Continuous Case Seminar: Problems in Early Integration and the
Holding Environment (PDPSA.4581.002) - Fall 2015
Instructor - Aaron Thaler
This course will focus on understanding early disturbances of personal
integration and continuity of being, and the therapeutic processes that can
lead to resolution of these problems. Using process material presented by
candidates, along with some reading, we will work toward in-depth,
empathic understanding of a patient's difficulties and a detailed view of
therapeutic changes unfolding within the patient/analyst dyad. We will
connect features of a particular patient and treatment with broader clinical
issues and questions that are central to analytic work in this area:
Clinical phenomena related to problems in early integration
How are disruptions of early integration reflected in clinical phenomena
such as disturbances of agency, identity, and emotional self-regulation;
feelings of emptiness, isolation, fragmentation, and depersonalization;
impaired sense of subjective reality or aliveness? How can we understand
self-holding, false self, and other dissociative defenses as reactions to early
disruptions in the continuity of being.
Working with primitive anxieties
How can we understand and distinguish signal anxiety and disintegration
anxiety? What are the roles of the early caregiving environment and the
analytic relationship in helping an individual tolerate and work through
primitive anxieties?
Holding and integration
What is a holding environment? How does holding lead to integration? What
distinguishes holding from containment? What aspects of the analytic
relationship work to bring the patient into the center of treatment and
facilitate agency, spontaneity, authentic self-expression, trust, and intimacy?
Transference relationship and therapeutic regression
How can analysts work with wide-ranging, often contradictory
transferences? At a given point in analysis, is the analyst inside (experienced
as a subjective object), outside, or at the border? How can we understand a
patient's regression to dependence, and how does an analyst receive this
regression? How can we understand and work with a patient's anger, rage,
and destructiveness?
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Readings and Discussion
Section 1. Therapeutic/Maternal Environment, Developing Continuity and
Integration
Introduction and historical overview
Compare and contrast various views on the role of the environment
and inborn tendencies toward integration in early development in the object
relations theories of Winnicott, Ferenczi, Klein.
The holding environment and the origins of the true self
Winnicott, D. W. (1962). Ego integration in child development. The
Maturational Processes and the Facilitating Environment: Studies in the
Theory of Emotional Development (pp. 140-152). International Universities
Press, 1965.
*Ogden, T. (2004). On holding and containing, being and dreaming.
International Journal of Psychoanalysis, 85:1349–64.
*Ferenczi, S. (1949). Confusion of the Tongues Between the Adults and the
Child—(The Language of Tenderness and of Passion). International Journal
of Psycho-Analysis, 30:225-230.
Section 2. Disturbances of Continuity and Integration
Reaction to failures of environmental provision, "unthinkable" anxieties and
early breakdown
Winnicott, D. W. (1963). Dependence in infant-care, child-care, and in the
psycho-analytic setting. The Maturational Processes and the Facilitating
Environment: Studies in the Theory of Emotional Development (pp. 249259). International Universities Press, 1965.
Winnicott, D. W. (1960). Ego distortion in terms of true and false self. The
Maturational Processes and the Facilitating Environment: Studies in the
Theory of Emotional Development (pp. 140-152). International Universities
Press, 1965.
Psychosis as defense, fear of breakdown, and the flight to invulnerability
Searles, H. (1977). The Development of Mature Hope in the Patient
Therapist Relationship. In: Countertransference and Related Subjects. New
York: International Universities Press.
Winnicott, D.W. (1974). Fear of breakdown. International Review of
Psycho-Analysis, 1:103-107.
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*Winnicott, D. W. (1965). The psychology of madness. In: C. Winnicott, R.
Shepherd, & M. Davis (Eds.), D.W. Winnicott: Psycho-Analytic
Explorations (pp. 119-129). Cambridge: Harvard University Press, 1989.
Section 3: Therapeutic Adaptation and Trust in the Patient's Process
Holding environment, mirror transference
Winnicott, D.W. (1956). Primary maternal preoccupation. Through
Paediatrics to Psycho-Analysis (pp. 300-305). New York: Basic Books
(1975).
Winnicott, D.W. (1971). Mirror-role of mother and family in child
development. Playing and Reality. London: Tavistock. Bach, S. (2006).
Psychoanalysis and love. Ch. 9 In: Getting from Here to There. Hillsdale,
NJ: The Analytic Press.
*Bach, S. (2001). On being forgotten and forgetting one's self.
Psychoanalytic Quarterly, 70:739-756.
*Thaler, A. (2012). Having a place in the mind and heart of another. Paper
presented at: The Power of Love: A Tribute to the Innovative Contributions
of Shelly Bach. NYU Postdoctoral Program, November 2012.
Silence
Balint, M. (1979). The unobtrusive analyst. The Basic Fault: Therapeutic
Aspects of Regression. Chapter 25. London/New York: Tavistock
Publications.
Winnicott, D.W. (1964). Two notes on the use of silence. In: C. Winnicott,
R. Shepherd, & M. Davis (Eds.), D.W. Winnicott: Psycho-Analytic
Explorations. Cambridge: Harvard University Press, 1989.
Section 4: Therapeutic Adaptation and Trust in the Reliability of the
Setting
Holding environment, idealizing transference
Kohut, H. (1977). Do we need a psychology of the self? Ch. 2 in:
Restoration of the self. New York: International Universities Press.
*Kohut H. (1984). The curative effect of Analysis: The self-psychological
reassessment of the therapeutic process. In. How Does Analysis Cure?
Chicago: The University of Chicago Press.
Section 5: Therapeutic Regression
Winnicott, D. W. (1967). The concept of clinical regression compared with
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that of defence organisation. Paper given at a Psychotherapy Symposium at
Mclean Hospital, Belmont, Massachusetts. In: C. Winnicott, R. Shepherd, &
M. Davis (Eds.), D.W. Winnicott: Psycho-Analytic Explorations (pp. 193199). Cambridge: Harvard University Press, 1989.
Winnicott, D.W. (1964). The importance of the setting in meeting regression
in psycho-analysis. In: C. Winnicott, R. Shepherd, & M. Davis (Eds.), D.W.
Winnicott: Psycho-Analytic Explorations (pp. 193-199). Cambridge:
Harvard University Press, 1989.
*Thaler, A. (2011). Breakdown and recovery in the analysis of a young
woman. In: Druck, A., Ellman, C., Freedman, B., and Thaler, A. (eds.), A
New Freudian Synthesis: Clinical Process in the Next Generation. London:
Karnac.
* Additional readings suggested but not required. All readings will be
supplied by instructor, both hard copy and electronic copy.
Learning Objectives
Overall learning objectives:
At the end of this course, candidates will be able to describe and explain
Winnicott's theory of early development, describe and explain his theory of
therapeutic process, and contrast these theories with earlier Freudian and
Kleinian theories of development and therapeutic process.
Specific learning objectives:
Class 1 - At the end of this class, candidates will be able to describe the
elements of integration and continuity of being in Winnicott's theory of early
development.
Class 2 - At the end of this class, candidates will be able to describe the
elements of a holding environment in Winnicott's theory of early
development.
Class 3 - At the end of this class, candidates will be able to explain the
relationship between elements of early integration and the properties of a
holding environment in Winnicott's theory of early development.
Class 4 - At the end of this class, candidates will be able to trace the
relationship between problems in early integration and varieties of
environmental failure.
Class 5 - At the end of this class, candidates will be able to list forms of
disintegration anxiety and explain differences between signal anxiety and
primary disintegration anxiety.
Class 6 - At the end of this class, candidates will be able to recognize and
assess indications of primary anxiety and other problems in early integration
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in adult case material.
Class 7 - At the end of this class, candidates will be able to summarize and
explain Winnicott's theory of regression to dependence.
Class 8 - At the end of this class, candidates will be able to apply Winnicott's
concept of regression to dependence in explaining clinical case material.
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