Psychoanalysis: Between Improving and Changing

5. The Deterioration of Psychoanalysis and its Crisis

The anxious and sometimes desperate ways psychoanalysts are dealing with their crisis does not, for sure, show a clear distinction between the body of knowledge that denote psychoanalysis as a theory and psychoanalysis as clinical practice. The obvious concern in their approach till now relates mostly to the deteriorating status of their practice. However, although analysts do not like to consider the distinction between theory and practice in their attitude toward the crisis, the IPA’s point of view, which shows in the recent mode of activity and vitality, meetings, and optimism, is leaning toward considering the crisis to be in the clinical meaning of psychoanalysis. The IPA is ignoring the other side of the coin which is the status of psychoanalysis itself; the dog that has a tail called clinical psychoanalysis. The proof to that leaning is a sudden burst of activities to promote psychoanalysis to regain the interest of people, staying away from examining the analysts’ own interest in real psychoanalysis.

We still have to decide which of the two meanings of the term psychoanalysis that is the one that is actually in crisis? Could it be that psychoanalysis as a body of knowledge (science !!) is losing the interest of people lately? For sure this is not the case, because psychoanalytic thinking is ‘now’ weaved in the fabric of daily human life. The interest in contemporary psychoanalyses is the main issue that the IPA is avoiding to tackle. In my opinion, the reason is that IPA is not capable of doing that due to limiting itself to the function of training, i.e., to psychoanalysis as a clinical practice. I might get beck to this point later, but for now the IPA is not equipped or should be expected to evaluate psychoanalysis, as a body of knowledge, thus is not mandated neither to approve the plurality of psychoanalysis nor the credibility of the current theoretical formulations of psychoanalysis.

Although the concern about the drop of interest in contemporary psychoanalysis is global, the degree of that drop depends on what part of the world we are talking about. However, there is no region of the IPA claiming exemption of that drop. The local and the international organizations are all approaching this issue from the angle of the public and the need to remind it of the ‘goodness’ of psychoanalysis. This idea attests to the need to examine the state of clinical practice of psychoanalysis as part of our responsibility toward the public; not as consumers but as honest and concerned professionals.  Psychoanalysis is not owned by the psychoanalysts; it is part of our human heritage, therefore we should participate in dealing with the crisis with objective and ethical evaluation of its efficacy.

Let us look at the modality of medicine to create a baseline for a fruitful discussion. The changes and improvements in the treatment of cancer in the last four decades is a natural outcome and extension of the advancements in medicine as a whole, which came as part of the major scientific leap of the ninetieth century. The scientific leap was only possible when the West Europeans overcame their religious irrationality, which was the code of their existence for the previous five centuries. They advanced their life and aspired for more advancements and stepped waring and started thinking. In other terms: the evolution of a science or a body of knowledge stems from a larger and more encompassing human endeavour. The question then: could we identify the roots that psychoanalysis sprouted from and allows us to refer to, as the starting point in its progress and evolution? Psychoanalysis is not an extension of medicine or derives much of its nature directly from other human sciences. The most we can say, as Freud used to say, is that psychoanalysis is a psychology of sorts. Yet, its evolution and the progress it achieved did not relate to the psychology of its time; not even of today. Therefore, what we have now as a crisis in the practice of psychoanalysis is coming from an undefined body of knowledge, which we psychoanalysts know very little about. Better, the IPA training institutes train new analyst to practice an unidentified body of knowledge.  In the most classical training programs in psychoanalysis the reading of Freud’s text (and the texts of other gifted analysts) with the most scholarly training analysts would not teach a clinical method of psychoanalysis. No analyst- who is sincere in examining the crisis of psychoanalysis -could identify the body of knowledge that he learned in training which taught him how to practice it as a profession.

The reason, surprisingly is in the nature of psychotherapy itself. Psychotherapy, in particular psychoanalytic psychotherapy, has no theory or even an identifiable recognized technique. If the therapist has an idea about therapy in the back of his mind, he still has to follow the patient’s speech and not his own theoretical bias. In psychoanalysis, the situation is even more strict: the analyst and the patient together should avoid any predetermined notions, theories, or systematic rhetoric.  The analyst is expected to catch himself breaking that rule to avoid it influencing his listening to the patient.

Historically, the practice of hypnosis was not initiated to do therapy but to discover the nature of the splitting of consciousness. The discovery of the repressed through hypnosis, started the idea of therapy. Uncovering the repressed as a means of psychotherapy proved that knowing the unconscious could be done without hypnotism. The next step was discovering the linkage between consciousness to the unconsciousness, and the mechanisms that bridged them. Thus, in principle, psychotherapy evolved to be an act of interpretation; interpreting the unconscious to consciousness, interpreting the patient’s rhetoric to become meaningful events, etc. [Lately, I attended two lectures by Mark Solms. One was on the new translation of the Standard Edition. He brilliantly showed that interpretation is a core in psychoanalytic knowledge in more than one meaning of the word].  The dialectical advancement of therapeutic psychoanalysis reveals that each finding leads to a better, but unexpected understanding of psychopathology. However, because there is no theory of interpretation and there is no way to teach and train in interpreting, the concept of training got to be revisited and re-examined. This is a continuous obligation because as psychoanalytic work changes while working with the patient, psychoanalysis in general must have changed and is still changing over the years.

We still have two other issues to deal with. (1). Psychoanalysis is not a theory of practice but a theory of what practice reveals to both the patient and the analyst. This is the opposite of the prevailing belief in the psychoanalytic community, which looks at the practice as applying a theory to the patient’s material. We thus need to answer this question: what do we then practice if not a theory?  The practice of psychotherapy (analytic or not) relies on learning the psychological functions of the subject that are subjects to fixation, deviation, frustration, maturation, relating etc.). Therefore, training in psychoanalysis (in IPA institutes) is worthless if the candidates do not learn more about what will they do therapy for. This notion is not the simplistic notion of correcting mistakes in the psychical system of the patient; it means knowing what gets sick in the patient’s psyche and how it gets sick in order to be able to understand and interpret. (2). Individual psychotherapy follows the same rules of psychoanalysis in general. We listen, notice, understand, discover links between the conscious and the unconscious, from the patient’s speech, and interpret them (reveal the unconscious core of the speech). This kind of work brings us to reconstruct a theory of the subject we are analyzing. What we do in practice is a replica of how psychoanalysis -as whole- evolved (or should have) and progressed: analysts listened, noticed, understood, discovered more links in the psychopathological conditions, all that is supposed to have provided psychoanalysts with more to work with. The work with patients did not rely on a theory of the psyche or a technique of practice; on the contrary, it led to new notions about the psyche and technique. We realize now that the workings of the primary process are what was called repression or ego-weakness fifty years ago. Listening to the speech of the patients as equivocal statements of the speaking subject (Ricoeur,1970) led Freud and the early analysts (and recent gifted analysts) to eventually restructure meaningful conceptions of the dynamics of the intrapsychic nature of the human subject. This is how Freud noticed transference as an implicit content in the patient’s rhetoric, and how we should deal with it. This same find is still active in nowadays patient but in the form of character formation. A very senior analyst- presenting a psychoanalytic case lately- kept calling the patient’s relationship with him: “in her transference”. When one of the audiences asked what he meant by transference he replied that every relationship with the analyst is transferiantial. The right way to say it: transference is what of past relations that could coexist in present relationships, including the one in the analytic relation. There is no transference but there are matters in the past that gets transferred to the present, i.e., transference is not a psychical thing, it is one of the ways the past influences the present.

It is imperative to acknowledge that a hundred years of psychoanalytic work has unveiled a great deal of the nature of the human subject, and that knowledge has become now common knowledge to the society, particularly to parents and educators. The human subject is no more unknown and has assimilated most of what psychoanalysis has revealed. Therefore, we do not treat the same patient of fifty years ago. The present subject knows most of what was our cherished secrets few decades ago. We need to look carefully at what we are offering the public as psychoanalysis.

The psychoanalysis we still teach, train to practice and consider the basis of our specialty is ‘mostly’ what has been the core of analysis several decades ago. I am not sure what the new schools of psychoanalysis have done to the curricula of analysis in the traditional training institutes of the IPA and the training system in them. Nevertheless, there is good reasons to suspect that psychoanalysis of nowadays is a deteriorated form of the traditional one. Traditional psychoanalysis (we can go back to any preferred point in its history) had a clear identified relation to the theory of psychoanalysis at that time.  If the theory was indicating that psychopathology is caused by repression psychoanalysis was the act of revealing the repressed, and so forth. Up till Kohut’s self-psychology there was that kind of respectable psychoanalysis. The ease by which analysts suggest new schools has dissipated this necessary link which preserves the potential for change without making psychoanalysis lose its respectability. Analysis, like any thought could deteriorates when it loses its bearings. If some institutes -mainly in Europe- still follow that rule their training psychoanalysis still could  suffer some deterioration, because psychoanalysis has to change to make sense of all the discoveries made in regard to the human subject (not the presumed modifications in the technique). Moreover, it would be ridiculous to think that the IPA training model is still enough to qualify psychoanalysts. Reviewing three training programs of psychotherapy in European universities, it became totally unfair to compare their intensity, their detailed curricula, and the time needed to complete one of the three levels of degrees to training in IPA institutes.  Moreover, getting someone fresh to learn psychotherapy is far more better than getting a mental health provider who is not inclined to learn psychoanalysis but seek only its clinical aspect.

The next and last posting of this topic will be: Give me a university or give me death (Psychoanalysis).  

Psychoanalysis: Between Improving and Changing

4. The Gap Between Theory and Practice:

In the early years of the psychoanalytic movement psychoanalysis was a term that denoted one meaning: what analysts do, which for several decades remained the same: psychotherapy, and only psychotherapy. Neither Freud nor the pioneers acknowledged that what they were doing, by practicing psychoanalytic psychotherapy was mostly discovering the nature of the human subject: unconsciousness, defensiveness, the pervasiveness of childhood constructs in psychical life in maturity, the conflictual nature of psychical life, and the split of consciousness, etc. Because of the novelty of the discoveries and Freud’s continuous work on a theory for those discoveries a subtle gap (which I will depict a little later) opened between clinical practice and theory. Clinical practice was without a theory, and the theory of the subject was yet to come, because Freud was continually changing its parameters. The gap between theory and practice was subtle to the extent that psychoanalysts did not notice its existence and its possible effect on the advancement of psychoanalysis. The continuing increase in the knowledge of the human subject that was accumulating with time and experience engendered some change in ‘psychoanalysis’, but did not deal with the gap between theory and practice.

Without serious consideration of what psychotherapy was accomplishing on the one hand and the analysts’ assumptions of psychopathology on the other, the two wings of psychoanalysis seemed working independently. Psychopathology could not get a separate formulation from the formulations given to practice. This detail entrenched the notion that psychoanalysis is merely a profession of psychotherapy. Because the act of therapy was technically undefined and cure was similarly vague, analysts did not distinguish between what they aspired to achieve in psychotherapy (strengthening the ego against the attacks of the instinctual pressure, for instance) and presuming that psychopathology is a result of the weakness of the ego defenses against demands of the instincts: ego psychology). Something worse in my opinion dug roots in our conception of psychoanalysis and its derivative psychotherapy. Analysts got accustomed to ignoring the paradox of using theory to confirm practice and consider practice the proof of the validity of the theory.

Freud’s advanced thinking in that regard made him improvise metapsychological conceptions that worked well- for a long time- in bridging the gap between psychotherapy and psychopathology. He considered metapsychology essential in the construction of theories (‘Analysis Terminable and Interminable (1937’).  After the demise of ego psychology and the birth of relational psychologies there was no place for metapsychology in psychoanalysis anymore, but there was no replacement for it either. The reason is that metapsychology needed “issues” to replace and to signify.  Relational psychology does not provide issues (like ego strength and defense mechanisms). It is only fair to say that at the early stages of establishing psychoanalysis as a method of psychotherapy it proved to be more than merely a technique of psychological treatment because it was always had a feedback that enriched the theory. That feedback from clinical work widened the scope of psychoanalysis beyond any expected improvement in psychotherapy, or the clinical aspect of psychoanalysis.

I have to interrupt this line of thought for a while to put in focus a commonly neglected fact. Freud’s discovery of infantile sexuality, the three types of the unconscious we encounter in practice, the working of the primary and secondary processes, narcissism, and reversing the theory of anxiety (1926), among other things were enough and could have unify the psychoanalytic theory of the subject and the practice of psychoanalysis in one comprehensive human science. Understandably, but still regrettably, analysts were concentrating on creating a profession of psychotherapy and showed no interest in creating a theory of the subject and the science that emerges from it. They insisted that psychotherapy is the only true source of the function of psychoanalysis.

Going back to the issue of clinical psychoanalysis I would say that the intentional or unintentional avoidance of thinking about psychoanalysis as the background of psychotherapy turned the way it was practiced at that time into a set of blind beliefs. Analysts followed the original manner of practice (in terms of the duration of the sessions and the number session per week, the couch, and some other details a bout payment, vacations, etc.) as a “protocol” to follow; yet it was a protocol taken out of context. Those features in the protocol became integral components of the work of therapy itself. In other terms: clinical psychoanalysis was replicating the circumstances of its practice forty, fifty, a hundred years ago without knowing those circumstances. Those circumstances became blindly paradigms of the profession of psychoanalyzing. In fact, the couch was Freud way of avoiding the tension of being looked at by the high number of patients he saw a day. The number of sessions per week was decided by the demand from candidates who came from different cities and towns and later from other countries for quick training. Normalizing the conditions of doing therapy is one of the most perceptive clinical intuitions Freud came up with, but we have to understand his approach instead of idealizing blindly what our forefathers did. Just as a hint: psychoanalysis is analyzing the intrapsychic core of the subject through the transference scenes. Thus, the analyst has to remain anonymous, neutral, and able to abstain from reacting to the patient’s unconscious demands in order to interpret and reveal the unconscious component in the patient’s associations. This protocol of practice corresponds to the classical theory of psychoanalysis (Fayek, 2017).

After Freud’s death psychoanalysis started to fragment into camps. Ego psychology versus relational psychology was the first to ensue among the English-speaking analysts. In the Latin-based communities, the split was between functional psychoanalysis and structural psychoanalysis. (In January of 2019 I posted on Freud: A reluctant structuralist). The main issues in the Anglo camp pertained to clinical and practice matters. There was more strict adherence to the old-fashioned system of performing analysis in terms of the number of sessions per week, the duration of the session, the length of analysis, and a blind adherence to some superficially understood rituals in the relationship between analyst and patient. In that camp psychoanalysis was a profession that already has technicalities to follow. The Latin camp of psychoanalysis was concerned more with discoveries in human nature which required thinking to comprehend and reach its underlying conceptions of practice. Most all, analysts in that camp were shedding off the apparent functional thinking of the pre and post Freud’s neglected revision of the theory of anxiety (1926).  In that work Freud was struggling hard with the traditional cause\effect, or functional understanding in psychoanalysis (Originally anxiety was regarded a function of failing defense mechanisms) and shed light on a structural understanding of anxiety as the initiator of psychical dynamics.

The structural maturation of psychoanalysis as a theory of the subject or the discovery of the intrapsychic core of our psychological life started in the thirties of the last century with the birth of general structuralism, which changed the face of the humanities for good. Up to the late fifties psychotherapy was still as it was all that time: interpreting the present by the past, with some additions coming from insights in regard to the difficulties encountered in the psychotherapy of new types of patients (character disorders). WE gained new vision of resistances). Instead of creating a parallel theoretical refinement analyst endeavoured to expand the field of psychotherapy unwisely by expanding the available theoretical formulations of the time to fit those new psychoapathologies. In other words, psychoanalysts, who were still mainly physicians, were not equipped to give those gaps enough thinking to realize that the discoveries of psychoanalysis exceeded the limitations of their theoretical knowledge and their technique of psychotherapy.

So, what is the basis of the discordance between analysts, which plagued psychoanalysis from the beginning of its inception? At the beginning the discrepancy and disagreements were about some concepts like interpretation, transference, resistance, but also about their meanings and their impact on practice. The discrepancy between the ‘ideal theory’ and the pragmatics of practice was the core problems since the early psychoanalytic movement. In the forties the conflicts were about what is the best medium to explore the unconscious? Defenses, relations, ego, i.e., the equivalent of the ego in interpersonal relationships or the self. Psychoanalysis as the act of understanding psychical phenomena gave its place to the conflicts about it. The topics of the conflicts became the psychoanalysis of today.

The issue of this this post brings us face to face with the deterioration of psychoanalysis.

Psychoanalysis: Between Improving and Changing

3.The Failure of Improving Psychoanalysis:

There is an intrinsic difficulty in answering the question of improving or changing psychoanalysis: the term has two points of reference: the Freudian meaning which the IPA does not consider in its mandate, and the IPA meaning, which is limited to  the clinical practice of psychoanalysis. Most analysts, because of training in IPA institutes, consider what they learned there is the only psychoanalysis that is. Few consider none clinical psychoanalysis merely applications of psychoanalysis in another fielded, but not ‘truly psychoanalysis’.  This attitude- which I remember myself being ‘afflicted’ with it early in my career- was stemming from the status of the clinical psychoanalyst compare with the nonclinical psychoanalysts whom I encountered few of. I liken it now to the graduates of private schools to the graduates of public schools.

The Freudian meaning of psychoanalysis has to derive from the way he developed psychoanalysis and spoke about. In 1892 Freud failed to induce a hypnotic state in his patient (Fräulein Elethebeth von R.). Instead, he resorted to reading in her symptoms the ‘meaning’ of her hysterical complaints. He called this first attempt of treating without hypnosis ‘psychical analysis’ (Jones, 1953). He did the same with the case of Katharina and another he alluded to in a letter to Flies (May 30, 1893). In those cases, his main concern was ‘psychoanalyzing’ the speech of the patient, as a discovery coming from within the acts of hypnotherapy. In other words, psychical analysis was not psychotherapy but a discovery that could replace hypnotherapy. He even alluded to his confusion about what to call those discoveries in another letter (March 1898). Freud was still unable to understand what he was doing in his therapeutic work, and asked Fleiss if he should call his work “metapsychology”. This query is evidence that Freud was not using the practice of psychotherapy as the discovery of psychoanalysis but as the means to discovering something (a new psychology) in the act of psychotherapy. Freud’s main discoveries and reformulations of his discoveries were products of practicing his psychical analysis, not that practicing psychological analysis was the discovery.

When Freud abandoned hypnosis totally, he was already close to the notion of ‘interpretation’ as the objective of psychotherapy. The idea of listening and reading the unconscious in what the patient says or does- while awake- made him pay attention to the link between consciousness and unconsciousness as the core of psychotherapy. He said (1919): “Psycho-analysis, in fact, more than any other system, is fitted for teaching psychology to medical students”. Thus, the Freudian meaning of psychoanalysis was more than a technique of psychotherapy; it was a new ‘brand’ of psychology. But what Brand? He proceeded to say: “. . . psychoanalysis pursues a specific method of its own. The application of this method is by no means confined to the field of psychological disorders, but extends also to the solution of problems in art, philosophy and religion. the philosophy of religion. .  . The fertilization effects of psychoanalysis on these other disciplines would certainly contribute greatly towards forging a closer link, in the sense of a universitas literarum”. The Freudian meaning of psychoanalysis is that it is a psychology of the human subject in his varied capacities and his self-revealing in multivariant forms expressions. This angle of identifying psychoanalysis yields new points of view and throws light on aspects that complement the findings of most of the other human sciences. In simple terms, clinical psychoanalysis is the usage of psychoanalysis in a clinical setting and nothing more. It has what is useful to make it applicable to do psychotherapy and only if the clinician has the right conception of psychopathology.

Psychoanalysis is thus subject to change because the more knowledge about the subject we gather, and the better our understanding of psychopathology psychoanalysis has to change to include all that in the process of interpretation\reconstruction. For instance: after two decades of a theory of sexual repression and cathartic abreaction Freud had already learned more about the primary process and role of infantile sexuality in the formation of symptom. He abandoned hypnosis and depended on free association and interpretation to psychoanalyse symptoms.  Therefore, psychoanalyzing changed from revealing incidences to exposing meanings of psychical manifestations.

I want to underline an important aspect of changing psychoanalysis which distinguishes it from improving it. Changing psychoanalysis relates to both the subject matter of the psychopathology (the complex formation of consciousness and unconsciousness in a symptom) and the method of dealing with it (interpreting in order to reveal what is unconscious). This kind of work is not improvement because improvement affects either the subject matter separately from the method of dealing with it. I will come to the detrimental effect of the desperate improvements of psychoanalysis that were tried in the time since the birth of the schools.   

The IPA’s claim to be both the institution of psychoanalysis and its educational arm restricted its function to training. The only meaningful and actual link between the IPA and psychoanalysis was determined by the training institutes, which was unfunctional, i.e., graduate its new membership. The IPA had to regard psychoanalysis just a clinical discipline and nothing else because that is its institutes could train for. The natural outcome of limiting the IPA to such meagre task created two major negative results:

A.   The function of the IPA as the sole training means of psychoanalysis created a closed group of narrow-minded practitioners who formed sort of a cult. They did not accept to open their membership to nonclinical cultured people, and did not want to add to their restricted program any cultural elements. Naturally, the psychoanalysis that the IPA was teaching and training became less encompassing of what is psychoanalytic and training became a relic of an old glorious discovery.

B.    Psychoanalysis was limited (till the seventies of last century) to Freud, very few other analysts of the old generation, and few of the contemporary analyst of the period of the splits in France and the controversies in England. At that time there was clear efforts to study those sourced scholastically to expose the implicit differences between psychoanalytic thinkers who did not create their own schools. However, it did not take long that analysts with little background in the original discoveries took the liberty to reinvent psychoanalysis with the blessings of the IPA.

Those two results that are engendered by the silence of the IPA in regard the changes done to basic and traditional psychoanalysis are continuing to erode and distort psychoanalysis. The deterioration of psychoanalysis is an issue that I will deal with in the next part of this posting. In the last part will be on the main point I want to highlight: Psychoanalysis and Academia.

Psychoanalysis: Between Improving and Changing

The Failure of  Improving Psychoanalysis:

In a previous posting I expressed my idea that the existence of the IPA is a hindrance to the development and improvement of psychoanalysis. At the present time, and for sometime now, the IPA is in a crisis of the dwindling down of its membership, and the inability to show a comprehensible function that justifies its existence. In North America psychoanalysis, consequently, psychoanalysts too, are going through a very difficult time: do they really exist outside their own minds (exist to people) and what could they call themselves: psychoanalysts! psychotherapists! Could they specify a sensible link with the psychoanalysis that the IPA claims to represent? In other parts of the world this puzzlement that is faced in North America is not as severe or demanding, but it should not be ignored just because it does not exist or form a crisis there. If the organization that identifies a profession does not maintain its identity by the professionals who constitute its membership, it loses its reason d’etre. Linking psychoanalysis and the IPA is the fundamental crisis because the IPA is comprised now of several (too many) psychoanalyses, and too many “presumed” psychoanalysts, and varying degrees of deterioration. The current unsettling situation is an intrinsic basic fault in the formation of the original and previously magnificent IPA, of the first half of the last century.

The IPA started in 1910 (more of a century ago) as a membership organization: a society of “belonging”. It was natural that when the issue of training a new generation came about the IPA assumed the responsibility of managing that task. Just as a reminder: training was MAINLY a response to the continued bickering among senior psychoanalysts then. With the enthusiasm and naivety of a new generation of psychoanalysts there was a belief that personal analysis will solve this problem.  Personal analysis was supposed to deal with the “members neuroses”, therefore it was made the spinal column of training. It was also made the most important quality that distinguishes psychoanalysts from “those who were not psychoanalysed”, therefore we could argue that we are different (better). Training became a requirement to be ordained a psychoanalyst. This matter attracted the ones who want to “belong”,  hence it had the additional purpose of keeping the IPA in existence. Early training was very little more than therapeutic personal psychoanalysis. This aspect of training remained its core under the guise of being necessary for didactic reasons. Two other aspects were added: practicing under supervision and learning the fundamental theoretical basis of the analytic discovery and some of the contemporary new theoretical additions and modifications.

None of those three aspects of training requires building the system of training institutes, because practically speaking training according to those rules does not require more than the candidate’s desire to get training. All the three aspects are available without any input from the IPA as an organization (mentioned in two previous and old postings). However, for the IPA to continue existing it was important to keep the training and the educational aspects under its auspices. To certify “the real psychoanalysts” the candidate has to go through the IPA institutes system because its organizational purposes was gradually eroded. Instead of existing because of our wish to belong, the IPA became the creator -by obligation-of that wish.  Nevertheless, delegating training to unsupervised training institutes created more problem and not resolving any.

Rationalising the existence of the IPA created three stubborn misconceptions about psychoanalysis:

1.     Psychoanalysis is a clinical discipline of psychotherapy.

2.     Psychoanalytic discoveries are special and different.

3.     Accrediting training in analysis has to come from the IPA system of training.

Instead of going into fruitless arguments about those points I will mention three observations to reflect upon:

A.   Freud’s 23 volumes of work, which contain the most revealing facts about the human subject- since the combined works of the Greek philosophy- has a scanty body of clinical material that no candidate of psychoanalysis would pass his candidacy if he presented it to a training committee. The other gifted psychoanalysts also left us rich knowledge of the human subject but similarly were stingy with their personal clinical material. Therefore, it is not correct to presume that psychoanalysis is a clinical discipline, although most of us made it our

profession!

B.    Many if not most of the Freudian discoveries of the human subject were reached before him by thinkers, philosophers, religious texts (the Talmud in particular), common sense of the common people, and some old physicians. Therefore, to assume that psychoanalysis is product of clinical work, which is a stubborn conviction of most psychoanalysts especially in North America, is incorrect (misleading the new generations of psychoanalysts). Psychoanalysis opened our eyes to the hidden meanings in our daily psychical lives. Freud’s adage “Dreams are Wish fulfillment” is not better that Joseph’s interpretation of Pharos’s Dreams. However, so early in his voyage of discoveries he showed that our intrapsychical life does not sleep. While ‘the all of us is sleeping’ a new way of expressing the not sleeping intrapsychic (the primary process) shows its nature.  This process was the language of infantile sexuality psychoneuroses, parapraxes and jokes too. The most glaring evidence of this fact is the banality, the insignificance and even hurtful clinical modifications suggested by “the new schools of psychoanalysis” which missed that what we try to configure in our work as analysts is “there” in the patients’ speech and not in their interpersonal or intersubjective relationships.

C.    The third stubborn misconception is that clinical psychoanalysts are entitled and free to produce any theoretical bases for their clinical methods of practice. Notwithstanding, only Freud was able to give a clear-cut protocol of clinical practice, which was in its basic nature boundaries to what should not be done, and nothing important regarding what is to be done. As a clinical analyst I knew what not to do, yet under that restriction I got material that makes the theory of psychoanalysis properly fitting to reveal to the patient the psychodynamics of his intrapsychical structure. This means that clinical psychoanalysis does not have a theory of practice but has a theory of the subject matter of the practice under its possible different conditions. Surgery has no theory but anatomy is the guideline for its practice. Therefore, psychoanalysis is a practice of listening to the patient talking consciously about himself and implicitly but unconsciously about his warped intrapsychical difficulties. The analyst also brings to the patient’s attention what to listen to saying in order for him to make the needed changes. Therefore, there is no local, regional, or international measures to qualify a training in the IPA institute as the accredited training. Moreover, the professors of clinical psychiatry and psychology are qualified to judge their graduates’ proficiency to work with patients.   

The answer to improve or change psychoanalysis is clearly decided by the condition it reached. For justifiable and obvious reasons when psychoanalysis and most analysts- in North America in particular-exhausted ego psychology and brought psychoanalysis with it to a stand still- psychoanalysis faced what it faces now: improve or change!

What happened is that analysts did not make much of a distinction between the subject matter of analysis and the suitability of the psychoanalytic method used in analyzing that subject. When ego psychology’s theory was exhausted to be useful in conducting analysis analysts thought that changing the subject matter of clinical analysis would be the solution. They went on a long trip of moving from relationality to intersubjective-calling and calling every change a school of analysis- assuming that they were improving psychoanalysis. Although most European IPA institutes seem to be less prone to go via the ‘school’ route they I do not know if there much change in the status of analysis there.

Therefore, my answer to the question is that the attempts to improve psychoanalysis is showing in the already failed schools that are useless and even damaging to psychoanalysis. However, this is what IPA still sponsors and it is evident that its membership has nothing else to offer: more schools. The Institutes that did not fall in that trap are not showing signs of looking seriously into the realistic solution of Academia.

Let us talk about that next time.

Psychoanalysis: Improve or Change:

Prologue

The view that psychoanalysis is in a crisis is an acceptable concern by most, if not considered by some an established fact. Its status is not the same in the different parts of the world where it is practiced. However, in the best case it could only be said that it is relatively better in some parts of the world than others. This is the basis for condidering psychoanalysis in crisis. If we cannot relate its declining status to particular parts of the world or associate its declination to time-based factors, then it must be in a crisis that is affecting it irrespective of temporary or enduring circumstances and everywhere. The crisis of psychoanalysis has been acknowledged by IPA more than thirty years ago. Still I could say with confidence that the IPA did nothing in regard to that crisis. Its feeble attempts at finding a remedy to that crisis were all unworthy of being called “serious” because they were not founded on any spelled out diagnosis of the causes of the crisis. Thus, it is fair to say the IPA is’now’ the cause of the crisis: it is neither doing anything to explore the causes of the crisis, yet continues to claim the absolute right to be the only responsible organization that should do that exploring.

This prelude is to give a background for my opinion that neither the current psychoanalysts nor their organizations are disposed to reaching a solution to the crisis. There are several ways to introduce this idea but one in particular could corner the answer within a clear limitation: does psychoanalysis need improvement to regain its previous status and appeal, or requires change to get rid of what made it lose its credibility and what makes it unable to point to possible solutions. If psychoanalysis needs improvement then the present system of IPA training institutes remains the way to qualifying psychoanalysts, which means that the method of training is right but some improvements should be made to the what is required to learn and train, and maybe add improvements to the function of the “training analyst’. This suggestion does not respond to what might have gone wrong over the last hundred years since the inception of its system of training, instead of what should have been expected of getting better with gaining insights and experience.

Psychoanalysis reached its high reputations in the sixties and seventies of the last century. Before that time psychoanalysis was still struggling with finding its theoretical anchors, integrating new insights and old workable but not totally correct concepts (Trieb or Drive psychology!), and standardizing the three basic elements of training. However, during the century of exploring a completely uncharted field of knowledge psychoanalysis maintained its focal point about the subject: his intrapsychical dynamics. Although some cracks were showing in the conception of sexuality and repression on one side and ego psychology and defense mechanisms on the other, new discoveries (Klein, child analysis, new concepts emanating from exploring new psychopathologies, and the contributions of remarkable psychoanalysts and the intellectual communities) enriched the psychoanalysis of the intrapsychical beyond the wildest expectations of the early pioneers, including Freud. Psychoanalysis remained anchored in its original base: the psychical core of the subject.

A period of transition from old psychoanalysis to contemporary psychoanalysis changed the scene of the IPA: ‘the international psychoanalytic association’. Although the IPA has an early(historical) functional link with the advancement of psychoanalysis it did not have a defined function outside the training endeavours. Its biannual meetings were not official events to advance the theory of psychoanalysis. They were the time to reorganize it so it could preserve its international qualification. The theoretical presenations in those meeting were usually of less qaulity compared with the published works of the membership.  In better terms, the IPA was an organization with one function: sanctioning its own training undertakings.

At the beginning of the analytic movement, future psychoanalysts had to go through training in IPA institute because there was no where else to learn and get trained. The training institutes mushroomed all over the world and the IPA, had to delegate the actual training and recognition of the training responsibilities to the regional and local branches and remained mainly a shell for ‘psychoanalysis’. At the same time, trained analysts were the only ones whose personal contributions to the theory were recognized as coming from a bona vide psychoanalyst. This arrangement created a confusing and an unhealthy situation in psychoanalysis. In all learning and training institutions or apprenticeships the relationship between the student or the pupil and the institution used to end by the completion of the task of educating and traing the newcomers. In psychoanalysis the relationship continues far beyond the period of formation, and to some degree remains forever in one form or another. The certified candidate seeks membership in the same organization that certified him. Those relationships could only be sustained by something implicit that lurks in the background of training inpsychoanalysis: infantilization. I mean by that, that the IPA’s system of the formationof the nalyst creates a personal conviction that training in psychoanalysis is a process of growing up under the guidance of the older generation of analysts. This setup is unacceptable in regular academic or traditional professional institutions. Once ‘finished training’ the graduate cuts the umbilical cord with his school. This feature is clear in the differences between admiring a professor or a teacher and idealizing (or its opposite) a training analyst. In more clear and observable way: the result of training and learning psychoanalysis in the inherited IPA system is unending, indelible, and with no doubt seeps into the analyst’s image of himself (ambivalence). This is the model of relating to Freud in the early days and is perpetuated in the IPA system of training till now.

In the next part of this post I will give my answer to the question of whether psychoanalysis needs improvement or substantial change.

2. The Crisis: Is it Psychoanalysis or the IPA:

Writing this post was a response to the IPA’s dealing with the crisis of the declining interest in psychoanalysis. The IPA offers solutions-like encouraging research-without looking for the causes of its fading relevance. I believe that the problem is with the psychoanalysis offered in the IPA’s training institutes. Increasing the membership to IPA-if it will ever happen- is not a measure or indication of gaining strength. The strength of psychoanalysis, which should be evident in the teachings and training in the IPA's institutes, is the measure of its usefulness as an international association. Better, instead of making psychoanalysis more appealing try making it more convincing as a science and a practice.

Resorting to some arguable measures of training to make psychoanalysis appeal to more candidates, as is the trend in some psychoanalytic circles will harm psychoanalysis more, or at least-will change its particular quality as a specific psychotherapy. This trend is responsible for allowing the improvisation of schools of psychoanalysis and for some analysts to revise basics analytic premises without enough scrutinization. The point to make is that if we-psychoanalysts- are members of an International organization- we should have a system to allow and disallow certain changes to psychoanalysis. Even though it is healthy that analysts consider making changes to psychoanalysis to advance it, the current changes to psychoanalysis do not have any convincing evidence that they are done to improve psychoanalysis or take it a step forward in its natural course of evolution. The IPA is supposed to be the insitution that should organize and provide an international agreed-upon standard from of uncontrollable changes to psychoanalysis. It is not right that under the provisions of the IPA there is learning and training in some societies and institutes of theories that contradict-openly and blatantly- the basic premises of “traditional” psychoanalysis.

The present situation in psychoanalysis reflects a state of chaos that has already made the future of psychanalysis untenable.  Firstly, we have a gap between psychoanalysis on this side of the Atlantic and the other side.  Psychoanalysis is comfortably established there as an academic subject. The IPA institutes seems to all be still adhering to traditional psychoanalysis. There is no noticeable conflict between the two systems. On this side of the ocean we had a dozen “schools” of psychoanalysis since Kohut initiated self-analysis. The birth and death of those schools does not follow any comprehensible theoretical line. The basis of one of the present popular schools is founded on almost a psychoanalytic rumor that one cannot hid his- self.  Psychoanalysis is not a political issue where people are free to follow their own preferences or their choices: we are professionals who provide an identified health service to people (and get paid for it), therefore we have to either agree on what we do or do not claim that we are all the same.

The IPA assumed and still presumably act as an international professional body of psychoanalysts who work to promote the right kind of psychoanalysis.  We have no idea of what is happening in the different, diverse, and theoretically confusing conditions of learning and training in the IPA institutes. It is understandable that monitoring training is left to the regional and local societies. However, maintaining the hundred years notion of the function of the IPA is misleading, and causing unnecessary distraction from the solution: If you cannot do it let that who could do it instead.

My argument is with analysts who should dispel the myth of the IPA, but do not want to lose the sense of distinction that comes with it. 
I should give up hope to convince the 12,000 analysts that they are better off with strong university programs adopting psychoanalysis. But, as a Chinese proverb says: not the last blow that splits the rock, all the blows that precede make that possible.

The Crisis: Is it Psychoanalysis or the IPA:

It is very important for this post to be put in its proper context for me to say that the psychoanalysis I am talking about here is that which the IPA claims to be the original classical one that it was entrusted, over a century ago, to promote and preserve. Psychoanalysis exists and thrives in some academic centers in many parts of the world. Yet, the IPA claims an original authoritative  legitimacy that stands as an obstacle in making psychoanalysis something more than the psychotherapy it imparts in its training institutes, producing a vague sort of a profession. 

Of late, it is noticeable that there are obvious concerns in the IPA community about the declining status and appeal of psychoanalysis. Just to show the nature of that concern I quote an exchange between two responsible and senior analysts about that matter. The first says: “…. North America had the fewest number of psychoanalytic candidates in training among the IPA’s regions, I have been thinking about ways in which the IPA could help …. to increase that number”. The other analyst commented by saying: “Institutes around the country, . . . have found that efforts put into the promotion of diversities can have multiple benefits, including an increase in the number of candidates (my emphasis) and clinical opportunities for them”. Most the discussions about the present predicament of psychoanalysis comes to the same point: the number of candidates in the IPA institutes. Worse, there is no mention in the rest of the exchange, and the ongoing discussions,  of the possible causes of that phenomenon or the benefits of increasing the number of candidates (since there is agreement on the declining number of patients seeking psychoanalysis for treatment).

Does the crisis we are facing pertain to something happening to the IPA and its membership, or pertains to something with psychoanalysis it advocates that makes it lose its status? Because I believe that the lack of interest in psychoanalysis shows only when we look at the IPA and its institutes. I wanted to underline two basic ideas: not all the psychoanalyses offered outside the IPA institutes are psychoanalysis, and that not all the psychoanalyses offered in the IPA institutes are psychoanalysis especially those that are offered under the guise of “a School”.

It was difficult to get any official or unofficial information from the IPA on the condition of psychoanalysis and training in the different parts of the world. Because of that difficulty I tried to get information directly about the from 11 different societies in Europe and South America. Not one was able to say that things are OK, four admitted having difficulties, the rest did not even go that far to disclose any information. In 1975 I asked casually about the number of analysts in the USA. I was given an unofficial figure that was close to the total number of analysts in world now. Only lately we got some statistics about the membership and the candidates in training from the IPA. Therefore, it is only logical to say that the crisis now is a crisis of the IPA, because of the dwindling number of memberships threatens its existence. However, I mentioned before that the relationship between psychoanalysis and the IPA is bad for both, because psychoanalysis is a theory that should not have organizational restrictions put on its progress, advancement, and reaching for farther horizons, which requires continued modifications in the system of learning and training. Even though IPA is supposedly an only membership organization, it still maintains and continues the early function of ‘psychoanalytic education and training’. This function was given to it due to certain circumstances related to the early initiation of psychoanalysis, which do not exist anymore. It is not proper or useful for the IPA to continue doing that, which is now interferes with its fundamental and its natural function of protecting psychoanalysis from deviating, deteriorating, stagnating, and dying. The IPA is not supposed to be both the teacher and the overseer of education. In another way of putting it, the training institutes of psychoanalysis are run by the IPA which is supposed to investigate, cheque, evaluate, and certify the quality of their learning\training programs. This is a violation of the most obvious rule of credibility.

My post is not about the credibility of training in the IPA institutes or the IPA’s latest attempts at reviving psychoanalysis. I want to bring to attention the role the IPA is playing in the deterioration of psychoanalysis and taking it to the verge of disappearing. We all know that there is no serios principle of checking the proficiency of any IPA training institute. This is logical and right because we have no clear system of teaching psychoanalysis and no criteria for assessing training. This is the case under the present conditions of training in IPA institutes, because of a very subtle but plainly missed reason. We might have a structure for training (the tripartite components of seminars, personal analysis, and supervision) but we have no uniformal functional definitions of those components.  If by horrific effort we could agree on a curriculum (a) for the seminars will not be able to do that with the other two legs of the stool.

 The IPA is concerned about its future as an ‘organization’ not about psychoanalysis as its professional reference. However, because the IPA assumes a major role in the formation -training- of the psychoanalysts and could also wield the power of accrediting training and granting membership, it becomes the tail that wags the dog. There is an inherent structure in the IPA of a hierarchy of positions and functions which come with some privileged statuses. It is an attractive and corrupting residual of the early days of the IPA. It still seeps down to the regional and local societies creating a self-destructive union between training and membership. The concerns of the IPA and the local societies about membership and recruitment shows in bursts of energy-every now and then- to vitalize the interest in psychoanalysis which are, in fact, concerns about the IPA and its future. For the last forty years psychoanalysis was distorted, infused with strange if not weird ideas, and is left to eventually will not exist. I mean that there wil come a time when we should not worry about psychoanalysis because it will not exist anymore.   

The Uselessness and Usefulness of the IPA:

The IPA served its purpose of protecting and growing the psychoanalytic movement for almost half a century. It established its prototype in all the culturally advances societies. It even found its way to the USA and managed to navigate its way in the turbulence of ‘the medical vs. none medical’. Duplicating its training institutes everywhere it existed does not need any comment. The IPA was with no doubt Freud’s smart idea. However, the fast success of the analytic movement tempted most members to assume the attitude of the different, the special, and the better, which isolated them from the professional base they came from. This trend had to backfire at some point, causing an unhealthy gulf within the wider circle of mental heath providers; we still hear its echoes. It also attracted quite a number of ambitious young professionals who were seeking status more than learning psychoanalysis. The membership of the IPA became aa it still- to an extent- a fringe benefit.

Because psychoanalysis is knowledge and experience it went on changing from merely a psychotherapeutic method to become a science of the human subject. Those changes started with discovering more details about the psychodynamics of the intrapsychic and its origins in childhood. It was also found out that the newly discovered intrapsychic dynamics show in the normal and natural expressions and manifestations of character formation and in interpersonal relationships. The range of psychoanalysis, both theoretically and involvement kept widening, and it was not possible to fit it anymore in the old training institutes of the IPA. Analysis requires a different setting to extends its reach. If not, it will disintegrate into schools, as mentioned above. Psychoanalysis has to become an academic program. This is happening now in many reputable academic set ups but the full power of this movement is hindered by the continued existence if the IPA institutes of training. The situation is like keeping the apprentice system of training physicians along with modern academic medicine.  

 What will happen if analysts failed, willed, worked on the demise of the IPA? Would psychoanalysis suffer from that or benefit? The answer with confidence will thrive and very likely will enter a new golden age. There is no place in the world that does not have some psychoanalytic activity. In those places or near by, a psychoanalytic establishment in the form of a university program or and academic intuition exists; next to the IPA organization if there is a psychoanalytic society in the vicinity. Thus, analysis will not disappear and the old belief that the IPA is the only “legitimate” base of psychoanalysis will eventually lose its credibility. However, this movement to change  has to be organized  to avoid some drawbacks of replacing the old with the new  without preparation. Bottom line, they cannot and should not coexist.