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This website highlights my views of the practice of psychiatry, particularly applying the art and science of psychoanalytic psychotherapy, in order to benefit a patient in the most optimal way. In the following web pages, I focus on my historical perspectives of the evolution of psychoanalytic psychotherapy, whereby,  with images and words, I review those authors, scholars, academicians, and clinicians that have helped to shape and inspire my clinical approaches to each patient.

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glossary of contemporary psychoanalytic terms

action, therapeutic - "...those complex healing factors of a therapeutic relationship deemed explanatory, causative, and responsible for improved changes of a patient's emotional health..." (peter j stein, md, ma, 2012); One such healing factor occurs when one "...establishes the analytic bond as a gradually expanding zone of safety within which previously sequestered regions of the patient's experience can be brought out of hiding and integrated..." (Contexts of Being, Stolorow & Atwood, 1992, p. 34).

affect - "...transpersonal, interactive processes that are organized variably with behaviors, self and other experiential units, and, on higher levels of organization, folded into a subjective sense of agency..." (Mitchell, S., Relationality From Attachment to Intersubjectivity, 2000, p. 69-70) "...affect - that is, subjective emotional experience...is something that from birth onward is regulated, or misregulated, within ongoing relational systems...locating affect at its center automatically entails a radical contextualization of virtually all aspects of human psychological life..." (Stolorow, et al, 2002, p. 10-11; Trauma and Human Existence, Stolorow, R, 2007, p. 1).

affect regulation - an interactive process, "...the core of the attachment relationship..." (Schore, 2012, p.199)

agency - "...a nascent sense of personal authorship, wherein we are the writers, directers, producers, and actors in the psychodramas of our existence..." (Ringstrom, P, 2014, p. 50)

attachment - "the outcome of the child's genetically encoded biological (tempermental) predisposition and the particular caregiver environment (Schore, 2012, p. 32)...[in which one observes]... interactive regulation of states of biological synchronicity between and within organisms...the dual regulatory process of affect synchrony, which creates states of positive arousal, and interactive repair, which modulates states of negative arousal, are the fundamental building blocks of attachment and its associated emotions..." (Schore, A., 2012, pp. 56-57).

attractor, interpersonal - "...maintains the [stable] organization [of a system] by perpetuating equilibrium as well as resolving emotional disequilibrium...) (Schore, A., Affect Regulation and the Repair of the Self, 2003, p.266)

chaos theory - the study of forever changing complex systems based on mathematical concepts of recursion, in the form of a recursive process, or a set of differential equations, in order to explain that complex and unpredictable results will occur in systems that are sensitive to their initial conditions.

co-construction - "...both participants, analyst and patient, contribute...to the organization of interaction, but not similarly or equally..." (Lachmann, 2008, p. 3).

co-creation - each partner has made some contribution to what emerges through the partners' interaction[s], but their contributions are not necessarily similar...or symmetrical..." (Lachmann, 2008, p. 110)

complex system - a system "...that is loosely guided by principles of self-organization, nonlinearity, emergence, unpredictability, and transformation..." (Coburn, 2007); a 'complex adaptive system' is "...composed of a diversity of agents that interact with each other, mutually affect each other, and [their internal dynamics] generate novel, emergent, behavior for the system as a whole..." (Lewin, R, 2000, p. 198).

complexity - the state of a system in which there is enough fluidity and randomness (or “chaos”) to allow for innovation, novelty, and change, on the one hand, and in which there is enough order and apparent structure to allow for the sustaining and continuance of those changes that do occur, on the other hand. (Coburn, 2007)

complexity theory (psychoanalytic) - "...concerned with the emergence and patterning of emotional experience from the self-organization and cooperation of many parts, with the conditions necessary to produce adaptive change, and with the process of making meaning out of apparent randomness..." (Coburn, 2007)

contextualism - "...centers on an appreciation of the role of context  in understanding experience and meaning, and of the unpredictability and fluidity of emotional development..." (Coburn, 2007); "...The concept of selfobject function (kohut, 1971), in emphasizing that the organization of self-experience is always co-determined by the felt responsiveness of others, is a prime example of contextualization...Truth is dialogic, crystallizing from the inescapable interplay of observer and observed..." (Stolorow, et. al, 2002, p. 71, 97).

co-transference - "...primarily names the analyst's contribution to the intersubjective field...the concurrent and mutual organizing activity of analyst and patient..." (Orange, 1995, p. 63).

countertransference - 

dissociation, pathological - "...an early forming... survival defense of the implicit self against overwhelming, unbearable, painful emotional experience, including those generated in relational attachment trauma...detachment from unbearable situations, the escape when there is no escape, the last resort defensive strategy...[a] fundamemtal defense to the memory of the arousal dysregulation of an overwhelming negative affective state blocks intense emotional pain from entering conscious awareness, and thereby instigates an altered state of consciousness..." (Schore, 2012, p.159);"...affect in the body is severed from its corresponding images in the mind and thereby an unbearably painful meaning is obliterated......by directing attention away from internal emotional states..." (Schore, 2012, p. 160).

dynamic systems theory - 

dynamic unconscious (intersubjective view) - "...[forgotten] emotional information...because it created conflict...[and] the memory would threaten the tie to caregivers...the effects...continue to appear as repetitive troubles..." (Orange, et al, 1997, pgs. 7-8)

emergence - complex pattern formation with higher level properties,  from more basic constituents, which cannot be explained or deduced from the properties of the lower level entities; "...occurs in systems in which a few simple rules govern the interaction of component parts..." (Lewin, R., 2000, p. 214).

empathic understanding: "...emotional knowledge gained by participation in a shared reality, arising from parents or therapists...those who are attuned to the emotional reality shared in the intersubjective situation...Empathic response comes from attunement to this shared reality..." (Orange, D., 1995, p. 21, 23).

empathy: "...the knowledge that emerges from personal relation and that creates the other as a subject..." (Orange, D., 1995, p. 21)

enactment (couple's therapy) - "...necessary in exposing multiple, dissociated self-states...so that they are no longer split off and projected from one partner onto the other..." (Ringstrom, 2014)

enactment - The "...living out of affective experience, usually both parties in the analytic dyad, within the strict boundaries of the psychoanalytic frame...Acting out [my italics], on the other hand, is a violation of the frame...both transference and countertransference enactments reflect an unconscious affective immersion in the interaction..." (Hirsch, I., The Interpersonal Tradition, 2015, p. 63). Hirsch adds that the concept was originally generated by E. A. Levenson (The Fallacy of Understanding, 1972), who described the process of analysis as a mutual engagement in analytic interaction, where "...there is no objective interpretive understanding to be derived from being in analysis - only sensible narratives that are inherently perspectival..." (Hirsch, p. 8). Hirsch further adds (ibid., p. 8) that T.J. Jacobs introduced the phrase "mutual enactment" (Jacobs, T.J., 1986, "On Countertransference Enactments", JAPA 34, : 289-307), reflecting the irreducible subjectivity of all analytic engagement; other contemporary definitions include: "...ruptures of the working alliance...occurring within the dyad that both parties experience as being the consequence of behavior in the other..." (Schore, 2012, p. 154); "...dialogically recreated in right brain to right brain transference-countertransference communications,...between the patient's relational unconscious and the therapist's relational unconscious (ibid., p. 158); "...a dynamic, naturally occurring manifestation of the transference and countertransference...making the past alive in the present..." (ibid., p. 158, on Maroda, 1998, p. 530); "...stereotyped, rigid, constricted, and highly selective ways of behaving and experiencing...involv[ing]...mutual stimulations of repressed [dissociated]...affective experience..." (ibid., p. 159). "...the jointly created scenarios that reflect the initially unconscious, overlapping vulnerabilities and needs of patient and therapist...the here-and-now behavioral manifestation of implicit relational knowings whose...roots lie in what we..."enacted" with our attachment figures as infants..." (Wallin, 2007, p. 122).

expectancies - "...a powerful factor in organizing the interactions between caregiver and infant...defined as the recurrent, characteristic patterns that the infant recognizes, expects, and anticipates (see 'RIG's")..." (Lachmann, , 2000, p.92); "...temporal sequences of what sensory and motor events tend to follow one another. The brain encodes these sequences at the implicit level as "expectancies" or "predictions" of what to anticipate in relation to the self and the world..." (Pally, R., 2005, p. 208). "...Repeated experiences of...responsiveness [that] contribute to...[the character of one's]...internal working models..." (Wallin, 2007, p. 107). A healing process of psychoanalytic psychotherapy occurs when the analyst begins to experience and understand the patient's thrusts of his/her expectancies (often unconsciously) upon the therapeutic relationship; expectancies that can be felt by both dyadic partners, and then more clearly and explicitly verbalized, clarified, defined, understood, and transformed into healthier, freer, inter-relational capacities and activities (Peter Jay Stein, MD, MA, 1.25.2017).

explicit declarative

fallibilism - "...Charles Sanders Pierce's word for a questioning attitude toward our own theories and formulations - and a devotion to dialogue with the possessors of other perspectives..." (Stolorow, et al, 2002, p. 27); "...an attitude recognizing that what we "know" or understand is inevitably partial and often mistaken..." (Orange, D., 1995, p. 43).

hermeneutics - "...attempts to explore the multifaceted interpretations of...literary works, and, increasingly, of human experiences..." (D. Orange, 1995, p. 46).

implicit - automatic, non-conscious

implicit memory - "...where the emotional and affective - sometimes traumatic - presymbolic and preverbal experiences of the primary mother-infant relations are stored..." (Schore, 2012, p. 88, on Mancia, 2006).

implicit relational knowing - "The interactions between therapist and patient in all therapies are accompanied by non conscious affective and interactive connections that have been referred to by Lyons-Ruth et al. (1998)" (Gabbard, 4th Edition, 2005, p. 111).

indeterminacy

intentional stance  - "...the child's abiity to infer the intentions that underlie [his own, and his parents'] behavior...recognizing [someone] as a separate being with a mind of her own..." (Wallin, 2007, p.48).

internal working models: internalized representational systems of the infant's past experiences with the caregiver (Campbell's Psychiatric Dictionary, ninth edition, 2009, p. 93).

intersubjective field - "...any system constituted by interacting experiential worlds...neither a mode of experience nor a sharing of experience [but] the contextual precondition for having any experience at alll..." (Atwood, Orange, Stolorow, 1997, p. 85). "...the central theoretical construct of intersubjectivity theory...defined as "a system composed of differently organized, interacting subjective worlds" (Stolorow, et al, 1987)...[which] brings to focus both the individual's world of...experience and its embeddedness with other such worlds in a continual flow of reciprocal mutual influence" (p. 18)..." (Stolorow, et al, 2002)."...created by a continuous process of mutual influence between analyst and patient..." (Beebe, et al, on Stolorow, et al, p. 22, 2005); "...co-constructed by 2 individuals [which] includes not just 2 minds but 2 bodies...[and] at the core of the...field is the attachment bond of emotional communication and interactive regulation..." (Schore, Allan, Judith, 2012, p. 40).

intersubjectivity - "...the oscillating psychological field created by the interplay between the [patient and psychotherapist]..." (Working Intersubjectively - Contextualism in Psychoanalytic Practice, Orange, Atwood, Stolorow, 1997, pp. 43-44); "...the psychological field formed by an infinite variety of forms of interaction as two differently organized subjectivities collide, interface and impact the other..." (Beebe, et al, 2005, on Stolorow, et al, 1997); "...a broad grouping of experiences, intentions, and goals, invoving others, that are essential to the development of all motivational systems..." (Lichtenberg, et al, 2011)"...implicit communication of regulated affective states in attachment communications between the right brains of the infant-mother dyad.." (Schore, 2012, p. 157).

intersubjectivity, forms of - "...what is occurring between two minds...the full range of patterns of self- and interactive regulation...[with] presymbolic origins... (Beebe, 2005, p. xxiii)...The full complexity of how two minds interrelate, align, fail to align, or disrupt and repair alignment...a bidirectional regulation process...sensing that one impacts the partner in an ongoing predictable (contingent) way, and that the partner has a significant input on oneself..." (Beebe, et al, 2005, p. 80).

intersubjectivity theory - "...metatheory of psychoanalysis that examines a field of two subjectivities in the system they create and from which they emerge..." (Orange, D, et al, 1997, p.3)

leading edge - "...addresses what the person is trying to achieve...carries hope and points to a direction in the future..." (Lachmann, 2000,p.ix). (see "selfobject dimension", and "trailing edge".

motivational system - "...irreducible, primary motivations that organize the sense of self, and are in turn organized by it..." (Lachmann, 2000, p. 53).

mentalization - "...a form of self-reflection that encompasses dimensions of empathy both for the self, as well as for others..." (Kieffer, IJPSP, p.7, 2012); "...a key process through which secure attachment is mediated..." (Mitchell, p. 86, 2000); "...the capacity to think about mental states as separate from, yet potentially causing actions...assumed...to arise  as part of an integration of the pretend and psychic equivalent modes of functioning..." (Bateman, Fonagy, 2004, p.70).

organizing principles or patterns - "...whether automatic and rigid, or reflective and flexible...(are) often unconscious, (and) are the emotional conclusions a person has drawn from lifelong experience of the emotional environment, especially the complex mutual connections with early caregivers. Until these principles become available for conscious reflection, and until new emotional experience leads a person to envision and expect new forms of emotional connection, these old inferences will thematize the sense of self...[which] includes convictions about the relational consequences of possible forms of being..(Orange, Atwood, Stolorow, 1997, p. 7); "...Recurring patterns of intersubjective transaction within the developmental system giv[ing] rise to principles ([such as] thematic patterns, meaning-structures, cognitive-affective schemas) that unconsciously organize subsequent emotional and relational experiences. Such organizing principles are unconscious, not in the ordinary sense of being repressed, but in being prereflective; they ordinarily do not enter the domain of reflective self-awareness..." (Stolorow, R, IAPSP Keynote, 2015)

phenomenology

perspectival realism - "...recognizes that the only truth or reality to which psychoanalysis provides access is the subjective organization of experience understood in the intersubjective context...such a subjective organization of experience is one perspective on a larger reality. We never fully attain or know this reality but we continually approach, articulate, and participate in it..." (Stolorow, Atwood, Orange, 2002, p. 109-110).

perspectivalism - "...embraces the hermeneutical axiom that all human thought involves interpretation and that...our understanding of anything is always from a perspective shaped and limited by the historicity of our own organizing principles..." (Orange, Atwood, Stolorow, 2002, 1997).

post-modernism - "...Meaning is...not an objective, rational perspective, but [found] in local, personal perspectives; the value of life is not measured by its conformity with a mature and transcendent vision, but by its vitality and the authenticity of its passion..." (Mitchell, Black, 1995, p. 169); "...postmodernism...disputes...the idea that there is a single empirical pregiven world and that knowledge consists in mirroring or mapping it...instead of asking what are the facts, [it] asks how we construct our knowledge...[that] we can not know the nature of reality...we only have different constructions of reality, which are...based on the context of the knower..." (Howell, E, 2005, p. 41).

psychic equivalence - "...The tendency for what has been called concrete thinking...i.e., to give the same weight and importance to an internal experience as one does to an external experience..." (Luyten, Fonagy, et al, 2015, p. 364).

psychic structure - (Kohut) - "...a reified conception of the self......a mental entity in its own right, achieving through processes of (transmuting) internalization varying degrees of its own internal structuralization..." (Orange, et., al., 1997, p. 64; (Intersubjectivity theory) - "...broad patterns within which experience repeatedly takes form, prereflective organizing principles manifest as recurring themes in the flow of subjective life (Stolorow, 1978)..." (Orange, et al, 1997, p. 64).

psychoanalytic therapy - "...a procedure through which a patient acquires reflective knowledge of his own, unconscious structuring activity..." (Stolorow, R., Atwood, G., Structures of Subjectivity, 1984, p, 28); "...a dialogical method for bringing prereflective organizing activity into reflective awareness,  particularly as it shows up within the therapeutic relationship..." (Stolorow, R, IAPSP Keynote, 2015)

psychoanalysis - "...a science of the intersubjective, grounded in empathic dialogue between 2 persons...[using]...a procedure through which a patient acquires reflective knowledge of his own, unconscious structuring activity..." (Stolorow, Atwood, Structures of Subjectivity, 1984, p. 29, 36); "...the science of unconscious processes..." (Schore, A. Affect Regulation... 2003, p. xvi); "...a method of illuminating the prereflective unconscious...by investigating the ways in which the patient's experience of the analytic relationship is unconsciously and recurrently patterned by the patient according to  developmentally preformed meanings and invariant themes..." (Stolorow, Atwood, 1992, p. 34); "...a special conversation about meaning...an attempt of analyst and patient to make sense together of the patient's emotional life..." (Orange, D., 1995, p. 7).

psychoanalytic understanding - "...knowledge gained from inside the intersubjective field formed by the intersection of two differently organized subjectivities...[in the context of secure attachment]...attempting to participate in the emotional experience, in the being, of the other...an intersubjective process of emotional comprehension...[with recognition of the triadic field, i.e., the interplay of the two subjectivities, plus the changing character of the relatedness, itself]..." (Orange, D., 1995, p. 5).

recursivity

reflective consciousness - "...involves awareness of one's own conscious processes, past, present, and future, and it makes possible all higher cognitive processes, such as symbolic representation, language, and theory of mind abilitites..." (Pally, et al, 2005, p. 194).

regulation, bidirectional - "...a two-way, reciprocal process in which each person's behavior can be statistically predicted from...the behavior of the partner...[it] occurs equally in aversive as well as positive interactions...is probabilistic...out of awareness...at the nonverbal level of action sequences...jointly defined by the behavior[s] of both partners..." (Beebe, et al, 2005)

regulation, interactive - "....bi-directional contingencies in which each partner's behavioral stream can be predicted from that of the other...a "co-constructed" process..." (Beebe, Psa Study of the Child, 2005, vol. 60, p. 6)

relational depth - "...(a) "moment of meeting" (Stern, 2004)...a state of profound contact and engagement between two people, in which each person is fully real with the Other, and able to understand and value the other's experience at a high level..." (Schore, 2012, p. 101, on Mearns & Cooper, 2005)

relativism - "...an approach that views knowledge as radically dependent on theory, social context, circumstance, or utility, [and] denies the existence of any universal truth or moral framework...A relativist can evaluate truth or morality only from within a socially agreed-upon system..." (D. Orange, 1995, p. 56-57).

resistance: "...the way analyst and patient protect their functioning as an analyzing unit by warding off elements that might disrupt it...the operation of defense within the analytic situation..." (Textbook of Psychoanalysis, 2011, pp. 102-103). "...the patient's expectations and fears in the transference that if his central affective states and developmental longings are exposed to the analyst, they will meet with the same traumatogenic, faulty responsiveness that they received from the original caregivers..." (Contexts of Being, Stolorow & Atwood, 1992, p. 34). The phenomena that comprise "...a patient's need to wall himself off from his own affectivity, from his yearnings for connection with the analyst that lend themselves to the patient's fears or anticipation of a repetition of childhood trauma (ibid., p. 59). The analytic relationship "...in mobilizing the thwarted developmental longings and painful emotional vulnerabilities in the transference...[causes] the fear or anticipation of retraumatization by the analyst..."(ibid. p. 58). "...the patient's resistance to experience...of what is felt to be unbearable emotional pain...[is] linked to the fear of an unhelpful response from the therapist...co-created in the interaction of patient and therapist {resistance]...is reconceived as communication rather than opposition..." (Wallin, 2007, p. 170, 178).

RIG'S or representations of interactions that are generalized:"...predictable patterns [that] are set up as to how a relationship usually goes...[and] may later accrue to expectations of interactive responsivity. Or RIGs may accrue to expectations of maternal...intrusion, and thus withdrawal by the infant may follow..." (Lachmann (on Stern, 1985), 2000, p. 92-93)

self - "...a psychological structure through which self experience acquires cohesion and continuity, and by virtue of which self-experience assumes its characteristic shape and enduring organization..." (Structures of Subjectivity, Stolorow & Atwood, 1984, p.34).

selfobject - coined by Kohut, this term signifies the self-affirming ways that the patient subjectively experiences the analyst or another person, that fulfill needed, self-sustaining, self-vitalizing, self-organizing needs (Lachmann, F, Transforming Narcissism, 2008, p. 8)."...[provided by} parents with mature psychological organizations..."selfobjects"...perform critical regulatory functions for the infant who possesses an immature, incomplete psychological organization...selfobjects are thus external psychobiological regulators (Taylor...1987) that facilitate the regulation of affective experience (Palombo, 1992),...to cocreate states of maximal cohesion and vitalization (Wolf, 1988)" (Schore, A., Affect Regulation, 2003, p. 13-14).

self-organizing - the task of making meaning out of randomness (Coburn, 2007, quoting Atlan, 1984))

self-organizing system - a system with a "...powerful propensity to categorize information [and] ...to create unity and cohesiveness...". (Fosshage, J., Persons In Context, 2011, p. 94)

self psychology - its central focus is "...on understanding the patient from within the patient's subjectivity...[i.e.] the patient's frame of reference, which is co-constructed by analyst and patient and provides the context for the patient's reactions..." (Lachmann, 2000, p. 3).

selfobject (or 'developmental' dimension of the) transference - "pertains to "that dimension of our experience of another person that relates to...shoring up our self" (Kohut, 1984, p. 49)......in treatment, the patient...derive[s] selfobject experiences in which the analyst is felt to be a source of self-coherence, affect regulation, and self-continuity. ..the analyst is experienced as a "function" that maintains and organizes the sense of self...[whereby}...the selfobject experience is a vitalizing, affective, self-restorative, or self-enhancing experience..." (Lachmannn, 2000, p. 10). "...experienced...by the patient as a "holding environment"...an archaic intersubjective context reinstating developmental processes of psychological differentiation and integration that were aborted and arrested during the patient's formative years..." (Stolorow, et al, 1987, p. 44).

trailing edge (of the transference) - "...addresses the contents and conflicts that are avoided, repressed, or disavowed...can be grim..."(Lachmann, 2000, p.ix).

transference: Although originally defined by Freud as a process that develops within the analytic relationship, transference is more accurately understood as the activation of internal, emotional, organizing  principals or organizing patterns, within all dimensions of our relational experience, by both analyst and patient (see co-transference), whereby the person assimilates and constructs his/her relational world (Fosshage, J., lecture, 2015).

transference, repetitive dimension - 'the reactivation, replication, and re-experiencing of the "invariant organizing principles" (Stolorow, 1987) of the original trauma' (Mermelstein, J., 1997); (Intersubjectivity) - "...the patient seeks responses from the analyst that would counteract invariant organizing principles...an addiction to the analyst's "responsiveness"... [whereby] the patient seeks an antidote to what is crushingly present ...that [clinically may] lead...to addictions..." (Orange, et. al., 1977, p.65-66)

transference, selfobject dimension - "...[as per Kohut] the patient longs for the bond with the analyst to supply missing developmental...mirroring... experiences...the search for...archaic selfobject functions...which foster integration and developmental transformation..." (Orange, et. al., 1977, p.65-66); 'the sustaining bond of the analyst who is experienced as part of the self, that may be disrupted by re-traumatization, due to the analyst's empathic failure' (Mermelstein, J., 1996); "...organized around the seeking responsiveness to his sense of AGENCY..." (Ringstrom, P, 2014, p. 51).

unconscious, dynamic  - "...emotional information, once consciously known, that had to be "sequestered", or forgotten, because it created conflict for the subject...the memory would threaten the tie to caregivers on whom the child needed to depend...the effects of such early experience, unavailable for reflection, continue to appear as repetitive troubles..." (Orange, et al, 1997, p. 7-8) "...experiences that were denied articulation because they were perceived to threaten needed ties..." (Contexts of Being, Stolorow, Atwood, 1992, p. 33).

unconscious, prereflective - "...represents  organizing principles, or emotional convictions, [that] operate automatically...out of awareness...[and the] emotional inferences a child draws from [the] intersubjective experience in the family of origin...{in order to] retain significant emotional ties...to organize some sense of self out of...confusing...relational experience..." (Orange, et al, 1997, p. 7) "...the organizing principles that unconsciously shape and thematize a person's experiences..." (Contexts of Being, Stolorow, Atwood, 1992, p.333)

unconscious, unvalidated - "...emotional experience that remains largely somatic, and unarticulated, symbolically or linguistically..." (Stolorow, R., PhD, interview, 2014).

vertical split - In Heinz Kohut's theory of Self psychology, the concept related to the defenses of  dissociation and disavowal,, whereby undesirable emotions, memories, and perceptions are warded off, walled off, from conscious awareness, contrasted with horizontal split, which relates to the sweeping psychic defense of repression (Textbook of Psychoanalysis, 2nd ed., 2012, p, 202, 587).

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