Nobel Laureate

It is hard to be an instructor in psychoanalysis. It is a struggle to hold lightly to our theories while attempting to impart key psychoanalytic concepts, and while simultaneously hoping to co-create an open inquiry in the classroom in order to both model open inquiry and to facilitate the procedural learning of it. The comments this week of Isreali born scientist Dan Schechtman may have helped.

Dan Schechtman, in 1982, described a new chemical structure “quasicrystals” which then defied the expectation that crystals are to be regular and repeating, and for this he lost his place on a US research team. In 1982 his idea was too unorthodox to be credible. Almost thirty years later, quasicrystals are being studied as a way to convert heat into electricity. Schechtman is not only vindicated, but honored when this week he was awarded the Nobel Prize in Chemistry.

Schechtman, now 70 years old, said about his work, “A good scientist is a humble and a listening scientist, and not one who is sure 100% in what he reads in the textbooks; and this is a lesson also to students to be open.”

Psychoanalytic Training Changed My Life, Really

Psychoanalytic training in the USA requires experience as an analysand, in addition to the clinical training as an analyst being supervised by more experienced analysts, as well as the didactic courses. Embarking on the journey to become a psychoanalyst required for me a radical shift from my medical training. As a physician and psychiatrist, I learned to be a diagnostician, pharmacologist, and advice-giver. Being a psychoanalyst requires a different perspective. Modifying the medical ‘fix it’ model, I had to emphasize collaboration with, instead of imparting knowledge to or directing, a patient. Symptoms and complaints take on additional communication about symbolic meaning and relationship. (Experience in interpreting poetry, literature, and film for their many levels of symbolic meaning gave me a good start for thinking about the many levels of connotative meaning, beyond the denotative, of a patient’s narrative.)

There are many theories about what is helpful to psychoanalytic psychotherapy patients. Theories of psychoanalysis and psychoanalytic psychotherapy have evolved for more than a century since Freud first introduced his ideas, and they continue to evolve, so we hold onto theories lightly. We still utilize some of the traditional Freudian principles, e.g. one of the cornerstones of psychoanalysis remains the acknowledgement of the Unconscious (or Unconsciouses) , though defining it, and ideas about accessing it, have undergone modification. The other aspect agreed upon is that the relationship is important.

While there is some research about what is mutative, it is relatively sparse. Various schools of psychoanalysis privilege different aspects. Structural/Ego analysts, for example, might aim to foster the more frequent use of more mature, adaptive defenses, or to ‘discover’, with the patient, unconscious conflict. Object Relations analysts might strive to keep pace with what part –object is manifest in the patient or analyst at any moment and to help the patient integrate her/his sense of self/others. Relational analysts might utilize what is going on within the therapeutic dyad to co-construct a narrative that helps patients connect more with themselves and with others. Self psychology recognizes the importance of empathy and attunement, and of the analyst serving as a selfobject experience for the patient so that the arrested psyche can recommence its development. The Intersubjective School might stress mutual recognition that fosters reciprocity and greater interpersonal satisfaction.

All authors and clinicians have their own biases about theories. From difference we enrich our repertoire and experience. Supervision and peer supervision is invaluable, as is sharing the conversational ‘space’ and embracing difference of opinions. While reading papers and texts may initially aid confidence, nothing can substitute for experience. Not only did psychoanalytic training improve my capacity to be open to and understand patients, benefitting treatment outcomes, but it allowed the building of a full and satisfying practice. One of the aspects of practicing psychoanalysis which makes it so delightful to me is that, if we are open to the present moment, we get better and better at it, day by day, minute by minute.

RELATIONSHIP AND LONELINESS

Perusing the preliminary program for the American Psychoanalytic Association’s 2010 Winter meeting Jan 13-17th at the Waldorf Astoria Hotel, NYC, I noticed that Discussion Group 95 is entitled “Toward an Understanding of Loneliness and Aloneness.” The presenter Lisa A. Piazza will share about a patient who uses a busy work schedule to avoid intimate connections. The Discussion Group plans to emphasize the experience of the patient’s loneliness and how therapists might best deal with loneliness in the patient. Perhaps this Discussion Group caught my eye because recently I had read a review of The Lonely American: Drifting Apart in the Twenty-First Century by two psychiatrists, Jacqueline Olds and Richard S. Schwartz. Their book noted that increasingly more people have fewer confidants and live alone, and that many of us are too busy and irritable for friends and self reflection, causing us to feel “left-out” despite it being a situation of our own making; all of this aggravated, of course, by the mythological American ideal of independence, autonomy, and self-reliance.

Both the course title and book review struck me, I think, because in classes recently at the Tampa Bay Institute for Psychoanalytic Studies, Inc., we, students and faculty alike, often find ourselves discussing what a lonely profession solo private practice is for the psychoanalyst/psychotherapist. Professional loneliness makes classes, meetings, and conferences all the more valuable to clinicians. This experience of professional loneliness seems equally worthy of discussion, and deserves exploration as to how it affects our relationships with patients.

Relational theories of psychoanalysis have helped us understand how unrealistic autonomy is as a goal in analysis if it does not also balance the reality of the embeddedness of humans in a human community. Relational psychoanalysis, offering reconfiguration of relationship paradigms, then becomes an important antidote to loneliness and avoidance, for both analysand and analyst. In fact, if what Olds and Schwartz write is true, then therapy may be the rare haven which allows for self-reflection while in relationship, and therapists may be the sole confidant for many people, making a relational approach in treatment all the more valuable.

Should Psychoanalysis be Taught?

In The New Yorker last month (June 8 & 15, 2009), Louis Menand, a professor of English at Harvard, in A Critic At Large, asked the question “Should creative writing be taught?” He quoted The University of Iowa Writers Workshop website which explained that
“…writing cannot be taught but writers can be encouraged.” This, naturally, got me to thinking about psychoanalytic education. Can one teach others how to be an analyst? or do we only encourage gifted clinicians to broaden their skills, by, for example, encouraging them to trust themselves, to include themselves, to look beyond themselves?

Because, among other things, an analytic attitude is both a way of thinking and a way of being in relationship, I have often wondered how instructors convey how to be an analyst. Do the therapists who cross the training door thresholds need only to learn theories and techniques, or do we as instructors need to model a way of being which also conveys not only what we do in the consulting room, but how we are? Having had the pleasure of participating as an instructor in courses, workshops, and seminars with mental health professionals interested in psychoanalytic thought, I am always in a quandary about how much right brain/ implicit learning to balance with how much left brain/didactic and explicit information to convey.

In observing colleagues I have sometimes not understood the answers in their models of instruction. [I have, for example, seen some instructors behave as classical analysts (anonymous, abstinent), saying little, encouraging little, as the candidates or attendees ‘free associate’ to the assigned reading material. Some have utilized bubba meisahs, regaling students with their own experiences. Some tolerate not only no other opinion, but no space is created in which others might speak. On occasion, if more than two instructors teach, I have seen them argue with one another about their ideas, sometimes getting uncomfortably personal, and seemingly oblivious to inviting student participation. None are behaviors that instructors may have explicitly wished to encourage in the consulting room.]

I try to imagine how varying theories might influence modeling how to be. As an instructor, can I encourage and co-create curiosity, enthusiasm, respect, and a space for mutuality, all ways of being in the consulting room? And how does one do this? When I think of my professional life I think of the many changes in analytic attitude which have evolved in my work. And I have great regret for analysands in my early training who I deprived of mutual recognition and relationship; where I took the stance of being the one who knows; and with whom I took pains to hide my love for them, stingy in my abstinence. In recent years, a number of my patients have found love for the first time. I like to imagine I had some small part in this, that is, having found my patients loveable, they reconfigured their convictions about their unlovability, and voila.

But how are we to reconfigure ourselves as instructors so that trainees reconfigure any old ideas about passively taking in what is spouted or printed? How do institutes allow for such alternative understandings in the classroom as to encourage therapists to allow for them in the consulting room? How do we model perspectival realism?

Ironically, here, in the psychoanalytic outpost of west central Florida, there are three or four psychoanalytic training institutions, but only a handful more of analysts. Here we have a few members of the American Psychoanalytic Association, and a few more who are members of the International Psychoanalytic Association, and a bit more who have had various training experiences and also go by the name ‘psychoanalyst.’ These training programs exist, not because of an interest in, nor a demand for, more training from local clinicians, though we all hope to cultivate the interest and demand (Build it and they will come), but because analysts in this area have found it exceedingly difficult to hold the tension between differences: differences of personalities, styles, power, and ideologies. I often wonder what implicit communication this sad fact models for potential trainees.

It is very hard to think independently in an institute and stay connected. For women in our local analytic community this may be even more difficult. One female colleague poignantly asked at a national workshop how one can hold on to one self while affiliating with an institute. Some find the only alternative is to align oneself with a powerful man of the hour. Another female colleague asked if, in Tampa with its tendency to empower machismo in male analytic leadership, perhaps the local analytic community cannot bear to brook ‘uppity’ women. She remained herself and was shunned by some, despite gracefully using her different voice.

In private practice, we strive to co-construct bridges between differences with clients/ patients, and they have some motivation to be in relationship with us. Where groups differ dramatically, it takes more than analytic being to be a skillful engineer.