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“Where All the Ladders Start”: Object Relations Legacies, Dissociation, and Playing (Stuart A. Pizer, Ph.D., Cambridge, MA)

  • 16 Oct 2022
  • 11:00 AM - 1:00 PM (EDT)
  • Virtual


Registration is closed


This detailed clinical narrative relates critical moments negotiated in a therapeutic relationship. The patient’s life and our process were challenged by the grip of her discrete dissociated self-states that haunted, restricted, and threatened to deaden living potential during a painful but tenuously hopeful period of the patient’s life. In this extensive account of my work with “Rachel,” I illustrate how the early object relations experiences that populate us, and give shapes and recurrent patterns to procedural memory, may be brought into intersubjective and, eventually, intrasubjective play. Beginning “where all the ladders start [quoting Yeats], in the foul rag-and-bone shop of the heart,” I illustrate the interactive and at times playful clinical process through which patient and analyst may discover, through lived experience in the therapeutic relationship, ways to climb to fresh levels of healthy self-cohesion and experiential freedom, thereby softening the self-destructive power of ungrieved object relations legacies and unbridged self-states that threaten repeatedly to monopolize and sabotage a robust life.

Learning Objectives

At the conclusion of this presentation, participants will be able to:
1. Discuss the potential usefulness of forms of playing in the treatment of highly

intellectualized, dissociated or “ethereal” patients.

2. Apply in practice a stance toward therapeutic negotiation ranging from gentle

accompaniment to colloquial playing, all in the service of the patient’s emergent

enlivenment and freedom.

3. Understand the grip of object relational legacies that shape deadening repetitions.


Stuart A. Pizer, Ph.D., ABPP is a Founding Board Member, Faculty, Supervising and Personal Analyst, and former President of the Massachusetts Institute for Psychoanalysis; Assistant Professor of Psychology (part time) in the Department of Psychiatry at Harvard Medical School; Faculty, Supervising and Personal Analyst at the Institute for Relational Psychoanalysis of Philadelphia; Visiting Faculty and Member of the Advisory Board at the Toronto Institute for Contemporary Psychoanalysis; Honorary Faculty at the Institute for Contemporary Psychoanalysis, Los Angeles; member of the Contemporary Freudian Society; and Adjunct Analyst member of the Boston Psychoanalytic Society and Institute. He is an Associate Editor of Psychoanalytic Dialogues and The Psychoanalytic Quarterly, as well as Past-President of the International Association for Relational Psychoanalysis and Psychotherapy. He is the author of Building Bridges: The Negotiation of Paradox in Psychoanalysis (The Analytic Press, 1998), which Routledge reissued in 2021 as a Classic Edition, and dozens of articles on analytic process as a negotiation, the state and stance of the analyst, impasse, playing, ethics, and the analyst’s generous involvement. He teaches, presents, and supervises nationally and internationally. His private practice is in Cambridge, MA.


Cooney, A. & Sopher, R. (eds.) (2021). Vitalization in Psychoanalysis. London & New York: Routledge

Pizer. S.A. (2022). Building Bridges: The Negotiation of Paradox in Psychoanalysis. Classic Edition. London & New York: Routledge (originally published in 1998)

Salberg, J. (ed.) (2022). Psychoanalytic Credos. London & New York: Routledge.

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