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Collisions and uncomfortable countertransference in the clinical process may have both conscious and unconscious contributions. The patient’s and therapist’s histories, character structure, wishes, and expectancies may clash, often fueled by external stresses and events, and these factors may cause the treatment to flounder, stagnate, or end altogether. We will begin by considering Joyce Slochower’s notion of psychoanalytic collisions in the consulting room. Slochower, who is a relational analyst influenced by Winnicott, examines situations in which the clinician’s personal and professional wishes clash with the realities of everyday clinical work. We will explore ways that psychoanalytic collisions can be productively engaged even if they cannot be fully resolved, which generally requires a maintenance of therapeutic hopefulness along with an acceptance of the therapist’s human fallibilities.

We will then undertake a closer examination of countertransference, specifically, Irwin Hirsch’s notion of coasting in the countertransference. Hirsch is relational analyst and intersubjectivist whose writings over the years have focused largely on countertransferential issues. Coasting refers to the clinician persisting in certain behaviors even after becoming aware of them, behaviors indicating our apparent willingness to sacrifice the patient’s interest for our own comfort and equilibrium. As such, we will examine how clinicians’ character structure and situational stresses influence their preference for certain types of patients and their clinical participation. We will consider how theory, however helpful and necessary, can also become a crutch. Finally, we will examine how money complicates the therapist-patient relationship.

This study group is appropriate for beginning and seasoned clinicians with an intermediate level of knowledge about psychoanalytic theory. We will utilize readings with case examples, which will hopefully stimulate open discussions about our own practices and patients. Study group participants must obtain a copy of the 2 textbook that we will use: Psychoanalytic Collisions (Slochower, 2012) and Coasting in the Countertransference (Hirsch, 2008).

1a) Explain what is meant by an existential crisis in treatment, give an example, explain its impact, and describe considerations in addressing it.

1b) Give an example of an emotional collision that occurred with one of your patients, explain how it impacted the treatment, and state ways that you could have better addressed it.

2a) Describe ways that idealizations of both patient and clinician can both facilitate and hamper a treatment.

2b) Explain why it is important to sustain moments of collision in dealing with the tension between professional ideals and actuality.

3a) Explain the concept of coasting in the treatment.

3b) Describe a situational factor that occurred in your life, and how it influenced your therapeutic participation.

3c) Give an example of how the clinician’s character structure and wish for equilibrium in the dyadic relationship hampered a treatment.

4a) Describe the sort of patients that you prefer and why.

4b) Explain why theory is necessary, yet can also obstruct a treatment.

5a) State whether you accept (or intend to accept) insurance or low-fee patients in your practice, and whether this causes any dissonance with your professional ideals.

5b) Describe your countertransference and actions when a patient lags behind in their payments.

Cynthia Mulder, LCSW-S, is a psychotherapist and psychoanalyst in private practice in Houston, Texas, as well as an assistant professor at Baylor College of Medicine, faculty member at the Center for Psychoanalytic Studies, and president of the Houston Psychoanalytic Society.  She earned a master’s degree from Smith College of Social Work in Northampton, Massachusetts. In 2005, she worked as a family therapist at the Austen Riggs Center in Stockbridge, Massachusetts. In 2010 she joined the Menninger Clinic as an individual, group and family therapist. Ms. Mulder began facilitating Brené Brown’s curriculum on shame, vulnerability and authenticity - The Daring WayTM to patients on the adult units at Menninger, and training clinicians across the country in Brown’s curriculum. In 2013 she was appointed the Director of Education and Training. She oversaw clinical training programs, coordinated Family Education Day, and organized the clinic’s local and national continuing education activities. She has presented nationally about shame resilience and suicide, and was an invited presenter at the APsaA meeting in February 2018 on a paper titled “How Far Can the Frame Be Stretched Before It Breaks”. She was the recipient of two awards at Menninger: The Arthur Mandlebaum Award for Excellence in Social Work Education in 2017 and the Jon G. Allen Distinguished Education Award in 2020.

Nancy J. Warren, PhD is a Clinical Psychologist who received her doctoral degree at St. Louis University in 1978. After graduating, she went on to be a faculty member at the University of North Carolina, Chapel Hill and Baylor College of Medicine, Houston, in the Department of Psychiatry. After leaving Baylor, she was in private practice for 15 years, during which time she completed psychoanalytic training at the Center for Psychoanalytic Studies (CFPS) in Houston in 2006. She currently serves as an adjunct faculty member at CFPS. In 2011, she moved to Charleston, South Carolina. She was on the faculty of the Medical University of South Carolina (MUSC), where she worked in the Community Outpatient Clinic, serving a mix of insured and uninsured adults, couples, and senior citizens. She continues to work part-time at MUSC, where she teaches and supervises a small number of psychiatric residents. She also maintains a small private practice in Charleston.

Hirsch, I. (2008). Coasting in the countertransference: Conflicts of self interest between analyst and patient. New York: Analytic Press.

Slochower, J. A. (2012). Psychoanalytic collisions, second edition. New York: Routledge.

Slochower (2012). Chap. 5. Existential Crises in the Consulting Room. Pp. 87-100.

Slochower (2012). Chap. 6. Emotional Collisions. Pp. 101-118.

Slochower (2012). Chap. 7. Asymmetrical and Colliding Idealizations. Pp. 119-138.

Slochower (2012). Chap. 8. The Ideal and the Actual. Pp. 139-162.

Hirsch (2008). Chap. 1. Coasting in the Countertransference: Analysts’ Pursuit of Self-Interest. Pp. 1-26.

Hirsch (2008). Chap. 2. The Influence of Situational Factors, in Analysts’ Lives and Analysts’ Preferred Relational States, on Analytic Participation. Pp. 27-52.

Hirsch (2008). Chap. 3. Analysts’ Character Structure and the Wish for Emotional Equilibrium. Pp. 53-80.

Hirsch (2008). Chap. 4. Preferred Patients, Preferred Relational Configurations. Pp. 81-108.

Hirsch (2008). Chap. 5. Psychoanalytic Theory and Its Unexamined Comforts. Pp. 109-132.

Hirsch (2008). Chap. 7. Money and the Therapeutic Frame. Pp. 155-176.

Hirsch (2008). Chap. 8. Money and the Ongoing Therapeutic Relationship. Pp. 177-200.

Hirsch, I. (2021). Mutative action: From insight to productive use of uncomfortable countertransference experience. Psychoanalytic Dialogues, 31: 674-683.

Slochower, J. (2015). An erotic dream, an erotic collision. Annual of Psychoanalysis, 38: 87-104.

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The American Psychoanalytic Association designates this Live Activity for a maximum of 7.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.