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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

From Reacting to Reflecting: "How Psychoanalysis Made Us Better Surgeons" with Mauro Vasella, MD and Flavio Vasella, MD, PhD (Zurich)

Psychoanalysis On and Off the Couch

"I have had quite some reactions to the article [on their psychoanalyses]. I was also telling Mauro and my colleagues that out of quite a number of articles I've published on maybe more pressing issues in the field of cancer research, for example, brain tumor research that I've spent quite some time with, I think it's actually the article [on psychoanalysis] that probably prompted the most reactions, at least in my personal surroundings, and the reactions have been overwhelmingly positive. So colleagues are very interested. They often ask questions about psychoanalysis, quite specifically, how...

'Why is This Happening in My Body'?: the meeting of/between patients' imaginings and analysts' theories with Sharone Bergner, PhD (New York)

Psychoanalysis On and Off the Couch

“I really think that the purpose is to make space for the unknown, uncertainty, and for our kind of humility in the face of the complexity of our belonging to the physical world. So it's our animality, our physicality, all of that is so complicated and difficult to grapple with. The unknown is uncontrollable and is a huge abyss, as we know, for everybody. I do think that I'm trying to pivot here a little bit towards meeting the patient's attempts to grapple with that unknown.” Episode description: We begin by examining the assumptions of causality that we humans commonly invoke when...

Affairs: Exploring the Dynamic Mind with non-Clinical Readers with Juliet Rosenfeld(London)

Psychoanalysis On and Off the Couch

“The subject of affairs, I think it's of interest to everybody. We have all had an Oedipal experience - we've all been babies who have at some point realized that we are not the only person. We're not perfectly fused with our mother, and she has other things to do, and there may be a father. We've all known what rejection feels like, and probably betrayal, and I think that affairs are in our unconscious. I think that's sort of evident in the way that most great novels, most great films, or at least many, have an affair at their heart. From Anna Karenina to Madame Bovary to Fatal Attraction,...

Affects, Curiosity, and Corporal Punishment with Paul Holinger, MD, MPH (Chicago)

Psychoanalysis On and Off the Couch

“Now's the time to tell that wonderful story of the little boy. He was about two or three years old, and he went in the icebox to get some milk, and he managed to get this big carton and spill it all over the floor. Now, needless to say, there'd be a lot of parents that would react very negatively and frustrated - this mother happened to be a scientist. So she came in, she saw the bottle of milk, and what had happened. She went and got some paper towels, put them on the milk, and said, ‘Look at this. Look how the milk starts creeping up these fibers of the towel. Isn't that cool?’ And...

The 'Necessary Foreignness' of Psychoanalysis with Mariano Horenstein, PhD (Cordoba, Argentina)

Psychoanalysis On and Off the Couch

“In the analysis, the place where you face the experience of otherness, of foreignness, of the unconscious that goes through you, it doesn't appear as knowledge. Of course, in an analysis, you get a lot of knowledge, but it's not an important aspect of an analysis. I think that in the analysis, and that's the idea of using that word ‘transmission’ instead of ‘teaching’, what you receive is something that the analyst doesn't have. When you receive some knowledge from a teacher, you receive the knowledge the teacher has. When you transmit something, or when you receive something that...

Care of a Former Analysand with Dementia with Maxine Anderson, MD (Seattle, Washington)

Psychoanalysis On and Off the Couch

“I think that my analytic awareness of denial and projection and the concreteness of psychic reality when executive function wanes, that I could help the other caretakers to understand some of what was going on - to give them a way to understand that relieves their sense of frustration and uncertainty. I think that the analytic awareness of denial, of projection, that these things are not generally recognized by many caretakers, but it does reorient and make the caretaking function much more tolerable. It expands the understanding of what goes on in the waning personality. I also think that...

Before 'Ghosts' become 'Ancestors' with Shalini Masih, PhD (Worcestershire, UK)

Psychoanalysis On and Off the Couch

“All of this together shaped how I began to think about mind, not as something to be mastered, but as a landscape of the unspoken whether it was ghosts or griefs or desires that were hard to relinquish. I saw that the ghost was not always an ‘other’. It was often intimate, tied to lost ones, sometimes to unmet desires, to unbearable longings, but in some ways possession was an attempt to keep close what was slipping away. The ghost doesn't just haunt, it feels as if it wants something, and we just have to learn to develop ears to listen to what it wants.” Episode Description: We...

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.”...

More Episodes

“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 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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