Review of the “International Journal of Psychoanalytic Self Psychology” (Volume 11, Number 2, 2016)

Review by Roman for Sept Newsletter
for ICP+P’s September 2016 Newsletter

The issue features a number of interesting and thought-provoking discussions, but I would like to focus on the three-article conversation between Joye Weisel-Barth and Steven Stern, regarding the “reality” and “boundaries” of relational analytic therapy.

The conversation begins with Weisel-Barth’s article, in which she discusses the question of boundaries in the co-created relational space in the example of her own work with a patient. This case highlights a shared love for animals between her and a female patient, which created a stabilizing factor in an otherwise “long and volatile” therapeutic relationship (p. 121). However, one day, the patient brings two abandoned animals into the room, and Weisel-Barth ends up adopting one of them. This action “began an enactment that ended in a therapeutic disaster” when – through an unthinkable turn of events, the patient learned of a sacrifice Weisel-Barth had to make in her personal life that was related to her decision to adopt one of the animals. A period of angry calls and emails leads to the termination of their therapy – “the rugged sundering” that echoes the patient’s “long history of ragged endings” (p. 123) – although Weisel-Barth does report a positive email exchange with her patient several years later.

Weisel-Barth acknowledges inevitably feeling “some love and/or, tenderness, and/or passion” for all her long-term patients (p. 116). Using the feelings that emerge in the relational analytic space can “change patterns of relational expectations” and “open new behavioral possibilities” – in other words, “they expand repertoires of interaction and connection inside and outside of the therapy” (p. 116). However, positive emotions and the experiences of pleasure and healing may carry a threat of danger and pain. One reason for this possibility stems from the fact that, however ‘real’ the therapeutic space may feel (and be), it still may be “shockingly separate” from “the reality of other life contexts” (p. 117). Weisel-Barth’s clinical example highlights the “analytic hurt” resulting from the discrepancies between the co-created analytic space on the one hand, and the external realities of both the patient’s and the therapist’s lives on the other.

Weisel-Barth points out that, in the traditional psychoanalytic mode, boundaries tend to be clearer than they are in relational analysis, where they “can be cloudy and damnably confusing” (p. 121). And yet, in some ways, relational work invites more ambiguity because it is a transitional play space, laden with unconscious forces and fantasies. Nonetheless, this lovely space carries a significant risk of the therapist becoming lost alongside the patient “in the illusory, ‘as if’ nature of the play space” (Weisel-Barth, p. 118). And the case discussed by Weisel-Barth represents an instance of the therapist having lost her therapeutic stance in the ambiguous analytic space.

In the following article, Stern discusses the relational therapist’s “greater participatory freedom” (p. 126) in the example of Weisel-Barth’s case. One of the perspectives in Stern’s discussion highlights the concept of the mutuality – asymmetry dialectic. According to Stern, Weisel-Barth’s case exemplifies the undermining of the asymmetrical frame of therapy, where the therapist should remain “at all times, the member of the dyad responsible for shepherding [the process] in which the patient’s therapeutic needs and interests are privileged” (Stern, p. 128). In addition, Stern argues that the dyad’s mutuality dimension was also affected by Weisel-Barth’s choosing to make – unilaterally – a sacrifice that was very meaningfully related to both of them. And, because both dimensions of the mutuality – asymmetry dialectic were compromised, the imbalance in asymmetry could not be rescued by a potential increase in mutuality.

Another perspective employed by Stern is related to the “as-if” quality, or “the necessary ambiguity,” of the therapeutic relationship. While the therapist’s relationship with the patient is fully real, there should remain a sense of ambiguity “in which everything that occurs is simultaneously a product of, and subsumed within, the constantly evolving therapeutic process” (Stern, p. 130). In Stern’s view, Weisel-Barth’s actions brought forth the loss of this necessary ambiguity – and even talking about this loss could not remedy the situation, since such conversation would require Weisel-Barth to disclose numerous elements of her own, real life outside the therapy room.

Lastly, Stern makes a comparison between the Boston Change Process Study Group’s relational model – which privileges “the implicit, non-verbal interchanges” as primary in the therapeutic action – and the contemporary Bionian model – which focuses on the “collaboration (conscious and unconscious) between patient and analyst in pursuit of the patient’s truth (and the truth of the analytic moment) through verbal articulation” (p. 132). Stern then suggests that Weisel-Barth’s act of accepting one of the abandoned animals may have represented “a defensive foreclosure of posing and trying to answer the question, ‘What is going on here with our shared … enactments?’” (p. 133; emphasis in original). Although it can be argued that Weisel-Barth’s actual participation could have constituted a “benign, self-selfobject, developmental” enactment, it is also possible that this enactment prevented the opportunity to open up other aspects of the patient’s experience – such as, anger and volatility – thus resulting in “actually going in less close” (p. 133; emphasis in original).

In her response, Weisel-Barth addresses some of the points raised by Stern, yet focuses mostly on the issue of telling and retelling case stories. She points out how complex and extensive our clinical narratives are, and how reduced and obscured they can become when we tell and retell (and print) them. Weisel-Barth also reminds the reader that enactments “sometimes proceed for a long time underground; and … an unexpected confluence of interactive factors may bring them to sudden and surprising conscious life” (p. 139). To dissect a story that happened in the past; to attempt negotiating it with the other person’s ‘truth’ – when an enactment that used to be hidden is suddenly so apparent now – may enrich our understanding of our theory and work, but is likely to fall short in presenting a definitive analysis of a particular therapeutic relationship.

Echoing Weisel-Barth’s point about narratives, I invite our readers to take a few moments to read this fascinating discussion. I – for one – found it tremendously enjoyable and enriching.

Affect and Self-Regulation Study Group 2016-2017 Learning Objectives


First Monday of the month, October through May, 7:30 PM
Washington, DC

The overarching frame of reference for this year of study is to deepen our understanding of what has been called the severe neuroses and typically involves the treatment of borderline and dissociative phenomena. We will explore the extent to which an unconscious need to regulate intense affectivity and maintain a sense of self during periods of experiencing severe impingement, attacks on being, play an active role in these clinical categories. There will be seven sessions, one for each chapter in our reference work (Wurmser, L. (2000), The power of the inner judge:Psychodynamic treatment of the severe neuroses, Northvale, New Jersey: Jason Aronson.).

Members who attend this study group will be able to:

  1. Describe how an interpersonal view of shame creates advantages for a psychotherapy that exceed the utility of an intrapersonal view
  2. Describe how right-brain to right-brain interaction fits de Young’s model of shame.
  3. Discuss how deYoung’s theory of shame supports the idea of shame being about a sense of disintegration of self in relation to a dysregulating other.
  4. Describe how a “regulating other” actually behaves in a healthy environment.
  5. Describe the behavior of a dysregulating other and their impact on neurobiological function
  6. Describe the subjective experience of self-disintegration
  7. Discuss the genesis of felt internal harshness from the presence of the “needy self.”
  8. Describe how Bacal’s notion of shame as an affect of discrepancy fits presented casework.
  9. Discuss the advantages of Schore’s idea of attributing the ego ideal to the right brain and conscience to the left brain influences how to work with shame.
  10. Describe how perfectionism and procrastination are related to chronic shame.
  11. Describe how insecure infant attachment patterns contain shame scripts.
  12. Explain how implicit relational knowing holds unformulated narratives of emotional trauma.
  13. Describe how a “shame-free” clinical stance can be approximated.
  14. Explain how chronic shame may best be seen as something to manage rather than cure.
  15. Describe how dissociation influences the subjective experience of shame.
  16. Describe the role of the “not-me” self-state in the interaction between dissociation and shame.


In Memory of Damon Silvers, PhD, ICP+P Founding Member

Damon Silvers, PhD.

It is with deep sorrow that we mark the death of one of our founding members, Damon Silvers, PhD.  Damon passed away unexpectedly but peacefully from complications related to a recent heart attack while at his vacation home in Bethany Beach, Delaware, on July 2, 2016.

We encourage fellow ICP+P members, colleagues, friends and family to express their feelings and leave comments on this page (scroll down the page further to find the comment section).

If you are not able to see the comment section below, please reload the page (may need to be done more than once) and/or clear your browser cache. Instructions for clearning your browser cache can be found via Google Search.

Read The Washington Post Obituary

Experiential and Theoretical Investigation into the Creative Process Study Group 2016-2017 Learning Objectives

Third Tuesday of the month, September through June, 7:30 PM
3715 Alton Place, NW, Washington, DC 20016

Our group views creativity as a capacity that is integral to being human, although the ability to express that creativity may be developed to differing degrees. Our readings have built up a body of thinking about creativity that draws on classical, self psychological, and relational theories. The group shares some responsibility for suggesting topics and readings related to these issues, and collaborates in inviting researchers and artists to join us to discuss their process.

Members who attend this study group will be able to:

1) a. Describe the role of creativity in the grieving process after seeing The Year of Magical Thinking, a play based on a book about the loss of the author Joan Didion’s husband.

1) b. Compare this to theories about grieving described by theorists such as Kubler-Ross and Lindemann.

2) a. Explore the Common Threads use of story cloths in the treatment of women who have experienced gender based violence.

2) b. Identify several ways in which this method enhances trauma treatment especially when the clinician does not share the culture or language of the patient.

3) a. Using Press’s self-psychologically informed theories of dance in The Dance of Self, explore the work of dancer Bill T. Jones. Explain how this may inform your clinical practice.

3) b. After reading his memoir, discuss Jones’s use of his dancing body as an expression of his experience as a gay man. Explain how this may inform your clinical practice.

4) a. Observe the significance of personal narrative in the lives of the characters in the Wim Wenders film Wings of Desire, using Michael White’s theories about the importance of story and of dual listening in the therapy hour. Explain how this may inform your clinical practice.

4) b. Discuss the function of the individual therapist and of group members as witnesses in light of insight gained from viewing the film and reading Wenders’s commentary.

5) a. Having critiqued Mark Doty’s autobiography Fire Bird, explore the ways his creative process allowed him to come to terms with a troubled history. Explain how this may inform your clinical practice.

5) b. Apply the assumption implicit in his statement “the act of making a poem requires that someone’s listening” to the relationship between therapist and patient.

6) Discuss the development of a sense of personal and cultural identity (“who I am and how I fit into the world”) after viewing the Yo Yo Ma documentary The Music of Strangers. Apply these insights to the challenge of helping patients grapple with this question.

7) Describe, in self-psychological terms, the process by which Helen MacDonald, the author of H Is for Hawk, uses her knowledge of falconry and her relationship with her hawk to grieve the death of her father. Determine ways, in the clinical situation, to distinguish between grief and clinical depression.

8) a. After viewing Out of Our Heads: A Male Journey into the Heart, a film by Allen Moore, and hearing Moore discuss the film, identify issues that arise for men who are depressed and conditions in the culture that may contribute to the incidence of depression in men.

8) b. Using clinical examples, compare the group approach depicted in the film to various methods used by clinicians in the study group. Explain how this may inform your clinical practice.

9) After viewing Linn Meyers’s installation at the Hirshhorn, and attending several gallery talks, discuss the parallels between the creative process involved in making her mural with the creative process in a therapy session, focusing on such elements as the balance between plan and spontaneity, theory and interaction, boundary and improvisation.

10) a. Apply Hagman’s theories about the self-object function of viewing and collecting art to the experience of the collectors of art at the Glenstone Museum and the Barnes Museum, through visiting Glenstone and reading the writings of Albert Barnes. Explain how this may inform your clinical practice.

10) b. Using clinical examples and reading Yalom, discuss ways in which the therapist can help patients develop and deepen their sense of self through the experience of altruism.



The Science, Art, and Application of Psychotherapy Integration Study Group 2016-2017 Learning Objectives

2nd and 4th Wednesday of every month from 11:00 am-12:30 pm
3000 Connecticut Ave, NW, Suite 327, Washington, DC 20008

This study group will focus upon the convergence of selected components of theory and practice that serve to enhance and intensify the therapeutic encounter. The central role of the integration of contemporary psychodynamic approaches, affective and social neural science and mind/body principles will be explored. A didactic and experiential format will be employed to facilitate the application of this model to clinical practice.

Members who attend this study group will be able to:

  1. Describe how the convergence of relational psychotherapy, Neural Science and Mind/Body approaches promote best practice in treatment.
  2. Describe the central concepts within object relations theory, selfpsychology and intersubjectivity that can be employed to enhance treatment in a convergence model.
  3. Discuss the central concepts of Neural Science that relate to healing, emotional regulation and psychotherapy.
  4. Explore the powerful and healing effects of Mind/Body approaches to psychological functioning and the psychobiological transformation that occurs when used within a model of integration.
  5. Explain a dynamic model of treatment which combines theory, practice, scientific findings and effective clinical application to promote psychological wellbeing and life enhancement.
  6. Explain the relationship among intersubjectivity, transference and counter transference, and the creation of a new healing narrative in psychotherapy.
  7. Discuss the effect of Mind/Body (M/B) approaches upon psychological functioning from both a psychogenic and neuro-biological prospective.
  8. Discuss the relationship among engaged equanimity, emotional balance, and neural integration.
  9. Apply M/B techniques for the reduction of anxiety and the treatment of depression within an integrated model of treatment.
  10. Identify the principal components that enhance the trance experience and create an altered state of consciousness.
  11. Discuss the fundamental principles employed within hypnotic inductions.
  12. Discuss ethical considerations and issues of competency when using M/B strategies in therapy.
  13. Discuss the effects of cortisol on the hippocampus,memory and learning.
  14. Discuss the neurological consequences of trauma.
  15. Describe the neurochemistry of PTSD and its effects upon psychological functioning.
  16. Define and discuss the Social Brain.
  17. Define and discuss Mirror Neurons.
  18. Define and discuss Mindfulness.
  19. Discuss the Neurological substrates of Transference and Countertransference.
  20. Discuss the Neurobiological substrates of Borderline personality disorders.
  21. Describe the effects of a cocreated healing narrative upon Neural Integration and bihemispheric communication.


Aging and Mortality Study Group 2016-2017 Learning Objectives

3rd Friday of every month from 2:30-4:00 pm
4400 East-West Highway
Bethesda, MD 20814

The focus of the group will be the aging process and treatment of older adults. We will be reading books that discuss clinical phenomena and therapeutic approaches as well as fictionalized accounts and other literary works about the aging process. Group discussions will be informed by members’ work with older adults and their ways of dealing (or not) with their own aging and mortality.

Members who attend this study group will be able to:

  1. Considering the title of the book, Another Country, identify 3 ways in which the passage from middle age to old age is analogous to moving to a foreign land.
  2. Identify 3 factors that contribute to the majority of elders living segregated lives.
  3. Describe 4 ways in which xenophobia applies to the plight of the elderly.
  4. Identify 3 ways that moving from a communal to an individualistic culture has affected the elderly.
  5. Describe the ways in which aging is like chronic PTSD.
  6. Enumerate positive coping strategies that the elderly and their caregivers can employ.
  7. Identify how interactions between ‘grandparents’ and younger generations can be mutually beneficial.
  8. Discuss Mary Pipher’s contention that intergenerational connections are vital to the continuity of culture and the health of communities.
  9. Discuss the fear of dying as it is experienced through the developmental stages of life.
  10. Describe ways of recognizing covert death anxiety hidden behind other symptoms
  11. Define what Yalom means by “The Awakening Experience”.
  12. Identify and discuss life milestones as awakening experiences.
  13. Describe three Epicurean arguments that may be used to ameliorate death anxiety.
  14. Enumerate some of the aphorisms, or ‘mighty thoughts’, that can help to overcome the fear of death.
  15. Distinguish between everyday loneliness and existential loneliness.
  16. Describe how to use presence and gratitude to alleviate the loneliness of death.
  17. Discuss how people influence one another through the rippling effect.
  18. List Yalom’s four ultimate concerns germane to the practice of psychotherapy.
  19. Describe the connection between love, sex and death.
  20. Explain three rationales Yalom suggests for using immediacy in psychotherapy.
  21. Discuss Yalom’s stance on the use of therapist self-disclosure and how this relates to a self-psychological and a relational approach to psychotherapy.


Developmental Psychotherapy Across the Lifespan: Integrating Child-Centered Therapy Principles to Treating Adults with Dysregulation

Featuring Georgia DeGangi, PhD and Marc Nemiroff, PhD


Saturday, November 5, 2016           Silver Spring Civic Building at Veterans Plaza
Registration: 8:30-9am                      One Veterans Place
Program: 9:00am-12:30pm               Silver Spring, MD 20910

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This half-day workshop is designed for clinicians interested in applying developmental psychotherapy to the treatment of adults with disorders of self-regulation and/or experiences of trauma. These individuals are highly sensitive to stimulation from the environment, emotionally reactive, and have difficulty maintaining relationships and an organized, regulated lifestyle. Drs. DeGangi and Nemiroff will present child-centered therapy, a technique that focuses on the process of self-regulation, affect attunement, emotional communication, attachment, and relational knowing. They will give an example of child-centered therapy as applied to a disengaged mother-infant dyad with a highly irritable infant. Dr. DeGangi and Dr. Nemiroff will each present an in-depth case of adults with severe dysregulation and psychically active childhood trauma. The treatment in both cases exemplifies the application of developmental psychotherapy to the adult population.

At the conclusion of this program, participants will be able to:

  1. Describe the application of child-centered therapy in addressing the constitutional and emotional needs of adults with high irritability and mood dysregulation and the experience of trauma.
  2. Discuss how developmental psychotherapy facilitates self-regulation, affect attunement, emotional communication, and attachment.
  3. Discuss modifications in treatment between children and adults using principles of developmental psychotherapy.

This conference is appropriate for clinicians at all levels of experience and
offers 3 CE credits.

About our Presenters:

Georgia DeGangi, PhD, OTR, FAOTA is a clinical psychologist and an occupational therapist in private practice at ITS: PALSS (Integrated Therapy Services: Psychological and Learning Support Services), Inc. in Kensington, MD. She has over 30 years’ experience working with children, adolescents, and adults. She has extensive experience with diagnosis and treatment of a range of developmental, sensory, behavioral, and emotional problems.  Dr. DeGangi has conducted research for many years to examine the most effective ways of treating individuals as well as examining how problems of self-regulation, sensory processing, attention, and social interactions develop over time. Among her publications are The Dysregulated Adult: Integrated Treatment Approaches; and Pediatric Disorders of Regulation in Affect and Behavior: A therapist’s guide to assessment and treatment. She has also recently published a book entitled Effective Parenting Strategies for the Hard-to-Manage Child co-authored with Anne Kendall. Dr. DeGangi is internationally recognized as a leading expert in the assessment and treatment of self-regulation, sensory processing, attention, and interactional problems.  She was the 1992 recipient of the A. Jean Ayres award from the American Occupational Therapy Foundation and the 2011 recipient of the Reginald S. Lourie Center award. She is on the faculty of the Developmental Psychotherapy Seminar program of the Washington School of Psychiatry.

Marc Nemiroff, PhD is a clinical psychologist in practice for over 40 years.  He is on faculty at The Washington School of Psychiatry and affiliated with the Baltimore-Washington Center for Psychotherapy and Psychoanalysis.  He is the co-author of numerous therapeutic children’s books published by the American Psychological Association and co-author with Dr. DeGangi of The Kids’ Club Letters: Narrative Tools for Stimulating Process and Dialogue in Therapy Groups for Children and Adolescents.  His most recent book is Stepping Into the River:  An American Psychologist in Mother India, based on his experiences during nine years (every January) of pro bono mental health work in India, primarily in the slums and with the street children of Mumbai.  Dr. Nemiroff has taught and presented at The Washington School of Psychiatry, The Washington Center for Psychoanalysis Film Series on Trauma, The Baltimore-Washington Center for Psychotherapy and Psychoanalysis, The Bombay Psychological Association, and The Washington Society for Psychotherapy and Psychoanalysis, on such topics as childhood trauma, play therapy, the relevance of child development to adult psychotherapy, the uses of interpretation, termination of treatment, and other topics.  During the Gulf War, Dr. Nemiroff served as a representative of the American Psychological Association to the media on the topic of the effect of televised war violence on children.

CE Credit is granted to participants with documented attendance at individual workshops and completed evaluation forms for those sessions. Credit will not be granted to registrants who are more than 15 minutes late or depart more than 15 minutes early from a session.

Continuing education credit: ­ 3 CE credits available for full attendance. The Institute of Contemporary Psychotherapy and Psychoanalysis (ICP+P) is approved by the American Psychological Association to sponsor continuing education for psychologists. ICP+P maintains responsibility for this program and its content. ICP+P is approved by the Maryland Board of Social Work Examiners to offer Category I continuing education credit. Because ICP+P has approval from the Maryland Board, CE credit hours awarded by ICP+P may also be claimed by social workers licensed in Virginia and the District of Columbia. These continuing education credits meet the ANCC approval standards for nurses and the approved standards for marriage and family therapists. Attendees from the above professional groups will earn 3 CE credits for attending the conference. Full attendance is required to receive the designated CE credit. ICP+P is accredited by MedChi, the Maryland State Medical Society to provide continuing medical education for physicians. ICP+P designates this educational activity for a maximum of 3 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

Registration and fees

Free for ICP+P Members
$90 for Non-members
$35 for Unaffiliated Students

If you wish to attend and are in need of disability accommodations, please contact us by October 20, at

Register online and pay by credit card at Eventbrite

Register by mail and pay with a check by sending this flier to:
4601 Connecticut Ave., NW
Suite 8
Washington, DC 20008

* Georgia DeGangi, PhD and Marc Nemiroff, PhD and the planners have informed us that they do not have a conflict of interest and have disclosed that they have no relevant financial relationship with any commercial interests pertaining to this educational activity. Additionally, the presenters have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during this presentation. This presentation will not contain any references to off­-label (non­-FDA approved) use of products or devices.

ICP+P’s Annual Pot Luck and Fall Kick-Off September 11, 2016

Sunday, September 11, 2016 11:00 AM to 2:00 PM 
Chevy Chase Village Hall
5906 Connecticut Avenue, Chevy Chase, MD 20815
(a couple of blocks north of Chevy Chase Circle)

Please park on the street.

This kick-off event gives us a chance to come together as a community to renew ongoing relationships as well as to welcome new members. Members-in-Training and individuals who have joined ICP+P during the last year will be introduced. In addition, we are planning to have a town hall meeting, in which members can participate in open discussion about ICP+P, including the year’s upcoming programs, planning for future programs and other areas of interest or concern to the ICP+P community. The potluck has always been an informal, lively, and fun event with lots of great food!

If you are a new member or have never attended a potluck before, please let us know if you would like to be met and greeted by a member at the door when you arrive. They will introduce you to other members and help you get to know the community.

Please RSVP to this event by emailing (no phone calls, please) Kathy Beck at indicating what you plan to bring:

*appetizer        *side dish        *fruit salad        *green salad        *entrée        
*dessert        *alcoholic beverage      *non-alcoholic beverage        
*notify me and I’ll bring whatever is most needed
* Also please indicate whether you are available to help 
with set-up or clean-up.
*Please let us know if you would like a “meet and greet” 
welcome when you arrive.

Thank you! We look forward to seeing you there!

Background for Couples Therapy: An Investigation of Theoretical Underpinnings


To help readers understand the theoretical paper, we offer a brief summary of the couple’s history and current situation:


Joe and Amy met in college. He was drawn to Amy’s smile, her admiration of his artistic talent, and her attentiveness to his concerns. Amy was drawn to Joe’s stability, his relaxed manner, and his dependability. Amy pressured Joe to marry right after graduation from college. At age 23, Amy started graduate school and Joe, age 25, began to work as a photographer. Four years later, the couple had their first baby girl, followed a few years later by their second.

Amy’s mother was intrusive, very anxious, and an alcoholic. The oldest of three girls, a parentified Amy took care of her younger sisters. She describes feeling lonely and scared by her out-of-control mother, and unable to rely on her constantly travelling father.

Joe’s mother was critical and his father was passive. While there was little conflict in the family’s relationships, there was tremendous distance. No one discussed feelings, and Joe learned to withdraw and shut down in the face of criticism.

The vignettes introduce us to the couple at ages 37 and 39. Amy presents as anxious, controlling, vigilant and overfunctioning. Amy carries herself as being competent and in control, and relates in an intense and anxious manner. She is a middle school teacher at a magnet school. She has very high standards for herself as a teacher and a mom. Amy does too much, resents it, and is exhausted.

Joe, 39, appears to be a nice guy, calm, coherent and logical, with an easygoing manner. He is working as a photographer and has a flexible schedule. He is creative, and can spend many hours in front of the computer crafting his images, but he is not focused on details – he is not a good bookkeeper and has trouble juggling multiple roles.

Joe’s work requires week-long travel four times a year. It was during one such work week that he began an affair with a colleague, Jennifer, also on assignment. Jennifer was single, younger, and idealized Joe. He found this relationship to be enlivening and affirming, and they had a powerful sexual chemistry that had dwindled in his relationship with Amy. At home, Joe left his cell phone out one day, and Amy noticed a text message that popped up. Glancing at the phone, she saw that it was a sexual message from Jennifer, checking on the plans with Joe for their upcoming travel week.


As the vignette begins, Amy appears anxious, flooded, and angry. She is berating and shaming Joe – clearly not for the first time – for his affair and generally irresponsible behavior. Joe, slouching in his chair and looking away from the therapist and Amy, defensively intellectualizes the conflict between them, the affair, and his desire to leave Amy. Joe is unaware of his own feelings and has trouble expressing himself. He has tried hard to please Amy but feels inadequate and incompetent with her. The two vignettes show the couple at the beginning of the treatment and then at a session during the midphase.

Using this couple’s background and vignette’s, Barbara Shapard’s paper discusses some theoretical underpinnings of the work on understanding and repairing this very deep trauma to the couple.

Click here to return to the working paper…