The Transformative Therapeutic Relationship: A Challenge and Opportunity.

The transformative therapeutic relationship is a unique interpersonal and intrapsychic phenomenon between analyst and patient. It occurs within the therapeutic framework, and is characterized by specific boundaries of time, place, and verbal and behavioral interactions. Collectively, these interactions may facilitate mutual trust, caring, respect, and affection between analyst and patient. The shared experience of the transformative therapeutic relationship can result in significant intrapsychic and interpersonal changes for both patient and analyst. Clinical case presentations are provided.

A Primer on Human Birth Theory.

In the 1970s Massimo Fagioli (1931-2017) proposed a new theory of mind that he called the Human Birth Theory, based on a healthy conception of the baby and of the nonconscious mind. Fagioli made significant contributions to the understanding of mental dynamics at birth, the pathophysiology of mental illness, and the nonconscious identity of psychiatrists and psychotherapists. His original contributions to psychodynamic psychotherapy included variations on the setting and understanding of transference and dream interpretations that deviated from classical psychoanalytic techniques. This article introduces the basic tenets of Human Birth Theory, its neuropsychiatric correlates, and clinical applications.

The Importance of Psychotherapy for Treatment-Resistant Depression.

Many clinicians choose psychoanalytic psychotherapy or supportive psychotherapy as the primary method of treating depression with or without antidepressant medications. Despite new antidepressants, 20% or more patients showed inadequate responses to the medications, and remained in chronic courses, known as "treatment-resistant depression (TRD)."In this chapter, we described (1) the reasons for psychotherapy in treating TRD from the perspectives of the hazard of polypharmacy, resistance, and neural mechanisms. (2) Next, we focused on the importance of assessment with two clinical vignettes and the original modality of psychoanalysis, psychoanalytic psychotherapy, and supportive psychotherapy in brief. (3) Finally, we described specific considerations in undertaking psychotherapy for TRD patients in terms of transference, countertransference, and resistance. In addition, the efficacy of psychoanalytic psychotherapy in childhood, adolescent, and late-life depression has been depicted in this paper.

Splits in the fabric: A community psychoanalytic project during COVID-19.

Demonstrating how psychoanalysts can be useful in community settings outside the conventional consulting room, this paper describes consultation and group interventions conducted at a San Francisco mental health agency serving a largely Asian community. In the traumatic context of the COVID-19 pandemic, agency staff became fragmented, due to remote working conditions and differential work assignments, including mandated deployments to emergency sites. Two psychoanalysts worked with agency leadership to devise a weekly process group held by video conferencing over 6 months, in an attempt to heal resentments and splits in the fabric of the agency. Examples of the group process, interventions, and major themes that emerged are described, as well as recommendations made, including the formation of an ongoing clinical consultation group. The paper situates these interventions in the greater context of the pandemic which exposed not only a universal threat to life and health, but also structural vulnerabilities organized along lines of (racial) difference and inequity. The dynamics at the agency are thus described as rooted within greater nested histories: of the clinic, its leadership, and their relationship with a strained public health system, and more broadly, of the tangled intersection of these histories with anti-Asian racism. These are understood as manifestations of the Social Unconscious, and the intervention as an example of Community Psychoanalysis.

Introduction to "The older analyst at work: The old man and the sea?"

This Analyst at Work section examines the work of an older psychoanalyst as he ages yet continues to work as a psychoanalyst. Eike Hinze describes his work with a disturbed young man. Decisions about starting an analysis and the struggles involved in 'reaching' this patient form part of the question of whether this is a 'quest', or another analysis, near the end of an analytic career.Of particular note is Dr. Hinze's explicit use of his own 'reverie'/ countertransference/ unconscious states to form interventions. The two discussants express their own understanding of how they might approach the problems posed. They both speak to the forms of intervening that differ from their own, and their clinical understanding of revealing one's own associations in the clinical hour. They also speak to how the process of aging might have influenced the clinical work itself.The possible shift in technique over the course of Dr. Hinze's clinical career is more difficult to assess: does it come from age, maturity, shifts in theory and technique, or an intense desire to make emotional contact within this particular patient and clinical setting? These are the "question marks" conveyed in their discussions, like the one in the title itself.

Examination of a case of "treatment failure" in long-term psychoanalytic psychotherapy for treatment-resistant depression.

Randomized controlled trials have reported psychoanalytic psychotherapy to improve longer-term post-treatment outcomes in patients with treatment-resistant depression. In this case study, we examine the therapy process of a female trial participant diagnosed with treatment-resistant depression. Structured clinical assessments indicated that the patient's level of depression remained unchanged during and after treatment. Over the course of the therapy, she repeatedly broke away from important others and finally also from the therapy itself, which we linked to the impact of earlier experiences of abandonment on her internal world. In the discussion, we present a variety of reflections that were put forward by the authors during a series of case discussion meetings. Some of these reflections relate to how the inner world of this patient might have triggered a negative therapeutic reaction and a destructive pattern of repetition. The interpretative stance, in which the therapist interpreted this reaction as indicative of a psychic conflict and linked this conflict to the therapeutic relationship, seemed to be experienced by the patient as unhelpful and persecutory. Other elements that were brought up include basic distrust, lack of symbolization and trauma in the patient, as well as the constraints of the research context.

Traumatic experience and loss: A brief therapy with a traumatized refugee boy and his parents in exile.

In this paper, the author portrays the psychoanalytic therapy with a twelve-year-old refugee boy and his parents, prior to which the boy had been traumatised by the deaths of both his brothers in the civil war. In 2015 he had travelled with his father to Austria, where he was warmly received in a small community. The author examines how this child reacted to the traumatising experiences, as well as which resilience factors played a role in overcoming them. The psychoanalytic process is illuminated in a detailed analysis of the therapy sessions, which created a space for overcoming the helplessness, mourning the loss and furthering the integration process of the identity, disturbed after the traumatic experiences.

Embodied intersubjectivity: Forms of psyche-soma structuring in the encounter between self and other-than-self.

This paper explores the mechanisms that lead to a destructive tendency in the formation and functioning of the psychic apparatus, to the characteristic states of subjects who are drawn to non-life. The dynamics of the primary mother-child relationship involve a structural interaction between mind and body, subject and object. The dialectic between the life drive and the death drive is conceptualized as the structuring of homeostatic dynamic equilibria, in which both drives belong to the living, provided they are kept in a non-isolated system. This conception has analogies with other disciplines that have changed their paradigms, such as neurobiology, which, for living beings in open systems, hypothesises a continuous interconnected Becoming of undivided separation and of discontinuity. In unitary psyche-soma functioning, a dynamic homoeostatic balance marks the state of health of the relating subject; or if, instead, the system is isolated, a pathological dysregulation depending on the emotional-affective vicissitudes it undergoes. Two clinical cases illustrate these dynamics. For this tendency on the level of the somatopsychic unit, the name alloiosis has been put forward, in analogy with cellular apoptosis.

Letting go to let be: Psychoanalysis as creative flow.

This paper explores experiences of surrender to an aspect of mind that is unconfined, empty of dualistic concepts, and lucidly aware. Ghent's concept of surrender, Farber's unconscious will, and Buddhist philosophers' essence of mind all link to creative processes described by Poincaré and Mozart. This impressionistic collage points to the spaciousness to know beyond our usual stories. From this essential mind more wholesome actions proceed.

Re-learning from teaching: a personal reflection on Jeremy Safran's legacy.

Jeremy Safran's pedagogical style was singular in its emphasis on experiential learning through role-plays, use of session video recordings, and his full-hearted embrace of therapists' subjectivity as a tool for therapeutic change. This paper is a personal reflection on the author's experiences as Jeremy Safran's student and how they have translated into her own teaching and supervision. She shares how teaching has been a means of reconnecting with her experiences learning from Jeremy, and the ways in which she tries to carry forward his unique contributions to the next generation of students and trainees.

EMBRACING DISAPPOINTMENT AS PSYCHOANALYTIC PRAXIS.

Psychoanalysis involves studying how people maintain not knowing what they "know." As a result, how psychoanalytic psychotherapists orient toward what their patients may be experiencing but cannot say is at the core of psychoanalytic praxis. Jeremy Safran's unique psychoanalytic sensibilities were a model for how to yield to feeling states and relational dynamics that are at the heart of therapeutic action, but which all too frequently get bypassed. This brief recollection highlights how Safran's commitment to open inquiry and mutuality-not just with his patients but also with his students-continues to impact the field.

The enchanted unconscious, impasses, negotiation and surrender: Jeremy Safran in dialogue with the Rebbes of Ishbitz/Radzin.

Dr. Jeremy Safran had a unique talent to seamlessly weave together clinical work with his broad knowledge of philosophy, history, and theology. Alongside his commitment to researching the minutest clinical interactions, he was conscious of the broad values of the nature of the good life that underpinned his analytic approach. This paper will explore the concepts of the enchanted unconscious, clinical impasses, negotiation, and surrender, suggesting that these concepts together provide insight into Safran's larger philosophy of life. It will then provide the approach to these concepts of the Rebbes of Ishbitz/Radzin, a school of Polish Hasidic thought. It will conclude with an exploration of how both Safran's psychoanalytic approach and the Ishbitz/Radzin Rebbes' Hasidic approach to the Torah provide distinct insights and applications of these concepts, which can be mutually enriching for both disciplines.

Samsara in psychotherapy. A rebirth of Jeremy Safran's Buddhist dialogue.

This paper reflects the legacy of Jeremy Safran's application of Buddhist principles to clinical practice and supervision. The rebirth of his life and work in the clinical work and supervision of his students is examined. The paper explores transformation or enlightenment in cyclical spaces of loss and suffering or samsara.

The heart of healing: Echoes of Sándor Ferenczi's legacy in Jeremy Safran's relational commitments.

In this duet of two voices honoring Jeremy Safran's legacy, the authors celebrate some points of resonance between Sándor Ferenczi's groundbreaking relational interventions and Safran's approach to the therapeutic relationship as the heart of healing. Karen Starr first highlights Ferenczi's now well-known creative experimentation with technique and his emphasis on and care for the relational dimension of psychoanalytic treatment. Jill Bresler then links Safran's career-long dedication to the therapeutic alliance to Starr's introductory remarks, honoring Safran and Ferenczi's shared dedication to expanding options in clinical practice through focus on the relationship. Recalling Safran's naming Ferenczi as a key figure in psychotherapy integration's origin story, Bresler reflects on her own learning from Safran's groundbreaking transtheoretical research into the mutative aspects of psychotherapy and his translating a psychoanalytic focus on the therapeutic relationship to CBT researchers and practitioners.