Once More

Psychoanalysis and the Academy:

Four

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 Proper Place of Psychoanalysis is Academia:

A.    A proposal for improving training.

Kernberg and Michels’s published a proposal of changes to the present institute system of training so that it could be moved to academia to benefit from the strength of its establishment. A second reading of Kernberg and Michels’s (K&M) proposal reminded me of a discussion (argument!!) I had-some thirty years ago- with a former mentor who was Lacanian. Lacan’s seminar that year concentrated on the concept “desire”.  I said to him that Lacan does not make a distinction between desire (Desir) and wish (Souhait), which are different in implications. He replied that there isn’t any difference. I mentioned that dreams are wish fulfillment and not desire gratification. He gave up in exasperation and asked me to say what is the difference. Knowing that Lacanians respond by making statement that breed other statements I said that wishes are appeals and aspirations, and desires are demands and expectations. That was the end of the discussion and several other things.

I mentioned this event to point out that K&M proposal is a weaved fabric of wishes that deceptively look like a well thought of practical plan to change training in psychoanalysis and prepare it to become part of an academic endeavour. It was not easy to come to such conclusion. Most living analysts are indebted to Kernberg for a substantial body of knowledge and I think he and Michels just did not notice that their proposal is wishful thinking. To give an example of that failing I quote them: “we believe it is possible to develop reliable, transparent criteria for assessing standards that would justify the certification of psychoanalysts as a competent member of the profession. . . We believe that it is possible to define minimally expected knowledge (assessed by instrument) and that a broad spectrum of technical capacities can be achieved and evaluated as has been demonstrated for other medical specialities using clinical examinations that test knowledge and technical ability” (JAPA, 64,483-4). This statement of K&M is confusing wish and none existing reality. The reality is psychoanalysis is not like medicine, never was and will never be, or even be like clinical psychology if that matters. In medicine, you can look at blood work and know the size of his spleen to come up with the desired conclusion, without even seeing that patient. In clinical psychology, you could look at an MMPI profile and a Rorschach protocol in isolation of the patient and give a good diagnostic opinion. In psychoanalysis, there is no substitute for seeing the patient and be seen by the patient to do your job. Psychoanalysis is not like or will ever be like the regular medical specialities. I am blindly sure that K&M knew that but their wish for a solution they do not know where to look for blinded them from this banal idea.

Their proposal is a nice woven fabric of wishes of that sort.  As an analyst and a training analysts, and also a psychologist who knows enough about “assessment instruments” and the difficulty of constructing and validating them I would say to K&M please forget about this type of assessing standards of professional competence, and be ware of what you wish for. I will end this section of the post with a more comprehensive statement about wishes and the innate inhibition we have when we face the reality of the need to change our training system.

Now to K&M’s proposal.

·         The absence of professional standards of competence. They look for those standards in the trainers and trainees, not in the substanceof training, which is obviously of poor quality in general (will come to that a little later). 

·         A closed and a private educational system which mystifies the process of training. They considered that that was advantageous in the early stages of training but not anymore.

·         The closed system of training necessitated -at the beginning- forming an intellectual elite (the training analysts’ system), which with time became a major factor in the deterioration of the standards of professional competency. It also affected the relationship between the institutes and the branch societies, and created a general atmosphere of discontentment in the psychoanalytic community.

They skirted around those problem, which they considered a threat to the future of psychoanalysis. Yet, they made another clear statement about the more acute and pressing danger by saying: “The barrier between psychoanalysis and the university, perhaps necessary in earlier years, may well have become the greatest threat to its survival” (ibid,487). What is that barrier? This barrier is identified in the proposed solution: integrate psychoanalysis in the academic enterprise, but they did not why and how that is going to save psychoanalsysis. They said that isolating “training analysts” from outside interference or imposition is a problem that has to be overcome. They implicitly believe, and rightly so, that those three problems would find their solution by moving training to academia. However, they did not mention or notice that training as it is performed now andevenafter the suggested improvrments would not integrate well in an academic system. It is not possible to improve the present system of institute training and aske a university to adopt it as a specialty institute in one of its faculties.

To avoid this striking fact K&M identify two other problems in integrating training in an academic entity. The two problems are: the lack of research that support the credibility of psychoanalytic thought, and the need to improve the present system of training. Despite their faith in the feasibility of moving training to the university they foresee a conflict between institutes that are academically initiated, and imported institutes, like ours, that preserve the tradition of its origin. Universities would considered our institutes unfit to train psychoanalystswould not be ready to change our traditional ways of training.

The second problem is research in psychoanalysis. This is just one of those dreamy wishes and distraction. When psychoanalysis was in the zenith of its glory it was not standing high on research bases. Psychoanalysis suffered from loss of credibility when its training system was producing poorly trained and unqualified analysts. In other words: the credibility crisis in psychoanalysis, which is very real, is caused by the quality of the psychoanalysts and the psychoanalysis they practice. Moreover, it is notpossible to do reaserche in psychoanalysis. There are two kinds of research: explore to verfy, and experiment to prove.

The reason behind the deterioration of the standers of professional competency is in the training system and could be summarized in five points:

1.In the early years of the analytic movement there was a lot of new discoveries and there was eagerness discover; things that do not exist now as a natural result of a maturing theory.

2. The system of institute training was adequate because it was founded on transmitting the available knowledge-whether theoretical or clinical- to a new generation, which was assumed to have no other means to get that knowledge except through personal contact with senior analysts.

3. In spite of the new discoveries the theory was changing in the same direction, when now there are schools of psychoanalysis with major differences in their basic stands from the theory.

4. The population of patients and the prevailing psychopathological classifications were stable. There was limitation to the changes expected in curricula from one class to another.

5. (This is a major and neglected aspect in training) The birth of psychoanalysis was the initiator of the birth of the human sciences. Psychoanalysis became a discovery that does not belong only to the clinician but belonged to all those who are involved in the studies of the human subject. The pride of the early psychoanalyst in their pioneering explorations of the human phenomenon changed to conceit in contemporary psychoanalyst, when they insisted on maintaining the identity of the legitimate owners of psychoanalysis.

Those five points do not show some flaws or mistakes that need correction; they expose fundamental characteristic in the present system of training that result in poor quality training. They also make focus on the tripartite structure of the ongoing system of training: Seminars, supervision, and personal analysis. K&M suggested some impotent improvements to the seminars and to supervision, in addition to clarify some aspects of assessing the progress of training and graduation. Their suggestions could improve what is presently don in those areas of training but they do not offer any changes to the system of training. The reason I mention that is the fact that if we aim at integrating training in the academic system some very radical changes has to be implemented first.

B.     The unacceptable solution:

Because K&M were talking mainly about psychoanalysis in the states they did not say much about it in other parts of the world. In other parts of the world there is a steady trend to bring psychoanalysis to the universities, though from the few examples I know of there is hesitancy to go all the way and move training itself to the academic institution. I believe there is connection between the wish for improving a decaying system of training, so that it could be maintained and kept, and the hesitancy to move to a better and more sustaining method putting psychoanalysis on the right track of progress. I will dare myself and say my views now and spend the rest of this section of the post and the next in explaining my point of view. It is a point of view that triggers immediate refutation, though it should prompt serious consideration. I think

The present training system (the institute system) should be phased out and replaced by the academic system of educating and training professionals. Psychoanalysis is losing its grounds because it is a discovery that opened our eyes to a much and much more discoveries. Those discoveries are too immense to include in our seminars, and too important to ignore.

This shift to an academic system of education and training would also imply that psychoanalysis is a profession that has several specialities, one of which is psychotherapy. Thus, psychoanalysis would get its status as an academic branch of knowledge and the clinicians would be trained to practice a profession and not merely the ‘art’ of treating people.

The seminars and supervision component of the tripartite institutes system are much better served in academia with its rich and varied faculties, instead of the limited teaching and supervising resources of the institutes.  But what about the third component of personal analysis? This issue deserves a special section in the post.

I have two reasons to advocate phasing out the present system of training: there is no hope that improving it will stop the continuing decline of present-day psychoanalysis. The idea of training psychoanalysts in itself belongs to a very different psychoanalysis; psychoanalysis of movement, when psychoanalysis now is a theory behind most of the ideographic sciences. Therefore, its traditional training should be phase out to get replaced by other suitable training systems that match the new conception of psychoanalysis.

The second reason, and as K&M state: “the educational system [in psychoanalysis] is old-fashioned, it should be modernized…we invasion not a psychoanalysis that will be more scientific than it is today, but rather one that will include and welcome superior science and will therefore be influenced by it.” (ibid,539). Where else could that be done except in a university setting! How could it be done!

Yet there are obstacles in that solution. Psychoanalysts do not accept training be part of an education (as in all other professions. Worse, they have no plan to phase out their system of training and integrate clinical psychoanalysis in a more comprehensive scientific initiative. Psychoanalysts are attached (mindlessly) to their institution than to psychoanalysis itself.

Three are more obvious reasons to plan and prepare to move the functions of psychoanalytic institute to a department of psychoanalysis in the university, than any obvious reason to keep tinkering with a dying system. The result is the chance (maybe the only chance) to keep clinical psychoanalysis alive. Just at the numbers is evident enough.

In the next section of the post (section 5) I will deal with the sacred cow of psychoanalysis.