the WINTER/SPRING 2008 AMERICAN Volume 42, No. 1 PSYCHOANALYST Quarterly Magazine of The American Psychoanalytic Association

The Right to Health Information INSIDE TAP... Privacy: Victories in Hand, Winter Meeting Awards Challenges Ahead and Photos ...... 6–8 James C. Pyles Absolute Power: The Eist Case ...... 10 The American Psychoanalytic Association professionals in the United States fighting for just completed its most successful year in its health information privacy. The Congressman Election Results ...... 12 efforts to preserve the right to health infor- pledged to work with APsaA to introduce mation privacy, essential for effective psy- “comprehensive privacy legislation” to attach The Sopranos ...... 16 chotherapy and psychoanalytic treatment. to health information technology legislation Unfortunately, serious threats remain, and the in this session of Congress. Special Section next eight months may determine whether the Over the past year, intensive efforts were on Family ...... 18–23 right to health information privacy survives. made by Senators Ted Kennedy (D-MA), At the Winter 2008 Meeting in New York, Hillary Clinton (D-NY), Michael Enzi (R-WY), Psychoanalysis in President Lynne Moritz inaugurated Campaign and Orrin Hatch (R-UT) to push through a Puerto Rico ...... 24 2008! with a symposium by honorary member health information technology (health IT) bill, Drew Westen, author of The Political Brain.At the Wired for Health Care Quality Act (S. Atlanta Program the conclusion of his talk, Moritz brought the 1693), lacking health information privacy pro- Highlights...... 36 importance of being politically active home by tections. APsaA was able to work awarding a Special Presidential Commendation closely with numerous members to Congressman Ed Markey (D-MA). [See of the Senate to help ensure that article on page 5.] Congressman Markey has the bill did not pass without basic worked closely with APsaA to preserve privacy protections for the patient’s right protections in the context of health informa- to health information privacy. tion technology legislation in Congress. Markey Senators Patrick Leahy (D-VT) has fought to protect the patient’s right to and Olympia Snowe (R-ME) health information privacy for most of his 32 played the most prominent roles years in Congress. The Congressman noted in in ensuring that the bill did not his acceptance remarks that the American pass without privacy protections. Psychoanalytic Association has become the Many APsaA members contacted “number one” organization of health-care their senators, particularly Sena- tor Chuck Schumer (D-NY), to t inform them of the importance r a w e t S James C. Pyles, J.D., is a founding partner of of including privacy protections in n i v r Powers, Pyles, Sutter & Verville, a health-care health IT legislation. These efforts e M

: o t

by APsaA members proved to be of o

law firm in Washington, D.C. He is legislative h P counsel for APsaA and a leading expert in critical importance. Congressman Ed Markey with Jim Pyles privacy law. Continued on page 4

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 1 CONTENTS: Winter/Spring 2008 THE AMERICAN PSYCHOANALYTIC ASSOCIATION President: K. Lynne Moritz 3 Greatness or Obsolescence—The Challenge of Niko Canner Lynne Moritz President-Elect: Prudence Gourguechon 2008 Special Presidential Commendation Secretary: Robert M. Galatzer-Levy 5 Treasurer: Warren Procci 6 Awards and Photos Executive Director: Dean K. Stein 9 CORST Prize for Essays on Psychoanalysis in Culture Marks 10th Anniversary Vera J. Camden THE AMERICAN PSYCHOANALYST Politics and Public Policy: Absolute Power: The Eist Case Bob Pyles Magazine of the 10 American Psychoanalytic Association Cal Narcisi and Myrna Weiss 11 Innovations in Education Editor 12 APsaA Elections Janis Chester COPE: Impact of Boundary Violations Brenda Solomon Editor (on leave) 13 Michael Slevin Science and Psychoanalysis: Psychoanalysis and Genomics: 14 Associate Editor Strange Bedfellows with Chance for a Future Andrew J. Gerber Christine Ury 16 Requiem for The Sopranos Glen O. Gabbard National Editor Robert M. Galatzer-Levy SPECIAL SECTION Editorial Board Family Brenda Bauer, Vera J. Camden, Edited by Michael Slevin Leslie Cummins, Phillip S. Freeman, Maxine Fenton Gann, Noreen Honeycutt, 18 Special Section Introduction: Working Parents and Their Children: Sheri Butler Hunt, Laura Jensen, Psychoanalytic Perspectives and Public Policy Jennifer Stuart Nadine Levinson, A. Michele Morgan, Julie Jaffee Nagel, Marie Rudden, Two Views of Work and Home Life—Parent and Child Ellen Galinsky Hinda Simon, Vaia Tsolas, 19 Dean K. Stein, ex officio Law, Psychoanalysis, and the Work-Family Conflict Anne C. Dailey 20 Senior Correspondent 21 Help for Working Mothers Coping with Ambivalence Leon Hoffman Jane Walvoord 22 Work and Motherhood: A Clinical Study Jennifer Stuart Photographer Mervin Stewart Psychoanalysis in Puerto Rico Today Alberto M. Varela 24 Manuscript and Production Editors 25 Dream and Fantasy on a Belated Trip to Rome Fred M. Sander Michael and Helene Wolff, 26 Letters to the Editor Technology Management Communications SOFAR: Supporting Families, Invisible Casualties of War Kenneth I. Reich The American Psychoanalyst is published quar- 27 terly. Subscriptions are provided automatically 28 The Many Ways a PR Consultant Can Help Your Organization to members of The American Psychoanalytic Mary E. Tressel Association. For non-members, domestic and Canadian subscription rates are $36 for individ- Poets Making Poems: A Program on Poetry and Psychoanalysis uals and $80 for institutions. Outside the U.S. 29 and Canada, rates are $56 for individuals and Forrest Hamer $100 for institutions. To subscribe to The American FORWARD!: Switching to the Center Model: Two Organizational Psychoanalyst, visit http://store.yahoo.com/ 30 americanpsych/subscriptions.html, or write TAP Journeys: Part I Dionne Hogans and Elizabeth Manne Subscriptions, The American Psychoanalytic Association, 309 East 49th Street, New York, New 31 Poetry: From the Unconscious Sheri Butler Hunt York 10017; call 212-752-0450 x18 or e-mail 32 NAPsaC—North American Psychoanalytic Confederation [email protected]. Harriet I. Basseches Copyright © 2008 The American Psychoanalytic Debra Steinke Wardell Association. All rights reserved. No part of this 33 APsaA Membership: Of Benefit to You publication may be reproduced, stored in a Is It Shame? Inhibitions of Writing as Just a Candidate Vaia Tsolas retrieval system, or transmitted in any form or by 34 any means without the written permission of The Transplanting a Psychoanalysis Undergraduate Minor American Psychoanalytic Association, 309 East 35 49th Street, New York, New York 10017. from Colorado to Chicago Marcia D.-S. Dobson 36 Program Highlights of the 97th Annual Meeting in Atlanta ISSN 1052-7958 Gary Grossman The American Psychoanalytic Association does 37 The New South: Dining and Shopping in Atlanta M. Jane Yates not hold itself responsible for statements made in The American Psychoanalyst by contributors or 39 Booklist advertisers. Unless otherwise stated, material in The American Psychoanalyst does not reflect the endorsement, official attitude, or position of Correspondence and letters to the editor should be sent to TAP editor, The American Psychoanalytic Association or The Janis Chester, at [email protected]. American Psychoanalyst.

2 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 FROM THE PRESIDENT

These observations are striking to an outside Greatness or Obsolescence— observer. A great deal of contest, consuming a great deal of energy, is going on at multiple The Challenge of Niko Canner levels. There are potential legal challenges, Lynne Moritz elections, special committees, and task forces that are rarely able to fulfill their missions. A Instead of pub- is not regarded well and frequently with tremendous energy is being expended on the lishing the column distrust. question of the formal design of the organi- I prepared follow- • The membership base of the Association zation, while in fact, the organization controls ing the January is aging. New entrants enter at mid-life and very little of the future of the profession. meetings, I have not at the height of their creative work At the same time, the stakes are very high. decided to use and careers. The fact that the external environment is so this page to recall • The profession is organized around a challenging means that our acts could poten- to you the extraor- model of analysis that accounts for less tially be deeply important. What is critical is the dinary challenge and less of what an analyst actually does. extent to which the organization can harness

Lynne Moritz set out for us by • The public’s need and ability to pay for the energies of our bright and talented mem- Niko Canner four treatment has changed. There is too little bers in order to pursue a few salient aspects years ago. Canner, a management consultant, evidence that psychoanalysis delivers out- of the collective challenge. interviewed a wide range of Association repre- comes that patients need and that insur- Canner described a BOPS fellow’s com- sentatives in the midst of our governance wars. ers are willing to fund. ment on the preceding day about a Shake- He spoke to the Executive Council on January 22, • There is little, and decreasing, interest in speare festival and a program for local 2004. The following is not a transcript, but a funding research on psychoanalysis and university students that showed how psy- detailed summary I prepared as secretary. its impact as a form of treatment. Little choanalysis could contribute to the under- public funding is devoted to it. standing of the plays. It seemed to be a small Niko Canner has been a friend to psycho- The world presents a challenging environ- instance of the way a few people could change analysis from an early age—his father intro- ment for psychoanalysis, and it will take an the way psychoanalysis is viewed in the com- duced him to Freud as a teenager: There is a extraordinary effort to change this environ- munity—a way to deepen one’s understand- way of finding an abundance of meaning. It is ment. Many forces are trending against the ing of the world. This exemplifies how a a great motivation to think he could be help- kind of treatment and way of thinking that few members can work on a local scale, but ful to a community of people who are advanc- we all want to see sustained and extended united behind a few common themes. Such ing this knowledge in the world. His intention over the course of the next generation. activities impact how the public thinks, whether is to reflect back—through his own prism— During this time of significant external chal- patients become interested, and perceptions some of the inferences he’s drawn from what lenge, a great deal of energy is focused inward of colleagues in the mental health profes- he’s heard from some leaders of our group. on the dynamics of the Association itself. Par- sions. The sum total of such activities is deeply He began with “apparent facts”: ticularly, there has been great emphasis on significant—much more so than the formal • The base of patients is decreasing slowly— how the Association and its component parts actions of the Association itself. Our formal about one percent per year. will be governed. This emphasis seems out of actions are important primarily in a symbolic • Increased challenges to reimbursement all proportion to the stakes involved. Canner way to unite people behind a common end, in a culture where all health professionals estimates that the entire discretionary budget even if the many means to achieve that end are worried about the reimbursability of available to the Association and its boards and are very different. their work. committees amounts to less than one-tenth Canner suggested that perhaps neither the • The policy environment is not friendly— of one percent of the income earned by psy- right nor the left of the organization is strong confidentiality, certification standards, etc. choanalysts in the U.S. The stakes for the things enough. We seem to have a deep-seated worry Psychoanalysis has too few friends in the that the Association actually controls—that about making any mistake. We are risk averse. policy world. can be formally governed—are very small in What if we enable people to do the “wrong • Although this varies, too few analysts are terms of the sum of personal and professional thing”? What if people with the “wrong views” regarded well by other mental health pro- concerns of its members. There is a strong are enabled to proceed? Perhaps there is a fessionals, and the profession as a whole perception of entrenched adversarial positions way to bracket those worries—to disagree on issues related to the Association’s dynamics about how things should be pursued—but to and governance. The emphasis is on process go into the world in different ways and exper- Lynne Moritz, M.D., is president of the and compromise between interests that are iment to find what works. American Psychoanalytic Association. taken for granted to be in opposition. Continued on page 4

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 3 Niko Canner Understanding that the action will always be Health Information Privacy Continued from page 3 elsewhere, the question is how to get to a gov- Continued from page 1 ernance structure that won’t hold us back— For psychoanalysis to overcome these get there quickly, with minimum friction, and APsaA also worked closely with the mem- trends, the concerted action required will be distract us as little as possible from the real and bers of the Mental Health Liaison Group (a significant. The question is not whether we will important work that must be done in the Washington based coalition), which includes be functional or dysfunctional, but rather a world. He proposed a plan with a division of representatives of the American Psychiatric question of greatness or obsolescence. If we labor between three different roles. Association, the American Psychological Asso- do not together do extraordinary things, sim- The executive group (elected leadership) ciation, and the National Association of Social ply good efforts will have little effect on right- would initiate a process and set parameters Workers. The Mental Health Liaison Group ing trends that have been set in motion by for a governance structure; a representative sent a letter to the Senate majority and minor- forces much larger than ourselves. It is not a group would do the detailed work to develop ity leaders signed by 28 mental health con- question of getting things “right” in terms of a single proposal; and the membership would sumer and professional organizations. The the mechanics of our organization, it is a make the decision whether it was good letter stated that any health IT legislation question of learning to imagine new possibil- enough to accomplish immediate goals. passed by the Senate should “at a minimum” ities for the profession that have not yet been Canner closed with an excerpt from a poem include the following four privacy protections: dreamed. The questions are fundamentally by W. H. Auden, “In Memory of Sigmund 1. acknowledgement that patients have a creative rather than fundamentally reactive. Freud”: right to health information privacy; Canner asked himself, how many of the 2. a right of consent for the disclosure of 10,000 brightest minds in the generation now He wasn’t clever at all: he merely told identifiable health information in routine graduating from college are likely to have the unhappy Present to recite the Past situations; any significant contact with psychoanalysis in like a poetry lesson till sooner 3. notice to the patients when their right the course of their lives? As things are now, or later it faltered at the line where to health information privacy is breached; the number is small. He compared that to the and number in Freud’s Vienna. Is there a way to long ago the accusations had begun, 4. strong enforcement measures for viola- invent and articulate relevance so that coming and suddenly knew by whom it had tions of the patient’s right to privacy. generations will have psychoanalysis as a larger been judged, All of these protections are contained in pri- part of their repertoire for understanding how rich life had been and how silly, vacy principles approved by APsaA. A similar the world and creating within the world? and was life-forgiven and more humble, letter was sent by Patient Privacy Rights (a There is no reason that this should not be watchdog group founded by APsaA member possible, but the scale of efforts and the vari- able to approach the Future as a friend Deborah Peel) which was signed by more ety and richness of experimentation required without a wardrobe of excuses, without than 45 consumer associations spanning the seem beyond where the sum total of organi- a set mask of rectitude or an political spectrum. zational efforts and individual efforts seem embarrassing over-familiar gesture. Senate sponsors of the Wired for Health likely to go today. Care Quality Act have stated that they will try Since we are an organization of volunteers, Canner concluded: again during the first eight months of 2008 to we are difficult to govern, but it is a source of You seem over-familiar with a get the bill passed without privacy protec- strength. It makes us able to tolerate a diver- certain way of debating with each tions. Fortunately, members of the Senate sity of efforts. We need to identify the few other, with a future that doesn’t look who have stood with APsaA and other men- goals that we collectively care most deeply friendly, but that could be approached tal health organizations in protecting the right about and create many different kinds of as a friend. It could be a setting in to privacy have stated that they will continue efforts in support of these goals. We can take which you exercise your consider- to insist on those protections. risks about the formal structure of the organ- able talents, your imagination, and ization and the nature of our formal, shared create out there in the world a new THE LITIGATION FRONT decisions, because the action is, and will always set of things that psychoanalysis can There was also significant success on the be, in the decentralized, volunteer work. do, a new level of impact in how we litigation front in 2007. The Maryland Court of Canner wanted to speak about how to understand ourselves, each other, Special Appeals issued its decision in Maryland deal with governance because there had been and our possibilities for health.… State Board of Physicians v. Eist, holding that a so much controversy about it. He proposed a If this conversation gives us any fur- state licensing board could not override the simple way of proceeding. Governance of the ther momentum in that direction, constitutionally protected right to health infor- Association should not be about finding “the it will have been a conversation mation privacy of psychiatric patients without best” solution, but a “good enough” solution. worth having. Continued on page 5

4 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 first showing a “compelling state interest.” The court further held that a psychiatrist 2008 Special Presidential Commendation could assert his patients’ constitutional right President Lynne Moritz awarded a Special Presidential Commendation to Congressman Ed Markey to privacy and that the burden was then on (D-MA) for his efforts in preserving access to high quality psychotherapy and psychoanalytic therapy. the state to show in court why that right In Moritz’s words: should be overridden. The constitutional analy- “The right to privacy that you have defended is a core concept of our standards of ethics sis endorsed by the court was entirely con- and is a fundamental constitutional right of all Americans…. sistent with the arguments made by APsaA “Thanks to your efforts, many in Congress now understand that recognition and and 27 other organizations that signed onto preservation of the patient’s right to health information privacy also is essential for the an amicus curiae (friend of the court) brief. successful implementation of any nationwide electronic health information system…. [See “Politics and Policy,” page 10.] “Thank you for preserving the right to health privacy that most Americans, and certainly Unfortunately, the Maryland Court of our patients, want and expect.” Appeals (the highest court in the state) granted the state’s request to review the decision. So far, more than 40 mental health and medical associations have joined APsaA in agreeing to Remarks of the Honorable Ed Markey sign on to an amicus curiae brief to be sub- Accepting the American Psychoanalytic Association mitted to the Maryland Court of Appeals in 2008 Special Presidential Commendation March of 2008. The Court of Appeals is likely January 16, 2008 to hear arguments in the case in April. This case seems sure to become a landmark case in the Thank you, Jim [Pyles], so much, and thank all of you, Dr. Moritz, and all of law defining the privacy rights of patients in you who are gathered. This is a great honor to me. I have dedicated a very inquiries by governmental agencies. large portion of my 32-year career in the United States Congress to the The first eight months of 2008 could deter- protection of the privacy of Americans. There is no more important issue, mine whether the health information privacy and I really am quite sad that I cannot be here tonight with you but the press essential for quality mental health care will be of congressional business makes it impossible for me to be with you. preserved or eroded. Members of Congress I can assure you, since I am married to Dr. Susan Blumenthal, a psychiatrist are beginning to understand that health IT and a former assistant surgeon general of the United States and a two-star can be a tool for great good but also poses an admiral, I married the dream, a Jewish doctor, as an Irish Catholic politician imminent threat to the privacy necessary for from Massachusetts. So it’s not the fear of being on the couch because I’m quality health care. They are also beginning to constantly being analyzed on the couch in the car, in the kitchen, no matter appreciate that no health IT system is secure. where I go because I’m married to one of you. But that only reinforces for Health IT makes it possible, for the first time me how important this issue is. in the history of medicine, to steal, disclose, or William Butler Yeats once famously said that,“in dreams begins responsibility.” corrupt health records from anywhere in the Now for this audience, you would say in dreams begins many other things, as world without having physical access to those well. But,“in dreams begins responsibility” means to me that if this technological records. Unlike paper records, health infor- revolution makes health IT something that is real in the medical profession, mation privacy that is breached electronically then there is a concomitant responsibility to ensure that we responsibly can never be restored. guarantee the privacy of the information of patients who are part of that Congressional leaders from both parties health IT system. have announced that they will try to pass That is why I am going to introduce comprehensive privacy legislation to health IT legislation in 2008. The Maryland attach to this health IT revolution because it is indispensably linked, inextricably Court of Appeals could issue a pivotal decision linked, to that health IT revolution. that could be reviewed by the U.S. Supreme So for me, there can be no greater honor because your organization has Court. APsaA members can once again take been at the forefront, and I do believe the number one organization in the the lead in preserving the patient’s right to health care profession in the United States in fighting for privacy protections. health information privacy by contacting their It has been my honor to be partnered with you in these past years, and I promise congressional representatives. This is the year that in the years ahead I am going to try to prove that I warranted this great to do it. We may not get another chance to honor this evening. So thank you all, for having me with you this evening; preserve access to effective psychotherapy and I look forward to having you visit me in Washington. and psychoanalysis. The stakes are high but the opportunity has never been better.

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 5 Lynne Moritz Awards and Drew Westen President’s Award— The Honorable Edward Markey President’s Award—Abraham Zaleznik, D.C.S. Honorary Membership—Eric R. Kandel, M.D. Honorary Membership—Sander L. Gilman, Ph.D. Honorary Membership—Peter L. Rudnytsky, Ph.D. 2007 Award for Excellence in Journalism— Elizabeth Bernstein, Wall Street Journal health and medicine reporter for her article titled “After Arthur Farley, Selma Duckler, a Suicide, Privacy on Trial” Kerry Kelly Novick Children and Family Community Service Award— Era Loewenstein, Ph.D., accepted on behalf of the Child Development Program of the San Francisco Center for Psychoanalysis Karl A. Menninger Memorial Award— Julie Jaffee Nagel, Ph.D., for her paper “Psychoanalytic and Musical Perspectives on Shame in Donizetti’s Lucia di Lammermoor,” presented by Richard Munich, M.D., former chief of staff at the Menninger Clinic Eric Nuetzel and Susan Nuetzel CORST Essay Prize in Psychoanalysis and Culture—Elise Miller, Ph.D., for her essay, “Narrating Trauma: Autobiography and Healing,” presented by Mel Lansky, M.D., the chair of the Committee on Research and Special Training Edith Sabshin Teaching Awards—Paula G. Atkeson, D.S.W., George Ganick Fishman, M.D., and Richard Tuch, M.D., presented by Anna Yusim, M.D. Distinguished Service Awards— Selma Duckler and Mark Smaller, Ph.D., for their work on the Committee on Foundations, which nurtured the links between psychoanalysis Aneil Shirke and the community Jill M. Miller, Ph.D., and Robert N. Emde, M.D., with deep appreciation for conducting the Images of Change landmark research which resulted in Child Focused TAP photographer Mervin Stewart will be honored by the Psychoanalytic Training becoming an option for all Pittsburgh Psychoanalytic Center on April 11 and 12. APsaA institutes Glen Gabbard will be the featured speaker presenting the Poster Session Award—Eve Caligor, M.D., way that psychotherapy has been depicted in mainstream with Barry L. Stern, Ph.D., Margaret S. Hollywood cinema from the 1930s to the present. Hamilton, M.D., Verna MacCornack, Ph.D., For more information call the Pittsburgh Psychoanalytic for “Patient selection in the analytic clinic” Center at 412-661-4224.

6 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 Photos by Mervin Stewart Photo Ops Lynne Moritz and Prudence Gourguechon

Peter Rudnytsky and Lynne Moritz

Nadine Levinson

Lynne Moritz and Sander Gilman

Ronald Benson

Claudio Eizirik

Eric Kandel and Lynne Moritz

Abraham Zaleznik

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 7 PhotElizabeth Bernsteino Ops and Lynne Moritz

Elise Miller, Melvin Lansky and Lynne Moritz

Mark Smaller, his daughter, Selma Duckler, and Lynne Moritz

Kerry Kelly Novick and Erica Loewenstein

Jill Miller and Lynne Moritz

George Fishman and Lynne Moritz

Lynne Moritz and Paula Atkeson

Warren Procci and Norman Clemens

8 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 CORST PRIZE

CORST Prize for Essays on Psychoanalysis in Culture Marks 10th Anniversary 2003—“Psychoanalysis and the Vera J. Camden Ideal of Reasoned Deliberation in The Commit- Journal of the American Psychoanalytic Asso- Constitutional Law,” Anne Dailey, J.D. tee on Research ciation (JAPA), which has rights of first refusal 2004—“Lusting for Death: Some and Special Train- on all CORST winners. The winners over the Unconscious Meanings of Martyrdom ing (CORST) of past 10 years comprise an impressive array of Traditions,” Naomi Janovitz, Ph.D. the American scholarly and interdisciplinary distinction. 2005—“Toward a General Theory Psychoanalytic Fulfilling the mission of the CORST Prize as of Unconscious Processes in Association cele- first articulated by the committee under the Psychoanalysis and Anesthesiology,” brated its 10th leadership of Peter Loewenberg, the following George Masour, M.D. anniversary at list of winners exemplifies the interdiscipli- 2006—“Placing the Self: Dreaming, the winter meet- narity and sheer erudition of the prize winners. Vera J. Camden Discourse, and Disavowed Volition ing by awarding Such accomplishment and range of knowl- among the Tzotzil Maya of Highland the 2007 prize to Elise Miller for her paper, edge bear forth the theory and practice first Chaipas, Mexico,” Kevin Groark, Ph.D. “Narrating Trauma: Autobiography and Heal- enunciated by Sigmund Freud. His wide-rang- ing.” Miller is a literary scholar and a psycho- ing vision of diverse fields, from art history to 2007—“Narrating Trauma: therapist, whose winning paper demonstrated philosophy, from neuroscience to law, from Autobiography and Healing,” both her sensitivity as a clinician to effects of religion to clinical anesthesiology, must continue Elise Miller, Ph.D. trauma and her skillful reading of Dave Eggers’s to be embraced by the theory and technique autobiographical novel, A Heartbreaking Work of contemporary psychoanalysis if we are to I am proud to have served as chair of the of Staggering Genius. Our judges appreciated meaningfully interpret our culture and make a CORST Prize Committee for the past 10 years the ways in which psychoanalytic theory and difference in the lives of our patients. and appreciative to have had the assistance practice as well as her expertise in the field of The following list testifies to the enduring of Dottie Jeffries and the eminent juries who autobiography informed her interpretation of richness of the field: have been drawn from the ranks of CORST, this best-selling work. These strengths were on including Peter Loewenberg, Volney Gay, display as Miller led a “master class” in her pres- Robert Paul, Jonathan Lear, Allen Stern, Mel entation at the CORST lecture in New York, 1997—“Exploring the Frontier Lansky, Nancy Chodorow, Laurie Wilson, Nel- evoking a lively and rich discussion from the from the Inside Out: The Art of lie Thompson, Jeffrey Prager, Lewis Kirshner, audience. The complex strategies of Eggers in John Sloan,” Janice Coco, Ph.D. Paul Schwaber, Bert Cohler, Humphrey Morris, writing about his parents’ deaths, to which he 1998—“Diagnosing the English Sherwood Waldron, and Steve Levy. The hard, bore painful witness as caretaker, raise impor- Patient: Contributions to cheerful work as well as the brilliance of the tant issues for psychoanalytic witnessing and Understanding Schizoid Fantasies,” juries over the years have added to the luster listening to survivors. Norman Doidge, M.D. of the prize and will insure its continued success. Inaugurated at the winter meeting of the 1999—“Melancholia’s Cure It is a particular pleasure to welcome Lewis Association in 1996 to foster psychoanalytically or Resurrection by Poetry,” Kirshner as the new chair of the CORST Prize informed research into the biobehavioral Laura Mandell, Ph.D. Committee in 2008-09. We all eagerly anticipate sciences, social sciences, arts, and humanities, another decade—and beyond!—of sustained 2000—“The Role of Patronage the CORST Essay Prize has become one of success under his leadership. This prize is a nat- in Melanie Klein’s Clinical Work,” APsaA’s most distinguished prizes. Most of ural expression and outgrowth of the mission of Joseph Aguayo, Ph.D. its winning essays have been published in the CORST to extend the vision of psychoanalytic 2001—“Mourning Beyond thought to the full range of human learning and Vera J. Camden, Ph.D., is professor of Melancholia: Freud and Loss,” to bring to bear upon this evolving theory of the English at Kent State University, training Tammy Clewell, Ph.D. mind that same range of knowledge and insight. and supervising analyst at the Cleveland 2002—“Negotiations of Surface: Such reciprocal exchanges enrich the clinical Psychoanalytic Center, and assistant clinical Archeology within the Early and cultural soil of our psychoanalytic frontiers professor at Case Western Reserve University. Strata of Psychoanalysis,” from which grows the new and transformative The founding chair of the CORST Essay Prize, Diane O’Donoghue, Ph.D. research and writing represented each year in she is co-editor of American Imago. the winning CORST essay.

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 9 POLITICS and Jaffee-Redmond Supreme Court decision, which reaffirmed the therapist-patient privilege, PUBLIC POLICY Judge Eyler stated, “In fact, the psychiatrist- patient relationship depends in large part upon the patient’s having the trust in the doctor Absolute Power: The Eist Case and confidence in the privacy of the thera- Bob Pyles peutic relationship that will foster a willing- ness to disclose innermost thoughts. That “And remember, where you have a concentration and was told,“For your information, receipt of relationship can be damaged merely by the of power in a few hands, all too frequently men those medical records is not contingent upon threat that the records containing the patient’s with the mentality of gangsters get control. the consent of the patients.” Because he would most personal thoughts will be turned over to History has proven that. All power corrupts; not release the records until the patients others to examine.” absolute power corrupts absolutely.” So wrote allowed him to do so, Eist was charged with Lord Acton in his famous 1887 dictum. failure to cooperate with a lawful investigation. KEY FINDINGS The power of the medical board is not One hundred and twenty years later, this ISSUES IN THE CASE absolute. Like other American governmental sentiment reverberates throughout the opin- At the heart of this case is the Maryland agencies, it is subject to checks and balances. ion written by Judge Deborah S. Eyler of the board’s assertion that its power is absolute, not While the board has the right to issue a sub- Maryland Court of Special Appeals. The unan- answerable to patients, physicians, legal prece- poena for medical records, patients and clini- imous ruling in favor of Harold I. Eist in Mary- dents, or professional ethics. The board saw cians have the right to protest and challenge land State Board of Physicians v. Harold I. Eist, no need to directly notify the patients that their the subpoena. M.D., is the fifth decision in support of his charts were subpoenaed, nor did the board • The court clarified that the right of the stand for patient confidentiality and profes- see fit to conduct a less invasive investigation, state to obtain privileged information must sional ethics. In over five years of litigation, an such as interviewing the patients or requesting always be balanced against the individ- administrative law judge (twice), two sepa- the relevant sections of the chart (e.g., the ual’s right to privacy. The state is required rate Maryland circuit judges, and now three record of medications prescribed). The board to evaluate a patient’s constitutional pri- appellate judges have held that the prosecution ignored communications from the patients in- vacy interests and also to apply the “West- of Eist was unfounded. dicating that the charges were false, and that inghouse factors” (a landmark court case the treatment was satisfactory. It remained which outlined a balancing test) before it ORIGINAL COMPLAINT the board’s position that their issuance of a issues a subpoena. The board’s attempt to discipline Eist arose subpoena and the obligation of compliance • The patient must be notified that a sub- out of a bitterly contested divorce and custody were not open to challenge or legal review. poena, or a request for records, has been battle in which he was the treating psychiatrist issued by the board. for three members of a family (the wife and THE COURT’S DECISION • If the patient or physician challenges a two of the children). The father (an attorney) The court’s decision closely followed the request for medical records, the burden complained to the board that Eist was over- reasoning in the amicus brief submitted by rests with the board to prove that its need medicating these three patients and had 28 organizations representing mental health to invade privacy outweighs the patient’s behaved rudely toward him. In keeping with professionals, patients, and privacy protection right to privacy. It is then incumbent upon their policy, the board automatically demanded groups, including the American Psychoanalytic the board to seek an independent court the entire charts on all three patients without Association, the American Psychiatric Associa- ruling in which the Westinghouse factors considering the merit of the complaint or the tion, the National Association of Social Work- will again be applied in a legal setting. In motivation of the father. Indeed, it later devel- ers, and the Patient Privacy Rights Foundation. the words of Judge Eyler, “…a balancing oped that the board was prepared to comply In keeping with previous court rulings in this analysis that takes the Westinghouse with the father’s demand that the charts be case, the opinion was sharply critical of the factors into consideration is the proper turned over to him. board’s conduct and legal reasoning, and lauda- standard for weighing “individual privacy Acting in accordance with professional tory toward Eist for his principled stand in interests in medical records against com- ethics, Eist contacted his patient to obtain protection of his patient and professional ethics. peting state interests in those records,” permission, which was refused by the patients Perhaps the most heartening message from and that “[w]hether a compelling state and their attorneys. Eist notified the board the decision of this court was the respect interest can be shown in order to override and understanding on the part of the judges an individual’s privacy interest is to be Bob Pyles, M.D., is chair of the Committee on for the work we do with our patients. In lan- determined on a case-by-case basis.” Government Relations and Insurance. guage strongly reminiscent of the landmark Continued on page 12

10 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 FROM THE BOPS CHAIRS

Innovations in Education Cal Narcisi and Myrna Weiss

We would like to use the Third Congress of member institutes would agree to be gov- Institutes to organize and highlight some erned by the rule of the majority. Institutes that important innovations in psychoanalytic edu- did not want to join would be free to seek cation that BOPS is considering. The congress, accreditation with other accrediting bodies held January 15, 2008, during the winter meet- such as the International Psychoanalytical Asso- Cal Narcisi Myrna Weiss ings in New York, was chaired by Betsey Brett ciation (IPA) or the Accreditation Council for and Dan Jacobs, current chairs of the Com- Psychoanalytic Education (ACPE). APsaA and two councilors-at-large all campaigned as strong mittee on Institutes (COI). the new corporation would have a contractual supporters of “local option.” We feel strongly After outlining the history of previous con- agreement during a 10-year transition period that local option will put an end to national gresses, Brett focused specifically on reports of decreasing financial support. At the end of standards for education and credentialing of from the Task Force on Externalization, the the transition, the two entities would be sep- both institutes and individuals. We further Project for Innovation in Psychoanalytic Edu- arate and financially independent. believe that under local option, we will soon cation (PIPE), and the Certification Examination An ongoing collaborative relationship is en- become a loose confederation of institutes, Committee (CEC). visioned between the two organizations, both training candidates with educational standards Paul Mosher, co-chair of the Task Force on during and after the transition. It is important driven more by local practicalities than by a Externalization with Don Rosenblitt, presented to stress that the new standard setting and national consensus of educators and institutes. their preliminary report. Up to this point, they credentialing body would not have individual Michael Singer then gave a report from have focused on the feasibility of different members but would be composed of member PIPE presenting some exciting new ideas for an models for the externalization of some or all institutes that choose to join. alternative national pathway for certification. In this proposal, any applicant who preferred or was opposed to our current certification pro- Delegates and fellows seemed open to learning about the cedure could apply to a national panel of the- oretically diverse psychoanalysts. The applicant feasibility of the models and giving serious consideration would choose two examiners from this panel. to the deliberation of the task force. They would then engage in a primarily oral dis- cussion of clinical material over an extended period of time. A mentor would be assigned to assist the applicant throughout this process. of BOPS’s functions. Two models are being The II model might look very similar in the The traditional certification exam would also given the most serious consideration. One is end but would take a different path in getting remain an option for those who prefer it. This what was formerly called the Mosher-Narcisi there. Under this model, a group of like-minded new alternative pathway would not require a proposal and is now called the External Cor- institutes would come together and form a bylaw change and could be used to fulfill the poration model (EC). The other model, which new body. Others could join if they wanted certification requirement for training analyst has been proposed by Bob Michels, is now to. This would not be under the auspices of appointment. called the Institute Initiated model (II). APsaA, would not require a two-thirds vote of Paul Holinger, chair of the Certification Under the EC model, which presumably the membership or a bylaw change, and would Examination Committee, presented ways in would require bylaw changes, a separate not involve financial support from APsaA. which the committee is working to improve corporation would be set up to perform the It is interesting to note that there was much the present process. These include a mentor- educational standard setting, accrediting, and less opposition to the idea of externalization ing process for applicants, the possibility of certifying functions now contained within at both the congress and at BOPS. Delegates making the oral portion of the exam optional BOPS. Like-minded institutes would join and fellows seemed open to learning about and at the discretion of the applicant, as well as together in this new body, form a new board the feasibility of the models and giving serious the immediate resumption of the reliability of directors, and set up standards for edu- consideration to the deliberation of the task studies. In addition, the chairs of the CEC and cation, accreditation, and certification. These force. The task force plans to present its final the Certification Advisory Research and Devel- report in June 2008. opment Committee (CARD) observed several Cal Narcisi, M.D., and Myrna Weiss, M.D., We believe that a full consideration of exter- interviews at the January 2008 meeting and are are co-chairs of the Board on Professional nalization is critical at this juncture. Our recently considering making observers a routine part of Standards. elected president-elect, treasurer-elect, and future interviews.

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 11 APsaA secretaryelections Robert Galatzer-Levy announced the results of the election of candidates for office.

PRESIDENT-ELECT Norman Clemens Warren R. Procci (Elected)

TREASURER-ELECT Richard Lightbody Judith Schachter (Elected)

COUNCILORS-AT-LARGE-ELECT President-elect Councilor-at-large-elect Councilor-at-large-elect Councilor-at-large-elect Warren R. Procci Thomas A. Bartlett (Elected) Thomas A. Bartlett Ralph E. Fishkin Malkah T. Notman David I. Falk Ralph E. Fishkin (Elected to fill the unexpired two-year term of Robert Tyson) GENERAL BALLOTING STATISTICS Stuart D. Hirsch Ballots Mailed—3246 Malkah T.Notman (Elected) Ballots Returned—1325 (41%) Dwarakanath G. Rao Additional Ballots Received On-site—12 Stephanie D. Smith Total Ballots Received—1337 Invalid Ballots—52 (illegible name; no signature; no proxy; etc.) Treasurer-elect Judith Schachter Ballots eligible to be counted—1285

The Eist Case Court of Special Appeals can easily bear individual citizens. Acton seems to have intu- Continued from page 10 scrutiny from that court. Such an opinion itively understood that unchecked power would only further strengthen the privacy almost inevitably leads to narcissistic regression • The court explicitly recognized a federal rights of Maryland’s citizens. and abusive behavior. As James Madison right to privacy embedded in the Consti- The implications of this case extend beyond cogently stated, the primary purpose of the tution of the United States. the state of Maryland. Boards and professional Constitution is to protect citizens from their associations have been carefully observing this government. The Maryland Court of Special WHAT’S NEXT case which further establishes a model for a Appeals clearly agrees. The Maryland Court of Special Appeals just balance of power between professional found that the initial complaint against Eist boards and individual patients and clinicians. For the complete text of the decision, see was without merit; application of a balancing Lawmakers in all 50 states and Congress will Website.courts.md.us/opinions (Court of test would have failed to result in a subpoena benefit from this reaffirmation of a patient’s Special Appeals, 9/13/07) for the patient records. Therefore Eist had not right to privacy. This is of particular importance failed to cooperate with a lawful investiga- given the rush to embrace electronic health tion—the investigation itself was not “lawful.” records without adequate privacy protection. Editor’s Note: As noted in the cover story, The board has one more opportunity to Returning to Lord Acton’s dictum, this court this case will be heard on appeal by the request review from the highest court in has affirmed the importance of the principle of highest court in Maryland.TAP will continue Maryland. According to legal counsel, the checks and balances, particularly between the to follow the case closely. carefully detailed 56-page opinion of the interests of government versus the rights of

12 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 COPE violation, which makes processing and investi- gating complaints extremely difficult. In many cases, outside consultation was useful. Bringing Impact of Boundary Violations in colleagues who are knowledgeable about Brenda Solomon boundary violations, but not embroiled in the group dynamics of the institute, may provide a Analysts from the U.S. and abroad have One complication is that state laws concern- reasonably objective and fairer determination given the COPE Study Group on Boundary ing reporting or responding differ depending of the best way to proceed. Some institutes Violations detailed accounts of the impact of on discipline. (For example, M.D.s have man- have completely reorganized their bylaws in boundary violations on institutes. All spoke dated reporting in some circumstances while order to facilitate the process of healing and to of the negative consequences for psycho- Ph.D.s and M.S.W.s may not.) Furthermore, decentralize power. analysis as well as for the larger mental health when an analyst hears her analysand speak Frequently, the victim-patient is overlooked community. Candidates and analysts, alike, lose about a putative violator, especially if the in the aftermath of sexual violations. Marvin faith in what they are doing and referrals for violator is someone known to her—perhaps Margolis states,“The analytic society or insti- analytic treatment decrease. The destructive- even her training analyst or an important tute must be prepared to offer help to the ness magnifies when the violating analyst has source of referrals—the complications in- abused patient, especially in regard to referral been in a position of power, as in the case of crease. Often, there is a conspiracy of silence, to a new therapist. Consultation and/or medi- a training analyst or a public spokesperson not unlike the conspiracy of silence we find in ation may be indicated on a continuing basis.” for our profession. The study group has learned families struggling with incest or other well It can often be helpful for the analyst and how widespread these occurrences have been, guarded family secrets. Everyone involved feels patient to sit down together with a knowl- and how challenging it has been for an institute besmirched. In all the incidents we have heard edgeable third party. The whistle-blowers may to deal effectively when a boundary violation about, there was considerable lag time before also be neglected, shunned, or accused of comes to light. The initial reaction is almost the institutes were able to organize a serious unscrupulous motives. Involved institutes should always disbelief and denial. We have also response to the problem. make efforts to provide an analyst-advocate to learned how difficult and lengthy the healing Analysts typically pathologize the violator, prevent such marginalization. process has been in the aftermath of a bound- trying to disidentify and deny in themselves Experienced consultants recognize that we ary violation for the affected institute. We similar vulnerabilities. This tendency effectively are all subject to confounding transference- hope this column will be a resource for analysts replicates the kind of vertical splitting or com- countertransference situations. The notorious and institutes. partmentalization that makes one vulnerable to violators who are predators and who are Whether the institute is small or large, sexual misconduct in the first place. Power often responsible for multiple violations are the rumors (true or false) about alleged boundary and/or grandiosity in some analysts, notably minority. When conceptualizing the common violations, especially sexual ones, proliferate. training analysts, can exacerbate this splitting and characteristics of single victim cases, it is useful Once these speculations abound, they con- can lead to a narcissistic entitlement to go to consider a spectrum, with “lovesickness” taminate all of us. The alleged abuses are beyond the rules. Furthermore, we found that at one end and “masochistic surrender” at often discussed by both the aggrieved patient there is often a transgenerational impact when the other, with many points in between, as and by friends of the patient. If a friend is in analysands identify with these splits in their Gabbard and Eva Lester suggest. When col- treatment with another analyst, that analyst is training analysts. If these situations are not ade- leagues recognize that an analyst is enmeshed hamstrung, feeling caught between a duty to quately handled, violations continue to occur for in boundary crossings, they should use the keep confidentiality and a duty to report, espe- decades. Long-lasting aftershocks may be felt institute’s psychoanalytic assistance commit- cially if reporting is mandated by the state. even after effective action has been taken. tee, which is able to intercede. Local rules dif- Our COPE study group learned that “a sense fer on how complaints are handled, but it is of paralysis and helplessness can sweep over important that an institute has a clear path for Barbara Clorfene Solomon, M.D., is a education committees and ethics committees an individual to follow when he/she suspects a teaching and supervising analyst at the alike,” according to Glenn O. Gabbard, Morris L. boundary crossing or violation is occurring Chicago Institute for Psychoanalysis, teaching Peltz, and the COPE Study Group on Boundary and that he/she is never left alone with the ethics and psychoanalysis, a required course, Violations in their article,“Speaking the Unspeak- responsibility of what to do. We also encour- and assistant clinical professor at the able: Institutional Response to Boundary Viola- age all members, no matter how senior, to University of Illinois College of Medicine. tions by Training Analysts.” There are many make use of consultation on selected patients Eslee Samberg, M.D., is editor of the complicated transferences to the training ana- as a way of monitoring difficulties in early COPE column. lyst who has committed a sexual boundary transference enactments.

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 13 SCIENCE and HapMap project finished and gene chips cheaply available, it has become possible to Psychoanalysis thoroughly scan the entire genome for associ- ations to human traits with little or no a priori hypotheses about where to look. Lander Psychoanalysis and Genomics: advised psychiatrists to start collecting genetic samples of 1,000 or more subjects with what- Strange Bedfellows with Chance ever trait interests them and subjecting them to gene chip analysis. He believes that this for a Future shotgun approach will lead to a revolution in Andrew J. Gerber how we understand the genetic basis of human variation and psychopathology. For years, biologically based psychiatrists recorded. Then, Enter psychoanalysis. Contemporary psy- have forecasted a “genetic revolution” in which in 2007, two chiatry is notoriously bad at identifying the we learn the details of how most, if not all, further advances myriad of continuous traits that capture tem- disorders of the mind are predicted more by brought the goal peramental variation among individuals, hav- the genetic code than by some effect of early of identifying ing long ago opted for discrete categories that life or family. Psychiatric epidemiologists the genetic basis fit more neatly with drug trials and insur- demonstrated decades ago, mainly by study- of psychiatric ill- ance reimbursement. Personality psychologists ing pairs of identical and fraternal twins, that ness a great deal study these issues, but with little attention to psychiatric disorders are inherited to a signif- closer. Last Octo- psychopathology or to their relevance to icant degree. Yet, without exception, no simple Andrew J. Gerber ber the Interna- treatment and change. Psychoanalytically ori- gene or genetic mechanism has emerged to tional HapMap ented theorists and clinicians, on the other explain the etiology or pathophysiology of a Project published its entire dataset. This proj- hand, have devoted enormous energy to major psychiatric illness, despite billions of dol- ect identified the segments within the 3 billion describing how individuals vary from one lars spent in this pursuit. base pair sequence that show variation another and how this is manifested in their Caspi and colleagues demonstrated in 2002 between human beings (reflecting the fact that development, character structure, uncon- and 2003 that the interaction of environment the DNA sequence of any two people is 99.9 scious processes, defenses, response to treat- and gene (in one case, childhood maltreatment percent identical). The HapMap project tells us ment, and long-term outcome. Of course, and the monoamine oxidase A [MAOA] gene, that one only needs to capture 500,000 pieces psychoanalysis has traditionally focused on in another, stressful life events and the sero- of information (rather than 3 billion) about the environmental and personal-historical tonin transporter gene [5-HTT]) is a far more an individual’s genetic code in order to fully roots of such variation. However, from Freud powerful predictor of psychiatric outcome identify his or her unique genetic fingerprint. on down, this has always come with the than either alone. Since then, most psychi- Second, and just as astonishing, “gene chip” implicit or explicit acknowledgement that a atric research has focused on looking for more technology was developed to efficiently cap- significant part of psychic variability is inborn. such interactions, rather than studying the ture these 500,000 pieces of information (in The chance has come then, for the psycho- relationships between single disorders and the form of single nucleotide polymorphisms, analyst to use his or her ability to describe genes. Still, the clinically relevant results have or SNPs, pronounced “snips”) from a specimen such variation by partnering with those doing been few and far between. of human DNA quickly (on the order of hours) genetic studies. All this may now be about to change. In and inexpensively (on the order of $1,000 This work has already begun. Marian Bak- 2003, the Human Genome Project was com- per sample). erman-Kranenburg and Marinus van IJzen- pleted, which means that the entire 3 billion Leading figures in genomic research, such as doorn, pioneers of attachment research at base pair sequence of a single individual was Eric Lander, a professor at MIT and director Leiden University, published a review in 2007 of the Broad Institute, are saying that these of genetic links to attachment. From the advances have brought about an inflection dozen or so existing studies, they conclude Andrew J. Gerber, M.D., Ph.D., is a point in our ability to identify the role of the that a variant of a specific dopamine trans- fourth-year candidate at the Columbia genetic code in human traits, including those porter gene (DRD4) is associated with both University Center for Psychoanalytic Training relevant to psychiatry. Prior to 2007, scientists an increased risk for disorganized attachment and Research and a post-doctoral research needed to be lucky to find a direct link and a bad outcome when the environment is fellow at the New York State Psychiatric between a gene and a visible trait because bad and an increased risk for positive out- Institute/Columbia University Division these associations were usually not where come when the environment is favorable. of Child and Adolescent Psychiatry. they expected them to be. However, with the Continued on page 15

14 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 Somehow, then, we need to understand how “novelty-seeking” and “impulsivity” but not to It makes sense that individual psychological a difference in a neurotransmitter signaling “extraversion” as defined in the personality variation be this complicated and requires an system in the brain leads to an interaction of research literature. Personality theorists are appreciation of not only superficial traits early experience and the formation of internal at a loss on how to understand this. Psycho- but meaning as well. Science needs the input working models (i.e., attachment style). analysis remains the only comprehensive meta- of psychoanalytically trained clinicians and Meanwhile, the same DRD4 gene has been psychology with the theoretical complexity researchers to help sort out how better to linked in a new meta-analysis (Munafò, Yalcin, to help tease apart these questions, and understand and study the ways this variation Willis-Owen, and Flint, Biological Psychiatry, certainly the only one linked to a method for interacts with environment to shape person- 2008) to certain “approach behaviors” such as gathering the data about such structures. ality and psychopathology.

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 15 THE SOPRANOS

Requiem for The Sopranos Glen O. Gabbard

The final cur- sex addict.” Having found psychotherapy tain has fallen on extraordinarily helpful in her own life, she did The Sopranos. not want to be party to another instance of Hence it is an therapy bashing in prime time television. auspicious time The impact of the series on real life practice O B H to take stock. is difficult to measure. However, I received at / e t s e N

What did the least 18 or 20 e-mails from therapists who told y n o h

series mean to me that a male patient had come to see them t n A

y

us? The Sopranos largely because of the depiction of therapy on s e t r u o

is unparalleled in The Sopranos. Numerous anecdotes were also c

Glen O. Gabbard : o t o

the annals of tel- circulated about patients bringing examples h P evision. Called “the most compelling piece of of psychotherapy from The Sopranos to their popular culture ever” by critics, the series own sessions and asking their therapists why who treat antisocial patients get caught up in prompted many psychotherapists to sub- they were not more like Dr. Melfi. Some even excessive countertransference optimism. We scribe to HBO solely to see Jennifer Melfi’s felt that her interpretations provided insights thought there was a glimmer of hope for Tony latest therapy session with the mobster Tony that their own therapists had missed! Soprano. Maybe—just maybe—a bad man Soprano. On Monday mornings, e-mails and For the first three seasons, the psychother- could be transformed into a good man with water cooler chat often focused on the relative apy, a heroic treatment at best and an ill- the help of a skilled psychotherapist. merits of Dr. Melfi’s interpretations or the advised decision at worst, seemed to be taking length of her skirt. hold. Despite extensive acting out,Tony began THE SCENE DARKENS For once, psychoanalysts and psychothera- to reflect on what he was doing with his life. In the early seasons, Chase showed us the pists could sink their teeth into a portrayal of He chose not to “whack” a pedophile soccer sympathetic side of Tony. He might be capable psychoanalytic psychotherapy that in some coach after discussing it with Dr. Melfi. In the of brutal murder, but he also loved his children respects was similar to real life therapy. Dr. middle of a knock-down, drag-out fight with and, to some extent, his wife; he was capable Melfi was far from an ideal therapist. In fact, his mistress Gloria, he suddenly realized,“I’ve of loyalty both to his mob family and to his that’s what we liked about her. She struggled in known you all my life!” In other words, she was domestic family. Chase and his team of writers every session. She sought out her own therapy, an externalized version of the internal repre- also appropriated the Quentin Tarantino trope where she talked about her countertransfer- sentation of his mother that haunted him. The of placing moral dilemmas in the mouths of ence with her celebrity “bad boy” patient. She audience had its expectations raised in the sleazeballs. A man who is capable of feeling hung in there when many therapists would same way that mental health professionals pangs of conscience fosters hope in the ther- have quit or moved to a different city. The apist, no matter how evil he is at his core. writing was extraordinary in its psychological Midway through the series, however, the sophistication. In the early seasons, four of the wind shifted. Last May I interviewed Joe Pan- show’s five writers had been in psychotherapy toliano, who played the psychopathic Ralphie themselves, and their “inside” perspective was in the series. He suggested that shortly after impressive. Lorraine Bracco, the actress who Tony killed off his character, things took a played Dr. Melfi, said she told creator David darker turn. I agree. Tony became more des- Chase that she would play the role only if he picable, less sympathetic, and started showing promised her that the therapist would not be all the signs of a treatment failure in Dr. Melfi’s portrayed as a “drug-crazed psychotic killer consulting room. As Geoffrey O’Brien noted in his eloquent tribute in The New York Review of O B H Glen O. Gabbard, M.D., is Brown / Books,“What began as the story of a potential n r o h

Foundation Chair of Psychoanalysis, n healing became a description of the last stages e k n a professor of psychiatry at the Baylor College l B of an incurable sickness.”

g i a of Medicine, training and supervising analyst r David Chase had repeatedly warned his C

y s e t

at the Houston-Galveston Psychoanalytic r audiences that Tony and his mob were not nice u o c

Institute, and author of The Psychology : people. They were thugs. They were killers. o t o h of The Sopranos. P Continued on page 17

16 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 THE SOPRANOS

One of the most fascinating achievements of the show was that the writers somehow made us find these characters lovable. In the last season, the sophistication of Dr. Melfi seemed to disappear. In prior seasons, she had been a complex character whose actions appeared to grow out of motivations we could understand. Suddenly, she appeared to be manipulated by the needs of the plot to the point where she behaved in ways that lacked credibility. When she finally threw Tony out of her office, the writers linked this decision to her “discovering” an authoritative source on antisocial and criminal personalities that informed her of the possibility that socio- paths might misuse therapy and manipulate the therapist for their own interests. You don’t say! In fact, this information is usually mastered in Psychiatry 101 and is well known by all seasoned therapists. Nevertheless, within the show’s narrative, we were supposed to As usual, Chase chose to defy audience Of course not. Years of watching cinematic and believe that Dr. Melfi was naively taken by expectations and violate the conventions of tel- television depictions of psychotherapy have surprise to learn that patients like Tony had evision drama. No one in the family was killed. taught me that the needs of the genre and the other motives. Instead, life went on as usual. The family met demands of the plot will always trump a well- A eulogy would not be complete without at a diner and ate onion rings. Chase sent his intentioned effort to portray psychotherapy at some consideration of the final episode. The familiar message: In real life, there aren’t oper- work as it really is. Television is fundamentally media buzz around the ending of the series atic endings. Life goes on. The Sopranos is not entertainment. The writers owe us nothing. Art was deafening. Would Tony be murdered in a The Godfather. owes no debt to reality. Dr. Melfi and Tony blood-spurting, heartrending operatic finale? Many analytic colleagues were disappointed Soprano are not real people. They are points with the collapse of Tony’s psychother- of light on a television screen that we imbue apy during the last several episodes. with life each week. Into them we project our While Dr. Melfi’s manner of ending the hopes and dreams about what psychotherapy treatment may not have been entirely is and what it could be. unethical, it was certainly an example We must take heart in the showbiz apho- of poor technique. Moreover, at the rism that there is no such thing as negative dinner party precipitating this unilat- publicity. Having the nation buzzing about the O B H

/ eral termination, her own therapist, therapy of Tony Soprano placed psychotherapy r e h c t Eliot (Peter Bogdanovich), broke con- in the mainstream of popular culture. That’s e W

y r

r fidentiality by sharing the identity of exactly where we want it to be. a B

y

s Dr. Melfi’s patient dur- e t r u o

c ing dessert. Many of us

: o t o

h felt betrayed by David P Chase and the group Would the writers kill off one of his children of writers who had heretofore

instead of Tony himself, leaving him to spend seemed to have respected the O B H / r

the rest of his life in inconsolable grief? Would integrity of psychotherapy. e s n e G

Carmela finally get fed up and whack him at However, can we really t o b the kitchen table as he ate his gabagool? And expect a television drama to b A

y s e t

which song would play over the final roll of the bear the oppressive weight r u o c credits, a fitting capstone to the brilliant use of of a documentary about psy- : o t o h music throughout the series? choanalytic psychotherapy? P

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 17 SPECIAL SECTION: FAMILY

Introduction Working Parents and Their Children: Psychoanalytic Perspectives and Public Policy Jennifer Stuart

For all our concern about the changing A distinctly ana- idiographic particulars that draw our attention nature of analytic practice, we may fail to lytic perspec- in clinical work. appreciate the untarnished privileges of our tive on work Ellen Galinsky, a nationally recognized expert profession. Many of us are solely—or mainly— and family life on work and family issues, gives an overview of self-employed, at work that commands a liv- may have util- the changing American workforce, workplace, ing wage (or at least, half of one), in 40 hours ity beyond the and family, and outlines findings from a large- a week or less. We can adjust work commit- consulting scale study exploring children’s responses to ments to the needs of our growing families, room, as well. current conditions of work and family life. reducing hours when children are young or a Much classic Anne Dailey, a law professor with deep inter- parent’s health fails and adding them as family Jennifer Stuart analytic litera- est in and knowledge of our field, explores the demands diminish. We are largely free to set ture assumes implications of psychoanalytic developmental our own schedules, around our families’ needs. the full-time presence of a mother, at home theory for law and public policy regarding This does not mean we manage “work- with young children, in context of a two-par- work and family life. Psychoanalyst Leon Hoff- family balance” without conflict; surely, we do ent, single-earner household. The current real- man writes, from the perspective of his role as not. We may imagine colleagues’ disapproval ities of both paid work and family life call this director of the Pacella Parent Child Center of for any sacrifice of career to family life; some- basic assumption into question and add new the New York Psychoanalytic Society and Insti- times, there is a grain of reality to this concern. concerns. As analysts, we know some things tute, about a broad program of therapeutic We may know that work will restore self- about what children and their parents need. outreach to working parents and their children. esteem threatened by our first, clumsy forays into new parenthood; at the same time, we may be acutely aware of infants’ needs for In this special section of TAP, we explore the contemporary their parents. We may worry that the hours experience of work-family conflict on multiple levels, we spend with patients will translate, years ranging from the large-scale, political and socioeconomic hence, into hours our children spend in treat- ment, reconstructing the harm wrought by conditions in which we and our patients operate to the our beloved work lives. Like any other form of idiographic particulars that draw our attention in clinical work. personal conflict, this one—the analyst’s own struggle with “work-family balance,” in both its external and internal forms—can benefit our What can we say about the interface between I describe a multiple case study, reported fully work with patients, if we make good use of it. work and family life, in a world of busy, dual- in a recent issue of The Psychoanalytic Quarterly career families, single-parent households, and (2007:76), that explores women’s experience family poverty? How do we think about our of conflict around work and motherhood. patients’ increasingly common presenting As analysts, we have much to learn from complaint, concerning work-family balance? colleagues outside our discipline about the Are such conflicts any different, in quality, interface of work and family life (as well as a from others we encounter in treatment? great many other things) and also much to Given how we think about the needs of work- offer in return. ing parents and their children, how might we hope to influence law and public policy? *** In this special section of TAP, we explore the contemporary experience of work-family con- The authors of this special section of TAP would flict on multiple levels, ranging from the large- like to thank the APsaA Program Committee for scale, political and socioeconomic conditions featuring their work in a symposium of the same in which we and our patients operate to the title at the 2006 Winter Meeting.

18 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 SPECIAL SECTION: FAMILY

Two Views of Work and Home Life— Parent and Child Ellen Galinsky

Changes in the Technology makes it possible to work any time, nature of work any place, and, as a result, the boundaries between and family life are work and family life are increasingly blurry. of vital interest to Home life has changed too. There are more psychoanalysts dual-earner couples (from 66 percent in 1977 because they to 78 percent in 2002). While women have not form the context cut back on the hours they spend taking care in which people of and doing things with their children, perhaps live their lives. surprisingly men have increased their family

Ellen Galinsky My non-profit time, especially younger fathers. If we com- I found that the more time children spent research organi- pare Generation X fathers (between 23 and 37 with their parents, the more positive they felt zation, Families and Work Institute, is in a years old when we conducted the 2002 study) about the way they were being parented. unique position to track U.S. trends because with their Boomer counterparts (between 38 The fact that many people interpreted this we conduct the largest ongoing nationally rep- and 57), we find that Gen X fathers spend 1.2 finding as meaning that time is unimportant to resentative studies of the workforce, the hours more on workdays with their children children sends a signal that we as a country are National Study of the Changing Workforce, and of than Boomers. This is true even when we con- stuck in the wrong debates. We tend to think in the workplace, the National Study of Employers. trol for the age of their children. either/or terms: It’s quality or quantity time. It’s work or family. Even the word “balance” that is SURPRISING CHANGES CHILDREN’S RESPONSE commonly used indicates an either/or mentality. Some of our findings are not surprising—that I also conducted the first nationally repre- If you give to one side of your life (work or fam- the workforce is more diverse and older—but sentative study of children’s views of their ily), then you are taking away from the other. The others are. For example, women, now 48 per- working parents. There are five findings that research does not support these views. cent of all workers, are better educated than would be of special interest to psychoanalysts: men. Among employees 50 and younger, 32 2. Children rate their employed mothers’ percent of women have four-year degrees or 1. Children’s wishes are unexpected. parenting skills as highly as those with more, compared with 23 percent of men. Fur- In the study I asked children in the third at-home mothers. thermore, women in dual-earner families con- through the twelfth grades: “If you were I asked children to assess how they were tribute 42 percent of their family’s income. So granted one wish that would change the way being parented on 12 parenting skills such as clearly, working mothers are here to stay. that your mother’s/your father’s work affects “raises me with good values,” “is someone I can These changes in the demographics of the your life, what would that wish be?” go to when I am upset,” “spends time talking workforce run parallel to other changes in I also asked parents to guess what their with me,” “appreciates me for who I am,” “pro- work itself—specifically that work hours have children would wish. Most parents (56 percent) vides family traditions and rituals,” and others. increased and jobs have become more demand- guessed that their children would wish for The study found no differences in the assess- ing and hectic. The average woman now works more time with them. ment given by children who have employed more than 40 hours a week (that average However, more time was not at the top of mothers (both full- and part-time) and those includes the one woman in four who works children’s wish list. Only 10 percent of children with mothers at home. part time). In addition, 46 percent of employ- made that wish about their mothers and 15.5 This result confirms several decades of ees are contacted about work outside of percent about their fathers. Most children wished research indicating that you cannot tell much normal working hours regularly or occasionally. that their mothers (34 percent) and their fathers about how a child will turn out simply on the (27.5 percent) would be less stressed and tired. basis of whether or not his or her mother Ellen Galinsky, M.S., is the co-founder and By contrast, only 2 percent of parents guessed works. Overall, what matters most is how chil- president of the Families and Work Institute, that their children would make that wish. dren are parented—what values their parents a non-profit center for the study of the Does this finding mean that children do not have, whether the parents walk their talk, how changing workforce, changing family, and care about time? No. Children care about par- they connect to their children, and whether the changing community. She is the author ents being less stressed because they do care children are priorities in their parents’ lives. of Ask the Children (2000). about the time spent together. Furthermore, Continued on page 23

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 19 SPECIAL SECTION: FAMILY

environments to impoverished infants and tod- Law, Psychoanalysis, and the dlers rather than on the personal responsibility of overwhelmed adults. At a minimum, high Work-Family Conflict quality publicly funded infant and toddler day Anne C. Dailey care should be a part of the agenda for helping at-risk families. Research suggests that at-risk The work-family conflict is not a new phe- living in poverty children can actually benefit from high quality nomenon. Almost a century ago, Freud had in this country? childcare. The most successful early childhood something to say about the early trend toward How can poor programs combine high quality early child- mothers working in the paid labor force. Han- single mothers care with parental education and training. nah Decker in her book Freud, Dora, and Vienna be helped to Public-policy experts are beginning to study 1900, describes the following exchange. “At a manage a work- how investment in early childcare brings high 1908 meeting [of the Vienna Psychoanalytic family conflict long-term financial returns. According to the Society] devoted to ‘The Natural Position of that can be economist James Heckman at the University of Women,’ Freud commented during the dis- crushing to even Chicago, the Perry Preschool Program in Michi- cussion: ‘A woman cannot earn a living and the most privi- Anne C. Dailey gan produced long-term social gains of $13 for raise children at the same time. Women as a leged couples? every $1 invested in the program. The partic- group profit nothing by the modern feminist How do we ensure that the exponential level ipating children stayed in school longer, had movement…’ ” of stress that working brings to single-parent higher earnings, and engaged in less adult As many have observed, Freud had diffi- households does not prevent poor children criminal activity than the control group. culty stepping outside early 20th century Vien- from developing into successful, resilient, well- Analysts can join public-policy experts in nese culture on the question of women. While adjusted adults? explaining to a skeptical public how high qual- the idea that “a woman cannot earn a living Psychoanalysis usefully directs our attention ity early childcare helps to bring individual and and raise children at the same time” is belied away from the personal responsibility of adult social returns by alleviating the potential adverse today by statistics showing that 63 percent citizens and toward the needs of poor children. developmental effects of severe poverty on of mothers with children under the age of Lawyers and public-policy experts tend to young children. Psychoanalysis convincingly six and 78 percent of mothers with school age take a strictly maturational view of the matter: shows the basic role of the early caregiving rela- children are employed, the conflict between All children will develop the skills for eco- tionship to the development of the psycho- work and family unquestionably remains for nomic self-sufficiency and emotional well-being logical qualities and skills important for adult these working couples. as a matter of course. If these children fail to life, skills which include the development of Psychoanalysis has much to contribute to succeed as adults, that failure is the product of an integrated sense of self and others, a secure the public policy debate over how to reduce their own choices and is their own personal hold on the boundary between fantasy and the conflict between work and family life. responsibility. But as analysts well know, success reality, strong adaptive defenses, and the capac- Many facets of this contribution could be cited, in life is not simply a matter of maturation or ity for emotional self-regulation. All these devel- but one important and pressing area of con- choice. Single mothers without child support opmental achievements have roots in the early cern stands out: the distressing effect of the or day care or transportation, or even work- caregiving relationship. By collaborating with work-family conflict on poor children. In 1996, ing elevators face formidable obstacles to pro- lawyers, economists, sociologists, and public- Congress passed the Personal Responsibility viding good-enough care for their children, policy experts on the issue of universal early and Work Opportunity Reconciliation Act and these obstacles pose their own psycho- childcare, analysts have the opportunity to which, as its name implies, puts the personal logical challenges. Mothers without the psy- instill in the public’s imagination a renewed responsibility of parents at the center of the chological resiliency for tolerating the high appreciation for Freud’s core insight that early anti-poverty agenda. Since this law took effect, levels of stress that accompany work under childhood experience profoundly shapes our states have been required to reduce their conditions of poverty and the emotional adult lives. welfare caseloads by moving welfare recipients demands of childrearing in these trying cir- Psychoanalysts have a crucial role to play in into the paid labor force. cumstances need social and emotional sup- public advocacy for the importance of gov- How are we to understand the effect of the ports in order to provide a good-enough ernmental investment in early childhood welfare-to-work laws on the 12 million children caregiving environment for their children. Many programs. Yet efforts to educate lawyers, single mothers succeed without these sup- economists, and social scientists who have a Anne C. Dailey, J.D., is Evangeline Starr ports, of course. But many fail, as any of us serious interest in understanding the deeper Professor of Law and associate dean for might fail in similarly trying circumstances. realms of self-knowledge, the dynamic uncon- research and faculty development at the Anti-poverty policies in this country should be scious, child development, and human relations University of Connecticut School of Law. focused on providing good-enough caregiving Continued on page 23

20 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 SPECIAL SECTION: FAMILY

BALANCING Help for Working Mothers DEMANDS Some women Coping with Ambivalence experience con- Leon Hoffman flict and ambiva- lence about their The Bernard L. Pacella, MD Parent Child to understand the balances that are required sense of them- Center of the New York Psychoanalytic Soci- to combine child-rearing and homemaking selves as moth- ety and Institute promotes the optimal emo- with a professional life outside the home. ers, in contrast tional growth and development of families Leon Hoffman to a fuller sense and children (from pregnancy through age THE MOTHERHOOD CONSTELLATION of themselves as 12). Although the center provides a variety Many analysts in earlier decades studied working women. Other women feel greater of services and educational and research pregnancy and motherhood; their work came satisfaction from mothering their babies than programs, the backbone of its activities, since to be overshadowed by psychoanalytic femi- from working. Some women feel in conflict 1991, is a model of Parent Child Groups for nism of the 1980s and early 1990s, which between these desires, whereas others can parents and children (birth through 3 years). attempted to address women’s inhibitions in balance the demands of mothering more eas- The program, which has served 225-250 the social sphere. At the Pacella Center, see- ily with the demands of work life. mother-child dyads, has received citations for ing mothers who make varied choices—both Therefore, the same message cannot be excellence from the American Psychoana- those who work outside the home and those given to all mothers. Many mothers need to lytic Association and the Association for Child who do not—has allowed us to re-think the work for financial reasons and arrange the Psychoanalysis. central dogmas of feminist psychoanalytic most economical child care possible, including Our psychoeducational program is con- theories. A contemporary theorist whom we utilization of their extended families. Other ducted in a warm, accepting, and nonjudg- find helpful is Daniel Stern, with his seminal mothers work despite the fact that a large mental environment where mothers can feel contribution of the concept of “the mother- portion of their salary goes to child care. comfortable becoming the kinds of mothers hood constellation.” What we have learned throughout the years they choose to be. The center utilizes psy- Stern notes that the motherhood constel- is that some women are “better” moms choanalytic/developmental principles to help lation “concerns three different but related because they are home full time and others mothers address their voiced and unvoiced preoccupations and discourses, which are are “better” moms because they do work concerns to help them locate the best par- carried out internally and externally: full time. All too often, motherhood and enting tools within themselves and experi- advancement in the workforce outside the • the mother’s discourse with her own ence joy in their child rearing. The groups home seem to women to be two mutually mother, especially with her own mother- enable mothers to handle challenges in par- exclusive domains. But psychologically these as-mother-to-her-as-a-child, enthood arising from their own childhood domains need not be mutually exclusive. Each experiences; to evaluate developmental infor- • her discourse with herself, especially with woman needs to find a balance that works for mation and conflicting advice; and to learn to herself-as-mother, and her and her family. read the cues and needs of their children. In • her discourse with her baby.” these ways, group participation fosters their “WHAT SHOULD I DO WHEN I GET competence and confidence as mothers and Thus, a new mother may find that she is HOME FROM WORK?” furthers the socio-emotional development of less concerned with her father (and oedipal Working mothers’ conflicts can be mani- their children. themes), her baby’s father (usually also her fested when they come home from work. In a Over 50-60 percent of our mothers par- sexual partner), and with work than with the still-relevant classic paper from over two ticipate in the outside work world, many part new baby, her own mother, other women, decades ago, Doris Bernstein described a typ- time and some full time. Thus, we have come and with themes of growth and development. ical dilemma. Faced with two opposing Wishes to be valued and supported by a demands, such as, “I should prepare dinner maternal figure (“the good grandmother trans- for my children” and “I should work on a pro- Leon Hoffman, M.D., director of the ference”) may be prominent. Some psychic fessional task,” men in Western culture usually Pacella Parent Child Center, has spoken to reorganization along these lines occurs for have no conflict; the commitment to work is professional and lay audiences and written most new mothers, whether or not they work fixed and dominant. Women are more likely to widely on various parenting and child care outside the home, and whatever the reasons experience conflict in choosing which activity issues, including “Mothers’ Ambivalence with for their decisions about paid work. The moth- to do. Much more than men, they are likely to their Babies and Toddlers: Manifestations of erhood constellation promotes a woman’s experience guilt no matter what their choice. Conflicts with Aggression” in JAPA. emotional tie to her baby. Continued on page 23

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 21 SPECIAL SECTION: FAMILY

Another woman in the study, at the start of Work and Motherhood: an extended interview series, was working up to 80 hours per week with frequent travel; days A Clinical Study might pass without her seeing either of her two Jennifer Stuart children awake. Her job as a mother, she told me, was to be sure someone cared for them— Most women face real financial and practi- especially, that someone provided “challenges” cal obstacles to the integration of work and adequate to their talents, so they would not family life, and we encounter these challenges get bored. I soon learned that as a child, this in a climate of cultural ambivalence toward woman had been largely responsible for her working mothers. In this context, decisions immigrant family’s adaptation to life in the about work and motherhood can become a U.S. She was the first family member to learn lightning rod, attracting and concentrating English and the only one able to balance the expressions of unconscious conflict. Mean- books for her parents’ business. Her precocious while, personal decisions about work and achievement, her rising to challenges, was cen- motherhood are easily rationalized in the tral to her family’s survival. As we spoke— global terms of public discourse (some pop- several times over many months—she gradually ular texts offer rousing support for working made contact with the sadder aspects of her mothers, while others urge full-time, at-home current experience. Ultimately, she took some mothering for all who can afford it); so, the time off from her job and was relieved to find influences of personal history and uncon- that she very much enjoyed her children. At scious conflict often go unnoticed. last word, she was planning a job change that As both a mother and a psychoanalyst with would allow her to keep the career she loved serious career commitments, I have had my but have some time for family life, as well. own direct experience of “work-family conflict,” As a psychoanalyst, my eye is always on so I know just how much can lie underneath the personal, the idiographic. But as a quali- the visible tip of that iceberg. This, together tative researcher, I also seek broader patterns with an interest in multiple case research and themes. Though small from the perspec- methods, has led me to launch a psychoana- tive of large-scale, quantitative research, my lytically-informed clinical interview study, an Though some women are conversant with sample is large enough to support some gen- inquiry into the impact of personal history the impact of personal history and psychology eral observations: and unconscious motives on the conscious on their choices, some are quite surprised as • Women vary tremendously in the ease or experience of conflict between paid work previously unrecognized links between past difficulty with which they navigate real and motherhood. With funding from the Alfred and present, self and other (especially, self and obstacles to the integration of paid work P. Sloan Foundation’s Program on the Work- mother) emerge. Though the interviews are and motherhood. place,Workforce, and Working Families, I have not intended as clinical interventions, I have • Whether or not her mother worked out- so far interviewed 65 women—all 1984 grad- found that they sometimes have the degree of side the home has little impact on a uates of a single, Ivy League college—many of therapeutic impact that one might associate woman’s comfort with choices around them two, three, or four times. Our conver- with a good, thorough consultation. work and motherhood. Rather, her expe- sations are modeled, as closely as each research For example, one woman who gave up a rience of comfort or conflict with her participant allows, along the lines of a clinical career she enjoyed to home-school her chil- own choices is strongly influenced by the consultation with the experience of conflict dren had explained the decision to herself in quality of her relationship with her mother. between motherhood and career as present- terms of religious values. Across a series of four • Women whose relationships with their ing complaint. interviews, I learned that her mother had had mothers are troubled may find it difficult bouts of serious depression, especially after to thrive in any arrangement of work and Jennifer Stuart, Ph.D., is clinical assistant her birth; and she came to see that she risked family life. Conversely, women whose professor in the New York University Medical repeating with her children some troubling mothers fostered feelings of both warm Center Department of Psychiatry and on elements of her own early experience. Though attachment and confident autonomy may faculty at NYU Psychoanalytic Institute. earnestly trying to be more available than her find ways to enjoy their children and/or An early version report of her study, won mother had been to her, she felt bereft of work, often modifying work and family the Karl A. Menninger Award at the APsaA the “identity” that paid work brought and had environments in ways that favor both. Winter 2006 Meeting. become depressed herself. Continued on page 23

22 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 SPECIAL SECTION: FAMILY

Two Views environments come home in better moods Help for Working Mothers Continued from page 19 and have more energy for parenting. Continued from page 21

3. It is not just mothering that’s important; 5. Children do not think their parents Many mothers, while at work wish they fathering is very important too. like their jobs as much as they do. were home with their children, and while at The national conversation that we have I found that while three in five parents like home wish they were back at work. Unfortu- been having about work and family life focuses their jobs a lot, only two in five children think nately, too often it is believed that to be a good on mothers. Yet in finding after finding, the their parents do. Many parents see work as mother, a woman has to eliminate conflict importance of fathers to children is very evi- competitive with their children, so they do and ambivalence about her own personal dent. For example, children were asked if they not share much about their jobs. In addition, wishes as well as about her feelings toward her had too little, enough, or too much time with parents often come home and complain about children. Psychoanalyst Rozsika Parker sug- their mothers and fathers. Children were more work, without realizing that their words are a gests that the problem is not maternal ambiva- likely to say that they had too little time with living laboratory for children to learn about the lence itself but rather the guilt and anxiety their fathers (35 percent) than with their world of work. ambivalence provokes that prevents mothers mothers (28 percent). What is the bottom line of my findings? from acknowledging and accepting their Ask the children and include what they say ambivalence. 4. Parents’ jobs affect how they parent. in forming a picture of work and family life When the public considers how parents’ today. TAKING CHARGE OF ONE’S FEELINGS work affects children, discussion centers on In the Parent Child Groups at the Pacella how old the child was when the mother went Parent Child Center, we help mothers under- back to work and how much time parents Work-Family Conflict stand the universality of ambivalence, and spend working each day. In my study, I devel- Continued from page 20 we help them acknowledge their own con- oped a model to identify those aspects of flicted feelings to themselves in order to jobs that matter. I found four job factors make should also be undertaken. Outreach to aca- master their conflicts rather than having to a difference: 1) a job that keeps work demands demics and public-policy researchers requires deny them or become overwhelmed by them within reason; 2) a job that permits employed overcoming a certain institutional reserve because they are so frightening. They can parents to focus on their work while on the deriving from an earlier era when non-analysts feel more in charge of their own feelings and job (e.g., not too many interruptions and not applied psychoanalysis indiscriminately to create a better balance between work and being asked to multitask too much); 3) a job social and political problems. While risks cer- home; often, this involves ensuring that their that is meaningful, challenging, provides op- tainly exist, the result could be a renewed spouses participate in homemaking and child- portunities to learn, and offers autonomy; and role for psychoanalysis in enriching public- rearing activities. 4) a workplace environment with supportive policy debates on pressing social and political relationships that help parents succeed at problems. And in the process, psychoanalysis work and at home. Parents who work in these might find itself enriched as well. Work and Motherhood Continued from page 22

Work on this project has sharpened my appreciation of the complex interplay of broader social phenomena with individual psychology. Some careers are more easily mixed with family life than others. Some women have access to ample financial and social resources, including various forms of community support—like the Pacella Parent Child Center of the New York Psychoana- lytic Society and Institute—and others do not. But the murmur of the unconscious is always present, quietly instructing our choices from among the options realistically available as we decide whether, when, and how to combine work and motherhood.

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 23 PUERTO RICO

the forbidden and dangerous worlds of busi- Psychoanalysis in Puerto Rico Today ness and politics, from which, luckily, I emerged Alberto M. Varela unscathed, or so I think. I have been involved in teaching in a wide variety of forums, some When I was approached to write an article Rico in 1987. To for mental health disciplines but many from for TAP about my experiences as an analyst liv- facilitate the tran- other professional areas, such as law, reli- ing in the small, federal territory of Puerto sition from the gious, medical, and literary practitioners. I also Rico, I immediately knew that I faced a major mainland U.S.A., became intensely involved in public mental challenge. How would I avoid appearing con- I accepted a health education activities through regular tradictory in telling about my profound, per- position as med- appearances on TV and in print media. sonal satisfaction with my career while at the ical director of a After 20 years of intense professional work same time describing the sad state of affairs of new private psy- on this island, I feel very satisfied with the organized psychoanalysis on this island? And fur- chiatric hospital many opportunities I have had to share and thermore, how could I do this without adding Alberto M. Varela under develop- apply my psychoanalytic knowledge for the one more disheartening story to the already ment at the time. betterment of society. In the morally confused long inventory of unresolved issues which have After 4 years in that role and once the hospi- world we live in, I can proudly say that our created what psychoanalysts in all parts of tal was firmly established, I left to open a full- group has been able to demonstrate that the world have come to call “our crisis”? By time private practice. success and ethical values are not only com- “crisis” I mean our generalized concern about The practice attracted a large volume of patible but indispensable partners. Without the survival of psychoanalysis everywhere. patients and I decided to recruit other mental psychoanalysis, most of what we have been As I thought about my experiences, I had health professionals to serve them. Subse- able to achieve would not have been possible. to overcome my resistance to lamenting the quent opportunities for innovative mental The positive results which we have been able untoward outcomes which have come about health programs and services emerged. to bring about serving clients and patients as a result of processes in which I had played Because our group, now formally organized have strengthened my conviction that our a role as one of the protagonists. This lament, and known as INSPIRA, was interested in theory still remains the most powerful body of despite my recognition that even had I and my offering psychoanalytically informed solu- knowledge ever created to understand our- colleagues applied different strategies as we tions, we became involved in developing them. selves, both individually and collectively. Even with its relative lack of advancement, it remains the ultimate platform from which to launch an How would I avoid appearing contradictory in telling all out attack on human misery. Ours is a about my profound, personal satisfaction with my career mighty force indeed! Despite my sense of personal satisfaction, while at the same time describing the sad state of affairs I cannot help but regret the state of Puerto of organized psychoanalysis on this island? Rico’s psychoanalytic society. When I returned in 1987, the society was composed of eight members, all trained in American Psychoana- attempted to instill life into organized psy- As our group’s activities grew, being the leader lytic Association sponsored centers. We met choanalysis in Puerto Rico, in all probability, we and with much regret, I had to gradually reduce regularly, enjoyed excellent interpersonal rela- would still have come to the same, depressing the time devoted to clinical practice. This tionships, discussed scientific and cultural mat- situation in which we now find ourselves. allowed me not only to manage our firm more ters, and sponsored educational activities for First, a bit of personal history. I was born and adequately but also devote more time to other mental health professionals. We also attempted raised here. After medical school, I left to pur- professional matters such as training, consulting, to open a training center. However, we were sue both my psychiatric and psychoanalytic and becoming more actively engaged in our not successful in establishing one, due in part training in Houston and Philadelphia where I Puerto Rico Psychoanalytic Society, of which I to the residua of the abandoned orthodoxy to spent 20 years. I then returned to Puerto eventually became president. limit training to physicians. Because of the need for high quality mental Over the last 5 years, we have lost five of the Alberto M. Varela, M.D., is a psychiatrist health services on the Island, through INSPIRA original eight analysts in our society. At the and psychoanalyst living in San Juan. I have had many opportunities to work at present time, there are three fully trained ana- He is currently medical director of INSPIRA, the highest levels with a large number of pri- lysts (two recent arrivals and me) on the Island, a mental health organization he founded, vate organizations, key government agencies and another two who are partially trained. which provides a wide range of services and officials, and educational institutions. And, There is a Lacanian group whose details are to individuals and organizations. yes, I have even made occasional forays into Continued on page 26

24 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 ROME

I spent about an hour gazing at Moses from Dream and Fantasy on a Belated Trip every angle as I imagined Freud had done when trying to analyze the motivations of to Rome the Jewish lawgiver with whom he was so Fred M. Sander identified. By close examination of the details of the statue he tried to uncover Moses’ Well beyond Much else was different. The Piazza no longer emotions as he had begun to interpret his the middle of my contains the bandstand, the kitschy advertise- patients’ dreams as well as Norbert Hanold’s life’s journey, I ments, or the restaurant Freud mentioned. fictional dream and delusion which he traced embarked on a Now cars circled the Piazza replacing the to a childhood love. belated (tardivo) coaches and trams he described. first visit to It is a well-known fact that Freud often vis- MY DREAM Rome. With ited and wrote about the statue of Moses That night I dreamt of the Moses statue, Freud as one of sculpted by Michelangelo. I went to the church astonished in the dream to see Freud stand- my early heroes of San Pietro in Vincoli (in chains), home for ing silently and ghostlike behind and to the

Fred M. Sander who made his nearly 500 years of the statue of Moses com- side of Moses. He quickly vanished as I called own delayed trip missioned by Pope Julius II for his own mau- out to him in my original mother tongue, to the Eternal City about 100 years before, I soleum. For a host of reasons, Michelangelo “Will sie nicht etwas sagen?” (“Will you not say wished that magically I might commune with could not complete the statue until 40 years something?”) his spirit. I had read one of his personal vaca- later. Upon its completion, Michelangelo, then Moses, believing I was addressing him, tion letters and re-read his essay, “Delusion and about 70, is purported to have thrown a chisel stirred in his seat and asked me,“Why did you Dream,” on Jensen’s Gradiva, both written in at his creation exclaiming, “Perche non parli?” stare at me so intensely this afternoon? You 1907. In that novella an archeologist, Norbert (“Why don’t you speak?”) reminded me of another visitor, younger than Hanold, falls in love with a bas-relief of a young yourself, with a darker beard, better trimmed woman walking, found in the ruins of Pompeii, than yours and certainly than mine.” He told which Freud managed to see that same year me that the visitor came every day about 100 in the Vatican Museum. years ago and seemed to be wondering what Off I went to the Piazza Colonna which he was doing holding the stone tablets at such Freud wrote about in his September 22, 1907, an awkward angle. Moses went on to say to letter. He barely mentioned the column hon- me that he was resting following his arduous oring the Emperor Marcus Aurelius but climb down the mountain after receiving the detailed an evening in the Piazza, enjoying the stone tablets from God. When he caught sight evening air, and the music which “worked until of his people still worshipping idols, he was nine.” He also noted the insufferable kitschy pained and furious. As he was about to rise advertisements projected on a large screen. and rebuke them, he told me, “The tablets He commented at the end of his letter that slipped from my grasp and I caught them just the Roman women appeared “even beautiful in time.” when they are ugly.” Feeling lonely in the Without a pause I replied, “This man you crowd of a couple of thousand people, he are recalling was, like yourself, a prophet of returned “home” (his hotel) to write the letter. sorts. While you freed your people from Upon arriving at the Piazza, I immediately saw slavery and gave them laws to live by, this the tall Aurelius column commemorating in man, whose name was Freud, or Schlomo in low relief the victories of the Scholar Emperor. Hebrew, son of Jacob, and grandson of Rabbi Schlomo, also tried, a few millennia later, to free mankind from self-imposed enslavements Fred M. Sander, M.D., is associate clinical of the mind and its unending expression of professor of psychiatry, Weill-Cornell Medical and conflicts over aggression. He saw the School, and faculty at the Association for restraint in your posture indicating the pos- Psychoanalytic Medicine and psychotherapy sibility of taming such self-destructive anger. training program, New York Psychoanalytic He, like you, also had followers whose dis- Institute. He is author of Individual and loyalty pained and angered him. In fact the Family Therapy: Toward an Integration. Michelangelo’s Moses Continued on page 26

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 25 TH TO E E S D R I E T O T

R Belated Trip to Rome T 2 0 0 8

E

Continued from page 25 L same year he wrote an essay about what he felt was your self-control, he was also under CLARION CALL TO DO OUR BIT that this letterscountry is letting our young men a “behind the scenes” attack at a 1913 meet- I am a life member of the American and women die because of ignorance of ing of German psychiatrists in Breslau. Psychoanalytic Association. I retired after 45 our science. Every psychoanalytic institute Once awake, I turned my attention to an years of active practice in the year 2000. should offer it to every veteran, free if upcoming consultation at the Accademia di On Tuesday, Dec. 11, I heard the fol- necessary. Let us do our bit. Psicoterapia della Famiglia (the Academy of lowing shocking radio news report. In a We seem to have fallen victim to the Family Therapy) in Rome, arranged by a col- recent year, possibly 2005, over 6000 Iraq aggressive advances of drug treatment. league who had trained with me in the 1960s. war veterans in the United States com- Drug treatment should be used if needed, In the early 1970s, I was already attempting to mitted suicide. The number was hard to be- but it can never be a substitute for the talk- integrate psychoanalytic thinking with family lieve, but they broke it down to 120/week ing cure. It is as if we ourselves no longer therapy and wrote a paper on Freud’s use of that year. believe in its usefulness or effectiveness. hypnosis with a family involving a postpartum If the report is accurate, I hear it as a This is an old disease to us. Freud called depression. clarion call to action for members of our it traumatic neurosis. During WWI it was While having coffee before going to the Association. called shell shock. During WWII it was Accademia, I vividly imagined Freud sitting In my day, we believed we had a treat- called battle fatigue. Since the Vietnam War across the table. In my mind we spoke about ment for suicidal depression. It was called it has been given the glamorous name post his essays on Gradiva and Michelangelo’s Moses. psychoanalysis and psychoanalytic psy- traumatic stress disease. These are the same He showed curiosity as well as skepticism chotherapy. In the past decade or two it diseases. Freud taught us how to treat it. about the family consultation I was going to, seems to have disappeared from public Analysts, of all people, should remember but he said he would be interested to observe view. that Freud’s treatment consisted of abre- the interview. I imagined walking with him to With such a news report it is our moral action and catharsis, listening to the patient’s the consultation and telling him that, accord- and professional obligation to advertise in messages through free association, and ing to Maurizio Bettini, the Gradiva story was, every way possible that there is a rational, carefully dealing with transference, resist- in fact, a variation on the Pygmalion myth, effective treatment for depression.We owe ance, unconscious processes, and infantile which I had been applying to my analytic work it to our young men and women whom sexuality. It is not “counseling,” which means with families. Most family members attempt to we have sent to war who come home support and advice giving. It is through the create others, as Pygmalion did with his ivory unable to cope. We know how to help humane, human relationship between ana- statue, in their images of the others. “Yes, them cope. Let us shout from the rooftops lyst and patient established by the analytic indeed,” he might have said, “this is what I method that cure occurs. described as narcissistic transferences in my This is an urgent matter. Get a patient TAP welcomes letters to the editor. 1914 essay ‘On Narcissism.’ ” involved with you and you are on the way Letters must be less than 350 words to effective help for that patient. long. Letters will be printed as space Joseph E. Lifschutz, M.D. Editor’s note: Another article on Fred allows and at the discretion of the Clinical Professor of Sander’s visit to Rome will appear in a editorial board. Health and Medical Sciences future issue of TAP. University of California, Berkeley, ret.

Puerto Rico I worry about mankind’s future without I can only hope that our sad lesson in orga- Continued from page 24 psychoanalysis, a bleak future left to be nizational development in Puerto Rico can dominated by the brute, commercially driven, spur colleagues elsewhere to work together not available. After the more recent deaths, we managed care/medication-only industrial and strengthen their psychoanalytic groups stopped meeting on a regular, formal basis. complex and surface scratching, cosmetic to ensure their survival. If they do not, Puerto Despite the generous and strong support “cognitive” therapies. As I described above, Rico will not be the only geographic area from colleagues like Lila Kalinich from New with the demise of our psychoanalytic soci- where dark, implacable Thanatos will triumph York, both our society and our efforts are still ety, this is beginning to become a reality on over complacent, sweetly intoxicated, and in disarray. our island. tragically distracted Eros.

26 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 SOFAR

who experience trauma, if not treated, had a SOFAR: Supporting Families, 30 percent chance of transgenerationally repeating that trauma with their children. Invisible Casualties of War The Strategic Outreach to Families of All Kenneth I. Reich Reservists program (SOFAR) was created to address these issues of “secondary or vicarious We know from reviewing medical records of military bases trauma,” to help develop resilience within fam- Civil War soldiers that, by today’s diagnostic cri- where regular ilies, to work preventively with children, and to teria, almost 40 percent of soldiers suffered military troops engage teachers and pediatricians in workshops anxiety, depression. or post traumatic stress and families live, to assist them in better supporting these families. disorder. Today, one-third of homeless men in work, and train SOFAR began in Massachusetts as a pilot America are Vietnam veterans, with the num- together. This program with the full support of Major Gen- ber of homeless vets easily exceeding that of leaves not only eral Dennis Laich, the Commanding General of the soldiers actually killed in Vietnam. While no reservists but the 94th Regional Readiness Command of one has studied the impact of war on these sol- also their families the New England Reserves, and has extended diers’ families, it is not difficult to appreciate that more vulnerable through the New England area. Division of Kenneth I. Reich they too suffered the casualties of war. to the strains of Psychoanalysis (39) of the American Psycho- Since the beginning of the “War on Terror,” war than their logical Association and the American Psycho- over 1.6 million troops have been deployed full-time-soldier counterparts. These strains analytic Association are our national partners. for a total of 2 million deployments. For the are significant: Increases in deployments have Our pamphlet for teachers, parents, and pedi- first years of the war 80 percent of the troops resulted in a 60 percent increase in rates of atricians,“The ‘SOFAR’ Guide to Help Children in Afghanistan and 40 percent in Iraq were child abuse; wives have three times the risk of and Teens Deal with the Deployment of a Reserve and National Guard. Almost 50 per- postpartum depression; the suicide rate for Parent in the Military Reserves,” has been dis- cent of all the troops were married and a sig- veterans is twice that of the civilian population; tributed by the governor of North Carolina to nificant percentage had children. About 11 31 percent of Marines, 38 percent of soldiers, every school in the state and also distributed percent of deployed troops are women and and 49 percent of Reserve and Guard will to schools throughout the Virgin Islands. We they are wounded or dying at a proportional experience mental health problems. plan to replicate that distribution in every rate to men. The age range of deployed troops Family members may develop “secondary or state in the country. Our program is endorsed is from 18 to 62 years, which means families vicarious trauma,” be more vulnerable to by the American Academy of Pediatrics and have grandparents and grandchildren deployed, depression and anxiety, and have a higher we will be developing workshops for pedia- with often more than one member of the divorce rate as well as face an increase in tricians and teachers. same extended family serving at the same alcohol and drug use. And each time a soldier time. Of the 3350 Americans who died in Iraq deploys, the stressors become more com- OPPORTUNITY TO HELP and Afghanistan through early January 2007, plex, as the deployments create hosts of psy- SOFAR, soon to be national, is the only 1588 of them were married. To date, more chological, social, economic, and medical issues psychotherapeutic program working on the than 3800 troops have been killed. for family members at home. Harold Blum, in critical issues of intergenerational war trauma The Reserve and National Guard soldiers an article on “Holocaust, Trauma Recon- with soldiers’ families today. As psychoana- represent a unique and separate population structed” in Psychoanalytic Psychology, states, lysts, we are presented with the opportunity to from the regular military troops. Both their “The reverberations of traumatic experience use what we have learned about the com- equipment and their training have been less have even greater impact when they coalesce plexities of psychic functioning in helping these advanced compared to that afforded mem- in the conjoint or transmitted traumatic expe- families. We understand the powerful role bers of the regular armed forces, even though rience of the family, and in the wider social sur- separation and trauma play in the development these citizen soldiers operate in the same war roundings. Because of the immaturity of the of the individual and the reciprocal impacts of theater and are subjected to the same risks. ego, children are more susceptible to trauma these events on relationships in the family and The Reserve and National Guard and their and require greater support from sustaining in the social surround. We must use the tools families are not living on bases but live het- objects with whom they identify in order to we possess to address this developing national erogeneously, spread out across the country, recover from the traumatic experience with health care crisis that lies ahead for all mem- without the centralized support available on new mastery and adaptation.” bers of these families. Selma Fraiberg suggested this in her pre- It is vital to the future health of these families Kenneth I. Reich, Ed.D., is president of the scient article “Ghosts in the Nursery,” where and our national culture that we undertake this Psychoanalytic Couple and Family Institute of she highlighted the potential for parents to mission. We need your help. Please join with us New England and co-director of the Strategic pass their trauma to their children. And, later, and volunteer your time at [email protected]. Outreach to Families of All Reservists. Peter Fonagy reported research that children Our Web site is www.sofarusa.org.

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 27 OUTREACH

who were prepared to be interviewed and to The Many Ways a PR Consultant help the audience grapple with the grave emo- tional consequences of the attacks. Can Help Your Organization SFCP members were quoted in articles that Mary E. Tressel appeared in the Washington Post, Newsweek, USA Today, San Francisco Chronicle, San Jose Mer- It is no surprise that the field of psycho- the center’s “Evening of Art” and “Theater on cury News, San Mateo Daily Journal, Sacramento analysis is satirized in the popular media from the Couch” programs. Bee, Contra Costa Times, San Diego Union-Tribune, time to time. Unaware of the benefits that can Once a reporter is interested, I schedule an WebMD, and Marin Independent Journal. Tele- arise from proactively engaging with the media, interview for the designated analyst and pro- vision coverage included interviews by Channel leaders of our institutes and societies can feel vide advice about how to handle the interview. 7 News (ABC affiliate) and Channels 11 and 20 helpless in the face of these portrayals. A suc- In contrast, it is also my job to hear negative (San Francisco/San Jose independent stations). cessful West Coast public relations campaign, responses from harried reporters who are however, has resulted in more than 100 positive “not interested.” BUDGETING media stories for the field of psychoanalysis. Additionally, I write brochures and materials Schaaf focuses on the interactions between For the past 8 years, I have been providing for the center for use in outreach to the pub- the center and its public relations consultant. part-time public relations counsel to the San lic and in capital campaigns. SFPC’s administrative team holds an annual pub- Francisco Center for Psychoanalysis (SFCP). lic relations planning meeting to outline goals for SFCP executive director Sandra Schaaf, SFCP BEGINNING A CAMPAIGN the year. They also refer committees within the Public Information Committee chair Mary C. More than a decade ago, Lamia worked organization to me when they need public rela- Lamia, and I work as a team to create oppor- with other SFCP members to form the Public tions assistance in reaching new audiences. tunities for positive media coverage for this Information Committee. She created the fol- Schaaf addresses the budgetary issues sur- local institute. lowing committee purpose statement: rounding the employment of a part-time con- sultant, validating the need to pay for monthly assistance. Because media interest fluctuates A PR professional is an intermediary who uses her skills to unpredictably throughout the year, it is critical to place her client in the media spotlight. The basics of the maintain ongoing relationships with reporters throughout the year. job include writing press releases, distributing them to the Lamia has outlined several Public Information media, and cold-calling reporters with story ideas. Committee success stories for the SFCP Board of Directors to provide additional support for the budget. Among many others, these BASICS OF THE JOB • To enhance the accessibility and visibility stories included the following examples of A PR professional is an intermediary who of psychoanalysis and the San Francisco media coverage for SFCP members: uses her skills to place her client in the media Center for Psychoanalysis (encouraging • Alan Kessler was interviewed by the spotlight. The basics of the job include writing the recruitment of both patients and Ladies’ Home Journal managing editor on press releases, distributing them to the media, candidates) the topic of teen depression. and cold-calling reporters with story ideas. • To educate the public (if we don’t, some- • Mark I. Levy was interviewed by NBC 11’s For the San Francisco Center for Psycho- one else will) Morning Show and Nathan Szajnberg spoke analysis, I have written press releases that • To simplify psychoanalytic concepts for to KRON4 News regarding new FDA label- cover a wide variety of topics, from the psy- the public ing requirements for antidepressants. chological reasons Americans tend to over- • To offer presentation skills consultation • Saul E. Rosenberg was featured on the indulge during the holidays to events such as for members and candidates KQED Radio show, Forum with Michael Krasny, on the topic of overcoming MEDIA COVERAGE CASE STUDY writer’s block. Mary E. Tressel, B.A., is an award-winning The inclusion of SFCP members in media Hand-outs that address SFCP’s public rela- independent public relations consultant coverage following the September 11, 2001, tions success stories, tips for selecting a public with 20 years experience. In addition to terrorist attacks was notable for its breadth. relations consultant, and Lamia’s paper on her work with the San Francisco Center On that tragic day, I worked with the SFCP preparing mental health professionals for media for Psychoanalysis, she has been providing Public Information Committee to issue a brief, interviews are available. If you are interested in public relations support to APsaA for the one-page press release to the media. The copies of these materials, please send an e-mail last four years. release offered information about analysts message to [email protected].

28 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 POETRY AND PSYCHOANALYSIS

and psychoanalysis engaged in what each Poets Making Poems: A Program on terms “spiritual practice.” Williamson talked explicitly about Winnicott’s Poetry and Psychoanalysis ideas about transitional space. He was per- Forrest Hamer suaded that the process of making poems en- tails language being experienced by the poet as Recent outreach efforts by the San Francisco During the being both outside and inside, with the creating Center for Psychoanalysis (SFCP) to expand interview, poets poet engaged in transitional play. For Robinson, relationships with a variety of community were typically language is emphasized as an attention to men- interests have spurred involvement with local asked about their tal states which reflect the intersection between nursery schools, mental health centers, post- own paths to “the immanent and the transcendent.” g

performance discussion programs conducted n writing poetry, Some of these poets said poems emerged o W

in conjunction with the American Conserva- m how they each from their heightened receptivity and attention a L n tory Theater and the San Francisco Opera, and a think about the to compelling images, sounds, even phrases or w K

: o a public lecture series. t nature of their lines made salient within aesthetic states of o h P This past year, SFCP initiated a very suc- Forrest Hamer poems, supports mind. Williamson described the poem as cessful program on poetry and psychoanalysis, for and interfer- already formed at this point but, like an embryo, which has drawn in members of the public ences with creating their poems, the place of waiting to be developed. For others, some interested in poetry and has featured stimu- unconscious or nonconscious elements in the conscious preoccupation initiated poem mak- lating discussions of the creative process artic- process, and their experience of real and imag- ing; the poem was an opportunity to “think ulated by a variety of poets. Susan Kolodny, an ined audiences in writing and revision. After things through.” Hejinian, who likes to dwell SFCP faculty member, founded the program, a reading their poems, the poets described what in a “state of quandary,” feels poems are the series of 90-minute interviews with local poets they remembered about writing them, and result of conscious engagements with philo- conducted by Kolodny, Alice Jones, an SFCP they responded to questions and comments sophical, sociopolitical, or cultural questions or training and supervising analyst, and me. We further illuminating that process for the audi- problems. Most poets seemed to suggest that are analysts who also happen to be poets, ence and poets alike. both of these originations characterize to some and the interviews are organized particularly Several of the poets were asked what they extent the process of creating poems, the pre- to explore the process of making poems. thought about the relationship between poetry ferred character a function of personality and The guest poet is usually interviewed for a and psychoanalysis. Most pointed to a height- aesthetic style, formal and informal education, third of the program; another third is spent ened appreciation in both of the emergence and subject matter. reading and discussing the poet’s work, espe- and experience of language. Further, both The poets differed in the degree to which cially his or her thoughts about the poems; disciplines were characterized by an awe or they intended their poems to be expressive or and the rest of the time is devoted to questions appreciation for the nonconscious. abstract, and several spirited discussions ensued from the audience. During the first year, a dis- “Most everything we are is the uncon- concerning the matter of “accessibility” or “dif- tinguished group of six poets, who have each scious,” Hillman suggested, and she noted that ficulty” in poetry. The variety of their answers published poetry collections, participated in both writers and psychoanalysts strive to be highlighted the numerous paths they took to the program, which was attended by 35-75 better listeners to what emerges from the becoming poets (despite many shared condi- people each time. unconscious, especially significant metaphors. tions which favored poetry over other forms The poets and their most recently pub- Hoover suggested that poetry goes straight of creative expression or silence), the influences lished collections were Brenda Hillman of St. to and acts on the unconscious, and he con- of creative and intellectual mentors and tradi- Mary’s College, Pieces of Air in the Epic; Paul ceived of the relationship between poetry tions, even the many differences for poets in Hoover of San Francisco State University, Edge and psychoanalysis as formed especially around their respective audiences. and Fold; Dan Bellm, One Hand on the Wheel; an interest in the vicissitudes of mental states. The diversity of poets for the series has Lyn Hejinian of the University of California, Like Hoover, Hejinian was impressed with the helped us attract diverse audiences, with com- Berkeley, The Fatalist; Alan Williamson of the shared interests in language and mental states munity poets and artists equaling the number University of California, Davis, The Pattern More but emphasized the process of making poems of psychotherapists of various kinds. Com- Complicated: New and Selected Poems; and as more consciously countering the deter- ments from discussion participants have been Elizabeth Robinson, Apostrophe. minism inherent to the unconscious. enthusiastic, conveying excited anticipation of Bellm described the two traditions as future programs of how poets make poems, working in the realm of mystery, interested and how that process is similar to the height- Forrest Hamer, Ph.D., is an affiliate member thus in metaphor, image, and the tolerance of ened attention to meaningful language psy- at the San Francisco Center for Psychoanalysis. ambiguity. Bellm and Robinson see poetry choanalysis fosters.

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 29 divisions: membership services, psychoana- lytic training, community education and serv- ices, and research. Throughout the transition, issues surfaced that were addressed and resolved, and in July 2007 the plan was final- Switching to the Center Model: ized and the San Francisco Center for Psycho- analysis was formed. Two Organizational Journeys The structure of this newly formed center consists of a board of trustees, president, Part I and a management team that includes the Dionne Hogans and Elizabeth Manne executive director, the four divisions, and faculty/membership. The board of trustees Since 2001 a number of institutes, societies, incorporated as a single unit, which resulted in includes community and analyst members, and foundations have merged to form “cen- the development of more internal and exter- with the majority being community members. ters.” The center organizational model includes nal programs, a resource library, research spon- The board’s Nominating Committee has a psychoanalytic training, community-based sorship as well as an increase in membership. majority of analyst members. Glover, the programs, and fundraising plans. APsaA’s Com- In 1991 the San Francisco Foundation for center’s president, believes that community mittee on Societies and Centers (CoSc), Psychoanalysis was founded to support the board members will be instrumental in build- chaired by Richard Lightbody, conducted in- institute and society by raising funds, holding ing external relationships and generating rev- depth research on centers across the country, organizational assets and engaging in com- enue through fundraising activities. which resulted in the TAP article, “Societies munity outreach activities. For over 60 years With the center model in place, Glover and Centers: Current Trends in Governance the San Francisco Institute and Society had said that the workload is still being shaped Change,” (40/3). It gave readers an historical been offering psychoanalytic training and com- and is evolving due to the new structure. He view from the decision-making process of munity programs. In 2004, its board of trustees believes the new organizational model provides switching to the center model to identifying desired to better position the organization cleaner lines of accountability, and he looks common and differing features of the newly for the future, “to be more environmentally forward to more community involvement and formed centers. As of 2007, there are 11 local fit,” said William Glover, president of the San financial support. To date, the San Francisco groups out of 53 that call themselves centers Francisco Center for Psychoanalysis. The group Center for Psychoanalysis has more than 160 and/or function as centers. began an arduous strategic planning process practicing analysts, more than 45 candidates, In a two-part series, we will take a close with the assistance of a local consultant. and over 300 members. It is “dedicated to look at two centers with distinct structures: During this process concerns were ad- advancing the vitality and enduring value of the San Francisco Center for Psychoanalysis, dressed about long-term financial viability, psychoanalysis in northern California.” recently established in July 2007, and the Cleve- organizational effectiveness, membership In the next TAP,we will continue this series land Psychoanalytic Center, established in 2002. morale, the need to develop a financing plan with a description of the steps that the Cleve- These two centers are functioning as non- for a new building, the desire to build philan- land group took to form a center in 2002, and profit organizations that have combined their thropic support, and the changing environ- follow their progress and challenges over the tradition of providing psychoanalytic training ment for psychoanalysis and its practitioners. last five years. with programs that benefit the mental health The strategic planning process enabled the We are pleased to continue in the spirit of community and the general public along with group to look at its strengths and weaknesses FORWARD! by providing information to raise raising revenue. This first article focuses on and opportunities and obstacles through mem- awareness, educate, and offer suggestions the San Francisco Center. ber surveys, structured interviews, and focus for institutes, societies, foundations, and Since the 1940s the San Francisco Psycho- groups. The group realized that its previous individuals. We would like to hear from po- analytic Institute and Society had existed sep- mission, “being dedicated to training psycho- tential contributors. Please e-mail your sug- arately. In 1961 the two organizations were analysts and serving the needs of its members,” gestions and/or articles for future columns to no longer supported the broader direction in us at [email protected] and elizmanne which it wanted to move. @bwanalysis.org. Dionne Hogans, B.B.A., is the administrator The membership, with an 80 percent at the Wisconsin Psychoanalytic Institute, approval vote, decided to move forward with Editor’s note: For several years APsaA has Society and Foundation. the recommendations of the strategic plan to published FORWARD!, a newsletter about Elizabeth Manne, B.A., is the executive unify both entities (the institute and society disseminating psychoanalytic ideas in the director at the Baltimore Washington Center and the foundation) and achieve five strategic community.This new column is designed to for Psychoanalysis. Both are members of the goals. The group created new bylaws, reor- bring this information directly to TAP readers Association of Administrators, an auxiliary ganized the management structure, and cate- and to carry on the work of its predecessor. of APsaA. gorized programs and services into four

30 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 From the Said Unconscious Down where you can buy anything, poetry fish or fowl, Sheri Butler Hunt off a truck parked on the side of the road, Rebecca Meredith is a fourth-year they put the new piranha in the candidate at the Seattle Psychoanalytic swimming pool Society and Institute. She has a master while the storm was taking the tank of arts degree in clinical psychology from Goose and the Ladies and the house and the yard. Antioch University in Seattle. Meredith is I remember the milking barn’s smell They told me so afterward, in private practice seeing adult and child on cool mornings, striking matches, drawing in patients in psychodynamic psychotherapy the hay and cow pies, the oil from salt-soaked tobacco, holding on and adult patients in psychoanalysis. the milking machines, awhile before letting go. Her poetry has been published in CALYX, and how the hose water ran in Healing with Words, the Limbs of the little gutters They told me how the bottle Pine anthology, to name just a few, down each side of the long walkway trees moaned and she has had a chapbook published between the broad middles and the way women do when they (Intergenerational Delta Blues by Pudding bony rumps. tear their hair, then House Press, 2006) She has given poetry My Uncle Goose called them the how wine bottles, coke bottles, readings in such venues as radio KUOW’s Ladies, and treated medicine bottles flew “The Beat” and was first runner-up in each one as if it was their first date, like they’d been jilted-lover-flung, Seattle’s 2007 Bart Baxter Performance excusing himself, begging forgiveness they told me Poetry competition. She is interested for the antiseptic wash and the cool, how sea turtles swam past City Hall; in the reparative nature of creativity, sucking tubes. how dogs drowned. including play. He needn’t have bothered; the Ladies Meredith’s poetry gives an intimate- shifted and sighed A storm will do things, they said, feeling invitation into verses that tell a like a hundred splay-footed mothers, a man wishes he could do. story practically from the front porch easing “Yes, child!” A storm will preach a sermon, and encourage you to sit a spell with an as the night’s load lightened. break your enemy, idea wrapped warmly around your mind. And if they ever thought about piss seawater on the bushes, dam up Her words reveal a rich intertwining the bulls and the calves the rivers with pleasure boats, of her past and her cultural background. and the knackerman in the end, make an El Dorado swim down Best put in Meredith’s own words, they didn’t show it. a dirt road on its back. “…my relationship to the idea of ‘mother’ The milking barn was hospital white, You got to love a storm like that just manifesting in my relationship to the the radio on a little, between the sobs. culture in which I grew up (Mississippi to the early morning farm report, Gulf coast and New Orleans) and in where they were stars. About those man-eating fish, they said, my observations of the female in people Clover stretched just outside the door they’re out there somewhere in a and things all around me.” and over the hill nervous bayou to the blackwater creek. nibbling on nutria pups and heron The day would be hot, and the feet, circling, Sheri Butler Hunt, M.D., is a graduate live oaks on its bank cool, waiting for some damfool man or wind and tonight a tall and rangy man to come along and catch them up analyst in the adult and child divisions would blush once more and make hitch-hikers of them one at the Seattle Psychoanalytic Society and before taking the milk they’d spent more time, just passing through Institute. A published poet and member the day creating— like everything else. The story, of TAP’s editorial board, she welcomes giving it all they had. true or not, reader’s comments and suggestions “Yes, child, yes!” is the only thing that sticks around. at [email protected]. —Rebecca Meredith

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 31 NAPSAC

Please note NAPsaC—North American that inclusion in the database is Psychoanalytic Confederation not automatic. Harriet I. Basseches The IPA will not release your con- Some of you may wonder, what is NAPsaC— educational oversight and accreditation, and tact information a backpack? Actually, it is an acronym, repre- represents all of its societies under one um- without permis- senting the regional group of the International brella. NAPsaC’s regionality refers to its geo- sion. You must

Psychoanalytical Association (IPA) Societies in graphical locale: It comprises the North register with Harriet I. Basseches North America. It is the only organization to American region. It has counterparts in Europe the IPA to be unite all the IPA Societies in North America, and Latin America known as the European included in the database. Registration is easy— giving them the opportunity to work and think Psychoanalytic Federation (EPF) and the Fed- just log onto the site www.FindAnAnalyst.org together on matters of common concern. eration of Psychoanalytic Societies of Latin and click on “Get Listed.” NAPsaC, the North American Psycho- America (FEPAL). While none of the regional analytic Confederation, is composed of the groups has any official IPA status, they are val- FIPA—FELLOW OF THE IPA CREDENTIAL American Psychoanalytic Association (APsaA), ued and encouraged by the IPA, as they afford This title was developed and promoted by which is the only regional association in the each locale an opportunity for psychoanalysts NAPsaC’s Committee on Credentialing. All IPA; the Canadian Psychoanalytic Society from all the societies to work together and to members of the IPA living in the United States (CPS); the Confederation of Independent dialogue with the IPA Board in ways that focus and Canada may obtain FIPA certificates. Log Psychoanalytic Societies of the United States on the specific concerns of each region. onto the IPA Web site www.ipa.org.uk, use (CIPS), which includes the Institute for Psy- NAPsaC is a young organization that is your confidential user ID and password to choanalytic Training and Research (IPTAR), eager to solidify and foster a North American enter the “Private Area,” and click on “Order the Los Angeles Institute and Society for psychoanalytic identity and to demonstrate Certificates.” Psychoanalytic Studies (LAISPS), the Psycho- its relevance to its constituency. With those NAPsaC strongly encourages all IPA analysts analytic Center of California (PCC), the intentions, NAPsaC has developed three proj- living in North America to use the FIPA des- Northwestern Psychoanalytic Society (NPS), ects with you in mind. ignation on business cards, billing statements, and the San Francisco Institute for Psycho- professional stationery, professional directo- analytic Studies (IPS); and three otherwise FIND AN ANALYST WEB SITE ries, and society bulletins. FIPA will soon unaffiliated societies of the IPA, including the NAPsaC Find An Analyst Web site become identified with IPA psychoanalysis Japan Psychoanalytic Society (JPS), the New (www.FindAnAnalyst.org) will enable prospec- in North America, the way “M.D.,” “Ph.D.,” York Freudian Society (NYFS), and the Psy- tive patients in the United States and Canada and “C.S.W.” are identified as professional choanalytic Institute of Northern California to find an IPA psychoanalyst near them. The credentials. For more information contact (PINC). Together, these groups make up the Web site is a public service that allows us to Fredric Perlman, the creator and organizer entirety of IPA Societies in North America. promote psychoanalysis, the IPA, and our own of the FIPA and Find an Analyst projects, at The Japan Society is included because, as yet, practices in North America. The search func- [email protected]. it is the only psychoanalytic voice in Asia and tions on the site are linked to an IPA database. Continued on page 33 so we welcome them in our North American alliance. You may have noticed that NAPsaC is a “regional group” of the IPA, and yet APsaA is Members of the NAPsaC Board the only “regional association.” To clarify the distinction,APsaA is the only association within APsaA, Lynne Moritz and Prudence Gourguechon the IPA that completely undertakes its own CIPS, Fredric Perlman and Beth Kalish-Weiss CPS, Martin Gauthier and David Schaffelburg Harriet I. Basseches, Ph.D., FIPA, is chair JPS, Osamu Kitayama of NAPsaC. She is a representative to the NYFS, Nancy Wolf IPA Board, a training and supervising analyst PINC, Jeanne Wolff Bernstein at the New York Freudian Society, and a member of the Baltimore Washington Center Chair, Harriet I. Basseches for Psychoanalysis.

32 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 challenge ideas but have become an efficient tool for obtaining referrals. Affiliate Members are able to connect with candidates from all over membershipthe country as well as network with senior analysts at the scientific meetings. Committee participation allows analysts to work together on Of Benefit to You team projects for the benefit of psychoanalysis. Debra Steinke Wardell APsaA’s greatest resource is its membership. Therapy Directory Discount: The Ther- APsaA offers its members a broad range • Malpractice Insurance—an occurrence apy Directory by Psychology Today (http:// of benefits from career enriching tools to policy that covers claims made during therapists.psychologytoday.com/) is an online professional advocacy initiatives. Below I have your policy period even after you have directory that partners with many search highlighted a few of these exclusive member retired—therefore tail coverage is not engines, including Google, Yahoo!, WebMD, benefits which we hope you are taking advan- needed. All claim inquiries are assigned to AOL Health, and MSN Health, allowing you to tage of. a claims analyst who will track it as well as make a personal connection with thousands APsaA WorldPoints™ Credit Card: APsaA keep you up to date. For information on of potential new clients. APsaA members participates in an affinity no-fee credit card pro- the malpractice insurance program, please receive a 10% discount off the monthly fee. gram. You’ll earn one rewards point for every contact Margaret Church of Frenkel & For additional information and to join, call net retail dollar you spend using your card. Co. at 201-356-3422. 212-260-7210 and let them know you are an And at no cost to the cardholder, APsaA Networking Opportunities: APsaA mem- APsaA member—if joining online type “APsaA receives a royalty on all of your purchases bership provides many opportunities to en- Member” in the “Promo Code.” which, in turn, assists the Association in advo- hance your professional skills by attending and Your feedback on these benefits helps the cating for psychoanalysis. To learn more, call participating in the scientific meetings, getting National Office improve its service to you. If toll-free 1-866-438-6262 and please refer to involved on committees, and exchanging ideas you would like additional information on any of priority code FAAR56 when speaking with a on the many e-mail lists. The e-mail lists not the membership benefits, please don’t hesitate representative to apply. only provide a valuable forum to exchange and to contact me. Couch Discount: 10% discount on all pur- chases from the Analytic Couch Company. Visit www.analyticcouch.com or call 206-794- NAPsaC study groups, contact committee members 1053 and be sure to mention your APsaA Continued from page 32 Rich Reichbart ([email protected]) or membership. Peter Ruderman ([email protected]). Insurance Coverage: APsaA continues to STUDY GROUPS AND We on the NAPsaC Board understand the offer its members the following premium WORKING PARTIES challenges we face as a new organization in a insurance benefits (please browse APsaA’s The third project, a two-year pilot pro- professional world already densely populated insurance Web site for further details, gram, creates two educationally rich and with psychoanalytic organizations. In the few www.apsaainsurance.com): unique opportunities, organized by Abbot short years of our existence, we have been • Long-Term Disability—covering income Bronstein and his committee. The first is the providing a meaningful forum for our region. when a disability resulting from a cov- formation of continent-wide study groups, We will continue to do so in the belief that ered injury or illness occurs. whose members will meet yearly to focus the more we find common cause among us, • Long-Term Care—covering services such on clinical material in depth. The second the more we will serve psychoanalysis. as nursing home, assisted living facility, involves the formation of two working parties. The Board of NAPsaC is dedicated to or care services received at home. To One will study the implicit theories of the ana- creating better coordination between our participate in the disability or long-term lyst; the other, comparative clinical methods. constituent groups and the board of the IPA. care insurance programs, please contact The working parties model has been in suc- The better we can identify the services and Craig Hasday of Frenkel Benefits at 212- cessful operation in the EPF for some time. support we need in order to survive and 488-0274. Two leaders of the European effort, David thrive as a profession in North America, the Tuckett and Jorge Canestri, are consulting better prepared we will be to help ourselves with NAPsaC to help set these up. FEPAL has and our patients, and the more vigorously and For Membership assistance, please contact plans to offer a similar opportunity in Latin effectively we will represent the IPA and the Debra Steinke Wardell, manager, Education America. If you are interested in pursuing the greater psychoanalytic world. Not a bad set of & Membership Services, 212-752-0450 x26 working parties project, contact chairman goals. We welcome your participation in our or e-mail: [email protected]. Abbot Bronstein ([email protected]); for the new projects.

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 33 CANDIDATES

is there who has the power to see you, to Is It Shame? expose you, to make you “dissolve.” It seems that Andersen’s fairy tale is in Inhibitions of Writing agreement with Lacan’s statement. Shame guarantees that out there, as well as deep as Just a Candidate inside, there is an emperor dressed in excep- Vaia Tsolas tional clothes; but in order to maintain his sovereignty, he needs to be hidden from In the buzzing so he allowed himself to be paraded through exposure. But in our candidacy who is this hallways of psy- the town. The townsfolk, who had heard in Other who might threaten with fear of choanalytic in- advance about the suit’s special qualities, were absolute exposure of internal nakedness and stitutes, where as embarrassed as the emperor to reveal their inhibit the candidate’s drive to present a cre- everyday life stupidity by confessing that they, too, could ation of his own to the larger psychoanalytic regains its normal not see what he was wearing, and thus the community? non-classroom magnificent suit garnered nothing but the In our case, perhaps the emperor who dimensions with wildest of praise until a small child said: “But the believes that he is dressed in exceptional chitchat, gossip, emperor has nothing on!” and soon everyone in clothes may stand for the candidate’s need

Vaia Tsolas and discussion the crowd was shouting and laughing that the to idealize/identify with his new “parent,” or, about almost emperor was wearing no clothes. equally well, it might point to the simple real- everything, questions about writing seem rel- “The shamelessness of one forms the veil ity that still persists to some extent due to the atively rare. “Did you write your case sum- for the shame of the other,” Lacan observes. hierarchical organization of our institutes and mary?” is a question that you might consider Shame might be distinguished from guilt, the exceptional/ideal status of a training analyst. asking a fellow candidate, but you might hesi- since shame refers to being seen by and Regardless of what we may think of the hier- tate to ask, “What are you writing about?” exposed to the Other, while guilt refers to archy and where the candidate stands in it, it is Why do we have this particular hesitation? being judged by the Other. In other words, not lack that creates trouble, but, as in Ander- Candidates are professionals with a record of shame is the effect of a primordial Other sen’s story, our excessive wish to belong to an various accomplishments and successes, often who sees or does not see, whereas guilt imagined elite group of exceptional people. including previous publications. But what hap- comes later in development and points to the This wish can lead to silence, as in the fairy tale, pens when it comes to writing while in can- Other who can think, talk, and judge when we in order to avoid the embarrassment of ex- didacy? What is the inhibiting factor at play? transgress common shared values. Shame is posing one’s own limitations, i.e., stupidity. The Is it shame? the feeling of being exposed, naked, stripped status of candidacy alone implies a set of lim- In his fairy tale The Emperor’s New Clothes, down to our most intimate, deepest, inade- itations; and thus the inhibition to write and Hans Christian Andersen very skillfully ad- quately felt, and nameless sense of who we present to the imagined exceptional Other dresses the problematic of shame within the are. The fear of shame, which seems to be does not come as a surprise. structure of a group. The story begins with an different from shame, speaks to the fear that In addition, in an era in which psychoanaly- emperor who cared so much about his cloth- this exposure can be absolute. “Dying from sis is challenged at its core and is asked to ing that he fell prey to two swindlers who shame” is a common expression that speaks respond to the demands of our contemporary claimed that they could fashion for him the to this fear. Shame does not play with uncer- evidence-based world, the candidate is con- finest of all suits, spun from extraordinary tainty of the sort, “Is there an Other who fronted even further with the challenge of cloth that was not only exceptionally beauti- could see me?” Shame certifies that an Other finding a voice that, despite anxieties of how it ful, but also had the special quality of being sounds, speaks of the ‘”love of the truth.” In invisible to anyone who was either stupid or Anna Freud’s words: “If you want to be a real unfit for his position in the court. When the psychoanalyst you have to have a great love of swindlers presented the suit to the emperor, the truth, scientific truth as well as personal he was ashamed to admit that he was too unfit truth, and you have to place this appreciation for his position to see what he was wearing, of truth higher than any discomfort at meeting n

e unpleasant facts, whether they belong to the s r e d

Vaia Tsolas, Ph.D., a clinical psychologist e world outside or to your inner person.” In P

m l in private practice in New York City, is a e other words, you must have the courage to h l i V

y

candidate at the Columbia University Center b be the emperor donning a brand new outfit

n o i t for Psychoanalytic Training and Research. She a and, at the same time, the child who shouts, r t s u l l is also the winner of the 2007 Sacerdoti Prize. I “The emperor has no clothes !”

34 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 TEACHING

Unlike the courses referenced in a Novem- Transplanting a Psychoanalysis ber 2007 New York Times article,“Discovering the Unconscious” does not use Freud as a Undergraduate Minor from Colorado springboard for the analysis of other disci- plines. Rather it uses selected literature and film to Chicago to open up various theories of psychoanalysis, Marcia D.-S. Dobson which are understood in their historical context. As a practicing psychotherapist, I teach theory Jonathan Lee, John Riker, and I, tenured course they had ever taken, and four were together with case studies. We look at and professors at Colorado College in Colorado certain that they wished to pursue psycho- try to understand psychotherapy in an expe- Springs, initiated a minor in psychoanalysis analysis as a career. It was clear that their riential context. For example, our Freudian here several years ago. Riker, a professor of response was motivated by actually being at readings include “On Beginning the Treatment,” philosophy and a former Kohut Professor at the Institute and finding out firsthand possible and “Advice to Physicians.” I use Christopher the University of Chicago, teaches “Philosophy paths to the profession, as well as witnessing Bollas’s little book, Free Association, to allow and Psychoanalysis,” and “Philosophy and the joys, difficulties, and the sense of fulfillment the students to play at being therapist and Psychology of the Self.” Lee, also a professor it gave to the analysts, who presented eagerly patient in the classroom in order to gain insight of philosophy, teaches courses on Lacan and and empathically. into the loosening of the bind of consciousness French psychoanalysis. I, a double Ph.D. in When I first initiated “Discovering the and to practice how to listen so that this classics (specialties in ancient Greek drama, Unconscious” at Colorado College, it was happens. This exercise is valuable not only for myth, religion, and language) and in clinical cross-listed with “Humanities,” “Comparative would-be therapists but also for students seri- psychology, teach “Psychoanalysis and Psy- Literature,” and “Philosophy.” It found no ously interested in writing poetry or in stream chotherapy: Discovering the Unconscious,” home in our psychology department, because of consciousness writing, as in the works of and “Myth and Meaning.” it was not considered sufficiently scientific Virginia Woolf or James Joyce. In July 2007, thanks to the kindness and foresight of David Terman, director of the Perhaps it will serve as a model in the future for institutes that wish Chicago Institute for Psychoanalysis, Riker and I brought nine Colorado College students to open their doors to undergraduates for the purpose of spreading to the Institute to teach them a version of interest and excitement in what is (despite what some say) an alive and “Discovering the Unconscious: Psychoanalysis vibrant field for study, personal reflection, and possible future careers. and Psychotherapy,” the course that spawned the above minor. In Chicago we taught the course through reading works of a number of or empirically based to be worthy of psy- At the end of the course, I allow the students Chicago psychoanalysts, who were generous chological study. A few years ago, after the to use their own personal experience as case enough to talk to the class about their work. course proved to be a resounding success material to work through some of the theory The analysts participating were Arnold Gold- (it had one of the longest waiting lists of any we have discussed. The students who do this berg, Salee Jenkins, Christine Kieffer, Kenneth course at the college), the psychology depart- gain much insight. I also encourage students to Newman, Allen Siegel, Brenda Solomon, Frank ment agreed to give it a PY number but re- interpret works of literature or film in their final Summers, David Terman, Arnold Tobin,Marian fused to count it toward a psychology major. papers through the lens of various psychoan- Tolpin, and Ernest Wolf. It was an exceptional While some members of the department alytic theories, be they Freudian, object rela- experience for us all. Our nine students were frown on psychoanalysis as being at best an art tional, Winnicottian, or self psychological. unanimous in proclaiming this to be the best but scarcely a science, I try to focus on the We plan to teach the course in its “Chicago” connections and to address the differences form again this year, undoubtedly with more in a friendly way. students. The Chicago Institute is to be con- Marcia D.-S. Dobson, Ph.D., a It was the continued popularity of the gratulated for having the adventurous spirit psychoanalytically informed practicing course that initiated the possibility of creating to go along with us in this unique enterprise. psychotherapist, holds Ph.D.s in classical the psychoanalysis minor. Lee and Riker added Perhaps it will serve as a model in the future philology and clinical psychology. the required number of basic courses to con- for institutes that wish to open their doors to She is director of the Colorado Springs solidate the minor. The minor focuses on the undergraduates for the purpose of spreading Psychoanalytic Salon and past president theories themselves and then adds relevant interest and excitement in what is (despite of the Colorado Springs Jung Society. Her courses from the various disciplines so that stu- what some say) an alive and vibrant field publications focus on ancient Greek tragedy dents may, if they wish, direct their psychoan- for study, personal reflection, and possible and psychoanalysis. alytic knowledge to their major fields. future careers.

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 35 97TH ANNUAL MEETING

Association, Bernard C. Holland Professor of Program Highlights of the Psychiatry and Behavioral Sciences, Emory University School of Medicine, and training 97th Annual Meeting in Atlanta and supervising analyst, Emory University Gary Grossman Psychoanalytic Institute.

The upcoming spring meeting of the Amer- Chaired by Syd- TICHO LECTURE ican Psychoanalytic Association to be held ney Pulver, the The Gertrude and Ernst Ticho Memorial June 18-22 in Atlanta promises to be an unusu- panelists are Lecture, given annually by a mid-career analyst ally thought-provoking one with many rich Darlene Ehren- who is currently making significant contribu- clinical presentations and discussions focused berg, Jay Green- tions to psychoanalysis, will be presented by on specific clinical problems. berg, and Shelley Arnold Wilson of the Columbia University Cen- Orgel. Henry ter for Psychoanalytic Research and Training. WORKSHOPS Smith will serve His topic will be “On Believing in One Theory or Ronald Britton will be the featured discus- as the discussant. Another, or One Analyst Reports in Mid-Career.” sant for the two-day “Clinical Workshop in Gary Grossman A panel on Analytic Process and Technique,” chaired by “Symptoms in UNIVERSITY FORUM Irene Cairo. Britton, who is among the most Analysis,” chaired by Anne Erreich, will take a What can we learn from a conversation eloquent and thoughtful members of the cross-cultural clinical approach to under- between a behavioral neuroscientist, an anthro- contemporary Kleinians in London, is in high standing how different analysts understand pologist, and psychoanalysts? Find out at the demand as a teacher, supervisor, consultant the concept of symptoms and how they ana- University Forum featuring psychobiologist and discussant around the world, so this will lyze them. It will feature Ronald Britton, Dale Lisa Parr from The Yerkes National Primate likely be a very stimulating and popular work- Boesky, and Steven Cooper. Research Center of Emory University, and shop. The two-day “Workshop on Psycho- Patients who care little about the impact of anthropologist/psychoanalyst Robert Paul, who therapy Technique and Process,” chaired by their words and actions on others can be dif- is dean of Emory College. Analysts Alexandra Alan Pollack, will feature Phillip Freeman, with ficult for analysts of any level of experience. Harrison and David Olds will moderate. Laura Westen of Atlanta presenting. Freeman Through the use of a case presentation by is a training and supervising analyst at Boston Helen Stein and discussions with Jane Kite ORAL HISTORY Psychoanalytic Society and Institute (BPSI) and and Beth Seelig, a panel on “The Non-Judg- Ralph Roughton will chair an “Oral His- author of the recently published, Adaptations: mental Analyst Revisited,” chaired by Donald tory Workshop on Recent Developments in Disquisitions on Psychoanalysis. Alexandra Har- Moss, will explore the challenges that emerge Atlanta, New Orleans, and Birmingham.” The rison, also from BPSI, will be the discussant for in work with these patients who lack a “capac- workshop will provide a regional history of the two-day “Child and Adolescent Clinical ity for concern.” these southern cities, covering the important Workshop,” chaired by Ruth Fischer, APsaA’s A panel on “The Effects of Internet Interac- new developments since the 1991 workshop 2008 National Psychoanalytic Woman Scholar. tion on Our Patients,” chaired by Bonnie in New Orleans emphasizing the effects of Litowitz, will feature Mel Lansky, Kimberlyn Hurricane Katrina on local analysts. APsaA’s FIVE FASCINATING PANELS Leary, and Caryle Perlman, who will explore oral history workshops serve a vital function How do analysts from different persuasions this cutting-edge topic. for the organization by preserving the history understand the concept of the “analytic stance”? Finally, clinicians and researchers interested of psychoanalysis through recording the rec- How do they create it? What kind of difficul- in the minds and development of young chil- ollections of our colleagues who took part in ties do they encounter in their daily work that dren will not want to miss June’s Child and these events. These workshops act as catalysts, challenge it? When do analysts know that they Adolescent Panel, “Treating the Under Five awakening the interest of younger members are “on their game”? These are several of the Child,” chaired by Ruth Karush. The panelists, and candidates in our Association’s past, and questions that will be addressed in the panel, Denia Barrett, Paul Hollinger, and Judy Yanof, provide a comprehensive archive for use by “What Do Analysts Need to Be Analysts?” will each present clinical material using differ- future researchers. ent treatment methods, including work via Gary Grossman, Ph.D., is member and the mother, psychotherapy, and psychoanalysis. SENIOR ANALYST PRESENTATION faculty at the San Francisco Center for Candidates, affiliates, and students will be Psychoanalysis, where he also serves PLENARY particularly interested in attending the Senior as chair of the Community Education The distinguished Plenary speaker at this Analyst Presentation Program, chaired by and Service Division, and is a member June’s meeting will be Steven Levy, editor-in-chief Ethan Grumbach. This is a unique opportunity of APsaA’s Program Committee. of the Journal of the American Psychoanalytic Continued on page 38

36 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 ATLANTA

Two of the most critically acclaimed restau- The New South: rants in the city are Bacchanalia and Quinones at Bacchanalia, located to the west of down- Dining and Shopping in Atlanta town. Chefs/owners Anne Quatrano and Clif- M. Jane Yates ford Harrison present contemporary American cuisine in a prix fixe seasonal menu (a la carte In addition to the beauty of remnants of the restaurants with greater mass appeal. It is at the bar). They feature the freshest of ingre- old South, there is the excitement of the always a good idea to make advance reserva- dients, some of which come from the chefs’ newer, cosmopolitan Atlanta. The Hyatt tions, either with the restaurants or through own Summerland Farm. Creative and master- Regency Hotel, home of the APsaA meeting opentable.com ful, the four-course menu guarantees a unique June 18-22, is characterized by its lighted blue Consistent with national trends, over the dining experience. The James Beard Foundation dome. Designed and built in 1967 by John past decade many of our wonderful restaurants named Quatrano and Harrison the Best Chef Portman as the world’s first contemporary have been influenced by the California cuisine of the Southeast in 2003. Other honors include atrium hotel, it heralded the beginning of an movement and feature locally grown, fresh having been selected one of the top 50 restau- architectural movement in hotel design. and often organic ingredients. Although none rants in America in 2006 by Gourmet magazine Downtown Atlanta is experiencing a resur- of the restaurants mentioned are specifically and maintaining a Zagat #1 rating for the last gence, evident by the number of office/condo vegetarian, all of them offer delicious vege- 11 years. Even more up-scale is Quinones, a sis- towers under construction and new cultural, tarian options. Gastronomes in Atlanta are ter restaurant of Bacchanalia, located at the artistic, entertainment, and dining venues. The more loyal to their chefs than they are to same site. An exquisite tasting menu changes Ambassador Force of Downtown, created in their local or favorite restaurants and will fol- nightly and focuses on the use of southern 1996 for the Olympics, is a full-time hospitality low them to any part of the city. ingredients, served in elegant and intimate and public safety force that patrols and offers A number of fine downtown restaurants surroundings. Across town, the same chef duo information and assistance downtown. You can are within walking distance of your hotel. At create seasonal cuisine with a French, Italian, find printed information at a kiosk located at French American Brasserie (FAB) you can and Mediterranean influence at their more the corner of International and Peachtree. You expect well-prepared traditional French favor- casual Floataway Café near Emory. will recognize the ambassadors by their uni- ites in a beautiful contemporary setting at In Midtown near Woodruff Arts Center forms and white helmets. If you are walking and lunch and dinner. A selection of steaks and you will find Ecco and Trois. At Ecco, chef would feel more comfortable with an escort, sushi is available at the Room at Twelve Cen- Micah Willix presents “seasonally inspired call and an ambassador will meet you and tennial Park in the new Twelve Hotel. City cuisine with European influences.” The menu escort you to where you want to go. Grill is located in the historic Hurt Building, includes options to be shared, freshly pre- which was originally the Federal Reserve Bank pared pastas and creative main courses such DINING for the Southeast and is now on the National as fig glazed lamb loin. A special wine selection The integration of the old and new South is Register of Historic Places. The building itself is exclusive to Ecco is also a treat. Ecco and most evident in its restaurant scene. Dining in interesting with its triangular shape and beau- Trois have each been named one of the “best Atlanta will be a treat, especially if you are tiful rotunda entrance. The restaurant serves a new restaurants in America” by Esquire.At expecting only overcooked vegetables sea- traditional fare, has a good wine selection and Trois, which opened in 2007, chef Jeremy Lieb soned with bacon fat and carbohydrates of good service. creates a cuisine that combines modern French every kind. (Of course, you can find plenty of There are two excellent Buckhead restau- with a touch of classical brasserie style. this if you wish.) If more traditional southern rants, each named for its chef. The first and Chef Michael Touhy, a representative of the cooking interests you, fried chicken is served foremost is Restaurant Eugene, recently fea- “natural” revolution, was among the first to on Sunday nights at Restaurant Eugene and tured in Gourmet magazine and a current feature seasonal, locally grown, organic food Tuesday nights at Watershed. Atlanta favorite. The menu consists of con- and had created his reputation in a number Articles in the January 2008 issue of Gourmet temporary upscale American cuisine with sea- of restaurants before opening Woodfire Grill and March issue of Bon Appetit feature some sonal ingredients. In 2006 chef Eugene Linton in 2002. At the center of the restaurant is a of our best restaurants. Others featured here was the Iron Chef America Atlanta Challenge huge wood-fire grill, hence the name. This include those your concierge might not be winner and from 2005 to 2008 the restaurant casual restaurant has received acclaim by Food aware of or might not recommend in favor of has received Wine Spectator’s Award of Excel- and Wine Magazine, Gourmet, Wine Spectator, lence. Joel Antunes of Joel is another of and Bon Appetit magazines. M. Jane Yates, Ph.D., is president of the Atlanta’s award-winning chefs, as the winner of In Inman Park, the menu at Rathbun’s includes Atlanta Psychoanalytic Society and chair the 2005 James Beard Foundation Best Chef of a wide variety of small plates for sharing and of the Local Arrangements Committee for the Southeast. His French bistro cuisine cre- features premium seafood and prime meats. APsaA’s June meeting. ations are simple and delicious. Continued on page 38

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 37 Program Highlights The chef, Shaun Doty, well known to Atlanta Resources Atlanta restaurant lovers, creatively gives Continued from page 36 INFORMATION Trois southern favorites a contemporary twist. AND ASSISTANCE 1180 Peachtree St. for students at every level to hear and discuss Ambassador Force 404-815-3337 a week’s worth of analytic material presented SHOPPING 404-215-9600 www.trois3.com by a seasoned psychoanalyst. Presenting at the Buckhead has been called the shop- www.atlantadowntown.com Woodfire Grill June meetings will be Fred Griffin, training and ping mecca of the southeast. From your The buc 1782 Cheshire Bridge Road supervising analyst at the New Orleans-Birm- hotel you can take MARTA at Peachtree www.bucride.com 404-347-9055 www.woodfiregrill.com ingham Psychoanalytic Center and director of Center station to Lenox Station. From MARTA (Atlanta Rapid psychodynamic psychotherapy training at the there walk one block to Lenox Square or Transit authority) Westside University of Alabama School of Medicine. three blocks to Phipps Plaza. The buc, a 404-848-4711 Bacchanalia and Quinones www.itsmarta.com Be sure to make it to Atlanta, and keep your free Buckhead shuttle service, connects 1198 Howell Mill Road 404-365-0410 eyes out for the Preliminary Program for details MARTA’s Lenox and Buckhead stations SHOPPING www.starprovisions.com on symposiums, additional clinical workshops, to Phipps Plaza, Lenox Square, and many DeKalb Farmers Market seminars, the plenary address, scientific papers, more shops and restaurants. The shuttle 3000 E. Ponce de Leon Ave. Inman Park research programs, stimulating discussion runs every 8-30 minutes on a five-mile 404-377-6400 Rathbun’s www.dekalbfarmersmarket.com 112 Krog St. Suite R groups, special programs for psychiatric resi- loop during commute and lunch times. 404-524-8280 dents, psychology and social work students, Located at the intersection of Lenox Lenox Square www.rathbunrestaurant.com and an array of social events. and Peachtree Roads, Lenox Square and 3393 Peachtree Road N.E. Kevin Rathbun Steak Phipps Plaza are Atlanta’s highest-end 404-233-6767 154 Krog St, Suite 200 shopping malls. Lenox hosts Neiman www.lenoxsquare.com 404-524-5600 The New South Marcus, Bloomingdale’s, Macy’s, Louis Phipps Plaza www.kevinrathbunsteak.com Vuitton, Swarovski Crystal, Cartier, 3500 Peachtree Road N.E. Sotto Sotto Continued from page 37 404-262-0992 Anthropologie, Crate and Barrel, and 313 N. Highland Ave. www.phippsplaza.com 404-523-6678 Rathbun’s was voted the City’s Best in 2006 Sephora, to name a few. Phipps Plaza www.sottosottorestaurant.com and also was named “one of the best new has Nordstrom, Saks Fifth Avenue, Belk’s, RESTAURANTS Fritti restaurants in America” by Esquire in 2004. and Tiffany & Co. Both have an array of 309 N. Highland Ave. Buckhead Newly opened in 2007, Kevin Rathbun Steak, smaller specialty shops such as Teavana. 404-880-9559 Joel www.sottosottorestarant.com named one of the best steakhouses in the Although you won’t be cooking, a trip 3290 Northside Parkway United States, offers steaks from Allen Broth- to Your DeKalb Farmer’s Market will be 404-233-3500 Shaun’s ers of Chicago. You will find excellent wine an adventure as well as a multicultural www.joelrestaurant.com 1029 Edgewood Ave. N.E. 404-577-4358 selections with many available by the glass. experience. It is the world’s largest Restaurant Eugene www.shaunsrestaurant.com Sotto Sotto serves fine authentic Italian cui- indoor farmer’s market, offering food 2277 Peachtree Road sine, freshly prepared pastas, risottos, meats, and and produce from all over the world. 404-355-0321 Cabbagetown www.restauranteugene.com seafood, in a cozy setting. Sotto Sotto has been Employees also come from around the Redfish, A Creole Bistro 687 Memorial Drive a Wine Spectator Award of Excellence winner for globe and speak at least two languages, Downtown 404-475-1200 French American Brasserie the past few years. More casual Fritti, next many four or five. All languages and www.redfishcreole.com door, features authentic Italian wood-fire pizzas, dialects spoken are listed on their name 30 Ivan Allen Jr. Blvd. 404-266-1440 Agave Restaurant great appetizers, salads, and small plates. tags. They are familiar with items com- www.fabatlanta.com 242 Boulevard S.E. Redfish, A Creole Bistro, is the place to go mon in their native lands and are happy 404-588-0006 Room at Twelve www.agaverestaurant.com for true, New Orleans Cajun-Creole cuisine. to talk to you. If you are a gourmet Centennial Park Agave, named Atlanta’s best southwestern cook and need to find just the right 400 Peachtree St. N.E.. Emory Area www.roomattwelve.com restaurant hosts a tequila bar with an enormous exotic spice or want to try a unique Floataway Café selection. Both are excellent and located in coffee, you will probably find it here. City Grill 1123 Zonolite Rd, Suite 15 Cabbagetown. An interesting side story pertains We look forward to seeing you in 50 Hurt Plaza 404-892-1414 www.starprovisions to the name of this old area. According to Atlanta and want to help make your 404-254-2489 www.citygrillatlanta.com lore, a train loaded with cabbages derailed in stay an enjoyable one. Decatur this neighborhood of cotton mill workers and *** Midtown Watershed for the following week the odor of cabbages My thanks to professional colleague and Ecco 406 W. Ponce de Leon Ave. 40 7th St. 404-378-4900 cooking permeated the air. Another small fellow “foodies,” Judy Kisla and Miles 404-347-9555 www.watershedrestaurant.com restaurant that is presently receiving a lot of Crowder, for their assistance in preparing www.fifthgroup.com well-deserved attention recently is Shaun’s. this article.

38 THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 t s i

l New books by members In 2006 and 2007 members of APsaA wrote or edited the following books. k o o b

Salman Akhtar, Regarding Others: Alexander Grinstein and Adele B. Jack Novick and Kerry Kelly Novick, Reviews, Reflections, and Responses. Grinstein, Edwin Arlington Robinson: Good Goodbyes: Knowing How to End in Pitchstone Publishing, Charlottesville, Va. Child of Scorn. iUniverse. Psychotherapy and Psychoanalysis. Jason Aronson, New York, Salman Akhtar, ed., Listening to Others: Stuart T. Hauser, Joseph P.Allen, and Developmental and Clinical Aspects of Eve Golden, Out of the Woods: Tales of Jack Novick and Kerry Kelly Novick, Empathy and Attunement. Jason Aronson, Resilient Teens. Harvard University Press, Fearful Symmetry: The Development and Lanham, Md. Cambridge, Mass. Treatment of Sadomasochism (reissued in paperback). Jason Aronson, New York. Salman Akhtar and Maria Teresa Richard A. Isay, Commitment and Hooke, eds., The Geography of Meanings: Healing: Gay Men and the Need Elyn R. Saks, The Center Cannot Hold: Psychoanalytic Perspectives on Space, for Romantic Love. Wiley & Sons, My Journey through Madness. Hyperion, Land, Place, and Dislocation. London, New York. New York. International Psychoanalytic Association. Robert Langs, Love and Death in Beth J. Seelig and M. Alizade, El Ticho de Salman Akhtar, Bert van Luyn, and John Psychotherapy. Palgrave-Macmillan, Cristal: Perspectives Psicoanaliticas Sobre Las Livesley, eds., Severe Personality Disorders: London. Mujeres y el Poder. Lumen, Buenos Aires. Everyday Issues in Clinical Practice. Robert Langs, Beyond Yahweh and Allan Tasman and Jerald Kay, Essentials of Cambridge University Press, London. Jesus: Bringing Death’s Wisdom to Faith, Psychiatry. John Wiley & Sons, New York. Fredric Busch and Larry Sandberg, Spirituality, and Psychoanalysis. Jason Allan Tasman and Michael D. Tasman, Psychotherapy and Medication: The Aronson, Latham, Md. Clinical Guide to DSM IV-TR Disorders. Challenge of Integration. Analytic Press, Jonathan Lear, Radical Hope: Ethics in John Wiley & Sons, New York. New York City and London. the Face of Cultural Devastation. Harvard Allan Tasman and Jeffrey A. Lieberman, Donald Coleman, The Poetics of University Press, Cambridge, Mass. Handbook of Psychiatric Medications. Psychoanalysis: Freudian Theory Meets Donald M. Marcus and “Hope”, John Wiley & Sons, New York. Drama and Storytelling. Word Association Taking Risks from the Unconscious: Publishers, Tarentum,Penn. Kathryn J. Zerbe. Integrated Treatment of A Psychoanalysis as Experienced from Eating Disorders: Beyond the Body Betrayed. Arnold M. Cooper, ed., Contemporary Both Sides of the Couch. Rowman and W.W. Norton, New York. Psychoanalysis in America: Leading Analysts Littlefield, New York. Present Their Work. American Psychiatric John P. Muller and Jane G. Tillman, If you are the author of a book Publishing, Washington D.C. and London. eds., The Embodied Subject of published in 2007 or 2008, and would Phillip S. Freeman, Adaptations: Psychoanalysis: Minding the Body in like to see it listed in TAP,please send the Disquisitions on Psychoanalysis 1997-2006. Psychoanalysis, Vol. 68, Psychological title with your name, publisher, publisher’s Word Association Publishers/Hanns Sachs Issues, Morris Eagle, series ed., location, and publication date to Janis Library, Boston. Rowman & Littlefield, New York. Chester at [email protected].

THE AMERICAN PSYCHOANALYST • Volume 42, No. 1 • Winter/Spring 2008 39 NONPROFIT ORG. US POSTAGE PAID ALBANY, NY PERMIT #370

309 East 49th Street New York, New York 10017