IN VIVO ROLE PLAY OF THE OBJECT RELATIONS PSYCHOANALYTIC PROCESS:
SIX THEORETICAL VIEWS

Role Play – Case Presentation (Loray Daws) – Mastersonian Perspective

Abstract: “I lost my perfect dream”: Living between idealization and deflation – The Case of Eric

The patient to be role-played is a professional male analysand, mid-40s, referred to analysis by his psychiatrist with vague symptoms of depression, anxiety, and various somatic complaints (transient angina and irritable bowel syndrome). The analysand also reported immense emotional strain over a stagnant professional career and a growing schismatic relationship with his wife. During the initial clinical hours, it became increasingly evident that various developmental traumas had a profound effect on both the development and maintenance of esteem, finding a reliance on idealization and fusion, and the active splitting off of, in Mastersonian language, the aggressively fused object relations unit.

Learning points: At the end of this educational activity, its participants will be able to:

• Map the various developmental, self, and object relations realities in the developmental of the closet narcissistic disorder of Self (CNDS).
• Identify the split object relations units in the transference.
• Identify the CNDS triad, that is, deflation in esteem leads to anxiety that supports defense.
• Critically reflect on various therapeutic approaches in conceptualizing and reaching the intrapsychic and interpersonal strain given CNDS development.

Bio: Loray Daws, PhD, is a registered Clinical Psychologist in South Africa and British Columbia (Canada), and is currently in private practice in British Columbia (Canada). Dr. Daws has published and works in the areas of Daseinsanalysis, psychoanalytic psychotherapy (disorders of self, psychosomatic difficulties), and mental health ethics. Dr. Daws serves as a Senior Faculty member at the International Masterson Institute in New York and both teaches and supervises in South Africa, Australia, U.S.,  and Turkey in the psychoanalytic approach to disorders of the Self. He is currently a fourth-year candidate in training at the Object Relations Institute for Psychotherapy and Psychoanalysis. Dr. Loray Daws is the editor of 5 books, and he also serves as the assistant editor for the Global Journal of Health Sciences in Canada, as the evaluator and international advisory board member for the International Journal of Psychotherapy, and the assistant editor for EPIS (Existential Psychoanalytic Institute and Society).

Role Play – Neo-Kleinian Analyst’s Perspective (Susan Kavaler-Adler)

Abstract: During the role play, Dr. Kavaler-Adler will use her unique Object Relations psychoanalytic approach of developmental mourning, Klein-Winnicott dialectic, erotic intimacy and spirituality, as well as her long term experience of experiential role-play supervision and meditative psychic visualization that she utilizes in her private groups and during training courses at ORI.

Learning points: At the end of this educational activity, its participants will be able to:

• Discuss how the interventions of the analyst in the role-play therapeutic session dialogue reflect the Object Relations views of the unconscious.
• Compare the developmental mourning theoretical approach in clinical work to the Mastersonian approach working with the same patient/ analysand.

Bio: Susan Kavaler-Adler, PhD, ABPP, NCPsyA, hDLitt, is a clinical psychologist and psychoanalyst, who has been in practice in Manhattan for 45 years. In addition to treating individuals and couples, she conducts ongoing groups in her practice, such as a monthly writing group, a monthly online experiential supervision group, and a monthly “Mourning, Therapy, and Support Group” with guided visualization. Dr. Kavaler-Adler is a Fellow of the American Board and Academy of Psychoanalysis, and is the Founder and Executive Director of the Object Relations Institute for Psychotherapy and Psychoanalysis. She is a Training Analyst, Senior Supervisor and active faculty member at the Object Relations Institute for Psychotherapy and Psychoanalysis, a NYS Board of Regents chartered psychoanalytic training institute.

Dr. Kavaler-Adler is a prolific author, with published six books and over 70 articles and book chapters in the field of object relations psychoanalytic theory. Dr. Kavaler-Adler received 16 awards for her psychoanalytic writing. She is also on the editorial board of the International Journal of Controversial Conversations (IJCC). More information can be found at https://kavaleradler.com/.

Contemporary Freudian Perspective (Eva Papiasvili)

Abstract: Contemporary Freudian Perspective includes Modern Conflict Theory (Brenner, Rangell), Contemporary Ego Psychology (Busch), North American Integration of Object Relations Theory within Structural Theory (Mahler, Kernberg) , Contemporary Intersubjective Ego Psychology (Loewald, Chodorow, Kulish)), including International Freudian psychoanalytic thought (‘Third Topography’ of Green, Laplanche, Winnicott, Mancia, Bolognini and others).

Conceptually, rooted in Freud’s metapsychology, infantile sexuality, dual drive theory and structural theory, it integrates contemporary findings in areas of earliest development with the dynamic unconscious in its structural and fluid/process dimensions, unconscious conflict of both (pre-oedipal) dyadic and triadic (oedipal) constellations, unconscious ego functioning, including earliest primitive rudimentary body ego involvement; extended areas of developmental transformations over the whole lifespan; multiple facets of connections between trauma, memory and unconscious fantasy (Nachträglichkeit); inextricable connection between drive, object, and ‘the other’ in earliest stages of building of (intra-)psychic structure in the inter-psychic context through representation, symbolization and internalization.

In clinical practice, this approach employs ‘extended free associative interplay,’ making use of psychoanalytic situation as a safe transitional space/field of transference-countertransference, where all experiential systems – 1. nonsymbolized (enactments and sensations), 2. unconsciously symbolized (dreams, fantasies, daydreams), and 3.consciously symbolized (psychic surface, conscious communication) – can be (re)linked, understood, and interpreted, with the patient engaging affectively and expanding further on the analyst’s interpretation, within the asymmetrical psychoanalytic inquiry. The resistances are treated as a special category of a free association, initiating an inquiry towards the meaning of the latent drama of push for change of a status quo. Patient’s use of free association, in addition to the use of the analyst as an object, is in itself an object of inquiry.

While there are connecting points with the Masterson’s approach, and while the effective clinical work is never schematic and always individualized, a unique creation of an individual patient-analyst, for the sake of differentiation of this approach from the presented Masterson’s approach, perhaps the core difference lies in in the heighted attunement of the analyst to the prosody of language (musical, affective quality of language) and non-verbal behavior (not just what is said but how, with what tone, pauses, changes of tone, breathing, etc.), manner of representation and symbolization (switching languages)  is thoroughly explored, analyzed, connected, ‘translated’, interpreted, between the patient and the analyst. Traumatically dissociated or enacted, and dynamically repressed, processes and contents become the subject of analytic inquiry, exploration and interpretation. It is envisioned that such a close attunement to representational and symbolization processes and contents facilitate the psychic structure formation and the emergence of the revitalized authentic self within it.

Learning points: At the end of this educational activity, its participants will be able to:

• Discuss psychoanalytic phenomena from the Contemporary Freudian perspective.
• Compare the Contemporary and Mastersonian approach (used by Loray Daws, the presenter) to treatment of the character disorders.

Bio: Eva D. Papiasvili, Ph.D., ABPP is a Senior Clinical Faculty and Supervisor in the Doctoral program of Clinical Psychology at Columbia University in New York, the Past Executive Director and Dean of the Institute of the Postgraduate Psychoanalytic Society where she has been a Training and Supervising Analyst since 1996. She is also a Training, Teaching, and Supervising Analyst at the Object Relations Institute, and a Global Chair (Europe, North America, Latin America) and Editor-in-Chief of the International Psychoanalytical Association’s  Inter-Regional Encyclopedic Dictionary of Psychoanalysis (IRED). Dr. Papiasvili is the Founder and Chair of the Psychoanalysis, Art and Creativity working group (www.psychartcreativity.org), an Affiliate of the International Association for the Arts and Psychology; Editorial Board member of the International Journal for Group Psychotherapy; Special Issues Editor and Editorial Reader for the International Forum for Psychoanalysis and for the Psychoanalytic Inquiry.

Fairbairnian Perspective (David P. Celani)

Abstract: W.R.D. Fairbairn recognized that “attachment to bad objects” was a formidable source of resistance to treatment: as the patient develops emotionally in relation to the therapist, their unconscious bond to the parents who neglected them in childhood is threatened by the new relationship, and by the discoveries inherent in the treatment. The loss of their dysfunctional family appears to the patient to be catastrophic because they will have to confront the reality of their mistreatment in childhood. These unconscious loyalties are harbored in two mostly dissociated pairs of ego structures that developed from relational events between parent and child. These were (and are) intolerable for the child or even the adult to remember. Dr. Celani will discuss how to identify and respond to the two pairs of unconscious structures along with the patient’s developmental deficits, while minimizing resistance and early termination.

Learning points: At the end of this educational activity, its participants will be able to:

• Analyze transference as the projection of inner structures on to the analyst, who then is transformed into a bad object, and rendered impotent.
• Apply their understanding of attachment to bad objects to the patient’s strong emotional bond to the veryparents that abused or neglected them in childhood. This attachment allows avoidance of the external world, and offers the patient an illusory hope of developmental closure.

Bio: David Celani, PhD, is a licensed psychologist who practiced for more than twenty-five years in Burlington, Vermont. In treatment, he focused on his patients’ “attachment to bad objects”, which manifested through their inability to separate from parents, friends, or marital partners who demeaned, criticized, or abused them. Celani now presents workshops throughout the United States on Object Relations theory. His books with Columbia University Press include Fairbairn’s Object Relations Theory in the Clinical Setting, The Illusion of Love: Why the Battered Woman Returns to Her Abuser, and Leaving Home: How to Separate From Your Difficult Family.

Kleinian/Freudian Perspective (Rogelio Sosnik)

Abstract: From the Freudian and Kleinian perspective, one sees the psychoanalytic situation that develops within the psychoanalytic frame into which the psychoanalytic method is applied as the departing point for the unconscious manifestations. Then the work of interpretation takes place focusing in the transference and countertransference phenomena. From the Freudian/ Kleinian perspective, we regard the analytic frame, the scenario into which the dramatic interactions between the patient and the analyst will reflect the unconscious phantasy that is present at the moment. That provides the analytic setting, with the dream-like quality that is different from the role playing activity that we are observing in this presentation.

Learning points: At the end of this educational activity, its participants will be able to:

• Discuss the differences between “Role Playing” and “Role enacting.”
• Analyze and compare the different approaches to the Unconscious forces.
• Utilize the role play to understand what the analyst is “doing,” “enacting,” “interpreting.”

Bio: Rogelio Sosnik, M.D., is a Training and Supervising Analyst, Buenos Aires Psychoanalytic Association, and Training , Supervising , and Faculty , Contemporary Freudian Society, (U.S.A).His is also Member of The American Psychoanalytic Association, and the IPA. He is a Board Member of the International Journal of Psychoanalysis. He had published numerous papers in the U.S.A., Argentina, Uruguay, Italy. He is a consultant of the IPA Committee on Emigration and Relocation, now member of  CAPSA, the IPA Committee on Foreign Scholar Visitors,  and is in private practice in New York City.

Winnicottian Perspective (Stefanie Teitelbaum)

Abstract: Winnicott’s suspension of disbelief in the transitional space will be applied to the in vivo role play. Additionally his ideas about personality damaged as personality is forming and the development of a capacity for concern will be compared with Masterson’s ideas of character formation.

Learning points: At the end of this educational activity, its participants will be able to:

• Discuss Winnicott’s concept of transitional play as it applies to clinical practice.
• Utilize Winnicott’s concept of transitional play in one’s life and clinical practice.

Bio: Stefanie Teitelbaum, LCSW, NPsyA, B. Music — is the Supervisor, Training Analyst, Faculty of NPAP and IEA; Dean of Students, IEA; Instructor/Faculty, Training Analyst, Training Supervisor, ORI. She is the former staff psychotherapist at the Lower East Side Service Center’s Drug-Free Outpatient Program. Stefanie Teitelbaum is in private psychoanalytic practice in New York City.

Bionian perspective (Stefanie Teitelbaum)

Abstract: Bion’s deceptively short and simple “notes and memory and desire”, will be applied the in vivo role play. Bion’s own commentary on his earlier papers leading him to “notes” will be discussed.  Bion’s thoughts about projective identification and countertransference, each session standing alone as an encounter between analyst and patient, and the relationship of narcissism, greed and common sense will amplify the purpose of the analyst forgoing memory and desire in clinical practice

Learning points: At the end of this educational activity, its participants will be able to:

• Discuss Bion’s concept of forgoing memory and desire as it applies to clinical practice.
• Utilize Bion’s concept of forgoing memory, desire and understanding in clinical practice.

Bio: Stefanie Teitelbaum, LCSW, NPsyA, B. Music — is the Supervisor, Training Analyst, Faculty of NPAP and IEA; Dean of Students, IEA; Instructor/Faculty, Training Analyst, Training Supervisor, ORI. She is the former staff psychotherapist at the Lower East Side Service Center’s Drug-Free Outpatient Program. Stefanie Teitelbaum is in private psychoanalytic practice in New York City.

Meditative Intersubjective (Jeffrey Rubin)

Abstract: Intersubjective psychoanalysis believes that the psychotherapeutic process (like human development) is indissolubly contextual and dyadic—a product of specific interactions between two individuals. There is no such thing as an isolated patient, from an intersubjective perspective, there are only the specific interactions between particular analysts and analysands, which create inimitable relational configurations.

One of the gravest dangers afflicting our culture in general and the field of mental health in particular is the assault on human subjectivity; the decreasing interest in honoring and valuing people’s experience. In the craze to map the brain, label psychopathological syndromes, and prescribe pills for psychological disorders, the field of mental health is not only getting hijacked, it is losing its soul. But the people we work with are not illustrations of clinical syndromes or examples of particular psychoanalytic theories about human development and psychopathology—whether Freudian or Jungian, object relations or self-psychological, interpersonal or intersubjective—but unique individuals.

In psychoanalysis at its best, we are jazz improvisers who are grounded in the fundamentals of human development and the therapeutic relationship and process who can spring from what we know and respond whole-heartedly and creatively by listening with an unfettered and unclouded mind, rather than “customs officials” who know too much ahead of time about how therapy should proceed. Access to the unique surprise that is each person is greatly increased if I vacate what I think I know and empathically immerse myself in the particular relational world the person grew up in, the personal solutions they fashioned to the emotional challenges they confront(ed), and our relationship.

In order to do that it is indispensable that I am in the “right frame of mind,” which implies being a) highly focused and concentrated (mindful); b) open-hearted: holding my preferred theories lightly rather than tightly so that I can see patients outside of established psychoanalytic theories and categories and be receptive to the unknown and alert to surprise; c) intrepid: In Dante’s Divine Comedy the Roman poet Virgil accompanies Dante to the underworld. No one wants to be Virgil anymore—to “go into hell with Dante.” But the willingness to explore with patience and empathy the actual experience of what people undergo, no matter how horrific, is indispensable in healing the emotional afflictions that haunt human beings. And we shouldn’t be surprised that recipients of such understanding will be capable of both remarkable resilience and extraordinary healing.

Learning points: At the end of this educational activity, its participants will be able to:

• Discuss the value of treating one as idiographic, aka unique, individual rather than a nomothetic one (that illustrates general syndromes).
• Analyze our own shaping role in transformation of the analysand’s challenges and problems in living.
• Utilize variety of psychoanalytic perspectives in order to facilitate the patient’s self-knowledge and transformation.

[Notes: The nomothetic approach describes the study of people as a whole population. It aims to establish general laws about human behavior. The idiographic approach focuses on the individual and unique aspects of a person. It aims to collect in-depth and unique details on individuals.]

Bio: Jeffrey B. Rubin, PhD practices psychoanalysis and psychoanalytically-oriented psychotherapy and teaches meditation in New York City and North Salem, New York. He is considered one of the leading integrators of the Western psychotherapeutic and Eastern meditative traditions. A Sensei in the Nyogen Senzaki and Soen Nakagawa Rinzai Zen lineage and the creator of meditative psychotherapy, a practice that he developed through insights gained from decades of study, teaching and trying to helping people flourish, Dr. Rubin is the author of the new ebook, Meditative Psychotherapy and the critically acclaimed books The Art of Flourishing, Psychotherapy and Buddhism, The Good Life and A Psychoanalysis for Our Time.

Dr. Jeffrey Rubin has taught at various universities, psychoanalytic institutes and Buddhist and yoga centers. He lectures around the country and has given workshops at the United Nations, the Esalen Institute, the Open Center and the 92nd Street Y.