Once More

Psychoanalysis and the Academy:

Five

This Post is a response to a recent discussion of the subject of psychoanalysis and the academy in the Journal of the American Psychoanalytic Association (Volume 64. #3, June 2016). It should have properly written it as a paper on the raised issues in the volume, but I did not find the energy and the endurance to engage in a well vetted paper. However, I will try my best to avoid the temptation of being slack in raising issues and expounding them. I will make sure that scrutinizing this paper will prove that it came from documented literature and not be put to shame.

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The need for serious thinking about training:

This section of the post is about a mature psychoanalysis that should not be captive of an old system of training, because of a blind faith in the wisdom of the past. The history of strife in the psychoanalytic movement is a witness to the fragility of the old and also the chronic craving for change. Kernberg and Michels (K&M) proposal for improving training in psychoanalysis (JAPA,64, 477-494, 535-540), embodies that ambivalence: insistence on hanging on to its early system of education and training, yet offering what they consider an overhaul of that system with the hope of moving it to universities as a solution to endemic flaws in it. The analytic circles still avoid considering the declining interest in psychoanalysis and in analysis could be caused by the poor quality of psychoanalysis and psychoanalysts, that could be a result of the poor quality of training.

No analyst has a strait answer to two questions: 1) What is the connection or link between the original classical theory that the old Freudians adopted, and present psychoanalytic thought that we all claim it to be extension of the classical theory? 2). Is there any logic in holding on to the traditional system of institute training in light of the contemporary confusing theoretical diversities? Those two questions- if answered honestly- will require from us either to change the educating and training system, or give up the traditional theory of classical psychoanalysis as commonly defined. As a training analyst of the old generation, who witnessed the two peaks of psychoanalysis in the late fifties and the late seventies, and who dreamt and fulfilled his dream of being trained in the traditional way, I know how painful to face this situation we are now facing. We have to chose which we should sacrifice: the old theory or the old system of training. We can keep both and lose psychoanalysis itself. The choice is really not difficult to make if we do not look for cause-effect answers, and just look at an obvious issue: what should we keep or discard or revise in the classical theory, so it will not conflict with what this same theory led us to know more and better over the years? If we really honour psychoanalysis, we should accept that it is a developing theory and not a dogma. This will allow us to know, articulate, and maintain its fundamental and foundational propositions. Thus, obtain a better perspective of a proper training system that suits it. The answer to the two above mentioned questions is to let psychoanalysis tell us what to do with the theory and its system of training.

The most fundamental in the theory of psychoanalysis is the discovery of the intrapsychical. This was what amazed the world when it happened. All thinkers could not cross the threshold of the cognitive and the known, which reveal itself in our interpersonal relationships. Therefore, they did not know how to explain the human subject. It was Freud and psychoanalysis that brought out of the cognitive and the known their basic foundation, which was intrapsychical dynamics. The equally amazing proposition (which attracted more attention from the public and less from the psychoanalysts) was that everything human is written by two systems of expression: primary and more elementary and primitive and secondary that is more elaborate and sophisticated. If there is something very unique about Freud it was reading the primary text within the secondary text. With those two foundational propositions of psychoanalysis we can think of what to keep of Freud’s and the pioneer’s literature to make them basics in theoretical education. Just as an interjection, Freud had two kinds of texts: informative and instructive. The informative are no longer of real educational value and the instructive (The Interpretation of dreams, The Three Essays on Sexuality, the 1915 revisions of the main concepts, Inhibitions, Symptoms and Anxiety, etc.) are to be taught scholarly to get the gist of discovering the two fundamental propositions, and because they are no longer novelties.

With this in mind we can see that the issue of training is very important to revise.

The chronic problems of the early initiation of training are still here, but the issue of the training analysts is now the center of open and almost unanimous agreement on it is damaging effect on training. Reviewing the recent literature on the subject underpins one suggested solution: move training to the universities, as if the privileged and elite group of training analyst will disappear by that simple manoeuver. The obvious and basic danger in that suggestion is the advocates’ insistence on just improving the institute model then moving it to the universities. K&M ‘improved’ institute is to be instituted in the departments of psychiatry as autonomous divisions of those departments , which would get us back to the period of the pre-accepting none medical professional in training and membership.

Trite Thinking:

Wallerstein said that after the war: “we had two educational models, the independent institute as a privately-run night school, and the university-based institutes housed within the department of psychiatry”. This division distinguished implicitly between psychoanalytic training and psychoanalytic education.  K&M refer training to the department of psychiatry (ibid, 489) and encourage creating the scientifically trained psychoanalytic professionals. Thus, we should then end up with two classes of analytically involved people: the real ones who are trained with a mandatory basic Medical (psychiatric) knowledge, and the scientifically educated psychoanalytical professionals (psychologist, statisticians, social workers, etc.) who would be support to the real analysts by doing their research for them. This is the underlying theme in K&M’s proposal to improve psychoanalysis and the administrative solution to the problem of the expanding interest of the none medical analysts in psychoanalytic education. Training separate from education is a prescription for the official demise of psychanalysis as a community. Psychoanalysis, would go beck to the ridiculous notion of the medical psychoanalysts, because how much medicine does the medical psychoanalysts apply when he practices psychoanalysis? Another more blatantly narrow sightedness in K&M’s proposal is why would the scientifically trained psychoanalytic professionals want to do the research for someone who does not even know how to pause a proper research hypothesis?

I would like to reiterate here: psychoanalysis does not have a body of knowledge that could be defined and taught in seminars, nor it is a theory of anything specific like psychopathology where there are basic and differential issues to learn to practice. Psychoanalysis is the assimilated and integrated way of using the two foundational propositions of the theory -mentioned above- in listening and interpreting to patients what they say, or understanding social change or a work of art in the same way. Therefore, its place as an institute in a department of psychiatry would be misleading to the ones who seek to become psychoanalysts. Those institutes give the false message that psychoanalysis is a branch of psychiatry or medicine, and is only available to physician to train. Similarly, it would be misleading if institutes established in other university professional departments under the same guise proclaim exclusivity. Education in psychoanalysis is to learn the psychoanalytic way of thinking, but practicing it as a profession requires training. This trite idea that the institute system of training is where candidates learn psychoanalysis has to be dispelled and the training system has to follow and match the status of psychoanalysis, not the other way around.

If we think structurally and not functionally- the present system of institute training is creating the function of the training analysts’ class and not the other way around. Not paying attention to the reversed relationship between cause and effect in that regard results in several other trite and misleading convictions, like the claimed need for research to give back psychoanalysis is respectability, or a vital need for its survival. The limited knowledge about the nature of research amongst medical analysts and psychoanalysts in general –including K&M- has created the conviction that there are researchable issues in psychoanalysis. There are two systems of research: exploratory and investigative. The first is exemplified by epidemiological research, where the aim is to define relational aspects of a phenomenon like obesity and blood pressure as correlate. In this kind of research the maximum contribution of psychoanalysis is limited to offering suggestion of no direct analytic purpose: the relationship between the degree of depression (assessed psychometrically) and the use of the two main primary mechanisms of condensation and displacement in verbalising the pathological complaints. This type of research could barely be called psychoanalytical research. Analyst would not be active participants in that kind of research. Investigative research has to be designed on the experimental model of a control group which is the topic of the investigation and experimental groups which would verify or deny the hypotheses. Psychoanalysts are not experienced or versed enough in the techniques of sampling and the proper statistical handling of this kind of research. It is impossible to apply that model in psychoanalysis because there are no ways to control all factors in the experimental groups to allow comparisons between them and a control group. The complex nature of phenomena that have unconscious components is the reason of such impossibility. Psychoanalysis can generate research that it will not conduct, and could only benefit from the results of the researches of the other disciplines. Instead of arguing those trite convictions about where training and education of psychoanalysis should be, or the importance of research in psychoanalysis, I will get directly to the fact that we reached the point where we should dismiss the system of institute completely [it might survive a little longer among psychiatrist for reasons of their own].

The inadequacy of the institute system of training:

The original system of training, which mandated didactic analysis and early supervised practice was initiated originally to create treatment centers for the poor and the activation of the interest in researching the expected abundance of finding the trainees were expected to produce (Wallerstein, 2007). The seminar portion of the tripartite system was necessary to transmit the ever-growing body of theoretical knowledge and changes at the time. It also created a closed system that succeeded in giving psychoanalysis the chance to grow without much external interference or influence. The tripartite model of didactic analysis, supervision, and seminars persisted in a peculiar way: instead of noticing that its three elements needed revisions, from time to time, and possibly adding new elements of training and educations, it went in the direction of giving those elements different weights and functions as time passed and the demands for training increased. The trend was to amplify and overstate the significance of each element and arbitrarily decide the extent of contribution to tripartite activities of the program (in particular, the minimum time and sessions in the practical side of training). Although the system as it started and evolved had its flaws, the gradual changing of the functions of each of its three elements uncovered a major defect in the system. The institute system of training as a whole changed its function.  Training was a means to an need and changed to become and in its own right.

Didactic analysis was gradually underscored to become an essential part of theoretical preparation of the aspiring analyst. Extending the required time to spend in it indirectly changed its didactic function, and its therapeutic function took over the didactic one. In subtle ways, it acquired a different function; treating the candidate to relief him from personal difficulties that might interfere with his capabilities to do good analysis. This change was not only arbitrary; it went against it presumed benefits. Personal analysis that was extended arbitrarily to few years with high intensity, as a precondition for training that leads to graduation, forfeited its therapeutic value. Analysis fails if forced on someone for any reason. Personal analysis did not only create the Training Analyst, it also created the Idealizing Candidate (by choice or by force).

Supervision, which was in Freud’s time the main source of training and learning the technique of psychoanalysis, took a back seat to personal analysis in the institute system. This had a serious yet subtle bad impact on training. There were many discussions in the training committee I was member of about what the supervisor does if he notices something in the candidate that could be interfering with his learning the technique. This matter occupied several training centers in North America around that time (Mid Eighties). I took the position of mention it to the trainee relying on him to take back to his personal analysis. Some members of the committee opted to restrict themselves to supervision as a separate function of training. I was also promoting the idea of group supervision to the mature trainees, as a means to create subtle insights in the process analysing (did not take off).

The third element is the seminars. This seemingly banal part of training could-in fact- be the key reason to abandon the tripartite system of training completely. The seminars are meant to be where the theory is taught and learned. It is also where the benefits of personal analysis and supervision will integrate in a theoretical foundation. At the present time, I doubt that there is one cohesive curriculum for the seminars for all the training institutes, because we cannot (and should not) specify what is important or chose to teach. In the Canadian Institute (in my time) the first two years were dedicated to Freud and very little to its extensions in the British second group. The rest of the program was to visit the main figures in the French, the American and the budding object relations school in Britain. Kohut was just coming out of the woods. Now, it will be easy to cover the early years of psychoanalysis- Freud and others- in less than two years; if we present them in scholarly manner, since their works do not deal with the current problems that we face. The seminar’s component of the tripartite system need major attention because there is no way to get a consensus on what to keep from the original theory and in what way it could be integrated in whatever is considered significant in the contemporary psychoanalytic theory.  The advances in psychoanalysis have to be assessed nationally and not internationally, because there is no ‘real’ unique advancement that could be internationally accepted.

The academic solution:

If the tripartite model of the training institute is no longer serving its purpose and has become defective or deficient where do we go from there? What we need is a system that would start training early with basics that open the field of psychoanalysis as a branch of knowledge. In that stage the student would know the wider scope of that knowledge to make informed decisions in the next step to what area of psychoanalysis they would like to further their education. In the higher step the student would be able to decide if he wants to make psychoanalysis his future profession. Based on that decision the student would enter the field of training to acquire a recognised certification in his field.  A system of education that move from undergraduate to a post-graduate with recognised training could only be done in academia. Psychoanalysis as a profession should follow the same rout of other professions.