Psychoanalysis On and Off the Couch

"The role that an analyst plays is so important in terms of how people can be wounded, shamed and hurt in a variety of different ways. We need to be very thoughtful about our own residual psychopathology because no analyst is perfectly analyzed. It's a lifelong stretch that we are going through to try to figure out what is bothering us with a particular patient." Episode Description: We begin by describing the nature of feeling 'stuck' in a clinical situation. We consider the contributions from both sides of the couch and the role that internal and actual consultants can play in reintroducing an analyzing perspective on an encounter. Glen presents composite examples of colleagues who came to him for consultation especially around difficulties with sexual boundaries with patients. He has noted the hunger for love and loneliness as common themes in these analysts' lives. We discuss changes in our field regarding the focus on symptoms and the use of Zoom and we conclude with a discussion of what he feels is a more nuanced understanding of the termination process. Our Guest: Glen Gabbard, MD is a Clinical Professor of Psychiatry at Baylor College of Medicine in Houston and a training and supervising analyst at the Center for Psychoanalytic Studies in Houston. He is the author or editor of 29 books, including Love and Hate in the Analytic Setting, Textbook of Psychoanalysis, Boundaries and Boundary Violations, and The Psychology of the Sopranos. He is also the author of 365 scientific papers. He was awarded the Sigourney Award in 2000 and received the Lifetime Achievement Award from Sapienza University in Rome in 2021. From 2001-to 2007 he was Joint Editor-Chief of the International Journal of Psychoanalysis. Recommended Readings: Gabbard GO: The "dragons of primeval days": Termination and the persistence of the infantile. International Journal of Psychoanalysis. 2021 Gabbard GO: The analyst and the virus. Journal of the American Psychoanalytic Association 68, 1089-1099, 2021 2017—Sexual boundary violations in psychoanalysis: a 30-year retrospective. Psychoanalytic Psychology 34: 151-156. (Gabbard GO) 2010—The lure of the symptom in psychoanalytic treatment. JAPA 58:533-544 (Ogden TH & Gabbard GO) 2009—On Becoming a Psychoanalyst. International Journal of Psychoanalysis 90:311-327 (Gabbard GO, Ogden TH) 2003- Gabbard GO: Miscarriages of psychoanalytic treatment with suicidal patients. International Journal of Psychoanalysis 84:249-261

"You can do as much about the legacy of the Holocaust - and what I took from my depressed mother who lost all her family in the Holocaust - there is only so much I could do in personal analysis and there was another bit that I could do only in a strange kind of dialogue in the presence of Germans doing their own work. It is: 'do your own internal work in the presence of an other who is doing his/her internal work'." Episode Description: We begin by learning about Mira's involvement in the origin of Partners in Confronting Collective Atrocities (PCCA) 30 years ago. She shares with us the profound internal changes that occurred in both the Israeli and German analysts who came together and 'did their own work in the presence of the other'. She describes her ongoing consultative work with members of the Ukraine Psychoanalytic Society as they face terrible tragedies and uncertainties regarding their future. She advises humble respect for their need for psychological armor before recommending their encountering colleagues who are identified with the current aggressor. We close with her describing her pride in being Israeli and how it lives in her devotion to healing. Our Guest: Mira Erlich-Ginor, M.A, is a training and supervising analyst, and faculty of the Israel Psychoanalytic Society. She is deeply involved in psychoanalytic education and group relations work as well as serving as European representative for the IPA Board for two terms. Currently, she is Chair of the Steering Committee, IPA in the Community and the World. She has been co-director of the IPS psychotherapy track; chair of the education committee IPS, chair of the EPF (European Psychoanalytic Federation) Working Party on Education, Chair of Sponsoring Committee PSIKE, Turkey. She has also initiated and led several international research projects on psychoanalytic education among them is the End of Training Evaluation Project. She is committed to the application of psychoanalytic understandings to societal issues, co-founding the "Nazareth Project"- Group Relations work on transgenerational transmission of trauma as well as co-Founder, past chair, and member of OFEK – Israeli Group Relation organization. She is also Co-founder and in management of PCCA, Partners in Confronting Collective Atrocities, recipient of the Sigourney Award 2019. Recommended Readings: Partners in Confronting Collective Atrocities Confronting Personal Trauma in a Group. The Sigourney Award Beland, H. (2014) Collective Mourning - Who or What frees a Collective to Mourn. About First Step Out of the Most Malign Prejudice. In: Cyril Levitt, (Ed.): Hostile and Malignant Prejudice: Psychoanalytic Approaches. The International Psychoanalytical Association, Psychoanalytical Ideas and Application Series, Routledge, 2014. Davids, M. F. (2013) "Tears are better than blood; words are better than tears"; can we address current ongoing conflict? In A. Varchevker & E. McGinley (Eds.), Enduring Migration through the Life Cycle (pp. 187–210). London: Karnac. Erlich, H. S., Erlich-Ginor, M. & Beland, H. Fed with Tears – Poisoned with Milk. The "Nazareth" Group-Relations-Conferences: Germans and Israelis: The Past in the Present. Psychosozial Verlag: Gießen, 2009. Erlich, H. S., Erlich-Ginor, M. & Beland, H. Gestillt mit Tränen – Vergiftet mit Milch. Die Nazareth-Gruppenkonferenzen: Deutsche und Israelis – Die Vergangenheit ist gegenwärtig. Psychosozial Verlag: Gießen, 2009. Erlich, H. S., Erlich-Ginor, M. Beland H. (2009) Being in Berlin: A large group experience in the Berlin Congress, International Journal of Psycho-Analysis, 90. Erlich-Ginor, M. (2013) Fed with Tears, Poisoned with Milk: The Way Out from Under the Shadows of the Holocaust. In: Varchevker, A. McGinley, E. (ed.): Enduring Migration: External and Internal Migration Through the Life Cycle. London: Karnac.

"The father carries the separation function which is very important in terms of progressive differentiation from the mother rather than forceful opposition. It rests on something else that I think that we in psychoanalysis don't take seriously enough - though Peter Blos did when he talked about the isogender attachment. The father also has to be an attracting object to the little boy - not just the separating object, but the attracting object. The little boy wants to desire the father and the love of the father - the whole homoerotic connection with the father, wrestling with the father, touching the father's beard - all the beautiful sensual aspects of the male to male relationships that are inherent in the early dyadic father - son relationship." Episode Description: We begin by distinguishing analytic data from social and cultural theorizing. Michael walks us through the early history of psychoanalytic understandings of masculine development. He describes the 'third wave' of conceptualizations to which he contributed. This recognizes the formative aspect of the mother's relationship with her internalized masculinity and its reverberations towards her son. He discusses the challenge the little boy faces in acknowledging his gender difference from his mother, a task made more manageable by the dependable presence of his dyadically available father. He presents clinical material that demonstrates the power of the homoerotic transference/countertransference to "activate" a secure masculine identification. This grows into the discovery of "a man's inherent receptivity" which he is careful to distinguish from female receptivity. We close with his sharing with us a bit of his personal history that has led him to be interested in this work. Our Guest: Michael J. Diamond, Ph.D., is a Training and Supervising Analyst at the Los Angeles Institute and Society for Psychoanalytic Studies. His major publications are on psychoanalytic technique and analytic mindedness; masculinity, femininity, and gender theory; fathering and the paternal function; trauma and dissociation; hypnosis and altered states; and group processes and social action. He has written five books including today's featured book on Masculinity and Its Discontents: The Male Psyche and the Inherent Tensions of Maturing Manhood. His forthcoming book on applied psychoanalysis is Ruptures in the American Psyche: Containing Destructive Populism in Perilous Times. His other major books include My Father Before Me: How Fathers and Sons Influence Each Other Throughout Their Lives My and an edited book on The Second Century of Psychoanalysis: Evolving Perspectives on Therapeutic Action (with Chris Christian). He has a full-time clinical practice in Los Angeles, California where he remains active in teaching, supervising, and writing. Recommended Readings: Blos, P. (1985). Son and Father: Before and Beyond the Oedipus Complex. New York: Free Press. Corbett, K. (2009). Boyhoods: Rethinking Masculinities. New Haven, CT: Yale University Press. Diamond, M. J. (2004). The Shaping of Masculinity: Revisioning Boys Turning Away from Their Mothers to Construct Male Gender Identity. Int. J. Psychoanal., 85:359–380. Diamond, M. J. (2006). Masculinity Unraveled: The Roots of Male Gender Identity and the Shifting of Male Ego Ideals Throughout Life. J. Amer. Psychoanal. Assn., 54:1099–1130. Diamond, M. J. (2007). My Father Before Me: How Fathers and Sons Influence Each Other Throughout Their Lives. New York: Norton. Diamond, M. J. (2015). The Elusiveness of Masculinity: Primordial Vulnerability, Lack, and the Challenges of Male Development. Psychoanal. Q., 84:47–102. Diamond, M. J. (2017). The Missing Father Function in Psychoanalytic Theory and Technique: The Analyst's Internal Couple and Maturing Intimacy. Psychoanal. Q., 86:861–887. Diamond, M. J. (2020). The Elusiveness of "The Feminine" in the Male Analyst: Living in Yet Not Being of the Binary. Psychoanal. Q.,89:503–526. Diamond, M. J. (2021). Masculinity and Its Discontents: The Male Psyche and the Inherent Tensions of Maturing Manhood. London: Routledge. Freud, S. (1905). Three Essays on the Theory of Sexuality. S. E., 7:130–243. Friedman, R. C. & Downey, J. L. (2008). Sexual Differentiation of Behavior: The Foundation of a Developmental Model of Psychosexuality. J. Amer. Psychoanal. Assn., 56:147–175. Glasser, M. (1985). The "Weak Spot"—Some Observations on Male Sexuality. Int. J. Psychoanal., 66:405–414. Laplanche, J. (1997). The Theory of Seduction and the Problem of the Other. Int. J. Psychoanal., 78:653–666. Lax, R. F. (1997). Boys' Envy of Mother and the Consequences of This Narcissistic Mortification. Psychoanal. Study Child, 52:118–139. Moss, D. (2012). Thirteen Ways of Looking at a Man: Psychoanalysis and Masculinity. London: Routledge. Stoller, R. J. (1985). Presentations of Gender. New Haven, CT: Yale University Press.

"I have some very close friends in Russia and some of them emigrated now and some of them are in Russia. Of course, I can speak with them very personally about my experience. I see how much guilt they feel and how much pressure they feel from both sides, from inside Russia and outside. For example, the first letter that our society received from one of the Russian psychoanalytic organizations was full of apologies. But after that Russian members asked us not to share this letter because they could be persecuted in Russia." "[re Russian atrocities] it's absolutely a shocking experience that we were not able to expect. This absolutely wild hostility and cruelty from the Russian side. What you see on the internet is only part of it. Of course, if we speak with these people - raped women, injured children, tortured men – it is absolutely unbearable. We are shocked that the Russian army behaves in such a way - it is absolutely dehumanized behavior, bestial cruelty." "For our country, it's very important to feel solidarity now. We are very grateful to the States and to Britain who expressed their solidarity. Because several countries fell under Russian propaganda and still in some way hesitated about who is right and who is wrong. They say 'it is not war it is only an Ukrainian conflict', 'there are both sides and all sides have their truths'. It is very painful for us to hear such things. I think resistance to Putin's propaganda is very important support for us. To say truth about the situation, to say truth about this absolutely inhuman cruelty about this war and to defend people here." "Unfortunately, I see in many Western intellectual people who are missing an understanding of the situation. It is an absolutely unprovoked war. It is a very long war, because it started 8 years ago. Now it is only an acute stage of this war. But again and again I hear from my European colleagues that probably it is something that the Americans did, probably it is something that NATO did, it's some political trick, and so on and so on. But these people use a great deal of denial to not see the absolutely cruel aggression of the imperialistic mind and an imperialistic society. These European intellectuals are like Stalin called "useful idiots" who supported Stalinism."

"One of the things that I find absolutely remarkable about psychedelic medicines is the access one can have into discovering different parts of oneself, different ways in which we're put together Also, to see how we shape our worlds in a very interesting way, experientially. That has been shocking to me - to see and experience how our psychological frameworks have a coherence. They feel structural in a way that you can experience anxiety being removed and then it coming back and it being held somewhere in your body in a very distinct way. Even to be able to travel into an anxiety held in the body in a distinct way and understand its roots and origins as if it was a structure in and of itself. To say it is mind-blowing would be an understatement." Episode Description: We begin by discussing the medical aspects of ketamine which includes its long history of use and safety. Gita shares with us her psychoanalytic background and how it has played a central role in her work utilizing psychedelic medicines. We discuss the similarities and differences between the regressions in both treatments and share thoughts about the differing modes of therapeutic action. She describes clinical situations demonstrating the impact that a therapeutically assisted psychedelic experience can have on long-standing character impediments. We close with a reminder of the long-standing interest that psychoanalysts have had in this promising modality. Our Guest: Gita Vaid, MD is a board-certified psychiatrist and psychoanalyst practicing ketamine-assisted psychotherapy in New York City. She is a co-founder of the Center for Natural Intelligence, a multidisciplinary laboratory dedicated to psychedelic psychotherapy innovation and clinical practice. Dr. Vaid completed her residency training at NYU Medical Center and psychoanalytic training at the Psychoanalytic Association of New York. She trained as a fellow in clinical psychopharmacology and neurophysiology at New York Medical College and completed a research fellowship at NYU Medical Center. Dr. Vaid serves as the Director of Psychedelic Awareness at The Chopra Foundation and is on Faculty at The Ketamine Training Center. Linked Episodes: https://harveyschwartzmd.com/2022/01/28/ep-23-psychedelic-psychotherapy-for-ptsd-new-research-with-ingmar-gorman-phd/ https://harveyschwartzmd.com/2021/02/26/ep-2-psychedelic-medicines-therapeutic-context/ Recommended Readings: Critical Period Plasticity as a Framework for Psychedelic-Assisted Psychotherapy Lauren Lepow, Hirofumi Morishita and Rachel Yehuda Frontiers of Neuroscience Sept 2021 Pivotal Mental States Ari Brouwer and Robin Lester Carhart-Harris Journal of Psychopharmacology 1-34 2020 Psychedelic Communitas: Intersubjective Experience During Psychedelic Group Sessions Predicts Enduring Changes in Psychological Wellbeing and Social Connectedness H. Kettner, F. E. Rosas, C. Timmerman, L. Kartner, R.L.Carhart-Harris and L. Roseman Frontiers of Pharmacology, March 2021 Notes on Memory and Desire, W.R. Bion 1967) The Present Moment in Psychotherapy and Everyday Life. Daniel Stern 2004 Psychedelic Psychotherapy : Building Wholeness Through Connection Gita Vaid, MD; Barry Walker, M.Ed

"We understand that we are not alone. It is crucially important to feel like that because we are a large country compared to other European countries - we are the largest country in Europe and have 45 million population. But in comparison to Russia it is very small and actually the Russian army is the second largest army in the world. It was unbearably scary to think about it, and we are very grateful to all the world who protect us with words, who protect us with weapons and with other supplies, so we are incredibly thankful." "I would like to say that we are not afraid anymore in spite of the fear. We are not afraid and we ask you also not to be afraid. We ask the Russian people not to be afraid and to protest - Belarus people not to be afraid and to protest. We ask European countries not to be afraid and to tell the truth to their people, to their population, to each other because this war is not only in territory but also in mind." To provide assistance to Ukraine: Michael Pustovoyt at pmm2109@gmail.com https://linktr.ee/voiceforukraine?utm_source=linktree_profile_share&ltsid=a932117b-67f0-4ebd-bcd9-1ee89693c909 IPAOfftheCouch.org

Guest Dr. Rafael Ornstein, a psychiatrist and jazz pianist, discusses using musical improvisation to make sense of patients' fragmented harmonies. The podcast explores the parallels between musical improvisation and free association in psychoanalysis. They delve into creating new motifs through improvisation to represent challenging elements for deeper examination. The episode also touches on the intersections between music therapy and psychoanalysis, highlighting the importance of structure for meaningful expression.

"I'm interested in with what mind and what imagination and thoughts and association one person lives her life. That's the common thread in all three novels and that is of course what interests me as an analyst practicing psychoanalysis, doing psychoanalytic work. It is also what interests me in terms of psychoanalytic theory, what goes on in the mind? That's an endlessly fascinating question that I have." Episode Description: We consider three expressions of Cordelia's immersion in the world of psychoanalysis - her novels, her theoretical writings, and her work as chair of the IPA in Culture Committee. She shares with us her interest in the minds of her fictional characters especially as they reveal Oedipal struggles. She reads an excerpt that reflects her attunement to conflicts related to seeing - the wish, the taboo, and the punishment. Her theoretical focus is on fine-tuning Freud's notion of aggression with her emphasis on the more fundamental self and other preservative drives. We discuss her interest in culture and in the enriching experience of linking images with words. We close with her sharing her personal journey having trained in Switzerland and now living in the States. Our Guest: Cordelia Schmidt-Hellerau, Ph.D. is a Training and Supervising Analyst and on the Faculty of the Boston Psychoanalytic Society and Institute as well as of the Swiss Psychoanalytic Society. Her area of expertise is metapsychology, in particular drive theory. She has published numerous papers and three books on theoretical and clinical psychoanalysis. Her 2018 publication Driven to Survive was a finalist of the American Board & Academy of Psychoanalysis Book Prize. She has published her first novel in German in 2019, Rousseaus Traum, and in 2020 her second novel Memory's Eyes, and has just finished her third novel, Memento. Since 2017 she is the chair of the IPA in Culture Committee. She works in private practice in Chestnut Hill, Massachusetts. Recommended Readings: Freud, S. (1908). On the Sexual Theories of Children. Standard Edition, 9. Freud, S. (1940). An Outline of Psycho-Analysis. Standard Edition, 23. Lispector, C. (2015). The Complete Stories. Translated from the Portuguese by K. Dodson. New York: New Directions. NDiaye, M. (2013). Three Strong Women. Translated from the French by J. Fletcher. New York: Vintage Books. Schmidt-Hellerau, C. (2018) Driven to Survive. Selected Papers on Psychoanalysis. New York: International Psychoanalytic Books. Schmidt-Hellerau, C. (2020) Memory's Eyes. A New-York Oedipus Novel. Queens, NY: International Psychoanalytic Books. Schmidt-Hellerau, C. (2021) The Analyst as Storyteller / El analista como narrador. Queens, NY: International Psychoanalytic Books.

"We are all dependent and potentially addicted as well. We regularly use addictive objects whenever we are confronted with a circumstance that brings a lot of pain, emotional pain, more pain than we can bare." Episode Description: We begin by reviewing how remarkably pervasive pornography is on the internet. Claudia discusses the impact that viewing arousing scenes on a screen can have on one's psychosexual development. She describes its effects on our neurochemistry as well as on one's capacity to develop creative sublimations. The fundamental issue as seen by both guests involves detours from intimacy which Jose describes as involving dehumanization. This intolerance for what he calls "mature dependency" is seen as underlying the turn to "impoverished, desolate and concrete internal scenarios." We close with a conversation on the challenges of treating patients who experience themselves as dehumanized and unknowingly treat their analysts similarly. Despite these difficulties, the analyst's acceptance of such moments contains the seeds for hope and renewal. Our Guests: Claudia Spadazzi, MD, Full Member Italian Psychoanalytic Society (SPI) and International Psychoanalytical Association (IPA). Clinical psychologist, gynecologist, sexual therapist. Visiting Professor in Psychosomatic Gynecology at Università Politecnica delle Marche. She has been part of the IPA Committees: IPA/IPSO, COWAP, Public Information, CAPSA, and currently is a member of IPA Health Committee. Co-founder of Italian Psychoanalytic Dialogues. Founder of the Freud's bar, an outreach initiative. Founder of the Section of Cinema and Psychoanalysis, Festival of the Two Worlds, Spoleto. Jose Zusman, MD President and Training Analyst at Rio de Janeiro's Psychoanalytic Society, Post Doc at The Institute of Psychiatry of the Federal University of Rio de Janeiro/ Harvard under the mentorship of Edward Khantzian, Member of IPA Health Committee and Chair of IPA Subcommittee on Addiction Linked Interviews: The Mind, Body and Soul Podcast: Ep.9: A Gynecologist/ Psychoanalyst Treats Amenorrhea with Claudia Spadazzi, MD https://harveyschwartzmd.com/2021/06/04/ep-9-a-gynecologist-psychoanalyst-treats-amenorrhea/ Psychoanalysis On and Off the Couch Podcast: Ep.8 A Psychoanalyst Encounters Patients with Addictions http://ipaoffthecouch.org/2019/06/29/episode-8-a-psychoanalyst-encounters-patients-with-addictions/ Recommended Readings: Applying Psychoanalysis in Medical Care, edited by Harvey Schwartz Neuroscience of Internet Pornography Addiction: A Review and Update. Behav Sci 5(3): 388–433. Kahn, M. .M. .R. (1979). Alienation in Perversion, London: Karnac Doidge N. (2008).The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science, London: Penguin Solms M., Zellner M., Watts D., Panksepp J. (2011) Affective Neuroscientific and Neuropsychoanalytic Approaches to Two Intractable Psychiatric Problems: Why Depression Feels so Bad and What Addicts Really Want Neuroscience and Biobehavioral Reviews 2011 Balint, M. (1968/1979). The Basic Fault: Therapeutic Aspects of Regression. Tavistock Publication. London. Dodes, L (2003). The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors, HarperCollins Publishers. New York. Fairbairn, W: Then and Now (2014). Routledge Publishers. New York. Khantzian, E.J. -Treating Addiction as a Human Process (1997). Jason Aronson. New York McDougall, J (1995). The Many Faces of Eros. W.W. Norton Company, Inc., New York.

"The acknowledgment of guilt it's a prerequisite for reparation. There is no reparation without the acknowledgment of guilt and guilt arises when love and hatred come together within the same person. There is no need to feel guilt as long as we idealize a good object - there is no need to feel guilt as long as we have the bad object. When we discover that it is the same object, that our love feelings and our hatred are directed towards the same object, then guilt arises. I think of guilt more as a molecule, not as an atom." Episode Description: We begin by clarifying the meaning of trauma from its commonplace references all the way to the trauma of parental figures maintaining a malignant view of their child. We discuss the impact of early trauma on development with particular attention to the limitations on the capacity for nuanced affect and symbolization. Heinz describes in detail how this level of concreteness lives in the analytic situation and is shared in the counter-transference. The analyst's ability to imperfectly tolerate the projection of badness into them is demonstrated in his clinical vignette. The patient describes herself, There is something in me which is part of me and not part of me which thinks that I only have a right to live if I feel bad. We learn how that addictive attachment to dependable badness sustains her until she needs it less over the course of her analysis. The deepening capacity to tolerate guilt and for whole object gratitude marks the analysand's healing. Our Guest: Heinz Weiss, M.D., is the Head of the Department of Psychosomatic Medicine at the Robert Bosch Hospital in Stuttgart. He is also the head of the Medical Division and member of the directorate of the Sigmund-Freud Institute, Frankfurt/Main, and Chair of the Education Section of the International Journal of Psychoanalysis. Linked Episodes: https://harveyschwartzmd.com/2021/06/04/ep-9-a-gynecologist-psychoanalyst-treats-amenorrhea/ http://ipaoffthecouch.org/2019/06/29/episode-8-a-psychoanalyst-encounters-patients-with-addictions/ Recommended Readings: Money-Kyrle, R. (1956), Normal Countertransference and Some of Its Deviations. Int. J. Psychoanalysis 37: 360-366. Rey, H. (1994), Universals of Psychoanalysis in the Treatment of Psychotic and Borderline States. London: Free Associations Books. Steiner, J. (1993), Psychic Retreats. Pathological Organizations in Psychotic, Neurotic and Borderline Patients. London, New York: Routledge. Steiner, J. (2020), Illusion, Disillusion and Irony in Psychoanalysis. London, New York. Weiss, H. (2009), Das Labyrinth der Borderline-Kommunikation [The Labyrinth of Borderline-Communication]. Stuttgart: Klett-Cotta. Weiss, H. (2020), A Brief History of the Super-Ego with an Introduction to Three Papers: Int. J. Psychoanal. 4 (2020), 724-734. Weiss, H. (2020), A River with Several Different Tributary Streams: Reflections on the Repetition Compulsion. Int. J. Psychoanal. 101, 6: 1172-1187. Weiss, H.(2021), The Conceptualization of Trauma in Psychoanalysis: An Introduction. Int. J. Psychoanal. 102, 4: 755-764.