On Friday, January 11th, members of the Manhattan Institute community and guests gathered for a colloquium entitled “More Simply Clinical Than Otherwise: A Roundtable Discussion on Psychoanalytic Training.” Sandra Buechler, PhD, and Steve Kirschner, LCSW, presented papers, outlining some of their core principles of, not only training, but psychoanalytic work itself. Jamieson Webster, PhD, provocatively challenged the current state of training, particularly the hierarchical nature of most institutes. In a sense, all three presenters were in agreement about the need for openness, creativity, and self-discovery as central to training. 

A lively discussion with the audience ensued. Questions raised included how training has changed with the introduction of LP candidates, why the lack of diversity among faculty and candidates, what is the role of the training analysis, and whether we can learn anything from the tango community! 

Today, the co-editors of Analysis Now are pleased to offer an opportunity to continue this important conversation. Here are Steve Kirschner’s remarks in full. Please share your thoughts in the comments section below!

In thinking about psychoanalytic education I did some looking back, and one book that was very helpful in understanding the current state of psychoanalysis in America in the broadest context was The Rise and Crisis of Psychoanalysis in the United States by historian Nathan Hale. Hale describes how psychoanalysis went from being an obscure and esoteric visitor to this country to becoming a ubiquitous and inescapable feature of psychiatry and culture at large before being downsized to its current more marginal status. “In 1956, celebrating the centennial of Freud’s birth, popular magazines reported that this ‘Darwin of the Mind,’ had fathered modern psychiatry, psychology, child raising, education and sexual attitudes. But by 1975, Sir Peter Medawar, Nobel Prize winner and medical research scientist, announced in The New York Review of Books that doctrinaire psychoanalytic theory was the most tremendous intellectual confidence trick of the 20th century.” (Hale, 1995, p.3) Psychoanalysis has been humbled and although it is a very different thing today, it has endured, adapted and evolved.

Something else I read to help me think was an issue of Psychoanalytic Dialogues from 2003 on the state of psychoanalytic education. It was striking to me that the issues raised were not too different then and now with the exception of a lack of consideration of issues of race. I recommend taking a look at it. Some of the questions put to the panel were:

How can the structure of psychoanalytic training be reconciled with the belief in the highly personal nature of the development of each practitioner’s identity as an analyst?

How is psychoanalytic education affected by the theoretical diversity that characterizes the contemporary field?

The greater emphasis within clinical theorizing on preoedipal development and maternal transference parallels the greater representation of women entering the field. How does the student body composition of institutes affect the training and the field of psychoanalysis?

Attitudes toward sexual orientation are undergoing significant change. How do these changes affect training practices? (Black, 2003, p.377)

One of the things that attracted me to psychoanalysis was that it seemed like a field that encouraged unlimited curiosity. There was nothing I could read, learn or do that wasn’t relevant. This has turned out to be true and it influences my thinking about psychoanalytic education. In 1971 Richard Chessick proposed an outline for the training of therapists and analysts that included (in addition to supervision and personal analysis) the study of the classic and modern works of psychiatry, psychology and psychoanalysis and studies in sociology, biology, anthropology, medicine, evolutionary theory and current research in genetics and human behavior. He also wanted the students to have a general education in the history of art and music, ancient and modern literature, including biography, poetry, novels and drama. And to round them out further a knowledge of history, mythology, religion and philosophy. In summary, and I paraphrase, the psychoanalyst must have inborn talent, good supervision, a thorough knowledge of psychodynamics and psychoanalytic technique. “She or he must become a human being in the optimal sense of the word so she can offer the best  possible human encounter to her patients.” (Chessick, 1983, p.33)

I’ll admit it, I’m exhausted just thinking about all that.

Interestingly, we are in a new era of psychoanalysis, an era of much greater openness to candidates from widely varying educational and professional backgrounds. The war over lay analysis is over, at least in New York, and Freud’s view triumphed. With the creation of the license in psychoanalysis, we are now seeing not only psychologists and social workers coming to train, but a steady stream from the arts, sciences and humanities. They bring a wealth of experience and knowledge that is in keeping with Chessick’s vision of the broad intellectual background he encouraged for therapists and analysts.

Educational diversity among candidates is now a given. Gender diversity is ongoing. What was a male-dominated profession is now a place where just by looking around the rooms where I teach and glancing at the authors in the journals I read, I see women outnumbering men. The assumptions of heterosexuality have been for the most part successfully challenged and, again, I see that reflected in the diversity of candidates, faculty and supervisors. I see the field being increasingly welcoming to those who are trans, though we still have a long way to go. The obvious gap I see in terms of diversity is in the area of race. I don’t have the solution to the problem, but I have some suggestions. As with inclusivity around gender and sexual orientation, we have to look at our implicit biases, our defensive dissociation and denial of sexism, homophobia and racism.  We have to bring diversity to our curriculums, our faculties and our institutional structures. We have to listen to the dissatisfactions of our candidates and engage in frank conversations about how we are welcoming difference and how we are discouraging it.

Regarding theoretical diversity, I think we are doing a better job of working with it. Martin Bergmann noted that “Once an analyst has acquired a theoretical point of view, he is rarely genuinely open to learning other models. There is a paradox here, that must be faced. Psychoanalysis, a rational method of approaching the irrational, has not saved us from irrational attachment to cherished theories.” (Bergmann, 1993, p.950) That said, unless you’re living on the dark side of the moon, you know that multiple models and multiple theories are the current state of play. I think there is a very good reason for this, one that was articulated by Edgar Levenson in 1983. Levenson argued that Freud’s greatest accomplishment lay in using language as a therapeutic instrument, but he mistakenly attributed his success to what was talked about instead of the semiotic act. Freud and later analysts concluded that it was the content of the conversation rather than the process of conversing that brought about change. To quote Levenson, “If one examines the context, not content, one sees a highly clarified and defined linguistic discourse. In a situation of great constraint–which limits the anxiety of both participants and, consequently their anxious claims on each other–they talk. They examine what is talked about and they examine the context in which it is talked about: that is, who they are for each other.” (Levenson, 1995, p.8)

The emphasis on content led to a shutting down of communication between psychoanalysis and other disciplines and between analysts of different persuasions. As per the cliche, Freudian patients had sexual dreams, Jungian patients dreamt of  archetypes, Kleinian patients dreamt of escaping the bad breast while Interpersonal patients dreamed about their analysts being more interested in their dreams.

There are institutes that maintain a loyalty to and focus on a particular theory, but they often include some teaching of comparative psychoanalysis. Most institutes now teach in a framework of multiple theories, usually including object relations, interpersonal, self psychology, relational, Freudian, intersubjective and a healthy dollop of attachment theory. Jung and Lacan are presented in some institutes. This is challenging for candidates and faculty alike. No one is expected to master or  agree with so many perspectives, so courses on a particular model are usually taught by someone who is most knowledgeable of it. Candidates usually feel more attracted to some theories than others and will seek out supervision with those most aligned with those perspectives. If all goes well, we hope the candidate emerges with an overall grasp of the varieties of theory and the ability to think critically, independently and psychoanalytically. I agree with Irwin Hirsch when he writes: “No theory, regardless of how technical and prescriptive it might be, can ever dwarf the impact of the analysts’ personalities, and/or analyst’s degree of personal commitment or passion toward each unique patient. In the trenches of the transference/countertransference matrix, the technical inevitably breaks down, exposing analyst’s personalities and their degree of emotional connectedness and intensity toward each patient. This does not at all make partisan theory irrelevant, but it places any theory in a context where, ideally,  it is viewed as any analyst’s most comfortable home base. From this perspective it should be clear that each unique individual analyst prefers to work from within a familiar tradition, and comfortably remain in the warmth of that internalized family. In any given clinical situation, recognition of this may open the possibility of an analysis that may become more fresh, albeit potentially less comfortable, for both the analyst and the patient.” (Hirsch, 2008, p.131)

One of the challenges that arises from the increasing number of candidates who don’t come from a clinical background is how we foster in them the incredibly important clinical skills which we might assume someone trained in psychiatry, psychology or social work would have acquired in that training. My ten years as a social worker, working in close coordination with a team of psychiatrists, psychologists and other senior clinicians, was invaluable in preparing me to undertake the study of psychoanalysis. All the psychoanalytic orientations imply the need for a set of skills, aptitudes and attitudes a person must have  in order to do psychoanalysis. For lack of a better term, I call them core competencies. I make no claim to be comprehensive and I’m sure everyone in this room could make a list of their own. My short list includes curiosity, neutrality, empathy, skepticism, perspective, patience, the capacity to be comfortable not knowing and mental flexibility. Roy Schafer described his version of this skill set under the concept of the analytic attitude.

Doing analysis is hard work and, of course, learning to do analysis is hard work. You sit listening to your patients hour after hour and everything they say and do works on you, impacts and influences you in ways that are subtle and in ways not subtle at all. An ideal is to be able to be both deeply immersed in the material and the moment, receptive to and able to contain what the patient cannot, aware of your own feelings and associations, optimally responsive and at the same time able to maintain neutrality and perspective regarding what is happening. I say perspective rather than objectivity with a nod to constructivism and Owen Renik’s point about the analyst’s irreducible subjectivity. This state of affairs demands the mental flexibility to allow for frequent shifts in our perspective and a sharp eye to detect the encroachment of assumptions. Curiosity always pushes us to want to know more about what’s in front of us, what might be behind or under it and what’s around the next corner. Patience reminds us to wait for what is unfurling and might be lost or frightened away by our haste. Kafka said because of impatience we were thrown out of paradise and because of our impatience we cannot return. Objectivity is unattainable, but I think striving for perspective and acknowledging our subjectivity is crucial. Empathy and skepticism work best as a team. If I believe everything my patient tells me, I may resist challenging a chronic resistance on their part to their own agency. If I am always skeptical, well, that won’t end well.

Mental nimbleness of the kind I mean is undoubtedly somewhat innate and somewhat the product of all the relational matrices in which we grow up. Whatever raw ability the candidate brings to training, it is our job to enhance, cultivate and encourage. I think this is learned less in the classroom and more from personal analysis and supervision. The task is to help the candidate find and hone their version of being an analyst, what Bollas would call their unique idiom. Nina Coltart memorably put it like this: “The day that one qualifies as an analyst, the analyst that one is going to be is a mystery. Ten years later we may just about be able to look back and discern the shape of the rough beast–ourselves as analysts in embryo– as it slouches along under the months and years until, its hour come round at last, there is some clear sense of ourselves as analysts. The process of doing analysis has slowly given birth to an identity which we now, more or less, recognize as an analyst, or at least the identity which we have become, and are still becoming.” (Coltart, 2002, p. 2)

It is from this perspective that I attempt to understand what candidates present in supervision and why I am more likely to ask, “Why did you say that? What effect did that seem to have? What else might you have said, or not said?” Rather than tell them they should or shouldn’t have said what they said, according to what I think an analyst should do or what I think I would have said. In this way, it seems to me, that the candidate and I may discover what comes easily to them and what does not. For some, empathy is relatively easy but they find it difficult to use their skepticism even though it’s there. Some forget to be sufficiently curious and want the material to fit into a preconceived theoretical structure. Some find it’s easier to take a neutral stance but difficult to be playful. It’s not that there is some ideal combination of these things that I can teach them. My goal is that they appreciate the ever shifting complexity of who they are at different moments and with different patients, and what they allow themselves to bring into their work and what they withhold.

Steve Kirschner, LCSW, is co-director, faculty, supervisor and training analyst at the Manhattan Institute for Psychoanalysis; faculty and supervisor at the Psychoanalytic Psychotherapy Center; and faculty at the National Institute for the Psychotherapies. He is in private practice in Manhattan.

References

Bergmann, M. (1993). Reflections on the history of psychoanalysis. Journal of the American Psychoanalytic Association, 41 (4): 929-955.

Black, M. (2003). Issues in training, questions to panel. Psychoanalytic Dialogues, 13 (3): 377-378.

Chessick, R. (1983). Why Psychotherapists Fail. Northvale, NJ: Jason Aronson.

Coltart, N. (2003). Slouching Towards Bethlehem. New York: Other Press.

Hale, N. (1995). The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917-1985. Oxford: Oxford University Press.

Hirsch, I. (2008). Coasting in the Countertransference: Conflicts of Self Interest between Analyst and Patient. New York: The Analytic Press.

Levenson, E. (1995). The Ambiguity of Change. Northvale, NJ: Jason Aronson.

If you enjoyed this post, we recommend:
Why Did You Become a Psychoanalyst? PART I and PART II