama, along with whom (Hillary? Michele?), will produce a miraculous resolution to the 30 years of indifference, corruption, and the “dirty dealing,” from both the left and the right, that has skewed the national agenda away from justice and equality and more toward the rich and super-rich.

The bi-valent approach of Obama, toward more reality on the one hand, and toward manic stimulus on the other, suggests that he’s trying to serve some of the basic assumption needs of the group while attempting to engage the work function. The rabid resistance of the radical right shows the persistence of the Fight/Flight assumption and the seductive paranoid pull toward fantasy—away from reality testing. The lure of ideological psychosis persists in the core of the society, that is, at the center of each of us. Somehow, this position says, we should be able to solve our problems through hate and splitting, or through slavish dependency, without entering into a dialogue with reality.

We will soon see what elements of the group emerge and dominate the national agenda.

Russia Letter

Posted on December 5, 2008January 18, 2019 by Melonie Bell

By David E. Scharff, M.D.

October, 2008

Our invitation to Russia came from one of our International Psychotherapy Institute Fellows, Patrizia Pallaro, who returned from teaching in Moscow to inform us that two of our books were being translated. Did we know about that? Several months of discussion later, royalties and permissions arranged in medias res, Lena Spirkina from Moscow contacted us to say she had heard that we were interested in coming to Moscow to teach, and that she would be glad to arrange that. Negotiations about the conditions and time of year followed, and a year later we flew to Moscow for a five day visit with another few days in St. Petersburg as tourists.

Lena Spirkina (next to Jill) and other colleagues at lunch

Lena’s daughter-in-law, Anna, met us at the airport after 20 hours of uneventful travel, and drove us to the hotel through rush hour traffic, which exists throughout most of the day and into the late evening. The dense traffic that has mushroomed in the last ten years stayed with us throughout our stay. Moscow is a grey city of 15 million with wide streets and communist architecture that includes 7 nearly identical Stalin Palaces scattered through the city. They hold functions as diverse as a government ministry, Moscow State University, and an apartment building formerly for the elite.

One of the 7 "Stalin Palaces" in center view

On our second night Alina Krivstova, a charming, generous young woman whom we had met a few weeks earlier in Washington, took us to the opulent designer jewelry store “Alena Gorchakova,” in which she worked, where Russian-style pieces of designer jewelry, with prices perhaps exceeding any store we had ever entered, were displayed. She then took us to a restaurant in the fashion of the elite communist 1950’s, and on a night tour by car of Moscow. It was the most beautiful view of Moscow we saw during our stay.

Our young friend Alina in the Alena Gorchakova Jewelry Store

By day the same views of the city, although dotted by generous parks and two rivers, were a depressed grey, giving the impression of a traumatized populace who seemed never to look one in the eye. The buildings are grey stone and of a monumental scale that feels humanly diminishing. In all, we spent a total of three days as tourists, in palaces, famous churches and, most stunningly, in the Tretyakov Gallery – featuring an impressive and interesting collection of XI-XX century Russian art that had been given to the country. There are still more galleries we did not see, including the famous Pushkin Gallery, but we went to a wonderful opera concert — first row in an elegant hall — and ate in ethnic restaurants like our favorite, a Ukrainian restaurant decorated as a country inn. Borsht is wonderful everywhere.

Lena Spirkina and her colleagues were warm and gracious, helping us recover quickly from our doubts about what we had gotten ourselves into. They have been taught generously by IPA members from the US, including the couple Yulia Aleshina and Pasha Snejnevski who emigrated to Washington and worked with me at the Washington School of Psychiatry while beginning their analytic training more than 15 years ago.

Psychotherapy in Russia began with a group of psychologists that included Yulia and Pasha from Moscow State University. This group also included a seminal teacher who, having no access to Western psychoanalysis, had to make it up for himself and his students. Then a few, like Yulia and Pasha, got training in the West or even in Eastern Europe as it opened up after the Soviet Union dissolved in 1990 and psychoanalysis and analytic therapy were no longer forbidden.

Lena Spirkina, then in her 20’s, was among a small group of people invited to California in the 1980s — none of them as yet trained as psychotherapists — who were given red carpet treatment and a blitz of exposures to widely varying kinds of therapy. On her return, she decided that Russia had to have training, and she has over the years founded and developed the Moscow Institute for Psychoanalytic Psychotherapy. For a long time, the institute brought in teachers from overseas – many from the US, but also Europe, and then from the IPA who used shuttle analysis and seminars in Moscow to train enough people that there are now an IPA Study Group and local training analysts. But Lena is the heart and soul of the psychotherapy training. Although it is rigorously analytic, having evolved from being widely and tentatively eclectic, it has to teach basic academic psychology in order to receive state authentication. She is able to rent space in the state Institute of Psychology, but pays for that, and all the students pay tuition to study in this completely private institution. We developed an immediate and sustained admiration for her, her faculty and the students who sacrifice so much to learn what we, in our relative freedom and economic well-being, take for granted.

But there is really a more compelling case for this group of colleagues: Russia is a traumatized society. This generation of teachers and students come from families that grew up in the most traumatizing uncertainty, with parents under constant threat of being denounced, constantly on guard. Every family was either in fear of being undone or imprisoned, or among those doing the spying – traumatic in both directions. So both the therapists and the patients share this history in their social unconscious. Lena told us something of the dramatic and pervasive trauma to her family, spread through the generations, which I will not describe here because it is her story and I hope she will come to one of our conferences to tell it herself. But it makes clear that Russia itself has centuries of trauma, from the enslavement of the serfs, to the struggle to form a middle class that was abruptly cut off by the 1917 revolution, to the 70 years of fear, imprisonment and the death of 30 million people under Stalin. And then suddenly there was a shift. Nevertheless, while we were there, there were images of Putin on TV on his birthday, felling his karate teacher and marching through the forest bare-chested with a gun. It feels as though Russia is moving rapidly back towards the dictatorship that has been its state since the first unification under the Czars and that continued under communism. But this time there is a wealthy class, and a thriving middle class with education, and a sense of more political freedom to speak — at least privately — than in China.

So psychotherapy is a new boom industry, and Lena’s colleagues are hungry to know. They have formed a Society for Psychoanalytic Psychotherapy that forms the base on which formal analytic training should rest, and which offers to spread psychoanalytic application further than the limited reach that formal psychoanalysis can do by itself. Our brand of object relations theory, with its applications to family, couple and sex therapy – and even child therapy – is relatively new to them, especially in analytic form. So they are eager to learn.

Housed in the same institute building is the publisher of Russian psychoanalytic books, Victor Beloposky. A wiry, energetic white haired man, he bounced from his desk to greet us. Then we had an hour’s meeting trying to determine the best Russian translations of some of the key object relations terms. His editor and a translator are working on the third of our books that they will publish. After one particularly protracted discussion on the concept of psychological holding, the editor suddenly felt she understood and dashed from the room to get it down.

Victor Beloposky, left, with the editor and translator of one of our books

St. Petersburg is a stunning city! Palaces and broad beautiful vistas are surrounded by canals, rivers and the sea everywhere. The battleship Potemkin is now a museum docked on a quay. The buildings are painted bright colors, while the palaces are modeled on the 18th century European ones Peter the Great took as his model. Unlike Moscow, energetic people on the street look you in the eye. The depression lifts and even here, near the Arctic Circle on a chilly, bright October day, everything seems cheerful. The art in the Hermitage – mostly Russian and European – is stunning, although the Impressionist collection is much less extensive than I had imagined. But the palaces in the city and surrounding smaller towns, built by generations of Czars and their families in the 18th and 19th centuries, are magnificent. The Germans occupied the towns approaching St. Petersburg and almost completely destroyed the palaces, but they never made it into the city because of the heroism and persistence of the army and citizens over a three year siege. The palaces have been rebuilt from their gutting by the Germans with private and volunteer efforts and now shine as a tribute to the human spirit.

The battleship Potemkin's gun that began the 1917 Revolution

We met more briefly with a group of child analytic clinicians in St. Petersburg. They have been helped with psychotherapy and psychoanalytic training by the same Western and Eastern European teachers as in Moscow, but there are fewer of them in this smaller city. Warm and generous, Misha Yarish and his child therapy colleagues asked us to tell them about the rudiments of applying object relations to family and couple therapy, and concluded with the hope we would some day return to do more.

Misha Yarish (with beard) and child analytic colleagues in St. Petersburg

Russia has a small but rapidly growing number of colleagues who desperately want to know what we know, how we practice, how we work with patients. Like China, it has an enormous, long-standing history of trauma, although very different in detail. The number of informed colleagues may be smaller than in China, but they are better-educated and more organized in passing on and enlarging a foundation for future growth and work. They are eager for more help, making good on every opportunity, and in their resilience, their survival of a hundred years of trauma, they have a great deal to teach us in return.

Faith and Prejudice, Part Two: Identity

Posted on October 10, 2008January 18, 2019 by Melonie Bell

By Michael Stadter, Ph.D.

Sunrise from the Summit of Mt. Sinai, Sinai Desert, Egypt — Sunrise from the Summit of Mt. Sinai

In my previous posting, I described a remarkable trip that I took a year ago to the Middle East in the company of Christian seminarians of various denominations. The trip stimulated many personal reflections on faith and prejudice and I wrote about some of them. In this blog, I look at the role of faith and prejudice in the formation and maintenance of personal identity.

I will start with the premise that identity is partly defined by 2 perspectives of others. First, identity is defined by who we love and feel are part of our group (family, religion, country, etc.) – THIS IS ME. Second, it’s defined by who we see as different from us and who we might fear or hate – THIS IS NOT ME, REALLY NOT ME. If our view of these not-me people changes, it may dramatically change the way we see ourselves. We see ourselves both from the standpoint of who we are and who we are not.

Let me give a simple hypothetical example. Let’s say I’m prejudiced toward Arab Muslims. I’d maybe see myself and Americans as generally good, Christian, responsible peace-loving people. I’d see Arab Muslims as, perhaps, bad, violent, untrustworthy infidels. But, what if my view of Arab Muslims changes into one that is more positive, nuanced and accurate? Then my view of myself and America may be less self-righteous and positive and I would need to confront more of the negative aspects (e.g., violence, untrustworthiness) in me and in the groups that I affiliate with. That can be very uncomfortable and a powerful force for holding onto prejudice. If my view of my enemy changes, my view of myself changes. (I’ll leave to the reader how this might apply to conflicts between Republicans and Democrats in this election season.)

Here’s a real example. In an NPR interview in 2005, Eyad El-Sarraj, a psychiatrist and President of the Board of the Gaza Community Mental Health Programme, spoke about the effects of the Israeli withdrawal from Gaza on Palestinians. He noted that, while this was a very positive move, it created an identity crisis for them. Now Palestinians would have to shift away from defining themselves through their opposition to the Israeli occupation. The shift would need to be toward coping with the differences among themselves – “Who am I if I do not have my enemy?” Last summer we saw that, tragically, Palestinians in Gaza dealt with it in one way through the definition of enemy being other Palestinians – the Fatah/Hamas civil war.

RELIGIOUS IDENTITY AND PREJUDICE

For all of the enormous benefits of faith, religious identity can and often does lead to prejudice. Of course, this isn’t inevitable but I do think there is serious potential danger here. Consider only a few of the terms used for members of various faiths:

The Chosen People

The Eternal People

The Children of God

The Faithful

The Elect

The Believers

Christian Soldiers

Defenders of the Faith

Saints

So, if “we” are the chosen, who are “they”? Here’s what I worry about. Language structures our experience. When “we” refer to ourselves with such terms, it can unconsciously structure our experience of others as not only different from “us” but as not being as good as “us.” I think it can lead to a type of arrogance rather than to a sense of humility. If “we” are that list above, then what does that make “them”? Here are some possibilities:

The Chosen People — (The Not Chosen Ones)

The Eternal People — (The Mortal People)

The Children of God — (The Children of Who?)

The Faithful — (The Unfaithful)

The Elect — (The Rejected)

The Believers — (The Nonbelievers)

Christian Soldiers — (The Infidels, Pagans)

Defenders of the Faith — (Enemies of the Faith)

Saints — (Sinners)

At the extreme, this potential for seeing “us” as good and “them” as not good can transform into “them” as downright bad or evil and worthy of being cleansed, conquered or killed. Here we see how violence and war can be initiated in the name of God.

One of the most outstanding benefits of religious faith is that, in many ways, it can transform the unbearable into the bearable. Perhaps the most unbearable and terrifying experience of human existence is death and the knowledge of it: I will die, everyone I love will die, everyone dies. Religion can make death bearable through faith in God, in salvation, and in the afterlife. From that standpoint alone, the potential for faith to be used (I would say misused or perversely used) to do violence to others is great – the person who kills the enemy will be saved for eternity. In my previous posting, I gave 2 of the many possible quotes by religious leaders throughout history invoking killing of others that will lead to salvation in an afterlife. I’ll repeat them below:

“Now we hope that none of you will be slain but we wish you to know that the Kingdom of Heaven will be given as a reward to those who shall be killed in this war [against Muslims].” (Pope Leo IV, 9th century CE)

“The martyr [referring to suicide bombers], if he meets Allah, is forgiven his first drop of blood; he’s saved from the grave’s confines; he sees his seat in heaven; he’s saved from judgment day; he’s given seventy-two dark-eyed women; he’s an advocate for seventy members of his family.” (Sheikh Isma’il al-Adwan, 2001 CE)

This extreme of violence toward the different other has its beginning with our fear or intolerance of differences in others – our human predisposition to prejudice. It can be frighteningly catastrophic when the power of religion is attached to it.

IN CLOSING

I’d like to share 2 quotes that are very different from the previous 2. They speak of the struggle toward human connection and against divisiveness — even in the face of violence and trauma. Both are from Henri Parens, a psychoanalyst and Holocaust survivor, who has written extensively on aggression and prejudice. He was also a speaker at the IPI prejudice conference in Salt Lake City and is a co-editor of the book from that conference: The Future of Prejudice: Psychoanalysis and the Prevention of Prejudice (2007).

Parens described the experience of Rami Elhanan, an Israeli whose 14 year old daughter was killed in a suicide bombing in 2005 and whose initial reactions were rage and revenge.

“Then Elhanan met Yitzhak Frankenthal, whose own son had been kidnapped and killed by Hamas. Frankenthal, a founder of Parents Circle — an organization established in 1995 for the purpose of bringing together to meet and to talk Israeli and Palestinian parents who had lost a child to these reciprocal killings — talked Elhanan into attending one of their meetings. Elhanan was profoundly moved on hearing Palestinian mothers express the same grief and rage that he felt; his rage and wish for revenge turned into wanting to foster dialogue among bereft Palestinian and Israeli parents. While on both sides of the conflict there are some who think the Parents Circle is a crazy idea, others – seeing the dire state of life revenge has wrought, and is sure to continue doing, so long as it is the solution deemed most honorable and worthy – assert that we have to see each other as we are, not as we distort each other to be, and that we have to talk together in order to live together.”

Who is “us” and who is “them”?

Parens, wrote the following about the Holocaust and prejudice:

“We must not let it happen to us again.

We must not make it happen to others.

We must not be victims, and

We must not be perpetrators.

We must learn

To live together

With our difference.”

St. Catherine's Monastery, Foot of Mt. Sinai, Egypt (Under the protection of Muhammed who was granted asylum in the monastery from his enemies)

Ruins of Capernaum, Sea of Galilee, Israel

Faith and Prejudice, Part I

Posted on September 18, 2008January 18, 2019 by Melonie Bell

By Michael Stadter, Ph.D.

“Now we hope that none of you will be slain but we wish you to know that the Kingdom of Heaven will be given as a reward to those who shall be killed in this war [against Muslims].” (Pope Leo IV, 9th century CE)

“The martyr [referring to suicide bombers], if he meets Allah, is forgiven his first drop of blood; he’s saved from the grave’s confines; he sees his seat in heaven; he’s saved from judgment day; he’s given seventy-two dark-eyed women; he’s an advocate for seventy members of his family.” (Sheikh Isma’il al-Adwan, 2001 CE)

Astonishing statements aren’t they? Or, are they?

I had an opportunity this past summer to take a remarkable trip to the Middle East in the company of a group of Christian seminarians. It was a 3 week seminar led by a university professor to expose the seminarians to the “Holy Lands,” and to the cultures and religions of the region. We traveled through Syria, Jordan, Egypt, Israel, the West Bank and Greece. The trip was remarkable both at the level of the countries and peoples that I met but also at the level of the intensive 3 week contact with devout future ministers of diverse Christian faiths. The experience also brought me to a more personal exploration of prejudice, a topic that was examined at an IPI conference in Salt Lake City and became the subject of a book, The Future of Prejudice: Psychoanalysis and the Prevention of Prejudice (2007). In this blog, I will present my personal reflections and raise some questions that I hope our on-line community will discuss.

In the interests of fair disclosure, my reflections are influenced by my own spiritual orientation. I was raised Catholic, but haven’t been part of organized religion since my 20s.

FAITH

My fellow travelers’ faith in Jesus Christ was a powerful part of the experience. There are considerable differences among them over whether Jesus was A WAY or THE WAY or THE ONLY WAY. I found the depth and diversity of their faith to be very moving. Faith is central to their lives and to their loving

There were many instances of faith and devotion among other people and other faiths as well. In Damascus we saw numerous Shiite pilgrims. Many had made great sacrifices to come from Iran to the Umayyad Mosque to pray and to affirm their faith. This was especially affecting in the mosque’s shrine to the martyr, Hussein. We also saw the devotion of Muslims in their 5 calls to prayer each day.

omayyadmosquesmall — Omayyad Mosque in Damascus, Syria

wailingwallsmall — Wailing Wall in Jerusalem, Israel

muslimminaretsmall — Muslim Minaret and Christian Steeple in Bethlehem, West Bank

Yet, despite all of the powerful indications of love, faith and piety, the Middle East is such a blood-soaked land: fought over for thousands of years, continuing into today and, certainly, into tomorrow. Much of the violence has been in the name of religion – in the name of faith and love. We can argue that religion has been hijacked in the service of base motivations or that extremists have perverted the Word of God, but the evidence is clear that religion has been a force here (and elsewhere) that supports violence.

Witness the many instances in the world of this disturbing fact: Christian vs. Muslim, Christian vs. Jew, Catholic vs. Protestant, Sunni vs. Shiite, Jew vs. Muslim, Hindu vs. Muslim – to cite a partial list. And, of course we’re all too familiar with the terms Holy War and Jihad.

To put it succinctly, I left the trip being confronted with religion as embodying some of the absolute best and absolute worst of being human. It is a force that brings us together, connects us with the oneness of humanity and helps us care for one another. Also, religion is a force that divides us and promotes prejudice and violence.

PREJUDICE: 4 SIMPLE PRINCIPLES

1. PREJUDICE IN ITS MOST BASIC FORM IS PRE-JUDGMENT. This is a problem if we confidently keep that judgment in the face of our own ignorance or in the face of conflicting evidence. Carlo Strenger, an Israeli psychoanalyst writes, “prejudice is the maintenance of beliefs about an individual or a group without taking into account available evidence.” A prejudiced person is, as the saying goes, “Frequently wrong but never in doubt.”

2. I’M PREJUDICED, YOU’RE PREJUDICED, EVERYONE IS. Usually, when prejudice is discussed it’s easy for people to passionately agree that other people are prejudiced and “isn’t that just awful?” Then nothing much happens, except we can unite around our prejudice against those bad prejudiced OTHER people! But, if we look at the uncomfortable fact of prejudice in ourselves then that permits us to do something about it. We have a chance to accept the common humanity we share with other prejudiced people and to be open to the possibility of some transformation.

3. WE’RE ALL PREJUDICED BECAUSE IT COMES WITH BEING HUMAN. In normal development, at about 8 months, babies develop Stranger Anxiety. At this age, the infant perceives people outside of the family as DIFFERENT and becomes afraid of them. This is adaptive for a variety of reasons (e.g., emotionally knowing who the safe caregiver is vs. the relatively unsafe non-caregiver) but it also is the precursor of fear of difference. Consider that humans are predisposed to fear differences in others or, put another way, to fear others who are different from us. Also, I would suggest that we OFTEN HATE THOSE WE FEAR.

4. WE’RE ALSO FREQUENTLY PREJUDICED BECAUSE WE’RE TAUGHT TO BE by our parents, teachers and other people we respect (perhaps as a way that they unconsciously manage fear and difference). For example, I was surprised to learn from more than one seminarian that they were taught that Catholics aren’t Christian. Given the obvious denial of history this belief suggests, this is clearly a prejudice. The teaching of prejudice doesn’t have to be very explicit, either. It can be subtle and covert.

Simple prejudice can develop into malignant prejudice –malicious, humiliating violent, and discriminating behavior — through a variety of factors including overwhelming fear, hatred, emotional trauma and neglectful, abusive or otherwise inadequate parenting.

QUESTIONS

In a subsequent blog, I’ll write about issues of personal identity and the phenomenon of “them vs. us”. I invite you to discuss the following as well as whatever else was stimulated by this blog:

How does your religious/spiritual orientation inform your work as a psychotherapist?

What do you see as the relationship between religion and psychotherapy?

What do you see as the best and worst of religion?

What do you see as the connections between prejudice and faith?

What are your own experiences?

Panic Focused Psychotherapy Study

Posted on February 16, 2008 by Melonie Bell

By David E. Scharff, M.D.

Among the sessions I attended at the Winter Meetings of the American Psychoanalytic Association, one stood out on the findings of a randomized control trial of a new and manualized psychoanalytic treatment for panic disorder, overseen by its principal researcher, Barbara Milrod of Cornell Medical Center in New York City. The presentation was chaired by Stuart Hauser, a leading analytic researcher, and discussed by Peter Fonagy.

I’m writing about it here because it is a hopeful and beautifully done addition to our armamentarium concerning the efficacy of psychoanalytic therapy. It adds to studies being done by Fonagy, Target and their group in London on Mentalization-Based Therapy, and by Otto Kernberg’s group at Cornell, White Plains on Transference Focused Psychotherapy. The studies apparently have a good deal of overlap in their systematic use of transference and basic analytic techniques applied to a brief therapy that is therefore much easier to test for outcome.

In this study, Dr. Milrod and her colleagues treated Panic Disorder – including such symptoms of acute anxiety as intense fear, chest pain, heart palpitations, and shortness of breath — precisely because Panic Disorder has been a focus of CBT and medication outcome studies. Since these studies have been based on 12 weeks of treatment, she designed her Panic Focused Psychotherapy (PFP) study to conform to these parameters so they can be compared. PFP treatment is manualized in a manner similar to Kernberg’s Transference Focused Psychotherapy (TFP), but this is much briefer — 12 weeks of twice-weekly weekly as opposed to a year of therapy for TFP.

(Patients were left on medication if they were already on it at the time they began the study, so that is not in the comparison. Obviously, if they were on medication at the beginning of the study, it was not in itself curing the panic disorder because symptoms of panic attacks had to be present for a subject to qualify for the study.)

Panic Focused Psychotherapy begins with initial evaluation of the symptoms, relating them to the surrounding circumstances and attendant feelings, exploration of the personal meaning of symptoms and episodes. Then the therapist works to identify relevant psychodynamic conflict, focusing commonly on issues of separation, autonomy, and anger. In the first phase, therapy aims for panic relief and reduced agoraphobia.

The second phase of PFP explores panic vulnerability by addressing transference manifestations, and working through the many situations of conflict. In this phase, therapy hopes to result in improved relationships, less conflict and anxiety in the experience of anger, separation and sexuality, and reduced recurrence of panic. Finally, a termination phase permits re-experience of conflict around separation and anger themes in the transference, because a frequent temporary recrudescence of symptoms during termination allows for a review of problems that can again lead to an enhanced ability to manage separation and experience autonomy.

In a paper published in February of 2007 in the American Journal of Psychiatry (164:2 pp 265-272) Dr. Milrod and her colleagues reported on the preliminary study that showed 73% efficacy compared to 39% for Relaxation Therapy. This study prepared the research for later comparison to medication and CBT. But at the presentation in January, Dr. Milrod presented preliminary data on the comparisons going forward with CBT. So far and unofficially, PFP holds up well against CBT and especially shows a better capacity to maintain gains months after the completion of treatment. Although the treatment is “manualized” it is not a rote treatment. The manual offers a guide as to what issues to focus on in evolving phases of therapy. There are compromises with the way we practice analytic therapy that are required to construct such a manualized treatment, but anyone who has read Michael Stadter’s excellent book “Object Relations Brief Therapy” (Jason Aronson, 1996) will recognize the enormous overlap in methodology. Stadter’s model is one of a combined focus on the symptom and the dynamic unconscious structure that underlies it, all treated in the transference using working through and a late focus on termination and loss. Brief analytic treatments can be tested, while it is exponentially more difficult to do so with open-ended, long term therapy. These studies, done in ways that can be compared directly to CBT and medication, offer to give us the ammunition to defend our trade in clear and legitimate ways that have, until recently, been sorely lacking. Peter Fonagy spoke with deep appreciation of Barbara Milrod’s study, particularly noting how arduous and time consuming such studies are, and how thoroughly and rigorously she and her colleagues were in the conduct of this study.

Webb MD’s Denise Mann reported on January 17 that, “The psychodynamic psychotherapy regimen used in the study was so successful that the American Psychiatric Association is in the process of changing its guidelines to reflect the new findings, according to researcher Barbara Milrod.”(Until now the APA has only endorsed CBT and medication as treatments for Panic Disorder.)

This research and the few comparable studies now going on are a cause for hope for our way of thinking and practicing. I look forward to more results from Dr. Milrod and her colleagues.

From Klein Forward

Posted on August 6, 2007 by Melonie Bell

By David E. Scharff, M.D.

Psychoanalysis is in a state of evolution. It is almost as though if we don’t keep up with the advances in neuroscience, attachment theory or latest research on the validation of psychotherapy, we can’t do our daily work. But at the same time that there is such an explosion of research, one of the most important findings is precisely the validation of our work, of the basic kind of work that analysts and analytic therapists have been carrying on for the last hundred years. I believe that this hearkens back to Fairbairn’s thesis that the foundation of analytic potential lies in the therapeutic relationship itself, because without that, none of the other things that promote change have any effect. We can include in those elements of therapy that support growth the genetic reconstruction of early developmental experience, transference interpretation, the use of countertransference as a “global positioning system,” the patient’s acceptance of her own projective identifications, the understanding of the co-construction of emotional experience in therapy, and the support therapy offers for deficits in early experience. All of these are important. They are all building blocks for change. Even the offering of support and advice, long relegated to the mere ranks of supportive psychotherapy, can offer something to patients attempting analytic work, given at the right times and in the right dose. But fundamental to the whole system is that the therapist offers herself as a person – even though she is a person in a role – who is dedicated in that role to the growth of her client or patient. She is in the growth and development business in a very personal way, even when she is being most professional.

Today I want to go back to another element of our roots, to the work of Melanie Klein, whose work was for many years disparaged in the United States, only to be widely embraced in the last 30 years. Jim Grotstein, Jay Greenberg and Steve Mitchell, Otto Kernberg, Roy Schaefer and many others brought these ideas across the Atlantic. Jill Scharff and I followed Henry Dicks of London in applying her ideas to couple and family therapy, combining her discovery of projective identification with Fairbairn’s idea of a psyche made up of multiple self-object units, and since then have written extensively about projective and introjective identification in all aspects of development, pathology and treatment.

Today, I want to re-evaluate her contribution in the modern context. First her emphasis on early development. Klein posited an infant and young child whose mind was formed in bodily terms, and especially in terms of sexual conflict. She envisioned a child focused at first on her mother’s breast as good or bad, and soon seeing her parents locked in intercourse of an oral sort, the mother capturing the father’s over-valued penis. It was the dramatically worded body language that drew much attention, but the controversial parts also included the early dating of triangular conflicts – the early oral Oedipus – to times within the first year. So what do we think now of these controversial elements?

I think she was undoubtedly right that the young child, within the first year, does have an experience of the parents as a couple, and begins to “think” of herself in relationship to them as a pair. But are things so sexual? Probably not. Is the thinking in terms of bodies? Probably. The infant is very much body-based, and modes of thinking do echo the signals coming from inside her own body, and from its handling by the parents. But I think that Klein was analyzing children who were almost three years old – young by the standards then of course, but old enough that these children had already been sexualized from hormonal and cognitive development. Then she read the material from these relatively advanced children backwards into their infancy, and made an error of inference. So is early thinking triangular? Yes. Is it intensely sexual? Probably not. But early thinking does influence sexual thinking as it blossoms in the third and fourth years, and the sexual versions the child creates do reflect triangular thinking, which is sexualized from that point on.

Klein posited two modes of thinking that organize life from the earliest months: the Paranoid/Schizoid and Depressive Positions. In the first, the paranoid/schizoid, life is divided into good and bad, black and white, as absolutes. There isn’t much grey, and the object world is handled by the tendency to guard things inside or project them in paranoid or projecting mode into the outside. Persecuting inner objects are felt to offer persecution from the outside because of the child’s use of projection. It was in writing about this mode that Klein first understood projective identification – the mode of thinking in which the child (and actually all of us) locate parts of our own psychic processes in another person with whom we have established intimate emotional relations. Klein originally thought this process allowed the child to off-load an excess of aggression, to make his own inner world less toxic, but we now see it as an all-purpose mechanism of unconscious communication, in which each of us seeks to unconsciously communicate our emotions, fears, wishes, fantasies and inner organizations of self and object to the other person by finding unconscious resonance with her mind.

To this we have added an equal emphasis on introjective identification: that the mother or spouse takes in the unconscious communication, identifies with it, subjects it to her own processing (all still unconsciously) and feeds it back in a continuous cycle of mutual projective and introjective identification. I said a moment ago that Henry Dicks understood this to be the basis of marital intimacy and formulated it as the forerunner of a general theory of interpersonal communication. So did Wilfred Bion, who took this another step forward to make the continuous cycle of projective and introjective identification the basis for the origin of the infant’s mind. Mind is, we can now see, the product of continuous unconscious communication (mainly about affects and their regulation) between child and parent. Conscious communication, we now understand due to the neuroscience writing of Alan Schore and others, comes much later.

So here’s where the neuroscience comes in. In the last 20 years, Gallese and others have described the presence in the motor cortex of the brain of “mirror neurons” that mimic an observed action right next to the motor neurons that we fire if we actually perform an action. Now, since all emotions involve some sort of motor discharge (muscles, hormones, the autonomic nervous system,) this gives the mirror neurons a central role in the communication of emotion. The purpose of these mirror neurons, to paraphrase Gallese, is to instantiate a shared manifold of subjectivity – that is, the other person’s emotional experience is installed deep within our own mind in a way comparable to the way our own emotional experience is represented there. In short, Klein’s “wild ideas” about the communication of emotion have been fully upheld by modern neuroscience – and can now be seen to be the fundamental basis of the growth of mind.

When Klein posited her second fundamental state of mind, the Depressive Position, she wrote that it was the basis for a more integrated view of the other person. It includes the capacity for concern for the other, the ability to feel that the mother who has mistreated you is also the one who loves you, and a potential for guilt. It is a more mature position, but not a better one. We all need both. In the paranoid/schizoid position (aren’t the terms terrible?) we can sort things, divide, parse things, see qualities that contrast. In the depressive position, we can integrate and join affect with that more integrated view, we can work on healing rifts. Later Thomas Ogden added another position, which he thinks (and I think) comes before the paranoid/schizoid. He calls it the autistic/contiguous position, maintaining the penchant for obscure terms. But what he means by this is crucial: that the infant, and all of us throughout life, worry about the cohesion of our self, and we manage this psychically by pulling away from our objects into ourselves at times (the autistic pole,) and at other times by leaning against the edges of other people (the contiguous pole) and that we all move back and forth along this continuum. I do believe that self cohesion is a life long worry, and that it is at least equally fundamental to the other positions of mind. Ogden makes the convincing argument that all three positions exist all the time – all three groups of mental concerns exist all the time, but that at any one moment, one of them may be dominant and seen to be the principal organizing mode of someone’s psyche. This complex formulation fits with the most modern ideas of the organization of mind as a set of complex functions widely distributed throughout the brain and the mind, with the highest and most abstract functions overseen by executive function in the prefrontal lobes. The writing of Herbert Rosenfeld on pathological positions, and the subsequent work of John Steiner on what he called psychic retreats, both give us language for the perversion of these modes of thinking that represent a short circuiting of the normal fluidity between the three developmental positions in mental states of severe pathology.

There is much more of our work that derives from Melanie Klein’s ideas, all formulated from the 1920s through the 1950s: Her work on envy and gratitude that came late in her life, and her invention of ways of working with the psychological life of young children that was among her first contributions. But I think we have covered enough for one posting.

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