Category: Psychodynamic Weekend

Howard Levine April 2024

Posted on by Melonie Bell

Friday April 12, 2024

Today, IPI is back in its weekend conference location at the Rockville Hilton to study The Unstructured Unconscious and the Repressed Unconscious: A Clinical Paradigm for the 21st Century with Howard Levine as IPI’s distinguished guest. We haven’t been here since the weekend conference with Anne Alvarez in February of 2020.  The place feels so familiar, even the carpets are the same.  Friends I haven’t seen in four years. Students I have met only on Zoom until now.  I am sitting in my usual seat at the back of the conference room with colleagues – faculty and students who haven’t seen one another except online alongside new onsite participants, and other old and new faces on a large screen from various states and countries. It is only the second hybrid conference IPI has designed, and we are all curious and eager to participate in the integratino of our onsite and online learning community.  It’s a work in progress, an experiment in sharing, sensitivity to the needs of others, and experiencing hybrid as an object of study.  “Everyone hates hybrid,” we’ve heard, but our goal at IPI is to develop expertise in creating an effective hybrid learning environment for communicating across cultures.

April 2024 Hybrid Conference

Now Howard Levine is talking.  “Where are we?” he asks.  This is the central question for the analytic dyad in the unique epistemological universe that is psychoanalysis.  Levine, who is highly conversant with the related elements of theories of Bion, Winnicott, Freud, and Klein, warns us that theories tend to be rather final, exhaustive, exclusive of other ideas, and limiting of growth in the individual psyche and in the field of psychoanalysis.  He allows that models highlight characteristic elements which can be useful for making comparisons between various clinical approaches.  However, he reminds us that assumptions made by theories and models for understanding neuroses  (in which the unconscious is structured by representation of repressed unpleasant experience and desires) cannot be made to apply in the psychoanalytic treatment of all cases.  In widening scope cases, the analyst is responding to fragmented or psychosomatically expressed states of mind that are unrepresented because they are non-ideational.   The task here is to reach a wordless experience in the unstructured unconscious.  Here Levine turns to French psychosomatics and the work of Andre Green.  Heady stuff.  Clearly Levine likes to know the boundaries and break free of them.   His parting shot to us before pausing for discussion — “Are you dislocated enough yet?”

Responding to the word ‘dislocated’, my mind returns to his opening question: “Where are we?” I ask why the sense of place is the central question above all others.  He replies that the whole trend in psychoanalysis has been towards knowing and getting it right.  So, now we need to valorize the space for not knowing, for instability, and for acknowledging that the unstructured unconscious is a force without meaning.  Putting it simply, he says, “There is no there yet.” And that is what we have to be able to resonate with.  As for a more complete exploration of my question, Levine responds: “We will have the whole weekend for that!”

And we will be pondering the questions raised for much longer than that.

Jill Scharff

How the Light Gets In: Contemporary Understanding and Treatment of Trauma

Posted on by Melonie Bell

 A lecture-discussion by Dominique Scarfone

 Today is Saturday April, 10, 2021, and I am at the IPI Saturday morning guest lecture by Dominic Scarfone. I am sitting here in my Zoom window along with clinician colleagues from thirteen countries (Austria, Canada, India, Iran, Japan, Macao, Mexico, Netherlands, New Zealand, Panama, Phillipines, Romania, and South Africa) and twenty-five US states. The IPI Director has explained the use of technology so that we know how to introduce our questions and comments into the large group discussion of the ideas presented to us in the lecture “Trauma, Subjectivity, Subjectality.” Dominique Scarfone, a Montreal psychoanalyst, professor, and author of The Unpast and Laplanche, is talking about these ideas developed from those of the French psychoanalyst Laplanche. Since most of us are more familiar with Anglophone psychoanalysis, we’re looking to Scarfone for his translation of the French way of thinking about the impact of trauma upon the infant’s developing body and mind and subjectivity. Later we’ll hear about subjectality.

Scarfone tells us that, when trauma is the focus, psychoanalysts tend to see it as an exceptional problem as if it calls for something other than the foundational method of psychoanalysis. This is not justified. In his view, trauma is a general part of the impact of the other on the self and falls along a continuum. To him, trauma is normally, inextricably entwined in psychic life, as the infant subject confronts the other, and in particular has to deal with the impact of the care-giving adult’s infantile unconscious sexuality.  The theories of attachment or mentalization do not take sufficient account of the enigma that the adult’s infantile unconscious sexuality poses for the infant mind.  When the infant mind cannot articulate what is going on but can only register it, the experience creates a primordial split between what can be held in mind and what cannot.  This is due to implantation of the traumatic sexual enigma stuck in the infant mind like a foreign body, an experience the infant has to decode or translate — an effort which will be only partially successful.   When the sexual enigma is accompanied by violent passion, the translation effort is compromised and impeded what Laplanche calls intromission, and Scarfone calls intrusion.  The balance between implantation and intromission, is determined by the context of relationship with the other.

The mother who provides sensitive care for her baby always shows some deviation from the provision of care into the realm of sexuality. Lest this sound too abstract, Scarfone gives us an example.  Imagine the parent at bath-time, pretending to be a monster coming to eat the child up.  The parent communicates intense oral desires, but this is play, the infant enjoys the pretense, and the cannibalism doesn’t happen.  The mother who puts the baby to the breast may have sexual feelings and responses from the nipple stimulation.  All this is in the realm of ordinary parenting behavior.  In Scarfone’s view, unlike Freud’s view of psychosexual development, the infant is not sexually endowed at birth.  (I would put more value on the infant’s active pleasure-seeking, sucking and caressing, but that is not Scarfone’s focus).  He redefines infantile sexuality as being evoked in a libidinal and inviting interaction with the other. The child registers the various forays from the other, and stores them for future understanding.

The human context that the various others caring for the child provide is unpredictable. Attempts at consistency and reliability are never perfect – which is a challenge for the infant, but has an upside, since surprise and novelty stimulate adaptation and growth of individuality.  Scarfone agrees that the infant and mother work together to create a symmetrical attachment relationship, but believes that, since the powerful adult is endowed with sexual desire and the infant is not, this part of the mother-infant relationship is asymmetrical.  When an adult’s caring for an infant is infused with the exertion of power and mastery, the child, who thereby is required to submit to the desires of the other, suffers a greater amount of trauma than usual from the encounter with the other. The trauma is compounded because the infant (and later the child in that situation) is in a helpless state of mind, unable to put words to events and symbolize what has happened.

The normal development of our subjectivity is subject to the history that came before us, our sexual drive, unconscious elements all around us, our suffering, and the estrangement we have experienced.   The subject should be the center of action. But when treated as a thing, the person loses the sense of subjectivity. The child may be diminished by the shame of her helplessness or may respond by imagining she is special in order to preserve her dignity and elevate her helpless masochistic surrender to a triumph. Traumatized people who were so objectified may join others with similar feelings to form a compact mass for support, but are then subjected to the common opinion, and find themselves again victims of abuse of their own making.  It is difficult for them to recover their subjectivity.  Now we find out the meaning of subjectality – the taking back of one’s subjectivity and having one’s own opinions, desires and choices.

We are fascinated by Scarfone’s way of thinking, puzzled, intrigued, struggling a bit, and inspired.  We listen; we compare and contrast the French ideas to those of Freud and Winnicott; and we debate with him directly.  The fabric of our thinking has been torn by our contact with the other.  In the ensuing small affective learning groups, the translation and integration continue letting the light in through the cracks.

Jill Scharff

 

 

On the Intersectionality of Racism and Sexism

Posted on by Melonie Bell

Jill Savege Scharff

 

I am sitting in my home office, in front of my Zoom screen, where I sit often these days.  But today is a special day.  I am attending an IPI virtual conference that is timely and of much importance to therapists and psychoanalysts.  The conference is called “Be Thoughtful and Act: Confronting Systemic Racism Inside and Outside our Minds” from October 9 – 11, 2020.  Kirkland Vaughans, Earl Hopper and Beverly Greene spoke yesterday about the disadvantaged education of Black children, the need to recognize the impact of the socio-political unconscious on self-perception and behavior, and the constant state of alert in which Black people live.  Now it is Saturday morning and I am listening to Dr. Greene again, and then to Dr. Wolfe, on the topic of the Intersectionality of Racism and Sexism. I want to share a few of their comments and personal reflections that meant the most to me.

Dr. Beverly Greene via Zoom

Dr. Beverly Greene, Professor of Psychology at St. John’s University, entered the screen and began with the history of feminism.  Architects of the women’s movement for equality were White women who were successful in getting the right to vote in 1920. But for Black women, suffrage was mainly theoretical until the Voting Act of 1965. In the second wave of feminism, the focus was on the woman’s right to work.  Dr. Greene pointed out that the pioneering White women ignored the history of Black women who had always been viewed as workers, regardless of their sex.  Some Black women have internalized racist sterotypes about themselves.  Many of them feel compelled to fit the image of the tireless, uncomplaining, subordinate worker who has to be strong, silent, and resilient.  In therapy, they may present with difficulty in claiming attention for themselves instead of always putting others’ needs first.  The late psychoanalyst Cheryl Thompson called this moral masochism.  But in human terms, what we see is that these Black women exhaust themselves from caring for others to the point of depletion, thinking that Black women are supposed to be strong and resilient, bringing in income and raising their children, constantly teaching them how to avoid trouble, and how to stay alive when extra-judicial lynchings, brutal brutality, and demoralization are rampant in insane society.

Dr. Greene told a story about herself and her mother. Dr. Greene grew up in Northern New Jersey of parents from the deep South at the time of American apartheid.  Like millions of other Black Americans, her parents became refugees from domestic terrorism and were part of the Great Northern migration of African Americans from the deep South into Northern and Midwestern cities. Beverly Greene and her family visited her mother’s home in Southern Georgia often.  On one trip, the train had a problem, and so they had to stop for repairs in Jacksonville, Florida.  At that time, the station was completely segregated from bathrooms to convenience stores, with signs saying “Niggers will not be served.  Whites only” right next to signs saying “Coke is 10 Cents.”  The 10-year-old Beverly was furious.  She said, “That sign says Coke is a dime and I have a dime, I’m going in there to buy a Coke.”  She got very loud, and her mom gently said, “If you go in there, those people will not serve us. You can’t go in there.”  Her mother agreed that it was not fair, but explained, “We can’t go in to those places, and don’t think of calling the police, because they will hurt us. We are not going to get hurt just to buy a Coke. For the sake of a coke it’s not worth it.”  Beverly knew she was trying to be disruptive.  Her childhood tantrum was not only that of a child who wanted a coke.  Her outrage was about inequity and even more about its acceptance.  She was most angry that everyone was walking around in that station as if it was perfectly normal.  Her mother understood and accepted that Beverly was angry and wanted to do something.  So, she told her child that it was alright to be angry, but taught her not to go up against a stacked deck.

Dr. Harriet Wolfe via Zoom

Dr. Harriet Wolfe, President-elect of the International Psychoanalytical Association, and former President of the American Psychoanalytic Association, came on to speaker view next.   She talked about her own history in order to model the importance of our looking at ourselves and recognizing racism and other forms of prejudice in ourselves before we can effectively guide others, whether socially or clinically. She described her youth as a child going to a private school and a women’s college. Her Whiteness did not strike her as a problem back then.  In those days, she was more aware of sexism as a problem for her.  Growing up in her family, the daughter had to be protected from behavior that her brother was allowed.  Moving from liberal arts education to medical studies, she experienced sexism when she lost the support of her father who did not approve of her choice of career, her politics, or her being outside his control.  As a medical student sexism was reflected in her having to take breaks in the nurses’ lounge not the doctors’ lounge. This meant she did not have access to informal medical teaching which male students gleaned from locker room conversations with their mentors.  Prior to starting medical school, she had worked with and become friendly with a childcare worker who was Black. She had trouble understanding why her friend never invited her to her home though it was possible for her friend to come to her home.  Dr. Wolfe realized that her colleague lived in a Black community where she could not welcome Dr. Wolfe.  It was a painful experience of racial boundaries. She continues to regret that race remained an unexplored problem between them. Her psychoanalytic training, where the teaching was still based on a one-person psychology with a focus on the internal structure of the patient’s mind, did not draw her attention to her Whiteness and what it meant.  Modern psychoanalysts now think of psychoanalysis occurring in a two-person field in which patient and therapist interact in a mutually influencing relationship.  They also think about transgenerational transmission of trauma and the influence of internal objects on behavior, perception of others, and relationships.  Thanks to psychoanalysis, Dr. Wolfe became able to understand her father’s point of view, stemming from his history, as well as the impact of a racist culture on her upbringing.  Now that the entire psychoanalytic community is dealing with the traumatic impact of systemic racism, Dr. Wolfe is viewing her Whiteness quite differently, as an inter-racial and political challenge to be contemplated in dialogue with diverse others.

 

Reflections of the IPI Weekend Conference by Dra. Iraira Butcher 

Posted on by Melonie Bell

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

 

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

But I was pleasantly mistaken.

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

But it has proven to be a difficult task.

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

But it goes both ways.

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

But it is painful.

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

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

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

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

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

Cheers to hope.

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

Some thoughts about the transition to an online weekend conference  

Posted on by Melonie Bell

Jill Savege Scharff

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

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

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

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

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

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

CORE Student Reflection on French Psychoanalysis

Posted on by Melonie Bell

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

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

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

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

 

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

Analytic Student Reflection on French Psychoanalysis

Posted on by Melonie Bell

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

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

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

 

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

Alain Gibeault speaking at IPI, Saturday November 7, 2019

Posted on by Melonie Bell

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

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

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

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

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

 

Submitted by Jill Scharff  Saturday November 9th

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

Posted on by Melonie Bell

Jill Savege Scharff, October 5, 2019.

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

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

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


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

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

 

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

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

The Contribution and Influence of Enrique Pichon Riviere

Posted on by Melonie Bell
Lea Setton and David Scharff

 

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

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

 

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

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

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