REGISTER | A Psychoanalytic View of the Phenomenology and Treatment of Adults with Psychotic Spectrum Disorders Study Group

Houston Psychoanalytic Society

Study Group

Trauma, Psychosis, and Psychoanalytic Treatment

Facilitated by

J. Christopher Fowler, PhD

6 Tuesdays

February 20 - April 2, 2024

7:00 PM - 8:30 PM Central Time

Live via Zoom

*Pre-Registration required for Zoom invitation

The sessions will not be recorded

Registration Fees

HPS Full Members: $180

HPS Student Members: $120

Non-members: $210

9 CME/CEU/CE Credits

Instructional Level: Beginner - Advanced

The impact of interpersonal trauma on the expression of psychosis has been broadly understood since Freud’s case study of Daniel Paul Schreber (Freud, 1910/1911). In recent years the dual role of genetics and noxious environmental impacts (epigenetics) has come to dominate our collective understanding of how psychosis emerges (Taylor et al., 2022). This seminar will explore psychological sequelae of trauma on the expression of psychosis and psychotic spectrum disorders. Of equal or greater interest is the therapeutic impact of working with actualized (psychotic) transference, enhancing mentalizing, and restoring epistemic trust (all possible with the aid of psychotropics). A series of clinical papers will illustrate the psychoanalytic interventions that can bring about substantial reduction of psychotic symptoms (eg., Brent, 2015; Brent at al., 2014; Fowler & Celenza, 2008; Fowler, 2016; Volkan, 1994). Case discussions will illuminate the role of timing and staging of interventions that build upon epistemic trust through the use of marked-contingent mirroring, ego-support, and judicious use of linking interpretations (Volkan, 1994) to help patients consider the symbolic meaning of psychotically expressed emotions, conflicts, and interpersonal traumas that create self-alienation and isolation from others.

LEARNING OBJECTIVES

1a. Name and define forms of trauma and neglect.

1b. Identify a trauma to psychosis pathway.

2a. Identify core phenomenological features of psychotic experience.

2b. Name at least 1 viral-induced psychotic process and treatment implications.

3a. Cite research supporting psychodynamic approaches to psychosis.

3b. Name 3 specific interventions in the psychodynamic approach to psychosis.

4a. Describe the primary interventions of Mentalization-Based Therapy (MBT) for Psychosis.

4b. Identify the theoretical foundation of MBT for psychosis.

5a. Describe the role of regression in psychotic experiences.

5b. Describe the relationship between affect and psychotic symptoms.

6a. Describe 2 ways of working with Actualized Transference.

6b. Describe the process of therapeutic play in relation to transference.

Facilitator

J. Christopher Fowler, PhD, is Professor of Psychology in Neurosurgery, Houston Methodist Academic Institute; Professor of Psychology in Clinical Psychiatry, Weill Cornell Medical College in New York; and adjunct faculty member at the Center for Psychoanalytic Studies in Houston. He previously was on faculty at two inpatient settings which are or were well known for providing psychoanalytic treatment: (1) Austen Riggs Center in Stockbridge, Massachusetts and (2) Menninger Clinic in Houston. Dr. Fowler is an internationally recognized personality researcher whose publications include articles on the efficacy and interpretation of the Rorschach Inkblot Technique. His other scientific publications are in the areas of suicide, depression, neuroimaging, and treatment outcome. Dr. Fowler is past editor of The Bulletin of the Menninger Clinic.

Schedule/Syllabus/References

Session 1, February 20th - Trauma, Neglect, and Psychosis

1) Allen, J. G. (2013). Chap 4: Attachment trauma. Mentalizing in the development and treatment of attachment trauma. New York: Routledge, pp. 163-212.

2) Barker, V., Gumley, A., Schwannauer, M. & Lawrie, S. M. (2015). An integrated biopsychosocial model of childhood maltreatment and psychosis. British Journal of Psychiatry, 206(3): 177-180.

Session 2, February 27th - Phenomenology of Psychosis

1) Sass, L. (2022). Subjectivity, psychosis and the science of psychiatry. World Psychiatry, 21(2): 165-166.

2) Fusar-Poli, P. & 27 co-authors (2022). The lived experience of psychosis: A bottom-up review co-written by experts by experience and academics. World Psychiatry, 21(2): 168-188.

Session 3, March 5th - Psychodynamic Psychotherapy of Psychosis

1) Gottdiener, W. (2006). Individual psychodynamic psychotherapy of schizophrenia: Empirical evidence for the practicing clinician. Psychoanalytic Psychology, 23(3): 583–589.

2) Rosenbaum B., Knudsen, P., Koster, A., Lindhardt, A., Lajer, M., Valbak, K. & Winther, G. (2012). Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis: Two-year outcome. Psychiatry: Interpersonal & Biological Processes,75(4): 331-341.

Session 4, March 19th - Mentalization-Based Therapy for Psychosis

1) Brent, B. K. (2015). A mentalization-based approach to the development of the therapeutic alliance in the treatment of schizophrenia. Journal of Clinical Psychology, 71(2): 146-156.

Session 5, March 26th - Expanded psychoanalytic Parameters for Regressed Patients

1) Sandler, J. (1976). Countertransference and role-responsiveness. International Review of Psycho-analysis, 3(1): 43-47.

2) Volkan, V. D. (1994). Identification with the therapist's functions and ego-building in the treatment of schizophrenia. British Journal of Psychiatry, 164 (suppl. 23): 77-82.

Session 6, April 2nd - Therapeutic Play and Actualized Transference

1) Volkan, V. D. & Ast, G. (2001). Curing Gitta's "leaking body": Actualized unconscious fantasies and therapeutic play. Journal of Clinical Psychoanalysis,10(3/4): 567-606.

2) Fowler, J. C. & Celenza, A. (2008). Altering psychotic processes: Integrated psychoanalytic treatment of a schizophrenic patient. Modern Psychoanalysis, 33(1): 50-66.)

*All required reading will be supplied to study group participants

ADDITIONAL REFERENCES (not required reading)

Brent BK, Holt DJ, Keshavan MS, Seidman LJ, Fonagy P. Mentalization-based treatment for psychosis: linking an attachment-based model to the psychotherapy for impaired mental state understanding in people with psychotic disorders. Isr J Psychiatry Relat Sci. 2014;51(1):17-24.

Taylor MJ, Freeman D, Lundström S, Larsson H, Ronald A. Heritability of psychotic experiences in adolescents and interaction with environmental risk. JAMA psychiatry. 2022 Sep 1;79(9):889-97.

IMAGE from Can Stock depicting psychotic experience

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of American Psychoanalytic Association and Houston Psychoanalytic Society. The American Psychoanalytic Association is accredited by the ACCME to provide continuing medical education for physicians.

The American Psychoanalytic Association designates this Live Activity for a maximum of 9 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

IMPORTANT DISCLOSURE INFORMATION FOR ALL LEARNERS: None of the planners and presenters for this educational activity have relevant financial relationship(s)* to disclose with ineligible companies* whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

*Financial relationships are relevant if the educational content an individual can control is related to the business lines or products of the ineligible company.

-Updated July 2021-

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HPS, through co-sponsorship with the Center for Psychoanalytic Studies, also offers approved CEUs for Texas state-approved social workers, licensed professional counselors, and marriage and family therapists.