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.

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 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.