The Unique Characteristics of Supportive Therapy with Rodrigo Sanchez Escandon (Leeds, England)

"This patient taught me a lot. The context was that I just finished my second training as a psychodynamic psychotherapist and I felt I needed to prove a lot, and I clearly arrived with the wrong agenda. It was that if I was good enough and smart enough, a clever enough just graduated psychodynamic psychotherapist, I would manage to get into why the patient is struggling so much with the realization of his mother's cancer. That is a resistance, he didn't want to touch the topic at all. I thought that if I uncover the underlying reason why the cancer of his mother was so extremely distressing, and be able to explore with him how he's processing this, I would be helping him. I was extremely wrong. The patient was really generous with me. What I meant is he was forgiving. He clearly was tolerating me trying to push for something he really had no appetite for." "Psychoanalysis is not only about clever interpretations. Psychoanalysis can be about the tools to help us feel what we are experiencing. And in those radical settings, you become almost the object you are projected to be and you need a frame of mind to ground you that you are not that and can offer something different. So that is why I thought it was really useful."  Episode Description: We begin with a description of the distinction between supportive and exploratory psychotherapy. Rodrigo presents clinical examples of individuals who were in crises and their capacity to be aware of their inner experiences was not available to them,  hence supporting their defenses was vital. In addition, "being with them" became a key aspect of the therapeutic benefit they gained. We consider patients who are phobic about intimacy and have backgrounds where trusting others proved to be actually dangerous. He also spoke of therapists who unknowingly privilege their own need to feel like an interpretive healer in the face of their patients' more immediate need to be listened to. Rodrigo alerts us to the risks of colluding with patients' binary view of the world and recommends helping them recognize that "the therapist may not always be on their side or share their perspective" - this is the creative challenge of supportive work. We close with his sharing with us his personal journey and his appreciation that psychoanalysis can be meaningful as well in settings 'off the couch'.   Our Guest: Rodrigo Sanchez Escandón Trained as a Clinical Psychologist in Mexico City and completed his Psychoanalytic Psychotherapy training at the Mexican Psychoanalytic Association before moving to London to undertake further psychoanalytic training at the British Psychoanalytic Association (BPA). He is currently the BPA's Director of Curriculum Subcommittee. He is also the Course Lead for Adult Psychotherapies at the Tavistock and Portman NHS Foundation Trust, overseeing programmes in London and the North of England. He previously lectured in the Department of Psychosocial and Psychoanalytic Studies at Essex University, where he continues to supervise PhD students and pursue research. For seven years, Rodrigo worked extensively with individuals experiencing homelessness and complex needs, integrating psychoanalytic approaches into multidisciplinary care. He now maintains a private practice in Leeds, alongside his teaching and leadership roles.   Recommended Readings:   Winston, A., Rosenthal, R. N., & Roberts, L. W. (2020). Evolution of the concept of supportive psychotherapy. In Learning supportive psychotherapy: An illustrated guide (pp. xx–xx). American Psychiatric Association Publishing.   Winston, A., Rosenthal, R. N., & Roberts, L. W. (2020). General framework of supportive psychotherapy. In Learning supportive psychotherapy: An illustrated guide (pp. xx–xx). American Psychiatric Association Publishing.   Hellerstein, D. J., Rosenthal, R. N., Pinsker, H., & Klee, S. (1994). Supportive therapy as the treatment model of choice. American Journal of Psychotherapy, 48(1), 80–93.   Sanchez Escandon, R. (2025). Introduction to the fundamentals of supportive therapy. In Contemporary developments in supportive therapy: Principles and Practice. Palgrave.   Sanchez Escandon, R. (2025). Active and passive use of the transference. Contemporary developments in supportive therapy: Principles and practice. Palgrave.    

"We bring our patterns with us wherever we go, into every relationship, and we necessarily and inevitably bring them into the therapy relationship or the psychoanalytic relationship, because that's a relationship too. It's not a matter of choice. It simply happens. It happens everywhere. The therapist doesn't do anything to make it happen. This is the human condition. We bring our patterns. The thing that makes psychotherapy, psychotherapy, and not just another relationship, is that we do something different. What we do that's different is, instead of just repeating our same old patterns with a new person, we create the conditions where it becomes possible to notice the patterns, to recognize them, to put words to them, and understand them and discuss them. Out of that experience and that understanding comes the freedom to do things differently, to not have to repeat the same patterns. I always make a point, is that true for everyone? Does everybody need therapy? Well, everybody repeats earlier characteristic patterns. For some people, those patterns allow you to live a satisfying and rewarding life, with pleasure and connection and meaning and intimacy. So if that's the case, you're still repeating early patterns, but that's what it means to be human. However,  some people are living out patterns that cause distress or limitation, that get in the way of living the life they could lead, and that's what we work with in psychotherapy and psychoanalysis." Episode Description: We begin our conversation on the importance of communicating our basic concepts in jargon-free language. Jonathan shares with us the limitations he finds in academic psychology, where analytic ideas are meaningfully misunderstood. We work our way through his paper discussing 'unconscious mental life', the 'mind in conflict', 'disavowal' (instead of 'repression') and 'psychic continuity' (instead of 'psychic determinism') to name but a few of the topics we cover. We recognize the analytic opportunity to discover the ways that we live in the childhood 'then' as opposed to the novel 'now'. Jonathan presents clinical material to demonstrate these concepts, including his own 'disavowal' as he began his analysis. We close with an appreciation of the importance of one's own affective discovery of these otherwise unconscious forces. I also note Jonathan's passion and clarity about our work.   Our Guest: Jonathan Shedler, PhD is an author, consultant, and teacher. His article The Efficacy of Psychodynamic Psychotherapy helped establish psychoanalytic therapy as an evidence-based treatment. He's the author of over 100 scholarly articles, creator of the Shedler-Westen Assessment Procedure (SWAP) for personality diagnosis and case formulation, and co-author of the Psychodynamic Diagnostic Manual. He is Clinical Professor of Psychiatry at UCSF and a Training and Supervising Analyst at the San Francisco Center for Psychoanalysis. Follow Jonathan at: https://jonathanshedler.substack.com/.   Recommended Readings: Schopenhauer's Porcupines by Deborah Luepnitz offers a series of case studies that read like short stories. They will give you a "feel" for what goes on in the clinical consulting room & in the mind of the clinician.   Psychoanalytic Psychotherapy: A Practitioner's Guide by Nancy McWilliams offers a readable introduction to psychodynamic concepts and thinking.    Freud and Man's Soul by Bruno Bettelheim offers real insight into the origins of psychoanalytic theory and how and why it is personally relevant to everyone.    Therapeutic Communication by Paul Wachtel offers answers to the perennial clinician question, "What do I say and how do I say it?"   Long-term Psychodynamic Psychotherapy by Glen Gabbard is the closest thing to a comprehensive course in doing psychodynamic therapy.  Introduction to the Practice of Psychoanalytic Psychotherapy by Alessandra Lema   That Was Then, This Is Now: An Introduction to Contemporary Psychodynamic Psychotherapy by Jonathan Shedler, PhD

"The similarity between Freud and Kohelet [Ecclesiastes] is that both of them believe that there's no overarching totalistic system that  integrates all the disparate experiences that one has. You have that, Freud says, in psychotics, and you have that in philosophers, and you have that in devout people -  they look for systematicity. They try to cram everything into a framework of meaning. Both Freud and Kohelet reject that. They don't have a worldview in that way. However, in order to flourish, you do need a meaning-giving, affect-integrating and action-guiding set of considerations. You can't just be out there like a windowless monad floating around. There are some core beliefs and values that anchor a person, that give them footing. So there's a difference between a totalizing worldview and a workable framework that's open to critique."  Episode Description: We begin with a brief reading from On Transience and Ecclesiastes and consider how they both belong to 'Wisdom Literature' while separated by over 2000 years. Paul points out that while Freud works from a linear sense of time, Ecclesiastes (Kohelet) is drawn to the cycles of nature and human experience. He provides clinical examples that he feels are enriched by considering the teachings of Ecclesiastes which are very similar to the psychoanalytic way of thinking - "one must learn to live with what cannot be altered," the importance of the "downsizing of infantile narcissism," and  recognizing that "pleasure and joy are palpable, sensual and concrete experiences." We discuss the importance of an object-related life that includes forgiveness and gratitude as well as "embracing resignation without despair." We conclude with the deeply moving time poem "To every thing there is a season/ and a time to every purpose under heaven..."   Our Guest: Paul Marcus, PhD is a training and supervising analyst at the National Psychological Association for Psychoanalysis in New York and Co-chair of the discussion group Psychoanalysis and Spirituality in the American Psychoanalytic Association. He is the author/editor of 25 books including The Spiritual Resistance of Rabbi Leo Baeck: Psychoanalysis and Religion. He is the editor of Psychoanalytic Review.   Recommended Readings: Seow, C.L. 1997, Ecclesiastes: A New Translation. New Haven: Yale University Press   Fox, M. V., 2004, Ecclesiastes, Philadelphia: Jewish Publication Society   Heim, K.M., 2019, Ecclesiastes, Downers Grove: IVP Academic   

"With Kristi [second analyst], it was much, much deeper. This whole dependent and infantile part of me was coming out. This is psychoanalytic language - I was moving into a regression that was terrifying, because I had been trained by my mother, and it was my nature, and it was what had worked for me to really approach things as an 'independent person' ie I don't need anybody; I don't need anything; I can function whatever happens. While I explored a little bit of that with Lane [first analyst], it was only very slight, and we never talked about it. With Kristi, she would actually make me aware of it, and I would become aware of my own need for her and withdraw. With Kristi, it was immediate that I knew there was much greater complexity going on, a level of complexity that I couldn't have handled in my 20s. And we locked horns almost immediately." Episode Description: We begin with describing the various psychotherapy journeys that individuals undergo in search of healing. In her memoir, Joan describes two intense yet fundamentally different psychoanalyses at different points in her life. The first analysis was focused on uncovering the unrecognized story of her early family life. The second demonstrated how she was unknowingly replaying that family life in her relationship with her analyst, "I was reliving my whole childhood in our relationship." She came to recognize the "unacknowledged parts of myself" that her analyst "coaxed from its psychic den." She invites us into the frenetic 'regressive' periods where she both desperately craved the affections of her analyst and simultaneously refused to accept the care that was being offered. Multiple episodes of rupture and repair led her to come to terms with the human condition, both her own and her analysts. She closes with "As minutely as I've described these two analyses, I feel as if I've left half unsaid. And yet, as Kristi might say, it's enough."   Our Guest: Joan K. Peters, PhD, is a Professor Emeritus of Literature and Writing at California State University at California. She is the author most recently of Untangling: A Memoir of Psychoanalysis. At last year's meeting of The American Psychoanalytic Association, she gave a talk on memoir and psychoanalysis, and in the upcoming one, her book will be the subject of a panel discussion. In addition to her blog for Psychology Today, she's contributed an essay on dream interpretation for Psychoanalytic Inquiry, and is guest editing a special issue of that same journal on "The Patient Experience."   Recommended Readings: Patient Narratives – an annotated list  The Classics These few analysands who wrote (later on) about their analyses in the 1930's – 1950's offer brief and impressionistic overviews:   H.D.'s Tribute to Freud (New Directions, New York: 1956).   Nini Herman, My Kleinian Home: A Journey Through Four Psychotherapies (Free Association Books, London: 1988)   Margaret I. Little, Psychotic Anxieties and Containment: A Personal Record of An Analysis with Winnicott, (Jason Aronson Inc., Northvale, New Jersey, London: 1985)   Contemporary Memoirs:   Marie Cardinal, The Words To Say It, in French, 1975; English, (VanVactor & Goodheart, Cambridge, Mass.: 1983), introduction by Bruno Bettelheim.   Emma Forrest, Your Voice in My Head: A Memoir (Other Press, New York: 2011)   Andrew Solomon's beautiful essay, "Grieving for the Therapist Who Taught Me How to Grieve," The New Yorker, May 10, 2020, is more of a tribute to his therapist than an account of the process.   Best-sellers   Solomon's The Noonday Sun: An Atlas of Depression   Kay Redfield Jamison's An Unquiet Mind: A Memoir of Moods and Madness (Vintage Books, New York: 1995)   Elyn R. Saks' The Center Cannot Hold: My Journey Through Madness (Hachette Books, New York: 2007) are records of triumph over mental illnesses more than accounts of the therapies the authors underwent.   Fuller contemporary accounts of analysis   Kim Chernin, A Different Kind of Listening: My Psychoanalysis and its Shadow (HarperCollins, New York City: 1995)   Kate Daniels, Slow Fuse of the Possible: A Memoir of Poetry and Psychoanalysis (West Virginia University Press, Morgantown: 2022) offer severe critiques of the authors' analyses.  

"Some time ago, I realized that there was such a thing for me as experiencing my patients as being friends, but they were psychoanalytic friends. It was a psychoanalytic friendship that was quite unique and unlike any other friendship. I think that's what people are talking about when they write about psychoanalytic love. It's not love like any other kind of relationship, because the psychoanalytic relationship is so unique. And I feel the same way about psychoanalytic parenting. It's like it's close to mentoring, but it's different because the structure of the relationship is different than from a mentor or an esteemed and loved teacher. It really is helping somebody with the whole process of development and helping them grow, mature, and become more comfortable with themselves and to know themselves better. That seems to me the essence of parenting, and I don't think we should feel defensive about thinking about it that way. That doesn't seem to me that it's my counter-transference in needing to be a good mother, a good father, a good parent to my patients."  Episode Description: We discuss the challenge of transmitting the experiential knowledge of the dynamic therapies to new generations. David's book on therapeutic aphorisms demonstrates a number of key elements of this unique relationship - symbolic meanings in symptoms, 'psychotherapeutic parenting', the simultaneous use of medications and working with the unlikable patient to name but a few of the topics he brings forward. He describes the challenges of the negative therapeutic reaction, how "transference reactions are the creative soul of the patient's story" and what it was like for him to admit to a patient that he lied to her. We close with his reflecting on the meaning to him of retiring from full time practice, noting "I haven't retired my psychoanalytic mind."   Our Guest: David Joseph, MD is a supervising and training analyst at the Washington Baltimore Center for Psychoanalysis where he served as chair of the board and director of the Institute Council (education committee). For many years he was the Director of Residency Training at St. Elizabeths Hospital in Washington, DC.  He has a long-standing interest in ethics and has written and spoken about a number of ethical issues in the practice of psychoanalysis. He closed his clinical practice several years ago, at the age of 82. In June 2025, his book: Listening for a Lifetime: The Artful Science of Psychotherapy, was published by Mission Point Press.    Recommended Readings: Freud's technique papers.   Greenson, R. (1952) The Mother Tongue and the Mother. JAPA, 1   Zetzel. E. (1956) Anxiety and the Capacity to Bear It.    Schafer, R. (1976) A New Language for Psychoanalysis. Yale University Press. New Haven   Wachtel, P. L.(1977) Psychoanalysis and Behavior Therapy. Basic Books, NY.   Greenberg, J. and Mitchell, S. A. (1983) Object Relations in Psychoanalytic Theory. Harvard University Press.   Arlow, J. (1995) Stilted Listening: Psychoanalysis as Discourse. PQ, 215-233.   Schafer, R. (1999) Disappointment and Disappointedness. IJP, 80: 1093-1104.   Pine, F. (2011) Beyond Pluralism: Psychoanalysis and the Working of Mind. PQ: 80, 823-856.   Poland, W. (2018) Intimacy and Separateness in Psychoanalysis. Routledge, NY.   Holmes, D, (2022). Neutrality is not Neutral. JAPA, 70: 317-322  

"This really is the full motivation for my having written the memoir. I want people to know what the process is like; not only what the process is like but what the feelings are that don't really make you think of psychoanalysis as a way of changing your life. We're just living and hoping that things will change without really taking account of the fact that we could be living better lives and in a better way. I began to think of the ways of the world and the wickedness in it. There's so many things that we do to keep us going - me and my aphrodisiacs, and I think other people doing other things just to divert them from the misery and unhappiness that they feel.  I don't know how often that's looked at or discussed, so I hope the book does open that up a little bit."  Episode Description: We begin with Beverly's description of her early years of feeling lost and the consequent self-destructive patterns she replayed. Years of sensation-seeking led her to become "exhausted, limp, tarnished, and each time, more profoundly lost." She "landed on an analyst's couch in Little Venice, a section of London. I was paying for someone to recognize me. She did." Beverly shares her analytic journey with us and how vital her discovery of 'kindness' was, first from the outside and then from within. We discuss the early death of her father, her mother's depression and the devotion of her older brother.  She closes with "Like life, psychoanalysis is a continuing process. It doesn't stop...issues crop up, new feelings arise...we better understand what those feelings are telling us, and how to make use of them in an environment we have been able to choose for ourselves. And so it goes…"   Our Guest:  Beverly Kolsky, MSW has worked as a psychotherapist for more than forty years both in America and in England.  She trained as a psychoanalyst with the New York Institute for Psychoanalytic Self Psychology also and received training in London where she worked under the auspices of the Tavistock Clinic and the Institute of Marital Studies. Her work has been published in two journals:  Mind Consiliums and Voices: Art and Science of Psychotherapy. She had two psychoanalytic experiences in two countries with analysts of two different orientations. Her motivation for writing the book as a memoir was to let others in the community know the transformative and enduring power of psychoanalysis. She was in private practice in Englewood, N.J. and now lives, mostly retired, in the northern Adirondacks.   Recommended Readings: Jung, C.G. 1963. Memories, Dreams, Reflections. London: Collins and Routledge and Kegan Paul.   Kohut, H. 1984.  How Does Analysis Cure? Chicago: University of Chicago Press.   Kolsky, B. 2015  Mind Consiliums 15(10), (1-10).  Empathy and Secrecy: Discovering Suicide as a Form of Addiction."   Kolsky, B. 2019  "The Ghost in You: Psychotherapy and Grief" (Voices: The Art and Science of Psychotherapy.) Paperback The American Academy of Psychotherapists.   Kolsky, B. 2019  Voices: Journal of the American Academy of Psychotherapists. Vol 55 No 2 "To Be or Not To Be: A Patient's Search for the Lost Mother."    Kuchuck, S. 2021. London: Confer Books. The Relational Revolution in Psychoanalysis and Psychotherapy. Confer Books.    Malan, D, 1979.  England. Butterworth & Co Ltd. Individual Psychotherapy and the Science of Psychodynamics.   Taylor, K. 2002. U.S. Kevin Taylor M.D. Seduction of Suicide: Understanding and Recovering From Addiction to Suicide.  

"I think that the comparison [between political and erotic passions]  is related to the danger of transgressing boundaries from the side of the analyst. It's not totally the same, but it's because of the emotions and the danger of being too much involved as an analyst, if you don't pay attention to what is happening in ourselves with our own emotions, then it can be similar. I think both are important for the psychoanalytic process, to see it as a real relationship - there is this setting where two people in the room meet. They are real persons, but at the same time, a kind of dramatic play fantasy creation coming up from fantasies of the patient, and our own reactions as analysts come into play and gradually just build up the story that is mainly related to the patient's biography, the patient's relationships, and what's going on in her or his life at the moment, but now in relation with us."   Episode Description: We recognize the passionate political world we are living in and the challenges it introduces into the psychoanalytic relationship. Such moments of intense personal conviction challenge the clinician's capacity to hold those convictions, allow the same for the analysand and still locate an analytic surface with which to find additional meanings. Heribert feels that this creates opportunities for intensity akin to "erotic-sexual impulses." He discusses clinical encounters that include his "revealing my assessment of reality" as an aspect of his authentic self living in relation to the patient. He presents the case of a young man whose effort to locate his analyst's "soft spot" entailed provoking him with his idealization of Hitler. Unlike the patient's father who turned away from him at such times, his analyst  tolerated "my required countertransference" which enabled the patient to recognize and tolerate his  tender longings that had lived disguised in his sado-masochistic preoccupations. We close with Heribert, the new IPA president, sharing his vision of  psychoanalysis having a presence beyond the couch in universities and the community at large.   Our Guest: Heribert Blass, Dr. Med. (MD), Psychoanalyst and training analyst for adults, children and adolescents, member of the German Psychoanalytic Association and IPA (DPV/IPA), also specialist of psychosomatic medicine and psychotherapy, psychiatry, working in private practice in Düsseldorf, Germany. Since August 2025 President of the International Psychoanalytical Association (IPA). From 2020 to 20204 President of the European Psychoanalytical Federation (EPF). He has published on the image of the father, male identity and sexuality, gender dysphoria and transidentities, aspects of thought function in the psychoanalytic process and in the institution, psychoanalytic supervision, psychoanalysis in society and as editor of a book on Time and the Experience of Time (first in German, the English publication will follow soon) about the exchange of psychoanalysis with other sciences.   Recommended Readings: Blass, H. (2023). La actitud analítica en un contexto de creencias polarizadas en la consulta. In: La Cultura del Odio. El Odio a La Diferencia. Revista de Psicoanálisis de La Asociación Psicoanalítica de Madrid, Vol 38, Nr. 98, p.439-458 (ISSN: 1135-3171) Blos, P. (1962). On Adolescence. A Psychoanalytic Interpretation. New York: The Free Press Blos, P.  (1985). Son and Father. Before and Beyond the Oedipus Complex.  New York: The Free Press  Freud, S. (1915). Observations on Transference-Love (Further Recommendations on the Technique of Psycho-Analysis III). S.E. 12:157–171.  Gabbard, G. O. (1995). Countertransference: The Emerging Common Ground. International Journal of Psychoanalysis 76:475-485  Greenson, R.R. (1974). Loving, Hating and Indifference Towards the Patient. International Review of Psychoanalysis 1:259-266  Heimann, P. (1950). On Counter-Transference. International Journal of Psychoanalysis 31:81-84  Loewald, H. W. (1975). Psychoanalysis as an Art and the Fantasy Character of the Psychoanalytic Situation. Journal of the American Psychoanalytic Association, 23:277–299.   Tuckett, D. et al. (2024). Knowing What Psychoanalysts Do and Doing What Psychoanalysts Know. London: Rowman & Littlefield    

"I was quite protective of the parent reader while I was editing this. I feel that so many of the books out there on the shelf have a real kind of finger wagging quality to parents. They kind of tell parents what to do, what not to do, mostly what they're doing wrong. I  felt like I wanted to create a resource that empathized with the parents' position, and that protected them, because this is literally the hardest thing in the world. So the protectiveness felt important to me, and it was one of the things that was really quite important that we always held the parent in mind, which is why every letter starts with 'Dear Parent'."    Episode Description: We begin with acknowledging the 'profound ordinariness' of the parenting experiences that these thirty-nine psychoanalysts share with the reader.  They openly reveal their vulnerabilities, childishness, ambivalences and sorrows.  They also share their delights, pleasures and feelings of accomplishment. The letters that we read include those on parental protectionism, feelings of being excluded, rivalries and erotic feelings. All the contributors acknowledge the presence of their pasts in their parenting present. Andy speaks of her journey as a mother and how vital her finding psychoanalysis was for both her and her family. She concludes the book "I hope that you close this book with a deep sense of respect for yourself, a healthy curiosity and a few more questions than answers."   Our Guest: Andy Cohen is a psychoanalyst with the South African Psychoanalytical Association (SAPA). Her TEDx Talk, "A Mom Can't Always Act Like a Grown-Up – Here's Why", explores the unconscious forces between mother and child. She holds an MA Fine Art and has worked as an Art Counsellor using psychodynamic art-based interventions in at-risk communities. She currently lives and works in Johannesburg, South Africa.   Recommended Readings: TED Talk by Andy Cohen: "A mom can't always act like a grown up - here's why" When Mothers Talk - Magical Moments and Everyday Challenges from Birth to Three Years by Ilene S. Lefcourt Doing Psychoanalysis in Tehran by Gohar Homayounpour Psychoanalysis from the Inside Out by Lena Ehrlich Intimacy and Separateness by Warren Poland Dear Candidate: Analysts from around the World Offer Personal Reflections on Psychoanalytic Training, Education, and the Profession by Fred Busch  

"I have had quite some reactions to the article [on their psychoanalyses]. I was also telling Mauro and my colleagues that out of quite a number of articles I've published on maybe more pressing issues in the field of cancer research, for example, brain tumor research that I've spent quite some time with, I think it's actually the article [on psychoanalysis] that probably prompted the most reactions, at least in my personal surroundings, and the reactions have been overwhelmingly positive. So colleagues are very interested. They often ask questions about psychoanalysis, quite specifically, how it works, how it contributed, and also complemented the article in the sense that it was something that was quite outside of the box, so outside of the typical surgical publication." - FV   "How can we reach surgeons? How can we make this interesting and attractive for them to even consider? I think most surgeons will be very performance-driven people, and I think that it goes hand in hand that that type of person will seek ways to improve themselves, but probably more in a technical way. Let's say they want to get faster in their operations. They want to get more skillful. They want to do more complicated surgeries. So there's a lot about self improvement in that you exercise until you master something. And I think that analogy with sports was our way of saying, hey, you know, this is actually pretty cool. You can compare yourself to  professional athletes, in terms of self improvement, and this is actually one way you can get there, how you can improve. At the same time, it was also important for us to acknowledge that it's not for everyone so we also mentioned alternatives, of course." - MV   Episode Description: Mauro and Flavio begin by describing the encouragement they received from their father to pursue personal analysis "to explore our unconscious minds for a lighter life and less emotional baggage." They share their psychoanalytic journeys and give examples of how their greater capacity to reflect instead of react has led to improved surgical patient outcomes. They also describe collegial tensions that were more clearly addressed through their ability to authentically know how they felt. They recommend that like elite athletes who have sports psychologists to address obstacles to their performances, so might surgeons appreciate the utility of psychoanalysis and other measures to improve their clinical attunement. Mauro concludes "Everyone has their baggage - don't be afraid to look at it and to understand what's going on. It's worth it."   Our Guests: Flavio Vasella, MD PhD, is a junior attending neurosurgeon at the University Hospital Zurich, with a clinical and research focus on neurosurgical oncology. He earned his PhD in Molecular Life Sciences at the University of Zurich, where his research explored genome editing strategies in primary brain tumors. His primary academic interests include translational and clinical neuro-oncology as well as surgical education.   Mauro Vasella, MD, is a board-certified plastic surgeon with multiple years of clinical experience specializing in reconstructive surgery. He is affiliated with the University Hospital Zurich in Switzerland and the Royal Melbourne Hospital in Australia and has held positions as a fellow and attending surgeon. His practice and research field focuses on regenerative-reconstructive surgery and burn injuries.   Recommended Readings: FV - Paul Kalanithi – When Breath Becomes Air This memoir by a neurosurgeon-turned-patient is a poetic and piercing meditation on mortality, identity, and the transition from doctor to patient. It explores the tension between the analytical and emotional mind (somewhat paralleling the internal work of psychoanalysis) and offers profound insight into the humanity at the core of medical practice. Bill George – True North: Discover Your Authentic Leadership This book presents a leadership philosophy rooted in self-inquiry, values, and life stories. True North emphasizes that effective leadership comes from understanding your life narrative and using that insight to lead with integrity and resilience. True North challenges leaders to cultivate authenticity by exploring their internal landscape. While the book focuses on leadership in a business context, it offers a compelling, practical perspective for medical professionals as well. Atul Gawande – Complications: A Surgeon's Notes on an Imperfect Science Gawande offers a candid look at the uncertainties, dilemmas, and emotional burdens of being a surgeon. His reflection on fallibility and decision-making underlines the importance of non-technical skills and the internal work required to become not just competent, but humanely attuned, in medicine. The impact of nontechnical skills on technical performance in surgery: a systematic review. Hull L, Arora S, Aggarwal R, Darzi A, Vincent C, Sevdalis N. J Am Coll Surg.2012  This systematic review analyzed 28 studies linking surgeons' non-technical skills—such as teamwork, situational awareness, and stress management to actual technical performance in the operating room. It found evidence that effective NTS positively affects outcomes, while fatigue and communication failures contribute to technical errors.   MV - The Art of Loving – Erich Fromm Realizing the simple but somehow not always obvious fact that before being able to truly love someone, one must truly find themselves loveworthy. This implies and demands introspection, as well as forgiveness towards yourself and others. Outliers: The Story of Success – Malcolm Gladwell To master something, one must invest a substantial amount of time and dedication – this is not only true for technical skills, but also non-technical skills. Personal growth is only possible if you invest time, such as undergoing a psychoanalysis or similar. The Checklist Manifesto – Atul Gawande While the checklist itself is very technical, the way it was conceived and its effect was and still is rather non-technical. It is a question of putting your ego aside and truly focusing on areas which you can improve.  

"I really think that the purpose is to make space for the unknown, uncertainty, and for our kind of humility in the face of the complexity of our belonging to the physical world. So it's our animality, our physicality, all of that is so complicated and difficult to grapple with. The unknown is uncontrollable and is a huge abyss, as we know, for everybody. I do think that I'm trying to pivot here a little bit towards meeting the patient's attempts to grapple with that unknown." Episode description:  We begin by examining the assumptions of causality that we humans commonly invoke when faced with physical ailments. Childhood imaginings come forward during such times, and, despite being distressing, they offer comfort in the face of frightening uncertainty. Similarly, analytic theorizing has occasionally suggested certainties in the face of the unknown. This may limit the analytic space, thereby making vulnerability, fears, and new awarenesses less accessible. Sharone presents clinical material from patients with testicular cancer and lymphoma, where their psychogenic theories of etiology interfered with their medical care. We consider the distinction between patients with somatic symptoms and psychosomatic patients. We question the ability of the analytic method to uncover the origins of medical illnesses while emphasizing the importance of recognizing the "particular possibilities of our method."   Our Guest: Sharone Bergner Ph.D. is a clinical psychologist and psychoanalyst in full time private practice of psychoanalysis, psychotherapy and clinical supervision in New York City. She is a member and former faculty at the Institute for Psychoanalytic Training and Research and is Adjunct Assistant Clinical Professor and a clinical supervisor at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis, in the Contemporary Freudian track, where she teaches a course called The Body in Analytic Reverie. She is a member of the International Psychoanalytic Association and the editorial board of The Psychoanalytic Quarterly. She has a special interest in the body/mind in relation to maternal reverie in early development, vitality, embodiment, and medical issues, having worked early in her career in a cancer hospital, with the internal medicine, OBGYN, and dermatology clinics of a large urban teaching hospital, with political refugees and with parent-child pairs.    Recommended Readings: 1. Bergner, S. (2011). Seductive Symbolism: Psychoanalysis in the Context of Oncology. Psychoanalytic Psychology 28:267-292.   2. Gottlieb, R. (2003). Psychosomatic medicine: the divergent legacies of Freud and Janet. Journal of the American Psychoanalytic Association, 51:857-881.   3. Winnicott, D.W. (1966). Psycho-Somatic illness in its positive and negative aspects. International Journal of Psychoanalysis, 47:510-516.   4. Lombardi, R. (2017). Body-Mind Dissociation in Psychoanalysis: Developments After Bion. Routledge.   5. Lemma, A. (2015). Minding the Body: The Body in Psychoanalysis and Beyond. Routledge.   6. Miller, P. (2014). Driving Soma: A Transformational Process in the Analytic Encounter. London: Karnac. Not to be missed: case vignette: Recalling a Challenging Analytic Case, pp. xxvi-xxxviii