Interest in difficult-to-reach patients

"This came from an experience with a patient. It was early in my analytic training, and I was working with a supervisor who I really admired, and worked with her for a number of years. She was post-Kleinian, and was great at interpretation, formulation, and she was really helpful with just starting to guide me towards a lot of this work. I remember describing to her a patient session, and I was going through my process notes, and I said, 'I feel like the patient is inside of me. I feel like they want something that's in me, and I don't know what it is, and I can't quite access my own self, I don't know what to do'. It was through this initial experience where I really felt why analytic training versus other less intense training, we were also right at the time doing infant development, offered so much. It was early in my training and she suggested I think about an infant or even a toddler when they want something from their parents - they want something from their mother. The mother kind of feels this kind of gripping or this yearning from them, the baby wanting something. I started to think of my patients, not as infants or babies, but that what I was feeling was that there was something that the person I was working with needed, and they didn't have words yet to tell me what that was."

Episode Description: We begin by recognizing the unique journeys that lead clinicians to become psychoanalysts. Pam shares with us her initial exposure to dynamic thinking but felt that she was missing some awareness of what was happening in herself and in the patients she was working with - "I was curious...I wanted to go deeper, to know more." This led her to enroll in full-time analytic training. She shares with us her understanding of the 'difficult to reach patients' that she was treating and presents a fictionized case that represents the many countertransference struggles she faced. She noted that "instead of the patient realizing that she wanted something from me, she instead felt attacked by me." Supervision was essential in helping her make sense of her experiences and of learning to 'listen to the music'. We close by noting her open-ended curiosity and interest in learning more - lifelong attributes of analysts who continue to take pleasure in our work.

Our Guest: Pamela Polizzi, LCSW maintains a full-time private practice in New York City. She specializes in working with patients struggling with eating disorders, complex personality struggles, anxiety, depression, relational trauma, and life transitions. She earned her Master of Social Work (MSW) in Advanced Standing Clinical Practice from Fordham University at Lincoln Center in 2011. Currently, she is an Advanced Candidate at the Psychoanalytic Training Institute of the Contemporary Freudian Society (CFS) in Manhattan, working toward becoming a psychoanalyst. She completed a 2015 Two-Year Advanced Psychodynamic Psychotherapy Certificate in the Integrated Treatment of Eating Disorders from the Institute of Contemporary Psychotherapy (ICP), Center for the Study of Anorexia and Bulimia (CSAB). She also completed the Contemporary Freudian Society's (CFS) Two-Year Psychoanalytic Psychotherapy Program in 2019.

Recommended Readings:

Readings for Psychoanalytic Candidates:

Bach, S. (2011). The How-To Book For Students of Psychoanalysis and Psychotherapy. Karnac.

Busch, F. (2021). Dear Candidates: Analysts From Around The World Offer Personal Reflections on Psychoanalytic Training, Education, and The Profession. Routledge.

Readings on Clinical Practice with the Patient who is Difficult to Reach:

Bollas, C. (1996). Borderline Desire. Int. Forum Psychoanal., (5)(1):5-9.

Joseph. B., Feldman, M., & Spillius, M. (1989). Psychic Equilibrium and Psychic Change: Selected Papers of Betty Joseph. New Lib. of Psycho-Anal., (9):1-222. (on Pep-web).

• Joseph, B. (1975) The patient who is difficult to reach.

• Joseph, B. (1982) Addiction to near-death.

• Joseph, B. (1983) On understanding and not understanding: some technical issues.

Riesenberg-Malcolm, R. (1999). On Bearing Unbearable States of Mind. Routledge.

Steiner, J. (1993). Psychic Retreats: Pathological Organizations in Psychotic, Neurotic and Psychotic Patients. Routledge.

Winnicott, D.W. (1974). Fear of Breakdown. Int. R. of Psycho-Analysis. 1: 103-107.