Becoming (and Remaining) an Analyst in Latin America

The following overview of the development of psychoanalysis in Brazil and in Porto Alegre outlines the current situation and the challenges to psychoanalysis in my country. I will explain my own experiences on becoming an analyst, the main reasons for my choice, my main influences, and my evolution as a clinical psychoanalyst and as a member of psychoanalytic and psychiatric institutions. I include my main contributions to psychoanalysis and consider two broad areas of interest: psychoanalytic technique and its teaching, and the relationship of psychoanalysis and culture. As for the former, my main interests are studies on countertransference and analytic neutrality, to which I will propose a comprehensive concept. As for the latter, I discuss a culture that contrasts vividly with the one in which Freud created the discipline, psychoanalytic views on violence and perversity, psychoanalytic institutions, and the application of analytic ideas for the understanding of some artists and their work.

I will also describe some general features of my country and the development of psychoanalysis in it; report my experiences as a candidate and an analyst; and offer some information about my evolution as an analyst through papers I have written over the past 30 years.     

Psychoanalysis at the Millennium: A Personal Odyssey

A review of my development from psychology intern and research assistant to the psychoanalytic tester and theoretician David Rapaport at the Menninger Clinic in the 1940s, through my career psychological testing and my psychoanalytic training in the Western New England Institute and my working successively at the Austen Riggs Center, Yale Department of Psychiatry, Yale Student Mental Health Center, Cornell Department of Psychiatry, and eventually private practice in New York City. During this period, I rose to the academic rank of Professor and the analytic position of Training Analyst. I have written extensively: first on testing, then more or less in turn on psychoanalytic ego psychology, action language for psychoanalysis, feminist issues, narrative in psychoanalysis, and the contemporary Kleinians of London. This memoir traces the intellectual continuity that characterizes these writings and my continuing development as a psychoanalyst—my first ambition and great love.     

An Autobiographical Fragment

In this article, I attempt to locate some of the personal and professional roots of my identity as a psychoanalyst. Theoretically and clinically, I have arrived at what I think of as a “radical middle-of-the-road perspective” that includes both what I see as the most important and enduring sensibilities of mainstream Freudian thinking and what I see as the most interesting contributions of the interpersonal/relational tradition. Institutionally, I advocate a kind of cacophony that encourages respectful but most likely irresolvable debate among adherents of different points of view. My training, as a psychologist interested in psychoanalysis during the 1970s, was steeped in pluralism and conceptual heterodoxy. However, I believe that my personal history prepared me to seek out and to embrace this psychoanalytic world, which was at the time and to some extent remains slightly outside the mainstream.     

What After Pluralism? Ulysses Still on the Road

In this work I intend to convey from an autobiographic perspective what it meant for me to become an analyst in a small Latin American country, in an especially turbulent moment in its history. When I graduated from medical school and began my psychoanalytic training, there were marked contrasts in Uruguay. In the political arena there was a long military dictatorship during which human rights and freedom of expression were not respected, while within the Psychoanalytic Association of Uruguay a cultural ambience of pluralism and freedom of thought rich with European tradition could be felt. The existence of multiple approaches—both theoretical and technical—is a positive thing, depending on the way the differences are dealt with. I will reveal some characteristics of the coexistence of various perspectives in Uruguay and reflect on the conditions that made our pluralistic situation a fostering factor for psychoanalysis.     

On My Becoming a Psychoanalyst

I describe my experience of becoming a psychoanalyst in Germany between 1997 and 2002. The article combines my personal criticism of certain aspects of institutionalized psychoanalysis and some established procedures within psychoanalytic training, which underline the need for more evaluation and more transparency within the institutes and associations.     

Intersubjektivit?t und psychoanalytische Identit?t

The psychoanalytic identity is the result of identification with a psychoanalytic introject. It protects against the fears to which everyone who is attempting to illuminate the unconscious is exposed. In this paper the substantive issues of identity are discussed as a psychoanalyst who is a support for the work by providing concepts for the understanding of the unconscious. Using the example of the intersubjective wend in psychoanalysis it will be examined how these contents have changed under the influence of intersubjectivity. The notion that psychological development also occurs in psychoanalysis in unmistakable interpersonal contexts implies removing the restraints imposed by commitment to the technical rules and normative expectations. The intersubjective view of psychoanalysis therefore demands from the psychoanalyst an identity which is fundamentally different from that of the classical psychoanalyst. Processing the associated fears places the psychoanalytic identity at a more mature stage.     

Psychoanalysis in Postmodern Times: Some Questions and Challenges

As a consequence of the invitation to contribute this piece of writing, I acknowledge having a postmodern attitude, rather than subscribing to postmodernism as an ideology. The purpose behind this article is to reflect on the impact of postmodern times on psychoanalysis from the starting point of my own conception of psychoanalytic theory and practice. This article looks, in some detail, into the problem of truth in psychoanalysis, the issue of theory building in psychoanalysis in its relation to psychoanalytic practice, and the challenges for psychoanalysis as a pluralistic discipline. It repeatedly states that psychoanalysis evidences extreme theoretical and practical diversity, but no pluralism understood as an attitude and methodology of dialogue between theoretical orientations and practical approaches. The current challenge in psychoanalysis is, precisely, to go beyond postmodernism and to build a true pluralism on the basis on interdisciplinary exchange and collaboration.     

'My capital secret': Literature and the psychoanalytic agon

Taking as my departure point Freud 's unequivocal claim in The Question of Lay Analysis that psychoanalytic education should include "the history of civilization, mythology, the psychology of religion, and the science of literature" ( Freud, 1926b, p . 246), I advocate for an integration of psychoanalysis with the arts, the humanities, and the social sciences in psychoanalytic training. Foundations in these fields are not only acceptable as preliminary to clinical training but will also provide the diverse intellectual climate that is urgently needed in psychoanalytic institutes whose discursive range is often quite narrow. To provide one example of the salutary effect of such disciplinary integration on clinical practice, I illustrate how the transformative power of literature provides compelling metaphors for the psychoanalytic encounter. Through an example drawn from within my own experience as literary critic and psychoanalyst, I describe the ways that the troubling tensions in Milton's Samson Agonistes functioned to illuminate, for me, an analysand 's 'capital secret'.     

Learning about psychoanalysis combined with medication: a nonphysician's perspective

When medication is at play in an analysis, the nonphysician candidate or psychoanalyst faces conceptual and practical challenges, as well as countertransference risks and opportunities. A psychologist psychoanalytic candidate describes the treatment of an analysand who underwent a gradual uncovering and worsening of obsessive-compulsive and anxiety symptoms; at twenty-one months, the analysand introduced the topic of medication. These developments brought to light transference and countertransference themes connected to the analyst's status as a non-physician candidate; conceptual and practical uncertainties about medication in the context of psychoanalysis; the complex meanings of, and indications for, medication in this case; and the ramifications of a nonphysician candidate's referring a patient to a psychiatrist psychoanalyst for medication while being supervised by another psychiatrist psychoanalyst.     

Moving on From the Suburbs

This is an account of my development as a psychoanalyst beginning in a safe but very unquestioning culture of a London suburb. Some unusual features of my childhood, as well as a natural curiosity, made me need to question the apparent certainties of my surroundings. I describe how a number of events—the death of my father, my illness as an adolescent, and an unlikely encounter with psychoanalysis shortly after, set me onto a rather slow road toward becoming a psychoanalyst several years later. I describe the influences that were important to me. I have always been most inspired by those who could explain complex ideas in a simple and straightforward way, and this has become important objective for me.     

Beyond the Mainstreams

My interest in the theory and art of psychoanalysis is traced to some of its sources—my childhood and expulsion from Germany in the late 1930s, my experience as a member of a discriminated-against minority, my nonacceptance as a psychologist by American psychoanalytic societies, my invitation to participate in the development of self psychology, and my fortuitous encounter with personal and professional friends who have contributed to the scope of my psychoanalytic endeavors (e.g., to my abiding interest in research and, in particular, the empirical studies of the early mother–infant dyad). I offer this account as evidence of the varied and creative opportunities that await psychoanalysts not outside but beyond the mainstream of American psychoanalysis.     

THE WILDE ANALYST

Oscar Wilde (1854–1900) took on the challenge of teaching us how to live artfully. From the dynamic successes and tragedies of his own life Oscar knew that everything worthy of existence is worthy of art, including its ugliness and suffering. Oscar observed much about human nature, especially his own, in an era when convention was not challenged, knowledge was taught and appearances were everything. For him, “The supreme vice is shallowness.” Society and psychoanalysis can still be honored and shaken by his words. The paradoxical and complex nature of Oscar's insights was as good as any coming from a thoughtful psychoanalyst. After the first two attempts to write about Oscar fell flat, it became clear that I must engage with him and try to match the unsparing commitment to explore his unconscious and interior life. In the process of creating the array of sketches of my psychoanalytic encounters with Oscar, I also found the words to describe what drew me to the field some 20 years ago—the art of psychoanalysis.     

You Can Get Here From There

This paper is a review of my development from psychology intern and research assistant to the psychoanalytic tester and theoretician David Rapaport at the Menninger Clinic in the 1940s, through my career in psychological testing, my psychoanalytic training in the Western New England Institute, and my working successively at the Austen Riggs Center, Yale Department of Psychiatry, Yale Student Mental Health Center, Cornell Department of Psychiatry, and eventually private practice in New York City. During this period, I rose to the academic rank of Professor and the analytic position of Training Analyst. I have written extensively: first on testing, then more or less in turn on psychoanalytic ego psychology, action language for psychoanalysis, feminist issues, narrative in psychoanalysis, and the contemporary Kleinians of London. This memoir traces the intellectual continuity that characterizes these writings and my continuing development as a psycho-analyst—my first ambition and great love.     

Motivation: Sic Transit Gloria?

Sic transit gloria—so passes away the glory once accorded to motivation as a central focus of psychoanalytic theory and practice. How and why? That is the subject of this paper. I will track the ups and downs of motivation historically and its current replacement by the attention correctly afforded to relationships across a spectrum of contemporary theories. I will then take up my proposal of five motivational systems embedded in an intersubjective context and consider critiques of the proposal from different vantage points. Despite waning interest, motivation remains an intrinsic component of psychoanalysis.     

Now and Then

I describe my development as a psychoanalyst from my dream of psychoanalysis as a revolutionary movement battling against ignorance and fixed beliefs to finding in Freud's theoretical framework a reliable, scientific base from which I could pursue my own thinking. I trace the evolution of my thinking through my experiences on the training and at my first post-training job in an antenatal department. I give an account of the culmination of my analytic development in my work at Brent Adolescent Centre where my husband, Moe Laufer, and I developed our theory of developmental breakdown in adolescence. Here we pioneered work and research with adolescents in analysis and at the walk-in center.     

From Many into One: Attention,Energy, and the Containing of Multitudes

This paper is an effort to describe and express and the tension between the observing mind and the “wisdom mind,” which has its taproots in the deep and unformulated experience of connectedness. Nominally about the process of writing as a psychoanalyst, it is more like my personal “Credo” in relation to the work of psychoanalysis, the work of writing, and the work of living with contradictions—life. In it I try to bring together disparate reflections, to illustrate in the writing itself the process of making “many into one.” Because so much of this essay relates to themes in Mannie Ghent's work, including his work on surrender and his “Credo,” it seemed to be appropriate to offer it to readers of this issue dedicated to his memory.     

What's Possible? What Matters? Reply to Commentaries

The three discussants agree that a definition of psychoanalysis tied to session frequency is problematic and needs to change. Yet none supports my recommendation to redefine the practice of psychoanalysis in terms of the practitioner's training. This prompted me to look more closely at my proposal and push my thinking further. I argue that psychoanalysis, like many other professions, needs to define its practice as the application of its complex and evolving knowledge and skill base, grounded in its unique field of inquiry. Although there are individual exceptions, the inculcation of this knowledge and skill base is generally best accomplished through psychoanalytic training. This assertion, however, rests on the premise that our training curricula keep pace with our rapidly evolving field of inquiry and knowledge. To further clarify my vision I examine the nature of psychoanalytic expertise. I suggest that such expertise amounts to the inculcation and integration of a large number of psychoanalytic frames of reference. I contend further that the nature of contemporary psychoanalytic theories is such that important psychoanalytic frames of reference are proliferating more rapidly than in the past, that the relationships among them are becoming more complex, and that consequently the application of psychoanalytic theory to practice is also becoming more complex. Psychoanalytic training programs need to recognize this expanding complexity and revise curricula and pedagogic methods on an ongoing basis to reflect this evolution within our field.     

MEDITATIVE PSYCHOANALYSIS

Psychoanalysis and meditation not only compensate for the other’s blind spots, but also, when practiced together, can provide a richer experience than either discipline pursued alone. After considering the way meditation cultivates heightened attentiveness, refines sensory clarity, lessens self-criticism, and increases affect tolerance, thereby deepening psychoanalytic listening, I’ll examine how psychoanalytic perspectives on unconscious communication and meaning illuminate and transform the nearsightedness of meditation, aiding therapists and clients in understanding troubling thoughts, feelings, and behavior. This helps therapists deepen their capacity to help those people with whom they work. The paper also attempts to illuminate how the therapeutic relationship, conceived of in a freer and more empathic way—as the vehicle for both validating a person’s experience and providing opportunities for new forms of relatedness and self-transformation—provides a crucible in which old and dysfunctional ways of caring for oneself and relating to other people emerge and new patterns of self-care and intimacy can be established. In the concluding section, I will delineate meditative psychoanalysis, my own integration of meditation and psychoanalysis. Clinical material will illustrate my theoretical reflections.     

The dual impact of Freud's death and Freud's death instinct theory on the history of psychoanalysis

Since I have ranged over a rather large territory in this presentation I will summarize my main points. I claim that the very way Freud created psychoanalysis made it impossible for it to continue to grow and develop as a unified movement after his death. Unlike other sciences, psychoanalysis had no way of differentiating its basic findings from what is yet to be discovered. I then reintroduced my differentiation between heretics, modifiers, and extenders, claiming that after Freud’s death there was less opportunity for heretics and more space for modifiers. I assigned a crucial role to the fact that Anna Freud did not succeed in expelling the Kleinians. In the second part of the paper I presented the view of those who made use of Freud’s death instinct theory and those who opposed it. Many analysts preferred to ignore dealing with it rather than state their opposition. My presentation was biased in favor of those who chose to work with the death instinct as a clinical reality,highlighting Ferenczi’s construction. I made the claim, so far as I know never made before, that Freud’s death instinct theory had a traumatic impact on the psychoanalytic movement because it greatly limited the belief in the curative power of our therapeutic work. After his announcement of the dual-instinct theory Freud withdrew his interest in psychoanalysis as a method of cure. By doing so he inflicted a narcissistic wound on psychoanalysis. I believe that the creativity of psychoanalysis will improve if we face this difficult chapter in our history.     

Where Have All the Psychoanalytic Patients Gone? They're Still Here

Abstract

I develop my argument concerning the question of where have all the patients gone in a sequence of three parts. First, I indicate, very briefly, the nature of the issue and the array of confluent socioeconomic causes—as they are usually outlined—that are held responsible for it. Then I take up the remedy for this problem posed by Arnold Rothstein in his book (1998). which is the trigger to this series of invited commentaries, and I indicate how I both appreciate the merits of his proposal to recast the issue as much as possible within a psychological framework, amenable to psychoanalytic influence, and nonetheless feel his approach to be based on a one-sided, and to that extent, a limited and flawed assessment of the problem, and therefore an only partially useful remedial perspective. And lastly, 1 offer an alternative view of the internal historical developments in psychoanalysis that have played their complementary role in the evolution of this perceived “crisis” and the alteration of perspectives, based on my account of our contending current viewpoints on the nature of the relationship between psychoanalysis and its derivative psychoanalytic psychotherapies, that can perhaps promise a more effective counter to the crisis, despite the multiple external socioeconomic developments that are usually accorded causative primacy and that no doubt are indeed formidable.