Psychoanalytic training today.

Psychoanalytic education in the United States faces multiple challenges as we enter the last decade of this century. (1) Changing interest and career path patterns for psychiatrists have resulted in fewer medical applications for psychoanalytic training. (2) Increased opportunities for full psychoanalytic training of nonphysicians have resulted in increased applications from highly skilled clinicians who often have more clinical experience than their medical colleagues. (3) Increased enrollment of women candidates has required rethinking of progression requirements, in light of their combined careers as professionals and mothers. (4) Independent institutes not accredited by the American Psychoanalytic Association compete for applicants while maintaining training standards that require less time and immersion in psychoanalytic theory and practice. (5) Economic factors increasingly influence the desirability of prolonged psychoanalytic training and the availability of suitable analysands for control analyses. (6) Evolution of theory and practice and the emergence of "new schools" of psychoanalytic thought have rendered the previous psychoanalytic landscape dominated by drive theory and ego psychology more multifaceted and less uniform. The American Psychoanalytic Association and its institutes attempt to understand these changing patterns and take them into consideration in the design and implementation of psychoanalytic training programs. Only one aspect of this complex situation will be described in this work, the current state of psychoanalytic training in the 28 institutes accredited by the American Psychoanalytic Association. Although the data available at this time leave unanswered many important questions about the philosophies that organize the content and emphases of the curriculum in different institutes, much has been learned about the overall structure of psychoanalytic training programs.     

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.     

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.     

Moments of change in psychoanalytic theory: Discussion of a new theory of psychic change

This commentary briefly summarizes the model proposed by the Boston Group and attempts to place it in the context of attachment theory and other integrational attempts between cognitive science and psychoanalysis. The clinical implications of these ideas are considered, with particular reference to therapeutic technique and the role of the therapist, as a “new object.” Some suggestions for the further development of the model are considered, in particular the observational study of the therapeutic process, the use of some classical psychoanalytic ideas such as transference, and the need for using the model to encourage technical innovation in psychoanalysis. © 1998 Michigan Association for Infant Mental Health     

'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’.     

On psychoanalytic figures as transference objects

One of the tasks that analysts and therapists face at a certain stage in their career is how to develop a way of psychoanalytic thinking and practising of their own. To do this involves modifying or overcoming the transferences established during their training or early career. These transferences are to one's teachers or training analyst, investing them with authority and infallibility, and to received theory, which is treated as though it were dogma. The need to free oneself from such transferences has been discussed in the literature. There is, however, another kind of transference that the developing therapist also needs to resolve, which has received little attention. This is the transference made on to a key figure in the psychoanalytic tradition. Such a psychoanalytic figure will be seen as the originator of or embodiment of those theoretical ideas to which one becomes attached, and/or as standing behind one's training analyst or seminal teachers who become a representative of that figure. The value of an investigation of one's relationship to a psychoanalytic figure is that it is an excellent medium for revealing one's transference, as the figure in question is not a real person but only exists through his/her writings. The body of the paper consists of an extended example of such an analysis, that of my own transference on to the figure of Winnicott. In this example I illustrate how my evaluation of Winnicott's ideas changed from seeing them as providing answers to all my clinical questions to no longer satisfying me in some areas of my work. This change in my relationship to Winnicott's theory went hand in hand with a modification in my transference on to the figure of Winnicott, from seeing him as endowed with authority and goodness to an appreciation of him as a still sustaining figure but now with limits and flaws. In the final part of the paper several questions arising out of my analysis are posed. Can the pull of writing such an account in terms of dramatic rupture rather than gradual and partial change be avoided? Should my account be regarded purely as a form of self‐analysis or does it have anything to say about Winnicott himself and his theory? And do some psychoanalytic figures attract more intense or sticky transferences than others?     

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.     

Ist es utopisch, sich zukünftige Psychoanalytiker ohne besondere berufliche Identität vorzustellen?

The subject of the Identity of Psychoanalysis and of its representatives belongs to the orthodox psychoanalytic movement. Since about 15 years, under the presidency of J. Sandler, the International Psychoanalytic Association (IPA) has tried successfully to facilitate scientific research and to promote projects. If the resistance of influential analysts against empirical investigations further decreases, psychoanalytic movement and its unfavourable concommitants will be past. The development to a scientific community will no longer be hampered by controversies on professional identity. The question of identity was dominated by the idea of the so-called “strict, untendentious psychoanalysis” (Freud 1909b, S. 104, 1919a, S. 168). It never existed and could never materialise—it was a fiction. The psychosocial dimensions and its normative implications call the concept of identity into question. Instead it is advisable to speak of a pychoanalytic attitude which has to prove its therapeutic value. This “second (professional) self” (Schafer 1983) is closely connected to the “first (personal) self”, but it is necessary and possible to separate the method from the person and to objectify changes in the patient even if taking place in an intersubjective, relational space. For many years Freud defined what Psychoanalysis is about and who is entitled to call himself an analyst. Later on, the psychoanalytic movement and the institutionalised training system fulfilled this role. The training analysis had been at the centre of all curricula. The genealogy of the training analyst determined the membership in the evergrowing family. Dissidents belong to the history of Psychoanalysis. The official acceptance of the pluralisms within the International Psychoanalytical Association demands comparisons between the various schools according to scientific criteria. Modern process and outcome research provides criteria suited to serve as a model for clinical treatment reports.     

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 .     

Depth,Perception, and Action: Past,Present, and Future

This paper examines how images of depth are employed in the psychoanalytic literature and how they illuminate or obfuscate. It examines as well the price of using familiar terminologies to introduce new ideas, a practice more common in psychoanalysis than in many other disciplines. By obscuring the differences between old ideas and new through using the same terminology for both, the sense of adherence and belonging to the psychoanalytic community is enhanced but the ability to see fully the new possibilities for theory and practice to which these new ideas point is constrained. In elaborating on this point, the paper also considers the differences between a past-centered, archaeological model and a model in which older patterns are perpetuated through their repeated consequences, both intended and unintended. In such a model both action and perception are taken into account, as the aim of analysis becomes not just the patient’s internal world but her lived life.     

AGAINST RECORDING SESSIONS FOR SUPERVISION

The American Psychological Association’s (APA) 2014 injunction that supervisors must listen to recorded sessions of their supervisees’ work is based on a rich and thorough body of research, and yet it entails a narrative of psychotherapy as a discipline of Science. If psychotherapy is understood as an endeavor also of the Humanities, recording sessions may be anathematic to supervision and training. Developing ideas from Greenberg’s (2015) theory of “controlling fiction,” the writer presents a narrative of psychotherapy in which it is not wise to review recorded sessions in supervision.

     

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.     

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.     

Organizational Structure and the Establishment of Psychoanalytic Identification: Commentary on Paper by Randall Lehmann Sorenson

This commentary addresses two themes: parallels between religious and psychoanalytic education and the question of group survival in a world of competitive groups, whether religious (“strict” vs. “weak”) or psychoanalytic (differing psychoanalytic approaches). “Strict” religious education involves teaching both critical thinking and identification with the particular religion. This blend of critical thinking and identification with psychoanalysis is crucial in psychoanalytic education. We want to graduate students who see themselves as psychoanalysts rather than as being “interested” in psychoanalysis. This goal is accomplished when students have close, positive experience with personal analysts, supervisors, and teachers who are strongly committed to psychoanalysis but in a manner that encourages students to think critically and find their own psychoanalytic perspective. With regard to the second theme, I discuss how our narcissistic commitment to one or another psychoanalytic model interferes with open integration of new insights. Individual analysts privately integrate competing ideas in their own idiosyncratic ways. When these individuals publicly represent competing psychoanalytic groups, however, they tend to emphasize differences among these groups. They then find ways to appropriate new ideas as extensions of their own evolving tradition. In this way, a theoretical school is able to integrate new developments while preserving its own identity.     

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.     

A Mixed Bag: The Realities of Psychoanalytic Practice

For a variety of reasons, psychoanalytic training is done in somewhat of a vacuum. It teaches a theory and a way of practicing that does not always translate well to day-to-day private practice work. The clinical realities of psychoanalytic practice prove the psychoanalytic method to be one that provides help to a wider audience than classical psychoanalytic training programs might suggest. The psychoanalytic approach offers the analyst many special opportunities to work with and help a wide variety of patients. Analysts who accept both the limitations as well as the wide application and broad benefits of the psychoanalytic approach may have a more fulfilling experience than their training experiences might foster. At the same time, the analyst's level of therapeutic skill, the patient's diagnosis, and many multiple external factors create different limitations in the practice and outcome of psychoanalytic work. Extensive case material is used to show the broad range of patients who are helped by the psychoanalytic method. The clinical material also shows the less than perfect, but often good enough outcomes of these difficult cases with often severely disturbed patients.     

New Windows on Understanding Addictive Vulnerability: Commentary on Papers by Lisa Director and Noelle Burton

The author discusses papers by Director and Burton, placing their work in a context of contemporary psychoanalytic models for understanding addictive behavior. Whereas early psychoanalytic models stressed drive theory and a topographic model of the mind, the contemporary models discussed here emphasize themes of dissociation—integration, helplessness—omnipotence, self-organization, and relational therapy. The author considers how these modern themes resonate with psychoanalytic formulations of addictive vulnerability that have considered disturbances in affect recognition/tolerance, self-esteem, relationships, and self-care. The author concludes by suggesting that the dyadic paradigms advanced by Director and Burton likely have implications for psychodynamic group treatments.     

Advances in Neuropsychoanalysis,Attachment Theory,and Trauma Research: Implications for Self Psychology

In 1971, Heinz Kohut, trained in neurology and then psychoanalysis, published The Analysis of the Self, a detailed exposition of the central role of the self in human existence. This classic volume of both twentieth century psychoanalysis and psychology was more than a collection of various clinical observations—rather it represented an overarching integrated theory of the development, structuralization, psychopathogenesis, and psychotherapy of disorders of the self. Although some of these ideas were elaborations of previous psychoanalytic principles, a large number of his concepts, including an emphasis on self rather than ego, signified an innovative departure from mainstream psychoanalysis and yet a truly creative addition to Freud's theory.     

Between the basic fault and second skin

The ideas that are commonly associated with Esther Bick, such as primal skin function, defensive second skin phenomena and adhesive identity, are traditionally seen as affiliated to the larger body of work that constitutes the Kleinian school. I shall argue, however, that Bick's thinking owes a largely communally unrecognised debt to the work of her training analyst, Michael Balint. Beginning with a discussion of Bick's early psychoanalytic formation within the British Psychoanalytic Society, her ideas will be reapproached in the light of her contemporary psychoanalytic milieu, with particular reference to Balint's notions concerning primary object-love, the basic fault and space. A brief history of the Manchester Training Centre, a short-lived but pioneering British attempt to extend psychoanalytic training beyond London, is included incidentally. Bick's early intellectual openness to diverse psychoanalytic streams will then be discussed in relation to the formation of psychoanalytic groups and their relative capacity to tolerate difference.     

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.