Weekend Core: Final Integrative Course (4th year)

Final Integrative Course: Good Enough Endings

The Institute of Contemporary Psychoanalysis

Instructors: Susan Mendenhall, Psy.D. & Helen Ziskind, Psy.D.

Dates: Fridays 11:30- 2 pm, September 20, November 1, December 6, 2019; January 24, March 27, May 1, 2020

Academic Year, 2019-2020

Hours 2.5 per class, 15 hours total, 1 unit.

 Course Description

This integrative course, offered in the final year of analytic training, is intended to help candidates reflect on and articulate what they have learned from their training experiences at ICP, consider their transition from candidate to analyst and to address the subject of termination.

Candidates will prepare an oral presentation or paper whose theme encompasses their “Psychoanalytic Journey.”  Content should include reflections on their overall experience, including which theories, and experiences have most influenced the development of their own psychoanalytic voice and what it means to them to work psychoanalytically. The paper must include a bibliography.

Throughout the class there will be a discussion of the candidate’s personal experience of ending: ending of classes, regular times of connection with fellow candidates, perhaps their own personal analysis and supervisory experiences.

As well as exploring the experience of ending training, the complex topic of ending analytic treatments and relationships will be addressed. Paradigm shifts within psychoanalysis from objectivism to constructivism, and from a more intrapsychic conception of mind to a more relational one, warrant new conversations about termination. The impact of developments in infant and attachment research have influenced thinking in this area. We will consider multiple perspectives and grapple with some meaningful questions, including: how does an analytic dyad know or determine when it’s time to end; what value and meaning does ending, or leaving, have for different analysands and analysts; and are there useful guidelines or concepts to help analysts think about and navigate endings? We will consider issues of termination brought on by the suicide or death of the patient, death of the analyst, as well as cognitive impairment or dementia of the analyst.

Course Objectives:

The aim of this course is two-fold.  First is an attempt to create an opportunity for candidates to reflect on their experience of psychoanalytic training, and to facilitate the emergence of their analytic identity.  Via a review of literature, students can consider and then articulate (in writing or an oral presentation) the multitude of influences that have most significantly impacted their perspective on what it means to think and work psychoanalytically.

A second aim is to consider the topic of termination.  Candidates will be able to explain the differences between traditional and contemporary views on termination of psychoanalytic treatments.  They will be able to describe important considerations in making decisions about ending treatments.  Candidates will demonstrate an understanding of the management of treatments which end because of particular circumstances such as death, suicide and dementia.

Session 1 

  1. Consider and discuss the impact of studying multiple theoretical perspectives on the ongoing candidate experience.
  2. Explain the classical understanding of the termination process.

Session 2  

  1. Discuss the ways in which supervision, writing about patients and the experience of candidacy intersect to impact the development of the candidate analyst.
  2. Identify the way in which contemporary thinking has led to evolving ideas about termination.
  3.  The candidate will come to have a greater awareness of the variety of ways a psychoanalytic treatment may end, and will be able to describe the corresponding ramifications.

Session 3  

  1. Candidates will consider and discuss the meaning and impact of their “actual training” experience on control case work.
  2. Candidates will begin to present their own integration of what it means to them to work “analytically.”
  3. Candidates will consider and discuss what it means to have a treatment terminate because the patient “suicides.”

Session 4  

  1. Candidates will continue to present their own integration of what it means to work “analytically.”
  2. Candidates will reflect on and discuss the personal feelings that are evoked by the termination of a patient.
  3. Candidates will consider and describe the particular difficulty for the analyst when the therapy terminates as a result of the patient’s death, as well as explore ways to find adequate support.

Session 5

  1. Candidates will continue to present their own integration of what it means to them to work “analytically.”
  2. Candidates will understand and articulate the importance of preparation for the needs of their patients (including the development of a professional will) should they die or become incapacitated while still practicing.

Session 6

  1. Candidates will continue to present their own integration of what it means to them to work “analytically.”
  2. Candidates will reconsider and discuss traditional negative views of “interminable analyses.”

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Goals and Objectives Week by Week

Session 1   September 20, 2019

The first session will introduce the course and provide an overview of the two aims.

We will discuss the issues stimulated by being exposed to multiple theories and points of view regarding optimal therapeutic process.

Students will become familiar with the classical view of the termination process.

Readings

Aibel, M. (2014). Being Railroaded: A Candidate’s Struggle to Stay on Track. Psychoanalytic Perspectives, 11, 2 pp. 140-163. (PEP)

Ehrenberg, D. (2014). On Finding One’s Voice as an Analyst: Commentary on Matt Aibel’s “Being Railroaded: A Candidate’s Struggle to Stay on Track. Psychoanalytic Perspectives, 11, 2, pp. 173.187. (PEP)

Shane, M., Shane, E. (1984), The End Phase of Analysis: Indications, Functions, and Tasks of Termination, J. American Psychoanal. Assn. 43:739-722

Optional

Grossmark, R. (2014.) Feeling Heard and Held. Psychoanalytic Perspectives, 11, 2, pp. 154-172. (PEP)

Aibel, M. (2014). Response to Commentaries. Psychoanalytic Perspectives, 11, 2, pp. 188-197. (PEP)

Session 2   November 1, 2019

This session will explore ways in which supervision, writing and talking about patients, and the experience of membership in a candidate group intersect to impact one’s development.

Classical views on termination will be contrasted with evolving, more contemporary perspectives.

The variety of ways analyses end will be discussed.

Furman, Susan G. (2006). The Write of Passage from Candidate to Analyst: The Experience of Writing Analytic Process. Psychoanalytic Inquiry, 26(5) pp. 682-697. (PEP)

Carr, Elizabeth, M. (2006) On Knowing and Using Myself: Reflections on an Analyst’s Subjectivity, Intersubjectivity, and Psychoanalytic Change. Psychoanalytic Inquiry, 26(5)pp. 738-750.

Mendenhall, S. (2009). From Termination to the Evolution of a Relationships: A New Understanding. (PDF) Psychoanalytic Inquiry, 29(2), pp. 117-135.

Golland, J.H., (1997). Not an Endgame: Terminations in Psychoanalysis. Psychoanalytic Psychology 14(2), pp. 259-275. (PDF)

Session 3   December 6, 2019

This session examines the tensions that come with satisfying requirements, such as keeping patients in analysis, dealing with the patient’s knowledge of a third person (supervisor) involved in their process, etc.

In this session candidates will begin presenting their own integration of their psychoanalytic journey, as well as engage with that of their fellow candidates.

Candidates will explore the powerful issues surrounding the suicide of a patient.

Readings

Ehrlich Joshua (2003). Being a Candidate: Its Impact on Analytic Process. Journal of the American Psychoanalytic Association, 51(1), pp. 177-200. (PEP)

Chassay, S. (2019) Death in the Afternoon. Int. J. Psycho-Anal. ,87(1):203-2017.

Session 4  January 24, 2020

In this session candidates will continue presenting their own integration of their psychoanalytic journey, as well as engage with that of their fellow candidates.

In this session candidates will discuss personal feelings and issues that arise when a treatment terminates. The particular experience of having a patient die while in treatment will be explored.

Readings

Buechler, Sandra (2000). Necessary and Unnecessary Losses: The Analyst’s Mourning. Contemporary Psychoanalysis, 36 (1), 77-90.

Viorst, J. (1982).  Experiences of loss at the end of analysis:  The analyst’s response to termination. Psychoanalytic Inquiry, 2, pp. 399 – 418.

Session 5   March 27, 2020

In this session candidates will continue presenting their own integration of their psychoanalytic journey, as well as engage with that of their fellow candidates.

In this session candidates will address the crucial but often avoided issue of providing for the needs of their patients should they become incapacitated or die while still practicing.  The creating of a professional will will be discussed.

Readings

Rendely, Judith (1999).  The Death of an Analyst:  The Loss of a Real Relationship. Contemporary Psychoanalysis, 35 (1), 131-152. (PEP)

Alexander, J.; Kolodjiejski, K.; Sanville, J.; and Shaw, R. (1989).  On Final Terminations:  Consultation with a Dying Therapist. Clinical Social Work Journal, 17 (4), 307-324. (PDF)

An unpublished Reflection on Dementia. (pdf provided).

Licht, Michele (1996).  The Professional Will. California Society for Clinical Social Work Clinical Update, p. 3. (PDF)

Session 6     May 1, 2020

In this session candidates continue presenting their own integration of their psychoanalytic journey, as well as engage with that of their fellow candidates.

Interminable analysis has traditionally been viewed in a negative light.  In this session candidates will consider other perspectives on this issue.

Readings

Glennon, Stefanie S. (2010). Relational Analyses: Are they more difficult to end? In Salberg, J., Good Enough Endings, pp.257-275. New York: Routledge.

Rucker, Naomi (1993). Interminable Analysis Reconsidered. American Journal Psychoanalysis, 53: 159-172. (PDF)