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!
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.
- Individual Institutes/ Societies
- Groups of Institutes/Societies from the same region
- A regional body
- IPA Committees such as COCAP (Child and Adolescent Psychoanalytic Committee) and COWAP ( Women and Psychoanalysis Committee)
This is a generous program that has been underutilized in North America. Bionian perspectives are especially popular in Latin America. Laplanche and psychosomatics are two areas of study that are pursued among French-speaking analysts. French analysts also find the death instinct a valuable construct, a perspective you rarely hear discussed in the English-speaking North American analytic community.
Except for a very few psychoanalysts such as Gail Reed, Jonathan House and Suzanne Rosenfeld, not much is known or discussed by English-speaking analysts in North America about French psychoanalytic theorizing. Jonathan House informs the English-speaking North American psychoanalytic community with his translations of French texts.
After looking over the general description, click here for a Resource Document with more details on how to go about applying.
Look for a link in paragraph 8 that takes you to a downloadable version of the “CAPSA Application Form 2017.”
You can also download a pdf of the CAPSA Application form here. If you do use the CAPSA program, please give me a call or send me an email to let me know about your experience.
I wanted to tell you my impressions about what is happening in the IPA. There is indeed a lot going on in the IPA. First, let me provide you with some key statistics about the IPA. It has about 12,800 members and close to 6000 candidates. This past year, 664 new members from 51 different countries joined the IPA. There are now 72 IPA societies spread over 63 countries, with 43 languages spoken by IPA members. Clearly with this impressive set of figures, the rumors of its demise are premature. It is therefore unfortunate that so many North American analysts consider the IPA irrelevant to their professional lives. Many analysts here in North America are very concerned about the survival of psychoanalysis, something which is less obvious on the world-wide stage. At one point a few years ago, when Piers Pendred was the executive director, the London office was so swamped with applications for new study groups that they considered having each region do their own vetting of new requests. I hope that with greater contact with our colleagues overseas, we can share ideas and learn more about creating community interest in psychoanalysis.
The new IPA president, Virginia Ungar, has emphasized that analysts should step outside their consulting rooms and involve themselves more with the community. Here in North America, APsaA’s President Harriet Wolfe, set a fine example stepping out of her office with her trip to Houston. Harriet shared resources developed by Gil Kliman and her for children affected by the hurricane.
Recent environmental and political events mirror a rate of change and group trauma that is nearly unprecedented. I think we will benefit from learning what our analytic colleagues are doing in response to these challenges. I called Pablo Cuevas, a long-time friend and colleague in Mexico, following the earthquake to find out how the analytic community there was faring and how they are reacting to the earthquake there. I learned from Pablo that analysts set up a hot line for people to call and come in for help free of charge. They have made a special effort to provide help to people who had been buried and finally rescued after a long wait buried under the ruble. Fortunately, no analysts or candidates were personally injured and the society building is intact.
I also spoke recently with Peter Wegner, another longtime IPA colleague, because I was curious about the analysts’ reaction to the recent German election. There is concern about the rise of the right-wing party, he told me. German analysts have been engaged with the refugee population through various outreach efforts. Our colleagues in Germany are eager to let you know what they have been doing in this arena and I will have more to tell in a subsequent note.
Besides inherently doing good, these activities convey an impression to the public that psychoanalysts want to extend themselves and are willing to offer meaningful help to people in distress.
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.
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.