On the need of fundaments in psychoanalytic thinking

The questions concerning the foundations of psychoanalytic knowledge have been pressing from the beginning. Beside as a therapeutic practice, Freud conceived psychoanalysis as a science, maintaining that like other sciences psychoanalysis should have sound empirical and conceptual fundaments. Freud claimed that there is an inseparable bond (ein Junktim) between cure and acquiring knowledge in psychoanalysis. One of his aims in developing a metapsychology (analogously to metaphysics) was to explicate the conceptual structure of psychoanalytic knowledge. After Freud psychoanalysts have not reached a consensus in the questions concerning the foundations. What kind of foundations does psychoanalytic knowledge need? Are they to be found from the psychoanalytic practice and research on the couch, or rather from metapsychological constructions? In what way should psychoanalysis rely on external scientific research? The article addresses these questions, arguing that even though psychoanalytic work and knowledge do gain justification from various external sources, in the end psychoanalysis stands on its own foundations. It is further argued that especially under the prevailing plurality of theoretical and clinical approaches, psychoanalysis does not have – and does not need – a foundation that could not be further questioned. Thus a coherentist picture of psychoanalysis is defended.     

Psychoanalytic treatments and empirical research on their efficacy: A commentary

Abstract

The author summarizes the problems inherent in nomological approaches examining the efficacy of psychoanalysis as a form of treatment. He argues that nomologically oriented research operates with assumptions lacking empirical foundation and, moreover, that studies of this type merely give the impression of the effectiveness of psychoanalytic therapies while overlooking the specificity of the psychoanalytic method. He suggests that research into psychoanalytic treatments should not be subjected to a nomological conception of science, and that structural analysis of treatment courses should be examined and systematized within the frame of psychoanalytic treatment theory relative to their outcome. Given this approach, and provided that the theory of treatment is based on conceptual common ground, such studies would enable a prognostic conclusion that psychoanalytic treatments are successful, providing that the sequences generalized in the treatment theory do actually take place in treatments that take patients’ individuality into account.     

Editorial

This paper discusses contraindications to psychoanalysis and psychoanalytic training. From Freud onwards, there has been a clear understanding that not all patients are helped by psychoanalysis, but there has been considerable controversy as to who might benefit from treatment, and whether this depends on the diagnosis, the personality or the rather vague concept of “analysability". Increasing emphasis has been placed on the analyst-patient relationship and its characteristics, without this clearly solving the dilemma. Moreover, while psychoanalysis was previously perceived rather uniformly in its classical version, treating mainly neurotics, increasing differentiation between psychoanalytic schools has appeared in the last fifty years, which would seem to give grounds for a widening of indications. This development has increased the need for rational criteria for indications and contraindications. In this article, research findings relating to outcome and process and the therapeutic relationship will be examined in parallel with clinical experience. As the therapeutic relationship is probably decisive for the outcome of the treatment, scrutiny of who is suited to be a psychoanalyst should have been an important focus of research. This has not been the case. Available research on this issue and the experiences of practitioners in the evaluation of candidates will be discussed in the following.     

Like a phoenix from the ashes – or “sack cloth and ashes”?:1 The reconstitution of psychoanalytic institutions in Germany since 1945 and its consequences

Abstract

Here, I attempt to formulate some thoughts about the past, present, and future of psychoanalysis and its institutions in Germany. To do this, I have employed my varied experience as a supervisor and consultant to many such psychoanalytic institutes over the past several years. Themes discussed include the history of psychoanalysis in postwar Germany, the organizational structure of German psychoanalytic institutes, and their cultures in regard to group and organizational dynamics, and political and economic aspects. Finally, I add brief thoughts about the future, taking into account recent developments relating to planned changes in laws governing psychotherapy in Germany. Further, I attempt to analyze and comment on: coming to terms with the past; how to begin after the “Zero Hour”; the form of organization of psychoanalytic institutes in Germany; missing patients and missing candidates; constructive debate and hurting people’s feelings; the lack of “detoxification” and “recycling” of the poisonous remains of psychoanalytic processes; and the future of psychoanalytic institutions in Germany. I end with an example of a typical primary task used in conducting large groups in the institutes in which I worked, and include an anonymized table listing individual interventions, their duration, and frequency. These should provide an idea of my way of working, and an overview of the dimensions of the task.     

Social Work,Psychoanalysis, and Smoke-Filled Rooms

Abstract

This paper describes one social worker's journey from the first days of his social work education to his current experience as a psychoanalyst, and the subsequent transformation of his professional self. The complementary nature of the relationship between social work and psychoanalysis is considered. Through a personal vignette, the author hopes to remind current social work educators about the usefulness of psychoanalytic theory and practice within the context of casework values and principles.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

THE DIDACTICS OF PSYCHOANALYTIC EDUCATION2

The author first discusses general didactic considerations regarding psychoanalytic education and the teacher‐pupil relationship. He then demonstrates that psychoanalytic education is greatly influenced by the ideal of a liberal education, of which in Germany there is a strong tradition under the name ‘Bildung’. The main characteristics of ‘Bildung’ ‐ as opposed to professional training ‐ are that the objectives remain undefined and there is no attempt to achieve defined and operationalisable professional qualifications. The relationship between teacher and pupil is characterised by authority and trust. A psychoanalytic education by means of a ‘liberal education’ is based upon the assumption that the student should be motivated and supported in achieving competence through a passionate study of the world of psychic reality. Today, however, psychoanalytic education must be seen within a contemporary context that forces us to abandon the ideals of a liberal education, to operationalise the subjects studied and to control the education itself with regard to efficiency and results. These modern demands are the result of a professionalisation which has reached all social professions and from which psychoanalysis also cannot escape. Because of this, it is especially important to reflect on our educational methods and objectives. The author makes several suggestions on this subject. It is to be hoped that psychoanalysis will find its own way, without, on the one hand, losing sight of the special nature of psychoanalytic competence through an over‐hasty adaptation to the process of professionalisation and, on the other hand, without reverting to unquestioned and outdated ideas on education.     

Treatment manuals and the advancement of psychoanalytic knowledge: The Treatment Manual of the Tavistock Adult Depression Study

This paper has two aims: first, it seeks to understand the absence of treatment manuals in psychoanalysis. Secondly, it summarizes the treatment manual of the Tavistock Adult Depression Study, which describes the form of psychoanalytic psychotherapy whose effectiveness has been evaluated both in the Tavistock Adult Depression Study (TADS); and in the German Die Langzeittherapie bei chronischen Depressionen (LAC) Studie. Throughout the history of psychoanalysis, opinions about treatment manuals, empirical research and their antecedents have been deeply divided. After tracing the often polarized unfolding of these matters, the paper proposes that emotional and cognitive difficulties as well as scientific ones underpin their persistence. It is suggested that greater familiarity with them may lead to better combinations of outcome research and psychoanalysis: for example, the Tavistock manual seeks to match one account of the objects, aims, values, spirit and methods of psychoanalysis (as well as of connected forms of psychoanalytic psychotherapy); and also to meet what is required of treatment manuals by random allocation controlled trials. It has been a crucial element in the above studies of the outcome of long‐term psychoanalytic psychotherapies with chronically depressed patients. After describing the Tavistock Manual, the paper concludes suggesting that, if appropriately constructed, treatment manuals can make a contribution to the advancement of specifically psychoanalytic knowledge.     

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.     

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.      

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.     

Forum der Psychoanalyse: A journal documenting the “normalization” of the psychoanalytic field in Germany

Abstract

Forum der Psychoanalyse, which holds a firm place in the German-speaking world today, was founded in 1984 in a rugged landscape of psychoanalysis in Germany that was the consequence of the malignant group processes that had occurred between psychoanalytic societies after World War II. The Forum's foundation was guided by the idea of creating a constructive climate between the rivalrous groups and moderating the gap between them, given the increasing recognition of the shared history of psychoanalysis in Germany that had started to take root in the 1980s. Emphasizing the common ground in psychoanalytic theory and practice, the Forum is open to all psychoanalysts, to discussions of the various psychoanalytic trends, and to contemporary interdisciplinary dialogue. It promotes exchanges between psychoanalytic societies, and is also meant as a bridge to the development of psychoanalysis abroad.     

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).     

Mental health – a normal state?

ABSTRACT

How can we conceptualize mental health; what is the relation between mental health and normality; and what has psychoanalysis to say about these questions? After a short resume of the views concerning normality and melancholia in the last centuries, the author turns to Freud and Bion. For Freud, mental health at best seems to be a relatively mild neurotic state, and perfect mental health is an unattainable ideal. Bion underlines the dynamic nature of the concept; mental health comprehended as a process. Problems connected to the individual’s subjective view of his or her mental health are considered, and some consequences that the questions under discussion have for psychoanalytic treatment are discussed. The author concludes with a reflection on the complex relation between mental health and normality.     

Translating child analysis from the playroom to the classroom: opportunities and choices

Over the years, psychoanalysts and educators have made efforts to meld a psychoanalytic orientation with the education of young children. The resulting programs have variously been called psychoanalytic nurseries, therapeutic nurseries, therapeutic preschools, or psychoanalytic early childhood programs. The methodology of the application or integration of psychoanalysis with the education of young children has received relatively little attention. After a brief historical review of the application of psychoanalysis to helping children in group educational settings, a number of features common to programs integrating psychoanalysis and early childhood education are described. A specimen program is next presented in which an application of psychoanalysis is used to assist children whose development is proceeding in a psychopathological direction. Also demonstrated are various ways in which psychoanalysis may be adapted to such programs, some options involved, and the capacity, realized and potential, for work within a therapeutic nursery to expand the field of inquiry and the therapeutic action of child analysis as conducted within a traditional framework.     

In the Name of Psychoanalysis: Persistent Controversies and Evolution in Psychoanalysis: A Review of Impossible Training: A Relational View of Psychoanalytic Education by Emanuel Berman

In his book Impossible Training, Emanuel Berman stresses the historical roots of current standards of psychoanalytic training and demonstrates the persistence of controversies that have been present in psychoanalysis and psychoanalytic training from their inception. This perspective, of psychoanalysis and psychoanalytic education as evolving, encourages candidates and practitioners to be participants and creative voices in an evolving field rather than rote followers learning a trade. The author proposes ways that the transference of educators to the younger generation of psychoanalysts can facilitate or interfere with the training of candidates. Berman is applauded for shedding light on current controversies in psychoanalytic education by showing their roots in historical controversies. However, the author points out Berman's tendency to overvalue his side of the controversy rather than embrace controversy itself as in the best interest of the evolution and development of the field.     

The effectiveness of psychoanalysis in a case study using multi‐perspective methodology: Conflict in choosing a partner due to transgenerational mandate

A case study is presented to evaluate the effectiveness of psychoanalysis and the persistence of its benefits 20 years later in a young woman with severe depression, professional inhibition, and difficulties in partner selection due to transgenerational mandate (TGM). The investigation was carried out with psychoanalytic interviews with the patient and analyst, which were evaluated by both psychoanalytic and non‐psychoanalytic judges following a methodology based on one tested in Germany by Leuzinger‐Bohleber et al. (2003). The psychoanalytic treatment began in the early 1980s in Monterrey, Mexico. The study concludes that the psychoanalysis was effective in assisting with the patient's character disorder and partner selection, mainly because of the therapeutic alliance, the analysis of transference and character, and the patient's increased capacity for mentalization as a result of the interpretation of the TGMs.     

Grasping psychoanalysts’ practice in its own merits1

The central objective of this presentation is to reflect on the obstacles involved in the task proposed by the Chicago Congress, which is to explore convergences and divergences in psychoanalytic practice. The author discusses two major obstacles. First, the epistemological and methodological problems in relation to the construction of theory in psychoanalysis and especially the inaccessibility, in any reliable way, of what psychoanalysts really do in the intimacy of their practice. He proposes to separate, at least in part, theory from practice in psychoanalysis, in an attempt to grasp psychoanalysts' practice in its own merits. He then outlines a phenomenology of the practice of psychoanalysis, which reveals that, in their work with patients, analysts are guided more by practical reasons than theoretical reasons; that is, their interventions are predictions rather than explanations. Since these practical reasons need to be validated constantly in the analytic relationship based on their effects, he discusses the subject of validation in the clinical context of the core theory of therapeutic change in psychoanalysis, that is, the conditions required for clinical practice to satisfy the thesis of an inseparable union between gaining knowledge and cure. He ends by challenging the core of the psychoanalytic theory of change, arguing that it neither does justice to the practice of psychoanalysts nor to contemporary knowledge of processes and mechanisms of therapeutic change. Finally, he proposes that we detach practice from theory, in order to study the former in its own merits, utilising a plurality of methods ranging from systematic investigation to the recent methodology of the Working Party.     

Psychoanalysis and University in Brazil: Possibilities and Limits of This Articulation

The goal of this article is to clarify some of the aspects concerning the academic teaching and research that is carried out in the field of psychoanalysis in the Brazilian Universities, versus the transmission and training in psychoanalytic institutions. The author describes how psychoanalysis is present in the Brazilian university context, from undergraduate to graduate studies, and also points out perspectives regarding the future of psychoanalysis in Brazil.     

Comments on the Ikonen and Rechardt papers on the death drive and the origin of shame

In this paper, psychoanalysis is viewed as a method in opposition to the reigning spirit of our age with its demands for fast and measurable results. The concept ?the psychoanalytic room” is introduced in order to grasp the uniqueness of psychoanalysis and how it distinguishes itself from what is ordinarily held to be included under the category of work. The psychoanalytic room is explored in both a concrete and metaphoric sense and is discussed in relation to the concept of time, reality, Ogden's concept of the analytic third, and, inspired by Winnicott, children's play. The playroom of the child and its similarity with the analytic room is illustrated by the book ?Benny's Bathtub” by the Danish author Flemming Kvist Møller.