Psychoanalysis On and Off the Couch

"I was quite protective of the parent reader while I was editing this. I feel that so many of the books out there on the shelf have a real kind of finger wagging quality to parents. They kind of tell parents what to do, what not to do, mostly what they're doing wrong. I  felt like I wanted to create a resource that empathized with the parents' position, and that protected them, because this is literally the hardest thing in the world. So the protectiveness felt important to me, and it was one of the things that was really quite important that we always held the parent in mind, which is why every letter starts with ‘Dear Parent’.”    Episode Description: We begin with acknowledging the 'profound ordinariness' of the parenting experiences that these thirty-nine psychoanalysts share with the reader.  They openly reveal their vulnerabilities, childishness, ambivalences and sorrows.  They also share their delights, pleasures and feelings of accomplishment. The letters that we read include those on parental protectionism, feelings of being excluded, rivalries and erotic feelings. All the contributors acknowledge the presence of their pasts in their parenting present. Andy speaks of her journey as a mother and how vital her finding psychoanalysis was for both her and her family. She concludes the book "I hope that you close this book with a deep sense of respect for yourself, a healthy curiosity and a few more questions than answers."   Our Guest: Andy Cohen is a psychoanalyst with the South African Psychoanalytical Association (SAPA). Her TEDx Talk, "A Mom Can’t Always Act Like a Grown-Up – Here’s Why", explores the unconscious forces between mother and child. She holds an MA Fine Art and has worked as an Art Counsellor using psychodynamic art-based interventions in at-risk communities. She currently lives and works in Johannesburg, South Africa.   Recommended Readings: TED Talk by Andy Cohen: “A mom can’t always act like a grown up - here’s why” When Mothers Talk - Magical Moments and Everyday Challenges from Birth to Three Years by Ilene S. Lefcourt Doing Psychoanalysis in Tehran by Gohar Homayounpour Psychoanalysis from the Inside Out by Lena Ehrlich Intimacy and Separateness by Warren Poland Dear Candidate: Analysts from around the World Offer Personal Reflections on Psychoanalytic Training, Education, and the Profession by Fred Busch  

"I have had quite some reactions to the article [on their psychoanalyses]. I was also telling Mauro and my colleagues that out of quite a number of articles I've published on maybe more pressing issues in the field of cancer research, for example, brain tumor research that I've spent quite some time with, I think it's actually the article [on psychoanalysis] that probably prompted the most reactions, at least in my personal surroundings, and the reactions have been overwhelmingly positive. So colleagues are very interested. They often ask questions about psychoanalysis, quite specifically, how it works, how it contributed, and also complemented the article in the sense that it was something that was quite outside of the box, so outside of the typical surgical publication.” - FV   "How can we reach surgeons? How can we make this interesting and attractive for them to even consider? I think most surgeons will be very performance-driven people, and I think that it goes hand in hand that that type of person will seek ways to improve themselves, but probably more in a technical way. Let's say they want to get faster in their operations. They want to get more skillful. They want to do more complicated surgeries. So there's a lot about self improvement in that you exercise until you master something. And I think that analogy with sports was our way of saying, hey, you know, this is actually pretty cool. You can compare yourself to  professional athletes, in terms of self improvement, and this is actually one way you can get there, how you can improve. At the same time, it was also important for us to acknowledge that it's not for everyone so we also mentioned alternatives, of course." - MV   Episode Description: Mauro and Flavio begin by describing the encouragement they received from their father to pursue personal analysis "to explore our unconscious minds for a lighter life and less emotional baggage." They share their psychoanalytic journeys and give examples of how their greater capacity to reflect instead of react has led to improved surgical patient outcomes. They also describe collegial tensions that were more clearly addressed through their ability to authentically know how they felt. They recommend that like elite athletes who have sports psychologists to address obstacles to their performances, so might surgeons appreciate the utility of psychoanalysis and other measures to improve their clinical attunement. Mauro concludes "Everyone has their baggage - don't be afraid to look at it and to understand what's going on. It's worth it."   Our Guests: Flavio Vasella, MD PhD, is a junior attending neurosurgeon at the University Hospital Zurich, with a clinical and research focus on neurosurgical oncology. He earned his PhD in Molecular Life Sciences at the University of Zurich, where his research explored genome editing strategies in primary brain tumors. His primary academic interests include translational and clinical neuro-oncology as well as surgical education.   Mauro Vasella, MD, is a board-certified plastic surgeon with multiple years of clinical experience specializing in reconstructive surgery. He is affiliated with the University Hospital Zurich in Switzerland and the Royal Melbourne Hospital in Australia and has held positions as a fellow and attending surgeon. His practice and research field focuses on regenerative-reconstructive surgery and burn injuries.   Recommended Readings: FV - Paul Kalanithi – When Breath Becomes Air This memoir by a neurosurgeon-turned-patient is a poetic and piercing meditation on mortality, identity, and the transition from doctor to patient. It explores the tension between the analytical and emotional mind (somewhat paralleling the internal work of psychoanalysis) and offers profound insight into the humanity at the core of medical practice. Bill George – True North: Discover Your Authentic Leadership This book presents a leadership philosophy rooted in self-inquiry, values, and life stories. True North emphasizes that effective leadership comes from understanding your life narrative and using that insight to lead with integrity and resilience. True North challenges leaders to cultivate authenticity by exploring their internal landscape. While the book focuses on leadership in a business context, it offers a compelling, practical perspective for medical professionals as well. Atul Gawande – Complications: A Surgeon’s Notes on an Imperfect Science Gawande offers a candid look at the uncertainties, dilemmas, and emotional burdens of being a surgeon. His reflection on fallibility and decision-making underlines the importance of non-technical skills and the internal work required to become not just competent, but humanely attuned, in medicine. The impact of nontechnical skills on technical performance in surgery: a systematic review. Hull L, Arora S, Aggarwal R, Darzi A, Vincent C, Sevdalis N. J Am Coll Surg.2012  This systematic review analyzed 28 studies linking surgeons’ non-technical skills—such as teamwork, situational awareness, and stress management to actual technical performance in the operating room. It found evidence that effective NTS positively affects outcomes, while fatigue and communication failures contribute to technical errors.   MV - The Art of Loving – Erich Fromm Realizing the simple but somehow not always obvious fact that before being able to truly love someone, one must truly find themselves loveworthy. This implies and demands introspection, as well as forgiveness towards yourself and others. Outliers: The Story of Success – Malcolm Gladwell To master something, one must invest a substantial amount of time and dedication – this is not only true for technical skills, but also non-technical skills. Personal growth is only possible if you invest time, such as undergoing a psychoanalysis or similar. The Checklist Manifesto – Atul Gawande While the checklist itself is very technical, the way it was conceived and its effect was and still is rather non-technical. It is a question of putting your ego aside and truly focusing on areas which you can improve.  

“I really think that the purpose is to make space for the unknown, uncertainty, and for our kind of humility in the face of the complexity of our belonging to the physical world. So it's our animality, our physicality, all of that is so complicated and difficult to grapple with. The unknown is uncontrollable and is a huge abyss, as we know, for everybody. I do think that I'm trying to pivot here a little bit towards meeting the patient's attempts to grapple with that unknown.” Episode description:  We begin by examining the assumptions of causality that we humans commonly invoke when faced with physical ailments. Childhood imaginings come forward during such times, and, despite being distressing, they offer comfort in the face of frightening uncertainty. Similarly, analytic theorizing has occasionally suggested certainties in the face of the unknown. This may limit the analytic space, thereby making vulnerability, fears, and new awarenesses less accessible. Sharone presents clinical material from patients with testicular cancer and lymphoma, where their psychogenic theories of etiology interfered with their medical care. We consider the distinction between patients with somatic symptoms and psychosomatic patients. We question the ability of the analytic method to uncover the origins of medical illnesses while emphasizing the importance of recognizing the "particular possibilities of our method."   Our Guest: Sharone Bergner Ph.D. is a clinical psychologist and psychoanalyst in full time private practice of psychoanalysis, psychotherapy and clinical supervision in New York City. She is a member and former faculty at the Institute for Psychoanalytic Training and Research and is Adjunct Assistant Clinical Professor and a clinical supervisor at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis, in the Contemporary Freudian track, where she teaches a course called The Body in Analytic Reverie. She is a member of the International Psychoanalytic Association and the editorial board of The Psychoanalytic Quarterly. She has a special interest in the body/mind in relation to maternal reverie in early development, vitality, embodiment, and medical issues, having worked early in her career in a cancer hospital, with the internal medicine, OBGYN, and dermatology clinics of a large urban teaching hospital, with political refugees and with parent-child pairs.    Recommended Readings: 1. Bergner, S. (2011). Seductive Symbolism: Psychoanalysis in the Context of Oncology. Psychoanalytic Psychology 28:267-292.   2. Gottlieb, R. (2003). Psychosomatic medicine: the divergent legacies of Freud and Janet. Journal of the American Psychoanalytic Association, 51:857-881.   3. Winnicott, D.W. (1966). Psycho-Somatic illness in its positive and negative aspects. International Journal of Psychoanalysis, 47:510-516.   4. Lombardi, R. (2017). Body-Mind Dissociation in Psychoanalysis: Developments After Bion. Routledge.   5. Lemma, A. (2015). Minding the Body: The Body in Psychoanalysis and Beyond. Routledge.   6. Miller, P. (2014). Driving Soma: A Transformational Process in the Analytic Encounter. London: Karnac. Not to be missed: case vignette: Recalling a Challenging Analytic Case, pp. xxvi-xxxviii      

“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)     

Paul Holinger, a seasoned psychiatrist and former Dean at the Chicago Psychoanalytic Institute, shares valuable insights into emotional development and the power of curiosity in children. He recounts a touching story of a mother who transforms her child's milk spill into a learning moment. Holinger critiques the harmful effects of corporal punishment and advocates for nurturing environments that foster emotional awareness. He emphasizes the importance of understanding affects in therapy and how supportive interactions can shape a child's identity and empathy.

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.

Maxine Anderson, a training and supervising analyst from multiple psychoanalytic societies, discusses her unique experience caring for a former analysand with dementia. She shares insights into the emotional dynamics of caregiver-patient relationships, emphasizing the importance of analytic awareness in managing denial and projection. The conversation also highlights the rejuvenating impact of reconnecting with past patients, the complexities of communication in the face of memory loss, and the deep emotional undercurrents involved in navigating dementia care.

“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.