by: Patrick B. Kavanaugh, Ph.D.
(History and Context: An earlier version of this essay was first presented at the 27th Annual Spring Meetings of the American Psychological Association’s Division of Psychoanalysis (39) held in Toronto in April of 2007. The organizing theme of the spring meetings was: On Clinical Momentum: Time, Process, and Complexity in Psychoanalytic Engagement. From the program brochure, Clinical Momentum was understood as…
(t)he multiplicity of perspectives now entertained by psychoanalysis can generate a cornucopia of views on what we might call “clinical momentum.” Attempts to give expression to complex experience challenge received understandings about what, in our ways of being with others and with ourselves, propels the forward motion of clinical engagement. The contemporary affinity for uncertainty, interest in complexity, and the appreciation of each treatment’s unique flux, -moment by moment and through protracted time-, seize our attention. (Program Brochure)
In this context, a panel was formed to speak to the question of… Competency in Psychoanalysis: State Regulation, Self Regulation, the Integrity of the Profession, and Who Decides What Counts for Psychoanalysis. This essay is a more elaborated version of the thoughts presented at the conference.)
Who Decides What Counts for Psychoanalysis?
Philosophy, Culture, and Competency in Psychoanalysis
In the emerging worldview of the 21st century, the world is seen as operating in a random fashion about which we can only speak in terms of probabilities, potentialities, and possibilities. The fixed, stable and predictable world of modernity has transformed into a world that: exists in a state of continuous flux; consists of a fabric of invisible relations; and in which world, the events of everyday life are understood as irreducibly complex phenomena. As we enter the 21st century, we find that the natural order of things is not as natural as we had once thought, nor is it in the order we had so readily assumed for so long. And in the analytic culture, we have come face to face with how little we know about that which we have been so certain for so long. Indeed, we gather together this year to challenge our received understandings about what in our ways of being with others and ourselves propels the forward motion in the analytic engagement; that which brings about changes in the analytic engagement is not as obvious as it once seemed to have been. And our purpose in gathering this year invites the question: Are we not compelled to also challenge our received understandings of competency in bringing about -or, in participating in the process that brings about- such changes? Is it not time to call into question both our concept and measures of competency?
Although philosophy is generally thought of as the antithesis of psychoanalysis, recent years have witnessed certain foundational questions – philosophical in nature – encircling the analytic community: Shaken out of our traditional ways of thinking, we are compelled to rethink such metaphysical questions as: How do we know what we think we know?, Just what is it again that we think we know?, What is the nature of reality?…of human nature?; and, as suggested by the theme of this year’s meetings, ..of time, process, and complexity in the analytic engagement? Philosophy converges with psychoanalysis in challenging our assumptions about the nature of time, process, and complexity and bears quite directly on how our assumptions influence: how we might listen, understand, and respond in the analytic moment; our notions of science and process research; and, how we think of competency in psychoanalysis. The medical model of psychoanalysisbest illustrates, perhaps, the significance of our underlying assumptions regarding time, process, and complexity in our ways of being, presencing, and knowing.
The medical model assumes a linearized and sequential time flowing like a line independent of the events it supposedly contains and along which line events of the past occur, then those of the present, then those of the future. Indeed, all scientific processes of the modern era are assumed to occur along this invisible ‘line’ of linear time (Slife, 1993; 1995). Such linearized assumptions of time and place lay a deterministic foundation in analytic thinking in which past trauma psychically determines, of necessity, present symptoms. In the positivist tradition, temporal succession and spatial proximity are axiomatic assumptions in arriving at causal explanations: what happens in the present and what will happen in the future results largely from what has happened in the past. As our assumptions of a linear and sequential time are brought into question, the non-linear nature of time, place, logic, and causality are fore-grounded as we consider the incredible complexity of the psychoanalytic process in which experiences of the past and future might coexist, co-determine, and co-structure the present moment of the future-past…
Our concept and measures of competency are deeply rooted in the worldview of the early 1900’s in which view: the world was seen as fixed and stable; reality unchanging and predictable; and, adaptation to the status quo was the contextualizing value of both psychoanalytic education and treatment. During the 20th century, adaptation to the natural and self-evident world was part of the natural order of things in psychoanalysis. And in the fixed, stable, and predictable world of the Industrial Age, the evaluation of competency in psychoanalysis centered on the candidate’s mastery and application of received knowledges. More specifically, educational competency consisted of evaluating the candidate’s mastery of knowledges received through their coursework, supervision, and training analysis which often times was the central method of teaching and learning, …longstanding whispers of discontent in the analytic community notwithstanding. And practice competency consisted of evaluating the effectiveness of the candidate’s application of this knowledge via supervision and the successful outcomes of control cases. Outcome-based education and treatment have been the demonstrable evidences of both educational and practice competency since the founding of the Berlin Institute in 1922. And they still are as we enter the 21st century.
One cannot travel too very far in considering the question of Competency in Psychoanalysis before entering the intersection where the beliefs, values, and attitudes of the clinic and culture interface, if not collide. And in this intersection, the question arises, Who Decides What Counts for Psychoanalysis? … Is competency determined by state regulation?… or, by self-regulation? … And, …How is the integrity of the profession impacted if it is the state – as opposed to the individual- that decides? Significant as these questions are, they seem to stand in the shadows of an even larger question: Do the meanings and measures of Competency in Psychoanalysis, originating in a late 19th century worldview, continue as the unchallenged templates for evaluating the analyst’s competency in the 21st century? If so, the concept of competency remains situated in the mechanistic conceptions of people and life prevalent at the turn of the 20th century. If our educational and political institutions continue into the 21st century with 19th century measures of competency, do we not continue to fail to match our understandings of competency with our more contemporary psychologies of psychoanalysis, many of which rest on different understandings of time, process, and complexity in the analytic engagement?
In my measure of time this morning, I would like to call into question the question of Competency in Psychoanalysis in the industrialized cultures. My premise is that culture and psychoanalysis are inseparable; my thesis is that our highly technocratic and industrialized culture produces: the image of the analyst, the version of psychoanalysis, and the concept and measures of competency most needed by the culture. And further, that each, e.g. the image, the version, and the concept of competency, is changing as we transition from the Industrial to the Information Age. As my contribution to our consideration this morning, I would like to: first, focus on the question, Who Decides What Counts for Psychoanalysis? from several different perspectives: 1) our institutional definitions of psychoanalysis; 2) the role of the state in a culture of consumerism; 3) the positivist ideology and assumptions underlying our concepts and measures of competency; and, 4) the socio-political ideology most currently dominant in the analytic culture. And second, I would like to suggest a different understanding of Competency in Psychoanalysis which, I believe, is more in keeping with a 21st century worldview and the spirit of this year’s spring meetings. More specifically, I suggest that we develop competency in challenging and questioning our received psychoanalytic wisdoms, knowledge(s) and truths as an integral and ongoing aspect of our education and practice. And in so doing, engage in the process of destruction -and renewal- of psychoanalysis as epistemology, theory, ethics, education, and practice. To do otherwise, I believe, is to remain frozen in time and, in so doing, passively participate in a gradual process of the atrophication and destruction of psychoanalysis…
Who Decides What Counts for Psychoanalysis?
Institutional Definitions of Psychoanalysis and the Question of Competency
An historical perspective of institutional definitions of Competency in Psychoanalysis begins in the winter of 1923-24 with the training committee of the Berlin Society imposing standards and regulations on the learning activities and experiences of the candidates (Safouan, 2000). In so doing, psychoanalytic education became subject to a Competency in technocratic rationality in which the institution’s wisdom, oversight and discourse replaced everything in the realm of the candidate’s individual choice; uniform, objective and scientific methods of assessing, evaluating and making decisions were applied to each phase of the candidate’s education. And the responsibility for determining the analyst’s competency shifted from the individual -where it was situated in the earlier Vienna model- to the Institute in the Berlin model. And psychoanalysis became institutionalized. And further, the precedent was established in our pedagogical philosophy that an institutional rationality and oversight are needed -indeed, ethically required- to ensure that the good and the right takes place in education and training; a sovereign entity must develop the rules and evaluate matters of competency in each phase of the candidate’s education and training. Otherwise the candidate, it is assumed, would be totally incapable of developing a responsible and reasonable mode of self-instituting analytic training. Thus, in the best interests of psychoanalytic education and training -and also, to protect the public-, it is necessary for the Institute to decide what counts for psychoanalysis. And a triumph of triangulation prevailed between the training analyst, the institute, and the candidate; the other-as-third became an integral aspect of institute education and training. …And the beat goes on as we enter the 21st century.
In the summer of 2001, the Consortium, – a group of, arguably, the major players in organized psychoanalysis – advanced the most recent institutional definition of Competency in Psychoanalysis with their adoption of national health-care accreditation standards for education and training. In so doing, they defined a rather narrow, circular, and restrictive definition of psychoanalysis. What is psychoanalysis? Psychoanalysis is a healthcare profession, or a specialty thereof. What is psychoanalytic education? Psychoanalytic education is the demonstrated competence of those educational experiences taking place in an institute that meets healthcare and accreditation standards; and, Who is a psychoanalyst? A psychoanalyst is a mental health professional who successfully completes the educational and training requirements and graduates from an accredited institute. And despite the celebration of diversity in contemporary psychoanalysis, all graduates must demonstrate their mastery of core competencies as a mental heath professional who has acquired “… a ‘culture of evidence’ perspective about behavior based on scientific inquiry and reasoning, replicable methods of observation and measurement, and interpretation of qualitative and quantitative evidence” (The APA Educator, 2005). A science and pathology-driven model of understanding people continues to: provide the standards for education and training; produce the psychoanalyst as a mental health professional; and, prescribe the core competencies to be mastered and measured in order to receive a government-issued license to practice. And, the triangulation between analyst, analysand and institute legitimized in the winter of 1923-24 interweaves with an equally complex triangulation of the training analyst, the institute, and the government legitimized in the summer of 2001.
The question of Who Decides What Counts for Psychoanalysis? was answered very early in the history of psychoanalysis. By history and politics, the Institute -as opposed to the individual- decides what counts. And more recently, the Institute in partnership with the government. As an institutional system of the modern era, psychoanalysis stands as a modern scientific framework for the discovery and learning of practices of effective therapeutic intervention, the efficacy of which is determined by empirically-based outcome studies. As an institutional system, psychoanalysis is made up of a series of ‘models of the mind’ such as those developed by Freud, Klein, Bion, Sullivan, Kohut, Winnicott, Fairbairn, Balint, and Lacan. Such models can be taught and learned as a law and ordering of discursive rules from which a lattice of psychotherapeutic interpretations may be generated, exchanged, or posited (Barratt, Psychoanalysis and the Postmodern Impulse, 1993). As an institutional system, psychoanalysis rests on the learning of received knowledges, the rules of which are applied in the service of improving the individual’s adaptation to a fixed and stable world. And as an institutional system, psychoanalysis is reducible to measurable sets of core competencies as exemplified in the education and training of the analyst as a mental health professional.
It should be well-noted that institutional systems of psychoanalysis are rooted in linearized assumptions of time, place, logic, and causality and provide the foundational assumptions for our: educational and practice philosophies; research and science methodologies; theories and techniques; and, assessment strategies for evaluating educational and practice competency. And such institutional systems and definitions of psychoanalysis mock the very spirit of the analytic process which, nonetheless, continues to gently rise outside the walls of our educational and political institutions.
Who Decides What Counts for Psychoanalysis?
The Role of the State in a Culture of Consumerism
During the 20th century, psychoanalysis developed in the industrialized cultures of the west as they were transforming into cultures of consumerism characterized by the mass production, -distribution, and -consumption of goods and services ranging from automobiles to televisions, Big Macs to Viagra, and financial planning to consulting services. And these industrialized and technocratic societies relied on governmental standards and regulations to manage the Quality, Competition, and Fairness in such diverse sectors as the Economy, Foreign Trade, Education, and Business. Governmental standards standardize and their regulations regulate in the service of protecting the public in their consumption of the goods and services produced. Under the social contract, the state has both the right and duty to assume the role of protecting the public -if necessarythrough such measures as: legislation and regulation, developing industry-wide standards, and the licensure of service providers. In this way, the state assures that minimal standards of quality are met in each phase of production, distribution, and consumption. If and when the consumption of goods and services in any sector of the society reaches a certain percentage of gross national product (@16% GNP), that sector is declared to be an Industry and, in the interests of protecting the public, principles of industrialization and commercialization are applied.
In the United States, the most industrialized, technocratic, and consumer-driven of societies, the costs of healthcare have reached 16% of GNP and are rising. Healthcare is now known as The Behavioral Care Industry; healthcare professionals are now known as vendors; and -wrapped in the cloak of protecting the public – the state now requires: evidences of competency in the education of healthcare vendors (the production phase); evidences of continuing competencies in the delivery of their services (the distribution phase); and most recently; evidences of the efficacy of the services provided (the consumption phase). In the current era of assessment and accountability in healthcare, the issue of competency is ultimately determined by evidence-based strategies linking outcome and cost-effective research (Keisler, 2000). In order to be sanctioned and legitimized in our industrialized culture, the psychoanalysis produced must be organized around time and cost efficiency in producing its theoretically anticipated outcomes; measurable and predictable outcomes are the standards of competency in psychoanalytic education and practice.
An industrialized culture produces not only the understanding of psychoanalysis most needed by the culture but also produces the image of the psychoanalyst and the understanding of competency most needed. And the image of the analyst as a scientific practitioner is now in the final stages of being industrialized. That is, the analyst is now produced through the scientific management of her or his education and practice. And this management takes place through: the increased centralization of information, authority, and decision-making power in various educratic entities; and, an ever-increasing uniformity of policies and procedures that define our standards of education and training and of care and practice. In education, competency is concerned with the question, Has the candidate actually learned what the training program says they are teaching them? Educational competency is, thus, demonstrated by the intellectual mastery of received knowledges as measured by written and oral examinations. Practice competency is concerned with such questions as, How effectively do we do what we say we do? and, Does the treatment we offer bring about the theoretically anticipated outcome in ways that are both time- and cost- effective? After receiving a governmentissued license as evidence of one’s competency to practice, evidences of continuing competencies -or, continuing professional development programs, as they are most recently referred to- are demonstrated by fulfilling mandatory continuing education requirements for license renewal. …Who Decides What Counts in Psychoanalysis in a culture of consumerism? The State. And the State’s deciding is deeply embedded -and, endorsed- by the dominant socio-political-ideologies of the analytic culture.
Who Decides What Counts for Psychoanalysis?
Socio-political Ideologies: Liberalism Blended with Positivism
Any given ideology contains its own distinctive worldview, forms of rationality, and set of core beliefs and values by which a political group or social movement might understand and interpret itself. In the United States, the liberal and conservative ways of thinking are two of the most prominent socio-political ideologies. They represent “… two distinct conceptions of moral authority, … of apprehending reality, …of ordering experience, (and) of making moral judgements” ( Redding, 2005, 304). And further, they differ on their respective understandings of: human nature, the effective remedies for social problems, and the extent to which individuals are responsible for their own life and life circumstances. As opposed to a political conservatism, liberalism is usually seen as representing progressive values, an emphasis on community, and as supporting government-sponsored programs designed for the larger good.
In the liberal tradition the freedoms and responsibilities of both citizens and professionals are defined exclusively from within the social contract; individual freedoms, rights, and responsibilities ultimately derive from the collective interests. The liberal tradition assumes that without the elevation of the collective’s interests over the individual’s, the social contract would break down and there would be a generalized collapse of society into amoral chaos. The liberal’s worldview structures the relationship between the individual and the state; the State has the legal authority and moral responsibility to oversee matters as they pertain to the individual. In the liberal’s worldview, the State is the Who that Decides What Counts in Psychoanalysis. The State’s regulation of the analyst is: authorized by the social contract, defined by the interests of the collective, and embodied in the codification of law and ethics. And in the United States, a liberal ideology has been the most powerful voice during the 20th century in developing those policies that Decide What Counts for Psychoanalysis. And further, this ideology continues into the 21st century as part of the natural order of things in the analytic culture.
In their recent book, Destructive Trends in Mental Health: The Well-intentioned Path to Harm (2005), Rogers Wright and Nicholas Cummings argue for a re-evaluation of the practices and policies of professional organizations in the mental health field. Wright and Cummings are two self-described life-long liberals with distinguished careers as psychologists and leaders in the American Psychological Association (APA). In their book, they assert that the socio-political views guiding the research, advocacy, education, and practice of the mental health professions are most often liberal. They warn that psychology, psychiatry and social work have been captured by an ultra-liberal ideology, the agenda of which has trumped science at the highest levels of decision-making in the APA. And Richard Redding, an associate professor of law at Villanova University and associate professor of psychology at Drexel University, elaborates…
Although psychology celebrates diversity, which has come to be one of the profession’s core values …and strives to be inclusive by recognizing the value and legitimacy of diverse beliefs, the profession lacks socio-political diversity. Most psychologists are politically liberal, and conservatives are vastly underrepresented in the profession. (Redding, 2005, 303)
The lack of ideological diversity in our leadership and governance bodies persists despite the ideals clearly espoused in the APA’s ethical code urging psychologists to be sensitive to those cultural differences and biases that contribute to perpetuating a sociopolitical point of view that might exclude or oppress the perspectives of others. Operating in opposition to the profession’s core ethical principles regarding diversity has had devastating consequences for the profession and practice of psychology.
It biases research on social policy issues, damages psychology’s credibility with policymakers and the public, impedes serving conservative clients, results in de facto discrimination against conservative students and scholars, and has a chilling effect on liberal education. (Redding, 2005, 304)
A liberal ideology has biased research on social policies that are at the forefront of the culture wars specific examples of which include: exploring the relationships between: authoritarianism and conservatism; political psychology and restorative justice; and, adolescent competence in making birth control and abortion decisions. Other areas of a liberal bias in social policy research, they assert and document, includes: racism and affirmative action; welfare and school busing; individual v community rights; and, gay and lesbian parenting (Wright and Cummings, 2005).
Wrapped in a ‘radical and extreme form of political correctness,’ a supposedly empirically- based professional organization -the APA- has been taken over by an ultraliberal agenda. And often times, this agenda is advanced in ways damaging to psychology’s credibility with both policymakers and the public. Dr. Louise Silverstein, for example, writes in the American Psychologist (1991) on conducting research on day care for children, …
‘…psychologists must refuse to undertake any more research that looks for the negative consequences of ‘other-than-mother-care.’ The traditional conception of motherhood is nothing more than an ‘idealized myth’ concocted by the patriarchy to glorify motherhood in an attempt to encourage white, middleclass women to have more children. (Goldberg, 352, 2007)
And Sandra Scarr, a past president of the American Psychological Society, adds her comments on “other-than-mother-care” when she says,
However desirable or undesirable the ideal of fulltime maternal care may be, it is completely unrealistic in the world of the late 20th century. We need to create the new century’s ideal children. Multiple attachments to others will become the ideal. Shyness and exclusive maternal attachment will seem dysfunctional. New treatments will be developed for children with exclusive maternal attachments.
(italics added) (Goldberg, 353, 2007)
Is the characterization of an ultra-liberal agenda having “devastating consequences” with policymakers and the public a bit extreme? I don’t think so. The APA carries the distinction of being the only professional organization in this country to be censured by the House of Representatives and the Senate of the United States for publishing in one of its journals a meta-analysis and interview study of college students who had been molested as children. The article challenges the notion that experiences of molestation are deleterious to children. As cited by Cummings, not one of psychology’s traditional friends in the House or Senate voted against the resolution of censure, including the two psychologist members of the House who abstained rather than vote in opposition to the resolution. Cummings notes that several members of Congress confided in private that the APA testimony was so ambiguous and vague that voting against condemning the APA would have given the appearance of endorsing pedophilia! Citing other instances of equally damaging consequence, Wright and Cummings conclude that a misguided political correctness has tethered our intellects and has led to a political diversity so absent in mental health circles that, “… most psychologists and social workers live under a bubble, a bubble so encapsulating that psychologists were shocked when the APA was censured. Such negative political consequences and professional shock follow from a total disconnect from mainstream society” (Cummings, xv, 2005).
A series of very difficult question awaits the analytic community: Have our psychoanalytic organizations -including Division 39- been captured by an ultra-liberal worldview? And if so, How has its agenda impacted our professional standards in education and practice? As a political ideology, conservatism is usually seen as representing traditional values, an emphasis on self-reliance, and a fierce opposition to government-sponsored programs. A conservative ideology, however, is vastly underrepresented in psychology — our ethical commitment to diversity notwithstanding. Those of a conservative ideology probably oppose the state’s oversight in matters of Competency in Psychoanalysis while those of a liberal persuasion probably expect, endorse, and support the state’s oversight in Deciding What Counts in Psychoanalysis. And there is something more about socio-political ideology and the analytic culture:… the blending of an ideology of liberalism with that of positivism.
A positivist ideology… Birthed in a culture of positivism in the latter part of 19th century Germany, Freud’s psychology was understood as a natural science of mind. Infused with its medical ideology and rooted in evolutionary biology, psychoanalysis sought its validation in the methods and assumptions of the natural sciences. More than simply an epistemological doctrine, however, positivism is a potent form of ideology that grounds the institutions of the westernized cultures. As an ideology, positivism constructs a reality in which there is only One God, One World, One Logic, One Essence, and One Science producing One Truth at the .01 level of confidence. For most of the 20th century, the analytic culture embraced this positivist’s epistemology and seemed blinded to the ideological nature of its socio-political frame of reference so that, in the analytic culture, there was only One Reality; One Science; One Human Nature; One Logic; One Truth; One Theory; One Technique; One Transference; One Counter-transference; One Interpretation; and, One legitimate Institute from which to receive knowledge and experiences. And further, there was only One form of social formation for the political and educational institutions in the analytic culture: those organized to support principles of hierarchy and control and in which institutions the political and ideological hierarchies of power and knowledge were grounded in medicine, biology and the natural sciences.
Ethics, power, and knowledge are inseparable in the intersection where the State and Institute meet to issue the license to practice. The Institute’s understanding of Competency in Psychoanalysis mirrors the State’s ideology of social control: both are interested in bringing about the patient’s conformity and compliance with a normalizing doctrine. The interests of organized psychoanalysis in predicting and controlling human behavior as a natural science interface with those of the political sciences in the larger culture; both psychoanalysis and the political sciences share the positivist rationality that seeks the technical mastery of people through the scientific production of knowledge, its acquisition, and its applications.
During the modern era, the historical discipline of psychoanalysis has rested on a knowledge-base that is, at once, ahistorical and atemporal in nature.
Underlying all the major assumptions of the culture of positivism is a common theme: the denial of human action grounded in historical insight and committed to emancipation in all spheres of human activity. What is offered as a replacement is a form of social engineering analagous to the applied physical sciences. It is this very denial (of historical consciousness) which represents the essence of the prevailing hegemonic ideology. (Giroux, 1997, 12)
Positivist knowledge is understood as: scientific, bounded, cumulative, and context-free, far-removed from the individual, political, and cultural traditions that structure meaning. And the scientific fact is the foundation for our received knowledges, the mastery and applications of which form the basis for demonstrating competency in education and practice.
As we enter the 21st century, we do so with a noteworthy lack of diversity in: our intellectual and conceptual foundations; our pedagogical and practice philosophies; and, the socio-political ideologies of our leadership and governance bodies. By history and politics, the State and the Institution -as opposed to the individual- is the Who that Decides What Counts for Psychoanalysis.
On Developing Competency in the Destruction of Psychoanalysis:
Moving Into the 21st Century
Our traditional ways of perceiving, thinking about, and coming to know the world have been changing profoundly and irreversibly over the past century. The intellectual upheavals of the twentieth century have led to what Barratt describes as a collapsing of the master discourse that has regulated our human affairs over the past four centuries (Psychoanalysis and the Postmodern Impulse, 1993). And this irreversible process of collapse has been seeping into the epistemological fabric of the analytic culture, forcing us to reconsider our largely unquestioned assumptions about the nature of reality, …of human nature, and …of time, process, and complexity in the analytic engagement.
Over the past thirty years, a synergetic process of challenging and questioning our received educational and practice philosophies has generated the rich diversity of psychologies that characterize contemporary psychoanalysis. These psychologies premise different understandings of human nature, posit different methods of knowing about people, have very different understandings of the unconscious; and, assume very different purposes and outcomes of the analytic discourse. The core competencies of a mental health professional do not match, however, with what would constitute competency in many of these psychologies: the assumptions of a healthcare model simply do not apply. By acting as if they do, the illusion is created that the demonstration of competency as a mental health professional is somehow related to – or, is the equivalent of – Competency in Psychoanalysis. And representing this illusion of competency to the public seems rather disingenuous, at best. As the monolithic psychoanalysis of modernity slowly fades into the archives of Times Past so, too, do our positivist’s understanding and measures of competency.
Our measures of competency in psychoanalysis do not match -and, never have in my opinion- with the defining concept of psychoanalysis: the unconscious which, in contemporary psychoanalysis, is perhaps more precisely thought of as… the unconscious as conceptualized by: …the Freudians, the Jungians, the Kleinians, the Lacanians, the Kohutians, the Winnicotians, the relationists, the intersubjectivists, and those who speak from an existential, phenomenological, or other philosophically based paradigms — to name just a few. If it is the individual therapist or unique relationship and not the mastery and application of received knowledges, techniques or procedures that propels the forward motion of the analytic engagement, are we not ethically compelled to match our educational philosophy and objectives with our respective theory of the unconscious— however it is understood to be? And given our conceptual diversity, does not the definition and measures of competency in psychoanalysis necessarily depend on the particular understanding of psychoanalysis in question, be it Kleinian, Lacanian, Freudian, or …whichever?
In the time remaining, I would like to consider the following proposition: psychoanalysis as an institutional system is to the modern era as psychoanalysis as process is to the postmodern. In this consideration, I will speak to: some of the characteristics that differentiate a process from an institutional perspective; a process view of psychoanalysis that rests on Freud’s initial and intuitive concept of the unconscious as representation’s other; and lastly, the question of Competency in Psychoanalysis given a process understanding of psychoanalysis….
Psychoanalysis as Process: In contrast to an institutional system, psychoanalysis as process: stands outside the linear and sequential assumptions of the natural sciences; exists in a non-linear matrix of time, place, logic, and causality; and runs counter to – indeed, defies- its own institutional systematization. As process, psychoanalysis is positioned to continuously question its own received assumptions, knowledges, and socio-political ideologies; its discourse is a discourse on discourse which includes questioning the underlying assumptions and formations of its own discourse and requires the analyst be 100% outside the process while, at the same time, be 100% inside the process. And at the same time, be neither inside nor outside as there is no inside or outside. This rather mysterious process leads to unimagined and unpredictable outcomes, limited only by its ‘possibility of possibilities.’ As process, psychoanalysis is filled with conflict, dilemma, and the paradoxical and…
runs contrary to everything we are taught is the logical, rational, ‘scientific’ way to acquire knowledge. Yet it is only through using such an apparently illogical and subversive method that the patient’s psychic truth can be articulated, a breakthrough not only in the treatment of pathological structures of thought and character, but a revolution in the mind’s access to its unthought forms of knowledge. (Bollas, The Mystery of Things, 1999)
Indeed, Bollas likens the analytic process to a subversive activity – a kind of counterculture activity as opposed to conformity and compliance- in that an invitation is extended to the other to speak whatever is consciously experienced in her or his bodymindthinkingspeaking. In so doing, the process involves relinquishing the demand on both participants to be logical, rational, and coherent. And this strange process is illogical and subversive for both participants with its only goal being to further the associative process. The associative-interpretive process: undermines the intellectual sanctity of analytically acquired truths; sustains generative forms of destruction that break disturbances of thought and character; and, subverts the authority of both participants. And most importantly, this is the way it should be.
In very differing ways the method of free association and the act of interpretation are forces of destruction that decentre the analysand’s psychic hegemony and the repeated sensibleness of the analyst’s interpretive grasp. (Bollas, 27, 1999)
As the two participants create hermeneutic entities, they are immediately dispersed by the very associations they inspire. And in this strangely intimate and irrational process of being, speaking, and knowing a rather mysterious and sacred unfolding of the unknown known somehow occurs as ‘the natural order of things’ is called into question in ways that are both scientific and emancipatory, freeing the knowing and being of the enunciating subject. Participation in such a process requires, however, that the analyst trust the process, herself, and the other (of self). And uncertainty, unpredictability, and the unknown are constant companions in this process in which liberation comes through destruction..
As process, psychoanalysis radically challenges the accepted and acceptable criteria of judgement, the entire tradition of ‘right-minded’ or ‘appropriate’ thinking, and does not posture as a modern science; that is, as professionalized, standardized and technocratic (Barratt, 1993). As process, psychoanalysis speaks to a way of being, presencing, and knowing that envelopes an emotional, intellectual and ethical attitude that guides its unique ways of thinking and speaking and has as its only purpose the furthering of the associative-interpretive process (Kavanaugh, 2004; 2005). Psychoanalysis as process radically influences how we might listen, understand, and respond in the analytic moment; shapes our notions of science and research; and, suggests how we might think of Competency in Psychoanalysis in the 21st century.
The Question of Competency from a Process Perspective: Understood as…a venture into communication via the associative-interpretive process in a contextualizing metaphor from the performance arts, e.g., the psychic theatre of the mind, psychoanalysis is resituated in philosophy (of phenomenalism and language), the humanities (history and literature), and the arts (the transformative and performance arts). And this understanding of psychoanalysis structures very different implications for what constitutes Competency in Psychoanalysis. In this understanding, competency centers on the question: How well can the analyst be with self and other as the other (of self) speaks from the stage of their private theatre? And, How well can the analyst step out onto that stage and speak the inexplicable in ways meaningful to the other? Thus, from this perspective, practice competence is understood as,
…the implicit internalized knowledge of a language that the speaker (the analyst) possesses and that enables the speaker to produce and understand the language (being spoken by the other).
(emphasis added, Webster’s College Dictionary, 1999)
As a performance artist in the theatre of mind, the analyst performs her or his interpretive act in which competence is inextricably linked to the wording of the unthought known in ways that are, at once, meaningful for the client and furthers the associative process. In so doing, the analyst fulfills the mutually agreed upon purpose for meeting: to understand and translate the language of the unconscious of self and other in ways meaningful to the other (of self); such translations are spoken from the analyst’s ways of being with self and other. Thus from this perspective, the central question regarding competency is: How well does the analyst venture into communication via the associative-interpretive process in the work-play of the theatre? And this understanding of practice competency may or may not have anything to do with other contemporary psychologies of psychoanalysis. It has nothing to do, however, with the core competencies of a mental health professional. And further, competency from this perspective is not synonymous with bringing about a theoretically anticipated outcome as outcome is unpredictable and unknown…
In this synthesis and practice of psychoanalysis, practice competency is inextricably linked to the complex process of listening, understanding, and responding to the language of the unconscious of self (of other) and other (of self), a language which is, at once, the primary source of knowledge in and the primal linguistic of the analytic discourse. This synthesis of psychoanalysis rests on Freud’s initial and intuitive understanding of the unconscious as life, affectivity, or the life force, an understanding that did not -and, still does not- fit with our received philosophical, scientific, or medical paradigms (Henry, The Genealogy of Psychoanalysis, 1985). Their underlying assumptions simply do not apply. In its radical phenomenality, the unconscious understood as the life force: cannot be stated, taught, or learned within our more traditional worldviews; hearing and speaking its language cannot be mass-produced in the classroom, mass-distributed in supervision, or mass-consumed in the training analysis. Understood as life, the conceptual singularity of the unconscious places psychoanalysis outside of the classical worldview and the scientist’s symbols, Freud’s later declarations to the contrary notwithstanding (1937).
How is competency measured if the unconscious is understood as an ontology of life that emphasizes the process nature of our lived-experiences in which unrepresentability, invisibility, and formlessness are core characteristics? …What are the implications for competency if the defining aspect of psychoanalysis, e.g., the unconscious as process and dynamic, is understood as representation’s other? or, the life force?… If it is the individual therapist or unique relationship that speaks to a knowing, being, and presencing of self with other then what are the meaningful measures of competency -if any? …Irrespective of one’s particular understanding of the unconscious, however, the more immediate question remains: Do we continue into the 21st century conceptually tied to our received notions and measures of competency that trace their genealogy to a 19th century mechanistic view of the world and people?
The reexamination of our notions of Competency in Psychoanalysis involves the question of freedom and the freedom to question the natural order of things in the analytic culture and the analytic engagement in our educational and training programs. Developing competency in the ongoing destruction -and renewal- of psychoanalysis is premised on the questioning and challenging of our received assumptions, knowledges, and wisdoms in psychoanalytic epistemology, ethics, education, theory and practice. And there is a pressing urgency to do so. Our institutions remain rooted in a 19th century worldview and structure; our pedagogical philosophy, model and strategies have remained virtually unchanged since 1922; and, our standards of practice and care are organized around theories that gratuitously assume that people are the helpless passive victims of their life circumstances.
If, as Douglas Kirsner suggests, psychoanalysis is “…a basically humanistic discipline that has conceived and touted itself as a positivist science while organising itself institutionally as a religion” (Unfree Associations, 2000, p.233), then is it not time to unabashedly acknowledge to ourselves and the larger community that we form our own community of practice; hold our own distinctive views of human nature of which the unconscious is central and defining –however it might be defined; that we hold our own distinctive views of science and research methodology; and, that -in agreement with feminists and systems theorists- we hold a process perspective in which relational phenomena are fundamentally irreducible. And further, is it not time to advance psychoanalysis as an incredibly complex, non-linear process and, as such, is not premised on assumptions that can be measured by traditional natural science criteria, however modified to appeal to business, governmental and educratic entities which think in medical model terms (Bohart, 1997). As a humanistic discipline premised on a non-linear metaphysics and postmodern constructivist epistemology, the mechanistic assumptions of a natural science model simply do not apply. And from a humanistic perspective, outcome is highly ideothetic, the value of which is best judged by the participants in the process who are, ultimately, the only ones Who Can Decide What Counts For Psychoanalysis…
Dr. Kavanaugh is a former president of the Forum and served on its Board of Directors for fifteen years in various capacities. He is the founding president of the Academy for the Study of the Psychoanalytic Arts and a former president of the Michigan Society for Psychoanalytic Psychology. He has presented and published on psychoanalytic education, theory, practice, ethics, and epistemology. His book, Stories from the Bog: On Madness, Philosophy, and Psychoanalysis, is currently in press (Rodopi. 2011). He is private practice in Farmington Hills, Michigan.