Empty Heart Disease: Teaching and Learning in China.

Drawing on 15 years of experience teaching psychoanalytic theory and therapy primarily from an object relations perspective to Chinese psychotherapists onsite and online, the authors present their learning about Chinese culture, social history, and philosophy, and the Chinese way of communicating about emotional experience. Their essay is imbued with the Chinese use of metaphor and psychosomatic symbolization, particularly involving the heart. They elaborate on the Chinese concept of Empty Heart Disease, comparing and contrasting it to Western concepts from literature, sociology and psychoanalysis, namely spleen, anomie, dead mother, and schizoid, empty, false, and narcissistic self-states. They expand upon and extend the empty heart concept to various age groups and symptom presentations in China, illustrated by a vignette from individual psychoanalysis with a woman and three vignettes from applied psychoanalysis of a couple with no intimacy, a child with an obsessive psychosomatic symptom, and an adolescent school dropout who was self-harming and suicidal in response to academic pressure. Having emphasized the connection between symptom presentations and social life and times, they discuss the impact of trauma, its transgenerational transmission in China, and the impact of unprecedented economic growth and social change on individuals, couples and families.

Group affective learning in training for psychotherapy and psychoanalysis.

This paper describes The Group Affective Model, a method for teaching psychoanalytic concepts and their clinical application, using multi-channel teaching, process and review in group settings, and learning from experience in an open systems learning community for psychoanalysts and psychotherapists. This innovation arose in response to criticism of existing methods in psychoanalytic education that have subordinated the primary educational task to that of the training analysis. Noticing this split between education and training analysis, between cognition and affect, and between concepts of individual and group unconscious processes, we developed the Group Affective Model for teaching and learning psychoanalysis and psychotherapy in an open psychological space in which students and faculty experience individual and group processes of digestion, assimilation, and review, which demonstrate the concepts in action and make them available for internalization selectively. We discuss our philosophy and our educational stance. We describe our institution and our participants. We give examples of teaching situations that we have studied to provide some insight about assimilation and internalization of the concepts and clinical approaches being taught. We discuss the transferability of the Group Affective Model to other teaching settings and psychoanalytic training institutions and propose it as the fourth pillar of psychoanalytic training, next to analytic treatment, clinical supervision, and didactic seminars.

Case study: Analysis of a traumatized hemophiliac boy.

The author presents a case study of a hemophiliac boy in four-times-a-week analysis from the age of four to six and a half years. An extensive narrative of various phases of the analysis including the termination provides the reader access to the material for discussion of therapeutic action. Her analytic technique is based on a developmental point of view and illustrates the use of limits, play, and interpretation based on countertransference. She understands the boy's symptoms of preferring to be a girl, asking to cut his penis off, and wishing to die as defenses against the fear of castration, which in his case is aggravated by the actual threat of repeated medical interventions, and by the underlying fear of a lack of body composition. An unusual feature of the case is the illustration of the symptom, the analysis, and the recovery of the male self, captured in a complex collage that was made over the course of the relatively short analysis.

Technology-assisted psychoanalysis.

Teleanalysis-remote psychoanalysis by telephone, voice over internet protocol (VoIP), or videoteleconference (VTC)-has been thought of as a distortion of the frame that cannot support authentic analytic process. Yet it can augment continuity, permit optimum frequency of analytic sessions for in-depth analytic work, and enable outreach to analysands in areas far from specialized psychoanalytic centers. Theoretical arguments against teleanalysis are presented and countered and its advantages and disadvantages discussed. Vignettes of analytic process from teleanalytic sessions are presented, and indications, contraindications, and ethical concerns are addressed. The aim is to provide material from which to judge the authenticity of analytic process supported by technology.

Clinical issues in analyses over the telephone and the internet.

There is professional consensus that teleanalysis, the practice of psychoanalysis conducted remotely using the telephone and the Internet, is increasing in response to more mobility in the population. But there is controversy as to whether the use of technology leads to a dilution of analysis or to adaptive innovation that is clinically effective and true to the tenets of psychoanalysis. The author reviews the psychoanalytic literature and shows the development of analytic thinking about this technology-assisted practice of psychoanalysis. She summarizes analysts' perceptions and experiences of the advantages and disadvantages, and considers the indications and contra-indications. She focuses on the clinical concerns that arise in terms of the frame, resistance, and the development of analytic process through the unconscious communication of internal objects, unconscious fantasy, transference and countertransference. She gives vignettes from the analysis of a man with trauma-related depression to address the concerns raised and to support her argument that analysis using the telephone and the Internet is a viable, clinically effective alternative to traditional analysis where necessary.