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The Future of Psychoanalysis

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This book is concerned with the question of what psychoanalytic training should look like today. Should we go on with the system that has developed over time? Or should we abandon it, and if so, for which reasons?It provides a detailed and compelling account of the ongoing, sometimes heated, international debate about psychoanalytic training. After nearly a century since the onset of formal psychoanalytic training in the 1920s in Berlin, experiences with the prevalent Eitingon model are presented and looked at from different perspectives. Experienced psychoanalysts from all the regions of the psychoanalytic world and from different schools of psychoanalytic thought and clinical conceptualizations share their ideas, critique, and on occasion, their diagnoses.Perhaps no other topic of present-day scientific discussion in the field is as prone to evoke more controversial and passionate reactions than the subject of training. This is certainly a result of the fact that the training-analyst system that has been the unique feature of psychoanalytic training for so long, is being more and more fundamentally questioned and seen as a possibly deleterious impediment for the development of a psychoanalytic science that would be able to meet the exigencies of the modern world and of the patients we have to treat today.The objective of this book is to delineate the pros and cons of this discussion. If the debate is both a passionate and very difficult one, the reasons for this might be seen in the fact that we do not discuss and question scientific positions alone, but an intricate social system that has developed over time. Psychoanalysts have all grown up within this system, and this implies deep emotional identifications and transferences, both oedipal and preoedipal, which are not easy to challenge, change or even give up. However, as one of our modern poets has observed, "he not busy being born is busy dying". In this sense, this is a book about psychoanalytic obstetrics.With contributions by Emanuel Berman, Harold P. Blum, Elias M. da Rocha Barros, Kenneth Eisold, Claudio Laks Eizirik, Gigliola Fornari Spoto, Cesar Garza Guerrero, Otto F. Kernberg, Douglas Kirsner, Robert Michels, Luiz Meyer, Robert L. Pyles, Robert S. Wallerstein, Sara Zac de Filc, and Peter Zagermann.

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Chapter One - Change from within in a Traditional Psychoanalytic Institute: Twenty-Five Years of Debate and Transformation at the Israel Psychoanalytic Society

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Emanuel Berman

The Israel Psychoanalytic Society and its training body, the Israel Psychoanalytic Institute, were founded by Max Eitingon in 1933–1934, shortly after he had to leave Berlin. The institute is actually named the Eitingon Institute, although this title is rarely mentioned nowadays. The Society became an IPA component society from its first days (Rolnik, 2012). For many years it was a rather traditional organization. In the past quarter century, however, it went through rather radical changes, some of which were reached by consensus, whereas others were the final outcome of fierce debates, and could be controversial to this day.

In this chapter, I will summarize some of these changes, starting roughly around 1990–when I was a junior faculty member at the Institute–and reaching the time of writing in 2015. Let me say at the outset that I make no claim to be objective. I was quite active myself in promoting several of these changes, and I view the process as constructive, against the background of my criticism of what I see as major pitfalls of traditional psychoanalytic training, which I will outline briefly.

 

Chapter Two - Training Analysis and the Psychoanalytic Institute

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Harold P. Blum

Introduction

Psychoanalysis has always supported the concept of change in theory and clinical practice and, to a lesser degree, in psychoanalytic education. Freud initially thought that to become an analyst, to gain insight into unconscious mental life, one had only to analyze one's dreams. He soon realized that becoming an analyst required more than a lone journey on the royal road of dream interpretation.

So long as psychoanalysis flourished, so long as it had social status and influence in intellectual and academic spheres, psychoanalysts were both pleased and complacent.

Challenges to what seemed to be time honored and working well could be taken lightly and critics could be largely ignored. Indifference to, or disparaging attitudes toward, psychoanalysis in the community, in medicine, the behavioral sciences, and the humanities, however, were associated with a worldwide decline in clinical practice. With fewer patients and a corresponding decline in applicants for psychoanalytic training, dissatisfaction and disappointment intensified. Psychoanalytic institutes declined in size, scope, and morale. There were growing concerns about creativity among our candidates and recent graduates.

 

Chapter Three - Psychoanalytic Training: Then and Now

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Kenneth Eisold

The heroic age and the domestic era

Looking at the landscape of psychoanalysis today, there are few signs remaining of the battles that swept across it until recently: the bitter schisms that rent many institutes, the proscribing of dissident ideas, banishment of colleagues, arrogant dismissals of alternative treatments, sharp competitive judgments of fellow analysts, as well as harsh attitudes towards outsiders. All of that characterized psychoanalysis in its “heroic” age, as it was struggling to establish itself as well as, in a period of decline, it was struggling to hold on to its self-image as the “gold standard” of psychotherapy.

Freud, a self-identified “conquistador” in his youth (Masson, 1985, p. 398), became in adulthood a “good hater” (Sachs, 1944, p. 117), surrounding himself with a band of “paladins” (Grosskurth, 1991). He demanded of his followers that they do battle with him against his enemies, and then there were colleagues who constituted in his eyes a particular danger to psychoanalysis because they had been disciples and followers at the start: Adler, and Jung, of course, then Ferenczi. Subsequently, conflicts in New York led to what Ernest Jones referred to as the “psychoanalytical civil wars”, running roughly from 1931 to 1938 (Hale, 1995, p. 103; see also Frosch, 1991). This was followed by the outbreak of conflict in London between the local Kleinians and the émigré Freudians, intense in-fighting expressed, ultimately, in the Controversial Discussions that narrowly averted the splitting up of the British Society (see King & Steiner, 1991).

 

Chapter Four - Current Aspects and Challenges of Analytic Training

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Cláudio Laks Eizirik

This chapter starts by highlighting certain characteristics of contemporary analytic practice, since the ultimate goal of our educational institutions is to experience and address this specific scenario in order to prepare or encourage the training of analysts. Next, I examine aspects of personal analysis, supervision, and psychoanalytic institutions, as well as the challenges I consider most relevant in this endless process of developing and striving to maintain an analytic identity.

Have the patients we treat changed?

From about the 1980s, references began to appear in the literature concerning changes in analytic patients (Ahumada, 1997; Gaddini, 1987) and new descriptions gradually emerged that contrasted with Freud's classic indications of neurotic patients. Kernberg's research on borderline patients is well known, as are studies by Marty on psychosomatic patients (Aisenstein, 2014), new maladies of the soul (Kristeva, 2002) and perversions (McDougall, 1983), a set of clinical conditions in which difficulties with verbal expression and symbolization present specific barriers to analytic work. André Green's psychoanalytic work is based on French theoretical and clinical observations and the contributions of Bion and Winnicott, in which they described, understood, and suggested possible approaches for non-neurotic structures (Green, 2002, 2010; Urribarri, 2013).

 

Chapter Five - Psychoanalytical Training in Flux

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Gigliola Fornari Spoto

My contribution to the current debate about psychoanalytical training is based on the psychoanalytical culture I am familiar with, which is that of the British Psychoanalytical Society and my long involvement with its training, including a recent experience as Chair of its Education Committee. My perspective is unavoidably based on such a culture, its ethos, its history, its institutional dynamics and conflicts, and my identification with it, as well as my personal evolution as a psychoanalyst. So, this chapter contains the limitations that accompany such perspective, although in recent years, thanks to the effort of organizations such as the EPF, we have been able to become more familiar with other training models and less insular in the way we approach issues of training.

The transmission of psychoanalysis is a complex task which combines experiential and formal learning: the different training models which have evolved throughout the years in psychoanalytical societies have tried to address such complexities, developing institutional and organizational structures which deal with the whole process of training, starting from the selection of candidates, the setting of a syllabus, the evaluation during the training, through to the assessment of the competences deemed necessary to qualify as an analyst. Everybody who has been involved in psychoanalytical training is confronted with a fundamental intrinsic dilemma: how can we have a psychoanalytical training which is predicated on the specificity of the psychoanalytical ethos and process, is enabling rather than controlling, promotes freedom of thinking rather than conformity, while maintaining educational standards which ensure transmission of the essence of psychoanalytical thinking and clinical practice, and, at the same time, leading to the acquisition of a professional identity recognizable in the outside world? A training, in other words, which is modeled on the psychoanalytical process rather than one which abandons it in favor of organizational and bureaucratic concerns. In the Eitingon model, which requires the candidate to undergo an analysis with a training analyst, the analytical dyad and its relative freedom have to come to terms with the presence of several thirds: the aim to train as an analyst while being a patient in analysis, the presence of the institution which provides and evaluates the training, the relationship of the training analyst with the training institution, the interaction with one's analyst in an institutional setting, contact with analytical siblings, etc. This is, of course, one of the main reasons why, in the so-called French model, the analysis is kept separate from the training. The complexity of the analytical situation in the Eitingon model of training is also one of the reasons why higher levels of competence in the training analyst are deemed to be necessary.

 

Chapter Six - Psychoanalytic Education: Between Marginalization and Irrelevance

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Toward a critical organizational and educational reform

César Garza-Guerrero

There are two ways of making fools of ourselves.
One is to believe in that which is not certain.
The other is to refuse to believe in that which is certain.

(Kierkegaard, quoted in Harman, 1991)

Our disconcerting paradox

Although a growing body of evidence attests incrementally to the efficacy of psychodynamic psychotherapy (Huber et al., 2013; Leichsenring & Rabung, 2008, 2009, 2011; Leichsenring et al., 2013; Levy & Ablon, 2009; Shedler, 2010; Watkins, 2011), this in itself has not contributed to stimulate interest in psychoanalytic education (Watkins, 2011).

Moreover, in many clinical university settings these days, the influence of psychoanalysis as an exploratory framework of reference for personality functioning and as a major integrative conceptual perspective to investigate the interphase of psychological, biological, and socio-cultural etiopathogenic factors forms part of everyday practice in mental health and behavioral sciences. For instance, (1) in contemporary diagnostic methodologies which incorporate the psychodynamic exploration of subjective experience and unconscious motivations (e.g., Operationalized Psychodynamic Diagnostics (OPD Task Force, 2001); Psychodynamic Diagnostic Manual: Personality Patterns and Disorders (PDM Task Force, 2006)); (2) in the importance of knowing psychoanalytically informed levels of personality functioning in order to estimate a prognostic perspective and to plan a treatment strategy (Clarkin et al., 2006; Garza-Guerrero, 2006, 2011, 2012; McWilliams, 2011); (3) in grasping the psychodynamic meaning of interpersonal relatedness, regardless of treatment modalities and types of interventions (Gabbard & Westen, 2003; Garza-Guerrero, 2011); (4) in the application of psychoanalytic concepts to the empirical investigation of psychotherapies and the formulation of treatment manuals, which are already taught in residency programs of university centers (Caligor et al., 2007; Clarkin et al., 2006; Garza-Guerrero, 2006, 2011).

 

Chapter Seven - Thoughts on the Present and Future of Psychoanalytic Education

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Otto F. Kernberg and Robert Michels

Introduction

This chapter originated in a series of dialogues between the authors over a period of approximately one year, focused on present problems (and possible solutions) in psychoanalytic education, internationally but particularly in the USA. Both authors have been involved in psychoanalytic education and governance over many years and share a concern with where psychoanalysis presently stands and where it is going. They share the experience of being part of what today is a significant minority of psychoanalysts involved in academic pursuits, thus being situated at the boundary between psychoanalysis and university-based psychiatry as professions. Having been involved in the leadership of both psychoanalytic and psychiatric organizations, they share an interest in organizational theory, an additional joint interest influencing their approach to institutional aspects of psychoanalysis. Despite these commonalities, however, they have been identified as having differently shaded positions and views within psychoanalytic politics: Robert Michels as relatively conservative regarding controversial issues in psychoanalytic institutional functioning and governance, and Otto Kernberg as inclined toward rapid change regarding these issues (Auchincloss & Michels, 2003; Kernberg, 2014). This difference determined a dynamic of particular interest in their dialogue: the extent to which mutual respect, yet differing viewpoints, might issue in an analysis and joint recommendations that might be of interest to the field. In what follows, their achievement in that direction is spelled out in some detail.

 

Chapter Eight - The Training Analysis: Still a Roadblock in Psychoanalytic Education

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Douglas Kirsner

The science and therapy that Freud created over a century ago is a significant part of the zeitgeist, language, therapy, and conversation of the contemporary globalized world. Despite this success, however, psychoanalysis has become marginalized in academia, psychiatry, and psychology. The external challenges to psychoanalysis and psychodynamic approaches include competing therapies, especially cognitive–behavioral therapy (CBT), psychopharmacology, economic issues of expense from patients, insurance companies, and governments, increasing social demands for quick fixes, scientific critiques of lack of empirical research in psychodynamic therapies, cultural critiques of elitism and increasing anti-individualistic views. Despite some degree of interdisciplinary research in the neurosciences and social and behavioral sciences, there are significant threats within both the professions of psychology and psychiatry, together with ever-decreasing interest in universities in psychoanalysis across the board, even including humanities departments. In this situation, psychoanalysis as a therapy attracts a small number of patients, and institutes attract only a small number of candidates. With such marginalization in scholarship, research, and clinical practice, there is a real question as about the continued viability of the organized profession, which remains at the heart of the field in terms of providing a viable future (e.g., Procci 2013). The future of the field and profession depends on the effectiveness of organized psychoanalytic institutions in driving the transmission, stimulation and development of psychoanalysis. Although the field includes a wide range of organizations with a psychodynamic and psychoanalytic focus, the IPA and its societies must continue to play a central, though certainly not an exclusive role, in order for the discipline to have a future. This is especially true when viewed within the contexts of accelerated social and technological change, globalization and the development of alternative treatment modalities. A vital part of the future of psychoanalysis is to consider these new realities and where appropriate to utilize and adapt to them. Reshaping psychoanalytic educational systems and their objectives so as to align with contemporary realities is central to the future of the field.

 

Chapter Nine - Rethinking Psychoanalytic Education: Some Critical Points for Reflection

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Elias Mallet da Rocha Barros

I do not intend to review extensively what happens in the diverse institutes worldwide, but to discuss the question of psychoanalytic education from the perspective of a concerned critique (Kernberg, 1998) and to focus on reflections regarding the different controversies related to the question of transmitting the psychoanalytic way of thinking.

I consider that we are mature enough to think critically about Eitingon's tripartite model that has been adopted by nearly all institutes. This is neither an invitation to discard nor to reaffirm our adherence to this model, but to deepen our understanding of the theory and of the ideology underlying this model, and to invite the psychoanalytic community to reflect on how we are educating the future generations of psychoanalysts.

Nevertheless, while examining the Eitingon's model, we should keep in mind an important remark made by Jacqueline Amati-Mehler (1999) when she said that

The core issue is not the tripartite side of it (Eitingon's model), but rather how these three legs of the training combine, interact and are interwoven with each other to configure a certain system and the weight that each of these three variables has, according to different conceptualizations that underlie the training.

 

Chapter Ten - Training Analysis as Institutional Enactment

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Luiz Meyer

Over the past fifteen years, the training analysis issue, defined recently by Wallerstein (2010) as “psychoanalysis’ perennial problem”, whose history Balint (1948) classified as melancholic and around which an adverse literature continues to grow, has been of special interest to me. What first drew me to this was a bizarre happening of an anti-analytic nature: a colleague who had been in analysis for some years and finding it deeply beneficial, found himself obliged—actually, pressured—to change his analyst from the moment he decided to pursue his psychoanalytic training. He could do this only if he had an analyst who was recognized by the Institution. The violence of this situation led me to investigating this facet of training, and, related to this issue, I wrote various articles questioning its nature, its functioning, and the very need for it to exist (Meyer, 2002, 2003, 2007, 2008). The present work as a continuity to this critical posture aims to show how training analysis is structured and functions in the mode of enactment. The chapter comprises four sections.

 

Chapter Eleven - Still Crazy after all these Years

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Robert Pyles

Introduction

Yes, it really was previously a school for embalmers. I am referring to the massive mansion at 15 Commonwealth Avenue in Boston, the home of the Boston Psychoanalytic Society and Institute (BPSI) where I began my psychoanalytic training in 1967.

It contained a magnificent men's room, by far the largest I had ever seen, which was reputed to have been the embalming room. Massive in size, it had eight stalls and twelve urinals. Intimidating to say the least, but at least the sheer size made it less likely to wind up at a urinal next to a training analyst!

I report this partly in jest, but the anxiety for a beginning candidate was certainly real enough. Much later, I also came to appreciate that this, in an uncanny way, seemed a fitting metaphor that symbolized the essential organizational and educational dilemma for the whole profession.

What follows is a chapter in two parts. The first was written in 1984, at a time when my new institute, the Psychoanalytic Institute of New England East (PINE) had been in existence as a “provisional institute” for the mandatory five years required in order to be considered for permanent status by the American Psychoanalytic Association. This final approval had just been obtained, which meant that the institute was now approved to begin appointing new training analysts.

 

Chapter Twelve - Can Organized Psychoanalysis Create an Optimal Education?

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Robert S. Wallerstein

Over my professional lifetime in psychoanalysis (1949–2014, sixty-five years), I have mostly become known via two central perspectives: (1) my involvement, from the very start, in formal and systematic process and outcome research in psychoanalysis and psychoanalytic therapy (see 1986), and (2) my later focusing theoretical and clinical psychoanalytic attention on the issue of our burgeoning metapsychological pluralism, and what warrants the search for common ground within it that would give us to claim a shared psychoanalytic identity to which we all subscribed (see 1988, 1990). What has been, I think, less seen as central over my career, perhaps because of its more variegated and piecemeal expression over time, is my ongoing concern with the nature of psychoanalysis as a discipline, its status (or not) as a basic science of the mind (in its normal and aberrant functioning), and in the properly constructed research by which science incrementally tests and expands its knowledge base, and then in the educational structure within which psychoanalytic aspirants can be best trained.

 

Chapter Thirteen - Changes and Transformations in Psychoanalytic Training

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Sara Zac de Filc

Current challenges to psychoanalysis

Numerous changes have occurred in every sphere of human life since Freud discovered the unconscious and created psychoanalysis. Particularly in the past three or four decades, new social movements have emerged, the old geopolitical balance has been altered, new technologies have developed, communications, capital, and labor have been globalized, and nationalisms and fundamentalisms have spread. Such transformations have affected human life at every level—social, economic, political, and cultural—engendering suffering and violence that constantly threaten individuals’ mental stability and give rise to new and more serious pathologies than we had known so far.

At the same time, the advance of computer technologies has brought about deep transformations in social relations, the construction of identities, and the ways in which knowledge is produced and circulated. These transformations have generated many advantages in terms of knowledge and experience sharing, but they have also challenged different aspects of our practice. Faced with an increasingly complex world and changes that have affected the structure of demand, we must open to other ways of looking at the world and human interaction. We must deepen our understanding of these changes so that we can adjust our practice and our training when needed.

 

Chapter Fourteen - Theses on the Heart of Darkness

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The unresolved Oedipus complex of psychoanalytic institution formation*

Peter Zagermann

Since of the gathering bitter of years our people have drunken, Bitterness all the more dreadful because such fair hope had been blighted

(Goethe, 1798, p. 478)

If this chapter is not a polemic one, it certainly has traits of it. It tries to depict a situation which, as I see it, is primarily responsible for the fact that psychoanalysis is so much under pressure on the plane of societal acceptance, and which urgently has to be altered if it wants to survive. This problematic is a consequence of fatal miscarriages of its construction as an organization. Against this back-drop, this chapter is the description of a catastrophe that could destroy one of the finest inventions of the human spirit.

The three columns of training, according to the worldwide prevalent Eitingon model, are the training analysis, the supervision, and the theoretical teachings. Within this model, the institutional sub-formation consisting of all training analysts, that is to say, the training committee, occupies the central role within the institution, as both training analysis and the supervision of the educational analysess—and, in some institutes or societies, also key theoretical seminars—are tied to the function of training analyst. The training committee is, therefore, the identity-giving moment of a psychoanalytic institute. The mode of coming into being of the personnel makeup of this committee is, in principle, the same worldwide: a cooption procedure within which the reshuffle is effected by nomination from within the training committee itself.

 

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