Robert M. Young Online Writings
PSYCHOANALYSIS AND PSYCHOTHERAPY:THE GRAND LEADING THE BLAND
I went to a meeting in March of THERIP, The Higher Education Network for Teaching and Research in Psychoanalysis, on the topic ‘Who Speaks for Psychoanalysis?’, subtitled ‘The UKCP/BCP Debate’ (these initials refer, respectively, to two umbrella organizations representing psychotherapists, the broadly-based United Kingdom Council for Psychotherapy, and the British Confederation of Psychotherapists, a smaller organization inspired and dominated by the British Psycho-Analytical Society. I’ll say more about these organizations later). One of the speakers was the External Relations Officer of the British Psycho-Analytical Society. He began by saying that he could make short work of the main title: the Institute of Psychoanalysis speaks for psychoanalysis. When challenged, he stood his ground. It was objected that in this country the Institute may well speak for psychoanalysts, since there is a convention that only its members are called psychoanalysts (a convention not observed by Lacanians in Britain or by anyone in other countries, by the way).
However, psychoanalysis is another matter. Psychoanalysis is a discipline, a broad church, and no one institution owns it. There are over forty psychoanalytic journals in English, and I know of at least three new ones in the pipeline. Only a fraction of them are published by official psychoanalytic organizations. There are about a dozen graduate programmes in Psychoanalytic Studies in Britain and Ireland, only one of which is affiliated with the Institute, and it was a late bloomer. There are people of considerable psychoanalytic eminence who are not members of the Institute or affiliated with the International Psychoanalytic Association. I have in mind, for example, Anne Alvarez, Margaret Rustin, Gianna Williams and Dorothy Judd at the Tavistock Clinic. Casting the net more widely in this country, there are Joseph Berke, Nini Herman, Karl Figlio, Jeanne Magagna, Paul Gordon, Janet Sayers and Jan Abram, among practitioners, and Gordon Lawrence, David Armstrong. Jacqueline Rose, Barry Richards, Michael Rustin, Meg Harris Williams, to name a few significant psychoanalytic writers who are not also clinicians. If we look abroad Michael Eigen, Harold Boris, Kenneth Eisold, Jay Greenberg, Stephen Mitchell, Gérard Bléandonu and Otto Weininger come to mind. Come to that, I speak for psychoanalysis. I have published more psychoanalytic volumes than The International Library and The New International Library combined. Indeed, while I was running Free Association Books I published a multiple of the number of books by IPA psychoanalysts that their own book series did. I also wrote and edited a considerable number of psychoanalytic articles, books and collections. Even so, as I said, when challenged, he stood his ground: only the Institute is entitled to speak for psychoanalysis.When he turned to the question of the relations between the British Confederation of Psychotherapists or BCP and the United Kingdom Council for Psychotherapy or UKCP, he said, after much heated debate, that he had the impression that some of us thought that there was an eminence grise behind the problems between these two bodies purporting to speak for psychoanalytic psychotherapy, the Institute of Psychoanalysis. He assured us that it was his experience during a year’s involvement with the BCP that this was not so.This man is seen throughout the country as a symbol of leadership and good sportsmanship. Indeed, lest we forget this, when he was recently appointed to a Visiting Professorship in psychoanalysis at a British university, The Times Higher Education Supplement pictured him in full cricket regalia — a living symbol of fair play. He made his points in an assured and authoritative manner. And yet it takes only a moment’s reflection to realise that his stance on the matter of who speaks for psychoanalysis is arrogant and patronising, while his remark about there being no eminence grise behind the activities of the BCP was simply a hoot, and the audience fell about laughing at that point. Out for a duck, I’d say. (One need not reflect long before recalling a more recent Captain of England who rubbed dirt onto the ball in a way which was decidedly ’not cricket’. Psychoanalysis should teach us to be wary of idealisations.)
The whole raison d’être of the BCP is to create and maintain an elite which has hegemony over other psychotherapy organisations, while drawing a sharp line between those organisations and the rest of the profession, whose standards are said by them not to be adequate.What is going on in the culture of British psychoanalysis? This is my fourth sustained attempt to reflect on this question. The aspect I want to emphasize here is the dialectic between the elite corps of psychoanalysts, which includes about 300 people practising in this country, and the rest of the profession of psychoanalytic psychotherapists which numbers something over 2000. It is my contention that this dialectic has baleful consequences involving a subtle yet profound dis-enablement and self-limitation of the psychotherapists in the service of bolstering the status and self-esteem of the analysts. I do not find this point easy to grasp or to spell out or to make convincing, but I am sure of it.Analysts rarely go to psychotherapy conferences except as speakers, and then they usually only turn up to give their talks and then leave. I recall one occasion when an eminent analyst was scheduled to speak at a particular time. The programme was running late, but she insisted on leaving at the originally scheduled time with the remark that, after all, sessions had to begin and end strictly at the appointed times. There are a few exceptions — perhaps half a dozen people — but the rule is that analysts only go to conferences mounted by psychoanalysts (and sometimes by psychiatrists). They will not even put up notices on the Institute notice board about talks and events unless there is a link to their members. In my own training organisation psychoanalysts turn up for papers by other psychoanalysts but practically never to papers by psychotherapists. In certain organizations, including and especially mine, the regulations are gerrymandered so that only psychoanalysts can occupy certain key positions, especially those concerned with the training. In several training organizations only psychoanalysts can be training therapists (there are a few exceptions to this rule at the BAP). This has the shocking consequence that the graduates of those organizations cannot, at least in the foreseeable future, have important roles in the teaching, supervision and therapy of the trainees, even though they are members of long standing and may have considerable eminence as practitioners, writers, etc. It is my impression that psychoanalysts who take up the key roles in BCP-affiliated psychotherapy trainings are people who have not become and are unlikely to become training analysts at the Institute. I have a number of specific names in my mind. Some — including recent chairs of the Lincoln and the BAP — have not even become full members of the Institute. I have the impression that some psychoanalysts, having come from backgrounds which left them with low self-esteem, climbed the ladder to the Institute and then sought to pull it up after them for reasons of insecurity. In a recent exchange about such people on the internet a dissident Canadian analyst asked, ’Any ideas as to where genuine psychoanalysis will go in flight from the apparatchiks who have taken over its institutions, like the mechanical nightingale took over the Chinese emperor's court, sending the real nightingale back to its tree in the swamp, in Hans Christian Anderson's wonderful story?’I also have the impression that people who rise to power in training institutions, whether psychoanalysts or psychotherapists, often suffer from a need for power, which they pursue with the ruthlessness depicted in Donald Meltzer’s book on The Claustrum. They live just inside the nether end of their psychic digestive tracts in perpetual fear of expulsion into a breakdown. They will do anything at anyone’s expense to have and retain power. It is my experience that people who care about power usually believe themselves to be frauds and are desperately afraid of being found out. It is a tribute to folk wisdom that sensible people casually and universally refer to such folks as arseholes. Indeed, I heard Rory Bremner on the television the other night say, ‘You know that it’s said that people are what they eat. Well, picture Rupert Murdoch eating all those arseholes.’ This epithet has turned up in many of the messages and conversations I have had about power relations in the psychoanalytic community; the other one I often hear is ‘bullies’.This is the place for me to say that I do not want you to believe that I think all problems in the world of psychoanalytic psychotherapy should be laid at the door of the psychoanalysts and their running dogs. I could, if it was my topic for the day, regale you with baleful power struggles and other ructions in a number of psychotherapy training organisations — sex scandals, nepotism and cronyism, personality clashes among the founders, old guards who will not share power or move on, splits leading to the founding of new organizations. Although it is not my purpose to make the analysts the fount of all problems, I do want to point out that none of the stories about psychotherapy organizations which I am not telling you here and now blights or inhibits a whole stratum of the profession the way the hierarchical relations between the analysts and the psychotherapists do. I said at the beginning that I would say more about the UKCP and the BCP. The BCP was founded when a group, led by psychoanalysts, set up a rival organization to the UKCP. Four of the UKCP-affiliated organizations which joined the BCP elected to keep dual membership. Some, including my own, were removed from the UKCP without the membership being consulted. There has since been an unremitting struggle on the part of the BCP to get its member organizations to give up dual membership. For technical reasons they have had to allow the Tavistock Clinic and the Association of Child Psychotherapists to retain it. Indeed, the child psychotherapists have said they would allow themselves to be expelled from the BCP rather than give up dual membership. But the BCP have been teeth-clenchingly determined to force the British Association of Psychotherapists to withdraw, and, after a fight of several years, they look like having succeeded. They say this was achieved by a ’democratic vote’ of their member organizations, neglecting to mention that some have two votes, one of the training organization and another of that organization’s graduates. Never mind. Direct democracy is not their strong suit. There are about 500 members of the BAP, a significant number of whom are analysts. There are just over a hundred in the Lincoln, with a controlling minority of analysts (who do not have to undergo the same procedures to become full members that psychotherapists do). In all, the eleven BCP member organizations claim about 1300 members, as compared with about 2500 psychoanalytic psychotherapists in the UKCP (many also in the BCP) and about 4000 psychotherapists of all kinds in the UKCP.If you go to the BCP web site on the internet (http://www.bcp.org.uk/) and look at their Q&A, you find a pretty mealy-mouthed explanation about why its member organisations could not remain within the UKCP (called at the time the UKSCP). They say,
The umbrella body created was catholic in its membership. In order to recognise differences of titles and function, member institutions were divided into separate Sections. The momentum by which this was achieved made it difficult for the older and more established institutions, many of which were the parties to the original Professions Joint Working Party, to have their seniority recognised within the structure of the UKSCP. (It is difficult to represent with sufficient force the problem this presented. It was as if the United Nations had no permanent members of the Security Council, only nations elected to it from the General Assembly in which each nation had a single vote.)
The institutions of the UKSCP were not equal in their contribution to the field nor in the public esteem. Current and historically-based realities of that kind could not be accommodated within the constitutional structure of the UKSCP. Following the inauguration of the UKSCP in 1989, several psychoanalytic psychotherapy organisations made the request to achieve a separate section of their own within the UKSCP. This did not include the British Psycho-Analytical Society or the Society of Analytical Psychology which were already in a separate section. This request could not be accommodated and this was a decisive factor which led to the establishment of the BCP as a separate body.
(http://www.bcp.org.uk/questions_and_answers.html)However, it is pretty clear that the call for recognition of seniority, the Security Council analogy and the notions of non-equality and ‘historically-based realities’ beg a lot of questions, for example, whether or not the psychoanalysts are equivalent to China, the USA, Britain, France or the former Soviet Union, with psychoanalytic psychotherapy organizations down there with Belize and Uruguay or perhaps, like Germany and Japan, kept out of permanent seats because of having behaved badly in the past. I am suggesting that this is a very suspect analogy. Even so, the selfsame ‘Security Council’ analogy played a central part in the withdrawal of the BCP organizations. While still in the UKSCP they said that unless the psychoanalysts had a veto over all decisions of the whole organization, not just the psychoanalytic part, mind you, but the whole organization, they would withdraw. And they did, only to discover that the Institute of Psycho-Analysis had violated their own regulations in not consulting their own members, so they did that and duly got permission. At the time a wise elder statesman of the Institute said that doing this would be perceived by the rest of the professions as a declaration of war, as, indeed, it has been. My interest in all this, by the way, is not due to any attachment I have to the UKCP (some of whose leaders, it must be said, have indulged in their own — albeit rather less ruthless — skulduggery) but because I mind very much how the members of my own training organization have been treated by the psychoanalysts who control the organization, e.g., failing to accede to three successive votes to rejoin the UKCP. At one stage a prominent psychoanalyst who had emigrated from South Africa and who was in an influential position in the organization said at a meeting of the Professional Committee, ‘The blacks are getting restless’. There was eventually a fourth ballot, which involved some teaching officers lobbying the very students over whom they have the power of qualifying them or not. The fourth vote went the other way and — surprise, surprise — was accepted by the administration. It would be difficult to convey with sufficient force how nasty the UKCP/BCP conflict has been and continues to be. I have heard people say extraordinary things. For example, a member of my training organization who is a psychoanalyst and who now holds a central post in its training and on the Professional Committee referred to the BAP’s policy of dual membership as a ‘Vichy policy’, implying an analogy to collaboration with Nazis. He also said during the debate over rejoining the UKCP that anyone who was not a member of the BCP should not be allowed to call themselves a psychotherapist, because they were ’charlatans’. The dedicated apparatchiks of the BCP have generated stratagem after stratagem to eliminate dual membership, and those who have wished to keep it have been under tremendous pressure and strain within their own organizations. I keep a pretty close watch on these matters, and one referred to the pro-dual membership people in the BAP as ‘being slaughtered’. The chair of the BAP is a psychoanalyst, and the head of the Freudian training, a psychotherapist, is (or was until very recently) the chair of the BCP. The BAP and BCP are based at the same address. The BCP people do not like public debates or public accountability; they prefer to operate by stealth. I believe that I am the only person to have written extensively about this, although there was a long letter in the last UKCP newsletter by Janet Boakes, Honorary Secretary of the UKCP on behalf of its Governing Board supporting many of the things I have said, and a précis of one of my articles on these issues appears in the same issue. The letter says, among other things, ’The Governing Board regards the action taken by the BCP as aggressive and hostile, aimed directly at the destruction of the UKCP as a national body representing psychotherapy’. People willing to be publicly partisan in this debate seem to have a special social problem. At one of the few public meetings on the subject, two of which have been initiated by me, a UKCP stalwart said that she thought it imprudent to be seen sitting with me. It is my intention to suggest that the elitists in the psychoanalytic world will go to practically any lengths to preserve their hierarchical position over other therapists. What puzzles me is why the psychotherapists stand for it. They seem pathetically grateful to be allowed to sit near, if not at, the high table.I have known a number of people well who have been psychotherapists and then have become psychoanalysts. They change. They join in less. They cease to be seen in their old haunts. They speak more authoritatively, as if they were now in a supervisory role. But in another sense they keep their heads down and don’t make waves. Some become less forthcoming and more patronising. They are less likely to make referrals to psychotherapists. They become more likely to write up and publish their work. Some become more likely not to answer letters, a peculiarly British form of haughtiness which is frequently practised by senior analysts. I can recall two settings — one public and the other leaked — where analysts referred to their work as gold or as constituting a gold standard, while the work of psychotherapists or other organisations were seen as alloys, involving an admixture of base metals. One of these contexts was a conference on the relationship between psychoanalysis and psychotherapy; the other was a document about the launching of a programme in Theoretical Psychoanalysis which would be competing for students with the dozen or so already established MA programmes in Psychoanalytic Studies. In another context when I was trying to persuade an analyst to become a patron of a charity which, among other things, sponsored a biennial conference on psychotherapy with psychotics at the University of Essex, he replied that he might lend his name if it weren’t for the charity’s sponsoring such conferences and said that ‘There are already too many fringe organizations’. I was struck by the model of the psychoanalytic community which this comment implied: a centre-periphery one, with London and analysts at the centre and psychotherapy conferences in Essex as ‘fringe’.I have also seen newly-qualified analysts remove papers which they submitted to journals other than the International Journal of Psycho-Analysis, in order to publish them in that journal — in one case from a journal which had provided the context for the talk on which it was based, in the other case after fulsome thanks to the editor and after the article was already typeset. When the editor of the IJPA, who knew exactly what he was doing, made it a condition that they only appear in the IJPA, they simply withdrew their articles from the other journal, knowing full well that they were behaving badly and in a careerist way. Both of the authors were from minority culture backgrounds. I am suggesting, to sum up my point, that when people become analysts, they become grand. Indeed, the first Editor of the Institute’s book series (who is now editor of the IJPA) sought to persuade two authors and an editor to withdraw their books from another publisher, even though the original ideas for two of those books came from that publisher and even though the authors were under contract. One of the authors wavered seriously but eventually went back and said that it would be wrong — like gazumping or stealing a patient. On an earlier occasion the then-editor of the Institute’s book series attempted to scupper an edited collection by removing his contribution and trying to persuade others to do so. He then tried to get high permission fees charged for the articles under Institute copyright, but this was overruled by the then-editor of the IJPA, who was a gent. More recently I approached the editor of the IJPA, asking him, as I had the editors of a number of journals, to allow my Bulgarian colleagues to subscribe to the journal at a concessionary rate. All the others agreed; some simply gave copies and subscriptions free or at a student rate. He said he could not decide until I told him more about the group, since one could not be too careful about getting involved with the wrong people. It struck me that the main thing is to be sure there is an out-group. In fact, there were only a handful of people in Bulgaria interested in psychoanalysis, and they had not yet managed to have a split.What is bland about psychotherapists? I think that no matter how experienced or well thought of they are they feel less entitled to contribute to the literature, to be training therapists and supervisors or to play a full part in the culture of psychoanalysis. They feel that they are members of a lower caste. I am in an odd position here, since I had written and published a lot as a university academic before I became a psychotherapist and do not suffer from this deference. Perhaps this is the point to relate my history, since I am sure some of you may wonder or be speculating about my vantage point. I studied philosophy at Yale and Medical Sciences at Rochester and intended to become a psychiatrist and psychoanalyst. In the middle of my medical training my wife became mentally ill, and I made a career move which allowed me to care for our son. I took up a fellowship in Cambridge to study the history of ideas about mind and brain. This went well with the result that I was a Cambridge don for a long time. My work was about the history and philosophy of ideas about human nature, and I lectured for many years on psychoanalytic theory. Then I resigned to devote myself to cultural politics, including making a series of television documentaries, and founded Free Association Books and the journal Free Associations.I went into five times a week analysis at the end of the television series because I was depressed, and after about a year I recovered my earlier intention to become a therapist. My analyst encouraged me in this, and I had an initial interview with an Institute analyst. She began by saying that it had already been decided that I would not be allowed to apply because of my age and that giving me the interview was a courtesy granted because of my academic attainments. I gather that this age bar has since been somewhat relaxed. I was miffed but didn’t take it personally. My analyst eventually took the view that the other available trainings were not right for me. He advised me to apprentice myself to someone I respected, and I approached R. D. Hinshelwood. He trained me for a number of years in individual and group psychotherapy. Some years after he said I should consider myself qualified, I was approached by the head of the postgraduate training at the Lincoln Centre and asked if I would be interested in doing that course. I did so and am now a member of both the BCP and the UKCP and Professor of Psychotherapy and Psychoanalytic Studies at the Centre for Psychotherapeutic Studies of the University of Sheffield, which is Europe’s largest institution of its kind. The fact that I am a prolific writer is a continuation of habits of research and publishing I established while an academic. I never had to face the question of getting it together to write and publish solely on the basis of my identity as a psychotherapist. I stress this, because the culture of psychoanalytic psychotherapy does not, as I experience it, encourage writing. More fundamentally, it does not encourage people to believe that they are likely to have something to say. I know very well that there are journals, quite a few of them by now, primarily for psychotherapists and a number of others which cater for a mixed bag of contributors. I edit one of them and am involved with an number of others. Even so, as I move among psychotherapists, it is my firm impression that they reckon themselves less than analysts reckon themselves. Indeed, while I have been writing this paper I have had discussions with some who believe that, on the whole, the pecking order is fair and based on merit. One, who is currently being supervised by an eminent and prolific analyst, said that the way he made her feel in supervision led her to suspect that the hierarchy is a just one. Quite so. If we look at the literature, there is no doubt that by far the largest proportion of good published work comes from psychoanalysts. Is this simply a reflection of how much talent there is in the respective communities? I think not — or, at least not enough to account for the disparity. Some of the psychotherapists with whom I trained at the Lincoln are among the most perceptive and analytically thoughtful people I know, as are some of those I have worked with from other trainings.This point is not easy to grasp. It may help if we look more broadly. When the Portuguese left Mozambique there were no doctors, lawyers or other professional people in the country. The colonial rulers had created no professional educational opportunities for the black population. Something similar can be said of other subject people who were either not encouraged or were actively prevented from attaining certain positions or undertaking certain cultural roles. I am thinking of blacks, members of the working class, women. For the most part, such people ‘know their place’: they are bland, at least as far as certain kinds of writing are concerned. Others have been constrained to excel in certain fields because other areas of endeavour were closed to them, e.g., Jews in business, banking, writing, academic life, psychoanalysis; blacks in athletics but not in swimming or fencing or snooker. There are by now a handful of famous black tennis players and one famous black golfer, just as there was once — but only briefly — one black baseball player in the major leagues, Jackie Robinson. There were few famous women artists or scientists until very recently. These differences are not natural; they have to be explained by social forces. I am suggesting that the caste difference between psychotherapists and psychoanalysts does, too.In some ways the hold psychoanalysts have over psychotherapists is like the analogies I have mentioned; in some ways it is even deeper. A psychotherapist training at an organisation which belongs to the BCP is likely to have analysts as his or her training therapist, supervisors and teachers. We all like to believe that analysis in the end frees us from infantile dependencies, but it is also true that the transference never ends, and there are fundamental transferential and hierarchical elements in all of the above relationships. This is obvious with respect to one’s training therapist, but it is also true that the seminar leader and supervisor are assessing one’s worth as a therapist and determining whether or not one is a suitable person to qualify. In many profound and subtle ways we cede to these analytic figures the assessment of our worth as human beings — the quality of our perceptiveness, our sensibilities, our selves. We imagine that they can see into the windows of our souls. It is also the case that they will remain parent figures and hopefully patrons, e.g., in making referrals. In the early years of my practice all of my patients could be traced to the patronage of my mentor and teacher. In later years one analyst, Nina Coltart, sent me many of my patients, and at present two people (neither is an analyst) send me most of the ones I take on when I have a vacancy. It would be imprudent of me to fall out with these people.The situation is different in other countries in that they are more pluralistic. There are several psychoanalytic societies in France, Brazil, Argentina. In the United States there are at least three:1) William Alanson White Institute of Psychiatry, Psychoanalysis, and Psychology: http://www.wawhite.org/
2) National Psychological Association for Psychoanalysis: http://www.npap.org/index.htm 3) National Association for the Advancement of Psychoanalysis, a non-sectarian body which until recently maintained a National Registry of Psychoanalysts; it is now independent: http://www.naap.org
Sometimes the non-IPA societies are on an equal footing, sometimes, as in Switzerland, the non-IPA society is the more interesting one. In the United States until recently the IPA-affiliated societies required trainees to be medically qualified, but this was reversed as a result of a successful lawsuit on the part of psychologists, and non-medical people can now train in those institutes. However, there are still struggles going on there. I heard recently that the NAAP is going to court in the US to challenge the constitutionality of laws which restrict the training and practice of psychoanalysis to mental health professionals (with qualifications in psychology, medicine, social work, marriage guidance, family and child counselling). The case against the restriction of psychoanalysis to medical doctors was based on the argument that the existing policy was ‘in restraint of trade’, and that argument is now being deployed in Britain against the BCP. You will recall that Freud argued against the restriction of psychoanalysis to medical doctors in ‘The Question of Lay Analysis’, which was inspired by Theodore Reik’s not being able to practice in the US because he was not a doctor. This case led to the founding of the NPAP. We should note that the medical analysts and the mental health professionals did not give up power and restriction of practice voluntarily; they had to be sued. In Britain those who advocate the present situation and a special status for analysts and their protégés are very unkeen to acknowledge publicly that a lot of this is about power, patronage and protecting an economic niche. The BCP regulations, in effect, guarantee the psychoanalysts a certain number of analytic patients. There were similar struggles in the seventeenth century in which the physicians sought to restrict the status and activities of the barber-surgeons, which is why male surgeons to this day proudly call themselves ’Mr’, even though they are medically qualified. I have had letters from a number of eminent American practitioners, called psychoanalysts in that country, detailing their professional difficulties and the challenges to their morale, always ending on a note about soldiering on regardless of the machinations of the IPA-affiliated societies and some of their members. I’ll give you an example. I wrote to Michael Eigen, author of a number of writings I admire, and asked him about his affiliations. He replied,
Faculty, senior member, control/training analyst in the National Psychological Association for Psychoanalysis.Faculty, supervisor, New York University Postdoctoral Program in Psychotherapy and Psychoanalysis.Certified Psychoanalyst, National Association for the Advancement of Psychoanalysis.I'm not a member of the International, since NPAP and NYU haven't joined. There's been a split in the NPAP membership over this, but so far the vote has been to stay independent. We are the largest non-medical training institute, started when Theodore Reik got shafted by the New York Psa. Inst. many years ago. The history has many ins and outs. Also, I wasn't motivated enough to join one of the institutes that did join the Intl. Or I was too oblivious of what was happening. There was a rush to join the institutes that were joining. I guess I was too absorbed in my own processes to go through whatever motions had to be gone through. My training has been quite mixed and not really orthodox.
Afterthought: I've no idea whether or not I'm a psychoanalyst, at this point. But psychoanalysis plays a role in whatever I am.
In a later email he said,
How oddly familiar this all sounds to me. When I arrived on the scene, nonmedical trainees at the NY Psa Soc had to sign a thing saying they would not practice psa, but use it only for research purposes. The medical groups tried to control psa. So nonmedical institutes started, first by T. Reik and his students, many of whom are friends, those who are still alive (NPAP). Now there are many nonmedical institutes.As a practitioner I've fared pretty decently here. I built my base outside the medical establishment. It happened quite spontaneously. Now I'm more in demand than most of them. As an eminent APA analyst once put it to me in an aside, "You did the right thing. They're dead on the vine."Still, look what happens when I appear in public. I got attacked immediately on a psychoanalytic internet forum. Of course, some supportive people appeared too. Things are always split like that.In the end, the medical establishment began to cave in here. They were dull. They approached the psyche like a business, rather than a calling. The psychologists vied for power, and they are now becoming awful too. I don't know who’s worse. Probably the medical group. The fight continues, as Freud said.So it is in your land too, along different institutional lines. Psa snobbery is ghastly. I'd like to say it's self-destructive, but prigs like this often know how to work power. But I'm still here, doing at least as well or better than most of them. And making more interesting contributions, such as they are. At least my work somehow affirms the human spirit, or means to. I wish you well in your world with this business
Whoever grows from the O of psa speaks for psa.
When I asked if I could quote him, he asked me to add,
Things are not static. So I wouldn't want to create a totally either-or impression. Degrees and affiliation don't make you a good or bad worker. There are people from all camps doing creative work, people in all camps that are destructive, and people from all camps that are both. How does one know them by their fruits? Too often status is substituted for the real thing. But the difficulty you are fingering is real. And you can quote me, if you like, with this present "disclaimer".
I, of course, agree and owe more than I can say to creative psychoanalysts. The institutional arrangements, however, are another matter. Moreover, I do not want to suggest that the US and UK situations are exactly parallel. It is clear to me that the US situation is more pluralistic and that the non-IPA people are more robust and active on their own behalfs. I also think that until very recently the US analysts have largely been mired in a scientistic Freudian orthodoxy which does not predominate in Britain. There is an additional irony in these matters, since I have also been privy to remarkably similar tales of woe from people in one British analytic tendency in the Institute about others. Kleinians tend to peck Independents and both peck Contemporary Freudians. Indeed, there are also feuding sub-tendencies, e.g., Meltzerians v Hanna Segal acolytes. For example, no senior Kleinians attended the Bion Centenary celebration sponsored by the Freud Museum and the British Journal of Psychotherapy at which Donald Meltzer gave a paper. Sectarianism is always a place to hang and to project insecurities. Kenneth Eisold and Otto Kernberg have written eloquently about intolerance of diversity and inhibition of originality within psychoanalytic organizations, and I must say that one hears a lot about this in the British Institute. I shall never forget that when I went for a consultation in order to begin analysis, Enid Balint confirmed what I had been told for years about social relations in the analytic world. She said, ‘It’s true that we are all shits to one another.’ She managed to find for me someone about whom I had heard nothing, and after some years Irma Brenman Pick helped me to find another, a Kleinian, who had better boundaries. Moreover, I owe a great deal to a number of psychoanalysts and like and admire many. However, as I have been saying, the split between psychotherapists and psychoanalysts is not just sectarian or personally back-biting. It is a hierarchical one, and the analysts are always accorded the higher status. I suggest that the intra- and inter-institutional dynamics of the psychoanalytic culture would repay analysis in terms of Freud’s work on group psychology and the group relations tradition inspired by Bion. I believe that the distinguished student of group relations, Isabel Menzies Lyth, has had a look at the internal structure of the Institute, but her findings have not been made public.It is my impression, by the way, that people of certain personality types tend to get accepted by the Institute — not exclusively but largely. In fact, someone did a study a few years ago and found that among non-medics, eighty per cent of successful applicants already had a training in Child Psychotherapy from the Tavistock Clinic. I believe that this trend has since abated. The people I have known recently who have been successful applicants are good at being — or presenting themselves as — ’good’ in the sense of Head Girls in a British grammar school. I recall seeing one hugging the BCP roster to her bosom and saying with great feeling that it was wonderful to have in the pages of one book the names of all the people to whom she would be prepared to refer a patient. At the other extreme, rebels tend to walk away or to let their membership lapse, for example, Edward Glover, R. D. Laing, David Malan, Charles Rycroft, Donald Meltzer. Some others have quietly withdrawn from the training. In my work as an editor and teacher I have had occasion to get to know rather a lot of psychoanalysts and psychotherapists. I cannot point to any clear division morally, intellectually or clinically. I know lots of indiscreet, malicious, adulterous, philandering and promiscuous people in both groups. But it is in the analytic camp that I can think of people who write as if the wheel needed reinventing, as if there was no existing literature on a given topic, as if it is appropriate to spin off neologisms at will or use established terms as if there were no existing definitions, to pontificate, to sally forth in disciplines where there is established expertise with barely a nod to the established professional and subtle thinkers, writers and teachers in those domains. I have had some prima donnas among my psychotherapist authors, but I have had some ’dillys’ (as my mother would put it) among best-selling analysts. One took umbrage and decamped upon having any criticisms made of a manuscript; another was unwilling to consider any significant changes to his text. Another (not published by me) rang Karnac’s on a weekly basis to enquire about sales and talked of nothing but his own books in public settings. Mind you, I also know a psychotherapist who has become a globe-trotting media dandy and a Lacanian whose prose is just as poncy and enigmatic.At the other end of the continuum are those who elaborately defer to the analytic establishment. This group includes both analysts and psychotherapists. More importantly, in my opinion, it includes rather a lot of former radicals who seem to have lost their political outspokenness and activism in the course of second analyses or in becoming protégés and/or employees of institutions dominated by analysts. I note that some of these have not taken up public positions on the UKCP/BCP split. I recall writing a paper which included a short passage about an unnamed prominent analyst’s haughty behaviour at a conference on psychoanalysis and psychotherapy. Not only did the person in question — who had challenged him rather effectively at the conference — beseech me to remove the anecdote, but friends of this person independently approached me about it. I acquiesced but noted the anguish. That person has since become a psychoanalyst. There are also a number of people I can only describe as dupes or stooges or acolytes of the BCP establishment. I can think of three, in particular. One became a sort of combination of mascot and front person and was rewarded with high office. Another, who stood in when the BCP would send no representative to debate the issues, mounted the argument which was so familiar to me from my youth in racially segregated Texas: it is obvious that these groups don’t get along so let’s have ’separate development’. Still another was heard to say on one occasion that since we owe so much to the psychoanalysts, it would be most ungrateful to do anything with which they disagreed and on another that they deserved their status in the hierarchy, since they wrote almost all the interesting papers and ended with the sentence, ‘I know; I’ve tried and failed’. This begs all the questions about why one smallish group writes so much and the far larger one writes so little which I raised above. I believe the causes are in the dynamics of the relations between the subcultures. The Italian Marxist Antonio Gramsci defined ’hegemony’ as the organization of consent by ruling elites without the overt use of force and without those who were under the hegemony being uncomfortably aware of the forces at work in the situation. This kind of implicit power is embodied in social relations, institutions and practices and permeates all individual and collective activities (Sasoon, 1985, pp. 201-2). In his discussion of hegemony the distinguished cultural critic, Raymond Williams, points out that hegemonic social practices depend on consent to certain dominant ideas which express the needs of dominant groups. These are accepted as ‘commonsense’ and ‘normal reality’ by those in practice subordinated to them (Williams, 1976, p. 118). I suggest that the concept of hegemony illuminates the structured feelings and relations between the psychoanalysts and the psychotherapists.As I said, I was an academic for many years. Dons at Oxford and Cambridge think pretty well of themselves, but I know of none who does not acknowledge excellent departments in other universities, including redbricks, newbricks and former polytechnics. This is reflected in the triennial Research Assessment Exercises, for all their faults. Departments with 5 or 5* ratings turn up all over the place, even though they also tend to cluster in certain elite institutions. The same can be said of medical schools, law schools and so on. I say this to highlight how striking the hegemony of the Institute of Psychoanalysis is. Moreover, since almost all British analysts live in London, nay, in a single postal district of North London, there is a knock-on effect in the provinces. Everyone who trains outside London, (with the possible exceptions of Edinburgh and Bristol, where there are a few analysts) is deemed to have an inferior training. And so the caste system perpetuates itself. Provincial psychotherapy trainings are seen as dilutions of proper BCP psychoanalytic psychotherapy trainings, which are dilutions of psychoanalysis.This brings me to the question of whether or not psychotherapy is only dilute psychoanalysis. Is five times per week best, three times the minimum for a good training and less contemptible? I don’t know the answer (see Kitto 1988, 1994). I tend to thing more is better, but I also know that it is arguable that less frequent and less long-term therapies are disciplines in their own right and that historical trends are not on the elitists side of this argument. Indeed, history is not on the side of analytic psychotherapy at all or even of any form of psychotherapy. Here we are having our internecine squabbles, while the developed world is turning away from what we do in droves. New York analysts are said to have few three times per week patients, never mind five times per week, and developing countries such as those in Eastern Europe are drawn to something less labour-intensive and long-term than full psychoanalysis. I know, because I am Co-Director of the Bulgarian Institute of Human relations, and we are having an awful time getting money to train psychotherapists.It is almost as if we are fiddling while Rome burns. Psychoanalysis is under attack by a whole cabal of people who no longer believe in deliberation, liberalism, a morally-grounded civilization, and the importance of the inner world, and what does the analytic subculture of probably the best country for the discipline do? It clings to elitism, prices itself out of the market, declares all but 13% of its psychoanalytic practitioners second rate and treats the rest as members of an even lower caste. The pecking order goes: Institute pecks BCP which pecks UKCP, whose psychoanalytic and psychodynamic section uses up most of the oxygen. Beyond the pale there are those who believe that all of this stuff betrays what is essential in therapy, and they have formed their own anti-organization, the Independent Practitioners Network, which relies on peer review (Totton, 1997).I would like to close with a note about my tone. I suppose it strikes you as aggressive and critical. Well, what has been done to the psychotherapy profession is aggressive and disrespectful. In fact, it is oppressive. It is important to stand up and speak truth to power, and in finding one’s voice in an anxious-making situation one may lose some sleep and make some forgivable overstatements. On the other side, people who oppress others are very often relatively and sometimes completely unaware of the structural relations of which they are a part and with which they tacitly collude. This is certainly true of some people I know very well who used to hold political views which would at one time have made it intolerable to be part of an institution which treated colleagues this way. Now they are insiders and ’keep out of politics’, something they would formerly been ashamed of doing. One can only begin to break up the oppressive structure by being quite explicit about what is going on and setting out to make people accountable for the structures in which they find themselves and which constrain their behaviour, including being genteel within an unjust system, as the people in the Old South where I grew up were and as they were until recently in South Africa, where some of those most active in ’the grand leading the bland’ grew up. I know it makes them indignant to be called to account for their behaviour. They routinely show their affrontedness by pathologising their critics or accusing them of envy and spite. The fact that they may well be partially right about this dimension of their critics’ motivation does not invalidate the argument. We are here in a publicly accountable public domain, and the criteria which are applicable to the couch must be complemented by those which apply in moral and political discourse.I am here trying to achieve a point of view which is beyond the critical. It is critique, the examination of the framework, the assumptions and the structural causation in this situation. I am doing so according to moral and political criteria which I have tried to make explicit, ones involving integrity and mutual collegial respect and democratic organizations and procedures in pursuit of excellence. Critique in the name of such values is the equivalent in the sociology of knowledge of what we strive to do every day in the consulting room. Psychotherapists and psychoanalysts should acquire some sophistication in this activity and should learn to expect it, since people like me are going to go on calling a spade a spade, making criticisms and mounting critiques of the behaviour of people whose activities and organizations are, in these matters, in direct opposition to the deepest goals of psychoanalysis, which are: enhancing human freedom, husbanding and nurturing civility and containing anxiety in benign and enabling rather than malign and disabling ways.Paper presented to University Psychotherapy Association Annual Conference on ‘Power and Influence in Psychotherapy’, Brunei Gallery, London,15 November 1997.Note: When I delivered an abbreviated version of this paper at the above conference a respected colleague said that although she agreed strongly with my argument, she wondered about the ad hominem passages. I stand by them here as in my other writings. I go into this matter at some length in my essay on ‘Character and Morality’.
People who take up public roles should be publicly accountable, just as a Member of Parliament or local councillor or leader of any professional organization is. If they do not wish to be publicly accountable, they should not take on public or semi-public responsibilities. There are, of course, certain additional forms of discretion which, because of their patients, apply to therapists, but that protection is not absolute. People who take up chairperson, editorial or public relations roles are particularly open to scrutiny. This accountability is of the essence of democracy. Many professional organizations fudge it, as do many versions of ‘professional ethics’.
REFERENCESEigen, M. (1986). The Psychotic Core. Northvale, NJ/London: Jason Aronson.
______ (1993). The Electrified Tightrope. Northvale, NJ: Jason Aronson______ (1995). Reshaping the Self. Reflections on Renewal through Therapy. Madison, CT: Psychosocial PressEisold, Kenneth (1994) ‘Intolerance of Diversity in Psychoanalytic Institutes’, Int. J. Psycho-anal. 75: 785-800 .Kernberg, Otto (1996) ’Thirty Methods to Destroy the Creativity of Psychoanalytic Candidates’, Int. J. Psycho-anal., 77:1031-1040. http://ijpa.org/kernberg.exeKitto, Jane (1988) letter on BJP conference, Brit. J. Psychother. 5: 201.______ (1994) ‘Further to a Question of Ownership’, Brit. J. Psychother. 11: 127-30.Meltzer, Donald (1992) The Claustrum: An Investigation of Claustrophobic Phenomena. Strath Tay: Clunie. Sassoon, A. S. (1985) ‘Hegemony’, in Tom Bottomore et al., eds., A Dictionary of Marxist Thought. Oxford: Blackwell, pp. 201-3.Totton, Nick (1997) ’The Independent Practitioners Network: A New Model of Accountability’, in Richard House and Nick Totton, eds., Implausible Profession: Arguments for Realism and Autonomy in Psychotherapy and Counselling. Ross-on-Wye: PCCS Books, pp. 287-93; also available at http://www.lpiper.demon.co.uk/nitthart.htm
for a description of the network, see http://www.lpiper.demon.co.uk/ipnleafl.htmfor a more general critique of BCP/UKCP approaches, see http://www.lpiper.demon.co.uk/
Williams, Raymond (1976) ‘Hegemony’, in Keywords: A Vocabulary of Culture and Society. Fontana, pp. 1117-18. Young, Robert M. (1996) The Culture of British Psychoanalysis and Related Essays on Character and Morality and on The Psychodynamics of Psychoanalytic Organizations. Process Press.Copyright: The AuthorAddress for correspondence: 26 Freegrove Road, London N7 9RQ