2025 Riggs-Yale Virtual Conference on Parenting and Partnerships

Presented by the Erikson Institute of the Austen Riggs Center and the Yale Child Study Center

This virtual conference recording focuses on substance use and behavioral addiction in children and adolescents, examining the role of parental substance use, changing cultural norms, and efforts to find a community and belonging through substance use and/or technology. Topics covered include the complex interaction between biology, psychology, family systems, and social context in the development and progression of addictive processes. Early prevention and intervention strategies for children and adolescents vulnerable to substance use or behavioral addiction are discussed.

Photo of hands all in. Photo credit: Hannah Busing via UnSplash.

Hands All In

CE/CME Courses

On-demand recording of the 2025 Riggs-Yale Virtual Conference on Parenting and Partnerships

Substance Use and Behavioral Addiction in Childhood and Adolescence

There is a relationship between what the psychoanalyst hears and what the dermatologist sees. What the psychoanalyst hears in the doctor’s consulting room allows him to infer that there are unconscious factors which have a part in the motive and the time of consultation, the self-destructive patterns of behavior that make the disease worse, the kind of complaint or suffering that will be privileged by the patient, the acceptance or rejection of a treatment, and in some cases even the location of the lesions.

The identity and the skin, the self-inflicted lesions, the mimetic moment and the tattoos, the hypothetical role of mirror neurons, the death on the skin, the symbiosis, the skin and the gaze, are some of the items in which this presentation is focused. Finally, technical considerations to help psychoanalysts and dermatologists working with skin patients will be described.

Jorge Claudio Ulnik, MD, PhD

Free CE/CME course with Jorge Claudio Ulnik, MD, PhD

Psychoanalytic Approaches to the Skin Patient

 is a significant problem for people with psychosis and can interfere with their capacity to engage in psychosocial treatment. In this article, the developmental trajectory of mistrust is outlined, including the impact that attachment disruption, childhood trauma, attributional biases, internalized stigma, and discrimination can have on the person's capacity to form trusting bonds with others. After this review, three elements are described that may allow for the restoration of trust: the therapist's openness to understanding the patient's experience and agenda for therapy, the therapist's effort to honestly disclose their thoughts to encourage dialogue and mutual reflection, and therapist's attempt to promote metacognition through helping the patient develop more complex representations of the minds of others. These elements are framed in the context of metacognitive reflection and insight therapy, an integrative therapy that is well suited to address mistrust through its explicit focus on metacognition and intersubjectivity.

, despite pessimism in the field, persons experiencing psychosis can benefit from psychotherapy and recover. However, there are multiple factors that can interfere with the formation of a positive therapeutic alliance and lead to the premature termination of therapy, which is associated with poorer long-term outcomes. In this article, common therapist, patient, and intersubjective factors are identified that can inhibit personal growth and lead to stalled treatments. After reviewing these various roadblocks, four principles (e.g., an intersubjective orientation to realty, therapeutic openheartedness/vulnerability, “speaking the unspeakable”, and recognizing the pain beyond the psychosis) are outlined that can embolden the therapist to take judicious risks while avoiding common pitfalls when working with persons experiencing psychosis. These principles also enable the therapist to maintain an empathic connection to the patient and appreciate the pain beyond the psychotic symptom. The clinical implications and challenges of embodying these principles and implementing these interventions are discussed.

 is known to be a crucial factor that can facilitate recovery from psychosis. In contrast, hopelessness has been associated with a variety of poor outcomes for people with psychosis, such as low self-esteem, depression, and suicide. While hope is central to recovery, the concept of hope can be challenging to identify and define. Furthermore, little is known about how psychotherapists can help people with psychosis reawaken a sense of hope that enables them to recover and lead meaningful lives with a severe mental illness. In this paper, the concept of hope is explored based on a selective review of the psychological and philosophical literature and through engagement with first-person accounts of psychosis. Following the review, key principles and interventions are described, including the importance of reckoning with therapist’s hope, processing hopelessness, facilitating a sense of belonging, fostering agency, and making meaning of the psychosis and promoting spirituality, that can rekindle a sense of hope. These principles and interventions are transtheoretical and can be applied to a variety of psychotherapeutic orientations. Finally, future directions are considered and possible factors that might enable the formation of hope for people living with psychosis are explored.

Jeremy Ridenour, PsyD, ABPP, is the associate director of admissions and the director of psychological testing at the Austen Riggs Center.

Jeremy Ridenour, PsyD, ABPP

Free CE/CME course with Jeremy Ridenour, PsyD, ABPP

Techniques in the Psychotherapy for Psychosis

Course 2: Techniques in the Psychotherapy for Psychosis

 can be a central factor in the subjective experience of psychosis, and an important issue of focus in psychotherapy. The fears of the patient as well as those of their therapist can impact the quality of the therapeutic alliance and serve as a barrier to meaningful recovery. We have detailed several different types of fears patients and therapists may experience and have suggested that it is important for therapists to be sensitive and responsive to these in therapy. As therapists create space for the cultivation of trust, carefully notice the presence of fear, they can begin to help people experiencing psychosis to make sense of their fears and the impact these have on their lives. For many, this process may involve cultivating the abilities to recognize their own fears and to integrate this information into a larger account of themselves and others, allowing them to make self-directed choices about how they might respond to their fears.

 at higher rates than the general population and identify loneliness as one of the most significant barriers to personal recovery. While many researchers have called for psychosocial treatments to specifically target loneliness for people experiencing psychosis, there are limited treatment models that provide direct recommendations for therapists working with people with psychosis. In this paper, the concept of loneliness is explored through a review of psychological and philosophical literature and through first-person accounts of psychosis. Additionally, the correlation between specific psychotic symptoms and loneliness is also reviewed. Following this, four key practice elements are outlined, including addressing barriers to accessing the patient’s longing for connection, the loneliness of psychotic experiences, internalized stigma, and loneliness within the therapeutic relationship, that can serve to reduce loneliness through psychotherapy. These elements are transtheoretical and can be integrated into various theoretical orientations. Finally, future directions are considered and factors that can attenuate loneliness for people with psychosis.

One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing 

 and processing grief in relation to psychosis. Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person’s identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope.

Core Emotions in Psychosis

Patients presenting with persisting somatic symptoms or functional somatic symptoms constitute a very large subset of patients seen in routine healthcare. For instance, around 40% of patients with depression and anxiety also report high levels of functional somatic symptoms and long-term health conditions. Recent theoretical and empirical advances open up important new avenues for the treatment of these patients. In this talk, Dr. Luyten summarizes findings concerning the role of three related biobehavioral systems that play a central role in the development of these symptoms from a psychodynamic perspective (i.e., the attachment system, the mentalizing system, and impairments in epistemic trust), with a focus on the importance of fostering embodied mentalizing. He also reviews empirical evidence supporting the efficacy of psychodynamic psychotherapy with these patients. Finally, he outlines the treatment principles of dynamic interpersonal therapy, an integrative psychodynamic treatment that has been adapted for patients with functional somatic symptoms with varying levels of severity, based on a description of the treatment of a patient with chronic widespread pain. Dr. Luyten argues that labeling these patients as 'hard-to-reach' of ‘difficult-to-treat’ reflects a fundamental misunderstanding of their embodied mind.

Patrick Luyten, PhD

Free CE/CME course with Patrick Luyten, PhD

Patients with Persistent Somatic Symptoms or Functional Somatic Symptoms: An Integrative Psychodynamic Treatment Approach

Seth Pitman, PhD, ABPP, and Steven Ackerman, PhD, MBA, ABPP

The purpose of this talk is to explore how to effectively integrate Measurement-Based Care (MBC) into psychodynamic practice settings, focusing on how it can impact treatment outcomes and enhance patient authority over their treatment. The presentation emphasizes the importance of preserving the depth of patient experiences while incorporating measurable outcome assessments, and how MBC can support a nuanced understanding of treatment when implemented within a psychodynamic framework.

While psychodynamic clinicians may have concerns about how MBC aligns with traditional therapeutic approaches, the talk argues that embracing MBC is important for growth and representation within the field. Practical strategies are provided to initiate MBC that is informed by clinical observation, treatment technique, and the need for continual improvement, offering a clear pathway to integrating these methods into psychodynamic treatment.

Seth Pitman, PhD, ABPP, and Steven Ackerman, PhD, MBA, ABPP, headshots.

Free CE/CME course with Seth Pitman, PhD, ABPP, and Steven Ackerman, PhD, MBA, ABPP

Depth and Data: Using Measurement-Based Care to Deepen Understanding of Patient Experiences

What does it mean to be both a social critic and a practicing psychotherapist? In view of the social and political crises we face, this is surely one of our profession’s most pressing challenges. This talk draws on the early work of Erich Fromm, one of the twentieth century’s best known public intellectuals and least understood psychoanalysts. Fromm escaped Nazi Germany and was one of very few psychoanalysts to speak publicly about the dangers of fascism. As Director of Social Psychology and Psychoanalysis at the Institute for Social Research in Frankfurt, he developed a view of the human psyche as fundamentally social and political in nature. Shortly before the United States declared war on Nazi Germany, Fromm published Escape From Freedom, which sought to explain why so many Germans enthusiastically supported Hitler. What has remained virtually unknown is that when Fromm’s was openly arguing against fascism, he was simultaneously engaged in a campaign to save family members and colleagues who remained behind in Nazi Germany. Drawing on unpublished Holocaust correspondence, this talk shows how the traumas and tragedies in Fromm’s family shaped his public stance against racism and destructiveness. For Fromm, the personal was always political, and time was short. In an era when psychoanalysts sought to keep the individual psyche strictly separate from social and political concerns, Fromm was ostracized for his progressive stance. Given the growth of fascism today, what can we learn from Fromm’s sense of urgency? How might Fromm’s ethical stance apply to our current situation and to our work as practitioners?

Dr. Roger Frie presents the January 2025 Erikson Institute Friday Night Guest Lecture.

Dr. Roger Frie

Free CE/CME course with Roger Frie, PhD, PsyD, RPsych

Edge of Catastrophe: Erich Fromm’s Fight Against Fascism and Racism

Part of the 2024 Virtual Roundtable Series,
Minding the Gaps: Addressing Mental Health Through the Life Cycle

Erik Erikson outlined specific tasks associated with developmental stages across the life cycle. In Erikson’s model generativity, stagnation, ego integrity, and despair are all potential aspects of development in the second half of life. Aging brings a crisis and an opportunity to revisit and psychically rework all of Erikson’s eight stages. In this panel, three experts examine the mental health challenges in the second half of life including: loneliness and the importance of relationships, loss of physical and cognitive capacities and adaptations to these changes, and spiritual concerns related to meaning, purpose, and approaching the end of life. A crisis may emerge when physical and cognitive health declines, when stigma increases isolation, and when persistent economic and healthcare disparities threaten the social safety net. Our three panelists discuss these issues and ways to address mental health in later life.

Jane G. Tillman, PhD, ABPP

Free CE/CME Roundtable moderated by Jane G. Tillman, PhD, ABPP

Roundtable #6: Addressing the Mental Health Crisis in the Second Half of Life

Psychoanalysts and psychotherapists are currently showing considerable interest in, and concern over, the relevance of different forms of racism to psychological suffering and to the development of the field of psychoanalysis itself. This presentation aims to address gaps in current practice and clinical knowledge by reviewing recent approaches to the question of psychoanalysis and race. Stephens foregrounds her own approach, using a combination of psychoanalytic theories of large group identity formation (Volkan), epidermalization (Fanon), and multiple self-states (Bromberg) to offer insights and knowledge for improving both psychoanalytic theory and practice. The presentation ends with a discussion of how a meaningful engagement with black feminist theory, the field that first theorized the intersectionality (Crenshaw) of our personal and social identities, would be useful for the development of psychoanalyst’s and psychotherapist’s ability to navigate complex issues around racial, cultural and ethnic identities in clinical settings.

Dr. Michelle Stevens will be presenting the December 2024 Erikson Institute Friday Night Guest Lecture.

Dr. Michelle Stephens

Free CE/CME course with Michelle Stephens, LP, PhD

Relating Racially: Shifting Between We, They, and I Senses of Self

Daniel Pick, PhD, reflects on psychoanalytic thought about paranoia and considers its relevance to the exploration of mass phenomena, past and present. He draws on past work by a range of writers, including Freud, Tausk, Erikson, Klein, and Bion. He also returns to the work of historians and philosophers, including Hofstadter and Arendt, whose work is useful for exploring conspiracy theory and 'the paranoid style.' The talk concludes by engaging with various contemporary explorations of the crisis of democracy, the AI revolution, and the so-called ‘deep state’.

Erikson Institute Friday Night Guest Series October 2024 Presenter

Dr. Daniel Pick

Conspiracies? The "Paranoid Style" Revisited, in Psychoanalytic Thought, History, and Political Life

Clinical suicide risk assessment is often conducted using standardized assessment measures that fail to integrate contemporary theories and empirical findings, especially those pertaining the importance of analyzing the timing and contextual factors affecting suicide risk. This presentation supports a more nuanced understanding of patient-centered, ecologically valid methods of assessing risk for suicide in clinical populations, enabling attendees to develop greater precision and sensitivity in their risk assessment and intervention approaches.

Katie Lewis, PhD

Transforming Suicide Risk Assessment

The midlife period introduces a complex array of developmental challenges for most adults, representing a span of time in which expectations for stability and achievement are high despite ongoing evolutions in identity development, family relationships, health, and social roles and responsibilities to the outside world. Under the best of circumstances, positive attachment relationships and a mature sense of self developed earlier in life can provide firm footing for navigating this complex terrain; in the face of either early life adversity, new obstacles or traumas, or other forms of developmental interruption, the midlife period can feature special challenges that require consideration from both psychological, socio-historical, and cultural perspectives. In this roundtable, three experts in the field of midlife development and psychosocial functioning offer their perspectives on the particular issues and opportunities facing adults as they navigate the midlife period.

Free CE/CME Roundtable moderated by Katie Lewis, PhD

Roundtable #5 - Beyond Crisis: Identity, Connectedness, and Mental Health in Midlife

Emerging adults are reporting surging rates of loneliness and isolation, leaving many developmentally adrift and vulnerable to accumulating mental health troubles. This panel considers how social turmoil, mistrust, pessimism, and polarization uniquely challenge young adults’ identity development, agency, and sense of belonging. Additionally, the panel explores forms of engagement that encourage their social participation and harness their essential contributions to the world they are joining and helping.

Spencer Biel, PsyD

Free CE/CME Roundtable moderated by Spencer Biel, PsyD

Roundtable #4 - Loneliness and Belonging in Emerging Adulthood

Empathy is a category term for capacities related to perspective-taking and sharing in another’s experiences. It is valuable for bridging human connections and motivating us to take initiative to help others. However, empathy is notoriously biased. We empathize more with those who look like us, people we know, and those with higher social status. Moreover, empathy motivates good actions in the short term, not over the long term. With these things in mind, this talk addresses empathy in connection to justice. It explores other emotions, such as sympathy and compassion, that support care work. And it emphasizes the importance of acting from well-ordered habits of care, rather of relying on emotional connections, to motivate just actions.

Dr. Sabrina Little presents the August 2, 2024 Virtual Grand Rounds

Dr. Sabrina Little

Free CE/CME course with Sabrina Little, PhD

Empathy in Connection to Justice

The presentation describes two different views, often inconsistent with each other, of Freudian theory on fundamental aspects of the workings of the mind, including the nature and function of consciousness, of unconscious mental states, the relation between the two, and how the id-ego model is best understood. Dr. Eagle discusses the implications of these two different views for one’s conception of psychopathology and approach to treatment. He also discusses post-Freudian developments in light of the two different perspectives on Freudian theory.

Photo by Derek Quesada via Unsplash

Free CE/CME course with Morris Eagle, PhD, ABPP

The Two Freuds: Implications for Conceptions of the Mind, of Psychopathology, and Approach to Treatment

Suicide rates continue to rise in the USA despite increased efforts at prevention and intervention. How to understand and respond to suicide loss survivors is an emerging field of research and clinical application to help mitigate some of the long-lasting effects of suicide on survivors. In this presentation I will review the demographics of suicide and how these inform our understanding of the population of suicide loss survivors and the fallout one suicide death has on individuals, families, communities, and organizations. The findings of an empirical study of psychotherapists who have had a patient in treatment die by suicide are presented. Finally, understanding and responding to individuals and organizations following the suicide of a patient are reviewed.

Free CE/CME course with Jane G. Tillman, PhD, ABPP

The Effect of Suicide Loss on Clinicians and Organizations: Research and Response

This discussion focuses on the unique mental health difficulties facing school-aged children within the current socio-political-economic landscape of mental health care. Particular emphasis is placed on issues related to access to care and equity for minority children and their families, particularly in relation to immigrant communities. Drs. Zayde and Soliman discuss their work, experience, and ways of thinking about the intersection of these social issues along with experiences of loneliness and belonging in the treatment of school-aged children and their families. A moderated discussion and Q&A follows.

Daniel Knauss, PsyD, APBB

Free CE/CME Roundtable moderated by Daniel Knauss, PsyD, ABPP

Roundtable #3 - Loneliness, Belonging, and the Mental Health Crisis in School-Aged Children

In this presentation Steven D. Axelrod, PhD, elaborates two perspectives on the psychology of adulthood–a developmental scheme of tasks and emerging capacities and the drivers for individual growth and vitality.

The developmental framework Dr. Axelrod described in the recently published paper “

Growth in Adulthood: A Revised Psychoanalytic Framework for Adult Development

, 77(1), 126–142.) is a modification and expansion of Erikson’s original epigenetic scheme that incorporates what we have learned from others’ observations and theorizing. Dr. Axelrod then describes how this developmental perspective can inform and improve our clinical work and will illustrate this with some case material.

Dr. Axelrod's discussion of the drivers of individual growth includes, but is not limited to, object finding and object usage in both treatment and “in the wild.” He pays special attention to what has been called the “developmental object” by Anne Hurry and others following the child analytic work of Anna Freud.

A consideration of follow-up data from psychotherapy outcome studies can give us a special window into the processes of growth in adulthood more generally. Some research evidence points to the existence of a group of psychotherapy/psychoanalysis patients who show continuing improvement and better adjustment over time post-termination. One instance of this has been called the “sleeper effect.” Exploration of the factors in treatment and the processes post treatment that sustain these kinds of gains comprises the final portion of this presentation.

Steven D. Axelrod, PhD

Free CE/CME course with Steven D. Axelrod, PhD

The Dynamic Interplay of Adult Development and the Treatment Process

Linda Michaels, PsyD, MBA, and Eric M. Plakun, MD, DLFAPA, FACPsych 

In these last few years we have witnessed unprecedented upheaval in the areas of politics, social justice, the natural world, and public health. To help our patients and to support our practices, communities and the field as a whole, it is vitally important to understand what people are looking for in mental health treatment, and how they think and feel about the therapies we offer. It’s also crucial that public awareness and appreciation of therapies of depth, insight, and relationship improve. These therapies have been missing from, if not pushed out of, the public consciousness, and are misunderstood, undervalued, and overlooked by the general public.

To assess what people know about therapy and mental health and what they really want from treatment, the Psychotherapy Action Network (PsiAN) conducted extensive original research with the general public. Building on research we first conducted in 2020, we have new research to offer a post-pandemic perspective on the attitudes and expectations people have towards therapy, which benefits matter most, what their misperceptions and biases are, and what they know and don’t know about mental health and therapy.

The presentation will also offer a blueprint for engaging and communicating with the public, so that the public gains greater awareness, understanding and appreciation for therapies of depth, insight, and relationship.

Linda Michaels, PsyD, MBA, and Eric M. Plakun, MD, DLFAPA, FACPsych

Free CE/CME course with Linda Michaels, PsyD, MBA, and Eric M. Plakun, MD, DLFAPA, FACPsych

Going Beneath the Surface: What People Want from Therapy

There was a period in the United States during the 1930s and 40s that was marked by a vibrant interest in how the fields of cultural anthropology and psychoanalysis could inform each other. By the 1990s the psychoanalytic landscape had changed considerably, and any interest in cultural psychoanalysis appeared to have all but vanished. Candidates entering analytic training during this period faced two pernicious biases that converged into a type of conventional wisdom with a deleterious impact on training: On the one hand there was the implicit belief that any interest by a candidate in cultural issues suggested a less serious interest in psychoanalysis; and on the other, there was the belief that psychoanalysis was simply irrelevant to the suffering of minoritized populations. In this presentation, after revisiting the decline of cultural psychoanalysis in the United States, the author will discuss the treatment of a patient presenting with a culture bound syndrome known as ataque de nervios. The treatment serves as a challenge to biases within psychoanalysis and about psychoanalysis. The presentation will conclude by arguing for a new paradigm of cultural theorizing.

Chris Christian, PhD

Free CE/CME course with Chris Christian, PhD

The Vanishing of Culture in Psychoanalysis: History and New Directions

, presents a way of understanding the traumatic impact of narcissism as it is engendered developmentally, and as it is enacted relationally. Focusing on the dynamics of narcissism in interpersonal relations, Shaw describes the relational system of what he terms the 'traumatizing narcissist' as a system of subjugation–the objectification of one person in a relationship as the means of enforcing the dominance of the subjectivity of the other.

Daniel Shaw, LCSW

Free CE/CME course with Daniel Shaw, LCSW

The Relational System of the Traumatizing Narcissist

The purpose of this talk is to provide the audience with a review of psychotherapy research over the past century. Instead of just presenting a listing of studies, a case will be made that this information needs to be considered within larger contexts. The “need” for psychotherapy research emerged as a confluence of psychology in early adolescence, professional politics, and the health care industry. Discussion will include both the ways that this movement added legitimacy to the use of psychotherapy to treat a wide range of problems while at the same time narrowing access to mental health services.

Matthew Baity, PhD, ABPP

Free CE/CME course with Matthew Baity, PhD, ABPP

Paving with Good Intentions: A Story of Psychotherapy Research

Mindy Thompson Fullilove, MD, HON AIA, DLFAPA

This presentation will focus on South Korean television series known as “K-drama,” a genre that tells stories in 16-20 one-hour episodes. The stories focus on individuals in crisis, who resolve their issues in several steps that lead to a deeper engagement with their friends and family. This “team” then is able to tackle larger problems of the society. This optimistic drama form offers insight, drawn from the syncretic philosophical and religious traditions of Korea, into the recovery of individuals and groups, from an array of traumas and social upheavals. Implications for cross-cultural understanding and considerations for US mental health systems will be discussed.

Mindy Fullilove

Free CE/CME course with Mindy Thompson Fullilove, MD, HON AIA, DLFAPA

The Tao of K-drama: Reflections on Displacement, Trauma, and Recovery

This roundtable focuses on two- and three-generation approaches to child and parent mental health. When adults become parents, they are in a dynamic developmental phase just as their infant and child is. In this roundtable, we will discuss the developmental and mental health needs for parents during the pre and postpartum period, innovations in programs for pregnant families, and policy implications for improving access to mental health services during this critical developmental period.

Linda C. Mayes, MD

Free CE/CME Roundtable moderated by Linda Mayes, MD

Addressing Parent and Early Childhood Mental Health

Introductory courses in psychodynamic approaches to psychiatric treatment featuring a number of Riggs clinical staff members. 

 - Eric M. Plakun, MD, DLFAPA, FACPsych (1.0 CE/CME credit)

The Frame in Psychoanalytic Psychotherapy: Tasks, Roles, and Boundaries

 - Jane Tillman, PhD, ABPP (1.0 CE/CME credit)

Countertransference: What It Is and How to Use It

 - Elizabeth Weinberg, MD (1.0 CE/CME credit)

 - Daniel Knauss, PsyD, ABPP (1.0 CE/CME credit)

The Y-Model for Teaching Psychotherapy Competencies

 - Eric M. Plakun, MD, DLFAPA, FACPsych (no CE/CME credit)

An image of a psychotherapy session at the Austen Riggs Center.

Psychotherapy at Austen Riggs

Introductory courses in psychodynamic approaches to psychiatric treatment. 

Introductory Courses for Residents and Trainees

Radical ethics, a philosophical position recognizing the priority of the other over the ego, specifically concerns the other’s suffering. It refuses to see the other as an instance of a category or concept, and therefor holds immense significance for workers in any mental health profession. But it can seem to deny, or minimize the needs of these workers, or of any individual’s needs in the face of the other’s suffering, and thus comes up against undeniable human limitations. It also raises the psychoanalytic problem of masochism. A revised and clearer idea of subjectivity, or of selfhood, can help us to see how we become ourselves in our very pre-existing responsibility for others, even when we come up against our limits.

Donna Orange, PhD, PsyD

Free CE/CME course with Donna Orange, PhD, PsyD

Subjectivity in Radical Ethics

Since 2020, “The Summer of Racial Reckoning,” professionals across fields and industries began to pay laser-like attention to issues of diversity, equity, inclusion, and social justice. Assessment professionals in various settings have struggled and, in some cases, plainly stated that these topics are too political to have relevance for our work. This counterpoint only illuminates the dearth of intensive resources to aid professionals in understanding that identity and all its intersectional factors is what is necessary for a comprehensive and holistic approach to assessment that truly considers the complexities of the individuals we serve. From the clinical interview to the final report, to the feedback session – who told the first story and the last story about the person assessed has the potential to create small and rippling or large and impactful change in that person’s life. Sometimes, impacts can include harm by what is unconsidered/unconfronted about who we are, how we were trained, where we work, and what we bring to the table. The identity of the assessor matters just as much as that of the person in front of us and requires a nuanced introspection of self and self in relation to “other,” that can be uncomfortable and necessarily challenges the status quo.

Ksera Dyette, PsyD

Free CE/CME course with Ksera Dyette, PsyD

What Is the First Story and the Last Story, and Are They the Only Stories: Intersectionality in the Assessment Encounter

Linda Mayers, PhD, and Doris Bertocci, LCSW

The adoption and mental health fields have viewed adoption as being only about children. Adopted adolescents are a more recent afterthought, with adults nowhere on the radar. From their psychodynamic perspectives on the psychology of being adopted, the presenters maintain that therapists often do not recognize the critical differences between adopted and non-adopted patients, or the need for important modifications in treatment. This requires specialized advanced training. Therapists’ knowledge base needs to include an understanding of early developmental trauma within the first three years of life and its implications for altered neuropsychological development, potentially into adulthood. Intensive psychodynamic treatment provides a pathway toward addressing the likely combination of ambiguous mourning, anxious attachments, fragmented identity formation, and confused sexual development. These stimulate unique complexities in the transference and countertransference and, for the therapist, a deeper appreciation of many universal issues.

Free CE/CME course with Linda Mayers, PhD, and Doris Bertocci, LCSW

The Complex Psychology of Being Adopted: What Clinicians Need to Know

Experiences of feeling haunted and of being in the presence of ghosts are prominent in narratives of patients/people of color in the United States and of mixed-race identity. A creative reading of Hans Loewald’s evocative statement on therapeutic action, the process of transforming “ghosts into ancestors,” is used to explore a way of being with and healing patients with mixed-race identities who are imprisoned in melancholic states. An extended case vignette of an Indian American psychoanalyst working with a patient with a mixed racial identity highlights racialized components of melancholia and illuminates specific countertransference states and enactments that can both impede and allow for the gradual and partial witnessing of racialized ghosts and their transformation into ancestors.

Dhwani Shah, MD

When Racialized Ghosts Refuse to Become Ancestors: Tasting the “Blood of Recognition” in Racial Melancholia and Mixed-Race Identities

The presentation begins with an introduction by Michael Garrett, MD, who briefly summarizes the recent renewed interest in trauma-informed psychotherapeutic treatments for psychotic conditions. Dr. Garrett then introduces a series of interviews he conducted with seven PGYIII psychiatric residents who describe the impact that training in psychological approaches to psychosis had on their treatment of their psychotic patients and the effect of this training on their developing identities as early career psychiatrists. The presentation concludes with a list of resources attendees who interested in additional information about training might seek out.

Michael Garrett, MD

Free CE/CME course with Michael Garrett, MD.

Training Early-Career Psychiatrists to Listen to Psychotic Patients with an Intent to Understand the Meaning of Psychotic Symptoms

The need for human connection across the lifespan.

In 2021, US Surgeon General Dr. Vivek Murthy described experiences of loneliness as “a dark thread through our nation’s most pressing public health challenges” (Murthy, 2021, Public Health Reports, 136[6]). Rates of loneliness across the globe have increased across age and demographic groups steadily over the past two decades, despite concomitant changes in communication technology and virtual interconnectedness. How do we account for the growing prevalence of feelings of isolation, disconnect, longing, and loss, which contribute not only to mental health challenges but also basic experiences of stability and safety within our families, communities, and sense of being a person in the world?

In this recorded panel, three experts in the field of social (dis)connection will share their perspectives on the rise of loneliness as a public health crisis. Dr. Niobe Way has devoted her career to examining social connectedness conceptualized through developmental, cultural, and psychological lenses, with a particular focus on how adolescent identity development. Her presentation will explore the roots, consequences, and solutions to loneliness as a crisis of connection. Dr. Paula Pietromonaco brings decades of expertise in the study of close family and other interpersonal relationships, examining how social perceptions, behaviors, and physiological responses to conflict and stress influence the capacity to experience social connection and emotional intimacy during adulthood. Dr. Blessing Ojembe will share her interdisciplinary expertise and perspective on loneliness and social isolation in Black older adults, highlighting the interplay between time, place and interaction, the contributing and contextual factors of race, age, disempowerment, marginalization, health, and immigration status. Each presenter discusses factors which affect loneliness across the lifespan and engages in a moderated discussion about potential pathways towards addressing social disconnection at both individual and community levels.

Austen Riggs community members walking around on Main Street in Stockbridge, MA.

Austen Riggs Patient Experience

Free CE/CME Roundtable moderated by Katie Lewis, PhD.

Loneliness and the Human Need for Connection Across the Lifespan

In the last two decades, psychedelics have re-emerged as promising novel agents for treatment of a broad range of mental health conditions including depression, PTSD, substance use disorders, end-of-life anxieties, eating disorders, and more. Our understanding of their putative mechanisms of action has significantly evolved as well. Several Phase II and III clinical trials of psychedelic-assisted therapy (PAT) using psilocybin and MDMA are either complete or nearing completion, with some of these therapies projected to receive FDA approval within the next couple of years. But are they ready for prime time? In this presentation, Marina Bayeva, MD, PhD, will review the growing evidence base for use of PAT in psychiatric disorders, outline their neurobiological effects, as well as highlight unanswered questions and areas of caution. We will conclude with a discussion of how psychedelics intersect with deep exploratory work of psychoanalysis and facilitate psychological change.

Marina Bayeva, MD, PhD

Free CE/CME course with Marina Bayeva, MD, PhD

Psychedelics, Psychotherapy, and the Process of Change: Integrating Insights from Neurobiology, Clinical Research, and Psychoanalytic Work

In this presentation, Dr. Sebastian Leikert describes the therapeutic path with a young male adolescent patient suffering from emotional instability, suicidality, and self-injury. Establishing therapeutic contact with his perception of disorganized bodily states led to relief from suicidal pressure. Working through these bodily sensations in a resonant presence of the therapist who privileges perception over interpretation in these episodes, played an important role in alleviating the intense fear of annihilation and helped him overcome states of autoaggression leading to self-injury in the past. Dr. Leikert describes the inner dynamics and structure of the bodily unconscious and the ways in which somatic narration and verbal interpretation can be brought into a fruitful relationship.

Dr. Sebastian Leikert

Free CE/CME course with Dr. Sebastian Leikert

Working with the Bodily Unconscious: Somatic Narration as a Method to Anchor the Working-Through in the Body-Self

All clinicians face the problem of working with patients whose treatments are not going well and who are not making progress. Clinicians often label these patients as "difficult" or "treatment resistant." This presentation addresses clinicians' own contributions to this experience, including the role of reductionist biomedical perspectives that do not match evolving evidence. The presentation also summarizes psychodynamic principles that may improve outcomes and the role of intermediate levels of care in treating some of these patients.

Headshot of Eric M. Plakun, MD, DLFAPA, FACPsych.

Eric M. Plakun, MD, DLFAPA, FACPsych

Free CE/CME Course with Riggs Medical Director/CEO (2018-2024) Eric M. Plakun, MD

When The Patient Isn't Getting Better

Recordings from the Erikson Institute of the Austen Riggs Center's 2023 Virtual Fall Conference: Losing Our Mind and Finding It: Re-Integrating Meaning in a Neurobiologically-Focused Era - A Conference for Psychiatric Care Providers, Psychotherapists, and Social Scientists

Despite our burgeoning neuroscientific knowledge, psychiatric outcomes are not significantly better than they were three decades ago. After decades of hopeful enthusiasm, the limits of a biomedically-reductionist approach to problems of mental health are increasingly clear. A renewed interest in integrating biomedical and psychosocial perspectives to optimize mental health outcomes is gaining momentum, whether in a focus on patient-centeredness, the development of collaborative care models, increasing attention to the social determinants of mental health, or efforts to re-integrate psychodynamic with medical approaches.

Part 3: Psychodynamic Technique in Pharmacotherapy

Part 4: Pharmacotherapy as a Psychotherapeutic Focus

Tanya Luhrmann, PhD: “Of Two Minds, 30 Years Later”

Awais Aftab, MD: “Fault Lines in Biopsychosocial Psychiatry: Integrative Aspirations and the Path Forward”

Nancy McWilliams, PhD, ABPP: “Diagnosis and Its Discontents”

Kathryn T. Hall, PhD: “Meaning Effects and Health Equity”

: “Meaning & Medication: The Evidence Base

Haroula Konstantinidou, MBBS: “Challenges of Integrating Pharmacotherapy and Psychodynamics

Alicia Powell, MD: “The Medication Life”

Adele Tutter, MD, PhD: “Medication as Object”

David Mintz, MD

Presentation recordings from Riggs' 2023 Fall Conference - 9 CE/CME credits available

2023 Virtual Fall Conference - Losing Our Mind and Finding It: Re-Integrating Meaning in a Neurobiologically-Focused Era

patient receiving medication from a psychiatric nurse

Though psychiatry has benefited from an increasingly evidence-based perspective and a proliferation of safer and more tolerable treatments, outcomes are not substantially better than they were a quarter of a century ago. Treatment resistance remains a serious problem across psychiatric diagnoses. One source of treatment resistance is that systems within which psychiatrists are working often create pressures to practice in a biologically reductionistic framework. In this context, the important impact of psychosocial factors in prescribing have been relatively neglected, leaving prescribers to work without some of our most potent tools.

Explore ways that a biomedically-reductionist, illness-centered approach may undermine positive pharmacotherapy outcomes, consider the meaning of patient-centeredness in pharmacotherapy, and explore why it may be beneficial to integrate basic psychotherapeutic skills into routine pharmacotherapy (“Thinking about Prescribing”),

Examine the considerable but oft-neglected evidence bases that describe how psychosocial factors influence medication outcomes and provide guidance about 

 to prescribe (“The Science of the Art of Pharmacotherapy”).

Explore ways that the patient’s dynamics and the interpersonal dynamics of the doctor-patient dyad may undermine pharmacologic treatment outcomes and highlight common dynamics that interfere with the healthy use of pharmacotherapy (“Psychodynamics of Pharmacologic Treatment-Resistance”), and

Explore a specific model, Psychodynamic Psychopharmacology, that integrates psychosocial evidence bases guiding effective prescribing with psychodynamic insights regarding treatment-resistance, offering technical principles for working effectively with complex, co-morbid, and treatment-refractory patients (Psychodynamic Psychopharmacology).

Consider implications of established treatment guidelines for when to use combined pharmacotherapy/psychotherapy as a first-line or second-line approach to psychiatric illness, as well as aspects of the evidence-based which provide guidance about how to select one treatment over the other for common psychiatric conditions. (Integrating Care: Combining Medications and Psychotherapy)

Each unit may be viewed as a stand-alone lecture, but the series as a whole provides a comprehensive perspective on a patient-centered approach that facilitates the integration of ordinary psychotherapeutic skills into pharmacotherapy in a way that supports psychiatrist and NPs in practicing at the true top of their licenses.

A patient getting their medications at the Austen Riggs Center medication area.

Medication Management at Austen Riggs

Free CE/CME Five-Part Course Series with David Mintz, MD

The Art of Pharmacotherapy: Enhancing Outcomes by Integrating Patient-Centered, Psychodynamically-Informed Perspectives

This presentation looks at physician burnout from a variety of perspectives, including:

the burnout crisis in the context of the last two decades of health system transformation cost, access, and quality

the relationship between burnout and depression

Free CE/CME course with Richard Summers, MD

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