The Patient Who Wouldn’t Be: The Clinical Problem of Patients Who Lack Interest in their Own Experience – Presented by Kristian Kemtrup, PhD, LMFT [Class]

NARRATIVE

There is a class of patients who can be difficult to treat because they present as having an absence of interest in their own subjective experience. In a way these are patients who have difficulty being patients. More generally, they have difficulty experiencing or living in what Winnicott (1954) refers to as “going on being,” a healthy flow of emotions and creative impulses that create internal vitality and the basis of thoughtful, meaningful engagement with others and the world. These patients do not present as having a problem that Killingmo (1989) would refer to as either an “internal conflict” or a “deficit,”nor do they seem to suffer from trauma, dissociation, or emotions that are overwhelming. They are neither emotionally dammed up nor emotionally flooded. Rather, they report a problem of being relatively “emotionally arid” and are authentically unclear if this is a problem for them or only for those around them. This talk discusses how such patients’ problems can be better understood psychoanalytically, paying particular attention to how their problems may be related to developmental histories that are superficially good enough but where caregivers were “soul blind” (Novick and Novick 2022) or unable to be curious about and receptive to their child’s emotions. Finally, we will discuss some ideas on how to proceed in treating them derived from the work of  Ogden (2025) and also Goldberg (2025).

LEARNING OBJECTIVES

Upon completion of this workshop, participants should be able to:

1. Differentiate among intrapsychic conflict, deficits in emotional containment, and impairments in the capacity to experience continuous emotional being (“going-on-being”)
2. Define the term “soul blind” as a description for some parents and how absence of interest in a child’s mind during development is often described by such adult patients who have difficulty “becoming patients.”
3. Define the construct “soul blindness” in caregiving and explain how a caregiver’s lack of interest in a child’s mental life during development may contribute to later difficulties engaging in the patient’s role in psychotherapy.
4. Define and identify 2 clinical challenges of applying traditional interpretive interventions or affect-containment strategies to patients who are neither intrapsychically conflicted nor affectively overwhelmed but instead present with emotional constriction or aridity.
5. Describe the importance of orienting the patient to “the frame” and psychotherapeutic neutrality for generating here and now interest in the patient’s internal world. 
6. Describe three areas of convergence and divergence, and identify two questions for further clinical inquiry, among emotionally constricted patients, individuals identifying as high functioning or mild autism, patients presenting with alexithymic features, and those conceptualized as occupying the autistic–contiguous position.

COURSE OUTLINE—4 hours

9:00 – 10:00 am

     Identifying “Patients Who Will Not Be”

10:00 – 10:45 am

     The Confusing Severity and Impossibility of The Problem

10:45 – 11:00 am

     BREAK

11:00 – 11:45 am

     Fragments of Three Cases

11:45 am – 1:00 pm

     Use of Reverie in The Treatment

     Open Reflection

Content Curriculum:

• This workshop will expand the participant’s knowledge about how to deal with a complex clinical situation that is not easily dealt with using ordinary psychodynamic clinical techniques
• The knowledge the participant gains will enhance their clinical work by helping them to identify a clinical problem that is not easily treatable by standard technique and that can be difficult to diagnose psychodynamically. Avenues for further study of these patients will be pointed out as scientifically and clinically important.
• The target audience is everyone who is working clinically in the mental health field.  The concepts will be explained simply enough so that they will be accessible to participants who are beginners in the field, as well as those with advanced knowledge.
• The content is based on books and articles which have been published by seminal psychodynamic authors theorizing based on their clinical cases and case studies, including a larger set of cases treating adolescents. Tentative hypotheses about the etiology of some clinical problems can be derived from these cases, and avenues for nomological study, ie randomized control trials, will be suggested but have not been conducted.
• The clinical approach presented can be applied to all clients, independent of culture, gender, sexual orientation or other identities. The cases selected for discussion and in the relevant materials reflect diverse populations. Particular attention will be paid to exploring whether cultural differences effect what counts to patients as a problem that stands in need of help or treatment.

BIO:

Kristian Kemtrup, PhD, LMFT is a psychoanalytic psychotherapist in private practice in Albany, California. He has taught in the philosophy department at San Francisco State since 2007, and now gives seminars at the Community Institute for Psychotherapy and the Northern California  Society for Psychoanalytic Psychotherapy. He writes the Making Sense of Therapy blog for Psychology Today.

COST:

CIP Members:

$100 early registration 10 business days prior to seminar; $120 after

Non-Members:

$120 early registration up to 10 business days prior to seminar, $140 after

CEs: 4 CEs for LMFTs, LCSWs, LPCCs and Psychologists

Community Institute for Psychotherapy is approved by the American Psychological Association to sponsor continuing education for psychologists.  Community Institute for Psychotherapy maintains responsibility for this program and its contents. 

Requirements for the successful completion of the activity are attending the program in it’s entirety, and completing an evaluation form.

Cancellations must be received in writing 10 business days prior to the seminar, class, or first study group session for a refund minus a $25 cancellation fee. Cancellations less than ten days will not be refunded.

Accommodations will be made wherever possible for those with disabilities. Please let us know of any disabilities upon registration to ensure proper accommodations are put in place prior to the workshop/training.