Psychoanalysis: Between Improving and Changing

6-7. University or Total Extinction.

The drop in the number of patients in psychoanalytic practice overwhelms psychoanalysts but highlights something not mentioned yet in our discussions of the crisis.  Psychoanalysts are certified professionals in three mental health professions (medicine, psychology, social work), and could practice their original professions along with a practice in psychoanalysis, and keep fully busy. However, psychoanalysts - almost always- refuse to consider their basic profession part of their pronounced identity as ‘psychoanalysts’. So, the crisis is really in psychoanalysis as a dying profession and not in its practice as a way of making a living. Analysts expected psychoanalysis to guaranty their practice, and did not pay enough attention to the gradual decline of its quality. In addition, they did not assume their responsibility for making the changes that would make it remain viable in practice. They preferred tinkering with it to accommodate their own preferences in practice. Freud’s tripartite protocol of practice demands strict discipline that some analysts could not bare, so they allowed themselves to do away with it, and in some cases to an objectionable degree.

The IPA did something similar: it relied on its membership to maintain its relevance, but it abandoned its responsibility to preserve psychoanalysis and allowed gradual divergences to become serious deviations. There is no honest and solid argument that would deny that the current crisis in psychoanalysis was and still is a crisis in the training and the formation of the psychoanalysts in the different specialised institutes of psychoanalysis. We might have now a crisis in the practice of psychoanalysis because of bad training psychanalysis in unsupervised institutes. The result of this possibility does not need any comments. What will happen in the next decade??  In 1966 there was a funny movie with the title “The Russians are Coming…The Russians are Coming”. I will use the title to say The Chinese are coming…The Chinese are coming. They will come in the tens of thousands and will- to the delight of the IPA- inflate its membership. Do we know much about their training and the training systems they will adopt after they anticipate from our present contribution to their preparation!

Unfortunately, and maybe fortunately, the crisis is the making of the IPA and its members, and not created by external factors. So, we can improve the situation if we want to, and if we will be able to take care of the unconscious resistance to change. The possible resistance will come from pride or guilt. The report of the IPA in 1995 poured the blame on outside forces that were even used to justify deviating from the traditional system of training. The report gave excuses for the analysts’ inaction and characterised those excuses as resistance to lowering the standards of classical practice to accommodate the presumed outside forces. In fact, the seeds of denying our responsibility for the crisis were already there in the report. The authors of the report predicted further decline in the number of patients, but were disagreeing on the causes: is it because of the continuing strictness of the, criteria or the tendency to relax those guidelines. The statements of the report and what materialized after its publication was denoting persistence of pride exemplified in we know better if we should change our techniques or not, and that we also know how. Obviously, we did not and still do not know. Guilt comes form admitting that we did not improve training but actually allowed it to decline and deteriorate. Realizing, admitting, and accepting all that requires courageous honesty. A review of the training systems in the last three decades would lead to admitting harmful deviation from original psychoanalysis to accommodate some ‘idealised’ training analysts who perpetuated to chronic belief that psychoanalysis is the ‘creation’ of individual geniuses. This tendency is very glaring in North America, but we should not forget the Lacnian waive and crisis of the short sessions crisis.

The crisis of psychoanalysis is a crisis of the formation of the analyst and confusing learning and training on one side, and practice and the analytic body of knowledge on the other. Some analysts do not make much of the separateness of those two opposites.

A Case for Change

It is problem nowadays is to agree on what psychoanalysis is, although there is an abundance of activities that calls itself psychoanalytic. Moreover, no organization, not even the IPA, has attempted or claimed the right or the ability to arbitrate that complex problem. Therefore, psychoanalysis-as a term- could currently be bestowed on none psychoanalytic activities without reservations, and psychoanalysis, this way, could exist (fictitiously) while it actually is not existent. But there is twist in that quasi-excuse or accusation. Analyst from the three professions, mentioned above, know that if psychoanalysis (to others) is only psychotherapy then they, as the psychotherapists, have to answer this question: What do we treat? We cannot say we treat pathological conditions because such conditions are not separate from the patient like diabetes and the diabetic. If we say we treat patients with pathological conditions then we should complete our answer by specifying what is a pathological condition: what does it mean that a patient of character disorder is psychopathologically affected? How those affections show and manifest themselves in patients. All possible answers to those details in practice come from the lexicon of psychiatry because psychoanalysis does not have its own lexicon of psychopathology. I am doing this exercise in controlled thinking to show that we, psychoanalysts, have withdrawn to our institutes and our international organization in a self-feeding processes, which has a negative effect on training. We transformed the uniqueness of the psychoanalytic discoveries of a half a century into personal distinction that isolated us from the world of the humanities. We refuse to be clinical psychologists or social workers anymore and retreated to an identity that does not have a defined entity yet. We are psychoanalysts without a psychoanalysis that has a meaning: there is no surgery without medicine because medicine gives the surgeon his professional identity. In the same way we need to identify psychoanalysis to give us our identity as psychoanalyst. The reason I keep harping on this point is because the little body of knowledge that we assume to be enough to practice psychoanalysis is full of substantial mistakes that causes concern. Those mistakes could quickly and accurately be corrected if psychoanalysis is a university department or even part of a department of psychology in a university. Academic knowledge forces correctness because the academician is accountable to the body of knowledge not to his colleagues.

Lately (March 24, 2019) Mark Solms (who is in charge of the new revision and translation of Freud’s Standard Edition), chose 7-8 terms to show the audience of his lecture how wrongly they were translated by Strachey and caused fundamental distortions in understanding psychoanalysis. As an example, Ego is Ich or I in English. It is not “a thing” or a psychic entity: it is the pronoun of first person. There is no Ego to strengthen or to treat; there is Ich or the pronoun I that is speaking to us about itself. As the patient says I lose my concentration when my superior criticizes me, he is not saying I have a weak ego; he says to the analysts I lose my natural sense of being when attacked. This condition determines if the analyst should respond, and if so with what. Psychoanalyzing is the act of showing the patient that what he said had another implicit meaning which deserves talking about because it could be affecting him without being aware (not using the term unconsciously because there is nothing that could be called “the unconscious”). Unconsciousness is a metaphor of a state of mind and not a signified.

If our training does not lead us to what psychoanalytic knowledge has taught us about the subject we will be totally lost because, all what we would be left with is some fictitious metaphors about imaginary psychological issues, i.e., metaphors of real things. Most of the time the candidates do not have clear knowledge of what they treat or they consider the terminology that was improvised by Freud or other authorities ‘things in themselves’ (projection, enactment, failure to construct the right self object, etc.). Neglecting, in training and learning psychoanalysis to show the candidate (and sometimes full-fledged analyst) the difference between what they encounter in practice and what they read in the literature results in difficulties in the relationship between the candidate and the supervisor (another angle to deal with the problem of the training analyst). Those issues and several others make me say that those essential problems in learning and training could not be properly managed in the present system of training in the IPA institutes. There is a lot to know before we teach psychoanalysis properly, which the system of the intuited could not hadle. The possibility of changing learning and training to be an academic endeavour should be seriously considered in the psychoanalytic circle. 

The way analysts are qualified lacks two basics: a spelled-out statement about the minimum theoretical knowledge that a candidate has to acquire before applying for training, and reviewing the time and the manner the tarining time will be managed in the process of training. It goes without saying that the institutes should also have a clear theoretical program for the formation of the candidates. This point is meant to highlight the serious need to know what are the fundamentals of training and to exchange and discuss matters between the ‘different’ training facilities in different parts of the world. In my time -the Canadian Institute was four years of seminars (once a week for three hours each), of which the first two years were dedicated to the Slandered Edition, the other two years were for the contemporary schools. In addition, there was personal analysis and supervision. Thankfully, Kohut was the first and only enfant terrible in my time, so there was time to have deep discussions regarding the budding conflict between drive psychology and relational psychology. What would be the situation now with the dozen or so new schools?

The most puzzling now is the existence of very impressive university programs in psychotherapy designed, run, and managed by psychoanalysts. What is involved in those programs is far more expansive and of high quality than any IPA institute could accommodate in its current or past modality of training. The puzzlement is why those programs repeat the IPA mistake by limiting psychoanalysis to psychotherapy. There are all the reasons for academicians not to limit their conception of psychoanalysis to psychotherapy. The most glaring reason is that psychotherapy was not originally the only stipulation psychoanalysis, and that what is dying in psychoanalysis as psychotherapy? I am thinking of three reasons for that, and I mention them because I hope some analyst\academician will try to look into that matter: 1.we do not know what else could be psychoanalysis, 2. there is no demand to learn anything else but psychotherapy, 3. aside of psychotherapy psychoanalysis is just applications in other fields, which makes of less prestigious to include in an academic program.   

 However psychoanalysts want to cut it psychoanalysis is a theory of the human subject. Before psychoanalysis the human subject was subject of speculation that sometimes were nothing more than traditional believes. Since the birth of psychoanalysis speculating about a human phenomenon is not acceptable in the educated communities. Psychical phenomena-ranging from history to politics- are psychoanalysble, i.e., subjected to processes of understanding. Freud’s preliminary conceptions of the intrapsychic and his advancement of his points became our attitude toward the subject: an object of discovery and each discovery uncovers the next issue to study. Therefore, psychoanalysis is more than a psychotherapy: it is the study of the human subject.

The two other preconditions in a proper training are personal analysis [didactic] and supervision. I think those two preconditions which came from training in psychotherapy should be viewed in light of making psychoanalysis a separate and defined body of knowledge; a science. Personal analysis is essential in training as psychotherapist but, not for the chronic phantasy of its value as therapy and treatment. Any dictated personal psychoanalysis would not achieve any therapeutic success. However, we cannot learn how psychoanalysis is done by any other means but undergoing a good period of didactic personal analysis. Explaining that to the future aspiring clinician should put his mind in the right place. He would know how the clinical protocol is observed for the benefit of the “patient”, and how therapy is a natural result of that type of relation. It still has good effect on the trainees in other fields of psychoanalysis. Nothing could explain the unconscious as well as hearing one’s self saying things within regular speech that never occurred to his mind. Supervision is part of any work that is based on the accumulation of expertise. The varied circumstances in the dealing with psychopathology could also show the candidate the blind spots in his understanding of human nature.

                   The Negative Side of Institute Training

Training in IPA institutes is a lonely venture; it is analysts teaching analysts, training analysts qualifying analysts an accrediting their own work. Therefore, without a critical eye from outside, their closed circle is likely to take certain things within their sphere of knowledge as facts when they are not more than metaphors of findings. The institutes follow the divisions in the societies, which are mostly personal and political. The major dividing event in the British Society in the early fifties, resulted in three different systems of training based on a mix of personal and theoretical differences. The most negative result of this division was the creation of what was called drive psychology and relational psychology, following the rift between Anna Freud and M. Klein. Ego psychology was considered a drive psychology because it emphasized the psychodynamics of pressure and defence against the ‘instinctual’ demands. This conception was based on translating Trieb with instinct, which was blatantly wrong. Freud defined what he meant by Trieb “the pressure put on the mind to act [represent the stimulus psychically]” (1915c). For a period of time sex was a drive, but after considering infantile sexuality as basis of more than sexuality, sex was not treated anymore as a drive but as a Trieb. Making M. Klein the founder of relational psychology is a subtle but very important misconception. Klein examined, identified, understood, what happens to the child in infancy. She gave us a way to understanding the adult’s intrapsychic core that was influenced by the relationship he had with the mother in infancy. Her interest was the formation of the intrapsychic via the interrelationship with the care giver. In other terms, she was looking at psychical formations, not the relations to the mother. Other analysts who are grouped as Kleinians, like Winnicott, were interested in the transference of the infant-mother relationship to the current relationships, not the relationships themselves. They were not relationists; they were psychoanalysts.

Clinical psychoanalysts were isolated in their training institutes (particularly in North America) and were not exposed to the external input of a very important phase in the history of psychoanalysis. There was a revival in the sixties and the early seventies, in Europe and North America, of structuralism, which was the anti functional thinking in the humanities. Just as a side idea to this: Mark Solms main endeavour in revising Freud’s Standard Edition is meant to correct the translation of some basic terms that made psychoanalysis a functional theory. His corrections will be -as he indicated and demonstrated- to find the structural version of psychoanalysis in the Freudian text. In the sixties and seventies, the return to the essence of psychoanalysis allowed thinkers, philosophers, literary people, artists, etc., to participate in creating a structural version of psychoanalysis.  It seems that North American psychoanalyst missed that external input and remained captives of their institutes of clinical psychoanalysis. The harmful effect of training in isolated specialised institutes is evidenced in the North American psychoanalysis. When psychoanalysis was getting over its functional version in Europe and including a wider range analytic thinking,  psychoanalysts  in North America analysts were dealing with the limitations of functional psychoanalysis by being critical of the basics of the of psychoanalysis itself (Holt, Perkin, Renik),  The notions of the plurality of psychoanalysis and the schools happened at that same time when psychoanalysis was booming everywhere else. The intellectual revolution of those decades was constructive to psychoanalysis when and where it was open to others, and destructive when it was isolated in specialized Institutes.  

What I want to underline is that learning and training in institutes of psychoanalysis, whatever their affiliation, is susceptible to provide distorted, if not wrong understanding of psychoanalysis. The graduates (accredited and certified as psychoanalysts) learn a psychoanalysis that has no link to anything else but psychoanalysis. The normal process of the development and evolution of any body of knowledge is to widen and spread its boundaries of exploration and insights. This expansion would inevitably touch the widened and the spreads of neighbouring bodies of knowledge. This process is not passible in the case of the current system of training in IPA institutes. To be fair, I do not know anything in that system that prohibit such expansions, but the structure of the system makes it difficult. The death of psychoanalysis is happening because its system of learning and training does not have provisions for its revitalisation by the input from the other humanities. The solution is to move learning and training in psychoanalysis to where the contact with other sources of knowledge is available and comes naturally. We should give training and learning of psychoanalysis to academia if we are keen to keep it alive. Although this idea is not objected to in Europe much, but what is noticeable is not agreeing to making training and learning of psychoanalysis more than just degrees in the field of psychotherapy (offering Ph.D. in what is in fact psychotherapy).