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 .     

Sollen Psychoanalytiker Psychotherapeuten ausbilden?

With respect to the radical changes in psychotherapeutic education as a consequence of the Law for Psychotherapy that has been put into force, the author elaborates on political, medical and strategic aspects. It is of special interest whether psychoanalysts having had the “monopoly” of training in depth psychological therapy should further take responsibility for the training in and the development of this method. Meanwhile, other therapeutic schools are claiming depth psychological psychotherapy for themselves and they deny the essential role of psychoanalysis as a foundation of it. In addition, the psychoanalytic institutes themselves do not agree on this issue. A further aspect of the question is that of marketing strategies: in order to survive, it is for psychoanalytic institutes at a time of lessening interest in standard psychoanalytic training important to offer training in depth psychological therapy with its comparatively less expensive and less extensive curriculum. But the essential question remains: should psychoanalysts train psychotherapists and take responsibility for an independent depth psychological therapy, or not? The author calls for a separate profound education in depth psychology taught by psychoanalysts in order to maintain a positive atmosphere for psychoanalysis e.g. in clinical institutions. He agrees with the IPV that this would help to solve “the crisis of the psycho analysis”. Finally, some of the most important, unsolved questions referring to a separate and profound education in depth psychology are presented and possible solutions are offered. It is of crucial importance to take up again the discussion within the psychoanalytical associations and to adjust their medical as well as political attitude to the new ways depth psychology is taught at psychoanalytical institutes.     

Lernziel: Kontextbezogene psychotherapeutische Kompetenz

Several authors (e.g. Thomä 2004) of critical reviews about psychoanalytical training stated repeatedly, that the learning objective of psychoanalytical training is not to be defined. In the case of psychoanalytical training, being at the same time a pedagogical undertaking, the search for a learning objective is seen as indispensable. Wampold (2001) presented a metaanalysis of psychotherapeutic outcome studies. He examined and evaluated the results of psychotherapeutic research on the basis of hypotheses derived from the “medical model” and the “contextual model”. He concludes that psychotherapeutic treatments based on theoretical models and implementations derived from the “contextual model” are those which are effective. Starting from Wampold’s empirically evaluated theses a definition of contextual psychotherapeutic competence is developed. This definition is proposed to serve as the central learning objective of psychoanalytic education. With regard to this learning objective aspects of a contextual pedagogical conception of the psychoanalytical education are discussed. Which pedagogical theory and concepts of learning and teaching, are to be subsumed under the “contextual model” and are, therefore, suited for psychoanalytical training? What is the difference between psychotherapeutical and pedagogical relationship in psychoanalytic training? What is a contextual pedagogical competence of the analytic teacher? Are learning opportunities in psychoanalytic training apt to challenge psychoanalysts-in-training to develop spontaneously contextual psychotherapeutic competence? With regard to these questions the practice of psychoanalytic training, i.e. self-experience, supervision, imparting of theory and family observation are discussed.     

Historiography and psychoanalysis

Abstract

The act of writing the history of psychoanalysis poses crucial questions with regard to the openness of society. This article examines the fundamental issues faced by researchers when they set about writing the history of psychoanalysis in a specific country. The significance of reconstructing features of the psychoanalytical practice is discussed. The opposition that exists between the current academic ideals and those of the psychoanalytic societies is outlined with reference to the changes that society has undergone, particularly during the past 30 years. In this context, the stance maintained by psychoanalysts with regard to psychiatry, academic psychology, and the university education of psychotherapists is defined. Government accreditation processes for psychologists and psychotherapists are likewise illustrated in the light of the opinions held by psychoanalysts at different moments in time.     

'This is not psychoanalysis': On the stony way of the Danish Psychoanalytical Society

When Freud founded the International Psychoanalytical Association (IPA), he wanted a network of local groups responsible for psychoanalytic training. The groups would function as ‘headquarters whose business it would be to declare: All this nonsense is nothing to do with analysis; this is not psychoanalysis. Today, with psychoanalytic pluralism, Tuckett (in press) has asked ‘Does anything go? He has pointed out that the psychoanalytic community has been increasingly willing to accept within its ranks apparently very varied approaches to theory and practice, and that this increasing diversity has many negative consequences for psychoanalytic institutions and especially for training schemas. The aim of this paper is to give an example of psychoanalysis that ‘did not go’, and how that led to a shaky start for the new Danish Psychoanalytical Society, with confusing boundary relations between psychoanalysis and psychotherapy and no training institute. Beginning with the written psychoanalytical contribution of the three founders of the Danish Society, the paper will try to identify factors that contributed to the ‘shaky start’. The paper will also examine how stones were removed from the path, thus paving the way for the members of the Society to discover ‘competent psychoanalysis’.     

Psychoanalysis and University in Brazil: Possibilities and Limits of This Articulation

The goal of this article is to clarify some of the aspects concerning the academic teaching and research that is carried out in the field of psychoanalysis in the Brazilian Universities, versus the transmission and training in psychoanalytic institutions. The author describes how psychoanalysis is present in the Brazilian university context, from undergraduate to graduate studies, and also points out perspectives regarding the future of psychoanalysis in Brazil.     

The relationship of the inner and the outer in psychoanalysis

What is internal and what is external according to psychoanalytic theory? This is a surprisingly complicated question. The terminology is often ambiguous and inconsistent as, for instance, in the use of terms like ‘object’ and ‘other’. The relationship between internal and external in psychoanalysis is analysed from a philosophical, concept analytical, developmental psychological, methodological and trauma versus internal dynamics point of view. It is argued that psychoanalytical writing is influenced by the authors’ need to create their personal psychoanalytic theory and language. This is seen as one of the main reasons for the terminological variety and ambiguity in psychoanalytic writing. It is also argued that one particular reason for difficulties concerning the internal–external terminology is the existential anxiety awakened by the threat of the essential aloneness of man. The consciousness of this has a tendency to fade and lead to unclear terminology. The importance of the transitional world as a resting place from the hard reality of this essential aloneness is emphasized. The transitional world is also seen as a necessary part of psychoanalytical practice, as an aid in striving for the truth and reality, important goals of psychoanalysis.     

Seeking an Analytic Identity

Abstract

Rothstein has stimulated all analysts to rethink how we can better commit ourselves to our analytic work. In this paper I focus on factors in analysts' personalities and experiences in their training and practice that contribute to or distract from establishing an analytic identity.

First, I explore analysts' background and motivation. In admissions to psychoanalytic institutes we look for candidates who can see psychoanalysis as an intellectual puzzle to be solved and an emotional involvement to be experienced. We look for earlv conflicts that the candidate can sublimate in the service of analytic functioning. We assume that the capacity to sublimate is only partial and that analysts in their development continue to recognize conflicts in transference—countertransference reactions.

Second, I give some examples of experiences from analysts' training that stimulate the formation of their analytic identities. These include transient identifications and counter-identifications with the training analyst, supervisor, seminar leader, and favorite analytic authors.

Third, I discuss more external factors that influence the development of analytic identity. These include the climate in training and continuing education at the institute. How much does the institute support its members in immersion in psychoanalysis? Economic factors continue to he an important factor in determining individual choice in this immersion.

Finally, I review studies on the effectiveness of psychoanalysis. Dedicated analysts with considerable experience believe that analysis works despite some limitations. Part of high motivation to continue analytic work includes understanding how analytic results differ from the simpler solutions achieved by nonanalytic therapies.     

The analytic process in psychoanalysis and psychotherapy: from the interpersonal to the intrapsychic level

The current debate over the conflicting interpersonal and intrapsychic views of the analytic process may or may not help us to distinguish between psychoanalysis and analytic psychotherapy. A comparison of psychoanalysis in the English-speaking world--especially in the United States--with French psychoanalysis reveals the features that unite and at the same time divide these different psychoanalytical tendencies, both of which are the heirs to Freud's thought, in terms, in particular, of the setting (couch and chair) and of technique (interpretation, transference analysis and technical neutrality). Whereas all psychoanalytic work belongs within the framework of an interpersonal relationship, that relationship becomes meaningful only when linked to the intrapsychic dimension, which alone can open the way to the unconscious and to infantile sexuality.     

Indikation zu Psychoanalyse und analytischer Psychotherapie

Based on the diagnostic process in the initial interview, which is an intersubjective encounter, the various developmental steps for establishment of the indications for psychoanalysis are presented. Freud and his followers, who were initially oriented to the psychiatric diagnosis, were later oriented to the criteria of approachability, analysability and in particular on the aptitude for psychoanalysis. The criterion of aptitude was not only elaborated from the perspective of Ego psychology but was also relevant for all high frequency non-terminated psychoanalyses which followed the basic psychoanalytical principles of “afocality”. This has so far characterized the standard procedure of all psychoanalytic schools. Due to the experiences of psychoanalysts with early disturbed, structurally Ego-disturbed neuroses and personality disorders, the extent of lability of the mental structure and by turning to countertransference analysis, the person of the psychoanalyst become more important for the assessment of the indications. In Germany the integration of psychotherapy, which is financially supported by healthcare insurance, ultimately leads to differential indication assessments between high frequency psychoanalysis or analytical psychotherapy, modified psychoanalytical psychotherapy and less frequent psychodynamic procedures.     

A reassessment of psychoanalytic education: Controversies and changes2

To understand the many controversies surrounding psychoanalytic education, it is necessary first to understand the unique role played by education in our field where control of educational structures remains the most important measure of professional success for the majority of psychoanalysts. To keep debate about educational policy focused on the task of strengthening the intellectual basis of psychoanalysis, it is also necessary to understand that forces affecting education arise from at least three different domains which can too easily become confused with one another: 1) the domain of knowledge‐ intellectual, scientific and clinical; 2) the domain of the organized professional community; and 3) the domain of local institutional politics. The authors explore controversy arising within and among each of these domains. They also explore the major alternatives proposed to the Eitingon model of psychoanalytic education, arguing that excessive authoritarianism in education arises not from the existence of hierarchical structures per se (as suggested by the ‘French model’), but from two other factors: the condensation of all important professional functions into the single ‘monolithic’ position of the training analyst, and the lack of agreed upon methodology for determining the validity of theoretical propositions. The solution lies not in obliterating all gaps in expertise and status by doing away with hierarchical structures altogether, but rather in strengthening the intellectual, scholarly and research context within which psychoanalytic education takes place. We must attempt to relocate our experience of a gap where it belongs: not between those who are training analysts and those who are not, but between what we feel we already know about mental life and what we do not yet know.     

Infant observation and the French model

Psychoanalytic training in the French Societies belonging to the International Psychoanalytic Association does not grant any place to the observation of babies as it exists in certain societies of other countries. Infant observation is even the object of sharp critiques by eminent French theoreticians. The reasons given for condemning infant observation and refusing to give it any place in the training programme lie in theoretical positions concerning the very nature of the Freudian discovery and its interpretation, which is more idealistic than empirical. The author discusses these reasons while drawing attention to the frequent confusion between a reference to empiricism and a reference to the experimental. The fear of a psychologizing deviation of metapsychology and of a denial of psychic reality leads, in the French model, to placing the emphasis on personal analytic experience during the candidate's psychoanalysis, prolonged by supervisions. It excludes any academic teaching of metapsychology or of related disciplines. The confusion between the empiricism of Esther Bick's method and the recourse to experimental procedures in developmental research stands in the way of making a place for infant observation and of recognizing its training value, not so much for the acquisition of new knowledge or the validation of metapsychological models, as for its usefulness in developing a mode of psychoanalytic observation and an increase in the candidates' containing capacities.     

Out of the consulting room and into the world: hermeneutic dialogue, phronesis, and psychoanalytic theory as practice

One of the relics of positivism has been an underappreciation of the moral and ethical dimensions of psychoanalytic theory and practice. In a positivist metapsychology, cure and therapeutic gain were often defined instrumentally, with relatively little consideration given to aspects of human experience (e.g., moral, cultural, spiritual) that did not fit within a positivist framework. Conceptual and paradigmatic shifts in psychoanalysis have occurred, in part, because of the inability of the classical model to provide a language that adequately captures deeply felt human values and beliefs. Aided by hermeneutic and postmodern influences, many contemporary psychoanalytic theories are beginning to focus greater attention on the notion that analytic therapy is empowered by a set of ethical convictions, beliefs, and commitments, which are tied to a certain understanding of the good life. Along these lines, the author argues that developing a fresh understanding of the moral and ethical dimensions of psychoanalysis requires elaborating a new ontology of human subjectivity and social life. The author offers a sketch of how this gargantuan task might be started by integrating psychoanalysis within a hermeneutic perspective on dialogue, by suggesting that it would be helpful to view psychoanalysis as promoting Aristotelian practical wisdom or phronesis, and by rethinking psychoanalytic theory and interpretation as a form of practice.     

Editorial

The use of drugs during psychoanalysis as well as the psychoanalytical treatment of patients who need psychopharmacological medication raise a whole series of problems that are also the subject of controversial discussion. Nevertheless, the body of literature available on this topic is still quite small. Medication is invariably an outside parameter that is introduced into the psychoanalysis and it can cause a blind spot in the psychoanalytic treatment. On the other hand, as we are treating severely disturbed patients, we are confronted with a growing necessity to introduce medication into the psychoanalytic setting. The paper discusses the related conflicts of the psychoanalyst and shows in a case report how an analytic stance can go hand in hand with adequate medication. The paper argues that we have to accept the state of the art in psychiatry and at the same time continue to talk about medication in terms of psychological processes even though it poses a conflict and is also a threat to our narcissistic equilibrium.     

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.     

'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'.     

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.     

BECOMING RELATED: THE EDUCATION OF A PSYCHOANALYST

The author uses a “professional memoir,” a story about his first experiences in clinical work, to illustrate what he believes to be certain fundamental aspects of an analytic attitude. Taking place in a psychiatric hospital, it is meant to highlight the central place of intuition, emotional receptivity, empathy, relatedness—and their inherent dangers—in engaging therapeutically with patients' emotional disturbances. The author postulates that these and related aspects of clinical psychoanalysis are not sufficiently emphasized in psychoanalytic training and are often eclipsed by idealizations of psychoanalytic theories and their derivative techniques, third‐party demands for evidence‐based data, preoccupations with neurobiological correlates of experience, etc. Despite the clinical fact that psychoanalysis can be extraordinarily helpful to patients, he questions whether clinical psychoanalysis is rightly regarded as a “treatment.”     

Comments on the Ikonen & Rechardt paper on the origin of shame

Psychoanalysis is concerned with the unconscious; it weaves fleeting connections with it, and studies its effect on the conscious mind. This is the only method which allows us to reach the unconscious, making use of the technique of dream interpretation and free association. The various effects of unconscious impulses take the form of psychic and somatic symptoms and of impulsive behavior. The psychoanalytic method should enable the analysand to make contact with the veiled meanings of the repressed self, above all with its strivings. Simultaneously, the origins of poorly-functioning psychic structures are also revealed. Psychoanalysis also needs to examine the varying potential of the patient to benefit from analytical work and arrive at a better understanding of his or her unconscious mind. We have seen, as Freud did in his time, that the benefit derived from analytical understanding, i.e., interpretation, is by no means self-evident. In the mental structures of patients, we encounter aspects which reject the integrating effect of the analytical understanding. This finding, the so-called negative therapeutic reaction, and the more detailed psychoanalytical study of its contents and the psychic functions and structures involved, has made psychoanalysis every year more and more challenging and interesting.