[R]Evolutionary Reflections on the Eitingon Model

 

Psychoanalytic training and the Eitingon model are at the center of current controversies. The Eitingon model is now almost 100 years old. Over the years it has become increasingly controversial primarily because of two components: frequency and the TA system.

Current debates about these issues needs to be understood in a historical context.

One hundred years ago, psychoanalysis was struggling to be recognized as a legitimate discipline. This goal required a relatively rigid set of rules and clear boundaries. Defining clearly who was and wasn’t a well-trained, legitimate psychoanalyst was essential to the developing profession’s survival.

Today we are facing very different challenges. There are lively disagreements about what constitutes psychoanalytic treatment and how and for whom it works. As an established profession, we now have the luxury of being able to look at our basic assumptions. And perhaps an obligation to do so.

Max Eitingon (center in the photo above) was a man who worked behind the scenes. He kept a tight watch on the functioning of the Berlin Institute as its co-founder and first President. Although he did not publish any scientific or research papers, he is a central figure in the history of psychoanalysis.

Eitingon focused on organizational matters, convinced that psychoanalysis required an organized structure and standards to achieve legitimacy. He developed standardized training procedures to replace the informal training methods that had been prevalent up until his time.

Eitingon’s influence extended from 1919 to 1932. In this period, thanks largely to Eitingon, psychoanalysis assumed its identity as a profession. The IPA and its branch societies made the training of therapeutic specialists their main task.

This maturing process took place in two phases. The first involved the founding of training institutes. Eitingon’s “Poliklinik” and Berlin Institute, established in 1920, served as the model for other institutes.  

In late 1924, Eitingon outlined an educational plan entitled “Guidelines for the conduct of teaching and training,” initiating the second phase of the profession’s consolidation. The International Training Commission of the IPA was created in 1925 to establish an international standard of training. This came to be known as the Eitingon (or tripartite) model and was made up of three elements: training analysis, theoretical instruction and treatment under supervision.  Training candidates using this model within the structure of an institute became the standard of analytic training.

Opinions and Applications of the Eitingon Model in Today’s IPA

Having co-chaired APsaA’s Eitingon task force (part of the 6-point plan effort) and now being a member of the IPA’s Eitingon Task Force, I have gained an overview of the different views of the Eitingon model and how it is currently applied in psychoanalytic societies in all three regions of the IPA. There is a wide variation in the interpretation of the model.

The Issue of Frequency

The issue of frequency has recently led to heated discussions within the IPA culminating in the Board vote in July 2017 approving a frequency standard of 3-5 times a week. Many societies in the U.S. and Europe still see 4-5 a week frequency as an essential part of the Eitingon training model. In other parts of the world, particularly Argentina, the “internal setting” of the analyst is felt to determine what is or isn’t “psychoanalysis” whether the patient is seen 4-5 times a week, once a week or once a month. A sizable psychoanalytic contingent in Latin America that shares this view.

In parts of Europe, there is a fear that the officially sanctioned 3x a week frequency will fatally blur the distinction between psychoanalysis and psychotherapy.  The quandary of the Europeans was best expressed by one of their society presidents: “If we keep the standards as they are, psychoanalysis will marginalize even further, but if we change the standards, psychoanalysis will dilute; the borders with psychotherapy will disappear.”

The Training Analyst System

Critiques of the TA system are not new.  Early on, Michael Balint criticized the system. And Greenacre stated in 1966: “In many ways training impedes and interferes with the full development of the therapeutic aspects of a personal analysis…personal analysis during training [may be] so complicated or even deformed as to make it therapeutically almost valueless.”

Over the last 25 years, each region and the IPA itself (Training Analyst pre-congresses 1991-2001) has held panels to discuss this difficult issue and an extensive literature on the subject has developed, most of it pointing to deleterious aspects of the system.

The 1991 panel, entitled “Between Chaos and Petrification’ was summarized by Robert Wallerstein. All the analysts quoted by Wallerstein emphasized the abuses of power and how candidates were damaged by the dogmatism of institutional psychoanalysis. A negative view regarding the importance of the TA system dominated discussions at each TA pre-congress of the IPA over the course of a decade.

Certainly, over the years, there has been a decrease in authoritarian attitudes concomitant with a progressive democratization within most institutes. Despite winds of change, there is considerable inertia and a clinging to the old way of doing things.

In APsaA, roughly 30% of analysts feel that the TA system is a must and certainly more are moderately supportive. A sizeable contingent of IPA analysts continues to endorse it.

How can we understand this reluctance to change the TA system despite decades of criticism and discussion of its shortcomings?

The analysts who favor disruption of the TA system are quite outspoken about their views.  Those who favor the status quo have not produced evidence to back their view that there is a merit to the system, but clearly there is great attachment to our 100-year-old training model.  We commonly see any attempts at discussion devolve into polarized and stubbornly passionate claims and counter-claims without any possibility for meaningful dialogue in sight. Among the reasons for this impasse may be attachment to the past, fear of change and issues of status, hierarchy and privilege.

I believe that it is time to reevaluate the entire psychoanalytic training model. What was necessary 100 years ago, when psychoanalysis was carving out a place in the mental health field, is not necessarily what is needed under present circumstances. What kind of training is most appropriate to promote psychoanalytic competence and how do we evaluate this skill? Finally, how does one maintain the difficult equilibrium between the responsibilities inherent in providing analytic training while respecting the unique mode in which each candidate undertakes his/her training?

Obviously, in order to train candidates a certain structure is necessary. The question arises: where to draw the line between an anything goes attitude and excessive, controlling rigidity.

I suggest that we not confine ourselves to debates about particular features of existing training models, including the Eitingon model. Instead, let’s take a fresh look at crafting optimal standards for psychoanalytic training in today’s world, incorporating the best of the three current models as well as new ideas.

As an IPA Board member, I propose a thorough reevaluation of every aspect of training and consideration of a model re-envisioned from basic principles. I think Max Eitingon would approve. These are pressing problems and require a basic rethinking of psychoanalytic education.

 

Gunther

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