Robert Aberg, Ph.D.

Dr. Robert Aberg will offer the next presentation in DSPP's series on Finding and Being Found: Self and Other Through the Life Span at our January meeting. Dr. Aberg's presentation, The Other in Love, will explore the paradoxical nature of intimate, loving relationships where the inner object world becomes co-mingled with the reality of the other. He will be looking at some traditional versus more current formulations of the dynamics of loving relationships. Dr. Aberg has subtitled his talk: "Is You Is or Is You Ain't My Baby?"

Dr. Aberg has ably served DSPP in many capacities. Previously Program Chairman, Division 39 Representative, and President Elect, he is currently serving as President of DSPP. He has also presented at DSPP on numerous occasions.

Dr. Aberg holds a Ph.D. from the University of Texas Southwestern Medical Center at Dallas, where he has an appointment as Clinical Assistant Professor in the Department of Psychiatry, Division of Psychology. He is a clinical psychologist in private practice in Dallas and focuses on the treatment of children and adolescents. Dr. Aberg also maintains a career as a jazz musician. The Robert Aberg Trio has just released a new CD called Degrees of Freedom.

Topic: The Other in Love

EDWARD R. SHAPIRO, M.D.

reviewed by

Myrna Little, Ph.D.

Dr. Edward Shapiro, medical director and CEO of the Austen Riggs Center in Massachusetts and director of the Erik Erickson Institute for Education and Research, brought his finely honed integration of psychoanalytic treatment and organizational dynamics to DSPP's Fall Workshop in his presentation, Lost in Familiar Places. Observing that the meeting room was arranged to induce passive rather than active learning, he nevertheless engaged workshop participants in a very lively, interactive discussion of the analytic task in the present cultural context.

Dr. Shapiro began by noting that a massive, cultural shift has been occasioned by the rise of a "totalitarian" system of managed care. Today, the analytic dyad inevitably operates in a context significantly impacted by this shift. Treatment paradigms are changing. As clinicians, we may feel "lost in familiar places." Resources are strictly limited. Managed care does not take care of patients by providing refuge and asylum. The treatment paradigm has shifted from classical concerns with neurotic symptoms in patients who present with internal conflicts for which they take responsibility, to the treatment of character disorders marked by ego syntonic psychopathology for which the patient does not take responsibility.

Dr. Shapiro maintained that the frame for the psychoanalytic dyad has changed as well; until the therapeutic task is understood in the context of the larger, cultural shift, we cannot lean on our previous professional understanding of the frame for guidance. The salient question becomes: What are the boundaries within which we make interpretations?

Shifting to his own contextual setting, the Austen Riggs "laboratory", which may be the only long-term treatment center left in America, Dr. Shapiro described the treatment program for resistant patients with as many as 100 previous short term, ineffective treatments. The therapeutic milieu is composed of 1) an open, unlocked treatment setting, 2) a therapeutic community with considerable patient authority, 3) an activities program which provides an "interpretive-free zone" for expression, 4) intensive psychotherapy four times/week, and 5) collaborative resource management, an interesting feature of the program where clinicians and business people work with the patient to manage limited financial resources as effectively as possible. For the staff at Austen Riggs, the idea of limited resources is both an external reality and a metaphor - limited financial resources compose external reality, while the metaphor consists of what the patient makes of limited resources, i.e., what is the meaning of limited resources?

Focusing next on the technology, or the structure of the psychodynamic task, Dr. Shapiro discussed three essential and interlocking components of that task: projective identification, enactment, and the holding context as the "third."

Projective Identification: Differentiating projective identification as a behavior, from Melanie Klein's view as unconscious phantasy only, Dr. Shapiro elaborated the essential characteristics of projective identification: 1) projection of a dystonic aspect of the self, 2) a "hook", i.e., the capacity to scan the human environment to find an aspect of the other corresponding to what can't be tolerated in the self, 3) willingness of the other, 4) an enduring relationship, 5) conscious disavowal of the projected aspect, 6) unconscious identification with the projected aspect, 7) behavior that induces data from the other that becomes confirmation of the projection, 8) selective inattention, 9) pathological certainty, and 10) complementarity.

Dr. Shapiro then demonstrated from his own case material how these mutual projections function reciprocally in marital couples in their fixed, irrational roles. Focusing on the consequent pathology enacted in the hospitalized, adolescent daughter of such a couple, he presented both the relevant family sessions and the pivotal individual interactions of himself and the identified patient. The audience was asked to decipher what was projected, resisted, and acknowledged. In this way, participants experienced the dramatic moment in which the patient "treated" her doctor, who was trying to "correct" the patient's reality. It was a tense moment in which the patient was the first to own responsibility, saying "... I know I...".

Enactment: By demonstrating this "shared burden" in the therapeutic context, Dr. Shapiro also experientially elaborated his "paradigm for enactment." Enactment differs from both acting out and projection. It is defined as the "shared regression in service of a task, a non-verbal interaction with unconscious meaning to both." For the therapist, these projections are derived from childhood ("blind spots") or from lack of training ("dumb spots"). Enactment, Shapiro believes, occurs when the therapist does not have the right structure for understanding the transference, and either "actualizes" or "refuses" the projection(s). For example, the abuser-transference is refused with reassurance and actualized by denial; the victim- transference is refused by an angry lecture, while actualized through masochistic surrender; the abandoning-mother transference is refused by reassurance and coddling, while actualized in the inability to tolerate details of the abuse.

The Holding Context: The Third : The alternative to enactment is the "holding" of the projections within the transference, which becomes the "sanctuary" for both patient and therapist to regress, and then to find understanding. Dr. Shapiro suggested that we think of psychopathology as a central dynamic, which may shift; that we recognize enactment as inevitable in all treatment; and that we remember that the burden of the work is shared. "If you hold the notion of projective identification, you get allies."

Clinical illustrations were followed by a lively and intense discussion of the issues raised by Dr. Shapiro's presentation. The discussion touched upon: the acknowledgment of bi-directional inducements of psychopathology in clinician and patient ("We create pathology all the time when we get it wrong."); the inevitability of "getting it wrong" and our concomitant task of grasping the interactive pressures; the differentiation of "identification with the aggressor" as intrapsychic, in contrast to "projective identification" as intersubjective; etc.

In the afternoon, Dr. Ronald Schenk presented a case which aptly demonstrated being "lost in familiar places." Using the audience as "supervisor" to the therapist, and himself as consultant to the supervisors, Dr. Shapiro discussed the parallel processes occurring. Not only did the patient seem lost, but we, the supervising audience, could make little sense of the process because the therapist was lost in the patient's unconscious reenactments. While audience members questioned the advisability of the case, Dr. Shapiro described the case as ordinary in a world of overlapping contexts and complemented Dr. Schenk on being the first person in the patient's life who had struggled to hold and examine the interactive pressures. He concluded with a quote from Semrad: "The analytic task is to acknowledge, to bear, and to put into perspective painful life experiences."

COMPETITION

Submission deadline is March 15, 1999.

For information and entry forms,

See the DSPP Web Site at

http://www.dspp.com

ARTS COMMITTEE EVENTS

5:00 P.M.

Readings will be excerpts from the recently published memoir, Summer of Deliverance, by journalist, Christopher Dickey. The memoir is about Dickey's lifelong struggle in his relationship with his brilliant, difficult, self-centered, alcoholic father, prize-winning poet and novelist James Dickey. Selections from James Dickey's writings will also be read.

Winter food and drink will be provided along with fire, pillows and blankies.

Home of Judith Samson, Ph.D.

5741 Glen Falls Lane

Dallas, TX 75209

214 750 7692

1986 Academy Award Best Foreign Film.

This Dutch film begins during the occupation of Holland. One night a child is traumatized. He is separated from his family. He witnesses horrors. He is jailed and then set free. The film depicts his attempts to undo the trauma through all his life experiences.

hosted by

Salomon Grimberg, M.D.

602 Monte Vista

Dallas, Texas 75214

214 321 6887