Psychoanalysis On and Off the Couch

"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.

"[A couple state of mind] is the capacity to be subjectively involved with both individuals, but then importantly, to be able to step back, find a third position, and try to understand what the couple are creating together. Although it's kind of obvious in a way, because surely, that's what a couple therapist is doing, they're trying to understand the couple relationship. It can have quite a powerful effect on the couple coming for help, because very often they're coming with a different state of mind. They're coming with a state of mind where the other one is felt to be the problem. Quite often, one partner feels brought by the other for treatment, and it's very much a kind of two-person interaction - 'You know, if you weren't this way or if you did this for me, then I would be happy'. What perhaps the couples don't  have is the capacity themselves to step back and observe what they're creating together - that's the couple state of mind. The couple state of mind is initially in the therapist. It's the couple therapist's analytic stance, if you like. But what I'm suggesting is that over time, this gets identified with and internalized by the couple into their relationship." 
 
Episode Description: We begin by describing the nature of the 'couple state of mind' as it exists in the mind of the therapist and as it grows in the couple allowing them to reflect on their 'coupleness'. We consider the similarities and differences between this and the familiar analytic self-reflective capacities that develop in intensive individual treatment. Mary presents clinical examples of her countertransference inclinations that are evoked in working with those who are initially 'likable' or 'unpleasant', i.e., "I can't understand why they're together" and how that evolves into a deeper understanding of the nature of their 'togetherness'. She discusses fixed unconscious fantasies and projective identifications that are both defensive and creative. We also discuss how "curiosity is the opposite of narcissism" and how that vital ability lives in the therapist and in the couple. We close with recognizing that the couple's capacity for their own 'couple state of mind' is an indication of readiness for termination.
 
Our Guest: Mary Morgan, is a Psychoanalyst, Couple Psychoanalytic Psychotherapist, and a writer. She is a Fellow of the British Psychoanalytical Society, Senior Fellow of Tavistock Relationships and Honorary Member of the Polish Society for Psychoanalytic Psychotherapy. She is a consultant member of the International Psychoanalytic Association's Committee on Couple and Family Psychoanalysis, a member of the Editorial board of the International Journal of Psychoanalysis and a member of the International Advisory Board of the journal of Couple and Family Psychoanalysis. She worked for many years at Tavistock Relationships, London, where she was the Reader in Couple Psychoanalysis and Head of the MA and Professional Doctorate in Couple Psychoanalytic Psychotherapy. She currently has a private practice of individuals, couples, supervision, and teaching. Along with Andrew Balfour and Christopher Vincent in 2012, she co-edited How Couple Relationships Shape Our World: Clinical Practice, Research and Policy Perspectives. Her book A Couple State of Mind: Psychoanalysis of Couples – the Tavistock Relationships Model (2019) is available in several languages. Her latest book Couple Relations: A Contemporary Introduction was published in 2025 and is available as an audiobook.
Recommended Readings:
Morgan, M. (2019) A couple state of mind: psychoanalysis of couples and the Tavistock Relationships Model. London & New York: Routledge.
 
Morgan, M. (2025) Couple Relations: A Contemporary Introduction. London: Routledge.
 
Ruszczynski, S. & Fisher, J. V. (Eds.) (1995). Intrusiveness and Intimacy in the Couple. London: Karnac.
 
Fisher, J. (1999). The Uninvited Guest. Emerging from Narcissism towards Marriage. London: Karnac.
 
Grier, F. (Ed.) (2005a). Oedipus and the Couple. London: Karnac.
 
Morgan, M. (2019) Love, Hate, and Otherness in Intimate Relating. Couple and Family Psychoanalysis 9:15-21
 
Clulow, C. (2009) (Ed) Sex, Attachment and Couple Psychotherapy: Psychoanalytic Perspectives (pp. 75–101). London: Karnac.

"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

"A saturated state is a state in which the conceptual or emotional object has absolute value, it is already stacked or closed to new meanings and therefore cannot undergo any kind of transformation. An unsaturated state, on the other hand, is a state in which the emotional or conceptual object is in an open state in which it is still open to transformation, to new meanings, to all kinds of change. What I think is interesting and important is to understand that one of the most difficult aims of working with traumatic objects is linked to this transformation from saturated to unsaturated states. Traumatic objects become fixed in a saturated state, which does not allow them to undergo any transformation within the psyche or within the therapeutic analytic process. The saturated state of traumatic events or objects is a frozen state in which therapy or analysis is used to preserve rather than intervene. This creates, in quite a few cases, a situation that I call false therapy or false analysis - a process, a therapeutic process in which very detailed materials are ostensibly presented, but in fact they are presented in a way that forces the therapist or  to either swallow them as they are, or vomit them up but not digest them because they are presented in a way that does not tolerate any intervention, any other point of view, any creation of movement within the given frozen narrative."
 
Episode Description: We begin with describing the difference between 'saturated' and 'unsaturated' memories - those that are frozen and without the freedom to reflect from those that contain the capacity to create new meaning. Dana emphasizes the importance of not simply collecting the particulars of a trauma, the 'notes', as much as attending to the nature of its delivery, the 'music' - "the way they tell the story." She presents a case involving 'parasitic language' where imitation of the other is at the level of fetishistic attachment lacking a voice of their own. In her countertransference she noted "I search for you - all I find is myself." We consider how this pseudo-relating induces a peculiar sense of closeness that ultimately contributes to a sense of claustrophobia in the analyst. She shares with us her personal story and reflects "Being a psychoanalyst doesn't mean giving up being a musician." Dana concludes with reading her final paragraph on 'forgiveness.'
 
Our Guest: Dana Amir, PhD., is a clinical psychologist, supervising and training analyst at the Israel Psychoanalytic Society, full professor, and head of the interdisciplinary doctoral program in psychoanalysis at the Zramim Postgraduate Psychoanalytic Psychotherapy Program at Haifa University, poetess and literature researcher. She is the author of seven poetry books, four memoirs in prose, and five psychoanalytic books published by Routledge. She was awarded literary as well as academic prizes, including seven international psychoanalytic awards, including the prestigious Sigourney Award (2025).
 
Recommended Readings:
Amir, D. (2012). The Inner Witness. The International Journal of Psycho-analysis, 93:879–896.
Amir, D. (2013). The Chameleon Language of Perversion. Psychoanalytic Dialogues, 23: 393-407.  
Amir, D. (2016). The Metaphoric, the Metonymic and the Psychotic aspects of Obsessive-Sympomatology. International Journal of Psychoanalysis, 97, 259–280. 
Amir, D. (2016). Hermetic Narratives and False Analysis: A Unique Variant of the Mechanism of Identification with the Aggressor. Psychoanalytic Review 103(4):539-54
Amir, D. (2023). "From Turning Away to Turning Toward: Adoption as Radical Hospitality". Psychoanalytic Perspectives, 21: 1–18.
Amir, D. (2024). From mind-deadness to mindedness, from collaboration to cooperation. International Journal of Applied Psychoanalytic Studies, 21(4).

"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.