Audience

Wednesday, 27 November 2019

Psychoanalysis, Psychotherapy, and the End of an Era

                           >>>>>>>>>>>>>>

{This posting will be in four parts: Introduction, The Deterioration of Psychoanalytic Psychotherapy, The Uncomfortable Duo of Psychoanalysis and Psychotherapy, The Demise of the Profession of Psychoanalytic Psychotherapy}.
                             .....................

2.The Deterioration of Psychoanalysis:

Anna Freud and Melanie Klein

Psychoanalysis, like any other intellectual movement, had its share of internal conflicts and moment of impending danger of disintegration. However, the presence of Freud in the movement and his leadership played a big role in avoiding those threats. After his death in 1939 nothing seemed to have changed much. Psychoanalysis was expanding everywhere it had some existence, and new groups joined the IPA. Even theoretically, new elaborations and sophisticated clarifications were appearing in the more active filed of publications. It became clear that psychoanalysis was not a movement associated with the talent of one person or even the talents of more advocates who were everywhere it was established, it was not a fad but an addition to the burgeoning endeavors of the intellectual everywhere.
    
The strongest evidence that psychoanalysis was not a historical event but a serious movement in the humanities came almost a decade after Freud’s death. In the late forties the natural evolution of psychoanalysis led two of the movement’s principal psychoanalysts, who were in Great Britain due to the war circumstances, to a significant point of disagreement. The conflict between Anna Freud and Melanie Klein was significant enough to warrant creating two (later three) groups to solve the problem of coexisting, because there was no mention of those two leading figures to leave and form their societies, and they were both the initiators of solid points of view.

Similarly, the French society and institute went through a similar alarming period of conflicts around the same time. A real threat to the existence of psychoanalysis in France was not possible to ignore. Lacan and his early companions (Lagashe and other) requested changes in the modality of theoretical formations and its impact on training by questioning the merits of ego psychology and the significance of moving to structural thinking instead This time the rebels were expelled from the IPA, before they were reinstated a couple of years later (except Lacan). The two events were almost identical in timing and the main topic of discontent: the need to move from ego psychology (later called in the US drive psychology) to a psychoanalysis of psychical structures. The controversy in Britain set Anna Freud to be the guardian of ego psychology as Sacha Nacht was in France. Better to say that psychoanalysis after Freud was liberating itself from the functional psychoanalysis of the Ego (ironically called the Structural Theory) and getting well positioned to advance to exploring the intrapsychical nature of the human subject, but with substantial opposition. In the US it was the same but in a different style.

We got- in the first part of this posting- to the same distinction between two types of psychoanalysis:  the functional and the structural psychoanalyses. It is understandable that psychoanalyst who are mainly medical people would not give the idea of functional and structural psychoanalyses much attention. Most psychoanalysts did not and do not think much about the usefulness of this distinction to their practice. This distinction is what makes the difference between psychoanalysis and psychotherapy. However, in the humanities, good functional formulations would eventually lead to the structural nature of the phenomenon. The early Freudian functional findings led to structural reformulations of the of the subject exemplified in unsuccessful attempts- at the end of his life- to revive metapsychology.

Anna Freud and Melanie Klein stood for two apposite stands from the theory of psychoanalysis [ Some attempts were made to consider the conflict a matter of personal competitions]. Anna Freud put the Ego and its affairs as the subject matter of psychoanalysis. Melanie Klein made the formation of the intrapsychic- through the relations the infant goes through with the care-givers- the core of psychoanalysis. Their disagreements were genuine points of view: is the intrapsychic a product of ego functions, thus the ego is the cause and the psyche is the effect, or the formed intrapsychic is the cause of the formation of the ego thus it is its the effect.

Psychoanalysis was divided.  Although this old dichotomy does not constitute a criterion of good/bad or right/ and wrong psychoanalyses it was understood by analysts as differentiation between old Passé psychoanalysis and new advancing one. The motto behind the new trend was an opposition between Ego psychology and relational psychology. Anyone who is aware of the works of the serious ego psychologist of the sixties till the eighties (Arlow, Brenner, Rangell,etc.,) would notice that they were dealing with the ego as a structure and not as an ontological entity.  Klein was the new and the correction of the rigidity of Ego Psychology that characterized what Freud left us with. However, misunderstanding the jest of the ‘controversies’ and the popularity Klein gained despite Anna Freud’s desperate effort to curtail it made some young analysts to think that psychoanalysis is about interrelationships and the structure of the intrapsychic is not pivotal in psychoanalysis anymore. This trend became the head of a the new trend of ‘relationality and relational psychoanalysis’.  Lacan’s trend, which was becoming the other antidote to a declining functional ego psychology had limited attractiveness outside France because of his style of presenting it. Yet (as I learned from a French Friend who was visiting South America frequently) both Klein and Lacan had strong support in Brazil and Argentina.  However, the proof that the ‘controversies’ were not simple squabble amongst some competing analysts, and it was a manifestation of a turning point in the developing course of psychoanalysis is the way Klein’s point of view surpassed being just a novelty.
Klein gave us a closer look at and into the formation of the intrapsychic through examining the relational world of the infant and the child. All along, without clear vision of what psychoanalysis was, it was the act of analyzing the intrapsychical in order to reveal the unconscious components in its structure. Therefore, we should consider the “controversies” not a historical phase in the history of psychoanalysis but a revelation of the problematic of psychoanalysis; therefore it is important to re-examine its deterioration that came after a genuine development after Freud.


The Inception of Deterioration:

Deterioration is when something good that kept improving its goodness seizes to advance in the same direction. The mere stoppage of the good indicates its deterioration. It deteriorates by just not moving forward.

Psychoanalysis started as a process of investigating the causes of psychoneuroses, and eventually developed to turn those discoveries into therapeutic works. When it reached the time of the ‘controversies’ it was at a cross roads: a very rich stash of information about childhood and its effect on adulthood, which also opened the door for widening the scope of psychotherapy beyond expectations. It was also a time when this rich endowment of knowledge about the subject was strongly suggesting intensifying, improving, refining, and expanding psychoanalysis beyond its fixed identity as psychotherapy. Psychoanalysts and the psychoanalytic organizations neither worked in that direction nor encouraged others (none analysts) to do that.

The second road was concentrating the efforts of the organization and the analysts to strengthen the organization and extend its training reach. In taking that venue, more so in North America, the success of expanding psychoanalysis clearly came on the expense of the first point: enriching the knowledge of the psychoanalysts. Psychoanalysis started to deteriorate. Worse, there was, instead, a determined effort to keep psychoanalysis in isolation from none analysts’ contributions. Another and most revealing happening took hold of the analytic community. Analysts developed a tendency to hastily give new and rigid meanings to certain events or happening in the field. The most obvious and also destructive was (and still is) considering Klein’s theory and practice “relational psychoanalysis in contrast with ego psychology” or what was dubbed drive psychology. The drive psychology ‘thing’ was the outcome of the poor system of institutes education which does not respond to theoretical fads with good scholarly response.  In 1905 Freud turned the theory ‘urges’ to the concept of Trieb; psychoanalysis lost any link with drives since.    

This trend created two camps of psychoanalysis that are based on misunderstanding, even discarding the works of their explainers. Ego or drive psychology and Kleinian psychology got meanings that are beyond their real functions, resulting in them standing for meaningless conflicts. In France those two terms stood for the conflict about the traditional viewpoint (maybe Mary Bonaparte as its symbol) and the general cultural vitality that commenced after the World War. In Britain they had more of personal meaning related to individuals and their status in the psychoanalytic community. In the USA they stood for different locations and centers of psychoanalytic organizations (East\West, regional institutes and universities, and sometimes popular training Analysts). The point is that new bestowed meanings on the two terms distanced psychoanalysts from the real concerns in the issues that were supposed to advance.

The Deterioration:

How could we reach a judgement that psychoanalysis is deteriorated or improved? The appeal or rejection of psychoanalysis is not a good criterion for the simple reason that intellectual issues are measured by their own quality not by comparing them with other intellectual endeavors. We cannot say that psychoanalysis is better or worse because it appeals to more people or less. To get directly to the point: the deterioration of psychoanalysis is evident in both the absence of an intellectual identification of its subject matter (therapy, theory, theory of practice, explanation of psychopathology, etc.) and the variations and disparities of in its practice (an  experienced and well placed analyst to judge this matter counted twelve schools of analysis in the US. I still consider three schools to be proof of the looseness of training and education in the IPA institutes). The classical modality of psychoanalysis was: knowing the structure and dynamics of the intrapsychic and its psychopathologies, psychoanalyzing how the patient ‘talks’ about his case, interpreting his speech to effect changes in his intrapsychic structures. Freud protocol of neutrality abstinence and anonymity fitted well in that modality because if any good will come from therapy it has to come from the analyst clearing the session from anything but the patient’s speech. In other words, psychoanalyzing is the process that makes the patient realizes and concentrates on his intrapsychic dynamics to initiate the desirable change in them. The analyst should demonstrate to the patient that wanting to establish a relation with the analyst beyond the therapeutic one disguises his intrapsychical difficulties that he came to find a better solution for them than acting them out in relationships with others..

The gate for deterioration opened gradually to end up in North America into a critical case of a crisis, when in Europe diverting some substantial parts of psychoanalysis to universities is proving to be protecting it from total collapse. Approaching  ‘hesitantly’ a full academic merging of psychoanalysis with academia (full merger is by stopping IPA from being involved in the Formation of Psychoanalysts) would demand a more declaration that psychoanalysis should be considered a profession, not just an appendage to other professions.  The apparent reason is that analysts do not give enough attention to how the general theory of psychoanalysis and the preferred method of practicing it as psychotherapy are linked and affect each other. For instance, if psychoanalysis (theory) is relationally oriented psychotherapy would then be directed to making relations the filed of discovering the unconscious in order to effect treatment. Psychoanalysis deteriorates if the analyst does not pay attention to what he is doing: practicing a theory or proving a theory; freeing the patients from the unconscious compulsion to act out his intrapsychic flaws in relationships or suggesting better kinds of relationships.
Is there a difference between psychoanalyzing and psychotheraputizing. 

In the next part of the posting a more elaborate distinction between psychotherapy and psychoanalysis will be tackled.  

No comments:

Post a Comment