DIRECTORS' COLUMN

By Seth Warren, PhD

We have lingered in the chambers of the sea,

By sea-girls wreathed with seaweed red and brown,

till human voices wake us, and we drown.

- T.S. Eliot, The Lovesong of J. Alfred Prufrock

I have always loved Winnicott's conception of early psychic development. On the one hand, he refers to "true self" experiencing, "psyche indwelling in the soma," "going on being." This is the area of creativity, the source of the "spontaneous gesture," and the origin of a potential creative interplay between self and environment that begins even before there can be awareness of environment or other. We can trace this vital quality of experience throughout our lifespans. Feeling deeply involved in something, "losing one's self" in an activity, feeling connected and open without excessive (or any) self-conscious thought. Near the end of the show, Billy Elliot, during Billy's interview at the Royal Ballet, he is asked what he feels like when he dances. "I disappear...I feel like electricity." For Winnicott this aspect of pure being is the seed of all creative experience, mystical experience, and the quality of subjective aliveness.

But there is of course the other side of this early developmental process, the inadvertent or careless or intentional intrusion of the environment, the demand for a response, which Winnicott describes as "impingement." This defines a mode of reacting, rather than "going on being" - perhaps representing the dawn of self-consciousness. I liken it to being awakened, perhaps rudely or even violently, as depicted by poor J. Alfred. One is transported back, out of oneself, into a precocious awareness of the external world. Such impingement is presumably inevitable to some extent. Even the "good enough" environment" impinges at times. We are all socialized, we all learn, one way or another, to "get along" in the world, to "fit in," and to varying degrees, conform to external expectations. Nonetheless Winnicott describes this aspect of experience as traumatic. Ego is distorted in the service of compliance. In more extreme versions of "ego distortion" he describes a continuum of "false self" structures, adaptive responses to impingement that increasingly lead to the isolation of true self - a loss of authenticity and spontaneity in one's relationship to self and other. We are all woken from our reveries. There is a continuous and rhythmic tension between psychosomatic immersion and impingement.

I would like to suggest that all of us, as professionals, have an area of creativity, places in which our passion, individuality, and aliveness is expressed. It is not always easy in our line of work! If you ask people when they feel most alive, most fully present, they often will describe physical activities that are compelling - running, dancing, sexual activity, cultural or religious experiences - 'mind indwelling in the body.' Because in the work we do, we tend to rely on talking and thinking, sitting in our 'comfortable' chairs for many hours, we can sometimes forget we are embodied beings!

But at its best, clinical work can involve real reverie, immersion, passion, psychosomatic connection, and a full present-minded awareness. I believe all of us touch this place daily in our work, responding in ways that are not predictable or specifiable, reflecting absolutely the reality of our own individual and personal selves. And there are other parts of our professional lives in which we may experience this: writing, presenting and relating to cases, group activities, and even just thinking about our cases. I presume that the greatest satisfaction we feel in our professional work comes from this area, in which there is a relative suspension of awareness of the "external world," demands or expectations, an area where work feels like play, even when the content is emotionally difficult.

In my recent columns I have described the "impingements" we face as psychoanalytic practitioners. Bureaucratic and administrative demands, the devaluing of the unique kinds of work we do, and the attacks on our ability to make a living working from our own creativity, training, and experience through clinical micromanagement, "cost-containment" tactics, and onerous administrative requirements, all serve to "wake us" from creative and passionate reverie. I have already described what I believe is, for us, the toxicity of the health-care system. I have described contact with insurance companies and other administrative bureaucracies as traumatic - and Winnicott's conception of spontaneity and compliance is quite useful in understanding how this is so.

How do we avoid collective "ego distortion" in the face of this pressure? How do we resist the "false self" transformation of our creative and personal work under the pressure for external compliance (needless to say, while recognizing the legitimacy of relevant laws and our own ethical principles)?

I encourage all of us to consider our own creative cores, the areas in which we experience full and passionate involvement and meaning, and to find new ways of expressing those parts of ourselves. I would strongly encourage all of our members to consider writing, for a wide public audience as well as in more professional contexts. Winnicott almost certainly had the widest cultural impact of any psychoanalyst since Freud. He translated his ideas about infant development, play, and child-rearing, into ordinary language, intentionally making these accessible to lay-audiences. And more than any psychoanalyst I can think of, he presented publically to audiences of mothers, nurses, pediatricians, educators, and others involved with the care of children.

There is a great need to educate "consumers" and policy-makers about who we are and what we have to offer, about the real limitations of an insurance-system driven model of psychotherapy, about the real costs and value of good psychotherapeutic treatment. The blogs that have appeared on our website, contributed by our members, illustrate this beautifully. Keep in mind that everything we post on our websites, everything we write, is now accessible to the entire world via the internet. These days you never know when something you write may "blow up" and suddenly reach large audiences.

I hope it is clear that CPPNJ - as a "facilitating environment" - strives to support the creative clinical and professional development of all its members, through our training structures, supervision, workshops and social networking. Involvement in our institute is an important vehicle of support and development for every one of our members, and I would encourage every member to consider ways they can participate and contribute.

DON'T MISS THESE IMPORTANT PROGRAMS OFFERED IN MARCH

March 16, 2013 Conference  

The Integration of Attachment Theory and Neurobiology

Part II: Clinical Applications and Case Understanding

Using Somatic Interventions to Regulate the Nervous System and Build Affective Capacity  

Affect regulation is an emerging paradigm based in integrations of psychoanalysis, evolutionary biology, affective neurobiology, infant studies, and attachment studies. The primary integrationists are Allan Schore, Daniel Siegel and Peter Fonagy. In Part 2 Dr. Hill will focus on clinical vignettes that illustrate many of the theoretical concepts discussed in Part 1. Attendees will learn interpersonal neurobiology's developmental theory of bodymind, how attachment theory and affective neurobiology are integrated into a modern attachment theory, a relational trauma-based understanding of disorders of affect regulation, and therapeutic actions and techniques for treating disorders of affect regulation.

Dan Hill, PhD is a psychoanalyst, educator, and a leading proponent of the paradigm shift to affect regulation. His publications and presentations range from the clinical use of multiple models through religious fundamentalism understood through the lens of affect regulation. For the past six years he has conducted yearly conferences and on-going study groups focused on an in-depth understanding of the regulation of affect as understood in Allan Schore's Regulation Theory and Peter Fonagy's theory of mentalization. He is on the faculties of the National Institute of the Psychotherapies and the New York University Postdoctoral Program in Psychoanalysis and Psychotherapy.

This daylong conference will take up the topic of Dr. Philip Ringstrom's new book A Relational Psychoanalytic Approach to Couples Treatment. This original work is premised on three organizing themes: self-actualization in a long term committed relationship, mutual recognition of the partners and the relationship having a mind of its own. These themes are addressed theoretically supporting a model of practice that is articulated in six steps. Conference participants will learn how unveiling each partner's bi-dimensional modes of transference (e.g. the developmental versus repetitive dimension) helps the therapist attune to each partner in a manner that draws them powerfully into the treatment. This also helps them uncover the vicious circles entanglements in which the partners find themselves when their longings and wishes trigger one another's repetitive transference disappointments, and how the exploration of key developmental concerns, such as attachment styles, affect tolerance, implicit versus explicit communication, trauma, gender and culture facilitate a deepening of understanding of each partner's subjective take on reality.  As well, conference participants will learn about the inevitable role enactments play in couple's psychotherapy, as well as the therapists involvement in them, and  about the crucial role of each partner's multiple self-states.

Philip Ringstrom, PhD, PsyD is a Senior Training and Supervising Analyst and a Faculty Member at the Institute of Contemporary Psychoanalysis, in Los Angeles, California. He is a Member of the Editorial Boards of both the International Journal on Psychoanalytic Self Psychology and Psychoanalytic Dialogues, and Psychoanalytic Perspectives. He is also a member of the International Council of Self-Psychologists, and a founding member of the Board of Directors of the International Association of Relational Psychoanalysis and Psychotherapy. He has published over 50 journal articles and has presented at conferences all over the world. He is currently under contract with Routledge Publications for his upcoming book in 2013 entitled A Relational Psychoanalytic Approach to Conjoint Therapy.

Maureen Gallagher, PhD

February 3, 2013: A Workshop with Maureen Gallagher, PhD

Sean Frankino, LCSW

and Sean Frankino, LCSW

Talk is Not Enough: Using Somatic Interventions to Regulate the Nervous System and Build Affective Capacity

By Sandra Sinicropi, LCSW

On Sunday February 3, CPPNJ faculty member Maureen Gallagher, PhD, and Sean Frankino, LCSW, presented a workshop on Somatic Experiencing (SE): When Talk is not Enough. Both Maureen and Sean have been training in SE and have come to understand the effectiveness of using this technique with patients who have experienced either a specific traumatic event, or early relational trauma. Based on the work by Eugene Gendlen in the early 60's and further developed by Peter Levine, this technique brings awareness to "feelings" as they are experienced in the body.   The idea is that by doing so, patients will develop a grounding in their body that will help them process emotions that get activated when talking about material that triggers traumatic memories.  

This technique is best used when the sympathetic nervous system (SNS) is getting activated in a session. When the SNS is activated we know that verbal processing is stymied. When the threat response has been triggered, much of what is said is either not registering and being metabolized or could be further disorganizing and overwhelming.   By encouraging the patient to focus on their body, describing what they are feeling both negative, i.e. tension in the neck, as well as positive, i.e., a feeling of solidity in one's legs, the Parasympathetic Nervous System should become engaged. When the PSNS is activated, they are in a more relaxed state and therefore better able to metabolize the material being processed and/or the experience they are having with you in the session.

Sean and Maureen presented the theory behind SE and then had the audience practice both applying and receiving this technique.   The feedback was positive. Audience members talked about how this process helped slow them down to better experience how what they were talking about "felt," which many noted is sometimes easier done than said.

Nancy McWilliams, PhD

By Marion Houghton, EdS, LMFT

Nancy McWilliams will be in Valhalla, NY on Feb.26, 2013, in Vancouver, Canada on April 19, and in Istanbul, Turkey on May 17! But on Jan. 20, 2013 Nancy was at home here with her CPPNJ colleagues as she led a thought-provoking workshop about supervision from a psychodynamic perspective. In the afternoon, Eric Sherman, who is chair of the Training Committee's Evaluations and Supervisory Training Subcommittee, launched the first of a new series of workshops led by and for faculty on important topics in supervision. Both presentations were part of CPPNJ's new initiative to offer training in psychodynamic supervision and to enhance the supervisory, teaching and evaluation processes at the Institute.

Nancy's presentation included a wide-ranging presentation of what the supervisory experience is like, both from a historical perspective and from her personal perspective. Some of the responses shared by CPPNJ attendees were:

Veronica Bearison-- Nancy told a story of the history of the development of the practice of supervision and the emergence of a valid theory. She used examples from her own supervisory activity. She emphasized the importance of understanding parallel process-what is actually going on in the supervisory experience. She spoke about the warm and supportive environment that CPPNJ provides for its members, which seemed to capture the spirit of the day's program.

Janet Hoffer-- Nancy noted that the supervisory relationship provides an experience that transcends the learning of techniques and the rules of therapy. She answered the "teach or treat" question about supervision by sharing that she doesn't ask supervisees "where does that come from in your dynamic?  She feels that is better left to treatment unless the supervisee raises their own dynamics as it relates to the dynamics of the patient. Rather,she feels supervision is primarily for teaching supervisees to mentalize or imagine the different subjectivity of the other.

Susan Stein-- expressed her own experience of Nancy's presentation as... wonderful, amazing, smart and interesting! Nancy gave beautiful vignettes. She also gave examples from both sides to show problems that can arise, as well as how helpful the experience can be.

In the afternoon, faculty-only workshop, 26 members of the faculty engaged in a robust and wide-ranging discussion led by Eric Sherman about issues of supervising and teaching at CPPNJ. A number of useful suggestions came out of the workshop, which will be discussed within the Training Committee in the coming months.                                                                        

In addition to the new training program, we can all look forward to the next workshop in the Supervision Workshop Series, "Analytic Field Theory and the Complexities of Psychoanalytic Supervision," which will be presented by Martin Silverman on

October 6, 2013.

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

Our CPPNJ Blog

By Eric Sherman, LCSW 

Martin Silverman, MD

Publications:

 "On Myths and Myth-making: Psychoanalytic Theorizing about Mother- Daughter Relationships and the 'Female Oedipus Complex'" in The Psychoanalytic Quarterly, 81:727-749, 2012.

Review of Wearing My Tutu to Analysis and Other Stories, by Kerry Malawista, Anne Adelman, and Catherine Anderson, in The Psychoanalytic Quarterly, 81: 783-791, 2012.

"A Quantum Mechanical Introduction to Two Reviews of Lear on Irony," in The Psychoanalytic Quarterly, 81: 955-958, 2012. 

Review of Woman's Unconscious Use of Her Body: A Psychoanalytic Perspective, by Dinora Pines, in The Psychoanalytic Quarterly, 81:999-1007, 2012.

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 March 2013.