Seminar Leader: M.K. O’Neil
The purpose of this course is to provide candidates, from the outset of their analytic training, exposure to clinical thinking and process, as well as ongoing participation in discussion about their own and their colleagues’ developing practices and skill acquisition. This is an important foundation and stimulus for the ability to sensitively and confidently enable patients to enter into and profit from psychodynamic therapy, with the goal of nurturing the unfolding therapeutic relationship, and increasing patients’ receptivity to participating in psychoanalytic treatment. This course will also discuss the establishment and maintenance of the treatment “frame” or “contract” as it facilitates analytic process as well as serves the needs of defense and resistance. The Group Supervision is based on clinical material brought by one candidate (who is also receiving individual supervision for the case). A brief history is followed by verbatim sessions from an on-going psychoanalytic case. A training and supervising psychoanalyst will facilitate an in-depth discussion of the clinical material. The intensive study of the psychoanalytic case will allow the candidate to observe when the process is deepening, when resistances intensify or weaken, when conflicts become ready for interpretation and to understand how to foster this deepening, to integrate aspects of basic psychoanalytic technique, such as listening with evenly hovering attention, the formulation and timing of interpretations, and listening to the patient’s conscious but, especially to involuntary, unconscious responses to the interpretations. The focus is on integration of the many faceted psychoanalytic theories of human psychological functioning and theories of change. Through a detailed examination of many sessions the group supervision course teaches candidates how to perceive, comprehend, and manage in a helpful manner, transference, countertransference, and their interaction. The group supervision provides candidates with experience of the uses and benefits of clinical consultation and discussion. The Psychoanalytic Case Seminar focuses at all times on the safe and effective use of the self and on risk assessment. The candidates learn to structure and to facilitate a therapeutic process. They read professional literature and applied research suited to the case.
Candidates will be able to:
- Use the clinical material from a current case brought by a candidate in order to explore the nature of a patients’ anxiety, depression, neurotic and borderline symptoms, and inhibitions; to apply a knowledge of psychopathology (1.2) to formulate a risk assessment (4.4) using major diagnostic categories (1.3), including the impact of trauma (1.2).
- Apply psychoanalytic theories of change (1.2) and demonstrate that they can make effective interventions based on sound formulations to bring about beneficial change in the patient.
- Become aware of signals in the countertransference to the patient, which require attention (possibly in the personal analysis) so as to protect the patient from a negative impact of the therapist’s subjective context on the therapeutic process, a counterproductive impact of power dynamics within the therapeutic relationship, or an imposition of the therapist’s personal issues. (4.3)
- Employ effective verbal and non-verbal communication adapted to the patient, and use self-disclosure appropriately. (4.3)
- Individualize goals and objectives for the particular problems of the patient being presented (4.5), in order to formulate and re-formulate a direction for therapy (4.5), and to assess for specific risks (4.4) in the opening phase and as the psychoanalysis progresses. (1.4)
- Apply a range of clinical concepts in making interventions: understanding problems with depression, self esteem regulation, emotional regulation, anxiety, trauma, dependency vs. independence, identity conflicts, capacity for intimacy; tracking and interpreting enactments, narcissistic transferences, indications of unconscious fantasy; interpreting defenses as strategies, such as projective identification, denial, acting out, intellectualization, dissociation. (1.2, 1.4)
- Apply the core clinical concepts and techniques defined and elaborated in the readings on technique, which incorporate recent research (5. 2 a). Candidates will use the verbatim session material from the on-going case to make sound, therapeutic formulations and to establish an interventional strategy which can guide a therapeutic approach suited to each patient’s malfunctions, thus mastering sound technical approaches to the healing of neurotic suffering by means of psychoanalysis and psychoanalytic psychotherapy. (1.2, 1.4)
- Track the impact of therapist on the patient (1.4) by listening to how the patient hears an intervention or adjusts to an issue in the frame.
- Establish a therapeutic relationship (1.2) understanding the therapeutic alliance
- Employ sympathetic understanding, empathy, respect, authenticity, establish rapport and make good contact with the patient (4.2).
- Maintain a non-judgmental stance (4.2) using the fundamental “analytic attitude”.
- Develop skills in observation of self and the therapeutic process (4.2) by tracking the countertransference and listening to the way the patient hears us; re-formulating the case progressively tracking change and no change in the patient; interpreting in new directions as the patient’s psychic functioning shifts to make new interpretive strategies possible and appropriate (4.5).
- Respond non-reactively to anger, hostility, and criticism from the patient; respond professionally to expressions of inappropriate sexual or aggressive attachments and transferences (4.5); remain sensitive to the analytic setting and maintain appropriate therapeutic boundaries (4.2).
- Experience the benefits of clinical consultation and peer group clinical discussion, so as to establish on-going professional development after graduation. (3.4)
- Be able to identify whenever a patient may be benefited by a consultation with an allied professional, such as a psychiatric consultation for severe depression or psychosis (4.4).
- Maintain effective relationships with peers in the Group Supervision; recognize and address any conflict over theoretical approaches in a constructive manner; demonstrate personal and professional integrity (2.2).
- Contribute to a collaborative and productive atmosphere in the class discussions of verbatim clinical material; create and sustain working relationships with colleagues of diverse socio-cultural identities in the class and show respect to others who have different views on a clinical problem (2.2).
- Take the first steps to evaluate and enhance professional practice; to undertake critical self-reflection; plan, rethink, and implement methods to assess effectiveness of interventions; obtain feedback from peers and supervisors to assist in practice review; identify strengths as a therapist and areas for development; initiate clinical supervision or consultation when appropriate or required and learn methods of disguising the patient’s identifying data to protect client privacy and confidentiality.(3.4)
- Structure and facilitate the therapeutic process to focus and guide sessions; engage client according to their demonstrated level of commitment to therapy; facilitate client exploration of issues and patterns of behaviour; support client to explore a range of emotions; employ a variety of helping strategies; ensure timeliness of interventions; recognize the significance of both action and inaction; identify contextual influences; review therapeutic process and progress periodically and make appropriate adjustments. (4.5, 1.4)
- Remain current with professional literature; read current professional literature relevant to practice area; access information from a variety of current sources; analyze information critically; determine the applicability of information to particular clinical situations; apply knowledge gathered to enhance practice; remain current with developments in foundational areas (5.1).
- Use research findings to inform clinical practice; integrate knowledge of research methods and practices; determine the applicability of research findings to particular clinical situations; analyze research findings critically; apply knowledge gathered to enhance practice (5.2).
Clinical Approaches with Narcissistic disorders and Borderline disorders and Dissociative disorder
Bird, B. (1972). Notes on transference, universal phenomenon and hardest part of analysis: “destructive tendencies”. Journal of the American Psychoanalytic Association, 20, 287-296.
Stein, M.H. (1990). Acting out: special considerations of diagnosis and technique. In On Beginning Analysis (pp. 179-20). Jacobs & Rothstein (Eds.). Madison, CT: International Universities Press.
Boyer, L.B. (1989). Countertransference and technique with regressed patients. International Journal of Psychoanalysis, 70, 701-713.
Abend, Porder & Willick. (1983). Chapter 7: Transference and technique. In Borderline Patients: Psychoanalytic Perspectives (pp. 174-205). New York, NY: New York University Press.
Orgel, S. (1977). A form of acting out in the narcissistic transference. Psychoanalytic Quarterly, 46, 684-685.
Brenner, I. (1996). On trauma, perversion, and “multiple personality”. Journal of the American Psychoanalytic Association, 44, 785-814.
Rosenfeld H.A. (1964). On the psychopathology of narcissism: a clinical approach. International Journal of Psychoanalysis, 45, 332-337.
Segal, H. (1972). A delusional system as a defence against the re-emergence of a catastrophic situation. International Journal of Psychoanalysis, 53, 393-401.
Joseph, B. (1983). On understanding and not understanding: some technical issues. International Journal of Psychoanalysis, 64, 291-298.
Joseph, B. (1982). Addiction to near-death. International Journal of Psychoanalysis, 63, 449-456.
Segal, H., Britton, R. (1981). Interpretation and primitive psychic processes: A Kleinian view. Psychoanalytic Inquiry, 1, 267-277.
Steiner, J. (2011). Helplessness and the exercise of power in the analytic session. International Journal of Psychoanalysis, 92, 135-147.