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Research and Symposia Abstracts

from the Congress of the International
Neuropsychoanalysis Society, 2016
Maggie Zellner
To cite this article: Maggie Zellner (2016): Research and Symposia Abstracts from the
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Date: 09 October 2016, At: 13:25

Publisher: Taylor & Francis & International Neuropsychoanalysis Society

Journal: Neuropsychoanalysis
DOI: 10.1080/15294145.2016.1232124

Research and Symposia Abstracts from the Congress of the International
Neuropsychoanalysis Society, 2016
Maggie Zellner

The 17th International Neuropsychoanalysis Congress, Chicago, July 7-10, 2016: Other
Have you yet to attend a congress of the International Neuropsychoanalysis Society? You can get
a flavor for the diverse and cutting-edge research being presented at our meetings by reading the
abstracts of the symposia and research sessions below.
Presenters from almost every continent discussed a range of topics, including affective
neuroscience, affective touch, anosognosia, consciousness, resilience, splitting, subliminal
processes, and much more.
Single-case presentations linked everyday clinical processes to neurobiological models, or drew
psychodynamic insights from the consequences of brain injury. Comparative clinic-anatomical
work, looking at larger groups of subjects, enriched single-case reports. And a variety of
experimental methods were represented, including EEG, fMRI, and pharmacological
We encourage you to consider submitting proposals for our next congress in London, in July
2017; stay tuned for details!
Maggie Zellner

Friday, July 8
Symposium: The Skin Ego: Neuropsychoanalytic Studies on the Origins of the Self and
Katerina Fotopoulou, Chair

This symposium focuses on how interpersonal, affective touch shapes our sense of self as an
embodied and social being. In a series of talks and brief data presentations, we will present
empirical findings highlighting how affective, affiliative signals shape the emotional, core of

selfhood and set the boundaries of the self. The empirical talks will focus particularly on
affective touch as a neurophysiologically specialized domain of interoception (the so-called CT
afferent system) as a paradigmatic example of proximal intersubjectivity. We will more
specifically consider its role in (a) experimental illusions and clinical disorders of body
awareness, body spatiality and body image such as asomatognosia and anorexia nervosa (total
N = 70); (b) in the perception of physical and psychological pleasure and pain in healthy adult
volunteers (total N = 80). Theoretically we will integrate our findings into a novel
neuropsychoanalytic perspective on selfhood and intersubjectivity. Specifically, against the
background of debates within and beyond psychoanalysis, regarding the primacy of narcissism,
or self-other relating, we argue in favor of a reconceptualization of minimal selfhood that
surpasses such debates and instead traces the relational origins of the self on fundamental
principles and regularities of the human embodied condition. Specifically, our position is
motivated by the following five observations: (1) The progressive integration of sensory and
motor signals constitutes the foundations of the minimal self; (2) Minimal selfhood is best
understood by taking into account all sensory and motor modalities, instead of relying mostly
on a visuo-spatial detached model of 'exteroceptive' experience, and by extension a model of
detached social understanding; (3) Crucially, as some of these sensorimotor modalities are
specialized to respond to experiences within and on the physical boundaries of the body
(e.g. the skin), an experiencing subject is not primarily understood as being here and facing a
perceptual object or subject there, i.e. in a separate physical location. (4) Instead,
interactions with other people are motivated and constrained by the same principles that
govern the mentalization of sensorimotor signals in the singular individual and hence the
mentalization of ones body includes anybody in physical proximity and interaction. (5) Finally,
given the premature birth and social dependency of humans in early infancy, there is a
homeostatically-necessary and culturally enriched, plethora of such embodied proximal
experiences and interactions. Collectively, such experiences of proximal intersubjectivity
sculpture the progressive sophistication of mental distinctions between subject-object,
here-there as well as good-bad.
Aikaterini (Katerina) Fotopoulou Ph.D., studied cognitive neuropsychology and theoretical psychoanalysis at UCL
before completing her PhD in cognitive neuroscience at the University of Durham, UK. She is currently a Reader at
UCL and the Director of the London Neuropsychoanalysis Centre. She runs the London Neuropsychoanalysis Research
Group on: Psychodynamic Neuroscience and Neuropsychology. She is the editor of the volume: Fotopoulou, A.
Conway, M.A., Pfaff, D.: From the Couch to the Lab: Trends in Psychodynamic Neuroscience, Oxford University Press,


Bodily pleasure and the self

Laura Crucianelli

Slow, caress-like touch may play a unique role in the development and maintenance of
psychological wellbeing in humans. In particular, recent evidence shows that affective touch
(i.e. slow, caress-like touch mediated by the C Tactile system), and more generally
interoception signals (i.e. information about the physiological condition of the body) may make
a unique contribution to the sense of body ownership. From a neurobiological point of view,
positive tactile experiences such as massages and hugging a loved one seem to be related to
the release of a neuropeptide, oxytocin (OXT) which is mainly known for its role in labor and
breast feeding. Consequently, from a behavioral point of view, OXT is believed to facilitate
maternal behavior, and it has been associated with social bonding more generally, mediating
interpersonal style of relating (e.g. attachment). In light of this evidence, we will describe
recent experimental evidence suggesting an impaired C Tactile system in anorexia nervosa
(AN), an eating disorders characterized by restricting eating, body image concerns and social
difficulties. Our data (30 AN patients and 30 healthy controls) suggest a reduced perception of
bodily pleasure in response to affective touch compared to healthy controls. These findings are
in line with studies showing altered subjective responses to other interoceptive stimuli such as

hunger, physical pain and perception of bodily signals. This affective tactile anhedonia could
potentially be involved in the onset and maintenance of AN. Subsequently, recent research
investigating the effect of intranasal OXT on the perception of affective touch, interoceptive
processing and body representation will be discussed (30 participants). Our data suggest that
OXT does not seem to affect the perception of interoceptive stimuli or the sense of body
ownership, when experimentally manipulated by means of a bodily illusion paradigm (i.e.
Rubber Hand Illusion). However, we found a tendency for OXT to improve the distinction
between affective/emotionally positive and discriminative/emotionally neutral tactile stimuli.
Implications and future directions of these findings in relation to psychological wellbeing and
body image will be highlighted and discussed.
Laura Crucianelli gained a BSc in Psychology and an MSc in Neuroscience and Neuropsychological Rehabilitation from
University of Bologna (Italy). During her Master Degree, she spent 6 months at Heythrop College, University of London
in the context of the European Erasmus programme. She undertook a year a professional internship at the Department
of Psychology, Institute of Psychiatry, Kings College London, under the supervision of Dr. Katerina Fotopoulou, where
she spent further 4 months working as research assistant. Her duties were mainly aimed at conducting research about
awareness of illness in anosognosic patients following right-hemisphere stroke. Laura recently completed her PhD in
the Department of Psychology, University of Hertfordshire, under the supervision of Dr. Paul Jenkinson and Dr.
Katerina Fotopoulou. Her PhD project investigated affective touch, interoceptive awareness and the sense of body
ownership, in both healthy and clinical populations.


Why Love Hurts

Mariana Von Mohr

Pain is one of the largest health problems in the developing world, being one of the most
common and debilitating markers and consequences of disease. In the clinical realm, the social
modulation of pain has been a particularly important topic, which unfortunately, has been
neglected by research. Among social interactions, physical ways through which we interact
and have interacted across development with others may play a critical role in our experience
of the world and therefore, may shape the way we experience pain. Particularly, given its
opposite affective value and social meaning to pain, interpersonal affective touch which
recent research suggests may be mediated by a separate, specific neurophysiological system
may reduce pain experience, as compared to discriminative, neutral touch. Critically, our
perception of these two opposite affective modalities may also depend on prior object-related
experiences about these modalities. Therefore, in a number of studies (n=80) conducted in
healthy subjects, we examined the effects of affective touch in the perception of both
psychological and physical pain, as well as the role of prior experiences about interpersonal
relating. To examine the role of affective touch on psychological pain, we used a virtual
paradigm involving a ball-tossing game to create social rejection, a form of social pain, while
participants received either neutral or affective touch. In turn, to examine the effects of
affective touch on physical pain, we delivered brief laser heat painful stimuli while assessing
brain response; under different social contexts accompanied by affective and neutral touch. As
predicted, affective touch, as compared to neutral touch, and particularly when provided by a
significant other, reduced pain perception. Interestingly, such effects were mediated by prior
experiences about interpersonal relating, such as attachment style. These findings have
potential implications to our understanding of pain and how interpersonal bodily interactions,
related to an individuals object relations, might impact such experience.
Mariana von Mohr completed her BA in Psychology at the Universidad Iberoamericana, in Mexico. She then completed
the MSc in Developmental Neuroscience and Psychopathology a two-year programme through which she completed
her first year at UCL, and her second year at Yale University. At Yale, Marianas research focused on the neurobiology
of parenting and how addiction might impact maternal sensitivity to infant cues. Mariana is now in the first year of
her PhD at UCL, funded by Consejo Nacional de Ciencia y Tecnologa (CONACyT), and supervised by Dr. Katerina
Fotopoulou. Her Ph.D. research focuses on the social modulation of interoceptive modalities, such as affective touch
and pain, as well as the role of oxytocin.


Face ownership illusions and affective touch

Elena Panagiotopoulou

Through his concept of body ego, Freud (1923) pointed to a double-sided sensorial body from
which both external and internal perceptions may spring. The integration of information from
different sensory modalities (exteroceptive and interoceptive) is a powerful mechanism for
constructing on-line body awareness in the brain and, thus, key for a sense of selfhood in face
recognition. Synchronous, visuo-tactile stimulation between two faces changes the categorical
boundary between self and other, by shifting it towards the others face (enfacement illusion).
Evidence suggests that interoceptive signals coming from the outside (i.e. affective touch) may
have a unique contribution to the sense of body ownership (Crucianelli, Metkaf, Fotopoulou &
Jenkinson, 2013). However, the question of whether face ownership might also be affected by
affective touch remains unanswered. Twenty-four healthy females saw an unfamiliar face being
touched synchronously or asynchronously with their own face and we sought to investigate how
the enfacement is modulated by affective touch. Our data suggest that affective touch plays a
crucial role in shaping our sense of self and, more specifically, our face perception.
Elena Panagiotopoulou completed a BSc (Hons) in Psychology at UCL and an MSc (Distinction) in Psychoanalytic
Developmental Psychology at UCL and the Anna Freud Centre. During and after her MSc, she gained research and
clinical work experience at UCL, Imperial College London, Tavistock and Portman NHS Foundation Trust and the Anna
Freud Centre. She then completed an MSc in Cognitive Neuroscience at UCL as part of a 1+3 PhD studentship cofunded by the Economic and Social Research Council (ESRC) and the Neuro-psychoanalysis Fund (NPSA). Elena is
currently in the first year of her PhD, which investigates body image resilience, affective touch and mentalization,
under the supervision of Dr. Fotopoulou.


Symposium: Core Enactment and the Neurobiology of Psychotherapy

Jesse Viner, Chair

This presentation will inform participants as to the essential principles of the Developmental
Neurobiological Model. This will be followed by a review of the research on brain maturation in
emerging young adulthood in an effort to apply the principles of developmental neurobiology to
this age group. This will extend into a presentation of how the current body of exploding
neuroscience research informs treatment of emerging adults. The presentation will then focus
on the evolution, current status and neurobiological underpinnings of the concept of core
enactment within the spectrum of in-depth psychotherapies. A case example of two individuals
in psychotherapeutic residential treatment will then illustrate the concepts presented and
provide a basis for rich and mutually informing discussion.
Following his education at Yale, The Chicago Medical School, Northwestern University Medical School Psychiatry
Residency and The Chicago Institute for Psychoanalysis, Dr. Jesse Viner has over three decades of experience applying
the knowledge of psychiatry and psychoanalysis to the challenge of creating meaningful and pragmatically effective
treatment programs. He has served on the faculties of the Chicago Institute for Psychoanalysis where he also served
seven years on the Board of Trustees, and as an Assistant Professor of Psychiatry at Northwestern Feinberg School of
Medicine. Dr. Viner is a Distinguished Life Fellow of the American Psychiatric Association. Dr. Viner created
Yellowbrick in recognition of the specialized needs of emerging adults and their families, and the necessity for a
treatment system that addressed the unique challenges of the transition into adulthood. Dr. Viner is parent to six
emerging adult sons and daughters.

Dr. Laura Viner is a Clinical Psychologist and tenured Associate Professor of Psychiatry and Behavioral Sciences at
Northwestern University Medical School. For over 30 years, Dr. Viner has done clinical research, teaching of
Psychology and Psychiatry students, and assessment and clinical treatment of individuals, families and groups with
adults, adolescents, and children. She has published over 50 scholarly articles in scientific journals and books,

including her recent popular psychology book on psychoneuroimmunology, The Joy Formula for Health and Beauty. Dr.
Viner also gives scientific presentations to professional audiences around the country. Dr. Laura Viner is Director of
the Emerging Adult Assessment Center and Research at Yellowbrick. Prior to Yellowbrick, Dr. Viner was Senior Staff
Psychologist at The Family Institute at Northwestern University where she also developed and directed a program for
inner city children and their families to prevent violence and antisocial behavior. Earlier at Northwestern, Dr. Viner
was Director of the Outpatient Eating Disorders Program. Dr. Viner is a parent to six emerging adult and young adult

Dr. Monroe-Cook earned his Ph.D. in Counseling Psychology from Michigan State University in 1979, completing
specialized training in family therapy through the Family Life Clinic there. He has extensive clinical and
administrative experience in the treatment of substance abuse and dual diagnosis disorders, including functioning as
Chief of Family Services for the substance abuse program at Martha Washington Hospital and as the Director of
Substance Abuse Services at Four Winds Chicago. Throughout his career, he has maintained a commitment to the
development and implementation of integrative models of treatment for individuals and families with concerns
regarding addictive behaviors. As VP of Clinical Operations at Yellowbrick since the opening of Yellowbrick in 2006,
Dr. Monroe-Cook functions as Chief Clinical Officer and is responsible for development and implementation of the
comprehensive Family Model and the Parents as Partners Program. Dr. Monroe-Cook is the father of an emerging adult
son and daughter.


Symposium: What psychoanalysis teaches us about (not) reaching the other: The uses
and limits of neural perspectives on empathy
Ariane Bazan & Josh Kellman

This symposium is a psychoanalytic reflection on understanding the other, empathy, and

altruism. The starting point will be a clinical case for each of the presenters, from which
clinical and theoretical issues related to reaching the other (or not) will be discussed. Based
on these clinical data, either parallels will be made with neuroscience data being used to
inform the clinical observations, or, the other way round, interpretation of the neuroscience
data will be proposed on the basis of clinical observations.
In the first presentation Joshua Kellman will discuss a case in which a transferencecountertransference enactment led to a complete rupture. The arduous repair of the
treatment relationship will be described. This psychoanalytic process is used to illustrate the
importance of recognizing early modes of relating to and understanding the other in an
interpersonal context, and place these in the context of a larger hierarchy of levels of
relatedness and ability to grasp the other.
Aikaterini Fotopoulou has introduced us to the subject of affective touch and its implications
for the construction and bounding of the self with respect to the other. We will explore the
extent to which early modes of relatedness, involving basic neural substrates such as the Ctactile afferents that conduct the signal of affective touch, involve at the neural as well as the
emotional/psychological level, issues of self versus other, self as regulated by the other, inside
versus outside, and good versus bad, and how these play out in psychopathology.
We will also explore the issue of optimal boundaries for healthy, reciprocal relatedness for
which an optimal degree of self-regulation is necessary, versus the situation in which one is
obligatorily dependent on the other for regulation, and the ramifications of this for such basic
self-attributes as a sense of agency. Finally, we speculate that other afferent neural systems
such as those for sight and sound (involving prosody of speech, body language, dance, music,
visual arts) may similarly conduct dual exteroceptive and interoceptive signals via their
capacity to carry affective information. If this conceptual leap has merit, we can begin to see

how in the natural milieu of the infants life, a balance is struck in the course of early
development, as well as later in life, that relates to the regulation and elaboration of self and
affective states, and the extent to which an other is needed to regulate these.
In the second presentation, Ariane Bazan will also discuss a clinical case. Through this case
study it will be argued that empathy is merely an extension of self-love and that the ability to
reach the other is crucially not decided by empathy, but by castration, that is, by the
imposition of triadic, ultimately cultural, constraints and taboos. Their arbitrary nature is
decisive for this process: indeed, this implies that there is no way for the child or for anyone
else for that matter to empathize with the imposed constraints. This is the essence of a taboo
which also founds the Oedipal challenge: it is only and precisely by being able to submit to this
arbitrary law, even while protesting, that the child will get access to the social realm.
Reaching the other, then, is accepting that which is radically ungraspable to us as a subject. It
is the active result of civilization intentionally interfering with physiology, in other words, with
civilization extraneously imposing inhibition upon the brain dynamics. It will be argued that
nothing of this is programmed in biological development, that nothing is, or even can be, a
priori guaranteed. Rather, the biological developmental guarantee we do have is to become a
mammal but for us to come to the human condition, it is always and inevitably a matter of an
a priori undecided civilization challenge.
The presenters will conclude with a discussion concerning the discrepancies between their
(neuro-)psychoanalytic views as well as the potential for integration of the different
Ariane Bazan is PhD in Biology (University of Ghent, Belgium) and in Psychology (University of Lyon, France). She is a
professor of clinical psychology at the Universit Libre de Bruxelles (Brussels, Belgium). She is a practicing
psychoanalyst and author of the book Des fantmes dans la voix. Une hypothse neuropsychanalytique sur la structure
de linconscient (Phantoms in the voice. A neuropsychoanalytic hypothesis on the structure of the unconscious, Ed.
Liber, Montral, 2007). She is recipient of the Clifford Yorke prize for neuropsychoanalysis 2008 and specialty-fieldeditor-in-chief of Frontiers in Psychoanalysis and Neuropsychoanalysis, (a section of Frontiers in Psychology).

Joshua Kellman, M.D. is on the faculty at the University of Chicago, in the department of psychiatry, in the section
of child and adolescent psychiatry. He teaches classes there on development, personality disorders, and working with
children. He also supervises child psychiatry fellows, as well as adult psychiatry residents. He is also on the faculty
at the Chicago Institute for Psychoanalysis, where he teaches classes on Mind and Brain with Virginia Barry, as well as
Hierarchical Models in Psychoanalysis, and Music and Art in Preverbal Aspects of Psychoanalysis. He is in private
practice of adult and child psychiatry and psychoanalysis in Chicago and Wilmette, Illinois.


Session: Clinical Research

Phenomenological Case Study of Athymhormia and the Alien Hand Syndrome secondary
to Moyamoya Disease
Max Rudansky

Phenomenological Case Study of Athymhormia and the Alien Hand Syndrome Secondary to
Moyamoya Disease. Clinico-neuroanatomical correlation of the subjective experience
(metacognition) of the cognitive, affective, and motoric symptoms consequent to focal lesion
(stroke) of limbic striatum and thalamocortical pathways. Ms. Ks personal narrative eloquently
deconstructs her subjective experience and objective behavioral correlate: lack of motivation

(athymhormia), lack of volitional control (anarchic hand), lack of agency (dissociative state).
These metacognitive fragmentations of self offer a dialectical perspective of the mind-brain
conundrum where decision-making (dynamic unconscious) gives rise to an intentional volitional
act (preconscious) resulting in a sense of personal agency (conscious awareness) of
responsibility--culpability for ones behavior. Starting with the classical Neurological Case
Study paradigm of correlating cognitive-affective-motoric deficits phenomenologically observed
with discrete neuroanatomical lesion (ventral striatum), then utilizing fMRI imaging to reveal
the iterative distributive neural networks spatial and functional connectivity--giving rise to the
cerebral representation of emergent metacognitive experience. This dissolves the dualistic
schism in favor of a dynamic nonlinear system where the subjective experience of the mind and
the objective study of the brain are two sides of the same coin broadening and clarifying each
other. CLINICAL CASE NARRATIVE: What philosophical question does this case raise as to the
nature of human volition and free will? Neurophysiological studies of Professor Benjamin Libet:
electrophysiological studies demonstrating subcortical electrical activity preceding the
subjects conscious intention to initiate movement, raising doubt as to the very existence of
free will! Neuroanatomical-neurophysiological discussion of the neural substrate of
metacognition: Free Wont Freuds description of primary-id and secondary-ego
processes and their correlation with f MRI of cortical-subcortical intrinsic default network
Basal ganglia (ventral striatum)-thalamo-cortical connections (inhibitory thalamic reticular
nucleus) and their pivotal role in selection of appropriate actions. Connectivity of the basal
ganglia-thalamo-cortical pathways allowing for cognitive-affective-motoric neurophysiological
cross-talk to represent the tripartite metacognitive structure of self: choice-volition-agency.
NEUROPHILOSOPHICAL REFLECTIONS ON FREE WILL Professor Frankfurt of Princeton University
contemporary compatibilist argument for the existence of free will predicated on the ability to
reflect on second order desires; an account that is consonant with the neuroscience of volition.
Putting it all together; the masterful working of cortico-striatal-thalamo-cortical pathways
resulting in the ecstasy of victory. Revisiting the Case of Ms. K and explicating her symptoms in
the context of a basal ganglia that has come unhinged.
Max Rudansky, MD, FACP is Emeritus Chief, Neurology and Emeritus Director, Stroke Unit at Huntington Hospital. He
is currently Co-Director of the Traumatic Brain Injury Unit at St Johnland Nursing Center; Clinical Assistant Professor,
Department of Neurology, Hofstra North Shore-LIJ School of Medicine; and Neuropsychiatric Consultant to Gurwin
Jewish Nursing Center. Dr. Rudansky is Board Certified in Neurology as well as Neuropsychiatry/Behavioral Neurology.
Dr. Rudansky had the good fortune to train under Dr. Morris Bender and Dr. Melvin Yahr at Mt. Sinai Medical Center,
Dr. Rudansky has lectured extensively on topics pertaining to Behavioral Neurology/Neuropsychiatry, including
Neuroscience Grand Rounds at Mt. Sinai Medical School and North Shore University Hospital. He has practiced Adult
Neurology for over 30 years in private practice.


Anosognosia in a Patient with Right-Sided Brain Injury

Ann Rose Simon

A clinical case will be presented of a middle-aged man who suffered an intraventricular

hemorrhage in the right medial posterior frontal and parietal regions from a grade 5 AVM,
resulting in hydrocephalus and midline shift from right to left. Although the patient
demonstrated significant early progress, it also became apparent that the damage to the fronttemporal-parietal area in his right brain hemisphere left him with a condition known as
"anosognosia", thought to be caused by damage to higher neurocognitive processes that are
involved in integrating sensory information with processes that support spatial or bodily
representations. As the psychotherapy focuses more directly on these symptoms, there is
evidence that there has been improvement.
Ann Rose Simon, LCSW is a psychoanalyst in private practice in New York City and Westchester County who works with
adults, children and parent-infant dyads. She is on the Board of Directors of the National Psychological Association for

Psychoanalysis (NPAP) and the Object Relations Institute (ORI) where she is also a supervisor and faculty member. She
is a founding member of the Neuropsychoanalytic Clinical Study Center of NPAP and has been working with patients
with focal brain injuries for twelve years. She has presented clinical papers of work with these patients at several
venues including at the Neuropsychoanalytic Congress in South Africa (2013) and New York (2014).
A Rare

Visual Disorder

Aimee Dollman (co-author: Mark Solms)

The otherness of other minds is bridged by our consensual perception of a shared, objective
world. But Freuds intellectual hero, Helmholtz, theorized perception as a process of
unconscious inference whereby the mind generates predictions arising from a subjective model
of the world rather than the world itself. Friston endorses the same theory today. A unique
opportunity to demonstrate the difference between such mental predictions and the world
itself - and thereby the radical otherness of other minds - has arisen in the form of a patient
with a rare brain condition which causes her to (amongst other things) reverse visual space in
the horizontal plane. She acts as if objects on the left were on the right and vice-versa; that is,
she acts on the basis of a systematic prediction error which reverses her spatial relationship
with the world. My experiments on this patient show how conscious perception is constructed
from subjective, unconscious processes, rather than from simple sensory inputs.
Aimee Dollman is a Neuropsychologist who graduated with a MA in Neuropsychology from the University of Cape Town
(UCT) in 2014. She obtained her BSocSci (Hons) (Psych) and BSc (Human Bioscience) degrees at UCT. She is active in
both private and public Neuropsychology practice. She has an interest in traumatic brain injury (TBI), and her MA
research focused on academic and behavioral outcomes, and the specific role of premorbid functioning in children
following severe TBI (under the supervision of Dr. Leigh Schrieff-Elson, Prof Anthony Figaji, and Dr Pedro Wolf). Her
current research interest lies in visuospatial cognition, and she is investigating a rare visuospatial disorder for her
PhD, through the Department of Psychology at UCT, under the supervision of Prof Mark Solms. Aimee has also been
involved in the development and implementation of various online learning projects such as the Massive Open Online
Course (MOOC) What is a Mind?


EnRAGEd: Introductory Notes to Aggression in a Case of Orbitofrontal Syndrome

Jose Fernando Muoz Ziga

Orbitofrontal syndrome is a neuropsychiatric syndrome secondary to damage in the orbital

areas of the prefrontal cortex. It is composed of cognitive, behavioral and affective symptoms
of different grades of severity, often leading to permanent changes in personality. The case of
a young man who developed reactive, ego-dystonic, non-reflective and explosive aggression
(Silver, 2011) as part of his orbitofrontal syndrome due to a ruptured aneurysm is examined.
The clinical material is taken from multiple hospitalizations in a psychiatric clinic in Bogota,
Colombia. A series of correlations are made between neuropsychiatric symptoms,
neuropsychological data, neuroanatomical lesions as shown on neuroimaging, and first-person
subjective data. This is done with the purpose of showing metapsychological correlates of a
specific prefrontal lesion, particularly how aggressive drives can be altered and experienced as
primary process intrusions. Using an affective neuroscience framework (Panksepp, 1998), it is
hypothesized that damage to executive control of the RAGE system due to an orbitofrontal
lesion leads to altered top-down neuronal constraint, with relative independence of the
eliciting conditions of the affective attack episodes, whether they are precipitated by simple
forms of environmental frustration or highly complex cognitive representations of object
relations. As the patient underwent short-term supportive therapy, owing to the clinical
necessity of gaining greater control over aggressive behaviors, and not a formal psychoanalysis,
any data emerging from this single case study should be contrasted with future evidence in
these kinds of patients. Cases like these should, however, lead to a more precise,
neuroscience-informed, psychoanalytic theory of instincts.

Jos Fernando Muoz Ziga is a Medical doctor, Universidad Tecnologica de Pereira Psychiatrist, Pontificia
Universidad Javeriana de Bogota; Neuropsychiatrist, Universidad Nacional Autonoma de Mexico; Psychoanalytic
candidate, Colombia Freudian Psychoanalytic Society.


Research Session: Experimental Research

First language egocentrism: Selective Brain Changes, after 400 ms, in Defense of Your
Oliver Turnbull

Evidence that emotion can shape beliefs has had empirical support in neuropsychology for
several decades. However, much of the work has been behavioral, and there has been little
evidence at the millisecond level (from event-related potentials, ERP) to support and better
investigate the claims. ERP technology has been used to show that language can influence nonemotional cognitive operations: such as color perception, object categorization, and motionevent-perception. However, ERP has not been used to investigate a more emotionally-charged
domain, such as feelings of national identity. In the first investigation of its kind, we sought to
modify an emotion-related variable (national pride), in the context of a linguistic variable (first
vs second language use, in fluent bilinguals). We predicted that the pro-national statements, in
the national language, would produce selective changes in meaning (as indexed by ERP changes
(N400) measuring the degree of semantic integration).
Prof Turnbull is a Neuropsychologist (and a Clinical Psychologist), with an interest in emotion and its many
consequences for mental life. His interests include: emotion-based learning, and the experience that we describe as
'intuition'; the role of emotion in false beliefs, especially in neurological patients; and the neuroscience of
psychotherapy. He is the author of a number of scientific articles on these topics, and (together with Mark Solms) of
the popular science text 'The Brain and the Inner World'. He is a Professor of Neuropsychology in Bangor University,
where he is also Pro Vice Chancellor (Teaching & Learning).

Dealing with Conflict: Too Little or Too Much? Perspectives from the Psychosis
Tiziano Colibazzi

Conflict is a ubiquitous phenomenon in mental life and, for many years, one of the
cornerstones of psychoanalytic theory. Recent developments in neuroscience have shed light on
the neural functions underlying the processing and the resolution of conflict, specifically
cognitive control, a set of functions that develop throughout adolescence. Abnormalities of
cognitive control have been implicated in the pathogenesis of a variety of mental disorders,
among which are psychotic disorders. An overview of the neural circuits underlying cognitive
control and in particular conflict processing will be provided. The role of abnormalities of
conflict processing in the pathogenesis of psychosis will be discussed both in established
psychotic illness and in its prodromal phase, illustrating how such abnormalities may confer risk
of developing psychosis. Imaging data from a large cohort of subjects at risk for psychosis will
be presented. In this study, we recruited 56 participants at clinical high-risk (CHR) for
psychosis based on the Structured Interview for Psychosis-Risk Syndromes (SIPS) and 49 healthy
controls. Twelve of the CHR participants eventually developed psychosis. We compared
functional magnetic resonance imaging (fMRI) BOLD signal during the performance of the Simon
task. We tested for differences between CHR individuals and controls in conflict-related
functional activity. In the CHR group when compared with controls, we detected smaller
conflict-related activations in several cortical areas, including the dorsolateral prefrontal
cortex (DLPFC). Furthermore, conflict-related activations in the DLPFC of those CHR individuals

who ultimately developed psychosis (CHR converters) were smaller than in non-converters (CHR
non-converters). Higher levels of conflict-related activation were associated with better social
and role outcome. Risk for psychosis was associated at the neural level with reduced conflictrelated brain activity. This neural phenotype appears correlated within the DLPFC with the
development of psychosis and with functional outcome. Our data indicates that impaired
ability to effectively process mental conflict is associated to the development of
psychopathology. We do not know whether such impairments are the result of deficient
conflict-processing or indiscriminate response to non-conflict stimuli as if they were conflictladen. Implications for psychoanalytic theory of conflict are discussed.
Dr. Colibazzis research focuses on the neuroscience of emotions as well on brain imaging of psychotic disorders,
using a variety of imaging techniques including resting state and task-based fMRI, anatomical imaging, DTI and PET.
Dr. Colibazzi is also trained as a psychoanalyst and sex therapist. He is a psycho-pharmacology supervisor for the
Columbia Psychiatry residency program and a sex therapy supervisor for the trainees in the NYU Human Sexuality


Narcissistic Spatial Bias in Depression

Iftah Biran

Background: Many languages use spatial metaphors to describe affective states such as an
upward bias to denote positive mood (i.e. 'elevated mood') and a downward bias to denote
negative mood (i.e. 'depressed mood') as well as a body proximity bias to denote affective
narcissistic induced concern (i.e. 'it touched my heart', 'it touched me'). These biases might be
related to experiential traces related to these affective states. If this is the case, depressed
subjects would show either a downward spatial bias or a body proximity bias. We evaluated the
occurrence of such biases in subjects with depression as compared to healthy controls using a
line bisection task. Methods: Subjects: 10 subjects with depression treated in an outpatient
clinic (DEP) and 10 healthy controls without depression (CON). Subjects were matched for age
and education (DEP: 5F:5M; age - 47.2_15.2; education - 15.0_2.7; CON: 5F:5M; age 45.8_14.5; education - 15.3_2.4). Experimental task: Subjects were asked to bisect lines at
their midline. Lines were presented in one of 3 spatial orientations (vertical, horizontal, radial)
and were either blank, composed of words (negative, positive, neutral) or of smileys (negative,
positive, neutral). Overall there were 21 line types and each was presented 8 times. Results:
Compared with healthy controls subjects with depression bisected radial lines significantly
closer to their body [a proximity spatial bias]: Happy smileys lines: DEP-CON=1.8mm, p=0.024;
sad smileys lines: DEP-CON=2.1 mm, p=0.064; neutral smileys lines: DEP-CON=1.5 mm, p=0.042;
sad word lines; DEP- CON=2.5mm, p=0.08. There were no significant differences for either
horizontal or vertical lines. Conclusion: The proximity spatial bias observed in subjects with
depression suggests that depression might activate neural spatial networks. We argue that
these networks could be dynamically activated through narcissistic mechanisms as implied in
"Mourning and Melancholia" where Freud postulates a narcissistic mediated bias in depression
according to which the depressed (or the melancholic in Freud's words) withdraws from the
outside world.
Iftah Biran is a behavioral neurologist and a psychiatrist working as a psychiatric consult to the department of
neurology in Tel Aviv Medical Center. He is a psychoanalytic candidate at the Max Eitingon institute of Psychoanalysis.


Changing Minds in Therapy

Margaret Wilkinson

How do minds change? How did a clients mind get to become the mind we encounter in that
distressed other who arrives in the consulting-room in need of help? How can minds change in a
way that means our clients leave therapy with a more robust sense of self and a more
confident approach to living? We will explore the relevance of contemporary neuroscience,
trauma research and attachment research to the process of changing minds. Traditionally we
have emphasized words, interpretations, and meaning-making as agents of change. Now we
also have a greater appreciation of the affective, relational, embodied aspects of our
encounters with other minds. We will examine the traumatic early interactive experience that
establishes the patterns of being and relating that will determine an individuals experience of
the mind of another and discuss some of the research that sheds some light on the most
effective ways to conduct our therapeutic encounter with another mind. We will explore,
experience and discuss some aspects of the best of 21st-century thinking and research that is
relevant to the process of changing minds that have been damaged by early relational trauma
and abuse.
Margaret Wilkinson is a training analyst in the Society of Analytical Psychology London, registered with the British
Psychoanalytic Council, and a member of the editorial board of the Journal of Analytical Psychology. She leads
interpersonal neurobiology research reading and clinical seminars for The Northern School of Child and Adolescent
Psychotherapy in Leeds, Cambridge and Edinburgh, and for The Institute of Mental Health at the University of
Nottingham. She lectures internationally on interpersonal neurobiology and its relevance to clinical work. She is the
author of numerous papers and two books: Coming into mind. The mind-brain relationship: A Jungian clinical
perspective. (2006, Routledge), and Changing Minds in Therapy. (2010, Norton Interpersonal Neurobiology series). She
is in private practice in North Derbyshire, England.


Research Session: Clinically-Oriented Research

Subliminal emotional priming effects to dynamic facial expressions in adults with ASD
Yasutaka Kubota
Wataru Sato
Motomi Toichi

Processing of emotional face plays an important role in human social cognition. For example,
fear face elicits fear/anxiety responses automatically, even before the stimulus is appraised
consciously. Previously we reported that the subliminal presentations of dynamic fearful facial
expressions reliably induce unconscious emotional priming effects on healthy subjects (Sato
and Kubota 2014). Here we investigated the subliminal effects of dynamic fear faces on
conscious appraisal of subsequently presented neutral faces in adult subjects with autism
spectrum disorder (ASD). Twelve subjects with ASD and age-and gender matched controls
participated the study. Fearful or happy facial expressions were presented subliminally or
supraliminally, followed by a mosaic mask. Then target neutral faces were presented, and the
participants evaluated the feeling depicted by the target face. Both subliminal and
supraliminal prims of dynamic fearful faces induced evident emotional biases for the
subsequent evaluation in controls. In the ASD group, the subliminal effects of fear expression
were relatively diminished while the supraliminal effects were preserved. The results
suggested that subliminal processing of socially important facial expressions might be
compromised in subjects with ASD. Dysfunctions in subcortical neural circuitries involving
superior colliculus (SC), pulvinar and amygdala were implicated as neural background.
Yasutaka Kubota is a Psychiatrist, Professor in Health and Medical Service Center of Shiga University, Japan. His
research interests include unconscious mental processes in healthy subjects as well as individuals with mental

disorders. He conducted psychophysiological studies on clinical population such as schizophrenia, bipolar disorders,
and autism spectrum disorders, by using EEG, heart rate fluctuation analysis, or near-infrared spectroscopy
( As a psychiatrist with training background
of Lacanian psychoanalysis, his clinical activities mainly focused on psychotherapy for university students.


Affect as A Bridge Concept Between Psychoanalysis and The Neurosciences: A

Comparative Study Between Major and Latent Depressions
Daniela Flores Mosri

Major depressive disorder (MDD) is a worrying well-described category that has been related to
an evolutionarily adaptive mechanism by Watt and Panksepp (2009) with specific PANIC and
SEEKING dysregulations amongst others. Yet, psychoanalytic literature has described a type of
depression that can be called latent and that has been predominantly studied by French
psychoanalysis. This type of depression constitutes the basis of many other psychopathologies,
but has not been clinically characterized because of its latent features. This paper aims to use
affect as a bridging concept between psychoanalysis and the neurosciences to attempt a
description of latent depressions and a comparison against MDD. Two patients treated with
psychoanalytic psychotherapy were compared from a psychodynamic and an affective
neuroscience perspective to identify the features of each depressive state. The MDD patient
showed affective consistency indicated by specific symptoms and patterns, particularly seen in
clinical indicators that suggest high PANIC activation and very low SEEKING activation. The
patient diagnosed with a latent depression was found to show affective uncertainty, suggesting
unstable patterns of activation and deactivation of the basic emotion systems as indicated by
the clinical material. Thus affective uncertainty is considered to be a chronic response to
trauma that still keeps some hope featured by the costly defenses used by the patient. This
defensive configuration can cause clinicians to fail at identifying the presence of a latent
depression as patients can be seen as if (Deutsch, 1942) they were normal or even hypernormal (Bergeret, 1975), which is why affect should be used to achieve a more accurate
diagnosis and to build identifiers that help design better treatment strategies. Correctly
identifying a latent depression can prevent or help the deeper treatment of other disorders
such as addiction, psychosomatic illness and other disorders that may even lead to death.
Affect is the main topic in depression of any kind, thus the probable interaction between its
neurochemistry and subjective aspects is of high importance and a good reason to attempt to
use clinical identifiers of the functioning of the basic emotion systems during psychodynamic
treatments, particularly for patients that appear to have no symptoms but experience a very
high amount of subjective suffering.
Daniela Flores Mosri has a Ph.D. in Psychoanalysis, an M.Sc. in psychoanalytic psychotherapy, and a B.Sc. psychology
degree, all from Universidad Intercontinental, Mexico. She is a Researcher and Lecturer in Psychoanalysis and
Psychology at that same University. She has a clinical practice focused on borderline states, addiction, depression,
psychosomatic illness and eating disorders amongst others. She has been a liaison officer in Latin America for the
International Neuropsychoanalysis Society since 2014.


The Results of the Study of Resilience among 33 Women Victims of Incest

Danile Lapointe

This doctoral research focuses on the study of resilience with thirty-three (33) women victims
of incest during childhood and/or adolescence on the part of their father or their stepfather.
Relying on an interactionist perspective of resilience and the complementarity of
psychological, intrapsychic and environmental factors, it poses the following research question:
To what extent individual and environmental factors theoretically associated with the

development of resilience allow empirically to distinguish people who demonstrate a form of

empowerment from injuries related to an incestuous relationship compared to traditional
clinical symptoms? To answer this question, a comparative analysis of the construct of
resilience was conducted in two parts. The first part consisted in identifying thirty-three (33)
participants in the study according to two pre-defined profiles, on the hand, participants with
traditional impacts clinical (PTCI) and on the other hand, participants engaged in a process of
resilience (PEPR). The second component of the study presented the operationalization of the
comparative analysis of the two profiles according to three key indicators theoretically
associated with resilience in the context of an incestuous relationship: coping strategies, the
link of attachment and mentalization. More specifically, participants having experienced the
incest and engaged in a process of resilience (PEPR) differ significantly from participants with
traditional clinical impacts (PTIC) according on these three factors. This communication is to
present the results of this study.
Mrs. Danile Lapointe of Canada is a PhD student, Psychologist and Clinical Supervisor, particularly with stakeholders
working in the field of trauma. She also teaches at the University of Laval and the University of Montreal. She has
been interested for many years in dealing with victims who developed PTSD. For example, she is currently completing
a doctoral research that deals specifically with victims of incest and the phenomenon of resilience.


White Matter Impairment is Associated with Affective Dysfunctioning in Poly Drug use:
An Existential Neuroscience Perspective
Human-Friedrich Unterrainer
(Co-authors: Michaela Hiebler-Ragger Msc; Karl Koschutnig, Psy.D.; Jrgen Fuchshuber Msc;
Sebastian Tscheschner, Msc; Maria Url, M.D.; Jolana Wagner-Skacel, M.D.; Ilona Papousek, Psy.D.;
Elisabeth Weiss, M.D. Psy.D.; Andreas Fink, Psy.D.)

In this study we adopt the perspective of existential neuroscience to investigate the link
between the integrity of White Matter (WM) and adverse affective bonding experiences in
substance use disordered (SUD) patients. We place special emphasis on spirituality as a higher
order affective human attribute as well as an important factor for SUD treatment. A total
sample of 59 right-handed males, comprising two groups of drug-misusing (n=20) vs. non-drug
using (n=20) control subjects and one SUD patient group (n=19) diagnosed for poly drug use
disorder (PUD) were included in the study. Diffusion Tensor Imaging was used to investigate
differences in WM neural connectivity. On a behavioral level, we applied the Adult Attachment
Scale, the short version of the Affective Neuroscience Personality Scale and the
Multidimensional Inventory for Religious/Spiritual Well-being. We observed that WM
impairment in PUD patients was linked with more anxious attachment styles and to a minor
extent with diminished spirituality. This study confirms the idea of addiction as an attachment
disorder on a neuronal as well as behavioral level. Further research focusing on neuro-affective
correlates of SUD might also consider spirituality as a core dimension of human existence.
Human-Friedrich Unterrainer, Ph.D., Psy.D. is a clinical psychologist, psychodynamic psychotherapist and a private
lecturer at the Universities of Graz and Vienna, Austria. He acts as the scientific director of the Center of Integrative
Addiction Research and works in private practice in Vienna. He is a former fellow of the Research Training Program
(RTP; 2010) of the International Psychoanalytic Association (IPA). His research interests include substance use
disorders, creativity and spirituality, and EEG-Neurofeedback.


Research Session: Therapy & Theoretical Research

At the Ground Level of Psyche and Soma: Attending to Sensory, Motor, and
Communicative Systems in Session Room
Diane Selinger & Christina Peters

In the midst to the ongoing debate in the psychoanalytic community between

empirical/positivist beliefs and hermeneutic/social-constructivists beliefs, many clinicians are
caught wondering how to maintain an individualized psychoanalytic process that upholds
subjective meaning while also incorporating neurobiological findings. How do we actually
utilize neuroscientific information and still be psychoanalytic? This presentation will discuss a
model of psychoanalytic treatment for children and adults that incorporates a neuroscientific
understanding at the ground level of the process in the session room. This presentation will
provide rich case examples, both child and adult, that highlight how biology -- specifically
sensorimotor systems and language development -- shape the psyche. We will demonstrate how
attunement to these areas strengthens our clinical formulations and interventions. This
perspective challenges psychoanalysis to do what has historically not been a strength:
collaborating with other disciplines. Throughout the presentation we will also illustrate how
clinicians can reach across disciplines and collaborate, while maintaining a meaning-based,
psychoanalytic process. Through multi-disciplinary collaboration, we believe psychoanalysis can
expand its applicability to a wider scope in life, enriching the work of other disciplines as well
as strengthening our own psychoanalytic frameworks. Consider, for example, an impulsive
child. His behavior might be understood psychoanalytically in terms of unconscious wishes,
intrapsychic organization, unmet self-object needs, or the intersubjective meanings derived
from the relational history. What is typically not considered, and yet can significantly impact
intrapsychic development and interpersonal experiences, are areas such as motor development
and the childs visual-spatial capacity to modulate his body in space, subtle differences in
language processing, or regulation of sensory input. Consideration of these biological aspects
dramatically enriches our clinical understanding of individuals. Instead of focusing exclusively
on the ineffective or pathological parent, this model seeks to integrate a wider understanding
of sensorimotor and language systems as a component for deciphering co-created meanings
within parent-child relationships. Similar thinking can enliven and deepen our understanding of
the acting out or the inhibited adult patient, whose unique biological make-up may have
impacted the psychological and relational dynamics we see in our consulting rooms.
Christina Peters is Director of Mental Services, Beth Osten & Associates, Skokie, IL Analytic Candidate, National
Institute for the Psychotherapies, National Training Program, NY, NY Faculty, Profectum Foundation DIR Institute
Faculty Member Consulting Psychologist at Soaring Eagle Academy, Burr Ridge, IL Presentations and Publications
(abbreviated) Selinger, D, Peters, C (2015). Collaboration with Parents in the Clinical Process." Presented at National
Pediatric Developmental Differences Forum, Chicago, IL Selinger, D (2013). Developing Symbolic Thinking. Profectum
Foundation Video Series. Selinger, D. (2008). Siblings-The Other Children. Workshop presented at the Interdisciplinary
Council on Developmental and Learning Disorders (ICDL) conference. Glovinsky, I., Pass, S., and Selinger, D. (2008)
Understanding Aggression from a DIR Perspective. Workshop presented at the Interdisciplinary Council and
Developmental and Learning Disorders (ICDL) conference. Burke, W., Summers, F., Selinger, D., Polonus, T. (1985).
The Comprehensive Object Relations Profile: A Preliminary Report. Psychoanalytic Psychology, 3, 173-185.
Emails: &

The Splitting of the Ego

Fabio Tha

The splitting of the ego (Ichspaltung) comes from the disavowal (verleugnung) of the
perception of the anatomical sexual difference, which means the experience of an especially
afflictive situation, the narcissistic trauma designated by Freud as castration, in which the ego
undergoes a frightening experience that confronts him with a real obstacle to the satisfaction

of drives. Between acknowledging the real danger and abandoning the satisfaction or denying
the danger and keeping the satisfaction, the ego, through the creation of a symbol (in this case
the fetish), keeps the two options by splitting itself. In his last writings (Splitting of the Ego in
the Defensive Process and An Outline of Psychoanalysis), Freud extends the notion of the
splitting of the ego to a universal characteristic of mental life, in which two contradictory and
independent attitudes are active and may be triggered either by disavowal or repression
(verdrangung). If both can be considered defenses (repression addressed to Id and disavowal to
reality), it seems that the splitting of the Ego is more structural, providing the bases to the
acting of the defenses. This idea will be related to the splitting of the instincts, which Freud
presents in Formulations Regarding the Two Principles in Mental Functioning, and to certain
semantic facts identified by G. Lakoff (1996) in the natural languages regarding the
conceptualization of the notion of the self, which is divided between a self and a subject. The
splitting will also be discussed in reference to binocular rivalry based on the Bayesian approach
(J. Hopkins, 2012) and on the mechanism of dissociation (H. A. Berlin, 2011). Finally, I will
discuss the question of the subjective splitting in relation to consciousness, since both attitudes
under some circumstances have access to consciousness, although remaining isolated and not
interfering with each other.
Psychologist, Ph.D. in Linguistics, psychoanalyst at Balneario Camboriu - Brazil, author of the books: Uma semantica
para o ato falho (A semantics for parapraxis) and Categorias conceituais da subjetividade (Conceptual categories
of subjectivity), Ed. Annablume, Sao Paulo.


The Ego as a Self-Organizing System: A Systems Theory Perspective on Freuds Energic

Patrick Connolly

The body of Psychoanalytic theory is faced with a core difficulty which is the lack of a coherent
metapsychology which is adequately compatible with current knowledge in neuroscience and
other fields, and within which findings from neuroscience can be integrated with both the key
propositions of psychoanalytic theory as well as with the central observations found in the
analytic setting. Traditionally, Freuds theory of psychic energy was meant to play the role of
such a metapsychological foundation: such notions as the tendency to discharge or maintain
excitement at a constant, the pleasure principle, libidinal cathexis and anti-cathexis were
founded as the central organizing principles of the ego and the defenses. However, despite the
fundamental importance of the role that the energic theory was supposed to play in explaining
behavior and affect, and in integrating vast amounts of data from the analytic situation, it was
the subject of several decades of active debate which clarified a number of problems with the
energic theory that have remained effectively unsolved until the present. This included a
central problem of no neurophysiological correlate being found for the energic mechanisms
Freud described, nor for the tendency of maintaining activation at a constant. Grobbelaar
(1989) suggested that the central assumptions and propositions of systems theory may
successfully reformulate some of the key difficulties of psychoanalytic metapsychology. This
paper describes how Freuds energic theory can be reconsidered from within a systems theory
epistemology that makes use of Maturana and Varelas (1980) notions of autopoiesis and
structural coupling, as well as Wieners (1948) cybernetic principles of information and
feedback. From this perspective it is argued that the ego is not regulated by a principle of
maintaining excitement at a constant, but by a principle of maintaining its organization, and
that energy in this context can be understood on an informational level, as change and
disorder. Such a formulation has the benefit of greater compatibility with a growing field of
systems neuroscience and such contemporary notions as Karl Tristons (2010) notion of the
minimization of free energy, as well as with developments in the field of computer-based
thinking which also model the self-organization of systems.

Patrick Connolly is a psychoanalytically-oriented psychologist, and has submitted his Ph.D. thesis for examination at
the University of South Africa at the time of preparing this Bio. He qualified as a psychologist in 2004 after
completing a Master degree at the University of the Witwatersrand in Johannesburg, South Africa. He has almost 12
years of experience as a lecturer in Psychology including a post held as Lecturer at the University of the
Witwatersrand from 2007 to 2011 when he emigrated to China. Prior to this he also completed an internship and a
further 6 years of part-time consultation as a psychologist at Gateway House a residential community psychiatric
facility in Johannesburg specializing in long term care of patients with psychotic disorders. He also ran a part-time
private psychotherapy practice for almost 6 years in Johannesburg and was active in activities of the psychoanalytic
community in Johannesburg during that time. Early in 2011 he left South Africa to take a position as Lecturer in
Psychology at Hubei University in Wuhan, China for three and a half years. He is currently psychology lecturer at
Raffles College a private education institution in Singapore.

A View of Consciousness that Includes All Animals

Terence Rogers

We propose that the possession of a conscious state by all animals is a natural consequence of
our multicellular nature. We further propose a model of consciousness that suggests its
evolutionary advantages, how major characteristics of the conscious state may have evolved,
and how human consciousness fits into this framework of animal consciousness. The model
suggests a unified way to study consciousness in different animals and to see human
consciousness as one variation on a shared core aspect of animal life.
Dr. Rogers obtained a Ph.D. in Elementary Particle Physics at Cambridge University (UK), and continued research at
Cambridge, Princeton and Berkeley Universities. He subsequently researched and developed software systems at IBM
and Lotus, and later led the effort to design and build an advanced internet - now called Internet2 - which was
announced at the White House in 1998. After completing Internet2, Dr. Rogers became President of the ThinkQuest
Foundation, running an international program challenging 100,000 teenagers worldwide to build educational software.
He is now studying models of the mind/brain as Assistant Clinical Professor in the Department of Psychiatry at the
Icahn School of Medicine at Mount Sinai, and has presented papers on Consciousness, the Oscillatory Brain and the
Arrow of Time. He published a review of Dehaene's book, "Consciousness and the Brain" and will shortly publish a book
proposing a new way to organize public schooling in America.


Research Session: Developmental Research

A Creative Process Made Visible: Fronto-Temporal Hemodynamic Correlates of

Sandplay Therapy
Michiko Akimoto
(co-authors: Keiko Furukawa, M.A.; Junko Ito, M.A.; Yasutaka Kubota, M.D., Ph.D.)

Sandplay therapy is a form of art or play therapy based on Jungian analytical psychology. It
activates deep layers of the unconscious in the service of healing and development (Ammann,
R., 1991). Although sandplay often brings about dramatic transformations in the psychological
states of sandplayers, his/her inner processes have only been subjectively understood by
examining individual cases, and underlying neural mechanisms have not been investigated. We
have attempted, for the first time, to investigate neural backgrounds for the creative process
of sandplay by using near-infrared spectroscopy (NIRS). Method: A healthy volunteer graduate
student, right-handed male subject in his 20s (Cl) and a right-handed veteran male therapist in
his 40s (Th) participated in the study. In a 10-mintues- simulated sandplay therapy session, Cl

freely made a scene, and Th watched it. A multi-channel NIRS measured the hemodynamics of
Cl, in the total of 20 channels in the bilateral prefrontal and temporal areas. After completion
of the sand scene, debriefing was conducted by Th about Cls thoughts and feelings during
sandplay. The session was videotaped and monitored. The changes in oxy-Hb concentration in
Cl were analyzed together with the video data and the interview responses. Results and
Discussion: (1) When Cl was digging a river, there was a sharp increase in the oxy-Hb levels of
both superior temporal area and dorsolateral prefrontal area. Probably due to sensory-motor
stimuli, the sand and hands, fronto-temporal networks were activated to explore inner
unconscious images with cognitive control. (2) When Cl was re-examining a miniature he had
once placed on the sand, there was increase only in the oxy-Hb levels of the DLPFC but not of
the temporal region, suggesting that sandplay involve at least two different brain modes of
thoughts: generative and evaluative. There was a remarkable rise in oxy-Hb concentration in
the frontopolar cortex, when Cl was deliberating on how to finish, which might reflect the
frontopolar function of evaluating inner products (Christoff, K. et al., 2000). The subjective
experiences of CI yielded by the interview were largely in accordance with the temporal
patterns of distributed cortical activity revealed by NIRS. Observed hemodynamic activities in
the fronto-temporal and the frontopolar areas seemed to have contributed to Cls realizing a
unique image in the sandbox. Further research is necessary to clarify the roles of different
brain areas involved in sandplay.
Michiko Akimoto is an Associate professor of clinical psychology at Toyo Eiwa University, Yokohama, Japan. She is a
pioneer sandplay therapist for brain- damaged patients. For this work, she received the Hayao Kawai Award from The
Japan Association of Sandplay Therapy in 2009. She has been exploring the meanings of neuropsychological symptoms
from the perspective of clinical psychology. She has also done research on psychological care for patients with
diabetes. She has published papers on sandplay therapy, co-authored several books on diabetes care, clinical
psychological assessment, and the recently published Introduction to Neuropsychoanalysis (edited by Norifumi
Kishimoto). Her current research focuses on neural underpinnings of sandplay therapy.


Pruning of mind and brain: Behavioural Video Observations and Brain Imaging
Gilbert Kliman

The author will present snippets of videotaped interviews of ten severely traumatized children.
Their behavior is excessively simplified and repetitively constrained into behavioral enactments
of the dangers to which they have been exposed. Brain imaging findings in chronic PTSD are
reviewed. A theory is suggested in which both brain and behavior become chronically
impoverished by a neuropoptic process. The pruning leads to favoring of behavioral repetition
compulsion and ultimately to brain atrophy in several emotional and cognitive processing
Gilbert Kliman is Medical Director of The Children's Psychological Health Center, Inc., Senior Life Fellow of American
Academy of Child and Adolescent Psychiatry and of American Academy of Child and Adolescent Psychiatry. Certified
Psychoanalyst for Adults, Children and Adolescents. He is author of 75 scientific papers on treatment of severely
disturbed children.


Becoming a Real Boy: A Journey from Early Intervention to Analysis

Holly Johnston

Children with serious neurodevelopmental vulnerabilities in relating, communicating, and

thinking present a challenge to the psychoanalyst. This paper tracks the long-term intensive
treatment of a child with autistic features, illustrating an analytic process that alters along
with the capacities and needs of the child and his family. Fluctuations in distance and

connection, in thinking and retreat from thinking, and in playing genuinely and playing
ritualistically characterized this treatment, which began as parent-infant psychotherapy and
progressed into analytic work continuing into adolescence. Treatment began in a floor time
model, helping parents and child find each other and engage in ways that validated the childs
cues and that did not require him to retreat from impingement into autistic withdrawal. In the
course of the analytic work, Martin moved from a non-speaking, intensely anxious toddler, to a
boy who could speak about his feelings and discover his own agency, who could, like Pinocchio
(his first favorite story), move into true human relatedness. He no longer needed his analyst to
scaffold his play and provide a running narrative but could imagine and narrate his own stories.
At the same time, Martin could turn away from thinking and retreat into autisms, often in an
effort to shut down painful affects. His efforts to self-soothe resulted in mindless obsessional
activity. For a child with serious difficulties in relatedness, analytic focus changes as the child
changes, but it begins with containment with the analysts capacity to hold the child in mind,
to think about and reflect on the process. Children who resort to autistic self-protections
attempt to avoid thinking and relating. They appear frozen, removed from normal relatedness
and thus from normal development. Close attention to the fluctuating distance and connection,
and to the expression and naming of affects within the play can contribute to the emergence of
genuine play and genuine relatedness. Analyst and child slowly construct together a way to
represent and to think about the childs complex and confusing internal world. The steadfast
attention of the analyst provides an anchor, a homebase from which to move out into the
world, available to interact with others and think about what he finds. Time and space open
up, allowing not just for defense and avoidance, but also for a true self to emerge and be seen,
not just by the analyst but by the child.
Holly Johnston, Ph.D., is a clinical psychologist in private practice in Chicago. She received her doctoral degree from
the University of Chicago Committee on Human Development. She is a child and adult psychoanalyst and is on the
faculty of the Chicago Institute for Psychoanalysis. She is the co-author of a book, Assessing Schizophrenic Thinking.
Dr. Johnston began her career working with psychotic children at the Orthogenic School under Bruno Bettleheim,
where she also had her first exposure to psychoanalytic thinking. She obtained further training from the Center for
Psychoanalytic Studies in Chicago, where she was a training analyst and faculty member. Her clinical practice includes
child psychological testing, which she taught at the Illinois School of Professional Psychology. She trained in DIR
floortime, which she finds to be a useful adjunct to her analytic approach to very young children and their parents.


Remodeling Insecure Attachment through Psychoanalysis: Common Threads in Extreme

Cases of Brain Injured, Borderline and Autistic Patients
Rossana De Angelis
Vittorio Da Pieve, Physician and Psychotherapist; Davide Tomatis, Psychoanalyst, Neuropsychologist;
Clelia Conti, Pedagogue; Chiara Marazzato, Trainee; Christine Schneider, Assistant)

The mother-child relationship in the first two years of life with its impenetrable procedural
memories can reveal its fundamental importance through the results of a patient therapeutic
reconstruction. In all our patients treated in years of therapy, the evidence was the difficulty
of early attachment in all its manifestations, sometimes very serious, others just marginal.
Especially in coma with its disconnection and autism with its deficiencies emerge the basic
need of attachment for the processing of frozen or indecipherable emotions. It has been widely
discussed in the psychoanalytic environments what results are obtainable with different
methods of psychodynamic psychotherapy in restructuring over time a dysfunctional
attachment. In our experience of rehabilitative psychotherapy and in the light of neuropsychoanalytic studies, we noticed a common thread that unites various dysfunctional types.
We present three cases: traumatic coma, autism and borderline development in adolescence.
We will illustrate the way from minimal signs of a possible development of attachment until its
stabilization in a positive sense and emphasize the difference between restoring a healthy
attachment that goes towards autonomy as opposed to a spurious kind of attachment producing
dependence, confusion and problems of an unresolved analyst-patient relationship. The work
of remodeling attachment is extended to the family and the environment, in order to not

precipitate our results in the ancient fabric of a dysfunctional attachment reproduced by the
family. The cases presented are monitored by a control psychotherapy. We can confirm that
the restructuring of a damaged attachment requests a long time, but gives good results like
empathic relationships, the capability to love and be loved, entering in relationship with the
external environment even if it presents itself in difficult and hostile ways.
Rossana De Angelis is a psychotherapist trained in Freudian psychoanalysis and Jungian analytical psychology. She
specialized in child and adolescent psychotherapy (Milan, London), group analysis (Karen Horney, Rome), in psycho
diagnostics (Geneva, Zurich) and neuropsychology (Milan, Tel Aviv). She developed her own psychotherapeutic
approach of modular therapy, specializing in brain rehabilitation of coma, brain-injured and autistic patients, in a
multidisciplinary rehabilitation team at the Morosini Foundation, Milan, which she is directing as President. In the
last thirty years, she has treated hundreds of cases presenting her research in various publications and international


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