American Psychoanalytic Association Research Articles

Ethics Education in Psychoanalytic Institutes

ABSTRACT Over the past thirteen years, the Ethics Education Committee (EEC) at Boston Psychoanalytic Society and Institute (BPSI) has engaged in a dedicated, proactive initiative to help trainees, members, and the field at large, address questions of ethics, boundaries, and professional conduct. This endeavor began in the wake of a series of what are often euphemistically referred to as “egregious boundary violations” at BPSI; in other words, sexual transgressions perpetrated by analysts toward their patients. The initiative evolved to address questions including, but also above and beyond, sexual transgressions, in recognition that complex ethical dilemmas are endemic to our work, though often go un-discussed. This paper will describe why the EEC was formed, the techniques used to open-up discussions of ethical decision-making which have been used at BPSI, national meetings of the American Psychoanalytic Association (APsaA), and institutes across the country, and what we have learned about fostering safe environments to grapple with issues around ethical decision-making and professional conduct. Examples of vignettes depicting complex ethical dilemmas, a primary tool in our technique, will also be included.

Psychoanalysis-More Than a Profession: Presidential Address, American Psychoanalytic Association, New York, February 3, 2023.

This plenary address was delivered just before learning the successful outcome of a bylaw amendment extending full American Psychoanalytic Association (APsA) membership to psychoanalytic psychotherapists, researchers, scholars, and all who share a commitment to psychoanalysis. This historic change culminated efforts over the previous four decades to rectify exclusionary harms and revitalize psychoanalysis in the United States as a clinical practice and a cultural force. Membership expansion is discussed in the historical and sociological context of psychoanalysis as a profession with a focus on organizational resistance to change. Professionalization established and legitimized psychoanalysis but also contained the seeds of gradual decline as monopoly over training and practice distanced APsA from the wider psychoanalytic community. Expanding membership beyond the profession is a step toward uniting the community and strengthening all applications of psychoanalysis, including the traditional form. These developments at APsA reflect changes in other disciplines that feature inclusion, generosity, situated learning, and distributed subjectivity in epistemic communities of practice.

Tony Pipolo, Editor, The Psychoanalytic Review, 2016-2023: An Appreciation.

Tony Pipolo, Editor, The Psychoanalytic Review, 2016-2023: An AppreciationGerald J. GargiuloGerald J. GargiuloInterim EditorGerald J. Gargiulo, PhD, is a control and training analyst and faculty member of the National Psychological Association for Psychoanalysis (NPAP). He is on the editorial boards of The Psychoanalytic Review and Psychoanalytic Psychology. He is the author of numerous psychoanalytic papers; his latest text is Quantum Psychoanalysis: Essays on Physics, Mind, and Analysis Today (IPBooks), for which he won the 2017 Gradiva Award from the National Association for the Advancement of Psychoanalysis. He is also the recipient of the 2014 Distinguished Educator Award from the International Forum for Psychoanalytic Education. He is a former president of the NPAP Training Institute as well as of the International Forum for Psychoanalytic Education and a member of the American Psychoanalytic Association and the International Psychoanalytical Association.Search for more papers by this authorPublished Online:June 2023https://doi.org/10.1521/prev.2023.110.2.131PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About"Tony Pipolo, Editor, The Psychoanalytic Review, 2016-2023: An Appreciation." , 110(2), pp. 131–132 Next article FiguresReferencesRelatedDetails Volume 110Issue 2Jun 2023 Information© 2023 N.P.A.P.PDF download

The Relational Revolution in Psychoanalysis and Psychotherapy By Steven Kuchuck. Confer Books, 2021. 198 pp.

The Relational Revolution in Psychoanalysis and Psychotherapy By Steven Kuchuck. Confer Books, 2021. 198 pp.Robin YoungRobin YoungRobin Young, PhD, is a senior member, training analyst, and instructor at the National Psychological Association for Psychoanalysis (NPAP); an assistant adjunct lecturer at New York University (NYU); and founder of an international Loewald reading group. Young has published research on the revised psychoanalytic theories of female development; studied the mother/infant dyad under Lousie Kaplan at NYU; made international and national psychoanalytic presentations; and undertaken private studies with Lew Aron and Jessica Benjamin. She is a member of the International Association for Relational Psychoanalysis and Psychotherapy, and has had a private practice of psychoanalysis and psychotherapy since 1980.Search for more papers by this authorPublished Online:June 2023https://doi.org/10.1521/prev.2023.110.2.229PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutReferencesAron L. (2006). Analytic impasse and the third: Clinical implications of intersubjectivity theory. International Journal of Psycho-Analysis, 87, 349–368. Crossref Medline, Google ScholarBalsam R. H. (2008). The essence of Hans Loewald. Journal of the American Psychoanalytic Association, 56, 1117–1128. Crossref Medline, Google ScholarBenjamin J. (2004). Beyond doer and done to: An intersubjective view of thirdness. Psychoanalytic Quarterly, 73(1), 5–46. Crossref Medline, Google ScholarFerenczi S. (1949). Confusion of tongues between adults and the child. International Journal of Psychoanalysis, 30, 225–230. Google ScholarFreud S. (1912). Recommendations to physicians practicing psycho-analysis. In Strachey J. (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 12, pp. 109–120). London: Hogarth Press, 1957–1974. Google ScholarKuhn T. (1949). The structure of scientific revolutions. Chicago: University of Chicago Press. Google ScholarLoewald H. (1951). Ego and reality. International Journal of Psycho-Analysis, 32, 10–18. Google ScholarMaroda K. J. (2005). Legitimate gratification of the analysts’ needs. Contemporary Psychoanalysis, 41, 371–388. Crossref, Google ScholarRenik O. (1999). Playing one's cards face up in analysis: An approach to the problem of self-disclosure. Psychoanalytic Quarterly, 68(4), 521–539. https://doi.org/10.1002/j.2167-4086.1999.tb00546.x Crossref Medline, Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 110Issue 2Jun 2023 Information© 2023 N.P.A.P.PDF download

Fighting for Psychotherapy by Psychiatrists: Join Us!

Fighting for Psychotherapy by Psychiatrists: Join Us!

APA Calls on U.N. to Respond Urgently to Charges of Iranian Misuse of Psychiatry

APA Calls on U.N. to Respond Urgently to Charges of Iranian Misuse of Psychiatry

The social unconscious: Then and now

AbstractThis is a brief introductory paper about the history and centrality of the social unconscious in psychoanalytic theory and practice. The term―Social Unconscious―was introduced into our literature more than 100 years ago by the first formally trained American psychoanalyst―Trigant Burrow. It opens new pathways for understanding the social and collective dimensions of the unconscious, allowing us to extend our reach with our patients and our relevance with fellow citizens. Despite its potential, the social unconscious and the theories that undergird it were denigrated by Freud. In the early 1930’s, Freud instructed the American Psychoanalytic Association to remove Trigant Burrow from its membership and to excise this scholarship from its curricula. Coordinated attempts to suppress these ideas harmed the field’s development and retarded its relevance. Understanding the social dimensions of the unconscious is necessary because the unconscious is largely structured by social, cultural and collective coordinates. Fortunately, the turn into the 21st century is seeing a proliferation in analytic scholarship regarding the centrality of the socio‐cultural in structuring the unconscious of individuals and groups. New terms are being introduced such as vinculo, normative unconscious, interpellation, semiotic code, and ego‐habitus that aim to elaborate the various ways culture, ideology, large‐groups, and geopolitical processes shape the unconscious. Their potential to deepen our contact with patients across the spectrum of human difference is immense. I suggest using the capacious term―social unconscious―as a core conceptual category that organizes this vein of expanding analytic scholarship.

Reflections on the guidelines proposed by the American Psychoanalytic Association Covid-19 Advisory Team on returning to in-person treatment

This essay reflects on the guidelines proposed by the American Psychoanalytic Association Covid-19 Advisory team on returning to in-person clinical practice, the implications of the guidelines for the practice of psychoanalysis during the pandemic and beyond, as well as what is at stake when psychoanalysts become compliant with the authority of established norms. (Author’s own translation)

Identity and Political Independence

Identity and Political Independence

Psychoanalysis online: An interview with Jill Savege Scharff

Gabriella Giustino interviews Jill Savege Scharff, editor of the book Psychoanalysis online, after the rapid shift to teleanalysis, recommended by the American Psychoanalytic Association in response to COVID-19 restrictions on personal movement.

Rear Window: Double-Take, the Uncanny, and Glimpses of Mortality

Drawing on American Psychoanalytic Association presentations with Ann Adelman and Stephanie Brody on psychoanalysis during Covid, the author explores the disruption to our everyday, taken-for-granted being-in-the-world of others, now supplanted by a new virtual world of presence that is nested within larger societal dislocations. With the stark foregrounding of the visual and auditory, and deprived of other sensory, bodily dimensions, comes an uncanny aura that signals shocks to our existential grounding. Exploring the uncanny similarities of our new virtual world with Hitchcock's Rear Window, Sartre's "look of the other", Lacan and Zizek on anamorphic distortions, and our omnipresent visual immersion in societal violence and fragmentation, this paper weaves connections to our contemporary existential challenges. We are penetrated by anxieties of isolation, loss, threat, and death—and we long to find our way back home within a brave, new world.

Remote Working during the Pandemic: A Q&A with Gillian Isaacs Russell

In this interview by email, Gillian Isaacs Russell, author of the influential Screen Relations: The Limits of Computer‐Mediated Psychoanalysis and Psychotherapy, responds to a set of questions from the BJP. The interview focuses on the impact of remote working during the coronavirus epidemic, starting with the question of whether an effective therapeutic process can occur without physical co‐presence. Isaacs Russell shares her immediate thoughts about the virtually overnight changes to our practice that came with the epidemic, and the work of the American Psychoanalytic Association's Covid‐19 Advisory Team, on which she sits. Her responses are informed by recent cross‐disciplinary and neuropsychological research on the digital age. She considers what happens to free association, evenly suspended attention and reverie when working by phone or online; the loss of the consulting room as a containing physical space for both clinician and patient; the relationship between place and time; and whether (and how) we can maintain a focus on transference and countertransference in the presence of the threat of death. The interview ends with her thoughts on whether we should assume that the landscape of analytic therapy will be permanently altered by Covid‐19, and with her hope that general awareness of the impact of trauma on our mental health has been raised.

The Organizational Structure of the American Psychoanalytic Association: The Politics of Exclusion.

This article traces the history of the American Psychoanalytic Association since its reorganization in 1945. This reorganization established the hegemony of the Board on Professional Standard and the secondary status of the larger membership. It considers the centrality of the requirement of certification for becoming a member, for running for office, and for voting on bylaw amendments, all of which have since been undone, and for training analyst appointments, which continues to this day. A context for this discussion is the decline of APsaA since the 1970s and its struggle to maintain its place in American psychoanalysis and in psychoanalytic education.

The Psychoanalytic Education of CAPA Graduates

ABSTRACTThe CAPA Psychodynamic Psychotherapy Training Program and the evolution of Internet videoconferencing applications have inspired and enabled graduates of its advanced program to seek distance psychoanalytic training, mainly in approved institutes of the American Psychoanalytic Association. Two forms of training, Formal Distance Programs and Distance Accommodation, are described. Distance analytic training presents technical and pedagogical challenges to institutes and to their faculty. Some of the objections to distance education that hamper participation by essential faculty are presented. These issues are discussed and remedies are suggested. With experience, these challenges can be addressed and the training experience becomes satisfying for faculty as well as students. The candidates themselves, in two letters, describe their positive experiences in simultaneous training. A sample of clinical work brought to supervision by a distance candidate in the early years of training is presented to give some sense of the aptitude for psychoanalytic work that exists among distance candidates. Some preliminary thoughts about the variations in the psychoanalytic processes are raised and will need to be supplemented by further experience.

Ethical Issues in Psychotherapy Training in China

ABSTRACTThe growth of psychodynamic psychotherapy in China has been accompanied by a small number of ethical complaints. Some particular aspects of the logistics of building a practice in China have contributed to these ethical situations and are discussed. The CAPA Ethics Committee has worked with its Chinese counterparts to explicate the basic concepts of ethics and professional behavior, and ethics investigations, as they are articulated in the CAPA Ethics Procedures, the Ethics Code of the American Psychoanalytic Association and the Ethics Code of the Chinese Psychological Society. Continued education by CAPA and CIC about the essence of ethical and professional behavior will be a feature of its training going forward, and should be extended after graduation by means of continuing education programs.

Analytic Process from the Perspective of Conflict and Interpersonal/Relational Theory: A Potential Linguistic Indicator

There is a great deal of disagreement about the definition and therapeutic value of an analytic process (AP). Does it exist? If it does, how to determine its presence, how to measure it, and in what kinds of treatments does it occur? In this article I highlight some of the literature from the “classical” school (such as by members of a COPE Study Group from the American Psychoanalytic Association (Committee on Psychoanalytic Education)), as well as from Theodore Jacobs, whom I consider to be an intermediate figure, and members of the “relational/interpersonal” school: Philip Bromberg, Edgar Levenson, and Donnel Stern. This selective review reveals three broad conceptualizations of the AP. It occurs (1) within the patient and is understood by the analyst via the patient’s words; (2) within the patient as revealed to the analyst both by the patient’s words and actions as well as by the analyst’s understanding of his or her own subjective experience in response to the analysand; and (3) as a result of the real interaction between patient and analyst, and not as a result of the vicissitudes of the patient’s transferences. All of these conceptualizations maintain that the AP can only be observed in the flow of what occurs between analysand and analyst over a period of time. Some empirical measures, which assess the presence or absence of an AP are noted. Yet, they are not generally employed in theoretical or clinical discussions, including supervision. Four decades ago, Brian Bird noted that “conclusions [about the analytic process] stem more often from assertions than from evidence and reasonable inferences.” This article emphasizes that analysts need to integrate systematic empirical studies with clinical approaches.

EMOTIONAL AWARENESS AND EXPRESSION THERAPY OR COGNITIVE BEHAVIOR THERAPY FOR THE TREATMENT OF CHRONIC MUSCULOSKELETAL PAIN IN OLDER VETERANS: A PILOT RANDOMIZED CLINICAL TRIAL

Introduction Chronic pain affects as many as 80% of older veterans and is one of the mostly costly disorders treated in Veterans Affairs (VA) settings. Both the CDC and VA recently recommended psychosocial treatments as first-line treatments for chronic pain, along with non-opioid pharmacologic options. Yet standard psychosocial treatment options currently implemented in VA, such as Cognitive Behavioral Therapy (CBT), have only modest benefits for a minority of patients. In contrast, a novel manualized psychotherapy approach with a heretofore underutilized mechanism, Emotional Awareness and Expression Therapy (EAET), has shown medium-to-large effect size benefits for some patients, which may indicate promise for helping older patients avoid riskier treatment options such as opioid analgesics and invasive procedures for their pain. Methods This study is a pilot randomized (1:1) clinical trial (RCT) comparing two group psychotherapy treatment conditions (EAET and CBT) for chronic musculoskeletal pain in Veterans age 50 years and older, currently underway (target N=64). The main objectives of this pilot were to assess the acceptability and feasibility of the treatments, and to provide limited-efficacy testing and obtain an estimated effect size for power calculations for a subsequent larger RCT. Patients received one 90-minute individual session and eight 90-minute group psychotherapy sessions according to the condition to which they were randomly assigned. EAET sessions were conducted by either the study principal investigator or a psychology intern, and CBT sessions were conducted by an experienced psychologist and a geriatric psychology fellow. Demographics (age, gender, years of education) and clinical variables (number of medications, number of medical conditions, presence of opioids) were collected at baseline. Patient-centered outcomes, including pain severity (primary outcome), pain interference, depression, anxiety, PTSD symptoms, sleep disturbance, fatigue, and treatment satisfaction, were collected at baseline, posttreatment, and at three-month follow-up. Two-sample t-tests were used to assess group differences on change scores for each outcome. Effect sizes were calculated using the following formula: (posttreatment mean – baseline mean)/baseline SD. Results To date, 48 patients were enrolled, and 35 patients completed baseline and posttreatment assessments. No differences between treatment conditions were found on any demographic or clinical variable at baseline. Patient drop-out rates were relatively low and comparable in each treatment condition. Similarly, no differences were found between treatment conditions in patient attendance or treatment satisfaction. However, a non-significant trend toward more improvement in the primary outcome of pain severity was found which favored EAET over CBT (t=1.868, p=0.07). Several patients in the EAET condition (N=3, 18%) had large improvements in pain severity, greater than -3 on an 11-point (0-10) scale, whereas no patient in the CBT condition had such large improvements. Overall, EAET delivered a moderate effect size of -0.60 for pain severity, whereas CBT had a small effect size of -0.22. Improvements in secondary outcomes (pain interference, depression, anxiety, sleep disturbance, fatigue, and PTSD symptoms) were generally small and did not differ between groups. Conclusions EAET appears to be a reasonable, and potentially more efficacious, alternative to CBT for older veterans with chronic musculoskeletal pain. Additional groups are planned for this pilot, and 3-month follow-up data are currently being analyzed. In addition, a larger RCT using therapists who are not involved in the research design and methods is planned. Further research is also needed to elucidate the distinct and similar mechanisms of action for each treatment approach and to assess baseline predictors of treatment response, especially given the large improvements among some patients in the EAET condition. This research was funded by This research was supported with a Beginning Scholar Pilot Grant from the American Psychoanalytic Association.

Psychoanalytic Reflections on the Impact of Separation and Divorce

ABSTRACTSeparation and divorce are not isolated events in a child’s life, but rather, must be understood as processes that influence and reverberate throughout the life trajectory. This panel, which was presented at the 2016 American Psychoanalytic Association Winter Meetings, explores the impact of separation and divorce on children going through the court process (Sarezky film, Talk to Strangers); discusses the psychoanalytic treatment of the child (Bram) and the adult (Lament); and is the focus of observational research of infants and toddlers and research interviews with adults (Gunsberg). Our discussant (Straus) raises important questions regarding how separation and divorce influence developmental progression and become critical to the life narrative of the child and adult, and how these processes affect the parents’ ability to parent. The parent is consumed with loss: loss of the spousal relationship, loss of the family as it was previously known, loss of contact with the child, and loss of one’s own self as previously constructed. Straus concludes by considering the high-conflict parental relationship in which one parent’s preoccupation with loss leads to destructive thoughts and behaviors toward the other parent and children.

American Psychoanalytic Association Prizes: Call for Entries

American Psychoanalytic Association Prizes: Call for Entries

The Intersubjective Safety/Danger Dialectic

ABSTRACTSafety, or more accurately the feeling of safety and its inverse, danger, is an experiential variable that has received relatively little attention in the psychodynamic literature and discussion. This changed in January of 2013 when Joseph Lichtenberg, M.D., convened a panel during the annual winter meeting of the American Psychoanalytic Association to discuss the question of safety for the analysand, the analyst, and the dyad. As the reporter (Segalla, 2013) on that panel, this discussion shifted my attention and thinking toward an aspect of therapy and psychoanalysis often taken for granted—the way we take oxygen for granted—all around us but rarely directly discussed or explored. This article attempts to articulate this thinking and some thoughts about bringing the question of safety and danger into the psychoanalytic dialogue.