The Analyst's Self-Care: Further Reflections after the Pandemic on Cultivating Resilience and the Essential Role of the Body-Mind Relationship in Clinical Practice.

Sparse attention is paid in the psychoanalytic literature to the management of self-care needs of the analyst. I suggest that pandemic fatigue experienced by psychotherapists during the Covid-19 global crisis has thrown into bold relief the requirement for clinicians to attune to the body, particularly the requirement for rest and creative space. Physical and emotional exhaustion is multidetermined and not unique to this time period; the global crisis appears to have unmasked particular difficulties in sensing and tending to requirements of the body-mind. Changes observed in sleep, dreams, exercise, eating, and somatic states during the pandemic raise additional questions about modifiable risk factors of burnout. Drawing upon contemporary evidence emerging from the fields of cognitive psychology, neuroscience, and psychodynamic practice and theory, suggestions are made to assist the analyst in rendering essential self-care.

Aches, Pains, Rumbles, and Stumbles: Applying Somatic Countertransference and Body Reactivity in Clinical Work and Teaching.

Recognizing somatic countertransference reactions is an essential tool for the psychodynamic clinician. Although the analyst's bodily reactivity has been written about throughout the history of our field, contemporary neuroscience, multiple code theory, and nonlinear system dynamics provide scientific buttressing to understand embodied phenomena. Patients often speak with and about their bodies, and the clinician who pays attention to these communications, as well as those emanating from his or her own body, has an additional resource to help the patient. Elvin Semrad's classic but largely unremembered "tour of the body" is one tool that can assist clinicians in how to receive and process body reactions that may be unconsciously split off, consciously withheld, or felt dangerous or beguiling. Three examples are used to illustrate embodiment and somatic countertransference as important clinical guides. An argument is made that these concepts should be taught and integrated into psychodynamic curricula.

The Secret Life of Secrets: Deleterious Psychosomatic Effects on Patient and Analyst.

The impact and complex nature of keeping secrets deserves greater scrutiny within psychoanalysis. While the capacity to keep a secret is a developmental achievement that furthers conscious choice and healthy boundary setting between self and others, an individual's need for privacy must be distinguished from untoward costs of collusion and concealment. Clinical case material shows that not all secrets are unconscious or multilayered, as assumed in most of the psychoanalytic literature. Nonetheless, in these cases deleterious effects to psyche and soma took root. These patients assumed that their secret was irreparably destructive to an essential object relationship; shame, guilt, narcissistic vulnerability, unconscious identification with an injured party, and developmental deficit were other factors found to undergird this mode of pathogenic dissembling. Two clinical examples also demonstrate that embodied countertransference reactions may herald the revelation of a secret in treatment that had been hidden, but in plain view. Secrets appear to exert their profound psychological and physical effects on patient and analyst by biological mechanisms that are as yet poorly understood but are readily observed in clinical practice. Psychoanalysts who keep in conscious awareness both the adaptive value and the potential costs of maintaining the confidences of others over the course of a career are better positioned to assist their patients and themselves in rendering essential self-care.

Bring Me Your Hungers: Omnipotence, Mourning, and the Inexorable Limits of Time and Self in the Psychodynamic Treatment of Eating Disorders.

Drawing upon the classic use of physical hunger as both a concrete sign of and metaphor for deep emotional needs, this article elaborates upon the many layers of hunger the eating disorder patient experiences and narcissistic defenses commonly employed to deny them. The authors use two extended case examples that illustrate the arduous but worthwhile task of welcoming patients to "bring their hungers"-an invitation that calls clinicians to make contact with the patient's human desires, to repeatedly chip away at the omnipotence used to mask such cravings, and to provide a space for working through the inexorable limitations imposed by time and mortality. A third example of a clinician who struggled with embodied countertransference reactions further elucidates different manifestations of these defenses. This paper highlights the unique value that psychodynamic clinical work offers patients in tolerating their healthy physical and emotional appetites to ultimately facilitate a more satisfying life.

Essential Others and Spontaneous Recovery in the Life and Work of Emily Carr: Implications for Understanding Remission of Illness and Resilience.

Artist Emily Carr 1A majority of paintings by Emily Carr are in the permanent collection of the Vancouver Art Gallery. Others may be viewed in the National Gallery of Ontario and the British Columbia Archives in Victoria, BC. They are also available as photographed reproductions on the web at vancouverartgallery.bc.ca. 1 (1871-1945) has attained iconic status in Canada and throughout the world for her prodigious output as a painter and writer of the Pacific Northwest. This article describes how the arrival of three "essential others" at pivotal moments in middle life helped lift Carr out of a serious, lifelong depression and nurtured and inspired her creative output. I propose that Carr's productivity and psychological recovery were facilitated by sequential, cumulative input from these generative human contacts. The creative partnership formed between an artist and her muse has features akin to the patient/therapist dyad, ranging from sparking new and healthier adaptations, to reshaping the internal landscape via internalization, to facilitation and promotion of unique talent. This psychobiographical study of Emily Carr is a vehicle for clinicians to further contemplate elements imbedded in our daily work that give rise to greater resilience, spontaneous recovery from illness, and personal transformation in the lives of our patients.

L'artiste Emily Carr (1871­1945) a atteint un statut iconique au Canada et à travers le monde pour sa prodigieuse production en tant que peintre et écrivain du Pacifique Nord-Ouest. Cet article décrit comment l'arrivée de trois "autres essentiels" à des moments pivots au moitié de sa vie a aidé à sortir Carr d'une sérieuse dépression de longue durée et a nourri et inspiré sa production créatrice. Je propose que la productivité et la guérison pychologique de Carr ont été facilitées par l'apport séquentiel et cumulatif de ces contacts humains générateurs. Le partenariat créateur entre un artiste et sa muse comporte des aspects semblables à la dyade patient/thérapeute, allant de la stimulation de nouvelles et plus saines adaptations, à la restructuration du paysage intérieur via l'internalisation, à la facilitation et la promotion d'un talent unique. Cette étude psychobiographique d'Emily Carr est un véhicule pour les cliniciens pour mieux saisir les éléments ancrés dans notre travail quotidien donnant lieu à une plus grande résilience, à une guérison spontanée de la maladie, et à la transformation personnelle dans les vies de nos patients.

L'artista Emily Carr (1871­1945) ha conseguito lo status di icona in Canada e nel mondo per la sua portentosa produzione come pittrice e scrittrice dell'area nord-occidentale del Pacifico. Il lavoro descrive come l'arrivo di tre "altri essenziali" in momenti decisivi nell'età di mezzo della Carr le permisero di sollevarsi da una grave depressione durata tutta la vita e alimentarono e ispirarono la sua creatività. Io avanzo l'ipotesi che la produttività della Carr e la sua guarigione psichica siano state facilitate dall'apporto successivo e cumulativo rappresentato da questi rigeneranti contatti umani. Il legame creativo tra l'artista e la sua musa ha connotati simili a quelli della diade paziente/terapeuta, che vanno dal dar vita a modalità adattive nuove e più adeguate al rimodellare il paesaggio interno attraverso l'interiorizzazione fino a facilitare e promuovere talenti specifici. Questo studio psico-biografico di Emily Carr è per i clinici un modo per considerare ulteriormente i fattori intrinseci al lavoro quotidiano che determinano nei pazienti una più ampia resilienza, la guarigione spontanea dalla malattia e la trasformazione personale della loro vita.

Eating disorders in the 21st century: identification, management, and prevention in obstetrics and gynecology.

Eating disorders are extremely common and carry a high degree of medical and psychiatric morbidity. These disorders are challenging to treat because many patients deny their symptoms, have poor motivation to change, and can become frustrating to the clinician. Case identification based upon suggested screening questions and ongoing management of medical consequences are important roles for the obstetrician/gynecologist involved in the care of these patients. This chapter discusses the benefits and limitations of contemporary treatment, special populations at risk (e.g. athletes, diabetics), and screening guidelines for office practice. Signs, symptoms, laboratory abnormalities, and the perils of associated psychiatric illness are briefly reviewed. Patients do respond to a comprehensive, integrated treatment plan that includes nutritional stabilization, psychotherapy, and pharmacotherapy. Collaboration between all professionals involved in the patient's care is essential for state-of-the-art care. Those patients who become pregnant or wish to become pregnant pose certain additional treatment considerations. Ongoing and future research aimed at understanding how eating disorders develop - and may be prevented by early identification and education - will result in enhanced knowledge of these life-threatening and often chronic illnesses in the 21st century.

New perspectives on the psychotherapy of women: cost effective and clinical interventions.

Psychotherapy is a cost-effective treatment modality with demonstrated effectiveness in various medical and psychiatric conditions. The author reviews contemporary trends in the psychodynamic understanding of and practice of psychotherapy for women. Emphasis is placed on practical interventions that the primary care clinician can use in practice.