The Politics of Exclusion

Starting as a movement based on the discoveries of a genius, psychoanalysis aspired to be a science. A deeply subjective method of data gathering, it had to transform new findings into its founder's objectively coherent theory or revise it and challenge the founder. Exclusion from the group emerged as scientific judgment and punishment. From early on, when Freud barely distinguished between disagreement and enmity, assessment of new ideas was entwined with narcissistic conflicts. Exclusion not only maintained the relative coherence of the theory—a reasonable, laudable goal—but led to an enhanced in-group motivated to maintain the theory and a devalued out-group that would need to turn the tables. The way was paved for fortification of established ideas and overidealization of new ideas. But the decision by the American Psychoanalytic Association (APA) to accept only physicians for psychoanalytic training extended exclusion to group membership. The result was the establishment of training outside the official APA/International Psycho-analytical Association umbrella. Formation of nonestablishment psychoanalytic institutes not only allowed more heterogeneity of ideas during the rule of orthodoxy but introduced seemingly less hierarchical organizational structures. Ideas embodied in these structures are now advocated by those who find hierarchy too oppressive. The paper ends with an examination of some of these ideas.     

Psychoanalysis Unbound: A Contextual Consideration of Boundaries From a Developmental Systems Self Psychology Perspective

Each individual analyst has a unique way of evolving and developing over the years, in theory and in style of working with analysands. Different environmental conditions as well as one's personal inner life are significant influences. My analytic journey started in 1950 in Los Angeles and the turmoil of the psychoanalytic institutes had a significant impact on me. Often difficulties in the institutes were said to be about theory and ideas in psychoanalysis, but power issues were always present. The American Psychoanalytic Association was also involved in these matters with their attitude on “correct” theory. This paper discusses the interplay of these events and other aspects of my own evolution—from ego to self.     

How do we evaluate learning from the curriculum? Thirty phone interviews with Institutes of the American Psychoanalytic Association

A telephone survey of curriculum directors of the thirty institutes of the American Psychoanalytic Association revealed that 75 percent of institutes highly value the importance of evaluating what candidates learn from the curriculum. Paradoxically, however, most institutes do not do evaluations in this area. Typically, institutes evaluate candidates' satisfaction with courses, or their attendance and conduct in classes, rather than learning per se. Some institutes have more rigorous evaluation methods, including oral exams. Objections to evaluating what candidates learn included (1) evaluations involve too much work; (2) evaluations of learning are considered inappropriate or invalid; (3) evaluations would hurt candidates, faculty, the learning process, and the institute. Some curriculum directors dismissed these objections, contending that it is the responsibility of psychoanalytic educators to set teaching goals and evaluate learning.     

Why don't our institutes teach the methodology of clinical psychoanalytic evidence?

One of the most pressing theoretical, therapeutic, and educational problems confronting the advance of psychoanalysis is our confusion about the nature of clinical evidence. There is considerable disagreement among psychoanalysts about how to define evidence. Recently, there has also been a growing tendency toward evidential nihilism, justified by some of the more radical constructivist-narrative views of postmodern epistemology. Two surveys, conducted ten years apart, of all the psychoanalytic institutes recognized by the American Psychoanalytic Association, indicate a continuing and disturbing neglect of this topic in the curricula of our institutes. This paper reports the views of a number of psychoanalytic educators who participated in these surveys and is intended to stimulate discussion about the causes of this critical problem.     

Psychoanalytic ecumenism and varieties of psychoanalytic experience.

Using the metaphor of ecumenism, the current status of psychoanalysis and the American Psychoanalytic Association is examined. The dialectical tendencies to oppose and to unify are noted in psychoanalytic theory, technique, and practice, as well as in the administrative and political life of our organization. Fostering tolerance for new hypotheses without sacrificing empirical discrimination, and promoting broad participation without lowering standards confront us as major tasks demanding continuing vigilance and effort.     

The American Psychoanalytic Association: a decade of change

The American Psychoanalytic Association in the last decade has undergone the most extensive organizational changes in its history. Efforts at inclusion, outreach, and democratization have halted a decline in candidates, active members, and cultural influence and led to a vibrant, growing organization, as new professional groups have gradually been included in the association's training programs. The goal of increasing training opportunities for minority candidates has only partially been achieved. A recent effort to offer affiliate status to psychotherapists and students has begun, though with modest results. Alliances with otherpsychoanalytic groups have led to creation of the Psychoanalytic Consortium and steady progress toward external accreditation of institutes and licensure of psychoanalysts. In the interest of unification there is a need to develop pathways of affiliation and membership for independent institutes and societies that desire to join the association. Democracy has in large measure already been enhanced at the national level. Deliberations are now transparent, and an invigorated Executive Committee willingly shares power with the Executive Council. Candidates now are deeply involved in the governance of Board and Council and their committees. But only when all members and candidates enjoy full voting rights and all members are able to serve as officers and Executive Councilors will the decades-long effort to democratize the association be concluded.     

Current comments on Freud's treatment of "The question of lay analysis"]

The author gives a review on Freud's basic thoughts on lay analysis from 1926 and proceeds with the question why the Deutsche Psychoanalytische Vereinigung (German Psychoanalytic Association) admits only such candidates for psychoanalytic training who are physicians or psychologists. This corresponds with the policies of German health insurance agencies, which include only physicians directly or psychologists indirectly in their plans. He suggests that this attitude derives from a limited view of psychoanalysis, for which he names three different reasons: historical, institutional, and those that grow out of the specifics of psychoanalytic practice.     

When theory and practice diverge: gender-related patterns of referral to psychoanalysts.

This study tests the hypothesis that female analysts, relative to male analysts, receive a disproportionately small percentage of male referrals. Referral patterns for 170 analysts from four institutes accredited by the American Psychoanalytic Association were examined. One thousand, five hundred and ten patients referrals were studied. The findings were extremely robust and offered dramatic confirmation of our hypothesis. The major implications of the study are as follows: (1) Women analysts receive relatively few adult male referrals, making it difficult for them to gain requisite clinical experience with men. (2) Analysts and nonanalysts alike demonstrate a reluctance to refer male patients to female analysts. (3) Adult referrals, including those made by analysts, are significantly influenced by the issue of gender match between patient and analyst. (4) Analysts' behavior with regard to making referrals does not correspond to explicit clinical theory regarding how analysts make referrals--specifically, the extent to which gender influences the referral process is not adequately described by theory. We believe that these findings are of some concern from the standpoint of analytic education and that they also raise questions regarding unacknowledged aspects of how gender match between patient and analyst enters into clinical decision making.(ABSTRACT TRUNCATED AT 250 WORDS)     

An Overview of Joseph Sandler's Key Contributions to Theoretical and Clinical Psychoanalysis

Joseph Sandler was instrumental in bringing about what Ogden (1992) has termed the “quiet revolution” in psychoanalytic theory over the past several decades. His accomplishments reflected his capacity to combine empirical research skills with the highest order of understanding of psychoanalytic theory. From the more traditional frame of reference acquired through his analytic training, Sandler gradually evolved a complex integration of ego psychology and object relations theory that has become increasingly dominant. Throughout this process, Sandler strove to keep theory tied to clinical activity. While most analysts pay lip service to the intimate relationship of theory and practice, Sandler, using the Hampstead Psychoanalytic Index as his framework, researched the applicability of psychoanalytic concepts to the clinical setting. This resulted in reconceptualizations of some of the basic building blocks of psychoanalysis. His training as an experimental psychologist gave him a fresh perspective on traditional concepts, which he supported and altered on the basis of empirical research. His immersion in child development at the Anna Freud Centre also influenced his intellectual development.     

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.     

On methods of reporting clinical material.

The members of the Committee on Scientific Activities of the American Psychoanalytic Association are concerned about the paucity of clinical data in psychoanalytic reports and by the quality of what does exist. We have proposed a few standards for clinical reports that we believe will be reliable and clear and will have enduring usefulness. We recognize the need for maintaining confidentiality and, at times, for disguise; we also recognize the need to balance these requirements against the dangers of misleading the reader (or listener). These conflicting requirements have resulted in our concentrating on some general principles for clinical reporting. We have appended a tentative form, and examples, to be considered for that purpose.     

The future of psychoanalysis and its institutes.

If the function of psychoanalytic training institutes is to train practitioners of psychoanalytic technique, it is unreasonable to expect institutes to offer effective training in research or other scholarly applications of psychoanalysis. But if one insists that the training of psychoanalysts should, at least in some instances, encompass more than the teaching of psychoanalytic therapy, the training institutes have been failing in their function to educate candidates for scholarly activities. Whether the structure of the independent training institutes can permit such broadened training is questioned. One solution is to move the educational function into the university setting.     

Our analytic heritage: ideals and idealizations

The relation between ideals and idealizations is examined with regard to the aims of the American Psychoanalytic Association in advancing psychoanalytic education, practice, and research. Ideals are essential for preserving the past and as guides for the future. However, the idealizations that often develop in response to new discoveries and innovations may lead to a defensive clinging to the past as well as to an overly enthusiastic embrace of new ideas. Both these forms of idealization may serve as powerful resistances to creative and constructive change.     

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.     

The transformation of psychoanalysis in America: emigré analysts and the New York Psychoanalytic Society and institute, 1935-1961

Part I reviews the role of the Emergency Committee on Relief and Immigration of the American Psychoanalytic Association, chaired by Lawrence Kubie and Bettina Warburg, members of the New York Psychoanalytic Society, in facilitating the immigration to the United States of scores of European analysts and candidates between 1938 and 1943. The challenges facing the committee are outlined in reports written by Kubie and Warburg. In particular, the intractable problem of how to integrate European lay analysts into the American Psychoanalytic Association was an ever present problem. Part II describes the impact emigré analysts had on the intellectual life of the New York Psychoanalytic Society and Institute, and considers how the psychoanalytic work of the emigrés was influenced by their move to America. The reminiscences of two emigré analysts, Peter Neubauer and Kurt R. Eissler, on their experience of coming to the United States close the paper.     

A training analysis for psychoanalytic psychotherapists

For historical reasons, psychoanalytic psychotherapy has been regarded as a second-class treatment in comparison with psychoanalysis, and standards for training in it have lagged behind those for psychoanalysis. However, psychoanalytic psychotherapy is the treatment of choice for many healthier (or higher-level) patients who cannot receive analysis for any reason, and also for a large population of more-disturbed patients who are not appropriate for psychoanalysis. Mastering techniques of psychoanalytic psychotherapy may be as difficult as mastering those of psychoanalysis, and should require comparable theoretical training, supervision, and personal treatment. This "development lag" in the training of psychoanalytic psychotherapists has taken place for several reasons: (1) Psychoanalytic ideas first emerged in America in the context of a new movement toward an electric, but dynamic psychiatry from which psychoanalysis had to establish its separate identity. (2) Psychotherapy was associated with techniques of suggestion and manipulation from which psychoanalysis wished to separate. (3) Because psychotherapy was seen as an inferior form of therapy which required little training, institutes were slow in being established, and reluctant to require a "training analysis." It is suggested that with the full training of psychoanalytic psychotherapists, this discipline may be regarded as a profession comparable to psychoanalysis. It is further suggested that the optimal treatment for the full training of the psychoanalytic psychotherapist is psychoanalysis, and that a "training psychotherapy" is not an adequate substitute, but may provide a transitional step to resolve initial resistances and to prepare the therapist for a training analysis.     

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 .     

Survey of current clinical and research trends in clinical psychology

A survey of the directors of APA accredited clinical psychology programs was conducted to explore current trends in the training of clinical psychologists. Specifically, information was obtained regarding the research areas represented at each school, the types of clinical training sites available to graduate students, and the prevalence of different clinical orientations (e.g., cognitive-behavioral, systems, or psychoanalytic). Results of the survey provide a summary of the activities of faculty and students at the more than 100 fully accredited clinical psychology programs.     

Listening to Themes in a Review of Psychoanalytic Literature About Lesbianism

Using the bibliography of the Committee on Homosexuality of the American Psychoanalytic Association as a resource, a wide review of the psychoanalytic literature on lesbianism and bisexuality in women was undertaken. An evolution in theory, over time, was observed in the writing by authors more familiar to most analysts. A second group of less widely known writers has also written extensively on the subject. This chapter focuses on the predominant, recurring themes found in the second body of work. These themes include: separating the concepts of gender identity and object choice; reexamining assumptions about developmental pathways; fluidity in object choice in women; dilemmas in lesbian experience; and treatment issues. Dilemmas include feeling different, coming out, relationship patterns, and decisions about parenting. Similarities between the ideas found in the two bodies of work are noted.