International Psychoanalysis

In New York, perhaps more so than in the rest of the country, turf wars are increasing as the turf itself seems to be shrinking. Waging war is expensive in terms of time and money. Such war waging is costing the art, craft, and science of psychoanalysis precious energy and it is for this reason that I post this editorial written by Arlene Kramer Richards. This short and eloquent piece will be delivered at the December 1 and 2 Conference: The Future of Psychoanalytic Education, an ecumenical meeting with Jurgen Reeder as keynote speaker. (Click here for conference details)
Jane S. Hall, Op-Ed Editor

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Why Do I Want to Include Our Colleagues in Licensing as Psychoanalysts? by Arlene Kramer Richards

Different points of view about psychoanalytic education and theory can be grouped, I think, into two categories. One camp argues that psychoanalysis must be safeguarded from those who would debase it by using the name to include therapies that are scheduled for less than three times per week. The other camp argues that psychoanalysis is, as Freud himself defined it, the use of the concepts of transference and resistance to understand the unconscious and especially unconscious affects, wishes, prohibitions and fears. Who is right?

The question has theoretical and practical aspects. I would like to focus on the practical first since I believe that theory serves to elucidate practice, not the other way around. Practically, the words “psychoanalysis” and “psychoanalyst” have become gradually less chic in our culture in the United States. Scientists have complained that the concepts are elusive and un-testable. People who have sought psychoanalytic training have complained of being excluded as not good enough or smart enough to do psychoanalytic work. Those who are excluded then turn around and denigrate the group that excluded them. It should be no surprise to a sophisticated audience to learn that excluding people does not make them friends. But psychoanalysts have been doing such excluding for over a century. How do we get away with it? I think that we get away with it because we have a very valuable technique that speaks to people’s hearts and minds in a way that no other technique does.

The psychoanalytic theory that goes along with this technique seems to some to have no technical consequences. Some have argued that all analysts do the same thing regardless of the theory they espouse. Self psychologists do give interpretations, modern Freudians do take account of narcissistic vulnerability. Kleinians do wait for what they think is a propitious moment to make an interpretation, Bionians do speak to their patients in ordinary language and so on. Others believe that theory calls attention to aspects of the analytic conversation that would otherwise be obscured or ignored. But many analysts agree that the more frequent the sessions, the better the work goes.

Some even believe that no one has the right to call herself an analyst unless she had had her own analysis at three times per week and has been supervised weekly on a case conducted at least three times per week. Some think four times is the minimum to call the work analysis. Some think five times per week is better yet. I myself believe this. But not everyone does. And the number of studies replicated at different times and different places that would be necessary to constitute reliable scientific evidence to back up my opinion is inadequate.

So what do we have to gain and what do we have to lose by insisting that the name “psychoanalysis” be used only for those who meet our preferred standards? I believe that something I learned from a kindergarten teacher and something else I learned from sociologist are relevant here. I went to kindergarten in Brooklyn speaking Yiddish and acting like my grandparents” coddled darling. The kindergarten teacher was teaching me English language and American manners. The teacher said: “If you want to make friends with somebody, you go up to them and say ‘My name is Arlene, what is yours?’. And whatever name they say, that’s what you call them.” I used that to some effect when Section 1 of Division 39 was in a lawsuit that they had brought against Section 5. Section 1 was called Psychoanalyst Clinicians and Section 5 had changed its name from Clinicians Interested in Psychoanalysis to Psychoanalyst Practitioners. Section 5 had no frequency requirements. As then President of Section 1 I believed that Section 5 had the right to call themselves by a name they chose. I invited the officers to a cocktail party, told them what my kindergarten teacher taught me and dropped the lawsuit. Since then no one to my knowledge has suffered from their naming themselves what they aspire to be. On the contrary, the two sections have worked together much better and have even put on joint scientific paper programs. Mutual respect and mutual trust have benefited both sections. Ironically, both are known by number rather than name. People call them Section 1 and Section 5.

Another practical question about the use of the term “psychoanalyst” is the issue of patient referrals. Here there is a less charming story to tell. This is the point I learned from a sociologist. He investigated why there were twenty wedding gown stores on a short street on the Lower East Side of New York. Did it make sense to have so many competitors together? He asked the shoppers and they said they preferred to be able to see everything before they chose anything as important as a wedding gown. He asked shopkeepers and they said they got more shoppers in that location because the shoppers could see more inventory than any one shop could afford to carry. Although it is counter-intuitive, locating a store in a neighborhood that already has a similar store is a better marketing move than pioneering. The more that is offered, the more people will come to see the offerings and select something. Walking down Madison Avenue the other day, I noticed a block that has nothing but high end jewelry stores, more than the local residents could ever need. The principal is the same. And interestingly, lots of stores selling fake jewelry were right nearby. All price levels, all quality levels and lots of shoppers. No one mistakes the fakes for the real, no one chooses the fakes over the real. People buy what they can afford and what seems worth it to them. Having Fords on the market does not hurt the sale of Mercedes. In fact, people call them both cars, but some people want and can afford the Mercedes, some want the Ford even if they can afford the Mercedes and having the most choice makes for the best sales for everyone.

When I told a colleague that I think that those who do less frequent treatment are good for psychoanalysis she said: “Of course, they are the people we supervise and they are the people who come to us for analysis. They know what is best. They treat the people who can’t afford us and we treat the treaters.” In my own practice and those of my colleagues and friends it is rare for a person outside of our field to come into treatment asking for psychoanalysis. It is even more rare for a person to ask about credentials beyond whether one participates in an insurance plan or not. The truth is that most people come because they have a complaint or a symptom or multiple complaints and multiple symptoms. They want relief. And anyone who can deliver that relief is the one they want to see. The people who come for psychoanalysis are often the people who are in or entering our field. Often they get a referral. And therein lies the controversy. Does one get more referrals if one excludes others, or does one get more referrals because one has a wide network of friends? It has been my experience that the wide network wins over exclusion every time. And one way to a wide network of friends is to avoid hurting other people’s feelings unnecessarily. Of course another way is to band together against a common enemy. Find an outsider against whom all the anger and frustration can be directed thereby ensuring a diminution of anger and frustration within the group itself. I prefer the first way. Others may prefer the second. I believe that psychoanalysts need more friends, not a common enemy.

So much for the practical; now a moment for the theoretical. With regard to the concepts of transference and resistance as the measures of whether a treatment is psychoanalytic or not, I was amazed to recognize that Freud had used adherence to libido theory as the touchstone of what was psychoanalytic until he gave it up for the dual drive model. It was only then that he appropriated the ideas of colleagues he had read out of the movement, ideas about power that had come from Adler and ideas about ego that had been broached by Jung and incorporated these ideas into psychoanalysis. Of course, we all have experienced being told by supervisors to look for the negative transference, to articulate the erotic transference, to look for transferences from the parent of the sex opposite to the analyst. We all know that this is the difference between other therapies and psychoanalytic therapy. Those of us who do supervision know that it is the heart of the supervisor’s job to listen for and point out the transference meanings of the patient’s communications. This is the intersection of theory and practice. This is the crux of the analytic process. All the rest is variable: one patient needs help with self esteem issues, another with anger management, another with fears and so on, but the constant in psychoanalysis is the focus on what is going on in the room, what is happening in the transference, what counter-transferences are evoked, what counter-transferences are being brought into the room by the analyst, how these interplay in the analytic conversation. The need for learning through supervision, the need for learning theory from the literature and the need for having a personal analysis are all correlates of recognizing the power of transference and are all ways of learning how to recognize, articulate and communicate it when it appears. Psychoanalytic education that includes all of these is important. We all agree on that. The issue of frequency and the issue of how frequency interacts with diagnosis are still debated. As long as they are questioned, they are a less firm base for standards than is the centrality of transference and resistance.

For both the practical reason that we want to continue the field of psychoanalysis and our own analytic practices and the theoretical reason that transference and resistance are the firmest foundation for analytic understanding, I think we need to welcome our colleagues who practice at different frequency from ourselves as fellow psychoanalysts and welcome ones.

This entry was posted on Friday, October 12th, 2007 at 6:58 pm and is filed under Editorials. You can subscribe via RSS 2.0 feed to this post's comments. You can comment below, or link to this permanent URL from your own site. Your comments will be moderated but will appear as soon as humanly possible.