Jan 20th, 2023 Meeting – Standing in the Spaces between Loewald and Bromberg

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Keyhill Sheorn, MD

3801 Commodore Point Place, Suite 200

Midlothian, VA 23112  804.240.1095

Dr. Rayner graduated from the United States Naval Academy in 1987, and from Tulane University School of Medicine, with M.D. and MPH degrees in 1991. Between internship and psychiatry residency, both at Naval Medical Center San Diego, he served as the Flight Surgeon back at the Naval Academy. Following residency, he entered psychoanalytic training at the San Diego Psychoanalytic Center, graduating in 2003, while on deployment in Operation Iraqi Freedom, where he led a Combat Stress Platoon. He left the Navy and set up private practice in psychiatry, psychotherapy, and psychoanalysis in 2004.

He served for over 12 years on both the Board of Directors and the Education Committee of SDPC, where he was co-Director of Education for six years and has taught classe s every year. Meanwhile, he was becoming more active in the leadership of the American Psychoanalytic Association on both the Executive Council (Board of Directors) and the Board on Professional Standards. In 2018, he became the first Lead Director on the Board of Directors of APsaA, and with that position, Chair of the Governance Committee, while simultaneously serving as Chair of the Governance Committee. Most recently, he chaired the Expanded Membership Task Force, which has produced a Bylaws Amendment w hich was brought to a vote by the Membership of APsaA in February 2022. He also serves on the Task Force on Future Meetings, the Inter-Institutional Initiative, and the Strategic Advisory Committee of APsaA.

In 1988, Arnold Cooper compared Strachey’s 1934 paper on the Nature of Therapeutic Action with Loewald’s 1960 paper on the same subject. The latter was 28 years old at the time, but Cooper was noting that a quiet revolution had taken place, marking a substantial shift in how mainstream psychoanalysis conceptualizes how our treatment works. As Dr. Rayner wrote this, Bromberg’s Standing in the Spaces is 28 years old. It is his impression that this paper, and much of the work that came before and after it, is equally seismic in its implications.

In this paper, Dr. Rayner attempts to capture what he saw as the “Loewald Treatment” that he applied to a number of time-honored meta-psychological concepts, mostly originating from Freud. He saw processes originally described as moving in one direction as being flexibly bidirectional under ideal circumstances. He saw relationships originally described as adversarial as having an underappreciated positive quality, and vice versa. The upshot of all of this is seen in his papers on therapeutic action, which demonstrate that growth in patients, and in people, occurs in dialectic tension centered on relationships, especially the analytic relationship.

Bromberg introduces an important concept pertaining to psychic structure that is scarcely acknowledged by Loewa ld, and that is the existence of multiple discontinuous self-states and the use of dissociation in all individuals. While pathological dissociation involves the rigid, protective separation of self-states in response to trauma, in health, individuals are a ble to “stand in the spaces” between self-states, accessing them and shifting seamlessly and unconsciously as relational contexts change. The implications for clinical process are profound. The analyst must establish relationships of recognition with each f the patient’s different self-states, which inevitably mobilizes dissociated self-states. Thus, Bromberg extends the shift toward appreciating and elucidating the role of the analytic relationship in therapeutic change and growth. Dr. Rayner also applie d the “Loewald Treatment” to Bromberg, further extending his contributions to understanding psychological functioning in sickness, health, and treatment.

Objective 1:  Describe several key contributions of Hans Loewald, and how together they have reshaped our understanding of the therapeutic action of psychoanalysis.

Objective 2:  Identify the lineage, key contributors and major tenets of the American Independent Tradition of Intersubjective Ego Psychology.

Objective 3:  Understand the major assertions of Philip Bromberg regarding normal psychological functioning, normal and pathological dissociation, and their implications for psychoanalytic listening and interaction.

Objective 4:  Recognize where Bromberg’s contributions extend beyond thos e represented by the Independent American Tradition of Intersubjective Ego Psychology and be able to speak to why they agree or disagree.

Loewald, H. W. (1955) Hypnoid State, Repression, Abreaction and Recollection. Journal of the American Psychoanalytic Association 3:201-210

Loewald, H. W. (196 0) On the Therapeutic Action of Psycho-Analysis. International Journal of Psychoanalysis 41:16-33

Loewald, H. W. (1972) The Experience of Time. Psychoanalytic Study of the Child 27:401-410

Schore, A. N. (2007) Review of Awakening the Dreamer: Clinical Jo urneys by Philip M. Bromberg. Psychoanalytic Dialogues 17:753-767