Part of the 2024 Virtual Roundtable Series,
Minding the Gaps: Addressing Mental Health Through the Life Cycle

Emerging adults are reporting surging rates of loneliness and isolation, leaving many developmentally adrift and vulnerable to accumulating mental health troubles. This panel considers how social turmoil, mistrust, pessimism, and polarization uniquely challenge young adults’ identity development, agency, and sense of belonging. Additionally, the panel explores forms of engagement that encourage their social participation and harness their essential contributions to the world they are joining and helping.

CE/CME Courses

Free CE/CME Roundtable moderated by Spencer Biel, PsyD

Roundtable #4 - Loneliness and Belonging in Emerging Adulthood

Empathy is a category term for capacities related to perspective-taking and sharing in another’s experiences. It is valuable for bridging human connections and motivating us to take initiative to help others. However, empathy is notoriously biased. We empathize more with those who look like us, people we know, and those with higher social status. Moreover, empathy motivates good actions in the short term, not over the long term. With these things in mind, this talk addresses empathy in connection to justice. It explores other emotions, such as sympathy and compassion, that support care work. And it emphasizes the importance of acting from well-ordered habits of care, rather of relying on emotional connections, to motivate just actions.

Dr. Sabrina Little presents the August 2, 2024 Virtual Grand Rounds

Dr. Sabrina Little addresses empathy in connection to justice and explores other emotions, such as sympathy and compassion, that support care work. Register for free CE/CME credit.

Dr. Sabrina Little

Free CE/CME course with Sabrina Little, PhD

Empathy in Connection to Justice

The presentation describes two different views, often inconsistent with each other, of Freudian theory on fundamental aspects of the workings of the mind, including the nature and function of consciousness, of unconscious mental states, the relation between the two, and how the id-ego model is best understood. Dr. Eagle discusses the implications of these two different views for one’s conception of psychopathology and approach to treatment. He also discusses post-Freudian developments in light of the two different perspectives on Freudian theory.

Free CE/CME course with Morris Eagle, PhD, ABPP

The Two Freuds: Implications for Conceptions of the Mind, of Psychopathology, and Approach to Treatment

Suicide rates continue to rise in the USA despite increased efforts at prevention and intervention. How to understand and respond to suicide loss survivors is an emerging field of research and clinical application to help mitigate some of the long-lasting effects of suicide on survivors. In this presentation I will review the demographics of suicide and how these inform our understanding of the population of suicide loss survivors and the fallout one suicide death has on individuals, families, communities, and organizations. The findings of an empirical study of psychotherapists who have had a patient in treatment die by suicide are presented. Finally, understanding and responding to individuals and organizations following the suicide of a patient are reviewed.

Jane G. Tillman, PhD, ABPP, is the Evelyn Stefansson Nef Director of the Erikson Institute for Education, Research, and Advocacy at the Austen Riggs Center.

Jane G. Tillman, PhD, ABPP

Free CE/CME course with Jane G. Tillman, PhD, ABPP

The Effect of Suicide Loss on Clinicians and Organizations: Research and Response

This discussion focuses on the unique mental health difficulties facing school-aged children within the current socio-political-economic landscape of mental health care. Particular emphasis is placed on issues related to access to care and equity for minority children and their families, particularly in relation to immigrant communities. Drs. Zayde and Soliman discuss their work, experience, and ways of thinking about the intersection of these social issues along with experiences of loneliness and belonging in the treatment of school-aged children and their families. A moderated discussion and Q&A follows.

Free CE/CME Roundtable moderated by Daniel Knauss, PsyD, ABPP

Roundtable #3 - Loneliness, Belonging, and the Mental Health Crisis in School-Aged Children

In this presentation Steven D. Axelrod, PhD, elaborates two perspectives on the psychology of adulthood–a developmental scheme of tasks and emerging capacities and the drivers for individual growth and vitality.

The developmental framework Dr. Axelrod described in the recently published paper “

Growth in Adulthood: A Revised Psychoanalytic Framework for Adult Development

, 77(1), 126–142.) is a modification and expansion of Erikson’s original epigenetic scheme that incorporates what we have learned from others’ observations and theorizing. Dr. Axelrod then describes how this developmental perspective can inform and improve our clinical work and will illustrate this with some case material.

Dr. Axelrod's discussion of the drivers of individual growth includes, but is not limited to, object finding and object usage in both treatment and “in the wild.” He pays special attention to what has been called the “developmental object” by Anne Hurry and others following the child analytic work of Anna Freud.

A consideration of follow-up data from psychotherapy outcome studies can give us a special window into the processes of growth in adulthood more generally. Some research evidence points to the existence of a group of psychotherapy/psychoanalysis patients who show continuing improvement and better adjustment over time post-termination. One instance of this has been called the “sleeper effect.” Exploration of the factors in treatment and the processes post treatment that sustain these kinds of gains comprises the final portion of this presentation.

Free CE/CME course with Steven D. Axelrod, PhD

The Dynamic Interplay of Adult Development and the Treatment Process

Linda Michaels, PsyD, MBA, and Eric M. Plakun, MD, DLFAPA, FACPsych 

In these last few years we have witnessed unprecedented upheaval in the areas of politics, social justice, the natural world, and public health. To help our patients and to support our practices, communities and the field as a whole, it is vitally important to understand what people are looking for in mental health treatment, and how they think and feel about the therapies we offer. It’s also crucial that public awareness and appreciation of therapies of depth, insight, and relationship improve. These therapies have been missing from, if not pushed out of, the public consciousness, and are misunderstood, undervalued, and overlooked by the general public.

To assess what people know about therapy and mental health and what they really want from treatment, the Psychotherapy Action Network (PsiAN) conducted extensive original research with the general public. Building on research we first conducted in 2020, we have new research to offer a post-pandemic perspective on the attitudes and expectations people have towards therapy, which benefits matter most, what their misperceptions and biases are, and what they know and don’t know about mental health and therapy.

The presentation will also offer a blueprint for engaging and communicating with the public, so that the public gains greater awareness, understanding and appreciation for therapies of depth, insight, and relationship.

Free CE/CME course with Linda Michaels, PsyD, MBA, and Eric M. Plakun, MD, DLFAPA, FACPsych

Going Beneath the Surface: What People Want from Therapy

There was a period in the United States during the 1930s and 40s that was marked by a vibrant interest in how the fields of cultural anthropology and psychoanalysis could inform each other. By the 1990s the psychoanalytic landscape had changed considerably, and any interest in cultural psychoanalysis appeared to have all but vanished. Candidates entering analytic training during this period faced two pernicious biases that converged into a type of conventional wisdom with a deleterious impact on training: On the one hand there was the implicit belief that any interest by a candidate in cultural issues suggested a less serious interest in psychoanalysis; and on the other, there was the belief that psychoanalysis was simply irrelevant to the suffering of minoritized populations. In this presentation, after revisiting the decline of cultural psychoanalysis in the United States, the author will discuss the treatment of a patient presenting with a culture bound syndrome known as ataque de nervios. The treatment serves as a challenge to biases within psychoanalysis and about psychoanalysis. The presentation will conclude by arguing for a new paradigm of cultural theorizing.

Free CE/CME course with Chris Christian, PhD

The Vanishing of Culture in Psychoanalysis: History and New Directions

, presents a way of understanding the traumatic impact of narcissism as it is engendered developmentally, and as it is enacted relationally. Focusing on the dynamics of narcissism in interpersonal relations, Shaw describes the relational system of what he terms the 'traumatizing narcissist' as a system of subjugation–the objectification of one person in a relationship as the means of enforcing the dominance of the subjectivity of the other.

Free CE/CME course with Daniel Shaw, LCSW

The Relational System of the Traumatizing Narcissist

The purpose of this talk is to provide the audience with a review of psychotherapy research over the past century. Instead of just presenting a listing of studies, a case will be made that this information needs to be considered within larger contexts. The “need” for psychotherapy research emerged as a confluence of psychology in early adolescence, professional politics, and the health care industry. Discussion will include both the ways that this movement added legitimacy to the use of psychotherapy to treat a wide range of problems while at the same time narrowing access to mental health services.

Free CE/CME course with Matthew Baity, PhD, ABPP

Paving with Good Intentions: A Story of Psychotherapy Research

Mindy Thompson Fullilove, MD, HON AIA, DLFAPA

This presentation will focus on South Korean television series known as “K-drama,” a genre that tells stories in 16-20 one-hour episodes. The stories focus on individuals in crisis, who resolve their issues in several steps that lead to a deeper engagement with their friends and family. This “team” then is able to tackle larger problems of the society. This optimistic drama form offers insight, drawn from the syncretic philosophical and religious traditions of Korea, into the recovery of individuals and groups, from an array of traumas and social upheavals. Implications for cross-cultural understanding and considerations for US mental health systems will be discussed.

Free CE/CME course with Mindy Thompson Fullilove, MD, HON AIA, DLFAPA

The Tao of K-drama: Reflections on Displacement, Trauma, and Recovery

This roundtable focuses on two- and three-generation approaches to child and parent mental health. When adults become parents, they are in a dynamic developmental phase just as their infant and child is. In this roundtable, we will discuss the developmental and mental health needs for parents during the pre and postpartum period, innovations in programs for pregnant families, and policy implications for improving access to mental health services during this critical developmental period.

Free CE/CME Roundtable moderated by Linda Mayes, MD

Addressing Parent and Early Childhood Mental Health

Introductory courses in psychodynamic approaches to psychiatric treatment featuring a number of Riggs clinical staff members. 

 - Eric M. Plakun, MD, DLFAPA, FACPsych (1.0 CE/CME credit)

The Frame in Psychoanalytic Psychotherapy: Tasks, Roles, and Boundaries

 - Jane Tillman, PhD, ABPP (1.0 CE/CME credit)

Countertransference: What It Is and How to Use It

 - Elizabeth Weinberg, MD (1.0 CE/CME credit)

 - Daniel Knauss, PsyD, ABPP (1.0 CE/CME credit)

The Y-Model for Teaching Psychotherapy Competencies

 - Eric M. Plakun, MD, DLFAPA, FACPsych (no CE/CME credit)

Introductory courses in psychodynamic approaches to psychiatric treatment. 

Introductory Courses for Residents and Trainees

Radical ethics, a philosophical position recognizing the priority of the other over the ego, specifically concerns the other’s suffering. It refuses to see the other as an instance of a category or concept, and therefor holds immense significance for workers in any mental health profession. But it can seem to deny, or minimize the needs of these workers, or of any individual’s needs in the face of the other’s suffering, and thus comes up against undeniable human limitations. It also raises the psychoanalytic problem of masochism. A revised and clearer idea of subjectivity, or of selfhood, can help us to see how we become ourselves in our very pre-existing responsibility for others, even when we come up against our limits.

Free CE/CME course with Donna Orange, PhD, PsyD

Subjectivity in Radical Ethics

Since 2020, “The Summer of Racial Reckoning,” professionals across fields and industries began to pay laser-like attention to issues of diversity, equity, inclusion, and social justice. Assessment professionals in various settings have struggled and, in some cases, plainly stated that these topics are too political to have relevance for our work. This counterpoint only illuminates the dearth of intensive resources to aid professionals in understanding that identity and all its intersectional factors is what is necessary for a comprehensive and holistic approach to assessment that truly considers the complexities of the individuals we serve. From the clinical interview to the final report, to the feedback session – who told the first story and the last story about the person assessed has the potential to create small and rippling or large and impactful change in that person’s life. Sometimes, impacts can include harm by what is unconsidered/unconfronted about who we are, how we were trained, where we work, and what we bring to the table. The identity of the assessor matters just as much as that of the person in front of us and requires a nuanced introspection of self and self in relation to “other,” that can be uncomfortable and necessarily challenges the status quo.

Free CE/CME course with Ksera Dyette, PsyD

What Is the First Story and the Last Story, and Are They the Only Stories: Intersectionality in the Assessment Encounter

Linda Mayers, PhD, and Doris Bertocci, LCSW

The adoption and mental health fields have viewed adoption as being only about children. Adopted adolescents are a more recent afterthought, with adults nowhere on the radar. From their psychodynamic perspectives on the psychology of being adopted, the presenters maintain that therapists often do not recognize the critical differences between adopted and non-adopted patients, or the need for important modifications in treatment. This requires specialized advanced training. Therapists’ knowledge base needs to include an understanding of early developmental trauma within the first three years of life and its implications for altered neuropsychological development, potentially into adulthood. Intensive psychodynamic treatment provides a pathway toward addressing the likely combination of ambiguous mourning, anxious attachments, fragmented identity formation, and confused sexual development. These stimulate unique complexities in the transference and countertransference and, for the therapist, a deeper appreciation of many universal issues.

Free CE/CME course with Linda Mayers, PhD, and Doris Bertocci, LCSW

The Complex Psychology of Being Adopted: What Clinicians Need to Know

Experiences of feeling haunted and of being in the presence of ghosts are prominent in narratives of patients/people of color in the United States and of mixed-race identity. A creative reading of Hans Loewald’s evocative statement on therapeutic action, the process of transforming “ghosts into ancestors,” is used to explore a way of being with and healing patients with mixed-race identities who are imprisoned in melancholic states. An extended case vignette of an Indian American psychoanalyst working with a patient with a mixed racial identity highlights racialized components of melancholia and illuminates specific countertransference states and enactments that can both impede and allow for the gradual and partial witnessing of racialized ghosts and their transformation into ancestors.

When Racialized Ghosts Refuse to Become Ancestors: Tasting the “Blood of Recognition” in Racial Melancholia and Mixed-Race Identities

The presentation begins with an introduction by Michael Garrett, MD, who briefly summarizes the recent renewed interest in trauma-informed psychotherapeutic treatments for psychotic conditions. Dr. Garrett then introduces a series of interviews he conducted with seven PGYIII psychiatric residents who describe the impact that training in psychological approaches to psychosis had on their treatment of their psychotic patients and the effect of this training on their developing identities as early career psychiatrists. The presentation concludes with a list of resources attendees who interested in additional information about training might seek out.

Free CE/CME course with Michael Garrett, MD.

Training Early-Career Psychiatrists to Listen to Psychotic Patients with an Intent to Understand the Meaning of Psychotic Symptoms

The need for human connection across the lifespan.

In 2021, US Surgeon General Dr. Vivek Murthy described experiences of loneliness as “a dark thread through our nation’s most pressing public health challenges” (Murthy, 2021, Public Health Reports, 136[6]). Rates of loneliness across the globe have increased across age and demographic groups steadily over the past two decades, despite concomitant changes in communication technology and virtual interconnectedness. How do we account for the growing prevalence of feelings of isolation, disconnect, longing, and loss, which contribute not only to mental health challenges but also basic experiences of stability and safety within our families, communities, and sense of being a person in the world?

In this recorded panel, three experts in the field of social (dis)connection will share their perspectives on the rise of loneliness as a public health crisis. Dr. Niobe Way has devoted her career to examining social connectedness conceptualized through developmental, cultural, and psychological lenses, with a particular focus on how adolescent identity development. Her presentation will explore the roots, consequences, and solutions to loneliness as a crisis of connection. Dr. Paula Pietromonaco brings decades of expertise in the study of close family and other interpersonal relationships, examining how social perceptions, behaviors, and physiological responses to conflict and stress influence the capacity to experience social connection and emotional intimacy during adulthood. Dr. Blessing Ojembe will share her interdisciplinary expertise and perspective on loneliness and social isolation in Black older adults, highlighting the interplay between time, place and interaction, the contributing and contextual factors of race, age, disempowerment, marginalization, health, and immigration status. Each presenter discusses factors which affect loneliness across the lifespan and engages in a moderated discussion about potential pathways towards addressing social disconnection at both individual and community levels.

Free CE/CME Roundtable moderated by Katie Lewis, PhD.

Loneliness and the Human Need for Connection Across the Lifespan

In the last two decades, psychedelics have re-emerged as promising novel agents for treatment of a broad range of mental health conditions including depression, PTSD, substance use disorders, end-of-life anxieties, eating disorders, and more. Our understanding of their putative mechanisms of action has significantly evolved as well. Several Phase II and III clinical trials of psychedelic-assisted therapy (PAT) using psilocybin and MDMA are either complete or nearing completion, with some of these therapies projected to receive FDA approval within the next couple of years. But are they ready for prime time? In this presentation, Marina Bayeva, MD, PhD, will review the growing evidence base for use of PAT in psychiatric disorders, outline their neurobiological effects, as well as highlight unanswered questions and areas of caution. We will conclude with a discussion of how psychedelics intersect with deep exploratory work of psychoanalysis and facilitate psychological change.

Free CE/CME course with Marina Bayeva, MD, PhD

Psychedelics, Psychotherapy, and the Process of Change: Integrating Insights from Neurobiology, Clinical Research, and Psychoanalytic Work

In this presentation, Dr. Sebastian Leikert describes the therapeutic path with a young male adolescent patient suffering from emotional instability, suicidality, and self-injury. Establishing therapeutic contact with his perception of disorganized bodily states led to relief from suicidal pressure. Working through these bodily sensations in a resonant presence of the therapist who privileges perception over interpretation in these episodes, played an important role in alleviating the intense fear of annihilation and helped him overcome states of autoaggression leading to self-injury in the past. Dr. Leikert describes the inner dynamics and structure of the bodily unconscious and the ways in which somatic narration and verbal interpretation can be brought into a fruitful relationship.

Free CE/CME course with Dr. Sebastian Leikert

Working with the Bodily Unconscious: Somatic Narration as a Method to Anchor the Working-Through in the Body-Self

All clinicians face the problem of working with patients whose treatments are not going well and who are not making progress. Clinicians often label these patients as "difficult" or "treatment resistant." This presentation addresses clinicians' own contributions to this experience, including the role of reductionist biomedical perspectives that do not match evolving evidence. The presentation also summarizes psychodynamic principles that may improve outcomes and the role of intermediate levels of care in treating some of these patients.

Free CE/CME Course with Riggs Medical Director/CEO Eric M. Plakun, MD

When The Patient Isn't Getting Better

Recordings from the Erikson Institute of the Austen Riggs Center's 2023 Virtual Fall Conference: Losing Our Mind and Finding It: Re-Integrating Meaning in a Neurobiologically-Focused Era - A Conference for Psychiatric Care Providers, Psychotherapists, and Social Scientists

Despite our burgeoning neuroscientific knowledge, psychiatric outcomes are not significantly better than they were three decades ago. After decades of hopeful enthusiasm, the limits of a biomedically-reductionist approach to problems of mental health are increasingly clear. A renewed interest in integrating biomedical and psychosocial perspectives to optimize mental health outcomes is gaining momentum, whether in a focus on patient-centeredness, the development of collaborative care models, increasing attention to the social determinants of mental health, or efforts to re-integrate psychodynamic with medical approaches.

Part 3: Psychodynamic Technique in Pharmacotherapy

Part 4: Pharmacotherapy as a Psychotherapeutic Focus

Tanya Luhrmann, PhD: “Of Two Minds, 30 Years Later”

Awais Aftab, MD: “Fault Lines in Biopsychosocial Psychiatry: Integrative Aspirations and the Path Forward”

Nancy McWilliams, PhD, ABPP: “Diagnosis and Its Discontents”

Kathryn T. Hall, PhD: “Meaning Effects and Health Equity”

: “Meaning & Medication: The Evidence Base

Haroula Konstantinidou, MBBS: “Challenges of Integrating Pharmacotherapy and Psychodynamics

Alicia Powell, MD: “The Medication Life”

Adele Tutter, MD, PhD: “Medication as Object”

Presentation recordings from Riggs' 2023 Fall Conference - 9 CE/CME credits available

2023 Virtual Fall Conference - Losing Our Mind and Finding It: Re-Integrating Meaning in a Neurobiologically-Focused Era

Though psychiatry has benefited from an increasingly evidence-based perspective and a proliferation of safer and more tolerable treatments, outcomes are not substantially better than they were a quarter of a century ago. Treatment resistance remains a serious problem across psychiatric diagnoses. One source of treatment resistance is that systems within which psychiatrists are working often create pressures to practice in a biologically reductionistic framework. In this context, the important impact of psychosocial factors in prescribing have been relatively neglected, leaving prescribers to work without some of our most potent tools.

Explore ways that a biomedically-reductionist, illness-centered approach may undermine positive pharmacotherapy outcomes, consider the meaning of patient-centeredness in pharmacotherapy, and explore why it may be beneficial to integrate basic psychotherapeutic skills into routine pharmacotherapy (“Thinking about Prescribing”),

Examine the considerable but oft-neglected evidence bases that describe how psychosocial factors influence medication outcomes and provide guidance about 

 to prescribe (“The Science of the Art of Pharmacotherapy”).

Explore ways that the patient’s dynamics and the interpersonal dynamics of the doctor-patient dyad may undermine pharmacologic treatment outcomes and highlight common dynamics that interfere with the healthy use of pharmacotherapy (“Psychodynamics of Pharmacologic Treatment-Resistance”), and

Explore a specific model, Psychodynamic Psychopharmacology, that integrates psychosocial evidence bases guiding effective prescribing with psychodynamic insights regarding treatment-resistance, offering technical principles for working effectively with complex, co-morbid, and treatment-refractory patients (Psychodynamic Psychopharmacology).

Each unit may be viewed as a stand-alone lecture, but the series as a whole provides a comprehensive perspective on a patient-centered approach that facilitates the integration of ordinary psychotherapeutic skills into pharmacotherapy in a way that supports psychiatrist and NPs in practicing at the true top of their licenses.

Free CE/CME Four-Part Course Series with David Mintz, MD

The Art of Pharmacotherapy: Enhancing Outcomes by Integrating Patient-Centered, Psychodynamically-Informed Perspectives

This presentation looks at physician burnout from a variety of perspectives, including:

the burnout crisis in the context of the last two decades of health system transformation cost, access, and quality

the relationship between burnout and depression

recent data about burnout nationally and internationally

systemic interventions for wellbeing and burnout

Free CE/CME course with Richard Summers, MD

Physician Wellbeing, Crisis, and System Change

How does moral injury occur and what steps can we take to understand and repair the damage it does to individuals and institutions?

Hear from experienced scholars and clinicians at this year’s Erikson Institute Fall Conference as we examine moral injury and repair related to:

Moral injury happens at the intersection of the individual, the institution, and society. Often it leaves a lasting wound to the psyche and the soul that is suffused with the experience of perpetration and betrayal.

First associated with war and military practices, we now know moral injury occurs in other social catastrophes such as the pandemic, the lasting destructive damage of the institution of slavery in the United States, and in various institutional contexts including healthcare, governance, and education.

The growing prevalence of moral injury calls for changes at the level of the community that require cultivating moral practices in leadership and policy.

Participants can expect to come away from this conference with a better understanding of moral injury in multiple contexts and practical actions they can take to aid in efforts at repair.

Hear from experienced scholars and clinicians at the 2022 Erikson Institute Fall Conference as we examine moral injury and repair 

2022 Virtual Fall Conference - Moral Injury: Individual and Collective Trauma, and Its Repair

Aging is associated with a spectrum of cognitive changes ranging from normative mild alterations to clinically significant changes to debilitating impairments. Behavioral symptoms, too, are common and these can resemble non-cognitive mental health disorders. In this presentation, Dr. Ellison will review these cognitive syndromes, discuss assessment, and review decision-making and management issues relevant to the care of persons living with mild cognitive impairment and early dementia.

Free CE/CME Course with James M. Ellison, MD, MPH

Aging and the Spectrum of Cognitive Changes: Assessment and Decision-Making

A Clinical and Empirical discussion with Katie Lewis, PhD

Suicidal thoughts are known to fluctuate dramatically over time, presenting an ongoing challenge to clinicians and researchers alike. While supportive social relationships are known to help reduce risk over time, the short-term impact of interpersonal conflicts on suicide risk is less well understood. In this presentation, contemporary theories drawn from the realms of personality science and suicide prevention will be used as a foundation for understanding the role of implicit relational dynamics in suicide risk. The concepts of agency and communion will be explored as important dimensions that may help to predict the kinds of social situations in which suicidal thoughts will arise. Novel findings from a daily diary study of psychiatric patients enrolled in long-term psychoanalytic treatment will highlight the role of complementarity (versus discordance) in agency and communion between interaction partners as a potential signal of proximal suicide risk. The presentation will discuss treatment implications based on these findings and highlight future areas of inquiry.

Katie Lewis, PhD, is the director of research at the Austen Riggs Center.

Katie Lewis, PhD

How Do Interpersonal Conflicts Contribute to Suicide Risk?

Serious mental health struggles among college students are rising in the nation, increasing the need for access to treatment that can help them remain in school. College is a time of developmental transition as students work to establish themselves as adults in the world. This presentation highlights a novel 

that goes beyond mere crisis stabilization to help students grasp the meaning and achieve mastery of their struggles to lead more self-directed lives. Presenters use a case vignette to demonstrate a treatment model that integrates individual and group therapy, skill discovery and building, psychodynamic psychopharmacology, family work, and collaboration with college counseling centers.

Toward a Self-Directed Life: A Psychodynamic Systems Approach to Treatment of College Students - November 4, 2022, Virtual Grand Rounds by the Austen Riggs Center.

Compass

Free CE/CME course with Spencer Biel, PsyD; Jacquelyn Harden, PsyD; and Eric M. Plakun, MD, DLFAPA, FACPsych

Toward a Self-Directed Life: A Psychodynamic Systems Approach to Treatment of College Students

In the last 25 years suicide has increased by 30% in the US, while a growing crisis in mental health is recognized in the post-pandemic world. Broadening training of clinicians to treat suicidal patients is an appropriate response. Although several manualized behavioral and psychodynamic therapies have been found to be efficacious in treatment of suicidal and self-destructive borderline patients, few clinicians achieve proficiency in even one of these. This workshop presents nine practical principles helpful in establishing and maintaining a therapeutic alliance in the psychodynamic psychotherapy of self-destructive borderline patients. The approach focuses on the therapeutic alliance, viewing suicide as an interpersonal event with meaning in the therapeutic relationship, and engages the patient’s negative transference as underlying suicidal and some self-destructive behavior. The principles are: (1) differentiate therapy from consultation, (2) differentiate lethal from non-lethal self-destructive behavior, (3) include the patient’s responsibility to stay alive as part of the therapeutic alliance, (4) contain and metabolize the countertransference, (5) engage affect, (6) non-punitively interpret the patient’s aggression in considering ending the therapy through suicide, (7) hold the patient responsible for preservation of the therapy, (8) search for the perceived injury from the therapist that may have precipitated the self-destructive behavior, and (9) provide an opportunity for repair. These principles are noted to be congruent with shared elements identified by an expert consensus panel review of behavioral and psychodynamic therapies for suicidal patients with borderline personality disorder. Case material will be used to illustrate the principles and create a space for highly interactive discussion. Workshop participants will also be encouraged to offer case examples from their own practices. The result will be a highly interactive opportunity to discuss and learn about this challenging and important clinical problem.

Free CE/CME course with Eric M. Plakun, MD, DLFAPA, FACPsych

Alliance-Based Intervention for Suicide

A longstanding clinical conviction is that people with anxiety disorders must directly confront their feared object or situation in order to reduce fear of it. This dogma is the basis of exposure therapy and cognitive-behavioral therapies. Challenging this belief, Dr. Siegel and his collaborators have repeatedly shown that repeated, unconscious exposure to phobic stimuli–what they term very brief exposure (VBE)–reduces avoidance and self-reported fear of a live tarantula in highly spider-phobic persons. VBE is based on both the neuroscience of fear and psychoanalytic theory, specifically Freud’s (1932) proposal that “inside of every phobic, there is a counter-phobic”: phobic people are actually unconsciously conflicted about their fears. Dr. Siegel presents a series of randomized controlled tests (RCTs) of VBE, including RCTs conducted during fMRI scanning and psychophysiological monitoring, which provide a window into the dynamic mechanisms of unconscious exposure. He also presents current and future research directions, which include using VBE to treat combat-related, post-traumatic stress disorder in recent US combat veterans, and to reduce phobia-based, COVID-19 vaccine hesitancy.

Paul Siegel, PhD, will be presenting a virtual Grand Rounds on October 28, 2022, through the Erikson Institute of the Austen Riggs Center.

Paul Siegel, PhD

Free CE/CME course with Paul Siegel, PhD.

Getting Unconscious Conflict to Work For, Rather than Against, Us: The Therapeutic Effects of Unconscious Exposure

Therapies of depth, insight, and relationship have been missing from, if not pushed out of, the public conversation on mental health treatment. After decades of attack from multiple fronts, these therapies are misunderstood, undervalued, and overlooked by the general public. To assess what people know about therapy and mental health, and what they really want from treatment, the Psychotherapy Action Network (PsiAN) conducted extensive original research with the general public. From this innovative and unprecedented effort to “listen” to the public, we learned about the attitudes and expectations people have towards therapy, which benefits matter most, what their misperceptions and biases are, and what they know and don’t know about mental health and therapy. This presentation shares the findings from PsiAN’s qualitative and quantitative research. It also offers a blueprint for engaging and communicating with the public, so that the public gains greater awareness, understanding, and appreciation for therapies of depth, insight, and relationship.

PsiAN

Free CE/CME course with Linda Michaels, PsyD, MBA.

Psychotherapy Action Network (PsiAN) and Their Changing the Narrative About Therapy

David Celani, PhD, presents an overview of Fairbairn's model with an emphasis on three aspects of his model. First, he describes Fairbairn's sensitive and nuanced understanding of the emotional vulnerability of children to rejection of their needs by his/her caregiver. The child's dependency is so intense that any lived experiences of indifference or rejection are intolerable for his/ her sense of security, and are dissociated and held in the unconscious.

The second aspect of the model emphasized is the fate of the dissociated material, which collates into memories of the child's self in relation to its objects. There are two pairs of (mostly) unconscious structures, that relate only to each other and engage in a dialogue with each other in the unconscious. They are the antilibidinal ego, which is the child's self in relation to the rejecting parent. This self is suffused with memories of self hate, object hate, a sense of worthlessness and a strong desire for retaliation toward the rejecting object. The rejecting object is simply and internalization (and exaggeration) of memories of the parent when he/she behaved indifferently or in a hostile manner toward the child. The second pair of dissociated selves is called the libidinal ego and it is the child's storehouse of hope for love in the future. It relates to the exciting object part-parent which the child's fantasy that the exciting object part parent actually contains the love for which the child desperately longs. These two pairs of structures are the source of Fairbairn's most significant construct which is called "the attachment to bad objects". Splitting the parental object prevents integration of good and bad part objects (and stifles differentation), and allows the child to hate the rejecting object with a fury and love the exciting object with all their heart.

The final part of the presentation describes how the four sub-ego structures present in the clinical interview, and how the therapist can most effectively respond to them, with the goal of introducing the split off material to the patient's conscious central ego.

Free CE/CME course with David Celani, PhD.

Working with Fairbairn's Structural Model in the Clinical Interview

Addiction to alcohol, tobacco, cocaine, benzodiazepines, cannabis, and opioids can be devastating, as we all know. But video games, online porn, internet gaming, internet gambling, and other technological addictions can be every bit as addictive as substances. These addictions can have real-world ramifications and lead to the loss of jobs, money, and loved ones. As technology becomes integrated into every facet of modern life, these technological addictions are becoming increasingly prevalent. This session will inform healthcare professionals about the addictive potential of technology and help them view these addictions as legitimate psychiatric conditions worthy of medical assessment, diagnosis, and treatment.

Free CE/CME course with Petros Levounis, MD, MA, informing healthcare professionals about the addictive potential of technology and helping them view these addictions as legitimate psychiatric conditions.

Petros Levounis, MD

Free CE/CME course with Petros Levounis, MD, MA,  informing healthcare professionals about the addictive potential of technology and helping them view these addictions as legitimate psychiatric conditions.

Technological Addictions: The New Frontier of Addiction Psychiatry

The presentation will provide an introduction to the concept of epistemic trust and its recent application to developmental psychopathology. Epistemic trust refers to trust in communication or communicated knowledge, and has been implicated in both social learning and psychopathology, as a result of disruptions in the capacity to adopt an appropriate epistemic strategy in relation to social information. These ideas were initially based on experimental work by developmental psychologists but in order to develop a broader empirical basis for this thinking, we have recently created and validated a questionnaire assessing epistemic stance (ES)–the Epistemic Trust, Mistrust and Credulity Questionnaire (ETMCQ). Initial findings will be described that suggest intriguing links between the epistemic stance and developmental psychopathology constructs. Mistrust and Credulity scores were associated with childhood adversity and higher scores on the global psychopathology severity index and both factors partially mediated the link between early adversity and mental health symptoms. Mistrust and Credulity were positively associated with difficulties in understanding mental states and insecure attachment styles. The implications of the theory and these findings will be discussed in relation to psychotherapeutic treatments, particularly in relation to personality disorders and working with groups who have been traditionally labelled as “hard to reach.”

Free CE/CME course with Chloe Campbell, PhD, who provides an introduction to the concept of epistemic trust and its recent application to developmental psychopathology.

 Epistemic Trust and Its Implications for Psychopathology

Psychoanalytic therapy is an evidence-based treatment. Effect sizes are as large as those of other therapies that are actively promoted as “empirically supported” and “evidence-based,” and patients who receive psychoanalytic therapy not only maintain therapeutic gains but continue improving after treatment ends. Research also shows that other forms of therapy may be effective largely because the more skilled practitioners incorporate (often unacknowledged) psychodynamic methods. Jonathan Shedler, PhD, will discuss the seven key features of contemporary psychodynamic treatment in clear, jargon-free language, the scientific evidence for its efficacy, and how it compares to other “evidence-based” treatments like cognitive behavioral therapy (CBT) and antidepressant medication.

Free CE/CME course with Jonathan Shedler, PhD, discussing the seven key features of contemporary psychodynamic treatment in clear, jargon-free language.

The Efficacy of Psychoanalytic Therapy: The Talking Cure in the Era of Evidence-Based Practice

The presentation is based on the recently published book entitled 

Toward a Unified Psychoanalytic Theory: Foundation in a Revised and Expanded Ego Psychology

. The main themes of the presentation are: demonstrating that revised and expanded ego psychotherapy constitutes the strongest foundation for (1) a unified psychoanalytic theory; (2) is best able to integrate relevant findings from other disciplines; (3) provides a more accurate account of the nature of psychopathology; (4) serves to better identify the nature of positive therapeutic outcome.

Free CE/CME course with Morris N. Eagle, PhD.

Race as a lens through which we achieve psychoanalytic understanding is not universally valued or adopted in institutional psychoanalysis. There is either -or-ism-either we are psychoanalysts who stay true to our traditions, or we threaten, weaken, dilute, or confuse the identity by errantly venturing into the social realm. Because of this persistent bifurcation, there is no widely accepted set of standards regarding race in psychoanalysis: for study in institutes, for professional practice, for scholarly inquiry, for admission and retention, or for career progression. The presentation will critique this current situation by examining how it came to be, the stubborn resistances to change, and will discuss how it will be challenged, with a focus on the work of the Holmes Commission. The talk will offer a view of how psychoanalysis will be strengthened when and if it adopts a “yes and” point of view that recognizes considerations of race as an essential additional element of psychoanalysis.

Free CE/CME course with Dorothy Evans Holmes, PhD, ABPP, FABP.

2022 Yasmin Roberts Memorial Lecture - "Journeying Toward Racial Equity in North American Psychoanalysis"

This presentation will identify a series of common, clinical training dilemmas associated with race-based bias, discrimination, hatred, and prejudice. The presenter will use these examples to explore racial legacies in clinical supervisory relationships that are often shared/passed down in training settings, including in psychoanalytic institutes and across psychoanalytically-informed training contexts. The session will focus on 1) direct engagement with policies devised to counteract interpersonal and institutional racism and 2) approaches necessary to foster repair in same race and cross-racial training relationships premised on uneven power dynamics. The presenter will also demonstrate how particular misinterpretations of antiracism tenets and of broader racial and social justice discourses hamper the potential use of psychoanalytic ideas for exploring the complex, intersecting identities of supervisor-supervisee, patient-therapist, and trainee-training institution.

Free CE/CME course with Monique Bowen, PhD identifying a series of common, clinical training dilemmas associated with race-based bias, discrimination, hatred, and prejudice.

Incorporating Racial Justice Principles into Psychoanalytically-informed Supervision

White Privilege: Psychoanalytic Perspectives

In this lecture Neil Altman, PhD, will look at race and the critical role it plays in society and in clinical practice. Much of the effort going into racial consciousness-raising for people who identify as white rests on the notion of unearned “white privilege.” Altman looks deeply into this idea, along with associated concepts of guilt, power, and identity. He suggests that there are embedded assumptions therein that perpetuate the very racially prejudicial ways of thinking that are purportedly being dismantled.

Free CE/CME course with Neil Altman, PhD, who will look at race and the critical role it plays in society and in clinical practice.

David Levit, PhD, ABPP, SEP, speaks about interweaving principles and approaches from a somatically based trauma therapy, Somatic Experiencing (SE), into psychoanalytic treatment. He focuses on patients with severe early traumas who are chronically vulnerable to states of catastrophic dissociative dissolution. When dissociation takes this form, not merely compartmentalization, but “dis-mentalization,” the mind and body are bombarded by overwhelming and disorganizing fragments of disturbing physical sensations, calamitous affects, disconnected and malevolent flashback echoes and images, and autonomic flooding and freezing. It is a terrible dilemma in treatment when patients are so swept up in the flood and/or lost in the fog, that there is no self who is present enough to hear, take in, and participate in the desperately needed holding and containment that we offer. Levit illustrates somatically based interventions that help contend with such catastrophic dissociative states. He also shows how these somatic interventions, borrowed from non-psychoanalytic trauma treatments, can enfold into our psychoanalytic modes of therapeutic process and therapeutic action.

Free CE/CME course with David Levit, PhD, ABPP, SEP speaking about interweaving principles and approaches from a somatically based trauma therapy, Somatic Experiencing (SE), into psychoanalytic treatment.

Somatic Experiencing: Enhancing Psychoanalytic Holding for Trauma and Catastrophic Dissociation–Contending with the Flood and the Fog

Both the American Psychological and the American Psychiatric Associations have recently advocated specific courses in supervision for their trainees. Good supervision has been described in terms of specific competences or progressive skill sets, often measured via symptom reduction in the supervisee’s clients. Emphasis has also been put on adapting supervision, like treatment, to areas of diversity. But there has been less attention to general developmental goals such as the supervisee’s overall professional and personal growth, and to areas of maturation that constitute progress in both therapist and patient. This talk contextualizes clinical supervision historically, exploring some less frequently measured areas of supervisory competence. It aims to be relevant to the practical and professional needs of both supervisors and supervisees.

Free CE/CME course with Nancy McWilliams, PhD, who  contextualizes clinical supervision historically, exploring some less frequently measured areas of supervisory competence.

Psychotherapy Supervision: Old Controversies and New Dilemmas

This lecture will focus on the seldom-addressed therapeutic dyad in which social privilege favors the patient. Through her matrix of relative privilege, Malin Fors will discuss how social power issues are inevitably negotiated in the therapeutic setting and how this process plays out in transference, countertransference, and resistance. Drawing on empirical research from other areas on how people handle sudden loss of privilege, Fors explores the implications of such disparities and explores playful (versus more narcissistically defensive) ways to handle clinical situations in which a patient is dependent on a socially less-privileged therapist.

Free CE/CME course with Malin Fors focusing on the seldom-addressed therapeutic dyad in which social privilege favors the patient.

When Social Privilege Favors the Patient

The impact of reduced social contact on mental health during the COVID-19 pandemic has been identified as a major public health concern. While personality factors such as attachment style have been associated with psychological distress during the pandemic, the longitudinal relevance of these factors and the role of daily social contact in mitigating distress remains poorly understood. This presentation reviews findings from a study that evaluated the impact of social contact and attachment style on changes in loneliness and suicidality over the course of the first year of the COVID-19 pandemic, using experience sampling methods and longitudinal follow-up design. The influence of both exposure to loss/bereavement as well as general attitudes towards grief were explored for their influence on adaptation as pandemic-related conditions continued to endure. Differences in the trajectory of risk, resilience, and adaptation in individuals with anxious versus avoidant attachment traits are described and implications for therapeutic treatment reviewed. Findings overall confirm the relevance of both enduring personality characteristics and daily social behaviors as risk factors for poor emotional health outcomes during the pandemic and point to potential targets for clinical intervention and future empirical study.

Free CE/CME course with Katie Lewis, PhD, who reviews findings from a study that evaluated the impact of social contact and attachment style on changes in loneliness and suicidality over the course of the first year of the COVID-19 pandemic.

Longitudinal Adaptation to Loss During COVID-19

In this talk, Lisa Barksdale-Shaw, JD, PhD, confronts how the examination of early modern English renaissance characters in a sixteenth-century drama recovers, remembers, and recovers race in a way that belies the well-crafted narrative in Christopher Marlowe’s 

. Removing him from the margins of this tragedy, she centers Ithadore, a captured and enslaved Turk, who serves as the figure through which she studies the legal repercussions of the violence that surrounds him. As a way to read the character, Barksdale-Shaw assesses his potential sociopathy and analyzes how the narrative of the play “prosecutes” or makes judgments against the behavior of Ithadore. To determine his relationship to the world, she also considers the dynamics between trauma and the master-servant relationship exists in his role as a bondsman. Further complicating these psychological and legal assessments, Barksdale-Shaw compares the agency of Marlowe’s Ithadore and Shakespeare’s Aaron the Moor from 

. Overall, this case study offers a way to expand how we contemplate contemporary social relationships, racial capitalism, and labor agreements on the global stage.

Free CE/CME course with Lisa Barksdale Shaw, JD, PhD, who  offers a way to expand how we contemplate contemporary social relationships, racial capitalism, and labor agreements on the global stage.

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