DIRECTORS' COLUMN

By Seth Warren, PhD

Some of you may already know that the new version of the Diagnostic and Statistical Manual published by the American Psychiatric Association (DSM-V) will do away with Axis II as we all currently know it, and as it had existed in the previous 4 versions of DSM. Initially, the DSM-V Work Group proposed a complete revision of Personality Disorders (previously of Axis II), eliminating all of the categorical personality diagnoses (and all the familiar descriptions of personality disorders) that had been in place (with some variations) since 1980.

The Work Group's first revision represented a significantly different approach to diagnosis. It attempted to break down the concise models of personality disorders, which sometimes are too rigid to fit pa¬tients' symptoms, and replaced them with a trait-specific method. Using this model, clinicians would have determined if their patients had a personality disorder by looking at the traits suggested by their symptoms and ranking each trait by severity. (American Psychiatric Association Website, http://www.dsm5.org/Documents/Personality%20Disorders%20Fact%20Sheet.pdf) 

Those initial proposals were apparently deemed too radical and impractical and were ultimately overturned by the APA Board of Trustees, leaving in place the ten categories of personality disorder that have been used for decades, although a modified "hybrid" version of the originally-proposed model has been included in the new DSM-V for "research purposes."

Why should this matter to psychoanalysts?

Ambivalence about the diagnostic value of "personality disorders" has been present for a considerable time. Almost all of the personality disorder diagnoses in current use were originally described by psychoanalytic practitioners, including borderline personality disorder, narcissistic personality disorder, schizoid personality disorder, obsessive-compulsive personality disorder, histrionic personality disorder, etc. This is not surprising, as psychoanalytic practitioners were the only psychotherapists around prior to the 1950s or so.

But also, it is not surprising because, from the very beginning, psychoanalysis was concerned with the idea of personality organization. Along with being a theory of psychopathology and a developmental theory, psychoanalysis was concerned with the idea that human beings are motivated, have conflicts, have characteristic ways of dealing with the human and non-human world, have internalized structures that represent expectations and ideas about self and others and interactions between them. Psychoanalysis has always been a way of thinking about personality, and psychoanalytic theorists and practitioners continue to engage in fundamental questions about the nature of personality and its relation to psychopathology and the clinical process.

As far back as DSM-III, there was a push to eliminate the theoretical framework within which ideas about "personality disorders" had been understood; to create an "atheoretical" descriptive psychiatry based on observable symptoms and behaviors. So, even though DSM retained the category of Personality Disorders (with pared-down descriptions focusing on observable behaviors), they were placed on a separate axis (the original Axis II). In some ways this was not a bad solution, because in theory, it allowed practitioners to attend to both "Axis I" symptoms, such as mood disorders and anxiety disorder, as well as personality organization. It makes intuitive sense that, for example, someone with borderline personality organization may also be depressed or anxious or substance abusing, etc.

But something funny happened to Axis II on the way to the 90s. Insurance companies began to deny insurance reimbursement for Axis II diagnoses. They didn't care about Axis II as it turned out, even with the more behavioral and less theoretical descriptions, and rather predictably, practitioners began to ignore Axis II in their clinical assessments because they needed to provide an Axis I diagnosis for reimbursement, and an Axis II diagnosis added nothing from that point of view.

At the same time, psychiatry was continuing to become more biologically oriented and pharmacologically oriented and, on the whole (with notable exceptions), psychiatrists had less and less interest in the idea of personality structure and its relation to "Axis I" conditions. While everybody agrees that some kind of "biopsychosocial model" is most appropriate, in reality, contemporary psychiatry has attended less and less to the psychological and cultural aspects of psychiatric conditions, and has focused more and more attention on psychopharmacological treatments at the expense of psychotherapy. In mainstream psychiatry, disturbance of mood, or thought, or feeling, is increasingly viewed from a biological point of view, and is treated accordingly. From this perspective, the idea of personality and "personality disorders" becomes peripheral, or even irrelevant, and people whose difficulties were once understood primarily in terms of personality dynamics are now given descriptive diagnoses and their symptoms treated with little consideration of the "psychosocial" dimension.

It may turn out that by first eliminating multi-axial diagnoses (with the intention of creating a new diagnostic system for personality disorders) and then being forced to "restore" the traditional personality disorders, which will now be diagnosed on the same "axis" as all other psychiatric diagnoses, the authors of DSM-V will have inadvertently supported the increased use of personality diagnoses. It may be difficult for insurance companies to continue to deny coverage for personality disorders when they are included without any axial differentiation from the other DSM conditions. That remains to be seen.

Psychoanalytic theories and treatments continue to emphasize the importance of developmental processes and personality structure in understanding human beings and treating human distress and psychological suffering. This is one of the unique contributions psychoanalytic approaches can offer; in the current climate of quick and simple fixes to complex and difficult problems, we continue to attend to the depths and diversity of human experience, and maintain respect for complexity, ambiguity, and at times, the elusiveness of understanding. Psychoanalytic conceptions of personality have affected our entire culture, our language, how we think about persons, and human relationships. These ideas are part of a creative and valuable cultural and historical tradition, and it is our collective responsibility to nurture, protect, and transmit them.

CPPNJ Welcome Back Brunch 

Top: Donna Schatten & Lisa Grossi Middle: Martha Temple, Andy Lapides & Alexandra Granville Bottom: Genny Shineman & Bob Morrow

Seth Warren, Director, welcomed CPPNJ analysts and candidates to the beginning of a new academic year. He observed that the institute is "doing well", while noting that a rigid boundary setting psychoanalysis apart from other mental health disciplines is no longer a viable approach for our future. In this regard, he highlighted the new Continuing Education program as an effort at broadening our scope and reminded us that recruiting needs to be a personal concern for all CPPNJ members.

Michelle Bauer is now the head of the Training Committee. Mary Lantz is Board Secretary. Charles Most, the new Treasurer, reported that CPPNJ is solid financially.

Rose Oosting, head of Public Relations, described her division as the "external face" of CPPNJ. She urged new attention to advertising, graphics, redesigning the website, copywriting and issued a call for volunteers in these areas. The Speaker's Bureau will also be a focus of renewed emphasis.

The Outreach Committee, chaired by Marion Houghton, will be changing its direction to address the issues of culture and diversity within our Institute. Further information will be included in the November Newsletter.

Rosalind Dorlen is the new chair of the Recruitment and Marketing committee. She asked all CPPNJ members to "be recruiters" and also invited interested persons to attend the organizational meeting of the committee after the Brunch.

The Psychotherapy Center is under the direction of Susan Stein, assisted by Mirel Goldstein. Susan noted that the clinic is a resource center for the community at large, a source of cases for candidates, and a source of income for CPPNJ.

Bob Morrow, Dean of Faculty, welcomed four new faculty members: Lynn Egan, Evelyn Rappoport, Jeffrey Longhofer and Jerry Floersch. He also clarified that Faculty Forums, consisting of presentations by CPPNJ's faculty, are open to the public. Anyone may attend. He noted the ongoing activity of the scholarship committee. Bob also called attention to CPPNJ's Facebook page.

The Continuing Education Division presently does not have a Director, and is still open to interested persons to join. This is one of the major initiatives CPPNJ is launching with the view to expanding course offerings beyond the traditional psychoanalytic curriculum in order to reach the broader community of therapists. The popular Supervision Training Program, with Eric Sherman and Susan Masluk as co-coordinators, will be part of the Continuing Education Division and will be expanded to

Lila Redmount, Melanie Karger & Ilya Weiner.

include non-CPPNJ participants.

New initiatives are also being launched by the three area coordinators:

• Cheryl Nifoussi, coordinator for Bergen/Passaic, reported on recent breakfast and brunch get togethers.
• Ellie Muska, chair for Essex, Morris, Union has planned another brunch and discussion on Jody Davies' article dealing with enactments.
• Tom Johnson, coordinator for the Middlesex/Mercer Area, reported on a successful discussion recently led by CPPNJ analyst Bill Blum on Sandor Ferenczi. Tom also spoke about networking efforts involving CPPNJ and GSAPP.

Other emerging and ongoing activities include: the Child-Adolescent Interest Group and "A Home Within", led by Debra Roelke; the Trauma Study Group chaired by Nina Thomas; an Eating Disorders Study group being organized by Susan Gutwill; and the Reading Group on Psychoanalysis and Neuroscience, convened by Harlene Goldschmidt and Marty Silverman.  

Anyone interested in participating should contact the above-named persons.

The meeting adjourned for lunch and was followed afterwards by separate Faculty and Candidate meetings.

Back row: Joe Vernic, Paige Oszmanski, Andy Lapides, Dayna Bandman, Martha Temple, Debbie Frank, Melanie Karger, Ilya Weiner, David Sard, Arlene Kappraff, John Charles & Mirel Goldstein. Front row: Lisa Grossi, Donna Schatten, Madine DeSantis, Alexandra Granville, Genny Shineman & Sue Gerstley

Ferenczi: The Father of the Empathic Interpersonal Approach

By Marion Houghton, EdS, LMFT and Tom Johnson, LCSW, EdD   

Ferenczi at Freud's first appearance in the U.S. - at Clark University with Jung, Brill, Jones and Stanley Hall.

On September 16, 2014, a gathering of 18 CPPNJ members and guests welcomed CPPNJ analyst Dr. William Lum to talk about Sandor Ferenczi-one of the pioneers in the history of psychoanalysis. The meeting was hosted by Susan Gutwill at her home in Highland Park, and was the first of this year's meetings of the Central Region Group of CPPNJ

Bill described Ferenczi as a "tragic figure," whose tragic experiences revolved around the loss of his treasured friendship and colleagueship with Freud, as well as the loss of his early venerable stature in the analytic world. Ferenczi met Freud in 1908, and quickly became Freud's closest friend and colleague. Over the course of his career, Ferenczi differentiated from Freud and developed an alternate perspective on psychic reality in that he emphasized "actual facts"-the reality of the child's environment-as opposed to the intrapsychic focus that Freud emphasized when he distanced himself from his earlier "seduction theory." Ferenczi came to believe in the reports of actual child trauma in his adult analytic patients. This set him far afield from the dominant analytic perspective of the time which understood these reports as psychic reality and fantasy. These conflicts about trauma and about analytic practice eventually led to a cutoff from Freud after many years. The cutoff haunted much of his later clinical writing, and is particularly evident in Ferenczi's Clinical Diary. As Ferenczi experimented more and more boldly, typified by his later-life practice of "mutual analysis, " he became more and more exiled from the dominant analytic community. However, Ferenczi's ideas about practice prefigured many of the developments in contemporary psychoanalysis seen in such Relational ideas as: the myth of neutrality; mutuality and symmetry in the therapeutic relationship; the use of enactment; and countertransference disclosure. Ferenczi's work with trauma also prefigured many of our ideas about dissociation and multiplicity. We can see the influence of Ferenczi's ideas in the work of Winnicott, Kohut, the Interpersonalists, and the British Object Relations School. Ferenczi also served as an analyst for some of the influential thinkers in the analytic world: Melanie Klein, Michael Balint, and Clara Thompson (who was sent to Ferenczi by Harry Stack Sullivan).  

Bill also referred to Ferenczi as an "incurable charismatic" who kept "the child in himself alive" and was sensitive to the "child in his patients". His creativity, dedication and his intellectual bravery led to his being seen as the therapist of last resort for many highly disturbed patients. It was in this clinical work that he experimented with technique and developed many of his groundbreaking perspectives on working deeply in the transference-countertransference matrix.

Sandor Ferenczi

If we look at the history and development of Ferenczi's ideas, we can see his ongoing dedication to evaluation and innovation in  clinical practice. The period from 1908 to 1919 is known as the "active period" of Ferenczi's professional life, in which he, like Freud, sought innovative "ways of gaining access to inaccessible unconscious material" during treatment. Ferenczi said that the analyst should actively intervene in stalemated cases through the use of " commands, prohibitions, and suggestions to deprive and frustrate the patient". At the height of his experimentation with this perspective, criticism of his technique by Freud and other analysts caused Ferenczi to publicly renounce his methods and to re-align himself with Freud's more moderate approach, which prioritized slow and steady work in the transference.

 Click HERE to read the rest of this article  

Melanie Karger, PsyD

Having just earned my PsyD from Rutgers, GSAPP I'm excited to be an official CPPNJ candidate! While at GSAPP I was fortunate to have several of my early courses taught by CPPNJ faculty and I quickly became hooked on contemporary psychoanalytic thinking. As an extern I participated in CPPNJ's one year introductory program.  I completed an internship at Rutgers College Counseling Center where I focused on mindfulness approaches. I have recently joined the Summit Psychological Services group practice where I work with individuals of all ages as well as couples.  I have a particular interest in working with individuals dealing with issues of grief, loss and trauma. I have also worked extensively with children and families involved with DCP&P.

Member Presentations and Publications

Ruth Lijtmaer, PhD
Article Published
"Violations of Human Rights: Trauma and Social Trauma - Can We Forgive?" Psychoanalytic Theory: Perspectives, Techniques and Social Implications. Series: Psychology Research Progress. Chapter 4, p. 57-71. Phillip Fenton (Ed) ISBN: 978-1-63321-312-8.

Thank you for joining us. Look for our next newsletter in November 2014 when we will feature news from the CPPNJ Candidates' Organization.