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Saturday, 16 December 2017

4. A view of the future of learning and training in psychoanalysis:

It would be presumptuous if I thought that my views in this posting is going to effect change in the present state of learning and training in psychoanalysis. The resistance to change in the field of psychoanalytic organization (not in theory) is beyond explanation. As one of the quotes that the publisher of “International Psychoanalysis” generously offers us daily says “It is not necessary to change. Survival is not mandatory”.  I think that the maximum my post might do is make more psychoanalysts reflect on the stubborn fixation on the model and function of the IPA training system, which has outlived its usefulness. In spite of acknowledging, in 1995, that psychoanalysis is in a very threatened crisis (see the report of the House of Delegates of the IPA, in 1995).  The report, which is a set of articles written by senior analysts from different societies, ranged from criticising the rigidity of the IPA theoretical position to its laxity, and from the inflexibility of the training system to its loss of identity and vagueness. The best of it was introducing the report by saying that the crises in psychoanalysis is like the epidemic that inflicted Thebes and that we have murder Freud.

The dissatisfaction with the situation created by IPA’s domination od the psychoanalytic scene justified the emergence of universities and university programs in many parts of the world that educate in psychoanalysis, and provide training in aspects of psychotherapy. They are mostly run by trained analysts but their graduates are not recognised by the IPA as psychoanalysts. I am not confident enough to talk with certainty about the adequacy of those academic institutions to train in psychoanalysis. But from the little I know and the few I had a look at their programs I thinks the only obstacle in considering their effectiveness is the loyalty and reluctance of their professors to compete with (betray) the IPA (they are senior members of the institutions in their cities). Contrary to the common belief in the psychoanalytic circles, the IPA institutes offer very deficient training programs. Let alone the rigid belief  that psychoanalysis is mainly  training with some required theoretical background for its practice, training in those institutes is part time, lacks clear standers of education and supervision, unclear about the degree of participation of its tripartite requirements in the formation of the candidates. There is also a major difficulty in dealing with the extensive literature in the clinical field, and in other related sciences, which is overlooked or chosen for teaching for personal preferences among the faculty.

If psychoanalysis is just training in its usage in psychotherapy, the IPA system would only need some mending of its decaying model of learning and training. and that would suffice. Nevertheless, whether psychoanalysts like it or not, psychoanalysis is a human science and not just a method of psychotherapy. No method of psychotherapy, whatever its uniqueness and distinction, could change the human subject and his society the way psychoanalysis did with the whole Western culture. Freud was very conscious of that when he said to Jung on their trip to the US that the Americans do not know what trouble we are bringing them”. I can point out two features in the history of the psychoanalytic movement that confirms that we clinicians did not pay attention to: every advancement in understanding psychopathology opened the gate for knowing much more about the regular ‘human subject’, and every- thing we understood about the individual resulted in understanding issue that are more encompassing that the individual phenomena. As an example, the early conception of repression of sexuality and its discontents led Freud to write about civilization and its discontents. Better, whatever was discovered in the offices of psychoanalysts proved to be much more important on a social level. This is the proof that psychoanalysis is more than psychotherapy. It is also more of a science of the human subject than it was deemed because it influenced the approaches of several other human sciences. Yet, it has to be clearly stated that psychoanalysis is a special human science because it is about the conscious and the unconscious human subject, when the other humanities deal only with issues of consciousness. Psychoanalysis compliments all other human sciences, because including the unconscious in understanding of the subject requires learning a novel way of thinking: the analytic way of thinking.

Psychoanalysts are supposed to be  taught that every psychical given is the manifest of something latent, and that they were also trained to know how to get the latent content through a process of analysis. There are people who area more gifted in that process than others, that is why psychoanalysis as a human science considers the link between the manifest and the latent a matter of learning and not of training. As an example, psychoanalysts should read The Interpretation of Dreams not to learn how to interpret dreams but to learn how a fresh uncontaminated mind (Freud’s) made those leaps from the manifest to the latent, discovering in the way the workings of the primary process in creating the manifest. Learning the psychoanalytic way of thinking is learning how to consider everything human product of an unconscious process that creates a ‘complex’ human phenomenon; or the human phenomena are complex because they are products of conscious and unconscious contents.  Sociologist with a psychoanalytic learning and training will look at marriage and see that behind all patterns of pairing the marital couples is the law of incest: how to avoid it depending of the structure of the society. There is another even more important aspect of the psychoanalytic way of thinking. Freud’s discovery of the role played by the interfamilial conflicts in structuring the unconscious (the Oedipus Complex) obliges the psychoanalyst to think of the unconscious as the way childhood experiences has influenced consciousness, i.e., past or childhood experiences become unconscious. In the other human sciences, the situation is reversed: past experiences are conscious and their meaning becomes the unconscious of the society. However, the psychoanalytic way of thinking makes possible to understand social events psychoanalytically. Nine -eleven is a conscious memory but it created and activated unconscious reactions that were instrumental in electing a black president two terms.  

Psychoanalysis is a human science, and it has a legitimate place in academia. It should be a subject of education first, then its applications would decide its branching into specialization, of which one is psychotherapy. This conception of psychoanalysis imposes on us the duty of looking into the modalities of its learning and training; a task that would make the honest psychoanalysts recognize and realize the limitation of training in the IPA institutes or the similar but independent ones. Having reached this point I find myself in a very uncomfortable bind: I have to show that I have an idea of what I am preaching (or keep silent) but I know that this the work of teams of people from different specializations and are much more competent than I. My experience in academia goes back sixty years and my experience as clinical analyst also goes back several years.  However, I think that moving learning and training to academia should be on the basis of an undergraduate degree in psychoanalysis that covers its onset, evolution, the main discoveries and the extra clinical endeavours, in addition to expose the areas that analytic thinking is required. Post graduate sturdies should be done with emphasis on training, research, collaborative and joint works as the focus of preparing the analyst to work in those fields (just as an example, child psychology, and sociology of the masses).  Some issues of training in the clinical aspect of psychoanalysis will benefit from other academic programs like psychiatry and statistics, that are not available now in the system of training.

This is the end of my post, which is the last posting I will publish on my blog. Becuas of that, I am using this opportunity to express an opinion about training in the process of psyshoanalytic psychotherapy (not in the common coneception of a diluted psychoanalysis). I feel that is could be helpful in clarifying few problems we encounter the learning of psychotherapy.


 Training in the Clinical Practice of Psychoanalysis should not be called training in psychoanalysis, because it is just part of the whole theory

 The reason for underlining this point is a general trend to discarding what is so particular and specific in training in the psychotherapy in psychoanalysis. For training in the clinical practice of psychoanalysis be meaningful, and to serve the purpose of revealing the unconscious (the workings of the primary process in creating the undesirable psychological condition) we have to give extra care to two points: studying, discussing, clarifying and clearly stipulating the importance of Freud’s ‘clinical protocol’ of Anonymity, Abstinence, and Neutrality, and the importance of the regularity of the sessions and their length of time (not the number per week). I am bringing those two points to attention because they were firstly criticized in the literature badly in the eighties and nineties, and secondly because some analysts made a mockery of them by exaggerating them to a silly degree of rigidity. When we come to clinical practice we should remember of our parent’s wise saying: don’t what I do, do what I say. That applies to Freud: do what he says and not what he did in clinical work. The man who discovered transference and transference resistance tried to analyse his daughter!!

Revisiting the Freudian protocol of practice and his conception of transference is essential in distinguishing psychoanalytic psychotherapy from any other psychotherapy. This is what makes psychoanalytic treatment not any psychotherapy. I am raising this point here and now because ‘in my opinion’ rediscovering psychoanalytic psychotherapy is very timely when a review of training is much needed and its future should be considered. Knowing what is therapeutic in psychoanalysis compared to other psychotherapies that do not follow that protocol, makes training in the clinical application of psychoanalysis defined by its function and not by an abstract theory.

To end my post, we should remind ourselves that something significant, major, and essentially daring has to happen in psychoanalysis. I tried several ways to quantitively measure the effectiveness of ‘a clinical psychoanalyst’ if he worked a full day for thirty-five years. The maximum number of patients he could cure ranges between 120-150. Psychoanalysis is more useful than that.

Saturday, 2 December 2017

Psychoanalysis: training or learning?

3. Revision of Dysfunctional System of Training

The training system of Eitingon and its institutes were “unintentionally” a bubble that protected the early psychoanalytic movement from several dangers. The analytic community grew in a homogeneous way, and got early confidence in its distinction from being an organization that is self-ruling. Anyone who wanted to join had to go through the same procedure. The theory was improving and expanding, and it was transmitted to the new comers and the seekers of membership in an organized manner, which tightened the cohesiveness of the analytic community irrespective of its geographic location. Psychoanalysts were saved from having to deal with the critical and negative views of psychoanalysis, which were strong and widespread at the time. Analysts did not have effective means to deal with them within a budding movement few members in number, an unsettled theory and equally unsettling to its members. There was little external social support from the medical profession, which considered psychoanalysis an imposition on it. The new movement was dependent mostly on the status of Freud. 
That bubble was quite useful at the beginning of the movement, but it had its disadvantages. It gave the psychoanalysis a sense of distinction and superiority that was not founded on anything concrete except their isolation. The isolation was reciprocal, as they isolated ourselves from others, others were also avoiding communicating with them. The protective bubble eventually proved to have negative outcomes. Analysts neglected their responsibility to prove themselves and the public was divided unequally in their views about psychoanalysis; a minority was blindly supportive of the progressive ideas implicit in psychoanalysis and a majority were demanding proofs to what psychoanalysts were claiming. Both sides accepted the bubble created by the particular requirement of training specified by the psychoanalytic organization. 
Freud's death revealed a very paradoxical feature in psychoanalysis. During his life psychoanalysts did not make a distinction between theory and practice, or better between learning and training. Freud's view represented both those two aspects of psychoanalysis. Logically, what should have kept the movement united and intact was a stable theory, that it could engender a training system.  What happened was the opposite: Freud did not leave us a theory to unite us, and the system of training, which has become more or less international, functioned as the force behind the continuation of the analytic movement. However,  there were signs of cracks in the organization everywhere due to the evolution of the theoretical issues in psychoanalysis in spite of a silent belief that psychoanalysts was a unified theory. Once again the system of training was the real force that kept the analytic movement seemingly intact. How could psychoanalysis continue on without a unified theory and survive on system of training? Those cracks were not seen then as problems in the theory but were mostly treated as personal conflicts (neurotic idiosyncrasies).
In the late fifties and the sixties of last century a strange thing happened in a natural way; an explosion of publications, formal and informal meetings and media discussion about the unconscious and indirectly psychoanalysis. Almost, a spontaneous ‘international symposium’ was formed from intellectuals in the fields of philosophy (existentialism and phenomenology), literature, theater (the absurd literature of Beckett, Ionesco, Camus!), literary critiquing of old works (Kafka, Flaubert, Dostoevsky), visual arts, and most of all the promising structural theory in the humanities. It was a decade of very rich revival of mutual interest in the human subject, very much in the style of Freud’s dream for psychoanalysis. It was basically a symposium on the unconscious and its presence in all aspects of human phenomena. Some analysts participated ( Rollo May)in that symposium but did not contribute anything of significance, because they were leery of having non-analyst (non-clinician) in their bubble. They were also unable to talk meaningfully about the unconscious that those “amateurs’ were making an issue of.  Psychoanalysts ignored Freud’s third meaning of Ucs. as a system  and the non-repressed unconscious, as they still do. They also did not pay attention that the unconscious has become culturally acceptable and ordinary people started to integrate psychoanalysis in their daily life. In other words, analysts and the analytic organization did not take score of the changes psychoanalysis has introduced to the world outside the bubble of training. The protective bubble changed to become a salient cell of isolation. There is no better verification to this customarily denied fact than what happened soon after that symposium.    
By the seventies clinical psychoanalysis was well founded and extended its domination on several well-established professions like psychiatry, for instance. It also found a place in academia but not in the programs that could have adopted it to link firmly with the university. Yet, something ‘unexpected’ actually happened: the superficial cracks in the British society were no longer mere personal disagreements but were fundamental theoretical differences. The same happened in France but the Lacanian group gave the splits a different flavour: it was a conflict between something  fascinating but does not promise stability and continuity of staid scholarly revision of the Freudian theory. In the US the ‘schools’ accepted coexistence almost creating a federal system of psychoanalysis, yet there were also very novel approaches to long  ignored psychical issue like the psychosomatics, the narcissistic disorders and the borderline conditions. As far as I know, psychoanalysis in South America leaned toward accepting a coexistence of the Kleinian the Lacanian approaches. The diversities of views in the international scene of psychoanalysis were threatening an imminent disintegration of the psychoanalytic organization. Wallerstein as the president of the IPA suggested to accept in principle of psychoanalytic plurality (1989). The schools, as I mentioned in the first part, where not theories of analysis, or new trends in practice; they were the adopting new aspects of the human phenomenon and working on them as main issues in the psychoanalyzing the human subject (interpersonal relations, intersubjective interactions, with contemporary conflicts, etc. In other words, psychoanalysis was no longer a unified theory, but remained a system of training. What is peculiar about that is neglecting the fact that training cannot stand alone but has to be "training in something". So, if psychoanalysis is not a unified theory then we should end up with different kinds of training. This is not the case. We ended up with three training modalities for several schools pf psychoanalysis. Once again the mere concept of training is the force behind the unity of the psychoanalytic organization. Could we have one way of prayer that fits all our religions?
At this point I need to underline an idea that might not sit well with some (many!). After Freud’s death it did not take long for his ‘presumably’ unified theory to fragment. It is easy to use a psychoanalytic template to relate that to the death of the father, so on and so forth. The fact of the matter is that psychoanalysis came with the finding of the unconscious to make the human subject a viable subject for understanding, thus opened the way for disagreements about his understanding. The maturation of the psychoanalytic movement proved that psychoanalysis is a multifaceted approach to the study of the human subject and not a simple one unified discipline. The notion of psychoanalytic plurality became a licence to form schools, which camouflages the fact that psychoanalysis is the science of the human subject and not the amalgam of points of view regarding him the. It is important to bring to attention that all those schools maintained the concept of training with its tripartite structure, and the society and the IPA as the mother of the institutes. In other but more revealing words: the divisions in psychoanalysis kept training and the institutes model as the bubble that keeps outsiders out of the psychoanalytic community.  The revelation that psychoanalysis is not a unified theory should have made analysts look closely into their basic premises and decide if they should follow the training system of the unified Freudian theory or adjust their training to the future practice of their premises.

There was no time in its history when psychoanalysis when a unified theory engendered agreement between all its members. I think that psychoanalysts upheld the idea that psychoanalysis is a matter of training-whatever their theoretical affiliations-to maintain that it could be done only in the IPA institutes. This attitude admirable as it was and still is came on the expense of psychoanalysis itself: it is no longer of any recognizable features, identity, or even professional weight due to putting the emphasis on preserving the institution and not psychoanalysis itself.  Instead of going on articulating the obvious without clear aim to my effort I will give my opinion as I have reached it over several decades of gradual change from a dedicated and loyal advocate of psychoanalysis to becoming a candidate then an analyst and moving to being a training and supervising analyst and finally, now I am back to where I was at the beginning: a dedicated and loyal advocate of psychoanalysis.

Psychoanalysis would force the honest clinician to admit that it is a science of the subject, i.e. it is not just a technique to be trained to use. Better, since analysts could practice psychoanalysis by choosing different psychological manifestations to work with, then psychoanalysis is a branch of the humanities, i.e., psychoanalysis is a human science that covers the totality of the human subject and not only his interpersonal relations, his intersubjective dynamic, his conflicts, etc. Just because it was delivered by a physician and not a mid-wife it is neither a medical specialty nor just a method of treatment. All human sciences (even physical sciences too) started as a unified field to eventually reveal that it could branch out into specialties. Wundt’s and William James's psychologies are now  dozens specialties with links to dozens of specialties.  Acknowledging that psychoanalysis is human science requires realizing that, as such, it was destined to branch out into specialties that links with other sciences, not only idiographic ones. This idea would not find welcoming ears, not because it is wrong but because to comes close to several sensitive points in us. Psychiatrist would consider it a threat to their established privileged position in psychoanalysis. Other professions like psychology and social work, which are involved in the health providing services, would not like being grouped with other branches of the humanities that are not in the field of health services (education, sociology, politics, etc.). Nevertheless, it is not the lack of supporters for the idea of defining the 'genre' of psychoanalysis as idiographic science that would fail; it is the demand it puts on us (all) to revise the system of learning and training in psychoanalysis if psychoanalysis is considered a science in its own right.  

What would the learning and training in psychoanalysis be like if we, our training institutes, and the IPA accepted the idea that psychoanalysis-on its own- is a science and that training in its technique of psychotherapy is only one of its facets?