DIRECTORS'S COLUMN

By Seth Warren, PhD

I want to thank all faculty, associates and candidates who were able to attend our 2012 Fall Brunch this past weekend. Around 75 members - candidates, associates, and faculty - were in attendance. Our meeting was lively and collegial, our Candidates Organization prepared an enjoyable event for candidates, and our Board was pleased to present the rich and varied work our Center is involved in.

 For some of the highlights, please see Marion Houghton's report in this edition of our newsletter.

I would like to take note of a couple of developments of importance to our full membership.

I want to remind everyone that we have initiated a pilot Externship Program this year for graduate students in clinical psychology training. Michelle Bauer is coordinating this project, and we hope to expand the program to include more graduate programs, including trainees from social work programs and possibly other graduate trainees in mental health fields. If you have any connection to such a training program, please consider ways you might promote our Externship Program for future years, and please get in touch with Michelle to work out details of training requirements and the resources CPPNJ can offer.

Also, I want to emphasize that we are aware of the need to maintain geographical diversity both for our current members who live in the North and "Central" regions of the state; to maintain accessibility to classes, programs, and events, for all members, despite the challenges. Tom Johnson spoke at our meeting about the need to offer classes and programs further north and south both to reach out to new potential trainees and also to keep our connections to faculty who live in those regions and wish to remain active in CPPNJ. In the past there have been regional brunches, as social events for our Bergen and Middlesex (and south) members, and I would like to encourage anyone willing to host such an event to please get in touch with me so we can schedule them.

We discussed some of the implications of the implementation of the NJ State Certified Psychoanalyst law, as well as some of the pros and cons of seeking accreditation as an institute with one of the existing national bodies that accredit psychoanalytic training programs. This is a complicated set of interrelated issues of real importance to the future of the institute, requiring careful consideration and planning. To address these issues we have formed a working group to further explore the potential costs and benefits of accreditation, along with forming an organizational response to the certification law. Anyone interested in participating in this working group should please contact me directly at seth.warren@me.com

As always, I want to encourage our members to consider ways they can participate in one of our standing or ad hoc committees. In particular, our Program Chair Carol Marcus invites any faculty, associates or candidates to join her on the Program Committee. Also, our Events Committee, chaired by Susan Masluk, can always use additional members to help with our various events during the course of the year - Graduation, Holiday Party, fundraisers, etc.

One special committee to think about for next year: we will need volunteers for our IDfest fundraiser. This will be our third such event, and this special event committee can use some extra help in planning and organizing our next special fundraiser. Our previous two IDfests have been extremely fun and successful, and we look forward to another great evening of food and comedy - please contact me or Susan Masluk for more information.

If you are a new member of our institute, please don't hesitate to consider joining one of these committees. Your contribution can be based on your own availability and time, but any participation is appreciated. Committee work is not always glorious, but much needed, and represents one of the major ways our community is expressed and given form. It is a great way to get to know some of the more active members, to feel a part of the community, and to share your knowledge and skills.

And, for all of you who currently are involved in some aspect of our Center's work and projects, my thanks. I am endlessly in awe of the generosity and creativity of our membership, the willingness of all of you who, through your volunteer activities, make up the lifeblood of our institute, and make all our training programs, outreach, conferences, and social events possible.

Best to all,

Seth

Conquering Bronchial Asthma via Psychodynamic Therapy

A Psychosomatic Victory

By Martin Silverman, MD

  A few months ago, in this Newsletter, I described an experience I had in which I was able to cure a three-year-old boy of severe stuttering of recent origin in three sessions of psychodynamic psychotherapy. One might think that something like this could happen only with a very young child who had had his somatic expression of intense emotional distress for a relatively short time. That is not so, however. In the right circumstances, a long-standing psychosomatic disorder in an adult can also respond wonderfully to fortuitous psychotherapeutic intervention. For this reason, I'd like to share an illustrative experience I had some time ago.

I was a psychiatrist in the United States serving with NATO Forces in what then was West Germany. All doctors serving at the 97th Army General Hospital in Frankfurt-am-Mein were required to cover the emergency room as a general medical officer, in rotation, no matter what their medical specialty might have been. One evening, while I was on duty in the E.R., the thirty year old wife of an American soldier was brought in suffering from a very bad asthmatic attack.   She told me that she had been having increasingly severe and increasingly frequent asthmatic episodes for eight or nine months. She thought they were caused in part by a great deal of stress she had been experiencing in her life during that time. She complained loudly and bitterly that she kept crying out for help but no one seemed to care and no one responded to her entreaties.

I did everything I could to pull her out of the asthma attack. None of the inhalers or the medications I provided for her did more than slightly reducing the intensity of her wheezing. I tried and tried but nothing worked. Finally, I was forced to give up. She agreed, albeit reluctantly, to my admitting her to the hospital as an in-patient. Thinking of what she had angrily said to me about no one appreciating what she was experiencing and no one providing for her needs, I had an inspiration. After I settled her in on one of the hospital's medical floors, I left a very unusual order at the desk in the Nursing Station: "Anything she asks for, if you can give it to her, do so no matter what it is." The nurses were flabbergasted by what I had written, and they did not hesitate to tell me how annoyed they were with me. They had never received such an order, they told me, and they had no intention of carrying it out.

I pleaded with them to bear with me and please follow the order, and I explained to them my rationale for writing it. They grudgingly agreed to give it a try. She made repeated, frequent demands upon the nurses to do all sorts of little things for her, and, true to their word, they uncomplainingly did everything she asked of them. To their astonishment, my satisfaction, and the patient's great delight, it worked! Although she had been in medication-resistant status asthmaticus for a number of days, the attack broke. She stopped wheezing and was discharged from the hospital two days later.

About a week after her discharge, the clerk in the Psychiatry Department received a telephone call from her, asking if she could come into treatment with me as an outpatient. We began to work together in exploratory psychotherapy. The story that emerged was as surprising as it was dramatic. At the time I met her, she was married to an American G-I. During World War II, however, she was a little girl living in Germany. When the Allied bombing of German cities began, the children were evacuated to the countryside to protect them from harm. She was placed on a farm, with a couple and their twelve-year-old son. She was eight years old at the time. The farming couple's son resented the intrusion of a child from the city into what he considered to be his world, and he set about to torment her as much as possible. She put up with the torture for as long as she could, but then she broke down and began to cry. "You are crying?" the farmer asked. "Your father is fighting on the Russian front! Your mother is risking her life in a munitions plant in a city being bombed so that she too can protect the fatherland! You are safe, and you are crying? You have no right to cry! Stop crying!" She stopped crying, and began to wheeze. Ever since then, she had been suffering from asthma. In recent times, certain things taking place in her life had once again imposed guilt upon her for complaining and seeking compassion for what was happening that was troubling her. As a consequence, her asthma attacks had been growing more and more frequent and more and more severe.

For a year after her discharge from the hospital, she came twice a week for psychotherapy sessions, during which she reached back to the events that had precipitated the beginning of her asthmatic condition and poured out the pain, the anguish, the fear, and the guilt which she had been storing within her for over twenty years. She wrestled with the feelings mobilized by what she was currently experiencing in her life, which were not only tormenting her in their own right but also were re-igniting the painful memories of what she had experienced as a little girl during the war. She cried and cried throughout every session, using about half a box of tissues each time. But she never wheezed again!

Our Events: Fall Brunch: Launching CPPNJ for 2012-2013

By Marion Houghton, EdS, LMFT 

Seventy-five faculty, associates and candidates gathered at the Maplewood Community Center on Sunday, Sept. 30, 2012 to open the new academic year. A new feature was a gently-used books sale for the benefit of CPPNJ and the CPPNJ Scholarship Fund.

Seth Warren, Director of CPPNJ, opened the faculty part of the meeting after a lively social hour, while the candidates held a separate meeting. The two groups adjourned for lunch at 12:00 noon and then participated in a short combined session before adjourning for the day.

The faculty meeting began with a report from the Treasurer, Bob Levine, who wholeheartedly delivered the good news that CPPNJ had had a "very good year" in 2011-12. Various aspects of the Institute's activities last year combined, through hard work by everyone involved, to produce successful results overall-including financial! Everyone felt encouraged.

Other reports included: A Home Within by Debe Roelke, the Couples Division by Dan Goldberg, the Psychotherapy Center by Sandra Sinicropi, Marketing by Bob Morrow, Program Committee by Carol Marcus and Recruiting (Outreach) by Marion Houghton. Tom Johnson spoke as the Dean of Faculty, Michelle Bauer as the Associate Director and Election Committee chair for 2013, and Veronica Bearison on behalf of the Training Committee. Ronnie thanked the members of the Training Committee for their hard work and commitment to CPPNJ.  

Seth Warren raised the issue of Institute accreditation which has been highlighted by the recently passed legislation to confer State Certification on qualified analysts. He also discussed a related topic-the admission and training of non-mental health professionals. It was suggested that a committee be formed to address the accreditation process for CPPNJ and report back to the membership with a recommendation. Anyone interested is asked to contact Seth Warren.

Tom Johnson spoke about the importance of cultivating institute activity in the Bergen County and central New Jersey areas. A suggestion to revisit regional brunches was made as a way of accomplishing this goal.

Seth Warren announced that Stan Moldawsky will be honored at CPPNJ's Graduation on June 2, 2013-SAVE THE DATE!

Our Events: A Workshop with Dr. Suzanne Iasenza: The Unconscious Meets Modern Sex Therapy

By Daniel Goldberg, PhD

Directly addressing sexual dynamics and issues with a couple creates specific challenges for any couples therapist. Dr. Suzanne Iasenza visited CPPNJ and the New Jersey Couples Therapy Program on September 14, 2012 for an afternoon workshop on queer theory, peer relationships, and a revised way of thinking about standard sex therapy practices. She covered four main themes in her talk which was also spiced with clinical vignettes illustrating her theoretical points.

Her first point was that we have a number of expansive models of sexuality that allow us more freedom in understanding sexual orientation and imagination. She honored the pioneering work of Kinsey and his colleagues who developed the Kinsey scale over 50 years ago. Their research was the first to establish that sexual variation or "queer" lives was more the norm than the unusual. Even back in the early 50's, Kinsey noted that it is far less common for people to be exclusively heterosexual or homosexual than is commonly believed. We now know that either in their behavior or their fantasy a significant majority of individuals combine a mix of heterosexual and homosexual inclinations.

In addition, Dr. Iasenza described innovative ways to think about how sexual activity is initiated. Traditionally, the typical sexual cycle model starts with sexual desire. She talked about how couples are often burdened by this model as they wait for the sexual spark to emerge. New concepts, primarily developed by Rosemary Basson, discuss "willingness" to engage in sex as a cognitive decision that allows individuals to be open to a sexual encounter. In Basson's model, desire may emerge during a sex, but often only after the couple begins a sexual encounter. This revision is particularly applicable to long-term relationships and recognizes the effects of aging on individuals.  

Dr. Iasenza's second major topic presented a new way of thinking about conducting a sexual history as a narrative. Taking a sexual history is not just gathering a dry clinical collection of sexual facts about a person, but but asking them to tell their life as a story that unfolds from childhood, to adolescence, to adulthood, and then to current functioning. Her psychoanalytic approach, in contrast to that of the behavioral therapist, came through in the first question asked: "What is your earliest memory of sexuality?" Very specific questions can be difficult to ask, but it is as much about the person's experience and the affects associated with sexual events that is most informative.

Couples need to develop a vision for their sexual wishes with their partner. Often, couples struggle with a lack of tolerant communication about this. Dr. Iasenza described in vivid imagery the importance of developing a "sexual menu."  When people go to a restaurant, they don't automatically say, "I'll have what she's having". Rather, they have different preferences. Dr. Iasenza described ways that couples can nonjudgementally discuss these preferences, and then discussed sexual differentiation - how each member of a couple can articulate possibilities so that sex does not always become what is expected by unconscious cultural templates; nor is it necessarily equated with intercourse.

Dr. Iasenza examined the typical exercises used in sex therapy and encouraged us to view sensate focus as mindfulness meditation. In this way, couples could simply allow for any sexual feeling to be experienced without judgment. Sensate focus exercises often create expectations that anxiety will be reduced if penetration/intercourse is not the focus of sex.

The last part of the workshop expanded on the problem of peer relationships: couples where sexual expression is absent. Couples adapt to a sexless life and then come into therapy wanting a reversal of years of adaptation to a companionate existence. Dr. Iasenza wondered if the growing mutuality of power between partners creates tensions that dampen erotic life.   She also wondered about the age old notion of personality and how our personality inclinations shape our ability to experience sexual pleasure. She also gave clinical examples of the power of projection in peer relationships: for example, a partner may see the aging thighs of their partner and become turned off, which may be more an unconscious process designed to avoid the pain of loss than a response to the actual reality of the partner's body, perhaps as a defense to dealing with death anxiety as one audience member suggested. If the partner who receives the projection dampens his/her own sexual desire (projective identification in action), an unconscious system has been developed. Analyzing these interpersonal and intrapsychic dynamics is the key to working analytically with peer relationships.

Dr. Iasenza ended the workshop with a description of Jack Morin's recent research (author of The Erotic Mind). He thought that couples who have sustained an active, erotic life throughout a long-term relationship may have something to teach us. In addition to each partner regarding sex as highly important, they recovered well when sex did not go so well. These couples were helped by strong self-esteem and egos that were not easily wounded by rejection. Perhaps the most interesting thing, and clearly controversial, was that these couples introduced a "third" into their relationship - never as a secretive act of betrayal, but as an open exploration of how to grapple with monogamy. Is that what has made 50 Shades of Grey so popular - is that book the "third" in many bedrooms today? Just a thought, based on an inspiring afternoon with Dr. Iasenza.

All Programs are Co-Sponsored with the New Jersey Society for Clinical Social Workers 

Our E-Newsletter Editorial Staff

Unsolicited articles are welcome.  Something you'd like to write?  Send it to us at cppnj@aol.com.  We're happy to hear from you.   

Thank you for joining us. Look for our next newsletter in November 2012.