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.)

Categories: Psychoanalysis