The IPA, its affiliates, and the future of psychoanalysis by Ahmed Fayak

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3 Comments on “The IPA, its affiliates, and the future of psychoanalysis by Ahmed Fayak”

  1. Tamar Schwartz Says:

    Dear Abbot and All,

    First, thanks to you, to all who responded, and to future responders. I will post this to the open line too, where there is no limit to posts. Although I feel a bit misunderstood, I really welcome this beginning discussion and hope others will join in! We all need to use our voices.

    It is way past time to discuss in depth, exactly what a candidate at an ApsaA institute learns after four years of course work, many hours of supervision, and a training analysis, with a training analyst. Does she learn a psychoanalytic attitude that she brings to all her patients regardless of diagnosis, or does she learn that only a special segment of her pt population, that she is taught to measure, is capable of a special form of work called psychoanalysis? To me this is the crux of the matter. As Bhaskar asked in my original post, is psychoanalysis a delicate orchid or a thorny rose.

    In Chapter 2 of Deepening the Treatment I said about benevolent curiosity: But, if we keep it (BC) as the most important stance to strive for we can interest the patient in deepening the treatment. One reason is that patients see therapists over time as non-judgmental and worthy of their trust. Another reason is that through identifying with the analytic attitude patients become less critical and more curious. In fact, if there is one thing that engages patients in looking inside it is the ability to be benevolently curious about themselves. The therapist***s spirit of inquiry is what makes analytic work possible. How she conveys it is what matters. In depth work is the most rewarding and truly fascinating work. This is why we love it and fight about how to preserve it. But if we truly believe that it is our gift of listening that we present to a patient in a humble yet sincere way, most of our pts will sign on for the journey. Why some of us have full analytic practices an!
    d others do not is a complex issue, not related to the economy or the times. As Arnie pointed out, money is an issue for each of us to contend with in our own ways. But, the more analysis we do, the better we get, and this is what keeps us going.

    My classical training and my training analysis came to life again during my last personal analysis and after my exposure to open minded folks. In order to write Deepening the Treatment 18 years ago, I returned to analysis because, as I said to the analyst: Who am I to write a book? Me, a social worker, amongst all these MD guru/giants. It took this year of therapy to appreciate that I too had a valuable voice and that I had earned the right to use it. My problem was not solely internal because I had experienced in real life, what is going on right now with your some of your letters. How dare I question the purity of psychoanalysis?

    My letter that started this discussion was an attempt to answer Ahmed Fayek’s pessimistic outlook on our field and I used Bhaskar Sripada’s words to bolster my optimism. Interestingly, it was my note that drew the fire. Be that as it may, I gladly carry the flag. Interestingly, no one challenged Ahmet Fayek or Bhaskar Sripada, both MD scholars from distant lands, when they spoke the words I quoted. I mention this to illustrate the game we still sometimes play. Shades of the playground??

    Anyway, it seems to me that if a graduate comes away with an analytic attitude, she will greet all her patients no matter what ails them in a way that no other clinician does: ***free enough from her own conflicts to allow the patient to project his needs, desires, idealizations, and hate onto her and to work non-defensively with these expectations. For extended periods, she may need to be simply a container for the patient***s painful affects, confusion, and hopelessness without succumbing to those feelings herself. She must be receptive to the patient***s transference needs and not rush to correct the distortions. Being an analyst requires emotional engagement in an intense human relationship, while also maintaining appropriate boundaries, refraining from exploiting the patient***s vulnerabilities, and keeping one***s own subjectivities and biases in check so as not to distort the patient***s process of self-discovery.*** Ralph Roughton http://tinyurl.com/zd9xdmz

    I learned early on that this attitude is invaluable when working with the more troubled patients who often thrive on projection. These patients need to do psychoanalytic work and fail with clinicians who do not have an analytic attitude. Having worked with quite distressed people, I attribute all success to this psychoanalytic work that often goes on for 15, 20 years and begins at once or twice a week. Some use the couch and frequency varies. Of course it is easier with daily work. If I was forced to label what we do I would say psychoanalysis with no problem but I prefer the term psychoanalytic work. Unbelievably, just today a patient said that the difference between the psychotherapy she had before me involved pointing out issues and with me she figured out why she had those issues. This pt began at 2ce a week and moved to 3x – now 4x and has been working for 7 years. The change and growth is there for both of us to see. We are on the way to the end – and that will be t!
    he most difficult part. No one really likes goodbyes.

    So, Abbot and others, I understand what you say and I put analysis on a pedastal for years. Trained classically I was taught that frequency and couch equaled psychoanalysis. All else was psychotherapy. The phrase ***that is not psychoanalysis*** was uttered derisively and our pride was buttressed by how many psychoanalytic cases we could claim. It looks like the 1954 debate in JAPA was never resolved. Why? It took place during the hey-day of psychoanalysis. Everyone who was anyone flocked to the couches of psychiatrists who ‘knew what they were doing’ and who ended up training many of us. But did they really know? Did they really see beyond their one person psychology? Did they really go beyond the tilted situation of expert and patient? Could they have been comfortable with the Tom Ogdens we have today? I would say that in 1954 the ApsaA brand of psychoanalysis was responsible for its slow but steady demise. Yet, we cling to the mind-set of elitism and Dr. knows best. Plea!
    se remember that our star analysts of those days gave advice, attended social events, saw relatives and close friends, often blurring the boundaries. Remember, analysts were celebreties then and it went to their heads. How could it not? In the process of being popular (a brand new experience for many who were the nerds in high school) these analysts enjoyed their newfound power and allowed themselves to be idealized. These ghosts are haunting us today and our attempts to go beyond are in the guise of telling the community that we care. Noble and even helpful as that is, I worry that we evade the real issue.

    Kohut, the relationalists, intersubjectivists, developmentalists, child analysts, two-person psychologists in general were/are trying valiantly to save this profession by, purposfully or not, taming our arrogance. As someone said: We do not have the answers, only the questions. People who have a true analytic attitude learn that all patients benefit from what some persist reserving for the special few ‘analyzable’ folks. And if you think about it, everything is free association if you listen analytically. And what really goes on is the conversations between the dyad***s unconsciouses. So how we value our work as guides on unique journeys is what matters most.

    It is my belief that unless and until we let go of the training analyst system and until we welcome our ***psychotherapist selves” (we are them) who understand how to build the ego as well how to analyze defenses, we are doomed because this system reinforces the hierarchical attitude it embodies, an attitude that breeds continued idealization. So we idealize the very treatment that has put us into this downward spiral. This is born out by those of us who sought out personal analyses after the training analysis that disappointed most. (see The Possible Profession by Ted Jacobs)

    There was a time I would have apologized with humility for these words. But today, I speak with passion and with the hope that we all reflect with open minds. I do realize how embedded our problems are and that the chance for change in my lifetime is small but every ray of light we can shine on our past and our perception of it *** as in analysis *** will illuminate the truth. We are now in the working through phase of what will hopefully be a successful psychoanalysis, one that analyzes the idealization still rampant all over the world.

    Jane Hall
    janehallpsychotherapy.com

  2. Tamar Schwartz Says:

    Comment from Bhaskar Sripada, M.D.:

    I do not personally know Bhaskar Sripada however I have been moved and enlightened by his letters on the mem list, letters I often go back to and here is one of my favorites. I think it is relevant in recent discussions. I hope you enjoy.

    *Definition of essential psychoanalysis and its implications*
    Any line of treatment or investigation which recognizes the facts of unconscious, or transference or resistance, takes them as the starting point of its work and regardless of its results, is psychoanalysis.
    This definition of psychoanalysis is based on Freud*s 1914 and 1926 statements concerning psychoanalysis. Freud wrote,

    It may thus be said that the theory of psychoanalysis is an attempt to account for two striking and unexpected facts of observation which emerge whenever an attempt is made to trace the symptoms of a neurotic back to their sources in his past life: the facts of transference and resistance. Any line of investigation which recognizes these two facts and takes them as the starting point of its work may call itself psychoanalysis though it arrives at results other than my own. (SE: 1914d, pg. 16)

    Freud defined psychoanalysis as the science of unconscious mental processes. (SE: 1926, pg. 264)

    This essential definition of psychoanalysis recognizes Freud*s principles (but delinks his principles from his person) and abstracts analysis as a treatment, method of investigation, theory which must be sustained by facts and evidence of its constantly accumulated findings. Neither Freud*s 1914 statement nor the essential definition of psychoanalysis make any reference to the frequency of the analytic sessions or the use of the couch, etc. This essential definition of psychoanalysis is a necessary and sufficient definition.

    Freud made recommendations concerning technique, relating to frequency of sessions per week and use of the couch, for which he did not claim any unconditional acceptance. Furthermore, Freud clarified that analysts differently constituted might adopt different attitudes towards their patients and the tasks before them. It is clear that such recommendations, for which he opposed any mechanization, were secondary considerations and are neither necessary nor sufficient conditions for psychoanalysis. (See Freud, SE: XII, 1913, pg. 123 and SE: XII, 1913, pg. 111)

    Nothing in the essential definition of psychoanalysis prohibits an analyst from directly adopting Freud*s personal preferences concerning technique as his or her own, or from adopting the recommendations of BOPS. However, the essential definition equally allows an analyst, based factors involving the personalities of the patient, analyst and specific tasks of an analysis, from utilizing techniques different from those that Freud used or that the BOPS mandates.

    The BOPS*s definition of psychoanalytic prerequisites for psychoanalysis pertaining to technical recommendations (frequency of sessions and use of couch) have been to-date widely accepted as guidelines for clinical analyses (non-educational analyses). In this mission creep of the BOPS* technical definition of psychoanalysis, generations of analysts have been complicit. This is an error which individual analysts can remedy by actions they alone can undertake.

    It is meaningless to continue our current custom of automatic questioning the frequency of the session or use of the couch to exclude a treatment from calling itself psychoanalysis. So long as a practitioner is cognizant of and can demonstrates actions that take into account facts of unconscious, transference and resistance, the definition grants any practitioner the right to call his work psychoanalysis, regardless of his or her results. This means that analyst, who subscribe to the essential definition of psychoanalysis, must be first and foremost, critically enquire whether the vignette or presentation demonstrates some aspect of the uncovering of unconscious, transference and resistance elements; and be curious and tolerant about the variations in the forms of psychoanalyses. Because of their interest in unconscious, transference and resistance phenomena instinctual, structural, Oedipal, meta-psychological, relational, selfal (relating to the self), inter-subjectival, developmental, etc. based efforts constitute variations of psychoanalysis.

    Essential psychoanalysis has to be based on science and not on dogma and its practitioners must be willing to subject their work to reasonable scrutiny. The freedom of the analyst always serves what is best for the patient. Thus a data base of psychoanalytic vignettes (each one, viewed as a unit of psychoanalytic effort) treated by essential psychoanalysis, using varying techniques (differing frequency of sessions, the use or non-use of the couch, etc.) can facilitate research into determining the efficacy of different frequencies and forms of treatments and test varying hypotheses. This change cannot be actuated by an individual analyst. Unless we invest in scientific practices, we run the risk of being viewed as closer to astrology than to scientific psychology.

    The idea of psychoanalysis and the larger notion of freedom was taught to me by a John, a large eight year old boy, whom I treated in analysis for four years. He was the first of two boys in an African American family that had recently moved from Mississippi to Chicago. His father was a policeman. When he started, he was teased, felt angry and was shy. Because of his size, he was afraid that if he acted out his anger he might become aggressive; he might seriously hurt of kill someone. I saw him four times a week and he used the couch was used for creative play. I treated this boy during era of Rodney King*s *Why can*t we all just get along?* He treated the couch as an imaginary electric chair to meet out justice. John felt that the abusive policeman deserved the death punishment and he was going to meet it out.

    John*s family regularly went to church and John was member of the church choir. The family was steeped in the history of African American culture. In his analysis he came to understand his anger stemmed from his previously unconscious hostile feelings for his younger brother and also feelings towards authority figures such as his dad who was a policeman. He felt both his father and brother somehow got more love from his mom. With the help of analysis he then became less prone to being teased and also more playful with his brother. He acknowledged that analysis had improved his symptoms. But he explored the influence of analysis further.
    Towards the end of his treatment John began to sing church hymns and songs he imagined his ancestors singing as slaves during the times of Abraham Lincoln. He imagined himself living in days of the Civil War. He felt that the songs were a solace in dealing with the pain of bondage and also ways to communicate and coordinate attempts to escape plantations and find a way to the underground railway. His hero was Martin Luther King and he said that his treatment with me was not a dream, but a reality of the “freedom of speech.” He felt that the treatment set him free. He made up songs for me, which he sang with an Indian accent, in fantasizing my adjustment to America as a foreigner. From him I learnt that psychoanalysis was not merely the technical method of interpreting free associations but a larger enterprise of freedom itself.

    The story of the nightingale by Hans Christian Anderson may have some lesson for us analysts. Here is my abbreviated version.

    The Emperor of China heard of the beautiful song of the nightingale, but no one knew where it lived. A poor little girl in the kitchen, led the Emperor*s courtiers to the plain looking nightingale in the forest and invited it to sing for the Emperor.

    The nightingale said that its song sounded the best in the green woods, but willingly came. When it sang for the Emperor the ladies of the court, footmen and chambermaids were all pleased and the visit was successful. The emperor was so visibly pleased and offered his gold slipper to her wear around her neck. She declined adding that seeing his tears was her reward. The emperor decreed that the nightingale was from then on live in the court and to have her own cage, with liberty to go out twice a day, and once during the night. On these occasions the emperor*s servants held her by a silken strings fastened to her leg. The nightingale did not find any pleasure in being thus bound.

    Subsequently the emperor received the gift of an artificial nightingale that was covered with diamonds. When wound it could sing beautifully. The music master who built the artificial bird asserted, that while no one could be sure what the real nightingale would sing, the progression of notes of the artificial bird were predictable and understandable. It was arranged that the two nightingales would sing a duet together. The real nightingale sang in its own natural way, but the artificial bird sang beautiful waltzes. The Emperor and the court fell in love with the artificial bird as it no doubt had extraordinary musical powers. It was pretty as well. Everyone was intoxicated with the songs of the artificial bird. However a poor fisherman remarked that while both the birds sang well, there was something wanting in the music of the artificial bird. He could not say what it was. The nightingale did not feel at home in the confines of the Court, and while no one noticed it flew away back into the forest. The emperor felt that the nightingale was ungrateful. The real nightingale was banished from the empire. The artificial bird was recognized as the best bird and had given an exulted position in the court, by the kings left side, close to his heart.

    After a few years the artificial bird broke down. The Emperor grew ill and appeared dead. The nightingale heard of the emperor*s illness and wanted to bring hope and trust to the kingdom. Suddenly from a bough on a nearby tree sweet music rang out. As she sang, the Emperor*s face lit up. Even Death, who was lurking nearby, said to the bird, *Go on, little nightingale, go on.*

    The Emperor was glad that although he had banished it, the nightingale returned. He asked it to stay and sing when it felt like it.
    In whatever I say, I do not impugn the intention, integrity or good will of the members of BOPS, or APsaA, or any of the great thinkers and leaders that have guided the fortunes of psychoanalysis. But I do question the results of our past and current actions that have led us to our current quandary and keep us there. Something went wrong. We have to change. Some questions will be decided by debate, organizational dynamics or the law, beyond the scope of the individual analyst, which will force us to act in some way or another. In these areas the individual analyst exerts indirect influence. However, there are critical areas, such as the adoption of an essential definition of psychoanalysis which are within the legitimate and direct province of every analyst.

    I invoked Sigmund Freud, Abraham Lincoln and even the Emperor of China to have you be mindful to a remediable area of chosen but unfortunate misdirection to which we all might have contributed. Here I stop. You decide. As an expert in self-correction, you should let your own conscience be your guide. None of these ideas are new, but they can be implemented by any analyst without one iota of APsaA or BOPS input. To the degree to which we agree, let us resolve to put the essential definition of psychoanalysis to work in our individual practices, at our Institutes and Universities, and collaborations with other professionals.
    Analysis is an insightful and corrective balm on man*s suffering. Any analyst*s ability to help a patient is influenced by the degree to which the analyst feels free to employ his own personality in the pursuit of the treatment. Many of our current problems can be remedied by re-remembering and accepting Freud*s original and essential definition of psychoanalysis but adapting it on the basis of every individual analyst*s freedom and for the good of the patient.

    Bhaskar Sripada, M.D.

  3. Tamar Schwartz Says:

    Comment from Arnold Richarads:

    The problem is that adherence to Dr Sripida’s psychoanalytical principles
    in my opinion does not assure a place in the organizational power structure and governance of some psychoanalytic institutes I have seen first hand that what is required is loyalty to those in charge and the group in charge use referrals of scarce psychoanalytic patients faculty positions and training analyst appointments to assure allegiance and conformity. Money talks and principles walk

    This may come across as a cynical point of view but it is consistent with Brecht. First feed the face than think right from wrong

    Arnold Richards


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