Michael Wannon, PhD is the Chair of our Couples Therapy Training Program. He sees both individuals and couples, so I was interested in his perspectives on how the two relate. Michael has presented nationally and internationally on couples treatment, the integration of Object Relations and Self Psychology, and the treatment of sexual issues as a therapeutic impasse. He is in private practice in Chevy Chase, Maryland, where he also runs consultation groups for couples therapists.
JS: What characterizes productive collaborations between couples and individual therapists?
MW: I think the most important factor is that the couples therapist and individual therapist trust each other, and that they both have experience and understanding about what goes on in couple sessions; that these modalities are different in some significant ways.
If there’s distrust between the two therapists, it’s felt by the patient. In the extreme, splitting occurs and the treatments become antagonistic. At the less extreme, it’s very common that without a mutual understanding between therapists, there’s an almost incongruous quality to the two treatments.
For example, let’s say that let’s say the two therapists get a signed release to talk, and the individual therapist says, “My patient describes her partner as very critical.” The individual therapist is working hard to understand her patient’s subjectivity, and understandably imagines the couple’s interaction as predominated by her patient trying to protect herself from that criticality. But the couples therapist says, “I don’t actually see that so much in the room: I see your patient as very reactive or, if anything, as the more critical and judgmental one in the room.”
If the two therapists don’t share an understanding that this difference is quite common, and actually can be very informative to the therapeutic process, than they may be more likely to mistrust the other therapist. For example, the individual therapist, and likely the patient, are frustrated and feel that the couples therapist is having the wool pulled over their eyes. Likewise, the couples therapist may dismiss the individual treatment as inadequate. But if the two therapists share an understanding of the process of couples treatment, then they understand together that this is actually very typical. In this example, the criticality the patient is reporting is partly what she is experiencing from her partner, but it’s also partly transference and projection. And because the couples therapist has the actual transference object in front of them, it’s more likely that the couples therapist sees this play out.
When both therapists are working together, the individual and couples therapy can greatly expand the frame of understanding for both patients. Likewise, when one member of the couple is keeping parts of themself hidden in the couples work it is often transformative when the therapists are able to work together to facilitate greater authenticity in the couples sessions.
JS: Where can the trust come from, between the therapists?
MW: One place is just a relationship outside of the consultation of the particular case. In our program, for example, it’s very common that our graduates go on to form strong collegial and personal relationships. They interact in all kinds of ways: study groups, supervision groups, socially, and they often are referring to one another. So they have those personal relationships that are important for very honest and authentic feedback with each other.
But if you don’t have any connection with the other therapist, than I’ve found that it’s key that the individual therapist have some experience and understanding of what couples therapy is, how it’s different than individual work, and how these differences manifest in the two treatments.
JS: How do you think your work as a couples therapist contributes to your work with individuals? Do you think or work in different ways when you’re with a couple rather than an individual?
MW: When I’m working with an individual, I’m immersed in their subjectivity. It’s the foundation of what I think is essential for the relationship to bring about healing and change. But because I do so much couples work, when a patient is telling me about their experience with a partner it’s always in my mind that there’s another perspective. There’s nothing like doing a lot of couples work to appreciate viscerally that what we’re hearing is completely and authentically a person’s reality, and yet that reality can be so different from how their partner experiences it. When I feel the patient is in a place where they can take a stab at trying to appreciate the other perspective, I ask them to go out of their subjectivity, and wonder with me what it would feel like for the other.
As long as I don’t jump to that too quickly, I find most of the time patients appreciate being able to mentalize the other’s perspective. This can also help the patient think about their partner’s history and how it might inform the way they’re reacting to them.
Another influence on my work with individuals is my focus with couples on their communicative process, and specifically in helping them become conscious of their difficulties with empathic immersion and curiosity. So when I’m working with an individual at some point its pretty typical for me to say, “did you express those feelings or thoughts?” And to explore what literally happened in the communicative process between them – the “he said, she said.” Or, more often, “he didn’t say, and neither did he.”
JS: When you’re asking them about the communication process, do they usually include the nonverbal?
MW: Well, in the couples work I actually see the process. So if I’m seeing one of them shaking their head, or very often the way they’re actually not looking at each other, or rolling their eyes or giving a contemptuous look or posture, I always bring that into awareness. But when I’m working with an individual that’s harder to do.
If I’m working with an individual, this is an example of when it’s very helpful if I’m working with their couples therapist. For example, I might see an individual and she’s really quite open in the individual work, and quite reflective. But I might hear from the couples therapists how closed off she is, and perhaps even contemptuous. I would not have guessed that this is what’s happening. Because I completely trust this therapist, it helps me to bring that feedback into the context of our individual work, where the patient can feel safer to begin to examine what she is putting out nonverbally.
JS: Do you have any thoughts about working with an individual patient when their partner has a severe and chronic diagnosis?
MW: When you’re doing couples work, what is never going to work in a couples treatment is a treatment where there is an identified patient — if the couple feels the work is really a stand-in for individual work to address one partner’s mental health issues. It will shape and negate the possibility of the couples work building intimacy. Intimacy comes from both people exploring how they both need to stretch to create an authentic and intimate bond.
But there is the question of whether every couple is appropriate or ready to be doing couples work. If issues completely dominate the couples work, that’s probably an indication of “not now” in terms of couples work. Or, at the very least, I might make it a condition of the couples work that they be in individual therapy as well.
For example, if a person has severe trauma or a substance abuse issue, that is obviously going to be an important area of exploration in their couples work. If the person is also doing the individual work they’re more likely to be able to tolerate discussing their partner’s experience of those issues.
Another concern is whether the “healthier” member of the couple gets enough of their own needs met in the relationship — and that’s an important thing to give voice to. I think part of a couples therapist’s job is to speak the unspeakable, to help a couple to be as transparent and as authentic as absolutely possible. Maybe they’re not getting enough of their needs met. Maybe they feel guilty, or trapped, or burdened. All of which are important to articulate and work-through.
Then, the question is, does the other partner have the capacity to tolerate those feelings once they’re articulated? It depends on their self-structure and, importantly, the connection they feel with their individual therapist.
JS: How do you work thoughtfully with biological or physical factors in a couple?
MW: It is important to keep in mind what’s happening even organically for each of the members of the couple. For instance, sexual issues are pervasive with couples we see. The most common issue is a discrepancy in expressed interest in sex. Sometimes the impact of an SSRI, or a depressive or anxious episode, on sleep, can be a significant contributor to this issue. Likewise, hormonal changes and biological changes that come with menopause often lead to issues like pain during intercourse. Or for men, as they age there is greater likelihood of impotence and other kinds of sexual dysfunction. So yes, as you suggest, part of what the couples therapist needs to do is assess for the multiple contributors to the issues, including biological or physical factors.
JS: Do you think about major themes in couples work?
MW: Yes, there are certain themes that I’m always keeping in mind.
One is that I’m always trying to get a sense of the couple’s functioning in intimacy across three major areas: verbal intimacy, physical intimacy, and play. So what is their intimacy in terms of their communicative process? How much do they talk about their feelings and private thoughts? What is their intimacy in their physical touching, caressing, sexual life? And what is their intimacy in terms of play? Do they enjoy activities together, and do they laugh together?
So I’m always trying to get a flavor for how they’re doing across these three areas. The work is about unpacking the multiple intrapsychic and interpersonal factors that are interfering with intimacy in these areas.
I also think its very important to understand how the issues the couples are presenting relate their unique “cultural issues.” What role do their religious beliefs, sexual orientation, and ethnicities play in the narratives they have about coupling and intimacy? What do we need to understand and name, so that differences in the room are openly acknowledged and fully appreciated.
Another theme I’m always paying attention to is what I call, “the protest in the conflict.” So when I’m working with conflict, I’m trying to understand and create a language that identifies “the repetitive theme,” and helps make sense of why each partner is protesting this particular theme.
The protest, in my view, is always related to early developmental themes that were thwarted during individual development. Maybe the theme is a protest of not wanting to be alone. Perhaps the protest is of wanting to be mirrored. Or of not wanting to be intimidated by the other’s anger. Maybe the protest is not wanting to feel less-than. Or of not wanting to feel abandoned.
We all protest unmet developmental needs, but we often don’t fully appreciate how that manifests in our coupling relationships. I believe it’s extremely therapeutic when the couples therapist begins to identify and translate ruptures as they relate to these developmental protests. This is another way that couples begin to become more conscious about their communicative process, and how central a role it plays in thwarting or facilitating intimacy.
It very moving to witness a couple begin to create a communicative process where mutual empathy and curiosity is possible, and where ruptures lead to the kind of repairs that lead to security and deep intimacy.
Welcome Our New Member
Meet Member Erin Gelzer!
Interview by Alexandra Kaghan
In August, I had the pleasure of talking with Erin Gelzer about her practice and how she became interested in becoming a psychotherapist. Erin joined ICP+P a year ago, as she was beginning her post doc at Georgetown University Counseling Center. She got her Doctorate in Psychology from George Washington University in 2017. About 10 years earlier, she obtained an MBA from the Wharton School and worked in the real estate development business. With time, she discovered that real estate development was not an ideal fit with her values. It was then that she switched to pursuing a career in psychology.
Part of what drew Erin to the world of psychotherapy was her experience in a leadership training program at Wharton where group dynamics were experienced and explored. The group opened her eyes to how the unconscious influences and affects behaviors. Throughout her training in psychology, she was able to continue her passion for studying group dynamics by co-leading process groups in both inpatient and outpatient settings. In addition, across her post doc, graduate internship and externships, Erin gained extensive experience working with individuals.
Erin currently has a private practice near Dupont Circle. She sees older adolescents and adults of all ages. She works with individuals, couples and groups. Her specialties include mood disorders, trauma, relationship issues, life transitions, and grief. She is particularly interested in working with clients who have identity concerns around sexuality, gender, race or profession. Erin also continues to consult with companies on how to improve their internal and external functioning. Besides daytime hours, Erin also offers evening and weekend appointments.
Erin appreciates the warm welcome she has gotten from ICP+P members and enjoys being part of our professional community. She has taken advantage of the many opportunities our organization has to offer. She has been in several study groups and has completed the fellowship program. With all of her business acumen, we are delighted that she will be serving on the Board as treasurer starting this fall.
Erin is from Atlanta but has lived in the Washington DC area for several years and now calls DC home. In her free time, she enjoys kayaking on the Potomac, going to museums and dancing. She loves all types of dancing including swing, ballet, jazz and hip hop.
Welcome to the new two year study group cycle, 2018-2020. Currently, ICP+P has 22 engaging and diverse study groups covering a wide range of interest areas. Many study groups still have openings and would welcome new members. Descriptions of all the study groups are included in the Study Group section of the website. Please note that some study groups include specific criteria for joining a study group. To more fully appreciate the in- depth focus of the readings and clinical focus of many study groups, you can review the Learning Objectives listed for the study groups that offer CE credit. Members can join study groups at any time during the two year cycle. Study groups are free of charge to members. Membership in ICP+P is required for participation in a group.
Four new study groups started this fall:
Authoritarian Leadership, Mental Health, and Culture
Psychoanalytic Look at Diversity and Trauma Through the Lens of Toni Morrison’s Novels
Reading Plays Group: Unleash Your Inner Thespian!
We are are always interested in adding new study groups, so please consider facilitating a new group, one modeled after an existing closed group, or one focused on another topic of interest.
Participating in a study group is an important and engaging way to be a part of the ICP+P community. If you haven’t already joined a study group, please consider doing so in this next two year cycle! Contact Etta Sandler for any questions, firstname.lastname@example.org. Join a group here!
Upcoming Training + Education
Building Intimacy – Connecting Couples Sexually and Emotionally
Deborah Fox, LICSW
October 26, 2018 ~ 12:30 – 3:45 pm ICP+P Office ~ 4601 Connecticut Ave., NW, Suite 8 ~ Washington, DC 20008
This workshop explores the intersection of sexual and emotional intimacy for couples who are having little or no sexual activity. A treatment model of intervention will be presented. We’ll discuss various factors that could result in this breakdown and consider the initial options for beginning therapy. We’ll then examine the most common reasons why therapy stalls or hits an impasse and the interventions most likely to lead to resolution.
Helping couples who struggle with their sexual relationship requires multiple skill sets. Cognitive behavioral sex therapy skills are essential, yet usually not sufficient. When a couple gets stuck, it’s usually due to the presence of underlying emotional factors. This treatment model includes interventions that can be used to explore deeper emotional factors which may be contributing to the impasse. Didactic, case example and interactive methods will be utilized.
At the conclusion of this program, participants will be able to:
List three reasons that could contribute to a breakdown in a couple’s sexual relationship.
Describe three possible interventions to help a couple resume a sexual relationship.
Discuss three aspects of a treatment model to build emotional and sexual intimacy in a couple.
This program is appropriate for clinicians at all levels of experience and offers 3 CEs.
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 credits 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 standards for nurses. Marriage and family therapists licensed in the District of Columbia, Maryland, and Virginia may submit these CE credits to their licensing boards. (Marriage and family therapists in other jurisdictions and licensed counselors should inquire with their local Boards regarding continuing education credit.) Attendees from the above professional groups will earn 3.0 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 3.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Contextualized Psychotherapy and Psychoanalysis:
Creative Input from Groups, Large and Small and 80th Birthday Celebration for Rosemary Segalla, PhD
Sunday, December 2, 2018 from 12:30-7:30 pm at The Georgetown University Conference Center, Washington, DC
Save the Date! Registration Will Begin in October
Other 2018-2019 Training
December 2, 2018, Conference – Contextualized Psychotherapy and Psychoanalysis: Creative Input from Groups, Large and Small and 80th Birthday Celebration for Rosemary Segalla, Georgetown University Conference Center, 12:30-7:30pm, 4 CEs.
January 26, 2019, Conference – Attackments: Subjugation, Shame, and the Attachment to Painful Affects & Objects, with Richard Chefetz, MD, Silver Spring Civic Building, 9:00am-12:30pm, 3CEs.
February 8, 2019, Short Course – To Group or Not To Group: Assessment and Preparation of Potential Group Members, ICP+P Office, 12:30-3:45pm, 3 CEs.
May 4, 2019, Annual Conference, with Steven Stern, Chevy Chase, MD, 9:00am-4:30pm, 6 CEs.
News + Notes
Tom Gray has received an “Invitational Fellowship for Research in Japan” from the Japanese Society for the Pursuit of Science. The fellowship will entail 3-4 weeks research/travel to Kyushu University in the Fukuoka Prefecture with a Keynote at Ryukoku University in Kyoto. The study will be in Tom’s second area of expertise, cooperatives and cooperative organization. Travel will occur in February and March 2019.
Rich Chefetz is participating as a speaker in a program of the Washington Psychiatric Society about clinician burnout and suicide. The title is “Healing the Healers” and it takes place on Thursday, October 18th from 6:30 pm – 9:00 pm at Clyde’s at Gallery Place. Click here to learn more.
Mauricio Cortina will be teaching the short course, Erich Fromm: social critic, radical humanist and clinician, at the Washington School of Psychiatry in February 2019. Click here to learn more.
Jan Gump, ICP+P member, will present on the experience of slavery, its emotional burden still haunting us through the transgenerational transmission of slavery’s traumas, its relevance and effect on our clinical work, and the ethical imperatives to confront it. Saturday, March 3, 2018, 10:00 am – 6:00 pm. Click here to learn more.
In June, ICP+P members Jen Sermoneta and Tom Holman joined with psychologist Judith Tischler from California to present a panel at the annual conference of the Society for the Exploration of Psychotherapy Integration (SEPI). The panel was entitled Cultural Attunement, Therapeutic Attunement, and Emotional Attunement With Special Needs Children and Families: Case Studies that Inform Case Conceptualization and the Therapeutic Alliance. A unifying theme of the panel was respect for disability culture and for the ways each person and family understands and deals with disabilities. All three presentations underlined the importance of the therapist’s ability to enter disability culture with respect and curiosity and learn from the people we want to help.
Judith illustrated a process of building and strengthening the therapeutic alliance through cultural attunement with parents of special needs children. She emphasized that problem solving and emotional expression are a shared process.
Jen presented on how an integrative therapist can work with a family member struggling with the identification of a disability in the family. Encompassing the patient’s experience as well as the therapist’s perspective, she illustrated the need to carefully track and support the patient’s own evolving perspectives and insights rather than trying to “hurry” this process by imposing the therapist’s point of view.
Tom shared his integrative approach to working with children with developmental disabilities. This includes meeting the child at their own level of development and self-expression; providing guidance through stages of development that may not look like anyone else’s stages of development; and staying attuned to parents. He illustrated how therapists may integrate several perspectives: neurodevelopmental, relational psychoanalysis, cognitive and behavioral, and family systems.
Cozy, sunny office available for rent in Washington Professional Group suite beginning on July 1, 2018. 112 sq ft office overlooks Washington Circle across from GWU and Foggy Bottom metro stop. Within walking distance of Georgetown. Paid parking is available in an underground garage in the building. Nightly cleaning, wi fi, and use of a printer is included. Contact Virginia Voigt, 410-808-3422 for more information.
Two of the sub-tenants in my Dupont Circle Office have ‘graduated’ to their own spaces, opening up Monday thru Wednesday mornings until 1:15 pm and all day Friday. Anyone interested should email Sheila Cahill at email@example.com or call or text to 202-322-6236.
Space available in therapy suite a block from the Tenleytown metro. Situated behind the Best Buy & Container Store in a professional building with a garden courtyard and easy neighborhood parking for your clients. The nicely appointed suite has been recently renovated and has a waiting room and kitchenette. Available Mondays & Fridays, Wednesday after 12 and Thurs evenings. Images of the building and one of the offices can be found here: https://www.kirstenchadwick.com/location/. Please contact Jennifer Grosman, firstname.lastname@example.org or Kirsten Chadwick, email@example.com.
Beautiful DuPont Circle Office Available to Rent in the Corcoran House Building at the corner of 18th and Corcoran Sts. NW, all day Friday + additional half day on Tuesday. Spacious, recently painted and re-decorated, a sunny office, waiting room and private bathroom. Many other amenities available, including wi-fi and fax. Excellent location, 2 blocks from DuPont Circle metro. 2 parking spaces available (1 inside bldg. and 1 outside for patients). If interested, please contact Sarah Pillsbury by email, firstname.lastname@example.org or by telephone at (202) 904-7510. Photos are available. Thank you.
Available for immediate long term, full time sublease, a large sunny office in our suite of five, and are hoping to find a psychodynamically oriented colleague join us. We’re located in the West End neighborhood of DC, convenient to the blue/orange and red lines of Metro, downtown, GW and Georgetown. Our suite is in a medical building with easy after hours and Saturday access. Please contact any of us for more information: Becky Bailey, email@example.com ~ Bill Pinney, firstname.lastname@example.org ~ Lucy Pugh, email@example.com ~ Steve Van Wagoner, firstname.lastname@example.org.
Tybe Diamond, email@example.com, has openings in two mixed, interpersonal, experiential groups. A pre-group evaluation is necessary to determine a good mutual fit. Tybe is happy to discuss any referral in more detail to help you determine the appropriateness of group therapy for your client. Individuals can also self-refer. Please forward this announcement to any interested client or colleague.
Space for men and women age 30 – 65 in a long term interpersonal group from 7-8:15 pm on Tuesday in upper NW DC. Group members are high functioning, creative professionals, who are motivated and seek personal and professional growth. Group interactions are processed in real time with a focus on relational development, interpersonal dynamics, self-reflection and self-awareness.
A second, women’s group (age 28 – 60) is starting at the end of September and meets from 6:30 – 7: 45 pm though the time of the group will be determined based on the possible times for members. High functioning women will be included in this interpersonal, process group where the focus is on relational development, interpersonal dynamics, self-reflection and self-awareness.
Supervision/Case-Consultation Group for DC-Baltimore Area Clinicians provides clinicians at all levels of experience a confidential and supportive setting for the exploration of clinical challenges. For more information, contact Trish Cleary, http://bit.ly/2N1VUZC.
Mixed & Men’s Therapy Groups have openings: (2) for Men’s Group & (1) woman for Mixed Group. Tuesdays & Thursdays at 6 pm, Downtown Silver Spring, Insurance/Sliding Scale. Adults of all ages/cultures welcome. Leader has many years of experience collaborating with individual therapists. Please contact (or have client contact) Jonathan Lebolt at Therapy@Doctor-Jon.com or 240-507-7696.
Greater Washington Society for Clinical Social Work in Alliance with American Association for Psychoanalysis in Clinical Social Work will present, When LGBT ‘Cured’ Psychiatry: The History You Never Knew! An Ethical Retrospective on Saturday, November 3, 2018 for this year’s Alice Kassabian Memorial Conference. The presenter is William Meyer, MSW, Associate Professor of Psychiatry and Ob/Gyn, Duke University who also hold faculty appointments at the University of North Carolina, Smith College School of Social Work and the Psychoanalytic Education Center of the Carolinas.The clinical and ethical exploration of this multimedia presentation focuses on the psychiatric diagnosis of homosexuality as a treatable psychopathology and the civil rights struggle that got it deleted from psychiatry’s official nomenclature. Over the years, many people suffered severe psychological injury from that diagnosis and unfortunately, some of its tragic legacy continues today.It will be held at the Cosmos Club in Washington, DC from 9AM-12:30PM and will award 3 LGBTQ+ and 3 Ethics CEU credits. Contact Golnar Simpson for questions, firstname.lastname@example.org.