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.     

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.     

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.     

Psychoanalytisch begründete Ans?tze in der forensischen Psychiatrie und Psychotherapie

After many years where manualized mainly behaviour treatments dominated in forensic settings, psychodynamic therapies are gaining acceptance and are performed and evaluated more and more in forensic hospitals and in prisons. This encompasses individual, couple, family and group therapies. Individual and group analysts are starting to perform these tasks again, mostly as workers in forensic settings but also as external therapists and supervisors. All staff members are important in creating a therapeutic community based on group analytic principles. They are therefore required to build up a therapeutic attitude supported by regular external case and team supervision. Delictogenic situations occur in everyday life as well as in professional settings and are analysed mainly in group therapies, considering situations of the past and the effect on other people. Modern manualized analytical concepts, such as transference-focussed psychotherapy (TFP) and mentalization-based therapy (MBT) depthen the quality of therapeutic work of all professionals in forensic settings. The multimorbid and sometimes dangerous patients require good ethical and professional attitudes. The psychoanalytic concepts of defence and resistance, transference and countertransference are essential parts of changing internalization and corrective emotional experience, important parts of useful forensic treatments.     

Clinical theory at the border(s): Emerging and unintended crossings in the development of clinical theory

The author provides some scaffolding for thinking about emerging and unintended integrative developments in clinical theory. The emergent theory to which the author refers works at a different level of theoretical discourse than explicit attempts at comparative translation of psychoanalytic concepts or theories. In contrast, most of the theory that is explored in this paper involves clinical discourse aimed at solving important common clinical problems. The work of a group of authors (Jay Greenberg, John Steiner, Anton Kris, Michael Feldman and Charles Spezzano) is described as simultaneously embedded within a particular orientation while demonstrating a kind of unwitting reach to a broad swathe of analysts. Distinctions are made between this kind of linking of clinical theory versus self‐consciously syncretic and integrative approaches to theory development. The author also discusses the educational implications of this emergent theory for teaching and learning during psychoanalytic training.     

The relevance of infant observation to clinical training and practice: An interpretation

In this paper, I discuss the effects of infant observation on the observer and the implications for mental health professionals. Similarities and differences between two Infant Observation Seminar groups of students are presented. Students performed in-home observations once a week over a 2-year period. Initially, there were motivational differences between the groups of students. One group had members committed to an intensive training program in psychoanalytic psychotherapy with children (Training Group), and the other group was a service delivery front-line worker group whose members voluntarily attended a weekly in-service training seminar (Work Group). In addition to infant observation, the Training Group had ongoing didactic seminars in psychoanalytic theory, 3 hours weekly for 4 years. The Work Group had a didactic seminar on some aspect of relevant infancy literature or psychoanalytic theory for 1 hour per week for the duration of the seminar, which was 2 years. The findings suggest that mental health workers can enhance their clinical skills through infant observation, that they can obtain a working knowledge of infant development, that prior training did not affect observation, and that all observers had difficulty observing mother-infant relationships due to counter-transference difficulties that involved unresolved conflicts from the past.     

Containment and the threat of catastrophic change in psychotherapy groups

Wilfred Bion's seminal work with treatment and training groups is considered by many group therapists to be a classic study of group behavior. Despite the influence of his early work on groups, practitioners frequently find his later writings difficult to apply to group settings. The purpose of this paper is to illustrate the potential usefulness of Bion's later psychoanalytic writings to our understanding of the complex dynamics active in therapy groups. This paper examines the relationship among four concepts that Bion emphasized in his later writings: projective identification, containercontained, (Ps<---->D), and catastrophic change. Two clinical vignettes are presented to demonstrate how these concepts can aid the therapist in understanding the complicated dynamics active in therapeutic group settings.     

情感教学心理学研究

为纪念中国心理学会诞辰90周年,应中国心理学会教育心理学分会邀请,特撰文反映卢家楣及其团队在情感教学心理学方面的研究概况。内容分以情感教学应用为导向的基础性研究和以情感教学理念为导向的应用性研究两部分。前者包括教学中的情感现象、教学中的情感作用、教学中的情绪调控、教学中的学习苦乐属性、教学中的情知基本矛盾等方面的相应研究;后者包括情感教学理念、情感教学现状、情感教学原则、情感教学策略、情感教学模式、情感教学目标和评价以及为基础教育服务等方面的相应研究。     

Cultural variation in psychopathology: From research to practice

In the context of a Professional Doctorate in Psychoanalytic Research, we examined how a group of psychoanalytic therapists responded to the ethos and methods of qualitative research. Although experienced therapy practitioners, the students were mostly new to qualitative research. We were interested in the extent to which students found psychoanalytic training and qualitative research compatible or in conflict. The data for the study was a focus group in which students discussed the experience of becoming researchers. The focus group was recorded, transcribed and analysed using Discursive Psychology but also informed by psychoanalytic analysis, in an iterative process including the participants. We concentrate here on some of the main discourses emerging, including intrinsic and extrinsic motivations for the course – bound up with life stage, sense of previous unfulfilled aspirations and the current challenges of working in UK mental health services. We also focus on tensions with the concept of developing a researcher identity, both concerning clinician identities and other roles. The sense of an uncomfortable ‘assimilation’ into a ‘foreign territory’ was explored, both in the focus group and the analysis. We use this to highlight some of the expectations and taboos of both psychoanalytic and research communities.     

Infantile anorexia,co‐excitation and co‐mastery in the parent/baby cathexis: The contribution of Sigmund and Anna Freud

Recent epidemiological studies show that 2% of babies in ordinary paediatric clinics suffer from infantile anorexia. In the first part of this paper we present a case study from our hospital clinical activity. Our framework combines clinical psychoanalytic sessions and perinatal videos. In the second part, we will focus on the concepts of instinct and excitation proposed by Sigmund Freud and the concept of mastery proposed by Anna Freud. In the third part, we will examine these concepts in the light of the case study. The fourth part is devoted to clinical recommendations from our hospital psychoanalytic practice. In conclusion, unlike other clinical settings, the psychoanalytic setting allows for the elaboration of the parental hatred included in the libidinal cathexis. Our psychoanalytic setting (sessions/videos) makes it possible to decontaminate parental intrapsychic elements overloaded with excitement, saturated with hate elements, and rendered sterile by the instinct for mastery. An initial part of the treatment process involves working through the intersubjective elements observed in the video.     

Teaching the Candidate in Case Seminar

There has been insufficient focus on the impact and usefulness of the case seminar for teaching in psychoanalytic institutes. In order to better understand case seminar, questionnaires were submitted to candidates, graduates, and faculty in two psychoanalytic teaching institutes. The responses indicate that the case seminar format should be standardized; level of experience of candidates should be similar; professors should examine suitability of the case beforehand; and candidates need to be prepared for the group process. Findings are useful in improving the teaching of psychoanalysis and encouraging the creative use of the candidate's self in psychoanalytic training.     

Learning from experience in case conference: A Bionian approach to teaching and consulting

In case conferences as well as didactic seminars, the power of the group can bring psychoanalytic education to life. However, primitive anxieties activated by group dynamics may also interfere with teaching and learning. The authors offer the example of a stalemated private practice case conference that had unconsciously organized against learning as the members began to read Bion's work. The case conference leader, an analyst, presented her case conference, which was mired in basic assumption dependency dynamics, to our peer consultation group. Drawing upon Bion's early contributions on groups, as well as his later ideas about thinking and mental growth, the peer group facilitated the case conference's return to work-group functioning and learning from experience. Activated in the peer group, commensal container↔contained processes gradually spread throughout the entire relational system of peer group, case-conference leader, case-conference members, and patients. This example underscores the importance of promoting within our institutes a culture in which faculty view themselves as part of an evolving intersubjective matrix that works to foster the containing capacities of candidates, patients, and faculty alike.     

Scharffs' Application of Hopper's Concept: “Incohesion: Aggregation/Massification”

We begin by stating our understanding of the concepts presented in Hopper's paper, then comment on the clinical illustration, and conclude by describing two group situations in which we have applied the concepts we have taken from Hopper's paper. Hopper's fourth basic assumption applies to our work as individual psychoanalysts, family therapists, and group leaders because it integrates psychoanalytic and social understanding. We demonstrate how and why we find Hopper's idea to be a useful advance.     

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.     

The effects of therapist turnover in a training clinic: The core group phenomenon

Group psychotherapy conducted in training settings presents the membership with a unique opportunity to experience and work through loss. This paper describes the potentially problematic influence of predictable therapist turnover in these clinical settings. The core group phenomenon which emerges as a function of this anticipatory grief is described, as are the dynamics of core group members who are particularly vulnerable to the comings and goings of therapists in training. Finally, the importance of therapist attention to the impact of the turnover process in group psychotherapy training programs is underscored.     

Dynamic interpersonal therapy in an NHS tertiary level specialist psychotherapy service

We describe the introduction of dynamic interpersonal psychotherapy (DIT) into an National Health Service (NHS) tertiary psychoanalytic specialist psychotherapy service. Training in DIT began as our contribution to Improving Access to Psychological Therapies and primary care services, supporting the training and supervision of their DIT practitioners. We then discovered DIT could be a valuable treatment within our own tertiary NHS service for patients with complex presentations. Currently fighting for survival, like many NHS psychoanalytic psychotherapy services nationally, we have adopted a manual-guided, psychoanalytically based therapy to broaden our tertiary clinical psychoanalytic service and accommodate trends in mental health service provision, whilst protecting the quality and integrity of our psychotherapy. DIT helped us continue providing relevant and beneficial psychoanalytic and psychodynamic services to individual patients despite limitations of the financially challenged NHS, NICE guidelines and Payment by Results. We outline the progress and outcomes for patients with complex mental health presentations, include individual case discussion and our experience of using the DIT approach within a traditionally longer term psychoanalytic psychotherapy service.     

The Quest for a Unified Psychoanalytic Theory: A Retreat from Uncertainty

There has been a historical shift in psychoanalysis from an earlier time of certainty to our present state of uncertainty with the coexistence of multiple theories competing for our attention. We realize retrospectively how entrenched groups ruled our institutions by maintaining faith in their authority as the keepers of “pure” psychoanalysis. Despite struggles between competing ideologies, there has been progress in integrating clinical theories. As no psychoanalytic theory or technique has been proved superior, we advocate an inclusive approach with all psychoanalysts keeping an open mind about the value of competing theories. This integration of disparate theories has led to a resurgence of interest in psychoanalytic training. Examples are given of some of the difficulties encountered when competing ideas are introduced in psychoanalytic groups.     

The educational boundary1

In this contribution, the authors defi ne and discuss the educational boundary in analytic training, which they believe is an often neglected and useful concept in psychoanalytic education. The framework on which their discussion rests includes the recent attention of psychoanalysts to issues of boundaries and ethics. Their understanding of how clinical work affects the mind of the analyst educator, as well as the ways the personalities of various analysts affect their dealings with faculty peers and students, are the other cornerstones of their discussion. The authors contend that many of the institutional problems encountered in the training of analysts can be better understood when viewed through the prism of the educational boundary. They present examples which illustrate several of the ways psychoanalytic educators complicate the training experience of candidates, offer specifi c explanations as to why analysts struggle as they try to manage their educational interventions, and indicate in a discussion of potential remedies that those behaviors might be avoided if the educational boundary is in focus. They also provide an example of how the educational boundary can be more effectively managed.     

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.