From Reacting to Reflecting: "How Psychoanalysis Made Us Better Surgeons" with Mauro Vasella, MD and Flavio Vasella, MD, PhD (Zurich)

"You have to understand the revolution of psychoanalysis as the idea that everything we represent both conceals something about our being-and-becoming as much as it reveals it. Once you are open to that, you, in a way, have entered the world in which free association is necessary, because free association, in my frame of reference, is not just uncensored talking. It's not just that. It's something that very specifically unsettles the rationality and the realism of discourse, such that it allows dimensions that were occluded or more accurately repressed than suppressed to come to the surface to a greater degree. In other words, we practice free association because it's freeing, and it's freeing of something that is essential to our being." Episode Description: Barnaby begins by describing how free association is a process that is not limited to speaking with increasingly less censorship. It is a process that is foundationally disruptive to the "repetitiously-compulsive way in which 'knowledge' has impeded the movement of being-becoming." He sees psychoanalysis less as a process of learning about oneself, an epistemological enterprise, and more as an opportunity of expanding one's sense of self, an ontological experience. As such, Barnaby sees free association as "inherently anti-technical, anti-theoretical and anti-authoritarian." We consider the use of the word resistance as opposed to hesitancy. He, like Pythagoras, emphasizes the role of the analyst as "a friend who accompanies you on a journey, facilitating your perseverance on the road to a happier life." Barnaby elaborates the experience of 'listening to listen', the importance of introductory psychotherapy and where 'reverie' fits into his thinking. He closes with "The psychoanalyst's enjoyment of their patients...is a spiritual praxis of 'finding the joy in' - that is, being steadfastly aware of an exultancy in the liveliness of life that girds even the most tragic of circumstances."

"I believe that to be inspiring, we have to have conviction. Conviction is the central thing to me. Conviction about treatment itself, and conviction about the way that we do treatment. I saw two analysts at two different times of my life, and they were very different. They had very different theoretical backgrounds, but one thing they had in common was their conviction - the conviction in the idea that this treatment was going to help me have a richer life, and I found that inspiring. I found them inspiring. I think that sometimes, in the effort not to be indoctrinating, not to engage in logical positivism, not to be seen as authoritative, I think we can err in the direction of a relativism that doesn't allow us to have the full-bodied conviction that I think we need in order to inspire people to stay the course of treatment and candidates to stay the course of training."

Although I believe that transference interpretation is the core mechanism of change in psychoanalysis, I don't believe it's the only mechanism. I think there are other things that go on too. I also think that alongside the transference relationship, there's a real relationship. The final chapter of the book is titled "A Cure by Love", and I do think that in the real relationship between patient and analyst, something happens. People speak of corrective emotional experiences. I believe that they occur, but I also believe that for them to really bring about change, you need to analyze them. You need to understand what has happened between you. This comes back to the question of countertransference enactment. Countertransference enactments are inevitable. They're not a bad thing, they're an inevitability. What would be a bad thing would be if they went unnoticed and unanalysed. So, there are opportunities. This is the sort of thing that my analysis was about. A core part of it was about my desire to connect with my father in a way that I never was able to achieve. This countertransference enactment, it's accurately described as that, but it's also diminished if it's only described as that. That was one of many opportunities for me to understand my own transference, but also it was a real thing that happened between me and him, which made me feel that he cared for me. Then again, this is real, and it's grist for the mill of understanding why it means so much." Episode Description: Mark shares with us aspects of his personal story, his analysis, his neuropsychology research and two clinical examples. He describes how neuroscience has discovered the mind "much like the one Freud sketched out in the first decades of the 20th century...merely by listening closely to what his patients told him." He reports on the impact of his brother's brain injury on his later interest in neuropsychology as well as his childhood conflicts over surpassing him. Regarding the issue of cure, we note both the importance of his identification with his analyst, which reflected his trying to reach his distant father, as well as the value of being able to recover traumatic memories. We consider the centrality of consciousness in the study of the brain, "Unless we adjust our research methods to accommodate subjective experience, we shall never understand how the brain works." Mark shares with us his current efforts to create an AI agent that has access to some version of 'feelings'. We discuss a patient who, through transference reliving of childhood trauma, was able to live a freer life and how dynamic treatment uniquely provides a sleeper effect whereby self-awareness and improvement continues after the treatment is completed. He closes "Looking back over my decades of involvement with psychoanalysis, I believe I can honestly recommend it as a way of thinking and working and being. There's something very powerful about the notion that, simply by attending closely to the feelings and memories of another person - the seemingly inconsequential details of a life - we can gain insights not only into their inner worlds, but into the deep structure of all souls."

"In analytic training, and actually through my own analysis, is really where it happened. I think I just got more of a sense that whatever was going on with my students and the parents of my students was maybe not about me. It might not be all up to me, and something about that really freed me up to do better work. Another way I'll describe what you're talking about is that I had an adult violin student several years ago, and she wanted me to explain everything. And I said, "Well, I can. Do you want to learn how the violin is played, or do you want to learn how to actually play the violin?" Those are two very different things to me. I feel like what happened in the course of my analytic training, in the course of my own analysis, is I learned how to play the violin. The pre-stuff to that was about how analysis is done, but I actually learned how to do it and how to be it by going through it. Episode Description: We begin Ed's musical journey with his describing the importance of his musical family and community on his interest in learning to play an instrument. When watching his older sister play piano, he discovered the feeling of I want to do that. He pursued violin playing and studied with Shin'ichi Suzuki in Japan. He then returned to the States and in an effort to better appreciate his young students' experiences, he immersed himself in the world of developmental psychology and earned an MSW. Later he would pursue analytic training at the St. Louis Psychoanalytic Institute. This training enabled him to actually become an analytic clinician rather than learning about analysis. We discuss how his clinical work influenced his work as a music instructor, helping him consider "who I become to the student in the lesson." He shares with us the many mentors who have inspired and educated him in his two careers. It was when observing senior colleagues' nuanced analytic ways of thinking that he discovered anew his experience of I want to do that.

"How do we continue doing this work when the socio-political realities are unimaginable? I've been living in Paris the last few years, and I continue to have a full caseload in Tehran and other cities. There was a time that the internet was cut off for our Iranian patients, so there is reality, and then there is a reality that actually affects the frame - they couldn't contact their analyst. But in the middle of all of these things, something very interesting came up, which is, some patients, as soon as there was the possibility of contacting me, they would find a way. There were other things that came up in the supervisions I was doing, particularly if the analysts were outside of Iran and the patients were in Iran. For example, one thing that came up in the supervision was that the analyst would write to the patient all the time, saying, "Are you safe? Are you okay?" That's not something I chose to do. When we discussed this and reflected upon this in the supervisions I felt like the analysts were feeling quite guilty for feeling that they are in a safe place and the patients weren't, or they were at times terrified of the aggression that could be awaiting them in the session. It was in a sense like a little bit of an acting out on the part of the analyst." Episode Description: We begin by acknowledging the ongoing war and Gohar's safety in Paris while many of her patients remain in Iran. We explore what this gradient in danger between analyst and analysand means and evokes for both parties. Gohar notes that many supervisees contact their patients to ask, "Are you OK?" and she invites them to reconsider this response. She also describes working with Russian colleagues, many of whom were abandoned by their Western supervisors after Russia's invasion of Ukraine. This leads to a discussion of analytic work with patients whose political views sharply differ from those of their analysts. Gohar reflects on Jonathan Lear's concept of "radical hope" and shares her perspective on the Woman, Life, Freedom movement. She closes by reminding us that, even with those we regard as 'other,' "our emancipation is inherently intertwined, whether we like it or not." Linked Episodes: https://ipaoffthecouch.org/2022/10/15/episode-120-foreignness-the-blues-and-psychoanalysis-in-iran-with-gohar-homayounpour-psyd-tehran/ https://ipaoffthecouch.org/2025/09/21/episode-189-when-we-feel-provoked-by-the-politics-of-our-patients-with-heribert-blass-dr-med-md-dusseldorf-germany/ Our Guest: Gohar Homayounpour PsyD is a psychoanalyst and author. She is a member of the International Psychoanalytic Association, the American Psychoanalytic Association, the Italian Psychoanalytical Society, and the National Association for the Advancement of Psychoanalysis (NAAP). She is a Training and Supervising Analyst of the Freudian Group of Tehran, of which she is the founder and past president. She is a member of the scientific board of the Freud Museum in Vienna and of the IPA group Geographies of Psychoanalysis. She serves on the editorial board of The Psychoanalytic Quarterly, Vestigia and Psychoanalysis, Culture & Society. She is also the editor-in-chief of the series Psychoanalytic Notebooks, published in Iran by Ghatreh Publishing House. Her first book, Doing Psychoanalysis in Tehran won the Gradiva Award and has been translated into many languages. Her latest book is Persian Blues: Psychoanalysis and Mourning.