The Site for Contemporary Psychoanalysis

Saturday Clinical Training 2021/22

October 16th – November 13th online Zoom November 20th – December 18th in person.

October 16 23 30, Nov 6 13

Psychosis and psychoanalysis Haya Oakley

Clinical Angela Kreeger

The reading list is for you to use before, during or after the seminars depending on how familiar you already are with the suggested reading and what inspires you as we go along. I will do my best to demonstrate some of the theoretical propositions with clinical material.

Freud, S (1911) ‘The Case of Schreber’ SEXII pp12-80 Standard Edition, Hogarth Press. London. Freud, S (1922b) ‘Some neurotic mechanisms’ in

Jealousy, Paranoia and Homosexuality. SE XIII 195 Freud, S (1924b) Neurosis and Psychosis. SE XIX 149

Freud, S (1924e) ‘The Loss of Reality’ in Neurosis and Psychosis SE XIX 183 (If you only have time for one, read this one)!

Klein, M Envy and Gratitude (1975) Hogarth Press. London

Laing, R D: Sanity, Madness and the family (1961), or The Divided Self (1960)

Lacan, J., ‘On a question preliminary to any possible treatment of psychosis’ in Écrits, a selection (London: Tavistock Publications 1977) pp 179-221 Roustang, F., ‘Towards a Theory of Psychosis’ in In Dire Mastery. Discipleship from Freud to Lacan (Baltimore and London: John Hopkins University Press 1976)

Seminar 1 The paradoxes of paranoia (no reading assigned)

Seminar 2 Why did Freud consider psychosis as not suitable for his psychoanalysis and how did Klein reopen the consulting room to the possibility of working with psychosis.

Seminar 3 Laing, Bateson and psychosocial theories of ‘madness’

Seminar 4 Lacan’s theory of psychosis Seminar 5 Francois Roustang

Nov 20 27, Dec 4 11 18

What can we trust? Who do we turn to? Five seminars examine contemporary anxieties and challenges around the practice of psychoanalysis.

Clinicals; Keith Armitage and Barbara Cawdron

Seminar 6 Peter Nevins

Safeguarding

How can a psychoanalytic association discharge its responsibilities around demands for safeguarding? What resources can an analyst in private practice draw on when issues arise that cannot be contained within the frame? Is safeguarding an appropriate or even safe procedure when faced with the fears and dangers of borderline and psychotic phenomena?

Seminar 7 Keith Armitage

Care

In this seminar, we will look at what happens when psychotherapeutic care and responsibility goes adrift and the complexity of factors and motivations that might be involved. As our texts, we will discuss the published decisions in a number of recent hearings brought against psychoanalytic psychotherapists through the UKCP’s Complaints and Conduct Process under the Code of Ethics. I will share these documents ahead of the seminar.

Seminar 8 Barbara Cawdron

The Frame

Working with people who present with risky behaviours such as self-harming, suicidal ideation, severe eating disorders and violence to others can be very disturbing and difficult to respond to. They often occur where there is a history of complex early trauma and abuse. In this seminar we will consider the way that the traditional psychoanalytic frame of the work may need to be rethought in these circumstances. Responses may be to extend the frame, having contact outside of the therapeutic hour, or to stick tightly to it, as a ‘container’ for unbearable thoughts and anxiety. When, and how, would you break the frame? Oakley gives a vivd account of her work with a patient that extends the boundary of the room, and Winnicott writes about the form and function of the frame and how it can act as an invitation to regression. I shall bring clinical examples from my NHS work.

Haya Oakley (1989) Touching and Being Touched, The Negotiated boundaries and the ‘extended’ consulting room, in Thresholds between philosophy and psychoanalysis: Papers from the Philadelphia Association

Winnicott (1955 ) Metapsychological and Clinical Aspects of Regression Within the Psycho-Analytic

Set-Up, International Journal of Psycho-Analysis 36:16-26 (available on PEP Web)

Seminar 9 Eric Harper

Suicide

In this seminar we will consider different ‘reasons’ and meanings attached to thoughts of wanting to end one’s life. We will discuss the differences between ‘dark thoughts’, impulsivity and immediate risk. We will explore potential risk indicators and risk management. Lastly, we will discuss the importance of a support network when working with clients deemed to be high risk.

Seminar 10 Plenary

The practice of psychoanalysis and a training in psychoanalysis brings upheaval and risk to all parties: patients, trainees, institutions. In this plenary session, we want to explore together our varied experiences of that upheaval and to reflect and learn from it and to think about our obligations of care for each other.

SPRING TERM

Jan 15 22 29, Feb 5 12

Living on the Edge Tom Bradshaw

The aim of these workshops is to support analytic work with borderline patients. We will be employing clinical thinking, of course, but the thrust of our efforts will be in the practical application of understanding to the treatment setting – what are we trying to achieve and why? The starting point is the assumption that to create contact with borderline experiences in others requires access to borderline states within oneself, and the ability to tolerate the ‘unheimlich’ experience of destabilisation which accompanies this awareness.

To that end, we will be using play/drama exercises to help us ‘inhabit’ our borderline characteristics. We will also bring case material from our practices and make reference to Freud’s case study of ‘The Wolfman.’ We encourage trainees to bring any relevant patient work to the morning sessions and afternoon clinicals groups for discussion.

Seminar 1 – Borderline Experience.

Trainees will be sent details of a drama exercise in advance of the seminar. We will play out the scripted scenario, then reflect together on what takes place.

What is this borderline experience, how can we understand it’s genesis?

Seminar 2 – Borderline Embodiment

Making sense of borderline experiences frequently staged through enactment and more specifically enactment with one’s body and the bodies of others.

Seminar 3 – Tolerating Borderline Experiences Self and other are elided in borderline states of mind and the therapist’s attempts to help can be experienced as abusive intrusions. How to support the building of an alliance through an adaptive therapeutic stance.

Seminar 4 – The Limits to Borderline Work

The need to withstand unreasonable demands/ threats, the place of limits in protecting the therapist and setting, and the importance of limits in signalling the creative potential of ‘otherness’.

Seminar 5 – Navigating Borderline Territory Revisiting our understanding of the borderline experience. How do we orientate ourselves within the drama, and what direction are we attempting to follow?

Psychoanalytic Texts

‘Three Characters – Narcissist, Borderline, Manic Depressive.’ Christopher Bollas 2021. Chapter 2. ‘The Developmental Roots of Borderline Personality Disorder in Early Attachment Relationships – A Theory and Some Evidence.’ Fonagy et al , 2003, in ‘Psychoanalytic Enquiry’, 23.

‘From the History of an Infantile Neurosis’ (The Wolfman) , S Freud, 1918.

‘The Difficult Patient’ R D Hinshelwood 1999, in ‘British Journal of Psychiatry’ 174.

‘Abusive Help- Helping Abuse: the Psychodynamic Impact of Severe Personality Disorder on Caring Institutions’, R D Hinshelwood, 2002, in ‘Criminal Behaviour and Mental Health’, 12.

‘Treatment of Personality Disorder: Limit Setting and the Use of Benign Authority’ D McLean and J Nathan, 2007, in British Journal of Psychotherapy. Vol 23, Issue 2.

‘Creative Readings – Essays on Seminal Analytic Works.’ Thomas Ogden, 2012. Chapter 2, ‘Freud’s Mourning and Melancholia.’

‘Reasons for Change in Borderline Personality Disorder’, M Zanarini, 2008, ‘Psychiatric Clinics of North America’ 31 (3).

Novels and Films

‘The Bell Jar’, Sylvia Plath, 1963. ‘Milkman’, Anna Burns, 2020. ‘Persona’, Ingmar Bergman, 1966.

‘A Woman Under the Influence’, John Cassavetes,1974.

Further Reading

‘The Dead Mother – the Work of Andre Green’ Ed G Kohon, 1999.

‘Schizoid Phenomenon in the Borderline’. J Henri Rey. In Melanie Klein Today, 1988, Vol 1. ‘Impasse and Interpretation’, H Rosenfeld, 1987. ‘Psychic Retreats’ J Steiner, 1993.

‘Ego Distortion in Terms of True and False Self’ D W Winnicott, 1960, in ‘The Maturational Process and the Facilitating Environment.’ 1965.

Feb 26, March 5

Geraldine Ryan and Peter Nevins Psychoanalysis for the People 

Reading to be sent to Resitations

March 12, 19, 26

In Freud’s Case: ‘Was will das Weib’?

Liz Guild

‘Psychoanalytic writing is a failure – as is all writing, from a psychoanalytic point of view – in the sense that it is always saying something other than it intends to’

Adam Phillips, Introduction to John Forrester,

Thinking in Cases (Polity, 2017)

For some commentators on Freud’s last case study ‘The Psychogenesis of a Case of Homosexuality in a Woman’ (‘Über die Psychogenese eine Falles von weiblicher Homosexualität’ (1920)) his ‘behaviour’ was ‘appalling’: homophobic, misogynist, heterosexist … the list goes on. Case closed. Or is it? These three seminars explore ways of reading this case – as much the how and why of our readings as the different theoretical approaches we bring to bear. How to read the case psychoanalytically, and how to think about the contradictions, blindspots and tensions we find in it – ‘Freud’s conceptions aren’t quite in agreement amongst themselves’ (Lacan, 1955) – and which some theoretical approaches may shut down whilst attempting to resolve? What can a case study written a century ago help us think about here and now, as 1. we (still) struggle to think as openly as possible about the question, ‘was will das Weib?’ what do women want? (the ambiguity introduced by the English translation will be useful to us as we go further), and about subjectivity, sexuality and desire, and 2. we think about how we want to present our own work?

1. Fail again, fail better : an impossible experiment in reading
   This seminar asks you just to read, or reread, the case, with as open a mind as possible. If we try to bring a form of ‘evenly suspended attention’ to Freud’s words, what emerges? Forget what you know of the case, forget the commentators and critiques (we’ll come to them another day); but then, what can’t you forget?A wholly neutral, value-free reading is of courseimpossible, as it is for us to read without traces of our own memory and desire. But if we focus on how we are reading, what we bring to the process, what does this reveal to us about our reading habits quite as much as what about Freud’s ideas and practice in this (one) case?And what of our own practice, our multidimensionallistening habits? And of our representation of our clinical practice? Can this exercise in just readinghelp us review what we think matters and how we like to present our work?
2. Rethinking Oedipus: if not Oedipus, then what?
   In the course of the case study Freud works with concepts of bisexuality and the Oedipus complex, which, in the light of what he learns of the girl’s early relationship with her mother, he has to revise in terms of Oedipal asymmetry – with all its implications for any woman’s sexuality. We need to revisit both the earlier ‘Three Essays on the Theory of Sexuality’ (1905) and the later ‘Female Sexuality’ (1931) to explore this further.If ‘The Psychogenesis …’ fails to help us understandthe origins of homosexuality, and female homosexuality (Freud’s term) here requires Freud to rethink Oedipus, a question that follows is, can we think about how human beings become sexed/ sexual without some such structural principle?How do you prefer to understand such questions of subjectivity, identification and desire? Ann D’Ercole’s reading of the case, ‘Designing the Lesbian Subject: Looking Backwards, Looking Forwards’ (1999) will help us think about a – not unproblematic— alternative.Or, to put the question more pointedly, how can werelease ‘female homosexuality’ from its association with masculinity?And how does our clinical practice help us think about these questions?
3. From ‘Homosexuality’ to ‘motherhood’ …

Freud’s ideas apparently travel from the first word in the case study, ‘Homosexuality’ to the last, ‘motherhood’: or do we need to read his account backwards, to help reveal something of the models of the feminine and of gender with which he works and struggles. To help us trace this, it’s time to turn elsewhere, as well as to turn again to the case study: again to his ‘Three Essays on the Theory of Sexuality’ (1905), and also to his first case study, Dora’s case. The seminar begins with a focus on the meaning of the dreams in both cases and on two scenes: Dora’s silent gazing on the Sistine Madonna in the Dresden Gallery and Freud’s analogy of his ‘homosexual’ patient’s lack of interest in his theorising as being like a ‘grande dame’’s indifference to objects in a museum she has been taken to visit; ‘how very interesting’. These focuses help us explore how ‘Homosexuality’, ‘motherhood’ and the ‘feminine’ are framed; as will some pages from Deborah Levy, Real Estate, on dreams, desires and missing or rewritten desires.

Reading List

There may be additions or alterations nearer the time of the seminars (though with plenty of notice), and some reading may be added in the light of what emerges in seminar discussion.

Seminar 1

Freud, ‘The Psychogenesis of a Case of Homosexuality in a Woman’ (1920), S.E. vol. 18, pp. 147-172; available on PEP

Seminar 2

Freud, ‘Three Essays on the Theory of Sexuality’ (1905), S.E. vol. 7, 123-246; available on PEP

Freud, ‘Female Sexuality’ (1931), S.E. vol. 21, pp.221-244; available on PEP

 d’Ercole, Ann, ‘Designing the Lesbian Subject: Looking Backwards, Looking Forwards’, in R.C. Lesser and E. Schoenberg (eds), That Obscure Object of Desire: Freud’s Female Homosexual

Revisited (Routledge, 1999), pp. 115-129 (scan available)

Worthington, Anne (2011) Female homosexuality: psychoanalysis and queer theory. PhD thesis, Middlesex University [Thesis], especially chapter 1 https://eprints.mdx.ac.uk/7222/1/ Worthington_PhD.pdf

Seminar 3

Freud, ‘Three Essays …’

Freud, ‘Fragment of an Analysis of a Case of Hysteria’, S. E. vol. 7, pp. 7-111 http://www.pep-web.org/document.php?id=se.007.0001a

Levy, D., Real Estate, chapter 2

For those of you wanting to read further:

Butler, J., Gender Trouble: Feminism and the Subversion of Identity (Routledge, 1990)

De Lauretis, T., ‘Letter to an Unknown Woman’, in

R.C. Lesser and E. Schoenberg (eds), That Obscure Object of Desire: Freud’s Female Homosexual Revisited (Routledge, 1999), pp.37-53

Forrester, J., Thinking in Cases (Polity, 2017) Harris, A., ‘Gender as Contradiction’, in R.C. Lesser and E. Schoenberg (eds), That Obscure Object of Desire: Freud’s Female Homosexual Revisited (Routledge, 1999), pp. 156-179

O’Connor N. and Ryan, J., Wild Desires and Mistaken Identities: Lesbianism and Psychoanalysis (Virago, 1993)

Stoller, R., Splitting: A Case of Female Masculinity (Quadrangle/NewYork Times Book Co, 1973) Stoller, R., ‘Patients responses to their own case reports’, Journal of the American Psychoanalytic Association, 36 (1988), 371-391

April 23/24 TRAINING WEEKEND

Anastasios Gaitanidis

“It is not a matter of fact; it is the fact that matters”

Empirical Research and Psychoanalysis

Most of the empirical research carried out in the field of psychotherapy and psychoanalysis today is influenced to a greater or lesser degree by the 20th Century ‘positivistic’ paradigm as it is believed to be the only one which can confer to them the status of ‘science’. Thus, the goal of most current empirical therapeutic research is to construct an objective and systematic foundation for therapeutic knowledge based on ‘facts’. These facts are given directly, or indirectly, in sensory observation and experimental investigation and are the only objects of knowledge. The world of ‘facts’ appears to be the ultimate arbiter of what constitutes valid therapeutic ‘knowledge’. This creates a structure of knowledge

and a type of therapeutic ‘reality’ which is as fixed, rigid, and dogmatic as the religious views and superstitions that Hume’s sceptical empiricism tried to combat. Any form of ‘unverifiable’ knowledge (i.e., the notion of ‘the unconscious’) or imaginative speculation which is not based on ‘facts’ – or cannot be manualised and/or operationalised – is discarded as irrelevant or superfluous. This produces a form of thought censorship and intellectual constipation which is counter-productive to a therapeutic environment which promotes creativity and imagination.

Under the pretext of examining the empirical

relevance of the suitability of multiple therapeutic truths and approaches for different patients, a hidden agenda is promoted which privileges one type of (hegemonic) truth/discourse over and above any single therapeutic truth – the truth of empirically verifiable ‘facts’. What is forgotten in this quest for empirical ‘facts’, is that facts cannot be seen in isolation but only as aspects of a total personal and social context caught up in the process of historical change.

Thus, the current emphasis on evidence-based

practice cannot be perceived only as a ‘neutral’, ‘objective’ process which independently validates the appropriateness and effectiveness of certain types of therapy. It also needs to be seen as a moment/ aspect of the general neo-liberal tendency to privilege certain practices – the ones that better serve its ideological objectives – and exclude others which seem to function against these objectives. In this respect, one needs to be suspicious of

therapeutic approaches which are proven to be ‘too effective’.

References

1. Gellner, E. (1992). ‘Psychoanalysis, Social Role and Testability’, in W. Dryden and C. Feltham (eds.),  Psychotherapy and its Discontents. Milton Keynes: Open University Press.
2. Steiner, R. (1995). ‘Hermeneutics or Hermes- mess?’ International Journal of Psycho-Analysis, 76.
3. Flax, J. (1981). ‘Psychoanalysis and the philosophy of science’, Journal of Philosophy, 78.
4. Flax, J. (1990) Thinking Fragments. Berkeley: University of California Press.

SUMMER TERM

Barry Watt

Clinical; Madhu Nandi

May 7, 14, 21, 28, June 11(No seminar June 4)

Re-Considering Freud’s ‘History of an Infantile Neurosis’

In this series of seminars, we are going to take the opportunity to read and consider together Freud’s seminal 1914 case study ‘From the History of an Infantile Neurosis’, which concerns Freud’s work with Sergei Pankejeff, the so-called ‘Wolf Man’.

We will begin the first half of our series of discussions by reviewing Freud’s text and contextualising Freud’s narrative within the

trajectory of his theory building – in particular, the development of his theory of narcissism and his elaboration of anal and oral sexualities – and the evolution of his clinical practice, especially as this was spurred by his rivalry with the increasingly dissenting opinions of Adler and Jung, whose views on theory and treatment Freud hoped the case study would definitively counter. Alongside this intellectual contextualisation, we will also take the chance to consider some recently published research into Freud’s clinical logbook, that gives us the fullest access so far to Freud’s own record of his working practices and clinical routine. This comparison allows us to raise the ever present and vexatious question of the relationship between theory and practice and how the two do – or do not – intersect and inform one another. With this question in mind, we will turn to consider the later accounts of Pankejeff’s involvement with psychoanalysis, his own memoir of his treatment with Freud and Ruth Mack Brunswick’s case study of her later work with Pankejeff. Given the vast divergence between Pankejeff’s version of his own life and Freud’s and Mack Brunswick’s versions, we will want to ask why this divergence is so marked and wonder about its implications.

The final two seminars will be devoted to

introducing the work of two hugely neglected and long overlooked Hungarian-French psychoanalysts, Maria Torok and Nicolas Abraham, whose lifelong collaborative engagement with Freud’s case study became the foundation of their own unique theoretical and clinical innovations, that are especially important for reframing urgent

contemporary questions concerning psychosis, so- c a l l e d ‘ b o r d e r l i n e ’ c o n d i t i o n s a n d t h e intergenerational transmission of trauma.

A full reading list will be sent closer to the time and PDFs will be provided of hard to find or out-of- print material. Core texts will include:

• Abraham N. & and Torok M. (1971) ‘The To p o g r a p h y o f R e a l i t y : S k e t c h i n g a Metapsychology of the Secret’.
• Abraham, N. & Torok, M. (1972) ‘Mourning or Melancholia: Introjection vs Incorporation’. Abraham, N. and Torok, M. (1975), ‘”The Lost O b j e c t – M e ” : N o t e s o n E n d o c r y p t i c Identification’.-  in (1994) The Shell and the Kernel: Renewals of Psychoanalysis, University of Chicago Press.
• Freud, S. (1918) From the History of an Infantile Neurosis, SE 17.
• Mack Brunswick, R. (1928) ‘A Supplement to Freud’s “History of an Infantile Neurosis”’, IJP (available on PEP Web).
• Mahalel, A.T. (2020) ‘The Wolf Man and Sigmund Freud by Sergei Pankejeff: between a case study and a memoir’, in Reading Freud’s Patients: Memoir, Narrative and Analysand, Routledge.
• May, U. (2018) Freud at Work: On the History of Psychoanalytic Theory and Practice with an Analysis of Freud’s Patient Record Book, Routledge.

June 18 25, July 2 9 16 Marginal voices

Eric Harper

Clinical; Russel Ayling

Seminar 1

Somewhere between Freud and Jung we find Ferenczi. And somewhere between a collective unconscious as seen with schizophrenia and neurosis as seen with incompatible drives, we find trauma and relationship. This session will re-visit the contribution of Ferenczi’s work and re-consider the role of trauma and dissociation.

Reading:

Sándor Ferenczi (1949). Confusion of the Tongues Between the Adults and the Child—(The Language of Tenderness and of Passion) Int. J. Psychoanal., (30):225-230. (Copy will be provided).

Judit Meszaros 2015 ‘Ferenczi in our Contemporary World’ in Adrienne Harris and Steven Kuchuck The Legacy of Sandor Ferenczi: From Ghost to Ancestor

p. 19-23. (Copy will be provided).

Seminar 2

Somewhere between Freud and Jung we find Sabina Spielrien. This seminar will compare Freud’s Beyond the Pleasure Principle with Sabina Spielrien 1994 Destruction as the Cause of Coming Into Being. The question of trauma touched on in the first seminar will be developed further.

Reading:

Sabina Spielrein 1994 Destruction as the Cause of Coming Into Being. Journal of Analytical Psychology. 39, 155-186.

Freud Beyond the Pleasure Principle (Copy will be provided).

Seminar 3

Somewhere between the psychoanalytic practice of Europe and the USA is a place called Argentina. This seminar will compare Pichon Riviere’s Linked Self with Bion’s Attacks on Links. The concept of trauma and relationship will now be explored via the work Riviere and Bion.

Pichon Riviere 2017 The Theory of the Link in Losso and De Setton The Linked Self in Psychoanalysis.

The pioneering work of Enrique Pichon Riviere. (Copy will be provided)

Bion 2018 Attacks on Links In Second Thoughts. Routledge.

Seminar 4

Moving from the field of trauma into the field of analytic aims, we will compare and contrast the work of a man and woman, one living the US and the other in the UK.

Karen Horney 1991 The Goals of Analytic Therapy The American lournal of Psychoanalysis, Vol. 51, No. 3, 1991

D W Winnicott 1962 The Aims of Psycho-Analytical Treatment (Copy will be provided).

Seminar 5

The final session will aim to see what surfaces as a thread between the different sessions. We shall also return to the title of the seminar, marginal text.

Reading to be suggested by trainees.