Psychoanalysis On and Off the Couch Harvey Schwartz MD

"Psychoanalysis landed in Finland in the 50s; before the Second World War there were one or two persons familiar with psychoanalysis. In the 50s, psychoanalysis got a lot of interest in Finland but then there was no possibility of training in Finland. The pioneers went abroad, some to Sweden and some to Switzerland. They picked up the theoretical preferences in the new countries and new institutes - the IPA Associations mainly were from people studying in Sweden and coming back to Finland and creating the IPA association. The Therapeia Institute consisted mainly of people studying in Switzerland and got a lot of influence from existential psychoanalysis and Jungian psychoanalysis… I tend to side with Lee Grossman [link below]; I guess the theoretical theories reflect more the character - when you listen to a case presentation of course people present them differently depending on their theoretical background, but in the consulting room I am not sure there is that much difference." 
 
Episode Description: We begin with acknowledging the value of meeting and learning from analyst colleagues from around the world.  We discover both similarities and differences in both the challenges and pleasures of this work. In Finland there was a government-mandated change in the structure of training in psychotherapy and psychoanalysis starting in 2012.  The anticipatory anxieties were considerable. There was input from the university on issues of curricula, research opportunities, and improved pedagogy. The fears of loss of meaningful autonomy proved to be mostly fears - not realized. We also discuss the origins and current state of psychoanalysis in Finland. We close with a few words of the pervasive role of sauna in Finnish life and the ways it manifests in analyses.
 
Linked Episode:
Episode 135: Technique is Character Rationalized with Lee Grossman, MD (Oakland, Ca.) – IPA Off the Couch
 
Our Guest: Jan Johansson is a psychologist and a training and supervising analyst at the Therapeia Institute in Helsinki, Finland. Currently, he’s working as a psychoanalyst in private practice in Helsinki. In addition, he supervises psychotherapists and psychoanalysts. He has been interested in issues concerning psychoanalytic training for the last decade and a half. Currently he is the chair of the board of the Institute, while also being a member of board of the Therapeia Society. He also was a member of the Executive Committee of the International Federation of Psychoanalytic Societies 2014 - 2022. He is interested in promoting the multitude of psychoanalytic voices; while being trained within an object-relational frame, he doesn’t identify exclusively with any particular theoretical frame of reference.
He lives in Espoo, a neighbor city of Helsinki with his wife. After languishing in the darkness of the Finnish winter from October to mid-March, in the summer they enjoy the light and the white nights at their summer-house at the seaside, heating their sauna everyday and swimming in the Finnish Gulf.
 
Linked Episode: 
Episode 135: Technique is Character Rationalized with Lee Grossman, MD (Oakland, Ca.)
  
Recommended Readings:
Grossman, L. (2023): The psychoanalytic encounter and the misuse of theory. New York: Routledge.
 
Kernberg, O.F. (2016). Psychoanalytic education at the crossroads: Reformation, change and the future of psychoanalytic training. New York: Routledge
 
Reeder, J. (2004). Hate and love in psychoanalytic institutions: The dilemmas of a profession. New York: Other Press.
 
Tuckett, D. (2005). Does anything go? Towards a framework for the more transparent assessment of psychoanalytic competence. Int J Psychoanal. 86: 31–49.
 
Tuckett, D., Amati Mehler, J., Collins, S., Diercks, M., Flynn, D., Franck, C., Millar, C., Skale, E., Wagtmann, A-M. (2020): Psychoanalytic education in the Eitingon model and its controversies: A way forward. Int J Psychoanal. 101: 1106 – 1135.
 

“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: