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 .     

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.     

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.     

COLLABORATING WITH THE UNCONSCIOUS OTHER

The analysand's capacity for making use of psychoanalytic treatment has been a subject of importance since the beginning of psychoanalysis. The author addresses an aspect of the difficulty encountered by analysands in achieving a psychic state that allows the creative use of free association, dreams, parapraxes and other spontaneous phenomena occurring during the course of treatment. He suggests that a very specific state of mind is essential to both the psychoanalytic process and the creative process. Using theoretical concepts derived from Freud, Klein and Bion, he develops the idea of an internal object relationship, 'the collaboration with the unconscious other', which forms the basis for both creative thinking and the psychoanalytic function of the personality. Creative thinking is distinguished from artistic endeavour and discussed as a universal potential, on which growth in psychoanalysis depends. The term 'unconscious other' is meant to signify the subjective experience of a foreign presence within oneself from which both spontaneous creative inspiration and involuntary psychic phenomena are felt to emanate. The author presents clinical material to suggest that paranoid-schizoid and depressive anxieties form obstacles to collaborating with the unconscious other, and must be worked through in order to achieve an analytic process.     

Controversies and Conflicts in the Institution of "Open" Psychoanalysis: Cases from the History of the Therapeia Foundation

The institution of psychoanalysis has included controversies, dissensions and expulsions at both the theoretical-methodological and personal-organizational levels. There have also been several intra- and intergroup conflicts in the history of psychoanalysis, and in constructing and patterning the future of psychoanalytic knowledge. In the context of Finnish psychoanalysis, the Therapeia Foundation (founded in 1958) met from the start with resistance from official psychiatry and also from the IPA. For example, in the mid-1960s, D. W. Winnicott, as the President of the IPA, supported the orthodox Finnish psychoanalytic study group (later to become the Finnish Psychoanalytical Society), and pronounced that the Therapeia group was too loose and was not strictly able to use the IPA-recognized designation "psychoanalytic." The Therapeia Foundation and its Training Seminar combined classical psychoanalysis and its new versions with existentialphenomenological views, anthropological medicine, research on "social pathology" and even modern theological research. On the basis of their Swiss analytic training, three Finnish psychiatrists, Martti Siirala, Kauko Kaila and Allan Johansson, organized Therapeian training to incorporate sciences and arts, and skills involving the therapeutic "carrying" of burdens. The multifacted nature of open psychoanalysis was seen to find its proper organizational expression when the Training Seminar of the Therapeia Foundation became, in 1974, a Member of the IFPS.     

Becoming and Being an Analyst in the British Psychoanalytical Society

The articles of Elizabeth Spillius and Jennifer Johns exemplify contrasting ways in which an analyst may form her psychoanalytic identity. She may recognize and accept a particular theoretical standpoint as valid, and form an analytic identity around that position. Or she may engage with a variety of viewpoints, and form an analytic identity through the interaction between these and her own internal self-experience. These approaches coexist in the British Psychoanalytical Society. There has been the potential for creative discussion between them, especially as regards their implications for analytic training. These six articles together, however, reveal how hard it has been for such discussion to take place. Spillius describes the disparity between the Society's three groups in relation to candidates' choice of supervisors, and I discuss this further. It seems to reflect an underlying difference in approach to psychoanalytic training, based on these different views of how an analyst's identity is formed. I suggest that the difficulty in debating this freely reflects a fear that opening up the issue might lead the Society to split. In 2005 the so-called Gentlemen's Agreement, which for 60 years governed group balance in the British Society, was formally abolished. In the light of this, I consider what is needed for a Society creatively to contain divergent philosophies of training.     

The crisis of psychoanalysis and psychoanalytical training: The suffering of the candidate on the long road towards qualifi cation1

The author assesses the impact of the so‐called ‘crisis of psychoanalysis’ on the training of candidates, and on those who accompany them through the course. Different causes of the most relevant symptom of the crisis, i.e. the diffi culty of fi nding patients for a four‐sessions‐weekly analysis, are considered. According to the author, analysts themselves must bear some of the responsibility for it. She draws attention to a number of interrelated phenomena, such as: trainees' tension in their encounters with potential analysands, due to awareness of their own needs as trainees; the necessity to accept very disturbed patients whose selection might arouse criticism from the training committee; analyses in which trainees seem to become patients' hostages because of ever‐present fears of interruption; the diffi cult construction of a psychoanalytic identity in trainees who also are in full‐time psychiatric practice; trainees' profound uncertainty about the future both of psychoanalysis in general and their own careers in particular. In agreement with Kernberg, the author stresses the importance of considering the ‘crisis of psychoanalysis’ as a phenomenon whose development may be infl uenced by the analysts themselves.     

Intersubjektivit?t und psychoanalytische Identit?t

The psychoanalytic identity is the result of identification with a psychoanalytic introject. It protects against the fears to which everyone who is attempting to illuminate the unconscious is exposed. In this paper the substantive issues of identity are discussed as a psychoanalyst who is a support for the work by providing concepts for the understanding of the unconscious. Using the example of the intersubjective wend in psychoanalysis it will be examined how these contents have changed under the influence of intersubjectivity. The notion that psychological development also occurs in psychoanalysis in unmistakable interpersonal contexts implies removing the restraints imposed by commitment to the technical rules and normative expectations. The intersubjective view of psychoanalysis therefore demands from the psychoanalyst an identity which is fundamentally different from that of the classical psychoanalyst. Processing the associated fears places the psychoanalytic identity at a more mature stage.     

The plight and promise of contemporary psychoanalysis in the light of its social history

This paper addresses the many changes which have beset psychoanalysis and the psychoanalytic community since the widespread, general acceptance of both by the educated, middle-class public in the 1950s. It attempts to explain these changes, at least in part, by reflecting upon them in the light of the history of the psychoanalytic movement and upon the rise of dynamic psychology as well. Many in the psychoanalytic community think that their work is being ignored, devalued, and even attacked by an increasing number of influential persons and organizations. Critics claim that, epistemologically, psychoanalysis is scientifically invalid; therapeutically, it is ineffective; economically, it is too costly and takes too long; and theoretically, it is pluralized to the point of fragmentation. This is the plight of psychoanalysis. This paper argues that many of the major problems which once beset Freud and his colleagues, and which beset the psychoanalytic community today, are best understood in terms of two sociological processes, legitimation and institutionalization. Legitimation is the socio-cultural process whereby a new idea (e.g., Freud's theories, Jung's theories) contests the established web of ideas which give coherence and meaning to social and personal identity. Institutionalization refers to the way legitimated ideas replace once-contested views of reality. The single most decisive factor generating the plight of contemporary psychoanalysis is the ‘decision’ (1) to socially locate (institutionalize) psychoanalysis in institutes, rather than in clinics or universities, and (2) to represent psychoanalysis to the public (legitimation) as a medical science. In order to illustrate and advance these claims, I first define and distinguish sociologically the institute, the clinic and the university. Second, I describe the origins and development of the ‘decision’, made by Freud and his followers, to locate or institutionalize psychoanalysis in institutes. Third, I compare and contrast this early pattern of legitimation and institutionalization with that of the present-day psychoanalytic movement in England (relatively benign institutionalization) and in the United States (relatively destructive institutionalization). Throughout this discussion I draw upon the new literature on the history of psychoanalysis, past and present. As for the ‘promise’ for psychoanalysis, it can materialize insofar as psychoanalysis establishes contact with the clinic and the university (re-legitimation) and insofar as that contact becomes so self-evident that it is taken for granted (i.e., it is re-institutionalized).     

How treating psychoanalysts respond to psychotherapy research constraints.

The psychoanalytic community increasingly recognizes the importance of research on psychoanalytic treatments, yet a significant number of psychoanalysts continue to believe that research is either irrelevant to psychoanalysis or impossible to accomplish. Psychoanalysts who accept the value of research express concern that intrusions required by research protocols create significant distortions in the psychoanalytic process. The authors, all psychoanalysts, are studying the outcome of a brief (twenty-four-session) psychodynamic treatment of panic disorder. They report their experiences and struggles with the intrusions of videotaping, working with a treatment manual, and time-limited treatment. This research process required them to question old beliefs and to confront feelings of disloyalty toward their analytic training and identity, particularly with regard to keeping a "clean field" and routinely performing long-term analysis of character. The therapists' psychoanalytic knowledge, however, emerged as crucial for them in managing specific research constraints. Despite concerns about providing inadequate treatment, therapists were found to engage patients with psychoanalytic tools and focus in vibrant and productive therapies that led to significant improvements in panic symptoms and associated quality of life. The authors suggest that psychoanalysts have been overestimating the potential damage of research constraints on psychoanalytic process and outcome.     

You Can Get Here From There

This paper is a review of my development from psychology intern and research assistant to the psychoanalytic tester and theoretician David Rapaport at the Menninger Clinic in the 1940s, through my career in psychological testing, my psychoanalytic training in the Western New England Institute, and my working successively at the Austen Riggs Center, Yale Department of Psychiatry, Yale Student Mental Health Center, Cornell Department of Psychiatry, and eventually private practice in New York City. During this period, I rose to the academic rank of Professor and the analytic position of Training Analyst. I have written extensively: first on testing, then more or less in turn on psychoanalytic ego psychology, action language for psychoanalysis, feminist issues, narrative in psychoanalysis, and the contemporary Kleinians of London. This memoir traces the intellectual continuity that characterizes these writings and my continuing development as a psycho-analyst—my first ambition and great love.     

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.”     

Becoming (and Remaining) an Analyst in Latin America

The following overview of the development of psychoanalysis in Brazil and in Porto Alegre outlines the current situation and the challenges to psychoanalysis in my country. I will explain my own experiences on becoming an analyst, the main reasons for my choice, my main influences, and my evolution as a clinical psychoanalyst and as a member of psychoanalytic and psychiatric institutions. I include my main contributions to psychoanalysis and consider two broad areas of interest: psychoanalytic technique and its teaching, and the relationship of psychoanalysis and culture. As for the former, my main interests are studies on countertransference and analytic neutrality, to which I will propose a comprehensive concept. As for the latter, I discuss a culture that contrasts vividly with the one in which Freud created the discipline, psychoanalytic views on violence and perversity, psychoanalytic institutions, and the application of analytic ideas for the understanding of some artists and their work.

I will also describe some general features of my country and the development of psychoanalysis in it; report my experiences as a candidate and an analyst; and offer some information about my evolution as an analyst through papers I have written over the past 30 years.     

Foundations of psychoanalysis reconsidered

Grünbaum's approach to psychoanalysis suffers from several difficulties. It imposes a standard of logical reductionism and methodological purity that not only violates the nature of psychoanalytic knowledge, but imposes an invalid standard of verification and scientific confirmation. It utilizes a brand of dichotomous reasoning that forces psychoanalytic propositions into artificial positions that do not reflect the actuality of analytic practice. It imposes a standard of verification that is impossible for psychoanalysis, along with all forms of psychological knowledge, to reach. It visualizes psychoanalysis as encompassing only one form of knowledge of human psychic life, forcing it into a model that eliminates other aspects of the psychoanalytic process, so that psychoanalysis is subjected to criticism only on one dimension among several--a kind of psychoanalytic straw man. The psychoanalysis that is so impaled often is difficult for the psychoanalytic practitioner to recognize. To the extent that Grünbaum's skillful and highly informed criticism of the philosophical bases of psychoanalysis encounters these difficulties, the value of his argument falls short of providing a useful basis for advancing psychoanalytic knowledge and particularly for promoting the quest for pertinent standards of validation within psychoanalysis.     

Editorial

Abstract

This paper will examine the current crisis in psychoanalysis in terms of the profession's decline, the apparent lack of patients, the ongoing debate over what constitutes psychoanalysis versus other therapies, and the lack of clinical focus in those debates. The concept of analytic contact will be introduced, and clinical material is used to showcase this concept as a bridge from the circular political debates to a more meaningful examination of what is psychoanalytic. In addition, case material will explore how patients tend to fight off the establishment of analytic contact in favor of safer, less threatening modes of relating. The author suggests that most patients fight off analytic contact and try to shift the treatment into something less analytic. It is up to the analyst to detect this, interpret it, and notice any countertransference collusion that may occur. Although the state of psychoanalysis as a profession is less than stellar in the eyes of the public, and the profession is apt to sabotage itself with endless debates about what constitutes true analytic work, the end is not necessary near. This paper proposes analytic contact to be the more useful focus of research and productive area of clinical exploration. If the decline of our field is to turn around, it will be on the clinical battlefront, not in terms of the theorizing among disagreeing groups of territorial analysts afraid of losing their political high-ground. The concept of analytic contact assumes that a deep exploration of intrapsychic phenomena, conflicts, and defenses, all within the realm of the transference, is the best clinical method of helping the mentally troubled individual. This genuine chance of change is best administered by a trained psychoanalyst. This simple idea is something the profession has contaminated with its often pointless arguments over frequency, analyzability, couch, and so forth. The clinical material will show that what happens in the room between analyst and patient is what best defines the true psychoanalytic treatment.     

Understanding Hope. Persons in the Process of Dying

Changes both within the profession of psychoanalysis and in society as a whole have affected our psychoanalytic training programs and presented new ethical challenges. Whereas in earlier decades training programs needed to be concerned primarily about the inviolability of the training analysis and the choice of appropriate analytic candidates, today there is little support for psychoanalysis as a treatment modality. Institutes are experiencing greater competition in attracting quality candidates and in providing them with adequate training experiences. This strain encourages institutes to operate in unethical ways to attract candidates. On the other hand, within the profession itself we are experiencing much theoretical ferment and the increasing feminization of the profession. These changes are affecting our training institutes and our ethical values in both positive and negative ways.     

Psychoanalysis at the Millennium: A Personal Odyssey

A review of my development from psychology intern and research assistant to the psychoanalytic tester and theoretician David Rapaport at the Menninger Clinic in the 1940s, through my career psychological testing and my psychoanalytic training in the Western New England Institute and my working successively at the Austen Riggs Center, Yale Department of Psychiatry, Yale Student Mental Health Center, Cornell Department of Psychiatry, and eventually private practice in New York City. During this period, I rose to the academic rank of Professor and the analytic position of Training Analyst. I have written extensively: first on testing, then more or less in turn on psychoanalytic ego psychology, action language for psychoanalysis, feminist issues, narrative in psychoanalysis, and the contemporary Kleinians of London. This memoir traces the intellectual continuity that characterizes these writings and my continuing development as a psychoanalyst—my first ambition and great love.     

The invasion of reality (or of negotiation): The psychoanalytic ethic and extinction anxiety

Extinction anxiety is the expression used to describe a pervasive and ever more realistic sense of futurelessness. A group emotion characterized by terror of the extinction of the human race, the family, or professional or shared cultural group, it grips the individual with a sense of desperation and impotence through the internal groups present in the mind of every individual. The contribution presented here aims to demonstrate how extinction anxiety has also infected psychoanalysts and psychoanalytic institutions, thereby seriously weakening the ethics of psychoanalysis. The term ethics here should not be confused with morals, but is intended as the happiness that is derived from the capacity to be responsible for one's self and one's own professional identity. The contagion of extinction anxiety has, in fact, accentuated the crisis of psychoanalysts and their faith in psychoanalysis. The author relates a particularly tormented clinical experience in order to show how only the relationship with psychoanalysis and its capacity to interpret the manifestations of the unconscious, enables the recognition of the effects of what he defines as a true invasion of reality, thus restoring to thought the power to establish a deep, transformative, and fecund relationship between internal and external reality.     

Training analysis in the dutch society for psychoanalytic psychotherapy: A survey of attitudes and feasibility

SUMMARY

As is the case in many training courses in psychoanalytic psychotherapy, one of the training requirements of the Dutch Society for Psychoanalytical Psychotherapy (NVPP) is a training analysis, currently a minimum duration of 700 hours. During the last few years, this requirement has become somewhat controversial. Because the NVPP does not have information about the current interest in NVPP membership, the Board of the NVPP decided to do a survey. Of 995 psychiatrists, clinical psychologists and psychotherapists, who had recently completed their training, or were still in training, 623 filled in a questionnaire. Of those who are interested in the NVPP training, 39 per cent judged the training analysis as not feasible in terms of time, and 61 per cent in terms of money. Forms of personal treatment thought desirable for anyone who wishes to become a psychoanalytic psychotherapist at a specialist level are, in descending order, psychoanalytic psychotherapy (63%), psychoanalysis (39%), psychoanalytic group psychotherapy (25%), and psychoanalytic marital or family therapy (6%). Respondents who judge personal analysis as not feasible, also tend to judge psychoanalysis to be equivalent to other forms of psychoanalytic psychotherapy, whereas those who judge personal analysis as feasible, tend to think that personal analysis is essential for a psychoanalytic psychotherapist at the specialist level.     

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.