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410 Psychoanalytic Process: Initiating, Deepening the Analytic Process, Termination – 7 seminars

Seminar Leaders: C. Lunney, MD, D. Traub-Werner, MD, R. Ruskin, MD, M. K. O’Neil, PhD

Course Description

This Course relies on the previous Courses in assessment for analyzability, and the consultation with a Supervisor on suitability as a control case.

Part I Initiating Psychoanalysis
Papers and discussion in these two Seminars explore the questions: how does a psychoanalysis begin? What goes on when analyst and prospective analysand meet for the first time? What processes are activated to make the project for an analysis possible? Does the indication for analysis lie as much in the analyst as in the patient?

Part II Mid-phase Analytic Process: Therapeutic Action, Deepening the Analytic Process
In the second section of the Psychoanalytic Process Course, the papers and discussion will explore the major questions: What is it that happens in the course of psychoanalysis? How and why do changes occur? What is the nature of the psychoanalytic process? Review papers will outline the range of positions on the core factors at work in the analytic process and in therapeutic action. The seminar will also examine the analyst’s ambivalence about maintaining and deepening the analytic engagement and the analyst’s conflicts around maintaining the analytic frame.

Part III Termination
Three seminars on termination will discuss the major papers on this subject: Freud’s 1937 work on “Analysis Terminable and Interminable”. Balint, Buxbaum, Klein and Reich articles from the 1950s are considered in the light of the development of Freud’s ideas about termination. Issues which arise at termination are explored: Who decides readiness? Analyst, analysand or both?; ambivalance of analyst and analysand; completeness of the analysis; saying good-bye – loss, grief and mourning; and how the analysand approaches ending in the light of the person’s history and character.

Course Objectives

Candidates will:

  1. Review and consolidate ideas on initiating the psychoanalytic process, including the effective use of the self (1.2 a, 1.2.c, 4.5b).
  2. Learn and discuss the process of beginning of a psychoanalysis with difficult patients (1.2 f, 1.4.b, 4.2.a, 4.2.e, 4.2.k).
  3. Understand, and integrate into practice, the wide range of therapeutic factors that are work in effecting change in the patient through a psychoanalytic process (4.2.a, 4.5.o).
  4. Read major papers, early and recent, on termination of a psychoanalytic process in order to facilitate a therapeutic ending to the process (4.5.s, 4.5.t).

Part I: Initiating Psychoanalysis

Initiating an analysis is complex and multi-layered. We will arbitrarily divide the course into two seminars. The first seminar will focus on recommending psychoanalysis and establishing a working alliance, the second seminar will focus on initiating an analytic process and working towards establishing a solid therapeutic alliance. At the end of this course candidates should be able to:

  1. Conduct a successful initial psychoanalytic interview (Etchegoyen, Sandler and Reith).
  2. Understand the concept of the “analytic couple” in the initial interview and how they influence each other (Etchegoyen and Reith).
  3. Establish the basis for a Working Alliance (Brenner and Sandler).
  4. Become aware of how the analyst thinking will affect the prospective patient (Ehrlich).
  5. Formulate the components of the opening stage of analysis and its associated dyadic relation (Etchegoyen and Sandler).
  6. Progress the work towards the establishment of a Therapeutic Alliance (Meissner).
  7. Differentiate between the Treatment Alliance and the Therapeutic Alliance (Brenner and Sandler).
  8. Work with the resistance when initiating therapy (Rothstein).

Seminar 1

Recommending Psychoanalysis and the Working Alliance

Required Readings

Dare, C., Dreher, A.U., Holder, A. & Sandler, J. (1973). The clinical situation. In The Patient and The Analyst (pp. 21-26). Madison, CT: International University Press. (There is a 2011 updated edition printed by Karnac ISBN-13: 978-0823640317).

Brenner, C. (1979). Working alliance, therapeutic alliance, and transference. Journal of the American Psychoanalytic Association, 27(S), 37-157.

Etchegoyen, R.H. (1999). The psychoanalytic interview: development. In The Fundamentals of Psychoanalytic Technique (pp. 50-59). London: Karnac Books.

Ehrlich, L.T. (2013). Analysis begins in the analyst’s mind: Conceptual and technical considerations on recommending analysis. Journal of the American Psychoanalytic Association, 61(6), 1077-1107.

Supplementary Reading

Reith, B. (2011). The specific dynamics of initial interviews: Switching the level or opening a meaningful space. European Federation of Psychoanalysis, 64(S), 57-80. (Will make available).

Seminar 2

The Analytic Process with difficult patients and the Therapeutic Alliance

Required Readings

Sandler, J. Dare, C. and Holder A. (1973). The treatment alliance . In The Patient and The Analyst (pp. 27-36). Madison, CT: International University Press. (There is a 2011 updated edition printed by Karnac ISBN-13: 978-0823640317).

Meissner, W.W., S.J. (1992). The concept of the therapeutic alliance. Journal of the American Psychoanalytic Association, 40, 1059-1087.

Etchegoyen, R.H. (1999). The initial stage. In The Fundamentals of Psychoanalytic Technique (pp. 605-613). London: Karnac Books.

Reith, B., Moller, M., Boots, J., Crick, P., Gibeault, A., Jaffe, R., Lagerlof, S., & Vermote, R. (2018). Chapter 5: Facing the storm and creating psychoanalytic space: the vicissitudes of the analytic couple in first interviews (pp. 62-87). In Beginning Psychoanalysis: On the Process of Initiating Psychoanalysis. London: Routledge.

Supplementary Reading

Rothstein, A. (1998). On beginning with a reluctant patient. In T. Jacobs & A. Rothstein (Eds.) On Beginning an Analysis (pp. 153-162). Madison, CT: International University Press

II Mid phase: Analytic Process, Therapeutic Action and Deepening the analytic process

Seminar 3

Analytic Process and Therapeutic Action

Required Readings

Nacht, S. (1962). The curative factors in psychoanalysis. Part II. International Journal of Psychoanalysis, 43(4-5), 206-211.

Weinshel, E. M. (1984). Some observations on the psychoanalytic process. Psychoanalytic Quarterly, 53, 63-92.

Arlow, J.A. and Brenner, C. (1990). The psychoanalytic process. Psychoanalytic Quarterly, 59, 678-692.

Seminar 4

Deepening the analytic process

Required Readings

Killingmo, B. (1989). Conflict and deficit: Implications for technique. International Journal of Psychoanalysis, 70, 65-79.

Ehrlich, L.T. (2010). The analyst’s ambivalence about continuing and deepening an analysis. Journal of American Psychoanalytic Association, 58, 515-532.

III Termination

Seminar 5

Termination major papers

Required Readings

Freud, S. (1937). Analysis terminable and interminable. In The Standard Edition of the Complete Psychological Works of Sigmund Freud Vol. 23 (pp. 210-253).

Balint, M. (1950). On the termination of analysis. International Journal of Psychoanalysis, 31, 196-199.

Buxbaum, E. (1950). Technique of terminating analysis. International Journal of Psychoanalysis, 31,184-190.

Klein, M. (1950). On the criteria for the termination of an analysis. International Journal of Psychoanalysis, 31, 78-80; 204.

Reich, A. (1950). On the termination of analysis. International Journal of Psychoanalysis, 31, 179-183.

Seminar 6

Contemporary Concepts of Termination

Required Readings

Ticho, E. (1972). Termination in psychoanalysis: treatment goals, life goals. Psychoanalytic Quarterly, 41, 315-333.

Gabbard, G. (2009). What is “good enough” termination? Journal of American Psychoanalytic Association, 57, 575-594.

Seminar 7

Post-termination Contact

Required Readings

Schachter, J. et al. (1997). Clinical experience with psychoanalytic post-termination meetings. International Journal of Psychoanalysis, 78, 1183-1198.

Kantrowitz, J. (1990).   Follow-up of psychoanalysis five to ten years after termination: Part II: Development of the self-analytic function. Journal of American Psychoanalytic Association, 38(3), 637-678.

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