Some Reflections on Psychoanalytic Training
Peter Smith
(An earlier version of this paper was presented to the Bill Blomfield Conference in Melbourne in July 2023.)
In this paper I will be addressing and discussing some general aspects of psychoanalytic training and taking a particular look at the evaluation of student progress as a core aspect of training.
To begin, I thought it would be useful to selectively review some of the literature on psychoanalytic education.
In this paper I will be addressing and discussing some general aspects of psychoanalytic training and taking a particular look at the evaluation of student progress as a core aspect of training.
To begin, I thought it would be useful to selectively review some of the literature on psychoanalytic education.
This is a path which has been well trodden over many years by multiple psychoanalytic institutes and societies, individual analysts, sundry training committees and naturally, the IPA. I understand that currently there is a Psychoanalytic Education Committee (PEC) of the IPA whose stated mandate is to facilitate the exchange of ideas and experiences among the IPA Directors of training and to provide consultations and advice on request to IPA constituent organisations.
This pathway has not infrequently been one of vigorous debate and controversy, and at times with rancour, hostility, divisiveness and splits. The Controversial Discussions within the British Society in the 1940s is probably the best known of such disputes.
It is apparent that the conscious and unconscious emotional investments in the theoretical, philosophical and ideological underpinnings of training is intense and a vexed area for our profession. In particular, uncritical idealisations, unprocessed rejections and passionate affiliations all have the potential for lasting splits and tensions to persist in societies and training institutes.
Freud’s notion of the narcissism of minor differences in Civilization and its Discontents (1930) may be useful to consider as playing a part in our profession’s history of zealous adherences and counter-adherences, perhaps not unlike the Reformation and Counter-reformation.
With regard to the philosophy and practice of psychoanalytic education and development, a fundamental question is whether we instruct and teach or do we provide the means to facilitate and foster learning and development.
As we are aware, differences and divergences of opinion in respect to psychoanalytic training is that the IPA has three training models, the Eitingon, French and Uruguayan models. This pluralism reflects significant variations and differences in the intellectual rationale, philosophy of psychoanalytic education, breadth versus depth of exposure, issues of power, authority and authorisation.
Additionally, there are significant differences in the relative emphasis of the so-called three pillars of psychoanalytic education – the personal analysis, the seminar/curricular program and supervision of clinical work.
Regarding the evaluation of student progress as a central aspect of psychoanalytic education, the question is raised explicitly or implicitly about the aims, purpose and objectives of psychoanalytic training. How do we collectively think about the process as well as the outcome for the person who has been assessed as being a successful applicant to training and thereafter participates in the training program, successfully completing the stipulated requirements and emerging in x number of years as a qualified psychoanalyst.
Our colleague, Ken Israelstam developed (about 16 years ago) what he termed an Interactive Category Schema for Candidate Competence (ICSCC).
In this framework Ken proposed a template with seven dimensions of approaching the evaluation of psychoanalytic competence in a candidate.
These are analytic stance, collaborative capacities, boundary and ethical functions, perceptual capacity, conceptual capacity, the capacity for emotional regulation and finally interventional capacities both interpretive and non-interpretive in nature.
For each of these seven dimensions, a rating scale for each was also later proposed.
In elaborating each of these dimensions there is considerable overlap of features and characteristics of the capacity for empathic attunement, moral integrity, authenticity and a healthy capacity for tolerating frustration. I think too that the capacity for navigating intense emotional reactions and affective upheavals in one’s patient and oneself is implied in this construct. A healthy curiosity, respect for psychic reality, the quest for truth and intelligence are most important in Ken’s schema.
I suspect that when we submit a report on a student either in the context of supervision or in the context of a seminar, we address most of these dimensions not explicitly as discrete categories but more as intuited observations.
To put this in another way, in the process of arriving at an evaluation of a student’s performance, these dimensions are addressed indirectly and a global evaluation of professional competence as either satisfactory or not satisfactory is arrived at. This might be thought of as a kind of gestalt approach rather than an explicated categorical one.
Whether or not it is actually utilised in a report, I think the value of the categorical approach is that it requires of the evaluating analyst to think carefully and critically about the observational basis upon which he or she makes the assessment of a student’s presented work to a supervisor or seminar leader. And on this point the matter of observer bias is also something to consider and perhaps worth keeping in mind.
In Thomas Ogden’s paper On Psychoanalytic Supervision (2005), the author conceptualises the analytic supervision experience as a form of “guided dreaming” in which the supervisor helps the trainee to “dream” aspects of the analytic relationship that the trainee is unable to dream of, or is only partially able to dream about. In this model, it is the task of the supervisory couple to “dream up” the patient by providing the time, opportunity for free associated thinking by both participants that will enhance the range and depth of what can be learned about the analytic couple from the experience of supervision.
One could contrast Ogden’s model of supervision with one in which the supervisor possesses already the requisite knowledge and skills necessary for the trainee to be instructed in, and to learn from. This could be thought of as a sort of pedagogic or apprenticeship model. Perhaps even a transactional one in the service of psychoanalytic education and professional development.
At its most extreme, this could be thought of as the supervisory and assessing analyst as the possessor, interpreter and guarantor of psychoanalytic truths to be conveyed to the neophyte (trainee) from the expert.
In this vein, I would like to comment briefly on the position taken by Otto Kernberg (2006), a former IPA President, about psychoanalytic education.
As some of you would be aware, Kernberg has been a trenchant critic of the bureaucratic and institutional dimension of psychoanalytic authoritarianism.
He asserts as anti-learning the hierarchical and structural aspects of psychoanalytic institutions. He is especially critical of the training analyst status and its idealisation as essentially dysfunctional in creating paranoia and stultification in candidates. He states, “this results in the inhibition of creativity, professional impoverishment and scientific standstill.”
As a rejoinder to Kernberg, others have put forward the view that the problem lies not in hierarchical structures, per se, but rather the loss of the prime purpose of the scientific and educational objectives these structures should serve.
Although many aspects of Kernberg’s critique are beyond the scope of this review, I note that he constructively advocates open and frank discussion between supervisor and supervisee and is a proponent for clear communication between supervisors and progress committees. He also stresses the important role of the mentor in mitigating persecutory thinking, lessening of candidate inhibitions and obviating infantilization of candidates.
In David Tuckett’s paper (2005) “Does Anything Go?” the author introduces his topic with the opening sentence “it has been difficult to know what does and what does not constitute competent psychoanalytic work and so equally difficult to assess when it is being practised and when it is not.” The subtitle of Tuckett’s paper is “Toward a framework for the more transparent assessment of psychoanalytic competence.”
Tuckett points out the overwhelming range of contradictory theories and techniques and the panoply of psychoanalytic training schemes dearly and jealously held by their adherent groups but without consensus as to the actual nature of clinical competence in psychoanalytic work. Does this reflect psychoanalytic pluralism and rich diversity as some claim or the babel of tongues as others do?
Tuckett raises the question as to whether we can find “good enough” ways to know when psychoanalytic practice is more or less competent. His aspiration in this paper is to develop a psychoanalytic framework based on an empirically supported demonstration of analytic capacity keeping in mind two facts. First, that there is more than one way to practice psychoanalysis and second, that it is necessary to avoid “anything goes.”
The author makes the point that the assessment of psychoanalytic competence is often made on the basis of implicit rather than explicit criteria. Furthermore, that there can be a tendency to reach a judgement about clinical capacity on the basis of the perceived character and personality of a candidate and conflictual interpersonal dynamics.
On this point he claims that politics between sundry personnel within training institutions can play a role rather than direct evidence-based demonstrated competence or the lack of it.
Tuckett puts forward the view that the psychoanalytic task of assessing competence in a candidate could be seen as requiring three specific capacities; (1) to create an external and internal setting to which to sense the relevant data especially in regard to affective expression and unconscious meanings; (2) to be able to conceptualise what is sensed, and (3) to offer interpretations based on these understandings as well as to sense and to conceive of their effects.
Tuckett proposes the central importance of the trainee analyst being able to establish and maintain a participant – observer frame. The trainee analyst’s involved curiosity, emotional engagement and commitment are central aspects of this view.
Being able to identify, process and think about the transference/countertransference within the analytic frame are of the greatest importance – without premature or otherwise defensive closure of emergent experiences in the mind of the trainee analyst.
The capacity to intervene with interpretive comments in an appropriate and timely way is considered by Tuckett to be of the essence in the development of analytic competence. Hence it is important to evaluate a candidate’s capacity or lack of capacity for affective attunement, empathic identification and reflective thought.
Tuckett concludes by stating that in psychoanalytic training organisations with no transparent and commonly agreed criteria of what it is a candidate has been found not to have mastered, will invariably be traumatic and conflictual for the individual and generally problematic for the training body.
And so, the assessment of analytic competence and the explication of the observational basis for this evaluation (or lack of it) are front and centre. This reiterates Ken Israelstam’s conceptual framework.
I found it interesting that some authors in the psychoanalytic literature referred to the aim of psychoanalytic education not in terms of the development of competence but rather in terms of the formation and acquisition of a psychoanalytic identity.
In Michael Parsons’ two papers “Forming an Identity: Reflections on Psychoanalytic Training and “Becoming and being an analyst in the British Psychoanalytical Society” (2009), he emphasises the central importance of, and the rationale for, the candidate’s own analysis.
Parsons states that not only candidates and their supervisors but the analysts of candidates are invariably faced with issues which compel them to contemplate the nature of their psychoanalytic training organisation, the nature of psychoanalysis and what becoming an analyst means. For the most part, these are often implicit. They centre around the notion of analytic neutrality and the formation of an analytic stance or attitude which is a central notion in the formation of psychoanalytic identity.
Parsons speaks from the unusual position of belonging to two psychoanalytic organisations, the British and the French which operate very different training systems.
In detailing some of the differences between the Eitingon model and the French model, Parsons highlights the differences between the role of the supervisor in each system.
The author discusses the central common importance of the training analyst in each system. He states that the training analysis has a double function, and that the training analyst has a double responsibility. The development of a candidate’s psychoanalytic identity necessarily involves not only an identification with the person of the analyst but also an internalisation of the analyst’s attitude to psychoanalysis.
The candidate or trainee needs the personal analysis for his or her emotional difficulties (conscious and unconscious) and continued personal psychic development. But the candidate also has an experience of what psychoanalysis is all about via their analyst and their personal analysis.
In this way, the candidate is both patient and perforce a true student of psychoanalysis. In time, and in turn, the candidate will pass on or transmit psychoanalysis upon qualification to their own patients and the next generation of psychoanalysts if they proceed to analysing candidates. Hence, the part played by the internalisation of the trainee’s own analyst as well as the process of the personal analysis are both of central importance in the trainee’s professional and personal development.
Regarding readiness and eligibility for qualification, in the Eitingon model, there is the necessity for the successful completion of training requirements including supervisors’ reports testifying to clinical competence. As I understand it, this contrasts with the French model in which the assessment of the candidate’s “evolution of the supervision process” is a prime consideration pre-qualification.
Common to both systems are the notions of attainment of an analytic stance or attitude, spirit of inquiry and what Parsons calls “psychoanalytic sensibility.”
Parsons is critical of didactic teaching in seminars. He sees this as antithetical to spontaneity and free association of true creative thinking by candidates and analysts. “The task of a seminar leader” Parsons writes, “is to foster an atmosphere without knowing where it will lead and also to help the seminar group think psychoanalytically about what transpires”.
In this context and climate of openness, there are no judgements about how well or badly someone performs in such a seminar. The aim says Parsons, is to discover what it means to maintain a psychoanalytic attitude and a psychoanalytic perspective.
In the British system, what is called psychoanalytic training is referred to in the French system as “formation”.
This is an interesting word with the connotation not of teaching but of something taking shape through lived experience “growing from the inside” as Parsons puts it. To my mind this also implies that the environmental factors (in Winnicott’s sense of this term) are optimal for growth and maturation.
While acknowledging the importance of the acquisition of a psychoanalytic knowledge base and psychoanalytic skills, for example maintaining the analytic frame, identifying transference and resistance and learning to interpret appropriately Parsons’ emphasis is clearly on the development and growth of the candidate’s mind as an evolutionary process.
Of necessity this risks, vulnerability and anxiety associated with not knowing and allowing contact with aspects of one’s own unconscious/preconscious mind and the unconscious/preconscious aspects of another person or person’s mind, be they patients, supervisors and colleagues.
Parsons concludes “the challenge is to arrive at a system(s) of training that will help candidates develop this conjunction between the universally human and the specific psychoanalytic in the form of a professional identity.”
One interesting aspect to reflect upon from my review of these papers is what we are attempting to achieve as a goal or outcome with a psychoanalytic training program. Do we think of the outcome as the development of psychoanalytic competence through the acquisition of knowledge and skills or do we speak of the objective in terms of the formation of a stable psychoanalytic identity. Is this in reality an either/or matter or perhaps a successful training incorporates both.
Bion stated “it is only after you have qualified as an analyst that you have a chance of becoming an analyst. The analyst you become is you and you alone, and you have to respect the uniqueness of your own personality – that is what you use, not all the interpretations and theories that you used before to combat the feeling that you are not really an analyst and do not know how to become one.”
Taking up Bion’s comments, Gabbard and Ogden's paper (2009) “On becoming a psychoanalyst” is worth reading. The two authors put forward a number of what they term “maturational experiences” that have been important to them in their development as analysts following completion of their psychoanalytic training. They also discuss the anxiety that is inherent to this maturational process of genuinely becoming an analyst in “one's own terms.”
The key maturational experiences they identified include developing a voice of one's own, presenting clinical material to peers and also utilising one's analytic work as a principal medium for ongoing self-analysis. Daring to be creative and having a preparedness to improvise in one's analytic work, they see as necessary for the maintenance of an authentic contact with one's patients and to avoid stagnation and mindless stereotypic repetition in one's work.
Ogden writes of the development of a personal analytic style and Gabbard mentions the painstaking effort to shed over time the shackles of orthodoxy, tradition and one's own unconscious irrational prohibitions. The analyst’s struggle with psychoanalytic theory as master or servant may be an integral aspect of this development. So too may be ambivalence toward psychoanalytic theory and practice.
The thesis of Gabbard and Ogden's paper is that this process develops (and I think they suggest can only develop) following the completion of formal psychoanalytic training.
Their central point is that the newly qualified analyst post- qualification has both the opportunity and the responsibility to become an analyst “in one's own terms.” For us as psychoanalytic educators this phrase is worth reflecting on.
Does this mean that an analyst’s training as a candidate is not on one's own terms. Well, I think the answer has to be yes to a greater or lesser degree. It's on the stipulated terms of the IPA and the APAS and the local branch committees authorised to implement and oversee training requirements and importantly to evaluate analytic competence and progress. And ultimately, to assess a candidate’s eligibility, readiness and suitability for qualification and membership of our Society.
So, post qualification when the stipulated terms are no longer necessary and in place, only then can “one's own terms” begin to come into play to a relatively greater degree than during training.
After reading and reflecting on Gabbard and Ogden's paper, I wondered about the psychoanalytic training program as a kind of psychic structure with the intrinsic element of containment in which development can potentially occur. I thought of this as akin to the early experiences of, and within, the context of the family of origin replete with love, hate and ambivalence towards parental figures and siblings.
To be sure, the oedipal and pre-oedipal dimensions of psychoanalytic training have been written about and discussed by many authors.
Such discussions have been not only in terms of the transference/countertransference issues that arise in the analysis of trainee analysts, but transferences also to figures of authority and the requirements of the training organisation. The realities of the training program necessarily have to be confronted and negotiated in terms not only what we call external realities and requirements in particular, but also the personal psychic significance and meaning for every individual in that training program.
Becoming an analyst then, on one's own terms, could from this perspective be thought of as the continuation of working through with one's patients, one's colleagues and oneself post qualification. If we think of the outcome of a successful or good enough analysis as the development of a capacity for self-analysis, then the outcome of a good enough training might be to become or start to become one's own supervisor and seminar leader. I think this incorporates both the attainment of psychoanalytic competence and formation of an individual analytic identity as objectives of training.
Returning to Parsons, on the basis of his reviewing a series of articles by British analysts of different orientations, he expressed the view that there were two distinct and crucial elements in which a psychoanalytic identity forms itself.
First, the analyst’s subjective experience of what has gone into forming his or her own personal identity in general and second, the evaluation of whatever diversity of analytic viewpoints the analyst has been and is exposed to in his or her own analysis and in psychoanalytic training.
Parsons states “in the complex kaleidoscopic interaction between these two, a unique and individual analytic identity is gradually elaborated in each and every candidate.
As an aside, I was reminded of a comment made by the painter John Olsen who died earlier this year. When asked many years ago why he chose to become a painter, he responded by saying ‘painting chose me, I didn’t choose painting”. Something of his own personal identity and sense of himself was centrally and inextricably linked with his work as a painter.
Of his 1966 painting in the NGV ‘Man absorbed in landscape’, Olsen said “I am in the landscape and the landscape is in me’. An independent reviewer commented ‘the unruly nature of this work is suggestive of both the untidiness of humankind and the landscape’.
I thought this was a favourable and tactful review!
Before moving away from the evaluation of candidate competence and assessment of progress to some organizational aspects of training, I was reminded recently of a comment made by the late Italian Nobel Prize laureate Rita Levi-Montalcini who received this award in 1986 for her exceptional work in neurobiology. She is quoted as saying ‘imagination is more important than knowledge.’
She was, of course, emphasising the vital importance of imaginative and visionary thinking in her own groundbreaking research work. But she was also a vocal advocate for the important role of creative imagination in scientific as well as artistic pursuits.
Could the freedom to use one’s imagination creatively and constructively be a factor in Gabbard and Ogden’s idea of becoming an analyst in ‘one’s own terms’. This might also be likened to improvising in music - perhaps unrealistic to expect during training but hopefully a development that occurs post-qualification.
In recent years, issues relating to psychoanalytic training in the Eitingon model have been examined closely by David Tuckett and eight other European analysts. This paper (2020) is entitled “Psychoanalytic Training in the Eitingon Model and its Controversies: A Way Forward.”
The abstract is worth quoting in full:
“Psychoanalytic training has been an object of controversy for many years. Arguments have been intense about the details, sometimes called ‘requirements, and particularly over whether or not training institutes should have routine external validation. We describe these arguments and present preliminary conclusions about the core challenges psychoanalytic trainings face using a unique set of detailed observations collected during structured ‘conversations’ inside nine European institutes. We conclude that whether a psychoanalytic training is ‘working’ or not, is not a matter of compliance with requirements. Rather it is an issue of how candidates, training analysts, supervisors and committee members, confront within, and between each other the consequences of the unconscious dynamics that psychoanalytic training must inevitability create. Institutional psychoanalytic capacity is to take itself as the object. Consequentially, we propose that training committees that seek to claim that their psychoanalytic training is genuinely and safely producing psychoanalysts would be ones that institute routine procedures to show to themselves, transparently, how they attend to the dynamics just mentioned and how they take a neutral inquisitive stance towards them. Fear of oversight, we suggest, is a symptom of deeper anxieties. They can be faced by creating an appropriate setting. Properly conducted visits from outsiders are welcomed.”
One of the interesting points the authors make is that conflicts and disagreements around training are part of an inevitable and ongoing, always incomplete, struggle to help trainees internalise a “third” position in relation to themselves in their analytic work.
This position of the third is considered one in which self-observation, self-evaluation and reflective thinking are desired objectives in the candidates we train.
In addition, the authors propose that every training organisation should formally and regularly commit itself, to providing for itself, an audit of its own functioning as a training body. The authors posit several questions that could be usefully raised. These include:
What is the atmosphere like in our group?
Do we have dominant cliques in our group which make decisions difficult or prevent open discussion?
Do we recognise, bring to the surface and resolve the conflict among us, or do we let “sleeping dogs lie”?
Has our organisation institutionalised a third position in order to explore and report on difficulties or not?
Are our assessment systems transparent so that the failures are recognised and our conflicts around them openly explored and discussed?
Do we have secrets and silences among us in the present or in our collective history we cannot discuss?
What is the state of the training group? Is it cut off from, or integrated, within the larger group of analysts?
Is our group comfortable and willing to invite visits from outside to share thoughts and details?
This set of questions is not exhaustive. In essence, the questions and questioning process represent the training organisation evaluating itself by taking itself as the object of critical examination and review.
In reflecting on this set of questions, I was reminded of Bion’s ideas about the basic assumption dynamics in group functioning that can derail, divert and undermine the central task of the work group.
In recent years there have been a number of developments in keeping with the spirit and intent of the suggested direction and ethos of the 2020 paper by Tuckett and others.
As I understand it, an Exchange Visit Program (EVP) was set up to look at Eitingon training programs in Europe. One aspect of this brief was to look at the capacity for institutional reflection.
The stated purpose was to build the confidence of those organising training programs by “friendly but rigorous external oversight.” And secondly, to develop a shareable set of criteria for what constitutes a high quality Eitingon training in psychoanalysis that goes beyond defining it in terms of requirements, most notably the frequency of sessions.
In mid-2021, there were two videoconference meetings set up by our own Society in which the visiting team of Claudia Frank and Denis Flynn met with members of APAS.
For me, one important message that emerged from this virtual meeting was the reiteration of the necessity for providing time, space and opportunity for discussion and reflection of all aspects not only of our training programs but other more general aspects of our own institutional life and functioning together as analysts.
The potential benefit of visits from analysts outside our Society was a reinforcement of the message about the need for an analytic ‘third-position’ from which we could reflect critically on our own training programs and our own functioning as an analytic group with a central focus of our collective task, activity and responsibility pertaining to psychoanalytic education and training.
I am not sure whether the birth of our Society’s NEAT committee, an advisory body emerged out of these discussions but perhaps others are more informed than me on this matter.
Before concluding, I note that our Society’s Training Procedures and Guidelines Manual was revised last year. I understand there is a further iteration to be discussed at our AGM.
As perhaps as you are aware, there is a section on the review of candidate progress, There are four sub-sections. These cover the review of candidates at least on a six-monthly basis, the advancement of candidates through the various stages of training, the provision for the opportunity for feedback on a regular basis by candidates and lastly the opportunity for candidates, supervisors, progress advisors and a representative of the student progress subcommittee to meet and discuss as required.
In the other guideline we have, the now somewhat outdated ‘blue book” on Melbourne Branch role descriptions and procedures, it is noted that ‘it shall remain an issue of prime concern for the SPSC to consider at length those students who evidence a lack of progress in their training.”
I think this is worth including because it raises the very interesting question of how and when ‘lack of progress’ is be identified, thoughtfully considered and carefully handled.
I began this paper by saying that thinking about psychoanalytic education was a path well-trodden. As I come to the end of the paper, I wonder if I need to amend the metaphor. Perhaps the wheel is a more apt one.
On this point, in my collection of papers, I came across notice of a Melbourne Branch scientific meeting entitled “Can we improve on training”. This meeting was held in March 2001. Robert Daniel was on the scientific affairs subcommittee at that time and convened the meeting. Bob Salo chaired the meeting. Hence my reference to the wheel and unfortunately, I have to report that I could find no record of what was discussed.
Perhaps one important point here is that we need to continue reviewing and reflecting on the training of our candidates as a recurring quality assurance professional group activity. The other reality might be that raising questions is easier and less challenging than coming up with definitive answers or solutions.
To end, a kind of postscript comment. I am aware that I have used the terms, candidate, student and trainee interchangeably. From one perspective, these could be considered synonyms. From another angle, one could consider that there are subtle differences in these descriptors which may reflect different attitudes or conflicting mindsets that we have toward those colleagues for whom we have the responsibility for educating in psychoanalytic theory and practice.
REFERENCES
Freud (1930) Civilization and its Discontents. SE Vol XXI
Ogden T (2005) On Psychoanalytic Supervision IJPA 86: 1265-1280
Kernberg O (2006) The coming changes in psychoanalytic education IJPA 87:1649-1673
Tuckett D (2005) Does anything go? Towards a framework for the more transparent assessment of psychoanalytic competence IJPA 86: 31-49
Parsons M (2009) Becoming and being an analyst in the British Psychoanalytical Society Psychoanalytic Inquiry (29) (3):236-246
Gabbard G and Ogden T (2009) On becoming a psychoanalyst IJPA 90: 311-327
Tuckett D et al (2020) Psychoanalytic training in the Eitingon model and its controversies: a way forward IJPA 101: 1106-1135