I want to thank Dr. Jachim for a stimulating essay on this very controversial topic in psychoanalysis. It raises the question as to whether the insistence on a certain frequency has less to do with the need of the patient than with some fixed rule decreed by the powers that be for extra-analytic reasons.
Psychoanalytic training has always been a contentious subject. The most recent upheaval was precipitated by the action of the IPA Board at the Buenos Aires Congress in 2017. By an overwhelming majority, the Board voted to allow societies to have training analysis at three times a week if they so desired. It added a measure of flexibility, giving more autonomy to local societies. At the same time societies who wanted to continue with the old frequency requirements were perfectly free to do so. Both North America and Latin America voted in favor of the change. In Europe there was a split where the societies of Northern Europe vehemently opposed the change. It should be noted that the vote explicitly did not make the change mandatory. Each society is free to choose, according to local conditions, which frequency it would require. This makes the vehement objections more interesting.
This vote by the IPA Board had both political and theoretical reverberations. The president of the British Society, in a letter this year to the president of the IPA, questioned what the core IPA function was and what was the main contribution the IPA can offer the psychoanalytic community. In addition, she wondered whether the IPA was still responding to European concerns and interests. Another member of the British Society wrote a blistering letter questioning the legality of APsaA's regional status and its independence in training matters from the IPA. In parts of Europe, there is a fear that the officially sanctioned times per a week frequency will fatally blur the distinction between psychoanalysis
and psychotherapy. The quandary of the Europeans was best expressed by one of their society presidents: “If we keep the standards as they are, psychoanalysis will marginalize even further, but if we change the standards, psychoanalysis will dilute; the borders with psychotherapy will disappear.”
In my experience (some 50 years of it) there is no procrustean bed into which one fits all patients. There is nothing sacrosanct about frequency, be it either three, four or five times a week. It should be noted that originally Freud saw patients six times a week. Freud practiced analysis at that frequency for decades. Ultimately, what should really guide one's approach is the need of the patient. Some patients do very well at three times a week but for more severe pathologies higher frequency generally produces better outcomes.
Having lost the frequency debate, the Europeans then resorted to another strategy. Presently Europe pays slightly over 50% of IPA dues, more than North and South America combined. Their argument is that since they pay a disproportionate amount, they should have greater representation on the IPA Board. With greater representation they would have greater power and steer IPA policies according to their wishes. There is also a feeling among some Europeans that the three regions are so different that each region should decide how to manage their affairs. This would result in a dramatic weakening of the IPA as a worldwide organization.
Another reverberation resulting from the vote on frequency has been a heated argument as to how the IPA should vet German societies that practice training analysis three times per weekand now want to join the IPA. To complicate matters, in the DPV (German Psychoanalytic Association) several of its branches favor 3x three times per week training analysis already. Both British and some Germans fear that if a mandatory 4-5x a week is not rigidly enforced many members will opt for the lower frequency.
It seems evident to me that the present cultural milieu is one where there is much less acceptance of analysis at high frequency. A rigid set of rules
set forth by some authority is not very likely to be followed obediently.
As can be seen from the above observations, none of these objections addresses the theoretical issue as to whether there is a difference in the psychoanalytic process in analyses conducted at different frequencies. Nevertheless, the British are rigid in their belief that higher frequency facilitates access to more primitive material regardless of the character structure of the patient.
The issue of frequency inevitably raises the question of whether there is a difference between psychoanalysis and psychoanalytic psychotherapy. Some insist that frequency alone is responsible for the difference, but others feel that there is a difference in the management of the transference. Wallerstein (1991), however, warned that “the complacent certainties about the distinct compartmentalization of psychoanalysis and psychoanalytic psychotherapies no longer exist. The borders between them are now blurred, and they shift constantly, depending on one's theoretical predilections.” Argentinian analysts feel what characterizes psychoanalysis depends on the internal setting of the analysts. In my understanding, this means that the analyst's focus is on the internal life of the patient viewing day to day conflicts as derivatives on unconscious conflicts.
Brunet (2019), in his paper “Psychoanalysis and Psychotherapy: Continuum or Rupture?” emphasizes that the essential difference lies in the handling of the transference and that frequency per se is not the defining feature of psychoanalysis.
Brunet's position brings us back to Jachim's view that since frequency is not the sine qua non condition of analytic therapy we should turn to characteristics of the analyst. He raises the question, what makes an individual a therapeutic person? There has been a longstanding argument regarding how to identify and certify someone as a competent analyst, especially when they are given the responsibility of analyzing candidates.
The old solution was the training analyst system, which leads to the old conundrum of how does one vet such an individual. From the very
beginning of institutional teaching of psychoanalysis, the issue of training analyst status has been a source of controversy. Both Eitingon and Ferenczi favored it, but for different reasons. Eitingon felt that instructional or didactic analysis differs from therapeutic analysis in having an additional aim which supersedes the therapeutic aim.
Ferenczi felt that Eitingon's approach was too pedagogical and political. Instead, Ferenczi advocated a “super analysis” to achieve the depth that a thorough psychoanalysis hopes to achieve because the destiny of a number of people depend on the analyst's competence. The “super analysis” implied a much longer analysis at much greater depth than was generally practiced at that time. It should be remembered that analyses at that time generally lasted only a few months.
Michael Balint criticized the training analyst system for authoritarian dogmatism and the obligatory submissiveness expected of the candidates.
Rangell (2004 p.127) stated: “I had long felt that too much importance was attached to the status of training analyst… I always had doubts about giving such prominence to training analysts, many of whom were quite passive and uncreative in scientific affairs, and inhibitory of the works of others.”
Cremerius (1990), in his article “Psychoanalysis and Power,” argues that the IPA was organized as a quasi-religious community where there was uncritical acceptance of everything the authorities say and do. In his opinion, echoing Balint, didactic analysis was set up as an instrument of power and as a ritual of submission and indoctrination. What was originally conceived as a method to help the individual learn about the functioning of his unconscious and the work of repression quickly became a way of indoctrination and a bulwark against heresy. He quotes Hans Sachs's (1930) statement that “psychoanalysis requires something similar to the novitiate in the church.”
In my opinion, there is no fool proof way to determine who is a “therapeutic person” or a superior analyst Frequently, the decision on appointment is made less on therapeutic competence than the politics of the
Institute. Independent thinkers are frowned upon because their heretical ideas could upset “the way things are done.” All of us older analysts have witnessed corruption and collusion usually at the expense of the candidate. In a manner similar to the Catholic Church, there is more emphasis on preserving the psychoanalytic institution than in protecting the candidate. This started with Freud. Knowing of Jung's affair with Sabina Spielrein, he sided with Jung against her. Freud protected Jung because he felt that a psychiatrist and non-Jew should be his successor as the head of the movement. The institution mattered more than the welfare of the patient. (Cremerius 1990).
The French seemed to have devised a solution to the TA system. The candidate's analysis is completely outside psychoanalytic training and it is the supervisor who assesses the analytic competence of the candidate.
An unfortunate consequence of the TA system is that it creates a group of powerful people who too often want to perpetuate their prestige and power. Freud used a quote of Anatole France: “When a man is endowed with power, it is hard for him not to misuse it.” The power differential risks creating a tiered system where some are the anointed superiors. We have all witnessed the arrogance of those in power. Looking outside our borders, non-analysts have too often been treated patronizingly as unenlightened individuals, generating a great deal of hostility toward psychoanalysis. The endemic power corruption has a lot to do with the institutional stalemate and controversies in psychoanalysis.
To end, I want to thank Dr. Jachim for highlighting some serious difficulties in our field and I want to join him in finding ways of addressing some of these unending disputes that beset out field.