Psychoanalysis On and Off the Couch

“The subject of affairs, I think it's of interest to everybody. We have all had an Oedipal experience - we've all been babies who have at some point realized that we are not the only person. We're not perfectly fused with our mother, and she has other things to do, and there may be a father. We've all known what rejection feels like, and probably betrayal, and I think that affairs are in our unconscious. I think that's sort of evident in the way that most great novels, most great films, or at least many, have an affair at their heart. From Anna Karenina to Madame Bovary to Fatal Attraction, I think this is something that is just interesting. I wanted to write about affairs because I think they are a way of showing what psychoanalysis can do in a field in which everyone has an opinion on, and probably most people, in some way, have been indirectly or directly affected by. That was really the sort of the genesis for wanting to write about affairs.” Episode Description: We consider the challenge of writing about dynamic treatments in a manner that is accessible to the non-clinical reader. Juliet's book about affairs opens up this widely recognized experience and adds intrapsychic insights without using emotionally - distancing jargon. She introduces us to individuals who have been involved in affairs, with carefully protected confidentiality, who generally reveal the power of past experiences to influence adult choices. Some end happily, and some end in agony. Juliet demonstrates the usefulness of bringing a dynamic listening to both accepting and deepening each individual's lifelong search for love.   Our Guest: Juliet Rosenfeld is a psychoanalyst and a member of the British Psychoanalytical Society, London. She studied at Oxford before a 15-year career in advertising and marketing, ending up in Government Communications. During this time, she began a Master's at the Tavistock and Portman Trust in Organizational Consultancy and started training as a psychotherapist a year later. She qualified as an integrative psychotherapist in 2012. Juliet was an elected trustee of the UK Council of Psychotherapy for four years, and is presently one of two clinician Trustees at the Freud Museum London, Sigmund Freud's final home. Juliet is the author of two books, The State of Disbelief ( 2020) and Affairs, True Stories of Love, Lies, Hope and Desire. Juliet's broader interest is in how psychoanalysis might be more accessible, and its ideas put into non-clinical language for audiences who may never be able to access psychotherapy themselves but are curious about what the unconscious means and what goes on in the consulting room. Recommended Readings: Creativity and Perversion by Janine Chasseguet-Smirgel (W. W. Norton & Co., Inc., 1984)   Dreams of Love and Fateful Encounters by Ethel S. Person (American Psychiatric Association Publishing, 2006)   Home Is Where We Start From by D. W. Winnicott (Penguin, 1990)   Love in the Time of the Internet by Martina Burdet (underbau, 2020)   Sex, Death and the Super Ego by Ronald Britton (Routledge, 2020)   Sexual Attraction in Therapy edited by Maria Luca (Wiley-Blackwell, 2014)   Sexuality and Attachment in Clinical Practice edited by Joseph Schwartz and Kate White (Routledge, 2019)   The Bonds of Love by Jessica Benjamin (Knopf Doubleday Publishing Group, 1988)   The New Sexual Landscape and Contemporary Psychoanalysis by Danielle Knafo and Rocco Lo Bosco (Confer Books, 2020)   Novels about Affairs Anna Karenina by Leo Tolstoy (Penguin Classics, 2003)   A Very English Scandal by John Preston (Penguin, 2017)   Deception by Philip Roth (Vintage, 1991)   Getting Lost by Annie Ernaux (Fitzcarraldo Editions, 2022)   Madame Bovary by Gustave Flaubert (Wordsworth Editions, 1993)   Middlemarch by George Eliot (Wordsworth Editions, 1993)   The End of the Affair by Graeme Green (Vintage Classics, 2004)     

“Now's the time to tell that wonderful story of the little boy. He was about two or three years old, and he went in the icebox to get some milk, and he managed to get this big carton and spill it all over the floor. Now, needless to say, there'd be a lot of parents that would react very negatively and frustrated - this mother happened to be a scientist. So she came in, she saw the bottle of milk, and what had happened. She went and got some paper towels, put them on the milk, and said, ‘Look at this. Look how the milk starts creeping up these fibers of the towel. Isn't that cool?’ And then she said, ‘Look, if you have something heavy you need to get out of the refrigerator, feel free to call me. But how neat is this that  the milk is being absorbed by the towel?’ Well, she was a scientist, and he became a world-class scientist. She understood his interest and she didn’t bring a fear and shame-inducing reaction, and all the negative effects that could have resulted if she had handled it differently. Instead, she put a sense of joy and interest in being intrigued with his interests, and turned the whole thing around.” Episode Description: Paul starts our conversation about affects by referencing Tomkins’ work, which identified 6 negative and 2 positive affects/feeling states, all of which are represented by different facial expressions in infancy. He reports on clinical work that is enhanced by locating the patient's affective surface, which enables meaningful contact within the dyad. We focus on the affect of interest and how essential it is in establishing a sense of self in the world. He also shares the many ways that this interest can be undermined by the child's environment. He describes research on the capacities of 18-month-olds and how they differ from 14-month-olds regarding the awareness of self and other. Paul also emphasizes how destructive corporal punishment is in the lives of children and in society at large. We end with the final sentence from his book, a quote from Abraham Lincoln, "We can succeed only by concert. It is not 'Can any of us imagine better?' but 'Can we all do better?' Object whatsoever is possible, still the question recurs, 'Can we do better?'   Our Guest: Paul Holinger, MD, MPH, is a psychiatrist and psychoanalyst, Faculty and Former Dean at the Chicago Psychoanalytic Institute, Training/Supervising and Child/Adolescent Supervising Analyst. He is Professor of Psychiatry (Retired) at Rush University Medical Center, Chicago. His most recent books include Affects, Cognition, and Language as Foundations of Human Development and What Babies Say Before They Can Talk: The Nine Signals Infants Use to Express Their Feelings. Recommended Readings: Holinger PC: Violent Deaths in the United States: An Epidemiologic Study of Suicide, Homicide, and Accidents. New York: The Guilford Press, 1987.   Holinger PC: Offer D; Barter JT: Bell CC: Suicide and Homicide Among Adolescents. The Guilford Press, 1994.   Holinger PC: What Babies Say Before They Can Talk: The Nine Signals Infants Use to Express Their Feelings. New York: Simon & Schuster, 2003. (Several Translations)   Holinger PC: Affects, Cognition, and Language as Foundations of Human Development. New York/London: Routledge, 2024.   Holinger PC: Violent deaths as a leading cause of mortality: An epidemiologic study of suicide, homicide, and accidents. Amer J Psychiatry 137: 472-476, 1980.   Holinger PC: A developmental perspective on psychotherapy and psychoanalysis. Amer J Psychiatry 146: 1404-1412, 1989.   Holinger PC: Noninterpretive interventions in psychoanalysis and psychotherapy: A developmental perspective. Psychoanalytic Psychology 16: 233-253, 1999.   Holinger PC: Further issues in the psychology of affect and motivation: A developmental perspective. Psychoanalytic Psychology 25: 425-442, 2008.   Holinger PC: Further considerations of theory, technique, and affect in child analysis: Two prelatency cases. International J Psychoanalysis 97: 1279-1297, 2016.   Holinger PC: The problem of physical punishment and its persistence: The potential roles of psychoanalysis. The Psychoanalytic Study of the Child 73:1-9, 2020.  

Mariano Horenstein, a distinguished psychoanalyst from Cordoba, Argentina, discusses the 'necessary foreignness' in psychoanalysis. He emphasizes how being an outsider enhances understanding of the unconscious, encouraging a vibrant exploration of identity. Horenstein contrasts traditional teaching with the deeper insights gained through analysis, noting the significance of asymmetry in this process. He also shares a whimsical tale of a polar bear as a metaphor for migration and examines the intersection of psychoanalysis with geography, advocating for a fresh interpretative lens in therapeutic practices.

“I think that my analytic awareness of denial and projection and the concreteness of psychic reality when executive function wanes, that I could help the other caretakers to understand some of what was going on - to give them a way to understand that relieves their sense of frustration and uncertainty. I think that the analytic awareness of denial, of projection, that these things are not generally recognized by many caretakers, but it does reorient and make the caretaking function much more tolerable. It expands the understanding of what goes on in the waning personality. I also think that analytic work fosters the capacity to tolerate ambiguity, uncertainty, pain and frustration and in that way may allow us, the analytic mind, to tolerate some of the intense affect - as sort of the phrase I love from an Italian analyst, as “writings waiting to be completed” - by the analytic mind. We can hold and metabolize the difficulty and offer that kind of function rather than unpleasantness just to be rid of. These are some of the things that I felt are useful as a psychoanalyst.” Episode Description: We begin with describing how dementia is a cloud over our field both for individuals and for institutes. Maxine then introduces us to 'Sally' who was her analysand 40 years prior to recontacting her to care for her cognitive decline. Maxine mentions that just hearing her former patient's voice instantly brought alive her past experiences with her. We discuss how she approached the issue of caring for her and her neurological condition. We consider the at times overlap between psychogenic and organic symptoms and she shares with us her countertransference experiences of herself losing her memory. Maxine also shares her approach to answering Sally’s questions about the possibility of recovering. We close with her describing how she feels that being an analyst aided her care of Sally and what she learned from that experience that she brought to her other patients -"to face the pain of difficult truths."   Our Guest: Maxine Anderson, MD, is a training and supervising analyst at the Northwestern Psychoanalytic Society and Institute, the Seattle Psychoanalytic Institute and Society and the Canadian Psychoanalytic Society. Originally trained in psychiatry, she pursued psychoanalytic training in Seattle in the early 1970s and then pursued post-graduate work at the British Psychoanalytical Society for 8 years, returning to Seattle in 1992.  Thereafter, she became a Founding Member of the Northwestern Psychoanalytic Society and Institute. Maxine has published several articles, and chapters and 3 books, the most recent being The Hardest Passage: a psychoanalyst accompanies her patient’s journey into dementia (Karnac, 2025). Feeling herself now to be an Elder in life and in her field, Maxine hopes to continue to think and write about this phase of personal and professional life.   Recommended Readings: Balfour, A. (2007). Facts, phenomenology, and psychoanalytic contributions to dementia care.    In: R. Davenhill (Ed.) Looking into Later Life: a psychoanalytic approach to depression and dementia in Old Age. (pp. 222–247). London: Routledge, 2007.   Davenhill, R. (Ed.) (2007) Looking into Later Life. A Psychoanalytic approach to Depression and Dementia in Old Age. London: Karnac.   Davenhill, R. (2007). No truce with the furies: issues of containment in the provision of care for people with dementia and those who care for them.   In: R. Davenhill ( Ed.), Looking into later life: a psychoanalytic approach to dementia and depression in old age. (pp. 201-221). London: Routledge.   Evans, S. (2008). “Beyond forgetfulness”: How psychoanalytic ideas can help us to understand the experience of patients with dementia”. Psychoanalytic Psychotherapy, 22(3):155–176.   Kitwood, T. (1997). Dementia Reconsidered: The Person Comes First. Milton Keynes: Open University Press.   Malloy, L (2009). Thinking about dementia – a psychodynamic understanding of links between early infantile experience and dementia. Psychoanalytic Psychotherapy, 23(2): 109–120.   Plotkin, D. (2014). Older adults and psychoanalytic treatment: It’s about time. Psychodynamic Psychiatry, 42(1): 23–60.   Sherwood, J. (2019). Dementia: childhood and loss. In White, K. Cotter, A. & Leventhal, H. (Eds.), Dementia: An Attachment Approach. London: Routledge.  

“All of this together shaped how I began to think about mind, not as something to be mastered, but as a landscape of the unspoken whether it was ghosts or griefs or desires that were hard to relinquish. I saw that the ghost was not always an ‘other’. It was often intimate, tied to lost ones, sometimes to unmet desires, to unbearable longings, but in some ways possession was an attempt to keep close what was slipping away. The ghost doesn't just haunt, it feels as if it wants something, and we just have to learn to develop ears to listen to what it wants.”  Episode Description: We acknowledge Loewald's concept of 'ghosts becoming ancestors' and consider the similarities and differences with those who hold 'ghosts' to be literal. Shalini shares with us her journey to open herself to the uncertainty and ambiguity of these externalized entities while appreciating both their cultural and intrapsychic sources. We learn of her family's involvement with exorcisms, especially her grandmother's "fearless warmth" and "empathy that saw beyond the terror of the ghosts." She considers the many facets of mind that are represented by 'ghosts' and the essential value of approaching them as guides to the "landscape of the unspoken." Shalini describes a long term engagement that she had with an individual who "taught me to receive the inchoate and horrific...to contain the brokenness and not interpret it away.. and to appreciate the glimpses of beauty in the most grotesque parts of self."   Our Guest: Shalini Masih, a psychoanalytic psychotherapist and writer, grew up in India amidst priests and healers, witnessing spirit possession and exorcism. Now based in Worcestershire, UK, she holds a Master’s degree in Psychoanalytic Studies from Tavistock & Portman, London, and a PhD from the University of Delhi. Mentored by psychoanalysts Michael Eigen and Sudhir Kakar, she’s an award-winning scholar of the American Psychological Association. She has taught and supervised psychoanalytic psychotherapists in Ambedkar University, Delhi and in Birkbeck, University of London. Her acclaimed paper, 'Devil! Sing me the Blues', was nominated for Gradiva Awards in 2020. Her debut book is Psychoanalytic Conversations with States of Spirit Possession: Beauty in Brokenness.  Recommended Readings: Kakar, Sudhir. Shamans, mystics, and doctors: A psychological inquiry into India and its healing traditions. Chicago, IL: University of Chicago Press, 1991.   Kakar, Sudhir. Mad and Divine. India: Penguin Books India, 2008.   Eigen, Michael. “On Demonized Aspects of the Self” In The Electrified Tightrope. Routledge. 2018.   Kumar, Mansi, Dhar Anup & Mishra, Anurag. Psychoanalysis from the Indian Terroir: Emerging Themes in Culture, Family, and Childhood. New York:Lexington Books, 2018.   Meltzer, Donald, and Williams, Meg H. The apprehension of beauty: The role of aesthetic conflict in development, art and violence. Karnac, London: The Harris Meltzer Trust, 2008.   Obeyesekere, Gananath. Medusa’s Hair: An Essay on Personal Symbols and Religious Experience. Chicago, IL: University of Chicago Press, 1981.   Ogden, Thomas. This Art of Psychoanalysis—Dreaming Undreamt Dreams and Interrupted Cries. East Sussex: Routledge, 2005   Botella, Cesar, and Botella, Sara. The Work of Psychic Figurability: Mental States without Representation. Brunner-Routledge. Taylor and Francis Group: Hove and New York. 2005.   Winnicott. Donald W. “Transitional objects and transitional phenomena.”  International Journal of Psycho-Analysis, 34, (1953): 89–97

Himanshu Agrawal, an adult and child psychiatrist and associate professor, shares insights from his recent psychoanalytic training. He discusses the emotional rollercoaster candidates face, from initial terror and excitement to feelings of apathy. Agrawal highlights the importance of peer support through the International Psychoanalytical Studies Organization, emphasizing shared experiences that foster community. He reflects on how cultural backgrounds shape training and the transformative journey of becoming a psychoanalyst amid challenges like the COVID-19 pandemic.

Stefano Bolognini, a prominent psychiatrist and former IPA president, shares insights on the evolving landscape of psychoanalysis. He discusses the shift from internal conflicts to contemporary issues of self-perception driven by societal pressures. Bolognini emphasizes the importance of long-term therapeutic relationships, highlighting how transformation in a patient can emerge from deep engagement with their internal world. The conversation touches on the impact of modern family dynamics and the need for personalized care in navigating the complexities of identity.

“The original papers that were written about the analyst’s unconscious being attuned to the patient's unconscious  by Hyman and Racker, in both cases they talk about this phenomenon. But both of them utter a caution, which is that one always has to take into account one's own ‘mishegas’.  Essentially, what they're saying is, the unconscious is pretty individualistic and we have our own things, and we have to consider that possibly it's our own difficulties, our own unconscious, that is playing a bigger role in our countertransference reaction to the patient's unconscious.” Episode Description: We begin by discussing the meaning of the many italics throughout the book and my sense of their being an expression of Fred's wish to be carefully understood. This is part of our conversation where we examine how internal reactions are used to comprehend another person's mind. There are a number of themes to this work, and to Fred's contributions over the years, which focus on helping individuals understand the way their mind works, as distinct from the particular contents of their mind. One of the gifts of psychoanalysis is to facilitate patient's discovery of the freedom to think which allows for a post-termination capacity for self-analysis. We discuss how self-criticism can serve as an unconscious lifeline, the importance of attending to the need for silence as distinct from what is not being said and the seductiveness of gossip, to name but a few of the topics in the book that we cover. Fred closes by describing "The wonderful thing about being a psychoanalyst is there are always things to learn and ways to grow."   Our Guest: Fred Busch, Ph.D. is a Training and Supervising Analyst at the Boston Psychoanalytic Society and Institute. He has published eight books, and over 80 articles on psychoanalytic technique, along with many book reviews and chapters in books.  His work has been translated into many languages, and he has been invited to present over 180 papers and clinical workshops nationally and internationally. His last six books are: Creating a Psychoanalytic Mind (2014); The Analyst’s Reveries: Explorations in Bion’s Enigmatic Concept (2019); Dear Candidate: Analyst From Around the World Offer Personal Reflections on Psychoanalytic Training, Education, and the Profession (2020); A Fresh Look at Psychoanalytic Technique (2021), Psychoanalysis at the Crossroads: An International Perspective (2023).The Ego and Id: 100 years later (2023), How Does Analysis Cure? (2024).   Recommended Readings: Busch, F. (2014). Creating a Psychoanalytic Mind: A Psychoanalytic Method and Theory. London: Routledge.   Busch, F. (2019). The Analyst’s Reveries: Explorations in Bion’s Enigmatic Concept. London: Routledge.   Busch, F. (2021). A Fresh Look at Psychoanalytic Technique: Selected papers on Psychoanalysis. Routledge: London.   Busch, F. (2023) The Significance of the Ego in “The Ego and the Id” and its Unfulfilled Promise. International Journal of Psychoanalysis 104:1077-1090.   Busch, F. (2000). What is a deep interpretation? J. Amer. Psychoanal.Assn., 48:238-254.   Busch, F. (2005). Conflict Theory/Trauma Theory. Psychoanal.Q., 74: 27-46.   Busch, F. (2006). A shadow concept. Int.J.Psychoanal.,87: 1471-1485. Also appearing as Un oncerto ombra, Psycoanalisi, 11:5-26.   Busch, F. (2015). Our Vital Profession*. Int. J. Psycho-Anal., 96(3):553-568. Reprinted in Busch, F. (2015). La nostra professione vitale. Rivista Psicoanal., 61(2):435-456; Busch, F. (2015). Nuestra profesión vital*. Int. J. Psycho-Anal. Es., 1(3):605-627; Busch, F. (2015). Nuestra profesión vital1. Rev. Psicoanál. Asoc. Psico. Madrid, 75:131-153.  

David Black, a retired fellow of the British Psychoanalytical Society, dives into the intersection of psychoanalysis and religion. He discusses Freud's perspective of religion as a protective illusion against life's uncertainties. Black highlights Levinas's call for ethical recognition of the 'other,' emphasizing our interconnectedness. The conversation shifts to the dangers of dogmatism in religion versus the poetic depth of allegory, drawing parallels with Dante's works. Ultimately, he reflects on how personal trauma shapes identity and ethical responsibility.

“There are very specific fears that people have that are specifically related to their own childhood, and I'd like to give an example. A mom with twins had a kidnapping fear. She was afraid every time she saw a car drive by her house that her twins would be kidnapped. Now this mother was herself adopted when she was a newborn, but her adoption did not become final until she was one year old. Her twins were approaching one year. I was struck by the anniversary of her fear of kidnapping, and when I asked her who she thought was driving the car that drove by her house, she blurted out, 'my biological mother - adoption was never an issue for me, I have the best parents,' she said, but her fears about her babies being kidnapped were rooted in her own guilty feelings. She said, 'I get to keep my biological babies and my biological mother did not. I can have biological babies and my adoptive mother could not.' Carrie’s fantasy that her biological mother was threatening to kidnap her babies represented both her fears of retaliation for her aggressive victories over both her biological mother and her adoptive mother, and the repair of her disavowed feeling of loss by a reunion with her biological mother. This meaning of the memory, this understanding of the memory, resolved her kidnapping fear. It dissolved.” Episode Description: We begin with an overview of the importance of mothers' childhood memories in their experience of their own children. These memories are of the conscious sort and also the not-so conscious. They are of the loving as well as the misattuned versions. "The challenge for mothers is to understand the complexity of their own childhood memories and to help their babies and toddlers adapt to the everyday ups and downs of life, as well as to the exceptional ones." We discuss typical fears, sleep problems, 'mutually-regulated patterns', naming body parts, nakedness, weaning and screen time. Ilene ran mother-baby-toddler groups for 35 years and shares with us her relentless curiosity for what we all bring to the parenting experience.   Our Guest: In 1982, Ilene Lefcourt established the Sackler Lefcourt Center for Child Development - programs for parents and their children from birth to three years. She was the Director, led the Mother-Baby-Toddler Groups, and provided Developmental Consultation to parents for over 35 years. She saw over 1,000 families and taught Child Psychiatry Residents and Parent-Infant Psychotherapy Trainees about her work. She has been a faculty member at the Columbia Psychoanalytic Center since 1995. Ms. Lefcourt is currently in private practice in New York City. She is the author of When Mothers Talk, Parenting and Childhood Memories, and Mother-Baby-Toddler Group Guide. Her forthcoming book is, Mothers and Daughters: The First Three Years. Visit Ilene’s website: http://ilenelefcourt.com/.      Recommended Readings: 1975, Fraiberg S. Adelson E., Shapiro V., Ghosts in the Nursery,  Journal of the American Academy of Child Psychiatry, 14, 387-421   1975, Mahler, M., F. and Bergman, A. The Psychological Birth of the Human Infant, Basic Books   1985, Main, M. Kaplan, N. Cassidy, J. Security in Infancy, Childhood, and Adulthood: A move to the Level of Representation. Monographs of the Society for Research in Child Development   1991, Fonagy, P., Steele, M., Steele,H., Moran, G. S . The Capacity for Understanding Mental States. Infant Mental Health Journal, 12(3) 201-218   1992, Bretherton, I. The Origins of Attachment Theory. Developmental Psychology, 28(5) 759-775   1993, Lieberman, A ., The Emotional Life of the Toddler, Simon and Schuster    1995, Stern, D. The Motherhood Constellation, Basic Books   1998, Stern, D., Brushwweiler-Stern, N. The Birth of a Mother. Basic Books   2005, Lieberman, A., Angels in The Nursery, Infant Mental Health Journal. Vol. 26(6)