In reading this paper I cannot help but be sympathetic to its author as he expresses his distress at the past state of things in the Institutes of the American Psychoanalytic Association. However, my response to his negative feelings about the current state of affairs, at least in regard to how he sees the influence of post-modernism and the diminished respect for the knowledge of experts, is quite mixed as it contains some agreement and much disagreement with his arguments. Since we have both been trained in Institutes of the APsaA, he at the Michigan Psychoanalytic Institute and me at the Boston Psychoanalytic Society and Institute we undoubtedly have shared the experience of the authoritarian atmosphere that characterized these Institutes in our own training years. While I am the even older than he is I suspect that neither geography or more informed thinking resulted in either organization being more open to curiousity and questioning of what could only be called the received wisdom of that period. In those days either you went along with what was being presented as true psychoanalysis or you would simply not advance or beyond that be extruded from the local world of psychoanalysis in your city and Institute. Many talented individuals with independent creative thinking were denied training or deemed unworthy of elevation to training analyst status. Furthermore, our Institutes shared in and reflected societal homophobia and adversion to divorce and sexuality outside of marriage in general. It is a fair conclusion, one that I share with Fred Busch, that the 60s-80s were in general very bad times for the Institutes of the American Psychoanalytic Society, not in terms of recruitment for training but because of who was deemed desirable and who was excluded.
But then Busch goes on to describe what for him is a most unfortunate
and unwelcome change from the regrettable authoritarian atmosphere of psychoanalytic training to the even more unfortunate turn against what he sees as legitimate authority. Authority that, in his opinion, and possibly compatible with some of my own views, is the legitimate claim of those who know, who have had experience, who rightfully lay claim to superior knowledge that should be respected and even revered by those who choose to learn psychoanalysis. The candidates have, in his experience and opinion, lost respect or regard for the knowledge that experienced analysts and teachers have acquired over their decades of experience. They lack respect (for him) as well as for their elders who should be respected. If, as beginners, they know next to nothing how dare they question the truth and knowledge that those who have practiced and thought about the human condition present to them as truth. He further asserts that our Institutes have failed to value classes and seminars preferring to have psychoanalytic education rest on the training analysis and supervision with the result that candidates ignore the importance of significant contributions that have come through the literature. These papers, for him, should represent a kind of canon of psychoanalysis, the knowledge everyone who trains in psychoanalysis should and must be expected to learn. He sees education without such stringent emphasis on what we already know and have codified in our literature as degraded and more or less worthless.
I think that the changes Busch is reacting to in Institutes of the APsaA cannot be denied, however, the historical context of change needs to be elucidated in order that they be evaluated in terms different from the ones that Busch enumerates and focuses on. When I began psychoanalytic training the Institutes of the APsaA were maintaining their insistence that only those with medical training could be considered for training in our Institutes. Thus, we as candidates were all graduates of medical school, internships and residencies in psychiatry. Psychoanalysis dominated the psychiatric departments around the country. In Boston, for instance, the heads of psychiatric departments at our three medical schools were all analysts, with several bearing the title of Training Analyst. Psychiatric training was expanding such that a program like the Harvard-Massachusetts Mental Health Center (the Old Boston
Psychopathic Hospital) had 25 residents in each of three years. Most of those going through Mass Mental as it was called then applied for psychoanalytic training at the one Institute in Boston, namely BPSI. A surprising number were rejected on the first application and most were accepted only provisionally. Not only were you expected to be outstanding in your medical and psychiatric training, you were also supposed to be what was deemed to be emotionally stable and mature. Ego psychology reigned supreme and many forms of being were considered evidence of ego deficits. Homosexuals (certainly of the male type if overt), heterosexuals with multiple partners and no sign of settled stability of marriage, divorced individuals all failed to meet the criteria for acceptance into BPSI. Retrospectively, one could equate the standards for acceptance to those current at that time for country clubs with the exception that Jews were welcome! It was highly usual for a candidate to be forced out when he or she clashed with their Training Analyst and there was no appeal process. The excluded individuals were seen as defective; the judgement of the TAs being considered above reproach and countertransference hate was never acknowledged or recognized.
Institute life between the 1960s and 1980s was dominated by powerful TAs who maintained strict control over who advanced as a candidate, who was allowed to teach and who would be “tapped” to be considered for promotion to TA status. The failure to be elevated to TA status meant that you would be a “service” analyst, one, who if favored could teach courses on theory and technique but not be given responsibility for clinical seminars. Furthermore, it was unlikely that such an overlooked analyst would have a full practice of patients in psychoanalysis at a 4-5 x/week frequency. Training analysts on the other hand could expect to have as many as 6 candidates in analysis at any one time because the number of applicants for training was so high. The hierarchical nature of our Institutes resembled a bee hive with a solitary Queen bee being replaced by the many TAs who were like Kings and Queens. Life flowed from them to those below who if they chose to remain connected to the Institute and Society accepted their lesser role and gladly provided services that were below the TAs sense of themselves. The establishment TAs selected new TAs who would join the club, fit in with the overall
zeitgeist of the particular Institute, thus insuring a continuity of theoretical stance and practice of psychoanalysis. The overall effect of the TA system as practiced was to establish only one pathway to power and economic certainty; either you became a TA or you somehow managed to survive on the overage from the TA establishment. The latter fact resulted in the suppression of dissent because to question the system meant to be outside the overflow system of referrals.
All might have been seen as perfect, the natural order of things in the psychoanalytic hierarchy. At our national meetings badges were color coded to indicate where any individual attending fit into the hierarchy. There were, of course, critics who expressed discontent about the status quo. The non-medical psychoanalysts managed to continue to exist and at least in New York had their own Institutes that did well enough for those in clinical practice although their contributions in terms of papers were sequestered from the mainstream psychoanalytic journals like the Psychoanalytic Quarterly and the Journal of the American Psychoanalytic Association. Psychologists like Fred Busch who managed to get through the waiver process were accepted for training thus producing a series of psychologist psychoanalysts whose training was in classical psychoanalysis. The fortress mentality was developed around a fight on several borders. First, the attempt to keep the APsaA entirely medical meant establishing a pathway to accept some PhD psychologists through a complex system of waivers after the initial attempt to do so by having them pledge to train in analysis only for research purposes. Although this pledge was often openly ignored the psychologist psychoanalysts pretty much towed the line and fit in with the goals of the establishment. It was in this atmosphere of holding the line that three non analyst outside psychologists started a lawsuit against the APsaA on the grounds of restraint of trade. This was a costly lawsuit that was seen by the leadership of the APsaA as important to fight; keeping the psychologists out appeared to be necessary for the survival of psychoanalysis as a prestigeous medical sub-speciality of psychiatry. It was feared that openly admitting psychologists with PhD's would in turn result in lower earnings for psychoanalysts and less respect from the public. However, considering the importance of psychologists in Europe and
South America the insistence that psychoanalysis stay in the hands of psychiatrically trained MDs was obviously a difficult argument to win.
As cost of the lawsuit mounted the leadership decided rather precipitously to settle the lawsuit, granting the psychologists full entry into the Institutes of the APsaA as well as giving them financial assistance in starting their own Institutes. To many members of the APsaA this appeared to be a serious defeat, a capitulation to those whose presence in our ranks would lessen the prestige and standing of psychoanalysis with the public but to others, the settlement by avoiding a trial that would have been expensive and tarnish our reputation, was the best possible alternative. The administration that settled the lawsuit was seen as effective in saving the organization from financial ruin when we all knew that psychologists lawsuit was likely to be lost if for no other reason than that psychoanalysis was being practiced by non-medical psychoanalysts around the world and in the United States by psychologists trained in non APsaA Institutes. What followed the settlement of the psychologists legal victory wasn't predicted by many if any members of the APsaA whether or not they favored opening training to non-medically trained individuals. Because of factors that hadn't been considered the number of medically trained applicants for training dropped off precipitously because of a confluence of factors. First and most important residency programs in psychiatry began to turn away from teaching dynamically based psychotherapy as part of the basic curriculum. Unlike earlier times when many graduates of psychiatric residencies could be assumed to have been exposed to at least 2x/week psychotherapy with suitable patients there no longer was such a group of potential candidates. Psychiatry programs had turned away from teaching dynamic psychotherapy based upon psychoanalytic ideas of development and therapeutic approach to a biological orientation that aimed at utilizing the increasing number of psychopharmacological possibilites for treating psychosis and depression.
If psychoanalysis was to survive in the institutes of the APsaA it would have to have sufficient numbers of candidates able to be in training analyses and in turn able to maintain practices to generate their own cases
for analytic supervision. Ironically, the lawsuit provided an immediate solution although it required the broadening of non medical candidates to include social workers. Including these two disciplines rescued our Institutes from a slow death by attrition but it also changed the nature of institute life by providing candidates totally unused to the hierarchical nature of medical training. Psychologists, in general, applied for psychoanalytic training at a much older age, many of them having practiced dynamic therapy for many years if not decades before applying. They saw this training as something they had been wrongfully denied and as such entered training with a sense that they were going to take what they saw as helpful to their current practice of treatment. Social workers were often younger and less interested in the economic issues involved in training or practice because they were mainly female, married and able to afford the training because of their spouses economic success.
In Fred Busch's description of his experience in leading a current clinical seminar for candidates his sense of injury and offense at the candidate who liked it better when they all just sat around and said what they thought about the case (then when Fred led and monitored the discussion) is central to his argument against the new atmosphere in our institutes. The unfortunately outspoken candidate seems to represent, for Busch, all that is wrong with those who are dominated by post-modernism, the dominance of individual subjectivity (Owen Renik) and the inevitability of countertransference and its use by the analyst in crafting his or her interventions. I don't doubt that any experienced psychoanalyst might be offended by a candidate indicating that it would be best if he or she left their seniority at home and simply associated in response to the clinical material in the same way that each of the candidates were expected to; spontaneity and individuality were now being given preference over authority and its claim to superior knowledge. However, it is likely that an appreciation of the changes in the world of psychoanalysis that had taken place over the decades that followed the dominance of an authoritarian atmosphere in our institutes would have lessened the discomfort at encountering the new democratic approach to learning that Fred Busch encountered.
The position stated by Roy Schaefer as quoted by Busch describes quite accurately how psychoanalysts like Schaefer saw the role of the training analysis in providing all graduates with the capacity to monitor and filter out their own subjectivity to prevent it from intruding on the analysis. A well analyzed analyst, according to Schaefer need not worry that his or her objectivity will be overshadowed by their subjectivity, nor will countertransference be uncontrolled and enter into the analytic field. Busch finds Renik's assertion that we never, as analyst, know anything about our patients objectively but that what we are always talking about comes from ourselves. In this view of Renik, a view that is clearly in opposition to Renik's actual perspective, Busch sees an avatar of all he finds as proof of the deteriorating appreciation of truth. Here, he is definitely wrong because Renik isn't denying the existence of truth but merely insisting that the truth the analyst can actually “know” is about himself and not some absolute representation of the patient's inner reality. Renik in the 90s represented a unique critic of psychoanalytic practice in the United States. His was a voice that carried great weight and as Editor of the Psychoanalytic Quarterly and Chair of the Program Committee of the APsaA he was able to recognize the importance of the interpersonal relational perspective. He not only introduced relational psychoanalysts like Stephen Mitchell, Jay Greenberg and Jody Mesler Davies to the meetings of the APsaA he also brought their papers into the Quarterly at great risk to his status with classical psychoanalysts who largely dominated the Psychoanalytic Quarterly. As revisionist as Renik was at that time he avoided addressing any issues that he had with classical psychoanalytic theory. He was steadfast in his respect for the importance of the drives i.e. a psycho-biological orientation and for the primary importance of the pleasure principle in determining defenses and choices that any individual makes in the course of their development.
In contrast with his conservative position regarding basic classical psychoanalytic theory Renik virtually attacked the traditionally received wisdom about technique. Most famously he wrote about “playing with your cards up”. The analyst's insistence on Maintaining anonymity was seen by Renik as a kind of willful mystification of the analyst that served only to intensify transference distortions. The analyst in his view had to
be a real person simply because it was his or her subjectivity that entered into all aspects of communication between analyst and patient. Because Renik's revisionist approach to technique led the way to change in how psychoanalysis could be practiced by those who were uncomfortable with working from behind the safety of a “professionally constructed self” his papers and presentations meshed with the interpersonal-relational perspective. This alliance and his insistently open and inviting position to members of the William Alanson White Institute resulted in a greater receptiveness among classical training psychoanalysts to the work of the relational school. Papers published in Psychoanalytic Dialogues began to appear on the curriculum of APsaA Institutes which in turn helped derail the control of those who represented the classical contemporary conflict theory model that had dominated the APsaA Institutes.
In Busch's concern and critique about the status of “true (or valid) authority” and knowledge in the Institutes of the APsaA he points to the erosion of respect for psychoanalytic theory and beyond this with accepted models of clinical psychoanalysis. Both have, in his perspective, the right to claim ownership of psychoanalysis. The challenges to classical conflict theory, the stuctural hypothesis and its dominant expression as ego psychology however have undermined the assertion, so basic to Busch's argument, that there is a core of knowledge that stands for our psychoanalytic heritage and against the post modern stance that knowledge is always a construct that changes based upon the subjectivity of the individual attempting to be a psychoanalyst. The existence of competing psychoanalytic theoretical schools has to be acknowledged as does our inability to prove that any particular approach results in superior clinical outcomes. The theoretical contributions of Melanie Klein represented the first serious challenge to Freudian psychoanalytic theory that proved too resilient to be silenced as the theoretical challenges from Adler, Jung and Ferenczi had been. Klein and her thinking simply overwhelmed Anna Freud and the Freudians in London and while a compromise within the London psychoanalytic preserved a Freudian track the robust track has remained clearly Kleinian in orientation. Klein as a non-medical psychoanalyst assumed a degree of freedom in her assumption of a complex mental life of an infant in the first year of life.
She and her followers endorsed a theory that was meant to explain all aspects of mental life ranging from generalized concepts like envy, hate, restoration, repair, guilt and depression as well as the etiology of major mental illnesses like schizophrenia and manic-depression.
In the United States with its medically trained psychoanalysts the impact of Klein's theory between 1960 and 2000 was not only minimal but was greeted with total rejection precisely because it posited a fantasy life tied to nursing, excreting and parental intercourse that exceeded the biological capacity of the infant's brain development. The Kleinians while ignored in this country captured the majority of analysts in Great Britain and most of South America. With the publication of Roy Schaefer's “The Kleinians of London” there began to be a greater appreciation of how modern Kleinians used her theory in approaching or finding a deeper inner psychotic core in all patients regardless of what problem they initially brought to their analyst. Since 2000 there have been increasing inroads of Kleinian thinking on psychoanalysts in the United States. This is particularly true when it comes to adopting parts of Klein's system into the conflict model through the pathway of the defense mechanism of projective identification. Klein's followers in Great Britain have made this concept central to their work with all patients in analysis. The power of projective identification rests in its enhancement of the analyst's use of countertransference feeling states to make attribution to the patient about what the patient is actually wanting to rid themselves of by insistently putting that content into the analyst. The shift to an enhanced use of the analyst's countertransference has contributed to the trend in our institutes that Busch finds so distressing. If countertransference is the analyst's guide to the inner unconscious life of his or her patient then there are no generalities that can be taught to candidates; rather they can only learn psychoanalysis from consulting with their own countertransference! Under such an assumption it isn't surprising to find candidates questioning authority even when it is free from an authoritarian bent.
The existence of competing schools of psychoanalytic theory is an additional source that encourages scepticism among those currently in
training at our institutes. Relational analysts may see themselves as quite distinct from Self Psychologically oriented analysts but both can be experienced by candidates as in opposition to classical contemporary conflict oriented analysts. The prescribed technical stance of abstinence, anonymity and neutrality that have reigned supreme in classical ego psychology technique are quite inappropriate for those analysts whose focus isn't on infantile drives sequested in the unconscious. Such a theoretical set of assumptions that reduces the aim of psychoanalysis to an uncovering of repressed and suppressed drive derivatives inevitably results in an analyst who is more an objective observer and interpreter of the patient's unconscious drives and the resistance to these drive-wishes being revealed. Once analytic theory is freed from total dependence on drives and the unconscious there follows a shift in technique away from psychoanalysis as a treatment with a specific goal of reaching unconscious drive derivatives and interpreting their existence to an unsuspecting patient. Once there is a shift to a two person vision of psychoanalysis we enter a form of psychoanalysis where there is no certainty, no clear causalities and no explanations of behavior that can be considered to be anything more than co-created fantasies of the analytic couple.
What we have reached is the very point about knowledge that so distresses Fred Busch when he reflects on the current status of knowledge in institutes of the APsaA. In so far as he is correct we would have to acknowledge that post modernism combined with an increased emphasis on the analyst's subjectivity and countertransference intuition has resulted in a kind of anti-intellectualism and an “authoritarian anti-authority”. In a word, not only has nothing good happened but quite the opposite, essentially the decline and fall of psychoanalytic greatness, a greatness that rested on the establishment of an unquestioned body of psychoanalytic knowledge. In the context that I have described a very different interpretation of these changes that Busch deplores is not only possible but mandatory. The practice of psychoanalysis has taught many analysts to be sceptical of the received wisdom coming from our esteemed predecessors. The tradition of analysts following one “master” followed by another continues to dominate in many quarters. In Italian Psychoanalysis Winnicott and/or Bion seem to be the dominant
intellectual powers in the work of Ferro and other prominent Italian contributors to the literature. Of course tribute is always paid to Freud before the contributions of others are seen as superceeding his earlier and clearer view of psychoanalysis as a theory and a therapy. While Bion has admonished all those who would be analysts to approach each hour “without memory or desire” in an attempt to allow analysts to make new observations and discoveries in each hour with each patient there is little evidence that even his followers are able to free themselves from the influence of his broader ideas. For some analysts who practice utilizing multiple theories it is a matter of matching a particular clinical moment with a specific theory in order to explain the intervention that they make. Such analysts are able to hold all theories and use them in accordance with how they see fit, how well a particular theory utilized at the moment will move the analysis forward. In doing so they successfully avoid dealing with contradictions between theories, contradictions that a strong critical position such as the one taken by Rachael Blass regarding the totality of Kleinian theory making it unsuitable for partial adoption, finds inevitable.
Is it possible to completely turn Busch's problem with knowledge in our Institutes on its head and in doing so conclude that the very changes he deplores are possibly both positive and useful if we are to develop an approach to psychoanalysis that makes it viable and adapted to the demands of the current marketplace of psychotherapies. Busch's argument rests on our past history of authoritarian teaching at our Institutes but, while he and I agree about the deplorable nature of authoritarian teaching in the past, he sees the erosion of respect for authority, particularly for those who teach in seminars, as most unfortunate while I, to the contrary understand and approve of questioning authority itself. The result is a leveling of the hierarchy and the establishment of a more democratic individualistic approach to teaching in which each participant in any seminar or supervision should see their own subjective response to a patient or a paper in a seminar as of equal importance to that of the experienced teacher or supervisor. This isn't the anti-intellectualism that Busch claims it represents. Rather, it acknowledges that if psychoanalysis is a clinical discipline it has to change with the experience of
those who practice it as clinicians who are open to learning new things from those individuals they analyze. The rules of technique and the limits imposed on thinking by theory need always to be held in abeyance, always considered as potentially limiting the therapeutic effectiveness of a particular patient's analysis, and sometimes rejected as belonging to a different period when social norms were constricting and harmful to many individuals.
When we as psychoanalysts insist not so much that we be without memory or desire but rather that we be without preconceived notions that result in our operating from behind a professional self that suppresses our ability to be a true participant observer we will have evolved beyond the limits imposed by the legacy of our beginnings. The technical triad of anonymity, neutrality and abstinence has historically served the purpose of supporting psychoanalysis as the only pathway to uncovering the destructiveness of the infantile drives that are purportedly sequestered in the safety of the unconscious but always capable of driving our lives into pathological actions and decisions. The role of the relationship between analyst and patient in achieving a therapeutic outcome was historically denigrated thus depriving patients of what they needed to understand themselves, their conscious and unconscious selves and their character structure, conscious and unconscious. While many in analysis were able by force of character to extract the relationship they needed from even a technically excellent analyst this element has continued to be downplayed or ignored by many in the world of psychoanalysis. The changes in how authority is viewed and the resistance to the idea of authority possessing knowledge may well be our salvation rather than the ruination that Busch believes it to be.