Care of a Former Analysand with Dementia with Maxine Anderson, MD (Seattle, Washington)
Psychoanalysis On and Off the Couch
Release Date: 05/18/2025
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...
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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...
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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...
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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...
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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...
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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...
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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.”...
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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...
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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...
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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...
info_outline“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 analytic work fosters the capacity to tolerate ambiguity, uncertainty, pain and frustration and in that way may allow us, the analytic mind, to tolerate some of the intense affect - as sort of the phrase I love from an Italian analyst, as “writings waiting to be completed” - by the analytic mind. We can hold and metabolize the difficulty and offer that kind of function rather than unpleasantness just to be rid of. These are some of the things that I felt are useful as a psychoanalyst.”
Episode Description: We begin with describing how dementia is a cloud over our field both for individuals and for institutes. Maxine then introduces us to 'Sally' who was her analysand 40 years prior to recontacting her to care for her cognitive decline. Maxine mentions that just hearing her former patient's voice instantly brought alive her past experiences with her. We discuss how she approached the issue of caring for her and her neurological condition. We consider the at times overlap between psychogenic and organic symptoms and she shares with us her countertransference experiences of herself losing her memory. Maxine also shares her approach to answering Sally’s questions about the possibility of recovering. We close with her describing how she feels that being an analyst aided her care of Sally and what she learned from that experience that she brought to her other patients -"to face the pain of difficult truths."
Our Guest: Maxine Anderson, MD, is a training and supervising analyst at the Northwestern Psychoanalytic Society and Institute, the Seattle Psychoanalytic Institute and Society and the Canadian Psychoanalytic Society. Originally trained in psychiatry, she pursued psychoanalytic training in Seattle in the early 1970s and then pursued post-graduate work at the British Psychoanalytical Society for 8 years, returning to Seattle in 1992. Thereafter, she became a Founding Member of the Northwestern Psychoanalytic Society and Institute. Maxine has published several articles, and chapters and 3 books, the most recent being The Hardest Passage: a psychoanalyst accompanies her patient’s journey into dementia (Karnac, 2025). Feeling herself now to be an Elder in life and in her field, Maxine hopes to continue to think and write about this phase of personal and professional life.
Recommended Readings:
Balfour, A. (2007). Facts, phenomenology, and psychoanalytic contributions to dementia care.
In: R. Davenhill (Ed.) Looking into Later Life: a psychoanalytic approach to depression and dementia in Old Age. (pp. 222–247). London: Routledge, 2007.
Davenhill, R. (Ed.) (2007) Looking into Later Life. A Psychoanalytic approach to Depression and Dementia in Old Age. London: Karnac.
Davenhill, R. (2007). No truce with the furies: issues of containment in the provision of care for people with dementia and those who care for them.
In: R. Davenhill ( Ed.), Looking into later life: a psychoanalytic approach to dementia and depression in old age. (pp. 201-221). London: Routledge.
Evans, S. (2008). “Beyond forgetfulness”: How psychoanalytic ideas can help us to understand the experience of patients with dementia”. Psychoanalytic Psychotherapy, 22(3):155–176.
Kitwood, T. (1997). Dementia Reconsidered: The Person Comes First. Milton Keynes: Open University Press.
Malloy, L (2009). Thinking about dementia – a psychodynamic understanding of links between early infantile experience and dementia. Psychoanalytic Psychotherapy, 23(2): 109–120.
Plotkin, D. (2014). Older adults and psychoanalytic treatment: It’s about time. Psychodynamic Psychiatry, 42(1): 23–60.
Sherwood, J. (2019). Dementia: childhood and loss. In White, K. Cotter, A. & Leventhal, H. (Eds.), Dementia: An Attachment Approach. London: Routledge.