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Saturday, 10 February 2018

The Need for liberating Psychoanalysis

This post is a slightly modified version of an exchange between a well-versed colleague and me, regarding training, and the need for a serious revision of what needs correction, change, and maybe additions, to the IPA system of training, to catch up with the status of psychoanalysis nowadays. I will start with stating my views about contemporary psychoanalysis, to save the reader the trouble of guessing where I am coming from. 

In 1995, the IPA asked a number of distinguished psychoanalysts from around the world to give their opinion regarding the decline of interest in psychoanalysis.Their response was not- in my opinion- satisfactory but it confirmed that the crisis is real and threatening. I believe-though I haven't got confirmed results yet- the crisis is even worse now than it was more than two decades ago. My view is that all the desperate 'justifications' the IPA and the Regional Associations are coming up with are avoiding the REAL reason. Psychoanalysis as knowledge and practice has deteriorated badly over the years. The deterioration, if not just because of the self-deception of some advocates of new schools of psychoanalysis; it is because the IPA training system is by now archaic and not in touch with the changes that happened in the field since 1926. It was originally flawed because of the circumstances of psychoanalysis then, deteriorated further with the deterioration of the Training Analysts' status, and got even worse with the resistance to look at the problem directly as one issue, and the insistence on patchy solutions to its many dysfunctions. Any plea to save psychoanalysis from deteriorating and the very real possibility of its demise hits a stone wall made from denying some obvious facts about training and the practice under the guise of the new schools. 

My learned Colleague is calling for freeing ourselves from an arcane devotion to certain unsupported ideas about psychoanalysis and its practice, which were inherited blindly. She also advocates questioning what has become of the theory of analysis. I agree with what she is advocating but I wanted to add that it is a duty of experienced analysts to protect psychoanalysis from irresponsible attempts at replacing it with very scanty theories and provide it with better revisions of the basic conceptions of the classical theory.

My colleague calls for freeing ourselves from defining psychoanalysis rigidly by what was established for its practice eighty years ago. That practice of psychoanalysis is outlined for us in a haphazard way. The result is that any deviating from that model would not be considered psychoanalysis. Example, if I do psychoanalysis with a patient twice a weak that would not be psychoanalysis. My colleague argues, and I concur that it is not right to judge what is psychoanalytic by the standards of practice that were established in Berlin ninety years ago. When I expressed my ideas about the practice of analysis (in my book on the Classical Theory) I received -let us say- discouraging remarks from here and from some other parts of the world. This is a very strange situation: we are expected to practice psychoanalysis according to a model (Eitengon) that never had a theoretical basis to explain it nor does it have any current justification. Eitengon's model specifies the number of sessions for practice but does not underline the importance of adhering to Freud's clinical protocol. Even worse, Eitengonh model was established at a time when the theory of psychoanalysis-let alone its practice- was not fully developed to be taken as the ultimate in guiding training. At the same time, many analysts practice some sort of psychotherapy based on their school of thought, but four times a week and call that psychoanalysis. Furthermore, there is no defined link between theory and practice in psychoanalysis except Freud's tripartite reservations that we should stick to.  Yet, the most maligned part of the classical theory is that particular well-defined aspect in practice. We have not agreed yet on the relationship that should be between what we call theory and what we designate as the right way to practice.

The reason I am posting this post is a common misuse of the term psychoanalysis. Most analysts-nowadays-take the term to mean what they practice. They have been using the Eitingon model as the criterion of psychoanalysis whatever was their theoretical stance, which could be very far from the classical theory. My colleague raised the flag: psychoanalysis is the dog and Eitngon is the tail. The tail doe does not wag the dog...period. Therefore, it is imperative, necessary, unnegotiable to have a theory of psychoanalysis, that is not a modification, an update, a version of the original. Once that theory is established it could provide a practice protocol that belongs to it and there will be no confusion: what is a psychoanalytic practice.

Saturday, 16 December 2017

4. A view of the future of learning and training in psychoanalysis:

It would be presumptuous if I thought that my views in this posting is going to effect change in the present state of learning and training in psychoanalysis. The resistance to change in the field of psychoanalytic organization (not in theory) is beyond explanation. As one of the quotes that the publisher of “International Psychoanalysis” generously offers us daily says “It is not necessary to change. Survival is not mandatory”.  I think that the maximum my post might do is make more psychoanalysts reflect on the stubborn fixation on the model and function of the IPA training system, which has outlived its usefulness. In spite of acknowledging, in 1995, that psychoanalysis is in a very threatened crisis (see the report of the House of Delegates of the IPA, in 1995).  The report, which is a set of articles written by senior analysts from different societies, ranged from criticising the rigidity of the IPA theoretical position to its laxity, and from the inflexibility of the training system to its loss of identity and vagueness. The best of it was introducing the report by saying that the crises in psychoanalysis is like the epidemic that inflicted Thebes and that we have murder Freud.

The dissatisfaction with the situation created by IPA’s domination od the psychoanalytic scene justified the emergence of universities and university programs in many parts of the world that educate in psychoanalysis, and provide training in aspects of psychotherapy. They are mostly run by trained analysts but their graduates are not recognised by the IPA as psychoanalysts. I am not confident enough to talk with certainty about the adequacy of those academic institutions to train in psychoanalysis. But from the little I know and the few I had a look at their programs I thinks the only obstacle in considering their effectiveness is the loyalty and reluctance of their professors to compete with (betray) the IPA (they are senior members of the institutions in their cities). Contrary to the common belief in the psychoanalytic circles, the IPA institutes offer very deficient training programs. Let alone the rigid belief  that psychoanalysis is mainly  training with some required theoretical background for its practice, training in those institutes is part time, lacks clear standers of education and supervision, unclear about the degree of participation of its tripartite requirements in the formation of the candidates. There is also a major difficulty in dealing with the extensive literature in the clinical field, and in other related sciences, which is overlooked or chosen for teaching for personal preferences among the faculty.

If psychoanalysis is just training in its usage in psychotherapy, the IPA system would only need some mending of its decaying model of learning and training. and that would suffice. Nevertheless, whether psychoanalysts like it or not, psychoanalysis is a human science and not just a method of psychotherapy. No method of psychotherapy, whatever its uniqueness and distinction, could change the human subject and his society the way psychoanalysis did with the whole Western culture. Freud was very conscious of that when he said to Jung on their trip to the US that the Americans do not know what trouble we are bringing them”. I can point out two features in the history of the psychoanalytic movement that confirms that we clinicians did not pay attention to: every advancement in understanding psychopathology opened the gate for knowing much more about the regular ‘human subject’, and every- thing we understood about the individual resulted in understanding issue that are more encompassing that the individual phenomena. As an example, the early conception of repression of sexuality and its discontents led Freud to write about civilization and its discontents. Better, whatever was discovered in the offices of psychoanalysts proved to be much more important on a social level. This is the proof that psychoanalysis is more than psychotherapy. It is also more of a science of the human subject than it was deemed because it influenced the approaches of several other human sciences. Yet, it has to be clearly stated that psychoanalysis is a special human science because it is about the conscious and the unconscious human subject, when the other humanities deal only with issues of consciousness. Psychoanalysis compliments all other human sciences, because including the unconscious in understanding of the subject requires learning a novel way of thinking: the analytic way of thinking.

Psychoanalysts are supposed to be  taught that every psychical given is the manifest of something latent, and that they were also trained to know how to get the latent content through a process of analysis. There are people who area more gifted in that process than others, that is why psychoanalysis as a human science considers the link between the manifest and the latent a matter of learning and not of training. As an example, psychoanalysts should read The Interpretation of Dreams not to learn how to interpret dreams but to learn how a fresh uncontaminated mind (Freud’s) made those leaps from the manifest to the latent, discovering in the way the workings of the primary process in creating the manifest. Learning the psychoanalytic way of thinking is learning how to consider everything human product of an unconscious process that creates a ‘complex’ human phenomenon; or the human phenomena are complex because they are products of conscious and unconscious contents.  Sociologist with a psychoanalytic learning and training will look at marriage and see that behind all patterns of pairing the marital couples is the law of incest: how to avoid it depending of the structure of the society. There is another even more important aspect of the psychoanalytic way of thinking. Freud’s discovery of the role played by the interfamilial conflicts in structuring the unconscious (the Oedipus Complex) obliges the psychoanalyst to think of the unconscious as the way childhood experiences has influenced consciousness, i.e., past or childhood experiences become unconscious. In the other human sciences, the situation is reversed: past experiences are conscious and their meaning becomes the unconscious of the society. However, the psychoanalytic way of thinking makes possible to understand social events psychoanalytically. Nine -eleven is a conscious memory but it created and activated unconscious reactions that were instrumental in electing a black president two terms.  

Psychoanalysis is a human science, and it has a legitimate place in academia. It should be a subject of education first, then its applications would decide its branching into specialization, of which one is psychotherapy. This conception of psychoanalysis imposes on us the duty of looking into the modalities of its learning and training; a task that would make the honest psychoanalysts recognize and realize the limitation of training in the IPA institutes or the similar but independent ones. Having reached this point I find myself in a very uncomfortable bind: I have to show that I have an idea of what I am preaching (or keep silent) but I know that this the work of teams of people from different specializations and are much more competent than I. My experience in academia goes back sixty years and my experience as clinical analyst also goes back several years.  However, I think that moving learning and training to academia should be on the basis of an undergraduate degree in psychoanalysis that covers its onset, evolution, the main discoveries and the extra clinical endeavours, in addition to expose the areas that analytic thinking is required. Post graduate sturdies should be done with emphasis on training, research, collaborative and joint works as the focus of preparing the analyst to work in those fields (just as an example, child psychology, and sociology of the masses).  Some issues of training in the clinical aspect of psychoanalysis will benefit from other academic programs like psychiatry and statistics, that are not available now in the system of training.

This is the end of my post, which is the last posting I will publish on my blog. Becuas of that, I am using this opportunity to express an opinion about training in the process of psyshoanalytic psychotherapy (not in the common coneception of a diluted psychoanalysis). I feel that is could be helpful in clarifying few problems we encounter the learning of psychotherapy.


 Training in the Clinical Practice of Psychoanalysis should not be called training in psychoanalysis, because it is just part of the whole theory

 The reason for underlining this point is a general trend to discarding what is so particular and specific in training in the psychotherapy in psychoanalysis. For training in the clinical practice of psychoanalysis be meaningful, and to serve the purpose of revealing the unconscious (the workings of the primary process in creating the undesirable psychological condition) we have to give extra care to two points: studying, discussing, clarifying and clearly stipulating the importance of Freud’s ‘clinical protocol’ of Anonymity, Abstinence, and Neutrality, and the importance of the regularity of the sessions and their length of time (not the number per week). I am bringing those two points to attention because they were firstly criticized in the literature badly in the eighties and nineties, and secondly because some analysts made a mockery of them by exaggerating them to a silly degree of rigidity. When we come to clinical practice we should remember of our parent’s wise saying: don’t what I do, do what I say. That applies to Freud: do what he says and not what he did in clinical work. The man who discovered transference and transference resistance tried to analyse his daughter!!

Revisiting the Freudian protocol of practice and his conception of transference is essential in distinguishing psychoanalytic psychotherapy from any other psychotherapy. This is what makes psychoanalytic treatment not any psychotherapy. I am raising this point here and now because ‘in my opinion’ rediscovering psychoanalytic psychotherapy is very timely when a review of training is much needed and its future should be considered. Knowing what is therapeutic in psychoanalysis compared to other psychotherapies that do not follow that protocol, makes training in the clinical application of psychoanalysis defined by its function and not by an abstract theory.

To end my post, we should remind ourselves that something significant, major, and essentially daring has to happen in psychoanalysis. I tried several ways to quantitively measure the effectiveness of ‘a clinical psychoanalyst’ if he worked a full day for thirty-five years. The maximum number of patients he could cure ranges between 120-150. Psychoanalysis is more useful than that.

Saturday, 2 December 2017

Psychoanalysis: training or learning?

3. Revision of Dysfunctional System of Training

The training system of Eitingon and its institutes were “unintentionally” a bubble that protected the early psychoanalytic movement from several dangers. The analytic community grew in a homogeneous way, and got early confidence in its distinction from being an organization that is self-ruling. Anyone who wanted to join had to go through the same procedure. The theory was improving and expanding, and it was transmitted to the new comers and the seekers of membership in an organized manner, which tightened the cohesiveness of the analytic community irrespective of its geographic location. Psychoanalysts were saved from having to deal with the critical and negative views of psychoanalysis, which were strong and widespread at the time. Analysts did not have effective means to deal with them within a budding movement few members in number, an unsettled theory and equally unsettling to its members. There was little external social support from the medical profession, which considered psychoanalysis an imposition on it. The new movement was dependent mostly on the status of Freud. 
That bubble was quite useful at the beginning of the movement, but it had its disadvantages. It gave the psychoanalysis a sense of distinction and superiority that was not founded on anything concrete except their isolation. The isolation was reciprocal, as they isolated ourselves from others, others were also avoiding communicating with them. The protective bubble eventually proved to have negative outcomes. Analysts neglected their responsibility to prove themselves and the public was divided unequally in their views about psychoanalysis; a minority was blindly supportive of the progressive ideas implicit in psychoanalysis and a majority were demanding proofs to what psychoanalysts were claiming. Both sides accepted the bubble created by the particular requirement of training specified by the psychoanalytic organization. 
Freud's death revealed a very paradoxical feature in psychoanalysis. During his life psychoanalysts did not make a distinction between theory and practice, or better between learning and training. Freud's view represented both those two aspects of psychoanalysis. Logically, what should have kept the movement united and intact was a stable theory, that it could engender a training system.  What happened was the opposite: Freud did not leave us a theory to unite us, and the system of training, which has become more or less international, functioned as the force behind the continuation of the analytic movement. However,  there were signs of cracks in the organization everywhere due to the evolution of the theoretical issues in psychoanalysis in spite of a silent belief that psychoanalysts was a unified theory. Once again the system of training was the real force that kept the analytic movement seemingly intact. How could psychoanalysis continue on without a unified theory and survive on system of training? Those cracks were not seen then as problems in the theory but were mostly treated as personal conflicts (neurotic idiosyncrasies).
In the late fifties and the sixties of last century a strange thing happened in a natural way; an explosion of publications, formal and informal meetings and media discussion about the unconscious and indirectly psychoanalysis. Almost, a spontaneous ‘international symposium’ was formed from intellectuals in the fields of philosophy (existentialism and phenomenology), literature, theater (the absurd literature of Beckett, Ionesco, Camus!), literary critiquing of old works (Kafka, Flaubert, Dostoevsky), visual arts, and most of all the promising structural theory in the humanities. It was a decade of very rich revival of mutual interest in the human subject, very much in the style of Freud’s dream for psychoanalysis. It was basically a symposium on the unconscious and its presence in all aspects of human phenomena. Some analysts participated ( Rollo May)in that symposium but did not contribute anything of significance, because they were leery of having non-analyst (non-clinician) in their bubble. They were also unable to talk meaningfully about the unconscious that those “amateurs’ were making an issue of.  Psychoanalysts ignored Freud’s third meaning of Ucs. as a system  and the non-repressed unconscious, as they still do. They also did not pay attention that the unconscious has become culturally acceptable and ordinary people started to integrate psychoanalysis in their daily life. In other words, analysts and the analytic organization did not take score of the changes psychoanalysis has introduced to the world outside the bubble of training. The protective bubble changed to become a salient cell of isolation. There is no better verification to this customarily denied fact than what happened soon after that symposium.    
By the seventies clinical psychoanalysis was well founded and extended its domination on several well-established professions like psychiatry, for instance. It also found a place in academia but not in the programs that could have adopted it to link firmly with the university. Yet, something ‘unexpected’ actually happened: the superficial cracks in the British society were no longer mere personal disagreements but were fundamental theoretical differences. The same happened in France but the Lacanian group gave the splits a different flavour: it was a conflict between something  fascinating but does not promise stability and continuity of staid scholarly revision of the Freudian theory. In the US the ‘schools’ accepted coexistence almost creating a federal system of psychoanalysis, yet there were also very novel approaches to long  ignored psychical issue like the psychosomatics, the narcissistic disorders and the borderline conditions. As far as I know, psychoanalysis in South America leaned toward accepting a coexistence of the Kleinian the Lacanian approaches. The diversities of views in the international scene of psychoanalysis were threatening an imminent disintegration of the psychoanalytic organization. Wallerstein as the president of the IPA suggested to accept in principle of psychoanalytic plurality (1989). The schools, as I mentioned in the first part, where not theories of analysis, or new trends in practice; they were the adopting new aspects of the human phenomenon and working on them as main issues in the psychoanalyzing the human subject (interpersonal relations, intersubjective interactions, with contemporary conflicts, etc. In other words, psychoanalysis was no longer a unified theory, but remained a system of training. What is peculiar about that is neglecting the fact that training cannot stand alone but has to be "training in something". So, if psychoanalysis is not a unified theory then we should end up with different kinds of training. This is not the case. We ended up with three training modalities for several schools pf psychoanalysis. Once again the mere concept of training is the force behind the unity of the psychoanalytic organization. Could we have one way of prayer that fits all our religions?
At this point I need to underline an idea that might not sit well with some (many!). After Freud’s death it did not take long for his ‘presumably’ unified theory to fragment. It is easy to use a psychoanalytic template to relate that to the death of the father, so on and so forth. The fact of the matter is that psychoanalysis came with the finding of the unconscious to make the human subject a viable subject for understanding, thus opened the way for disagreements about his understanding. The maturation of the psychoanalytic movement proved that psychoanalysis is a multifaceted approach to the study of the human subject and not a simple one unified discipline. The notion of psychoanalytic plurality became a licence to form schools, which camouflages the fact that psychoanalysis is the science of the human subject and not the amalgam of points of view regarding him the. It is important to bring to attention that all those schools maintained the concept of training with its tripartite structure, and the society and the IPA as the mother of the institutes. In other but more revealing words: the divisions in psychoanalysis kept training and the institutes model as the bubble that keeps outsiders out of the psychoanalytic community.  The revelation that psychoanalysis is not a unified theory should have made analysts look closely into their basic premises and decide if they should follow the training system of the unified Freudian theory or adjust their training to the future practice of their premises.

There was no time in its history when psychoanalysis when a unified theory engendered agreement between all its members. I think that psychoanalysts upheld the idea that psychoanalysis is a matter of training-whatever their theoretical affiliations-to maintain that it could be done only in the IPA institutes. This attitude admirable as it was and still is came on the expense of psychoanalysis itself: it is no longer of any recognizable features, identity, or even professional weight due to putting the emphasis on preserving the institution and not psychoanalysis itself.  Instead of going on articulating the obvious without clear aim to my effort I will give my opinion as I have reached it over several decades of gradual change from a dedicated and loyal advocate of psychoanalysis to becoming a candidate then an analyst and moving to being a training and supervising analyst and finally, now I am back to where I was at the beginning: a dedicated and loyal advocate of psychoanalysis.

Psychoanalysis would force the honest clinician to admit that it is a science of the subject, i.e. it is not just a technique to be trained to use. Better, since analysts could practice psychoanalysis by choosing different psychological manifestations to work with, then psychoanalysis is a branch of the humanities, i.e., psychoanalysis is a human science that covers the totality of the human subject and not only his interpersonal relations, his intersubjective dynamic, his conflicts, etc. Just because it was delivered by a physician and not a mid-wife it is neither a medical specialty nor just a method of treatment. All human sciences (even physical sciences too) started as a unified field to eventually reveal that it could branch out into specialties. Wundt’s and William James's psychologies are now  dozens specialties with links to dozens of specialties.  Acknowledging that psychoanalysis is human science requires realizing that, as such, it was destined to branch out into specialties that links with other sciences, not only idiographic ones. This idea would not find welcoming ears, not because it is wrong but because to comes close to several sensitive points in us. Psychiatrist would consider it a threat to their established privileged position in psychoanalysis. Other professions like psychology and social work, which are involved in the health providing services, would not like being grouped with other branches of the humanities that are not in the field of health services (education, sociology, politics, etc.). Nevertheless, it is not the lack of supporters for the idea of defining the 'genre' of psychoanalysis as idiographic science that would fail; it is the demand it puts on us (all) to revise the system of learning and training in psychoanalysis if psychoanalysis is considered a science in its own right.  

What would the learning and training in psychoanalysis be like if we, our training institutes, and the IPA accepted the idea that psychoanalysis-on its own- is a science and that training in its technique of psychotherapy is only one of its facets?  

Sunday, 19 November 2017

2. Does Trainting Help Psychoanalysis or Hurt it?
      My question could sound frivolous because it cannot be answered before asking another preliminary question: what else is psychoanalysis if not what we are trained to practice? Training- up till now- is the only formal and settled way of acquiring knowledge and expertise in psychoanalysis. It is also the only way to formerly join the psychoanalytic community. The implicit characterisation of psychoanalysis as practice creates a paradox: psychoanalysis is the practice of psychoanalysis.
      In the first part I stressed that the psychoanalytic movement has benefited from the notion of training and the institute system. It allowed giving the new discipline the needed outline to grow and build an identity and to identify its membership. However, when the movement reached full extension and expansion and popularity in the late sixties and the early seventies it started to show signs of fatigue. Those signs showed themselves in a telling way: a trend toward divisions. The one analysis generated several schools, and the schools, with their explicit titles, claimed to be new modalities of psychoanalysis. Yet, they were merely expanding the boundaries of the theory (haphazardly most of the time), indirectly criticizing the limitations of the Freudian Theory and trying to replace it. The result was deterioration in the status of significance and distinction which psychoanalysis enjoyed since its inception. There was also noticeable decline in the interest of young professional in joining the movement. The schools of psychoanalysis created confusion instead of delivering clear ideas of what they suggested to replace the classical theory with. Notwithstanding, all the factions that came out of the main psychoanalytic body maintained the same method of qualifying its members: training in the accredited training institutes. In other terms: whatever the position the new schools took from psychoanalysis, psychoanalysis remained an issue of training. Psychoanalysts, whatever their theoretical bend could not see in psychoanalysis anything beyond its practice. 
      In the last part I tried to show that if it was not for Klein and Kleinian’s psychoanalysis, psychoanalysis would have stifled to death under the weight of ego psychology.  To make that statement relevant to a discussion I would say that ego psychology had a settled and established theoretical formulation of the intrapsychical components and their dynamic interactions, i.e., it had “things to know and to do”. For example, psychoanalysis (the practice) was to strengthen the ego to cope with the demand of the id and the super ego. Theory and practice were substitutes for each other. Klein and the Kleinians thought about those givens, questioned their nature, origins, their implications in understanding the psychical phenomena and what they stand for. For instance, identification was not any more a psychical happening that results from assimilating and owning a characteristic or an attribute of the object, i.e. not a mechanism.  Kleinian psychoanalysis viewed identification as part of the process of the formation of the subject. By doing that the psychoanalytic theory moved from giving things to know to explaining what to be known first. The most significant product of Kleinian psychoanalysis was a new conception of development: what happens to the intrapsychical configuration when the infant starts to have objects and relates to others? Development was not a happening to the psychosexual constituents of the subject, but a transformation in the dealing with the world: external and internal. They were in search of the meaning of what we encounter in clinical practice, and came up with concepts that sometimes were useful (the true and false self) and sometimes not so useful (the paranoid- schizoid position and the depressive position).  The difference between the two schools was that one had firm knowledge that does not need more thinking, and the other was inviting the process of thinking about what is known, because naming them did not explain much. Repeating my self: still although the Kleinians introduced several totally new conceptions to psychoanalysis about what we encounter in its practice and opened the eyes to the need to learn more about those concepts, the Eitingon model of training remained the core of psychoanalytic knowledge. Psychoanalysts refused (not resisted) to see psychoanalysis outside its practice mode despite the vast interest of the none clinicians and the intellectuals in psychoanalysis, since the end of the second world war.
      It was not only the Kleinians who kept the hart of psychoanalysis beating. In France, the end of the first split allowed some of the most dedicated and academicians analyst establish a new society that introduced the scholarly study of the Freudian text; an approach that left ego psychology behind and advance a new and brilliant approach to psychoanalysis. Even Lacan, who was for a while one of that new trend still delivered a dozen Seminars in his “return to Freud” which were exceptionally revealing of Freud’s genius. After that he began his own trip in psychoanalysis. Although I do not know what happened in South America except some responding to both Klein and Lacan, I cannot dismiss the possibility of some great psychoanalysis there judging by Matte-Blanco’s work on the unconscious. Although in both France and South America some significant improvement were introduced to the systems of training was still the only open door to learn psychoanalysis.  
      The Kleinian approach to psychoanalysis showed that there is more to ‘learn’ about the human subject than what training system was offering in the late forties and early fifties. The strong emergence of Keinianism proved that psychoanalysts should take serious steps to explore new domains of the intrapsychical field. Training was lagging behind the novel conceptions that exceeded the stale theory of ego psychology. Kleinianism and the new additions that came from the French and the South American schools of psychoanalysis opened psychoanalysis to the humanities (which existed but was still limited). The new discoveries in infancy could have started child psychology in the fifties on a brilliant course of research and findings. Bion’s theories of thinking and group dynamics could have given projective techniques (Rorschach, TAT, drawing, etc.)  major push to explore the Alfa and Beta elements and functions in psychometry and provide social and industrial psychology with a new vision of small and large group dynamics. Even Ego Psychology, which was almost dying, had things to offer to psychotherapy by the innovations suggested by Rappaport and Gill. There were things to learn and to do in psychoanalysis beside training. Better, the limited understating of psychoanalysis kept the analysts captives of the concept of training and the institutes as the only places for that training to take place. Conflating and fusing (confusing) learning and training in psychoanalysis hurt psychoanalysis badly, not only because it made us, psychoanalysts, miss the chance to link with the humanities, but made other psychoanalyses have the same fate of ego psychology. We turned the psychical processes into operational definitions; for example instead of talking about the ego as ‘ a thing’ we talked about the introjection of ‘part objects’ as a thing that actually happen. Worse, Kleinian psychoanalysis seemed to have something to say about the oral phase and much less to what happened after the infant dealt with the transitory objects, although the way of thinking about the old psychosexual model of developing could have benefited from the Kleinian additions to the oral phase, and extended it to the other psychosexual phases.
      Turning thought into concrete entities, or turning psychical processes into psychical concepts is almost a hidden unconscious agreement not to question each other about what we mean by what we say [ you know what I mean; we are both Kleinians or Lacanians]. This attitude is seldom if ever found in academia, but it is a the pervasive attituded in the training institutes in psychoanalysis: we are not supposed to expect more from training than training. What complicates matters more is that candidates are usually trained by senior analysts who have known affiliations to a school or another. Confusing training with learning made idealizing the training analysts take a disguise in idealising the school the TA follows. It less infantile or neurotic. The problem with the negative role the TA plays in training is not related to the position of the TA, and would disappear by eliminating that post. The problem is limiting psychoanalysis to the idea of training, which in itself puts all the emphasis on training and putting learning outside the equation of the formation of the candidate. The institutes of psychoanalysis are not supposed to be places to learn psychoanalysis but places to trained to practice it. If the reason is not that the TA is a clinician and not a teacher, then it is because the time and the organization of the curriculum in the institutes do not permit enough time to get into the basic propositions of the intrapsychical configuration.  Thus, the learning part in the formation of the new generation is reduced to knowing some fixed conceptions of a very dynamic filed of activity.  What is taught in the institutes is ready made concepts, description of processes that have clinical importence but are meaningless without a good theoretical verification and explanation.
      The answer to my question of does training hurt psychoanalysis is yes. Training blocks learning and gives the impression that what is to be learned regarding psychoanalysis is the technique of practicing it as psychotherapy. It is common in the institutes discourage the candidates who inquire about something implicit in a technical issue. This notion is an inherited parochial belief that psychoanalysis is psychotherapy and every thing else is merely application of its theory. Firstly, we do not have a theory of psychoanalysis yet. Secondly, psychoanalysis is part of and belongs to the humanities; it has a clinical application in the field of psychopathology. Thirdly, psychoanalysis could be taken both as a transitive verb and as a noun: as a verb it is an act that requires training, but as a noun it is a body of knowledge that demands learning. It started as an act but by now it is an important body of knowledge, clearly a component of the human sciences (idiographic sciences), and it is a big mistake to think that that its body of knowledge that could be obtained from other fields of the humanities is of no major importance to the clinicians.

      It is not a secret that psychoanalysts are the ones who reject (not just resist) changing the status quo in psychoanalysis. They are always ready to look into the flaws of the structure of their organizations and try to make modifications here and there. But, they are not ready to see that it is not simply a practice that could be learned by training. There are two obvious points: training in analysis is not learning psychoanalysis, and the institute system of training is not only outdated, it is counterproductive. Why then analysts do not want admit to those two obvious points and work on changing the institute model that was once our reason of existence and now is the threat of our demise. 

Saturday, 11 November 2017

Psychoanalysis: training or learning?

I am disappointed by the  new psychoanalyst’s he level of knowledge of the basic psychoanalytic concepts, and the way they understand and use the works of the main prominent creative psychoanalysts of the past. I base my dissatisfaction on what I regularly read in four main psychoanalytic journals.  My dissatisfaction does not come from disagreeing with what they publish, but from the distorted idea of psychoanalysis which they convey in their works, and using- in inappropriate ways- the works of genuinely creative minds of the past. I lived the glorious days of the splits in the British and the French societies, the rise and fall of ego psychology in the USA, and the birth of the schools of psychoanalysis. Yet, there was always a well protected and preserved core of psychoanalysis among the adversaries, i.e., there were somethings too fundamental to be distorted to fit a debate; the place of the unconscious (not the repressed) in the psychical phenomena, the place of the primary process in interpreting the patient’s material, and the significance of the transference in the psychoanalytic situation. I think the explanation of that unspoken agreement amongst the old and senior analysts came from firm, sturdy and well conducted system of training. We were all trained in psychoanalysis whatever the institute belonged or dominated by some prevailing ideas. I believe that the reason behind what I consider deterioration in contemporary psychoanalysis relates to training more than any other offered causes. That is what I want to discuss in this post. To be clear from the beginning, I am critical of the current attempts to modify, improve, and correct the flaws of the institute system of training despite the serious and sincere intentions of the people who are trying that. I will explain.   
First, I think the tripartite system of training was very logical at the start of the psychoanalytic movement. It guaranteed proper competence in practicing psychoanalysis. However, we have to remember that in the time Abraham and later Eitingon the theory of psychoanalysis was still evolving and there was more than a decade before Freud come to write “The Outline”. Moreover, despite Freud’s remarkable insights regarding the practice of psychoanalysis, which he wrote in 1912, there was little appreciation of its deep understanding of the process of psychoanalysis (I wrote a more extensive version of this idea in my book explaining the classical theory). All in all, psychoanalysis did not have a stable body of knowledge or a clear system of practice that correspond to that theory at the time. Training was necessarily done in institutes. All trades (and psychoanalysis at that early period was merely a budding trade) were doing that in the system of guilds that was the foundation of the industrial revolution and the birth of academia too.
1.The link between training and the theory:
It took the psychoanalytic movement three decades or more to come up with the notion of training the new comers to the movement. At the beginning, training was not the main objective but was the means to screen membership to the movement, and to give the message that recognising one’s affiliation to the movement has to be legitimate by the approval of the already recognised analysts, who ‘founded’ of the movement. This sensible condition became sort of tradition. The objective was very modest and legitimate at the time, because psychoanalysis was merely a new discipline looking for an identity (despite the majority of its members were physicians, some were not and Freud was of the opinion that it does not belong solely to medicine). Thus, establishing institutes for training was very logical because psychoanalysis as a new discipline with very little true literature to learn from had to rely on the old and experienced generation to transmit to the new generation their experience and knowledge; particularly in a one-to-one basis.
In the early phase of building the movement the three branches of training-seminars, supervision, and personal analysis- proved to be the natural and the only available way to transmit experience and knowledge; through personal contact. There was no way to show how analysis is done but by undergoing a period of personal analysis (that it is how it gained the title of didactic analysis). I do not remember the name of the analyst who suggested that didactic analysis is also essential so the psychoanalyst could get rid of his own difficulties. Supervision was also didactic in a more concrete sense of the term. The formation of local communities of analysts initiated the idea of systematizing revision of the available literature, and the seminars were established as the third leg in the tripod of training. Better, training reflected the state of affair in psychoanalysis at the time of its onset, and aimed at transmitting the experience of the old to the new in the fashion of training.
Up till Freud’s passing psychoanalysis was continuing the discovering the intrapsychical and exploring its transformations. As an example, Freud’s discovering of the contribution of infantile sexuality in psychical conflict brought out the notion of the sexual Trieb the ego Trieb. This polarity evolved to eventually become life and death polarity. The cathartic theory evolved into a theory of psychical transformations and constructs (I wrote about Freudian’s other theory that should replace the cathartic theory in 2013). However, Freud kept chasing a final configuration of his discoveries till the end, and maybe gave in to his daughter by accepting her version of ego psychology as a final articulation of the theory. Understandably, training changed into a refined, elaboration, and expansion of the demands of the tripartite system, and founding the institute model of training as the only way of learning psychoanalysis. However, Anna Freud’s presumption that the theory has already been completed, and it only needs to be practiced as such was heading for a big surprise: She just identified the beginning of psychoanalysis. 
While Anna Freud thought that ego psychology is the final version of a theory of the intrapsychical Melanie Klein was turning her attention from exploring the intrapsychical to its origin and early formation.   Her contribution was almost declaring the end of the Road for the Freudian psychology and the beginning of using it to explore something seriously new about the subject. The difference between A. Freud’s mechanisms of defense and Klein’s projective identification was like one closing the door on something established and the other is opening the door for crossing that established limit. Anna Freud calcified and reified the intrapsychical by making a neat description of its content, while Klein gave it life by showing its interpersonal origin and relational framework. Psychoanalysis was stepping out of Freud’s original frame work, thus was changing. Training remained the same tripartite system but personal analysis was expected to become more intense to meet the Kleinian conception of the intrapsychical. Although Kleinianism was not the school of thought in France, for instance, the extended length of time for personal analysis was adopted by the two traditional societies ( while the Lacanians made sort of a mockery of it). They added another aspect to personal analysis in training: a period of personal analysis before applying for training. I think this was a reflection of considering personal analysis separate from training and should be a matter of agreement between analyst and analysand.
The end of pure Freudian psychoanalysis of pressure, defense, and decathecting as the main intrapsychical dynamics, and the rise of psychoanalysis of the processes and transformations was a major theoretical change. Nonetheless it did not affect training in any noticeable way! It is an important question but answering it needs more examination of changes in psychoanalysis itself.
The distinction psychoanalysts made between ‘drive’ psychology and ‘relational’ psychology was interesting, useful but wrong. Classical psychoanalysis was not a drive psychology but of Trieb: the psychology of the representation of a wish in the mind. A representation of a wish IS the psychical, and comes as a manifest that has a content that necessitates its discovery by psychoanalysis. The psychology of the interpersonal is the psychology of the birth of the subject within early relations with the caregivers and the re-emergence of old relational configurations in the contemporary interpersonal relations of the subject. Better, Klein’s psychoanalysis was turning Trieben into be a bridge between the past and the present.  
Could that change have required revision of training and its parochial system? Yes, but the flawed distinction between drive psychology and relational psychology distracted us from the main issue. Nonetheless, it introduced to the training a novel issue in the practice of psychoanalysis: what is the best aspect of psychoanalysing that could reveal the unconscious link between the manifest and the latent in a psychical event? Without paying much attention to the nature of the Kleinian breakthrough analysts (unconsciously) were stated to look for the best method to reach the unconscious link between the manifest (the patient’s complaint) and its content. Better, analysts noticed that they have a chance to read in the patient’s interpersonal relations the unconscious link between the manifest and the latent. In the seventies of last century, the psychoanalytic scene exploded with the schools, which were merely the choice the analysts make in practicing psychoanalysis. 
The schools of psychoanalysis do not offer novel theories of the psyche as the followers think or prefer to think. The schools are not more than a preference of the medium the analyst choses to look for the unconscious. Arguing this point more and better would show that psychoanalysis (training) has to respond to those changes.

In the next section I will address a thorny topic: Does the idea of training the psychoanalysts serves psychoanalysis or hurts it?

Friday, 6 October 2017

Separated Realities
Anyone familiar with the filed of psychiatry is also familiar with the notion that psychotic patients are detached from reality. Yet, anyone who worked with psychotic patients knows that they have their own realities, which is not totally chaotic or loosely put together; their realities are strongly convincing to them. It just isolates them from other realities behind the thick line of psychosis, a line that does not allow crossing it from both directions preventing exchanging ideas.
We (none psychotics) have our own personal realities too. It separates us from other realities with a thin line of subjectivity. It is thin because it could be crossed both ways: we allow others to cross it to test our reality and we cross it to test theirs. It goes without saying that all that happens in relative degrees of easiness. Despite the ease of that exchange we still maintain our own reality behind that thin line of subjectivity.
I have three reasons to mention this simplistic conception of the clashes of realities: The last mass murder in Las Vagus, Trumps speech in the UN a couple of weeks ago, and a subtle but important clinical matter.
It seems that the guy who did the shooting in Vegus did not show any signs of psychosis or history of serious cognitive pathology. He did not cross from his side of the line to our realities. However, his act of shooting has all the signs of psychosis of the schizophrenic (thought disorder). An act of that nature suggests a moment or a short period of psychotic breakdown. Could that what has happened? We are accustomed to measure the severity of mental disorder by the severity of the acts that result from them,  not by the severity of the psychical condition itself, which could lay dormant and naturally out the patient’s own judgment. Dormant sever psychoses is seldom explored now a day, because of many positive developments in psychiatric care and many negative changes in our social life. This “crazy” man was going through a breakdown of his line of reality for only few months before he acted upon it. It showed before his overt breakdown in the spree of buying guns and ammunitions beyond any reasonable proportions to just committing his heinous crime. The personal reality of this man jumped the line and came to our world with a bang. His reality replaced other realities by jumping over the psychotic barrier. .
Trumps speech in the UN was another example of crossing a thick line between his reality and the ‘world’s’ reality.  The reality of the situation was a gathering of presidents, prime ministers and rulers of nations, to give homage to the organization that represents the whole world…..not the  place or the time to declare or initiate any national policy. This REALITY did not penetrate the thick line of Trump’s reality, which is confidence in succeeding to manipulate any crowd as he does in Alabama and Tennessee. The barrier that kept the reality of the situation from reaching him is “narcissism”. We all know that there is a gap between I and Me and that there is a difference between saying I am so and so and being that so and so. In Trump’s case there is no gap between the two pronouns and possibly he has no sense of I-ness to build that gap. Thus, reality to him is not an issue to fret about because it is what he says what it is.
Clinically, we work to introduce the patient to that thin line between his subjective reality and other realities. In a way we suggest crossing that barrier. The neurotic’s psychical difficulty is in that regard is what we call phantasy (his reality is phantasmic). The patient’s phantasy is his identity; it is his Me. It is the identity which was gradually he built from his caregiver’s definition of him during growing up. Its phanatasmic quality stems from unconsciously assimilating what the caregivers thought of him and maybe what he should be. It is not phantasy because there was no realty to compare with in his early childhood. Keeping that in mind should make us carful in crossing the line of the patient’s reality and trying to bring it more closely to another- so called- more or better reality. It could be more harmful to lose this phantasmic reality in the process of analysing it as a phantasy. because all what we could achieve by doing so is suggesting leaving something cardinal in one’s identity without having something to replace it.
I remember three cases that baffled me at the time of working with them and I was able to understand few years after my work with them ended. Two of them left the analysis by their request (one very angry and disappointed) when I became more active in bringing their unconscious reality into focus. The third patient was showing signs of regression when I tried to do that and I had to terminate her analysis before I could have considered it properly terminated.
Final statement in that regard: the most difficult and important in psychoanalysis is dealing with material stemming from parental input especially of that input was accompanied by its verbal equivalent. This explains to me the Americans resistance to eliminating the second amendment which was to serve a temporary purpose when it was adopted, As with patients, doubting or giving up a recommendation by parental authority (the forefathers) creates the anxiety of loosing the nation’s identity, without that amendment the US will not be the same. In a previous mass killing in 2015 there was a TV encounter with a young mother surrounded by her three children who just bought a gun saying she has to protect herself and her kids. That was her reality that  neglected that she lives in a country of great police forces and an equally great judicial system. What the forefathers said becomes the ultimate and the name of the one and only reality.

Question: could we psychoanalysts insist on Eitingon’s model of training for the same reason.  

Saturday, 9 September 2017

Hints about the theory of the subject:

After an interesting exchange with a colleague about the “theory of the subject” I replied to some of his queries in the following note, which he seemed to be a greable to publish it on my blog.

I believe we do not have the same meaning for the term “theory”. A theory, epistemologically speaking, is a statement (s) regarding a subject matter in which the theory provides a comprehensive understanding of the link between the structure and the function of that subject matter. I limit my usage of that definition to what I consider a theoretical aspect in psychoanalysis. Freud did not have a theory of psychoanalysis but had three theories about issues he dealt with in investigating the intrapsychic (dreams, sexuality and Trieb (instinct). For example, his theory of dreams goes that way: a dream’s structure is combining the day residue and a corresponding infantile situation in a visual image, in which the unpleasant condition that instigated the dream is changed to a better outcome (fulfilling a wish). The theory also includes an extensive elaboration of the manner the unpleasant instigator of the dream is transformed into the visual nature of the dream. The theory also shows the mechanisms that makes the function of the dream (wish fulfilment) reach its objective through that particular structure (the dream). I cannot see how psychoanalysis as a whole (not as theories of dreams and theories of sexuality and Trieben) could have a comprehensive theory without a comprehensive theory of the subject, as an ontological entity. Let us go to something concrete. Medicine in the middle ages was a practice without a theory; just very few procedures that were practiced, like bleeding patient of fever or infections. In needed a comprehensive theory of the subject (the person who gets sick) to be become a true profession of medicine. Basically, we still believe in some sort of modified theories of catharsis: make the patient get rid of his neuroses by bleeding out his unconscious as confession, without any idea of how revealing the repressed cures. We also aspire to provide the patient with what could replace his neuroses with new fresh psychical constructs. All that without a theory of the subject or even of cure (in first fifty years of psychoanalysis there was a deep conviction that we work according to a theory of pathology and of cure).

        Some physicians in the middle ages started to investigate the ‘intrafunctions’ of the human body and gradually built the theory of physiology in which each organ has a function that corresponds well with its structure. They also considered the whole body a physiologically dynamic functional entity. At the sametime, when the prohibition on anatomy was lifted anatomy complimented physiology with a better understanding of the anatomical nature of the organs. A better conception of modern medicine was thus born. We do not have such a comprehensive theory of the subject equivalent to physiology and anatomy in medicine. Therefore, we can only claim that our practice of psychoanalysis is ‘points of view’. What we have is modalities, assumptions of functions derived from each analyst’s understanding of their signification, and some idiosyncratic vocabularies. What we need is a theory of the subject as an ontological entity (homosapiens). The human subject is the only living entity that has an intrapsychical life, which has distinct manifestations that are absent even in the high primates. The intrapsychical life of the subject gives him the latent psychoneurotic nature., which other living entities are ‘deprive’ of.
       We practice with objectives and criteria of our creation and based on a belief that they are supported by the theory we adopt. This is belief is unsubstantiated  because what analysts used to have is Freud’s ever developing and changing theoretical configurations. After his death every “idealised” analyst had input in the heritage Freud left us. Freud’s importance is in being the first thinker who stipulated firmly that the human subject has an internal psychical life (in contrast with the banality of knowing that we have human reactions) and that intrapsychical life is affecting ALL our apparent human reactions. Better, Freud is the first thinker who pointed out that understanding human reactions will come from exploring the intrapsychical life of the subject. It is important to note that the insight that created psychoanalysis was the product of more than half a century of laborious works that were full of twists and turns. It was not a brilliant insight that hit Freud like Einstein’s first of two insights that engendered his two theories of relativity. It is important to underline this fact because Freud’s significance appears only when he is studied scholarly to comprehend the way of thinking that was prophylactic against the sudden and premature death of his endeavour. This is a better way of idealizing him. Therefore, we need to investigate and study the intrapsychical enough and better to derive from it what we could use to formulated the theory of the subject. This has to be a collective, collaborative work.
       My interest in the subject pulled my attention to four psychoanalytic Freudian discoveries in the intrapsychical: the wish and wishing, the duality of the I and the Me in self conception, sexuality (infantile and adult) and anxiety. I believe that those four intrapsychical could help other analyst in advancing the theory quickly.  Those four attributes distinguish the human subject from all other living entities including the higher primates. They are also of significant diagnostic value within the homosapiens entity. We can, or used to be able, to relate most of the subjects creative and pathological manifestation to the dynamics of those attributes. Psychoanalysis has to go through the same process that gave medicine its physiology and anatomy; and pharmacology too. Discovering (and or assimilating) the notion that the human subject as a dynamic system of psychological function that integrate to create the psychological human being we deal with, is an essential demand if we want to continue calling ourselves psychoanalysts. I can say that psychology, as an academic discipline has covered a great deal of that territory but got no help from psychoanalysis to compliment the cognitive discoveries in psychology. In other words, the theory of the subject, the physiology and anatomy of the psychological human being, needs to be constructed and seriously construed with an eye on what we still do not know about our intrapsychical life.      However, this is not possible to consider unless we agree on an answer to this question: Is psychoanalysis education or training?

       A couple of years ago I was expressing the idea that training needs a general overhaul and academia should be considered as a way to get to that point. The idea of moving psychoanalysis from the institute system of training to academia, was not well put together in my mind. Thanks to Dr. Arlyne Richards’s sharp mind, she put the problem in this format: education instead of training. What we cannot miss is the psychoanalysts’ preference of training over education. I do not need to delve into the conscious and the unconscious reasons for that preference. However, the main point in answering this question is that psychoanalysis was born as training, not out of choice but out of necessity. There was nothing much to consider the issue of education, and whatever was there to study was piecemeal knowledge. Moreover, Freud and his followers, that will one day require anything different from what they were that time. They were limited clinicians.  E. Roudinesco (2016) said:” Freud had thus invented a “discipline” not only impossible to integrate into the field of physical or natural science but into that of human sciences, an area that had been steadily expanding since the late nineteenth century. For scientist, psychoanalysis belonged to literature; for anthropologists and sociologists, it attested to the resurgence of the ancient mythologies; in philosophers’ eyes, it resembled a strange psychology that had sprung up both Romanticism and from Darwinianism, while psychologist saw in it as putting the vert principle of psychology in danger” (217). No blaming her but to us practicing psychoanalysts. We did not develop the theory of the subject in conjunction with the other blooming sciences and imprisoned ourselves in a narcissistic imaginary isolation. If and when we will configure a theory of the subject we would then provide the neurologist, the biologist, the geneticist, and maybe the pharmacologist with few hypothesises that could guide their pure scientific research in regard of the nature of the human subject, which distinguishes him from the rest of the rest of the living creatures. We could also do something similar with the human sciences.  One of the most important attributes of the human subject is hummer and laughter. It is more than just a differential characteristic of the human subject, it is also-in a way- a differential diagnostic feature. Moreover, it is a developmental yardstick in the evolution of the human infant. We could come up with many questions to aske the the academic psychologist (adult and child) about this feature and let him create a scientific theory about this human subject’s useful attribute, which is a new and rich method of expression (forget the Alamo, and remember Freud’s book on Jokes, 1905).There is a wealth of issues about the subject that has been dug out by the related human sciences that we, as they, needed to work together to create a more comprehensive theory of the human subject. The training system., especially in our institute system, is physically inadequate to regenerate psychoanalysts. Future psychoanalysts need few years of full time education by academics from the other branches of science. A more enlightened training program has to be developed to make psychoanalysis less restricted and not associated solely with the couch. It is expected that this method of preparing future scientific psychoanalysts will not be accepted by the current candidates of training.  Logically, psychoanalysis in its present state will die in two or three decades. However, I firmly believe that psychoanalysis is the genie that came our of Alaadeen’s  (Freud’s) lamp and no one could put it  back anymore. We will eventually wake up.