Treating without diagnosis: Psychoanalysis in medical settings in Argentina

This article is part of a larger research project, the aim of which is to understand the discursive conditions of access and adherence to an outpatient mental health service at a public hospital in Buenos Aires, Argentina. The focus is on the historical conflict between medical discourse and psychoanalytical discourse as it emerges in the negotiation of treatment and diagnostic sequences at first consultations. It can be seen that patients who are socialized in medical discourse--and even in psychiatric discourse--expect the usual procedure in which a diagnosis, however transitory, is offered first and then followed by a treatment recommendation. However, psychoanalysts, in contrast, tend to reject diagnostic labels and offer treatment without further justification. This has an impact on the adherence of patients, and we can argue for the need to negotiate with medical discourse in order to guarantee engagement and continuity in treatment.

Max Eitingon and a question of politics

Max Eitingon is thought not to have left behind original theoretical work, despite the fact that he wrote some 40 articles and a dozen psychoanalytic congress reports. He has been almost forgotten over the years, even though he occupied an important political place in the history of the psychoanalytic movement. In recent times, he has again become a subject of attention. In this article the author takes a look at Eitingon as an activist who was intensely involved in the social and political struggles of his time. He represents the political aspect of psychoanalysis on two counts: first, within the psychoanalytic movement, where he had a particular role in the institutionalizing of psychoanalysis, and, second, in relating it to wider social and political ends.

'Weaving thoughts' : A method for presenting and case material in a peer group

The authors argue that there are good reasons for seriously considering the dynamics of the peer group when discussing psychoanalytical case material. The setting and procedure have to protect and facilitate for the presenter and the group members to work together. The aim of this paper is to discuss the problems connected with presenting and discussing clinical psychoanalytical material in a peer group and to describe one such specific method, which the authors call the 'weaving thoughts' method. The design is primarily inspired by Bion's formulation 'thoughts in search of a thinker'. The group participants re?ect on the presented clinical material in a way that the authors metaphorically describe as creating a weave of thoughts that emerges from the material. The aim of the method is to facilitate a work-group climate that allows thoughts to wander about, and to avert group members from debating and compromising the integrity of its members by letting basic assumptions come into power. The method is described from theoretical and practical points of view, with two illustrations of seminars according to this design and finally a discussion of the advantages and drawbacks of the method.

On psychoanalytic supervision

The author provides both a theoretical context for, and clinical illustrations of, the way in which he thinks and works as a psychoanalytic supervisor. The analytic supervisory experience is conceived of as a form of 'guided dreaming'. In the supervisory relationship, the supervisor helps the analyst to dream (to do conscious and unconscious psychological work with) aspects of the analytic relationship that the analyst is unable to dream or is only partially able to dream. It is the task of the supervisory pair to 'dream up' the patient, that is, to create a 'fiction' that is true to the supervisee's emotional experience with the analysand. To carry out this work, the supervisor must provide a frame that ensures the supervisee's freedom to think and dream and be alive to what is occurring in the analytic and the supervisory relationship, as well as in the interplay between the two. In one of the clinical illustrations presented, the author illustrates his conception of the importance of the feeling on the part of supervisor and supervisee that (at least occasionally) they have 'time to waste'. Such a state of mind may provide an opportunity for a type of freely associative thinking that enhances the range and depth of what can be learned from the supervisory experience. In another clinical example, the author describes his own experience in supervision with Harold Searles, which contributed to his conception of the supervisory process.

Psychoanalytic practice in the early postgraduate years

As a pilot investigation for a longitudinal study of psychoanalytic careers, a survey was conducted of analysts who graduated during the last fifteen years from the Columbia University Center for Psychoanalytic Training and Research. Graduates were asked to describe both their analytic practice and their interest in pursuing appointment as training and supervising analysts. The 23-item questionnaire was completed by 67 of 102 potential respondents (66%). The study identified two subgroups of graduates: those who were not certified and were not training analysts (GAs), 78% of the sample, and certified and training analysts (CAs, TAs), 22% of the sample. GAs started a mean of 1.4 new analytic cases since graduation, as compared to CAs and TAs, who started a mean of 5.4 and 8.3 new cases, respectively. CAs and TAs also saw more twice-weekly therapy cases than did GAs. Once-weekly therapy was the most commonly practiced treatment for all subgroups. Interest in becoming a TA was highest during the first five postgraduate years and was lower among non-TAs five to fifteen years after graduation. Only one of the CA respondents met current APsaA immersion criteria for training analyst appointment.

Organisational and educational internal impediments of psychoanalysis: contemporary challenges

Our psychoanalytic discipline originated, has evolved and is still located within a congregational network that blends and binds together, in an inextricable and contradictory way, the missionary mandates and commendations of a 'movement' and a 'cause' with the inherent prerogatives and functions of academic professions and sciences. In this paper the author explores the consequential past and present impedimenta of this organisational and educational syncretism, for six fundamental dimensions of action for psychoanalysis. Subsequently, the nature of a proposition is delineated, suggesting a reorganisation, local and international, to address what the author visualises as five of our most pressing contemporary challenges: a) an autonomous university educational model, freed from regressive societal-political inertias, enabling us to abandon our seclusive monasticism; b) the consolidation of an epistemological frame of reference, idiographic and nomothetically substantiated against our cumulative inductivism, which is the seedbed of our sectarianism, cross-sterilisation and pseudo-ecumenism; c) local and external educational and professional systems of accreditation and certification, independent from affiliation and membership privileges of our supraordinate ecclesia; d) social relevance and community presence, moving away from our meaningless organisational and educational cloistering; and e) a local and international functional and interdependent reorganisation, in the context of sovereignty and integrity, in contrast to our prevalently crusading and indoctrinating homogamous pathological co-dependency. The author concludes that only a harmonisation of objectives and administrative structure might loosen the talons of faith that keep us retrogressively tied to our past.

Countertransference management and therapy outcome: an initial evaluation

The relationship between therapist countertransference management ability and therapy outcome was examined. Participants were 32 therapist-trainees and their clinical supervisors. Supervisors completed the Countertransference Factors Inventory (CFI) with regard to their supervisees. The CFI assesses five therapist characteristics thought to comprise countertransference management: Self-Insight, Self-Integration, Anxiety Management, Empathy, and Conceptualizing Skills. Both trainees and their supervisors rated the degree of improvement for each client seen in therapy. Results indicated that the CFI total score and the subscales of Anxiety Management and Conceptualizing Skills were positively related to both trainee and supervisor ratings of outcome; Self-Integration was related to trainee, but not supervisor, outcome ratings.

Institutional conflicts in Jungian analysis

This paper explores how the institutional life of analytical psychology has been beset by its historical and continuing conflictual relationship with psychoanalysis. Stemming from a division in Jung's identity, that of the spiritual seeker and that of a mental health practitioner, the organizations of analytical psychology have repeatedly enacted that division, resulting in an unclear mission and considerable conflict. In England those conflicts have led to schisms; in America they have played out in internal conflicts within training institutes. Examples of areas of conflict are provided, along with suggestions for addressing these conflicts by recognizing them more openly.

Making the case for psychoanalytic therapies in the current psychiatric environment

A variety of political, economic, and scientific forces have caused psychoanalytic therapies to become marginalized in psychiatry. These therapies are given short shrift in recently developed treatment guidelines, which are based largely on notions of empirical validation narrowly construed. Questions about the efficacy of psychoanalytic therapy can be meaningfully addressed by systematic assessment of available knowledge and potential data bases and by explicit efforts to locate the role of psychoanalytic therapies alongside other modalities. Several steps that might lend the psychoanalytic therapies greater credibility are proposed: (1) define the distinguishing features; (2) identify clear indications and contraindications; (3) systematically collect case histories of successfully treated mentally ill (diagnosable) patients; (4) increase vigilance (together with the patient) toward assessing progress in treatment.

The IPA and the American Psychoanalytic Association: a perspective on the regional association agreement

Ever since 1938 the American Psychoanalytic Association has had a special autonomous relationship within the IPA accorded to no other component organisation. This Regional Association status has had two main features: (1) total internal control over training standards and membership criteria, with no accountability to the IPA; and (2) an 'exclusive franchise', so that the IPA was barred from recognising any other component within the United States. This unique Regional Association status reflected the resolution at the time (1938) of the long-standing controversy between the IPA and the American over the issue of 'lay analysis', and remained unaltered for half a century until, with the resolution of the 3 1/2-year long law-suit against the American (and secondarily against the IPA) in 1988, the Regional Association agreement was modified (but not totally abrogated) by the American's giving up the 'exclusive franchise' aspect (thus permitting IPA recognition of psychoanalytic groups in the US organised outside the American), but still retaining its internal full control over training and membership. The meanings and consequences for psychoanalysis of this special status of the American are explored.

EM-PSYCH: a training program scheduling database

EM-PSYCH is a scheduling database for training programs. It stores scheduling records and generates schedules and letters informing students, supervisors, and advisors of deadlines. Since EM-PSYCH was originally designed for a psychoanalytic institute, the institute model is presented as well as the database model to illustrate how the database program can be applied. EM-PSYCH is very user friendly and makes scheduling and sending reminders efficient and easy. It can handle any number of trainees and can be modified for any number of years or schedule interval. It can be easily adapted for psychiatric residencies, medical student education, psychology internships, and other training programs.