Therapeutic Action

ICP: 2019- 2020

Meeting Time: Sundays 11:30 AM to 2:00 PM

Meeting Dates: 9/22/19, 11/3/19, 12/8/19, 1/26/20, 3/29/20, 5/3/20

Hours of Instruction: 2.5 hour sessions x 6 meeting = 15 hours

Instructor: Peter Schou, Ph.D

Peteraschou@gmail.com

Ph: (323)899-3480

Course Description:

When we talk about therapeutic action, we address the question of how psychoanalytic treatment is helpful to our patients. Much has been written about this question, and many diverse answers have been provided, consistent with the development of psychoanalysis as a multi- perspectival endeavor. In this course, we will review a range of subjects related to the idea of therapeutic action. It is useful to distinguish between 1) therapeutic action, the question of how does psychoanalytic treatment work, 2) therapeutic goals, the question of what we are trying to achieve, and 3) the means, or technique, which we use to achieve the goals. This distinction, although useful, is harder to maintain when we look at what has been written about therapeutic action. I have arranged the course around subject areas that all touch on the question of what moves treatment forward. Agency, novelty and play, identification, freedom, empathy and recognition. There is considerable overlap between these areas, as we will see.

What are the sources of what we know about therapeutic action? Here are some of our sources. Our clinical work with our patients, our own experience as analysands, what patients tell us directly about what helps, and, finally, the psychoanalytic literature. In this course, we will draw on all four sources. We will start each session with a review of the assigned readings. On a rotating basis, I will ask the members of the group to provide a brief summary of each reading as well as reflections and questions that have been stimulated by the reading. We will then proceed to a more clinically oriented part of the session where members of the group will articulate their own thoughts about therapeutic action based on their own experience. This will involve clinical vignettes but, because of time constraints, will not be full case presentations.

Course Objectives:

The objective of the course is to provide an overview of the psychoanalytic literature on therapeutic action and to use readings from the literature to stimulate our thinking about our own theories of therapeutic action based on personal clinical experience. My hope is that the course can have a “therapeutic” effect on our thinking about our clinical work by focusing on our – often latent and unformulated – beliefs about what facilitates therapeutic change.

Session 1:

  1. Differentiate trends in psychoanalytic thinking about therapeutic action through history.
  2. Identify aspects of thinking about therapeutic action that have particular relevance from a contemporary perspective.

Session 2:

  1. Explain the terms internalization and identification with specific reference to therapeutic action.
  2. Discuss the usefulness of these terms in clinical work.

Session 3:

  1. Differentiate trends in psychoanalytic thinking about freedom as applied to clinical process.
  2. Discuss the usefulness of the notion of freedom in clinical practice.

Session 4:

  1. Differentiate trends in psychoanalytic thinking about agency and its role in therapeutic action.
  2. Discuss the application of the concept of agency in clinical work.

Session 5:

  1. Differentiate trends in psychoanalytic thinking about empathy and recognition.
  2. Discuss the use of empathy and recognition in clinical work.

Session 1. September 22, 2020

Introduction

The readings for this session function primarily as an introduction to the history of the concept of therapeutic action in psychoanalysis. Because of the pluralism of contemporary psychoanalytic thinking, therapeutic action is conceptualized in many different ways by different schools of though. Is that a problem?

  • Gabbard, G. O. Western, D. (2003). Rethinking therapeutic action. Int. J. Psycho-Anal., 84(4): 8823-841
  • Greenberg, J. (2015). Therapeutic Action and the Analyst’s Responsibility. J. Amer. Psychoanal. Assn., 63(1):15-32.
  • Stern, D.B. (2012). Implicit Theories of Technique and the Values That Inspire Them. Psychoanal. Inq., 32(1):33-49

Session 2. November 3, 2019.

Identification and Internalization.

These readings are classic texts on therapeutic action. The language and ways of understanding psychoanalysis in these readings reflect the climate of thought of their time (1934 and 1960). They can, therefore, be challenging to read, but the ideas continue to be reference in writings about therapeutic action. Does this idea of internalizing and identifying with the analyst have value in your own way of thinking? How central is interpretation in your own work?

In the Leowald article, note the emphasis on the child-parent relationship, the analyst as a new object, and the role of the future. You can skip section 2 which is mostly about drive dynamics and go to section 4 on transference. Note his often quoted metaphor of transference as a the awakening of ghost tasting blood (p.29).

  • Stachey, J. (1934). The Nature of the Therapeutic Action of Psycho-Analysis. Int. J. Psycho-Anal., 15:127-159.
  • Loewald, H.W. (1960). On the Therapeutic Action of Psycho-Analysis. Int. J. Psycho-Anal., 41:16-33.

Session 3. December 89, 2019.

Freedom

The readings focus on freedom as a key value in treatment, both as facilitating development in the dyad and as an outcome of treatment. Does the idea of “free associations” play a role in your clinical work? D.B. Stern asks: “How can we encourage relational freedom?” Does that question resonate with your idea of therapeutic action? Hoffman’s article is a classic in relational literature. Is it still relevant?

  • Symington, N. (1983). The Analyst’s Act of Freedom as Agent of Therapeutic Change. Int. R. Psycho-Anal., 10:283-291.
  • Stern, D.B. (2013). Relational Freedom and Therapeutic Action. J. Amer. Psychoanal. Assn., 61(2):227-255.
  • Hoffman, I.Z. (1994). Dialectical Thinking and Therapeutic Action in the Psychoanalytic Process. Psychoanal Q., 63:187-218.

Session 4. January 29, 2020

Agency

The idea of agency as a value in and an outcome of treatment has attracted limited attention in the psychoanalytic literature. Why would that be?

  • Weisel-Barth, J. (2009). Stuck Choice and Agency in Psychoanalysis Int. J. Psychoanal. Self Psychol., 4(3):288-312
  • Caston, J. (2011). Agency as a Psychoanalytic Idea J. Amer. Psychoanal. Assn., 59(5):907-938

Session 5. March 29, 2020

Novelty and Play

This session focuses on playing, novelty, and emergence, the last two concepts mostly derived from a systems perspective. Winnicott’s notion of playing has been very influential in forming some writers’ idea of therapeutic action. Does playing, in Winnicott’s sense, have a role in your own work and understanding of therapeutic action. Note the reformation of enactment by the Boston Change Process Study Group. Do you agree with their critique?

  • Winnicott, D.W. (1971). Playing and Reality. p. 53-70. London: Travistock Publications.
  • Boston Change Process Study Group (2013). Enactment and the Emergence of New Relational Organization. J. Amer. Psychoanal. Assn., 61(4); 727-749.
  • Coburn, W.J. (2014). Complexity, Therapeutic Action and Jack. Chapter 4 in: W.J. Coburn: Psychoanalytic Complexity, New York, 2014 (PDF)

Session 6. May 3, 2020

Empathy and Recognition

Empathy and recognition figure prominently in current psychoanalytic thinking about clinical process and therapeutic action. Questions remain about the meaning of these terms, and they have become markers of divisions between schools of thought. We start out with Kohut’s last comments on the meaning of empathy for him. Note that he does not think of empathy as curative. What do you think? The article by McKay represents a relational perspective on these terms. The article also illustrates their meaning within the politics of contemporary psychoanalysis, as also highlighted in Aron’s broader and more inclusive comments.

  • Kohut, H. (2010). On Empathy: Heinz Kohut (1981). Int. J. Psychoanal, Self Psychol., 5(2):122-131.
  • McKay, R.K., Ph.D. (2019). Bread and Roses: Empathy and Recognition. Psychoanal. Dial., 29(1):75-91.
  • Aron, L. (2019). Discussion of “Bread and Roses: Empathy and Recognition.” Psychoanal. Dial., 29(1):92-102.