In his response to the Roundtable Discussions on what is effective in psychoanalytic psychotherapy, the author focuses on the renewed interest in the concept of dissociation that began to emerge toward the end of the 20th century. A contemporary psychoanalytic position informed by the impact of developmental trauma has led to an understanding of and interest in the dissociative mind. The actuality of trauma during infancy and early childhood is recognized as a key factor leading to the emergence of dissociative processes, the potential dissociative structuring of the mind, and mind being characterized by multiple, discontinuous, centers of consciousness. The therapeutic goal in the psychoanalytic work with fragmented patients is to establish communication and understanding between the dissociated self-states. The author offers two brief clinical examples of working with dissociated self-states.

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  1. 1.

    The Roundtable Discussion, “What is effective in the therapeutic process?” took place at the Annual Meeting of the American Psychiatric Association in Chicago, Illinois on May 1, 1956. Bella S. Van Bark, M.D. moderated the panel. Other presenters were Elizabeth Kilpatrick, M.D., Lewis Wolberg, M.D., Marianne Horney Eckardt, M.D., Frederick A. Weiss, M.D., Leslie H. Farber, M.D., Louis E. DeRosis, M.D., and Silvano Arieti, M.D.

  2. 2.

    The Scientific Program Committee of the Association for the Advancement of Psychoanalysis, under the chairmanship of Dr. Frederick A. Weiss, arranged the Roundtable Discussion, “What Leads to Basic Change in Psychoanalytic Therapy?” at the New York Academy of Medicine in the Spring of 1964. Melvin Boigon, M.D. moderated the panel. Other participants were William V. Silverberg, M.D., Frederick A. Weiss, M.D. and Alfred H. Rifkin, M.D.


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The author wishes to thank Philip Bromberg and Elizabeth Howell for their profound influence on his work. He also wishes to thank Robert Prince for his assistance in the preparation of this paper, and Giselle Galdi for explaining the importance of Horney’s ideas of basic anxiety and its relationship to dissociation.

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Correspondence to Sheldon Itzkowitz.

Additional information

This reaction paper is part of the celebration of the 75th Anniversary of the American Journal of Psychoanalysis, Special Issue, guest edited by Dr. Robert M. Prince. Other responders to the 1956 and 1964 AJP Roundtables are: Drs. Steven D. Axelrod, Emily Kuriloff, Ronald C. Naso and Larry M. Rosenberg.

1Sheldon Itzkowitz, Ph.D., ABPP, is a Faculty member and Clinical Consultant at the NYU Postdoctoral Program in Psychotherapy & Psychoanalysis.

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Itzkowitz, S. THE DISSOCIATIVE TURN IN PSYCHOANALYSIS. Am J Psychoanal 75, 145–153 (2015).

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  • basic anxiety
  • developmental trauma
  • dissociation
  • fragmentation
  • self-states