border dispute between parent and child
of: S. Frisch (ed.) (2001). Psychoanalysis and psychotherapy. The controversies
and the future. London: Karnac, ISBN 1-8555-266-2, 154 pages, price: £19.99
I was asked to review the book Psychoanalysis and psychotherapy I hoped
that the dispute between psychoanalysis and psychoanalytic psychotherapy
would not be battled out exclusively on the basis of Freud's 'gold' versus
'brass' metaphor. From this compilation by ten well-known authors it is
evident that there is far more to be said on the matter.
In his foreword Wallerstein maps out the post-war history of the relationship
between psychoanalysis and psychoanalytic psychotherapy in the United
States. This history can be traced in terms of the rise and fall of the
ego-psychological paradigm put forward by Hartmann cum suis. Its rise
resulted in the so-called 'classical' analysis model, which was the sole
norm for a long time. This paradigm started to waver when work by authors
like Sullivan, Klein, Kohut and Kernberg was published. Furthermore, it
was influenced by the application of psychoanalytical therapy. Wallerstein's
publications (Forty-two lives in treatment, 1986; The talking cures, 1995)
played an important role in the discussion as well. Similar streams arose
in North-West Europe at the same time as in the United States. The present
collection, with six of the ten contributions by writers from the Romanic
language area, illustrates that reflecting on the relationship between
psychoanalysis and psychoanalytical psychotherapy has filtered through
to Southern Europe and to Latin America.
Frisch (Luxemburg) points out in his introduction that a number of psychoanalysts
showed an interest in psychotherapy from the very start, namely Adler,
Stekel, Jung, Rank, Ferenczi, Alexander and Fromm-Reichmann. They were
usually interested in using it for patients who, in psychoanalysis, ran
the risk of falling into a deep regression. The demand for psychoanalytical
psychotherapy, or modified versions of it, increased enormously in the
period running from the end of the second World War to the oil crisis
in the seventies. This development got underway because medical insurance
policies started to include psychotherapy in their cover; and because
the first psychoanalytic psychotherapy associations were founded, making
it possible to be trained elsewhere instead of only at recognised psychoanalytical
training institutes. Since the oil crisis the controversy has acquired
an institutional, political and financial dimension in addition to the
initial scholarly debate.
Bell (Germany) devotes a large part of her contribution to this side of
matters. She describes the situation in Germany, where the insurance cover
- an extrinsic factor - has a decisive influence on how psychoanalysts
and psychoanalytic psychotherapists work in their practices. As an introduction
to this, she outlines the historical debate in the United States using
the insight/affect (Freud/Ferenczi) dichotomy as a basis for her argument.
She cites Gill, who mainly attributes the distinction between psychoanalysis
and psychoanalytical psychotherapy to extrinsic factors like lying down/sitting
up, frequency, well/not well integrated patient and completely/incompletely
trained analyst. In Gill's view, apart from the external setting, it is
a question of actively promoting - through interpretation - transference
into the here and now, whereby the analyst - as a real person - has a
personal contribution to make not only to the relationship but also to
the transference. Bell finishes her essay by expressing her desire to
be in a position to carry out an objective evaluation of all forms of
psychoanalytical therapy, including the influence of external factors.
The essay by Aisenstein (France) has the no-nonsense title: Psychoanalytic
psychotherapy does not exist. Her arguments are cogent and logical. In
her view only a complete course of training to become a psychoanalyst
provides an adequate basis for carrying out psychoanalytic psychotherapy.
She gives a convincing account of this type of therapy which takes place
once a week for an unlimited period, using as an example an ice-dancer
whose emotional life was frozen but which gradually thawed after years
of treatment. She poses the question as to whether it is ethically justifiable
that psychoanalysts should offer their services to train aspirant psychotherapists
who have been rejected for the psychoanalyst course. Thus the students
with the least training are often faced with the most severe pathology.
Frisch, however, states in his introduction that she is ignoring the reality
of the growing number of practitioners. A large group of psychoanalytic
psychotherapists has been trained in this manner; the longer established
psychoanalysts will have to find a way to relate to this reality.
Gauthier (French-speaking Belgium) in his philosophically-tinged essay
looks into the implicit assumptions made about the time dimension involved.
Often the distinction between psychoanalysis and psychoanalytic psychotherapy
is brought about by the pressures of time. He wonders whether the principle
of an unlimited period of time for psychoanalysis is not based on unfounded
idealism. Gauthier fears that the debate about psychoanalysis versus psychotherapy
is more like a crusade than a scholarly exchange. For him empirical research
is the only solution.
The contribution made by Coles (England), traces her own development as
a psychoanalytic psychotherapist. It is a factual account of trial and
error, of persevering despite the low status this work has in the psychoanalytical
community. She reverses the order of 'gold' and 'brass'. Brass is stronger
and can be used in a greater number of ways than gold. There are practical
reasons for opting for greater frequency. Who, for example, can keep track
of thirty-five patients when they only see them once a week? Psychoanalytical
psychotherapy once a week feels different from more intensive therapy:
more outside events are brought in. At the start of her career she dearly
missed separate training in this sort of therapy and makes a powerful
case for its introduction. In so doing she offers a counterbalance to
Resnick, in his contribution On madness: a psychotherapeutic approach
gives superb examples of his method of work with psychotics. He makes
use of his own creativity during the sessions to find, with the aid of
the patient, instruments which make joint work possible.
When reading Golse's contribution I thought about the fact that the historical
marginalisation of child analysis is somewhat reminiscent of the harsh
way in which psychoanalytic psychotherapy has been treated. Golse thinks
that the problems child analysis are wrestling with may generate new and
fruitful developments for psychoanalysis in general. In answer to the
question as to who should be trained to become a child therapist, he opts
for a pragmatic approach: the need for good therapists must be met, even
if they are not completely trained psychoanalysts. Suman and Brignone
(Italy) attempt to understand why the demand for psychoanalytical psychotherapy
is so much greater than for psychoanalysis. In a postmodern culture people
put absolute truths, ideology and religion into perspective. Scientific
theories can also be added to this list. There are a great number of meaningful
stories and truths all vying with one another for precedence. The postmodern
man is frightened lest the psychoanalyst should be given too much influence
and finds a single weekly session more democratic. If psychoanalysis can
be characterised as 'free-floating' then psychoanalytical psychotherapy
is more selective in its choice of focus - which may in fact change at
each session. This satisfies the expectations of the present-day patient.
Kirsner (Australia) describes in his contribution how psychoanalytic psychotherapists
who have not be trained to IPA standards are ignored by this organisation,
despite the fact that they represent an important part of daily reality
in terms of manpower, talent and availability on the market. He stresses
the fact that psychoanalysis has become to much of a 'movement' instead
of a science, with all the inherent hazards, and he makes a plea for a
scholarly approach embracing more openness.
Hinselword in his concluding words shows that the task Freud set himself
in the past - making a demarcation line between psychoanalysis and suggestion
- has evolved over the years. The problem is not so much that psychoanalysis
and psychoanalytical psychotherapy are on opposite sides of the fence,
but rather that they resemble each other. The long search for one distinguishing
characteristic has been in vain. The more difficult it became to find
it, the harder it was pursued. He compares it to a situation which arose
during the evolutionary process: the difference between two practically
identical populations only becomes clear over a long period of time. In
the early stages there is a great deal of overlap between individuals
from both populations. The motivation to search for one distinguishing
feature is not driven by scientific interest alone. Other motives are
equally important: group identity, status and income.
I greatly enjoyed reading this interesting book in which a topical theme
has been approached from many angles. The contributions are accessible
and clearly written. The fact that they sometimes overlap and are based
on identical sources in no way detracts from their quality, as this makes
it all the more clear to what extent viewpoints converge and diverge.
It struck me that characteristic new developments within psychoanalysis,
like validation of the support factor, the influence of the analyst as
a real-life person, the interactive character of two-person psychology,
the active emphasis on the importance of affect, are all elements that
have been a matter of course in psychoanalytical psychotherapy practice
for quite some time!
Certainly for those involved with setting up joint courses for the various
psychoanalytical associations this book is to be highly recommended.
de Klerk, is a clinical psychologist and psychoanalyst with his own practice.