Psychotherapy stirs up new awareness and challenges existing beliefs. I find this stirring-up enlivening and exciting. Teaching provides a means to realize what I do not know, and a means to continue learning. Through teaching, I share my excitement in the process of thinking and feeling, enriching my work, and learning from students. In this way my work is fresh and enlivening.
RECENT CLASSES:
- Working Through Therapeutic Impasses: Attachment Bonds, Trauma and Mourning
- RACISM: BIOGRAPHICAL, CULTURAL AND PSYCHODYNAMIC PERSPECTIVES
- Bion’s Container/Contained: Integration and Internalization
- Introduction to Psychodynamic Thinking
- The Use of the Frame in Psychodynamic Psychotherapy
- Projective Identification: Communication and Defense
- Symbolic Function
- Bion: Attacks on Linking
March – June 2022
Working Through Therapeutic Impasses: Attachment Bonds, Trauma and Mourning
4 meetings, 10 CE hours
This seminar will be structured around the careful reading and study of the book: "Suffering and Sacrifice in the Clinical Encounter", with supporting articles by Thomas Ogden.
We will consider the clinical features and technical difficulties intrinsic to clinical work with highly defended patients, especially those who have suffered trauma early in their lives that interfered with their feeling sufficiently held and contained by their primary objects of attachment. Using a psychodynamic approach, we will identify and elaborate a new paradigm for managing impasses in the psychotherapy process for patients entrenched in self-blaming and masochistic patterns of behavior.
COURSE SYLLABUS AND OBJECTIVES:
Class 1: Forward and Introduction Suffering and Sacrifice and Ogden, T. H. (2002). A New Reading of the Origins of Object-Relations Theory. International Journal of Psychoanalysis 83:767-782.
CE Objectives:
1. Identify the distinction between suffering and sacrifice in clinical work.
2. Identify 3 core psychological problems of early trauma and significant attachment disorders.
3. Describe the difference between mourning and melancholia using 1 clinical example.
Class 2: Chapters 1 and 2 Suffering and Sacrifice
CE Objectives:
1.Name 3 examples for the role of mourning in facilitating psychological change.
2. Describe 2 functions of the scapegoat dynamic and give 1 clinical example.
3. Describe the concept of container-contained and give one clinical example of the interactional process of containment.
Class 3: Chapter 3 Suffering and Sacrifice and Ogden, T. H. (2006) Reading Loewald: Oedipus Reconceived. International Journal of Psychoanalysis 87:651-666.
CE Objectives:
1. Apply the concept of parricide in the Oedipal Complex to the development of a healthy measure of self-agency and autonomy.
2. Discuss 2 ways the good object differs from the ego ideal.
Class 4: Chapters 4 and 5 Suffering and Sacrifice
CE Objectives:
1. Describe 3 ways that the therapist can approach the core trauma and associated losses that lie within and behind the presenting symptoms.
2. Define 2 ways of working in the countertransference and give one clinical example.
3. Identify two clinical examples of resistances communicating emotional pain thought to be intolerable.
LEADER, MEETING TIMES, AND DATES:
The Saturday seminar will be led by Karen Fraley, LCSW, and will meet by Zoom, from 9:00 - 11:30 am on the following Saturday mornings:
March 12, 2022
April 23, 2022
May 21, 2022
June 4, 2022
Cost: $240.00 for 4 meetings.
A 25% discount for PSCSW members with financial need is available.
CE CREDITS:
For Pennsylvania Social Workers, Marriage and Family Therapists, and Professional Counselors, this program is approved for professional workshop sponsored by the Pennsylvania Society for Clinical Social Work, a state affiliate of the Clinical Social Work Association, listed in Section 47.36 of the PA Code, State Board of Social Work Examiners. This program is also approved for professional workshop for marriage and family therapists (Section 48.36) and professional counselors (Section 49.36).
For New Jersey Social Workers: This program is approved for 20 clinical hours. Attendance at programs or courses given at state or national social work association conferences, where criteria for membership is an academic degree in social work, is a valid source of continuing education credit (NJCA 13-44G-6.4(c)).
For psychologists: The International Psychotherapy Institute is
approved by the American Psychological Association to offer continuing
education credit for psychologists. IPI maintains responsibility for
this program.
September to December 2020
RACISM: BIOGRAPHICAL, CULTURAL AND PSYCHODYNAMIC PERSPECTIVES
4 sessions, 10 CE hours
Awareness of persistent systemic racism in our country has recently called for our attention, reminding us once again that the underpinnings of our society, and much of what we take for granted in our daily lives, rests on racist assumptions and values.
While we recognize the fact of slavery as key in the formation of our nation, we turn a blind eye to the after affects of the violence done to others, and the deep divisions in class and status that remain unheeded. And we realize that all of us must face the deep shame and guilt for our part in allowing these injustices to continue, for our failure to clearly see the obscure and profound consequences of our history.
In this seminar we will read and discuss a series of papers offering psychodynamic perspectives on these issues and consider implications for our clinical practices. We will begin with Betty Joseph's classic paper "Toward the experiencing of psychic pain" addressing some of the ways we turn a blind eye, and the difficulties of moving towards the recognition of our failures and subsequent losses. Kirkland Vaughns describes the traumas suffered, and the intergenerational transmissions of these traumas.
We will read several chapters by Angela Davis highlighting the specific racism black women have faced, and continue to endure, as mothers and wage earners. In her paper, Ummula-Narra considers skin color as a source of identification. We will then turn to the problem of mourning, as a society as a whole, and our mutual dependency as a basic fact of the human condition, as brilliantly outlined by Judith Butler in her paper "Violence, Mourning, Politics".
We will conclude the seminar with the study of Ta-Nehisi Coates' recent essay, "The Case for Reparations". Using as a reference point Melanie Klein's formulations about the meaning of reparation in individual development, we will strive for a broader and deeper understanding of what reparation might look in terms of repairing the damage racism has caused over the centuries.
In conclusion we will discuss the application of these ideas to our practices, and how we might take action to address the on-going racism in our communities and in our profession.
In addition to lecture and discussion of the readings, participants will be invited to share relevant case material and personal experiences.
Following this seminar, an additional seminar consisting of two meetings and providing ethics CEs will be offered to participants: Ethical Perspectives on the Presence and Influence of Racism in the Clinical Encounter.
September to December 2019
Bion’s Container/Contained: Integration and Internalization
4 sessions, 10 CE hours
In this seminar we will consider how the internal object world of each individual emerges as the result of identifications with early experiences of primary figures and the on-going imaginative, creative and sometimes protective elaborations of those experiences through introjective and projective processes. Once established an identification is subsequently processed, both consciously and unconsciously, to establish an internal object, a distinct and certified part of the self. The distinctions between identifications and internalizations will be explored.
Bion's posits the model of the container/contained and the development of links as essential functions in developing the capacity to feel, think and learn. Taking early attachment sequences into account, Bion elaborates the role of maternal containment in the baby's construction of an internal world, the basis of a secure attachment for the establishment of the self.
The importance of mourning, and its functions in letting go of certain identifications, and in creating new internal object relations will be emphasized.
The readings will include a mixture of theory and clinical application of these ideas, using case examples.
Discussion of clinical experiences will be used to further the understanding of the clinical usefulness of the readings.
Karen Fraley, MSS, LCSW, BCD, is in private practice in Exton, PA, providing psychoanalytic psychotherapy to individuals and couples, and clinical supervision to therapists. She holds certification in Object Relations Therapy from the International Psychotherapy Institute (IPI) in Washington, DC. She is also an active faculty member at IPI and a founding member of the Philadelphia Psychotherapy Study Center. She is a Fellow member of the Pennsylvania Society for Clinical Social Work.
For more information contact: Karen Fraley at (610) 952-0435 or kfraley55@icloud.com.
June 2018 - June 2020
Psychoanalytic Psychotherapy Training Program
This will be a comprehensive program designed to give the practicing clinician a solid foundation for the practice of psychoanalytically-oriented psychodynamic psychotherapy.
The didactic part of the program will be provided by three week-long summer institutes and four 20-hour seminars over the course of the two years.
The summer institutes will entail three presentations each day by PPSC faculty and will also include a small group experience. The small groups will meet twice daily and will keep the same membership and facilitators over the course of the three institutes. The small groups are designed to help the participants to further elaborate and digest the material being presented, to link that material to clinical and personal experience and to the immediacy of the group process, and to help with any internal blockages to the participants' learning.
Each summer institute will also include two plenary meetings, which will include the institute faculty and all participants, to consider the impact of the learning on the entire large group. The summer institutes will convene at St. Paul's Episcopal Church, in Chestnut Hill. The cost for each summer institute will be $750.
The four seminars will include practitioners not enrolled in the certificate program and will be provided in several locations:
Tuesday mornings in Doylestown, Wednesday mornings in Wyndmoor, Friday mornings in Chestnut Hill, and Saturday mornings in Doylestown. If none of those times are suitable for program participants, we will make every effort to make other arrangements. The cost of each seminar, for program participants, will be $400.
There will also be a supervision requirement, which will be 50 hours of individual supervision from three PPSC supervisors (20 with one supervisor, 15 with two others). Supervision will be offered at a reduced rate of $75 per hour. After completion of supervisions, each participant will write up and present a case to a committee of three faculty of the participant's choosing. This will not be a pass-fail test, but rather it will serve as an occasion to receive feedback and an assessment of where the participant currently is in his or her learning and what learning tasks might then best be undertaken.
PROGRAM OUTLINE:
Summer Institute I: Object Relations Perspectives on the Human Life Cycle:
Normality and Pathology
June 18 - 22, 2018
This initial summer institute will follow and explore the human life cycle from beginning to end. We will identify and consider the particular tasks, challenges and potential difficulties that are encountered at each stage of normal emotional and psychological development. We will highlight and emphasize how the achievements that are wrought from the successful negotiation of each developmental stage remain available to enrich the mind and heart of each individual as he or she continues on through life. We will also consider and elaborate the particular psychopathologies that may emerge when development is stalled or thwarted by obstacles and/or trauma at particular stages.
Seminar I: The Developmental Significance and Clinical Uses of Fairy Tales, Folk Tales, and Comic-book Superheroes
Fall, 2018
This seminar will further elaborate the development themes addressed in the first summer institute. The seminar will be structured around the careful reading of The Uses of Enchantment: The Meaning and importance of Fairy Tales, the classic text by Bruno Bettelheim. We will also consider: Maurice Sendak's Where the Wild Things Are; the lesser-known fairy tale, Iron John, as explicated by the poet Robert Bly; and Martin Widzer's paper, The Comic-Book
Superhero: A Study of the Family Romance Fantasy.
Seminar II: Learning from the Patient: The Work of Patrick Casement
Spring, 2019
This seminar will be built around the reading and studying of Patrick Casement's book, Learning From the Patient. We will discuss and elaborate Casement's presentation of clinical themes, including listening, holding, and containment, the uses and misuses of theory, interactional unconscious communication, the manifestations of trauma in the transference and countertransference, and the relationship between regression and unconscious hope.
Summer Institute II: Foundations of Object Relations Theory
June, 2019
The second summer institute will be devoted to studying and exploring the seminal theoretical formulations and associated clinical thinking of Melanie Klein, D.W. Winnicott, R.W.D. Fairbairn, and Wilfred Bion, as well as the more recent contributions of Neville Symington and Thomas Ogden.
Seminar III: Internalization, Mourning and Psychic Change
Fall, 2019
In this seminar we will consider how the internal object world of each individual emerges as a product of the internalization - and the imaginative, the creative, and the defensive elaboration - of early experiences with primary figures, and how that internal world is projected and deployed into the external world, including the "world" of the clinical encounter with the therapist. We will emphasize the importance of mourning in the recognition, the suffering, the acceptance, and the restructuring of one's internal world.
Seminar IV: Transference and Countertransference
Spring, 2020
Using Glen Gabbard's book, Love and Hate in the Analytic Setting, we will in this seminar consider the concepts of transference and countertransference, as those concepts first emerged in the work of Freud and as they were elaborated and extended by his many followers.
We will explore the relationship between projective and introspective identification and transference and countertransference, and we will discuss techniques for managing hateful and erotic transferences.
Summer Institute III: Basic Elements and Principles of the Technique of
Psychodynamic Psychotherapy
June, 2020
This summer institute will be devoted to exploring the basic elements and guidelines for the effective practice of psychodynamic psychotherapy. These will include: the elements of the frame; the nature of analytic listening, and containing; the recognition of derivatives of unconscious thinking and perceiving; the inviting and using of dream material; the choices of intervention; and guidelines for interpretation.
Psychodynamic Perspective on The Body, Sexuality and Technology
COURSE DESCRIPTION:
This seminar will be structured around the careful reading and study of four papers by Alessandra Lemma about the development of an embodied identity, and the effects of technology, body piercings and transsexuality on developmental processes.
The body is the primary experience of self-representation, rooting the ego in bodily experiences and sensations. From this primary root, the development of the mind and the self takes hold. Using attachment theory and object relations, Lemma considers the psychological experience of embodiment, and its role in the development of the mind. In her work with adolescents, Lemma considers the wider social context for adolescent sexuality, particularly the effects of the internet, and the "black mirror" of the computer, its plasticity and immediacy as a mirror to portray and project a phantasy of the "perfect" body. She offers an alternative model, based in attachment theory, to aid the therapist to "see" and understand the psychic experience of body identity, self , body piercings and transsexuality.
Object Relations Perspectives on Shame and Ungorgiving States of Mind
SEMINAR DESCRIPTION:
As the Indo-European root, "skam", of our word shame means "to hide", it is not surprising that the affect of shame has until recently been relatively neglected in psychoanalytic theorizing and in our literature and our dialogues.
In this seminar we will consider and discuss eight recent papers on shame and on the unforgiving states of mind that unbearable and unacknowledged shame tends to generate. We will consider the earliest origins of shame in the disruptions to the infants mirrored relation to the mother and how, when disruptions in that relationship are "dosed" in a tolerable and manageable way, it will foster a healthy tension and dialogue between one's omnipotent and idealized self on the one hand and one's ordinary and actual self on the other hand. We will then investigate how, when the self is saturated with unbearable shame, it can lead to unforgiving states of mind organized around grievance, bitterness, blame, and the relentless search for revenge and justice. We will investigate potential technical strategies for recognizing and symbolizing unbearable shame and for fostering the increased capacity to bear it.
We will also consider the complex relationship of, and interaction between, shame and guilt and the separate but related lines of development of each.
Psychodynamic Perspective on The Body, Sexuality and Technology
COURSE DESCRIPTION:
This seminar will be structured around the careful reading and study of four papers by Alessandra Lemma about the development of an embodied identity, and the effects of technology, body piercings and transsexuality on developmental processes.
The body is the primary experience of self-representation, rooting the ego in bodily experiences and sensations. From this primary root, the development of the mind and the self takes hold. Using attachment theory and object relations, Lemma considers the psychological experience of embodiment, and its role in the development of the mind. In her work with adolescents, Lemma considers the wider social context for adolescent sexuality, particularly the effects of the internet, and the "black mirror" of the computer, its plasticity and immediacy as a mirror to portray and project a phantasy of the "perfect" body. She offers an alternative model, based in attachment theory, to aid the therapist to "see" and understand the psychic experience of body identity, self , body piercings and transsexuality.
GROWING PAINS AND THE USE OF THE OBJECT: A CONTEMPORARY READING OF D. W. WINNICOTT
COURSE DESCRIPTION:
This seminar will be structured around the careful reading and study of 4 of D.W. Winnicott's enduring and useful papers, and 4 papers by Thomas Ogden about his reading of the Winnicott's papers. The course will be designed both to introduce Winnicott's ideas and theories to those who are unacquainted with his contributions as well as to deepen the understanding of those who are already familiar with his work.
A major focus of the seminar will be to explicate and illustrate the ways in which Winnicott's ideas are manifest and useful in the clinical encounter. In addition to lecture and discussion of the readings, participants will be invited to share relevant case material for illustration and elaboration.
Retreat and Emergence: The Work of John Steiner
COURSE DESCRIPTION:
This seminar will be structured around the reading and the study of two books by John Steiner: Psychic Retreats (1993) and Seeing and Being Seen: Emerging from a Psychic Retreat (2011).
In these books Steiner describes the psychic retreat as a psychic structure -- that is, a highly-organized set of interlocking defenses geared toward alleviating what are felt to be unbearable anxieties and toward protecting the patient from the catastrophic persecution, fragmentation, and depression that are feared will follow if those defenses are given up. He illustrates how primitive feelings of shame, humiliation, and narcissistic injury arise as the defenses of the psychic retreat begin to shift, and he emphasizes the importance of mourning in facilitating emergence from the retreat.
In addition to lecture and discussion of the readings, participants will be invited to share relevant case material for illustration and discussion.
OVERCOMING TRAUMA: THE WORK OF BESSEL VAN DER KOLK
COURSE DESCRIPTION:
This seminar will be structured around the careful reading and study of Bessel van der Kolk's recent book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. In this book Dr. van der Kolk describes how recent advances in neuroscience have increased and sharpened our understanding of the ways in which trauma not only affects but leaves a palpable imprint on the brain, the mind, and the body of the victim. His book provides a comprehensive approach to the treatment of trauma victims that integrates traditional talk therapy with psychopharmacology, body therapies, and EMDR.
We will augment the chapters in The Body Keeps the Score that deal with treating victims of childhood abuse with selected chapters from two other books: Soul Murder: the Effects of Childhood Abuse and Deprivation, by Leonard Shengold; and, Treating the Adult Survivor of Childhood Sexual Abuse, by Jody Messler Davies and Mary Gail Frawley.
In addition to lecture and discussion of the readings, participants will be invited to share relative case material for illustration and discussion.
The "I" of the Hawk: One Woman's Journey of Mourning, Dreaming and Self-Discovery
COURSE DESCRIPTION:
This seminar will be structured around the reading and the study of Helen Macdonald's recent memoir, H Is For Hawk. In that book, Macdonald chronicles her coming to terms with the sudden death of her father. An experienced and life-long falconer, she decides, in the aftermath of his death, to train, for the first time, a goshawk. As a part of that endeavor, she studies T.H. White's account of his attempt to train a goshawk decades before. Macdonald also explores and describes how White's abusive childhood impacted both his life and his finally failed attempt to train his hawk, and she contemplates and contrasts his story as a shadowy subtext to her own.
We will augment our study of Helen Macdonald's book with selected papers on mourning, dreaming, and the mid-life passage by Freud, Thomas Ogden, Elliott Jaques, Otto Kernberg, and Jay Greenberg.
In addition to lecture and discussion of the readings, participants will be invited to share relevant case material for illustration and elaboration of the themes we will be studying.
Psychodynamic Understanding of Trauma and Its Aftermath
COURSE DESCRIPTION:
This seminar will be structured around a careful reading and discussion of the book, Understanding Trauma, edited by Caroline Garland. The primary focus of each of the chapters in this book is to explicate the many and complex ways in which traumatic events are experienced by -- and interpreted by -- each particular individual according to the structure and nature of his or her internal world. We will consider modes of treatment and choices of interventions that might best facilitate the integration of the traumatic event into an overall narrative or view of the individual's self and life. We will also consider therapeutic strategies for engaging trauma-related themes such as identification with the aggressor, difficulties in symbolizing the traumatic experience, grievance and the wish for justice, restitution and/or revenge, mourning for the lost, pre-trauma self, and the symbolic repetition of the traumatic event in the transference/countertransference.
Reason, Passion, and Freedom of Thought: the Work and the Legacy of Hanna Segal
COURSE DESCRIPTION:
In this seminar we will read and study some of the major papers by Hanna Segal, who was one of the most influential psychoanalytic thinkers of the twentieth century. In studying these papers we will follow Segal's careful and concise explication of the work of Melanie Klein as well as her own expansion and elaboration of Klein's ideas. We will give particular attention to the many ways in which Segal links Kleinian theory to the clinical situation and how Kleinian concepts can be useful in guiding and structuring our interventions and interpretations.
In the course of our discussions participants will be invited to share clinical material to highlight and illustrate the concepts and ideas we will be studying.
Going to Extremes: Ethical Perspectives on Unusual Interventions
COURSE DESCRIPTION:
This seminar will be structured around the careful reading and study of Salman Akhtar's recent book, Unusual Interventions: Alterations in the Frame, Method, and Relationship in Psychotherapy and Psychoanalysis.
Each of the nine contributors to this volume present their views on a particular unusual or unorthodox intervention. We will study each of these contributions and consider the ethical issues and dilemmas that the use of these interventions contain and imply. We will not so much judge each unusual intervention as being right or wrong as much as we will seek to establish guidelines for ourselves when we consider such interventions, in order to help us to distinguish when those interventions might indeed be useful to our patients and clients and when they might reflect countertransference reactions and/or may further contribute to enactments that might be better handled by means of containment and symbolization.
We will also consider how to listen for our patients' unconscious, symbolic commentary on our interventions--both usual and unusual--in their material following an intervention as a way to help us to determined how our interventions have been received.
Work, Play, and Paradox: The Enduring Legacy of D.W.Winnicott, CE seminar.
COURSE DESCRIPTION:
This seminar will be structured around the careful reading and study of 15 of Winnicott's most lasting and useful papers. The seminar is designed both to introduce Winnicott's ideas and theories to those who are unfamiliar with his work and to deepen the understanding of those already familiar with his contributions. A major focus of the course will be to explicate and illustrate the ways in Which Winnicott's ideas are manifest and applicable in the clinical situation.
In addition to lecture and discussion of the readings, participants will be invited to share relevant case material for illustration and elaboration.
Seeing It Through: Essential Elements for Establishing, Protecting and Sustaining Psychodynamic Psychotherapy, CE seminar.
This seminar will focus on the clinical and technical issues involved in establishing the conditions and parameters necessary for a dynamic psychotherapy to come to life and to grow and develop. We will also consider the ways in which therapy founder or come to impasse when those conditions and parameters are not properly established and/or sustained. We will give particular attention to engaging situations where patients are about to terminate treatment prematurely or precipitously.
The seminar will be structured around a careful reading of Salman Akhtar's book, Turning Points in Dynamic Psychotherapy, as well as several chapters from Herbert Strean's book, Don't Lose Your Patients!: Responding to Patients Who Want to Quit Treatment.
Suffering and Sacrifice in the Therapeutic Encounter
The Scapegoat
The "scape- goat"- term comes from an ancient ritual of sacrifice and cleansing, in which two goats were chosen as sacrificial victims. One goat carried the sins for the group and was sent off into the wilderness to survive on its own. The other goat, pure and innocent, was sacrificed to the god or gods, in order to ensure the safety and goodness of the group. The goat sent off into the wilderness was the "escape- goat", the origin of the word "scapegoat". This goat carried the pain and suffering of the group, so that the group could live in harmony and peace together. Although we no longer practice animal sacrifices, we continue to think that we can banish unacceptable feelings, such as hate or anger. The scape-goat part of the self is banished to the wilderness, never to be seen or heard from again. Psychologically, this sacrifice is an act of denial of the part of the self deemed as un-acceptable to others.
- A client said: "I felt like the scarecrow in the Wizard of Oz- stuffed full of straw with no back-bone. I did everything my husband wanted to try to please him so he would not be angry anymore."
- Depression and anxiety can result from taking care of others through sacrificing ourselves.
- Women often say they have to be perfect in order to be loved. Or, they can only be happy if the people they love are happy first.
- These strategies are part of a security program designed to protect our loving relationships from conflict.
- The downside of this strategy is a loss of self agency.
- The Merriam-Webster dictionary defines "agency" as "the capacity, condition, or state of acting or exerting power".
- A client said: "My life is dictated by others, not by me. I have to do what others want me to do".
- Psychotherapy is the process of re-claiming and re-storing self agency and self authority.
- A client said: "My car is a mess, and I cleaned it out. I thought, I am in this car everyday and I do not take care of it. I realized I do not take care of myself."
- This woman is empowering herself to take action on her own behalf. This act of self agency will in turn benefit those she loves.