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The Dying Patient in Treatment with Mark Moore, PhD (Philadelphia) and Peggy Warren, MD (Boston)

Release Date: 06/02/2024

Candidates' Reflections on their Psychoanalytic Training with Himanshu Agrawal, MD (Milwaukee, Wisconsin)

Psychoanalysis On and Off the Couch

“The theme that I found with IPSO [International Psychoanalytical Studies Organization] was that there was a common theme [in psychoanalytic training]. There was an initial phase full of terror and excitement, and then a middle phase of maybe some lethargy or apathy or disillusionment. In that middle phase, many candidates found IPSO, or IPSO found them, where they found refuge. They found solace. They found community, not just at their local institutes, but at this kind of world market. Many of the candidates talk about what a timely and wonderful experience it was to be seen, to be...

Reflections on Our Changing Field with Stefano Bolognini, MD (Bologna)

Psychoanalysis On and Off the Couch

“When we reconstruct [in a patient] a possible lacking object or role or function, we see that if the analyst himself has been able and the patient allowing him to be able to enter to a deep level the objective reality of the internal world of the patient, it can happen that some new function or position can be achieved. This is something that could be rare but it happens. This is one more reason for not blaming the length of some analytic treatments, because time is needed for entering that internal deep area where the analytic relation can create something new. Transformation...

Discovering the Process of One's Mind with Fred Busch, PhD (Chestnut Hill, Mass.)

Psychoanalysis On and Off the Couch

“The original papers that were written about the analyst’s unconscious being attuned to the patient's unconscious by Hyman and Racker, in both cases they talk about this phenomenon. But both of them utter a caution, which is that one always has to take into account one's own ‘mishegas’. Essentially, what they're saying is, the unconscious is pretty individualistic and we have our own things, and we have to consider that possibly it's our own difficulties, our own unconscious, that is playing a bigger role in our countertransference reaction to the patient's unconscious.”...

Religion, 'Allegorical Objects' and Levinas with David Black, PhD (London)

Psychoanalysis On and Off the Couch

“The idea of analytic neutrality, which was more or less a cliche truth when I was training back in the 1980s, is clearly getting at something very important, which is that we mustn't try to pre-conceive where the patient's development is going to take him or her. But that doesn't mean that the development is not in a direction. Aristotle famously said that the human being is a ‘zoon politikon’, a creature who belongs in a somewhat structured society. Healthy development is in that sort of direction as we become more integrated, as our ‘ghosts become more like ancestors’, to use that...

Childhood Memories: Their Impact on Mothers and Their 0–3-year-old Children with Ilene Lefcourt (New York)

Psychoanalysis On and Off the Couch

“There are very specific fears that people have that are specifically related to their own childhood, and I'd like to give an example. A mom with twins had a kidnapping fear. She was afraid every time she saw a car drive by her house that her twins would be kidnapped. Now this mother was herself adopted when she was a newborn, but her adoption did not become final until she was one year old. Her twins were approaching one year. I was struck by the anniversary of her fear of kidnapping, and when I asked her who she thought was driving the car that drove by her house, she blurted out, 'my...

Forbidden Intimacy: Marrying the 'Other' with Ashis Roy, PhD (Kolkata, India)

Psychoanalysis On and Off the Couch

“The amount of guilt and the sense of alienation that people feel when they fall in love with someone who is ‘outside’, and the struggle that they have to undergo to explain that choice which they fully don't understand themselves, is a very deep conflict that my work tries to capture. The title of my book is ‘Intimacy in Alienation’, and alienation is something that is really very pregnant in the identities of these individuals who feel like aliens to their own community because their community cannot imagine why are they seeing the other as something positive but not as how the...

The Making of the Documentary: Outsider. Freud with Yair Qedar (Tel Aviv)

Psychoanalysis On and Off the Couch

“I belong to the race that in the Middle Ages was blamed for all the plagues and such experiences have a sobering effect, and they do not arouse the tendency to believe in illusions. Much of my life has been devoted to trying to shed illusions. But if there is an illusion worth believing in, at least partially, this is the illusion: that we learn how to divert the impulse of destruction from our own kind, how to stop hating each other because of trivial differences, and stop killing each other for profits. That we stop taking advantage of the achievements of progress to control the forces of...

A Fourth Pillar: Unlocking the Power of Case Writing in Analytic Training with Stephen B. Bernstein, MD (Brookline, Mass.)

Psychoanalysis On and Off the Couch

“I've had the experience of having some wonderful supervisees, many of whom have done quite fine work and where it has not been an issue of any kind of great concerns. And allowing the candidate to see what's written and also discussing it with them, obviously makes it quite easy for them to get both positive input, but also at times, input that will help them evolve and deepen their work even more.” Episode Description: We begin by exploring the critical role of case writing in psychoanalytic training, discussing Stephen’s concept of "a fourth pillar of analytic training." Stephen...

The Unspoken: Analyst's 'Delinquencies', Post-Treatment Contact and Aging with Joyce Slochower, PhD (New York)

Psychoanalysis On and Off the Couch

“I feel so strongly about this [collective commemorative ritual]. I think that early psychoanalytic writing overemphasized the value of separation-individuation and pathologized the opposite. It's been through personal experience that I have come to see that in a different way with regard to Jewish commemorative ritual which takes place a couple of times a year. But also some experiences that I have had outside the realm of religion. The one that pops to mind was what President Biden did about a year after the first onslaught of the Covid epidemic. He had candles put all around the...

Poetry of the Mind and the Process of Mourning with Cordelia Schmidt-Hellerau, PhD (Chestnut Hill, Massachusetts)

Psychoanalysis On and Off the Couch

"What Freud may have missed here is that the investment in the lost object is a much more reconstructive and integrative process. It’s one where we remember all the stories that we have heard from the lost object - the repetitive stories about the childhood of the person or how they met significant others and all these stories are within us and revived, and we have questions. We think: ‘Too bad I never asked about this or that’ and in activating these memories we also experience joy and we have a slow process of integration which is not necessarily about loss but about how continuous...

More Episodes

“What is it like to be a clinician with a patient who either comes because they're going to be dying or it happens in the treatment - what is it like for the clinician? It's lonely in a way because there is a lot of parallel with what the patient is going through. To me, and as a field, I would like to think we could talk about this and write about it. My peer group at the time was terribly important to me - colleagues, people that basically would be with me in this. But in the end I was the one that went alone to the service at the funeral home and I went to my patient's luncheon, not to have the lunch but to talk to the family, and then I left - I didn't stay for the lunch, I thought that might be a little intrusive. There's nothing really to read about, talk about, pick somebody's brain about how do they experience this in their work or I don't really understand why we've been so quiet about this in our work.” PW

“You mentioned about being alone in it, and there is a way in which it's very true. I think a large part is that not many of our colleagues have had this experience. But on the flip side, maybe because I’ve worked with so many patients and I’m beginning to notice a certain consistency, but I've also had such an experience of close intimacy with these patients. There's a closeness that is to be had particularly in analytic work and work over time - but it happens quite quickly in the work with dying patients, and in that regard, I felt less alone in my work. In some ways in the rest of our work, because we maintain a careful distance in a way, a boundary with the patient, a frame - I feel with the dying patients, I feel like both of us are more in the room together.” MM

Episode Description: We begin with acknowledging the tension that exists between the literal and metaphoric aspects of the analytic relationship and how that is highlighted in the face of physical illness in either party. We focus on patients' illnesses both as they present upon initial consultation and when they develop in the course of treatment. Mark describes his years of work with cancer patients, and Peggy shares her experience with an analysand who, in the 6th year of her treatment, developed a terminal illness. We consider the emotional challenges associated with making home visits, the meaning of 'boundaries', feelings associated with fees, and the shared experience of love between patient and analyst. We consider the ways that the analyst’s affective intensity may also be associated with earlier and feared illnesses in their own life. We close with considering the difficulties that our field has in honestly communicating this aspect of the heart and soul of psychoanalysis.

Linked Episodes:

Episode 23: A Psychoanalyst Encounters the Dying – Discovering ‘Existential Maturity’

Episode 40: How Psycho-Oncology Informs an Approach to the Covid-19 Crises with Norman Straker, MD

Our Guests:

Mark Moore, PhD, is a clinical psychologist and psychoanalyst who works in private practice in Philadelphia. He was the Director of Psychological Services at the Abramson Cancer Center at Pennsylvania Hospital from 2004-2014 where he supervised psychology interns and post-doctoral fellows during their psycho-oncology rotation and provided psychological services to cancer patients and their families. He is also currently a co-leader for a weekly doctoring group for neurology residents at Penn Medicine. He was the Director of the Psychotherapy Training Program from 2014-2020 at the Psychoanalytic Center of Philadelphia, where he currently teaches courses on Writing, Assessment, Core Concepts, and a comparative course on Psychotherapy and Psychoanalysis. He was a recipient of the 2020 Edith Sabshin Teaching Award from the American Psychoanalytic Association, and he runs a monthly teaching forum for faculty at his institute. Dr. Moore’s clinical work focuses on health issues, notably chronic illness, losses, and life transitions associated with cancer, and the fear of dying. He has written several book chapters on topics including the concept of harmony in Japan, cultural perspectives on lying, conducting therapy outside the office, the experience of bodily betrayal in illness and aging, the experience of shame across the adult lifespan, and more recently about friendship.

Peggy Warren, MD, is a psychiatrist and psychoanalyst in Boston. Originally from Chicago, she danced professionally with Giordano Dance Chicago from ages 15 to 21, which created a lifelong interest in the effects of creativity and mentoring on human development. Fascinated by cell biology, she received a master’s degree in microbiology from Chicago Medical School and then an MD from Rush University. In medical school, she was chosen to be an Osler Honor Fellow in Pathology/Oncology, where she was first exposed to dying patients. Awarded the Nathan Freer prize for excellence in a medical student at graduation, she used the prize money to buy the Complete Works of Freud and began to learn about the power of the unconscious. After completing residency training in psychiatry at Massachusetts General Hospital, she pursued analytic training and graduated from the Boston Psychoanalytic Society and Institute. She was on the teaching and supervising faculty of the MGH/McLean psychiatry residency program for 30 years, the Boston Psychoanalytic faculty for 20 years, and won the teaching award from the Harvard Medical School MGH/McLean residency program in 2010. She has given talks on “Vaslav Nijinski: Creativity and Madness,” was a discussant with Doris Kearns Goodwin on Abraham Lincoln and depression, lectured on the effect of twinships on siblings, was a discussant in the “Off the Couch Film Series,” (Boston Coolidge Corner theater), a case presenter “On the Dying Patient” at the 2017 American Psychoanalytic meetings, and is a faculty member of the American Psychoanalytic Association’s annual Workshop on Psychoanalytic Writing. She has been in private practice in Boston as a psychoanalyst for 38 years.

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