We are now witnessing a lively debate on what a new direction in psychoanalytic training and formation should be. I believe many of our current controversies (which also happen to be very longstanding ones) are symptomatic, not foundational.
The recent vote of the IPA Board regarding the frequency of psychoanalysis and the discussions in APsaA over this past year have raised anew the question: what is the essence of psychoanalysis and how should it be taught? We are now caught in a limbo between our founding values and the recognition that psychoanalysis needs to evolve.
We are ambivalent about the icons of organized psychoanalysis – the couch, the TA system and the regulated frequency of weekly sessions during training. Many prefer to define psychoanalysis without reference to concrete techniques such as the use of the couch or 4-5 a week frequency. Yet these same people express the feeling that those techniques have played an important role in their own development as a psychoanalyst. Given this ambiguity, the question arises as to what constitutes the best possible psychoanalytic education or how to arrive at this.
The topic of training models has been discussed for decades and more than 300 papers have been written about this issue. Up until 2006, the only official model in the IPA procedural code was the Eitingon model with the 4-5 times a week frequency, although the French model had existed side-by-side since 1980. In 2003, Daniel Wildocher, the IPA president, proposed that analysis could be practiced 3,4 or 5 times a week. Indeed, three times a week analysis was already well ensconced in Latin America due to economic and cultural factors even though their model of education was fundamentally Eitingon. A task force composed of Bob Pyles, Shmuel Ehrlich and Fernando Weissman was created to study the problem eventually led to the IPA’s approval of three training models by 2006. To some degree, this development shifted the focus in psychoanalytic training from frequency to content although, in reality, this shift in emphasis did not generalize to the broad membership in North America and Europe.
In North America (with the exception of the Montreal French group, the SPM, which uses the French system) many feel that the weight of the past embodied in the Eitingon model has become a burdensome legacy. Given today’s pluralistic corpus of psychoanalysis, how do we define its essential characteristics and how do we teach it so as to educate competent and engaged analysts?
Longstanding debates about the difference between psychoanalysis and psychotherapy point to our confusion about the essence of psychoanalysis and the implications of that confusion for training. Judy Logue recently raised the question: “is there a qualitative difference between psychoanalysis and psychotherapy or do we have a continuum in the spectrum?”
As far back as 1954, Rangell, in his paper, “Similarities and differences between Psychoanalysis and Dynamic Psychotherapy,” commented that APsaA’s committee formed to study this had not been able to “arrive at a modicum of agreement as to what constitutes psychoanalysis, psychotherapy and possible transitional forms”. The committee was forced to conclude that a strong resistance to any investigation of this problem existed.
I recall that a past president of FEPAL, the Latin American regional organization, related that he practices analysis in his view whether he sees the patient 5 sessions a week, once a week or once a month. His definition rests on the internal psychoanalytic setting of the analyst in terms of what defines the process as psychoanalytic.
So, here we are some 60 years later still without a general consensus regarding the differences between these two therapeutic approaches let alone a shared idea about the essence of what psychoanalysis is. We need to understand the meaning of this intellectual stalemate rather than continuing to argue past each other.
Current views of psychoanalysis have enlarged its definition. Presently, it is viewed both as a one-person psychology that studies intrapsychic processes and an intra-subjective process which asserts that the psychic realities of both participants are involved in the encounter and transformed by it.
It’s important to be aware that we use the word psychoanalysis to refer to two different things: a comprehensive theory of the mind and behavior and a clinical approach to relieve human suffering and facilitate human growth. Further, in terms of psychoanalytic clinical work, there are two uses for the word. First, we refer to classic psychoanalytic treatment which is also the official psychoanalytic training for the candidate within the institute and, secondly, the “psychoanalytic approach” which is widely recognized within mental health practice as a distinct and valuable perspective.
Tuckett (2005) chose to approach the subject from the point of view of what defined psychoanalytic competence. Importantly, in his formulation, he left out the issue of frequency or the use of the couch. Instead, he proposed three linked frames (specific to psychoanalysis) that he terms the participant-observational, the conceptual and the interventional.
When we consider what kind of psychoanalytic education we should strive for in order to qualify competent practitioners, this must be linked to what we mean by psychoanalysis and, in particular, what constitutes its essence. I wonder whether our confusion about its essence makes us prone to fall back on authoritarian means of enforcing one aspect or another. In the IPA at the moment, frequency is the battleground.
Unfortunately, we as a group show tremendous resistance to change. I don’t think this can be explained entirely by reference to power dynamics. For example, the Europeans who pioneered the exploration of defining psychoanalysis operationally (e.g. the working parties on comparative clinical methods and the specificity of psychoanalysis) are currently the most alarmed about the IPA’s recognition of 3x a week treatment frequency as a minimum within the Eitingon model.
So, given the complexities of the present situation what are possible steps to clarify the problems we are now facing? I would suggest the following:
· A respectful dialogue between opposing or different views devoid of rants or slurs. To achieve this, we have to face the anxiety we are experiencing as the field confronts the necessity for change juxtaposed with our attachment to traditional practices.
· That we try to embrace the necessity of change intelligently and tolerate, explore and compare different approaches looking for what is essentially psychoanalytic across paradigms. Within ApsaA, for example, why not pair one institute that is pursuing a personal analyst approach with one that feels strongly about a TA system and let them have an ongoing dialogue about their training experience and results? This process of a 3-5-year collaboration during this time of openness and change could culminate in a valuable conference or publication that would help put educational standards on a basis of shared observation and experience rather than partisan passion.
· Dare to engage in an international process to arrive at a consensually accepted definition of the essence of psychoanalysis as a theory of mind and what differentiates it as a clinical approach. I believe we can and must agree on a few principles that unite us as psychoanalysts in spite of our pluralistic views. Can we not answer the question of what a patient can expect when he comes to a psychoanalyst for help whether that analyst is a Kleinian, self-psychologist, relational or field theorist etc? When we offer a “psychoanalytic” perspective outside the consulting room, we need an agreed upon definition of the essence of that perspective.
· We must reach beyond our self-imposed borders and engage in a dialogue with related disciplines and become part of our present cultural ferment.
That is my hope and I would like for our discipline to achieve these not so utopian goals!