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Psychoanalysis On and Off the Couch

Mar 6, 2022

"Patients may be bringing in harmonies that are tough to connect, fragments of life or things that cannot be integrated. And part of the improvisation in a way is to make sense, to create maybe a new improvisation that ties together different affects or maybe clusters of chords that feel unpleasant. Can we work with them musically to make sense of them at least? And maybe represent them not always in a pleasing way but through our improvisation, be able to create a new motif that now can be examined in different ways."


Episode Description: We begin by recognizing the well-known analytic challenge which is to learn the basic scales and then learn to improvise — both being essential tools for creating a dependable and creative analytic space. Rafael shares with us his early familial psychoanalytic influences and his search to find his own voice. We discuss the similarities between analytic free-association and musical improvisation. He demonstrates his clinical observations with three live musical renditions — first the melody and then two riffs off it with increasingly loose connections to the original theme. We discuss how this is similar to the deepening of an analytic process allowing for greater freedom of imagination and self-awareness. We consider the musical versions of countertransference as well as the termination capacity for improvised self-reflection.


Our Guest: Rafael Ornstein, MD is a psychiatrist and psychoanalyst with a private practice in Brookline Massachusetts. He is a graduate of and on the faculty at the Boston Psychoanalytic Society and Institute. He is an Instructor in Psychiatry at Harvard Medical School and he supervises psychiatry residents at Massachusetts General Hospital. He is a frequent contributor to the Harvard Medical School continuing education course on psychodynamic psychotherapy. He enjoys playing piano in the sextet Bluedog Jazz, a band with monthly gigs in local restaurants and clubs. You can find them on Spotify.


Recommended Reading and Listening:


Alev, Simeon, (2021), Jazz and Psychotherapy: Perspectives on the Complexity of Improvisation. Routledge.


Knoblach, Steven, (2000), The Musical Edge of the Therapeutic Dialogue. Routledge.


Lichtenstein, David, (1993), “The Rhetoric of Improvisation: Spontaneous Discourse in Jazz and Psychotherapy”. American Imago. 50:227-252


Markman, Henry, (2020), “Accompaniment in Jazz and Psychoanalysis”. Psychoanalytic Dialogues. 30 (4), 432-447 Denny Zeitlin, MD is a psychiatrist and a significant figure in Jazz, in both performance and composition. His website has a wealth of information on jazz and its intersections with psychology.


Selected Recordings


Oscar Peterson’s Blues Etude


Fats and Monk: Lulu’s Back In town.

Comparing Fats Waller and Thelonious Monk. Fats improvising on the structure. Monk stretching the structure.


John Coltrane: A Love Supreme

Improvisation and the Spiritual


Bill Evans: Alone

Solo album, Evans creates very strong emotion and a sense of introspection in his approach.


Elaine Elias: Chega De Saudade

Elaine sings it straight and then stretches out with an amazing piano solo, with striking group interactions, coming back to the melody.


Blue Dog Jazz on Spotify

Rafael Ornstein piano tracks 1,2,5,6, and 8.