ISSUES IN THE DEVELOPMENT OF CLINICAL PSYCHOLOGY IN THE U.S.A.

All States in the U.S.A. license or certify psychologists. The basic degree for licensure/certification is a doctoral degree. Licensure/certification is usually generic but various other forms of specific credentialling in Clinical Psychology are possible. Most health insurance schemes provide payment for psychological services, though not invariably on a fully independent basis. The major instrument in achieving this recognition has been ‘freedom of choice’ legislation. It is maintained that the three issues of credentialling, licensure/certification, and receipt of third-party/insurance payments are highly interdependent.     

Toward a tripartite vision of supervision for psychoanalysis and psychoanalytic psychotherapies: alliance, transference-countertransference configuration, and real relationship

The psychoanalytic supervision relationship is examined as a tripartite phenomenon, comprised of the supervisory alliance, transference-countertransference configuration, and real relationship. While most supervisory analysts would readily acknowledge that a real (or personal) relationship element exists in analytic supervision, that facet of the supervision relationship has not routinely been incorporated into considerations of psychoanalytic supervision. In this vision of supervision, real relationship, supervisory alliance, and transference-countertransference configuration are presented as integral and complementary constructs that define psychoanalytic supervision. Each of those three components is examined briefly with regard to its beginnings, evolution, and contemporary status; each component is also considered from an empirical perspective. While we have a growing quantitative and qualitative research foundation that supports psychoanalytic practice, psychoanalytic supervision has largely been ignored as a subject and object of scientific study. Supervisory alliance, transference-countertransference configuration, and real relationship are explored as research ready variables. Some clinical hypotheses--eminently testable and worthy of investigation--are proposed with regard to each component of the model, and some ideas--albeit tentative and preliminary--about how to initiate such inquiries are offered.     

Psychoanalytic Interpretation as Pharmakon: Applying Derrida’s “Plato’s Pharmacy” to Psychoanalysis

This paper presents a metaphorical heuristic to expand psychoanalysts’ views on the nature and method of interpretation from an intersubjective perspective. It uses one of Jacques Derrida’s findings in his essay “Plato’s Pharmacy,” a critique of Plato’s Phaedrus, as a model of psychoanalytic interaction. A parallel is drawn between psychoanalytic interpretation and the pharmakon—an ancient Greek term for ‘drug’ that means both remedy and poison. From this comparison, the inescapable dependence of personal meaning on contextual factors, specifically the context of the clinical intersubjective field, is shown. As a result, when an interpretation is offered, the analyst cannot truly know if the patient will receive it as remedy or poison. By keeping the context-dependent nature of personal meaning in awareness through the use of the pharmakon metaphor, analysts increase their abilities of interpretive understanding. In further discussion, the classical psychoanalytic concept of ‘negative therapeutic reaction’ is presented as an example of a decontextualized and reified psychoanalytic construct that becomes superfluous when interpretations are viewed through an intersubjective lens as pharmakon. Without the burden of expectation for being the authoritative imparter of reality and truth, the analyst may now attend to the patient in a way that is more fluid and reciprocal, where the relational field becomes what is primarily interpreted. Further, practical clinical implications of the concept of pharmakon suggest that since the analytic interpretation is subjective in every respect, effective clinical practice cannot be reduced to rigid protocols of technique.     

A mixed-model for psychoanalytic education*

Abstract

If psychoanalysis is to avoid total marginalization, something has to be changed in the way future generations are prepared for working with patients and doing research. Reformation of psychoanalytic education may easily be the crucial issue when it comes to the survival of psychoanalysis. Its current organizational scheme has been criticized for various reasons, and various models of its structure have been proposed. I advocate a model that would combine the best features of the university education (training in clinical skills together with philosophy of science and research methodology) with personal analysis as part of psychoanalytic institutes. Although universities can remedy some of the problems of psychoanalytic institutions, they cannot contain the subjective experience of being analyzed.     

The stigma of the self

Abstract

After recounting some personal life experiences that sensitized him to the kind of stigma that Erving Goffman systematically explored in his 1963 classic, Stigma, the author, who Is a psychoanalytic psychotherapist, introduces hit concept of the stigma of the self. Paradoxically, the stigma of the self may occur when a person is treated as merely normal, and as only a social self and when, a? a consequence, there does not seem to be any recognition of what D. W. Winnicott has termed the true self. Drawing on his studies of the self [in his recently published The Singles Scene: A Psychoanalytic Study of the Breakdown of Intimacy(Alper, 1995)] the author explores the dynamics of what he calls intimacy hunger, an unappreciated but powerful need that, especially after a sufficient period of deprivation has elapsed, cannot be satuifed by a purely social substitute.     

PATIENT‐ANALYST “WITHNESS”: ON ANALYTIC “PRESENCING,” PASSION,AND COMPASSION IN STATES OF BREAKDOWN,DESPAIR, AND DEADNESS

This paper focuses on the analyst's “presencing” (being there) within the patient's experiential world and within the grip of the psychoanalytic process, and the ensuing deep patient–analyst interconnectedness, as a fundamental dimension of analytic work. It engenders new possibilities for extending the reach of psychoanalytic treatment to more disturbed patients. Here patient and analyst forge an emergent new entity of interconnectedness or “withness” that goes beyond the confines of their separate subjectivities and the simple summation of the two. Using a detailed clinical illustration of a difficult analysis with a severely fetishistic‐masochistic patient, the author describes the kind of knowledge, experience, and powerful effects that come into being when the analyst interconnects psychically with the patient in living through the process, and that relate specifically to the analyst's compassion.     

Luck Egalitarianism,Universal Health Care,and Non-Responsibility-Based Reasons for Responsibilization

In recent literature, there has been much debate about whether and how luck egalitarianism, given its focus on personal responsibility, can justify universal health care. In this paper we argue that, whether or not this is so, and in fact whether or not egalitarianism should be sensitive to responsibility at all, the question of personal responsibilization for health is not settled. This is the case because whether or not individuals are responsible for their own health condition is not all that is relevant when considering whether we should somehow hold them responsible for their own health condition, e.g. cost-wise. There may also be efficiency-based reasons to hold them responsible, and there may even be egalitarian reasons. Defining universal health care as an insurance system where everyone’s deductible and premium is 0, we will argue that efficiency-based reasons for cost-responsibilization are not convincing, but that there are egalitarian reasons for cost-responsibilization. Luck egalitarianism, therefore, cannot, at least not on its own term, justify universal health care.

     

Objections to personal counselling in schools

This paper seeks to identify some of the more compelling arguments put forward by those who oppose or criticise personal counselling in schools. These arguments cannot be dismissed lightly, and counsellors will have to give them serious consideration if a satisfactory resolution of the issues is to be achieved.     

The “death of freud”; and the rebirth of free psychoanalytic inquiry

The relevance of Grunbaum's recent critique of psychoanalytic theory is explored as it relates to relational/interpersonal theories. Griinbaum finds no scientific evidence for repression, the cornerstone of psychoanalysis. I argue that studies demonstrating the effects of motivated, unconscious processes are beginning to emerge in psychological research. This research, as well as interpersonal theory, refers to these processes as dissociated, not “repressed.”; I agree with Griinbaum that scientific validation of psychoanalytic theories of the mind, personality, and change cannot be gleaned from case studies alone. In relational theories the analytic situation is admittedly “contaminated”; with the analyst's participation by its very nature. There is beginning to be support for some relational hypotheses, but measures to validate these hypotheses are only now being developed. Grunbaum's criticisms have come at a time when the convergence between relational theories and theories in social/clinical psychology makes it more likely that relational hypotheses will be articulated in a more precise manner by researchers, if not by analysts.

The issues of the difficulty of measuring unconscious processes and the quest for knowledge seemingly beyond human limitations are addressed. Psychoanalysis is not only less than scientific, but more encompassing, in that it is also a creative activity that cannot be understood through science alone.

Science is not enough, nor art: In this work patience plays a part [Goethe].

The most beautiful and deepest experience a man can have is the sense of the mysterious.... To me it suffices to wonder at these secrets and to attempt humbly to grasp with my mind a mere image of the lofty structure of all that there is [Albert Einstein, quoted in Pagels, 1985].     

Introduction Voices The Editors

Postmodern theory and critiques currently exert a considerable influence on psychoanalytic theory, particularly in regard to the revision of a theory of sexuality and gender. This article reviews some of the critiques and alternative views of sexuality proposed by various postmodern theorists such as Butler, Jameson, Baudrillard, and Foucault. After conducting a critical comparison of these critiques and alternatives with contemporary analytic revisionist theory, I contend that, despite the useful aspects of postmodernism's critical cultural perspective, some postmodern positions run directly counter to certain key psychoanalytic tenets about human agency and the existence of an inner psychic world or selfhood. Furthermore, I believe that, despite the laudable politics of many postmodern writers to promote a greater diversity of nonpathologized sexual experience, the atrophied views of agency and selfhood depicted in the postmodern writings reviewed in this essay cannot support an approach that is concerned with clinical treatment or with describing processes of psychological transformation. A case vignette is provided illustrating the main arguments of the paper.     

The Cross

ABSTRACT

My aim is a philosophical understanding of sacrifice, and especially of the Christian conception of sacrifice. Initially distancing myself a little from the strictly ritual notion of sacrifice, I work with a concept of sacrifice as 1) a voluntary choice (2) to forgo or lose or give away (3) something costly, perhaps supremely costly, (4) as an expressive action, where (5) what is so expressed typically is or includes devotion or loyalty to something exalted. I consider three historical examples of political sacrifices, sacrifices made for a cause, and three literary examples of personal sacrifices, sacrifices made by one person for another. I note that in the Christian context it is very common for sacrifices either political or personal to be taken to be imitations of Jesus’ sacrifice as presented in the New Testament, and ask therefore how we are to understand that. My conclusion is that Jesus’ sacrifice can be seen as involving both a political and a personal aspect—but that in fact, it can only be made as intelligible as may be by understanding it, as the Letter to the Hebrews does, in ritual terms.     

Bullying in Psychoanalytic Life: A Few Episodes,and Some Thoughts

This article explores several examples of bullying in psychoanalytic training (often candidates bullied by faculty, but at times faculty bullied by candidates, or mutual bullying among candidates) and within psychoanalytic societies. It proposes that this may happen both in homogeneous groups (where individuals seen as disloyal to the common views may be harassed) and in heterogeneous groups (where theoretical disagreements and competition may deteriorate). Interpretations outside the consulting room (and in some instances even within an analytic setting) may become a subtle form of bullying. Although many professional and political groups may exhibit subtle and rationalized forms of bullying, their impact is more powerful in psychoanalytic groups on the background of transference–countertransference feelings originating in members' personal analyses with other members. A readiness to expose and discuss such episodes is crucial if we wish to reduce their destructive influence in training and in subsequent relations among analytic colleagues.     

Commodification or Compensation: A Reply to Ketchum

I defend the permissibility of paid surrogacy arrangements against the arguments Sara Ketchum advances in “Selling Babies and Selling Bodies.” I argue that the arrangements cannot be prohibited out of hand on the grounds that they treat persons as objects of sale, because it is possible to view the payments made in these arrangements as compensation for the woman's services. I also argue that the arguments based on exploitation and parental custodial rights fail to provide adequate grounds for prohibiting the arrangements.     

The Position of Metapsychology in the Formation of Psychoanalytic Knowledge and the Concept of “I” (Ego)

Psychoanalysis is unique in that competence in the field can be achieved only through applying the method to oneself. Different psychoanalytic schools differ in their understanding of the unconscious, about how to approach it, or how to define the specificity of the psychoanalytic interaction. Consequently, there are differences in the criteria for the definition of the ‘good-enough analysis’. There are many different opinions about how to select candidates, organise the curriculum and length of training. To define psychoanalytic talent is difficult; the uncertainty in the definition of criteria to use for selection is great; the problematic overlap between personal analysis and training is constantly present; to achieve conditions in which learning and creativity can develop is complicated by trainee, supervisor and their relationship to the Institute. Confrontations about training are often heated and divergent, as well as repetitive. Systematic studies about psychoanalytic education are very few. After a short discussion of the different concerns about selection, personal versus training analysis and the ambiguities of the supervisory situation, the author gives a review of three studies on how psychoanalytic education—as viewed by trainers and trainees—is conducted and experienced at the Swedish Psychoanalytic Institute. Training is felt to be well grounded in theory and tradition; nonetheless most do not have a sufficiently clear picture of training as a whole. Both candidates and trainers see the development of a psychoanalytic identity as the goal of training, where the competencies to be acquired are equated with important personality qualities. The candidates have a feeling of “being chosen"; they “wish to belong to a group who share an interest and fascination for psychoanalytic thinking and theory". All praise the warm and open atmosphere, and the mutual and continuous evaluations and the deep involvement of all. The surge to be rooted in an overreaching psychoanalytic ethic, the culture of gratitude within the Institute and the devotion to the task to train psychoanalytic clinicians for the future may preserve an idealised image of psychoanalysis and the fantasy that psychoanalysts are exceptional persons and give a mystifying colour to the psychoanalytic profession. This might also stand in the way of a more radical change in the traditions of training—according to the rather drastically changing climate in which psychoanalysts of the future will have to work.     

Minding the gap between positivism and hermeneutics in psychoanalytic research

Two quite different cultures are to be found within psychoanalysis, one more clinical in orientation, more focused on meaning and interpretation, and relying primarily on the traditional case study method, the other more research-oriented, focused on cause-and-effect relationships, and relying primarily on methods borrowed from the natural and social sciences. The history of this divide is reviewed and arguments, pro and con, about the potential contributions of specific types of empirical investigation are discussed. Increasingly, it seems, criticisms concerning the scientific status of psychoanalysis are being responded to by empirical research. This has contributed to a growing recognition within the scientific community of the credibility of aspects of psychoanalytic theories and of the effectiveness of psychodynamic treatment. However, some segments of the psychoanalytic community are concerned that this increase in the quantity and quality of empirical research on psychoanalytic concepts risks creating an empirical one-sidedness, while other segments are concerned that not engaging in systematic empirical research can lead to intellectual isolation, fragmentation, stagnation, and orthodoxy. To counter this polarizing tendency, a recommendation is made for methodological pluralism. Adopting this stance could contribute to an enriched understanding of the clinical process and to the development of new research methodologies to investigate complex psychodynamic hypotheses, thus bridging the gap between the two psychoanalytic cultures, as well as the gap between research and clinical practice.     

KANT'S TRANSCENDENTAL STRATEGY

The interpretation of transcendental arguments remains a contentious issue for contemporary epistemology. It is usually agreed that they originated in Kant's theoretical philosophy and were intended to have some kind of anti-sceptical efficacy. I argue that the sceptic with whom Kant was concerned has been consistently misidentified. The actual sceptic was Hume, questioning whether the faculty of reason can justify any of our judgements whatsoever. His challenge is a sceptical argument regarding rule-following which engenders a vicious regress. Once this sceptical threat is properly identified, the prospects of transcendental arguments must be re-evaluated.     

In Progress … I Hope: From Pediatrics to Psychoanalysis to …

Psychoanalysis must be an idiosyncratic matter. That means that the encounter between the patient and the analyst is carried out through the personal character of both participants. But there is something more. Historical and cultural patterns are also most influential. The present and the past social context where the psychoanalytic bipersonal meeting occurs is a significant factor in the evanescent constitution and the constant movement between the ego of the analyst and the ego of the patient. Therefore, in this radical view only Freud would fulfill a Freudian encounter. We, as probable post-Freudians, must be permanently searching for personal, idiosyncratic ways in the clinical work. Brazilian psychoanalysts face the challenge to treat their patients in a Brazilian way. To understand Brazilian people and the way psychoanalysis may develop in this land, we must know that Brazilians' lived experience is frequently blended by irony, paradox, and the fleeting character of the human life. Words—a pragmatic perspective of Brazilian words in action—are essential for the task. Interrogative psychoanalytic dialogues are my main topic of research.     

Ausbildungs- und Berufserfahrungen älterer Psychoanalytiker

Based on the discussion about the crisis of psychoanalysis and in particular of psychoanalytic training, 145 (female and male) analysts older than 70 years of age were interviewed about their training and professional experiences as well as about their attitudes towards psychoanalysis. This older generation is of great interest because their training generally took place prior to 1967 and preceded the introduction of guideline therapy (cost coverage by the general health insurance) and under much less formalized conditions, which can be seen almost as a contrast to the current circumstances and conditions. This research has shown that especially personal or content and value-based motivations (personal problems, therapeutic experience, interest in the subject, the desire for depth, self-realization and expansion of the situation perceived as restrictive of their former profession) were the main determining factors for the choice of career. The training analyses were, despite some exceptions, of substantial length even then (an average of 544 h), but often had a lower frequency (30% had less than 3 h per week). Since the age limitation for running a psychoanalytic practice within the general health services (formerly 68 years) is no longer compulsory, the results of this study regarding the professional life of older psychoanalysts are of special interest. Of the respondents 45% are still running their own practice and 22% are working as training analysts.