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Title: How the Sense of Self Breaks Down and Recovers in Neurosis and Psychosis

Presenter: Andrew Lotterman, MD

Discussant: Danielle Knafo, Ph.D.

Date(s)/Time: November 4, 2025

8:00 pm - 9:30 pm Eastern Time

Location: via Zoom
Credit Hours: 1.5 credit hours

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Description: 

In this presentation Dr. Lotterman documents the extensive overlap between the symptoms and psychology of neurotic and psychotic patients. He portrays the way the sense of self falls apart, and its possible recovery in psychological therapy. Areas of convergence between neurosis and psychosis include: the fragmenting of the sense of self, the sense of aloneness in the world, the loss of identity, the presence of an internal and often hostile inner figure and the creation of a camouflaged surrogate self to draw the fire of attackers. Dr. Lotterman also highlights the essential supports of the self’s resilience: the acceptance by caregivers of what is genuine about the self, and the appreciation of the value of the love given by the self. He discusses Winnicott’s and Fairbairn’s contributions to these ideas. He also describes paranoid psychology in terms of a fear of being seduced into the experience of annihilation. Finally, he emphasizes that understanding the areas of common psychology shared by both neurosis and psychosis can lead to better informed treatments of each.

Learning Objectives:

1. Describe the development of a sense of self through applicable psychoanalytic concepts. 

2. Describe key overlaps in the experience of the breakdown in sense of self between psychotic and neurotic patients.

3. Explain how psychoanalysis and psychoanalytic therapy can promote a sense of recovery of the self in both neurosis and psychosis.

Presenter AND Discussant Bios:

Andrew Lotterman, MD is a Supervising and Training Psychoanalyst at the Columbia Center for Psychoanalytic Training and Research and an Associate Clinical Professor of Psychiatry at Columbia University. He has written two books and multiple articles on psychotherapy, psychoanalysis and the psychotherapy of patients diagnosed with schizophrenia. These include:  “Guilt About Being Born and Debt Concerning the Gift of Life,” "Affect as a Marker of the Psychic Surface,” Psychotherapy for People Diagnosed with Schizophrenia and “Psychological Mindedness as a Predictor of Psychotherapy Outcome”. He has given numerous presentations in the US and abroad, and has been teaching and supervising for many years at the Columbia Psychoanalytic Center.

Danielle Knafo, PhD., is a clinical psychologist and psychoanalyst with expertise in the treatment of psychosis. During her 22-year tenure as professor at LIU's clinical psychology doctoral program, she chaired a specialty concentration that trained doctoral students on how to work psychodynamically with serious mental illness.  Currently she is faculty and supervisor at NYU's postdoctoral program in psychoanalysis and Adelphi's postgraduate programs. She has written and lectured extensively on the topics of art and creativity, psychoanalysis, trauma and psychosis, sexuality and technology. From Breakdown to Breakthrough: Psychoanalytic Treatment of Psychosis (co-author: Michael Selzer) is her 10th book. Dr Knafo has worked psychodynamically with psychosis for 40 years, and she maintains a private practice in Manhattan and Great Neck NY.