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Monday, 10 April 2017

Part Five: 
Training and the analytic community:
Psychoanalysis in Europe, particularly in the Latin countries, did not depend ‘that much’ on the clinical psychoanalysts to advance and keep going. It got very good and valuable input from the public both the analytical savants, and just cultured people. However, clinical analysts in Europe did not decline their responsibilities and worked on some of the traditional topics in clinical work, e.g., reconstruction and the bases of some of the main concepts like sexuality, affect, narcissism. Psychoanalysis there maintained its distinguished status among the intellectuals despite suffering from the same international trend of declining interest in its clinical practice. In the USA clinical psychoanalysis suffered from the same trend of declining interest in its clinical part, but it also suffered from the declining interest of the clinicians in their field. They stopped developing clinical psychoanalysis as I pointed out before. Because clinical psychoanalysis in North America was almost a synonym of psychoanalysis, psychoanalysis started to die as a result. The interest in exploring the clinical domain was neglected because of an implicit belief that it has reached its limits, instead of realizing that analysts refused to change with the change of their patients. Clinical analysts became instead theoreticians who embarked on ‘modernizing’ the classical theory. The subtle and indirect result was deterioration in the quality of psychoanalysis and the drop in the interest in it. Therefore, reviving psychoanalysis needs the clinical side to explore new horizons in the area of technique and practice to answer to the new psychopathologies we work with now. To do that, we have to plea, advocate, act, and go to our basic psychoanalytic characteristic: breaking new grounds of discovery in all the stagnant aspects of our discipline: teaching, training, supervising, qualifying the new generation of psychoanalyst, revising our arsenal of basic literature for a revitalized training system, our believes that we kept as if they were religious sacred ides. However, all that could be done in a destructive way if we do it as attempt to rid ourselves from whatever psychoanalysis we still have. But it could also be done to protect the psychoanalytic revolution from becoming history.
I will get directly to the practical way to achieve that (in my opinion).
It is more than clear that the trajectory of the future of psychoanalysis is to decline and inevitably to disappear; that is if we insist on maintaining the present course of qualifying psychoanalysts. After a hundred and ten years of its life and after the glorious first half of its life, the membership of the IPA stands at 12,000 members in the whole world. This is close to the membership of the APsaA in its glorious days. Psychoanalysis will die either by attrition (the age of its membership) or by suicide (implosion under the weight of its haphazard obsessive trend to increase the membership numbers). There is good arguments that the IPA and its branches could be responsible for that, not only by neglect but by active undermining of making the necessary changes to training.   
·          In Europe, there are very serious and productive universities that are teaching psychoanalysis and providing equally serious training in its various aspects. Those universities are established and run by “baptized” trained psychoanalysts. In my limited contact with a couple of those universities it was emphasized that the graduates are not trained to be called psychoanalysts. This point was stressed by the faculty, because the faculty of those academic programs are members of the IPA and would not undermine its status. The education and training of the students qualify them to officially practice the psychotherapy they learn in their university programs (which is psychoanalytic). I surmised (and I could be wrong but not much) that the academics who run those programs, who are graduates of the IPA, do not want to create problems of ‘conflict of interest’ with their basic training institutions. Thus, with very minor changes in those academic programs to include trivial differences from the APA’s training system the graduates could easily become members of the IPA. They are, in more that one way, better qualified as psychoanalyst but need vetting their clinical because the regular institute candidate is accepted for training after obtaining a degree in a specialty in a branch of mental health.
·          Opening up a sincere and mature discussion of the almost delusional conviction that the local, regional, and international organizations have the authority to certify psychoanalysts, will expose a basic misleading belief. The IPA training institutes do not certify the graduate to practice psychoanalysis. We are accepted in the traditional institute because we are already certified to practice psychoanalysis (treatment of patients). Removing this false impression from our unchecked believes would give the universities the freedom to establish it own standers of practicing a mental heath act, and go full speed in improving their programs to create the profession of psychoanalysis. If the IPA refuses to accept those graduates as members- who will be in the hundreds- it will be submitting its future to dissolution.  
·          To minimize the ‘withdrawal symptoms’ of such a bold change the IPA could be given partial say in the academic programs and a period of grace to participate in building those academic programs. This, I believe, will easy because up till now both camps are made up of psychoanalysts who think and talk the same language and have the same objectives. Another privilege could be allowed to the IPA to  continue its institutes’ training parallel to the academic programs until it fades away in a natural way. Recognizing, agonizing and admitting that the present system of training is deceptive is in the best interest of the IPA and its national and regional branches. Psychoanalysis will regain its status by being part of a system that adopts clear, traditional, well tested and proven models of training professionals, which of a higher caliber to the present outdated system training. The present system has been described by hose who are in charge of it as being corrupted by factors that are intrinsically part of its structure.
·          Turning psychoanalysis to academia will change the narcissistic element of getting the institutes training into professional pride. Becoming a psychoanalyst with an accredited university degree in psychoanalysis is much better for us as analysts and for the needing patients, because a university degree qualifies a person objectively to belong to a profession. The years of learning psychoanalysis in academia that should replace the numbered (counted) hours for gradation will give the psychoanalyst a distinct identity instead of the vague identity of a member of a trade.
·          Hopefully, this will also deal with a central issue in training: personal psychoanalysis. In the academic setting of training personal analysis should not be this mysterious obligation that serves a false purpose. On the contrary, it will be a necessity to benefit properly from the clinical supervision part of training. Without it it will be difficult to meat requirement of competence in dealing with psychoanalytic situation and technicalities of the set up of the analytic session. The candidate realizes specifically what it is for, and where its functional usage stems from. Personal analysis in the present system of training has to be neuroticized to be swallowed and accepted.   
·          There is an obvious characteristic of contemporary psychoanalysts. They are very noisy about their imaginary acts of changing without looking at what they have changed. This is a main feature in irrationality. The irrational is usually so absorbed in stubbornly repeating his previously failed solution, that he would not notice that he is actually without real hope in changing anything. This feature is complicated in psychoanalysis: contemporary psychoanalysts have already witnessed the failure of several previous attempt to change psychoanalysis. They also witnessed-as candidates - how their training was useless or limited in keeping up with changes within the area of practice. Therefore, they resort to idealizations to tolerate the disappointment if not repression in their training and training analysts. Repeating their experiences is sometimes stretched to imagining that what they are doing is improvement or different from what was done with them. We do not encounter this irrationality in academia. A failed program is recognised as a failure according to the traditional academic standers and not according to how the creative professor or the students feel about their professors.

Closing words:
Anyone who lived long enough and kept an eye on the past and the other on the future will see that we are at a different moment in the history in our evolution. The human subject has changed drastically after the last three centuries and is now better equipped to judge himself than at any time before.  The irrational clashes and wars of those cemeteries, in particular, were baffling and led to Freud’s discovery of the existence of psychical life. Psychoanalysis has given our forefathers a way to think about the human factor in shaping history. Wars and irrationality have become unacceptable human attributes. By the end of the twentieth century the human race-for the first time- renounced the old morality of discriminations. But, as the last breath of resistance to that radical change we face desperate efforts to maintain the ethics of discrimination. For example, the advancing movement toward ignoring borders and boundaries in Europe generated the Islamic segregation ideology, which is based and founded on another internal segregation and a split between two fictitious religious sects. The agonizing terrorist waves are reactions to the unstoppable movement toward a unity among the developing human race.

At least, we can realize the breakthrough psychoanalysis has created to advance our knowledge of the psychological nature of our existence. But, it will take some convincing that psychoanalysis is not a great discovery; it is the outcome and the by-product of a need to know what we the human subjects are made of. Freud reacted to that need well, and in the best way possible. Now, as we have already achieved that success, and we are already evolved beyond the point he reached and guided us toward, we cannot stop at that. It would be a major mistake if we let ourselves believe that we can face the new human achievement by a psychoanalysis of the part-object, the introjected bad breast, the tragic man, and the democratic patient-analyst relationship. We have to evolve and change. The clinical analysts have to assume the responsibility of exploring new horizons in the practice of psychoanalysis and come up with questions and answers for the none clinical analyst. The important point here is that psychoanalysis could die as a clinical discipline but not as the theory of human subject. We need to change to remain useful because if we don’t psychoanalysis will continue its advancement and we will stay behind,

Saturday, 8 April 2017

Part Five:
The Irrational Resistance to Changing Psychoanalysis:

I define the gist of my Post: New Horizons for Clinical Psychoanalysis by two aimed for objectives: First: Bring to attention that clinical analysts have stopped considering their field an ever-evolving field in the area of clinical work, and put most of their energy and creativity in recycling recycled concepts (several times) of the original theory of psychoanalysis. Second: that clinical psychoanalysts are not giving attention to the deteriorated condition of psychoanalysis, both as theory and clinical practice, although the claimed the responsibility to bring psychoanalysis out of its slumber. Temporarily, I would say that the closed community of psychoanalysts and the institute system of training that is archaic and strained are insolating analysts and candidates from the outside world of the humanities and do not allow or accept non-analytic criteria to measure their activities against.
A closed community is not closed by force but by choice; analysts seem to like it like that. Everything in the field of psychoanalysis show that change is desirable, required, and most of all inevitable, that is if we care to keep psychoanalysis viable we are inclined to be part of its future. All the efforts made to maintain the status quo have failed. Wallerstein, over thirty years ago suggested the big tent idea. That was-against his expectation-a call for whoever to spread their own tents. The recent efforts to resuscitate psychoanalysis locally or internationally are just delaying its demise. Although there are not many suggestions to revive it there is undeniable irrational resistance to considering changing the status quo. The irrational is continuing the failed solutions with hope that next time one will work instead of trying a new solution
What is new that calls for change?
There are two issues that are seldom considered by clinical psychoanalysts because they insist on denying the obvious: they are dealing with new and different patients that they study in the Institute training. They overlook the fact that humans now are very different from what they were two hundred years ago, for instance. We change and make our changes change us. Over time changes affect our psychical and social life, they generate new and different emotional concerns, even new moralities. We form different ideas on maters of society and individual responsibility which in turn demand new ways of bringing up our children, thus influencing the intrapsychical dynamics of the individual. Those changes might not interest the limited clinical psychoanalyst but there no way away from studying the factors that impact clinical practice and our views of psychopathology. It is unlikely in todays practice of clinical psychoanalysis to encounter patients that are similar to the patients that were treated by our predecessors. Anxiety hysteria for one, was the neurosis of preference for the middle-class females of Vienna a hundred years ago. Now it would not be called a neurosis anymore but just feminine silliness or neuro myalgia. Patients fifty years ago, came with symptoms, when patient of nowadays come with the complaints about their lives. Without considering that fact we will not notice that our theoretical mess and confusion about practice come from refusing to change, while the patients are changing. Thirty years ago, there was still room in the field of psychopathology to name new kinds of patients. They came without displaying neurotic symptoms so we were able to call them ‘narcissistic disorders’, but not any more. Most of the very successful and well adjusted people and leaders of our time would be diagnosed that way if we are not carful to acknowledge that we humans have changed lately and could not be understood using old nosologies.
Secondly, all the previous attempts at formulating a comprehensive theory of psychoanalysis were derived from poor and hasty theoretical configurations of psychopathology. The reason is that psychopathology was a novel way of looking at human nature. The novelty was also in finding new vocabulary to describe the new discoveries. The new vocabulary was implicitly suggestive of a sort of explaining the described behaviour (repression, defense, resistance sublimation, etc.). The newness that was introduced by the psychoanalytic movement to the budding branch of psychiatry generated the idea of psychotherapy. For the old generations of psychoanalysts this novelty did not cause any confusion. They did not concern themselves with what is not pathological; the normal was just normal. They were working with symptoms and to a degree some purely psychical complaints that had some semblance to symptoms. Although it took time before we started to spread our wings to apply psychoanalysis to “non-pathological’ manifestation of the human subject, we did not have anything else to use but our theory of psychopathology. Frequently some of us came up with ridiculous explanations of ordinary phenomena and considered that “application” of psychoanalysis. Applied psychoanalysis of the time was not applying the psychoanalytic method of investigation of certain phenomena, but applying the theory itself of psychopathology on non-pathological phenomena, both individual and groups. The necessary distinction between a general theory of the unconscious (a theory of the subject) and a specific theory of the unconscious ( a theory of the patient) was not made in those works; psychoanalysts then were fascinated by their newly discovered freedom to engage-with authority- in any sort of debate about the human subject and his phenomena.
The outcome is what we have now: desperate attempts at formulating theories to regain a superiority lost, when we have made almost no new clinical discoveries for decades. Confusing what the analyst listens to with the practice of a new presumably new psychoanalytic theory is now accepted as our advanced clinical psychoanalysis. What I mean is: the analyst who identifies himself as a self psychologist convinced himself that he is listening to the self and not to what the object relationist listens to. Presumably, if the self psychologist still considers himself a psychoanalyst he should be honing in on something unconscious in whatever the patient is talking about. The psychoanalytic technique of practice is looking for the unconscious in whatever patient’s is presenting in his speech. Thus, a smart response to my interjection would be that the analyst listens to what he considers more demonstrative of the unconscious than other things. A smart reply to the smart response is: what do we psychoanalysts endeavour to achieve with our patients: change ‘their’ selves, their intersubjective relationships, their object relations, etc., or try and help the patient change himself so he could later change whatever he likes or dislike about himself?
What is new in clinical psychoanalysis is calling mere unsupported view points psychoanalysis, under the guise of contemporary theories. We, clinical analysts neglected our responsibility of preserving the original theory, and adapting the newness of psychopathology to that theory not adapting the theory to the original conceptions of psychopathology. I will give example a little later.
The Source of Resistance to Change:
The contemporary literature of psychoanalysis is rife with poorly recycled ideas of earlier analysts; mainly the second generation (Klein, Bion, Winnicott, Hartmann, Fairbairn, etc.). When those ideas and their terminologies were first published we (third generation) new what they meant: they were terminologies that explain the vocabulary of the first generation in a manner that is offering the chance to formulate a theory of the subject. The good-enough mother, the good object, the alpha and beta functions, did not stand for something new; they meant a mother that give the child a healthy Oedipus triangle, a father that encourages his daughter to be attached without guilt or shame, or coexistence of primary and secondary processes creating the link between fantasy and thought. Compare that with a young analyst (20..!) who translated Freud famous adage of where id was ego should be as the: “growing up (the task of the child) and getting better (the task of the patient) have to do with transforming id into ego. Freud’s adage was a metaphor that expressed the outcome of interpretation in a good practice, then, the young clinical analyst used that adage as a concrete replacement to making the unconscious conscious.  The original and its explication are now a theoretical idea that has no roots, except historically. Contemporary psychoanalysts and the candidates of recent believe that if they could use those adages of the older generation analysts correctly then could claim that they are doing clinical analysis as well as those other analysts. Just as an additional clarification to that: could any new analyst tell me what is the clinical equivalent to “the persistence of searching for the good object”, or how could I convey to the patient, in the simple direct language of interpretation or reconstruction, such neurotic inclination? I had candidates in supervision and in the seminars who knew all the concepts and the vocabulary of the old and the latest improvised theories but did not understand them or know what they could extract from them to use in practice. They were flaunting their knowledge, which in fact worked as a barrier between them and understanding psychoanalysis: Listen to the patient (not to Winnicott or so and so), Understand (not invite Klein to understand him for you), Interpret, and reconstruct the patient’s associations (which must have told you his specific experiences not some generic stories).
What is new and has to change starts with training and the link between Institute training and the psychoanalytic organizations. The reason is that psychoanalysis now is more involved and more elaborate to be communicated and transmitted to new generations of already keen candidates in five or six hundred hours of seminars and supervision. It is also in foundational links with several human sciences that were not existing when the training institutes were first established. Changing training to meet the requirements of a modern psychoanalyst will demand and force radical adjustments in both in system of trainingg, the faculty that will train, consequently the psychoanalytic institution and its professional functions, A threat that made some privileged psychoanalysts resist and fight against, even if irrationally.

How to go about that when and if we manage the resistance to change.