Psychoanalysis On and Off the Couch Harvey Schwartz MD

“My interest is to rather than continue with the psychoanalytic tilt which has tended to try to find the words - to find the areas of the analyst that has words to engage with these states and then help the patient transform these states into something thinkable and communicable. [In contrast] my interest has been to take the patient where they are; it’s kind of a radical way of saying ‘meeting the patient where they are’, and find our way and lend ourselves to engaging with them in their own idiom, using Bollas’s term, in their own way of being and to find ways to be with them that don’t necessarily rely on talking about things and making things known.”
 
Episode Description: We begin by considering patient's non-represented mental states and their manifestation in somatic and motoric registers. Robert describes his understanding and approach to clinically engage those who "barely experience continuity of the self or subjectivity in themselves or others." He recommends 'companioning' with them. This entails not trying to "move the patient out of these regressed areas into greater relatedness ...but to welcome these other dimensions and their full expression within the analytic space." We consider the role of enactive engagements, the non-verbal vs the pre-verbal and 'radical neutrality'. He presents a case where the patient and analyst shared music, food and not discussed emotional intimacy between them that he felt was vital to enable the patient to emerge as a 'real person'. We close with speaking of Robert's professional history of working early on with psychotic individuals and finding that his approach enabled them, often to their surprise, to feel heard. He also describes his attunement to the experience of being an 'other' that emerged from his growing up as an 'other' - a Jew in London.  
 
 
Our Guest: 
Robert Grossmark, Ph.D., ABPP, is a psychoanalyst in New York City. He works with individuals, groups, and couples. He is on the teaching and supervising faculty at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis, The National Institute for the Psychotherapies Program in Adult Psychoanalysis, The National Training Program in Psychoanalysis, National Faculty Member, the Florida Psychoanalytic Center and lectures at other psychoanalytic institutes and clinical psychology training programs nationally and internationally. He is an Associate Editor for Psychoanalytic Dialogues. He is the author of The Unobtrusive Relational Analyst: Explorations in Psychoanalytic Companioning and co-edited The One and the Many: Relational Approaches to Group Psychotherapy and Heterosexual Masculinities: Contemporary Perspectives from Psychoanalytic Gender Theory. 
 
 
Recommended Readings:
Grossmark, R. (2024) The Untelling, Psychoanalytic Dialogues. In press.
 
Grossmark, R. (2019) The anguish of fatherhood, Psychoanalytic Perspectives,  16 (3), 316-325.
Grossmark, R. (2023) A child is being murdered: A contemporary psychoanalytic treatment of a compulsion to child pornography, Psychoanalytic Psychology, 40: 25-30
 
Bach, S. (2011) Chimeras: Immunity, interpenetration and t he true self. Psychoanalytic Review, 98(1): 39-56
 
Winnicott, D. W. (1974). Fear of breakdown. International Review of Psycho-Analysis, 1(1-2), 103–107.
 
Bollas, C. (2011) Character and interformality. In C. Bollas, The Christopher Bollas Reader (p. 238-248)
 
Ogden, T.O. (2017) Dreaming the analytic session: A clinical essay. Psychoanalytic Quarterly, 86: 1-20.
 
Stern, D.B. (2022) On coming into possession of oneself: Witnessing and the formulation of experience. Psychoanalytic Quarterly, 91: 639-667
 
Symington, N. (2012) The Essence of psychoanalysis as opposed to what is secondary. Psychoanalytic Dialogues. 22, 4, 395-409

"The first line treatment for adolescents with anorexia now is family-based therapy typically, which involves helping the parents facilitate the refeeding of the adolescent. So, I was working with the patient in that way and found it to be helpful and useful, but was consistently struck by the neglect of the patient’s inner life, and found, at least based on my experience with many patients, that while you could get some symptomatic relief, if you didn't, in some way, address the deeper dynamics, the aspects of the patient's personality organization that drove the disorder, that were implicated at the disorder, there was a way that the patient would snap back to their old behaviors over time, that deeper change and a deeper understanding of what was going on was really necessary; and so that's been kind of evolution from my work over the past ten years from  my first book, which was about anorexia in males, and tried to present a kind of Integrative understanding of that phenomena, increasingly over time I've become more and more interested in the deeper kind of analytic thinking that we can bring to bear on this kind of suffering.” 
 
Episode Description: 
We begin with a description of the common contertransferential pull to intervene behaviorally in the face of repetitive self-destructive eating disorder symptoms. This intention can inform but not compel the clinical decision as to the indicated treatment of choice for someone at any particular moment. Behavioral and pharmacologic treatments can be important in softening the pressure of eating disorder symptoms. They do not, however, give an individual access to their interoceptive life, from which these disturbing self-preoccupations emerge. We discuss the challenges of working with those who have limited capacities for mentalisation and as a result, live out their inner lives somatically and motorically. Immersive treatment leads the clinician to experience these proto-affects in one's own body and in one's own ruminations. Tom discusses alexithymia, typical family structures, and the presence of the 'abject' experience in the lives of these patients. He presents a disguised case of a patient who was able to work through both the early struggles and later neurotic aspects of these conflicts analytically. We close with his sharing with us his vision for the future which includes more integration between the dynamic and adynamic approaches to these challenging patients.
 
Our Guest: Tom Wooldridge, PsyD, is Chair in the Department of Psychology at Golden Gate University as well as a psychoanalyst and board-certified, licensed psychologist. His first book, Understanding Anorexia Nervosa in Males, was published in 2016. His second book, Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak, an edited volume in the Relational Perspectives Book Series, was published in 2018. His third book, Eating Disorders (New Introductions to Contemporary Psychoanalysis), was released in 2022.  His fourth book, co-edited with Burke, Michaels, and Muhr, is entitled Advancing Psychotherapy for the Next Generation: Rehumanizing Mental Health Policy and Practice. He has also written a novel about the process of psychotherapy, Ghosts of the Unremembered Past, additionally released as an audiobook. He is a Personal and Supervising Analyst at the Psychoanalytic Institute for Northern California and a Training Analyst at the San Francisco Center for Psychoanalysis. He is on the Scientific Advisory Council of the National Eating Disorders Association, Faculty at the Psychoanalytic Institute of Northern California (PINC), the Northern California Society for Psychoanalytic Psychology (NCSPP), the William Alanson White Institute’s Eating Disorders, Compulsions, and Addictions program, and the San Francisco Center for Psychoanalysis, and has a private practice in Berkeley, CA.
 
 
Recommended Readings:
 
Williams, G. (1997). Reflections On Some Dyn

"The ability to play means we can indulge in a kind of illusion, not delusion, and make a distinction. It always amazes me that when the patient arrives, they like the routine of an analysis; nobody breaks that, it's an illusion; it is a piece of theater every time. We open the door to our patients and they lie on the couch, and yet there is something enormously gratifying as the patient works out their sense of  reality from that illusory field. I think it is exactly what the mother is able to bring to the infant - this capacity to play and this capacity to continue to evolve beyond the analysis as an internalization of that experience of being listened to and being with someone. The details of that is related to an intrapsychic surviving and non- surviving object in the analyst  who continues to think and feel and be with the patient in the consulting room.”
 
Episode Description: Joel begins his conversation with Jan around Winnicott's conceptualization of aggression in development and in the analytic encounter. She noted that he had a very sophisticated developmental theory of aggression which culminated with the role that the destruction of the object plays in constituting reality. Jan explains that she has elaborated Winnicott’s late theory of aggression with her notion of the ‘surviving object'. She distinguishes the 'surviving object' from the 'good object', especially as it stands apart from a moralizing position. She considers its internalization as an essential condition for healthy development. They discussed the role that insight continued to play for Winnicott after he emphasized the importance of the patient’s experience in the analytic process. They also consider the ‘fear of woman’ as a root of misogyny. After discussing the uniqueness of the analytic setting to facilitate play, fantasy, and “magic which is not psychosis,” Jan concludes by emphasizing the importance of in-person treatment in order to have an in vivo experience of the non-retaliatory analyst.
 
Linked Episode:
Episode 144: Why Winnicott? Joel Whitebook, PhD
 
Our Interviewer and Guest:
Joel Whitebook, PhD is a philosopher and psychoanalyst. He is on the Faculty of the Columbia University Center for Psychoanalytic Training and Research and was the founding Director of the University’s Psychoanalytic Studies Program. In addition to many articles on psychoanalysis, philosophy, and critical theory, Dr. Whitebook is also the author of Perversion and Utopia (MIT) and Freud: An Intellectual Biography (Cambridge).
Jan Abram, PhD is a training and supervising analyst of the British Psychoanalytical Society and in private practice in London. She is a Visiting Professor of the Psychoanalysis Unit at University College London and is currently Vice President of the European Psychoanalytic Federation for the Annual Conferences. She is President-Elect for the EPF to start her term in March 2024. She is a Visiting Lecturer and supervisor at the Tavistock Clinic in London. In 2016, she was a Visiting Professor at the University of Kyoto, Japan, where she resided for a writing sabbatical. Jan Abram has published several books and articles notably The Language of Winnicott, Donald Winnicott Today (2013), The Clinical Paradigms of Melanie Klein and Donald Winnicott: Comparisons and Dialogues (co-authored with R.D. Hinshelwood 2018); The Surviving Object: psychoanalytic clinical essays on psychic survival-of-the-object (2022) and her second book with R.D. Hinshelwood: The Clinical Paradigms of Donald Winnicott and Wilfred Bion: Comparisons and Dialogues (2023).
 
 
Recommended Readings:
ben
Abram, J. (2022) The Surviving Object: Psychoanalytic Clinical Essays on Psychic survival-of-the-object New Library of Psychoanalysis Routledge
 
Abram, J. (2023) Holding and Containing: on the specificity of Winnicott's object relations theory Holding und Containing: Zur spezifischen Natur der Objektbeziehungen bei Winnicott. P

“I was speaking to the tendency of the popular media to perceive narratives of Indian women's sexuality via the lens of oppression. Now, of course, sexual violence against women is an important concern in India, as it is worldwide. But telling the story of violence against women misses the story of how women desire, which is what I wanted to highlight. What struck me from reading the responses from these psychoanalytic interviews that I did was just how much women adapted their Eros to their circumstances. Particularly the older women that were interviewed, those who were older than 35, didn’t feel very oppressed, even as they narrated experiences and circumstances that sounded oppressive to me. Of course, if these were patients instead of the psychoanalytic interviewees that they were, one might wait for a kind of realization of oppression, but I wanted to see how psychoanalysis could be useful in mapping how Eros leaks within a framework where oppression is internalized, as it was for many of my interviewees. What I found very interesting was some of the imaginative ways that women found to satisfy their sexual desires while still maintaining community belonging. Viewed from the outside, this can look like oppressive forms of hypocrisy or enactments. But within the frame of these women's lives, it seems like they had found some creative ways of making Eros central and also of having Eros and breathing it at the same time in order to move forward." 
 
 
Episode Description: Amrita focuses our attention on the presence of women's active sexual desire which often gets obscured by society's tendency to see women as simply victims of violence and oppression. In her book, Women's Sexuality and Modern India - In a Rapture of Distress, she shares with us the results of in-depth interviews as well as latent clinical data from educated and financially comfortable Indian women. We discuss the erotic aspects of modesty; the differences between Indian and International feminisms; the role of the protective parent to foster girlish excitement, i.e. to offer a helping hand to their daughter; and the importance of the involved father to enable an identification for comfortable aggression. We close with a description of an unusual culturally imbued sexual practice that invites Amrita's deep attunement to multiple levels of meaning.
 
Our Guest: Amrita Narayanan, PsyD, is a Clinical Psychologist and Psychoanalyst and the author of Women's Sexuality and Modern India: In a Rapture of Distress. She has a longstanding interest in how a civilization's culture shapes its sexuality and its psychoanalysis.  She is an essayist in The Parrots of Desire: 3000 Years of Erotica in India and in Pha(bu)llus: a cultural history of the Phallus. She also writes a monthly column, Sexual Politics, for a newspaper, The Deccan Herald, Bengaluru. Aside from her clinical practice, Amrita is a Visiting Professor of English at Ashoka University, New Delhi, where she teaches psychoanalysis at the undergraduate and Masters level.     
 
Recommended Readings:
Narayanan, A. (2023) Women's Sexuality and Modern India: In a Rapture of Distress (Oxford University Press, 2023)
 
Kakar, S. (1990) Intimate Relations: Exploring Indian Sexuality. Penguin Books: New Delhi.
 
Menon, M. (2019). Infinite Variety: A History of Desire in India. Speaking Tiger Books: New Delhi.
 
Narayanan, A and Kakar, S. (2023) The Capacious Freud In Busch, F and Delgado, N. The Ego and Id: 100 Years Later. Contemporary Freud, Turning Points and Critical Issues Series. Routledge: UK. 
 
Narayanan, A. (2018). When the Enthralled Mother Dreams: a clinical and cultural composition. IN Kumar, M. Mishra, A., and Dhar, A. (Eds). Psychoanalysis in the Indian Terroir: Emerging Themes in Culture, Family and Childhood. Lexington Books: USA.
 
Narayanan. A. (2013). Ambivalent Subjects: Psychoanalysis, Women’s Sexuality in India and the writings of Sudhir Kakar. Psyc

"The genetic asymmetry [with sperm donorship] will create issues and complications -  it puts a strain on the relationship, i.e. who is excluded; who has more rights to this product? In other words, if the sperm donor is from a stranger,  the father feels ‘am I really adequately or sufficiently related that I could claim fatherhood’?”
 
Episode Description: We begin by acknowledging the erroneous assumption that  unconscious conflicts over becoming a parent are etiologic for what had been called 'psychogenic infertility.' Correlation is not causality. We review the widespread use of assisted reproductive technologies, with up to 750,000 babies born per year through these methods. Mali presents a composite case of a 48-year-old woman who went through many arduous IVF cycles before appreciating the degree of omnipotence and denial that characterized her approach to this problem, as it had toward many other issues in her life. She shares with us the common experience of infertility representing a sense of defectiveness and guilt. We consider the many challenges of sperm and egg donorship, including who one chooses as a donor as well as when one should tell children of their biological origins. We close with Mali sharing with us her recommendations to rejuvenate the field of child analysis.
 
Our Guest:
Mali Mann, M.D, is a Training and Supervising psychoanalyst and Child Supervisor at the San Francisco Center for Psychoanalysis. She is a clinical professor Adjunct at Stanford University School of Medicine, Department of Psychiatry and Behavioral Science.  Some of her published papers include, "Immigrant Parents and their Emigrant Adolescents: The Tension of Inner and Outer Worlds;" "Shame Veiled and Unveiled," "Aggression in Children: Origins, Manifestation, and Management through Play," Adolescent Psychoanalysis book chapter. "The Formation and Development of Ethnic Identity." Her edited book, Psychoanalytic Aspects of Assisted Reproductive Technology, won three awards: 1) Pinnacle Book Award, 2) International Book Awards in Family and "Parenting and Family" category in 2016, 3) Finalist for Book Vana Award in 2016. She has published two books of poetry: Whisper, Forget Me Not, and A Path with No Name. Her latest book, My Pony, Keran, is a semi-autobiographical children's book. She has been a member of Flying Doctors for nearly three decades (Los Medicos Voladores). She and her late husband, Dr. William James Stover, traveled to the Orphanages in  South America and Mexico to offer medical help to children and their families. In her spare time, she paints abstract expressionism and figurative; her art has been exhibited in US galleries and won several awards. 
 
 
Recommended Readings:
Allison. G. H. (1997). Motherhood, motherliness, and psychogenic infertility. Psychoanalytic Quarterly, 66: 1-17
 
Ludden, J. (2011) A. F. (1961). A new openness for donor kids about their biology. NPR:
Making Babies: 21st Century Families.(17 September).
 
Bibring, G. L.’ Dwyer, T. F., Huntington, D.S., & Valenstein, A. F. (1961). A Study of Psychological Process in pregnancy and the earliest mother and child relationship. Psychoanalytic Study of the Child, 16: 9-72
 
Ehrensaft, D. (2008), When baby makes three or four or more, Psychanal. Study Child, 63:3-23.
 
Freud, S. (1914). Remembering, repeating, and working through. (Further recommendations on the technique of psycho-analysis II.) S.E., 12.
 
Inderbitzin, L. B & Levy, S. (1998). Repetition Compulsion revisited: Implication for Technique, Psychoanalytic Quarterly. 67:32-53
 
Lester, E. P. & Notman, M. (1986). Pregnancy, developmental crisis, and object relations: Psychoanalytic considerations. Int. J. Psychoanal., 62: 357-366
 
Notman, M. & Lester, E. P. (1988). Pregnancy: theoretical considerations. Psychoanl. Inq., 8: 139-160
 
Pines, D. (1982). Relevance of early development to pregnancy and abortion. Int. J. Psychoanal., 61:

"As I elaborate in the book, there was no physical contact or romantic engagement. The reason why I chose the ‘lover’ as the [psychoanalytic] analogy is, in the real world outside of psychoanalytic practice, where else do you have an interpersonal encounter that is so intensely engaging, attentive, respectful, and caring? That would be in the first six weeks or six months of a romantic relationship. If we eliminate the romantic/sexual part and just stay with ‘wow, this other party is paying such attention to me’ -  reminds me of Lacan's idea that what we really seek in the other is their desire for us, which by the way, I don't completely agree with because I think it goes both ways - I would say that that is the analogy from the world of lovers that I would map onto psychoanalytic work at least on the part of the psychoanalyst - he or she ideally pays that kind of intense attention, care, respect and attunement, that you would find between lovers.”
 
Episode Description: We begin with discussing the various ways that we can shape our psychoanalytic frame to enable a deepening of the clinical encounter. This is in contrast to frames that have gone awry. In his book Lover - Exorcist - Critic Alan describes a composite patient where he became over-involved to the detriment of the work that was eventually repaired. We reference a problematic frame in his earlier training analysis that perhaps set the stage for this difficulty. He shares with us his concept that "by enlightening subjectivity, by raising consciousness, depth psychotherapy liberates." We discuss in some detail the forces in him, his patient, and their relationship that led him to greater enactments than were useful. He shares with us the challenges he faced in remedying his emotional imbalance with her and the intense rage it awakened in her, deriving from various periods in her life. We both emphasized the vital role of the consultant at such times. We close with Alan describing his co-founding and leadership in the Rose City Center - a low fee clinic providing dynamic psychotherapy to individuals who would never otherwise see the inside of an analyst's office.
 
Our Guest: Alan Michael Karbelnig, PhD is a psychoanalyst, writer, teacher, and forensic psychologist and practices in Pasadena, California. He is a supervising and training psychoanalyst at the New Center for Psychoanalysis in Los Angeles. He lectures nationally and internationally, including in China, India, Thailand, and Israel. He writes a weekly Substack newsletter titled Journeys to the Unconscious Mind. Alan has published 20 scholarly articles and five book chapters in addition to his book Lover, Exorcist, and Critic. He considers his 2004 founding of Rose City Center—a nonprofit clinic providing psychoanalytic psychotherapy for economically disadvantaged persons throughout California—his proudest professional accomplishment. 
 
Recommended Readings:
 
Bellow, H. (1962). Herzog. New York: Viking.
 
Bromberg, P. (1996). The multiplicity of self and the psychoanalytic relationship. Standing in the spaces: Essays on clinical process, trauma & dissociation. London: The Analytic Press.
 
Greenberg, J. and Mitchell, S. (1983) Object relations in psychoanalytic theory. Harvard University Press. Cambridge, MA.
 
Karbelnig, A. M. (2022). Chasing Infinity: Why clinical psychoanalysis’ future lies in pluralism. International Journal of Psychoanalysis, 103(1):5-25.
 
McEwan, I. (2019). Machines Like Me. New York: Anchor.
 
Strenger, C. (1989). The classic and romantic visions in psychoanalysis. International Journal of Psychoanalysis. 70:593-610