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.

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.

"It's a fight - the whole personality of the patient to win." The development of concepts of psychosis in the Jewish Hospital in Warsaw, 1898-1943.

This study investigates the development of concepts of psychosis in the Jewish Hospital in Warsaw, within the context of social and historical processes to which the hospital was the subject and a broader scope of European concepts of psychosis. In the years 1898-1909, the first chief physician of the psychiatric ward, Adam Wizel, focused mainly on hysteria. The interest in psychoses was initiated by Maurycy Bornsztajn, who started to promote psychoanalytic ideas. The second decade of the functioning of the Jewish Hospital's psychiatric ward was marked by issues concerning the classification of psychoses. In the third decade, after Poland regained independence, psychosis became the main focus of the hospital's staff. Newly appointed psychiatrists, Gustaw Bychowski and Wladyslaw Matecki, contributed substantially to the psychoanalytic understanding of psychosis. Bornsztajn continued to develop his psychoanalytically based concept of psychosis. Wizel changed his attitude toward psychoanalysis and acknowledged the importance of Freud's discoveries. Wladyslaw Sterling contributed to the biological understanding of schizophrenia. In the last period, 1931-1943, the Jewish Hospital in Warsaw struggled with the consequences of the economic crisis in Poland, Wizel's death, and Bychowski's departure, which resulted in the reduced number of publications in the field of psychosis. Nevertheless, Bornsztajn managed to further develop his concept of somatopsychic schizophrenia and Matecki introduced the category of pseudo-neurotic schizophrenia. The psychoanalytic approach developed by Wizel, Bornsztajn, Bychowski, and Matecki was supplemented with other influences, especially phenomenology. Wizel, Bychowski, and Matecki were advocates of the psychoanalytic psychotherapy of psychotic patients.

From Anxiety to Aesthetics: "Rank Horror: An International Symposium".

This report on the proceedings of the "Rank Horror" symposium, convened in May 2024 to reconsider Otto Rank's life, work, and enduring contributions to psychoanalytic theory and practice, includes a brief historical survey of Rank's relationship to Sigmund Freud and other original members of the International Psychoanalytic Association's Central Committee, and an account of the symposium's wider intellectual and political context. It outlines the reasons for returning to Rank now, and a summary of the papers presented. Particular focus is afforded to Rank's 1924 book, The Trauma of Birth.

Do we want to know?

The weak evidence base and profound consequences of gender-affirming interventions for youth call for a particularly sensitive and complex psychoanalytic exploration. However, prohibitions on knowing at the individual and social levels significantly constrain psychoanalytic work with trans-identified youth. Barriers to exploration and thinking that patients bring to treatment are reinforced and reified by the dominant socio-political trends that saturate the contexts in which young people dwell. These trends increasingly frame any attempt to deeply explore why a young person is seeking medical or surgical gender-affirming interventions as "off-limits" and a form of conversion therapy. Furthermore, politically driven clinicians who promote medical gender-affirming interventions misrepresent and attempt to discredit clinicians who explore the meaning and function of trans identification, or who express concern that transitioning may be a drastic solution to various forms of psychic pain. In doing so, they minimise the significance of the weak evidence base for these interventions and their serious, known risks. At the same time, they obscure or deny the psychic pain that is sometimes humming beneath the experience of gender dysphoria. The author asks: If there are significant uncertainties and risks of harm associated with medical interventions for young people, do we want to know?

Regression in the service of bibliotherapy-What can "Captain Underpants" teach us?

Regression in the service of the ego is a unique phenomenon that often occurs within therapeutic settings. In the current study, I show how it emerges within child therapy and how bibliotherapy manages to give it presence and thus to process it. The methodology that guided this study was based on a critical reading of psychoanalysis and bibliotherapy theories. In addition, the methodology is based on a therapeutic vignette aimed at demonstrating the qualities of bibliotherapy with children. I claim that bibliotherapy, based as it is primarily on the use of reading and writing processes, offers additional ways of processing and thinking about this phenomenon. The study provides an innovative contribution that is related to the interdisciplinary approach to therapy. There are important links between the two major disciplines examined in this study, psychoanalysis and bibliotherapy. Their intertwining generates interrelations and mutual inspiration. Moreover, this study adds to the theoretical and practical foundation of bibliotherapy and further establishes the understanding regarding the power of reading and writing processes to "relate the soul" within the analytical process.

Establishing a Method of Systematic and Reliable Analysis of Psychodynamic Process Notes.

Introduction: Process notes contain unique information concerning core elements of a psychodynamic treatment. These elements may be both conscious and unconscious for the author. One element for study is the tendency to which a therapist writes about providing either supportive or expressive interventions. This study sought to establish a method of systematically and reliably identifying the records of therapists' interventions as supportive or expressive. Methods: Three early-career clinicians were trained in the use of a process note intervention rating scale constructed specifically for this study. Quantitative statistical analyses assessed the scale's reliability and internal consistency. Results: Interrater reliability analysis determined at a p of 0.005 a Fleiss's kappa of 0.24 and an intraclass correlation coefficient of 0.264, suggesting a low but statistically significant reliability between the raters. A Cronbach's alpha of 0.67 and a McDonald's omega of 0.53 suggested questionable internal consistency. Discussion: Early-career clinicians can reliably code the manifestations of interventions in psychodynamic process notes as supportive or expressive. Future studies may improve the reliability and internal consistency of the scale, add measures of interpretation content, and evaluate these data in relation to other core elements of process notes, such as the author's emotional engagement as manifested in language measures and clinical outcome.

The Development of Psychodynamic Psychiatry in China.

The development of psychoanalysis and psychodynamic psychiatry in China is influenced by political, economic, cultural, and social ideology. The process of psychoanalysis entering China is also a reflection of Chinese history, mirroring China's transition from conservatism to openness, from focusing on tradition to embracing modernity, and from focusing on community and family to individualism. These changes align with the Chinese continuous exploration and pursuit of integration, adaptation, and individuation in the process of globalization, urbanization, and modernization. This article describes the continuous expansion and development of psychoanalysis and psychodynamics in China parallel to societal changes and how an increasing number of people have begun to engage in psychoanalysis or psychoanalytic practices and research. The author describes challenges to how psychoanalysis can better serve the Chinese people through clinical practice and in-depth research under the country's unique social, cultural, historical, and political background.

Demystifying Jung's "Archetypes" with Embodied Cognition.

Since he first proposed it, Carl Jung's "archetype" theory has faced resistance from a pervasive but seldom examined set of underlying Cartesian assumptions embedded in mainstream psychology. This paradigm assumed a physical universe (and hence body) free of psyche that coincided with an essentially disembodied mind largely concerned with abstract symbol manipulation. This situation led archetype theory to remain largely within insulated psychoanalytic circles for decades. Since the 1980s, however, cognitive psychology has increasingly become embodied from a variety of standpoints. This article shows how the results of embodied cognition and spontaneous thought "demystify" many of the attributes Jung described in his archetype theory, making archetype theory not only more comprehensible but clinically applicable. Combining approaches suggests new avenues of inquiry for experimental research and enriches the psychoanalytic perspective.

Recapitulation, Heredity, and Freud's View of Human Nature.

There's something strange about Freud's Civilization and its Discontents (1930). Biologically, Freud was a Neo-Lamarckian, who believed in both the modification of organisms through need and the inheritance of acquired characteristics. However, in Civilization, Freud argued that because human nature is immutable, society has dim odds of improving substantially. Lamarckians, of course, rejected that any species-nature is immutable, as species can always be transformed via the inheritance of acquired characteristics. In fact, many of Freud's Viennese contemporaries-such as Wilhelm Reich, Julius Tandler, and Paul Kammerer-took their Lamarckism to license precisely the sorts of radical social projects Freud deemed impossible. Thus the Freud of Civilization helped himself to a rigid view of human nature which, given his associated biological views, he seemingly ought to have rejected. In this paper, I explain this apparent inconsistency, and suggest Freud resolved it in the following way: Freud was not merely a Lamarckian, but also a strong and peculiar kind of recapitulationist, who believed stages of psychological development both recapitulate phylogeny, and "remain with us" throughout both individual lives and future species-history. I suggest Freud's recapitulationism supposed a certain inertia: what occurred in phylogenetic history cannot un-occur, and therefore there are aspects of our nature which we cannot un-acquire. In this way, Freud reached a rigid conception of human nature despite his Lamarckism.

The innate story code.

Code biology reveals a great many codes beyond the genetic code as integral to biological functioning. Recent scholars have linked the growing field of code biology to analytical psychology, confirming that the encoded information inherited by the human organism is indeed massive and capable of great sophistication. In this discussion, I will expand on this project by showing how developments in embodied cognition reveal a code that links the world of universal emotional responses to common experiences to the world of embodied visuospatial narratives--i.e., the "archetypes" of analytical psychology. Viewed in this manner, archetypes become spontaneous symbolic narratives that symbolize universal emotional responses to typical human environments. Such symbolic narratives aim toward adaptation, and use a universal code that maps such situations to visuospatial narratives, with the adaptor being the human body itself.

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.

Finding one's way.

The following is a meditative reflection on an anecdote from Jeremy Safran's Psychoanalysis and Buddhism. Moving through Safran's description of an important moment in his development as a student of Buddhism, the author weaves images, practices, and ways of being and feeling into an homage to Safran's legacy integrating psychoanalytic and Buddhist praxis and epistemology.

Remembering Jeremy Safran: continuing the conversation.

This introduction provides an overview to this special issue honoring the work and legacy of Jeremy D. Safran. Born of the Jeremy Safran Memorial Conference, held on April 2nd, 2023, this issue features a wide range of contributions from leaders in the field, former students, and early career professionals whose work engages and develops central ideas from Safran's work and reflects on his impact on their own clinical work and scholarship. Themes center around the three domains of Safran's major contributions: pedagogy; psychotherapy integration; and Buddhism, spirituality, and psychoanalysis. We observe among the contributions an experiential reconnecting with the deeply relational commitments of our friend and colleague.

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.

Gender-affirming care through the lens of abnormal illness behaviour and abnormal treatment behaviour.

OBJECTIVE: To describe the increasing number and changing demographics of patients presenting with gender dysphoria and provide an account of patient- and clinician-related factors which may have contributed to these changes. The concept of abnormal illness behaviours introduced by Pilowsky, and its extension to the concept of abnormal treatment behaviours by Singh, provides a framework for understanding healthy and pathological interactions between gender dysphoria patients and their doctors. CONCLUSIONS: Abnormal illness behaviours driven by the reinforcing contingencies of gender-affirming care may explain, in part, the increasing number and changing demographics of gender dysphoria, as well as the increasing incidence of desistance and detransition. The under-diagnosis and under-treatment of mental health disorders by clinicians treating these patients are examples of abnormal treatment behaviours. Uncritical affirmation of patient reported gender identity appears likely to conceal unconscious motivations of some patients and clinicians, increasing the risks of harm to both.

A New Way of Analysing Dreams on Its Profoundest Level: The Development of Motif Analysis and Phase Model (MAP) as an Extension of Structural Dream Analysis (SDA).

Dream research today assumes that there is a connection between dreams and waking life. However, the structural alteration of dream motifs in connection with the psychotherapeutic process and waking life has not yet been researched extensively. This study depicts the development of the new Motif Analysis and Phase Model (MAP), a dynamic method which allows research on the previous aspects. The following question was investigated as an accompanying key issue: can a connection be established between the course of the dream patterns and the agency of the dream ego as well as the dream contents and the course of the psychotherapies of the dreaming person as a whole? Four hypotheses were formulated and tested. The data material consists of 217 dreams of a male test subject. The motifs were analysed using Structural Dream Analysis (SDA) at first. Thereafter, the content was linked to the test subject's waking life in a guided interview. The findings show a strong connection between the dream content and the psychotherapies as well as the test subject's waking life. Five motifs with structural changes were found, through which the Phase Model with four phases was developed. At turning points, the transformative child motif also appears in the dreams. The course of the dream patterns and agency of the dream ego, however, has not changed. The results, the method and the generalisability were critically discussed and recommendations for future research were formulated.

Death as rupture, mourning as repair: A relational rendering of grief.

This paper honors Jeremy Safran's legacy of scholarship and pedagogy through the lens of his emphasis on rupture and repair. Challenging a Freudian rendering of mourning as ultimately giving up a lost object, the author draws on Nicholas Abraham and Maria Torok's application of Sandor Ferenczi's concept of introjection to offer a relational rendering of the grieving process.

Psychoanalysis of the unspectacular.

From the perspective of a poet and first-year psychoanalytic training candidate, this paper develops Jeremy Safran's ideas about the dialectic between psychoanalysis and Buddhism by drawing an analogy between their processes and those of a poetry practice to define an alternative to pathological dissociation under capitalist systems of value. The paper details the writer's experience of working a day job in an office and the pathological dissociation which she subsequently attempts to overcome and critique through writing poetry. Various poems written at work are shared and analyzed as evidence. Drawing from Safran's edited volume, Psychoanalysis and Buddhism, the author then identifies aspects of Zen Buddhist meditation practice and the psychoanalytic process that focus on connecting with reality, however conflicted, as opposed to escaping it. This paper was written under the mentorship of the psychoanalyst and Zen teacher Barry Magid.

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.