In the same spirit of my post about the present glorious times of a world going through change I want to add a couple of short paragraphs.
I was in Portugal lately. I followed a very significant European political event: the electing of the Parliament of the EU 28 countries for the next five years. Over 500 million subjects (old friends a foes) electing more than seven hundred representatives based on each country's independent political system. No procedural glitches, whatsoever. The dazzling thing is the role of the young is playing in the different countries and changing the face of the world there. The greens got rid of the central right and left parties. One of the leaders of the new movement is a 16 years old young woman with all the bright, mature, self confidence that we did not see in the "seasoned" politicians of Brexit and anti-Brexit. A child of Eight manged to make Starbucks stop plastic straws. In the US we watched something similar but on a smaller scale when school shooting happened and issue of the climate were mentioned in opposition to the knowledge and wisdom of Trump and his likes. The call for free education, health services, substantive changes in social justice is gaining recognition and strength in the States by pressure coming from teenagers and young people.
This is more than a phantasy for a guy who lived and still remembers the war in Europe and in East Asia, initiated by "old experienced politicians" (Hitler, Roosevelt, Stalin, Franco, Charles De Gaulle, Mao, Minh, etc.). In history, the history of of any human issue, the young start the revolutions and pressure for change but the old usurp the revolutions, and here we go again. But it seems that this is not happening anymore. The young are moving and holding to the reigns of power.
Could we see something similar in psychoanalysis? Psychoanalysis is also dying like old politics. We, old analysts,talk about the need for change and we just give it a lip service (maybe this the only part we could still move). Young analysts learned only the old analysis we taught them, in the same archaic institutes system, and infused in them the distorted image of the training analyst. The desperate needs for modernizing psychoanalysis expressed in "schools" were even more destructive because the schools were not dealing with the subject of analysis; they were distortions in its practice: from empathy to inter-subjectivity. The schools are the old hanging on to the straws that were the first indication of a sinking psychoanalysis.
Young analysts have no ideology to call a revolution and renewal. How could they assume the leadership in changing psychoanalysis or holding back the old dying psychoanalysis? They should know that we have nothing to offer, so they have to look at two things: why they want to be analysts, and that analysis is not matter of training. It is a knowledge, a theory of "something", and they will find it in psychoanalytic literature not in training based on transmitting knowledge from a person to person. Is it too much to expect a generation of psychoanalysts who say that we will stop doing analysis as psychotherapy and we will look for new, different, meanings to the act of psychoanalyzing? "We want to be analysts because it is knowledge we aspire to learn, not a profession we want to practice. It is too much to find enough young analysts who are trained by us-the old parochial-training analysts, who would say out loud: analysis is not psychotherapy?? Analysis is....something else and we will find ways to learn it. There are some actual analysts who are knowledgeable of what psychoanalysis is who would extend a helping hand.
The hope-and there should be some left- is some psychoanalysts who hold academic positions will bring it where they work as academics, making it an academic issue and not a 'professional' matter. The hope is to take reign of matters and not leave it to us the old cadre. We will not allow But even resist) our ways to be pushed aside and a new true knowledge of psychoanalysis emerge.
Things change, that is the normal course of events. Change needs new and daring people who know what is wrong with the present and take that as the starting point of finding the future.
Why not psychoanalysis too?
Wednesday, 24 April 2019
A Glorious Time to Live:
Psychoanalysts tend to think of the unconscious as material existing outside realm of consciousness. The unconscious material exists in consciousness but in a disguised way, and that what makes it unconscious. We are supposed to be trained to decipher those disguises and restore the material to its original state. Treating a patient requires discovering the disguise and revealing it to the patient, so he could do with it what he wishes. Social groups do something similar with their matters, i.e., disguising their willingness or unwillingness to change; similar but not the same. We are presently living a period of history where change is not limited to one aspect of our life or one place in the world. There is a mass of processes of social change going on everywhere with different degrees of urgency. Yet, there is something unique about that world awakening.
The world is going through major changes that are different from equally drastic changes that happened before. Before, every step forward taken by humanity involved resistance, which we can see around us again in different degrees of intensity. Social resistance to change in the past manifested itself in to changes resulted in more need for changing the changes that happened. The German reaction to the Versailles surrender created changes that needed changes in a second war. War was always the most used measure for resisting change or paying for the change in advance. The equivalent to that in psychotherapy is named resistance, which made change in most of the times a war with the therapist as an enemy.
The current changes are different because they are mostly done in conditions of peace or done peacefully (with the exception of the changes in the Islamic world). Living in north America, watching the changes that are happening in the US lately, and knowing few things about its impact on other parts of the world (middle east for instance) urge me to mark some features that could be of interest to analysts regarding social disguising of intentions and meanings (social unconsciousness).
The current happenings in the US are both political and social changes that will soon be in history books and be read about only in books. It is a privilege to be close by and witness that change. To witness the change is better than anything written about it. The change in the US will ‘eventually’ have a remarkable effect on the world. They are political changes but they are more of a change in the nature of the American nation itself; an important nation that had a central place in the events of at least the last century. It is also a nation which has shown obstinate rejection to change in the past and blind adulation of its forefathers, consequently of itself. The significance of the recent changes in the US are not a simple process of maturation; they are creating a different perspective for a past that was hastily judged to create a great deal of distortions of the meaning of events. Americans changes will definitely have an impact on a wide range of the world when they reach their Zenith. Just as a start to put all that in perspective: A nation that-few decades ago- would not elect the better candidate for president just because he was Catholic is now open to elect a Jewish Socialist; that was when few months ago the word socialism and few other terms were anti American and taboos .
Changes of such nature and extent have to be put in a context; any context- but not to be looked at just as incomprehensible unusual turn of events. Fredrick Engels, after an extensive and very intelligent analysis of the course history usually takes in its progress, stipulated that History evolves in a dialectical spiral. Small events happen in what seems a casual way and reactions to the whims of some political characters or local events. They accumulate (unconsciously to the individuals) leading to the day when a deciding event or events that relate in a clear way to the innocuous events that happened casually before. Then, and suddenly, the society takes note of that deciding event and it becomes a historical moment; i.e., a historical thesis. The historical thesis creates its antithesis and both initiate a sweeping historical change. Minor and individual events, relating to racial discrimination, kept happening (the multiple events that took place in the US from the times of eliminating school segregations to the wave of open objections to police brutality with blacks) till 9\11 happened and the whole narcissistic edifice collapsed: ‘we are not what we always thought that we are’. Then, suddenly BOOM, the election of a black president.
The election of a black president was not the only available reaction to the American nation in its struggle against racial discrimination, but it was the antithesis that proved to be essential for other changes to continue advancing and not die sooner than it should. The US changed radically when Obama was elected: no more prefabricated ideas of the supposedly right president for ‘us’, maybe no prefabricated ideas about ‘our’ social life as whole as well. Following the election of a black president a wave of breaking old taboos became a national obsession. The idea of the white peoples’ entitlement over the blacks, or the entitlement of some groups over the rights of their opposites (poor, uneducated, homosexuals, woman, etc.) was a national game. However, to appreciate social change properly it has to be put in the context of what was to be changed. In that case, the context that made electing a black president significant was declaring the readiness to give up sacred and very old dear and sacred elements of life that were gripping the nation’s. Those fixed notions were a core of a sense of moral superiority. It meant that some unquestioned sacred beliefs and convictions are now merely debatable
The Americans looked back at their past, and the present, and possibly the future, especially after the 9\11 drama, and became aware of a tendency to create pervasive unquestionable and blind senses of righteousness. It took more time for the American to become aware that they are not entitled to run the world according to their own sense of what is right and what is wrong. It was also a shock to realize that there are other and better ways of doing things than their own. Americans are open now to “not despise’ what is not American. It was difficult to come to acknowledge that some blacks could be better than an American white. The most important aspect in those changes is how the Americans basic ideological sense of being is founded on those same principles they believed that they have followed all the time. The whole world was also waking up to its bundles of prejudices. The way Nelson Mandela was received in Great Britain was far different from how Ghandi was received eighty years before.
What we can see in the US is an obvious (not yet fully sincere) trend to be just a part of the world, not only its leader. It goes without saying that the impact of that kind of change is so new and unfamiliar to the three generation living now in the US and the rest of the world to appreciate its future effect. The impact of change in the US on the Western world and the rest of it is very significant because it has already made great progress in eliminating dictatorship in the world. There is something ironic in this phenomenon. Dictators of the past suspended the constitutions of their countries to rule without opposition; they did not break the law. In the US the present elected president is trying to “constutionalize” dictatorship.
Analysts should study social phenomena psychoanalytically and not use psychoanalysis to explain social phneomena.
Monday, 8 April 2019
Psychoanalysis: Between Improving and Changing
6-7. University or Total Extinction.
The drop in the number of patients in psychoanalytic practice overwhelms psychoanalysts but highlights something not mentioned yet in our discussions of the crisis. Psychoanalysts are certified professionals in three mental health professions (medicine, psychology, social work), and could practice their original professions along with a practice in psychoanalysis, and keep fully busy. However, psychoanalysts - almost always- refuse to consider their basic profession part of their pronounced identity as ‘psychoanalysts’. So, the crisis is really in psychoanalysis as a dying profession and not in its practice as a way of making a living. Analysts expected psychoanalysis to guaranty their practice, and did not pay enough attention to the gradual decline of its quality. In addition, they did not assume their responsibility for making the changes that would make it remain viable in practice. They preferred tinkering with it to accommodate their own preferences in practice. Freud’s tripartite protocol of practice demands strict discipline that some analysts could not bare, so they allowed themselves to do away with it, and in some cases to an objectionable degree.
The IPA did something similar: it relied on its membership to maintain its relevance, but it abandoned its responsibility to preserve psychoanalysis and allowed gradual divergences to become serious deviations. There is no honest and solid argument that would deny that the current crisis in psychoanalysis was and still is a crisis in the training and the formation of the psychoanalysts in the different specialised institutes of psychoanalysis. We might have now a crisis in the practice of psychoanalysis because of bad training psychanalysis in unsupervised institutes. The result of this possibility does not need any comments. What will happen in the next decade?? In 1966 there was a funny movie with the title “The Russians are Coming…The Russians are Coming”. I will use the title to say The Chinese are coming…The Chinese are coming. They will come in the tens of thousands and will- to the delight of the IPA- inflate its membership. Do we know much about their training and the training systems they will adopt after they anticipate from our present contribution to their preparation!
Unfortunately, and maybe fortunately, the crisis is the making of the IPA and its members, and not created by external factors. So, we can improve the situation if we want to, and if we will be able to take care of the unconscious resistance to change. The possible resistance will come from pride or guilt. The report of the IPA in 1995 poured the blame on outside forces that were even used to justify deviating from the traditional system of training. The report gave excuses for the analysts’ inaction and characterised those excuses as resistance to lowering the standards of classical practice to accommodate the presumed outside forces. In fact, the seeds of denying our responsibility for the crisis were already there in the report. The authors of the report predicted further decline in the number of patients, but were disagreeing on the causes: is it because of the continuing strictness of the, criteria or the tendency to relax those guidelines. The statements of the report and what materialized after its publication was denoting persistence of pride exemplified in we know better if we should change our techniques or not, and that we also know how. Obviously, we did not and still do not know. Guilt comes form admitting that we did not improve training but actually allowed it to decline and deteriorate. Realizing, admitting, and accepting all that requires courageous honesty. A review of the training systems in the last three decades would lead to admitting harmful deviation from original psychoanalysis to accommodate some ‘idealised’ training analysts who perpetuated to chronic belief that psychoanalysis is the ‘creation’ of individual geniuses. This tendency is very glaring in North America, but we should not forget the Lacnian waive and crisis of the short sessions crisis.
The crisis of psychoanalysis is a crisis of the formation of the analyst and confusing learning and training on one side, and practice and the analytic body of knowledge on the other. Some analysts do not make much of the separateness of those two opposites.
A Case for Change
It is problem nowadays is to agree on what psychoanalysis is, although there is an abundance of activities that calls itself psychoanalytic. Moreover, no organization, not even the IPA, has attempted or claimed the right or the ability to arbitrate that complex problem. Therefore, psychoanalysis-as a term- could currently be bestowed on none psychoanalytic activities without reservations, and psychoanalysis, this way, could exist (fictitiously) while it actually is not existent. But there is twist in that quasi-excuse or accusation. Analyst from the three professions, mentioned above, know that if psychoanalysis (to others) is only psychotherapy then they, as the psychotherapists, have to answer this question: What do we treat? We cannot say we treat pathological conditions because such conditions are not separate from the patient like diabetes and the diabetic. If we say we treat patients with pathological conditions then we should complete our answer by specifying what is a pathological condition: what does it mean that a patient of character disorder is psychopathologically affected? How those affections show and manifest themselves in patients. All possible answers to those details in practice come from the lexicon of psychiatry because psychoanalysis does not have its own lexicon of psychopathology. I am doing this exercise in controlled thinking to show that we, psychoanalysts, have withdrawn to our institutes and our international organization in a self-feeding processes, which has a negative effect on training. We transformed the uniqueness of the psychoanalytic discoveries of a half a century into personal distinction that isolated us from the world of the humanities. We refuse to be clinical psychologists or social workers anymore and retreated to an identity that does not have a defined entity yet. We are psychoanalysts without a psychoanalysis that has a meaning: there is no surgery without medicine because medicine gives the surgeon his professional identity. In the same way we need to identify psychoanalysis to give us our identity as psychoanalyst. The reason I keep harping on this point is because the little body of knowledge that we assume to be enough to practice psychoanalysis is full of substantial mistakes that causes concern. Those mistakes could quickly and accurately be corrected if psychoanalysis is a university department or even part of a department of psychology in a university. Academic knowledge forces correctness because the academician is accountable to the body of knowledge not to his colleagues.
Lately (March 24, 2019) Mark Solms (who is in charge of the new revision and translation of Freud’s Standard Edition), chose 7-8 terms to show the audience of his lecture how wrongly they were translated by Strachey and caused fundamental distortions in understanding psychoanalysis. As an example, Ego is Ich or I in English. It is not “a thing” or a psychic entity: it is the pronoun of first person. There is no Ego to strengthen or to treat; there is Ich or the pronoun I that is speaking to us about itself. As the patient says I lose my concentration when my superior criticizes me, he is not saying I have a weak ego; he says to the analysts I lose my natural sense of being when attacked. This condition determines if the analyst should respond, and if so with what. Psychoanalyzing is the act of showing the patient that what he said had another implicit meaning which deserves talking about because it could be affecting him without being aware (not using the term unconsciously because there is nothing that could be called “the unconscious”). Unconsciousness is a metaphor of a state of mind and not a signified.
If our training does not lead us to what psychoanalytic knowledge has taught us about the subject we will be totally lost because, all what we would be left with is some fictitious metaphors about imaginary psychological issues, i.e., metaphors of real things. Most of the time the candidates do not have clear knowledge of what they treat or they consider the terminology that was improvised by Freud or other authorities ‘things in themselves’ (projection, enactment, failure to construct the right self object, etc.). Neglecting, in training and learning psychoanalysis to show the candidate (and sometimes full-fledged analyst) the difference between what they encounter in practice and what they read in the literature results in difficulties in the relationship between the candidate and the supervisor (another angle to deal with the problem of the training analyst). Those issues and several others make me say that those essential problems in learning and training could not be properly managed in the present system of training in the IPA institutes. There is a lot to know before we teach psychoanalysis properly, which the system of the intuited could not hadle. The possibility of changing learning and training to be an academic endeavour should be seriously considered in the psychoanalytic circle.
The way analysts are qualified lacks two basics: a spelled-out statement about the minimum theoretical knowledge that a candidate has to acquire before applying for training, and reviewing the time and the manner the tarining time will be managed in the process of training. It goes without saying that the institutes should also have a clear theoretical program for the formation of the candidates. This point is meant to highlight the serious need to know what are the fundamentals of training and to exchange and discuss matters between the ‘different’ training facilities in different parts of the world. In my time -the Canadian Institute was four years of seminars (once a week for three hours each), of which the first two years were dedicated to the Slandered Edition, the other two years were for the contemporary schools. In addition, there was personal analysis and supervision. Thankfully, Kohut was the first and only enfant terrible in my time, so there was time to have deep discussions regarding the budding conflict between drive psychology and relational psychology. What would be the situation now with the dozen or so new schools?
The most puzzling now is the existence of very impressive university programs in psychotherapy designed, run, and managed by psychoanalysts. What is involved in those programs is far more expansive and of high quality than any IPA institute could accommodate in its current or past modality of training. The puzzlement is why those programs repeat the IPA mistake by limiting psychoanalysis to psychotherapy. There are all the reasons for academicians not to limit their conception of psychoanalysis to psychotherapy. The most glaring reason is that psychotherapy was not originally the only stipulation psychoanalysis, and that what is dying in psychoanalysis as psychotherapy? I am thinking of three reasons for that, and I mention them because I hope some analyst\academician will try to look into that matter: 1.we do not know what else could be psychoanalysis, 2. there is no demand to learn anything else but psychotherapy, 3. aside of psychotherapy psychoanalysis is just applications in other fields, which makes of less prestigious to include in an academic program.
However psychoanalysts want to cut it psychoanalysis is a theory of the human subject. Before psychoanalysis the human subject was subject of speculation that sometimes were nothing more than traditional believes. Since the birth of psychoanalysis speculating about a human phenomenon is not acceptable in the educated communities. Psychical phenomena-ranging from history to politics- are psychoanalysble, i.e., subjected to processes of understanding. Freud’s preliminary conceptions of the intrapsychic and his advancement of his points became our attitude toward the subject: an object of discovery and each discovery uncovers the next issue to study. Therefore, psychoanalysis is more than a psychotherapy: it is the study of the human subject.
The two other preconditions in a proper training are personal analysis [didactic] and supervision. I think those two preconditions which came from training in psychotherapy should be viewed in light of making psychoanalysis a separate and defined body of knowledge; a science. Personal analysis is essential in training as psychotherapist but, not for the chronic phantasy of its value as therapy and treatment. Any dictated personal psychoanalysis would not achieve any therapeutic success. However, we cannot learn how psychoanalysis is done by any other means but undergoing a good period of didactic personal analysis. Explaining that to the future aspiring clinician should put his mind in the right place. He would know how the clinical protocol is observed for the benefit of the “patient”, and how therapy is a natural result of that type of relation. It still has good effect on the trainees in other fields of psychoanalysis. Nothing could explain the unconscious as well as hearing one’s self saying things within regular speech that never occurred to his mind. Supervision is part of any work that is based on the accumulation of expertise. The varied circumstances in the dealing with psychopathology could also show the candidate the blind spots in his understanding of human nature.
The Negative Side of Institute Training
Training in IPA institutes is a lonely venture; it is analysts teaching analysts, training analysts qualifying analysts an accrediting their own work. Therefore, without a critical eye from outside, their closed circle is likely to take certain things within their sphere of knowledge as facts when they are not more than metaphors of findings. The institutes follow the divisions in the societies, which are mostly personal and political. The major dividing event in the British Society in the early fifties, resulted in three different systems of training based on a mix of personal and theoretical differences. The most negative result of this division was the creation of what was called drive psychology and relational psychology, following the rift between Anna Freud and M. Klein. Ego psychology was considered a drive psychology because it emphasized the psychodynamics of pressure and defence against the ‘instinctual’ demands. This conception was based on translating Trieb with instinct, which was blatantly wrong. Freud defined what he meant by Trieb “the pressure put on the mind to act [represent the stimulus psychically]” (1915c). For a period of time sex was a drive, but after considering infantile sexuality as basis of more than sexuality, sex was not treated anymore as a drive but as a Trieb. Making M. Klein the founder of relational psychology is a subtle but very important misconception. Klein examined, identified, understood, what happens to the child in infancy. She gave us a way to understanding the adult’s intrapsychic core that was influenced by the relationship he had with the mother in infancy. Her interest was the formation of the intrapsychic via the interrelationship with the care giver. In other terms, she was looking at psychical formations, not the relations to the mother. Other analysts who are grouped as Kleinians, like Winnicott, were interested in the transference of the infant-mother relationship to the current relationships, not the relationships themselves. They were not relationists; they were psychoanalysts.
Clinical psychoanalysts were isolated in their training institutes (particularly in North America) and were not exposed to the external input of a very important phase in the history of psychoanalysis. There was a revival in the sixties and the early seventies, in Europe and North America, of structuralism, which was the anti functional thinking in the humanities. Just as a side idea to this: Mark Solms main endeavour in revising Freud’s Standard Edition is meant to correct the translation of some basic terms that made psychoanalysis a functional theory. His corrections will be -as he indicated and demonstrated- to find the structural version of psychoanalysis in the Freudian text. In the sixties and seventies, the return to the essence of psychoanalysis allowed thinkers, philosophers, literary people, artists, etc., to participate in creating a structural version of psychoanalysis. It seems that North American psychoanalyst missed that external input and remained captives of their institutes of clinical psychoanalysis. The harmful effect of training in isolated specialised institutes is evidenced in the North American psychoanalysis. When psychoanalysis was getting over its functional version in Europe and including a wider range analytic thinking, psychoanalysts in North America analysts were dealing with the limitations of functional psychoanalysis by being critical of the basics of the of psychoanalysis itself (Holt, Perkin, Renik), The notions of the plurality of psychoanalysis and the schools happened at that same time when psychoanalysis was booming everywhere else. The intellectual revolution of those decades was constructive to psychoanalysis when and where it was open to others, and destructive when it was isolated in specialized Institutes.
What I want to underline is that learning and training in institutes of psychoanalysis, whatever their affiliation, is susceptible to provide distorted, if not wrong understanding of psychoanalysis. The graduates (accredited and certified as psychoanalysts) learn a psychoanalysis that has no link to anything else but psychoanalysis. The normal process of the development and evolution of any body of knowledge is to widen and spread its boundaries of exploration and insights. This expansion would inevitably touch the widened and the spreads of neighbouring bodies of knowledge. This process is not passible in the case of the current system of training in IPA institutes. To be fair, I do not know anything in that system that prohibit such expansions, but the structure of the system makes it difficult. The death of psychoanalysis is happening because its system of learning and training does not have provisions for its revitalisation by the input from the other humanities. The solution is to move learning and training in psychoanalysis to where the contact with other sources of knowledge is available and comes naturally. We should give training and learning of psychoanalysis to academia if we are keen to keep it alive. Although this idea is not objected to in Europe much, but what is noticeable is not agreeing to making training and learning of psychoanalysis more than just degrees in the field of psychotherapy (offering Ph.D. in what is in fact psychotherapy).
Sunday, 31 March 2019
Psychoanalysis: Between Improving and Changing
5. The Deterioration of Psychoanalysis and its Crisis
The anxious and sometimes desperate ways psychoanalysts are dealing with their crisis does not, for sure, show a clear distinction between the body of knowledge that denote psychoanalysis as a theory and psychoanalysis as clinical practice. The obvious concern in their approach till now relates mostly to the deteriorating status of their practice. However, although analysts do not like to consider the distinction between theory and practice in their attitude toward the crisis, the IPA’s point of view, which shows in the recent mode of activity and vitality, meetings, and optimism, is leaning toward considering the crisis to be in the clinical meaning of psychoanalysis. The IPA is ignoring the other side of the coin which is the status of psychoanalysis itself; the dog that has a tail called clinical psychoanalysis. The proof to that leaning is a sudden burst of activities to promote psychoanalysis to regain the interest of people, staying away from examining the analysts’ own interest in real psychoanalysis.
We still have to decide which of the two meanings of the term psychoanalysis that is the one that is actually in crisis? Could it be that psychoanalysis as a body of knowledge (science !!) is losing the interest of people lately? For sure this is not the case, because psychoanalytic thinking is ‘now’ weaved in the fabric of daily human life. The interest in contemporary psychoanalyses is the main issue that the IPA is avoiding to tackle. In my opinion, the reason is that IPA is not capable of doing that due to limiting itself to the function of training, i.e., to psychoanalysis as a clinical practice. I might get beck to this point later, but for now the IPA is not equipped or should be expected to evaluate psychoanalysis, as a body of knowledge, thus is not mandated neither to approve the plurality of psychoanalysis nor the credibility of the current theoretical formulations of psychoanalysis.
Although the concern about the drop of interest in contemporary psychoanalysis is global, the degree of that drop depends on what part of the world we are talking about. However, there is no region of the IPA claiming exemption of that drop. The local and the international organizations are all approaching this issue from the angle of the public and the need to remind it of the ‘goodness’ of psychoanalysis. This idea attests to the need to examine the state of clinical practice of psychoanalysis as part of our responsibility toward the public; not as consumers but as honest and concerned professionals. Psychoanalysis is not owned by the psychoanalysts; it is part of our human heritage, therefore we should participate in dealing with the crisis with objective and ethical evaluation of its efficacy.
Let us look at the modality of medicine to create a baseline for a fruitful discussion. The changes and improvements in the treatment of cancer in the last four decades is a natural outcome and extension of the advancements in medicine as a whole, which came as part of the major scientific leap of the ninetieth century. The scientific leap was only possible when the West Europeans overcame their religious irrationality, which was the code of their existence for the previous five centuries. They advanced their life and aspired for more advancements and stepped waring and started thinking. In other terms: the evolution of a science or a body of knowledge stems from a larger and more encompassing human endeavour. The question then: could we identify the roots that psychoanalysis sprouted from and allows us to refer to, as the starting point in its progress and evolution? Psychoanalysis is not an extension of medicine or derives much of its nature directly from other human sciences. The most we can say, as Freud used to say, is that psychoanalysis is a psychology of sorts. Yet, its evolution and the progress it achieved did not relate to the psychology of its time; not even of today. Therefore, what we have now as a crisis in the practice of psychoanalysis is coming from an undefined body of knowledge, which we psychoanalysts know very little about. Better, the IPA training institutes train new analyst to practice an unidentified body of knowledge. In the most classical training programs in psychoanalysis the reading of Freud’s text (and the texts of other gifted analysts) with the most scholarly training analysts would not teach a clinical method of psychoanalysis. No analyst- who is sincere in examining the crisis of psychoanalysis -could identify the body of knowledge that he learned in training which taught him how to practice it as a profession.
The reason, surprisingly is in the nature of psychotherapy itself. Psychotherapy, in particular psychoanalytic psychotherapy, has no theory or even an identifiable recognized technique. If the therapist has an idea about therapy in the back of his mind, he still has to follow the patient’s speech and not his own theoretical bias. In psychoanalysis, the situation is even more strict: the analyst and the patient together should avoid any predetermined notions, theories, or systematic rhetoric. The analyst is expected to catch himself breaking that rule to avoid it influencing his listening to the patient.
Historically, the practice of hypnosis was not initiated to do therapy but to discover the nature of the splitting of consciousness. The discovery of the repressed through hypnosis, started the idea of therapy. Uncovering the repressed as a means of psychotherapy proved that knowing the unconscious could be done without hypnotism. The next step was discovering the linkage between consciousness to the unconsciousness, and the mechanisms that bridged them. Thus, in principle, psychotherapy evolved to be an act of interpretation; interpreting the unconscious to consciousness, interpreting the patient’s rhetoric to become meaningful events, etc. [Lately, I attended two lectures by Mark Solms. One was on the new translation of the Standard Edition. He brilliantly showed that interpretation is a core in psychoanalytic knowledge in more than one meaning of the word]. The dialectical advancement of therapeutic psychoanalysis reveals that each finding leads to a better, but unexpected understanding of psychopathology. However, because there is no theory of interpretation and there is no way to teach and train in interpreting, the concept of training got to be revisited and re-examined. This is a continuous obligation because as psychoanalytic work changes while working with the patient, psychoanalysis in general must have changed and is still changing over the years.
We still have two other issues to deal with. (1). Psychoanalysis is not a theory of practice but a theory of what practice reveals to both the patient and the analyst. This is the opposite of the prevailing belief in the psychoanalytic community, which looks at the practice as applying a theory to the patient’s material. We thus need to answer this question: what do we then practice if not a theory? The practice of psychotherapy (analytic or not) relies on learning the psychological functions of the subject that are subjects to fixation, deviation, frustration, maturation, relating etc.). Therefore, training in psychoanalysis (in IPA institutes) is worthless if the candidates do not learn more about what will they do therapy for. This notion is not the simplistic notion of correcting mistakes in the psychical system of the patient; it means knowing what gets sick in the patient’s psyche and how it gets sick in order to be able to understand and interpret. (2). Individual psychotherapy follows the same rules of psychoanalysis in general. We listen, notice, understand, discover links between the conscious and the unconscious, from the patient’s speech, and interpret them (reveal the unconscious core of the speech). This kind of work brings us to reconstruct a theory of the subject we are analyzing. What we do in practice is a replica of how psychoanalysis -as whole- evolved (or should have) and progressed: analysts listened, noticed, understood, discovered more links in the psychopathological conditions, all that is supposed to have provided psychoanalysts with more to work with. The work with patients did not rely on a theory of the psyche or a technique of practice; on the contrary, it led to new notions about the psyche and technique. We realize now that the workings of the primary process are what was called repression or ego-weakness fifty years ago. Listening to the speech of the patients as equivocal statements of the speaking subject (Ricoeur,1970) led Freud and the early analysts (and recent gifted analysts) to eventually restructure meaningful conceptions of the dynamics of the intrapsychic nature of the human subject. This is how Freud noticed transference as an implicit content in the patient’s rhetoric, and how we should deal with it. This same find is still active in nowadays patient but in the form of character formation. A very senior analyst- presenting a psychoanalytic case lately- kept calling the patient’s relationship with him: “in her transference”. When one of the audiences asked what he meant by transference he replied that every relationship with the analyst is transferiantial. The right way to say it: transference is what of past relations that could coexist in present relationships, including the one in the analytic relation. There is no transference but there are matters in the past that gets transferred to the present, i.e., transference is not a psychical thing, it is one of the ways the past influences the present.
It is imperative to acknowledge that a hundred years of psychoanalytic work has unveiled a great deal of the nature of the human subject, and that knowledge has become now common knowledge to the society, particularly to parents and educators. The human subject is no more unknown and has assimilated most of what psychoanalysis has revealed. Therefore, we do not treat the same patient of fifty years ago. The present subject knows most of what was our cherished secrets few decades ago. We need to look carefully at what we are offering the public as psychoanalysis.
The psychoanalysis we still teach, train to practice and consider the basis of our specialty is ‘mostly’ what has been the core of analysis several decades ago. I am not sure what the new schools of psychoanalysis have done to the curricula of analysis in the traditional training institutes of the IPA and the training system in them. Nevertheless, there is good reasons to suspect that psychoanalysis of nowadays is a deteriorated form of the traditional one. Traditional psychoanalysis (we can go back to any preferred point in its history) had a clear identified relation to the theory of psychoanalysis at that time. If the theory was indicating that psychopathology is caused by repression psychoanalysis was the act of revealing the repressed, and so forth. Up till Kohut’s self-psychology there was that kind of respectable psychoanalysis. The ease by which analysts suggest new schools has dissipated this necessary link which preserves the potential for change without making psychoanalysis lose its respectability. Analysis, like any thought could deteriorates when it loses its bearings. If some institutes -mainly in Europe- still follow that rule their training psychoanalysis still could suffer some deterioration, because psychoanalysis has to change to make sense of all the discoveries made in regard to the human subject (not the presumed modifications in the technique). Moreover, it would be ridiculous to think that the IPA training model is still enough to qualify psychoanalysts. Reviewing three training programs of psychotherapy in European universities, it became totally unfair to compare their intensity, their detailed curricula, and the time needed to complete one of the three levels of degrees to training in IPA institutes. Moreover, getting someone fresh to learn psychotherapy is far more better than getting a mental health provider who is not inclined to learn psychoanalysis but seek only its clinical aspect.
The next and last posting of this topic will be: Give me a university or give me death (Psychoanalysis).
Sunday, 17 March 2019
Psychoanalysis: Between Improving and Changing
4. The Gap Between Theory and Practice:
In the early years of the psychoanalytic movement psychoanalysis was a term that denoted one meaning: what analysts do, which for several decades remained the same: psychotherapy, and only psychotherapy. Neither Freud nor the pioneers acknowledged that what they were doing, by practicing psychoanalytic psychotherapy was mostly discovering the nature of the human subject: unconsciousness, defensiveness, the pervasiveness of childhood constructs in psychical life in maturity, the conflictual nature of psychical life, and the split of consciousness, etc. Because of the novelty of the discoveries and Freud’s continuous work on a theory for those discoveries a subtle gap (which I will depict a little later) opened between clinical practice and theory. Clinical practice was without a theory, and the theory of the subject was yet to come, because Freud was continually changing its parameters. The gap between theory and practice was subtle to the extent that psychoanalysts did not notice its existence and its possible effect on the advancement of psychoanalysis. The continuing increase in the knowledge of the human subject that was accumulating with time and experience engendered some change in ‘psychoanalysis’, but did not deal with the gap between theory and practice.
Without serious consideration of what psychotherapy was accomplishing on the one hand and the analysts’ assumptions of psychopathology on the other, the two wings of psychoanalysis seemed working independently. Psychopathology could not get a separate formulation from the formulations given to practice. This detail entrenched the notion that psychoanalysis is merely a profession of psychotherapy. Because the act of therapy was technically undefined and cure was similarly vague, analysts did not distinguish between what they aspired to achieve in psychotherapy (strengthening the ego against the attacks of the instinctual pressure, for instance) and presuming that psychopathology is a result of the weakness of the ego defenses against demands of the instincts: ego psychology). Something worse in my opinion dug roots in our conception of psychoanalysis and its derivative psychotherapy. Analysts got accustomed to ignoring the paradox of using theory to confirm practice and consider practice the proof of the validity of the theory.
Freud’s advanced thinking in that regard made him improvise metapsychological conceptions that worked well- for a long time- in bridging the gap between psychotherapy and psychopathology. He considered metapsychology essential in the construction of theories (‘Analysis Terminable and Interminable (1937’). After the demise of ego psychology and the birth of relational psychologies there was no place for metapsychology in psychoanalysis anymore, but there was no replacement for it either. The reason is that metapsychology needed “issues” to replace and to signify. Relational psychology does not provide issues (like ego strength and defense mechanisms). It is only fair to say that at the early stages of establishing psychoanalysis as a method of psychotherapy it proved to be more than merely a technique of psychological treatment because it was always had a feedback that enriched the theory. That feedback from clinical work widened the scope of psychoanalysis beyond any expected improvement in psychotherapy, or the clinical aspect of psychoanalysis.
I have to interrupt this line of thought for a while to put in focus a commonly neglected fact. Freud’s discovery of infantile sexuality, the three types of the unconscious we encounter in practice, the working of the primary and secondary processes, narcissism, and reversing the theory of anxiety (1926), among other things were enough and could have unify the psychoanalytic theory of the subject and the practice of psychoanalysis in one comprehensive human science. Understandably, but still regrettably, analysts were concentrating on creating a profession of psychotherapy and showed no interest in creating a theory of the subject and the science that emerges from it. They insisted that psychotherapy is the only true source of the function of psychoanalysis.
Going back to the issue of clinical psychoanalysis I would say that the intentional or unintentional avoidance of thinking about psychoanalysis as the background of psychotherapy turned the way it was practiced at that time into a set of blind beliefs. Analysts followed the original manner of practice (in terms of the duration of the sessions and the number session per week, the couch, and some other details a bout payment, vacations, etc.) as a “protocol” to follow; yet it was a protocol taken out of context. Those features in the protocol became integral components of the work of therapy itself. In other terms: clinical psychoanalysis was replicating the circumstances of its practice forty, fifty, a hundred years ago without knowing those circumstances. Those circumstances became blindly paradigms of the profession of psychoanalyzing. In fact, the couch was Freud way of avoiding the tension of being looked at by the high number of patients he saw a day. The number of sessions per week was decided by the demand from candidates who came from different cities and towns and later from other countries for quick training. Normalizing the conditions of doing therapy is one of the most perceptive clinical intuitions Freud came up with, but we have to understand his approach instead of idealizing blindly what our forefathers did. Just as a hint: psychoanalysis is analyzing the intrapsychic core of the subject through the transference scenes. Thus, the analyst has to remain anonymous, neutral, and able to abstain from reacting to the patient’s unconscious demands in order to interpret and reveal the unconscious component in the patient’s associations. This protocol of practice corresponds to the classical theory of psychoanalysis (Fayek, 2017).
After Freud’s death psychoanalysis started to fragment into camps. Ego psychology versus relational psychology was the first to ensue among the English-speaking analysts. In the Latin-based communities, the split was between functional psychoanalysis and structural psychoanalysis. (In January of 2019 I posted on Freud: A reluctant structuralist). The main issues in the Anglo camp pertained to clinical and practice matters. There was more strict adherence to the old-fashioned system of performing analysis in terms of the number of sessions per week, the duration of the session, the length of analysis, and a blind adherence to some superficially understood rituals in the relationship between analyst and patient. In that camp psychoanalysis was a profession that already has technicalities to follow. The Latin camp of psychoanalysis was concerned more with discoveries in human nature which required thinking to comprehend and reach its underlying conceptions of practice. Most all, analysts in that camp were shedding off the apparent functional thinking of the pre and post Freud’s neglected revision of the theory of anxiety (1926). In that work Freud was struggling hard with the traditional cause\effect, or functional understanding in psychoanalysis (Originally anxiety was regarded a function of failing defense mechanisms) and shed light on a structural understanding of anxiety as the initiator of psychical dynamics.
The structural maturation of psychoanalysis as a theory of the subject or the discovery of the intrapsychic core of our psychological life started in the thirties of the last century with the birth of general structuralism, which changed the face of the humanities for good. Up to the late fifties psychotherapy was still as it was all that time: interpreting the present by the past, with some additions coming from insights in regard to the difficulties encountered in the psychotherapy of new types of patients (character disorders). WE gained new vision of resistances). Instead of creating a parallel theoretical refinement analyst endeavoured to expand the field of psychotherapy unwisely by expanding the available theoretical formulations of the time to fit those new psychoapathologies. In other words, psychoanalysts, who were still mainly physicians, were not equipped to give those gaps enough thinking to realize that the discoveries of psychoanalysis exceeded the limitations of their theoretical knowledge and their technique of psychotherapy.
So, what is the basis of the discordance between analysts, which plagued psychoanalysis from the beginning of its inception? At the beginning the discrepancy and disagreements were about some concepts like interpretation, transference, resistance, but also about their meanings and their impact on practice. The discrepancy between the ‘ideal theory’ and the pragmatics of practice was the core problems since the early psychoanalytic movement. In the forties the conflicts were about what is the best medium to explore the unconscious? Defenses, relations, ego, i.e., the equivalent of the ego in interpersonal relationships or the self. Psychoanalysis as the act of understanding psychical phenomena gave its place to the conflicts about it. The topics of the conflicts became the psychoanalysis of today.
The issue of this this post brings us face to face with the deterioration of psychoanalysis.
Sunday, 10 March 2019
Psychoanalysis: Between Improving and Changing
3.The Failure of Improving Psychoanalysis:
There is an intrinsic difficulty in answering the question of improving or changing psychoanalysis: the term has two points of reference: the Freudian meaning which the IPA does not consider in its mandate, and the IPA meaning, which is limited to the clinical practice of psychoanalysis. Most analysts, because of training in IPA institutes, consider what they learned there is the only psychoanalysis that is. Few consider none clinical psychoanalysis merely applications of psychoanalysis in another fielded, but not ‘truly psychoanalysis’. This attitude- which I remember myself being ‘afflicted’ with it early in my career- was stemming from the status of the clinical psychoanalyst compare with the nonclinical psychoanalysts whom I encountered few of. I liken it now to the graduates of private schools to the graduates of public schools.
The Freudian meaning of psychoanalysis has to derive from the way he developed psychoanalysis and spoke about. In 1892 Freud failed to induce a hypnotic state in his patient (Fräulein Elethebeth von R.). Instead, he resorted to reading in her symptoms the ‘meaning’ of her hysterical complaints. He called this first attempt of treating without hypnosis ‘psychical analysis’ (Jones, 1953). He did the same with the case of Katharina and another he alluded to in a letter to Flies (May 30, 1893). In those cases, his main concern was ‘psychoanalyzing’ the speech of the patient, as a discovery coming from within the acts of hypnotherapy. In other words, psychical analysis was not psychotherapy but a discovery that could replace hypnotherapy. He even alluded to his confusion about what to call those discoveries in another letter (March 1898). Freud was still unable to understand what he was doing in his therapeutic work, and asked Fleiss if he should call his work “metapsychology”. This query is evidence that Freud was not using the practice of psychotherapy as the discovery of psychoanalysis but as the means to discovering something (a new psychology) in the act of psychotherapy. Freud’s main discoveries and reformulations of his discoveries were products of practicing his psychical analysis, not that practicing psychological analysis was the discovery.
When Freud abandoned hypnosis totally, he was already close to the notion of ‘interpretation’ as the objective of psychotherapy. The idea of listening and reading the unconscious in what the patient says or does- while awake- made him pay attention to the link between consciousness and unconsciousness as the core of psychotherapy. He said (1919): “Psycho-analysis, in fact, more than any other system, is fitted for teaching psychology to medical students”. Thus, the Freudian meaning of psychoanalysis was more than a technique of psychotherapy; it was a new ‘brand’ of psychology. But what Brand? He proceeded to say: “. . . psychoanalysis pursues a specific method of its own. The application of this method is by no means confined to the field of psychological disorders, but extends also to the solution of problems in art, philosophy and religion. the philosophy of religion. . . The fertilization effects of psychoanalysis on these other disciplines would certainly contribute greatly towards forging a closer link, in the sense of a universitas literarum”. The Freudian meaning of psychoanalysis is that it is a psychology of the human subject in his varied capacities and his self-revealing in multivariant forms expressions. This angle of identifying psychoanalysis yields new points of view and throws light on aspects that complement the findings of most of the other human sciences. In simple terms, clinical psychoanalysis is the usage of psychoanalysis in a clinical setting and nothing more. It has what is useful to make it applicable to do psychotherapy and only if the clinician has the right conception of psychopathology.
Psychoanalysis is thus subject to change because the more knowledge about the subject we gather, and the better our understanding of psychopathology psychoanalysis has to change to include all that in the process of interpretation\reconstruction. For instance: after two decades of a theory of sexual repression and cathartic abreaction Freud had already learned more about the primary process and role of infantile sexuality in the formation of symptom. He abandoned hypnosis and depended on free association and interpretation to psychoanalyse symptoms. Therefore, psychoanalyzing changed from revealing incidences to exposing meanings of psychical manifestations.
I want to underline an important aspect of changing psychoanalysis which distinguishes it from improving it. Changing psychoanalysis relates to both the subject matter of the psychopathology (the complex formation of consciousness and unconsciousness in a symptom) and the method of dealing with it (interpreting in order to reveal what is unconscious). This kind of work is not improvement because improvement affects either the subject matter separately from the method of dealing with it. I will come to the detrimental effect of the desperate improvements of psychoanalysis that were tried in the time since the birth of the schools.
The IPA’s claim to be both the institution of psychoanalysis and its educational arm restricted its function to training. The only meaningful and actual link between the IPA and psychoanalysis was determined by the training institutes, which was unfunctional, i.e., graduate its new membership. The IPA had to regard psychoanalysis just a clinical discipline and nothing else because that is its institutes could train for. The natural outcome of limiting the IPA to such meagre task created two major negative results:
A. The function of the IPA as the sole training means of psychoanalysis created a closed group of narrow-minded practitioners who formed sort of a cult. They did not accept to open their membership to nonclinical cultured people, and did not want to add to their restricted program any cultural elements. Naturally, the psychoanalysis that the IPA was teaching and training became less encompassing of what is psychoanalytic and training became a relic of an old glorious discovery.
B. Psychoanalysis was limited (till the seventies of last century) to Freud, very few other analysts of the old generation, and few of the contemporary analyst of the period of the splits in France and the controversies in England. At that time there was clear efforts to study those sourced scholastically to expose the implicit differences between psychoanalytic thinkers who did not create their own schools. However, it did not take long that analysts with little background in the original discoveries took the liberty to reinvent psychoanalysis with the blessings of the IPA.
Those two results that are engendered by the silence of the IPA in regard the changes done to basic and traditional psychoanalysis are continuing to erode and distort psychoanalysis. The deterioration of psychoanalysis is an issue that I will deal with in the next part of this posting. In the last part will be on the main point I want to highlight: Psychoanalysis and Academia.
Sunday, 3 March 2019
Psychoanalysis: Between Improving and Changing
The Failure of Improving Psychoanalysis:
In a previous posting I expressed my idea that the existence of the IPA is a hindrance to the development and improvement of psychoanalysis. At the present time, and for sometime now, the IPA is in a crisis of the dwindling down of its membership, and the inability to show a comprehensible function that justifies its existence. In North America psychoanalysis, consequently, psychoanalysts too, are going through a very difficult time: do they really exist outside their own minds (exist to people) and what could they call themselves: psychoanalysts! psychotherapists! Could they specify a sensible link with the psychoanalysis that the IPA claims to represent? In other parts of the world this puzzlement that is faced in North America is not as severe or demanding, but it should not be ignored just because it does not exist or form a crisis there. If the organization that identifies a profession does not maintain its identity by the professionals who constitute its membership, it loses its reason d’etre. Linking psychoanalysis and the IPA is the fundamental crisis because the IPA is comprised now of several (too many) psychoanalyses, and too many “presumed” psychoanalysts, and varying degrees of deterioration. The current unsettling situation is an intrinsic basic fault in the formation of the original and previously magnificent IPA, of the first half of the last century.
The IPA started in 1910 (more of a century ago) as a membership organization: a society of “belonging”. It was natural that when the issue of training a new generation came about the IPA assumed the responsibility of managing that task. Just as a reminder: training was MAINLY a response to the continued bickering among senior psychoanalysts then. With the enthusiasm and naivety of a new generation of psychoanalysts there was a belief that personal analysis will solve this problem. Personal analysis was supposed to deal with the “members neuroses”, therefore it was made the spinal column of training. It was also made the most important quality that distinguishes psychoanalysts from “those who were not psychoanalysed”, therefore we could argue that we are different (better). Training became a requirement to be ordained a psychoanalyst. This matter attracted the ones who want to “belong”, hence it had the additional purpose of keeping the IPA in existence. Early training was very little more than therapeutic personal psychoanalysis. This aspect of training remained its core under the guise of being necessary for didactic reasons. Two other aspects were added: practicing under supervision and learning the fundamental theoretical basis of the analytic discovery and some of the contemporary new theoretical additions and modifications.
None of those three aspects of training requires building the system of training institutes, because practically speaking training according to those rules does not require more than the candidate’s desire to get training. All the three aspects are available without any input from the IPA as an organization (mentioned in two previous and old postings). However, for the IPA to continue existing it was important to keep the training and the educational aspects under its auspices. To certify “the real psychoanalysts” the candidate has to go through the IPA institutes system because its organizational purposes was gradually eroded. Instead of existing because of our wish to belong, the IPA became the creator -by obligation-of that wish. Nevertheless, delegating training to unsupervised training institutes created more problem and not resolving any.
Rationalising the existence of the IPA created three stubborn misconceptions about psychoanalysis:
1. Psychoanalysis is a clinical discipline of psychotherapy.
2. Psychoanalytic discoveries are special and different.
3. Accrediting training in analysis has to come from the IPA system of training.
Instead of going into fruitless arguments about those points I will mention three observations to reflect upon:
A. Freud’s 23 volumes of work, which contain the most revealing facts about the human subject- since the combined works of the Greek philosophy- has a scanty body of clinical material that no candidate of psychoanalysis would pass his candidacy if he presented it to a training committee. The other gifted psychoanalysts also left us rich knowledge of the human subject but similarly were stingy with their personal clinical material. Therefore, it is not correct to presume that psychoanalysis is a clinical discipline, although most of us made it our
B. Many if not most of the Freudian discoveries of the human subject were reached before him by thinkers, philosophers, religious texts (the Talmud in particular), common sense of the common people, and some old physicians. Therefore, to assume that psychoanalysis is product of clinical work, which is a stubborn conviction of most psychoanalysts especially in North America, is incorrect (misleading the new generations of psychoanalysts). Psychoanalysis opened our eyes to the hidden meanings in our daily psychical lives. Freud’s adage “Dreams are Wish fulfillment” is not better that Joseph’s interpretation of Pharos’s Dreams. However, so early in his voyage of discoveries he showed that our intrapsychical life does not sleep. While ‘the all of us is sleeping’ a new way of expressing the not sleeping intrapsychic (the primary process) shows its nature. This process was the language of infantile sexuality psychoneuroses, parapraxes and jokes too. The most glaring evidence of this fact is the banality, the insignificance and even hurtful clinical modifications suggested by “the new schools of psychoanalysis” which missed that what we try to configure in our work as analysts is “there” in the patients’ speech and not in their interpersonal or intersubjective relationships.
C. The third stubborn misconception is that clinical psychoanalysts are entitled and free to produce any theoretical bases for their clinical methods of practice. Notwithstanding, only Freud was able to give a clear-cut protocol of clinical practice, which was in its basic nature boundaries to what should not be done, and nothing important regarding what is to be done. As a clinical analyst I knew what not to do, yet under that restriction I got material that makes the theory of psychoanalysis properly fitting to reveal to the patient the psychodynamics of his intrapsychical structure. This means that clinical psychoanalysis does not have a theory of practice but has a theory of the subject matter of the practice under its possible different conditions. Surgery has no theory but anatomy is the guideline for its practice. Therefore, psychoanalysis is a practice of listening to the patient talking consciously about himself and implicitly but unconsciously about his warped intrapsychical difficulties. The analyst also brings to the patient’s attention what to listen to saying in order for him to make the needed changes. Therefore, there is no local, regional, or international measures to qualify a training in the IPA institute as the accredited training. Moreover, the professors of clinical psychiatry and psychology are qualified to judge their graduates’ proficiency to work with patients.
The answer to improve or change psychoanalysis is clearly decided by the condition it reached. For justifiable and obvious reasons when psychoanalysis and most analysts- in North America in particular-exhausted ego psychology and brought psychoanalysis with it to a stand still- psychoanalysis faced what it faces now: improve or change!
What happened is that analysts did not make much of a distinction between the subject matter of analysis and the suitability of the psychoanalytic method used in analyzing that subject. When ego psychology’s theory was exhausted to be useful in conducting analysis analysts thought that changing the subject matter of clinical analysis would be the solution. They went on a long trip of moving from relationality to intersubjective-calling and calling every change a school of analysis- assuming that they were improving psychoanalysis. Although most European IPA institutes seem to be less prone to go via the ‘school’ route they I do not know if there much change in the status of analysis there.
Therefore, my answer to the question is that the attempts to improve psychoanalysis is showing in the already failed schools that are useless and even damaging to psychoanalysis. However, this is what IPA still sponsors and it is evident that its membership has nothing else to offer: more schools. The Institutes that did not fall in that trap are not showing signs of looking seriously into the realistic solution of Academia.
Let us talk about that next time.