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Report from IPA Congress: New Leadership Team, 4th Region in Development

Dear Colleagues:

I returned from the IPA Congress in Buenos Aires intending to give you a report on the meeting.  Meanwhile, flooding created a crisis in my hometown of New Orleans, and our country is witnessing a national crisis, with the events in Charlottesville and their aftermath.  In that context, one could ask “who cares about the IPA Congress?” For me, engagement with international psychoanalysis feels more important than ever, and I’m determined to make that case to you, as one of your representatives on the IPA Board.

For instance, our European colleagues (for example, Sally Weintraub in London and Christer Sjödin in Sweden) have made major contributions offering psychoanalytic perspectives on global warming, undoubtedly one of the reasons New Orleans’ very existence is threatened.

And psychoanalysts in Latin America and Europe have much to offer us in understanding our current political crisis.

New IPA administration focusing on communication, outreach & inreach

A new administration assumed office at the Buenos Aires Congress and wants to change the image of psychoanalysis and the IPA. Virginia Ungar, our new President, made a point that analysts need to go outside their consulting room. She and Vice-President Sergio Nick want to involve more members and improve communication between the IPA and the membership. There is a strong feeling in this administration that the IPA needs to do more in-reach and outreach, especially to our younger members, involving them in the affairs of the IPA and seeking their feedback about what they would like the IPA to do for them.

We have kept ourselves out of the public eye.  We cannot continue to hide in our offices while the world is falling apart.  Analysts need to connect with the community and convey our experience and passion for our work.

The president was very emphatic stating that we should have a presence in hospitals, schools, universities, engage in dialogues with related disciplines like anthropology and political science and also humanitarian organizations such as UNESCO, UNICEF, Doctors Without Borders and agencies that deal with deal with refugee issues. Board members felt our voices have not been heard about the political situation we are in and our social ills.

I found this discussion both heartening and curious.  I’m glad my fellow Board members are thinking about bringing psychoanalysis out of the consulting room.  I also had the impression that many are unaware of the many ways colleagues have engaged with social issues, with APsaA’s efforts regarding LGBTQ rights and service members’ needs being one important example. Personally, I was fortunate in being able to join a team of psychoanalyst who had been asked to advise Mozambique how to deal with the societal consequences of the of child soldiers who have now grown up and are very disruptive to the nation. This information gap is another example of the need for more communication and sharing of ideas.

Plans for fourth IPA region in Asia

Another very exciting development-plans are underway to develop a 4th region in the IPA. At the Buenos Aires Congress three Iranian psychoanalysts presented papers. Several groups in Iran have contacted the IPA wishing to become Study Groups. The Japanese Society has been in existence for almost 100 years and the Indian society is almost as old. The IPA has Study Groups in China and Taiwan and had two Asian conferences recently. COWAP (Women and Psychoanalysis Committee) had a meeting in Wuhan China attended by 800 people. In the Eizirik administration (2005-9) there was a psychoanalytic meeting in Irkutsk, Siberia which is closer to Beijing than to Moscow. The enthusiasm and eagerness with which psychoanalysis is received is very refreshing. In contrast with what is happening in the States, people in Asia are breaking down doors to get access to psychoanalytic training!

Psychoanalysis arose out of a Western European tradition. Both Hindu and Confucian philosophies can add other perspectives to our understanding of the UCS.

The establishment of an official Fourth Region in Asia will unify these efforts and provide greater access to the thinking of colleagues in Asia.

Gunther

En Route to Buenos Aires: International Psychoanalysis-What is its Value?

On the eve of the IPA Congress in Buenos Aires I would like to reflect on what belonging to the IPA means to me. Over this past year I spoke to many North American members. The feeling among the majority of the people I talked to is that the IPA does nothing for them and is basically irrelevant to their professional lives. I think the IPA has not been forceful enough in communicating the value of international engagement to its members. But if we are not involved with the IPA, I think we in North America are missing out on lively discussions on many topics of psychoanalytic and sociopolitical interest.

As the reach of the IPA expands to different parts of the world, it is confronted by very different customs and mindsets. For example, there was recently an IPA meeting in Rome on Psychoanalysis and Geography. The question at that meeting was whether psychoanalytic concepts are universal and if our methodology is applicable to different cultures worldwide and how to establish comparisons between different anthropological positions. Is psychoanalysis able to deal with very different cultures without changing it methodology?

Analysts from various backgrounds spoke on how to deal with transcultural problems. A Muslim South African analyst of Malaysian origin practicing in London spoke of the challenges for a Muslim analyst trained in western thinking to go back in time to his earlier cultural mind and address customs, taboos and family values with patients coming from a non-western culture. These issues are not just of esoteric interest. In our practice, we are confronted with immigrants who have come to the US with hopes of having a better life but at the same time still live psychologically in their old cultural environment.

You might be interested to know that the IPA is adding a fourth region, Asia, because of an intense interest in that part of the world in our theory and methods.

How can we accommodate these different cultures under the umbrella of Psychoanalysis? There have been many articles by analysts regarding the problems of immigration the whole world is facing today. These can be found on the IPA website which is veritable treasure trove of information or in the latest IPA Newsletter sent out to the members on July 20th.

Another perk offered by the IPA is the CAPSA program. APsaA societies in particular have not availed themselves of that benefit. In that program, the IPA pays transportation for an analyst from another region to come and spend a few days with your Society. The Society provides for lodging. It is shame to walk away leaving money on the table when this is offered at a very modest cost to the Society. This allows for exposure to other points of view and allows a comparison between what we do now and how an analyst from another region conceptualizes his/her analytic work. I would be happy to help societies interested in this benefit find interesting scholars from other regions and make connections.  Here is the link for more information ipa.world/ipa/en/IPA/procedural_Code/….aspx

In future communications, I plan to acquaint-or reacquaint- North American  members with other benefits the IPA provides. I also urge you to browse the IPA website www.ipa.world and see what might appeal to you or your society. I am always available to explain the programs further, or provide needed introductions.

If you are going to the IPA Congress in Buenos Aires, I’d be delighted to say hello and introduce you to Latin American or European analysts who might share your interests.

 

Getting Outside our Psychoanalytic Silo: Engaging the Public and Solving our Morale Problem

 

I have been asking myself lately why has psychoanalysis become so marginalized?  Analysts have a morale problem. A large number have withdrawn and have removed themselves from the analytic scene. Fifty years ago our discipline was very much part of the Zeitgeist and an integral part of the cultural scene of North America.  At that time, most psychiatry department chairs were analysts. These days there are hardly any left in those positions.  Some joke that the situation has gotten so bad that we don’t even rate cartoons in the New Yorker. What has been our responsibility in the way psychoanalysis is viewed by the public? How has CBT been able to dominate the field of therapy to the point that psychoanalysis or psychoanalytically oriented psychotherapy are not even considered as therapeutic options? What has happened that we have ceded the field to CBT?  Psychoanalysts have written about short-term interventions but have we taken a thoughtful public health point of view and made our knowledge maximally useful to the public?  To make matters worse so many analysts are disenchanted with local, national and international organizations and question whether the time and expense of training was worth the effort and whether organizational membership has a pay-off.

It is always painful to look at one’s shortcomings and it is much easier to blame outsiders. We have all heard theories about the reasons for our decline. That psychoanalysis is too threatening, that Freud reduced everything to sex, that it takes too long etc. To compound the situation, we as analysts have not wanted to engage “mano a mano” with our critics. I have often heard the statement from analysts that if you have not been analyzed you are not qualified to critique psychoanalysis.  Psychoanalysts in the past prided themselves for keeping apart from scientific discussions claiming that our discipline is unique and therefore scrutiny from outside scholars is illegitimate.

Why have we not educated the public? We were proud of our isolation and unfortunately the world has passed us by. We have not conveyed to the public that psychoanalysis is not a static discipline and that we have evolved in the last 100 years.  CBT does not arouse the same negative reactions in people. What have the CBT people done that we have not been able to do? The received wisdom is that CBT can accomplish results faster than a psychodynamic intervention. Analysts have written about short-term therapy and crisis intervention.  Yet in spite of these publications we have not been able to swing the tide of public opinion in our favor.  Something else must be at work.  What have we done to contribute to our undoing?

Psychoanalysis was set up in a rigid hierarchical way where the elders had the wisdom and were the owners of the truths. Unfortunately, different truths were promoted as the only possible way of viewing the mind. The public mocked our arrogance and candidates were put in a position of having to choose and acquiesce to demands that in any other circumstance would not be countenanced. The role of ideology in the psychoanalytic process poses the danger of analyst indoctrinating his patient with his own beliefs and ideas. The objectivity of the analyst may be disturbed by his own ideological beliefs or by political ambitions within institutions. So why have young analysts participated in this dysfunctional set up?

The compact in these situations revolves around the promise that if the candidate shows loyalty to his or her analyst or to an important figure in the society he/she will be rewarded by advancement in the organization or by the referral of patients.  The use of younger people to further the ambition of senior people has permeated many of our societies and led to great ambivalence toward authority that is then projected on to our national and international organizations.

The perception about some of our organizations is that strife in their ranks is essentially endless; people want to stay away and wash their hands of the whole scene. Interestingly, rightly or wrongly CBT is perceived in the mental health field as more democratic without the power struggles that plague psychoanalysis.

It does not have to be that way. Psychoanalysis is thriving in other countries. There is excitement about our discipline along with a lively dialogue with psychiatry, anthropology, epistemology etc.

I am running for the position of North American representative to the IPA Board and I would like to change the negative perceptions about psychoanalysis by promoting both interdisciplinary and interregional dialogues. In the past, I organized several clinical conferences where members of FEPAL and NAPSAC alternated presenting clinical cases in small groups. These conferences had an uplifting effect on all the participants. We need more exchanges with other disciplines. Why don’t we have them with CBT therapists, Jungian analysts or personal change gurus like Brené Brown? They are obviously perceived as having something to offer to the public. Has any psychoanalyst ever given a TED talk? If not, why not? Paradoxically, as our profession struggles, there is evident public thirst for insight into motive, emotion and ways to change and lead a more satisfying life. That’s what we know.

If we talk to the public and people outside our psychoanalytic silo, we might learn something from each other.

The Far Reaches of Psychoanalysis: Mozambiques’ Child Soldiers

 

 

Belonging to an international organization like the IPA has opened unanticipated doors for me and exposed me to many interesting problems worldwide.  A Brazilian psychoanalytic society has undertaken the task of providing mental health consultation in ex-Portuguese colonies.  In 2011 I was invited to participate in a conference in Mozambique to discuss therapeutic approaches to assist the nation as it struggles with the problems of former child soldiers–children  who   fought in the civil war that ended in the mid nineteen-nineties. Reintegrating these former child soldiers into society is one of the most challenging tasks facing Mozambique as well as other countries that engaged in the same practices.

 

The forced conscription of children to become soldiers is one of the most egregious crimes against humanity. This practice not only harms the children themselves but also the society as a whole. In Mozambique both sides consistently practiced abduction and forced recruitment. The stories we heard about recruitment practices were unimaginably inhumane and horrifying. Boys were forced to engage in violent acts that were witnessed by their villages, effectively closing the door to any possibility of a return home. This insured the boy’s alienation from his village. To harden their psyches the children were deliberately exposed to horrific scenes. They were physically and sexually abused and made to witness the killing of family members.  Such experiences made the children commit violent acts during and after the armed conflict. Obviously the psychological wounds and traumas suffered in childhood reverberated throughout their lives as they grew up.

 

The children are utterly and, in most cases, irrevocably altered by their child soldier experience.  Former child soldiers have no skills for life in peacetime and have had great difficulty in letting go of the conviction that violence was a legitimate means of achieving their aims. This conviction has made the transition to a non-violent life style very difficult. In addition, to having been exposed to years of unrelenting killing and violence, these children lost years of stability and schooling. The result has been a reduction of human and economic potential for Mozambique.

 

The challenge at the conference was to come up with a way to address these emotional consequences.  Western psychodynamic therapies obviously were not an answer but psychodynamic understanding was of value, especially theories of attachment and the sequelae of trauma. A local psychiatrist who had psychoanalytic training in Germany came up with a solution. He recognized the importance of myths in the local tribal culture and the fact that many traumatized former child soldiers consulted the shamans for help. The challenge was how to form a therapeutic alliance between the mental health professionals and the shamans.

 

He had succeeded in forming a collaborative program with shamans where psychodynamic concepts were discussed in the terms of the local myths. The mental health professionals, university graduates themselves, told us that when they were sick, they first consulted the shamans to invoke the help of the spirits and only when that didn’t work would they visit a conventional western trained physician.

 

The results of the conferences with the shamans have been promising; the main bottleneck has been the difficulty in training sufficient mental health professionals to talk  psychodynamically in myth language to help the shamans deal with their patients.

 

The impact on the participants in the conference, confronted with this unspeakably brutal reality, was enormous. It was hard to process the powerful emotions generated in us as we worked to help the local people cope with this overwhelming trauma. The analysts from the Brazilian Society who were present have also continued their work in other ex-Portuguese colonies particularly in Angola where the same practices prevailed in their civil war.

 

We all left the conference traumatized by the horrific stories we heard and it reminded me of my work interviewing holocaust survivors seeking reparations from the German government. The latter experience had a more direct impact on me because I could feel the pain and suffering in the person I was talking to in the room.  The Mozambique experience however shook all of us up because we heard about events where the most basic human taboos had been breached  in a most brutal manner.

 

Despite the painful content of the conference and the work I was proud at these times  to be part of international psychoanalysis, learning about the courageous work of colleagues like those in the Brazilian societies, and thinking together about the far extensions and applications of psychoanalytic ideas.

 

 

IPA Training Models and North American Concerns

Trying to understand why so many individuals in APsaA feel alienated and uninvolved with the IPA, I have seeking the opinions of members, who, to my knowledge, have not had much contact with the IPA. I was especially concerned to discover that even Training Directors often feel the IPA is not very relevant to their professional work.  

In talking with some who expressed this view, it seemed to me there is significant confusion about the Eitingon model. In a recent survey done by APsaA’s Task Force on the Eitingon model of some 15 societies in Europe, Latin America and US, we found there is wide variation in their training approaches regarding frequency of sessions, gender of control cases, graduation requirements and criteria for career advancement from associate member to full member to training analyst. (To clarify terminology that can be confusing, the word “society” is used generically in IPA parlance to describe institute, center or association and implies a training function).

Here are some of our findings from the survey:  APsaA is the only society that requires certification. Everywhere else, graduation from an institute is a sufficient credential to apply to the society. However, some societies have stringent requirements for graduates to advance to full membership. We found that considerable variation exists regarding requirements for frequency and number of training cases.

Although at every Congress the IPA has an afternoon meeting with training directors of societies, among some training directors I spoke with there is a feeling that there is not enough communication between the training directors and the IPA and that there is a general attitude of indifference toward them.

I asked Fernando Weissmann, the chair of the IPA Training and Oversight Committee, to clarify the IPA’s position regarding its role in overseeing training he said the following: “The Eitingon model is an abstraction and there are many variations on the model depending on various circumstances such as the size of the society, political and economical considerations. The model exists only to give an appearance of unity in the IPA. The component societies have complete autonomy.”

A lively argument is going on in North America about what training requirements should be regarding frequency, hours of supervision and whether variations of the Eitingon model are acceptable to the IPA.  Some members wish for more definitive guidelines while others prefer more latitude. Those in the latter category resent the feeling that big brother is watching them.

As a result of the increased flexibility the big challenge ahead is in who can analyze candidates. The old rigid tradition-bound rules seem less relevant. Here the IPA could provide tangible help in the form of an online discussion forum where differing views can be discussed. This would be a very timely topic for the directors of training meeting during the IPA Congress.

Another area that needs exploration is the issue of criteria of competence for supervising analysts. What training is necessary? Some societies mandate attendance at supervisory seminars while others have instituted a piggyback system where a new supervisor presents his supervisory work to a trained supervisor.

Again this is another area where the IPA has dropped the ball.  I propose that the IPA address these questions and become more proactive in fostering discussions about TA’s and supervising analysts. These should take place in a collegial atmosphere that would encourage brainstorming and finding new solutions, rather than perpetuation of a tradition of gate-keeper type oversight that is no longer appropriate. That would make the IPA more relevant and usable.

 

 

Connection and Disconnection between Members and the IPA

It has been important to me to try to understand why so many IPA members in North American feel alienated and uninvolved with the IPA.  While this feeling is perhaps more widespread among APsaA members, I also know it is shared by some in other North American societies.  I embarked on an informal “listening tour”, seeking the opinions and perspective both of members who, to my knowledge, have not had much contact with the IPA and of members who have participated in IPA activities such as the biannual international congresses.

I discovered that too many analysts feel that the IPA is not very relevant to their professional lives. They wonder what role or purpose it serves and what benefits they get from their dues.

One person I spoke with said he had never received any communications from the IPA.  Another told me that it felt to her as if the IPA was from another planet and had no particular relevance to her professional endeavors. And this is a person who as a candidate was a member of IPSO (the IPA’s candidate association) and had presented her clinical work at two IPA Congresses.  There was no follow-up on the part of the IPA and she basically felt forgotten and not  valued as a member of the international analytic community. This kind of neglect is shocking and has a lot to do with the feeling of disenchantment that so many people feel about the IPA.

Several of the people I talked to were completely in the dark about IPA activities even when these related directly to their own interests. For example, almost no one knew about the IPA’s work developing new institutes in Eastern Europe and Latin America.

 

Another interesting (and little known in North America) IPA project is the CAPSA project.  It provides financial help to a society (or institute) to bring in a guest speaker from another IPA region to spend a weekend lecturing, teaching and supervising. Latin American societies have availed themselves of this opportunity and invited several European analysts to visit them. Unfortunately, the majority of North American societies seem unaware of this program, have not requested these funds and have walked away leaving money on the table.

 

It is clear that the IPA has to do a better job of communicating with its North American members. While considerable efforts to improve IPA-to- IPA member communications have been made, they have not yet accomplished the necessary task of reaching, informing and engaging members.

 

Another common complaint is the high cost of registration for IPA Congresses. The registration fee is often twice the cost of regional meetings and that reality puts a dent in attendance at the Congresses. Younger analysts especially feel the cost of registering and getting to a congress is a great financial burden. The IPA has tried to address these issues, yet in spite of their efforts, every IPA congress, with the exception of the congress in New Orleans, has lost a great deal of money.  One factor that increases the costs of the congresses is the need for translations in multiple languages.  The high costs of IPA congresses needs to be looked into further.

I feel the issue of costs could be less burdensome if some of the younger participants felt welcome and less isolated.  The IPA should make a more concerted effort to make them feel more part of the international analytic community.  One way to do it would be to have some older experienced analysts help them in their efforts to get acquainted with analysts of other regions.

The IPA is facing some difficult times.  The causes of these and other problems are complex and the solutions aren’t easy.  But clearly the Board needs to make a much greater effort to be more in tune with the dissatisfaction in the membership.

For my part, my listening tour has opened my eyes about what needs to be done and I will do my best to get the Board to address these problems.

 

 

Beyond our Southern Border

I see a tremendous value for North American psychoanalytic societies to reach out past US borders. In the Gulf States our proximity to the Caribbean and South America offers a great opportunity to increase our visibility and the possibility of getting referrals from Latin Americans.  This is a connection that has largely been overlooked here in the States. Analysts in the US can benefit from learning about psychoanalytic work done by Latin American analysts. There are North American cities that are natural gateways to the US.

Miami, for example, is a city that holds great interest for Latin Americans because of its large Hispanic population. People come to the States for medical check ups and extended care. While here, they often request consultations for various mental health problems.

Let me give a couple of examples of the interest in psychoanalysis in the Caribbean basin. ILAP (the Latin American Institute of Psychoanalysis) is funded 50% by the IPA and 50% by FEPAL (Latin American Federation of Psychoanalysis). When ILAP went to Puerto Rico they found that many psychiatric residents were interested in psychoanalytic training. But ILAP was reluctant to invest their resources because, since with Puerto Rico being American territory, the graduates would upon graduation belong to North America. When I was Secretary-General (a role now called Vice President) of the IPA I helped attempt to form a joint enterprise, which unfortunately got bogged down.

In Europe the PIEE (Psychoanalytic Institute of Eastern Europe) began analytic training in the early nineties in the countries that had been behind the iron curtain. Because of the geographic distances they started doing concentrated analyses in tranches. That means that the analyst would see the analysand for two sessions (not consecutive) a day for 4 days every two weeks. In this way they gradually began to form a cadre of mental health professionals who were then ready to begin analytic training.

Following the PIEE example, ILAP was created in 2006. Before ILAP was formed, an Argentine analyst started going to Paraguay every other Thursday and seeing analysands until Sunday. Paraguay started out as an Allied Center. This means simply that a group of people who showed interest in psychoanalysis got together. The Allied Center was the nucleus of the eventual IPA Study Group. An IPA Study Group is the predecessor to a full-fledged psychoanalytic society in the IPA system.

In Panama, ILAP   provided the analysts for the candidates to have concentrated analyses and the seminars.   There are now other opportunities in the Caribbean basin.  When ILAP lectured in Honduras  they had 500 people signed up for the seminars. There is an interest in Guatemala but the unavailability of trained analyst has stymied their development. In Cuba, ILAP has made contact with Havana professionals and is considering started some seminars.

Reaching out to these countries, possibly with the exception of Cuba, could be an excellent source of referrals. In the past before, Miami and Houston became destination cities, affluent people from the Caribbean basin frequently visited New Orleans because of its connection with the United Fruit Company. Becoming known as someone who could communicate with these visitors turned out to be a steady source of psychotherapy patients and even an occasional analytic patient.

Let me address the language issue.  Obviously if an analyst in the Gulf states is fluent in Spanish he or she has a natural advantage in working with patients or candidates from the Caribbean basin.  But many educated and/or wealthy people in these countries who might be interested in treatment or training opportunities are fully fluent in English.

Psychoanalysis is held in high esteem in Latin America. The last FEPAL congress had 1140 participants. It took place this year in September, in Cartagena, Colombia. This gives an indication of the interest in psychoanalysis in the region. There were simultaneous translations but very few North Americans attended.

What I want to stress is that there exist many international opportunities for North American analysts to be enriched by reaching out to neighboring countries and opening their vistas to other cultures. The cultural exchanges are intellectually stimulating and as an added bonus can be good sources of referrals.

Image credit:  Kmusser – Own work, all data from Vector Map., CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=14857874