Supervision, transference and countertransference

The author discusses supervision, transference and countertransference as seen in the context of the clinical case of a patient who had been first seen as a training analysis case and who later, in a fortuitous way, was treated by the supervisor of the training analysis. The supervisor, who in the first instance did not recognize the patient, discusses the reasons for this unusual experience in terms of the presence and absence of transference during the analysis of this patient as a training case and the problems inherent in the task of supervising. The patient's feelings towards the first and the second analyst and the vicissitudes of transference and countertransference during the supervision of the training analysis and its influence on the presentation of the analytical sessions by the student are also detailed and discussed. The question of recorded supervision presentations and their possible influence on the dynamics of supervision is raised.     

Confidentiality, privacy, and the facilitating role of psychoanalytic organizations

Burgeoning external threats to confidentiality by claims to clinical information create unprecedented challenges for psychoanalysts. Internal threats arise from the use of clinical material for educational, scientific and historical purposes. Traditionally, confidentiality is considered a patient's right and an analyst's obligation; privacy is not usually stated as a professional requirement. Little consideration has been given to the impact of the confidentiality and privacy dilemmas that analysts encounter throughout their careers. There has been no systematic examination of the confidentiality policies of psychoanalytic organizations, nor has their role in facilitating maintenance of patient confidentiality and analysts' privacy been made explicit. The research reported here was undertaken to address these issues and to obtain baseline information about the current confidentiality policies and practices of psychoanalytic organizations in three English-speaking countries (Britain, Canada and the USA). The author discusses survey results in the light of the challenges which arise at each phase of the analytic career. She makes suggestions as to how psychoanalytic organizations can and should facilitate analysts' resolutions of contemporary confidentiality and privacy dilemmas.     

Jungian theory of dreaming and contemporary dream research – findings from the research project ‘Structural Dream Analysis’

The research method ‘Structural Dream Analysis’ (SDA) is described which allows for systematic and objective analysis of the meaning of dreams produced by patients in Jungian psychotherapies. The method focuses especially on the relationship between the dream ego and other figures in the dream and the extent of activity of the dream ego. Five major dream patterns were identified which accounted for the majority of the dreams. The clients’ dream series were dominated by one or two repetitive patterns which were closely connected to the psychological problems of the dreamers. Additionally, typical changes in the dream series’ patterns could be identified which corresponded with therapeutic change. These findings support Jung's theory of dreams as providing a holistic image of the dreamer’s psyche, including unconscious aspects. The implications for different psychoanalytic theories of dreaming and dream interpretation are discussed as well as implications for the continuity hypothesis.     

Psychoanalysis in the university: A full‐time vision1

Psychoanalysis may be unique among scholarly disciplines and professions in having grown as an educational enterprise in a private part‐time setting, outside the university. Freud would have liked it to be otherwise, but in Central Europe, when it was created, university placement was not possible. In America, after World War II, the concept of the medical school department of psychiatry psychoanalytic institute was established in some psychoanalytic training centers but it could only partly overcome the educational and research inadequacies of traditional psychoanalytic training. The possibilities for a true university‐based full‐time training structure are explored.     

Technique and final cause in psychoanalysis: Four ways of looking at one moment

This paper argues that if one considers just a single clinical moment there may be no principled way to choose among different approaches to psychoanalytic technique. One must in addition take into account what Aristotle called the final cause of psychoanalysis, which this paper argues is freedom. However, freedom is itself an open‐ended concept with many aspects that need to be explored and developed from a psychoanalytic perspective. This paper considers one analytic moment from the perspectives of the techniques of Paul Gray, Hans Loewald, the contemporary Kleinians and Jacques Lacan. It argues that, if we are to evaluate these techniques, we must take into account the different conceptions of freedom they are trying to facilitate.     

我国医疗机构产权制度改革的实践与思考

产权制度改革是医疗机构适应市场经济发展的必由之路.就改革过程中出现的一些如国有资产流失、交易费用过高、民营医院不公正待遇、如何妥善安排富余人员等问题进行了分析,并提出了相应的对策;纠正了一些有关医疗机构产权制度改革认识上的误区.     

Candidate progression in analytic institutes: A multi-center study

This study documents the criteria for graduation and for awarding credit for training cases used by thirteen institutes of the American Psychoanalytic Association (APsA). At the time of this study, these thirteen institutes were training 63% of all candidates enrolled at institutes of the APsA. Questionnaires were sent to the progression committee chairperson (PCC), a junior candidate and a senior candidate, and a recent graduate at each institute. Each participant also had a follow-up semi-structured telephone interview. Return rate was 100%. 92% per cent of the institutes reported that in order to receive credit for cases, the patient needed to be in treatment for some minimum amount of time (average 18.3 months). Many PCCs were skeptical about writing down the criteria for credit, stating that this made candidates overly focused on the time requirement. 85% per cent of PCCs felt that graduation from the institute was based primarily on obtaining credit for cases. Few required a terminated case and only one felt that classroom work was an important factor. 47% per cent of candidates felt that the need to keep patients in treatment to receive credit for cases affected their treatment of patients and only 46% of candidates could state the minimum time requirement used by their institute. These results indicate that graduation from institutes of the APsA depends primarily on receiving credit for cases, that case length is an important criterion for awarding credit and that this method of evaluating candidates may not be the best way to support educational objectives.     

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.     

FROM KNOWLEDGE TO COMPETENCE: REFLECTIONS ON THEORETICAL WORK

In this paper, the author maintains that the language of the clinical situation is and should be that of common-sense psychology. The author argues that the languages of clinical theory and metapsychology are at a distinctive distance from clinical language. In fact, no theory could be produced, should this distance not be upheld. The function of clinical theory is to act as a corrective to the tendency of common-sense psychology to fall back into the banalities and prejudices of general ideology. In addition, the function of metapsychology is said to be that of scrutinising clinical theory and defining its range of operation. Due to the claimed distance between the common-sensical language of the clinical situation and the language of theory, the analyst must utilise specific 'techniques' to appropriate the theoretical material and make it part of his competence and capacity for psychoanalytic action. This aspect of theoretical work is given the name 'assimilation' and, in turn, relies upon a process where theoretical concepts are 'deconstructed' as to their knowledge content.