visit of Prof. Siv Boalt Boethius, Chair, European Federation for Psychoanalytic
Psychotherapy - Summary
From 13 to 16 November, 2003, Professor Siv Boalt Boethius, of Stockholm,
chair of the European Federation for Psychoanalytic Psychotherapy (EFPP),
was the guest of the Israeli Association for Psychoanalytic Psychotherapy.
On the first evening of her visit, Prof. Boethius lectured at the weekly
Thursday meeting of the Association on 'Differences between Psychoanalytic
Psychotherapy and Psychoanalysis - Disagreements, What They Have in Common,
How They Differ'. She noted in her lecture that according to Kernberg
(1999), several kinds of distinctions have generally been made between
psychoanalysis and psychoanalytic psychotherapy: conceptual, clinical,
political, and educational. Some see the two approaches as the poles of
a continuum, involving differences in degree (a quantitative difference),
while others see the difference between psychoanalysis and psychoanalytic
psychotherapy in qualitative terms. Today, according to Prof. Boethius,
the current trend is less to draw sharp distinctions between the two approaches
as to view them as opposite ends of a spectrum. She finds it interesting
that while psychotherapy had originally developed from psychoanalysis,
and had for many years been seen as an alternative form of psychoanalysis,
today the situation is the reverse. In Sweden psychoanalysis is considered
(at least outside psychoanalytic circles) as one particular form of psychoanalytic
psychotherapy. The least common denominator between the two is that they
both deal with an interpersonal process aimed at changing emotions, thoughts,
attitudes or behaviour that can cause a person to experience an excessive
degree of discomfort
Two observations have been vital to the separate developments of the two
approaches. One (which Freud had already noted in 1905), is that not all
patients can, or are willing to, be treated with 'classical' analytic
techniques. The other is that non-analytical techniques have also had
proved effect on patient symptoms.
From the standpoint of the aims of therapy, a classic debate has centered
on the question of cure versus the accumulation of knowledge. Freud considered
the aim of psychoanalytic psychotherapy to ultimately arrive at cure,
while the aim of psychoanalysis was to achieve increased insight, both
for the patient and for science in general. This distinction is believed
to explain to a considerable extent why psychoanalysts have largely avoided
becoming involved in any systematic empirical research. On a more profound,
inner, level, however, dissimilarities are discussed in terms of content,
or dynamic versus structural focus on resistances and defences. Furthermore,
there are differences in emphasis on interpretations of transference,
on the importance of transference neurosis, and the degree of abstinence
on behalf of the therapist/analyst.
Professor Boethius went on to discuss the significant developments in
psychotherapeutic research in recent decades.
The next day, the Association brought Professor Boethius together with
the teaching committees of the various psychotherapeutic programmes in
Representatives of all the programmes in Israel were invited to the meeting.
Those who participated were: representatives of the programmes at Tel-Aviv
and Bar-Ilan universities; The Israeli Institute for Psychoanalysis, and
the Institute's Hidavrut [Dialogue] programme; Centre for the Study of
Psychoanalytic Psychotherapy, Geha Hospital; Tel-Aviv Institute for Contemporary
Psychoanalysis; and the Israeli Institute for Analytic Group Therapy.
The psychotherapy programmes of the departments of psychology, and health
and welfare at the University of Haifa; the psychotherapy course conducted
by The Israeli Institute for Psychoanalysis; and the Institute for Group
Psychoanalytic Therapy, Jerusalem, sent regrets, but expressed the wish
to be informed about and involved in future activities.
Zvi Fajerman, chair of the Association and moderator of the gathering,
opened the gathering with a survey of programmes for psychoanalytic psychotherapy
in Israel. Professor Boethius then spoke, in her direct and open manner,
of her own personal professional development: training in psychoanalysis;
work with children, as well as with families and organizations; and 15
years as director of the Erica Foundation, the centre for therapy and
training in psychoanalytic psychotherapy for children and adolescents,
in Stockholm. In the course of her academic work, Prof. Boethius did considerable
work with groups, which contributed to expanding the scope of her interests;
today, one of her main activities is clinically based research on psychotherapy,
both qualitative and quantitative. Even now as chair of the EFPP, the
subject is close to her heart. Prof. Boethius went on to speak, inter
alia, about the EFPP, training programmes in Sweden and other European
countries, and requirements for admission to the European Federation.
A lively discussion followed, in which most of the 25 persons in attendance
participated. We shall bring the main, and a representative, part of the
comments made. Dr Henry Shor (Tel-Aviv University) began the discussion
by expressing concern over psychoanalytic psychotherapy in Israel in the
light of the security and economic situation, and asked how those engaged
in the field in Europe deal with the crisis that is to an extent also
being experienced there. He also reflected on the similarities and differences
between the Israeli Federation of Psychotherapy and the Israeli Association
of Psychoanalytic Psychotherapy.
Dr Gabby Mann (Bar-Ilan University) raised the question of whether psychotherapy
programmes should fulfil a strictly education role, or should also serve
as bodies that grant certain professional-statutory certification. She
asked about the way the matter is dealt with in Europe.
The question of 'marketing' psychoanalytic psychotherapy was raised, so
that it can survive these troubled times, and attain external recognition
from those upon whom we are dependent. Prof. Boethius claims that it is
important that we in Israel prepare, in a sober yet creative way, for
the budgetary blow that she believes we will undoubtedly be subjected
to, as has occurred throughout the Western world. She emphasises again
the importance she attaches to different kinds of systematic documentation
of ordinary psychotherapeutic work as a prerequiste for clinically based
research, and as a basic tool in integrating psychotherapeutic theory
and practice. She believes that the solidification of knowledge including
a better understanding of our therapeutic work, and its demystification,
serve as fundamental tools in the firm establishment of psychotherapy
and its confrontation of the forces that attack it.
Concerning the training process, in her view the motivation of an applicant
for the training process constitutes a factor of the highest importance
in consideration of his acceptance. It is very important that institutions
permit those who study and teach in them to express the human and therapeutic
essence within themselves, that they intensively study the therapies they
give and their results, and that they serves as potential 'containers'
and a therapeutic domain for the teams that work in them, parallel to
this central function in psychoanalytic psychotherapy. Furthermore, open,
non-critical discussion amongst students is a tool of fundamental importance
in the creation of such an institutional container. The containment, she
believes, is engendered mainly during supervision, which is a highly significant
part in the training of therapists. She therefore believes that the supervisors
to which trainees are exposed should be varied, and that what is done
during supervision should be properly followed up. Furthermore, it is
important to undertake studies that explore the different parts of the
training process and how it is conceived by the trainees, the supervisors
and the seminar leaders as the training institute.
At this point, Dr Avi Berman (the Israeli Institute for Analytic Group
Therapy) changes the discussion from 'external' to 'internal' matters:
the competition between the various programmes. Prof. Boethius contends
that the firm establishing of the unique contribution of each institution
constitutes, in her judgement, a basic tool in curtailing the destructive
competition between institutions, and between psychoanalysis and psychoanalytic
psychotherapy. She attaches importance to fruitful cooperation among those
engaged in individual, group, and child therapy.
A discussion develops about the current criteria in Israel for certifying
psychotherapists. On the one hand, the conditions for admission to masters'
degree programmes are becoming quite impossible, and on the other hand,
criteria for certification as a 'psychotherapist' are becoming easier
all the time. The profession is 'wide open' from a legal standpoint. Hanna
Reinschreiber (Bar-Ilan University) expresses her concern over the lack
of a clear psychotherapy law in Israel, a state of affairs that, she contends,
results in a continuing decline in the level of those admitted to psychotherapy
schools and licensed to engage in the profession. Dr Rina Lazar (Tel-Aviv
University) states that in her view, not only the law determines the way
things are, but also the prevailing consensus. Dr Gila Ofer (Tel-Aviv
Institute for Contemporary Psychoanalysis) sees specialisation as only
one milestone in an ongoing learning process.
A discussion develops about the impact of competition between the schools.
Dr Gabby Mann explains the policy at Bar-Ilan of admitting several art
therapists each year for psychotherapy training. Dr Ofra Eshel (Hidavrut)
considers such a step problematic, because such therapists lack a theoretical
Miriam Berger (the Israeli Institute for Analytic Group Therapy) mentions
the fact that this is the first time that representative of the Israeli
Institute for Analytic Group Therapy are participating in a forum such
as the present gathering, and stresses its importance and the desperate
need for dialogue amongst ourselves.
Dr Rina Lazar asks how, as Association members, it would be possible to
profit from the present meeting. Such meetings had already been held in
the past, and had taken up matters currently under discussion. Concerning
admission criteria for schools, there is much pressure from professionals
in other disciplines, such as educational psychology, for admission to
psychotherapy programmes, for reasons of prestige.
Hanna Reinschreiber emphases the seriousness of the gathering and its
importance, and the grave responsibility we have for the discipline of
psychoanalytic psychotherapy. In her view the clinical university departments
see more of such responsibility towards the profession than the psychotherapy
Zvi Fajerman asked whether those in attendance are interested in another
gathering. Sandra Halevi (Hidavrut) says there is, but wonders whether
there would be more scope for discussion about the content of matters
and in which professionals must genuinely contend, rather than about concrete
matters. Dr Dalia Freiberger (Centre for the Study of Psychoanalytic Psychotherapy)
asks for time, because of her workload and anxiety about committing herself.
Zvi Fajerman announces that the Association will take the liberty of inviting
those in attendance to another gathering. Prof. Boethius supports the
idea about thinking and discussing together, within the programmes and
in small groups, about central matters of concern.
Towards the conclusion of the meeting, the conference that the Association
plans to hold on 8-9 January 2004 on the topic of training and supervision
in psychotherapy is mentioned; the possibility is raised of holding a
workshop at the conference of members of the teaching committees, with
the aim of continuing and deepening discussion of the matters brought
up at the present meeting.
The next day, Saturday, the Association executive held a concluding meeting
with Prof. Boethius, at which topics brought up during her visit were
further clarified. As members of the EFPP and as the representatives of
the State of Israel there, they discussed strengthening ties between Israel
Professor Boethius reviewed her visit in a very positive light, stressing
how impressed she was by the quality of professional work in Israel, as
reflected in the discussions at the gatherings in which she participated.
Furthermore, she mentioned her own learning, and the many thoughts she
takes with her to the European Federation. We, for our part, reviewed
the visit and the activities we prepared in its wake with satisfaction.
Also, meeting her was personally very pleasant. We thank Prof. Boethius
and the members of the teaching committees who took part in the gathering,
and those who encouraged it and helped to bring it to fruition. Our thoughts
are now directed towards the future.