Psychotherapeutic Aphorisms: Reflections from a Lifetime of Listening with David Joseph, MD (Washington DC)
Psychoanalysis On and Off the Couch
Release Date: 10/19/2025
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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“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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“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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“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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“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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"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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"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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“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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“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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“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“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 from a mentor or an esteemed and loved teacher. It really is helping somebody with the whole process of development and helping them grow, mature, and become more comfortable with themselves and to know themselves better. That seems to me the essence of parenting, and I don't think we should feel defensive about thinking about it that way. That doesn't seem to me that it's my counter-transference in needing to be a good mother, a good father, a good parent to my patients.”
Episode Description: We discuss the challenge of transmitting the experiential knowledge of the dynamic therapies to new generations. David's book on therapeutic aphorisms demonstrates a number of key elements of this unique relationship - symbolic meanings in symptoms, 'psychotherapeutic parenting', the simultaneous use of medications and working with the unlikable patient to name but a few of the topics he brings forward. He describes the challenges of the negative therapeutic reaction, how "transference reactions are the creative soul of the patient's story" and what it was like for him to admit to a patient that he lied to her. We close with his reflecting on the meaning to him of retiring from full time practice, noting "I haven't retired my psychoanalytic mind."
Our Guest: David Joseph, MD is a supervising and training analyst at the Washington Baltimore Center for Psychoanalysis where he served as chair of the board and director of the Institute Council (education committee). For many years he was the Director of Residency Training at St. Elizabeths Hospital in Washington, DC.
He has a long-standing interest in ethics and has written and spoken about a number of ethical issues in the practice of psychoanalysis. He closed his clinical practice several years ago, at the age of 82. In June 2025, his book: Listening for a Lifetime: The Artful Science of Psychotherapy, was published by Mission Point Press.
Recommended Readings:
Greenson, R. (1952) The Mother Tongue and the Mother. JAPA, 1
Zetzel. E. (1956) Anxiety and the Capacity to Bear It.
Schafer, R. (1976) A New Language for Psychoanalysis. Yale University Press. New Haven
Wachtel, P. L.(1977) Psychoanalysis and Behavior Therapy. Basic Books, NY.
Greenberg, J. and Mitchell, S. A. (1983) Object Relations in Psychoanalytic Theory. Harvard University Press.
Arlow, J. (1995) Stilted Listening: Psychoanalysis as Discourse. PQ, 215-233.
Schafer, R. (1999) Disappointment and Disappointedness. IJP, 80: 1093-1104.
Pine, F. (2011) Beyond Pluralism: Psychoanalysis and the Working of Mind. PQ: 80, 823-856.
Poland, W. (2018) Intimacy and Separateness in Psychoanalysis. Routledge, NY.
Holmes, D, (2022). Neutrality is not Neutral. JAPA, 70: 317-322