Psychoanalytic Practice (2 x 30 minute presentations)- Counter-transference Hopelessness and Hate and the Burnout of FEP Clinicians - Irene Hurford, MD
- Madness and the Real: Recentering the Unconscious in the Clinic of Psychosis - Elan Y. Cohen, PhD
Counter-transference Hopelessness and Hate and the Burnout of FEP Clinicians - Irene Hurford, MD
Working with young people experiencing early psychosis is deeply rewarding work. It is also difficult, draining, and at times heartbreaking. The rate of turnover of staff in CSC programs is unknown, but experientially it aligns with other community mental health (CMH) turnover rates, which are high (Herschell et al., 2020). Reasons given for turnover in CMH are myriad (Beidas et al., 2016; Yanchus et al., 2017). What is rarely mentioned in research publications is the sense of hopelessness that is often engendered in clinicians as they work with young people with psychosis. Some of this despair may be related to the social disparities that many of their clients face, including poverty, abuse, and homelessness, or to the difficulty of the work itself, because recovering from psychosis is non-linear, and sometimes unsuccessful. But some of it is related to counter-transference hate and hopelessness. While analytic clinicians in the 1950s-1970s wrote about these experiences fairly regularly (Searles, Harold F, 1963), as treatment turned medical and/or cognitive, the focus on the feelings engendered in the clinician by the work with psychotic people disappeared. In my experience, it is rarely discussed in supervision, and when brought up, is sometimes met with judgement from other clinicians. And yet these feelings are a critical part of deep work with psychotic individuals (Quagelli, Luca, 2019), an experiencing of the client’s own feelings of hopelessness and rage. But unmetabolized, these near-universal feelings in clinicians can lead to burnout and an ongoing exodus of clinicians from the CSC setting. I discuss these counter-transferential feelings in more depth using clinical examples, and relating it more broadly to the field, before discussing possible strategies to deal with counter-transference in the CSC workforce and ways to combat burnout and staff turnover.
Madness and the Real: Recentering the Unconscious in the Clinic of Psychosis - Elan Y. Cohen, PhDThis presentation problematizes classical assumptions about the relationship between dreams, madness, the unconscious, and reality. I critique an adaptationist psychoanalytic perspective that interprets psychosis as resulting from a defective ego, failing to regulate an excess of unconscious activity. I argue that the classical interpretation prioritizes ego functioning and emphasizes the subject’s adaptation to a defective social reality. In contrast, this presentation offers a psychoanalytic conceptualization of psychosis that aspires to liberate, approaching psychosis as a resistance to processes that efface subjectivity. As such, I advocate for a combined social and psychoanalytic approach to psychosis that recenters the unconscious, which I define as the psychic apparatus that buffers the subject from unmediated proximity to the Real. The presentation will review Freud’s two principles of mental functioning; Bion’s concepts of psychic metabolism, beta-elements and the alpha-function; and the Lacanian registers of the Real and the Symbolic. In each of these frameworks, psychosis can be understood as stemming from a traumatogenic reality that resists symbolization or alpha-betization. The presentation will highlight the utility of each of these frameworks in clinical practice.
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