COLUMBIA UNIVERSITY
CENTER FOR PSYCHOANALYTIC TRAINING AND RESEARCH
CLINICAL THEORY OF TECHNIQUE III: MIDDLE AND LATER PHASES & CURRENT
CONTROVERSIES
Course Chair - Dr. Brenda Berger
Associate Instructor – Dr. Barry Stern
Instructors: Drs. Sharone Ornstein, Gloria Stern, Hillery Bosworth, Tony Bass, Chris Allegra, and
Brenda Berger
MONDAYS, 11AM - 12:45PM
In this course we will discuss psychoanalytic theories of therapeutic action and how these inform
psychoanalytic technique. Special consideration will be given to different ways that
countertransference; erotic and sadomasochistic transferences are conceptualized and worked
with. By the end of the course candidates should be able to describe theories of therapeutic
action and essential techniques used in the ego psychological, Kleinian, self psychological, and
relationalist schools. Candidates, reflecting on their own cases, should be able to offer theories
as to how interventions they made affected change in their patients.
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing
Medical Education (ACCME) through the joint sponsorship of the American Psychoanalytic Association and the Columbia University Center for
Psychoanalytic Training and Research. The American Psychoanalytic Association is accredited by the ACCME to provide continuing medical
education for physicians.
The American Psychoanalytic Association designates this Live Activity for a maximum of 1 AMA PRA Category 1 Credit per hour of instruction.
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
IMPORTANT DISCLUSURE INFORMATION FOR ALL LEARNERS: None of the planners and presenters of this CME program have any relevant
financial information to disclose.
What is it we do: Mainstream Theories of Technique
1.
2.
3.
Defining Psychoanalysis - The Question of a Theory of Technique for
Psychoanalysis
Analysis of Transference – Object Relations-Ego Psychological Frame of
Reference
Countertransference – Object Relations –Ego Psychological Frame of Reference
Dr. Stern
Dr. Stern
Dr. Stern
Analytic Listening From a Self-Psychological Frame of Reference
4.
5.
6.
Analytic Listening and Intervening I– Self Psychological Approach
Analytic Listening and Intervening II – Self Psychological Approach
Working with Defense – Self Psychological Approach
Dr. Ornstein
Dr. Ornstein
Dr. Ornstein
Relational Theories of Technique
7.
8.
9.
Analytic Listening - Relational Perspectives
Analytic Intervention – Relational Perspectives
Analysis of Resistance - Ego Psychological, Object Relational and Relational
Perspectives
Dr. Bass
Dr. Bass
Dr. Bass
Transference Analysis and Working Through
10.
Understanding and Working with the Erotic Transference and Countertransference
Dr. Berger /
Dr. Allegra
11.
Understanding and Working with the Erotized Transference and
Countertransference
Understanding and Working with Sadomasochistic Transferences and Enactments
Dr. Berger /
Dr. Allegra
Dr. Berger
12.
The Analyst as a Real Person
13.
14.
The Impact of the Analyst’s Gender and Pregnancy on the Analysis
Analytic Anonymity in the Digital Age
Dr. Bosworth
Dr. Bosworth
Working with Dreams
15.
16.
Working with Dreams Classically
Working with Dreams as a Kleinian/Interpersonalist/Object Relationist
Dr. Bosworth
Dr. Bosworth
What is it we do: Mainstream Theories of Technique
1.
Defining Psychoanalysis - The Question of a Theory of Technique for
Psychoanalysis
Dr. Stern
1. Abend, S.B (2007): Therapeutic action in modern conflict theory. Psychoanalytic Quarterly,
76S:1417-1442
2. Godbout, C (2004): Reflections on Bion’s “Elements of Psychoanalysis.” International Journal of
Psychoanalysis, 85:1123-36
3. Kernberg, O. (2004): Convergences and Divergences in contemporary analytic technique. In
Contemporary Controversies in Psychoanalytic Theory, Techniques and their Applications. New Haven,
Yale University Press, Chap 17, 267-284
______________________________________________________________________________
2.
Analysis of Transference – Object Relations-Ego Psychological Frame of
Reference
Dr. Stern
1. Cooper, A. (1987): Changes in psychoanalytic ideas: transference interpretation. JAPA 35: 77-98
2. Joseph, B (1985): Transference: the total situation. IJP, 66:447-454
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3.
Countertransference – Object Relations –Ego Psychological Frame of Reference
Dr. Stern
1. Racker, H (1957): The meanings and uses of countertransference. Psychoanalytic Quarterly 26:303357
2. Steiner, J (2006): Interpretive enactments and the analytic settings (with comments by Edgar
Levenson) International Journal of Psychoanalysis, 87:315-328
Analytic Listening From a Self-Psychological Frame of Reference
4.
Analytic Listening and Intervening I– Self Psychological Approach
Dr. Ornstein
In these three classes, we will discuss the listening stance, what we are listening for, the interpretive
process and the concept of the therapeutic action from a self psychological perspective. In each class, we
will discuss the author’s views on these topics, their usefulness to your work, as well as your own ideas
about these concepts in your work.
Schwaber E.A. (1981): Narcissism, Self Psychology and the Listening Perspective. The Annual of
Psychoanalysis, 9:115-131.
Self object definition – entry from Psychoanalytic Terms and Concepts, edited by Auchincloss and
Samberg
Study questions
What does Schwaber think is essential in Kohut’s contribution to narcissism?
What does Schwaber mean by ‘contextual unit’ and what are its therapeutic implications?
Using Schwaber’s clinical vignettes, discuss her use of empathy and her understanding of defense and
resistance.
What is Schwaber’s description of ‘narcissistic entitlement’ and how does she approach it?
______________________________________________________________________________
5.
Analytic Listening and Intervening – Self Psychological Approach
Dr. Ornstein
Along with the readings, we will use the clinical material that Alicia presented in your last class to discuss
the treatment process and particularly the use of countertransference from a self psychological
perspective.
1. Teicholz J.G. (2000): Chapter 3 The Analyst’s Empathy, Subjectivity, and Authenticity, Affect as
the Common Denominator. Progress in Self Psychology, 16: 33-53. On PEP WEB
This article is a response to a critique of self psychology from the relational perspective. It is
likely to be a perspective that you are not familiar with. It will open a discussion of the
different ways in which psychoanalysts think about themselves and use themselves in the
analytic situation. This will necessarily include the variety of ways in which
countertransference is viewed and used.
Study Questions
What is Teicholz’s view of empathy? How does she relate it to the analyst’s subjectivity and
authenticity?
Using the lens of one person and two person psychology, where does Teicholz place self
psychology?
Have you had a recent experience in which you struggled with how to use your subjectivity in the
service of an empathic response to a patient?
.
2. Stolorow, R. (1993): Thoughts on the Nature and Therapeutic Action of Psychoanalytic
Interpretation. In Progress in Self Psychology, 9: 31-42. [on PEP WEB]
This is a succinct statement about therapeutic action informed by self psychology. Stolorow makes the
important distinction between empathy as establishing a bond between two people and a mode of
observation and listening perspective.
Study Questions
What is Stolorow’s rationale for using the phrase, ‘sustained empathic inquiry’, rather than Kohut’s
phrase, ‘sustained empathic immersion’? Do you find his parsing of empathy useful?
What is Stolorow’s view of the dichotomy between interpretation and the therapeutic relationship? How
does this compare to other psychoanalytic perspectives?
In Stolorow’s view, what gives interpretations their mutative power?
______________________________________________________________________________
6.
Working with an Idealizing Transference and Narcissistic Rage: A Self
Psychological Approach
Dr. Ornstein
Goal of this class:
In this class we will use of clinical material to discuss and illustrate ways of working with an idealizing
transference and narcissistic rage. Once you conceptualize clinical material in terms of a selfobject
transference, it alters your interpretative approach of transference and its disruption. I will present some
clinical material. Please feel free to bring in a clinical vignette in which you struggled with the issue of
narcissistic rage in the treatment process.
You can review Kohut’s classic paper ‘Thoughts on Narcissism and Narcissistic Rage’ (1972) which you
read last year in Theory II.
Readings:
1. Kohut, H. (1971) Analysis of the Self, Chapters 1,2, 3, 4 pp. 37-101. These chapters discuss
idealizing transferences and contain a clinical illustration. It is more reading than I usually assign,
but I think the struggle with the material will be worth it.
I am assigning this reading because it comes from a classic work that has had a significant impact on
psychoanalysis since its publication. It is difficult reading because Kohut is using old ego psychological
terms to discuss new ideas and his writing style is not particularly clear. You will certainly have a feel for
how seriously Kohut took psychoanalytic theory. Keep your focus on the big ideas. Here are some
points to guide your reading:
1. Kohut is introducing the selfobject (written self-object at the time) concept. He uses the term
idealizing libido- he is referring to the quality of a relationship. See footnote on page 42.
2. He is talking about narcissism as a re-instated need with its own line of development from
archaic to mature and not as a retreat or defense from object love or a reaction formation
against hostility.
3. Kohut’s clinical example is notable for many things, but for the contemporary reader it is
most notable for its lack of description of Kohut’s countertransference. There is very little
description of process. His goal was to illustrate his theoretical conceptualization. We will
use the ideas presented in these chapters, including the clinical case, to see how thinking and
technique differ among different theoretical frames of reference.
Narcissistic Rage, definition entry from Psychoanalytic Terms and Concepts, ed by Auchincloss and
Samberg. To be email. Not for copy or circulation.
Relational Theories of Technique
Each of these three sessions on a relational theory of technique will combine a consideration of relational
perspectives on a theory of technique through discussing relevant selections from the relational literature
(each essay contains clinical material along with a consideration of the theory that guides clinical choices)
with an experiential, interactive process in which we will explore and demonstrate a relational approach
to therapeutic praxis. We will approach the latter by considering unconscious dimensions of
psychoanalytic relating and being, and our approach to patients through our engagement with difficult
analytic moments.
Participants in the seminar will be invited to share their work with patients with whom they have found
themselves to be unusually intensely involved: that is, with patients who have evoked particularly intense
(countertransference) reactions in their analyst. Please bring clinical vignettes and/or process material
reflecting difficult or challenging patients or moments, to class. This might include patients who are
found to be particularly affectively arousing in one way or another (patients whom we love or hate, arouse
us erotically, or to anger or sadness), or disturbing, patients about whom one dreams at night, or becomes
preoccupied with by day, or who evoke anxious or counter-resistive responses, such as falling asleep or
becoming bored. These analytic moments that are often at the heart of enactments in psychoanalytic
work, from a relational perspective, provide special opportunities for gaining access to the ways in which
the unconscious life of patient and analyst emerge in the analysis, creating special challenges and special
opportunities for deepening the work. We will consider these moments in the context of key relational
concepts, such as working in the tranference/countertransference field, enactment, inadvertent and
intentional self-disclosure, the analyst’s use of his/herself, intersubjectivity and its relevance to analytic
process, approaches to constructing and negotiating an analytic frame, etc. Please come to class prepared
to share some clinical process for us all to consider.
7.
Relational Perspectives - Analytic Listening and Intervention (historical roots and
contemporary perspectives
Dr. Bass
1. Selection from Ferenczi’s Diary—the Roots of Working with Countertransference
2. Ferenczi, S—Confusion of Tongues between the Adults and the Child: The Language of Tenderness
and Passion (early roots of relational clinical theory)
3. Parsons, M., 2009 An Independent Theory of Clinical Technique Psychoanalytic Dialogues Vol. 19
Issue 3 221-236 11-711-716
4. Bass, A., 2009 An Independent Theory of Clinical Technique viewed through a Relational Lens
Psychoanalytic Dialogues Vol. 19 Issue 3 p. 237-245
Relational Theories of Technique, continued.
8.
Relational Perspectives - Analytic Listening and Intervention
Dr. Bass
1. Bass, A., 2001 It Takes One to Know One, or Whose Unconscious is It? Psychoanalytic Dialogues 11: 683-702
2. Williams, P. 2001 Object Relations: Symmetry and Asymmetry: Commentary on Paper by Bass
Psychoanalytic Dialogues 11: 711-716
3. Bass, A. 2001 Mental Process, Psychic Structure and Analytic Relations: How People Change in
Analysis: Reply to Commentaries 11:717-725
4. Mitchell, S. The Analyst’s Intentions: Chapter 6 in Influence and Autonomy
______________________________________________________________________________
9.
Relational Perspectives - Analytic Listening, Intervention and the Frame of Analysis
Dr. Bass
1. Bass, A. , 2007 When the Frame Doesn’t Fit the Picture Psych. Dialogues Vol. 17: 1-27
2. Bromberg, P. Bromberg, P.M. (2007). The Analytic Moment Doesn't Fit Analytic “Technique”:
Commentary on Tony Bass's “When the Frame Doesn't Fit the Picture”. Psychoanal. Dial., 17:909-921.
3. Gabbard, G. (2007). Flexibility of the Frame Revisited: Commentary on Tony Bass' “When the Frame
Doesn't Fit the Picture”. Psychoanal. Dial., 17:923-929.
4. Bass, A. 2007 Framing Further Considerations Psych. Dialogues 17: 931-943
Recommended readings (time-permitting)
1. Black, M.J. (2003). Enactment: Analytic Musings on Energy, Language, and Personal Growth.
Psychoanal. Dial., 13:633-655.
2. Bass, A. (2003). “E” Enactments in Psychoanalysis: Another Medium, Another Message. Psychoanal.
Dial., 13:657-675.
** NOTE - No Class on 12.6: Class #12 will meet on
Thursday, 12.9 from 11 –12’45 **
Transference Analysis and Working Through
10.
Understanding and Working with the Erotic Transference and Countertransference
Dr. Berger /
Dr. Allegra
Readings
1. Freud, S (1914): Observations on transference love. S.E. 12: 159-171
2. Gabbard, G. (1994): Sexual Excitement and Countertransference Love in the Analystc. JAPA 42:
1083-1106 [on PEP WEB]
Goals of sessions 10 and 11:
1. To define and understand the importance of the erotic and erotized transference and
countertransference
2. To grapple with the complex technical challenges involved in managing and working with them
Study Questions:
1. How does Freud conceptualize the analysts’ job viz-a-viz the working through of transference love?
With what kind of clinical examples is he working, and through which theoretical lens is he formulating?
2. Freud is ambivalent through this paper as to whether “erotic love” is real love. What does Freud mean
when he writes about transference love as “resistance?” Freud argues against transference love being a
“genuine kind of love.” What are your thoughts about this?
3. Freud and Gabbard refer to the centrality of MANAGING the erotic transference. What factors make
this technically complex?
4. How does Gabbard define an erotic transference enactment?
5. How do you understand the aggressive underpinnings of erotic transference and countertransference,
the aggression beneath the lovesickness going both ways?
6. To what kinds of subtle forms of countertransference enactment does Gabbard draw our attention? Can
you think of examples from your own clinical cases?
Transference Analysis and Working Through, cont.
11.
Understanding and Working with the Erotized Transference and
Countertransference
Readings
1. Gabbard, G (1994) On Love and Lust in Erotic Transference. JAPA 42:385-403)
Dr. Berger /
Dr. Allegra
2. Stern, Daniel (1993) Acting Versus Remembering in Transference Love and Infantile Love, pp. 172185 in Person, E. et al (ed) On Freud’s Observations on Transference Love” .
3. Schafer, R. (1993): “Five readings of Freud’s ‘Observations on transference love”, pp. 75-95. In
Person, E et al (ed) On Freud’s Observations on Transference-Love.
Study Questions:
1. What are Gabbard’s thoughts about why the erotic transference is so important to unpack, analyze and
work through?
2. In working through with Mr. M., how does Gabbard USE his countertransference effectively? Through
which theoretical lens or lenses does he view this case?
3. What are your thoughts about Gabbard’s idea that we have to establish a “dual state of awareness” in
this work, that we must simultaneously be active and passionate, as well as dispassionate and reflective
4. Schafer posits two possible reasons why Freud may not have taken up the real aspects of transference
love, one technical, the other theoretical. What were they?
5. Schafer points out that in contemporary psychoanalysis, we have a broader and more positive view of
countertransference and a different view of the aggression in the erotic transference. How do such
therapeutic changes help us technically?
6. Schafer strongly criticizes Freud for having what he calls a “patriarchal bias as a countertransference”
in the way he writes about the erotic transference. Do you agree/disagree? What are the theoretical and
technical implications of such a countertransference
7. Can you think about clinical examples in which you have seen Stern’s point that infantile love and
erotic transference look alike. How does Stern help you (or does he) with understanding what Freud
called the patients’ “preconditions for loving” revealed through analysis of erotic and erotized
transferences?
Transference Analysis and Working Through, cont.
12.
Understanding and Working with Sadomasochistic Transferences and Enactments
Dr. Berger
Readings
1. Steiner, J. (1993): “Revenge, resentment, remorse and reparation” in Psychic Retreats, pp. 74-87
2. Meyers, H. (1993) “A consideration of treatment technique in relation to the function of masochism,”
in Masochism: Current Psychoanalytic Perspectives ch. 10, p. 175-188.
3. Cooper, A. (1992): Problems in treating masochistic patients, 1992
Optional:
Cooper, A. (1988): “The Narcissistic Masochistic Character” in Masochism Current Psychological
Perspectives, ed. Glick and Meyers, Hillsdale: The Analytic Press, 1988
Novick and Novick (1987): The essence of masochism. Psychoanalytic Study of the Child, 42: 353-384
The Analyst as a Real Person
13.
The Impact of the analyst’s gender and pregnancy on the analysis
Dr. Bosworth
1. Raphling, D and Chused, J. (1988): Transference across gender lines. JAPA. 36:77-104.
2. Bassen, C. (1988): The impact of the analyst’s pregnancy on the course of analysis. Psa. Inquiry, 8:
280-298
___________________________________________________________________
14.
Analytic Anonymity in the Digital Age
Dr. Bosworth
1. Aron L (1991): The patient’s experience of the analyst’s subjectivity. In Mitchell SA & Aron L (eds.):
Relational Psychoanalysis: The Emergence of a Tradition, pp. 245-265. Hillsdale, NJ: Analytic Press,
1999 [orig. pub. Psychoanalytic Dialogues 1(1):29-51, 1991]
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Working with Dreams
15.
Dream Interpretation 1: Basic Principles and Ego psychological Perspectives
Dr. Bosworth
1. Greenson, R. (2001) Chapter 9 Basic Technical Suggestions for Dream Interpretation, in The
Technique and Practice of Psychoanalysis 2, pp. 181-210, Sugarman, A., Nemiroff, R., Greenson, D., eds.
2. Blechner, M (2001) Chapter 10 "How to Analyze Dreams: Fundamental Principles," in The Dream
Frontier pp. 122-140
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16.
Dream Interpretation 2: Kleinian and Interpersonalist Perspectives
Dr. Bosworth
1. Blechner, M. (2001): Chapter 15, “Kleinian positions and dreams,” in The Dream Frontier pp. 177184, Analytic Press.
2. Ogden, T.H. (1996). Section III "Dream Association," in Reconsidering Three Aspects Of
Psychoanalytic Technique. Int. J. Psycho-Anal., 77:891-896