On Treating the Severely Disturbed Patient
Heitor de Paola,
M.D
.
Rio de Janeiro,
Brazil
with
The Boyer House Foundation
Saturday,May 15, 1999
Miyako Hotel
Sakura Room
1625 Post Street
San Francisco
9— 9:30
Registration
9:45
Welcome and Introduction
10:00
Introduction of Dr. de Paola
On Working Through the
Paranoid-Schizoid Postion in the Transference and
Countertransference
11:00
Introduction of Dr. Dithrich
12— 1:30
Lunch (
Restaurants within
walking distance
)
1:30
Introduction to Boyer House
Foundation
1:45
Case Presentation to Dr. de
Paola
3:00
Dialogue with Boyer House
Foundation Consultants
4:30
End of Day
Scott Lines, Ph.D.
Laurette Schiff Gennis, Ph.D
Heitor de Paola, M.D.
Billie Lee Violette, LCSW
Discussion
Charles Dithrich, Ph.D.
Audience discussion
Sue von Baeyer, Ph.D.
Beth Steinberg, Ph.D.
Phillip Erdberg, Ph.D., Mardy Ireland, Ph.D., Peter
Goldberg, Ph.D.
Audience discussion
For well over 30 years L. Bryce Boyer,
M.D
. has written extensively on his work
with seriously disturbed patients. Dr. Boyer’s work developed at
a time when traditional psychoanalysts in the United States felt
strongly that psychoanalysis was not suitable to the treatment of
seriously disturbed and psychotic patients. However, Dr. Boyer, among
other pioneering psychoanalysts, attempted to understand and treat
these disorders using psychoanalytic theory and technique with very
few parameters, and over the years, pockets of clinical settings have
emerged where clinicians have attempted to treat these patients using
psychoanalytic means. One such setting that has been established is
the Boyer House Foundation, a unique Assisted Independent Living
program that provides psychoanalytic treatment within a
multidisciplinary context to severely disturbed patients. The
Foundation is named after L. Bryce Boyer, M.D. in a tribute to his
innovative and courageous work.
Latin American psychoanalytic
thinking
, heavily influenced by Klein
and Bion, has long been in the forefront of work with severely
disturbed patients. Over the years, L. Bryce Boyer, M.D. has formed
close ties with his Latin American colleagues, as both shared the
belief in the crucial importance of how the analyst uses his or her
own conscious and unconscious responses to the patient, whether
psychical or somatic, verbal or nonverbal. Heitor de Paola, M.D. has
written:
Psychotic transference is regarded as a survival of primitive modes of communication, defense mechanisms and behaviors that are presented in the analytic process through nonverbal means. Psychotic patients usually create a very powerful emotional atmosphere in the analytic setting, and by projective identification, stir up strong emotions and sensations. . . . The analyst must be most alert to be able to differentiate between his own feelings and those that are projected into him in the patient’s phantasy if he is to help the patient recognize himself as a separate person.
From this perspective, the understanding of
the countertransference is of comparable importance to and
inseparable from the analysis of the transference in work with
severely disturbed patients. Dr. de Paola and his Kleinian Brazilian
colleagues have devoted much of their thinking to the use of
countertransference and projective identification in the
understanding and treatment of severely disturbed patients.
In this special one-day
symposium
, Dr. de Paola will present
clinical material on a disturbed patient, incorporating theoretical
contributions of Klein and Bion with technical approaches to the
countertransference as characterized by Dr. Boyer. Dr. Charles
Dithrich, long associated with Dr. Boyer’s work, will discuss
Dr. de Paola’s ideas. In the afternoon, a patient from Boyer
House will be presented to Dr. de Paola. Finally, clinical staff and
analytic consultants from Boyer House Foundation will discuss this
patient from the unique standpoint of the Boyer House clinical case
conference, which focuses on countertransference, projective
identification and the inevitable parallels of patient dynamics in
the group process.
|
L. Bryce Boyer, M.D . has worked for over 50 years in the treatment of severely disturbed patients and in the education and training of clinicians. He has authored or coauthored numerous books and articles, including Technical Factors in the Treatment of the Severely Disturbed Patient, The Regressed Patient, and Psychoanalytic Treatment of the Schizophrenic, Border- line and Characterological Disorders. His latest book, Countertransference and Regression, has just been published by Aronson. He is the co- editor of The Psychoanalytic Study of Society (with his wife Ruth) and Master Clinicians on Treating the Regressed Patient, Volumes I and IL Various of his works have been translated into seven languages. He is Co-Director of the Center for the Advanced Study of Psychoses, San Francisco, and founding Director of the Boyer Research Institute, Berkeley. Dr. Boyer maintains a private practice in Berkeley, which includes supervising and teaching the staff at The Boyer House Foundation. |
Presenters
:
Heitor de Paola,
M.D
.
—has been working as a
Kleinian analyst for over 20 years in Rio de Janeiro, Brazil, and is
a renowned expert on psychoanalytic treatment of severely disturbed
patients. He is a close colleague and devoted friend of L. Bryce
Boyer, and for many years the two have worked and thought
collaboratively on the treatment of severely disturbed and psychotic
patients. Dr. de Paola is a Training Analyst and Supervisor at the
Institute of the Brazilian Psychoanalytic Society of Rio de Janeiro.
He has studied with Wilfred Bion, Herbert Rosenfeld and Betty Joseph,
among others, and has taught and lectured widely on such topics as
theoretical and clinical studies on psychosis, critical and
comparative studies on the work of Melanie Klein, and psychoanalytic
technique. He has published papers in the
International Journal of
Psychoanalysis
, the
Brazilian Psychoanalytic Review
,
chapters in
Master Clinicians on Treating the Regressed
Patient
,
Brazilian Psychoanalysis
, and David
Rosenfeld’s
The Psychotic Aspects of the Personality
.
Sue von Baeyer,
Ph.D
.
—Director of
Training and Education, Boyer House Foundation; Affiliate Member, San
Francisco Psychoanalytic Institute;
teaching faculty, Westside Crisis Clinic; private practice,
Berkeley.
Charles Dithrich,
Ph.D
.
— Core Faculty,
Personal and Supervising Analyst, Psychoanalytic Institute of
Northern California; Co-Director of the Boyer Research Institute;
private practice in Oakland.
Phillip Erdberg,
Ph.D
.
, ABPP — Director
of Research, Boyer House Foundation; Past President, Society for
Personality Assessment and 1995 recipient of the Society’s
Distinguished Contribution Award; author of several current chapters
on the Rorschach.
Peter Goldberg,
Ph.D.
— Faculty, Supervising
and Personal Analyst, Psychoanalytic Institute of Northern
California; Member and Teaching Faculty at the San Francisco
Psychoanalytic Institute; Faculty at UCSF/Mt. Zion and the Wright
Institute; private practice in Berkeley.
Mardy Ireland,
Ph.D
.
— Founding
Member, Lacanian School of Psychoanalysis; Faculty, Psychoanalytic
Institute of Northern California, Santa Clara University; Clinical
Supervisor, Boyer House Foundation, St. Mary’s Hospital-McAuley
Institute, UCSF/Mt. Zion; private practice, Berkeley.
Beth Steinberg,
Ph.D
.
— Chief Psychologist,
Boyer House Foundation; supervising faculty at UCSF/Mt. Zion and the
Wright Institute; private practice in San Francisco.
Registration
Name :
Address:
City:
Telephone:
Fees:
Advanced registration advised,
as space is limited.
___Members of NCSPP or
PINC
$80
___Non-Members
$100
___Associate
Members/Students
$25
On-site
registration:
___Members
$95
___Non-Members
$115
___Associate
Members/Students
$30
Payment by check or money order required for advanced
registration
Amount Enclosed: _______________________
Please mail your registration and a check payable to NCSPP to :
Cancellation:
No refund for
cancellation.
Parking
: Parking garage entrance located on Post or Geary
between
Laguna & Webster
CE credit for psychologists, MFCCs and LCSWs:
Pending (NOR017) 5 hours for each event.
The Northern California Society for
Psychoanalytic Psychology
is
committed to the study of psychoanalytic psychology and the
encouragement of its interest in the professional and general
communities. It is a multi-disciplinary, non-profit educational
membership organization open to all mental health professionals with
a minimum of a master’s degree.For information call (415)
957-3639.
The Psychoanalytic Institute of
Northern California
was established
in 1989 as a center for comparative psychoanalytic inquiry, research
and training. The Institute provides professionals from all mental
health disciplines and academia the opportunity to study the full
scope of psychoanalytic theory and practice.For information or
referral call (415) 922-4050.
The Boyer House
Foundation
is a
private, non-profit organization providing comprehensive long-term
treatment to adults with severe psychiatric problems. The therapeutic
program integrates intensive psychoanalytic individual and group
psychotherapy with a highly focused milieu treatment and a
therapeutic living situation. In addition, research and educational
activities are designed to improve the understanding and treatment of
severe mental illness.
For information or referral call (415) 456-9958
The Intensive Study Groups
San Francisco and the East Bay
Fall 1998 through Spring 1999
For the second year the Intensive Study Groups will focus on the development of Kleinian theory and technique.
The Kleinian Development
The evolution of psychoanalytic theory and technique in the
Kleinian development will be followed this year in an in-depth study
of three basic tenets of psychoanalytic metapsychology: Transference
and Countertransference, the Oedipus Complex and Psychosis.
Transference-Countertransference
In this section, we will follow the
transformation of the fundamental analytic notions of transference
and countertransference. Freud's view of transference stressed the
historical roots of the patient's use of the analyst. Transference
was viewed as interference in the recovery of repressed memories.
Melanie Klein brought transference into the present' postulating that
the patient lives out with the analyst not only aspects of
relationships with particular external objects of the past but also
more complex "internal" object relationships. Transference came to be
viewed as useful to the analytic process. Bion's emphasis on the
nature of the interaction between the members of the analytic couple
expanded Klein's view of transference. Bion described transference as
the formation or destruction of an analytic couple in each moment of
the analytic session.
The growing emphasis on transference as revealed through the
interaction of analyst and patient has given rise to the importance
and study of countertransference -- that is, the complexities of the
analyst's response lo the analytic situation. The development of the
ideas of projective identification and projective
counter-identification further elaborated our understanding of
countertransference.
The Oedipus Complex
In this section, we will study the
transformation and evolution of analytic conceptions of the Oedipus
complex, and how this evolution has impacted notions about analytic
technique. The evolution of the Oedipus complex in the Kleinian
development revealed new ideas about the nature of the superego and
its relation to psychic growth. The Freudian Oedipus complex, based
on the vicissitudes of the instincts in psychic development,
postulated the superego as the outcome of a successful working
through of conflicts related to the sexual parental couple.
Melanie Klein brought the instincts into the sphere of object
relations and described an early oedipal conflict, characterized by
the phantasy of a combined-parent figure and a primitive superego.
She stated that the ability to achieve whole object relations is
intrinsically linked with the working through of the early Oedipus
complex and the amelioration of the primitive superego through the
depressive position. Bion placed the Oedipus complex even earlier
than Klein. He hypothesized an innate oedipal preconception, raising
the issue of how a couple itself is formulated.
Psychosis
In this section' we will study how the notion
of psychosis has been expanded and through this expansion has
significantly changed the nature of the analytic process itself, as
well as the range of patients thought to be amenable to analytic
treatment. Freud viewed psychosis as restitution; that is, the
attempt by the patient to restore a destroyed object by substituting
in its place a pathological phantasied construction. He considered
psychotic conditions to be unanalyzable, stating that the psychotic
patient was unable to form a transference because of an incapacity to
form an object relation. Klein transformed the notion of psychosis by
describing primitive internal object relations She stated that
psychotic Anxieties existed in every infant, postulating a
paranoid-schizoid position. The analyzing of psychosis was thus
brought into the sphere of the analytic process. Bion described both
a psychotic and non-psychotic aspect of the personality. The
psychotic aspect attacks the awareness of reality through destroying
the functions of the ego itself. The analytic process provides,
through the analytic relationship, the hope for the restoration of
the ego's functioning.
Two Study Groups are offered, one in San Francisco and one in the East Bay. The year is divided into three 12-week sections, Transference-Countertransference, the Oedipus Complex, and Psychosis. Each section will study the Kleinian development from Freud to Klein to Bion and the Post Kleinians. The clinical and theoretical aspects of each are offered together in a single two-hour class.
San Francisco Intensive Study Group
Fridays, 12:00pm - 2pm
36 weeks, September 11, 1998 - June 4, 1999
Location: PINC 2252 Fillmore Street, 2nd floor
Course title Instructor
Transference and Countertransference Charles
Spezzano, Ph.D.
The Oedipus Complex Jed Sekoff, Ph.D.
Psychosis Peter Goldberg, Ph.D.
East Bay Intensive Study Group
Thursdays, 12:30pm - 2:30pm
36 weeks, September 10, 1998 - July 2, 1999
Location: TBA
Course title Instructor
Transference and Countertransference Lee
Rather, Ph.D.
The Oedipus Complex Enid Young, Ph.D.
Psychosis Deborah Melman, Ph.D.
Instructors
Peter Goldberg, Ph.D.
Member and teaching faculty, SFPI; teaching faculty, PINC, UCSF/Mount
Zion, Wright Institute
Deborah Melman, Ph.D.
Teaching faculty, Wright Institute, PINC; Clinical Faculty,
UCSF/Mount Zion, McAuley Institute
Lee Rather, Ph.D.
Advanced candidate, PINC; Adjunct faculty, CSPP, SFSPP
Jed Sekoff
Advanced candidate, Florida Psychoanalytic Institute; Adjunct
faculty, Wright Institute, CSPP; Former Director, Psychological
medicine, University of Miami Medical school
Charles Spezzano, Ph.D.
Supervising and Personal analyst, PINC; author of
Affect and
Psychoanalysis: A clinical Synthesis
Enid Young, Ph.D.
Member and Faculty, PINC; Editorial board, Journal of Melanie Klein
and Object Relations; lecturer, supervisor, consultant on addiction
issues.
Registration and Other Information
Due to demand, all potential registrants who deposits are received by August 1st, 1998 will be placed in a lottery and participants will be selected through this lottery. Class size will be limited to 20 participants. In filling the Intensive Study Groups priority will be given to people on the 1997 waiting list. NCSPP Members, Associate members, and Nonmembers will be considered for registration in this order.
Tuition
Tuition is $1000. A deposit of $300 is required and the balance is due August 26, 1998. The cost of tuition does not include the cost of reading materials. Refunds will be made up to one week prior to the registration deadline.
To register: Make your check payable to
NCSPP and mail it with your Name, Address, Telephone, and NCSPP
membership status to:
Judy Doty
1200 Mariposa Street
San Francisco, CA 94107