Care of a Former Analysand with Dementia with Maxine Anderson, MD (Seattle, Washington)
Psychoanalysis On and Off the Couch
Release Date: 05/18/2025
On Transience and the Cycle of Time: Freud and Ecclesiastes with Paul Marcus, PhD (Great Neck, New York)
Psychoanalysis On and Off the Couch
“The similarity between Freud and Kohelet [Ecclesiastes] is that both of them believe that there's no overarching totalistic system that integrates all the disparate experiences that one has. You have that, Freud says, in psychotics, and you have that in philosophers, and you have that in devout people - they look for systematicity. They try to cram everything into a framework of meaning. Both Freud and Kohelet reject that. They don't have a worldview in that way. However, in order to flourish, you do need a meaning-giving, affect-integrating and action-guiding set of...
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A Memoir of Transformation: a patient examines two analyses at two stages of life with Joan Peters, PhD (Ojai, California)
Psychoanalysis On and Off the Couch
“With Kristi [second analyst], it was much, much deeper. This whole dependent and infantile part of me was coming out. This is psychoanalytic language - I was moving into a regression that was terrifying, because I had been trained by my mother, and it was my nature, and it was what had worked for me to really approach things as an ‘independent person’ ie I don't need anybody; I don't need anything; I can function whatever happens. While I explored a little bit of that with Lane [first analyst], it was only very slight, and we never talked about it. With Kristi, she would actually make...
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Psychotherapeutic Aphorisms: Reflections from a Lifetime of Listening with David Joseph, MD (Washington DC)
Psychoanalysis On and Off the Couch
“Some time ago, I realized that there was such a thing for me as experiencing my patients as being friends, but they were psychoanalytic friends. It was a psychoanalytic friendship that was quite unique and unlike any other friendship. I think that's what people are talking about when they write about psychoanalytic love. It's not love like any other kind of relationship, because the psychoanalytic relationship is so unique. And I feel the same way about psychoanalytic parenting. It's like it's close to mentoring, but it's different because the structure of the relationship is different than...
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An Analyst's Reflections on Her Treatments and Her Life with Beverly Kolsky, MSW (Tupper Lake, New York)
Psychoanalysis On and Off the Couch
“This really is the full motivation for my having written the memoir. I want people to know what the process is like; not only what the process is like but what the feelings are that don't really make you think of psychoanalysis as a way of changing your life. We're just living and hoping that things will change without really taking account of the fact that we could be living better lives and in a better way. I began to think of the ways of the world and the wickedness in it. There's so many things that we do to keep us going - me and my aphrodisiacs, and I think other people doing other...
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When We Feel Provoked by the Politics of Our Patients with Heribert Blass, Dr. Med. (MD) (Dusseldorf, Germany)
Psychoanalysis On and Off the Couch
“I think that the comparison [between political and erotic passions] is related to the danger of transgressing boundaries from the side of the analyst. It's not totally the same, but it's because of the emotions and the danger of being too much involved as an analyst, if you don't pay attention to what is happening in ourselves with our own emotions, then it can be similar. I think both are important for the psychoanalytic process, to see it as a real relationship - there is this setting where two people in the room meet. They are real persons, but at the same time, a kind of dramatic...
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Analysts' Reflections on Their Parenting with Andy Cohen (Johannesburg)
Psychoanalysis On and Off the Couch
"I was quite protective of the parent reader while I was editing this. I feel that so many of the books out there on the shelf have a real kind of finger wagging quality to parents. They kind of tell parents what to do, what not to do, mostly what they're doing wrong. I felt like I wanted to create a resource that empathized with the parents' position, and that protected them, because this is literally the hardest thing in the world. So the protectiveness felt important to me, and it was one of the things that was really quite important that we always held the parent in mind, which is...
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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...
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'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...
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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,...
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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...
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.