From monologue to dialogue: a transition in psychoanalytic practice

During the latter part of the twentieth century, psychoanalysts of various stripes espoused the move from free association and neutrality to various forms of intersubjectivity and dialogue. This shift is studied from the vantage point of conversational rules in terms of the shift from monologue to dialogue, using the concepts of semantics, syntax, and pragmatics. Viewing the data of analysis in this manner offers a means of evaluating the contributions of both monologue and dialogue to our understanding of the conduct of an analysis and the kind of information that can be expected to emerge. Exclusive devotion to either stance, it is argued, renders less understanding than would emerge from a balanced use of both.     

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.     

On psychoanalytic writing

Analytic writing constitutes a literary genre of its own. It involves the linking of an analytic idea (developed in a scholarly manner) with an analytic experience created in the medium of language. What makes this literary genre so demanding is that experience-including analytic experience-does not come to us in words. This fact generates a paradox that lies at the core of analytic writing: analytic experience (which cannot be said or written) must be transformed into 'fi ction' (an imaginative rendering of experience in words) in order to convey to the reader something of what is true to the emotional experience that the analyst had with the patient. The author discusses a clinical passage from one of his recently published papers in an effort to demonstrate some of the conscious and unconscious thinking that goes into his writing. He then looks closely at the way the language works in a successful piece of theoretical analytic writing. The paper concludes with a discussion of a number of facets of the author's experience with analytic writing including the psychological 'state of writing', which is at once a meditation and a wrestling match with language; experimenting with the form (structure) of an analytic essay; and the question of originality in analytic writing.     

On psychoanalytic supervision

The author provides both a theoretical context for, and clinical illustrations of, the way in which he thinks and works as a psychoanalytic supervisor. The analytic supervisory experience is conceived of as a form of 'guided dreaming'. In the supervisory relationship, the supervisor helps the analyst to dream (to do conscious and unconscious psychological work with) aspects of the analytic relationship that the analyst is unable to dream or is only partially able to dream. It is the task of the supervisory pair to 'dream up' the patient, that is, to create a 'fi ction' that is true to the supervisee's emotional experience with the analysand. To carry out this work, the supervisor must provide a frame that ensures the supervisee's freedom to think and dream and be alive to what is occurring in the analytic and the supervisory relationship, as well as in the interplay between the two. In one of the clinical illustrations presented, the author illustrates his conception of the importance of the feeling on the part of supervisor and supervisee that (at least occasionally) they have 'time to waste'. Such a state of mind may provide an opportunity for a type of freely associative thinking that enhances the range and depth of what can be learned from the supervisory experience. In another clinical example, the author describes his own experience in supervision with Harold Searles, which contributed to his conception of the supervisory process.     

On psychoanalytic autobiography

This article considers how one might define ‘psychoanalytic autobiography’, using statements from theorists of ‘life-writing’ and extracts from autobiographers (some of them psychoanalysts), together with their own commentaries on the genre. The focus is less on content and more on the nature of the art form, with a view to noting analogies with the psychoanalytic process. These analogies are to be found, in particular, in the qualities of transference dialogue; in the art of transformative or communicative projective identification; and in the contrast between self-indulgent and constructive types of memory. Psychoanalytic autobiography is seen as a mode of remaking the self – not omnipotently but through exploratory self-analysis, frequently following the familiar pattern of loss and rediscovery. It entails a special imagined relationship with the unknown reader, and a sense of being guided by a detached observational eye equivalent to that which Bion terms the ‘third party’ in a psychoanalytic situation.     

The French model of psychoanalytic training: Ethical conflicts1

Research on psychoanalytical education within the IPA may be clarified by reflecting on the ethic behind each of the three main models (Eitingonian, French and Uruguayan). In fact, the ethic underpinning psychoanalytical education, whatever the model, is confronted by irreducible conflicts between transmitting psychoanalysis by means of analytical experience or by means of academic teaching. Transmission by experience is essentially based on the ethic of psychoanalytic practice, which is difficult to regulate through institutional standards, whereas the academic aspect can be evaluated by objective and public criteria. The importance of both aspects and their relative weight in the training process depend on the conception of psychoanalysis underlying each model. This paper will look primarily at the French training model, the essentially analytical aspects of which favour the transmission of the very ethical foundations of psychoanalytic practice itself: the application of the method both as a working tool and as a tool of evaluation. It presupposes expanding the observation and analysis of transference beyond the framework of treatment to that of supervision. From this analysis, the paper will attempt to demonstrate how the French model proposes dealing with the inevitable conflicts between transmission by means of analysis and training by means of apprenticeship.     

The Emperor's clothes: Some serious problems in psychoanalytic training

The author discusses some of the key problems in psychoanalytic training, in particular those problems that stem from the power differential between training analysts and students in training. One effect of this differential can be that some students feel a pressure to comply with their teachers and supervisors, even their training analyst, in ways that can be seriously detrimental to their development. Further, when something goes wrong in a student's training, how is this to be viewed by those in charge of the training? Also, how are complaints dealt with? Is suffi cient weight given to external reality? Too often training analysts, and training committees, get into pathologising a student in a process that should be recognised as ‘wild analysis in committee’, rather than considering more carefully the external realities that may be affecting a student's progress in the training. This ‘analysis’ in committee should never be allowed. There is an urgency for immediate changes to be made in psychoanalytic training so that the problems discussed, with more care being taken, should be prevented from happening. Too often, however, an institutional resistance to change dominates discussions in committee, and in society meetings, with the result that little or no change takes place even after years of debate.     

Between paranoia and creativity: candidates' experience of psychoanalytic training

There is widespread concern regarding various aspects of psychoanalytic education. A recent paper by Patrick Casement, drawn widely from his long experience as a supervisor both in the U.K. and abroad, implied that the British Psychoanalytical Society is not exempt from these concerns. To investigate this, a semistructured, anonymous questionnaire was devised and sent to all candidates and all recently qualified analysts at the society. Overall there was a 58% response rate, with 77% of candidates and 39% of recently qualified analysts responding. Concerns were expressed about aspects of the training, but on the whole these were balanced by appreciation. Although strong criticism was expressed by a minority, it seems that when something goes wrong for a candidate, this experience is felt keenly by the peer group as well. The results are discussed in the context of the current training and ethos of the British Society, as well as in relation to a more widespread move toward "competency-based" education. The maturational tasks facing both candidates and trainers are also addressed.     

The impact of graduation from psychoanalytic training

To examine candidates' experience of graduation from psychoanalytic training, 1997-2001 graduates of the Columbia University Center for Psychoanalytic Training and Research were sent a confidential questionnaire about their first year after analytic training. Of this group, 72 percent (23/32) returned the survey. Questions focused on the impact of graduation on time availability, net income, professional advancement, and sense of personal and professional autonomy. Graduates from analytic training were found to have more income in their first postgraduate year, a mean increase of 30,000 dollars, and more available time, a mean increase of sixteen hours. Increased earnings came primarily from seeing more patients during the time made available with the end of classes. In addition, graduates did not terminate their control cases or stop supervision. Graduates most valued their sense of professional accomplishment and ability to spend more time with their families. Although graduates also experienced relief from evaluation pressure, they did not rank this high in importance. For candidates, graduation profoundly impacts the structure of professional and personal life, but does not mean an end to learning.     

Functional communication training: From efficacy to effectiveness

Functional communication training (FCT; Carr & Durand, 1985) is a common function‐based treatment in which an alternative form of communication is taught to reduce problem behavior. FCT has been shown to result in substantial reductions of a variety of topographically and functionally different types of problem behavior in children and adults (efficacy). The extent to which these reductions maintain in relevant contexts and result in meaningful changes in the lives of those impacted (effectiveness) is the focus of this paper. This review evaluates the degree to which FCT has been established as an evidence‐based practice in psychology (EBPP) according to the definition set out by the American Psychological Association's 2005 Presidential Task Force on Evidence‐Based Practice. Our review finds overwhelming evidence in support of FCT as an efficacious treatment but highlights significant limitations in support of its effectiveness. In order to also be recognized as an EBPP, future research on FCT will need to focus more closely on issues related to home, school, and community application, feasibility, consumer satisfaction, and more general and global changes for the individual.     

From dyad to dialogue: language and the early relationship in American psychoanalytic theory

The centrality of language for a Freudian theory of mind and treatment has not been retained by most post-Freudian theorists. American writers have turned to academic developmental research on mother-child interactions to depict the preoedipal period as preverbal, presymbolic, nonconscious. This view presents the early relationship as developing in linear stages in which visual observational data (e.g., contingent behavior action patterns between two persons) are privileged over aural-oral data of communicational exchanges. An alternative view is presented that redefines the earliest relationship in terms of communicational exchanges, mediation, and dialogue. The claim is that understanding the nature of mediated communication keeps language central to psychoanalysis and reestablishes an intrapsychic dimension in the concept of relationship that is lost when relationship is reduced to behavioral patterns.