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.     

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.     

Day,Night, or Dawn: Commentary on Paper by Steven Stern

It was in the years immediately following World War II and through the 1950s that the psychoanalytic establishment officially defined psychoanalysis as a subspecialty of psychiatry, and it was in that context of the professionalization of American medicine that they codified the distinction between psychoanalysis and (psychoanalytic) psychotherapy. In this commentary on Steven Stern's “Session Frequency and the Definition of Psychoanalysis,” I deconstruct a series of binaries that was built into the analysis/therapy distinction and that has plagued our discipline. It is argued that psychoanalysis identified itself with the culturally “masculine” and heterosexual values of autonomous individuality (the intrapsychic), while it split off all that was relational and social (interpersonal), marked as “feminine,” homosexual, and “primitive,” onto psychotherapy, which it then devalued. The paper then examines the implications for practice and psychoanalytic education.     

A mixed-model for psychoanalytic education*

Abstract

If psychoanalysis is to avoid total marginalization, something has to be changed in the way future generations are prepared for working with patients and doing research. Reformation of psychoanalytic education may easily be the crucial issue when it comes to the survival of psychoanalysis. Its current organizational scheme has been criticized for various reasons, and various models of its structure have been proposed. I advocate a model that would combine the best features of the university education (training in clinical skills together with philosophy of science and research methodology) with personal analysis as part of psychoanalytic institutes. Although universities can remedy some of the problems of psychoanalytic institutions, they cannot contain the subjective experience of being analyzed.     

Historiography and psychoanalysis

Abstract

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

The Power of the Spoken Word in Life,Psychiatry, and Psychoanalysis—A Contribution to Interpersonal Psychoanalysis

Starting with a 1890 essay by Freud, the author goes in search of an interpersonal psychology native to Freud's psychoanalytic method and to in psychoanalysis and the interpersonal method in psychiatry. This derives from the basic interpersonal nature of the human situation in the lives of individuals and social groups. Psychiatry, the healing of the soul, and psychotherapy, therapy of the soul, are examined from the perspective of the communication model, based on the essential interpersonal function of language and the spoken word: persons addressing speeches to themselves and to others in relations, between family members, others in society, and the professionals who serve them. The communicational model is also applied in examining psychiatric disorders and psychiatric diagnoses, as well as psychodynamic formulas, which leads to a reformulation of the psychoanalytic therapy as a process. A plea is entered to define psychoanalysis as an interpersonal discipline, in analogy to Sullivan's interpersonal psychiatry.     

Can psychiatry residents be attracted to analytic training? A survey of five residency programs

In the face of fewer psychiatrist applicants for psychoanalytic training, determining the interest of current psychiatric residents in psychoanalysis and psychodynamic psychiatry is a pressing concern. To gauge this interest, an anonymous online survey was sent to residents from five psychiatry residency programs in the Midwest and South. Seventy-five residents responded, for a return rate of 42%. The data suggest that residents value psychoanalytic concepts and most plan to incorporate the practice of psychodynamic psychotherapy into their careers after graduation; however, residents have little confidence in their level of skill and the adequacy of their training. While 46% express interest in further psychodynamic psychotherapy training, only 22% express interest in psychoanalytic training. Most cite the cost and time involved as reasons they would not pursue further training. This study demonstrates that psychiatric residents have strong interest in and respect for psychodynamic psychotherapy and psychoanalysis. The data suggest that psychiatric residents are a viable pool of applicants for psychoanalytic training, especially if barriers to training can be reduced and creative ways for psychoanalysts to engage residents can be fostered.     

精神分析在日本的传播与发展

综述了精神分析在日本的传入与发展。包括:(1)精神传入日本的历史轨迹,如心理学、精神医学、文化学视角的传播;(2)精神分析在日本的发展,如精神分析疗法的推广,精神分析理论的运用;(3)日本对精神分析的评价。     

One Pilgrim's Progress Toward the Psychoanalytic Citadel

My psychoanalytic odyssey started in my childhood. My parents were avid readers of Freud and discussed his views with their friends. Our family doctor had been analyzed by Freud and spoke to my family about it on many occasions. I renewed my interest in psychoanalysis in college while studying English literature and then even more so in medical school, where we had a very inspiring department of psychiatry. My psychoanalytic training was to cross many frontiers: orthodox Freud, classical Freud, Fairbairn, Winnicott, and then Klein and Bion. I entered the field of psychoanalysis at a time when it was highly respected and virtually dominated the field of psychiatry, especially in medical schools. I have sadly watched its decline from popular favor and was even sadder to encounter its bitter divisiveness, especially in this country. Today psychoanalysis is left divisive and more variegated. Many different schools of thought have emerged that are now accorded legitimacy, fortunately. One might say that I have seen it at its best and at its worst but have not lost faith in its capacity to excite one's imagination and to inspire hope for a more evolved consciousness of self.     

Toward a postmodern realism for psychoanalysis.

The current status of psychoanalysis is explored in the light of the postmodern critique of forms of knowledge. Analysts have tended to respond by redefining psychoanalysis in the language of the exact sciences or by finding a language that includes both (Kuhn, Rorty), thereby falling either into a reductive "scientism" or the fallacies of the "strong program" in postmodern thought. However, psychoanalytic theories do not meet the probative requirements of science. Neither is the serious problem of competing theories and interpretations adequately addressed by hermeneutics. Philosophical realism (Putnam 1981, 1988) offers some helpful ways to look at this problem. Following Lacan, we define psychoanalysis as a clinical discipline which has as its unique object of study the human subject, an indeterminate and language dependent entity. Concepts and rules specific to our field make an internal realism of psychoanalytic inquiry possible. An extended case vignette accompanies this philosophical discussion.     

Psychoanalysis in Postmodern Times: Some Questions and Challenges

As a consequence of the invitation to contribute this piece of writing, I acknowledge having a postmodern attitude, rather than subscribing to postmodernism as an ideology. The purpose behind this article is to reflect on the impact of postmodern times on psychoanalysis from the starting point of my own conception of psychoanalytic theory and practice. This article looks, in some detail, into the problem of truth in psychoanalysis, the issue of theory building in psychoanalysis in its relation to psychoanalytic practice, and the challenges for psychoanalysis as a pluralistic discipline. It repeatedly states that psychoanalysis evidences extreme theoretical and practical diversity, but no pluralism understood as an attitude and methodology of dialogue between theoretical orientations and practical approaches. The current challenge in psychoanalysis is, precisely, to go beyond postmodernism and to build a true pluralism on the basis on interdisciplinary exchange and collaboration.     

Regulation and standards for psychoanalysis: The place of the Other in psychoanalysis and its teaching

In numerous Western countries, psychotherapies have come under increasing governmental regulation. A more recent development is the increasing scrutiny given to psychoanalysis in the United Kingdom, in France, and in the United States. This paper examines a particular document that was created by four professional psychoanalytic organizations that are based in the United States. The document called Standards of Psychoanalytic Education aims to develop criteria that would guide accreditation and the organization of psychoanalytic institutes. The document is part of a set of concerns and actions related to the state regulation of psychoanalytic practice, its professional status, and the protection of those who seek its services. The essay examines the putative theoretical neutrality of this document by unfolding its tenets in terms of Lacanian psychoanalysis, a school of psychoanalysis that would take exception to many of the ideas suggested in the document's template for psychoanalytic education. The paper follows one line of argumentation throughout: what is the place of the Social Field, the Symbolic Other, within psychoanalytic process and as a recourse for professional legitimization that stands outside of psychoanalysis? As a practice of particularity, what relation does the discipline bear to other mental health fields and to the norms and knowledge systems of the mental health professions? Using a Lacanian orientation, two senses of the Other are discussed, and the specificity of psychoanalysis is asserted. This specificity is contrasted with some of the goals and constraints that are introduced by current approaches to regulation.      

Revision from the Margins: Fromm's Contributions to Psychoanalysis

Fromm's important contributions to the modern development of psychoanalytic thought are often ignored and frequently misunderstood. An early proponent of revisions of psychoanalytic theory and therapy similar to recent trends in object relations, self-psychology and interpersonal psychoanalysis, Fromm was a visionary for a Freudian theory built upon orthodoxies of the past but going beyond them. It is argued here that Fromm's unique role in helping create a new version of psychoanalysis for the 21st century was as sociological as it was intellectual. Fromm's contributions were intimately linked to his institutional positioning close to the center but on the relative margins of the discipline. This paper will outline how sociological dynamics shaped Fromm's revision of psychoanalysis. We will conclude by discussing how Fromm was able to have a more dramatic influence than other Freudian revisionists who were less favourably positioned.     

The neglected object: A history of the concept of dreams in Polish psychiatry and psychology in the interwar period, 1918–1939

The development of the concept of dreams in interwar Polish psychiatry and psychology was influenced by Western European concepts as well as by sociocultural factors of the newly independent state. Few Polish psychiatrists addressed the subject of dreams. They were influenced mainly by Sigmund Freud's psychoanalytic concept of dreams, but also by Alferd Adler's, Carl Gustav Jung's, and Wilhelm Stekel's ideas. Nevertheless, they approached psychoanalysis critically. The most comprehensive concept of dreams in Polish psychiatry was oneiroanalysis by Tadeusz Bilikiewicz. Oneironalysis was a method of dream analysis based on psychoanalysis but it rejected the psychoanalytic method of free associations and challenged psychoanalytic approaches to the interpretation of dream symbols. Polish psychologists were even less interested in dreams than psychiatrists. Problems with dreams, the most elaborate psychological work by Stefan Szuman consisted of an outline of epistemological problems with general theories of dreams and a harsh critique of psychoanalysis. The neglect of the subject of dreams in Polish psychiatric society can be seen as connected with the social and professional reception of psychoanalysis in Poland. Psychoanalysis was met with opposition from conservative scholars and publicists presenting nationalistic and anti-Semitic attitudes. It was also criticized by the biologically oriented majority of psychiatrists of the Polish Psychiatric Association. In the case of psychology, the most influential Polish psychological school, Lvov-Warsaw School, promoted Brentanian intentionalism, introspection, and psychology of consciousness, therefore, leading to psychologists' reluctance to explore unconscious states like dreams.     

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.     

Genetics,Developmental Psychopathology,and Psychoanalytic Theory: The Case for Ending Our (Not So) Splendid Isolation

This paper considers the historical isolation of psychoanalysis from other scientific academic disciplines. The example of behavior genetics is used to illustrate the potential mutual benefit of cross-fertilization. Exploring links between the two disciplines makes it possible to debate antipsycho-analytic constructions in behavior genetics with greater vigor. At the same time, psychoanalysis, which studies subjectivity, is relevant to a discipline that naively explores the objective environment without considering the crucial mediation through the subjective world. Microbiology and genetics offer models of the mechanisms by which meaning generation and interpretive capacity might interface with the unfolding of genetic expression. Simultaneously, emerging psychoanalytic developmental models have provided an ontogenetic psychological framework that links development of this capacity to the infant-mother relationship. The paper concludes by stressing the need for a cadre of specialist psychoanalytic professionals dedicated to research as the precondition of any meaningful dialogue between psychoanalysis and any other discipline.     

Psychoanalytic lexicography: notes from two "harmless drudges"

The co-Editors in Chief of the American Psychoanalytic Association's new edition of Psychoanalytic Terms and Concepts (previously edited by Moore and Fine and last revised in 1990) recount their lexicographical adventures. Editing a dictionary at the turn of the twenty-first century is a daunting, some might say foolhardy, undertaking. The most obvious challenge faced by the editors was the growing pluralism within psychoanalysis. However, a more fundamental challenge was that the object of psychoanalytic study, the mind and its processes, can be known only by putting words to our observations, inferences, and interpretations. Psychoanalytic thinkers, starting with Freud, have wrestled with this challenge in ways that define the history of psychoanalysis itself. Long gone are the days when Freud could commend the "correctness" of Sterba's lexicographical efforts. Today postmodern critics, at the opposite extreme, argue that terms and concepts are best understood as "verbal gestures" in the "language-game" of psychoanalysis. Some go so far as to assert that dictionary-writing is obsolete. The co-Editors in Chief of Psychoanalytic Terms and Concepts have not succumbed to such nihilistic views, but have instead struggled to establish a reasonable stance within contemporary debates over the nature of psychoanalytic language.     

The story of an ambivalent relationship: Sigmund Freud and Eugen Bleuler

This paper examines the short-lived flirtation between psychoanalysis and academia and psychiatry in Europe and the reasons for, and consequences of, the fact that their paths diverged. It is argued that Bleuler's break with the psychoanalytic movement is a crucial and, until now, largely underestimated turning point. Bleuler's separation from the psychoanalytic movement was probably more important for the course it has since taken than those of Adler, Stekel, or even Jung. Bleuler's analysis by correspondence by Freud, and its failure, was of paramount importance for the future relationship between Freud and Bleuler, and for Bleuler's assessment of psychoanalysis.     

Down to cases: the ethical value of "non-scientificity" in dyadic psychoanalysis

The efficacy of the dyadic psychoanalytic method cannot be verified empirically, due to the impossibility of counterfactuals, controls, or double-blind experiments, although inventive psychoanalytic researchers have established validation methodologies for analyzing groups of case studies, outcomes, and even theoretical precepts. The unavailability of complete empirical validation for the most basic method of the discipline of psychoanalysis, or of its fundamental "report of findings"--the case study--means that the field's scientific rationale must be supplemented with public reasoning of another sort. Fortunately, the very conditions of uncertainty that make it impossible to falsify the findings of dyadic psychoanalysis lend it its ethical force by compelling its participants to confront the basic human dilemmas of freedom, meaning, and judgment, the ethical horizon of human affairs. One substantial value of psychoanalysis, then, is its capacity for generating "ethical knowledge" of the sort adumbrated by Aristotle's conception of practical knowledge (phronesis). Case studies written for a lay audience to highlight these basic dilemmas can demonstrate that psychoanalysis produces crucial knowledge, specific to individuals, for living a healthy and satisfying life.