Psychoanalysis On and Off the Couch

"I'm not suggesting that repression has lost its place as a fundamental defense mechanism. Repression remains central, coherent, and fundamental to the founding of the unconscious. It is what makes certain contents inaccessible to consciousness, and what we access as psychoanalysts through dreams, play, symptoms, and associations. That remains true. What I was observing, and I'm still observing more now, is something different. When I see children and adolescents that are more capable to work on a task while doing homework, and at the same time listening to music, and at the same time texting with somebody - I don't think that they are real. This is my point. I don't think they are real. This multitasking way of living is part of life today… The clinical question for us becomes this - when does this multiplicity become a symptom? When does it interfere with the capacity for depth, for intimacy, for a sustained emotional contact? I think that this is what we need to see, to study and to differentiate in our consulting room." Episode Description: We consider how changes in our culture may impact the individual's intrapsychic space and from that the nature of the psychoanalytic encounter. Virginia comments on the diminishing of the paternal symbolizing function and with that a change in the 'rites of passage' that adolescents traverse - now the rituals are "created by the young people themselves" as contrasted with those passed down by their elders. This, she feels, has resulted in "intimacy becoming spectacle" and for many, the analytic session is where "the construction of intimacy may begin." She shares clinical material with us from 40 years ago and contrasts the nature of her interventions with her contemporary treatments. Now, "I appreciate the mystery in the process and that we create meaning with the patient." Virginia closes with seeing analytic treatment as "an invitation to a process of thinking that, to remain alive, must be rethought." Our Guests: Virginia Ungar M.D., training analyst at the Buenos Aires Psychoanalytic Association (APdeBA). She specializes in child and adolescent analysis, was the Chair of the IPA's Child and Adolescent Psychoanalysis Committee (COCAP) and of the IPA Committee for Integrated Training. She was awarded a Konex of Platinum in 2016. She is the former President of the International Psychoanalytic Association (2017-2021). Recommended Readings: Etchegoyen, H. (1986) The fundamentals of Psychoanalytic Technique, chapters 25 and 26, Karnac, 1991. Meltzer, D. (1968). A note on analytic receptivity. In A. Hahn (Ed.), Sincerity and other works: Collected papers of Donald Meltzer, Karnac Books, 1994. Meltzer, D. (1988). The apprehension of Beauty, chapters 1, 2, and 4, Clunie Press, Perthshire, 1988. Sontag, S. (1966). Against Interpretation, Against Interpretation and Other Essays, Farrar, Straus & Giroux, New York. Ungar, V. (2017) Letter from Argentina, Vol 98, 3, IJP, 2017

"In addition to the easy convenience of bathing two children together, or three children together, there are other motivations of bathing them together. Parents are less aware that there is an excitement in seeing the children naked - although convenience is what's stated first, I think other things do go into it. Through development reactions to the genital difference and nudity will change, and I believe that being aware of those changes is very useful for parents to make decisions about what they want to do in their family, about family nudity, toileting, bathing, running around naked." Episode Description: Ilene demonstrates the many influences on mothers' engagements with their daughters which include their own remembered and forgotten pasts, cultural influences and their unique imaginations. She mentions the startling messaging in the famous movie "Gigi", "Thank heaven for little girls...so helpless and appealing, without them what would little boys do." We discuss the power of girls wishing to be like their mothers and how that at times conflicts with their wishes to also individuate from their mothers. The book demonstrates differences among new parents around the blue/pink choices for boys and girls, and she also discusses the many feelings parents have associated with family nudity. A special distinction is made between a three-year-old asking 'Do I look pretty?' vs 'Am I pretty' - each having very different meanings to the child and to her parents. We touch upon 'whining', self-stimulation, and what being a 'girly-girl' means to parents. We close with Ilene sharing with us how real her granddaughters found this work to be. Our Guest: Ilene Lefcourt established the Sackler Lefcourt Center for Child Development in 1982. She was the Director, led the Mother-Baby-Toddler Groups, and provided Developmental Consultation to parents for over 35 years. She taught Child Psychiatry Residents and Parent-Infant Psychotherapy Trainees about her work. She has been a faculty member at the Columbia University Center for Psychoanalytic Training and Research since 1995. Ms. Lefcourt is currently in private practice in New York City. She is the author of Parenting and Childhood Memories: A Psychoanalytic Approach to Reverberating Ghosts and Magic, Mother-Baby-Toddler Group Guide: A Psychodynamic Approach, When Mothers Talk: Magical Moments and Everyday Challenges, and Mothers and Daughters: The First Three Years. Visit Ilene's website: http://ilenelefcourt.com/. Recommended Readings: 1975, Fraiberg S. Adelson E., Shapiro V., Ghosts in the Nursery, Journal of the American Academy of Child Psychiatry, 14, 387-421 1993, Lieberman, A ., The Emotional Life of the Toddler, Simon and Schuster 2005, Lieberman, A., Angels in The Nursery, Infant Mental Health Journal. Vol. 26(6) 1995, Stern, D. The Motherhood Constellation, Basic Books

"This came from an experience with a patient. It was early in my analytic training, and I was working with a supervisor who I really admired, and worked with her for a number of years. She was post-Kleinian, and was great at interpretation, formulation, and she was really helpful with just starting to guide me towards a lot of this work. I remember describing to her a patient session, and I was going through my process notes, and I said, 'I feel like the patient is inside of me. I feel like they want something that's in me, and I don't know what it is, and I can't quite access my own self, I don't know what to do'. It was through this initial experience where I really felt why analytic training versus other less intense training, we were also right at the time doing infant development, offered so much. It was early in my training and she suggested I think about an infant or even a toddler when they want something from their parents - they want something from their mother. The mother kind of feels this kind of gripping or this yearning from them, the baby wanting something. I started to think of my patients, not as infants or babies, but that what I was feeling was that there was something that the person I was working with needed, and they didn't have words yet to tell me what that was." Episode Description: We begin by recognizing the unique journeys that lead clinicians to become psychoanalysts. Pam shares with us her initial exposure to dynamic thinking but felt that she was missing some awareness of what was happening in herself and in the patients she was working with - "I was curious...I wanted to go deeper, to know more." This led her to enroll in full-time analytic training. She shares with us her understanding of the 'difficult to reach patients' that she was treating and presents a fictionized case that represents the many countertransference struggles she faced. She noted that "instead of the patient realizing that she wanted something from me, she instead felt attacked by me." Supervision was essential in helping her make sense of her experiences and of learning to 'listen to the music'. We close by noting her open-ended curiosity and interest in learning more - lifelong attributes of analysts who continue to take pleasure in our work. Our Guest: Pamela Polizzi, LCSW maintains a full-time private practice in New York City. She specializes in working with patients struggling with eating disorders, complex personality struggles, anxiety, depression, relational trauma, and life transitions. She earned her Master of Social Work (MSW) in Advanced Standing Clinical Practice from Fordham University at Lincoln Center in 2011. Currently, she is an Advanced Candidate at the Psychoanalytic Training Institute of the Contemporary Freudian Society (CFS) in Manhattan, working toward becoming a psychoanalyst. She completed a 2015 Two-Year Advanced Psychodynamic Psychotherapy Certificate in the Integrated Treatment of Eating Disorders from the Institute of Contemporary Psychotherapy (ICP), Center for the Study of Anorexia and Bulimia (CSAB). She also completed the Contemporary Freudian Society's (CFS) Two-Year Psychoanalytic Psychotherapy Program in 2019. Recommended Readings: Readings for Psychoanalytic Candidates: Bach, S. (2011). The How-To Book For Students of Psychoanalysis and Psychotherapy. Karnac. Busch, F. (2021). Dear Candidates: Analysts From Around The World Offer Personal Reflections on Psychoanalytic Training, Education, and The Profession. Routledge. Readings on Clinical Practice with the Patient who is Difficult to Reach: Bollas, C. (1996). Borderline Desire. Int. Forum Psychoanal., (5)(1):5-9. Joseph. B., Feldman, M., & Spillius, M. (1989). Psychic Equilibrium and Psychic Change: Selected Papers of Betty Joseph. New Lib. of Psycho-Anal., (9):1-222. (on Pep-web). Joseph, B. (1975) The patient who is difficult to reach. Joseph, B. (1982) Addiction to near-death. Joseph, B. (1983) On understanding and not understanding: some technical issues. Riesenberg-Malcolm, R. (1999). On Bearing Unbearable States of Mind. Routledge. Steiner, J. (1993). Psychic Retreats: Pathological Organizations in Psychotic, Neurotic and Psychotic Patients. Routledge. Winnicott, D.W. (1974). Fear of Breakdown. Int. R. of Psycho-Analysis. 1: 103-107.

"To come back to this idea of 'groaning' - I really like it because I think it's a good description of the work we do, but particularly because it refers to Antonio Ferro's concept of the absorbency of the frame, which I think is another way of referring to it, that the frame can take a little give and take, that there's something organic about it. It has a structure, but it's absorbent, it can move, it's alive. So that is a very important concept. I think a lot of younger analysts or psychotherapists who want to be inspired by psychoanalysis don't let themselves feel comfortable letting things happen first before they try and immediately intervene and feel that they have to have some kind of magical response to it." Episode Description: We begin by unpacking the meanings contained in the metaphor of the 'groaning' analytic frame. Allannah speaks of flexibility, containment and "the expectation of misunderstanding." She shares the importance of the analyst having a sense of an internal frame which is then introduced to the patient and which contrasts with their assumptions of social relatedness - "Too much comfort in the relationship can lead to a pseudo-analysis." We take up the concept of the 'co-created' frame and touch upon the reflections of Aulagnier, Rothstein and Aisenstein. Allannah shares her thinking on the issue of charging for missed sessions and describes her reconsideration of her personal analytic experience with this. We close with a comment on the analyst's internal frame which enables them to "hear the patient in an out-of-the-ordinary way." Our Guest: Allannah Furlong, Ph.D., a psychologist and psychoanalyst, is a member of the Société psychanalytique de Montréal. After serving on the IPA North American Editorial Committee, she was one of the original members of the IPA Committee on Confidentiality and organizers of the first interdisciplinary Inter-Regional Conference on Confidentiality. These collaborations led to the co-editorship of two books on issues of confidentiality in psychoanalysis. In addition, Dr. Furlong has written on the frame, missed sessions, informed consent in psychoanalysis, and the use of clinical material for teaching or publication. She has also written about the temporality of lovesickness, unconscious choice, and dehumanization as a shield against helpless openness to the other, for which she received the JAPA Prize for excellence in psychoanalytic scholarship. Her current research is on the subject-creating function of baby talk. Recommended Readings: M., Baranger, W., & Mom, J. 1983. Process and Non-Process in Analytic Work. International Journal of Psychoanalysis 64:1–15. Bass, A. 2007a. When the Frame doesn't Fit the Picture. Psychoanalytic Dialogues 17:1–27. Bleger, J. 1967. Psycho-analysis of the psychoanalytic frame. In Symbiosis and ambiguity: a psychoanalytic study, 1–13, trans. S. Rogers and edited by J. Churcher & L. Bleger. London: Routledge, 2013. Caper, R. 1992. Does Psychoanalysis Heal? A Contribution to the Theory of Psychoanalytic Technique. International Journal of Psychoanalysis 73:283–292. Donnet, J.-L. 2001. From the Fundamental Rule to the Analysing Situation. International Journal of Psychoanalysis 82:129–140. Ogden, T. H. 1992. Comments on Transference and Countertransference in the Initial Analytic Meeting. Psychoanalytic Inquiry 12:225–247. Roussillon, R. 2015. An Introduction to the Work on Primary Symbolization. International Journal of Psychoanalysis 96:583–594. Stern, S. 2009. Session Frequency and the Definition of Psychoanalysis. Psychoanalytic Dialogues 19:639–655

"This patient taught me a lot. The context was that I just finished my second training as a psychodynamic psychotherapist and I felt I needed to prove a lot, and I clearly arrived with the wrong agenda. It was that if I was good enough and smart enough, a clever enough just graduated psychodynamic psychotherapist, I would manage to get into why the patient is struggling so much with the realization of his mother's cancer. That is a resistance, he didn't want to touch the topic at all. I thought that if I uncover the underlying reason why the cancer of his mother was so extremely distressing, and be able to explore with him how he's processing this, I would be helping him. I was extremely wrong. The patient was really generous with me. What I meant is he was forgiving. He clearly was tolerating me trying to push for something he really had no appetite for." "Psychoanalysis is not only about clever interpretations. Psychoanalysis can be about the tools to help us feel what we are experiencing. And in those radical settings, you become almost the object you are projected to be and you need a frame of mind to ground you that you are not that and can offer something different. So that is why I thought it was really useful." Episode Description: We begin with a description of the distinction between supportive and exploratory psychotherapy. Rodrigo presents clinical examples of individuals who were in crises and their capacity to be aware of their inner experiences was not available to them, hence supporting their defenses was vital. In addition, "being with them" became a key aspect of the therapeutic benefit they gained. We consider patients who are phobic about intimacy and have backgrounds where trusting others proved to be actually dangerous. He also spoke of therapists who unknowingly privilege their own need to feel like an interpretive healer in the face of their patients' more immediate need to be listened to. Rodrigo alerts us to the risks of colluding with patients' binary view of the world and recommends helping them recognize that "the therapist may not always be on their side or share their perspective" - this is the creative challenge of supportive work. We close with his sharing with us his personal journey and his appreciation that psychoanalysis can be meaningful as well in settings 'off the couch'. Our Guest: Rodrigo Sanchez Escandón Trained as a Clinical Psychologist in Mexico City and completed his Psychoanalytic Psychotherapy training at the Mexican Psychoanalytic Association before moving to London to undertake further psychoanalytic training at the British Psychoanalytic Association (BPA). He is currently the BPA's Director of Curriculum Subcommittee. He is also the Course Lead for Adult Psychotherapies at the Tavistock and Portman NHS Foundation Trust, overseeing programmes in London and the North of England. He previously lectured in the Department of Psychosocial and Psychoanalytic Studies at Essex University, where he continues to supervise PhD students and pursue research. For seven years, Rodrigo worked extensively with individuals experiencing homelessness and complex needs, integrating psychoanalytic approaches into multidisciplinary care. He now maintains a private practice in Leeds, alongside his teaching and leadership roles. Recommended Readings: Winston, A., Rosenthal, R. N., & Roberts, L. W. (2020). Evolution of the concept of supportive psychotherapy. In Learning supportive psychotherapy: An illustrated guide (pp. xx–xx). American Psychiatric Association Publishing. Winston, A., Rosenthal, R. N., & Roberts, L. W. (2020). General framework of supportive psychotherapy. In Learning supportive psychotherapy: An illustrated guide (pp. xx–xx). American Psychiatric Association Publishing. Hellerstein, D. J., Rosenthal, R. N., Pinsker, H., & Klee, S. (1994). Supportive therapy as the treatment model of choice. American Journal of Psychotherapy, 48(1), 80–93. Sanchez Escandon, R. (2025). Introduction to the fundamentals of supportive therapy. In Contemporary developments in supportive therapy: Principles and Practice. Palgrave. Sanchez Escandon, R. (2025). Active and passive use of the transference. Contemporary developments in supportive therapy: Principles and practice. Palgrave.

"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 considerations. You can't just be out there like a windowless monad floating around. There are some core beliefs and values that anchor a person, that give them footing. So there's a difference between a totalizing worldview and a workable framework that's open to critique." Episode Description: We begin with a brief reading from On Transience and Ecclesiastes and consider how they both belong to 'Wisdom Literature' while separated by over 2000 years. Paul points out that while Freud works from a linear sense of time, Ecclesiastes (Kohelet) is drawn to the cycles of nature and human experience. He provides clinical examples that he feels are enriched by considering the teachings of Ecclesiastes which are very similar to the psychoanalytic way of thinking - "one must learn to live with what cannot be altered," the importance of the "downsizing of infantile narcissism," and recognizing that "pleasure and joy are palpable, sensual and concrete experiences." We discuss the importance of an object-related life that includes forgiveness and gratitude as well as "embracing resignation without despair." We conclude with the deeply moving time poem "To every thing there is a season/ and a time to every purpose under heaven..." Our Guest: Paul Marcus, PhD is a training and supervising analyst at the National Psychological Association for Psychoanalysis in New York and Co-chair of the discussion group Psychoanalysis and Spirituality in the American Psychoanalytic Association. He is the author/editor of 25 books including The Spiritual Resistance of Rabbi Leo Baeck: Psychoanalysis and Religion. He is the editor of Psychoanalytic Review. Recommended Readings: Seow, C.L. 1997, Ecclesiastes: A New Translation. New Haven: Yale University Press Fox, M. V., 2004, Ecclesiastes, Philadelphia: Jewish Publication Society Heim, K.M., 2019, Ecclesiastes, Downers Grove: IVP Academic

"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: Freud's technique papers. 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

"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 play fantasy creation coming up from fantasies of the patient, and our own reactions as analysts come into play and gradually just build up the story that is mainly related to the patient's biography, the patient's relationships, and what's going on in her or his life at the moment, but now in relation with us." Episode Description: We recognize the passionate political world we are living in and the challenges it introduces into the psychoanalytic relationship. Such moments of intense personal conviction challenge the clinician's capacity to hold those convictions, allow the same for the analysand and still locate an analytic surface with which to find additional meanings. Heribert feels that this creates opportunities for intensity akin to "erotic-sexual impulses." He discusses clinical encounters that include his "revealing my assessment of reality" as an aspect of his authentic self living in relation to the patient. He presents the case of a young man whose effort to locate his analyst's "soft spot" entailed provoking him with his idealization of Hitler. Unlike the patient's father who turned away from him at such times, his analyst tolerated "my required countertransference" which enabled the patient to recognize and tolerate his tender longings that had lived disguised in his sado-masochistic preoccupations. We close with Heribert, the new IPA president, sharing his vision of psychoanalysis having a presence beyond the couch in universities and the community at large. Our Guest: Heribert Blass, Dr. Med. (MD), Psychoanalyst and training analyst for adults, children and adolescents, member of the German Psychoanalytic Association and IPA (DPV/IPA), also specialist of psychosomatic medicine and psychotherapy, psychiatry, working in private practice in Düsseldorf, Germany. Since August 2025 President of the International Psychoanalytical Association (IPA). From 2020 to 20204 President of the European Psychoanalytical Federation (EPF). He has published on the image of the father, male identity and sexuality, gender dysphoria and transidentities, aspects of thought function in the psychoanalytic process and in the institution, psychoanalytic supervision, psychoanalysis in society and as editor of a book on Time and the Experience of Time (first in German, the English publication will follow soon) about the exchange of psychoanalysis with other sciences. Recommended Readings: Blass, H. (2023). La actitud analítica en un contexto de creencias polarizadas en la consulta. In: La Cultura del Odio. El Odio a La Diferencia. Revista de Psicoanálisis de La Asociación Psicoanalítica de Madrid, Vol 38, Nr. 98, p.439-458 (ISSN: 1135-3171) Blos, P. (1962). On Adolescence. A Psychoanalytic Interpretation. New York: The Free Press Blos, P. (1985). Son and Father. Before and Beyond the Oedipus Complex. New York: The Free Press Freud, S. (1915). Observations on Transference-Love (Further Recommendations on the Technique of Psycho-Analysis III). S.E. 12:157–171. Gabbard, G. O. (1995). Countertransference: The Emerging Common Ground. International Journal of Psychoanalysis 76:475-485 Greenson, R.R. (1974). Loving, Hating and Indifference Towards the Patient. International Review of Psychoanalysis 1:259-266 Heimann, P. (1950). On Counter-Transference. International Journal of Psychoanalysis 31:81-84 Loewald, H. W. (1975). Psychoanalysis as an Art and the Fantasy Character of the Psychoanalytic Situation. Journal of the American Psychoanalytic Association, 23:277–299. Tuckett, D. et al. (2024). Knowing What Psychoanalysts Do and Doing What Psychoanalysts Know. London: Rowman & Littlefield

"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 it works, how it contributed, and also complemented the article in the sense that it was something that was quite outside of the box, so outside of the typical surgical publication." - FV "How can we reach surgeons? How can we make this interesting and attractive for them to even consider? I think most surgeons will be very performance-driven people, and I think that it goes hand in hand that that type of person will seek ways to improve themselves, but probably more in a technical way. Let's say they want to get faster in their operations. They want to get more skillful. They want to do more complicated surgeries. So there's a lot about self improvement in that you exercise until you master something. And I think that analogy with sports was our way of saying, hey, you know, this is actually pretty cool. You can compare yourself to professional athletes, in terms of self improvement, and this is actually one way you can get there, how you can improve. At the same time, it was also important for us to acknowledge that it's not for everyone so we also mentioned alternatives, of course." - MV Episode Description: Mauro and Flavio begin by describing the encouragement they received from their father to pursue personal analysis "to explore our unconscious minds for a lighter life and less emotional baggage." They share their psychoanalytic journeys and give examples of how their greater capacity to reflect instead of react has led to improved surgical patient outcomes. They also describe collegial tensions that were more clearly addressed through their ability to authentically know how they felt. They recommend that like elite athletes who have sports psychologists to address obstacles to their performances, so might surgeons appreciate the utility of psychoanalysis and other measures to improve their clinical attunement. Mauro concludes "Everyone has their baggage - don't be afraid to look at it and to understand what's going on. It's worth it." Our Guests: Flavio Vasella, MD PhD, is a junior attending neurosurgeon at the University Hospital Zurich, with a clinical and research focus on neurosurgical oncology. He earned his PhD in Molecular Life Sciences at the University of Zurich, where his research explored genome editing strategies in primary brain tumors. His primary academic interests include translational and clinical neuro-oncology as well as surgical education. Mauro Vasella, MD, is a board-certified plastic surgeon with multiple years of clinical experience specializing in reconstructive surgery. He is affiliated with the University Hospital Zurich in Switzerland and the Royal Melbourne Hospital in Australia and has held positions as a fellow and attending surgeon. His practice and research field focuses on regenerative-reconstructive surgery and burn injuries. Recommended Readings: FV - Paul Kalanithi – When Breath Becomes Air This memoir by a neurosurgeon-turned-patient is a poetic and piercing meditation on mortality, identity, and the transition from doctor to patient. It explores the tension between the analytical and emotional mind (somewhat paralleling the internal work of psychoanalysis) and offers profound insight into the humanity at the core of medical practice. Bill George – True North: Discover Your Authentic Leadership This book presents a leadership philosophy rooted in self-inquiry, values, and life stories. True North emphasizes that effective leadership comes from understanding your life narrative and using that insight to lead with integrity and resilience. True North challenges leaders to cultivate authenticity by exploring their internal landscape. While the book focuses on leadership in a business context, it offers a compelling, practical perspective for medical professionals as well. Atul Gawande – Complications: A Surgeon's Notes on an Imperfect Science Gawande offers a candid look at the uncertainties, dilemmas, and emotional burdens of being a surgeon. His reflection on fallibility and decision-making underlines the importance of non-technical skills and the internal work required to become not just competent, but humanely attuned, in medicine. The impact of nontechnical skills on technical performance in surgery: a systematic review. Hull L, Arora S, Aggarwal R, Darzi A, Vincent C, Sevdalis N. J Am Coll Surg.2012 This systematic review analyzed 28 studies linking surgeons' non-technical skills—such as teamwork, situational awareness, and stress management to actual technical performance in the operating room. It found evidence that effective NTS positively affects outcomes, while fatigue and communication failures contribute to technical errors. MV - The Art of Loving – Erich Fromm Realizing the simple but somehow not always obvious fact that before being able to truly love someone, one must truly find themselves loveworthy. This implies and demands introspection, as well as forgiveness towards yourself and others. Outliers: The Story of Success – Malcolm Gladwell To master something, one must invest a substantial amount of time and dedication – this is not only true for technical skills, but also non-technical skills. Personal growth is only possible if you invest time, such as undergoing a psychoanalysis or similar. The Checklist Manifesto – Atul Gawande While the checklist itself is very technical, the way it was conceived and its effect was and still is rather non-technical. It is a question of putting your ego aside and truly focusing on areas which you can improve.

"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, I think this is something that is just interesting. I wanted to write about affairs because I think they are a way of showing what psychoanalysis can do in a field in which everyone has an opinion on, and probably most people, in some way, have been indirectly or directly affected by. That was really the sort of the genesis for wanting to write about affairs." Episode Description: We consider the challenge of writing about dynamic treatments in a manner that is accessible to the non-clinical reader. Juliet's book about affairs opens up this widely recognized experience and adds intrapsychic insights without using emotionally - distancing jargon. She introduces us to individuals who have been involved in affairs, with carefully protected confidentiality, who generally reveal the power of past experiences to influence adult choices. Some end happily, and some end in agony. Juliet demonstrates the usefulness of bringing a dynamic listening to both accepting and deepening each individual's lifelong search for love. Our Guest: Juliet Rosenfeld is a psychoanalyst and a member of the British Psychoanalytical Society, London. She studied at Oxford before a 15-year career in advertising and marketing, ending up in Government Communications. During this time, she began a Master's at the Tavistock and Portman Trust in Organizational Consultancy and started training as a psychotherapist a year later. She qualified as an integrative psychotherapist in 2012. Juliet was an elected trustee of the UK Council of Psychotherapy for four years, and is presently one of two clinician Trustees at the Freud Museum London, Sigmund Freud's final home. Juliet is the author of two books, The State of Disbelief ( 2020) and Affairs, True Stories of Love, Lies, Hope and Desire. Juliet's broader interest is in how psychoanalysis might be more accessible, and its ideas put into non-clinical language for audiences who may never be able to access psychotherapy themselves but are curious about what the unconscious means and what goes on in the consulting room. Recommended Readings: Creativity and Perversion by Janine Chasseguet-Smirgel (W. W. Norton & Co., Inc., 1984) Dreams of Love and Fateful Encounters by Ethel S. Person (American Psychiatric Association Publishing, 2006) Home Is Where We Start From by D. W. Winnicott (Penguin, 1990) Love in the Time of the Internet by Martina Burdet (underbau, 2020) Sex, Death and the Super Ego by Ronald Britton (Routledge, 2020) Sexual Attraction in Therapy edited by Maria Luca (Wiley-Blackwell, 2014) Sexuality and Attachment in Clinical Practice edited by Joseph Schwartz and Kate White (Routledge, 2019) The Bonds of Love by Jessica Benjamin (Knopf Doubleday Publishing Group, 1988) The New Sexual Landscape and Contemporary Psychoanalysis by Danielle Knafo and Rocco Lo Bosco (Confer Books, 2020) Novels about Affairs Anna Karenina by Leo Tolstoy (Penguin Classics, 2003) A Very English Scandal by John Preston (Penguin, 2017) Deception by Philip Roth (Vintage, 1991) Getting Lost by Annie Ernaux (Fitzcarraldo Editions, 2022) Madame Bovary by Gustave Flaubert (Wordsworth Editions, 1993) Middlemarch by George Eliot (Wordsworth Editions, 1993) The End of the Affair by Graeme Green (Vintage Classics, 2004)

"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 has been transmitted by the analyst or by the psychoanalytical setting, is something that the other doesn't have. It's a kind of void. It's a kind of fire. It's like the baton that every runner passes to others in a relay race. It is something more difficult to be grasped with words, is something elusive to words, but it does exist." Episode Description: We begin with describing the 'necessary foreignness' of psychoanalysis, "It is from both a foreign perspective and foreign listening that makes it possible to notice the concealed underpinnings, to discover the new, and to express the unexpressed." We consider the clinical asymmetry that allows for the patient's unbridled freedom to think and speak the unspeakable. Educationally, Mariano discusses the essential transmission of analytic experience as contrasted with the teaching of knowledge - a distinction between science and mystery. He shares his thoughts on eclectisism, hypothesis testing and risk. We close with recognizing that the "anachronistic method of psychoanalytic listening is the most authentic way of being contemporary." Our Guest: Mariano Horenstein, PhD is a training and supervising analyst who belongs to the IPA, FEPAL (Latin American Psychoanalytical Federation), and the international research group "Geographies of Psychoanalysis". He is an IPA Board member and a former chief editor of Calibán, the official Journal of FEPAL. Former Training Director of APC (Argentina). His articles have been translated into Portuguese, English, Farsi, French, Russian, Italian, Portuguese and German. Author of four books :Psychoanalysis in Minor Language, The Compass and the Couch. Psychoanalysis and its Necessary Foreignness, Funambulistas. Travesía adolescente y riesgo and Artists, Writers and Philosophers on Psychoanalysis. From the Couch. He has received international awards as M. Bergwerk (about the clinic forms of Evil), Lucien Freud (about Psychoanalysis and Culture); Elise Hayman Award for the study of Holocaust and Genocide (given by the IPA); A. Garma (given by the Spanish Association of Neuropsychiatry); the FEPAL Award and Carolina Zamora Award (given by Madrid Psychoanalytical Association). http://www.marianohorenstein.com/ Recommended Readings: Horenstein, Mariano, The compass and the couch. Psychoanalysis and its necessary foreignness, Mimesis, Milan, 2018. Horenstein, Mariano, Artists, writers and philosophers on Psychoanalysis. From the couch, Routledge, London, 2024. Horenstein, Mariano, Psicoanálisis en lengua menor, Viento de Fondo, Córdoba, 2015. Preta, Lorena (ed), Dislocated subject, Mimesis, Milan, 2018. Preta, Lorena (ed), Geographies of Psychoanalysis, Mimesis, Milan, 2015. Preta, Lorena, The brutality of things. Psychic transformations of reality, Mimesis, Milan, 2019. Wohlfarth, I., Hombres del extranjero. Walter Benjamin y el Parnaso judeoalemán, Taurus, CDMX, 2014.

"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 acknowledge Loewald's concept of 'ghosts becoming ancestors' and consider the similarities and differences with those who hold 'ghosts' to be literal. Shalini shares with us her journey to open herself to the uncertainty and ambiguity of these externalized entities while appreciating both their cultural and intrapsychic sources. We learn of her family's involvement with exorcisms, especially her grandmother's "fearless warmth" and "empathy that saw beyond the terror of the ghosts." She considers the many facets of mind that are represented by 'ghosts' and the essential value of approaching them as guides to the "landscape of the unspoken." Shalini describes a long term engagement that she had with an individual who "taught me to receive the inchoate and horrific...to contain the brokenness and not interpret it away.. and to appreciate the glimpses of beauty in the most grotesque parts of self." Our Guest: Shalini Masih, a psychoanalytic psychotherapist and writer, grew up in India amidst priests and healers, witnessing spirit possession and exorcism. Now based in Worcestershire, UK, she holds a Master's degree in Psychoanalytic Studies from Tavistock & Portman, London, and a PhD from the University of Delhi. Mentored by psychoanalysts Michael Eigen and Sudhir Kakar, she's an award-winning scholar of the American Psychological Association. She has taught and supervised psychoanalytic psychotherapists in Ambedkar University, Delhi and in Birkbeck, University of London. Her acclaimed paper, 'Devil! Sing me the Blues', was nominated for Gradiva Awards in 2020. Her debut book is Psychoanalytic Conversations with States of Spirit Possession: Beauty in Brokenness. Recommended Readings: Kakar, Sudhir. Shamans, mystics, and doctors: A psychological inquiry into India and its healing traditions. Chicago, IL: University of Chicago Press, 1991. Kakar, Sudhir. Mad and Divine. India: Penguin Books India, 2008. Eigen, Michael. "On Demonized Aspects of the Self" In The Electrified Tightrope. Routledge. 2018. Kumar, Mansi, Dhar Anup & Mishra, Anurag. Psychoanalysis from the Indian Terroir: Emerging Themes in Culture, Family, and Childhood. New York:Lexington Books, 2018. Meltzer, Donald, and Williams, Meg H. The apprehension of beauty: The role of aesthetic conflict in development, art and violence. Karnac, London: The Harris Meltzer Trust, 2008. Obeyesekere, Gananath. Medusa's Hair: An Essay on Personal Symbols and Religious Experience. Chicago, IL: University of Chicago Press, 1981. Ogden, Thomas. This Art of Psychoanalysis—Dreaming Undreamt Dreams and Interrupted Cries. East Sussex: Routledge, 2005 Botella, Cesar, and Botella, Sara. The Work of Psychic Figurability: Mental States without Representation. Brunner-Routledge. Taylor and Francis Group: Hove and New York. 2005. Winnicott. Donald W. "Transitional objects and transitional phenomena." International Journal of Psycho-Analysis, 34, (1953): 89–97

"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 is also one of the words that in our analytic world became more and more common and utilized because we have achieved the certainty that there can be a transformation. Not only an understanding or a clarification, but also a transformation of the quality of the objective world and of the relation with it." Episode Description: We begin by describing the differences in psychoanalytic approaches today as compared to past generations. This shift has occurred alongside changes in patients' concerns; currently, individuals are disproportionately preoccupied with how they perceive themselves through others' eyes, rather than grappling with internal conflicts related to guilt. Stefano posits that this increased narcissistic investment stems from alterations in family structures and premature disruptions in "the physiological fusionality" with the early maternal caretaker. We discuss how this sense of distrust in the availability and reliability of caretakers affects the manner in which one introduces a patient into analysis, as well as the broader cultural emphasis on superficial bodily care - what he terms the aperitif experience. We consider the fundamental importance of the depth of object relations in understanding sexual diversities. Stefano concludes by reading the final paragraph from his book, which acknowledges the invaluable lessons learned from his analyst. We reflect on the enduring presence within him of this profoundly personal connection. Linked Episodes: Episode 140: Are Patients Different Today? with Stefano Bolognini, MD (Bologna) https://youtu.be/rjzpA8QZrWk?si=Srf_Tuxt0zTpsKNK Our Guest: Stefano Bolognini, MD, is a psychiatrist and training and supervising analyst of the Italian Psychoanalytic Society (SPI), where he served as president (2009-2013). He also was an IPA Board member (2002-2012) and was IPA president from 2013-2017. He was a member of the European Editorial Board of the International Journal of Psychoanalysis and a founder of the IPA Inter-Regional Encyclopedic Dictionary of Psychoanalysis. He has published over 280 psychoanalytic papers, and his books on empathy and on the inter-psychic dimension have been translated into several languages. Recommended Readings: Bolognini, Stefano - Secret Passages. The Theory and Technique of the Interpsychic Relations. IPA New Library, Routledge, London, 2010 https://www.amazon.com/Vital-Between-Non-Self-Library-Psychoanalysis/dp/1032132973, Routledge, London, 2022 https://pubmed.ncbi.nlm.nih.gov/21387998/ Psychoanal. Quart., vol. LXXX, 1, 33-54, 2012. Enchantments and disenchantments in the formation and use of psychoanalytic theories about psychic reality. The Italian Psychoanalytic Annual, 13, 11-24, July 2019. New forms of psychopathology in a changing world: a challenge for psychoanalysis in the twenty-first century. The Italian Psychoanalytic Annual, 2020. Reflections on the institutional Family of the Analyst and proposing a "fourth Pillar" for Education. Opportunities and problems of transferal dynamics in the training pathway". In Living and containing Psychoanalysis in Institutions. Psychoanalysts Working Together, edited by Gabriele Junkers, 89-104, Taylor & Francis, 2022. From What to How : A Conversational with Stefano Bolognini on Emotional Attunement by Luca Nicoli & Stefano Bolognini. The Psychoanalytic Quarterly, 91 : 3, 443-477, 2022. The Interpsychic, the Interpersonal, and the Intersubjective: Response to Steven H. Goldberg's Discussion. The Psychoanalytic Quarterly, 91:3, 489-494, 2022. Hidden unconscious, buried unconscious, implicit unconscious. The Italian Psychoanalytic Annual, 16, 87-102, 2022.