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Hate and Love in Psychoanalytical InstitutionsReview - Hate and Love in Psychoanalytical Institutions
The Dilemma of a Profession
by Jurgen Reeder
Other Press, 2004
Review by Samar Habl, M.D. and Lloyd A. Wells, Ph.D., M.D.
Jan 1st 2006 (Volume 10, Issue 52)

In this book, Jurgen Reeder, a Swedish psychoanalyst, discusses training in psychoanalysis and its possible flaws.  He does this in a lengthy and highly systematic process, developing not only an appreciation of the dilemmas of training, but also some measures that might be taken to address these dilemmas.

The book is addressed to readers who include not only psychoanalysts in training or in practice, but also individuals in the field contemplating future analytic training.  It provides an overview of what psychoanalysis is, its history, training curriculum and all the challenges of training that candidates encounter, often with little prior understanding of potential problems in training institutes and how these challenges affect the candidate in terms of quality and length of training and their possible future within the training institute.

Currently (and historically) training as a psychoanalyst occurs in a free-standing psychoanalytic institute rather than a university or medical school, and training consists of a personal analysis conducted by a training and supervising analyst of the institute, supervised therapy by the candidate, and course work.

Reeder argues that the role of training and supervising analysts inherently leads to significant ethical and pragmatic problems in the training experience and that the training experience creates serious and troubling pedagogic challenges.  He relays a sense of gravity to the intrinsic problems of institutes, hence the intensity of his arguments.

The book begins with a personal view about psychoanalytic treatment.  Reeder offers a compelling account of the interplay between the analyst and his analysand.  He highlights the role of the analyst's presence as an individual in the transferential experience and how it affects the content and timing of the emergence of the transference.  He provides an understanding of what assimilating the theory means, and how it involves a de-constructive process that allows a later reconstruction of the theory in ways that fit the matrix within which an analyst is working with an analysand.  He challenges the theory in its rigid and crude form and verbalizes the limitations of the psychoanalytic process in quite sophisticated ways. 

The author provides lengthy sections on the history of psychoanalytic training, from its beginnings with the Berlin institute up to its current state.  He captures many significant events that influenced and shaped the practice of psychoanalysis.  He pays attention to the contributions of the International Psychoanalytic Association (IPA) as well as other organizations and committees that emerged later.  This organization and centralization of psychoanalytic training served not only to promote its development, but also to impede its popularity in the rest of the world.

The author next points out how the controversies around what constitute qualities and virtues of an analyst might have created an institutional paranoia regarding the personal attributes of a candidate.  The interest that training institutes have taken in candidates' attributes reflects a possible institutional narcissism which manifests itself in seeking candidates that mirror the image the institution has of itself.

Reeder underscores the value in the candidate's seeking analysis for personal reasons, and therefore acquiring a first hand experience of what analysis could offer analysands.  While emphasizing the value of sometimes internalizing the training analyst's style, the author is able to see how that same process can hinder certain aspects of the training.  He specifically warns against the possible overidentification of the analysand with his analyst, which may result in transmitting a "work superego" to the candidate and result in an indoctrination process.

The author is also able to articulate conflicting issues intrinsic to the training and pertaining to the pedagogic aspect of supervision.  He points out how the supervisory role (evaluation) is in natural conflict with the candidate's wish to be open and show all the vulnerabilities of the treatment he or she is conducting.  Therefore the conflict between the unavoidable control assumed by the supervisor and the intimate nature of supervision could be a barrier to training and to the emergence of a candidate's creativity.  The author also addresses the third arm of training, which is the theoretical seminars, and questions the curriculum's relevance and its reflection of the progression that psychoanalytic theory has taken over the years.

Reeder introduces the notion of "superego complex", which, he argues, is a result of the rigidity of the psychoanalytic training system.  He points out different ways that training allows for phenomena that not only seem a result of a hateful superego, but also reinforce the attributes of the superego.  He highlights the ways in which training not only creates a professional and personal superego, but also an institutional one.  He underscores the reciprocal identification between a candidate and the analyst and the resulting unconscious wish of the candidate to replace the training analyst as well as the training analyst's unconscious wish to hinder the growth of the candidate.  The superego becomes "the reservoir of introjected hate", and therefore a culture of hate develops.  The author points out intelligently that through the process of internalization, the candidate internalizes virtues that are permeated with "control, rivalry and enactment of power."  The author quotes Stenssan who shares a similar perspective "Candidates will tend to introject the handling of power allocation and other ethical qualities of the interpersonal relations in the institute onto their psychoanalytic ego ideal and superego" (p. 173).  The author speaks to the superego complex development stating: "The process begins with the selection of candidates and has its final manifestation in the form of a collegiality characterized by hostility and fear, plus a phenomenon that I have chosen as 'the pursuit the psychopath" (P: 181).  The author pays special attention to the tendency of the institute to pathologize any attempt on the candidate's behalf to challenge and question the institute.  The candidate can therefore become the medium in which conflicts and difficulties emanating from the institute are expressed and pathologized.  Kernberg suggested that the psychoanalytic institute bears a doctrine that is not to be questioned by a candidate without the candidate risking becoming the "bearer" of the badness.  The task of writing becomes more difficult given that the writer must not only defend his theories and thoughts, but also defend that his theories are not reflective of a personal disturbance that has to be approached through more analysis.  The author underscores the risk a superego creates in the interpretive work, where there is limited room for challenging the established knowledge.  This dynamic can allow expression of a lot of aggression in a training system that lacks an intrinsic way of keeping the aggression in check.  

Reeder offers multiple suggestions that might help eliminate these intrinsic problems in training.  He underscores the importance of eliminating the need for personal analysis to be done by a training analyst at the institute.  He advocates for making it a prerequisite without any restrictions on who it is conducted by, as long as the analyst is qualified.  The author offers suggestions that involve scrutinizing the supervision process to make sure those supervisors are well qualified and that the curriculum is diverse and up-to-date.  Reeder places special emphasis on freeing the atmosphere from the attitude of attributing all problematic situations to candidates' unresolved issues, and therefore invites supervisors and analysts to remain open minded to their shortcomings, and to allow fostering of an environment that maximizes the candidate's creativity.

This book presents a clear view of the dialectic between training analysis and training, one which we need to consider seriously.  At the same time, rather than viewing psychoanalysis as a completely special case, we need to examine similar training conundra in other disciplines - and they are certainly present.  In the sciences, for example, letters from dissertation directors are absolutely essential in obtaining NSF early-career grants, and this is true to a lesser extent at NIH as well.  This highlights that as grave as some problems in psychoanalytic training may be, they are enduring problems in many large social organizations.  This raises a question from a group dynamic standpoint of how people handle and assume positions of power and how it gets exploited.

Reeder addresses the current psychoanalytic training system intensely, which raises the question of the reasons that lead him to develop a critical attitude towards the training system.  The author's experiences in his own training and his work later on as an analyst may have shaped his opinions in unique ways, and driven his keen criticism of the current system.

The author recognizes the institute's necessary interest in safeguarding the goodwill of its training mission, but looks for ways to allow candidates to be immune from most scrutinizing powers of the institute.  Where should the line be drawn?  As the book advances, its tone changes significantly to include a bleak view of psychoanalysis and a significantly pessimistic view of the training system.

Reeder's suggestions, despite being valuable and promising, can bring to the training new inherent systemic challenges that are not considered in the book and that might be difficult to assess before putting into practice.  For instance, personal analysis done outside the realm of the institute might result in creating a crack through the system that allows poorly qualified candidates to graduate.  Also, scrutinizing the content of supervision and the selection criteria of supervisors may be problematic itself.  The curriculum can become rigid in ways that are hard to assess and supervisors might become harder to find as they lose their motivation to seek qualification.  In other words, the changes implemented might defeat the purposes for which these changes were made in the first place.

This is an immensely thought-provoking book.

 

© 2005 Samar Habl and Lloyd A. Wells

 

 

 

Samar Habl, M.D., Fellow, Austen Riggs Center and Lloyd A. Wells, Ph.D., M.D., Mayo Clinic.  (Dr. Habl did her early training at Mayo Clinic and is currently a fellow at Austen Riggs Center.  She has a strong interest in psychodynamic and psychoanalytic psychotherapy.)


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