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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

Release Date: 01/12/2025

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...

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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 introduces the dynamic interplay between writing and self-reflection, arguing that the act of writing illuminates resistances, countertransference, and areas of growth that might elude the analyst in supervision or personal analysis. He shares his innovative "three-minute chess match" technique for identifying the heart of a case narrative and reflects on his journey—from his mother’s poetry to his current work mentoring candidates in the art of case writing.

We explore Stephen’s insights on the 're-immersion anxiety' that can inhibit case writing, and how addressing these resistances transforms the writing process and deepens clinical work. We conclude with a discussion of how the process of writing fosters an enduring capacity for self-supervision and analytic insight.

Our Guest: Dr. Stephen Bernstein, MD is a Training and Supervising Analyst at the Boston Psychoanalytic Society and Institute and has chaired a discussion group on writing about analytic cases for over 30 years. He is a prolific author, including his recent paper, The Process of Case Writing: A Fourth Pillar of Analytic Training, published in the Journal of the American Psychoanalytic Association. Dr. Bernstein’s work highlights the centrality of case writing as an essential tool for self-reflection and professional development. Beyond his focus on writing, he has contributed to the field with early research demonstrating the compatibility of preparatory psychotherapy with psychoanalysis and continues to mentor candidates, fostering their growth as analysts and writers.

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