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Inevitably, I look back all the way to the start, to my first day of psychiatric residency when, totally green and feeling lost, I was given the names of a dozen patients for whose therapy I now was responsible. Bewildered, I turned to a new co-resident, an older woman who had left her pediatric practice to learn child therapy and who herself was assigned a dozen child patients.
She was less confused than outraged. She stormed into the head of the department's office to confront the man at the top. How dare he assign patients the first day, before any of us had any idea of what we were supposed to do? These children were real people. She was willing to work hard, but patients could not be assigned to her until we had been taught how to do therapy.
The chief thought for a moment, then leaned forward and answered in a candid tone. “I'll tell you the truth,” he said. “We wanted Anna Freud, but she's busy.”
So we have to figure it out. We read, we study, we get supervision—but in the end, the essential responsibility for on-the-job training remains our own.
Over the decades I have been privileged here and in Europe to take part in many dozens of clinical study groups. I have been among the yeomen, arguing and learning with them, and I have been with the supposed immortals. And my early impression has only solidified through the years. It is that beneath the intense disputes over dynamics and technique lies the underlying question over which those battles are fought, the question of what an analysis is, what an analyst is trying to do.
Answer that and questions of technique become merely logical, because technique is attitude actualized. What makes