BRAZIL – Training Course in Winnicottian Clinical Practice – Brazilian Institute Of Winnicottian Psychoanalysis

| Activities

1. PRESENTATION

This Course in Winnicottian Clinical Practice, introduced in 2016 by Elsa Oliveira Dias and Zeljko Loparic is an extension of the Training Course in Winnicottian Psychoanalysis created by them in 2003. In its initial form, the structure and material of the course are a direct result of research developed since 1993 by these two professionals at the State University of Campinas (Unicamp) and the Pontifical Catholic University of São Paulo (PUC-SP) as well as within the Research Group on Philosophy and Psychotherapy Practice (GFPP) founded by them in 1995, and which formed the basis of the São Paulo Winnicottian School. This extended version of the course became possible and even necessary with the development of research within the São Paulo Winnicottian School. Whilst the training of psychoanalysts is the main focus of the course, this is also aimed at professionals from all of the areas covered by Winnicott’s practical and therapeutic interests, and for whom he also developed training projects.

2. ADMINISTRATION DATA

Level of the Course: graduate

Teachers: senior members of the IBPW with M.A. or Ph.D. qualification, guest lecturers.

The Course is aimed at: psychoanalysts, pediatricians, psychiatrists, obstetricians, neuroscientists, psychiatric social workers and social workers in general, jurists, educators and counselors.

Duration of the Course: 4 years.

Number of modules: 12 modules + 1 theoretical essay and 1 supervised case report (75 hours of individual supervision)

The Course is divided in half-yearly modules. First and second year consist of 15 classes. Third and fourth year modules consist of 10 classes.

Classes last for 3 hours

3. CONTENT OF THE COURSE

The 12 modules are divided in three parts. The first part is theoretical, the second is theoretical-clinical, and the third clinical and consists of supervised group seminaries. Completion of training requires presentation and defense of a Final Essay of Conclusion (FEC) and Study of a Clinical Case (SCC). For more course details, please look at the Regiment of the Course (see website: ibpw.org.br).

Part I: 4 theoretical modules (15×3 hours each)

1. Foundations of Winnicott’s psychoanalysis: theory of the maturational processes (basic elements of Winnicott´s paradigm)

2. Winnicott in the history of psychoanalysis

3. Winnicott’s psychopathology I: psychoses and psycho-somatic disorders

4. Winnicott’s psychopathology II: other maturational disorders

Part II: 4 theoretical-clinical modules (10×3 hours each)

5. Theoretical-clinical seminar I: basic concepts of Winnicott’s clinic

6. Theoretical-clinical seminar II: short cases reported by Winnicott

7. Theoretical-clinical seminar III: the B case (Holding and interpretation)

8. Theoretical-clinical seminar IV: the Piggle case

Part III: 4 modules in group supervisions (10×3 hours each)

9.  Group supervision seminar on case reports presented by trainees I

10. Group supervision seminar on case reports presented by trainees II

11. Group supervision seminar on case reports presented by trainees III

12. Group supervision seminar on case reports presented by trainees IV

4. CONTENT OF EACH OF THE 12 MODULES

I. Foundations of the Winnicottian clinic: The theory of the maturational processes

Summary: This module aims at explaining Winnicott’s theory of the maturational processes, a core part of Winnicott’s psychoanalytic paradigm which is the basis of his theory of maturational disorders (psychopathology) and his conception of clinical practice in the field of psychoanalysis and outside of it.

1. Lecture: Outline of Winnicott´s paradigm

2. Lecture: The maturational process: general aspects

3. Lecture: Birth experience. Pre-primitive stages

4. Lecture: Maturational tasks during the stage of the first theoretical feed I: Integrating in time and space

5. Lecture: Maturational tasks during the stage of the first theoretical feed II:  Indwelling of the psyche in the body

6. Lecture: Maturational tasks during the stage of the first theoretical feed III: Environmental and object relations

7. Lecture: Maturational tasks during the stage of the first theoretical feed IV: Establishment of the primary self

8. Lecture: Maturational tasks during the stage of transitional phenomena

9. Lecture: Maturational tasks at the beginning of the disillusionment process (weaning). Activation of mental functioning

10. Lecture: Maturational tasks during the stage of the use of an object and the I AM stage

11. Lecture: Maturational tasks during the stage of concern

12. Lecture: Tasks of socialization I: Creation of the family. The role of the parental couple. The role of the father. Cross-identification

13. Lecture: Tasks of socialization II: Triangular relations based on genital instincts

14. Lecture: Tasks of socialization III: Latency and adolescence

15. Lecture: Tasks of socialization IV: Adulthood and old age

II. Winnicott within the history of psychoanalysis

Summary: The History of Psychoanalysis will be studied in the present course through the dialogue established between Winnicott and the two groups of his predecessors and his contemporary interlocutors: 1) the psychoanalysts of the Freudian lineage (Freud, Klein, the first Bion, Lacan) and 2) the dissidents or independents (Jung, Ferenczi, Balint, Bowlby, Fairbain, late Bion, Kohut). This study will allow to explicit, in a more precise and detailed manner than the previous module, the paradigm shift created by Winnicott (consisting in his maturational theory, his psychopathology, his theory of human nature and his clinic) and his place in the development of Psychoanalysis.

1. Lecture: Winnicott about Winnicott

2. Lecture: Winnicott and Freud I: Freud´s personality analyzed. Freud´s paradigm

3. Lecture: Winnicott and Freud II: Neuroses and psychoses. Psychoanalytical clinic

4. Lecture: Winnicott and Freud III: Social order. Culture

5. Lecture: Winnicott and Klein I: Stage of the first theoretical feed vs. paranoid-schizoid position and theory of envy

6. Lecture: Winnicott and Klein II: Stage of concern vs. depressive position. Early Oedipus

7. Lecture: Winnicott and the first and the late Bion

8. Lecture: Winnicott and Lacan

9. Lecture: Winnicott and Jung I: The case Jung

10. Lecture: Winnicott and Jung II: Maturational theory as overcoming the opposition between Freud´s psychoanalysis and Jung´s analytical psychology

11. Lecture: Winnicott and Ferenczi

12. Lecture: Winnicott and Balint

13. Lecture: Winnicott and Fairbairn

14. Lecture: Winnicott and Bowlby

15. Lecture: Winnicott and Kohut

III. Winnicott´s Psychopathology I – Psychoses and psycho-somatic disorders

Summary: This module will initially offer a general characterization of Winnicott’s psychopathology in the light of the theory of the maturational processes. It will then further study maturational disorders of a psychotic nature, understood as defensive organizations against interruptions in the maturational process resulting from environmental deprivation and originating during the period prior to the constitution of personal unity at the I AM stage.

1. Lecture: Health and illness in the light of the maturational processes

2. Lecture: Winnicott’s lectureification of the maturational disorders

3. Lecture: Winnicott’s concept of trauma

4. Lecture: Birth trauma and corresponding defenses

5. Lecture: Primitive agonies and fear of breakdown

6. Lecture: Psychotic defenses against primitive agonies

7. Lecture: Child schizophrenia (autism)

8. Lecture: Split-off intellect defense (latent schizophrenia)

9. Lecture: False-self defense. Borderline personalities

10. Lecture: Schizoid personalities

11. Lecture: Disorders in the area of transitional phenomena

12. Lecture: Disorders occurring during the disillusionment process (weaning)

13. Lecture: A. Disorders of the stage of the use of an object. B. Disorders of the I AM stage

14. Lecture: Psycho-somatic disorders I

15. Lecture: Psycho-somatic disorders II

IV. Winnicott´s Psychopathology II: Other maturational disorders

Summary: This module aims to present Winnicott’s conception of the nature and aetiology of the principal maturational disorders originating most often after the primitive stages that culminate in the I AM stage, when acute risk of psychosis no longer exists. It is during this maturational stage that depressions, concern paranoias, disorders regarding family life, antissocial tendency, neuroses, disorders related to instincts, adolescent doldrums as well as problems regarding socialization in adult life.

1. Lecture: Disorders of the stage of concern: general characteristics

2. Lecture: Reactive depressions

3. Lecture: Impurities of depression

4. Lecture: Paranoias of the stage of concern

5. Lecture: Antisocial tendency I: Nature and aetiology

6. Lecture: Antisocial tendency II: Lectureification of symptoms

7. Lecture: Delinquency and character disorders

8. Lecture: Disorders of socialization in family life and in groups

9. Lecture: Issues regarding the development of pre-genital and genital instincts, sexual identity and gender identity

10. Lecture: Disorders of triangular family relations with a genital basis (neuroses) I

11. Lecture: Disorders of triangular family relations with a genital basis (neuroses) II: Lectureification of defenses – regressions and neurotic defenses

12. Lecture: Disorders of schooling: attention and learning

13. Lecture: Disorders of socialization in adolescence

14. Lecture: Disorders of socialization revealed in problems with democracy

15. Lecture: Disorders of socialization resulting from social conflicts, exclusive rationalization (objectification) and issues of cultural life. Problems of aging and of the end of the maturational processes

V. STC I: Basic aspects of Winnicott´s clinic and training

Summary: Considering the results of the four theoretical modules presented previously, this module aims not only to study Winnicott’s psychoanalytic clinic but the whole spectrum of clinical modalities that he practiced, clarifying the theoretical foundations of each one of them as well as practiced and recommended procedures. In addition, the training proposed by Winnicott for professionals of different areas will be discussed in the light of his theory of the maturational processes and his psychopathology.

1. Lecture: The patient: Unattended maturational needs

2. Lecture: The Winnicottian therapist

3. Lecture: Winnicottian treatment: general aspects

4. Lecture: Winnicottian treatment by verbalization (talking cure)

5. Lecture: The treatment of psychoses by individual non-standard analysis (care-cure)

6. Lecture: The treatment of antisocial tendency by individual and/or institutional care: an application of the common foundations of the Winnicott´s clinic

7. Lecture: Winnicott´s project of child psychiatry: an application of the common foundations of Winnicott’s clinic

8. Lecture: A. Therapeutic consultations in child psychiatry. B. Therapy on demand in child psychiatry

9. Lecture: Common foundations of Winnicott´s clinic applied to therapeutic procedures in other medical areas, in psychiatric social work, in social work in general, etc

10. Lecture: Training of therapists in different clinic modalities according to the basic theoretical commitments of Winnicott´s paradigm

VI. STC II: Winnicott’s brief clinical cases

Summary: This module aims to study Winnicott’s brief reports of clinical cases. The only exception will be the case report by Margaret Little, a patient of Winnicott. The aim is to provide examples in addition to those given in the previous modules of

1) variety of disorders treated by Winnicott in his clinic (psychoses, depressions, antisocial tendency, neuroses, disorders of adolescence, etc.)

2) aetiology of disorders in each case according to the moment of the interruption in the maturational process (birth, lactation, childhood, adolescence, adult life),

3) treatment procedures (Winnicott´s psychoanalysis and psychotherapy, use of the family as mental hospital, general and psychiatric social assistance, residential therapy),

4) limits of the resources of Winnicott´s clinic. (Other aspects of the Winnicott´s clinic will be clarified with the study of the case Piggle and the case B – SCT III and SCT IV. Some cases may be replaced by others as the module progresses.)

1. Lecture: The case Margaret Little

2. Lecture: The case of the young woman who relived her birth

3. Lecture: The case of the young woman who dreamed of a turtle

4. Lecture: The case FM

5. Lecture: The case Phillip

6. Lecture: The case Patrick

7. Lecture: The case of the woman of the jewels

8. Lecture: The case Jane

9. Lecture: A. Cases of adoption. B. Cases of psychiatric social work

10. Lecture: The case George

VII. STC III: The case Piggle

Summary: This module aims to analyze step by step the treatment given by Winnicott to a child with problems of paranoia, reactive depression, dissociation and antisocial behavior resulting from deprivation by the parental couple which took place during the maturational stage of concern, and in particular by the loss of maternal care which was good enough in earlier periods. This case illustrates many essential aspects of Winnicott´s theory of the maturational processes, of his pathology and clinical practice, especially his “psychoanalysis on demand” – the use of members of the family (the father) as elements of the setting (amplified setting) and the use of the family itself as a “mental hospital” (“shared psychoanalysis”) and as a therapeutic agent.

Ten 3-hour classes.

Bibliography:

Winnicott, D. W. 1977. The Piggle.

VIII. STC IV: The case B

Summary: The seminar aims to study those texts by Winnicott which discuss the case of patient B. In addition to clarifying the nature and aetiology of the case (psychotic depression with schizoid features resulting from deprivation by an intrusive mother) and to addressing the purely clinical aspects, namely Winnicott’s use of standard treatment by verbalization (talking-cure) in combination with the care-cure, the seminar will focus on the theoretical results extracted Winnicott from this material such as the concepts of mother’s lap as initial environment and of regression to dependence as the beginning of the cure process.

Ten 3-hour classes.

Bibliography:

Winnicott, D. W. (1954). “Withdrawal and  Regression”. In: Winnicott, 1958, cap. 20.

Winnicott, D. W. (1958): Through Paediatrics to Psychoanalysis. London: Karnac .

Winnicott, D. W. (1972). Holding and Interpretation. New York: Grove Press.

IX-XII. Group supervision seminars I-IV

Summary: The seminar will consist of supervision work aiming to assist the students in practicing Winnicott´s psychoanalysis as well as other modalities of Winnicott’s clinic. Reports of clinical cases from different modalities of the Winnicottian clinic will be considered in order to help with the monitoring.

Ten 3-hour classes.

5. DISTRIBUTION OF MODULES OVER 4 YEARS

YEAR 1

1st Term
Foundations of Winnicott’s psychoanalysis: theory of the maturational processes (basic elements of Winnicott´s paradigm)

2nd Term
Winnicott in the history of psychoanalysis

YEAR 2

1st Term
Winnicott’s psychopathology i: the psychoses and psycho-somatic disorders

2nd Term
Winnicott’s psychopathology ii: other maturational disorders

YEAR 3

1st Term
1. Theoretical clinical seminar I: basic concepts of Winnicott’s clinic
2. Group supervision of case reports presented by trainees I

2nd Term
1. Theoretical-clinical seminar II: short cases reported by Winnicott
2. Group supervision of case reports presented by trainees II

YEAR 4

1ST Term
1. Theoretical-clinical seminar IV: the B case (Holding and interpretation)
2. Group supervision of case reports presented by trainees III

2nd Term

1. Theoretical-clinical seminar III: the Piggle case
2. Group supervision of case reports presented by trainees IV