100: Introduction to the Theory and Practice of Psychoanalysis and Psychoanalytic Therapy
Instructors
Robert Smith, M.D.
Laurence Sprung, M.D.
September 11 – November 20, 2024
Wednesdays, 7:00 – 8:20 pm
No class: 10/2
Course Description
This course focuses on aspects of the clinical situation and theoretical concepts that are important in both psychoanalysis and psychotherapy. These include the analytic attitude, the clinical surface, intrapsychic conflict and compromise formation, unconscious fantasy, psychic reality, the developmental point of view, trauma, character and the transference-countertransference matrix. The discussion of these topics will be stimulated by clinical material contained in the readings and provided by the course instructors.
Course Objectives
Upon completion of this course, students will be able to:
1. Describe the essential elements of the clinical situation and the way in which they manifest themselves in clinical work with patients.
2. Explain how these elements are utilized by therapists conducting both psychodynamic psychotherapy and psychoanalysis.
3. Characterize the debates that are have emerged about these concepts, and demonstrate who the way in which the positions that different clinicians take about these debates changes the way they treat a patient.
Evaluation Method
Each student’s participation in class discussion and his or her demonstration of understanding of the course objectives and reading material is assessed in a written evaluation by the instructor(s).
These articles are protected under relevant copyright regulations. They are available in the New York Psychoanalytic Society & Institute Electronic Reserve for your convenience, and for your personal use.
READINGS ARE CONFIRMED.
I. Creating an Atmosphere of Safety
CLASS 1: September 11, 2024
Creating an atmosphere of safety may seem obvious but we want to emphasize its importance in view of the fact that individuals arrive and meet a total stranger to whom they are supposed to reveal everything. And we are also asking about the factors contributing to how that atmosphere can be maintained even in the face of unusual, strange or even socially “rude” behavior.
The therapeutic situation involves a number of profound paradoxes. For example, even for people who seem desperate for help, this new situation is a huge threat, consciously or not. Freud stressed that change is extremely hard for all of us, so paradoxically, individuals seek help to change, yet deeply don’t wish to change. Freud was also very aware of how powerfully the yearning for authority runs in humans, so we need to be careful about using authority instead of exploring it.
So “exploration” (or finding out more) is a key word for setting up this unique, new relationship, meaning not having an agenda for the person or what is talked about, without assuming anything is “obvious,” and with little prepared opinion about what’s best for the patient. If the situation isn’t safe, the patient cannot take on the multiple risks that are needed for progress. It helps to remember that when Freud wrote his technical papers, he had not yet detailed the developmental sequence of the prototypical danger situations: loss of the object, loss of the object’s love, castration, and superego condemnation. Nowadays we’d add loss of self-cohesion, annihilation, and loss of differentiation of self from the object.
The last point brings up the issue of boundaries and another paradox. Therapist and patient both have to deal with the temptation and fear of breaking down the therapeutic boundaries. Sidney Tarachow called this “object hunger” and helpfully emphasized that both participants are always struggling with it, although in different ways. Just consider the fact that in an intimate successful therapeutic venture there is a real and close working together of two minds. How do we reconcile this with the therapeutic barrier and therapeutic task? We keep exploring subjects that are difficult, thereby implying that our patients should take the risk of experiencing unpleasant, even painful feelings. We ask that our clients tolerate moments of loneliness and we ourselves have to tolerate it also. Tarachow mentions therapists’ common temptations: lessening the patient’s tension level and offering oneself as a nurturer.
REQUIRED READINGS
Schafer, R. (1983) The Analytic Attitude. Basic Books, NY Chapter 1, The Analytic Attitude, an introduction pp. 3-13. (You may enjoy reading other parts of this book.)
II. Conflict, Compromise Formation, and Unconscious Fantasy
CLASS 2: September 18, 2024
Largely through the study of dreams, Freud developed his early topographic model in which the psyche is constituted by three “systems”. He defined the unconscious as being composed of libidinal drive derivatives (wishes and fantasies), characterized by primary process (irrational) thought and operating under the pleasure principle. He further defined the preconscious and conscious systems as characterized by secondary (rational) process thought and operating under the reality principle. The self-preservative instincts repressed unconscious wishes because they were perceived as dangerous. As he gained clinical experience, Freud realized that patients often directed aggression towards themselves and unconsciously resisted analytic treatment despite their conscious wishes to get better. These problems led him to develop a new model, in which the mind is composed of the id, ego and superego and defends itself against four potential catastrophes. These are:
Loss of the object (initially the mother)
Loss of the love of the object
Castration anxiety
Superego anxiety (guilt)
In what came to be known as the structural model, the threat that one or more of these catastrophes could occur provokes signal anxiety which results in defense. Consequently, the technique employed in psychoanalysis shifted from interpreting repressed unconscious material to focusing on defense and intrapsychic conflict. Anna Freud made a major contribution with her 1936 book on defense mechanisms. Charles Brenner and Jacob Arlow (both of whom trained at NYPSI) further developed the concepts of conflict, defense, compromise formation and unconscious fantasy. They viewed intrapsychic conflict as essentially a dynamic state of opposition between or among important components of mental life, some of which are unconscious. Sander Abend was a prominent conflict theorist at NYPSI who explicated their views in a clear writing style using rich clinical material.
Since this paper is intended for practicing analysts as a technical guide to how to analyze intrapsychic conflict, the initial condensed summary will likely be difficult for some of you. Abend refers to later developments that have deepened our understanding of the concepts in his discussion. One is increased attention to pre-oedipal factors (referring to the period of development in the first three years of life) in which fears of being devoured or engulfed are common. Knowing this provides you with the theoretical basis for Abend’s speculations about these fears in his clinical example. We suggest that you read through the first pages and then focus on the clinical example beginning on page 14. [It is always helpful if you look up the meaning of any terms you encounter that you don’t understand.]
See if Abend’s understanding of his patient and the kinds of interpretations he makes strike you as apposite.
What would you say are the patient’s compromise formations? Unconscious fantasies?
Does Abend provide sufficient information to make his hypotheses about Mr. X. plausible? Do you see problems with his claims?
REQUIRED READINGS
Abend, S. (2005). Analyzing Intrapsychic Conflict. Psychoanal. Q., (74)(1):5-25
SUPPLEMENTAL READINGS
Erreich, A. (2015). Unconscious Fantasy as a Special Class of Mental Representation: A Contribution to a Model of Mind. JAPA, (63)(2):247-270.
Jimenez, J. (2017). Unconscious Fantasy (or Phantasy) as Clinical Concept. Int. J. Psychoanal., (98)(3):595-610.
Reed, G. (2017). Unconscious Fantasy in Context: The Work of Jacob A. Arlow. Int. J. Psychoanal., (98)(3):821-830.
III. The Clinical Surface
CLASS 3: September 25, 2024
Why is the idea of clinical surface important?
One reason is that the concept of analytic “surface” is as old as Freud’s earliest writings on his discovery of the “talking cure.” He meant what was consciously available to the patient, but he also meant that whatever manifested itself in consciousness was derived from the patient’s unconscious. He also emphasized unconscious “resistances” observable on the surface. The word “observable” is important here: we pay attention not only to what our patient says but also how he/she says it, his demeanor, and the way he behaves and moves.
Surface can be a useful metaphor, implying depth, but the meaning can be different for different clinicians. However, some similarities are notable among diverse practitioners: most mean some aspect of the patient’s verbal and non-verbal behavior to which the therapist and patient can direct their attention in order to gain access to important material that will be explored in a consistent manner. The disturbances, discontinuities, or disequilibria in the relationship orient practitioners’ listening. The focus is on changes or disturbances of the surface —the ripples, waves, or glass-like calm that appear and catch our attention, often with an element of surprise. Many clinicians make the theoretical assumption that something “deeper” in the present situation is being revealed by these surface phenomena. The major issue is what part of that “something” will be affectively accessible to the patient. What can the patient genuinely feel as belonging to him/her on that day? What is also alive and salient to the patient, not just cognitively reachable?
Remember that the whole context of the situation of the two people involved is important. The patient is also observing the therapist and possibly many other features of the situation. Analysts pay close attention to the issue of how to speak on a level where the patient is truly accessible. (Analysts from different schools define what is “accessible” differently, however.) Goldberger, following Paul Gray, stresses what is preconscious, i.e. the patient can recognize the affective issue as his own, simply by having his attention turned to it.
We will ask you all to think about and describe what you are likely to observe in this situation that suggests to you that “something” particularly noteworthy is going on, for example, pauses, changes in pace or volume, changes in posture, etc.
REQUIRED READINGS
Goldberger, M. Contribution to Panel on Surface, APsaA, 1990
Gray, P. (1990). The Nature of Therapeutic Action in Psychoanalysis. Journal of the American Psychoanalytic Association, 38:1083-1096. [Focus on the clinical example – pp 1088-1094]
IV. Object Relations/Klein
CLASS 4: October 9, 2024
Object Relations Theory was developed by Fairbairn, Klein and Winnicott, and further developed by Bion, Kernberg and others. An object relation is an intrapsychic representation or structure consisting of three parts: a self-representation, an object representation, and the representation of an affectively charged interaction between self and object. It postulates that all psychic experiences are organized by object relations and holds that individuals are object-seeking from birth. Some object relations theorists (such as Klein) considered the drives as of great importance but conceptualized them differently than Freud. Internalized object relations develop through the interaction of innate factors and relationships with primary caregivers.
Klein built on Freud’s theory of superego development from processes of projection, introjection and identification and proposed that the entire inner world is built out of multiple internalizations that begin very early in life. She developed a model of development through two “positions”, the paranoid-schizoid and the depressive, which differentiate two groups of anxieties and defenses, mental structures, and types of object relation. The chief defenses in the P-S position are splitting, projective identification, and idealization. The result is an unstable sense of sense with alternating phantasies of a good self with a bad object and a bad self with a good object. The depressive position occurs when there is a more advanced state of development. The patient can experience others as whole objects and have concern for the object which creates a capacity to feel guilt. Klein developed her theory influenced by Freud’s late papers and those of her analyst Karl Abraham. She used them to understand the interactions she observed while treating sicker patients.
REQUIRED READINGS
Feldman, M. (1992). Splitting and Projective Identification. Clinical Lectures on Klein and Bion, 14:74-88.
Steiner, J. (1992). The Equilibrium Between the Paranoid-Schizoid and the Depressive Positions. New Library of Psychoanalysis, 14:46-58.
SUPPLEMENTAL READINGS
Ogden, T. (1983). The Concept of Internal Object Relations. Int. J. Psychoanal., (64):227-241.
V. Therapeutic Action
CLASS 5: October 16, 2024
This paper by Gabbard and Westen speaks for itself, but we’re going to enlist all of you in thinking about the issue. “Therapeutic action” is a subject that has led to endless debate in our field: what works to help people? Really helps?
We all have our own very private ideas about what works, and later today we’re going to ask each one of you to say something about what you yourself think works. We want all of you to chime in, even if it seems as if you’re repeating something somebody else said.
Some concepts need to be clarified for all of us. Are you all familiar with the difference between implicit and explicit memory? Or as others might put it, procedural and declarative memory?
Just to help us have a handle on what we “do,” here is an old-fashioned list of “interventions.” (Edward Bibring, 1954) “One can roughly distinguish between five groups of basic techniques: (a) suggestive; (b) abreactive; (c) manipulative; (d) clarifying; and (e) interpretive…” The labels are just a way of being able to name to ourselves what we are doing. Do we need some examples? If you don’t understand any of the words used, please ask or look them up.
With regard to consciousness, several words are commonly used: unconscious, preconscious, subconscious, non-conscious. Let’s be clear among ourselves about those.
- Define reconstruction and enactment.
- What are the three kinds of unconscious associative networks psychoanalytic treatments aim to change?
- What are the two ways that unconscious associative networks must change in order to allow for therapeutic progress?
REQUIRED READINGS
Gabbard, G. and Westen, D. (2003). Rethinking Therapeutic Action. Int. J. Psychoanal., 84:823-841
SUPPLEMENTAL READINGS
Reed, G. S. (2009). An Empty Mirror: Reflections on Nonrepresentation. Psychoanalytic Quarterly, 78:1-26.
VI. Object Relations/Winnicott
CLASS 6: October 23, 2024
Object relations theory was initially developed by Melanie Klein, D.W. Winnicott, and Winfred Fairbairn. An object relation is an intrapsychic relationship between a self-representation and an object representation with an affectively charged interaction. These are formed during development by the combination of fantasy and actual experiences with others. (Klein’s views will be described in the course on Transference Focused Psychotherapy.) Winnicott’s ideas have had a major influence on psychoanalysis. He emphasized the dependence of the infant on the mother in psychic development, distinguishing between needs and wishes. Departing from Freud’s drive theory without completely abandoning it (unlike Fairbairn), he portrayed the baby as object seeking. In his model, a “good enough mother” provides a “holding environment” which allows for the infant to retain the omnipotent fantasy that he or she creates the environment, and thereby the beginning of the development of the self. A “transitional space” develops between the baby and mother where distinctions between “me” and “not-me” and “real” and “unreal” are not made. A “transitional object” such as a teddy bear or piece of cloth occupies the transitional space and is the infant’s first not-me possession. It serves as a psychic organizer for the process of separation-individuation. Winnicott, writing in a poetic style that is richly evocative for some and baffling for others, introduced a number of other important ideas. One is the capacity for concern. He proposed a new reparative approach to the treatment of sicker patients. The holding environment is recreated during the sessions and by the treatment frame.
What other changes in technique did Winnicott suggest? How would you describe the capacity for concern?
REQUIRED READINGS
Abram, J. (2012). On Winnicott’s Clinical Innovations in the Analysis of Adults. International Journal of Psychoanalysis, 93:1461-14.
Winnicott, D. W. (1955). Metapsychological and Clinical Aspects of Regression Within the Psycho-Analytical Set-Up. International Journal of Psychoanalysis, 36:16-26.
VII. Trauma and Dissociation
CLASS 7: October 30, 2024
Trauma is a confusing word. A common meaning of psychological trauma is of an objectively massive, threatening event, one that would be overwhelming to anyone. However, the “objective” meaning is often qualified, with the observation that not everyone who has been subjected to trauma develops posttraumatic stress. Various kinds and severity of “traumatic” events affect people differently. More specifically, many believe that trauma refers to what is overwhelming to that particular individual.
Trauma disrupts reflective functioning; it wipes out the ability to think rationally. “At the moment of trauma the victim is rendered helpless by overwhelming force.” Thus trauma is not just something upsetting—it refers to event(s) that could not be assimilated. Hence if the traumatic event cannot be taken in, it cannot be linked with other experience, and the result is a structural dissociation of experience. Experts on trauma (such as Van der Hart, Van der Kolk, et al.) have emphasized that trauma results in dissociation.
The development of psychoanalytic ideas about trauma is also confusing. In his earliest work with Breuer on hysteria, Freud seemed to be heading for a trauma-based theory that importantly included dissociation. (He certainly knew about dissociation from Janet.) But instead, Freud’s theory turned to an emphasis on repression of forbidden impulses, sexual and aggressive, and the dynamics involved in keeping those impulses out of consciousness.
Those authors who emphasize “the dissociative mind” consider that the presence of multiple “self-states” is a normal part of all human development, i.e., from the beginning of life, we all have disparate senses of our “self.” Only with development is there a more cohesive integration of our various self-states, but it is never fully complete. Philip Bromberg has written, “There is now abundant evidence that the psyche does not start as an integrated whole but is nonunitary in origin—a mental structure that begins and continues as a multiplicity of self-states that maturationally attain a feeling of coherence which overrides the awareness of discontinuity (Bromberg, 1993, p. 162). This leads to the experience of a cohesive sense of personal identity and the necessary illusion of being “one self.” One of the major reasons that this view of the human mind has taken so long to reach full scientific description is that changes of state are, for the most part, difficult to perceive in normal adults. The developmental process that eases the transitions across states of consciousness typically results in a healthy person being able to smooth out awareness of the changes, an achievement that is greatly facilitated by early caretakers who, through a process of mutual regulation, help the child attain nontraumatic state transitions by appropriate interactive responsiveness to the child’s subjectivity.
REQUIRED READINGS
Bohleber, W. and Leuzinger-Bohleber, M., (2016). The Special Problem of Interpretation in the Treatment of Traumatized Patients. Psychoanalytic Inquiry, 36:60-76.
SUPPLEMENTAL READINGS
Howell, E. F. (2014). Ferenczi’s Concept of Identification with the Aggressor: Understanding Dissociative Structure with Interacting Victim and Abuser Self-States. American Journal of Psychoanalysis, 74:48-59.
VIII. Character
Class 8: November 6, 2024
“Character” is not simple to define since it overlaps several concepts, including “ego,” self, style so that sometimes it becomes synonymous with the development of the whole personality. So, let’s first consider what each of us here thinks of as a person’s character.
Character traits are a person’s habitual, long used ways of dealing with the outside and inside worlds. In the old Moore and Fine “Glossary of Psychoanalytic Terms and Concepts” (1968), character is called “that aspect of the personality which reflects the individual’s habitual modes of ringing into harmony his own inner needs and the demands of the external world.” Character styles are also described in Shapiro’s famous 1965 elaboration of “neurotic styles”.
Anna Freud wrote in her 1936 monograph, patients do not feel that character defenses are a foreign body, so “it is not easy to convince him/her of the repetitive nature of these phenomena” (p. 20)
“In my opinion”, she wrote, “we do our patients a great injustice if we describe these transferred defense-reactions as ‘camouflage’ or say the patients are ‘pulling the analyst’s leg’ or purposely deceiving him in some other way. The patient is in fact candid when he gives expression to the impulse or affect in the only way still open to him, namely, in the distorted defensive measure.” She calls this the “transference of defense” and deems it the source of most of technical difficulties which arise between analyst and patient. What is “transference of defense?”
Clinically it’s very important to be aware of the ego-syntonicity of character traits. Are you all familiar with the idea of something being “ego syntonic?”
We’re reading Joseph Sandler because he was able to combine empirical research skills with the highest order of understanding of psychoanalytic theory. From the more traditional frame of reference acquired through his analytic training, Sandler gradually evolved a complex integration of ego psychology and object relations theory that has become increasingly dominant. His training as an experimental psychologist gave him a fresh perspective on traditional concepts, which he supported and altered on the basis of empirical research. His immersion in child development at the Anna Freud Centre also influenced his intellectual development. Sandler revised psychoanalytic theory by placing feeling states rather than psychic energy at the center of the psychoanalytic theory of motivation. This emphasis on feeling states created a bridge between classical drive theories and object relations theories. And it was exactly “bridges” that he wished to create—he liked the idea of “elastic” or “hinge” concepts. He also revised the concept of “superego,” emphasizing that the superego contains approving and permissive, as well as prohibiting, features by giving the child a background feeling of being loved.
Sandler introduced the term actualization into psychoanalysis, in the sense of “to make actual” or “to realize an action.” [We call it “enactment” here.] He wanted to stress that a relationship, an interaction, develops between the two parties to the analytic process. [We should read out loud his clinical examples.]
Sandler suggested that analysts should allow themselves a “free-floating responsiveness,” whereby they accept—at least in part—and reflect on the role assigned to them and put it to good use in understanding their patients. He thought that our interventions should be directed toward that which is most ‘hot’ in the mind of the patient, and by that he meant what was likely to be accessible preconsciously. Individuals are likely to automatically omit ideas they have learned are socially unacceptable. “The comment ‘don’t be silly’ is one of the most powerful and intimidating of the social prohibitions of childhood, and the fear of being ‘silly’ or ‘stupid’ is profound.” So, we become our own disapproving audience without being fully aware of it. Only content that is acceptable will be permitted through to consciousness. It must be plausible and not ridiculous or ‘silly’. This kind of censorship is much more of a narcissistic censorship and it often tends to center around fears of being laughed at, being thought to be silly, crazy, ridiculous or childish—essentially fears of being humiliated.
That’s why we stress creating a setting of safety, so that our patients can start to risk saying things they fear will make them sound some version of unacceptable.
Questions:
1) One common distinction used to contrast character from symptoms is the observation that character is ego-syntonic and symptoms are ego dystonic. What are some implications that this could have regarding the treatment of character related issues compared to the treatment of symptoms?
2) Sandler invites us in the 1981 paper to recognize character traits “as devices for evoking particular types of response in others in order to actualize the wished-for relationships existing in unconscious fantasy”. He also introduces the notion of “free floating responsiveness” in the 1976 paper to describe something happening within an analyst. How can these two concepts be combined to provide a method for carrying out character analysis?
3) Both of Sandler’s papers focus on the aspects of character that mediate a dynamic process occurring between a self and another. Do you think it’s possible to think about character without invoking this concept?
REQUIRED READINGS
Sandler, J. (1981). Character Traits and Object Relationships. Psychoanal. Q., 50:694-708.
Sandler, J. (1976). Countertransference and Role-Responsiveness. Int. R. Psycho-Anal., 3:43-47.
SUPPLEMENTAL READINGS
Lax, R. (1989). The Narcissistic Investment in Pathological Character Traits and the Narcissistic Depression: Some
Implications for Treatment. Int. J. Psychoanal. 70:81-90
IX. Transference-Countertransference
Class 9: November 13, 2024
The meaning of the term countertransference has evolved as different schools of psychoanalysis have developed. It has become such an important concept that if we can understand the way a school conceptualizes and uses countertransference in the clinical situation we learn a lot about the essence of that approach. Originally, countertransference was seen as an unhealthy reaction by the analyst to the patient’s transference which interfered with the analyst’s ability to observe the patient in an objective way and make correct interpretations. As such, it required self-analysis or consultation to eliminate or limit its destructive effects. With the development of the Klein/Bion model of object relations, it became a result of projective identification, a process in which the patient unconsciously projects unacceptable aspects of his or her self or object representations onto the analyst and then interacts with the analyst in ways that induce the analyst to subjectively experience those representations. We have already studied Sandler’s related but different view of countertransference as role responsiveness. Schwaber’s focus on attempts to detect all the ways in which the analyst is imposing his or her view on the patient is yet another perspective on countertransference which was influenced by Kohut’s self psychology. Some relational analysts would stress the analyst’s continuous and inevitable unconscious subjective responses to the patient which lead to enactments which can only be apprehended retrospectively. Understanding those enactments becomes the key to the treatment.
Most contemporary analysts agree that countertransference can be an unconscious problem in the analyst that manifests itself in destructive ways in the analysis. In addition, most would also agree that it can be an essential method of communication, a source of information about what is going on unconsciously in patient and analyst. In Ted Jacobs’ excellent case presentation, he sensitively describes how certain transferences and defenses in his patient stir up potential countertransferences in him, and how the patient’s issues overlap with some of his own. Consequently, he knows that he has to remain as aware as possible of these potential pitfalls in order to minimize their negative effects. Specifically, he describes his wariness about responding to Mr. B.’s aggression with attacks of his own, and how Mr. B.’s detachment from his feelings creates a pull in Dr. Jacobs to join the patient in guessing about what his patient might be feeling. Winnicott discusses the treatment of “psychotic patients” by mental health workers. The term refers to a group of patients that include those with what we would now consider more severe personality disorders. He defines objective hate in the countertransference as an appropriate reaction induced by the patient’s provocative, sadistic behavior. He warns that the analyst must recognize the hatred he feels towards the patient so he or she will be able to meet the needs of the patient. Winnicott stressed that, like a good enough mother with her child, the analyst must tolerate and accept the patient’s aggression.
REQUIRED READINGS
Jacobs, T. (2004). The Case of Mr. B. Int. J. Psychoanal. 85:1311-1319.
Winnicott, D.W. (1949). Hate in the counter-Transference. Int. J. Psychoanal. 30:69-74.
X. Racial Enactments
CLASS 10: November 20, 2024
Many contemporary psychoanalysts no longer make a sharp distinction between the social and the psychological. Leary defines racial enactments as interactive sequences embodying the actualization in the clinical situation of cultural attitudes towards race and racial differences. The Black Lives Matter movement has increased attention to the ways in which racism affects clinical practice. Leary observes that analysts have been slow to develop effective clinical theory about race and racial difference. The dynamics of race have centered around dialectics such as powerless and control, and privilege and exclusion so that social discourse on race has been avoided. Consequently, when racial enactments occur, they can be especially fruitfully explored if both parties are willing to take an honest look at what has transpired. Leary advocates a mutual exploration in which the analyst is open to considering her role in the enactment as described by the patient. She views some attempts to address the “developmental lag” in taking into account the role of race in analysis as a failure to appreciate how race and ethnicity are dynamic constellations with relevance to all persons. She also notes that the importance of race as an intimate, valuable, and independent aspect of personal social identity has been deemphasized or neglected by analytic theorists and practitioners. The variability in the ways in which individuals experience and define race highlights the degree to which it is socially constructed. Leary also points out that incorporating race into one’s self-image can increase self-esteem but also create susceptibility to narcissistic injury. These themes are illustrated in an extended clinical example.
Questions:
- What are the arguments for and against Dr. Leary telling her patient Gloria that the changes in their schedule were necessary because she was beginning her analytic training?
- What does Leary say makes racial enactment different from other clinical phenomenon?
- In what way do Boesky and Renik understand enactments differently?
REQUIRED READINGS
Leary, K. (2000). Racial Enactments in Dynamic Treatment. Psychoanal. Dial., (10)(4):639-653.
SUPPLEMENTAL READINGS
Powell, D. (2018). Race, African Americans, and Psychoanalysis: Collective Silence in the Therapeutic Conversation. J. Amer. Psychoanal. Assn., (66)(6):1021-1049.