The Body Language of Suffering: diagnosis and treatment of psychophysiologic pain disorders

The Body Language of Suffering: diagnosis and treatment of psychophysiologic pain disorders

In our latest blog post, “The Body Language of Suffering,” Dr. Eric Sherman, guest faculty in the Manhattan Institute’s trauma program, explores the connection between pain symptoms and disavowed emotions. Dr. Sherman challenges psychotherapists and medical professionals alike to think about symptoms’ meanings before they become lost in the medicalization of treatment.

 

It says here:
The average unmarried female
Basically insecure
Due to some long frustration may react
With psychosomatic symptoms
Difficult to endure
Affecting the upper respiratory tract.

In other words, just from waiting around for that plain little band of gold
A person can develop a cold.

You can spray her wherever you figure the streptococci lurk.
You can give her a shot for whatever’s she’s got, but it just won’t work.
If she’s tired of getting the fish-eye from the hotel clerk
A person can develop a cold.

-“Adelaide’s Lament,” Guys and Dolls (1955)

 

John E. Sarno, MD, former Clinical Professor of Rehabilitation Medicine at the New York University Langone Medical Center, pioneered the idea that a wide variety of pain disorders are psychophysiologic in origin. He initially identified certain presentations of pain symptomatology as Tension Myoneural Syndrome (TMS), now called PPD (Psychophysiologic Disorder). A therapist familiar with TMS, or PPD, conceptualizes the individual’s pain symptomatology as a desperate, self-protective measure to deflect awareness away from unbearable feelings. Such therapists do not exclusively view pain symptomatology as the unfortunate result of illness or accident which is then exacerbated by emotional distress. Whether musculoskeletal pain is conceptualized as a psychophysiological condition or not determines its fate as a symptom, a complaint, or a communication in the treatment situation.

Numerous studies over the past twenty-five years have consistently demonstrated that the relationship between MRI findings and back pain is coincidental. Nevertheless, physicians who treat pain, psychotherapists, and even people struggling with musculoskeletal pain attribute physical problems exclusively to anatomical defects, thereby “medicalizing” them. The failure to recognize the crucial role disavowed emotions play in the development of persistent musculoskeletal pain undermines the effectiveness of clinicians and inadvertently deprives people of beneficial treatment. When a structural or anatomical defect is diagnosed as the cause of someone’s pain and disability, a psychophysiological disorder can be misdiagnosed and physical treatments not only fail but may serve to intensify the symptomatology. Appropriate treatment may be delayed or denied. It is essential that physicians establish the diagnosis of a psychophysiologic disorder.

Both medical and mental health clinicians would agree, of course, that emotional distress must accompany any experience of physical pain and its associated losses and limitations in activity. In fact, when people deny such reactions, we generally become suspicious. It is widely recognized that anxiety and depression will exacerbate an individual’s experience of pain. Nevertheless, for many psychotherapists and physicians, pain symptomatology remains essentially a medical event which can be favorably or unfavorably influenced by psychological factors. For these health care providers, it is neither caused nor resolved by elucidating these very same emotional factors.

When my colleague Frances Sommer Anderson, PhD, SEP, and I treat people suffering from musculoskeletal pain, in contrast to mainstream thinking about its diagnosis and treatment, our approach is guided by the idea that pain symptomatology develops in response to intolerable emotional experiences, not the other way around. Obviously, such profound differences in ways of thinking about pain symptomatology influence the approach for treating people with psychophysiological disorders.

If the mental health professional regards the person’s pain symptomatology as the result of a herniated disc, for example, then the thrust of the work must be directed towards understanding the various ways that someone mourns his or her loss or struggles against accepting it. If someone exercises, then the behavior is branded as self-defeating and non-compliant, a defiant expression of their refusal to mourn and accept the losses that accompany the medical condition. Or, the patient is viewed as masochistic and passive when he or she doesn’t exhaustively pursue every medical option, including contradictory and illogical ones.

When someone grieves and accepts the permanence of their physical losses, the treatment is proceeding smoothly. However, if the individual complains incessantly about his pain, then the person is trying to make the therapist feel useless. Of course, the therapist is useless. He or she can’t fix structurally damaged bodies. In this model, the therapist can only help someone come to terms with their losses, but the individual’s demands relocate their relationship into an arena which is not within the scope of clinical practice.

Once a therapist recognizes musculoskeletal pain as a MindBody disorder, then the goals of treatment change. Complaints of pain are no longer disregarded as static in the background, but are appreciated instead as distress signals originating from the person’s inner life. The emphasis in therapy shifts from mourning the physical losses associated with pain symptomatology to developing a richer and more extensive emotional vocabulary to translate the body language of suffering into the heartache that first produced it.

 

Interested in learning more?

Join Eric Sherman, PsyD, and Frances Sommer Anderson, PhD, SEP, for their upcoming seminar, “When Stress Causes Pain, Can the Psychoanalyst Intervene?”

Part I (taught by Dr. Anderson): February 4, 11, and 25, 11 am to 1 pm
Part II (taught by Dr. Sherman): March 10, 17, and 24, 11 am to 1 pm

$360; $300 for candidates
12 hours CEUs for NYS social workers will be awarded

Learn more and register HERE

 

Eric Sherman, PsyD, is in full time private practice treating adults with psychophysiologic pain disorders and other MindBody conditions. He also treats individuals coping with the aftermath of serious medical illness and disability, as well as training physicians and mental health professionals in these areas. 

Dr. Sherman trained under the aegis of the late John Sarno, MD, at the NYU Langone Medical Center and collaborated with him on treating pain patients until Dr. Sarno’s retirement from private practice in 2012. Dr. Sherman received his postdoctoral certificate in psychotherapy and psychoanalysis from NYU and is guest faculty at the Manhattan Institute for Psychoanalysis. He was a founding member of the PPDA (Psychophysiologic Disorders Association), and is co-chair of the Committee for Psychoanalysis and Healthcare of  Division 39 (Psychoanalysis) of the American Psychological Association. He is the co-author with Dr. Frances Sommer Anderson of the book Pathways to Pain Relief.

 

 

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The Candidate’s Voice

On October 14, 2017, The Candidate Journal hosted an event at the National Psychological Association for Psychoanalysis (NPAP), “The Candidate, or, The Candidate, Barred,” as part of a series of panels on the topic of the candidate’s voice.

There, contributors to Issue 7 of the journal – myself included – as well as other psychoanalytic candidates and early-career clinicians, discussed “some of the themes brought up in the issue relating to questions of psychoanalytic training and institutional psychoanalysis: transference within the institute, matters of pedagogy, the transmission of psychoanalysis, the evaluation of candidates, the role of the state in psychoanalytic training, the training analysis and its place in the birth of an analyst. The goal, most broadly, was to provide an arena for candidates and early-career clinicians to theorize the candidate’s position, as well as to articulate something of the problem represented by the speaking candidate.”

It was my distinct pleasure to participate in this panel alongside peers from the Center for Modern Psychoanalytic Studies (CMPS), Washington Square Institute (WSI), Institute for Psychoanalytic Training and Research (IPTAR), Contemporary Freudian Society (CFS), and Toronto Institute of Psychoanalysis (TIP).

I made the following remarks in response to my own contribution to Issue 7, “The Making of Meaning in the License Qualifying Candidate: Some Experiential Reflections on Training,” and the issue as a whole. I am sharing them here on MIP’s Analysis Now blog in the hopes that we can continue the dialogue about vital issues of candidacy and training, within the Manhattan Institute and beyond.

*

I feel nervous to speak here today.

The irony isn’t lost on me. I’m an analytic candidate anxious about speaking on a panel devoted to an exploration of the candidate’s voice. Seems fitting, doesn’t it?

I’m never totally comfortable speaking in public. I get stomach flips, flushing, some shaking – the usual. But it seems noteworthy that I’m more nervous, more anxious, more insecure, to appear here today as a candidate than I would be if I were sitting on a panel about, say, how to write a book. I’m a writer and a writing coach. This was my professional identity, plain and simple… until I entered training.

Which seems like a lifetime ago, though it’s only been two years. That’s when I began to reevaluate who I am, what I do, and why I do it. I began to form a new identity, as a therapist, an analyst-in-training, and as a special category of candidate: the license-qualifying candidate. I began to grapple with that title and all that it carries, much of which I’m still discovering, some of which at this very moment.

All analytic candidates are engaged in a process of identity formation; this is an innate and necessary aspect of training. However, the LQ candidate, who enters training with no experience in a mental health-related field and therefore no identification as a provider of mental health, comes to this identity in a very different way than a traditional certificate candidate might. I would argue that this fundamental difference between candidates goes largely unattended.

After Issue 7 of The Candidate Journal came out, I heard from many readers who resonated with one particular moment in my paper where I suggest that “Our training does not yet and needs to encourage and facilitate a layering of identity and meaning (a message that sounds something like, in my case, ‘You are a writer and an analyst-candidate both’) rather than a substitution, one for the other (‘You were a writer; now you are an analyst-candidate’) — a position that is innately privileging, negating, and ultimately damaging.” One member of my institute, a social worker, shared with me that his experience of seeing his first-ever patient was akin to mine: in a word, panicked.

I appreciated his comments, and couldn’t help but wonder why I hadn’t heard anything like it before. I thought: Now you tell me! What a difference it would have made at the time to know that as an LQ candidate, I wasn’t alone in an experience that worried me precisely for that reason: I write, “As a writer by trade and identity, only a few short months into training, I was terrified of what [my] inexperience — my perceived and felt un-analyst-ness — might mean about me… now and in the future.”

We haven’t yet made up our minds about the relationship between who our candidates were and who they’re training to be. Maybe we never will. But in the meantime, this institutional ambivalence can make it so difficult, so nerve-racking, for an LQ candidate like me to speak about her experiences, and for existing members of the field, like my social worker colleague, to speak up with comparisons to his own. I suspect that if the LQ candidate’s voice is unsure, it’s because the field is unsure of it.

In this work that requires so much of ourselves, this work that in a very real sense is ourselves, the question we ask ourselves throughout training expands to take on new and important meanings: candidates start out asking “Who am I” and end up wondering “Who does the institution of psychoanalysis need for me to be?”

 

Justine Duhr, MFA,  is a candidate in the license-qualifying program at the Manhattan Institute for Psychoanalysis. She is co-editor of the Analysis Now blog and chair of SCOOP, MIP’s Student Cooperative. She owns and operates WriteByNight, a writers’ service dedicated to helping people achieve their creative potential and literary goals.

 

 

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#MeToo Enters the Consulting Room

On the day it was posted, #MeToo was used more than 100,000 times and retweeted more than 17,000 times in 24 hours.

In this thoughtful and timely post, Sandra L. Green, LCSW, SEP, responds to the phenomenon and its effects on trauma survivors. Why this? she wonders. Why now?

 

Since the recent cascade of accusations of sexual impropriety were waged against film producer Harvey Weinstein, the Twitter hashtag #MeToo (begun by Alyssa Milano) has gone viral. It has also entered the consulting room.

Many of my patients these past few weeks have recounted their own experiences of sexual assault to me, sometimes for the first time, and sometimes once again. In many instances, an altered measure of certainty, boldness, and strength seems to accent their narratives.

What is happening with what an October 26, 2017, online CNN report called, “the biggest national conversation on sexual harassment since the Anita Hill-Clarence Thomas battle”? What might be stimulating the increased confidence for making disclosures? As we therapists often ask, why now?

One patient, the victim of incestuous rape at age 13, was, for the first time in her life, able to access some anger at her rapist and to consequently feel a bit of compassion for her younger self (marking a decreased identification with her aggressor).

Another patient, a man working as a freelance actor, found himself feeling endangered despite the fact that his male boss had never been sexually inappropriate. His sense of peril became so acute that he suddenly felt in need of immediate protection, without a clear link to any current threat. As we explored this heightened anxiety, memories of sexual abuse that occurred repeatedly in his late childhood emerged – memories always known by him, but never previously formulated as influencing his chronic anxiety or unsettled sexual life.

Of course, not everyone I’ve spoken with feels emboldened or comforted by the invitation to publicize their abuse history. For example, two of my patients, both of whom had been quite seriously and violently sexually assaulted, expressed antipathy towards #MeToo, each voicing disdain for what they perceived as a minimization of the more severe ramifications of sexual victimization – the appearance of a loose equation between, say, a transient unwanted touch and violent or ongoing assault.

Several other patients initially decried #MeToo as encouraging mob mentality, a kind of witch hunt. These objections were based on the view that the hashtag phenomenon encouraged facile or specious disclosures and accusations; behaviors with which they did not wish to be associated. Still, in the wake of the Weinstein (et al.) chronicles, conflicts and questions regarding the purpose and meaning of disclosing abuse have become particularly poignant for some patients, especially those who have never revealed these pivotal experiences to the significant people in their lives.

In all of these ways, the turbulent external controversy surrounding #MeToo has reached into and affected the inner worlds of these trauma survivors.

*

So, why now? Perhaps it is the case that disclosures by famous actresses, such as Gwyneth Paltrow and Ashley Judd, are registered as being more credible and therefore more legitimizing than similar allegations made by average or “random” women. Maybe “We the People,” as inadvertent witnesses of such a high concentration of scandalous and repulsive exposés (Cosby, Ailes, O’Reilly, Trump, etc.), have reached a critical mass, a threshold of disturbance that exceeds the collective capacity for indifference and denial.

Certainly, the use of social media as a podium from which one can publicly malign others has been effectually ratified by the current president’s persistent, debasing Tweets. That the barrel of this very medium should now point in the opposite direction, giving the adversaries a dose of their own medicine, does seem fitting. In this way, the Internet can function as the town square once did.

It is easy for me to imagine the intense satisfaction enjoyed by many #MeToo participants and to recognize the exhilaration of being part of an enormous group of fellow victims joining together in rancorous protest. By supplying power in numbers, #MeToo offers instant membership in what may be seen as an emerging and potentially persuasive political movement. The e-platform grants consent to voice one’s outrage, indignation, pain, and loathing to a supportive, albeit anonymous, virtual community. By providing these incentives, fears of inevitable defeat and feelings of powerlessness and shame can be undercut; self-blame, reduced; and pride in being believed by others, readily secured.

The farther-reaching implications of the massive response to the trio of hashtags #MeToo, #BelieveYou, and #NotOkay remain uncertain. But I choose to believe that the time for change is ripe, and that this magnitude of passionate dissent will have sticking power long after the current “virus” recedes.

 

Sandra L. Green, LCSW, SEP, is executive director, faculty, and clinical consultant for the Certificate Program in Trauma Studies at the Manhattan Institute for Psychoanalysis, where she is also a training analyst and member of the psychoanalytic teaching and supervisory Faculty. Sandra teaches advanced courses on trauma at a number of other distinguished institutes, and runs consultation and study groups in her private practice.

 

 

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Feeding the Enemy: When Hatred and Racism Come Home

In a personal and moving story, Roberto Colangeli, fifth-year LQP candidate, delves into his family history and ponders how hatred and racism enter his many “homes.”

 

Born and raised in Italy, I moved to the U.S. in my late twenties. As a child, I often asked my mother and grandmother to tell me stories about their experiences growing up. Most of these stories were about the Second World War which caused so much destruction and loss in Italy and throughout Europe. My family, who maintained strong socialist roots and contributed to building the first Italian union, were targeted by the Nazis. My mother and grandmother never hid their hatred of the Fascist and Nazi regimes, and had no problem expressing their mistrust. In their minds, the Germans had caused two wars and, without a doubt, could cause a third. Although my mother and grandmother recognized that hating an entire population for something that happened in the past was nothing to be proud of, their racism was evident. My mother used to say, “I just can’t help hating them. When I’m dead the new generation will hopefully be able to move on, but I can’t.” Somehow as a child this made sense to me.

Among the many stories they told, there is one especially that stays with me.

On the night of July 9, 1943, the Allies invaded Sicily in Operation Husky, beginning an Italian campaign that aimed to weaken the Nazi presence on the Eastern Front. A couple of months later, on September 8, Italy signed with the Allies the Armistice of Cassibile, finally putting an end to the Italian-German alliance. Unfortunately, the Armistice was signed while Nazi troops were still in Italy, throwing most of the peninsula under Nazi occupation. As retaliation for what was considered a betrayal by the Italians, the Nazis implemented a one-to-three rule: for each Nazi soldier killed, three Italian civilians were to be killed at random. While the Allies advanced, the Nazis moved back into the Italian peninsula until they arrived in Rome, my hometown.

My grandmother’s story began on a late summer evening in 1944. She and her three daughters were at home cooking while my grandfather was at work. During the day he repaired phone cables for a communication company; at night he sabotaged the very same cables he had fixed that morning. As a member of the Italian resistance, he tried to destroy communication between Italy and Germany. That evening there was a knock at the door. My grandmother opened the door to discover a wounded Nazi soldier.

When she told me this story, she would usually pause at this part. For a long time I thought it was for dramatic effect – after all, we are Italian! But now I know it was something much more: fear. Even now, after so many years and so many tellings, I see her eyes stare into space, a face exhibiting no expression. She was terrified, though the soldier was unarmed and too weak to even talk. She also felt furious with this man who, to her, represented pure evil. With a voice filled with pain and shame, she would confess her desire to murder this soldier. After another long pause and a deep breath, my grandmother continued her story.

Amidst all of her intense emotions – anger, hate and fear – she realized that the Nazi soldier was little more than a boy of maybe twenty. He was skinny, with blond hair, sitting on the steps at my grandmother’s door. She found herself thinking about a mother, somewhere in Germany, waiting for her son to come home. After staring at the German soldier for what seemed to her – and to me hearing the story – an eternity, my grandmother carried him inside the house, fed him, and nursed his wounds as best she could. Early in the morning the German soldier left. No words had been spoken between them. The day after, June 5, 1944, the first American soldiers reached the center of Rome.

This story always puzzled me as a young boy. How could my grandmother have felt so much hatred toward the German people, particularly the Nazis, and still find it in herself to help one of them? I could never get a straight answer from my grandmother. Now, so many years later, I find myself pondering how hate and racism were, and still are, a part of my many homes – my family of origin, my country of origin, my new country, my profession, and even my psychoanalytic training.

Recent events in my life and in the world, the recent racial violence in Charlottesville, for example, have brought my grandmother’s story back to mind. I wonder, what made her able to transform a dehumanized Nazi soldier into a human being in order to help him? Why did the thought of the Nazi soldier’s mother suddenly appear in her mind? How was she able to contain the intense anger she felt towards him? Wilfred Bion (1963) describes a mother’s ability to contain and hold the overwhelmed child’s anxiety and emotions. In doing so, the child internalizes the sense of being contained and experiences the mother’s emotional availability, which aids the development of the child’s capacity for self-regulation. I wonder if the act of containing intense emotions, like the anger and hatred for the Nazi soldier, in itself allowed my grandmother to create a space where compassion and identification with another mother was possible.

Also surprising is my grandmother’s decision to invite the Nazi soldier into her home. Philip Bromberg (1996) describes “standing in the spaces” as the capacity of a person to make room for a subjective reality, a space that belongs not to each person individually but to both individuals; a space in which “the impossible” (my grandmother’s ability to relate to and help the Nazi soldier) becomes possible; a space in which incompatible selves awaken to their own “truth” (her hatred for Germans on one side and her love as a mother on the other), and can “dream” the reality of the other without risk to the self’s own integrity.

Only now, decades later, have I begun to understand my grandmother’s struggle with the German soldier. Her lifelong hatred, anger and fear of Germans broke, if only for a few hours that summer night in 1944, when she simultaneously experienced feelings for a man who for her represented everything bad and evil in the world and a young, scared boy in desperate need of help. Her experience seems to have traveled through time and space to find me, a grown man living in the U.S., whispering hope for the stories of our future.

 

Roberto Colangeli, PhD, is a fifth-year psychoanalytic candidate at the Manhattan Institute for Psychoanalysis and an assistant professor of microbiology at Rutgers University.

 

References

Bion, W.R. (1963). Elements of psycho-analysis. London, UK: Heinemann.

Bromberg, P.M. (1996). Standing in the spaces: The multiplicity of self and the psychoanalytic relationship. Contemp. Psychoanal., 32(4), 509-535.

 

 

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Sexuality in the Consulting Room

What happens when patients talk openly and even vividly about sex? Roberto Colangeli, 4th-year candidate, describes such an encounter with a patient and how he grapples with feelings that arise in the room and within himself.

 

As a psychoanalytic candidate, the topic of sex in the consulting room tends to generate anxiety. Readings, conversations, and seminars on the topic only partially prepare us for when and how our patients talk about sex. Even more difficult, and perhaps less considered, is how analysts-in-training will react and work with sexual issues when they arise.

During my first year of training, one of my patients, a middle-aged married man, described a sexual encounter between himself, his wife, and another man. His description of the threesome was comprehensive and graphic, with detailed images of various intimate aspects of the experience. At first, I felt nervous, uncomfortable, and concerned about my reactions. I also worried that he would sense my anxiety. At the same time, I was intrigued and curious. Shortly after he began his narrative, I found myself lost in the scene he was describing, and feeling what he was experiencing. This fantasy continued until I realized that I was becoming aroused. The realization brought me back sharply to the reality of consulting room.

I reacted with surprise, followed by anxiety, shame, and a feeling that something bad had just happened. I worried that my sexual reaction was inappropriate and wrong, that I was unable to control my sexual fantasies, and that I had broken analytic boundaries with my patient. In addition to all of these feelings and thoughts, by nature internal, I was aware that, as a man, my sexual arousal might have been apparent, potentially noticed by my patient.

As I listened to my patient’s words, another part of my mind wondered why his vivid description of a sexual encounter made me so uneasy, and also why I felt so astonished by my reaction to his story. I came to realize that much of my feelings of anxiety and shame were associated with the topic of sexuality entering the consulting room.

Sex and sexuality can awaken in the analyst, and perhaps especially the analyst-in-training (definitely in myself), primitive emotions, archaic fears, shame, reticence, hidden desires, vulnerability, anxiety about losing control, and maybe even fear of acting on one’s own wishes and fantasies in the consulting room. These powerful internal experiences have the potential to create a sort of hubbub in ourselves which interferes with the “right now” moment we share with our patients. This consideration helped me calm down and realize that becoming aroused by a provocative sexual description was not something to be afraid of, but instead, a natural response to intense stimulation.

If our goal is to feel our patients’ experiences when they talk about their sexuality, it is critical that we be able to organize and analyze our emotions without being overwhelmed.

This is yet another instance in which I realized the importance of my own analysis. I believe that our analysis is perhaps the most powerful and effective tool to deal with the topic of sexuality, a key component in our psychoanalytic training. My analyses—one in Italy as a teenager, and a few in New York over the last twenty years—have greatly helped me to understand and become more comfortable with my own sexuality. My experiences as a psychoanalytic patient have made my fears and demons less frightening; in some ways, they have become travel companions that inform my work as an analyst today.

Lessening the fear of my own internal experience encourages openness to possibility. Perhaps my patient’s sexual description was an invitation to join his experience and connect on a more intimate level, in the security of the consulting room, safely framed by the boundaries of the psychoanalytic relationship. The threesome was, after all, with another man (maybe with me?), and my arousal an acceptance of his invitation.

 

Roberto Colangeli, PhD, is a 4th-year psychoanalytic candidate at the Manhattan Institute for Psychoanalysis and assistant professor of Microbiology at Rutgers University.

 

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The Psychoanalytic Community: Becoming an Analyst

For the next installment in our series on psychoanalytic community, MIP graduate Christopher Bandini traces his professional journey — from music therapist to social worker to psychoanalyst — and shares the moment at which he “truly became an analyst.”

 

I can still recall how I made the decision to enter training. I had graduated from social work school eighteen months before, and fortunately had secured a well-paying, but probably temporary, job outside the field. So, I knew I had a narrow window of opportunity to start.

I had worked at a fee-for-service clinic, where not everyone was an analyst, nor aspiring to be, and where such training was often disparaged. Many therapists got by with private supervision, often under the wing of an octogenarian, Svengali-like supervisor, who taught his charges how to run lucrative groups, charge high fees, and keep patients in treatment indefinitely. I felt strongly that that wouldn’t be the right path for me. I needed something more comprehensive and, well, more ethical!

I looked at several institutes, but the interpersonal approach at Manhattan Institute, at the time unavailable to social workers anywhere else, seemed the best fit. Night classes, quality faculty who also taught at NYU Postdoc and the White Institute, reasonable tuition, and a warm, welcoming community all contributed to my decision. Also, my analyst at the time, who had graduated from MIP, said positive things about the institute and knew how to ask interesting questions—that piqued my curiosity. This maybe more than anything else motivated me to go further.

Before becoming a social worker, I trained as a music therapist. Most music therapists worked in hospitals, but I worked in a unique outpatient clinic that combined creative arts modalities with verbal therapy. So, by the time I got to Manhattan Institute, I had done a fair amount of what some might call psychotherapy: a mishmosh, I suppose, of Freudian interpretation, object relations, and interventions learned from a social work textbook. I was sincere and well-meaning, and some people said they found benefit in working with me, but, really, I had no idea what I was doing.

That all changed as my training progressed. Gradually, analytic training became a full immersion; classes, my own three times a week analysis, and especially expert supervision deepened my understanding year by year. The forthrightness of Elke Epstein; the street-wise pragmatism of Sheldon Kastner; the provocative yet kind Irwin Hirsch; the integrity of Willa Cobert and the wisdom of Gil Nachmani. These are remarkable people I don’t think I would have met any other way than through institute training.

Clinically, I began to know why I said the things I said. I asked questions that led to more depth. I could work in the moment in the transference, using my own feelings for the benefit of the patient. I absorbed the literature and gained the theoretical foundation I previously lacked. In those five years of training, I feel I truly became an analyst.

In many ways, graduating from training is only the beginning. Perhaps the most important aspect of post-candidate life is the community you join, the family you now belong to. It’s not unusual in our work to hear of candidates’ negative experiences at other institutes—feelings of shame, control cases being rejected, rigid orthodoxies, and hidebound instructors. I always marvel at these accounts because I simply cannot relate. To me, MIP is the most welcoming of analytic institutes.

In the years since my graduation, I’ve participated in the MIP community in many ways. I’ve served on the colloquium and curriculum committees, and now I supervise and teach. Starting a private practice can be difficult and isolating, but the friendships I’ve made at Manhattan have always helped the work go more easily, whether meeting a colleague for coffee or attending a colloquium after a long week.

I’ve been fortunate to have articles published and to host a podcast in which I interview psychoanalytic writers. I often feel that I might not have had the confidence to write or to put myself in the public eye had it not been for my formative experiences in training at Manhattan Institute. For that and so much more, I am grateful.

 

To learn more about training at MIP, join us for an open house and brunch on Sunday, June 11th, 11 am-1 pm. For location information and to RSVP, please click here.

 

Christopher Bandini is a psychoanalyst in private practice in New York City. He is trained as a clinical social worker and music therapist, and is a graduate of the Manhattan Institute for Psychoanalysis. He teaches and supervises at several psychoanalytic institutes, including MIP and the Institute for Contemporary Psychotherapies (ICP).

He is also a co-host of the podcast interview series New Books in Psychoanalysis.

 

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The Psychoanalytic Community: MIP Candidates Speak

What’s an institute without its candidates?

The Manhattan Institute’s candidates come from all walks of life, entering into training at various phases of their careers and with a range of professional goals in mind. Some are seasoned clinicians seeking post-graduate training; others, pursuing a new career altogether. Still others are testing the waters in the one-year program or receiving specialized training in trauma studies.

As part of our series on the psychoanalytic community, license qualifying candidate and Analysis Now blog web editor Justine Duhr, MFA, asked our candidates about their connection to MIP, what they like about it and why they chose it over other institutes.

Here’s what they had to say:

 

Cynthia Chalker, CPP, Year 5:

“As part of this community, the candidates I have met, especially the last two years, have offered a sense of camaraderie and support I’ve craved.”

 

Justine Duhr, License Qualifying Program (LQP), Year 2:

“Before I entered training, I hardly knew what a psychoanalytic institute was, let alone what it would be like to be a member of one. Now that I know, I feel that I can never go back. I’m hard-pressed to remember a time I’ve felt more immersed and intellectually stimulated; the work is fascinating. Every day, I am challenged anew. Put simply, my training at MIP is an experience unlike any other that has changed the way I view myself and the world.”

 

Emily Fitton, Certificate Program in Trauma Studies (CPTS), Year 2:

“MIP has excellent, accomplished and published senior clinicians on the faculty! For example, I’ve had classes with Elizabeth Howell, a leading authority on dissociative processes, Fran Anderson, a leading authority on psycho-somatic work, Grant Brenner, highly accomplished in neurophysiology. MIP’s supervisor list is also made of up similar senior clinicians. I’ve had the privilege of supervising with Elizabeth Howell, and am currently supervising with Eli Zal. I appreciate being part of this community, as I’ve also expanded my network of other like-minded clinicians. The listserv is a great way to stay connected. My former post-graduate institute discouraged candidates from building community, but MIP seems to actively foster it, with the listserv and parties and educational events.”

 

Emily Haseltine, CPTS, Year 2:

“Being connected to MIP means that I am part of a community of learners. This is meaningful to me because I am part of an organization that enriches, supports, and enlivens my professional life.”

 

Yurilka Hernandez, One-Year Program in Psychoanalytic Psychotherapy (OYP):

“After graduating from college I realized that I wasn’t fully ready to work in a clinical setting because I was missing fundamental skills to treat people in a more intimate way. I looked at other institutes and decided on MIP because it had the one-year program. It is important for me to test the waters before signing on for a five-year commitment—not to mention it was one of the least expensive institutes out there. I have learned a great deal since I enrolled. It has been a great experience and I got to meet great people. The most enjoyable part is my clinical supervisor, Dr. Spitz.”

 

Yelena Ivanova, CPP, Year 2:

“As a social worker and psychotherapist, my drive to excel in my work and deepen my engagement with the field led me to MIP. Being connected to a community and individuals who are rich in experience and knowledge is an important aspect of my life.”

 

Mary Lippin, CPP, Year 3:

“Recently I’ve been feeling MIP is the best book club/study group ever. I am looking for a group I feel I belong to, the practice in doing what it takes to achieve that. In readings and classes (and analysis), I find people who are trying and sometimes succeeding in articulating things that resonate with me… things I never heard anyone talk about. So my deep longing for connection with people who “get” me is awakened. The persistence, dedication, and hard work it takes to keep this thing going is awesome.”

 

Karen Nelson, CPTS, Year 1:

“Being connected to an institute means not being completely untethered in the lonely field of psychoanalytic private practice. It means continuing to exercise my brain and stay mentally and intellectually engaged in the field. And it means maintaining a supportive relationship with a well-trained supervisor I can look to for guidance and validation.”

 

P.B., Certificate Program in Psychoanalysis (CPP), Year 2:

“Being able to get connected to teaching and practicing analysts who have been around and back…access to information not otherwise known or available to professionals who have never had an institute connection…evolve and grow with classmates who begin and graduate with you…referrals and resource goldmine from classmates, instructors, patients, supervisors, and more.”

 

Amy Storey, CPTS, Year 1:

“Being connected to an institute offers a tremendous opportunity to become part of a community of like-minded people with whom to study and converse. This is further enhanced by the fortuitous situation of psychoanalysis in New York City; many of the founding members and true giants within the field, spanning all diverse divisions of theory and practice, are HERE, alive and present, making the conversation very vital and poignant. Through this community we are introduced to some of the best minds around the world, past and present. I am very grateful to be able to participate; we are surrounded by excellence.”

 

Hili Tsarfati, CPTS, Year 1:

“A long-term supportive professional community.”

 

Rosemarie Verderame, CPTS, Year 2:

“Being connected to an institute means to me having a supportive community where I can develop as a therapist.”

 

Kaitlin Ziegler, OYP:

“Being at MIP has given me access to a community of knowledgeable professionals and a wealth of resources. Each instructor and classmate has contributed unique dynamics to the courses. The reading material is comprehensive, eye-opening, and philosophically intriguing. At the same time, the material is practical and relevant enough to apply clinically in daily practice.”

 

 

Interested to learn more about training at MIP? Join us for an open house on Friday, March 10 at 7 p.m. at the NYU Kimmel Center, 60 Washington Square South at La Guardia Place, Room KC #808.

Faculty and graduates will answer questions about MIP’s array of training programs, followed by a colloquium at 8 p.m. featuring Diane Barclay, LCSW, presenting “An Analyst Has a Birthday: Forgiveness as a Psychoanalytic Concept” with discussant Jody Messler Davies, PhD.

Continuing Education Units: 2 contact hours. Cost: $40. Click here to register and pay.
Attendance without CE credits suggested contribution: $20 at the door. Click here to RSVP.

 

 

Justine Duhr, MFA, is a license qualifying candidate at MIP. She serves as web editor for the Analysis Now blog and chairs SCOOP, MIP’s Student Cooperative. She owns and operates WriteByNight, a writers’ service dedicated to helping people achieve their creative potential and literary goals.

 

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The Psychoanalytic Community: My “Attachment” to the Manhattan Institute

In our ongoing series on psychoanalytic community, Naomi Cutner, LCSW, incoming co-director of MIP, explores her attachment to the institute.

 

From a young age, I wanted to know what made people tick, in part because I wondered what made me tick. Like most children, I craved a sense of belonging and inclusiveness among my family and friend groups. At times I felt excluded, unwanted, and unworthy. Humans yearn for connection, and separateness from others can bring on feelings of pain, fear, and rejection.

As I think about my own need to feel attached, I think about British-born psychoanalyst John Bowlby, who developed attachment theory. Bowlby’s childhood was marked by separation and loss, his upper class parents leaving him and his five siblings in the care of nannies. At age four, his dearest nanny, to whom he felt most attached, left the household. Unlike this loving mother figure, his next nanny was cold and sharp. He later described this separation as akin to the tragic loss of a mother, one of many early caregiving experiences that left on Bowlby an indelible mark.

After studying psychology at Cambridge University, Bowlby worked at a school for emotionally disturbed children. This experience piqued his interest in developmental psychology and heavily influenced his professional trajectory. Here, he saw first-hand the effects of parental behavior on personality development, and decided to become a child psychiatrist. While still in medical school, he entered psychoanalytic training, vowing to consider the nature and impact of the child’s early relationships on subsequent development. He eventually proposed that a child develops a secure attachment to the caregiver (in his day, almost invariably the mother) who is attuned to her child’s needs and provides a dependable and safe environment.

Among the first clinicians to recognize that an infant enters the world predisposed to participate in social interaction, Bowlby asserted that disruption of the early caregiver-child relationship should be seen as a key precursor to mental disorder. His critical contribution—an unwavering focus on the infant’s need for a secure early attachment apart from other primary needs such as feeding—continues to be a central tenet of contemporary attachment theory.

As for me, I knew very early in my studies at NYU School of Social Work that I wanted to join a psychoanalytic institute, to continue my training and find a community where I could belong. After receiving my MSW, I worked at the Jewish Board of Family and Children’s Services (JBFCS) for more than 11 years, treating all kinds of people with a vast array of problems, and forming lasting friendships and a deep connection to the clinic. I began psychoanalytic training at the Manhattan Institute for Psychoanalysis (MIP) in my final years at JBFCS, and at MIP found the community I was looking for. Class with my peers, my personal analysis, supervision with seasoned psychoanalysts, and my work with patients all solidified my connection to a new and vital community.

Through these relationships I came to understand much more about the nature of relating, and the ways in which I, like my patients, perpetuated long-standing patterns that left me vulnerable in various ways. Fortunately, I found MIP to be a particularly warm and welcoming community, and a safe space in which to explore myself in relation to others, for which I am immensely grateful.

MIP continues to be a big part of my life, both professionally and personally. My psychoanalytic training at MIP has contributed immeasurably to my ability to inquire and make sense of my patients’ experiences, as well as my own. A psychoanalytic community such as MIP can be a psychological and emotional home, a place for exploration, openness, and curiosity about human nature in all its aspects. I cannot imagine doing this work without this deep level of training, and the ongoing opportunities to talk with colleagues about the challenges and dilemmas we encounter frequently in clinical work. I cherish the friendships I have formed over the years.

As a current faculty member, supervisor, and incoming co-director, I feel fortunate to be able to give back to the institute in new and meaningful ways. I hope to use my attachment to the people of MIP, and my curiosity and skills of inquiry, to understand the wants and needs of the community, its strengths, and its future direction while upholding its valued traditions. I want to ensure a sense of belonging in a safe environment where people can realize some of their dreams.

 

Naomi Cutner, LCSW, faculty, supervisor, and incoming co-director at the Manhattan Institute for Psychoanalysis, has a private practice in New York. She teaches attachment theory at MIP.

 

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The Psychoanalytic Community: My Post-Graduation Life at the Manhattan Institute

An ending or a beginning? Blair Casdin, LCSW, reflects on her connection to the Manhattan Institute following graduation from psychoanalytic training.

 

 

Having recently graduated, the question of what being part of a psychoanalytic community means to me feels more imperative than ever.

During psychoanalytic training, one takes for granted the connection to a community of classmates, supervisors, instructors, and our own analysts, not to mention psychoanalytic writers, ideas, and concepts. Alone with patients, one is never really alone. The content of our classes inevitably turns up in the consulting room. When studying dreams, patients present more dreams. While reading classic Freud, castration anxiety abounds. Learning about self psychology, we are more attuned to narcissistic injuries and repairs. And whatever the class, whatever the struggles with patients during the week, there is comfort in knowing that you can talk about it in class on Thursday night.

Outside of the classroom, I was able to participate in our community in so many important ways. I joined the curriculum committee, helping to establish MIP’s first-ever seminar series and reviewing the curriculum for opportunities to include conversations around race, sexuality, and diversity. As a member of the planning committee – aside from cleaning up after the holiday party! – we brought together candidates and graduates for the annual 11th week seminar to discuss, argue, probe, and ponder a variety of stimulating topics, from intergenerational transmission of trauma to dealing with money and technology to our transference towards the institute.

Last year, I started the Analysis Now blog, having no idea how much it would deepen my connection to the institute and members of the community. What a joy to be trusted to edit Irwin Hirsch, one of the most published interpersonal analysts of our time. Or to have the chance to inspire someone like Jonathan Kurfirst, a first-time blogger, to capture in words key aspects of his 30 years as an analyst on an inpatient unit. I have the pleasure of working closely with Willa Cobert, my former supervisor and one of MIP’s founders, and with the newest member of the editing team, Justine Duhr, a second-year LQP candidate, among others. I bring together faculty, supervisors, and candidates to brainstorm ideas and encourage members of the community to contribute, and in this way, I too stay connected. According to web editor Joe DiMattia, people around the globe read this blog! I never imagined community defined so broadly, and nothing could be more satisfying.

After graduation, how do we stay connected? At first, I was committed to taking a year off, reading fiction, and devoting Thursday nights to Netflix. That didn’t last long. I joined a reading group almost immediately. I found myself reading Ogden, Levenson, and Bromberg on the train to work. I even started a peer supervision group with MIP graduates whom I had gotten to know as part of the community, through seminars, colloquia, and committees. And, of course, I forge ahead with this blog!

The MIP community remains important to me as I grow my private practice. Clients referred to me by MIP’s clinic during my first years in the program are still in my practice. The relationships I’ve forged with close friends and colleagues at MIP will last long past my training days. I don’t know what more is in store for me in my professional life, but I know that MIP is a community that will continue to support me as an analyst, supervisor, teacher, and beyond.

 

Blair Casdin, LCSW, is a graduate of the Manhattan Institute for Psychoanalysis, and is in private practice in Manhattan. Blair is a co-editor of the Analysis Now blog.

 

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The Psychoanalytic Community: MIP at the Center

In our second post in the series on psychoanalytic community, Debora Worth, LCSW, graduate, faculty, and former co-director at MIP, reflects on what the institute means to her, both personally and professionally.

 

What does being part of the Manhattan Institute mean to me? How has being in the institute benefited me? Contemplating these questions, I thought my answer would be simple, but as I began to write, I realized that it’s actually quite multi-layered and complex. The fact that many, if not most, of my referrals come through my contacts in the institute is of course a very practical benefit, but the intangible gifts of my MIP affiliation are far more significant and personal.

I come from a very small family: my father was an only child; my mother had only one sibling; I am an only child; and I had an only child. So, corny as it sounds, the institute is the closest thing I have to a large extended family, and I cherish it, warts and all.

When I started my psychoanalytic training at MIP, I was working full-time at an outpatient clinic at the Jewish Board and had only two private patients in an office in midtown that I rented by the hour. As my practice grew and I progressed at the institute, I gradually decreased my time at the clinic and expanded my private practice, but I was still overworked and stressed. I commuted between Riverdale and Manhattan, and worked late every night. I was exhausted, with barely enough time for my family, let alone for reading assigned articles for classes. Clinic work became less and less gratifying, but I agonized about quitting my job and going into private practice full-time, largely because I feared losing the sense of community and support I felt among my colleagues at the clinic. I remember vividly a moment in my analysis, obsessively going back and forth about whether to quit my job, when my analyst finally said dryly, “Perhaps being able to see your friends every day isn’t a good enough reason to stay in a job that gives you so little else.” Lightbulb moment! So, in my third year of analytic training I took the plunge, rented an office, and left my salaried job. The institute became my professional center, and it remains so to this day.

Psychoanalysis and private practice can be lonely endeavors. Or perhaps, as Irwin Hirsch astutely observes in his recent post, depriving ones. We analysts are with people all day long, but have limited opportunities to talk about our experiences: the emotional pulls, the depth of feelings, the anxieties, and yes, the joys. Having a community in which to do that gives me a sense of balance that would be almost impossible to generate elsewhere.

About 14 years ago my husband was offered a very tempting job in Cambridge, Massachusetts, and I thought seriously about what it would mean for me to move away from New York City and MIP. I couldn’t imagine starting over and recreating for myself what I had at the institute, or continuing to do my work without it. Luckily, my husband felt the same way about his job here, and I was spared having to confront that challenge head-on.

Because MIP offers its members unique and varied opportunities to participate in the community, encouraging professional advancement at every turn, my involvement takes many forms. I teach, supervise, serve on committees, develop programs, and more – a range of professional activities that diversifies my days in a way that sitting in the consulting room with patients from dawn to dusk would not. Different intellectual and emotional muscles get exercised, which helps me maintain my focus and stamina for the difficult work analysts do. I’ve even had the honor of being a co-director and of being able to give something back to the institute that has nurtured me for so long. I have gotten to know people whom I never would have met otherwise, and I’ve made friends who have sustained me through some very difficult times.

I’ve learned a great deal about myself, not just through my analytic training, but by being part of this community and by navigating the relationships, conflicts, and growing pains that are inevitable in any group of strong-minded, smart, committed people. Each new role I have taken on has stretched and altered me in ways that have been life-changing both in and out of the consulting room, and the institute has provided the arena in which all of this important work could take place.

 

Debora M. Worth, LCSW, is a graduate of the Manhattan Institute for Psychoanalysis. She is teaching and supervising faculty at MIP, and served as co-director of the institute from 2007 – 2012. In addition, she is teaching and supervising faculty in the Child and Adolescent Training Program at the William Alanson White Institute. She is in private practice in New York City, working with adults, couples, children and adolescents.

 

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