Ethics Workshop Series: Four Parts 2015-2016

Western Branch Canadian Psychoanalytic Society | Extension Program
Ethics Workshop Series: Four Parts 2015-2016
June 12 & Nov 26, 2015 – Jan 29 & Feb 26, 2016
Judith Setton-Markus, R. Psych. FIPA, Coordinator

The Western Branch Canadian Psychoanalytic Society Extension Committee is pleased to offer a second four part series on ethics in the clinical setting. Each workshop is three hours and will consist of a theoretical discussion, followed by the opportunity to review case vignettes that apply to the theme of the workshop. Participants may register for each workshop separately or for all four. The workshops have been spread out over the span of two years so that registrants wishing to fulfill annual ethics requirements may do so for two consecutive years (2015 and 2016). Participants are encouraged to bring their own case vignettes.

Part I: Ethical Complexity: enactments and errors in psychoanalytic psychotherapy
Facilitator: David Kealy, MSW, Ph.D.
June 12, 2015

Enactments are widely recognized as inevitable occurrences in contemporary psychoanalytic psychotherapy, given the complex intertwining of transference, countertransference, and realistic elements of the therapeutic relationship.  Indeed, some actualization of these unconscious processes, when paired with resolution and analysis, may be therapeutically necessary for some patients.  Enactments may include the therapist’s errors, needs, and empathic limitations, and they carry a potential for negative consequences.  This complexity creates unique ethical considerations for psychoanalytic clinicians.  Therapists face the multiple demands of being receptive to the sway of unconscious communication, empathically intuiting the patient’s responsiveness needs, and safeguarding the therapeutic frame – all the while remaining “human” and subject to the pull of their own emotional life.

This workshop will provide an opportunity to explore the ethical and clinical implications of enactments, errors, and the influence of the psychotherapist’s human needs in the treatment situation.  Discussion will examine the inevitability of such occurrences, and the associated complexities faced by psychoanalytic clinicians.  Participants will be invited to share clinical experiences and observations, as well as reflections on three papers that pertain to different aspects of these phenomena:

David Kealy, MSW, Ph.D. supervises a community psychotherapy service, and is a Clinical Assistant Professor in the Department of Psychiatry, University of British Columbia.

Learning Objectives – By the end of the workshop, participants will have/be able to:

• An understanding of the clinical and ethical complexities associated with enactments in psychoanalytic psychotherapy
• Identify contributory dynamics in enactments, including countertransference, errors, and therapists’ defensive or narcissistic needs
• Balance clinical and ethical considerations associated with enactments and errors, and reduce the impact of potentially negative enactment sequences

Readings: Jacobs, T. J.  (2001).  On misreading and misleading patients: Some reflections on communications, miscommunications, and countertransference enactments. International Journal of Psychoanalysis, 82, 653-669. Slochower, J.  (2003).  The analyst’s secret delinquencies.  Psychoanalytic Dialogues, 13, 451-469. Maroda, K. J.  (2005).  Legitimate gratification of the analyst’s needs.  Contemporary Psychoanalysis, 41, 371-387.

Part II: The Fee as a Key That Opens and Closes
Facilitator: Darren Thompson, MD, FRCPC, FIPA
November 27, 2015

Addressing the fee with our patients can be an important key used to help open the way to moving therapeutic work forward. We can learn a great deal about both our patients and ourselves as therapists when we explore these issues. From the early days of psychoanalysis, Freud (1913) encouraged therapists to: “treat money matters with the same matter-of-course frankness to which he wishes to educate them in things relating to sexual life.” Yet even today, the real and symbolic meanings of money are often neglected and closed off.

Fee payment and nonpayment can reflect different developmental challenges to different people, or to the same person at different times within the same treatment. The fee is an aspect of the frame that communicates consciously and/or unconsciously to the patient that the therapist is a separate other. The experience of the therapist as a separate being, with his/her own desires, can assist the patient developmentally as he/she struggles through the transitional and paradoxical tension of relating separately while maintaining connection. The potential benefits of such confrontations can be enormous, including the possibilities of a new awakening with the realization that the other is in some fundamental way outside of one’s closed, omnipotent internal boundaries. While this can be stressful and even disorganizing, it can also culminate in enhancing one’s sense of aliveness and real engagement.

Darren Thompson, MD, FRCPC is a psychoanalyst and psychiatrist who is a member of the Western Branch of the Canadian Psychoanalytic Society and the Seattle Psychoanalytic Society and Institute.  He has a private practice in Vancouver where he treats people in psychoanalytic psychotherapy and psychoanalysis.

Learning Objectives – By the end of the workshop, participants will be able to:

• List three potential gains and risks in which addressing money matters can have to the therapeutic work.
• List this ethical implications of not addressing money issues in therapy
• View the discussion of money matters as a necessary part of the therapeutic endeavor.
• Discuss clinical vignettes which will provide participants with an opportunity to explore some of the clinical issues that arise from addressing payment and non-payment (e.g., therapeutic frame, transference and countertransference, enactments, resistance).

Readings:
Myers, K. (2008). Show Me the Money: (the “Problem” of) the Therapist’s Desire, Subjectivity, and Relationship to the Fee. Contemp. Psychoanal., 44:118-140. Gedo, J. (1963). A Note on Non-Payment of Psychiatric Fees. Int. J. Psycho-Anal., 44:368-371. Winnicott, D.W. (1953). Transitional Objects and Transitional Phenomena—A Study of the First Not-Me Possession. Int. J. Psycho-Anal., 34:89-97.

Part III: Self-Disclosure by the Therapist: Responsible or Indulgent?
Facilitator: James Fabian MD, FRCPC, FIPA
January 29, 2016

Self-disclosure has long been a controversial topic. The controversy is as least as old as the dispute between Freud, who tended to recommend the clinician function, “like a mirror”, and Ferenczi, whose experiments went so far as to include “mutual analysis”.

Contemporary clinicians need to navigate through tricky clinical waters in the complex interactions involved when two people meet to help one of them gain insight and, hopefully, growth.  Guidelines as to if and how to use one’s subjectivity “out loud” with the patient, in ways that are more likely to lead to therapeutic growth, need to be explored.  There are consequences to the indiscriminant use of self-disclosure by the therapist – consequences that could impact on such clinical concepts as anonymity and neutrality.  Self-disclosure may even become a part of the “slippery slope” of boundary violations.  But many authors feel that true anonymity is a myth, and that therapists are revealing aspects of themselves “all the time”.

This seminar will pose such questions as: “Should the therapist consciously reveal what he/she is thinking?” “What factors and principles can help guide this decision?” “If the therapist does choose to self-reveal, are there optimal ways to do so?”  Participants are encouraged to bring relevant clinical vignettes for discussion.

James Fabian, MD FRCPC is a psychoanalyst and the current President of the Western Branch of the Canadian Psychoanalytic Society.  He has a private practice in West Vancouver.  He is also a psychiatrist and provides psychiatric consultation and supervision to psychotherapists through the outpatient clinic of Lions Gate Hospital in North Vancouver.  He is an Assistant Professor in the Department of Psychiatry at UBC and is involved in the teaching and supervision of psychiatric residents.

Learning Objectives – By the end of the workshop, participants will be able to:

• Describe the principle of anonymity and how it is thought to be important in therapeutic technique.
• Identify interpersonal pressures a patient places on a clinician to “self disclose” and how to think about these pressures.
• Utilize the acquired understanding to potentially modify technique when it comes to whether or not and how to use self-disclosure.

Readings: Busch, F. (1988). “Self-Disclosure Ain’t What It’s Cracked Up To Be, At Least Not Yet”. Psychoanal. Inq. 18: 518-529. Greenberg, J. (1995).  “Self-disclosure/ Is It Psychoanalytic?”  Contemp. Psychoanal.  31:193-205. Renik, O. (1995).  “The Ideal of the Anonymous Analyst and the Problem of Self-Disclosure”.  Psychoanal. Q.  64: 466-495.

Part IV: Reigning in the Known: Ethics and primitive mental states
Facilitator: Catherine Mahoney, Ph.D., R. Psych.
February 26, 2016

Models of mind and mental growth keep developing across a wide range of arts and sciences with various applications to clinical methods of treatment. When more challenging patients confront therapists with the limits of their understanding and force us to question both our competence and confidence, the search for help from other minds is a best-practice standard regardless of treatment modality.

In this presentation, the Freud/Klein/Bion lineage of ideas related to theory and method will be used as the background to highlight specific parallel processes between patient and therapist that can emerge in treatment.  Reigning in what one thinks one knows to allow for the new can be challenging for patients and therapists alike as it’s easier to impose what’s been “tried and true” without regard for the unfamiliar, the unknown and very often the unwanted experience.  Clinical vignettes will be presented and audience discussion welcomed in determining what is difficult to bear in ourselves and in our patients.

Catherine Mahoney, Ph.D., R. Psych is a psychologist in Vancouver B.C. with a private practice in psychoanalytic psychotherapy and psychoanalysis.  She is currently a guest of the Western Branch of the Canadian Psychoanalytic Association (WBCPA) and completing psychoanalytic training at the Northwestern Psychoanalytic Society and Institute (NPSI) in Seattle.

Learning Objectives: At the end of this presentation participants will be able to:

• Distinguish four primitive defense dynamics that can emerge in the transference/countertransference relationship.
• Identify the intrapsychic interplay of ego strengths and weaknesses that can promote or obstruct mental growth.
• Recognize parallels in the mental processes of therapist and patient when stuck or at an impasse.

Readings: Hinshelwood, R. (1997). Therapy or Coercion.  London: Karnac.