Relational Trauma and its Psychoanalytic-Existential Response
Theoretical and Technical Considerations for Clinical Practice
Theoretical and Technical Considerations for Clinical Practice
July 23-27, 2018
In the beginning there is narrative. Life is about narrative. We are constituted through the stories inscribed in us by others and by the stories we attempt to compose for ourselves. Likewise, psychotherapy is about narrative. Within the intersubjectivity of the patient-therapist encounter we attempt to ascribe significance to our experience, particularly that which is often painful, unmetabolized, and dissociated from our capacity to formulate that experience into words. Without the capacity to speak our experience we can neither know who we are as subjects nor recognize the desire that shapes that subjectivity. When our founding trauma amputates our ability to speak with a human voice, allow ourselves to be known, and love others well, our subjectivity fades and we are thus condemned to an inauthentic existence.
In this seminar we'll explore how to help patients reconcile the "me" given to them by the gaze and words of the other with the "I" atrophied and buried in one's depths. We'll examine how the therapeutic relationship--how we listen to the symptom and to the patient's unconscious communication, how we create and manage the interactional space where the work transpires, and how we are able to carry the burden with the patient of what they have suffered--helps in the work of symbolization which lies at the heart of the therapeutic endeavor. Since technique and our manifest interventions are in themselves relational acts, we'll attempt to build a therapeutic narrative that will link technique to theory--in particular, the healing elements of the therapeutic relationship and the activity necessary for converting unmetabolized pain into the symbolic. In doing so, we'll work to connect our technical recommendations with our constructed therapeutic narrative. And, of course, we'll do all of this through a psychoanalytic-existential sensibility and through case material from our work.
Amelio A. D'Onofrio, PhD
This seminar meets 9:30 am - 12:30 pm Monday through Friday at LIBERA ACCADEMIA DI BELLE ARTE~~FIRENZE (LABA).
July 23-27, 2018
July 23-27, 2018
Schedule of Topics and Themes for our Conversation
While the themes discussed will be recursive throughout the week, an outline of topics and questions to be raised is provided below.
- Introductions and Overview of the Week
- Therapeutic Narrative and Archetypes of the Therapeutic Journey
- The Person of the Therapist, the Choice to Be a Therapist, and the Countertransferential Starting Point
- The Founding Trauma
- What does early life relational trauma do to the psyche? To the emerging subject? To one's defining desire?
- How are terror, rage, shame, guilt, and despair created through the founding trauma?
- What is lost through the founding trauma? What is internalized and retained from that loss?
- How does that loss send into motion patterns of repetition and insistence?
- How does this founding trauma inform the nature, process, and dynamics of the psychotherapeutic endeavor?
The Symptom, Death Anxiety, and the Unconscious Implications of our Therapeutic Comportment
- The Symptom
- How does the symptom speak for the subject who is rendered mute?
- How do we allow the patient to express his or her symptom?
- What is the economic gain the symptom creates and sustains?
- How is ego a symptom and how might we conceive of the process of dissociating and disentangling the subject from its ego?
- How do we help the subject move toward greater integration and restitution of his or her wholeness?
- Trauma, Death, and the Origin of Subjectivity
- How does death emerge as a peremptory force in life?
- How does death anxiety impel us toward not-knowing and to resistance in everyday life?
- How do we distinguish between death simply as an event and as a constantly lived relationship?
- How do we bind the destructiveness of death anxiety and authentically appropriate its emancipatory power?
- Death Anxiety and the Therapeutic Space
- What are the elements of an ideal therapeutic hold? The fixed frame? The intervention frame?
- How does a secure therapeutic frame function to contain unmetabolized affects?
- What are the unconscious implications of a secure therapeutic frame?
- How a secure therapeutic frame function to activate therapeutic material?
- How does a secure frame magnify death anxiety in both patient and therapist?
- Managing the Frame and Responding to Death Anxiety in the Moment
Listening and Therapeutic Relating I
- Listening and its Relationship to the Modes of Therapeutic Relatedness
- Reviving and Deepening the Art of Listening
- How do we appropriate maieutic silence as the generative starting point for engagement?
- How do we create a clearing in our inner spaces so as to receive the otherness of the other?
- How do we listen to the story of the patient's symptom?
- How do we listen to the derivative unconscious communication replete in patient narratives?
- How do we attune to the unconscious-to-unconscious discourse at play in session?
- How do orient ourselves so that we can listen for what we don't already know?
- How do we validate our clinical hypotheses within the listening process?
Listening and Therapeutic Relating II
- The Relationship as the Vehicle for Transmuting Pain into the Symbolic
- What is the role of separateness and merger in therapeutic symbiosis?
- How do we embody the maternal/paternal function as therapist?
- How might we love in the face of the patient's aggression?
- How might we therapists fortify the symptom through therapeutic misalliances, our own possible madness and parasitic forms of relatedness?
- The Transference
- What is the function of the therapist? As mirror? As other? As sustainer of patient's desire?
- What's the role of projective identification in the work and how might we use it clinically?
- Therapeutic and Non-Therapeutic Regression in the Therapeutic Dyad
Toward Integration: Humanizing Desire and Constiting the Subject
- Working with Patient Defenses and Resistances
- Forgiveness and the Interactional Nature of the "Cure"
- Beyond the Relationship: Insight, Symbolization, and Internalization
- The Patient as Unconscious Supervisor to the Therapist
- Therapist and Patient as Artists
- Concluding Remarks, Seminar Evaluation, and Celebration with Wine and Good Cheer
Sources for Inspiration and Conversation
- Ahktar, S. (2007). The 'listening cure': An overview. In S. Ahktar (Ed.) Listening to others: Developmental and clinical aspects of empathy and attunement (pp 1-16). Lahnam: Jason Aronson.Bateman, A., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: Mentalization–based treatment. London: Oxford University Press.
- Becker, E. (1972). The Denial of Death. New York: The Free Press.
- Bion, W. R. (1962/1984). Learning from experience. London: Karnac.
- Bion, W. R. (1981). Notes on memory and desire. In R. Langs (Ed.), Classics in psychoanalytic technique (pp. 259-260). New York: Jason Aronson.
- Bion, W. (1983). Attention and interpretation. Northvale: Aronson.
- Bion, W. (2005). The Tavistock lectures. London: Karnac.
- Biswanger, L. (1963). Being-in-the-world. (J. Needleman, trans.). New York: Harper & Row.
- Bowlby, J. (1982). Attachment (2nd ed.). New York: Basic Books.
- Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.
- Bollas, C. (1987). The shadow of the object: Psychoanalysis of the unthought known. New York: Columbia University Press.
- Boss, M. (1979). Existential foundations for medicine and psychology. New York: Jason Aronson.
- Bromberg, P. (1998). Standing in the spaces: Essays on clinical process, trauma, and dissociation. Hillsdale, NJ: The Analytic Press.
- Buber, M. (1955). Between man and man. Boston: Beacon Press.
- Buber, M (1958). The I and Thou. New York: Macmillan.
- Casement, P. (1991). Learning from the patient. London: Routledge.
- Casement, P. (2006). Learning from life: Becoming a psychoanalyst. London: Routledge.
- Cozolino, L. (2006). The neuroscience of psychotherapy, 2nd. New York: Norton.
- Davis, W. A. (1989). Inwardness and existence: Subjectivity in/and Hegel, Heidegger, Marx, and Freud. Madison: University of Wisconsin Press.
- Davis, W. A. (2001). Deracination: Historicity, Hiroshima, and the tragic imperative. Albany: SUNY Press.
- Dalle Pezze, B. (2006). Heidegger on gelassenheit. Minerva--An internet Journal of Philosophy, 10, 94-122.
- Fink, B. (2017). A clinical introduction to Freud: Techniques for everyday practice. New York: Norton.
- Fonagy, P., Gergely, G., Jurist, E., Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York: Other Press.
- Freud, S., In Strachey, J., In Freud, A., & In Richards, A. (1966). The Standard edition of the complete psychological works of Sigmund Freud. London: Hogarth Press.
- Friedman, M. (1985). The healing dialogue in psychotherapy. New York: Jason Aaronson.
- Fromm-Reichmann, F. (1960). Principles of intensive psychotherapy. Chicago: University of Chicago Press.
- Hall, B. (2016). Psychotherapy's pilgrim-poet: The story within. Colorado Springs, CO: University Professor's Press.
- Heidegger, M. (1927/1962). Being and time. (J. Macquarrie and E Robinson, trans.). San Francisco: HarperCollins.
- Jung, C. (1954). The practice of psychotherapy. Princeton: Princeton University Press.
- Jung, C. (1959). The concept of the collective unconscious (pp.42-53), Concerning the archetypes, with special reference to the anima concept (pp. 54-72), & Psychological aspects of the mother archetype (pp. 73-110). The archetypes of the Collective Unconscious, V 9,I of the Collected Works of C. G. Jung. Princeton: Princeton University Press.
- Kierkegaard, S. (1849/1989). The Sickness unto death. (A. Hannah, trans.). London: Penguin.
- Klein, M. (1952). The Origins of Transference. Int. J. Psycho-Anal., 33:433-438
- Klein, M. (1946). Notes on Some Schizoid Mechanisms1. Int. J. Psycho-Anal., 27:99-110
- Klein, M. (1937/1975). Love, Guilt and Reparation. In Love, Guilt, and Reparation and other essays, 1921-1945, pp. 306-343. New York: The Free Press.
- Klein, M. (1975). Envy and Gratitude. In Envy and Gratitude and Other Works 1946–1963. Int. Psycho-Anal. Lib., 176-235. London: The Hogarth Press and the Institute of Psycho-Analysis.
- Kleinberg-Levin, D. M. (2008). Before the voice of reason: Echoes of responsibility in Merleau-Ponty’s and Levinas’s Ethics. New York: SUNY Press.
- Kristeva, J. (1982). Powers of horror: An essay on abjection. (L. S. Roudiez, trans.). New York: Columbia University Press.
- Kristeva, J. (1987). Tales of love. New York: Columbia University Press.
- Kristeva, J. (1989). Black sun: Depression and melancholia. New York: Columbia University Press.
- Kristeva, J. (1995). New maladies of the soul. (R. Guberman, trans). New York: Columbia University Press.
- Kristeva, J. (2010). Hatred and forgiveness. New York: Columbia University Press.
- Lacan, J. (1988). The seminar of Jacques Lacan: Book I: Freud's papers on technique 1953-1954, (J. Forrester, trans.). New York: Norton.
- Lacan, J. (1988). The seminar of Jacques Lacan: Book II: The ego in Freud's theory and in the technique of psychoanalysis 1954-1955. (S. Tomasselli, trans.). New York: Norton.
- Lacan, J. (1993). The seminar of Jacques Lacan: Book III: Psychoses 1955-1956. (R. Grigg, trans.). New York: Norton.
- Lacan, J. (1998). The seminar of Jacques Lacan: Book XI: The four fundamental concepts of psychoanalysis. (A. Sheridan, trans.). New York: Norton.
- Lacan, J. (2006). Ecrits. (B. Fink, trans.). New York: Norton.
- Lacan, J. (2016). The seminar of Jacques Lacan: Book XXIII: The sinthome. (A. R. Price, trans.). Malden, MA: Polity.
- Langs, R. (1976). The bi-personal field. New York: Jason Aronson.
- Langs, R. (1978). The listening process. New York: Jason Aronson.
- Langs, R. (1979). The supervisory experience. New York: Jason Aronson.
- Langs, R. (1979). The therapeutic environment. New York: Jason Aronson.
- Langs, R. (1980). Interactions: The realm of transference and countertransference. New York: Jason Aronson.
- Langs, R. (1981) Resistances and interventions. New York: Jason Aronson.
- Langs, R. (1982). The psychotherapeutic conspiracy. New York: Jason Aronson.
- Langs, R. (1994). Doing supervision and being supervised. London: Karnac.
- Langs, R. (1997). Death anxiety in clinical practice. London: Karnac.
- Langs, R. (1999). The Evolution of the emotion processing mind: With an introduction to mental Darwinism. New York: International Universities Press.
- Langs, R. (2004). Fundamentals of adaptive psychotherapy and counselling. New York: Palgrave MacMillan.
- Langs, R. (2006). Love and death in psychotherapy. New York: Palgrave Macmillan.
- Levin, D. (1985). The body's recollection of being: Phenomenological psychology and the deconstruction of nihilism. New York: Routledge.
- Levin, D. (1988). The opening of vision: Nihilism and the post-modern situation. New York: Routledge.
- Levin, D. (1989). The listening self: Personal growth, social change, and the closure of metaphysics. London: Routledge.
- Mahler, M., Pine, F., & Bergman, A. (1975). The psychological birth of the infant: Symbiosis and individuation. New York: Basic Books.
- May, R., Angel, E., & Ellenberger, H. F. (1958). Existence: A new dimension in psychiatry and psychology. New York: Simon & Schuster.
- McGilchrist, I. (2009). The master and his emissary: The divided brain and the making of the western world. New Haven: Yale University Press.
- Neumann, E. (1954). The origins and history of consciousness. (R. F. C. Hull, trans.). Princeton: Princeton University Press.
- Neumann, E. (1963). The great mother. (R. Manheim, trans.). Princeton: Princeton University Press.
- Neumann, E. (1973). The child. Boston: Shambahala Publications.
- Oliver, K. (1998). Tracing the signifier behind the scenes of desire: Krestiva’s challenge to Lacan’s analysis. In H. Silverman, ed. Cultural Semiosis: Tracing the signifier, (pp. 83-104). New York: Routledge.
- Orange, D. (2011). The suffering stranger: Hermeneutics for everyday practice. New York: Routledge.
- Ricoeur, P. (1970). Freud and philosophy: An essay on interpretation. (D. Savage, trans.). New Haven: Yale University Press.
- Rogers, C. (1980). A way of being. Boston: Houghton Mifflin.
- Seinfeld, J. (1990). The bad object: Handling the negative therapeutic reaction in psychotherapy. Northvale, NJ: Jason Aronson.
- Seinfeld, J. (1993). Interpreting and holding. Northvale, NJ: Jason Aronson.
- Seinfeld, J. (1996). Containing Rage, Terror, and Despair. New York: Aronson.
- Searles, H.F. (1973). Concerning Therapeutic Symbiosis. Annu. Psychoanal., 1:247-262
- Searles, H. (1965). Collected papers on schizophrenia and related subjects. NY: International Universities Press.
- Searles, H. (1979). Countertransference and related subjects. Madison: International Universities Press.
- Schneiderman, S. (1980). Returning to Freud: Clinical psychoanalysis in the school of Lacan. New Haven: Yale University Press.
- Schore, A. (2012). The science of the art of psychotherapy. New York: Norton.
- Silverman, H. J. (Ed.) (1998). Cultural semiosis: Tracing the signifier. New York: Routledge.
- Sussman, M. (2007). A curious calling: Unconscious motivations for practicing psychotherapy, (2nd ed.). New York: Aronson.
- Verhaeghe, P. (2004). On being normal and other disorders: A manual for clinical psychodiagnostics, (S. Jotthandt, trans.). New York: Other Press.
- Wilberg, P. (2004). The therapist as listener: Martin Heidegger and the missing dimension of counseling and psychotherapy Training. Eastbourne, Sussex: New Gnosis Publications.
- Wilberg, P. (2013). Being and listening: Counselling, psychoanalysis, and the ontology of listening. Whistable, Great Britain: New Yoga Publications.
- Winnicott, D. (1958/1992). Through pediatrics to psycho-analysis: Collected papers. New York: Brunner/Mazel.
- Winnicott, D.W. (1949). Hate in the Counter-Transference. Int. J. Psycho-Anal., 30:69-74
- Winnicott, D.W. (1958). The Capacity to be Alone1. Int. J. Psycho-Anal., 39:416-420
- Winnicott, D.W. (1960). The Theory of the Parent-Infant Relationship1. Int. J. Psycho-Anal., 41:585-595
- Winnicott, D. W. (1965). Maturational processes and the facilitative environment. New York: International Universities Press.
- Winnicott, D. (1971/2005). Playing with reality. London: Routledge.
- Winnicott, D.W. (1974). Fear of Breakdown. Int. Rev. Psycho-Anal., 1:103-107.
*This selected bibliography represents sources of influence for the ideas presented in this seminar.
There is a listening that works this way: a listening that is responsible for creating what it hears--a listening, for example, with the power to cause or alleviate the very suffering it hears.