Psychoanalysis On and Off the Couch

"One of the things that I find absolutely remarkable about psychedelic medicines is the access one can have into discovering different parts of  oneself, different ways in which we’re put together  Also, to see how we shape our worlds in a very interesting way, experientially. That has been shocking to me - to see and experience how our psychological frameworks have a coherence. They feel structural in a way that you can experience anxiety being removed and then it coming back and it being held somewhere in your body in a very distinct way. Even to be able to travel into an anxiety held in the body in a distinct way and understand its roots and origins as if it was a structure in and of itself. To say it is mind-blowing would be an understatement."    Episode Description: We begin by discussing the medical aspects of ketamine which includes its long history of use and safety. Gita shares with us her psychoanalytic background and how it has played a central role in her work utilizing psychedelic medicines. We discuss the similarities and differences between the regressions in both treatments and share thoughts about the differing modes of therapeutic action. She describes clinical situations demonstrating the impact that a therapeutically assisted psychedelic experience can have on long-standing character impediments. We close with a reminder of the long-standing interest that psychoanalysts have had in this promising modality.    Our Guest: Gita Vaid, MD is a board-certified psychiatrist and psychoanalyst practicing ketamine-assisted psychotherapy in New York City. She is a co-founder of the Center for Natural Intelligence, a multidisciplinary laboratory dedicated to psychedelic psychotherapy innovation and clinical practice. Dr. Vaid completed her residency training at NYU Medical Center and psychoanalytic training at the Psychoanalytic Association of New York. She trained as a fellow in clinical psychopharmacology and neurophysiology at New York Medical College and completed a research fellowship at NYU Medical Center. Dr. Vaid serves as the Director of Psychedelic Awareness at The Chopra Foundation and is on Faculty at The Ketamine Training Center.    Linked Episodes:    https://harveyschwartzmd.com/2022/01/28/ep-23-psychedelic-psychotherapy-for-ptsd-new-research-with-ingmar-gorman-phd/    https://harveyschwartzmd.com/2021/02/26/ep-2-psychedelic-medicines-therapeutic-context/    Recommended Readings:  Critical Period Plasticity as a Framework for Psychedelic-Assisted Psychotherapy Lauren Lepow, Hirofumi Morishita and Rachel Yehuda  Frontiers of Neuroscience Sept 2021    Pivotal Mental States Ari Brouwer and Robin Lester Carhart-Harris Journal of Psychopharmacology 1-34 2020    Psychedelic Communitas: Intersubjective Experience During Psychedelic Group Sessions Predicts Enduring Changes in Psychological Wellbeing and Social Connectedness H. Kettner, F. E. Rosas, C. Timmerman, L. Kartner, R.L.Carhart-Harris and L. Roseman  Frontiers of Pharmacology, March 2021    Notes on Memory and Desire, W.R. Bion 1967)  The Present Moment in Psychotherapy and Everyday Life. Daniel Stern 2004  Psychedelic Psychotherapy : Building Wholeness Through Connection  Gita Vaid, MD; Barry Walker, M.Ed 

"We understand that we are not alone. It is crucially important to feel like that because we are a large country compared to other European countries - we are the largest country in Europe and have 45 million population. But in comparison to Russia it is very small and actually the Russian army is the second largest army in the world. It was unbearably scary to think about it, and we are very grateful to all the world who protect us with words, who protect us with weapons and with other supplies, so we are incredibly thankful."   "I would like to say that we are not afraid anymore in spite of the fear. We are not afraid and we ask you also not to be afraid. We ask the Russian people not to be afraid and to protest - Belarus people not to be afraid and to protest. We ask European countries not to be afraid and to tell the truth to their people, to their population, to each other because this war is not only in territory but also in mind."         To provide assistance to Ukraine:  Michael Pustovoyt at pmm2109@gmail.com  https://linktr.ee/voiceforukraine?utm_source=linktree_profile_share&ltsid=a932117b-67f0-4ebd-bcd9-1ee89693c909    IPAOfftheCouch.org 

Guest Dr. Rafael Ornstein, a psychiatrist and jazz pianist, discusses using musical improvisation to make sense of patients' fragmented harmonies. The podcast explores the parallels between musical improvisation and free association in psychoanalysis. They delve into creating new motifs through improvisation to represent challenging elements for deeper examination. The episode also touches on the intersections between music therapy and psychoanalysis, highlighting the importance of structure for meaningful expression.

"I'm interested in with what mind and what imagination and thoughts and association one person lives her life. That’s the common thread in all three novels and that is of course what interests me as an analyst practicing psychoanalysis, doing psychoanalytic work. It is also what interests me in terms of psychoanalytic theory, what goes on in the mind? That’s an endlessly fascinating question that I have."     Episode Description: We consider three expressions of Cordelia's immersion in the world of psychoanalysis - her novels, her theoretical writings, and her work as chair of the IPA in Culture Committee. She shares with us her interest in the minds of her fictional characters especially as they reveal Oedipal struggles. She reads an excerpt that reflects her attunement to conflicts related to seeing - the wish, the taboo, and the punishment. Her theoretical focus is on fine-tuning Freud's notion of aggression with her emphasis on the more fundamental self and other preservative drives. We discuss her interest in culture and in the enriching experience of linking images with words. We close with her sharing her personal journey having trained in Switzerland and now living in the States.    Our Guest: Cordelia Schmidt-Hellerau, Ph.D. is a Training and Supervising Analyst and on the Faculty of the Boston Psychoanalytic Society and Institute as well as of the Swiss Psychoanalytic Society. Her area of expertise is metapsychology, in particular drive theory. She has published numerous papers and three books on theoretical and clinical psychoanalysis. Her 2018 publication Driven to Survive was a finalist of the American Board & Academy of Psychoanalysis Book Prize. She has published her first novel in German in 2019, Rousseaus Traum, and in 2020 her second novel Memory’s Eyes, and has just finished her third novel, Memento. Since 2017 she is the chair of the IPA in Culture Committee. She works in private practice in Chestnut Hill, Massachusetts.    Recommended Readings:  Freud, S. (1908). On the Sexual Theories of Children. Standard Edition, 9.    Freud, S. (1940). An Outline of Psycho-Analysis. Standard Edition, 23.    Lispector, C. (2015). The Complete Stories. Translated from the Portuguese by K. Dodson. New York: New Directions.    NDiaye, M. (2013). Three Strong Women. Translated from the French by J. Fletcher. New York: Vintage Books.    Schmidt-Hellerau, C. (2018) Driven to Survive. Selected Papers on Psychoanalysis. New York: International Psychoanalytic Books.    Schmidt-Hellerau, C. (2020) Memory's Eyes. A New-York Oedipus Novel. Queens, NY: International Psychoanalytic Books.    Schmidt-Hellerau, C. (2021) The Analyst as Storyteller / El analista como narrador. Queens, NY: International Psychoanalytic Books. 

"We are all dependent and potentially addicted as well. We regularly use addictive objects whenever we are confronted with a circumstance that brings a lot of pain, emotional pain, more pain than we can bare."     Episode Description: We begin by reviewing how remarkably pervasive pornography is on the internet. Claudia discusses the impact that viewing arousing scenes on a screen can have on one's psychosexual development. She describes its effects on our neurochemistry as well as on one's capacity to develop creative sublimations. The fundamental issue as seen by both guests involves detours from intimacy which Jose describes as involving dehumanization. This intolerance for what he calls “mature dependency” is seen as underlying the turn to "impoverished, desolate and concrete internal scenarios." We close with a conversation on the challenges of treating patients who experience themselves as dehumanized and unknowingly treat their analysts similarly. Despite these difficulties, the analyst's acceptance of such moments contains the seeds for hope and renewal.    Our Guests: Claudia Spadazzi, MD, Full Member Italian Psychoanalytic Society (SPI) and International Psychoanalytical Association (IPA). Clinical psychologist, gynecologist, sexual therapist. Visiting Professor in Psychosomatic Gynecology at Università Politecnica delle Marche. She has been part of the IPA Committees: IPA/IPSO, COWAP, Public Information, CAPSA, and currently is a member of IPA Health Committee. Co-founder of Italian Psychoanalytic Dialogues. Founder of the Freud’s bar, an outreach initiative. Founder of the Section of Cinema and Psychoanalysis, Festival of the Two Worlds, Spoleto.    Jose Zusman, MD President and Training Analyst at Rio de Janeiro’s Psychoanalytic Society, Post Doc at The Institute of Psychiatry of the Federal University of Rio de Janeiro/ Harvard under the mentorship of Edward Khantzian, Member of IPA Health Committee and Chair of IPA Subcommittee on Addiction    Linked Interviews:  The Mind, Body and Soul Podcast: Ep.9: A Gynecologist/ Psychoanalyst Treats Amenorrhea with Claudia Spadazzi, MD   https://harveyschwartzmd.com/2021/06/04/ep-9-a-gynecologist-psychoanalyst-treats-amenorrhea/  Psychoanalysis On and Off the Couch Podcast: Ep.8 A Psychoanalyst Encounters Patients with Addictions  http://ipaoffthecouch.org/2019/06/29/episode-8-a-psychoanalyst-encounters-patients-with-addictions/    Recommended Readings:  Applying Psychoanalysis in Medical Care, edited by Harvey Schwartz    Neuroscience of Internet Pornography Addiction: A Review and Update. Behav Sci 5(3): 388–433.    Kahn, M. .M. .R. (1979). Alienation in Perversion, London: Karnac    Doidge N. (2008).The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science, London: Penguin    Solms M., Zellner M., Watts D., Panksepp J. (2011) Affective Neuroscientific and Neuropsychoanalytic Approaches to Two Intractable Psychiatric Problems: Why Depression Feels so Bad and What Addicts Really Want Neuroscience and Biobehavioral Reviews 2011    Balint, M. (1968/1979). The Basic Fault: Therapeutic Aspects of Regression. Tavistock Publication. London.    Dodes, L (2003). The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors, HarperCollins Publishers. New York.    Fairbairn, W: Then and Now (2014). Routledge Publishers. New York.    Khantzian, E.J. -Treating Addiction as a Human Process (1997). Jason Aronson.  New York    McDougall, J (1995). The Many Faces of Eros. W.W. Norton Company, Inc., New York. 

"The acknowledgment of guilt it’s a prerequisite for reparation. There is no reparation without the acknowledgment of guilt and guilt arises when love and hatred come together within the same person. There is no need to feel guilt as long as we idealize a good object - there is no need to feel guilt as long as we have the bad object. When we discover that it is the same object, that our love feelings and our hatred are directed towards the same object, then guilt arises. I think of guilt more as a molecule, not as an atom."     Episode Description: We begin by clarifying the meaning of trauma from its commonplace references all the way to the trauma of parental figures maintaining a malignant view of their child. We discuss the impact of early trauma on development with particular attention to the limitations on the capacity for nuanced affect and symbolization. Heinz describes in detail how this level of concreteness lives in the analytic situation and is shared in the counter-transference. The analyst's ability to imperfectly tolerate the projection of badness into them is demonstrated in his clinical vignette. The patient describes herself, There is something in me which is part of me and not part of me which thinks that I only have a right to live if I feel bad. We learn how that addictive attachment to dependable badness sustains her until she needs it less over the course of her analysis. The deepening capacity to tolerate guilt and for whole object gratitude marks the analysand’s healing.    Our Guest: Heinz Weiss, M.D., is the Head of the Department of Psychosomatic Medicine at the Robert Bosch Hospital in Stuttgart. He is also the head of the Medical Division and member of the directorate of the Sigmund-Freud Institute, Frankfurt/Main, and Chair of the Education Section of the International Journal of Psychoanalysis.    Linked Episodes:  https://harveyschwartzmd.com/2021/06/04/ep-9-a-gynecologist-psychoanalyst-treats-amenorrhea/  http://ipaoffthecouch.org/2019/06/29/episode-8-a-psychoanalyst-encounters-patients-with-addictions/    Recommended Readings:  Money-Kyrle, R. (1956), Normal Countertransference and Some of Its Deviations. Int. J. Psychoanalysis 37: 360-366.    Rey, H. (1994), Universals of Psychoanalysis in the Treatment of Psychotic and Borderline States. London: Free Associations Books.    Steiner, J. (1993), Psychic Retreats. Pathological Organizations in Psychotic, Neurotic and Borderline Patients. London, New York: Routledge.    Steiner, J. (2020), Illusion, Disillusion and Irony in Psychoanalysis. London, New York.    Weiss, H. (2009), Das Labyrinth der Borderline-Kommunikation [The Labyrinth of Borderline-Communication]. Stuttgart: Klett-Cotta.    Weiss, H. (2020), A Brief History of the Super-Ego with an Introduction to Three Papers: Int. J. Psychoanal. 4 (2020), 724-734.    Weiss, H. (2020), A River with Several Different Tributary Streams: Reflections on the Repetition Compulsion. Int. J. Psychoanal. 101, 6: 1172-1187.    Weiss, H.(2021), The Conceptualization of Trauma in Psychoanalysis: An Introduction. Int. J. Psychoanal. 102, 4: 755-764. 

"La gran propuesta que queremos avanzar a la sociedad civil, a la comunidad, es la posibilidad de que el psicoanálisis tenga un lugar para que la gente pueda acudir. Nuestra gran propuesta es fundamentalmente clínica, es la recepción de los quebrantos del sujeto, de los dolores de las mujeres, de la desesperación de los niños, de los familiares y la propuesta es justamente que estas personas puedan tener una escucha psicoanalítica."    ["The great proposal that we want to advance to civil society, to the community, is the possibility that psychoanalysis has a place so that people come and be heard. Our proposal is fundamentally clinical - it is the reception of the injuries of the subject, the pain of the women, the despair of the children, of the relatives, and the proposal is precisely that these people can have a psychoanalytic listening."]    Descripción del Episodio: El Dr. Helí Morales comienza la entrevista haciendo referencia a dos instituciones que el ha fundado, la escuela de la Letra Psicoanalítica y la Fundación Social del Psicoanálisis, la primera esta dirigida a la formación de psicoanalistas y la segunda al trabajo de los psicoanalistas en la comunidad , en ciudades como Puebla, Oaxaca , Cuernavaca, Morelia y en Ciudad de México. El trabajo comunitario a través de las “Clínicas de la Escucha” está dirigido principalmente a trabajar con mujeres víctimas de violencia y con familiares de personas que han desaparecido. Desarrolla diferentes conceptos teóricos desde el pensamiento de Freud y Lacan para dar cuenta de la violencia entre lo seres humanos y de la crueldad como satisfacción de poder. Dr. Helí Morales considera fundamental que el psicoanálisis extienda sus fronteras para poder instalar un diálogo con la comunidad que permita abrir los conceptos psicoanalíticos para que nuestra práctica se pueda ver enriquecida.    Episode Description: Dr. Helí Morales begins the interview by referring to two institutions that he has founded- the School of the Psychoanalysis (Letra) and the Social Foundation of Psychoanalysis. The first is aimed at training psychoanalysts and the second to the work of psychoanalysts in the community, in cities such as Puebla, Oaxaca, Cuernavaca, Morelia, and Mexico City. Community work through the "Listening Clinics" is aimed mainly at working with women victims of violence and with relatives of people who have disappeared. Heli develops different theoretical concepts from  Freud and Lacan to account for violence between human beings and cruelty as power satisfaction. He considers it essential that psychoanalysis extends its borders in order to establish a dialogue with the community that allows us to open psychoanalytic concepts so that our practice can be enriched.    Nuestro Invitado: Helí Morales Ph.D. fue ganador del Premio Sigourney 2020, otorgado por la Fundación Sigourney Trust en reconocimiento a su trayectoria de más de 10 años promoviendo el psicoanálisis en diferentes ámbitos de la vida social. El Dr. Helí Morales cuenta con una trayectoria reconocida en el campo del psicoanálisis en México y en otros países de América Latina, como así también en España y Francia. Ha creado dispositivos que facilitan la aplicación clínica del psicoanálisis a poblaciones de escasos recursos y situación vulnerable. Desde esta perspectiva, Helí Morales ha sido artífice de la creación de la Fundación Social del Psicoanálisis y de la Escuela Psicoanalítica (Letra).  Helí Morales cuenta con una sólida formación académica, es Doctor en Filosofía y Ciencias Sociales graduado de la Escuela de Altos Estudios en Ciencias Sociales de París. Estudió además la Maestría en Psicoanálisis y Campo Freudiano en la Universidad de París. También realizó la Maestría en Teoría Psicoanalítica en el Centro de Investigaciones y Estudios Psicoanalíticos de México.    Our Guest: Helí Morales Ph.D. was the winner of the Sigourney Prize 2020 in recognition of his work of more than 10 years promoting psychoanalysis in different areas of social life. Dr. Helí Morales has a recognized career in the field of psychoanalysis in Mexico and other Latin American countries, as well as in Spain and France. He has created settings that facilitate the clinical application of psychoanalysis to a population with limited resources and a vulnerable situation. From this perspective, Helí Morales has been the creator of the Social Foundation of Psychoanalysis and the Psychoanalytic School (Letra)  He has a Doctor of Philosophy and Social Sciences from the School of Higher Studies in Social Sciences in Paris. He also has a Master's in Psychoanalysis and Freudian Field at the University of Paris. He also completed a Master's Degree in Psychoanalytic Theory from the Centro de Investigaciones y Estudios Psicoanalíticos de México.    Recommended Readings:    Ana Petros. Compiladora. Sexualidad y lazos sociales, Buenos Aires, Letra Viva ediciones, 2018.  Andrés Manuel Jiménez. Compilador. La Cultura. Entre la Vida y la Muerte, México, Ed. Escuela de la Letra. 2020.  Helí Morales. Compilador. Psicoanálisis en la Cultura, México, Ed. Intempestivas, 2017.  Jacques Derrida. Estados de Ánimo del Psicoanálisis, Buenos Aires, Ed. Paidós, 2015.  Jacques Lacan. La Angustia, Buenos Aires, Ed. Paidós, 2014. 

"In conflict, especially in war when we have massive conflict, each side believes that truth and right are on their side. It is very difficult to reason with each side because each side believes that right and truth are on their side.”    Episode Description: We begin by describing the current widespread craving for social homogeneity - the 'other' is deemed not only as foreign but foul and dangerous. Violence towards those who are different is tolerated if not valorized as purifying. Psychoanalysis has something to offer those who shout in order to not hear themselves. In addition to speaking with colleagues, we suggest the value of applying aspects of our work 'off the couch' to reach those who don't seek listening but can benefit from it. Ronald's work in Balint groups provides a model of outreach that perhaps can apply to the social/political arena as well. We conclude with welcoming ideas from listeners about how best to apply our skills to the wider world in which we live.    Our Guest: Ronald Doctor, MD is a Consultant Psychiatrist in Medical Psychotherapy and Forensic Psychotherapy, West London NHS Trust, and a Psychoanalyst in private practice. He is a Fellow of the British Psychoanalytical Society, Senior Member of the British Psychotherapy Foundation, Fellow of the Royal College of Psychiatrists, Chair of the IPA Committee of Psychoanalysis and Law, and Board member of the International Association for Forensic Psychotherapy. He has edited two books: Dangerous Patients: A Psychodynamic Approach to Risk Assessment and Management (2003) and Murder; a Psychotherapeutic Investigation (2008) and published History, murder and the fear of death, International Journal of Applied Psychoanalytical Studies (2015) 12.2 152-160. 

“The students are fascinated to see that someone who ordinarily they know behind the couch can be on the stand and try to influence social justice, and influence foster care systems, influence schools, churches and often corporations.”    Episode Description: We begin by recalling Dr. Kliman's 92nd birthday request of inviting trainees to participate in his work with the Harlem Family Institute and the Harlem Psychoanalytic Institute. He presents clinical examples especially around the issue of giving voice to those who suffered trauma. His teaching includes demonstrating how an analyst engages with the legal system in order to seek justice for ignored victims. We also discuss his recent thinking on PTSD and the altruistic communicative aspects of otherwise individually disabling symptoms. We close with his sharing with us his precarious health, the impact of his Holocaust family history, and the usefulness of his current analysis.    Our Guest: Gilbert Kliman, MD. Medical Director, Preventive Psychiatry Associates Medical Group and The Children's Psychological Health Center, Inc. Chairperson, Harlem Family Institute. Recipient 2016 Anna Freud Award, 2020 Humanitarian Award of The American Psychoanalytic Association. 2020 Rieger Award, AACAP. Distinguished Life Fellow of the American Psychiatric Association, Diplomate of Am. Board of Psychiatry and Neurology; Life Fellow and Diplomate of the American Academy of Child and Adolescent Psychiatry; Certified Psychoanalyst for Children, Adolescents, and Adults, American Psychoanalytic Association, Diplomate; Fellow, American College of Psychoanalysts    Recommended Reading:    Schmidt Hellerau, C (2018) Driven to Survive. iP Books, NY NY  www.childrenspsychologicalhealthcenter.org (See especially the pages on “Reflective Network Therapy”, pages on “Results”, “Guided Activity Workbooks”)    www.harlemfamilyinstitute.org    Jeffery, E (2001) The Mortality of Psychoanalysts. J. Am. Psan. Assoc. 49:1.    Kliman, G (2010) Reflective Network Therapy in the Preschool Classroom. University Press of America, Durham MD. (available as hardcopy or Kindle at Amazon.com)    Kliman, G. (2020) Reflective Network Therapy for Childhood Autism and Childhood PTSD. J. Neuropsychoanalysis and Allied Disciplines. Volume 20, 2018 – Issue 2. https://doi.org/10.1080/15294145.2018.1535279        ________. (2020). Regularity of IQ Rise With an Interpersonal Preschool Treatment: 81 Treated Preschoolers vs 63 Comparison and Controls. Honors presentation – Rieger Award. 2020 Virtual Meeting, 2020 - aacap.confex.com. For a copy of the data tables, write to gilbertkliman2008@gmail.com        __________ (2021 in preparation) A Unifying New Theory of Posttraumatic Stress Disorder in Children. Draft available from gilbertkliman2008@gmail.com        Those who wish video recordings of my 2018, 2019 or 2021 seminars on Forensics or on Reflective Network Therapy, write gilbertkliman2008@gmail.com 

"A large group [of analysts] sitting in the circular Tavistock manner talked about their reactions to the state of the world. It wasn’t just about the law about Poland and the Holocaust but also about the populist movements that were gaining ground in many places. The psychoanalysts were saying ” What can we do? What can psychoanalysts do?” I thought to myself “Well, the IPA holds a wealth of expertise, certainly psychoanalysis and psychoanalytic thinking can make a difference in our troubled world."     Episode Description: Dr. Wolfe begins by sharing with us a pivotal moment in her decision to run for office. It was when she encountered political censorship, false facts, and indoctrination that she chose to seek a leadership role in the IPA. She describes her plans to bring our specifically psychoanalytic skills to make a difference in the larger social arena. She shares with us the variety of people and programs that are currently functioning in relation to the wider world. She feels that we can continue the tradition of being involved in our communities that originated in the 1920s and ‘30s in Europe. In sum, Dr. Wolfe asks and challenges, "We have so much to offer why don't we share it with the world."    Our Guest: Harriet Wolfe, M.D., is President of the International Psychoanalytical Association, Past President of the American Psychoanalytic Association, Clinical Professor of Psychiatry and Behavioral Sciences at the University of California San Francisco School of Medicine, and Training and Supervising Analyst at the San Francisco Center for Psychoanalysis. Her scholarly interests include clinical applications of psychoanalytic research, organizational processes, female development, and therapeutic action. She has a longstanding commitment to psychoanalytic public health intervention. She has co-authored a number of psychoanalytically informed guided activity workbooks for children, parents, and teachers to help children cope with natural and manmade disasters. She teaches analysts-in-training, psychiatric residents, and junior psychiatric faculty about the psychodynamic understandings of severely ill patients and the value of listening to listening to a la Haydee Faimberg in the clinical setting. She has a private practice of psychoanalysis and individual and couple’s psychoanalytic psychotherapy in San Francisco.