THE DIDACTICS OF PSYCHOANALYTIC EDUCATION2

The author first discusses general didactic considerations regarding psychoanalytic education and the teacher‐pupil relationship. He then demonstrates that psychoanalytic education is greatly influenced by the ideal of a liberal education, of which in Germany there is a strong tradition under the name ‘Bildung’. The main characteristics of ‘Bildung’ ‐ as opposed to professional training ‐ are that the objectives remain undefined and there is no attempt to achieve defined and operationalisable professional qualifications. The relationship between teacher and pupil is characterised by authority and trust. A psychoanalytic education by means of a ‘liberal education’ is based upon the assumption that the student should be motivated and supported in achieving competence through a passionate study of the world of psychic reality. Today, however, psychoanalytic education must be seen within a contemporary context that forces us to abandon the ideals of a liberal education, to operationalise the subjects studied and to control the education itself with regard to efficiency and results. These modern demands are the result of a professionalisation which has reached all social professions and from which psychoanalysis also cannot escape. Because of this, it is especially important to reflect on our educational methods and objectives. The author makes several suggestions on this subject. It is to be hoped that psychoanalysis will find its own way, without, on the one hand, losing sight of the special nature of psychoanalytic competence through an over‐hasty adaptation to the process of professionalisation and, on the other hand, without reverting to unquestioned and outdated ideas on education.     

Psychoanalysis in the university: A full‐time vision1

Psychoanalysis may be unique among scholarly disciplines and professions in having grown as an educational enterprise in a private part‐time setting, outside the university. Freud would have liked it to be otherwise, but in Central Europe, when it was created, university placement was not possible. In America, after World War II, the concept of the medical school department of psychiatry psychoanalytic institute was established in some psychoanalytic training centers but it could only partly overcome the educational and research inadequacies of traditional psychoanalytic training. The possibilities for a true university‐based full‐time training structure are explored.     

The competent psychoanalytic supervisor: Some thoughts about supervision competences for accountable practice and training

What are the competences required to satisfactorily practice effective or “good enough” psychoanalytic supervision? In this paper, I would like to consider that question. Over the past approximate 15-year period, increasing attention has been directed toward more specifically identifying and defining the components of competent psychoanalytic practice. But any parallel attention toward identifying and defining the components of competent psychoanalytic supervision practice has, in comparison, been sorely limited if not virtually absent. If we are to best practice competent psychoanalytic supervision and best train future psychoanalytic supervisors for competent practice, effort needs to be made to concretely delineate the competences that are requisite for such practice. In what follows, I present and adapt six broad-based families of internationally relevant supervision competence areas for use in psychoanalytic supervision: (1) knowledge about/understanding of psychoanalytic supervision models, methods, and intervention; (2) knowledge about/skill in attending to matters of ethical, legal, and professional concern; (3) knowledge about/skill in managing psychoanalytic supervision relationship processes; (4) knowledge about/skill in conducting psychoanalytic supervisory assessment and evaluation; (5) knowledge about/skill in fostering attention to difference and diversity; and (6) openness to/utilization of a self-reflective, self-assessment stance in psychoanalytic supervision. Although by no means an exhaustive list, 30 supervision competences (five per family) are proposed as significant for guiding competent psychoanalytic supervision practice and supervisor training, and a brief explanatory comment is offered in support of each broad-based family of competences.     

Group affective learning in training for psychotherapy and psychoanalysis

This paper describes The Group Affective Model, a method for teaching psychoanalytic concepts and their clinical application, using multi‐channel teaching, process and review in group settings, and learning from experience in an open systems learning community for psychoanalysts and psychotherapists. This innovation arose in response to criticism of existing methods in psychoanalytic education that have subordinated the primary educational task to that of the training analysis. Noticing this split between education and training analysis, between cognition and affect, and between concepts of individual and group unconscious processes, we developed the Group Affective Model for teaching and learning psychoanalysis and psychotherapy in an open psychological space in which students and faculty experience individual and group processes of digestion, assimilation, and review, which demonstrate the concepts in action and make them available for internalization selectively. We discuss our philosophy and our educational stance. We describe our institution and our participants. We give examples of teaching situations that we have studied to provide some insight about assimilation and internalization of the concepts and clinical approaches being taught. We discuss the transferability of the Group Affective Model to other teaching settings and psychoanalytic training institutions and propose it as the fourth pillar of psychoanalytic training, next to analytic treatment, clinical supervision, and didactic seminars.     

Psychoanalytic supervision in the new millennium: On pressing needs and impressing possibilities

Having now completed its first century, psychoanalytic supervision has been and continues to be regarded as the cornerstone of psychoanalytic education; it is the primary means by which (1) psychoanalytic ideology becomes translated into practical product, and (2) budding analytic practitioners develop and grow in their therapeutic skills and professional identity. The supreme significance of supervision in contributing to the “making” of the competent psychoanalytic practitioner now seems a widely accepted given, even axiomatic. But as its second century gets underway, what have we learned from psychoanalytic supervision's first 100 years? What are its most pressing needs and, in turn, impressing possibilities at this time? And what needs to most change if psychoanalytic supervision is to most profitably advance in the years and decades ahead? In this paper, I would like to consider those questions, giving focus to five needs that seem to most require attention now: (1) making the practice of psychoanalytic treatment an increasingly competency-based, concretized learning affair; (2) enhancing the efficacy of supervisors through competency-based practice and training in psychoanalytic supervision; (3) more effectively incorporating existing technology and emerging technological advances into supervision and using them to enhance the psychoanalytic learning process; (4) better attending to matters of difference and diversity, and striving to seamlessly integrate them into the conceptualization and conduct of the psychoanalytic supervision experience; and (5) vigorously researching the psychoanalytic supervision process and working to establish an evidence base for supervisory practice.     

Teaching psychodynamics in the twenty-first century

A lack of clarity in psychoanalytic education has negatively affected the educational experience of candidates now in training and makes it difficult for prospective candidates to understand the field. Three basic educational concepts--learning objectives, operationalizing, and adult learning theory--can help psychoanalysts teach and assess their students in a clearer, more objective way. Using these concepts has broad implications for both psychodynamic and psychoanalytic education in the twenty-first century.     

Does anything go? Towards a framework for the more transparent assessment of psychoanalytic competence1

It has been difficult to know what does and does not constitute competent psychoanalytic work and so equally difficult to assess when it is being practised and when it is not. This makes difficult any form of disciplined evaluation of the outcome of training, which has a series of problematic outcomes for psychoanalytic practice, psychoanalytic institutions and the relationship to allied disciplines and professions. In this paper, the author considers how far it might be possible to devise a framework for assessment of training programmes within a disciplined psychoanalytic pluralism. The aspiration is to develop a transparent framework, based on an empirically supported demonstration of analytic capacity. The framework needs to be sensitive and subtle, and to be able to withstand challenge. It needs to take cognisance of the twin facts that there is more than one way to practise psychoanalysis and that it is necessary to avoid ‘anything goes’. Drawing on an ongoing project undertaken by European IPA institutes, the author describes some of the problems colleagues have been experiencing in European institutes, because they have not had available transparent criteria for assessment. He outlines a preliminary form of a proposed method for making more transparent and supportable assessment. The author intends for this paper to inspire hope, enquiry and debate.     

What do we learn in psychoanalytic training?

Can one define the aims of psychoanalytic training that most analysts would agree upon? For more than a decade the EPF Working Party ‘End of Training Evaluation Project (ETEP)’ has worked on this issue. Summarizing results of this work the author describes a set of basic elements every developing analyst should have learned or internalized during his training. His assertion is that most analysts notwithstanding their theoretical orientation could agree upon these necessary requirements for a successful ending of psychoanalytic training. These elements are demonstrated in the ability to understand the emotional demand of a patient in every session and the often ensuing emotional storm, to appreciate and deeply understand the value of free association, to preserve a neutral stance, to think in terms of transference and countertransference, and to think conceptually about what is happening and what one is doing in the session.     

German students’ current choice of profession in the field of psychotherapy

The psychoanalytic societies in Germany as in many other countries are concerned by a decline in the number of candidates for full psychoanalytic training. While this situation is partly attributable to changes both in society and in educational and healthcare systems, it is questionable whether psychoanalytic training institutions have yet found adequate responses to it. Under the banner of ‘evidence‐based treatment’, behaviour therapy has come to be widely disseminated, with major implications for the teaching of different psychotherapy paradigms at universities. To investigate the determinants of this trend in the specific German situation, a large‐scale, multi‐method exploratory study supported by IPA's DPPT programme was undertaken, focusing on the reasons given by a population (N = 679) of German psychology, medical, and education students for embarking on training in psychoanalysis or behaviour therapy. The results suggest that behaviour therapy is more compatible with the prevailing scientific understanding and with current societal and cultural trends, owing in part to inadequacies or bias in university teaching of the various paradigms of psychotherapy. While most of the psychology students expressed a preference for behavioural training, the psychotherapy option proved less attractive for their counterparts in the fields of medicine and education. Semi‐standardized qualitative interviews were used to gain a deeper understanding of the students’ decisions for or against training in a specific paradigm, and led to the identification of seven decision‐making prototypes. Possible reasons for the students’ decisions are discussed, and concrete proposals and recommendations are presented.     

IUSAM-APdeBA: A higher education institute for psychoanalytic training

The history of the last century shows the almost constant presence of psychoanalysis in the academic setting and, simultaneously, the incredible absence of analytic training at the universities. This paper outlines the project of the Buenos Aires Psychoanalytic Association (APdeBA) to create a higher education institution of its own (IUSAM) specifically aimed at lodging psychoanalytic training within a university setting. The project was approved by the Argentine educational authorities in 2005 and received the economic support of the International Psychoanalytical Association (IPA). The academic structure of the university is described, whose goal is broadened to the interdisciplinary field of mental health with psychoanalysis as an integrating axis. Some of the characteristics of the traditional 'university model' as well as its relationship with psychoanalysis are pointed out. With the IUSAM, psychoanalytic training is not included as a part of an already established university, it rather creates a new one, with the support of a well-known psychoanalytical association (APdeBA) which endorses its activities and guarantees its identity. IPA's requirements for analytic training (didactic analysis, supervisions and seminars) have been fully preserved in this new context. Finally, some of the advantages and disadvantages of including analytic training into an academic environment are listed .     

How does psychoanalytic supervision work? A brief communication

In this brief communication, we offer one perspective – the contextual psychoanalytic supervision model (CPSM) – on how psychoanalytic supervision works. The CPSM, a supervisory extrapolation of Wampold’s contextual psychotherapy relationship model, accentuates four psychoanalytic supervisor–supervisee relationship variables as crucial and change inducing: the learning alliance bond, supervisor–supervisee real relationship, creating supervision expectations/providing an expectation-consistent form of supervision, and the supervisee’s engagement in facilitative educational actions. The CPSM is presented in hopes of stimulating further discussion about what makes psychoanalytic supervision work.     

Black client,white therapist: Working with race in psychoanalytic psychotherapy in South Africa

In post‐apartheid South Africa we speak about race extensively. It permeates our workplace, weaves a thread through the fabric of our professional and personal lives, as well as our private conversations and public interactions with others. From within psychoanalytic theory, the thread weaves through the unknown content of our racialized unconscious. When there is a focus on race in the South African psychoanalytic context it largely takes the form of the struggle to articulate the complexities of working with difference, as Swartz notes, or the struggle to map out issues of race. Such struggles are not localized in South Africa, but strongly reflect a much broader struggle within the global psychoanalytic community, as mirrored in the expanding focus on race. Although the consulting rooms seem far removed from the ongoing political tensions that have recently emerged in South Africa, psychoanalytic psychotherapy remains a space of meaningful engagement with the other, and where the therapeutic dyad is one of racial difference it permits an encounter with our racialized unconscious. This article seeks to document the experience of my black client and my white response to her racial pain and struggle; in doing so, I describe the racial ‘contact’ between us and within us that triggers a racialized transference and countertransference dynamic, which contains the space for racial healing for both of us.     

MAX EITINGON AND THE STRUGGLE TO ESTABLISH AN INTERNATIONAL STANDARD FOR PSYCHOANALYTIC TRAINING (1925‐1929)2

This paper deals with the first years of the IPA's International Training Commission (ITC). The author begins by outlining the Berlin model of training, including some less familiar aspects, and he describes how the foundation of the ITC in 1925 was designed for promoting the general establishment of institutionalised training according to this pioneer model. In relation to lay analysis, he highlights the issue of central power versus local autonomy with regard to admission policy. The latter part of the narrative is devoted to an ITC subcommittee (‘Eitingon Committee’), appointed in 1927, which tried to formulate training guidelines for the whole IPA, again with a clear Berlin profile. The discussion of the draft of these guidelines among all branch societies (with Freud himself participating) revealed some interesting disagreements, while the ‘closed’ nature of the system, as opposed to what later came to be called an ‘open system’, was hardly challenged. The initiative failed, apparently through American opposition, but essentially because of the developmental gap between local societies as to the institution of specialised psychoanalytic training. The paper is based largely on unpublished material and also provides some information about Max Eitingon, the least well known of the early leaders of psychoanalysis.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

Fostering the educational value of candidate evaluation

Approaches to fostering the educational value of candidate evaluation are presented, in view of the plethora of intra‐psychic challenges that combine with many other complexities of learning to work as an analyst. Four integrally interrelated practices have been found to address sensitivities inherent in candidates’ experience of training in general, and being evaluated in particular. When applied in concert, the institute's evaluative process not only becomes more considered, but also better promotes a psychoanalytic attitude and minimizes the intrusion of evaluators’ personal responses. The first is defining and employing in synergy criteria for clinical immersion based on demonstration of the development and deepening of an analytic process, as well as the development of psychoanalytic competencies. The second is mandating institute‐wide application of guidelines for assessment of progression/graduation that are clearly explicated to all candidates and faculty. The third is transparent and timely communication between candidates and their supervisors and progression advisors regarding progress essential to a sense of collaboration. Fourth the progression review process must be systematic and in‐depth, with built‐in consultative relationships serving as checks and balances on personal elements. The implementation and educational impact of these practices are considered in the case of one candidate.     

The search for evidence: Psychoanalytic practice and the male imaginary

In this paper, I will attempt to discuss the future of psychoanalytic practice in the wake of the National Institute of Health and Clinical Excellence’s (NICE) embrace of ‘evidence’-based practice. In 2005, NICE, whose task is to regulate the provision of health care across the National Health Service, adopted positivistic evidence-based protocols as the sole proof of the effectiveness of psychotherapy. Despite the success over the past 40?years of psychoanalytic and humanistic therapies in primary care and psychotherapy departments of psychiatric hospitals, NICE insists on restricting therapy, to those who can claim effectiveness as a result of using the data from client questionnaires commonly described as ‘outcome measures’ and it has gone on to promoting new modalities many of which have been imported from the States. As a consequence, most of the provision of psychotherapy in the public sector currently, whether as part of the National Health Service or the voluntary sector, has embraced evidence-based practice’ and many training organisations are promoting it, which will, in time, have an effect on private practice. I use some of the threads of the work of the feminist psychoanalyst Irigaray and others to understand this turn to positivistic science and how it can be understood as an instance of the retrenchment of the ‘male imaginary’ and a re-installation of the values of detachment and mastery. I query whether there are some problems within current theory, practice and institutionalisation which interfere with the emergence of a more progressive psychoanalytic practice.     

Comment on Björn Sahlberg’s paper

This paper is a comment on Björn Sahlberg’s paper on the function of training analysis in the Swedish psychoanalytic association and discusses some aspects of the candidates’ personal analysis and supervision. The paper further suggests some possible sources for inspiration and perspective on organizational and educational issues, for example taking an interest in the epistemology of professions, in what the concept of ‘reflection-in-action’ could mean in the training situation, or in empirical research about the educational models and the practice of psychoanalysis.     

Dante's Comedy: Precursors of psychoanalytic technique and psyche

This paper uses a literary approach to explore what common ground exists in both psychoanalytic technique and views of the psyche, of 'person'. While Western literature has developed various views of psyche and person over centuries, there have been crystallizing, seminal portraits, for instance Shakespeare's perspective on what is human, some of which have endured to the present. By using Dante's Commedia , particularly the Inferno , a 14th century poem that both integrates and revises previous models of psyche and personhood, we can examine what features of psyche, and 'techniques' in soul-healing psychoanalysts have inherited culturally. Discovering basic features of technique and model of psyche we share as psychoanalysts permits us to explore why we have differences in variations on technique and models of inner life.