CORE Student Reflection on French Psychoanalysis

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

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

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

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

 

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

Analytic Student Reflection on French Psychoanalysis

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

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

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

 

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

IPI Program Graduates

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

cake

 

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

 

 

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Graduation Dinner

 

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Caroline Sehon (IIPT chair) Michelle Kwintner (graduate) and Janine Wanlass (IPI Director)
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Two Year Core Students preparing for their last weekend small group as a cohort (Henriette van Eck, Kelly Seim, Steven McCowin, Christie Dietz)
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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.
Core graduates present their group leader with a blanket made of patchwork saris.

 

2015 Summer Institute in Rhodes, Greece

Jill Savege Scharff and Caroline Sehon

At the summer institute “Couple, Child and Family Therapy: Links from Theory to Clinical Practice” co-organized by the International Psychotherapy Institute (IPI) and the Department of Primary Education at the University of the Aegean, participants gathered from Greece, the United States, Canada, Israel, Australia, and South Africa to study together in Rhodes.

David Scharff and Anastasia Tsamparli
David Scharff and Anastasia Tsamparli

Led by David Scharff and Anastasia Tsamparli, the institute featured presentations by Greek and American child psychotherapists, couple and family therapists, and child analysts. David Scharff gave a theoretical and clinical introduction to object relations couple, child and family therapy to set the base on which the presenters built their talks. Janine Wanlass, Director of IPI, taught assessment of families and couples. Ionas Sapountzis, a Greek-American psychologist returning to his homeland, shared his Winnicottian approach to children with ADHD. Following her interest in field theory, Caroline Sehon gave a talk on decoding the links in families with psychosomatic difficulty. Jim Poulton of IPI-Salt Lake City gave a literature review of the concept of narcissism and illustrated its destructive effects in couple relationships. Greek colleague Dimitri Kyriazis elaborated on the destructive psychotic links in couple and families.

Jill Scharff outlined the history of the development of the concept of projective identification and why she has found it helpful in working with couples and families. Vali Maduro, Chair of the Couple, Child and Family program at IPI, took the concept of projective identification to the arena of the family where couples may project into their children. Norma Caruso addressed issues of sexuality and intimacy in couple therapy. In a related but very different presentation the summer institute host Anastasia Tsamparli spoke of the negotiation of sexual desire and the analytic third in couples. Dimitris Anassopoulos intrigued us with a highly complex paper on the analyst’s contribution to the intersubjective process.

We understood in discussions with our Greek colleagues that the economic situation is extremely uncertain. Many of them had lost patients that week and thought of canceling because of the crisis, but they came. As Americans we were buffered from the squeeze, since our credit cards backed by American banks were welcome whereas our colleagues’ could withdraw only 60 Euros a day or less. We were impressed by the Greeks’ willingness to confront the crisis and set it aside in order to learn.

Entertained by University of the Aegean
Entertained by University of the Aegean

In her opening speech of welcome, Anastasia said that although the crisis is humiliating, and everyone feels scared, we cannot succumb to feeling awful. We must keep on doing what we do, and keep thinking. Her clarity and strength of character was inspiring and set the tone for acknowledgement of the real crisis in the there-and-now and focus on the here-and-now of the learning process.

 

Participants new to IPI events were especially appreciative of the small group using the Group Affective Model (GAM) as a place to integrate professional cognitive apperception and personal emotional response to the material about couple, families and children.  As foreigners, the group leaders worked through group transferences that reflected the apprehension felt by Greece towards privileged nations to create a secure holding environment where these charged affects could be voiced, thought about, and understood as they relate to family dynamics and cultural context.

Photo by Caroline Sehon
Photo by Caroline Sehon
On the roof
On the roof

For example, having heard presented a vignette of a couple in which one partner unconsciously evoked in the other a sadistic response, the small group related these unconscious pulls to similar forces in the troubled marriage of Greece and Europe.

Despite the tremendous uncertainty, anxiety and terror at this crucial moment in history, there was an impressive turnout. The quiet space to think away from turbulent Athens brought relief and pleasure, but also led to guilt and conflict about family members left at home burdened by worries, such as whether they would lose their jobs, or how the political machinations would ultimately be resolved.

Nevertheless, Anastasia and her colleagues managed to give the visitors a wonderful Greek welcome, with informal dinners, a rooftop party courtesy of the University of the Aegean, trips to the sea, and Greek dancing which having watched a performance we were coaxed into getting on the cement floor of the balcony to participate in this Greek expression of emotion.

Greek dancers
Greek dancers

The IPI contingent returned to America grateful for all our opportunities at home, and impressed by the generous spirit of our Greek colleagues. We hope to see our Greek colleagues again soon, if not in person, then when they connect to IPI’s couple therapy videoconference training program.