Congratulations to NAAP’s (National Association for the Advancement of Psychoanalysis) 2016 Gradiva Award Winners:

ART

“Psyche, Symbol and Trauma:

The Art of Lilli Gettinger (1920-1999)”

Curated by the Center for Modern Psychoanalytic Studies

ARTICLE

BETH DARLINGTON

Kristine Mann: Jung’s “Miss X” and a Pioneer in Psychoanalysis

BOOK

EFRAT GINOT

The Neuropsychology of the Unconscious: Integrating Brain and Mind in Psychotherapy

W. Norton & Company

TREVOR PEDERSON

The Economics of Libido:

Psychic Bisexuality, the Superego, and the Centrality of the Oedipus Complex

Karnac Books

EDITED BOOK

ADRIENNE HARRIS & STEVEN KUCHUCK

The Legacy of Sandor Ferenczi: From Ghost to Ancestor

Routledge

FILM

MOLLY CASTELLOE

Vamik’s Room

NEW MEDIA

GALIT ATLAS

A Tale of Two Twins

in the NYT psychotherapy series “Couch”

Narcissus is the archetype of self- love, a character in mythology unable to merge with another in a loving relationship. In a pool of water Narcissus sees his own reflection and falls in love with this reflection that he thinks is someone else. The narrator of the myth asks: “Why try to grip an image? He does not exist-the one you love and long for” (Ovid, trans.1993, 429-331).

The myth symbolically depicts an image so useful to modern psychoanalysts in their understanding of narcissism. Narcissus can’t tell the difference between “me” (ego) and “not me” (object). Speaking to a blurred reflection in the water, thinking another person is present, not realizing he is talking to himself, he is alone at the pool. If he were a patient we would describe him as alone in the room.

The concept of “one person alone in the room” is difficult to accept for therapists (Semel, 2004, p. 195). In session with a regressed, schizophrenic patient it is easier to see that he is talking to himself in response to voices in his mind that he believes are other people. A patient who arrives at the session on time, has a job, or speaks rationally appears to be functioning on a more advanced level. However when this patient lies on the couch, that patient functioning on an object level outside the room may regress to the level of “alone in the room.” He becomes Narcissus talking to himself, to the images in his mind. In this early stage of development the images of self (ego) and other (object) are confused, overlapped and merged (Spotnitz, 1985).

Phillips (2001) offers an explanation of how the patient in this narcissistic state may affect the analyst. The patient alone in the room may induce the analyst to speak at the wrong time. Sitting with a patient who never asks a question or who never answers one may make the analyst feel that the patient isn’t aware that the analyst even exists, arousing feelings of rejection or inadequacy in the analyst (a narcissistic injury). Instead of following the contact, the analyst may be tempted to talk so the patient will be aware of his presence (a narcissistic countertransference resistance). Perhaps Phillips clarifies why we resist seeing that the seemingly higher functioning patient may also be alone in the room. The analyst wants to be engaged in an emotional relationship but the patient on the couch returns to a narcissistic stage of life, where there are no “people,” only shadowy impressions of the images the mind has not yet separated into ego and object.

The patient is alone in the room. Narcissus is alone at the pool, speaking to the object/ego field reflected in the water. Like Narcissus, the narcissistic patient is talking to part of his mind.

References

Phillips, A. (2001). Narcissism, for and against. In One way and another: New and selected

            essays (pp.129-153). NY: Basic Books.

Semel, V. Understanding the fieldwork experience: How do we know when students “get it”

about narcissism? Modern Psychoanalysis, 9(2), 193-214.

Spotnitz, H. (1985). Modern psychoanalysis of the schizophrenic patient (2^nd ed.). NY: Human

Sciences Press.

I was so moved by our ACAP graduation on October 18 and therefore I doubly rejoiced in the recent New York Times articles on the work we are so proud of doing. (http://opinionator.blogs.nytimes.com/author/christopher-bollas/ and

http://mobile.nytimes.com/2015/10/20/health/talk-therapy-found-to-ease-schizophrenia.)

Working with schizophrenics and borderline patients, along with all the other vulnerable populations we respect and serve, is the heart of modern psychoanalytic training and the foundation of students’ progress toward graduation.. What characterizes the experience of modern psychoanalysis? I believe modern analytic training is characterized by gentleness, fierceness, and liveliness.

Gentleness

There is a gentleness in the work as we protect the defenses of the patient and student. Therapists are taught to provide no sharp edges to the patient but to allow the patient to experience the therapist as a mirror or as part of the self or even as not there and as if alone in the room. This gentleness can also be a quiet period as the therapist learns to follow the contact function (which involves following the lead of the patient, not directing, but consulting the patient).

Fierceness

What is the fierceness we see? This occurs when the therapist is taught to intervene and to enjoy the aggression of the patient as well as their own energy and aggression. To echo the importance of expressing feelings often turned against the self, the faculty encourage the student’s perceptions and join them in an accepting and curious way. If the patient sees himself as inadequate or hopeless, the therapist is encouraged to accept this view and become curious about this stance. In parallel fashion, if criticized by the student, teachers are curious about how they had a bad effect and failed the student.

There is a fierceness in allowing the patient and student to experience negative feelings about the self and toward others. While reading the fascinating article by Bollas, I wondered if the positive comments he made about the patient’s functioning did not set off her regression. Fiercely allowing the patient’s negative perceptions while building ego strength requires a brave commitment to uncomfortable feelings in oneself and others. By the way, these feelings can be grandiosely positive as well as negative. Students learn to fiercely welcome all emotions no matter how uncomfortable or outrageous.

Liveliness

And now for liveliness. I think what helps prevent burnout in the work we do is that there is fun and a lightness about the most serious of topics. One can discuss aggressive fantasies or wishes for murderous activities with a humorous shape and tone. Walk past ACAP/BGSP-NJ classes in Livingston, New Jersey, and hear laughter and fun. The ability to turn discomfort into acceptance of one’s difficult feelings and thoughts creates a liveliness in our endeavor.

We like to think of the ripple effect of our educational experience. If we teachers and supervisors are doing our jobs properly, not only is the student maturing and developing better ways to work with patients, they are learning to help their students or bosses, even teenagers and spouses.

As teachers at ACAP, we have spent decades treating and training clinicians to help our more seriously mentally ill patients and their families. That the ACAP community celebration of our graduates occurred while the New York Times presented accounts in recognition of the commitment to treat and even “cure” the severely mentally ill seems a fitting reward for our commitment to our mission and a way to honor our students.

I am delighted and moved by our graduates’ achievement and by how the media conspired to celebrate their creative learning by showing that the more seriously disturbed patients could be helped to develop productive coping styles and can benefit from the gentleness, fierceness and liveliness of a well-trained modern psychoanalyst.

 

One of the lesser known facts about ACAP is that analytic training is available to people who do not live in ACAP’s immediate geographic area.  I live in Washington State and completed the entire course from there, graduating in October, 2015.  I was the first to complete analytic training in this manner at ACAP but most likely I will not be the last as other distance students will be graduating soon.

Most students at ACAP live no further than 30 miles from the campus, while I am living thousands of miles away.  So, the model of distance training in psychoanalysis seemed atypical, indeed.  I want to share a little bit about my experience and illustrate how it is possible to become a psychoanalyst and bridge the distance gap.

First of all, how does one even find an institute that offers distance training?  In the 21^st century all casual research seems to begin with a Google search and in this way I found a website for a psychoanalytic training institute in New Jersey that boasted distance learning.  After a brief interview and participation in one of ACAP’s summer conferences, I was hooked and I decided to enroll.

At the first ACAP conference I attended, I learned about the unique style of teaching that essentially models analytic methods.  Because this model is based on emotions and feelings, it was inherently satisfying to be at the conference and in workshops.  I could hardly wait to start my first official class.  While this type of training does not follow a mainstream educational pedagogy, for me it was educational and effective.  Class readings were related to the topic and the syllabus reflected a certain frame but the actual time in class was spent in whatever meandering free associations that a group of students could conjure.  Personal reflection in the form of class logs submitted to the instructor necessitated a recapture of the class in the mind of the student and with it, the associations to the readings.  Sometimes it seemed helter-skelter, but it worked.  Of course papers were required, and with those, a further opportunity for synthesis of knowledge and evolving emotional congruence.

My first classes were just over the phone with speaker phone technology but this was quickly eclipsed by video conferencing with better and better high speed and high resolution connections.  When I started I could only hear the class; by the time I graduated, I could see them and they could see me.  However even in the beginning and probably because of the skill of the analysts who were the instructors, I found a way to feel part of the class and felt like I had a presence and an impact.  Nowadays, if someone wanted to train as a modern psychoanalyst through ACAP it would be already in the video conferencing medium – see and be seen, just like real life.

Besides the classes this training has two practicum components that had to be negotiated from a distance.  The first is an externship where a student learns to understand the concept of emotional communication with a chronically mentally ill patient.  The second practicum consists of working with several ambulatory patients under clinical supervision with two supervisors.  One of the patients becomes the subject of an extensive treatise that is the exploration of a clinical question around motivation and psychic structure.  I did it all successfully from nearly 3000 miles away!

I began psychoanalytic training and graduate work in psychology at the same time. While getting my masters’ degree in psychology, I became connected to a large mental health center that also had residential treatment.  The staff there were quite welcoming to have me come and spend several hours a week with some of their residents.  What a fantastic experience to apprehend the inner emotional state of people locked in their mind.  Once through that training and by then also becoming a licensed mental health counselor, I began a part-time private practice and began to meet with some patients that served as my clinical training patients.

Throughout the training, the truth of the aphorism, “life is a journey – not a destination” became evident.  As such, it is an odd feeling to have arrived at my destination. The program was full of challenges and satisfactions and the results are that I now feel very rewarded by the whole experience. I have a rich view of the human condition and a sense of my own capacity for emotional growth. ACAP’s distance learning option is an excellent opportunity for anyone interested in psychoanalytic training who may not live near a training institute.