DIRECTORS' COLUMN

By Seth Warren, PhD

"Deeper Wells"

I understand that some of my columns may at times inspire anxiety or worry, reflecting my own worries and concerns about the future of our particular field, our way of working clinically, and our theoretical traditions, which I think we all recognize are threatened by the larger context of the changing nature of health care and how our civilization thinks about human beings, the difficulties they have, and the kinds of help they can use.

For this column I would like to do something different: to take the opportunity to express my appreciation and gratitude for the professional life I have. As I do so, I am certain that I am expressing feelings that most of you all share in important ways.

To begin with, I am grateful for the professional worlds I have been privileged to be a part of during the past 30 years or so. I have gotten so much from my colleagues, my professional relationships, the networks of other psychotherapists to whom I have been connected, and all the institutions - naturally including CPPNJ - with which I have been affiliated during those years. The solo practice of psychotherapy would be unimaginable without those important relationships and ties. This is one of many reasons why I have chosen to devote so much of myself to our own institute and its goals of postgraduate training and education for our candidates, for ourselves, and for the larger community to which we all belong.

I am deeply grateful that I have found a way to make a living that is thoroughly connected to who I am as a person. I like discovering techniques that work, but there is something important beyond that, which is work that includes one's total life experiences and one's whole self. I know that, at my best, I work from myself, in a way that is personal and unique, even as I share many aspects of our clinical and theoretical tradition. The opportunity to find expression in work for one's "true self," to use Winnicott's expression, is a very precious thing.

And just now, after I thought I had finished this column, in the course of preparing for a class I am teaching, I came across this quote by Harry Guntrip that seems to express something very similar: "Psychoanalytic therapy is not like a 'technique' of the experimental sciences, an objective 'thing-in-self' working automatically. It is a process of interaction, a function of two variables, the personalities of two people working together towards free spontaneous growth. The analyst grows as well as the analysand." 1 Although we may sometimes disparage ourselves, wondering who in their right mind would become a psychotherapist in the first place, I believe there is real reparation in the choices that many of us have made, driven often by unconscious forces that are, at their core, a seeking after recognition and responsiveness. Many of us have been lucky enough to find at least some of that in our lives - and in our own therapies.

I am grateful for the opportunity to work with other people daily, who bring their own creativity and passion to our work, and who share so much of themselves. Sometimes patients will wonder aloud to me, "how you can stand listening to people complain all day?" But the reality is, while there are certainly strains and challenges to doing the kind of work I do, a good deal of the time I take great joy and pleasure in the ongoing therapeutic conversations I engage in. Isaac Bashevis Singer says somewhere that "every person is a millionaire in feelings." So that means there are two millionaires in the same room! People are amazing, courageous, playful, and fascinating; as they come into contact with unfamiliar parts of themselves they bring out in me parts of myself I might not otherwise experience, and help me to understand more about myself just as much as about them. I'm afraid this may sound a bit Pollyannaish, but even with more difficult patients in difficult places, I find myself lately more engaged, curious, and present, waiting for new openings where I may as yet see none, searching for the parts of myself that will bring something new. Our work provides a unique kind of challenge, that certainly changes us, I think for the better, and brings growth of new capacities in ourselves.

I am also grateful that the field I find myself in is one that provides truly endless intellectual stimulation. Psychoanalytic psychology is a vast discipline that spans decades and the work of countless thoughtful, disciplined, devoted and clinically-experienced individuals. It is an intellectual culture that is unmatched in all of psychology; for me it is a source of great relief and pleasure to realize that I will never come to the end of it, that there will always be more to learn. Our wells are deep. New worlds appear, old ones revisited bringing new experiences, dialogues without end with one another and within ourselves.

The psychoanalytic tradition is linked to the arts, culture, religion, and philosophy, as well as science and medicine. Those links are presumed to be a great liability in our scientistic age, as other psychologies and clinical approaches seek to pare away those major rivers of human wisdom and experience. I see it otherwise. I find joy in being able to draw on those larger cultural experiences in my daily work, opening up channels of personal creativity that simply are not available in other kinds of clinical work. We get to move within and between thoughts, dreams, music, poetry, memories, images, feelings, and religious experience (how else to describe such fundamental human experiences as awe, compassion, dread, falling in love, facing death, feeling reborn - and yes, gratitude?). We get to be human beings in our work, every day, in all our complexity, passion, mortality, and aliveness.

What more could one ask for?

__________

1 Guntrip, H. (1975). My experience of analysis with Fairbairn and Winnicott. Int. Rev. of Psychoanalysis, 2, 145-156.

SPOTLIGHT ON ... CPPNJ Instructors

Karen Heffernan and Rose Oosting

By Debi Roelke, PhD  

This month, we introduce a new feature column in the newsletter that will spotlight the groups of people who give their time and effort to the programs and activities that make CPPNJ the vibrant, active institute that it is. This first column introduces two people who share their time and expertise with candidates in teaching the psychoanalytic courses that are the core of CPPNJ's mission. Karen Heffernan and Rose Oosting have taught a variety of psychoanalytic courses at CPPNJ with a variety of other teaching experiences as well. Both Rose and Karen cite the most valuable and rewarding part of their teaching experience as the opportunity to learn from their students.     

Karen Heffernan, PhD is a psychologist-psychoanalyst who practices in both New York and Westfield. While her practice encompasses patients struggling with a range of issues, a core focus for Karen is working with trauma, "...especially with patients who experienced abuse in early life, including those with DID and other dissociative defenses." She brings this focus to couples work as well, where she similarly deals with relationships where one or both partners have a history of trauma and/or abuse. "During my analytic training I was drawn to the British Independent School, especially Winnicott, and since then I have enjoyed bringing together these theories and contemporary relational approaches.

Karen taught for a number of years in the graduate program at GSAPP (Graduate School of Applied and Professional Psychology at Rutgers) on trauma-related topics. She has especially enjoyed the opportunity to teach specifically psychoanalytic courses at CPPNJ, in particular, the Clinical Process I course for beginning candidates. "It has been a gift for me to teach a class that is anchored in the 'felt sense' of what is happening in the room with a patient, and the use of oneself as the instrument we bring to the work." Karen comments that a course like this challenges both students and teacher "to 'play' at the border of the professional and the personal, in order to develop one's ability to truly bring oneself into the clinical encounter, to be present." She continues: "Some of the most meaningful moments have been when a student has been able to trust the safety of the class and say, 'I'm not sure I get this. Is it like the time when my patient...' and has gone on to 'try on' the concept under discussion, allowing the class to share in their internal process, until something comes together for them that is meaningful and useable. Students' generosity in sharing their experiences here deepens everyone's learning."

Rose Oosting, PhD is also a psychologist-psychoanalyst with a general adult and couples practice. Her office has been in Montclair for over 25 years, where she has also developed a long-time sub-specialty in working with creative artists of all kinds. She brings to this her own lifelong interests in writing, music and photography. Rose has also focused for many years on the impact of trauma on her patients, stemming from her early experience in child abuse casework. She comments that "...ever since, [I] have been impressed by the ubiquity of trauma of various levels in human life." She brings this particular sensibility to her work with patients from adolescence through the later years, as well as teaching, supervising and training analyses.

Rose studied developmental psychology at the University of Rochester, completing her doctorate in 1981. This focus on cognitive and psychic development has been an important backdrop to her continued thinking about human growth and change. She completed her psychoanalytic training at the Postgraduate Center for Mental Health in 1986, and opened a practice in New York, later moving to Montclair. Rose describes her early analytic training in Object Relations Theory and Classical Freudian Theory: "I studied Freud with Martin Bergmann, and then studied with Stephen Mitchell, participating in a reading group with him until his death in 2000. Through that work, I became a Relational Analyst, while retaining my roots in Fairbairnian Object Relations Theory." Rose has brought this deep and varied background to the many institute courses she has taught at CPPNJ, IPPNJ and CCAPS, as well as NJCTTP (NJ Couples Therapy Training Program). Her courses have included first year clinical courses in psychoanalytic psychotherapy, Freudian Theory, Object Relations Theory, and Concepts in Psychoanalytic Theory. As co-founder and faculty of the CPPNJ Couples Therapy Division, Rose has also taught the Sexuality class several times.

Rose speaks for many of her fellow CPPNJ instructors when she says: "Each class I have taught has taught me, too, and each has been rewarding. I have enjoyed my contacts with candidates, and have learned from them, too. There are many stresses as well, in the time spent preparing for classes, but these too have resulted in growth and I appreciate that. I'm glad to have had the opportunity to share what I know with others, and to engage in a continued study of our difficult profession."     

The Past Is Powerful Indeed

By Martin Silverman, MD

It was a beautiful morning. The sun was shining. Birds were singing. The woods were green and lush. I was sitting at the side of the tennis courts, at the mountain retreat where I and my family were spending the month of August. I had just played an hour of singles, and I was resting a bit before going out to play again. An elderly man ambled over and sat down next to me. He introduced himself and we began to talk. "I heard you're a psychoanalyst," he said. "I am," I replied. "How did you know?" He pointed to someone on one of the tennis courts, with whom I had played the day before. "He told me." Then he began asking me questions about psychoanalysis. "What is it? How does it work? How often do you meet? What does it cost?" and so on.

I realized after a while that he was asking me too many questions for this to be idle curiosity. "Is something bothering you? I asked. His face clouded over. "Yes, there is! Could I talk to you?" he asked plaintively. I sighed. I was on vacation! But he seemed so distressed that I just couldn't say no. "All right," I said. I have a little time. Let's go for a walk." We walked along a narrow trail in the woods. "What's bothering you?" I asked. He told me at length about a problem with which he had been dealing for some time involving his teenage daughter, who was struggling in school because of learning disabilities. For a while she had been so discouraged that she was talking about killing herself. He and his wife had obtained help for her from tutors and a reading specialist, and now she was doing well in school, was happy, and had friends. "Well," I said, "she seems to be doing okay now. How come you're so upset?"

His face screwed up in anger. "Actually, it's my daughter-in-law who's making my life miserable! She's driving me crazy. I can't eat! I can't sleep! She's all I think about!" "What's the problem?" I asked. My newly-found, elderly acquaintance spewed out a litany of complaints about his daughter-in-law, all of which sounded very minor to say the least. The most serious complaint he had was that she objected to his barging in, uninvited and unannounced, at 8:00 a.m. on a Sunday morning, when she and his son wanted some sleep and some privacy. She asked him to at least call first. "That doesn't sound like such an unreasonable request," I said. "You're just like my wife!" he burst out. "You don't understand me! No one understands me! I'm furious at my wife! I'm going to divorce her!" He went on: "The only one who understands me is the author of a book I'm reading. I have it with me. I'd like to show it to you." This was my opportunity to get away. And I had another tennis match coming up." "Okay," I said. "Why don't you come down to the tennis courts the same time tomorrow and show it to me." He agreed to do that, and I beat a hasty retreat.

He showed up right on time the next day. He carried a book with him, a mystery novel, and he opened it up to a page on which he had highlighted a sentence that seemed to me to mean absolutely nothing. Two lines below it, however, was the following sentence: "The past has a way at times of reaching out, grabbing you, and refusing to let go." That had to be the sentence! "What happened to you in the past?" I asked. His eyes opened wide and he turned as white as a ghost. "How did you know?" he asked, "That's my secret!" We walked and talked on the trail in the woods for the next hour and a half-while he cried and cried as he told me about his past life, in Germany, thirty-five years earlier, with another wife and another daughter. They were Jewish. The Nazis came into power. After a while, a friend urged him to take his family and leave. He spoke to his wife about it, but she refused. "My family has been here for hundreds of years," she said. "We have a thriving business here. We're happy here. And this is a civilized country. I'm not leaving."

Many months later, after conditions got worse, she agreed to go-but it was too late. They could not leave. Some time after that, a non-Jewish friend offered to take their little girl, get false papers for her, and arrange for her to go to a trusted family that would take her in and keep her safe. Once again, his wife said, "No." How could she bear to be parted from her precious, darling, little daughter. A few months later, after things got even worse, his wife relented and agreed to part with her. Once again, it was too late. He and his wife ended up in concentration camps-and he had to hand his little daughter to an SS guard who threw her alive into a fire!

Somehow, he and his wife survived the camps-but their marriage was over. They obtained a divorce. They both immigrated to the United States. After a while, he remarried and they had two children. We met every morning, for a few days, and we walked and talked on that trail in the woods. I learned that his current agitation had begun while his current wife had been pressuring him to take her to Europe. He had never returned to Europe, and he was very reluctant to do so. But his wife wanted to go to Spain.

He cried and cried as we talked about the way in which the past had lurked within him like a pocket of virulent bacteria that only needed to be stirred into activity that would transform it into the abscess that was bursting out of its containing walls, spewing pus out of each of his orifices. He began to recognize that the past, which had lain dormant within him for decades, had emerged from hiding and had so taken him over that he totally lost his perspective. He was terrified at first when I suggested that he take his wife on the trip for which she longed, so that he might face his demons and finally put them more or less at rest. After thinking about it overnight, he told me that he thought I was right. He didn't come to the tennis courts to bother me any more-but he did send me a picture post card from Spain in which he thanked me profusely for my assistance.

William Faulkner was quite right when he said: "The past isn't over! It's not even past!"

Culture and Psychoanalysis

By Marion Houghton, EdS, LMFT

Psychoanalysis, as we currently conceive it, has not sufficiently acknowledged its own roots. For many of us, it has been embedded in a milieu (European, American) that is presumed to be "beyond culture". Many psychoanalytic voices are now saying that we need to become aware of our own embeddedness, and be more curious about where "other people" come from and what has shaped their development and "meaning-making".

When I attended the conferences entitled "Black Psychoanalysts Speak I and II" in NYC within recent years, I was touched deeply by the presenters' stories. I now realize that I either had to deny their legitimacy as analysts or listen to their stories in a new way. Surprisingly to me, their stories awakened my own-actually brought my own story alive in me.

What will happen if we tell each other our stories in the community of CPPNJ? Do we assume that we come from the same place when perhaps we don't? Are our "particularities" important? Do our histories matter in our analytic work?

The CPPNJ Outreach Committee hopes to provide a forum for our own "storytelling" as analysts, and in so doing to deepen our therapeutic work with our patients as well as expand the diversity in our membership. Looking within CPPNJ for the resources we need, the Committee has found Ruth Lijtmaer, Ph.D., who is currently teaching "Multicultural Issues in Psychoanalysis and Psychoanalytic Psychotherapy" to CPPNJ candidates, and Cheryl Thompson, Ph.D., who has taught Multicultural Counseling, a course she created at Seton Hall University, for a number of years.

Plans for the 2015 Outreach Committee initiatives include screening a new documentary based on "Black Psychoanalysts Speak I and II", a program that was sponsored by IPTAR in New York City under the direction of Richard Reichbart, Ph.D., followed by discussion and the opportunity to share our own stories.

Outreach Committee members currently include: Marion Houghton, Chair, Joan Berkowitz, Gayle Coakley, Roslyn Gawthney and Marlene Rybinski. Interested CPPNJ persons are invited to provide additional ideas and feedback to this proposal.

By Karen Heffernan, PhD 

On November 8th, 2014 the NJCTTP and NJSCSW co-sponsored a presentation by Richard Schwartz, PhD, creator of the Internal Family Systems (IFS) therapy, entitled: Accessing Disowned Parts of the Self: Internal Family Systems Approach to Couples Therapy.

Dr. Schwartz's compelling 'story-telling' style immediately engaged the crowded room, as he invited us to recall those moments when, in the midst of conflict with a partner, we've had the experience of watching ourselves "run things off a cliff" and subsequently asked ourselves, "Who was that?!" The answer, he suggested, is subpersonalities, 'parts' of us whose role it is to protect other, vulnerable parts who have been triggered by our partner.

What are these 'parts'? IFS is anchored in a model of the mind as naturally multiple or divided, and brings together ideas and techniques from both intrapsychic process and family therapy to offer a systemic approach to the mind. A patient-centered model, it grew out of Schwartz's efforts to listen to his young patients who were struggling with bulimia, who told him about 'internal wars' between different parts of them. As he worked to understand these internal systems, he developed a 'map' of sorts, that identified three particular kinds of parts and the relationships among them, which he walked us through:

            EXILES: early, vulnerable parts who hold the feelings of hurt, shame, etc. that we have locked away - exiled - in our attempts to 'never go there again.' Not only are they left holding these painful experiences, frozen in the past; there is also a loss in our capacity for relationship if we exile the most loving, joyful, intimacy-seeking parts of ourselves.

            MANAGERS: pre-emptive, always-on-duty protectors whose job it is to keep exiles sequestered in the hope of avoiding their being triggered and overwhelming the system. But this is a big job, and entails such careful monitoring of how much access another person is allowed, that it limits how much closeness is possible.

But exiles do get triggered and overwhelmed by feelings, activating...

            FIREFIGHTERS who use any means necessary - substance use, rage, self

harm - to douse the flames. We are organized so that the parts protect the Self at all costs; the problem is, in doing this, they can lose faith in its ability to lead and come to believe they have to take over. Their extreme beliefs and behaviors are not their natural state: healing comes from relieving them of these roles and regaining trust in the ability of the Self to acknowledge and relieve the pain of the exiles.

Dr. Schwartz turned next to the pain of couples in conflict - what he called "Parts Wars," in which there are no Selves in the room. If we infer from the model that the rigidity or severity of managerial protective strategies will match the degree to which they believe the person is in danger of being re-injured, we can see the ready applicability to the painful cycles in which our couples can become locked.

So often, couples come to therapy each wanting their partner to change. Echoing Bowen's focus on helping people to individuate, to be less reactive to the other's difference, IFS encourages couples to identify and work on their own parts. The goal, Schwartz explained, is for each partner to become the primary caretaker to their own parts, rather than demanding this from their partners and being disappointed when it doesn't happen.

When the water buffalo battle in the marsh, it's the

frogs who suffer (Chinese saying)

Through videos and a brave role-play by two CPPNJ volunteers, Dr. Schwartz demonstrated the model in action, emphasizing the therapist's role as "Parts Detector": when one person's part began to attack the other, he would ask them to speak for, rather than from that part. By directing couples to listen to what their own parts were saying, he helped them to separate a little from that part, enough to be able to see its role as protector of more vulnerable parts, as well as its impact on the vulnerable parts of the other - thus stepping out of vicious cycles in which protectors take over. All good couples therapy, as Daniel Goldberg commented, has at its core this invitation to mutual recognition, to curiosity about one's impact on the other and what the other does in response, rather than remaining locked in one's own subjectivity. The attainment of compassion for the other - a key aspect of Self - and accountability for one's parts and the damage they have done to the other, are core aspects of the application of IFS to couples work.

The day included several lively discussions, particularly regarding points of difference and overlap between IFS and more psychoanalytic approaches, e.g., the therapist's stance, the pace of the work, and countertransference. During one such exchange Dr. Schwartz, with gentle humor towards himself and his interlocutor, demonstrated a basic stance of the IFS therapist in acknowledging that his own 'defensive' part had been activated and needed to be asked to step back. There is no avoiding the need to work with your own parts, said Dr. Schwartz: the therapist's own exiles will get triggered and their own protectors will get active. Theoretical differences recede when we talk about being present with our own hurt parts, so that we can help couples be present with theirs.

On October 19, 2014, Dr. Sue Grand, a psychologist and psychoanalyst well-known for her engaging, thought-provoking presentations on trauma, and for her book, The Reproduction of Evil, read her paper "Skin memories: On Race, Love and Loss." The program was cosponsored with the New Jersey Society for Clinical Social Work.

As an introduction to her paper, Dr. Grand discussed how the intergenerational transmission of trauma was marginalized in the field of psychoanalysis, even though after WWII many children of survivors of the Holocaust were traumatized by their parents' experiences of trauma. She described how those experiences affected not only second and third generations but also other issues related to that trauma like immigration, and how their stories were told or kept secret.

In recent years psychoanalysis has broadened its understanding of what is haunting our patients, as revealed in their enactments and their dreams. An understanding of how traumatic experience is transmitted intergenerationally challenged the bedrock theories of classical psychoanalysis by expanding its focus from the oedipal constellation to the culture at large, and by closing the gap between the clinical (intrapsychic) and the social (applied psychoanalysis). Freud's discussions about war and how societal law is constructed led Fromm and other interpersonalists to see how society and its norms affect personality development. Understanding that trauma can be transmitted intergenerationally through unconscious processes allows us to look into the psyches not only of the patients but also of the therapists. We enter the clinical process relationally, with two people, each with their own histories. This affects the therapeutic field, and influences how the therapist manages countertransference and technique. Connected to this we can see how attachment and separation will affect the individual experiences of each, and beyond that their shared larger social predicaments.

Dr. Grand's paper related primarily to Holocaust survivors and the intergenerational consequences of that trauma; but also she stressed that other types of trauma, such as family or racial trauma, can have the same effect. Sometimes surviving generations or their descendents do not want to know about the suffering, or the older generation cannot talk about it because it is too painful to remember. These dissociated parts may be transmitted to the next generation as strange anxiety behaviors like the way money is handled, or the hoarding of food. Most importantly, children of survivors have fantasies about their parent's behaviors that are unconscious and are lived out in the children's lives.

Dr. Grand entered treatment with an African-American analyst who was light skinned enough to pass, and who did not disclose her race to her patient. However, Dr. Grand said, she knew from others that her therapist was African-American in heritage. Through much of the treatment, this remained undiscussed. Dr. Grand related this lack of discussion to her experience with her Russian grandmother, and described the transference that developed in her analysis. In the transference, the history of slavery emerges: the analyst's apparent whiteness echoes with rape on the plantation. Racial guilt and conflict is worked through motifs of loss, forced separation, and internalized racism.

In this racial experience, the patient's losses through the Holocaust are understood and explicated. This historical fact in her analyst's life was left undiscussed in the treatment, though it profoundly affected it. The unrecognized atrocity of slavery is written into the skin of American analysts, but it has not penetrated psychoanalytic theory, practice, or consciousness. Dr. Grand traced the historical abuse of slave women's bodies and the transgenerational effects of the exploitation, while discussing the fact that this was never articulated in the treatment. In her own parallels with her experiences with her much-loved grandmother, who was a fierce defender of the underdog, she began to understand how the traumatic experiences of her therapist paralleled the traumatic experiences of her family, though the sources were very different. The paper was very well received and was followed by many questions and comments from the audience.

Member Presentations and Publications

Ruth Lijtmaer, PhD

Paper presented: "The ghosts of the past are remaining with me". In the Panel: Apparitions, ghosts and trauma: Linguering untold stories. IFPE (International Federation for Psychoanalytic Education) 11-6-14 to 11-8-14. San Francisco. CA 

Mitchell Milch, LCSW  

A Formula for Happiness in a Sometimes Cruel World - blog posting for Psychology Today, October 14, 2014. 

http://www.psychologytoday.com/blog/meaningful-you/201410/formula-happiness-in-sometimes-cruel-world 

Thank you for joining us. Look for our next newsletter in December 2014/January 2015.