April 2015
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DIRECTORS' COLUMN

By Seth Warren, PhD

 

Faculty Meeting May 17th

 

I am eager to meet with faculty next month at our scheduled meeting on the Florham Park campus of Fairleigh Dickinson University. I am reluctant to provide a detailed agenda for the meeting, as I am hopeful that our discussion can be both wide-ranging and shaped by the interests and concerns of those attending.

 

However, since it is obviously an unusual event, it seems useful to share some of my own concerns and interests, both to stimulate some reflection and to orient our members to the issues that I believe are currently most pressing for our organization.

 

We are now coming to the end of the 5th year of our existence as CPPNJ - the fifth year post-consolidation of our parent institutes, IPPNJ and CCAPS. Our Graduation event this June will mark the beginning of my sixth year as Director of CPPNJ, the final year of my second term as Director. Our work was cut out for us during the first few years after the consolidation. We were faced with completing the process of merging the two institutes in a manner that was true to the aims and intentions of those who planned and organized the merging of the two institutes, and also fair to our candidates who had entered two separate programs. We sought to accomplish this while maintaining high standards for clinical training in our programs, and to balance continuity with the need to develop our own new identity as an institute. We faced the tasks of combining our faculties and candidates, supporting the development of the (then) new Couples Therapy Training Program, and containing the interests and feelings of a wide range of psychoanalytic perspectives and backgrounds represented by our diverse faculty.

 

I believe we have been largely successful in facing these challenges, and the hopes of our previous directors to revive and strengthen the two institutes through consolidation seem to me substantially realized. Our combined faculty has grown to around 140 members. The Couples Division has continued to evolve into a highly creative and energetic training program that is attracting new students and certificate candidates every year. We are offering a large number of programs across the state, including full day conferences, workshops, colloquia, and meetings of our regional interest groups. Our Public Relations Division has grown enormously, with an excellent and successful website and active email marketing to a growing list of potential participants in the both the CPPNJ community and the larger circles of mental health professionals who have come to rely on our programming.

 

However, it is essential to continue to attract new and ongoing candidates to our core training programs, the 3-year certificate program in psychoanalytic psychotherapy, and in our full program in psychoanalysis. Our training programs are central to the purpose and existence of CPPNJ. While we have revamped our Recruitment activities to address this concern, it will nevertheless continue to be a primary concern. In addition, I would pose some of the following questions for your consideration and reflection:

  1. How do we organize and manage an institute that has grown substantially larger in the scope, breadth and ambitiousness of its training activities?
  2. How do we face the task of defining and articulating our evolving identity as a psychoanalytic institute offering a wider variety of training? This includes the issue of thinking about our long-range goals and aims, and balancing continuity with innovation.
  3. How do we develop and maintain our core training programs in a culture that increasingly emphasizes quick and easy scheduling and de-emphasizes the values that have sustained psychoanalytic work: commitment of time, energy and money, devotion to a practice, sustained attention in a distractible and over-stimulated world? How do we continue to offer a model of training in psychotherapy based on traditional emphases on the trainee's personal growth and development, apprenticeship, identification, and community?
  4. How do we maintain continuity with our organizational history as a diverse and democratically organized institute, opposed to rigid and politically motivated hierarchies, while preserving excellence and quality of training with a greatly enlarged faculty?
  5. How do we respond publicly as an institution to the degradation of psychotherapy through industrialization and assimilation into an increasingly corporate and technocratic health care system?

I look forward to seeing many of you at our May meeting, and wish to thank our faculty in advance for your time, attention, and wisdom.

CPPNJ Annual Graduation and
End of Year Celebration



We look forward to seeing you at CPPNJ's Annual Graduation and End of Year Celebration.

Come congratulate our many graduates!

And join us as we recognize Veronica Bearison's decades of devotion and service to IPPNJ and CPPNJ.

Date: Sunday, June 7, 2015
Time: 12:00noon-4:00pm
Location: Wyndham Hamilton Park Hotel (next door to the Fairleigh Dickinson Florham Park Campus)

Invitations to graduation are on the way in the mail. You will be able to register and pay online at www.cppnj.org or mail your payment to CPPNJ at 235 Main Street, #184, Madison, NJ 07940.

SAVE THE DATE

Saturday, November 21, 2015

IDfest 2015
An Evening of Comedy and Dessert

Location: Lenfell Hall, FDU Florham Park Campus, Madison
Time: 7:00pm-10:00pm
Details TBA
May is National Foster Care Month:

Join A Home Within and CPPNJ in Promoting Relationship-Based Services

for Foster Children, Youth and Young Adults

By Debi Roelke, NJ Clinical Director of A Home Within

 

debiroelke Our New Jersey chapter of A Home Within was founded in 2012 by Sandra Sinicropi and me as a public service initiative for CPPNJ. Since that time, our chapter has grown to 16 members from both within and outside of CPPNJ. We have two consultation groups led by highly experienced clinicians - Wendy Winograd and Janet Nelson - and 9-10 active cases. The work is challenging and sometimes frustrating, but ultimately very rewarding: the commitment and ongoing availability that we provide in our pro bono therapy sends a powerful message about the value of relationships to a child or young person whose experience has often been so fractured. The ripples of this message to the caretakers and helping professionals who are also involved is added value; A Home Within is one of the important ways that CPPNJ promotes psychodynamically informed and relationship-based work.

 

Started in 1994 by Dr. Toni Heineman in San Francisco, A Home Within has grown to include over 50 chapters in 22 states all across the country. Each chapter consists of a network of psychotherapists in private practice organized by a Clinical Director, and supported by one or more Consultation Group Leaders. The treatment model most often used is pro bono, once per week individual psychotherapy for the child or young adult, and support provided to the volunteer clinician through regular consultation groups led by experienced, volunteer group leaders. The goal is to provide a stable, ongoing treatment relationship that continues according to the needs of the child rather than the exigencies of the adults and/or agencies.

 

We invite you to consider becoming a volunteer for A Home Within. To find out more, please contact Debi Roelke at [email protected], 973-644-0033, or visit www.ahomewithin.org. Other ways to support this venture include spreading the word about A Home Within: mention the program to colleagues who might be interested, refer individuals and families who might be eligible or help make a connection between Debi and professionals in the foster care system who can make referrals to our chapter. Join the venture, and help CPPNJ and A Home Within further build an active presence for this program in our professional community.

Psychotherapy or Psychoanalysis: Can (Un)Identical Twins Be Told Apart?

By Martin A. Silverman, MD

 

martysilvermanphoto "How could he do that to me? How could he do that to me?" These were the words she sputtered out through a rainstorm of bitter tears. This was the opening line of a drama that would unfold within my consulting room, the theater she chose for its presentation, and into which I was being invited to join, as an audience member, actor, and, ultimately, co-producer and co-director. Susan, as I shall call her, went on to tell me, in some detail, about how her husband had shocked her by suddenly announcing that he was ending their marriage and leaving her. She had done nothing to deserve such scurrilous treatment. She was attractive. She was smart. She was affectionate. She was funny. They had always had a wonderful, active, seemingly fulfilling life together - as companions, as lovers, and as social beings with a slew of adoring friends. How could he do that to her? And why would he do it to her? She was absolutely flabbergasted!

 

I empathized with her plight and agreed to fulfill her request for someone to talk with about her pain and suffering.   We met weekly for many months while Susan poured her heart out to me as I listened to her tale of woe. For some time, I did little more than listen and nod my head from time to time to indicate that I had heard her painful expressions and felt with her how terrible had been the blows she had received to her pride and to her sense of worth and desirability as a woman.

 

After a while, I began to hear, mingled as they were with subtle allusions to dissatisfaction with the treatment she was receiving from me, tiny references to the possibility that she just might have contributed in small ways to the dissatisfaction her husband had developed to their being married to one another. I acknowledged my own contributions to the dissatisfactions she was feeling about what she was receiving from me, and we found that we were able to look together into the ways in which I was failing her and into what had been transpiring between us that was leading to them. Susan was puzzled to discover that she too had played a part in creating the little failures of attunement that had developed between us. She began to wonder about what she might have done to create the problems that developed between her and her husband. Perhaps it had not been totally one-sided.

 

Susan asked if it might be more productive for us to meet more often than only once a week. We considered it together and decided to increase the frequency of the sessions to twice a week. When we did so, her involvement in the meandering hike we were taking together through the countryside that spread out within her mind grew more and more focused and intense. She began to bring in dreams she had had that intrigued and puzzled her. She enlisted my aid in trying to unravel their meaning in daytime language. She was a bit puzzled when I not only joined in with her in wondering about her dream images but periodically found myself somewhat surprised that components of her dream life seemed to refer to me and to what we were doing together. She too was rather surprised. Her interest in the dreams intensified even more.

 

After a while, Susan herself began to find unexpected meanings in some of her dreams. The thoughts and feelings that occurred to her in connection with them increasingly led her away not only from what had happened between her and her husband, and from what was happening between the two of us, but to experiences and interactions with figures from her past, especially with her parents, siblings, and close childhood friends. She was both intrigued and puzzled. In return, I expressed appreciation of her psychological mindedness, but kept to myself the apparent competitiveness with me that she seemed to me to be exhibiting. One day, she said to me: "I'm beginning to see that there is a lot more going on inside of me than I thought. You have diplomas in your waiting room that say that you are a psychoanalyst. Tell me-what is psychoanalysis?" We discussed it at some length, and we decided together to shift our approach to meeting for psychoanalytic sessions four times a week.  

 

Revisiting the Dodo 

By Nancie Senet, PhD 

 

A few years ago I wrote the "Dodo" series for this newsletter. It's now time to revisit and update it. You will remember that the Dodo bird presided over a race in Alice in Wonderland and proclaimed that "EVERYBODY has won and all must have prizes." So it seemed to be the same when in 1936 Saul Rosenzweig published a comparison of results of various forms of psychotherapeutic treatment. He concluded that there were successes in each of the forms of psychotherapy and invoked the Dodo's verdict. That situation, we have been led to believe, had changed though over last several decades. Cognitive behavioral therapy outcome studies dominated research publications and consequently fostered the widely held belief that only cognitive behavioral therapy had proof of its effectiveness. It has been given the Gold Standard Award. You might say, the only one to win first prize.

 

To borrow a title from a recent Jonathan Shedler blog, we have been "Bamboozled by Bad Science." Cognitive behavioral therapy easily lends itself to empirical research. Manualized treatment protocols were used providing a relatively simple to learn and easily implemented standardized therapy for the research trials. Most of those studies did not compare CBT outcomes to those of other forms of bona fide psychotherapy, but rather to control groups receiving "treatmen-as-usual." Wampold et al. (2011) conducted a meta-analysis of studies comparing evidence-based treatments for depression and anxiety to treatment-as-usual control groups. They discovered that these control subjects did not receive any kind of legitimate therapy. Treatment-as-usual sometimes consisted of the primary care physician making a referral and were predominately treatments that did not include any type of psychotherapy or, even, therapy where the therapists were prevented from providing the kind of treatment that they normally would have provided. In other words the research evidence supporting CBT as the preeminently effective treatment is a sham.

 

With the more recent addition of research that compares results from various forms of real psychotherapy including psychodynamic therapy, the picture has changed. Overall that research has provided evidence that psychotherapy is beneficial, more beneficial than medication. And again, there is no winner among the psychotherapies. "All must have prizes," intones the Dodo. Take for instance the empirical evidence update of Leichsenring et al., published in 2014. They presented results from meta-analyses of outcome studies for a number of specific disorders. They concluded that "there is evidence from RCT's that psychodynamic therapy is efficacious in common mental disorders, that is, depressive disorders, anxiety disorders, somatic symptom disorders, personality disorders, eating disorders, complicated grief, posttraumatic stress disorder (PTSD), and substance-related disorder." (p.89)   They also reported that in most studies there was no difference found in the efficacy of psychodynamic psychotherapy and other bona fide psychotherapies including CBT.

 

We have here a good news/bad news scenario. For the most part, these empirical studies compared short-term psychotherapy. So, CBT holds no advantage over short-term psychodynamic (psychoanalytic) psychotherapy, both have evidence of efficacy and have comparable costs. But usually psychodynamic therapy is a long-term treatment. Here is where the nice, neat empirical evidence in support of our work dissipates, especially when cost is factored in. There are mixed results in empirical studies of long-term treatment. Leichsenring & Rabung, 2008, reported in a meta-analysis of long-term (defined as one year) psychodynamic psychotherapy (LTPP) with patients who had complex mental disorders (personality disorders or other chronic mental disorders) that the results yielded large and stable effects. Additionally the effect sizes increased significantly between termination of treatment and follow-up. These researchers updated that meta-analysis in 2011 and found that LTPP was superior to shorter forms of therapy with that patient population. However, in another meta-analysis, Leichsenring, Abbass, Luyten, Hilsenroth, & Rabung, 2012, did not find significant differences in efficacy between LTPP and other forms of long-term psychotherapy.

 

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A LOOK AT RECENT CPPNJ EVENTS  

Dr. Ronald Siegel: Mindfulness Practice in Psychology
By Ellen Fenster-Kuehl, PhD

Ronald Siegel 

CPPNJ's full-day spring presentation for 2015 featured Dr. Ronald D. Siegel, PsyD, part-time assistant profession of psychology at Harvard Medical School and author of numerous books and articles about the theory and practice of mindfulness in psychotherapy. A 'packed house' of CPPNJ members and professionals from the wider mental health community enjoyed Dr. Siegel's informative discussion about Mindfulness: Tailoring the Practice to the Person on Sunday, April 19 in Lenfell Hall on the Madison FDU campus. Defining therapeutic mindfulness as awareness of present experience with acceptance, Dr. Siegel described the process of mindfulness as insight into the workings of the mind in a 'laboratory' setting. By opening us up to depths of present experience, mindfulness is intended not to avoid pain but to help us bear the emotional and physical pain of experience. "Mindfulness is a systematic, therapeutic approach that opens us up to experience instead of leading to deadness," he stated.

 

Individualizing mindfulness practice, which Dr. Siegel applies to a range of problems including depression, anxiety, and physical pain, requires the practitioner to consider, among other variables, which skills to emphasize, what the objects of attention should be, narrative or experiencing mode, and "turning toward safety or sharp points." Narrative mode and focus on safer areas would be more appropriate, for example, when a patient is feeling more overwhelmed or fearful of loss of a sense of self. Then mindfulness might be achieved through walking or listening meditation and forms of guided imagery, providing a sense of grounding and stability for a traumatized patient. "Turning toward the sharp points" directs a patient toward experiences that have been avoided and the focus of the meditation is inward, how the trauma, for example, is experienced in the body. Dr. Siegel included specific rationale for the use of mindfulness in the treatment of depression and anxiety and focused much of his afternoon discussion on mindfulness for the treatment of chronic back pain.

 

CPPNJ's well-attended spring presentation included both lunch and a wine and cheese reception following the afternoon program, providing opportunities to connect with old friends and network with professionals. Faculty and current candidates were available to discuss CPPNJ's training programs with attendees interested in considering analytic training.  

 

Natalie Brown, Myra Klein and Stan Moldawsky
Mary Lantz and Seth Warren
Heather Lopes

Elizabeth Buonomo and Felice Toonkel

Eric Sherman Presents at Essex/Union/Morris Brunch
By Ellen Fenster-Kuehl, PhD

On Sunday, March 22, about 20 CPPNJ members and guests met at the home of Karyn Reader in Randolph for a pot-luck brunch, a

Eric Sherman 

chance to catch-up with old friends, and then a conversation with Eric Sherman, LCSW. Eric, a long-time CPPNJ faculty member, teacher, and supervisor, discussed his article From Dead to Alive: Desire, Dissociation and Passion in the Analytic Dyad, published in 2014 in Psychoanalytic Dialogues.

 

Prior to a discussion of the paper, Eric answered questions about his interest in writing about his work. He has already published both books and articles about the impact of the psychoanalyst's life - his own in particular - on the analytic relationship and treatment work. Talking about his enjoyment of the writing process and the ability to discuss his written work with colleagues, he finds writing a form of supervision in which we must think deeply about a case, share that with colleagues, and listen and relate to different points of view as the writing progresses.

 

From Dead to Alive discussed his work with a closeted and sexually inactive gay man from the point of view of Eric's own experiences as a gay man. While raising questions very specific to the lives and work of the two persons in this dyadic treatment relationship, those questions were applicable to the work of all analytic therapies: What impact does the desires of the analyst (to help the patient widen and enrich his or her life in ways that may be informed by the analyst's own life) have on the treatment? How can the analyst carefully attend to the shifting internal states of both patient and therapist, and the shifts of the analytic space, while also attending to what may be their different goals for treatment. "There are many potential benefits to the analyst's willingness to put his own desires in play. Nonetheless, working in such a way requires particular thoughtfulness about boundaries and the scope of the therapeutic relationship. Although analyst and patient may have similar wishes for regression, they are never identical, nor are they experienced the same way. Yet in the midst of a heated enactment, it can be difficult to sort out whose wishes are whose." (P. 208, Psychoanalytic Dialogues, 24.)

 

Eric discussed the nature of desire in the analytic relationship, the potential for desire to be dissociated through vulnerability or fear, and the resulting deadness that can be enacted between the therapist and the patient, often when there has just been a moment of the fulfillment for the desire of recognition in the treatment. "My ideas around mutually enacted deadness differ from those of Ogden (1995) who interprets the patient's lifelessness by finding it in his own reverie. I am proposing that the analyst sometimes cannot utilize his reverie because he has gone dead in the grip of the mutually dissociative process...[It is] a messier, more mutual process in which the analyst unwittingly contributes to the deadness by losing touch with his own unmet longings as well as the patient's." (P. 197.) With the patient discussed in his paper, Eric identified his own process of writing about the therapy as one way of monitoring his own withdrawal and dissociation about the patient.

 

The brunch provided a friendly, comfortable, and accessible way to participate in a discussion of some of the most intensive and difficult work that we do as analysts.

Recap of NJCTTP Weekend Workshop 
"Relational Trauma and its Impact on Couples' Therapy"
By Alexandra Granville, LCSW and Arlene Kappraff, LCSW 
 
Alexandra Granville 

On Friday, March 6th and Saturday, March 7th, thirteen couples therapists gathered at Fairleigh Dickinson

Arlene Kappraff 

University to participate in what turned out to be a lively, informative and interactive seminar; "Relational Trauma and Its Impact on Couple's Therapy" facilitated by Ellie Muska,LCSW, Susan D'Aloia, LCSW, and Helene Schwartzbach, EdD.

 

The seminar opened with a guided meditation and set the tone for the next day and a half of mutual sharing of experiential and clinical material. Once acquainted and settled in, Ellie discussed the bio-physiology impact of trauma on the neurological system and Susan presented attachment styles, their impact in the couple relationship and implications for clinical practice.

 

Saturday began with a presentation on self states, dissociation, enactment and projective identification and its application in the couple relationship and couples work. The group watched several segments from the HBO series "In Treatment" of a fictional couple engaged in couples therapy as a vehicle to spot the above mentioned phenomena. During the afternoon, Lisa Grossi, LCSW and Helene graciously and fearlessly allowed the group to observe and participate in a live supervisory session. Role plays were interspersed throughout the seminar and facilitated further experiential learning.

 

Saturday ended with a lively and spirited discussion of the special challenges of transference and countertransference in couples therapy. The leaders' knowledge, clinical skills and enthusiasm created a comfortable and safe environment, promoting attendees' active participation in all aspects of the weekend workshop and made for a very satisfying and enriching learning experience for all.

Upcoming 2015-2016 Events

 

May 26, 2015 - Middlesex/Mercer Networking Event - Eating Disorders/Body Image Study Group - Details TBA

June 7, 2015 - CPPNJ Graduation & End of Year Celebration - Wyndham Hamilton Park Hotel, Florham Park - 12:00noon-4:00pm

September 27, 2015 - CPPNJ Welcome Back Brunch - Maplewood Community Center, Maplewood - 9:30am-1:30pm

November 15, 2015 - Stephen B. Levine, MD presents Obstacles to Loving: Talking about Love with Couples - Lenfell Hall, The Mansion, FDU Florham Park Campus, Madison - 8:30am-4:00pm

November 21, 2015 - IDfest 2015 - Lenfell Hall, The Mansion, FDU Florham Park Campus, Madison - 7:00pm-10:00pm

April 16, 2016 - Virginia Goldner, PhD presents When Love Hurts: Attachment Negation, Abuse and Violence - Lenfell Hall, The Mansion, FDU Florham Park Campus, Madison - 9:30am-4:00pm
Visit our website at www.cppnj.org

Thank you for joining us. Look for our next newsletter in May 2015. 

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