Annual Conference 2000 Chicago

Abstracts of All Presentations

Annual Conference on the Psychology of the Self

Chicago, November 9-12, 2000

Thursday, November 9, 2000 ! 1:00 pm- 4:15 pm

Arthur A. Gray, PhD

Rosalind C. Chaplin Kindler, MFA

We are continuing to define what makes psychoanalysis effective. The Process of Change Study Group in Boston (1998) has established that psychoanalysis is most effective when constructed as an improvisational encounter between patient and analyst. This workshop draws upon improvisational training exercises used to increase the actor’s skill and effectiveness in performance. The goal of this workshop will be to use these training techniques to increase the analyst’s repertoire of responsiveness through enhanced improvisational skills.

Thursday, November 9, 2000 ! 1:00 pm- 4:15 pm

Ann D’Ercole, PhD, Judith Kaufman, MSW

Sandra M. Kiersky, PhD, Amanda Kottler, MA

In this workshop, we will explore various ways that gender and sexuality develope within intersubjective contexts. Cultures, communities, and families form the ways we come to know (and not know) our individual gendered and sexual selves. We will attempt to de-construct these false dichotomies: heterosexuality and homosexuality, male and female, mind and body. Biological potentials develop and disappear within specific intersubjective contexts. We will ask various questions. Is there something essential about "maleness" and "femaleness," or are these purely social constructions? What role does the body play in the construction of gender and sexuality? What is the place of affects in gender development? How do guilt and shame shape the lives of people who are homosexual or not exclusively heterosexual? How does the analyst’s sexual preference affect the therapeutic dyad? Clinical material will be used to illustrate our ideas and questions.

Thursday, November 9, 2000 ! 1:00 pm - 4:15 pm

Howard A. Bacal, MD, Bruce D. Herzog, MD

Midge Breslin, MEd, William A. Laurie, MSW

Lester Lenoff, MSW, Judith Lester, MEd

Carol A. Munschauer, PhD, Richard B. Rosenstein, MD

This is a two part workshop. Part two will take place on Saturday, November 11. The aim of the workshop is to elucidate and illustrate the principles of specificity theory and its clinical application, optimal responsiveness. After a brief theoretical presentation, a core (Balint-type) group will discuss clinical material, in both workshops. Participants will locate in a surrounding tier and will be able to participate in an open discussion of the theoretical presentation and the clinical work of the group. Involvement in both workshops is encouraged.

Thursday, November 9, 2000 ! 1:00 pm - 4:15 pm

Amy Eldridge, PhD, Joseph Palombo, CSW, Erika S. Schmidt, MSW

This workshop will provide a broad conceptual framework for evaluating children which is consistent with the principles of self psychology. The framework will include neurobiological, family, developmental, and social issues which impact the child's developing self structure. Attention will be paid to engaging the parents and child in the assessment and treatment process, and maintaining alliances with each. An in-depth case presentation will demonstrate the treatment process and the multiple issues that arise.

Thursday, November 9, 2000 ! 7:00 pm - 9:00 pm

Friday, November 10, 2000 ! 9:00 am - 11:15 am

Allen M. Siegel, MD, Constance O. Goldberg, MS, Sharone Ornstein, MD

This introductory course will provide participants with knowledge of the unconscious underpinnings that have served as the basis for the various theories that have flourished within the field of self psychology. We believe that a strong grasp of Kohut’s psychology of the self is essential to comprehend the other theories that have followed. With this in mind the first session, held on Thursday evening, will explicate the psychoanalytic principles that Kohut conceptualized. During the second session, held Friday morning, we will apply those principles to an ongoing treatment.

Thursday, November 9, 2000 ! 7:00 pm - 9:00 pm

2.0 Hours

Jill R. Gardner, PhD, Paul H. Ornstein, MD, Scott M. Davis, MD

In this presentation therapist and consultant will provide an unrehearsed sample of a clinical consultation, with subsequent discussion by the audience, in order to focus on the case consultation process.

Friday, November 10, 2000 ! 9:00 am - 11:45 am

Thursday, November 9, 2000 ! 7:00 pm - 9:00 pm

Friday, November 10, 2000 ! 9:00 am - 11:45 am

Martin S. Livingston, PhD, Carla M. Leone, PhD, David Shaddock, MA

This course will present a self psychological/intersubjective approach to the treatment of couples. It will include an introduction to basic concepts as well as recent developments in this area. Emphasis will be placed on the original work of the presenters. Clinical material from the leaders’ practice will be included to enrich and illustrate the concepts introduced. The last section will consist of small group discussions of the participants’ experiences with their own cases.

Thursday, November 9, 2000 ! 7:00 pm - 9:00 pm

Friday, November 10, 2000 ! 9:00 am - 11:45 am

Rosemary A. Segalla, PhD, Damon L. Silvers, Bruce S. Wine, PhD

This pre-conference course will teach participants about the application of self psychological principles to group psychotherapy. The underpinnings for the workshop are based on the theoretical advances developed by Drs. Segalla, Silvers, and Wine which emerged from twenty years of experience in co-conducting group therapy from a self psychological perspective.

The program is designed to teach and apply Kohutian, intersubjectivity, and motivational systems theory to group psychotherapy. Further advances also to be taught include the application of infant research to group therapy models, the multiple selfobject model, and groupobject theory (Segalla, 1997). In addition to the theoretical presentations, there will be a demonstration group designed to highlight a co-therapy model of treatment and the range of intervention strategies from a self psychology perspective. A combined treatment approach utilizing both individual and group therapies will be explicated as a model which proves optimally responsive environments. Ample clinical case material will be presented, including case material from the presenters and supervision/consultation with the presenters.

Friday, November 10, 2000 ! 1:15 pm - 3:15 pm

James L. Fosshage, PhD

Salee Jenkins, PhD

Daniel Kriegman, PhD

Marian D. Tolpin, MD

Panel I will focus on a re-evaluation from contemporary perspectives of the role of empathy and interpretation in the analytic process. For example, what is empathy and interpretation? What are the features that influence interpretive formulations? How do empathy and interpretation contribute to therapeutic action? Case material will be presented which will provide a clinical focus for addressing these issues of empathy and interpretation.

Friday, November 10, 2000 ! 3:45 pm - 4:45 pm

These conference sessions are designed to allow small groups to discuss the material presented in Panel I with an experienced self psychologist. The Post Panel Discussion Groups will allow the participants to ask questions and to clarify their understanding of the material presented in the panels and to make comments about their thoughts regarding the panels.

Saturday, November 11, 2000 ! 8:30 am - 10:30 am

Estelle Shane, PhD, Joye E. Weisel-Barth, PhD

Robert Stolorow, PhD, Lewis Aaron, PhD

This panel concerns relational considerations in self psychology. Participants include Robert D. Stolorow and Louis Aaron, who serve as discussants for a case presented by Joye Weisel-Barth. The chair and moderator is Estelle Shane. In their discussions of the case, and in their interactions with one another, Dr. Stolorow and Dr. Aaron will consider such questions as "How do you think about the analytic process?"; "What role do you think the relationship plays in the analytic process and in analytic cure?"; "How does the relationship manifest itself in this case presentation?" Through questions such as these, the role of relational considerations in self psychology and distinctions between relational analysis and self psychology will be articulated and clarified.

Saturday, November 11, 2000 ! 11:00 am - 12:00 pm

These conference sessions are designed to allow small groups to discuss the material presented in Panel II with an experienced self psychologist. The Post Panel Discussion Groups will allow the participants to ask questions and to clarify their understanding of the material presented in the panels and to make comments about their thoughts regarding the panels.

Saturday, November 11, 2000 ! 1:00 pm - 2:00 pm

MD, Mark J. Gehrie, PhD

Introduction by Paul Ornstein, MD

This presentation will review certain of Heinz Kohut’s basic tenets of psychoanalytic self psychology relative to later developments in the field. There will be a discussion of his perspective on process and cure, and an evaluation of some of the implications of shifts in perspective that have occurred since his death. The question of basic epistemological orientation and its relationship to the psychoanalytic situation will also be discussed, along with the author’s own views on these subjects. Some clinical material will be presented to illustrate the issues under discussion.

Saturday, November 11, 2000 12:15 pm - 3:45 pm

Sharone A. Abramowtiz, MD, Henry Szor, MD

The purpose of this paper is to show how applied self psychology and intersubjectivity can guide physicians out of the restrictions of biomedical Cartesian thinking and encourage them to integrate a psychosocial and relational psychotherapeutic perspective into their medical practice. Familiarizing physicians with a contemporary approach to depth psychology such as self psychology’s emphasis on empathy and its understanding of selfobject organization, transference of the unconscious (Kohut, 1959, 1971, 1977, 1984) and the systems theory of intersubjectivity (Stolorow, Brandchaft & Atwood, 1987) (Stolorow & Atwood, 1992) can help physicians improve their medical practice and relationship to patients by improving interviewing and medical history taking, patient collaboration with medical treatment, psychosomatic and psychiatric assessment, and the understanding of individual experience of illness. In my opinion, a depth psychology paradigm, not just a biomedical one, improves the practice of medicine. This is a contemporary adaptation of Michael Balint’s work (1957) on the physician-patient relationship.

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

James W. Anderson, PhD, Alan R. Kindler, MBBS, FRCP(C)

This paper argues that the position influential thinkers within psychoanalysis take towards the field largely derives from their most intimate experiences with psychoanalysis, particularly their own analyses. Freud created psychoanalysis n tandem with his self-analysis. Helen Deutsch, after a positive experience of analysis with Freud, became a fierce defender of psychoanalysis. Henry A. Murray had a disappointing analysis. He then became a critic of psychoanalysis and developed his own theory of personality as an alternative to psychoanalysis. Heinz Kohut had a mixed experience in his training analysis. He remained within the psychoanalytic movement but developed a theory, self psychology, which can be described as the approach that he felt would have helped him, and would have explained his personal psychopathology, more successfully that his training analysis had.

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

Lynn Preston, MA, MS, Ellen Shumsky, CSW, Josy E. Fisch, MD

This presentation is organized around a clinical case that illustrates one analyst’s movement from an empathic stance to an empathic dance. An analytic empathic stance is a unidirectional, sustained immersion in the patient’s subjectivity. An empathic dance is bidirectional. We expand on Sucharov’s (1996) metaphor of the empathic dance which includes the analyst’s attention to the patient’s self experience (empathy), the analyst’s self experience (authenticity), and the meta-perspective of the dyad. We are broadening the definition of empathy from something that one person does for or to another (putting oneself in the other’s shoes), to include a bilateral empathic connectedness which is a bridge between two subjectivities. Instead of a focus on the analyst’s empathic interpretations, we speak about the analytic couple negotiating meaning making on a moment to moment basis.

The clinical case captures the struggle of an analyst trained to provide sustained empathic attention, working with a patient who presses for spontaneous emotional engagement as a requirement for selfobject connection. We discuss the mutual regulation of meaning making, affect and issues of control in this tumultuous treatment.

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

Gabriel Trop, MA. Melanie Burke, LCSW

Jeffrey L. Trop, MD, Philip Ringstrom, PhD, PsyD

Intersubjectivity theory has been characterized by some of its proponents as an inherently contextualist philosophy. Attempts have been made by these same proponents to link intersubjectivity theory to dynamic systems theory, which they consider a provocative source of metaphors for ideas concerning contextualism and intersubjectivity. Although dynamic systems theory does indeed offer new insights into the intersubjective therapeutic situation, there are certain key concepts embedded in intersubjectivity theory that do not cohere with a dynamic systems approach, namely the concepts of "structures of subjectivity" and "organizing principles." The use of language that carries along with it unnecessary reifications prevents intersubjectivity theory from adopting a more radically contextualist philosophy. The concepts of "perceived experiential patterns" and "attractor states" are chosen by the authors as rhetorical metaphors that provisionally replace those of "structures of subjectivity" and "organizing principles." The clinical consequences of a dynamic systems approach to psychoanalysis involves expanding the domain of intersubjectivity theory as well as advocating a more properly contextualist stance toward psychoanalytic methodology.

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

Maria L. Slowiaczek, PhD, Prudence Leib, MD

This paper is a case study of a patient with Dissociative Identity Disorder treated from a self psychological perspective. The paper focuses on three main theoretical points. First, the case illustrates how work with survivors of chronic childhood trauma require the therapist to elaborate emotional experiences beyond what the patient can articulate. This is shown in particular, with a series of collages that the patient brought to treatment when she was unable to express herself verbally. Second, the paper illustrates how in working with severe dissociation, the therapist enters into the patient’s dissociated state, to understand and validate the experience and world view of each distinct personality. The case illustrates how several of the distinct personalities of this patient, came to therapy and developed relationships with the therapist. Third, with Dissociative Identity Disorder, there are multiple selves who are often different ages with different capacities and needs for selfobject relating. Three of the distinct personalities are described at different levels of psychological development and an attempt is made to discuss how their selfobject needs differed and how these needs were met.

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

Jacqueline Hanley, Dipl. TCPP, MCAPCT, John A. Sloan, MD, FRCP(C)

This presentation will deal with the application of self psychological principles to play therapy with a disturbed but remarkably imaginative child in the context of her deeply conflicted family. It illustrates the role of affect attunement, authentic self-expression and both consciously playful and unconscious enactments on the part of the analyst in the development of selfobject transferences that enhanced the child’s sense of "realness" of self and others.

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

Allen M. Siegel, MD, Renee Siegel, MA, LCSW, BCD, Susan Fisher, MD

In this workshop we consider the theoretical and clinical aspects of the adopted child’s idealizations of the fantasized birth parent, the actual adoptive parent, and the relationship between the two. The data for our study comes from fantasies of adopted children that have been reported in the literature, from creative productions of adopted artistic people such as Edward Albee, and from clinical material in our own practices. We hypothesize that the adopted child’s persistent idealization of the birth parents can be understood as both a symptom of a disturbance in the idealizability of the adoptive parent and an expression of the persistent unconscious need to have an idealizable object. The disrupted idealization in turn adversely effects the environmental matrix created between the adoptive parents and the adopted child. We will address the clinical implications of this understanding.

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

Paul H. Ornstein, MD, Axel Joneck, MA

Dostoevsky is considered to have anticipated Freud in many ways. A study of his works indicates that he also anticipated Kohut, perhaps even more comprehensively. This workshop will focus on Dostoevsky’s "The Gambler". The issue of addiction to gambling and the gambler’s highly ambivalent relationship to the woman he desires (and hers to him) is masterfully portrayed.

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

Constance O. Goldberg, MS, Pamela Jean Holliman, PhD, Celia Brickman, PhD

The purpose of this paper is to contribute to the dialogue within self psychology about the function of religious experience in the context of clinical/therapeutic work. I will suggest ways to hear/evaluate religious experience as selfobject experience. To do so I will briefly highlight some of the literature of pastoral care and counseling which suggests parallel themes of therapeutic practice primary in self psychology and which relate to selfobject functions of religious experience. Finally, I will suggest four ways of thinking about religious experience as selfobject experience: providing compensatory self structure, enhancing the development of self structure, sustaining self cohesion, and providing opportunities for self transformation.

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

Christine C. Kieffer, PhD, Robert J. Leider, MD

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

Charles E. Grayson, PhD, Marian D. Tolpin, MD, Sanford Shapiro, MD

In this workshop we are suggesting that the methods of free association and evenly hovering attention (which is the free association activity engaged in by the therapist) are relevant to self psychology. The activity of free association provides access to the depths of the nuclear self and in many instances can foster the strengthening and cohesion of the self. A review of the psychoanalytic literature bearing on the topic of free association and the technical principles of neutrality, abstinence, and anonymity, all of which are problematic if not antithetical to the goals and technical orientations of self psychology. We discuss the necessary conceptual spearation of free association from these technical principles. The workshop will focus on Kohut’s ideas pertaining to the topic. We will propose that free association, as described and defined by Kohut, and later by Lichtenberg, can be adapted to the empathic enterprise and that it is intrinsic to empathic immersion. Practical issues of technique will be considered and some examples of the value of free association will be presented.

Saturday, November 11, 2000 !2:15 pm - 3:45 pm

Irwin Hoffman, PhD, Malcolm Slavin, PhD

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

Anna Ornstein, MD, Ruth Gruenthal, MSS

This paper consists of three parts: 1. Review of relevant literature. The paper reviews and briefly summarizes the psychoanalytic literature of the consequences of the Holocaust trauma. The review serves the purpose to indicate how the absence of the empathic listening perspective had resulted in the exclusive emphasis on psychopathology in this patient population affecting not only the survivors but subsequent generations as well. 2. The psychology of adaptation to extreme conditions. The paper explicates the psychology of extreme conditions to indicate how the mode of adaptation to these conditions served as a bridge between pre-Holocaust personality organization and the survivor’s adaptation to post-war conditions. 3. The process of recovery and a clinical example. The paper’s major emphasis is on the process of recovery. A clinical example offers a sample of the manner in which survivors attempted to integrate their traumatic memories and the manner in which the therapist participated in this process.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

Martin S. Livingston, PhD, Dorienne Sorter, PhD

The analyst as a specific human person with needs and individual characteristics was originally seen as potentially an interference. The issue of to what extent the analyst can or should remain relatively inexpressive and anonymous raises significant fears when extreme positions are taken. Careless self_disclosure poses the danger of flooding the session with the analyst's feelings, needs, and opinions, thus overwhelming or burdening the patient. On the other hand, any approach to the analyst's subjectivity that focuses on controlling or eliminating his or her personhood, runs the risk of reducing emotional availability, responsiveness, and spontaneity.

Also, it is not just the effect of the disclosure at the particular moment that should be considered. Perhaps, the most important effect of therapist self disclosure or non-disclosure, is the effect it has on the analytic relationship over time. It is not the narrow issue of self disclosure that is most important. I would like to propose that it is the emotional and relational availability of the analyst, and his willingness to accept that analysis is a mutually vulnerable experience that is a key factor in facilitating vulnerability and deepening the therapeutic process.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

Barbara Fajardo, PhD, Frank M. Lachmann, PhD

This paper is an application of some principles of non-linear dynamic systems theory to expand our understanding of the therapeutic alliance in self psychology. The therapeutic alliance is understood as an aspect of a selfobject, a shared created experience in the process of a partnership between analyst and patient. Biologists and other scientists have used dynamic systems theory to describe shared behavior patterns that organize the lives of individuals forming a system, sometimes identifying the agents and parameters of change in the process of the system.

Applying the principles of spontaneous organization in biological processes to the embodied behavior and experience of the analytic dyad, patients and their analysts work together in an alliance that can be organized in several different ways. A synchronous alliance is characterized by symmetrical experiences and behaviors of the dyadic partners, when there is a feeling of being "in step," as in empathic attunement. An anti-synchronous alliance is when the partners are together but at odds, similar to music when a syncopated counterpoint plays parallel to the main melodic line. In the analytic dyad, this is exemplified by repetitious patterned behavior when the analyst does one thing and the patient does another, still responding to one another but experiencing different things in tandem. A third type of dyadic organization is incoherence, when the system is unable to achieve synchrony or anti-synchrony. This can be an impasse or it might be a phase transition which is followed by a spontaneous re-organization into new patterns related to growth and development in the patient’s self. Clinical vignettes are described to illustrate each type of alliance.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

Ilene J. Philipson, PhD, Mark Smaller, PhD

This paper focuses on a particular example of how self psychology can be used to understand our social world by examining the ways in which work---paid employment---provides intense, multifaceted, and potentially dangerous selfobject experiences and relationships. It is argued that as Americans are spending more hours at work, taking fewer vacations and remaining electronically connected to the workplace at all times, growing numbers of people are looking to their jobs for the satisfaction of psychological needs formerly filled by family, friends and neighbors.

Through a clinical case study, this paper demonstrates how the workplace is experienced, constructed and imagined as a richly layered environment filled with simultaneous selfobject relationships that allow a person to experience mirroring, idealization and kinship. However, there is significant danger in this psychological enterprise. Because the availability of environmental selfobjects often is hierarchically determined and subject to the whims of supervisors and managers over whom an employee has little control, the possibility for the sudden withdrawal of selfobject experience is enormous. The workplace can quickly become a domain of humiliation and shame that can precipitate a profound disruption of a person’s self-esteem, continuity, or coherence.

As increasing numbers of Americans turn to their jobs for the satisfaction of unmet emotional needs, understanding the intrapsychic dimension of out attachments to work seems increasingly relevant. The selfobject concept can facilitate this understanding and enrich not only our clinical work but the sociological imagination as well.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

Joseph D. Lichtenberg, MD, Gary M. Rodin, MD

The first section of this presentation will discuss the diminished significance of motivation in a period where emphasis has shifted to relational factors and postmodern considerations. The second part will offer a critique (and a defense) of motivational systems theory in the light of current preoccupations.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

R. Dennis Shelby, PhD, Joan Lang, MD

This paper explores the phenomenon of cruising for sexual encounters from the perspective of self psychology. Previous papers on the subject have viewed cruising as a homosexual act and offering elaborate libidinal dynamic formulations as evidence with little details as to the treatment as a whole or outcome. The author offers evidence that cruising is a human act that is quite common in our society. The central theme of the paper is that when cruising is approached in libidinal terms, the emphasis is on sexual acts not the needs of the self. By approaching cruising from the standpoint that the self is destabilized, and that cruising is an emergency measure, then the emphasis shifts to the need to search. Clinical examples are offered that illustrate how the need to cruise was viewed as a manifestation of distress and the destabilized self was brought into the transference. The result was a deepening of the transferences and a more complex and empathic understanding of the patient.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

David W. Krueger, MD, FAPA, FACP, Andrew P. Morrison, MD

Hope, the expectation of fulfillment of need or desire, fuels and guides ambition, and exists in evolving form and mission throughout development. The role of hope in normal development, its use as defensive function, the selfobject functions of hope, the transformation of hope in analysis, and hope in psychoanalyst are described and illustrated in clinical vignettes.

The internal dialectic of fantasies and achieved hope in the patient’s life story, as well as real and tranferential hope, intersect with the analyst’s own relationship to hope. The analyst’s hopefulness of the patient’s conflict resolution of developmental evolution, and of active, positive engagement with life is communicated in the clinical exchange, is build into interpretations that further the analytic process. The role of hope in both patient and analyst is reflected in the evolution of psychoanalysis to emphasize the developmental, the healthy and adaptive along with the defensive and pathological, and the intersubjective in recognizing that both patient and analyst co-author the analytic transformation of hope.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

Stuart D. Perlman, PhD, Linda Chernus, MSW

Increasingly in the literature dissociated identity disorder and severe dissociated states are becoming more widely accepted (Bromberg, 1999; Davies and Frawley, 1992, 1994; Perlman, 1999). Yet in an area like this where theory and practice seem unclear and tentative, it has been suggested and modeled by Stoller (Gelber, 1998), that publishing extended case presentations in detail with less theory are a way of beginning to build the literature upon which theory and clinical practice can be better developed. The moment-to-moment pragmatics of how to work with the transference, personalities splits, and select the necessary techniques and stances that may be useful with these patients has not fully been explored and illustrated. Even with a very profoundly dissociated and regressed patient one can have a deep and meaningful analytic process in the treatment including: dreams and their interpretation, working in the transference, developing insight, and transmuting internalizations. This paper will attempt to illustrate this using primarily the process of one session.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

Jeffrey J. Mermelstein, PhD, Paula B. Fuqua, MD

Although Kohut recognized that understanding and explaining are an integrated therapeutic unit, he drew the distinction between understanding and explaining steps in the therapeutic unit in order to stress the importance of empathic understanding as a necessary prerequisite for an explanation to be of value to the patient. Additionally, Kohut (1977, 1984) developed the dichotomy between understanding and explaining in order to explicate the clinical necessity of an early (and possibly prolonged) phase of pre-interpretative work with certain patieints whose early selfobjects had failed them traumatically. During the first phase of such an analysis, the analyst strives to provide the patient with understanding only; during the second phase, the analyst provides understanding followed by explanations in generic, dynamic, and psychoeconomic terms.

Clinical material was presented from four different patients in order to illustrate the diversity of clinical phenomena which may impact when a prolonged understanding only phase is useful—and when it may not be useful. The clinical material was chosen to demonstrate that patients, even patients with a similar degree of symptomatology or similar level of early selfobject failure, may differ in their experience of their analyst’s efforts to provide understanding only or in their experience of their analyst’s efforts to provide understanding with explanation. Patients who are likely to require a prolonged understanding phase of treatment are patients who experience interpretations as shaming or blaming them, patients who are vulnerable to fragmentation, and patients who feel mistrustful of their analyst’s intentions.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

Barbara Engelman, MFCC, Scott M. Davis, MD

How are we to understand moments of significant disruption in the self-sate of both patient and analyst that may be causative in therapeutic impasses? No where are these disruptions more striking than in the treatment of "Borderline" patients. How best can we conceptualize the dynamics of the therapeutic dyad in a way that will facilitate the restoration of a cohesive sense of self to the patient and therapist so that our therapeutic goals can be advanced?

Borderline Personality Disorder has recently been reconceptualized as originating in chronic trauma within the caregiver/child dyad. This paper seeks to integrate contributions from self psychology, trauma research and neurobiology. These theories are then applied to further understanding of how fluctuations in self-state within the intersubjective transference, countertransference matrix, can lead to the appearance of good/bad "splitting" which is a central borderline characteristic. Additionally, this paper illuminates how these fluctuations in patient and therapist self-state can lead to the dramatic and painful impasses that often occur in the course of treatment with patients diagnosed with borderline personality disorder; and, how this understanding can assist in resolving such impasses. A case discussion opens and closes the presentation illustrating the hypotheses and treatment suggestions offered.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

Doris Brothers, PhD, Donna M. Orange, PhD, PsyD

Kohut’s writings are suffused with his understanding that the continued strength, resilience, and enduring relevance of psychoanalysis depends on its acceptance of uncertainty. However, acknowledging the need for uncertainty in a theoretical domain and being able to tolerate it in one's life are quite different matters. For some people, especially trauma survivors, the experience of uncertainty may be unbearable. To the extent that faith and passion lend a sense of certainty to self-experience, they may serve as highly effective antidotes for fears of the unknown.

This paper attempts to demonstrate that passion and faith often intermingle in analytic relationships in which the need to stave off uncertainty is very strong. The sexual passion that sometimes arises between analysts who are experienced as omniscient gurus and analysands who are experienced by them as faithful devotees is examined. It is suggested that these relationships may be attributable to a mutual need to regulate uncertainty.

A clinical example describes the self-psychological treatment of a middle-aged woman whose childhood traumas left her profoundly uncertain about her psychological survival. Her need to maintain faith in her previous analyst despite this analyst’s efforts to involve her in a sexual relationship is explored.

Saturday, November 11, 2000 !4:15 pm - 5:45 pm

Howard A. Bacal, MD, Bruce D. Herzog, MD

Midge Breslin, MEd, William A. Laurie, MSW

Lester Lenoff, MSW, Judith Lester, MEd

Carol A. Munschauer, PhD, Richard B. Rosenstein, MD

This is part two of the workshop. Part one takes place on Thursday, November 9. The aim of the workshop is to elucidate and illustrate the principles of specificity theory and its clinical application, optimal responsiveness. After a brief theoretical presentation, a core (Balint-type) group will discuss clinical material, in both workshops. Participants will locate in a surrounding tier and will be able to participate in an open discussion of the theoretical presentation and the clinical work of the group. Involvement in both workshops is encouraged.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Robert D. Stolorow, PhD, Donna M. Orange, PhD, PsyD,

George E. Atwood, PhD, Charles M. Jaffe, MD

Beginning with a critique of the Cartesian, isolated-mind assumptions that saturate the Freudian vision of the unconscious, this article proposes the concept of multiply contextualized experiential worlds and their limiting horizons as a post-Cartesian alternative to the Freudian unconscious. To illustrate this contextualization, a dramatic instance of unconsciousness illuminated during an analysis conducted by one of the authors nearly 30 years ago is reexamined from an intersubjective systems perspective.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Lester Lenoff, MSW, Kenneth Newman, MD

At the 1998 International Conference in San Diego, Howard Bacal outlined Athe fundamental propositions of Optimal Responsiveness,@ which include Aa broad repertoire of responsivity@ in the context of a reciprocal clinical engagement . In this paper, I call upon Bacal=s fundamental propositions, along with other recent innovations in self psychological clinical theory - Marty Livingston=s concept of Avulnerable moments@, Marian Tolpin=s priority of focus on the Aforward edge@ of the patient=s transference and Anna Ornstein=s definition of Astructure@ as psychological capacity - to describe a passage of ongoing treatment and to illustrate the usefulness of Optimal Responsiveness as a basis for a flexible, yet distinctively Self Psychological, clinical approach.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Donna M. Mahoney, PhD, David Solomon, MD

This paper presents a model of panic that is informed by self psychological principles. The main contention is that panic results from selfobject failures, leading to disorganizing and fragmentation experiences. Early selfobject responses to panic set the stage for the meanings of panic in subsequent development. First, I provided a brief overview of the biological and psychological literature on panic, noting the major differences between a cognitive model of panic and a self psychological view of panic. Secondly, material from a single clinical case, along with examples from research, illustrated the benefit of focusing on developmental and unconscious/preconscious processes. It is hoped that the paper will demonstrate that a self psychological view, particularly the notion of self-fragmentation, broadens the lens with which to view panic and provides a broad-based approach to treatment.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Lallene J. Rector, PhD, Jeffrey B. Rubin, PhD

Self psychology provides an approach to understanding religious experience that allows both for positive and defensive functions within the psyche. In this paper, mystical experience and its relation to the idealizing selfobject need are explored. The idealizing selfobject need is defined and its developmental trajectory as outlined by Kohut is reviewed. A discussion of effects of inadequate developmental idealizing experience follows, including reference to the cases of Mr. U. and Mr. X. (Kohut, 1977). Their unresolved idealizing needs were expressed first, in the creation of a substitute selfobject, and second, in interest in the Peace Corps and identification with Christ. Kohut (1987) observed that unresolved idealizations in the transference sometimes lead to a preoccupation with religious matters. Kohut’s (1971) treatment of mysticism as a form of "fuzzy idealization" is discussed in relation to William James’ (1902) identification of the basic characteristics of mysticism. Attention is given to the issues of merger and regression. The paper concludes with the case of Mr. S. and a discussion of the mystical experience he reported early in treatment.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Carla Leone, PhD, Naomi Malin, DSW, PsyD

This paper applies the theory of self psychology to the understanding and treatment of families. The healthy family is viewed as a reliable source of selfobject experience for its members, while problems in or between family members are seen as due to a lack of adequate selfobject experience for one or more members. Causes of selfobject failures or misattunements in the family are examined, with an emphasis on the influence of previous relational experiences on current needs, capacities and experiences of others. A treatment approach designed to help family members become better able to provide empathically attuned responses for each other is outlined, with a case example used to illustrate key points. The question of whether "educating" or advice-giving interventions are useful in family work is examined, and guidelines are offered for deciding which family members should be treated and in which treatment modalities and by whom.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Gary Taerk, MD, FRCP(C), Steven Knoblauch, PhD

This paper describes the psychoanalytic treatment of a man suffering from a severe narcissistic personality disorder. I will emphasize the effect of two "moments of meeting" in the analysis which led to a profound shift in the analysand’s habitual way of being, particularly in the area of his enslavement to the needs and wishes of others. I will also discuss the implication of these so-called "now moments" in the treatment of personality disorders in general and of patients with enduring structures of pathological accommodation in particular.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Ann Eisenstein, CSW, Kathryn Rebillot, CSW, Shelley R. Doctors, PhD

The authors of biblical legends elaborated upon and thereby altered biblical stories that were confusing or ethically disturbing. In similar fashion, therapeutic relationships may, in that same timeless realm of transitional space, construct new "stories" to rework and redress patients’ original experiences of trauma. Just as studying sacred text traditionally occurs in pairs between learning partners, psychoanalytic work occurs in the co-constructed, intersubjective unit of the analyst/patient. In this paper, Kathryn and Ann–patient and analyst, respectively–discuss their 10-year analysis and demonstrate their process of "rewriting," and experiencing together, Kathryn’s pivotal childhood trauma. By incorporating Ann into a new vision–or Midrash–of her traumatic "story," Kathryn was able to internalize essential witnessing and holding selfobject functions. Ann and Kathy have each written in her own voice, demonstrating how each one’s subjectivity informs her understanding of the other’s. This format also provides an account of mutual influence–and mutual healing–from the perspective of both parties. The paper concludes with reflections on the spiritual implications of this transformative experience for both of them.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Nancy S. Wolf, MD, Mary Gales, MD,

Estelle Shane, PhD, Morton Shane, MD, Joseph Palombo, MA

In a recent paper entitled "Mirror Neurons, Procedural Learning and the Positive New Experience" (Wolf, Gales, Shane and Shane [in press]), data were presented about a special type of neuron, the mirror neuron, originally located by Rizzolatti and his colleagues (1992). These neurons were discussed as they related to a particular developmental view of psychotherapy and developmental self psychology (Shane, Shane and Gales, 1997).

In this paper we will focus on how this mirror neuron system might contribute to the development of communicative abilities in humans. We will first summarize the research findings about mirror neurons and how they apply to humans. We will then attempt to demonstrate how the mirror neuron system might be involved in a developmental sequence hypothesized by Kohut (1984), Stern (1985), and others to begin in infancy. We postulate that this trajectory starts with the onset of "amodal perception" (Stern, 1985), going then to affect resonance, joint attention, and ultimately to symbolization of language. In this paper, we will attempt to integrate these concepts with a formulation of empathy and demonstrate what might go awry in developmental disorders when the normative sequence of development described

Sunday, November 12, 2000 !8:30 am - 10:00 am

Susan H. Sands, PhD, Carol Perlman, LCSW

While self psychologists agree that eating disorders serve essential self-regulating functions, they have not adequately explained why these disorders necessarily involve ruthless attacks on the body. Object relations theorists have explained it in terms of the eating disordered patient’s equation of the body and the bad maternal object. I argue that it is clinically more useful to conceptualize the attacks on the body as an attempt to subjugate the needy self rather than the maternal object.

I also address the question of why females are so much more likely to develop eating disorders than men. I argue that while men are more likely to split-off , project and experience the needy self as residing in the Other, women are more likely to experience the needy self in the Body. Thus, men are more likely to subjugate the Other, while women are more likely to tyrannize their bodies to contain experiences of intolerable dependency.

The above issues will be illustrated in the case of Bonnie, who led off treatment with a severe example of bodily subjugation. Bonnie’s relational needs first appeared via a bodily enactment, then slowly became "desomaticized" and finally experienced in relation to me.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Paul H. Ornstein, MD, Axel Joneck, MA

Dostoevsky is considered to have anticipated Freud in many ways. A study of his works indicates that he also anticipated Kohut, perhaps even more comprehensively. This workshop will focus on Dostoevsky’s "The Gambler". The issue of addiction to gambling and the gambler’s highly ambivalent relationship to the woman he desires (and hers to him) is masterfully portrayed.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Diane L. Martinez, MD, Henry Friedman, MD

This paper explores the importance of the twinship selfobject experience in the psychological development and psychoanalytically-informed treatment of people who are gay. The definition and history of the concept of the twinship selfobject transference are briefly reviewed to provide a foundation. The experience of alienation, a common theme in the life histories of homosexual people, is discussed as a basis for and expression of the disruption of needed twinship selfobject experience in development and treatment. A case presentation of a young gay man, with particular emphasis on the importance of twinship issues in the transference, illustrates a self-psychological approach to understanding the treatment process. Three interventions that proved especially meaningful for the patient are understood as having provided crucial selfobject experiences of twinship in the transference. These interventions, which the therapist experienced as somewhat dystonic, allowed the patient to connect to and organize previously intolerable affects. The importance of the therapist's sensitivity to a potential particular vulnerability of the gay patient around twinship experience is elaborated on.

Sunday, November 12, 2000 !8:30 am - 10:00 am

Steven Stern, PsyD, Bruce Herzog, MD

This paper addresses postmodern critiques of the self psychological conception of the self as a unified and stable structure. It is proposed that the self be viewed as a series of momentary relationships between two dimensions of self experience: the primary subjective experience an individual brings to the present moment, and the intersubjectively constituted, now internalized, response to that experience. This momentary relationship may be more or less facilitating of the individual’s primary subjective experience, and determines the overall quality of the individual’s total self experience at that moment. The paper focuses especially on what are termed "identifications with the other’s response to the self" as a central organizer of intersubjectively constituted experience. This form of identification is thought to begin at birth and become part of the individual’s core or "pre-reflective" self. It is argued that this type of identification operates not only under conditions of optimal selfobject responsiveness/frustration (transmuting internalization), but also under non-optimal and traumatic conditions. The implications of this model for therapeutic action are discussed and illustrated with a "difficult" analytic case.

Sunday, November 12, 2000 ! 10:30 am - 12:30 pm

Arnold I. Goldberg, MD, Charles B. Strozier, PhD

Judith Guss Teicholz, EdD, Gerald N. Izenberg, PhD

This panel will deal with the individual in larger context. It will consider psychopathology in light of this conception and especially how self psychoanalysis can alleviate individual psychopathology.

[ Self Psychology Bulletin Board ]

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