Published in The International Journal of Psychoanalysis (2011)
The Education Committee of the Australian Psychoanalytic Society, inspired by David Tuckett’s research, relating to the measurement of candidate competence, conducted a similar study that, they believe, added value to his earlier work. The indicators of analytic competence were more numerous and specific, and greater emphasis was placed on how these criteria could further be operationalized. Besides being used in the measuring of candidate competence, the author makes a case for how the criteria can be adapted for use in the selection of prospective trainees; the defining of teaching and supervisory objectives and processes; and as a basis for further research. The close resonance that the qualitative research method used has with analytic thought and practice is highlighted. It is proposed that this synchrony reduces the resistance that analysts often have in participating in such research. There were definite advantages that arose out of the Australian project aside from producing a society-specific schema of candidate capacities. The research process opened up a space for dialogue, debate and experimentation that increased group cohesion and society identity. Including the candidates in the survey facilitated the increase of transparency between candidates and members, contributing to the strengthening of the educational alliance.
Keywords: criteria for candidate competence, educational objectives, evaluation of candidates, qualitative research, research criteria, selection of prospective trainees
Our societies’ procedures for assessing whether a candidate is ready to prac- tise as an analyst mirrors those of both the European and USA societies in that, as Tuckett has noted, candidate assessments are often made ‘‘globally’’ based on ‘‘implicit conceptual criteria...that are opaque and particularistic’’ (Tuckett, 2005, p. 34). He argues that the notion that: ‘‘This has worked well in the past’’ is no longer good enough, and believes that these criteria do not meet up with the professional and scientific standards that are required today (Tuckett, 2005, p. 34). This position is strongly echoed by Garza-Guerrero (2002), Vaughan (2000), Varvin (2003), Jimenez (2007), Szecsçdy (2008).
If we want to improve our professional standing, and therefore our market share of prospective analysts and patients, we are, as Tuckett has emphasized, going to have to work at becoming more transparent, explicit, universalistic and accountable. The one way that this can happen, he suggests, is through the conducting of such research projects that are empiri- cally supported (Tuckett, 2005, p. 34).
We, in Australia, decided that, rather than passively applying Tuckett’s schema to our own situation, we would heed his wish that: ‘‘Each institute ... develop their own indicators ... to share and debate’’ (2005, p. 45). By doing our own research, we had the advantage of actively learning from our own experience, and establishing a greater group cohesiveness and identity within our Society.
Our education committee has a growing concern that reflects those of Kernberg’s (2000), that is, that we have not credited enough the rich fruits of the candidates’ past experience that they bring to our training programme. Including candidates in the research project, we believe, acknowledges their capacity to contribute productively to their own education programme, strengthens the educational alliance between teachers and candidates, reduces the often excessive idealization of senior analysts and the corresponding infantalization of the candidates by the analysts (Kernberg, 1996, 2000, p. 107; Auchincloss and Michels, 2003).
We hoped in our study to take Tuckett’s work further by:
defining indicators of analytic competence that were more numerous and specific
exploring how these criteria could also be adapted for use in the selec- tion
of prospective trainees, the defining of teaching and supervisory objectives
and processes, and as a basis for further research.1
1. Research description
The project was initiated by e-mailing the membership and the students with the simple request of providing us with a list of indicators of the analytic capacities that they believed a candidate should be able to demonstrate and aspire to, in order to eventually be thought of as a competent analyst.
The resistance analysts have in ritualizing and formalizing their thinking processes has been well described (Tuckett, 2005). This anxiety (to be elaborated on later), although apparent in our Society’s response, was, I believe, markedly reduced as a result of the close resonance that qualitative research has with our own analytic thinking.2 We, as analysts, attempt to allow our theories of mind to emerge, rather than start with preconceived ideas (Bion, 1962). Likewise qualitative researchers dislike preconceived theories. They prefer the theory to emerge from the data (Strauss and Corbin, 1998, p. 11). As do analysts, qualitative researchers embrace subjectivity. They believe that these usually unwanted subjective ‘‘contaminants’’ actually help to sensitize the researcher to know what to look for, and what questions to ask (Strauss and Corbin, 1998, p. 5). They emphasize, however, that these conclusions are always open to modification and negotiation, and that researchers in this method encourage the making of their subjective supposi- tions explicit. Quantitative analysis and empirical research, where objectivity rules, directly contrast to this. Here one is to be as ‘blind’ to one’s subjectiv- ity as possible, preferably ‘doubly blind’. The aim in quantative research, as opposed to qualitative research, is to use one’s objectivity, to eliminate one’s subjectivity as much as possible (Strauss and Corbin, 1988).
1When I speak of ‘we’, I am referring to my fellow members of the Education Coordinating Committee, candidates and members of the Society who have assisted me in this research project. I want to emphasize though that I take ultimate responsibility for the final content, structure and application of the schema.
2Given the close similarities in analytic thought and practice that Australia has with the British and many of the European societies, this resonance, I believe, would apply to those societies as well. Int J Psychoanal (2011) Copyright a 2011 Institute of Psychoanalysis.
As with analysts (Winnicott, 1971), the capacity to play with ideas is cen- tral to the qualitative researchers’ research process (Strauss and Corbin, 1998, p. 5). As with qualitative researchers, we enjoy the creative challenge of struggling with fragments and elements, avoiding the premature relief and gratification of finding coherent ‘‘shape’’ and meaning (Bion, 1962; Winni- cott, 1971, p. 64). Qualitative researchers see their research as both an art and a science, and strive to find the balance between these two domains (Strauss and Corbin, 1998, p. 13). We too are involved with this dialectical dance that captures the essential process and spirit of both analysis and qualitative analysis (Hoffman, 1998; Israelstam, 2007; Ogden, 1992; Strauss and Corbin, 1998, p. 13).
The similarities between qualitative research and psychoanalysis can be summed up by the following quote by Strauss and Corbin (1998, p. 5):
Qualitative analysts: Relish interplay between themselves and data. Are unafraid to draw on their own experience. Are secure enough to regard their findings and theories as qualifiable and modifiable. Are open to criticism. Enjoy the play of ideas. Are able to sustain ambiguity and avoid quick closure of ideas.
About two out of three of each group, i.e. 7 of 8 candidates, 9 of 14 junior members and 38 of 56 senior members, responded with a total of over 200 individual indicators. Central to qualitative analysis is the process of conceptual ordering. This involves the organizing of the raw data into discrete categories according to their various general properties and dimen- sions, and involves a creative interplay between researcher and data. (Strauss and Corbin, 1998).
When the responses arrived, they were read over many times initiating a process of describing, debating and creative inquiry that set the stage for the remainder of the exploration and research. Key words were scanned for their similarities and differences, and were then organized into broader, more encompassing concepts. This process was facilitated by drawing connecting lines, colour coding and using movable self-sticking notelets. Gradually higher order groupings and clusters began to form and coalesce. The continual oscillating between fragment and form resulted in the evolu- tionary development of higher, more encompassing concepts and categories. Key words became subsumed by key sentences, which were subsumed by even higher order concepts, until the concepts became more and more satu- rated. This was akin to a kind of conceptual food chain, with the big ‘fish’ internalizing and assimilating the smaller ‘fish’.
In order for our research project to remain vital, alive and ‘a work in progress’, we encouraged a constant stream of feedback from the candidates and members. This was obtained through ongoing e-mail, as well as directly through two workshop-style presentations, where supervision material was explored in relation to the category schema; the advantages and disadvantages were explored; and revisions were made.
Concerns regarding our attempt to develop explicit criteria for candidate competence, as it turns out, came from a relatively small percentage (3%) of the members and candidates. We did, however, believe that these concerns represented very important issues for us to keep in mind and think about, as we proceeded with our research. The essence of these concerns can, I believe, best be conveyed by quoting them verbatim.
A conceptual framework ‘‘could become constrictive’’; ‘‘will foster compliance’’; ‘‘will encourage a culture of judgment’’; ‘‘may set unrealistic and idealized expectations’’; ‘‘will inhibit dynamic and creative experiencing and thinking’’; ‘‘may be containing, but containers can crush their contents’’; ‘‘there is no better alternative to a personal analytic judgement’’.
These concerns about formalizing what it is we do may be more fully understood, if viewed in the context of our Society’s prevailing theories of mind and practice that value highly, free-floating attentiveness (Freud, 1912), intuition, reverie (Bion, 1962) and dreaming (Ogden, 1992). The reluctance to structure our analytic thinking then could be understood as a fear of losing what we most cherish, i.e. our spontaneity and creativity. This fear is countered when we consider Winnicott’s (1971) conviction that a state of creativity, spontaneity and ‘play’, in the analytic situation, can only take place in relation to a secure framework. There are many examples in the arts that illustrate well the interdependence of structure and form in relation to spontaneity and creativity. When we are transported by the spontaneous, free-floating, soaring sounds of Ravi Shankar’s sitar music, we are relatively unaware of the ten years of dedicated study he has spent with his guru, coming to grips with technique, structure and bases of the raga. I am suggesting that it is this very internalized structure that ‘allows’ Shankar this improvizational freedom.
I am sure that, when Hoffmann (1998) suggests that we ‘throw away the (analytic) book’, he means us to have studied and internalized it first! This Cartesian splitting is rather fruitless. What really matters, I believe, is the relationship between intuition versus spontaneity and form versus structure. Viewing this dilemma from a dialectical perspective, gives us a chance to escape the dichotomous either ⁄ or mindset, where we have to choose between strangling submission to what is known, or face the anxiety of spontaneity exploding into chaos! It seems, then, that it is neither ritual (our indicators), nor spontaneity (our personal intuitive ideas) that seem to complicate and threaten to spoil our analytic endeavours, but rather our difficulty in being able to hold these two elements in dynamic oscillation relationship to one another (Israelstam, 2007, 2009; Ogden, 1992).
Designing the schema
In processing the respondents’ data into higher order categories, decisions need to be made as to when to stop the conceptual ordering. One of the important challenges in this research process is in deciding on the degree of ‘‘saturation’’ that each category should have (Strauss and Corbin, 1988, p. 136). If the categories become too large and all- encompassing, we arrive at a situation where we have the whole and no parts, i.e. ‘all trees and no wood’. In this situation, important details could well be overlooked. The opposite would be as problematic as well where we have too many unre- lated disconnected elements, to the point of seeing only the parts and no whole, i.e. ‘the wood and no trees’! In this situation the important gestalt is lost.
In grappling and ‘playing’ with how to organize the data, what finally began to ‘emerge’ from the data was a most simple and experience-near sys- tem relating to very basic and fundamental areas of human functioning, i.e. how we ‘perceive’, ‘think’, ‘feel’, and ‘act’. It was found that these overarch- ing categories were able to encompass the essence of the members’ and candidates’ indicators of candidate competence. Although these elements are described separately, it is stressed that they are part of a complex interactive system where each influences and informs the other (Bateson, 1979). For example, how we perceive, think and act, is intimately bound up with how we feel. How we feel, depends to large degree on how we think and perceive etc. When these realms are described separately, we are merely ‘zooming in’ for a close-up, in order to punctuate and explore these concepts in more depth. It is vital that we also ‘zoom out’ when required, in order to retain a broad systemic perspective.
Looking at psychoanalysis systemically, we might say that our analytic system functions something like this. Through our analytic perception, we absorb information (emotional and cognitive), which is then mentally–emo- tionally processed in order to develop working hypotheses, which lead to interventions that generate new information. These new perceptions act as feedback that are again processed and fed through the analytic system.
When we evaluate our candidates, it is vital that we keep this systemic flow in mind. As much as it is important that the individual capacities are present at the expected level of functioning, what is more relevant, we believe, to candidate competence is their capacity to integrate these catego- ries in a creative and productive manner.
Before proceeding with the description of the category schema, I would like to discuss the importance and relevance of the personal qualities of the candidate that were so highly represented in the responses (25%).
Although personal characteristics emerged as highly valued by our members and candidates, we decided not to organize them into a separate category of their own, but rather to weave them into the fabric of larger cat- egories, of which they seemed so much a part. In many ways these character traits, as described above, could be regarded as the ‘seeds’ around which the ‘flesh’ of many of the main categories develop.
The personal qualities that emerged from the members’ and candidates’ responses are as follows: empathic understanding, attunement, humility, acceptance, respect, frustration-tolerance, patience, firmness, curiosity, crea- tivity, authenticity, integrity, trust, ethics, and quest for truth. Examples of their relevance to categories to be described below are to be included in the ‘integrative section’ following each category described below.
It is interesting to note that Tuckett did not emphasize personal characteristics in his framework. He believed that personality characteristics were used too subjectively, and that evaluators tended to reach judgments based on character rather than demonstrated competence (Tuckett, 2005, p. 34). He was concerned that subjectively biased characteristics would be used instead of well-defined criteria for assessing candidate competence. I believe Tuck- ett’s stand to be questionable, given that the importance of the analysts’ and candidates’ personality qualities are so well documented in the literature (Bonaminio, 2008; Gaston 1990; Hartley 1985; Hovarth, 2005; Kite, 2008; Szecsçdy, 2003).To add weight to the importance of personality characteristics, there is research evidence that strongly suggests that these personality qualities are a prerequisite for change in most psychotherapy modalities, and may explain why no particular treatment method reveals itself to be more superior than another (Blatt and Shahar, 2004; Bordin, 1994; Hovarth, 2005; Smith et al., 1980). The importance of personal characteristics is well recognized in the initial assessment and selection of prospective candidates (Curtis, 1982; Stone, 1974; Szecsçdy, 2003). One might ask then, if personal characteristics are important in the selection of candidates, why should they not be so in the evaluation of candidates as well?
The importance of personality characteristics in the functioning of the analyst is reinforced by Rosenfeld:
To function carefully and sensitively, and so to be therapeutic, an analyst depends to a crucial extent on the functioning of his personality as an important instrument or tool. For that reason we are trained not only clinically and theoretically through lectures and supervision, but also through personal analysis ..., in his analysis the candidate’s character structure and character disturbance have to be located, gradu- ally brought into the open, and integrated into his personality. (Rosenfeld, 1987, p. 33, my italics)
I am concerned that de-emphasizing the relevance of personal characteris- tics when evaluating candidate competence would simply create another imbalance! I would like to argue rather that, by making personal character- istics more explicit, they can be kept in perspective, and be used judiciously in a balanced and thoughtful way, and are therefore less likely then to bias our evaluation. We believe that candidate capacities that relate to personal characteristics (that are not too entrenched) are amenable to further development and refinement through analysis and clinical and theoretical experience (Curtis, 1982; Rosenfeld, 1987). In this sense as well, they are worthwhile being identified and tracked.
The to and fro conceptual ordering eventually ‘crystallized’ into a total of seven categories of analytic competence that included nine sub-categories. In order to emphasize the dynamic and systemic relationship between the indi- vidual indicators, we have termed our framework the Interactive Category Schema of Candidate Competence (ICSCC).We have also highlighted this interplay by including sections termed ‘interactive links’ (see below).
The analytic stance refers to the way the candidates position themselves emotionally and mentally, in relation to their patients, in order to promote the effectiveness of the analytic work. For this, the candidates are required to adopt a ‘free-floating reflective–symbolic stance’. This is a state of mental functioning where the candidates’ mind floats freely while attending respon- sively to the symbolic elements of the unconscious that arise out of their own and their patients’ free associations, dreams, moment to moment behaviours and communications. In this stance, they can be said to be reflective when they experience new and ever-changing multiple perspectives from a meta (third) position, relating to the dynamics that are continually being generated in the analyst–patient relating.
It is hoped that, in this ‘free-floating reflective–symbolic stance’, the can- didates will develop an increasing capacity to bring forth and be informed by their own rich and creative imagery, associations and fantasies that are stimulated within the patient–therapist dynamic interactions. The analytic stance relates to such concepts as Freud’s (1912) ‘free-floating attention’, Bion’s (1962) ‘reverie’, Ogden’s (2004) ‘dreaming’ and Fonagy’s ‘reflective- ness’ (Fonagy and Target, 1997).
Interactive links The analytic stance, and later to be described, boundary function, the capacity for emotional regulation and reflective–perceptive awareness, are mutually enhancing and highly interactive and are in reality indispensable from one another for optimal functioning.
Relevant personal qualities involved include, curiosity, creativity, enthusiasm and courage.
Boundary and ethical functions
These functions refer to the capacity to have an awareness of, maintain, and establish clear and appropriate boundaries within three main areas:
(a) Analytic frame and setting This refers, at one level, to the more structural and procedural elements of the analytic relationship, i.e. length and frequency of sessions, holiday breaks, fees and use of the couch, etc. As candidates progress, it is a challenge for them to be able to identify the more symbolic and transformative elements inherent in these structures, and to demonstrate an understanding of how these procedural and structural elements, come to represent the conscious and unconscious aspects of the patient–therapist relating. They need to be able to demonstrate their under- standing of how even very small variations in the frame can impact on their patients.
(b) An awareness of the potential for sexual and non-sexual boundary viola- tions This refers to the capacities required in maintaining healthy and appro- priate ethical and professional boundaries, avoiding the potential for serious sexual and non-sexual boundary violations. It is expected that, as the candi- dates evolve, they will develop the capacity to identify, understand and avoid the more subtle sexual and non-sexual boundary violations that can occur in everyday analysis.
(c) Maintenance of self–other boundaries This refers to the candidates’ capacity to manage self–other differentiation, particularly in situations of extreme merger or isolation, where the candidate can be said to maintain ‘a mind of her own’ in the face of intense coercive projections emanating from the patient.
As candidates develop in their understanding and experience, it is antici- pated that they become increasingly aware of how the boundaries and frame often become the focal point around which unresolved, unprocessed and painful dramas are enacted⁄repeated. It is important in this context then that the candidates’ boundaries are flexible enough so as to ‘allow’ some degree of the patients’ boundary disruption to be expressed, yet firm enough to contribute to a secure setting and holding.
Interactive links The candidate’s reflective–symbolic stance, emotional reg- ulation and an awareness of self–other projective mechanisms (see below) are integral to, as well as dependent on well-functioning ethical and bound- ary functions and vice versa.
Relevant personal characteristics include honesty, integrity, frustration- tolerance, quest for truth and courage.
These capacities promote conditions of safety and trust for the patients, that help to promote in them a greater willingness to enter into a working and collaborative relationship with the analyst. Personal characteristics play a particularly vital role in this capacity (see ‘interactive links’ below).
Interactive links As the candidates develop, it is important for them to understand that collaboration is dependent on, inspired by and interacts with other capacities. This includes the capacity to establish firm bound- aries, a reflective–symbolic stance as above, emotional regulation, perceptual awareness and conceptual capacities as below, and vice versa.
Relevant personal relational qualities involved include empathic under- standing, attunement, humility, respect, integrity, trust, tolerance and patience.
The candidates need to demonstrate a capacity to be able to perceive in an ‘analytic’ way, i.e. an ability to take in information by focusing, listening, observing and reflecting on the symbolic nuances of their own and patients’ language, associations, images, actions and inactions. This information is not only acquired through the use of their usual sensory modalities, i.e. auditory and visual etc., but also by a capacity to reflect on their own and patients’ internal emotional–mental state, through the use and understand- ing of projective and introjective mechanisms (transference, countertransfer- ence and projective identification).
The challenge for the developing candidates is to be able to appreciate that even the most ordinary, obscure and minute events that unfold in the analytic dyad are capable of revealing ‘volumes’ of important information, when viewed in the ‘totality’ of the transference–countertransference interac- tions that emerge in the analyst–patient relating.
They need to demonstrate a capacity to reflectively perceive, i.e. absorb information from within three main areas of awareness, i.e. self, other, and self–other.
(a) Self awareness The candidates need to be able to demonstrate the ‘capacity for self-awareness’, i.e. moment to moment reflection as to how they think, feel and behave in the analytic situation, that includes an awareness of their motives, needs, fears, inadequacies, faults, etc. This ‘self awareness’ is fundamental to their understanding of ‘other’ and ‘self–other’.
(b) Other awareness The candidates need to be able to demonstrate a capacity to reflect on and understand the mind of the other. Besides the capacity to perceive the patients’ internal world more directly, they need to be able to demonstrate a capacity to get to know the inner world of the other by developing an awareness and understanding of the way the patients’ projections affect and impinge on themselves (countertransference and projective identification).
(c) Self–other awareness This involves the candidate’s capacity to be aware and reflect on the dynamics that arise through the process of mutual influence between themselves and the patient in the analytic interaction. They need, as they develop, to be able to identify, and demonstrate their understanding of the vital role that the complex transference, countertrans- ference and projective identifications play in the development of such dynamics as enactment.
Interactive links Perceptual awareness is dependent on, and contributes to the capacity for free-floating reflective–symbolic function, boundary func- tion and emotional regulation (see below). Relevant personal characteristics qualities involved include empathic attunement, frustration-tolerance, humil- ity, honesty and curiosity.
The capacity for emotional regulation lies at the very core of our analytic process and plays a major role in the regulation and stabilization of self and others’ intense emotional–mental state, generated within the candidates and their patients during the patient–therapist encounter. It is a challenge for the developing candidates to be able to continually process and regulate their own emotional arousal, for example, anxiety, anger, frustration and sexual arousal, that are typically activated and stirred up by the patients’ evocative and coercive projections. They need to manage the pain, tensions and frustration inherent in ‘not knowing’, needing to ‘cure’, and providing relief and emotional gratification (for self and patient). Essentially, emo- tional regulation contributes to the candidate’s and patient’s capacity to think rather than act.
Interactive links The capacity for emotional regulation is highly interactive with and mutually dependent on, the capacity for reflective – symbolic functioning, perceptual-awareness, boundary functioning, conceptual and interventive functioning (see below), and vice versa. Emotional regulation together with aforementioned capacities, form much of the basis for Bion’s ‘negative capability’, ‘reverie’ and ‘containment’ (Bion, 1962, 1970), and Winnicott’s ‘play’ and ‘holding’ (Winnicott, 1965).
Relevant personal characteristics involved include frustration-tolerance, patience and firmness.
A capacity for symbolic thought is integral to psychoanalysis. In Winnicot- tian parlance, we might say that there is no such thing as thinking without symbolizing. In spite of this I have chosen, rather than create a separate category, to weave this capacity into other categories. Besides its importance in conceptual capacities, symbolic functioning is most critical to reflective–symbolic stance and perceptual awareness (see back). A capacity for symbolic function also provides greater subtlety, depth and meaning to other analytic functions including collaborative, boundary and interventive capacities.
The candidates’ conceptual capacity is expressed in three main areas, i.e. information processing, development of a knowledge base and a capacity to learn.
(a) Information processing and hypothesizing The challenge for the can- didate in this realm is to be able to demonstrate in clinical presentations a capacity to construct hypotheses and theories relating to symptom forma- tion and maintenance, change and transformation. These theories need to emerge from within the ‘here and now’ of the transference–countertransfer- ence dynamics of the patient–therapist interaction and need to relate to the patients’ evolving narrative, and internal world. Developing candidates’ need to be able to demonstrate a capacity to be able to ‘test’ their emerging hypotheses and to be open to change and revise these as the analytic work progresses.
(b) Knowledge base The analytic knowledge acquired, relating to theory and mechanisms of mind, should have both breadth and depth. The chal- lenge for the candidates is to be able to demonstrate a capacity to integrate their knowledge with the information that relates to the patients’ narratives and themes, in the here and now of the analytic encounter. Knowledge should ideally act as the scaffolding, around which the creative ‘flesh’ of the analytic work can take place.
(c) Capacity to learn It is important that the candidate be able to demon- strate a capacity to learn from others, i.e. peers and teachers, to learn from patients, and to learn from experience.
Interactive links In order to be able to creatively conceptualize and learn, we need to gather information through a capacity for reflective–symbolic awareness and reflective-perception. A capacity for emotional regulation is important in order for the candidate to sustain ‘not knowing’, so as to prevent premature closure of thought.
Relevant personal qualities involved include curiosity, creativity, enthusi- asm, risking, courage, quest for truth and frustration-tolerance.
In this process, conceptualization and hypothesizing are translated into transformation. We might say that any action or inaction that has a transformational effect on the patients’ mental–emotional state could be considered to be an intervention. These can be classified as interpretive or non-interpretive.
Interpretive interventions can be classified in many ways. These are some suggestions that arose out of the respondents feedback:
• Focus: Analyst-centred vs. patient-centred; transference vs. extra-trans- ference; external world vs. internal world
• Function: Probing, elaborating, linking, deepening transference, etc. • Depth: Conscious vs. unconscious; surface vs. depth
Besides the focus, function and depth, the members also stressed that interpretations should be well timed, clear and relevant to the here and now context of the interpersonal dynamics and based in the ‘totality’ of the transference and countertransference.
Non-interpretive interventions are often far less consciously determined than verbal interpretations, and play a vital role in the process of transfor- mation. Many of the categories described above contain potent non- interpretive change elements in themselves. The analyst’s reflective–symbolic stance, deep empathic understanding, emotionally regulated state, collaboration and well-boundaried capacities are in themselves potentially transformational.
It is important that developing analysts learn to identify and describe both interpretive and non-interpretive interventions; how they have come to formulate them and the part they play in transformational moments. They should be able to demonstrate a capacity and be able to track and evaluate the effects and consequences of their interventions from session to session. They need to attend to how their interventions are taken up, by the patients’ subjective inner world, and be able to utilize this information as feedback for further conceptualization and intervention.
Interactive links Our interpretations emerge out of our capacity to concep- tualize and hypothesize, and are highly interdependent on our capacity for emotional regulation, reflective – symbolic thought, reflective-perception, collaboration, frame and boundaries.
Relevant personal qualities involved include curiosity, empathic attune- ment, creativity, enthusiasm, courage, quest for truth and frustration-tolerance.
We were immediately struck by the high degree of concordance of choice of indicators between candidates, junior members and senior members, reveal- ing a high degree of homogeneity in our aspirations regarding candidate competence. There were, however, large differences in the relative impor- tance of certain indicators over the other. In the spirit of attaining greater scientific validity, we requested of the three groups to do a separate ‘sort’, rating the various categories that they as a group had selected, in order of relative importance (see Figure 1).3
What stands out initially is that approximately 25% of the candidates, junior members and the senior members rated personal characteristics as most important. This result gives empirical weight to our belief that per- sonal qualities should form part of the evaluation of candidate competence.
It is noted that emotional regulation was rated second highest for all three groups (about 18%). This more than likely reflects the value that our Society places on the related mechanism of containment and its role played in transformation as described earlier.
The other notable result emerging out of the sort is the relatively low ratings given by all three groups to interpretive capacities (all around 9%). I am sure that this does not mean that interventive capacities are not impor- tant. Rather I believe that this points to the emphasis we place on non-verbal interventions in the process of change (see back). As for the low ratings that conceptual capacities received across all three groups (all around 7%), one might postulate that it may emphasize our society’s bias towards intui- tion, waking dreams and reverie, etc., over the more formalized qualities of thought.
3I emphasized that it was understood that all the indicators were very important and highly interactive.
With this in mind we asked them to sort the indicators in relative order of importance.
3I emphasized that it was understood that all the indicators were very important and highly interactive. With this in mind we asked them to sort the indicators in relative order of importance.
It is important to emphasize that these results show us what the respond- ers believe candidates should aspire to. They do not reveal the differences in how the different groups perform. We would certainly expect to find substantial differences between the less experienced and the more senior practitioners. (Please see later in the paper for an elaboration on this.)
Application of category schema
After elaborating on the use of the ICSCC for the assessment of candidate competence, by means of two case examples,4 I will proceed to illustrate how these criteria can be adapted and applied to the assessment of new can- didates, the development of a training programme and curriculum, and for further research.
1. Assessment of candidate competence
Before embarking on this assessment, I considered the following guidelines that I would recommend prospective assessors to consider prior to doing their assessment:
That assessors make themselves familiar with the ICSCC as outlined in this article prior to commencing their evaluation, so that ideally they can then ‘background’ the schema, while attending to the presentation (akin to a musician concentrating on the creative flow of the music, whilst having a solid theory in the background).
That when evaluating candidates it is important to keep in mind that their capacities will vary with their stage of development in their train- ing. It may be more productive to consider these capacities as those that candidates should be aspiring to (Tuckett, 2005, p. 46). As candidates progress, it would be expected that these capacities would develop in maturity, subtlety and depth.
Assessors are encouraged to provide actual examples to illustrate their evaluation of the candidates’ performance. This, I believe, would chal- lenge the assessors to participate more thoughtfully and critically in the process, thereby helping this template to remain creative and evolving.
Assessors are encouraged to add other descriptors that may not be present in the schema, and to come forth with feedback and criticism. In this way, the schema can be kept relevant and alive.
I again want to emphasize that the idea is not to diminish the importance of analytic intuition, but rather to exploit the creative potential between intuition and form (Israelstam, 2007).
Jane, a senior candidate close to qualifying, presented to me a 40 year-old male patient, Tim, a senior business executive who was in his 18th month of analysis. Jane described him as a person who had suffered serious emotional deprivation and abuse in his early development; a difficult and man who defended against his needing and dependence with arrogance, omnipotence and grandiosity. She acknowledged that his intimidating demeanor made it difficult for her to manage his reluctance to pay on time and to pay for missed sessions.
4Please note that the illustrations are heavily disguised cases from my work as clinical supervisor and are not part of the research project. To further protect candidate confidentiality, I have not chosen situations that have occurred within our Society.
Jane presented a first session following a two-week break. This is her description:
Tim sauntered into the room, as usual immaculately dressed in a dark business suit. Jane noticed, however, that his hair was unusually ruffled, that he was unevenly shaven and had an obvious bleeding shaving-cut on his neck. Jane noted that Tim seldom acknowledged any pain of missing her. She believed, however, that this distress was reflected in his ‘‘ruffled’’ and ‘‘cut-up’’ demeanor. She decided to hold off on making an interpretation relating to his experience of their break, believing that he was too much in control mode at this stage to take this in.
Tim revealed that, while Jane was away, he had, through ‘‘googling’’ her, discovered ‘‘what a low profile’’ she had. He stated dismissively how this confirmed his view that she was lacking in analytic depth and understand- ing! Jane noted Tim’s uncanny knack in being able to push ‘‘buttons’’ in her, this one related to her self-consciousness regarding her lack of publica- tions. Jane noted that she had to work hard in order to process this barrage of ‘‘insults and criticisms’’, so that she could resist her initial impulse to retaliate defensively. As Jane sat in silence, her mind drifted to a recently seen documentary. She recalled vivid and painful images of orphaned gorillas and their slaughtered mothers that had been poached for meat and trophies. Jane stated that she believed that her associations might have reflected Tim’s experience of being ‘‘abandoned’’ by her. I suggested that an alternative thought might be that her association might have reflected, via projective identification, Tim’s hostile dependent phantasy of attacking her, i.e. the feeding mother, thereby leaving himself orphaned. Jane was very receptive to my suggestions and proceeded to engage in a lively discussion with me relating to relevant theory.
Jane went on to report how, after processing her own anxieties and hurts, she came to understand how Tim’s projections and attacks represented his way of trying to evoke greater empathy and understanding from her ‘‘lacking’’ analytic mind. He was wanting her to feel his feelings of humiliation and anger at being abandoned. Based on this awareness, Jane suggested that she understood how Tim needed her to experience firsthand his ‘‘cut up’’ and ‘‘disturbed’’ feelings at being left by a ‘‘lack- ing’’ mother. Tim quietly sobbed. Jane felt that her interpretation had touched him, and that it was appropriate just to sit with his tears and say nothing.
After taking heed of ‘my guidelines to assessors’ as above, I attempted to illustrate how the ICSCC could be applied to Jane’s assessment. Please note that I have included in parentheses other categories that have an interactive bearing on the one being described.
Analytic stance I was impressed with Jane’s capacity to hold back, allow- ing enough time and space for her own and her patient’s associations to unfold. Her capacity for free-floating attention and reflective–symbolic func- tion was apparent in the way her associations were able to ‘drift’ to the image of the abandoned gorillas. (This ‘reverie’ also revealed her personal capacity for empathy and attunement, as well as a capacity for emotional regulation.)
Boundaries On the whole Jane’s boundaries were clear and appropriate. She did have some difficulties in being able to maintain a firm frame, espe- cially around fees. (Relative difficulties with emotional regulation.) She was well aware that this related to her being intimidated by him. (Capacity for self-awareness.)
Collaborative capacities Given Tim’s difficulty with trust, I believe that Jane had done well in establishing a reasonably viable working alliance. In spite of his protestations, Tim attended regularly and shared his vulnerabili- ties. The collaboration, I believe, was enhanced by Jane’s natural personal qualities of empathy, attunement, curiosity, integrity and humility, as well as her capacity to understand his inner world and to ‘stay’ with his provocations. (Associated capacity for reflective – symbolic thought, perceptual- awareness and emotional regulation.)
Capacity for perceptual-awareness I was impressed with Jane’s capacity to perceive analytically. For example, she understood the symbolic significance of his ‘‘ruffled’’ hair and ‘‘shave-cut’’ and her associations to the ‘‘orphaned gorillas’’. She was able, to some extent, to use her countertransference and understanding of the patient’s projective identification as a tool for knowing (perceiving) her patient’s inner world. She had, with some discussion with me, some understanding of how her own sense of inadequacy might have been activated by Tim’s projections. By recognizing and emotionally manag- ing her wish to retaliate, Jane demonstrated some capacity to understand and manage the process of enactment. (Associated capacity to conceptualize and for emotional regulation.)
Capacity for emotional regulation Given Tim’s rather controlling and over- bearing nature, I believe that Jane, although with a struggle, has done well in managing and regulating her own anger, fear and defensiveness. This enabled her to think rather than act, hold a reasonable frame and manage potential enactments, e.g. when Tim ‘‘googled’’ and ‘‘insulted’’ her. (Associ- ated capacity for self–other reflective-awareness, reflective–symbolic thought and boundary function.)
Conceptual capacity Jane demonstrated good capacity to conceptualize the nature of Tim’s problems and defences. She understood how his arrogant ‘shell’ co-existed with his vulnerable ‘abandoned child’, and their relation- ship to his narcissism. She appeared to have a good grasp (hypothesis) of how his pathology related to his developmental narrative. She understood how Tim’s vulnerabilities resonated with hers and the implication s of this for her work with him. I found Jane’s theoretical bases to be in keeping with her stage of training. I felt that her theoretical and her clinical–emotional understanding were well integrated, for example, when we discussed projec- tive identification and its relationship to her reverie and feelings of inade- quacy in relationship to Tim. I was impressed with Jane’s willingness to think about and take in new ideas, i.e. her capacity to learn. (Associated personality characteristics of curiosity and humility.)
Interventive capacities Jane demonstrated restraint and thoughtfulness in being able to hold off interpreting until she had a good grasp of Tim’s capacity to use her intervention. When she did interpret, she demonstrated the capacity to track the effects of her intervention, basing her next ‘move’ on this information. For example, when Tim sobbed following her interpre- tation regarding her absence, she chose to remain silent. Her interpretations were based on her capacity to make use of her reverie and countertransfer- ence feelings, e.g. she utilized her reflections relating to his ‘‘shave-cut’’ and her reflections on the ‘‘orphaned gorilla’’
Aron L (1996a). A meeting of minds: Mutuality in psychoanalysis. Hillsdale, NJ: Analytic Press.
Auchincloss EL, Michels R (2003). A reassessment of psychoanalytic education. Int J Psychoanalysis 84:387 – 403.
Bateson G (1979). Mind in nature. A necessary unity. London: Wildwood House.
Bion WR (1962). Learning from experience. London: Heinemann.
Bion WR (1970). Attention and interpretation: A scientific approach to insight in psychoanalysis.London: Tavistock.
Blatt SJ, Shahar G (2004). Psychoanalysis: For what, with whom, how? A comparison with psychothererapy. J Am Psychoanaltical Soc 52:393–447.
Bollas C, Diatkine G (2010). Shuttle analysis in the Han-Prakken Psychoanalytic Institute for Eastern Europe. Int J Psychoanalysis 91:1250–3.
Bonaminio V (2008). The person of the analyst: Interpreting, not interpreting, and countertransference. Psychoanalysis Q 78:1105–43.
Bordin E (1994). Theory and research in the therapeutic working alliance: New directions. In: Hovarth
AO, Greenberg LS, editors. The working alliance: Theory, research, and practice, 13–37. New York, NY: Wiley.
Curtis HC (1982). The educational prerequisites for analytic training. Ann Psychoanal 10:21–8. Fonagy P, Target M (1997). Attachment and reflective function: Their role in self-organization. Devel. Psychopathol 9:679–700.
Freud S (1912). Recommendations to physicians practising psychoanalysis. SE 12:109–20. Garza-Guerrero C (2002). Organizational and educational internal impediments of psychoanalysis. Int J Psychoanal 83:1407–33.
Gaston L (1990). The concept of the alliance and its role in psychotherapy: The theoretical and empirical considerations. Psychotherapy 27:143–53.
Halpern J (2003). The capacity to be an analyst: A contribution from attachment research to the study of candidate selection. Int J Psychoanal 84:1605–22.
Hartley C (1985). Research on the therapeutic alliance in psychotherapy. In: Hales R, Francis A, editors. Psychiatry update, 552–49. Washington, DC: APA.
Hoffman IZ (1998). Ritual and spontaneity in the psychoanalytic process: A dialectical–constructivist view. Hillsdale, NJ: Analytic Press.
Hovarth AO (2005). The therapeutic relationship: Research and theory. Psychother Res 15:3–7.
Irwig L (2010). Personal communication.
Israelstam K (2007). Creativity and dialectical phenomena. From dialectical edge to dialectical space. Int J Psychoanal 88:591–607.
Israelstam K (2009). The doubting analyst’s facilitation of a creative analytic space. Australasian J Psychother 28:15–34.
Jimenez JP (2007). Can research influence clinical practice? Int J Psychoanal 88:661–79.
Kapelle W (1996). How useful is selection? Int J Psychoanal 77:1213–32.
Kernberg OF (1996). Thirty methods to destroy the creativity of candidates. Int J Psychoanal 77:1031 – 40.
Kernberg OF (2000). A concerned critique of psychoanalytic education. Int J Psychoanal 81:97–120.
Kite JV (2008). Ideas of influence: The impact of the analyst’s character on the analysis. Psychoanal Q 78:1075–104.
Kohut H (1977). The restoration of the self. New York, NY: International UP.
Ogden TH (1992). Potential space. In: The matrix of the mind: Object relations and the psychoanalytic dialogue. London: Karnac.
Ogden TH (2004). This art of psychoanalysis: Dreaming undreamt dreams and interrupted cries. Int J Psychoanal 85:857–77.
Rosenfeld H (1987). Impasse and interpretation. London: Tavistock. (The New Library of Psychoanalysis.)
Safran JD (2003). The relational turn, the therapeutic alliance, and psychotherapy research: Strange bedfellows or postmodern marriage? Contemp Psychoanal 39:449–75.
O’Shaughnessy E (1964). The absent object. J Child Psychother 2:34–43.
Segal H (1978). On symbolism. Int J Psychoanal 5:315–19.
Smith M l, Glass GV, Miller M I (1980). The benefits of psychotherapy. Baltimore, MD: Johns Hopkins UP.
Steiner J (1994). Patient-centered and analyst-centered interpretations: Some implications of containment and countertransference. Psychoanal Inq 14:406–22.
Stone L (1974). The assesment of students’ progress. Ann Psychoanal 2:308–22.
Strauss AS, Corbin J (1990 8). Basics of qualitative research. London: Sage.
Szecso ̈ dy I (2003). To become or be made a psychoanalyst. Scand Psychoanal Rev 26:141–50. Tuckett D (2005). Does anything go? Towards a framework for the more transparent assessment. Int J Psychoanal 86:31–49.
Int J Psychoanal (2011) Copyright a 2011 Institute of Psychoanalysis The interactive category schema of candidate competence: An Australian experience 25
Varvin S (2003). Which patients should avoid psychoanalysis, and which professionals should avoid psychoanalytic training. Scand Psychoanal Rev 26:109–22.
Winnicott DW (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. London: Hogarth and the Institute of Psychoanalysis.
Winnicott DW (1971). Playing and reality. London: Tavistock. [(1996). Reprinted London: Routledge.]