The Issue of Change in History and in Psychoanalysis.

Prologue:

There are some political events happening now in the USA, which some of us in Canada follow attentively, with great amazement and apprehension too. Those events have exposed several shortcomings in the current US democratic system. Overlooking those issues created a sense of confusion about the ways issues are discussed and solutions are suggested. The discouraging thing about that state of puzzlement is not  mentioning or suggesting the possibility of change.  Americans tend to idealize their 'forefathers' who founded their country, more than two hundred years ago, on principles that could have and actually had dazzled the world with their novelty and progressivity.  But after two hundred years , being now more than three hundred million people who are diverse even geographically, the USA's democracy still depends on two political parties that were formed over two hundred years ago, and were speaking for the issue of that time. Things need to be reconsidered because listening to the active politicians (not just the regular citizen) one cannot miss the uneducated understanding of the vocabulary they us, and the almost total denial that  two hundred years have passed since those concepts were misconstrued. Resisting the notion that things change, and could get better if they do, 'looks' to many as betrayal of the loyalty to the forefathers. 

The reason that this state of matters concerns us in Canada, and possibly everywhere else in the world, is the important place the US occupies in the world. The significance of this point was forcefully demonstrated during the last three years when an unqualified person took the helm in that important country. Although the American establishment was capable of curtailing his harm he still kept the world on the edge and caused a lot of harm and pain to some communities, worldwide. They are also resistant to acknowledging that the US now is member of a modern world and not what it was after the WWII: the leader of the 'civilized' world. 

Noticing the strong ambivalence the Americans are showing in regard to change made me think of the current events, and the phenomenon of Trump, in terms of both the patients' resistance to change and the analysts’ resistance to change their system of training. As analyst I understand resistance to change to be routed in a state of narcissism (self image). Self image, whether in a person, an organization or a nation is Narcissus's reflection on the surface of the pond which he fell in love with. That image, though it is just the image, replaces the actual body that engendered it. Even if the self image is the cause of great pain giving it up without a replacement creates a narcissistic void, which is filled with rage.  In psychoanalysis (if it is done properly) the work of analysis builds the narcissistic replacement for the vanishing one in a gradual way. So, giving up the image- partially- to include the real scenes of the self in one's narcissism also happens gradually and such change becomes a relief. This process is more difficult in the narcissism of organizations, because it requires willingness to get rid of the past, confidence that a replacement is possible, and available, and an equal willingness to acquire it. This difficulty is what is standing between psychoanalysts and getting rid of the IPA model of training. In nations, the possibility of giving up a national identity to get a new one depends on the political activists who would make that exchange palatable to most. 

This post is an attempt at examining the nature and fabric of change, which the political events in the US could benefit from if the psychoanalytic experience may be considered. Change in psychoanalysis starts with resistance (this is not the problem). When resisting fails to stop the process of analysis the patient rejects the the interetations. When rejecting the work of interpretation does not work either self deception tries to nullify the pain of the impending narcissistic void. Yet, eventually change happens whatever the means are to stop it from happening: change is not matter of preference or choice; it is unavoidable and sometimes it is a duty. 

Could we make sense of the events in the US in the way described, using psychoanalytic principles?

1. Past and Present in Psychoanalysis:

Clinical example:

A young female patient was unhappy about her loose moral standards that make her have sexual relations with the husbands of her female friends. Moreover, when she had a relationship with a man, she tried -almost compulsively- to befriend his wife. She came to a point at which her life was no longer manageable with rumors, rejections, and loneliness and bad sense of enjoyment. At the beginning of her analysis she always related her loose morality to her mother’s “immoral mothering”: openly favouring her younger sister because she was prettier and looked like the mother. She accused her mother of being a bad moral model: “Mothers are supposed to love their kids equally and it is immoral to make distinctions of that sort and ignore my feeling”. She kept repeating that her behaviour with men and friends is only looking for attention and feeling that she belongs to people. Her associations were mainly rhetorical and about her mother’s and sister’s embarrassing selfishness and social immoral neglect of other people’s feelings. She was always recalling two childhood painful memories: her mother refusing to make her hair and ordering the maid to do it, while insisting on making her sister’s hair, and overhearing her mother once making a negative remark about her looks to a visiting relative and predicting for her a life without marriage. Her immoral sexual relations started to make sense to me but I refrained from tackling that point for a long while, because she was emeched in her resentment of her family situation to a degree that needed more time to express and listen to herself doing that. She could not fathom yet or enough the circumstance that constituted the past of her present.

In a suitable moment I mentioned the difference between her immorality and what she considered immoral of her mother. She did not pay attention to my remark, but this led to a gush of bitter memories of her mother’s authoritarian nature and her failure to get close to her ‘rejecting mother’ because she was impatient with her, as she was with the maids and the driver. It took some time before mentioning her father whom she also described as domineering, but to her mind in useless matters.  She sarcastically mentioned how he was once furious and insisted on her going to the hairdresser with her sister.  I mentioned then that there are different kinds of authorities like her father’s and her mothers. She suddenly paid attention to my previous distinction between the two moralities of hers and of her mother’s.  Gradually, the meaning of morality expanded to encompass any sort of abuse of privileges, misuse of status or authority, and the patient realized that she was mad at her mother for all sorts of other things, not only her attitude toward her and her sister. Working through and interpreting matters in light of this expanded sense of deprivations revealed other confusions about anger and humiliation. Her puzzlement about anger and humiliation revealed preconscious aspects in the transference for a wish for her father to have done something about the situation. The analytic situation was reflecting a sense of desperation:  her persistent complaint was that the analyst, not analysis, is the solution to her confusions.It was easy to make translate that idea into an analytic insight that ‘only father could straighten the situation, but he is not paying any attention to what is happening in the family’. 

Her history became an unbearable transference present. Working on the confusions she lived and exercised in regard to matters of values, rights, power and authority resulted in some positive changes in family life. She reported that her relationship with her mother and sister improved, and, especially when her father – unexpectedly- noticed and showed some signs of interest in his role in the family. The patient’s sexual acting out was becoming less demanding. At that point the patient suggested termination and I agreed because I was not confident that opening the issue of her sexual improprieties will be dealt with properly within a reasonable period of time. Analysis ended at that time with the noticeable improvement mentioned but the link between the past and the present was not dealt with properly.

I understood what happened to lead to termination, but did not understand the rest of the patient. I was unable to understand the process that led to the father’s appearance in the scene, let alone the issue related to the patient’s sexual inclination. Termination did not really happen, because the past of the present was not revealed to exchange meanings with the present. Yet, something noticeable I could be mentioned in that regard (I could be deceiving myself): the patient’s past of confusing family dynamics determined that her psychoneurosis was going to be of a confused young woman about morality, and also determined that cure would happen when she learns the nature of an orderly perception of matters and and social demands.
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After years of practicing psychoanalysis in the classical manner of: patients’ associations, interpretations that would reveal to the patient- bit by bit- the unconscious processes in his transference, and reconstructing the intrapsychical psychodynamics, also a bit by bit, I was left with a puzzling issue that was even problematic. How doing what I do as analyst initiates change? Parallel to that-as I will mention a little later: what instigates change in politics? This question was raised because -for me-the change in the process of psychoanalyzing was always unexpected, even the outcome seemed unrelated to what I thought I was dealing with. In other words: I did not know while I was working what instigates the change and how. Only retroactively it was possible to come to some insights.  Although I accept the parallelism between psychoanalysis and other human phenomena, which are also difficult to understand on the spot, and are always understood retroactively, I still could not accept that a practicing psychoanalyst would not know how his work works!

Few years of puzzlement about how to understand the process of psychoanalysis made me discuss the issue with a senior analyst of Lacanian leanings. I asked: why the process of cure can only be recognized after the fact and not during the work. He said that the primary process does not make distinctions between the three systems of Cs., Pcs., and Ucs.  Therefore, we do not know what system is affected by our interpretation. We cannot predict or correctly anticipate the reactions and the changes our interpretations generate, because each system has its own way of responding to a proper interpretation, and changes differently from the other systems.  Therefore, a good analysis (based on good interpretations) takes its course and declares its end without any fanfare. I took his remark a little further: trying to predict or anticipate outcomes of limited aspects of the material indicates that I am not doing good analysis. Analysis is a process that opens the way for all the sorts of freedoms that the psychoneurosis blocks. Analysis opens the way to freedom of sexual enjoyment and also of refraining from meaningless and destructive sexual relations. Psychoanalysis is a process of understanding but retroactively: that patient understands while and after associating, and the analyst while understanding and interpreting, not before.

Dealing with a past that is still lived in the present, as in the psychoneuroses, and aspiring to change it, raises this question: what happens to the changed past? In psychoanalysis we try to make the means for changing remain active and usable by the patient ‘for ever’.

In a nutshell: reading the present could reveal both the past and the possibilities of the future. This is the common issue in “psychotherapy”, i.e., to what degree the patient’s past will get better defined and is not going to remain a set of memories. This change happens when the patient realizes that his past was lived experiences that are compulsively repeated a distorts the present. In psychoanalysis we cannot free the patient from his past but we demonstrate to the patient how to avoid being misled by it and keeps alert to that possibility in his present.

4.The Demise of the Profession of Psychotherapy.

      The birth of psychoanalysis followed by the expansion of psychotherapy introduced the subject to his psychological nature and introduced him to the era of self-reflection and psychological awareness. This era lasted close to a century but in due course it started to fade away. The deteriorating interest in psychoanalysis that spread to affect psychotherapy too, is not the cause of the end of that era, as some analysts envisage. The era is waning because psychoanalysis has seeped into daily life and accomplished major and deep changes in the society; changes that require close attention to its impact on its practice as psychotherapy. In other words, psychoanalysis has caused substantial changes in the social live of the modern subject that resulted in parallel changes in the population of patients and in their symptomatology. It is very unlikely to find in the regular practice of a busy analyst ‘a Wolf Man’ or a phobic patient, or even an obsessive-compulsive professional.

The psychodynamics of the subject are not affected by the new ‘old’ discoveries anymore. Most of those old dynamics are taken care of at home where mothers are quite familiar now with them and how to avoid their impacts on their children. The media has popularized the notion of the unconscious to the degree that made ‘interpretation’ part of any discussion, private or public. In the early period of discovering psychoanalysis the means to discovering the psychical nature of the subject was also the core of doing therapy. Thus, when discovering anything genuinely new slowed down the approach to practicing psychotherapy had also to change. Those changes affected both the number people who seek psychological help and also the nature of their psychopathologies. The desperate efforts to revive psychotherapy by modifying its psychoanalytic basis “declared” the end of the era of the strict adherence to the analytic protocol, and the long psychotherapies. We cannot disregard anymore that there was actually no professional explanation to the established tradition of ‘the four session per week for several years of therapy’. Although this was merely a tradition that came from the early years of ‘training’ it was still part of the clinical protocol and should have been explained to justify its continuation. With ignoring the protocol of practice, the tradition did not have a theoretical justification to support its continuation. Furthermore, the theory of psychoanalysis was enthusiastically accepted by societies, and many- if not most- of its content was integrated in the daily life of the society and in formal and informal education.

Those changes are there to stay and the era of psychotherapy as it was before is gone because of the undeniable success of psychoanalysis. Discussing this subject amongst ourselves is difficult, because there is no way to avoid accusations and incriminations, especially that we are unable to say loudly if the demise of psychotherapy is a temporary phase or a permanent state of affairs. Moreover, to discuss this issue properly we have to put it in context. Psychoanalysts do not like to consider psychoanalysis within some context that might not be totally limited to psychoanalysis as we know it (psychoanalysis in the context of the change in the population of patients, for instance). We are accustomed, maybe also indoctrinated, to think of psychoanalysis as a sudden unique discovery, which has no past and only happened to happen, and was initiated by nothing or no one but Freud. Remembering that indoctrination process brings back some memories of belittling the attacks that were directed to what we do. We were indoctrinated to always think of our uniqueness.

Psychoanalysis as Knowledge:

Whatever psychoanalysts like to think now of psychoanalysis they have to acknowledge that it came after close to three centuries of philosophical endeavours in defining the human subject. Psychoanalysis was successful in unlocking the impasse reached by the philosopher in regard to explaining their very important and perceptive findings (could not explain the a priori principles that allows conceiving certain aspects of reality). The psychoanalytic discovery of the primary process could make Kant’s conceptions understandable.  This means one or both of these statements: “psychoanalysis is part of a large body of knowledge, or, psychoanalysis is a large body of knowledge not just a psychotherapy”.

Freud’s discoveries came from working with patients whose symptoms exposed aspects of human nature that were there but without an explanation. The philosophical heritage of the eighteen century was crucial and essential for Freud to be able to consider Dreams, Parapraxes, and Jokes keys to understand the subject’s hidden attributes, which escaped the philosophers. It is equally impossible not to note the part psychoanalysis plays in explaining the social and cultural manifestations of the human subject. The point is that any knowledge which contributed to the founding of psychoanalysis has to be part of the knowledge psychoanalysts should acquire.  Similarly, any knowledge that contributed to the core of psychoanalysis has to also be considered in the education and training of psychoanalysts. A psychoanalyst should be cognizant of his subject matter as is the case in all other respectable professions. Any training analyst who did some teaching and took the responsibility of supervising candidates must have known how the good knowledge of psychoanalysis has a very obvious effect on the ability to benefit from supervision. There is no way to do proper training in analysis without solid, undiluted, well presented body of psychoanalytic knowledge. Teaching Klein without explaining the difference between functional and structural concepts, makes Freud’s need to going back to the first topography to save his structural metapsychology of the second topography a meaningless gesture, when its is in fact the key to understanding the current crisis. The deterioration of psychoanalysis, changing its subject matter, allowing modifications in practicing psychotherapy lead are behind the ease by which serval analysts eliminate the importance of some fundamental aspect of the theory like transference without a blink of the eye. All the effort to revive psychoanalysis by degrading it to some sort of a healing profession, have reduced learning and training to a formality and a procedure of initiation into a profession by performing some rituals.

Misgiving about Contemporary Learning and Training in Psychoanalysis:

Psychoanalysis looked at its beginning as an attempt at answering some questions about us-the human subjects. The questions were about what, and why things are and how they become. The answers came from the work of psychotherapy. The idea of training emerged when new knowledge started accumulate and more insights in those new discoveries proved to be more complicated than was thought at the beginning. Identifying the best way to psychoanalyze the subject put psychoanalysis in a different perspective: we can now discover more about the subject. Psychoanalysis with the new discoveries was no longer merely a therapy, but rather a comprehensive body of knowledge that comprises knowledge about the subject, aspects that need to be considered in practicing psychoanalysis regardless of the diagnosis of the patient, and a defined conception of the process of therapy. Training in psychoanalysis had to change in order to address those three constituents of the profession.

 Since training was suggested almost a century ago it was done in few institutes that were under the auspices of the IPA. That was the only venue for psychoanalysis to survive and progress. The body knowledge at the beginning was limited, and the technique of psychotherapy was tentative, even after Freud postulated the clinical protocol. Training was less demanding in terms of the time a candidate needed to dedicate to study psychoanalysis and learn the subtle technicalities of practicing it.

The situation-at the present time- is drastically different. The institutes are in the hundreds and exist almost every where in the world. It is practically impossible for the presumed IPA standards of training to be checked to assess the quality of training in those institutes. There are independent institutes and some university programs that are participating in the formation of psychoanalysts. The amount of psychoanalytic knowledge available and required to doing good psychoanalyzing is impossible to learn in the institutes that function on the part-time basis. Just a sample: studying the “Interpretation of Dreams” to learn about the primary process has to also include the good works of other analysts who studied that work scholarly and were capable of understanding the primary process mush better than Freud. Thus, the aspect of the seminars has to be totally be reconsidered.

The second part of training is supervision of the candidates practice to make sure that the theoretical knowledge is properly assimilated. The task of evaluating the candidate’s knowledge of the theoretical basics of psychoanalyzing requires firm and well coordinated integration of the training project as a whole. This not possible to be done without a clear definition of the objective of training, which in light of the task of supervisor-supervisee turns training to a full-time endeavour for the candidates and to some of the training analysts too. Those changes make the IPA institutes and the independent institutes unfit to carry the responsibility of training. Training to be done well within these necessary modifications demands a dedicated faculty that could provide the properly needed expertise and width of knowledge. In my estimate a proper training in psychoanalysis would need between six and eight years.

Psychoanalysis is now fit for becoming a full-fledged university degree that could branch out to several specialties.

Closing Notes:

Waiting (hopefully) for the old days of analysts and therapists working in their comfortable offices is not realistic anymore. First, Training in psychoanalysis and consequently in psychotherapies is not good enough to generate in the patients the old sense of confidence in therapy. Second, Patients are getting a great part of their therapy from sources that are more effective and dependable; parents, educators, even the media. Third, the great volume of knowledge that accumulated over a century of work of great analysts and therapist should have advanced the practice of the therapy profession but it did not. Therapists are still captive of the concept of the training institute.

Two points still need and could be addressed:

·       Why psychoanalysts (and therapists) are the only group of people who refuse changing the present situation in their fields of expertise? I would not venture an answer because it will be nothing more than repeating a psychoanalytic template.

·       Where is the theory of the subject that would free the therapists and analysts from being stuck in a professional standstill (I will publish a book on that topic in few weeks). 

I think it’s a good way to end long years of dedication to psychoanalysis while taking an unpopular stand from the coming and going of the profession . 

I will post the introduction and the table of contents of the book in few days. 

3. Psychoanalysis and Psychotherapy: The Uncomfortable Duo.

      This is the most unappealing title for this part of the post, but I could not find another to express my aim of writing this part:  the distinction between learning psychoanalysis and training in psychotherapy, which is also the difference between psychoanalysis and other psychotherapies.

The birth and evolution of the idea of psychotherapy came from Freudian psychoanalysis. Thus, when Adler and Jung split from the Freudian movement, to form their psychoanalytic schools, they took it for granted that they should also have their own specific psychotherapies. There is no required link between building a psychoanalysis and creating ‘a psychotherapy’ for it. In fact, psychotherapy-the Freudian one- was created by using the discoveries that he made in the field the psychology of the subject and psychopathology to effect some therapeutic changes in the patients he worked with. Psychotherapy was always a step behind the theory and was never an area of examination or separate discussions as the theory was.

Transference, is the best example to show how simple and fragmented clinical observations led Freud to that concept, and how it made psychotherapy an issue in psychoanalysis. The significance of that discovery made Freud consider some ‘recommendations’ for practicing psychotherapy and created sort of a protocol of practice (1912). Freud’s clinical protocol was thought of when the manifestations of transference promised going back to when the intrapsychic was formed, better, deformed. The recommendations for good practice were very much to give transference all the space it needed to be ‘interpreted’ in order to reconstruct the intrapsychic as it appears in dynamics of transference. There are two more items of the protocol that were seldom discussed: the frequency of the sessions and the fixed time of the sessions.

          Early Uncomfortable Duo:

      Psychoanalysis generated a psychotherapeutic modality influenced by the protocol (neutrality, anonymity abstinence). In the early years of training and learning psychoanalysis some analysts took the protocol out of its context of working with transference (better though, working with the patient’s material as transference material) and turned it into rituals, which with time get separated from its purpose and become aims in their own right. The protocol was taken as the condition necessary to effect cure. Some analysts adhered to it, sometimes, in comic ways (a good number of analysts, of the early phase, used silence as a method of interpretation). Those analysts did not explain to their patients and supervisees the logic behind the protocol; thus, psychoanalysis had an almost mystical reputation of being unique. Psychoanalysts were quite pleased and protective of this reputation and worked to emphasize it, by exaggerating its uniqueness in their regular behaviours.

Psychoanalysis brought the concept of the psychic out of neglect, ignorance, and misunderstanding. The concept of psychotherapy- separate from psychoanalysis- eventually emerged, not as an application of a fringe psychoanalytic theory but as a possible new approach to working with patients. Psychologists were encouraged by the growing acceptance of psychopathology and the treatment of the psyche and felt that they too have something to say and do. This is when psychoanalysts had to compete and find ways to distinguish psychoanalysis from other psychotherapies. At this point I have to use an anecdote to underline a point. While still in Egypt before getting my official training in psychoanalysis I got in a discussion (argument!!) with a behaviour therapist who was my professor of psychology and taught me behaviourism (Skinner, Tolman, etc.). He was unable to respond to my inquiry of how does behaviorism deal with the effect of childhood experiences on the adult’s behaviour (which I got him to acknowledge first). His answer was ‘this is not  not psychoanalysis but is psychotherapy’.

I heard more analysts over the years say that same thing to anything that did not come from an analyst, as if the criterion of what is psychoanalytic has no distinctiveness quality of its own but is given that quality by the speaker. Psychoanalysis gave birth to psychotherapy but failed to maintain its uniqueness amongst the other psychotherapies. Confusing psychoanalysis with other psychotherapies was product of psychoanalysts’ gradual leniency with its parameters and some mild unnoticeable additions to its basic premise that are core issues in psychotherapy. For instance, Kohut added to psychoanalyzing the notion of empathy and vicarious insight. Doing that changed psychoanalysis to a psychotherapy because it made it dependant and aimed at something not constituent of the process of analyzing but specific to certain therapeutic actions. The lack of defining the difference of psychoanalysis from all other therapies was or the failure of acknowledging its existence makes an uncomfortable duo of a unique psychotherapy and all other psychotherapies.

The protocol of psychoanalysis is very important in distinguishing psychotherapy practiced the psychoanalytic way, and all other psychotherapies, even the presumably called psychoanalytic psychotherapy. The protocol defines the boundaries of what is psychoanalytic and what is psychotherapeutic.

A Fundamental Difference: Method and Substance.

In my opinion psychoanalysis is the practice of psychotherapy with strict adherence to the principles of the protocol. Better, adhering to the principals of the protocol makes the practice of psychotherapy psychoanalytic. The protocol is not a method of psychotherapy; it is the substance of its psychoanalytic practice. That substance is free association and interpretation. Free associating is impossible, because the patient cannot freeze consciousness completely thus what he says is transcended by unavoidable conscious functions. The struggle to say whatever comes to mind without modifications, and not being able to do so reveals that the supposedly free association has more than one meaning. This kind of material requires interpretation exactly as the ‘word of God’ caries the meaning that he wants declares as his commandments but we find out that he was saying something else than what we heard the clergy telling us. Interpreting what the patient says reveals what he unintentionally revealed in his ‘not real free association’.         

Psychoanalysis is only an act of psychotherapy when it is done with the Freudian protocol as its framework. I fined Freud’s outrageous violation of his great clinical insight (analysing his daughter) to be the convincing fact that the psychoanalytic protocol is an absolute element in any proper psychoanalysis because without it we cannot get to the unconscious material that would deserve analyzing.

To put this the practice in context we should review the stages psychoanalysis went through to reach this point. In a first stage hypnosis was used to freeze any conscious judgment, then confront the patient with what he said during hypnosis, i.e. informing the patient of what he does not know was the therapeutic aim. However, Freud realized that the unconscious reveals itself even in ordinary conscious interactions and was able to decipher it without hypnosis. So, psychoanalysis was done, while the patient was fully conscious of the analytic process, witnessing it happening. This change was the first definition of psychoanalysis as a unique psychotherapy; the analyst does the analysis and the patient does the therapy.  The third stage was following interpretations by reconstructing consciousness with the additional interpretations that revealed the unconscious. It is conceivable to see now that the protocol that demands excluding the analyst from the material (not the process) makes the analyst the proper subject of transference, and the analytic material would get its meaning from the lived experience with the analyst. In psychoanalysis, transference is not merely different analytic material but the method of doing analysis: it is the substance of psychoanalysis.  The unconscious material- or the past- resists being forgotten but is still difficult to remember. It is usually enacted in disguised transference acts and thoughts. Transference is the only possible and available medium for the analyst to reconstruct (reorganise) the past and give the patient a better narrative of his life story.

Psychoanalysis, Psychotherapy, and the End of an Era

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{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}.
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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.  

Ann addendum:

The negative responses to my post on psychotherapy and psychoanalysis make me post this addendum.

The first part of my post was to deal with the rigid conception that the term 'psychoanalysis' means psychotherapy and possibly some other theoretical view points. My objective is to show that psychoanalysis is a theory in its own right linked to psychotherapy but still a theory created by all thinkers who think and discover the human subject. Psychoanalysis is not psychotherapy even though psychotherapies owe their existence to psychoanalysis.

A second clarification: psychoanalysis is not a profession, never was, still is not, BUT should become a profession. I practiced and made a living working in psychoanalysis but under the auspice of the licence as a psychologist. Psychoanalysis is not even a designation in the three professions that permit analysts to use their licences to practice. Anyone in those three profession could claim to be a psychoanalyst without any recourse.

I will continue with my post.

Psychoanalysis, Psychotherapy, and the End of an Era

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{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}.

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1.    A Very Banal Introduction.

Every time the difficulties psychoanalysis is facing are raised the issue of psychotherapy- in general-comes to mind. The reason is that the birth of psychoanalysis forced sort of a symbiotic link between a theory and its application and the term ‘psychoanalysis’ signified both aspects. This linkage created and still creates may unresolved problems. However, over the years, psychotherapy reached a certain degree of independence of psychoanalysis and seemed to have chartered a course of its own, while psychoanalysis remained undecided about its place in that duo.

Psychoanalysis started as an attempt to marry the French discoveries of the split of consciousness, and of hypnotism as a means to paralyze the active one to reveal the split other. This attempt was meant- at the beginning- to explore hysteria. The attempt, with Freud’s insights and intuitions, led him to the notion that the process of exploring could be turned into a method of psychotherapy. This turning point came from realizing that the split of consciousness could be explained as repression of morbid ideas that conflicts with regular consciousness. In better terms: Freud realized that psychoneuroses could be functions of some psychical mechanism that separate (splits) the unacceptable conscious material from regular consciousness. Those discoveries resulted in creating a new vocabulary to express the findings, which were viewed more as a branch of mental health. Psychoanalysis became a new field within the mental health profession. The most important feature in this new theory was the desperate attempts by Freud and his disciples to come up with a comprehensive “functional” theory of psychoneuroses their psychotherapy (how repression causes the neurosis and removing it results in cure). They were looking for a theory of causes and effects. Discoveries were getting more comprehensive, more extensive, mistakes were corrected, new ways of looking into the nature of the ‘psychical’ were coming from gifted psychoanalysis who came from different cultural and philosophical backgrounds.

Yet, something remained illusive: what is the link within the dual nature of psychoanalysis as discoveries about the subject ant the psychotherapy of the neurotics: is it a theory of something (its subject matter!) that is applied as psychotherapy. The question had another formation: is psychotherapy (profession) that generates new discoveries that require new terminology and theoretical formulation? This question could be dismissed as superfluous if the answer is: the link between theory and practice is dialectical. However, the link between theory and practice psychotherapy did not display a dialectical quality because neither the theory of psychoanalysis got improved by accumulated experiences in practice, nor practices got any better by the “new” modifications in the theory of psychoanalysis (will come to that in part three of this posting). Dialectical links are supposed to create a more advance understandings of that link and create better links. The dilemma of theory and practice is still as complex as it was raised sometime ago and remains as it was before, and we will see later it got worse.

To avoid deviating from our objective by discussing those issues further now I will underline two pairs of concepts that affected the progress of psychoanalysis in manner that put psychotherapy-analytic and none analytic- in focus. They are reflection of a halted progress.

Functionalism and Structuralism.       

Until the thirties of last century, the only way of thinking that was considered scientific or aspiring for factual results, was ‘functional thinking’, i.e., finding the plausible ‘causes’ of phenomena ‘effects’. In the humanities, like psychoanalysis, thinkers and scientists had tremendous difficulties in getting to those functional formulation. They did not know-till Freud showed- that all human phenomena contained an unconscious aspect that interferes in the relationship between the causes and the effects. In the interpretation of the Irma dream the cause of the dream was the implicit criticism Freud read in Otto’s remarks on his patient’s suffering. Hence, he interpreted the scene (in the dream) of the confusion of the ‘great’ physicians about the patient’s diagnosis and the patient’s behaviour itself to be exonerating him from poor practice. The dream fulfilled his wish to deny that the patient’s lack of response to his treatment was because of him. But this rule ‘formula’ does not say anything about dreamers who are seldom aware of a fulfilled wish in their dreams (will get to that a little later). All the unconscious factors involved in creating a Freudian megalomaniac scene of debasing the adversaries were not considered in the interpretation of the dream. In fact, dreams-unconsciously- fulfill the antithesis wish of the ‘day residue’. The wish was to get praised for his good work, while the wish in the dream was to debase the adversaries for blaming him.

In Sociology, marriage was explained as a system to control sexual relations for the sake of normalizing the family unite. However, it was not possible to make sense of this understanding with the wide range of differences between societies in that regard. Sociology missed that whatever are the rules of marriage in the societies they all agree on one shared rule: avoid and prevent incest. Marriage- “unconsciously”- is to control incest, thus prevents interfamilial parricide. Dreams are not wish fulfillment; they are statements of wishing.    

It is very important to emphasize, even to over emphasize, that every time Freud came close to announcing his latest functional theory as the final theory of psychoanalysis, he stopped short of shutting the door behind him. He always sensed that his functional theories were inadequate. He knew what is not before knowing what is. After the theory of infantile sexuality Freud reversed the functional relation between the cause and effect between sexuality and psychoneurosis: the neurosis causes deviations in the sexual urge not that psychoneuroses are the effect of distorted sexuality. Twenty years later (Freud,1926d) reversed the cause\effect of the state of anxiety and psychoneurosis. Anxiety has become the sign for psychical processes to start to activate (unconsciously off course) instead of the old view that anxiety is the manifestation of a psychical process that went wrong.  

A different way of thinking was implicit in his major works. It seems that something similar existed in the best works of the human thinkers of the time. In the early thirties F. De-Saussure (a linguist) introduce structuralism as a distinct way of thinking in the humanities. The implicit became explicit. The jest of the structural way of thinking is to understand (interpret), then rebuild the phenomena based on what your understanding revealed of its internal structure. The ‘unconscious evolution of psychoanalysis coincided with the birth of the structural theory to give us a different psychoanalysis from the cause\effect understanding of the psyche.

The Intrapsychic and Interpersonal.

The second pair of the two concepts is the relational vs. the intrapsychic conception of the subject. As mentioned above we should keep in mind that Freud avoided several premature functional foreclosures on his theoretical endeavours. He ‘sensed’ that functional formulations are void of proper consideration of the unconscious and its participation in the final formulation. A scholarly examination of Freud’s various theoretical formulations revealed to thinkers, philosophers, and the intellectual community in general the presence of a structural component lurking in the background in all his previous functional attempts at theorizing psychoanalysis.

Freud’s finding about infantile sexuality did not stop at that, but he advanced the discovery to make sexuality a Trieb (a pressure put on the mind to work) and not Instinkt. This choice of terms did not stop him completely from trying to name other Trieb (s) but he immediately got to the process of representation (thing and word representations), which is the core structure of the Trieb activity. This means that Freud was a closet structuralist while his disciples, with very few exceptions, were functional theorists.  

Although the term ‘intrapsychic’ was not in use at that time Freud realized that the patient (subject) has his own way of responding to the pressure of the Trieb and realized that what we now call intrapsychic is the core structure of any psychical phenomena. Freud understood infantile sexuality and its relation to adult sexuality and sexual deviation as a process that starts and matures, and in its way to maturation it succumbs to modifications that changes the nature of its pressure on the mind and the response is always individual and subjective. He realized and acknowledged that sexuality is a process not an entity- thing.

 The proof that Freud’s psychoanalysis was ‘basically’ a structural theory is in its impact on the cultural and the philosophical communities. Psychoanalysis caught the attention of thinkers and philosophers quite early in its history. In 1926 Politzer (a Marxist philosopher who should have known the nature of structural thinking well) gave psychoanalysis a great amount of attention. He considered psychoanalysis a different psychology and that its understanding of the human subject (the psyche) is distinct from the other common psychologies, like Wundt’s psychology. Ludwig Binswanger (1881-1960), even suggested a psychotherapeutic approach based on his understanding of psychanalysis. He could be considered the spark that set on fire the attention of phenomenologists, existentialists, and arts and literature masters to psychoanalysis which, was isolated in its psychotherapy camp. Psychoanalysis promised the best of in those in fields an extension to their search for the nature of the subject. Psychoanalysis identified the missing item in the novel structural epistemology: the systemic and none repressed unconscious.  This early recognition of the psychoanalytic conception of the subject was a blessing and also a curse in disguise.

The blessing was extending the boundaries of psychoanalysis beyond its limited beginning as a clinical branch of psychiatry. The advancements in the discoveries about the subject, which made Freud extend psychoanalysis beyond psychopathology [his last creative work was Moses and Monotheism] was influenced by the thinkers, philosophers, and the intellectual in general. Hence psychoanalysis was a blessing in the disguise of what the concept of ‘application’ sometimes offers. None of those giants of the culture considered psychotherapy an application of psychoanalysis. It was also a curse because psychoanalysts felt threatened, surpassed in their knowledge of the subject, and became relentless in refusing none analysts to speak for psychoanalysis. They closed the field of learning, training, and practicing psychoanalysis to be their own field of being.

The serious thinkers and philosophers -mainly in Europe- continued integrating the psychoanalytic discovery of the subject’s psyche in their own philosophical works. The works of Heidegger, Habermas, Merleau-Ponty, Ricoeur, Foucault, etc. and the existential movement and many others in the associated branches of the humanities (anthropology, mythology, etc.) demonstrated a very significant fact: psychoanalysis can survive, even flourish without the practice of psychotherapy. However, psychoanalysts kept their belief that psychoanalysis is a clinical discipline. The faulty understanding of the link between theory and practice led the psychoanalysts to a basic blunder: they believed they can derive a theory of psychoanalysis from practicing it as psychotherapy and anything that does not come from the clinical filed is not psychoanalysis. The fundamental and definitive mistake in that blunder is the fact that psychotherapy is a closed field and it could only survive if there are none clinical sources that could keep it going and growing (imagine the general practitioners in medicine not accepting the discoveries in the other specialties or even in the field of medical instruments). Practicing psychoanalysts could either improve the technique or at best find in the theory of psychoanalysis, as the thinkers have advances it, some clinical aspects that could make psychotherapy more effective.

The distinction between functional psychoanalysis and structural psychoanalysis extends to distinguish between intrapsychic and relational theories of therapy, and between psychoanalysis as a different and separate psychotherapeutic work that does not share much with other psychotherapies. Psychoanalysis of causes and effects (trauma, poor mothering, unresolved Oedipus, etc.) is limited to dealing with relational issues. Relational issues, and their participation in the psychoneuroses dictate using explanations as the means to cure. Explanations do not affect the psychoneuroses that have been established in the patient before any understanding was possible, i.e., understanding them ‘now’ does not obviate the unconscious changes they already done to the intrapsychic psychodynamics when they happened. Functional psychoanalysis is psychotherapy, or we could say psychotherapy came about when psychoanalysis was still in the phase of functional thinking

The beginning of Freud’s attention to structuralism could be seen in the case of the Wolf Man and more so in his understanding of the Schreiber memoirs. In those two cases-though they were not pure clinical example- Freud talks about the person, the individual, the human subject, not about mechanisms or what confirms his theory. Structural psychoanalysis interprets what the patient says to get to its internal structure to reconstruct it with the patient and effect the desirable insights to continue self- analysis and changing the intrapsychic construct. Psychoanalysis aims at changing not improving the intrapsychic nature of the patient. WE are not healers, we are psychoanalysts.     

 Confusing a theory of psychoanalysis with presumably a theory of clinical practice had a very negative and serious result. In a very short period of time analysts started ‘improvising’ theories of practice (for reasons to be presented in part three of the posting) believing that they were advancing psychoanalysis. Some even created fictional new psychotherapeutic techniques and superimposed them on the philosophies of known philosophers of the new age of the human ‘subject’. The coexistence of functional concepts (relational, interpersonal, intersubjective….)  along side the structural understanding of psychoanalysis (identity, transference, narcissism) created two camps of practicing psychoanalysts: relational psychoanalysis and intrapsychic psychoanalysis.

This division has been by some analysts as schools of analysis. Those are not schools; they are deviations from psychoanalysis and caused it to deteriorate since the sixties of the last century.  

Is he impeachable 

I am sticking my neck out: 

Trump is unimpeachable. Impeachment has to be for intended breaching of a constitutional limitation. Trump is cognitively incapable of doing anything intentionally. An intention requires a process of thinking and the existence of issues that are separate or were separated from the person’s sense of wishing. We all know the difference between doing or saying something intentionally or impulsively or spontaneously or idiotly. 

Those two things do not have any presence in that man’s (Trump) mind. He is not able (incapable) to initiate a process of thinking about his wishes to try to fulfill them intentionally (he wished to discredit his rival, acted upon his wish without thinking of what or how he has to go about it). No intentionality -preparation- for requesting the favor from the Ukraine president. Mixed with that incapacity there is the pressure that everything he does has to be great. Thus, he considered that withholding aid from a president is only natural when he deals with others.   

How could anyone impeach a man like Trump: he is living in a world that has no exitance because his wishes and ideas is the only reality that others could and should be thinking of, or the only issue that could exist to others to think about. He does not lie; he does not change his mind. This is why nothing he mentions is like anything else (never before, worst thing ever, you have never seen something like it before, etc.).     

We do not have in psychoanalysis anything that could explain this man’s “condition”. Psychologically, Trump’s I.Q. cannot be measured because of his inability to think. However, I believe he has an I.Q.  is in the range of 90-99, but without the brains that could utilize this modest intelligence. How could you impeach a psychological –not a cognitively-idiot?