The PANY Bulletin

Psychoanalytic Association of New York
Volume 43, #2 Summer 2005

Scientific Meeting
A Work-In-Progress:
Helping Patients to Deepen the Treatment
February 28, 2005
Moderator : Stephanie Newman Ph. D.
Case Presentation: Anne Erreich, Ph. D
Discussant: Stephen Bernstein, M.D.
Reporter: Kimberly Chu, LCSW, DCSW

The February 28th PANY meeting this year was dedicated to the memory of Dr. Lawrence Chalfin, previous Director of the NYU Psychoanalytic Institute. Dr. Chalfin passed away January 1, 2005.

The topic of the meeting was of particular relevance to candidates, but also to all analysts developing psychoanalytic cases. “A Work-In-Progress: Helping Patients to Deepen the Treatment” was arranged by Drs. Stephanie Newman and Malini Singh, senior candidates of NYUPI. Dr. Anne Erreich, faculty member and Training and Supervising Analyst at NYUPI, presented clinical material from a case which she had been developing towards psychoanalysis. Dr. Stephen Bernstein, the invited discussant, is a Training and Supervising Analyst at the Boston Psychoanalytic Society and Institute and has participated in a number of events at NYUPI. In addition to his participation at the PANY meeting, Dr. Bernstein spoke to a cross-section of candidates from various classes on the craft of writing about psychoanalytic process in the Annual Case Writing Workshop For Candidates which was held on the same evening immediately before the panel.
Dr. Stephanie Newman, who moderated the evening's program, introduced the topic as the result of the previous year's candidates' meetings where concerns about selection, analyzability and the development of psychoanalytic cases were strongly present on the minds of candidates. A discussion of how to deepen a less intensive treatment to a psychoanalytic process was the focus of the presentations by Drs. Erreich and Bernstein, although with varying approaches as they discussed one particular case. The presentation of case material and discussion then was followed by questions and comments from the audience.

Dr. Erreich's clinical material about the development of a psychotherapy case to psychoanalysis presented questions about resistances to a deepening of treatment, the interpretation of resistances manifest in early transference fantasies, and the effects of previous treatments on current work. In her retrospective writing about the case, Dr. Erreich focused on offering the audience a view of the treatment screened for the details of resistances. She acknowledged that what she presented was a rather neat artifact, but was such in order to provide clarity to a particular issue for study by the meeting. The ending of the treatment, before it was possible for it to become an analysis, also allowed the audience to engage the material with the advantage of knowing its eventual outcome, opening the doors to a rigorous discussion of what might or might not have been.

Dr. Bernstein began his comments for the evening by speaking to the concept of “conversion”. He proposed that a more appropriate and compelling term, one which better describes what the analyst is attempting to do when deepening a psychotherapy towards an analysis, is “transition”. “Transition implies a continuum” he said, and the case as presented was a focus on one aspect of this transition. How to deepen the treatment and when? Dr. Bernstein advocated the analyst choosing when to interpret within the early transferences and when to interpret from within the patient's experience. He believes that in the early stages of a treatment it is important to develop an affective and safe connection to the analyst, one which can metabolize past experiences in preparation for transference work. It is through this relationship with the analyst that the work will deepen and interpretations within the transference will emerge and be accepted by the patient.

In continuing the discussion on how to develop a deepening relationship with a patient, Dr. Bernstein recommended that the analyst attempt to generalize towards a “middle space”, where one could further the sense of a working “us”, acknowledging a patient's pain but avoiding a premature focus on the analyst as feared object. He pointed out that in the beginning stages of a treatment, a patient may not be ready to experience the analyst as an external interpreting object. Before the inevitable awareness of separation between patient and analyst, the patient may need to experience the analyst as a part of herself. He believes that a patient's resistances may be better monitored by an analyst if this separation is not rushed and the connections between analyst and patient are allowed to evolve.

In his closing remarks, Dr. Bernstein commended Dr. Erreich for work on a case that he viewed as an extended evaluation for a possible analysis. Although it is not known whether this patient will ever enter a more intensive treatment, the case provided a rich field for the exploration of issues related to transitioning patients from psychotherapy to psychoanalysis. Specifically addressing the candidates present at the meeting, Dr. Bernstein encouraged them to be aware of the unique pressures that may impact this process in their work: practical challenges to facilitating first cases to analysis; preconscious shifts in the analyst who needs a case; the analyst's resistances to beginning an analysis. For those wishing to read more extensively on Dr. Bernstein's work on the topics of transition and the development of psychoanalytic cases, he has published numerous papers of interest to both candidates and tenured analysts alike.

Relevant papers by Dr. Stephen B. Bernstein, M.D.: (1983), Treatment Preparatory to Psychoanalysis, Journal of the American Psychoanalytic Association, Vol. 31, pp. 363-390; (1990), Motivation for Psychoanalysis and the Transition from Psychotherapy, Psychoanalytic Inquiry, 10:21-42; Developing a Psychoanalytic Practice, Psychoanalytic Inquiry, 20(4): 574-593.