What the patient acquires in the therapeutic encounter, then, is less a complete semantic, explanatory framework than a mode of imagining through which their past, present, and future subjectivity is ordered and understood. Trainee patients, therefore, on the cusp of entering the institute rarely find themselves, like the guests of Procrustes, in possession of a rigid structure to which they are forced to commit, but rather they possess a mode of seeing through which their subjective worlds are slowly being ordered, understood, and re-imagined.
Because I shall illustrate further the contours of this 'psychodynamic imagination' in the next chapter, here I shall conclude by listing those dispositions which we can now confidently assume trainees possess when at the threshold of entering the training institute.
Concluding Chapters Two and Three
At the outset of chapter two I noted that trainees approach the institute with a disposition of partiality towards the psychodynamic paradigm. This is largely guaranteed by a form of 'institutional vetting' which requires all trainees to first submit to dynamic therapy before entering the institute; a vetting which ensures, as informants confirm, that only those participants who are positively disposed to psychodynamic psychotherapy self-select to proceed with formal training. To this first disposition we now add a disposition towards imagining psychodynamically, so far as pre-training therapy obliges all trainees to first be patients before entering the institute and thus to learn to imagine themselves though a psychodynamic lens as any patient would. During the course of this discussion I have also taken the opportunity to clarify certain rudiments of psychodynamic thought, since, as we will see, the institutes appeal to this imagination to legitimate certain institutional devices central to the facilitation of the trainees' socialisation.
In closing this chapter one final point remains. Although I have argued that a symbolic approach does not entirely capture patient experience, this is not to say that 'symbolist theory' is wholly inapplicable to assessing the career of the trainee, since one of the most important aspects of any therapist's education is learning to master the conceptual framework integral to clinical practice. I differ from the symbolists only in saying that the mastering of concepts does not transpire in the therapeutic encounter but rather, in the case of the trainee, in the clinical and theoretical seminars during which theoretical explanations and symbols are grafted onto imaginal experience. So while there is agreement with the symbolist's conclusions in an ultimate sense, there is disagreement about the exact object to which they apply: not to the average patient (or patient-trainee) whose experience they were thought to capture, but to those who have taken the extra step of consciously working to translate private experience into public precept.
Chapter Four The Seminar Encounter: The Transmission of Psychodynamic Knowledge
Having described the basic therapeutic encounter in the last two chapters, and how this encounter endows trainees or patients with the disposition to imagine psychodynamically, we are now in a better position to understand the institutional devices of socialisation which appeal to this imagination for their legitimacy. In this chapter, then, by finally entering wholeheartedly into the training institute by describing the next stage of professional socialisation—seminar education—I will show how in seminars the psychodynamic imagination becomes deeply affirmed and wins for itself conceptual dressing.
When describing this second stage of training I shall lay special emphasis on how the roles between trainees and trainers are structured hierarchically. By making use of Elisabeth Hsu's (1999) concepts concerning how medical knowledge is transmitted to novice practitioners, I shall further illustrate how this hierarchy is legitim-atised by the various 'styles of knowing' (secret and personal) that obtain in the therapeutic community. Moreover, I shall explore how via the institutional transmission of 'standardised' therapeutic knowledge (knowledge contained in the 'official' or 'core' therapeutic texts) such knowledge is protected from criticism. In all, by dwelling on these themes I shall suggest that the educative atmosphere in which psychoanalytical knowledge is transmitted is by and large more 'affirmative' than 'critical', finally concluding that this style of 'affirmative' education reflects communal anxieties about the dissolution of the psychoanalytic tradition and about the need to duly protect it.
The Seminar
Theoretical seminars are usually held once weekly at the institute. These are meetings that last for about one and a half hours, where key theoretical ideas are taught and discussed. Typically on any one evening there might be a number of seminars taking place in different rooms, each seminar catering for candidates at different stages of their training. Before the seminars commence there is often a buoyant atmosphere in the halls, where trainees collect to greet each other, laugh, and share light conversation. As the hour approaches for the seminars to begin, the chattering din slowly abates as candidates gradually file into their respective groups. Doors close one by one until at last the hall sits silent.
Finding ourselves now in the seminar room we notice the group is small in size, comprising four to eight trainees and one group leader. We also notice that these meetings are not conducted in a lecture style, where the teacher, standing before neat rows of scribbling students, imparts knowledge from notes or memory with few interruptions. Rather the seating is arranged in circular fashion, this organisation being thought to better invite discussion and the sharing of ideas, and to encourage a deeper group intimacy than the formal lecture arrangement can produce.
Seminars leaders are always themselves trained therapists involved in professional practice, and are often graduates of the institution at which they teach. On occasion these leaders are newly qualified therapists who, aspiring to reach higher positions in their institutes, are travelling the familiar route by which such positions are attained: via the teaching and supervising of students. Institutions generally prefer to hire from their own membership (i.e. their own graduate body) since these therapists are familiar with the customs and traditions of the specific training. When seminar leaders are not graduates, however, they are often selected from 'parent' institutions, usually from those positioned higher up in what I have termed the genealogical structure. For instance, the BAP (British Association of Psychotherapists) and the Lincoln Centre will invariably hire leaders from either their own memberships or from the Institute of Psychoanalysis, the institute which heads the genealogical structure. That institutes prefer to 'hire up' than down was a fact I frequently observed.
As with the therapeutic space discussed in the last chapter, seminars are sites where communal ideas, values, and principles are transmitted, and thus could be envisaged as structurally comparable to ritual spaces through which collective meanings are affirmed and shared. That in these sites only communally accepted ideas are transmitted, in some measure explains why individual seminar leaders rarely design their own courses, but rather teach the established curriculum planned by the training committee (i.e. the senior members of the institute). The following summary of a typical theoretical programme, for instance, will remain the same despite the comings and goings of individual seminar leaders (see appendix three for further summaries):
Year 1
S. Freud; K. Abraham.
Year 2
M. Klein; D. W. Winnicott; Infant and Child Development; H. Kohut; Comparative Clinical Concepts; W.
D. Fairbairn; S. Ferenczi; M. Balint; Topics on Clinical Management.
Year 3
Psychoneurosis and Character Disorders; Depression; Narcissistic Disorders; Psychosomatic Disorders; Perversions; Comparative Clinical Concepts Revisited.
Year 4
W. R. Bion; Post-Kleinians; Current Themes in Sexuality; The Analytic Attitude.89
The commission made by the training committee to the seminar leader, cogently defines the leader's seminar duties. The leaders I spoke to often saw their role as one of primarily upholding and transmitting the collective views of the institute rather than of using seminar settings to communicate significantly personal views of their own. 'I am here to clarify points of theory and to teach the basic ideas of Freud', one leader commented. 'I see that as my remit'. And another: 'In seminars we have a responsibility to see that our trainees understand the core ideas; seminars are essentially about making sure this happens.' And again: 'my teaching is a clarification of the principles guiding clinical practice'(Interviews 2004).
To employ a Weberian (1963 [1922]: 4) distinction for a moment, the role of the seminar leader as conceived by the training committee approximates more closely to the pole of 'priest' than to that of 'prophet'. Prophets, for Weber, were distinguished by their charismatic promulgation of a personal vision or redeeming idea, while priests were those self-selecting individuals charged with the idea's preservation and dissemination: '[The priest] lays claim to authority by virtue of his service in a sacred tradition, while the prophet's claim is based on personal revelation and charisma' (1963 [1922]: 4).90 This is not to say that 'priests' share no moments of originality or creative rapture,91 this may well be, but rather that when donning their institutional role it is the communal rather than their own private vision that they are obliged to transmit.
Weber's idea of the priest is rendered more apposite if we recognise it need not only pertain to the religious sphere, since every kind of set and school, it could be argued, has its celebrants and upholders. In this sense we might speak of priests in philosophy, in politics, in the arts, and in psychotherapy. Often these individuals are very learned, and use their learning to administer the agreed-upon ideas so as to ensure that the communal message is transmitted to the next generation. In other words, the priest's duty is to disseminate 'acquired' not 'revealed' knowledge, and by this means to transmit that which is inherited and collective rather than that which is self-conceived.
The proscription laid out by the training committee defines the seminar leader's role as one of propagating communal rather than idiosyncratic knowledge. In this respect the leader's role demands a 'depersonalisation of interest' from those who embody it—this is to say, where one's personal interest diverges from that of the collective, the collective interest is to be preferred. Personal creativity, then, is only encouraged so far as it serves the collective agenda. One seminar leader explained:
We are all accountable and must respect that accountability. In our institute we have a definite therapeutic tradition to teach. It is no good if I diverge from that tradition and follow every whim. ['Are you ever tempted to?'] No, no because I feel these ideas as my own... I enjoy teaching them... and I think that my students enjoy learning them. We play our respective parts and get what we need from this. (Seminar leader 2004, italics added)
The role that seminar leaders adopt has implications for the trainees subject to it. As Goffman (1959: 253) has maintained, social roles lose their actuality when removed from their context; they assume reality only in relationship.92 The imparter exists only so far as there is one who receives, while the receiver's identity 'as receiver' dissolves in the absence of the giver. In Barth's terms (1971) we might say that the 'dominant role', embodied in our case in the seminar leader, must inevitably coerce its relational 'other' into the complementary position if it is to be realised. Speaking of the relational dynamic it creates, Sarah, a second year trainee commented:
Seminars are strange places, here you are an adult learner but often experiencing what you felt many years ago. There is something in the fact that you are expected to learn and that your questions should be more clarificatory than critical. You kind of learn this early on. ['Do you mind this?'] Well it is fine mostly, I suppose, but there are occasions when you want to challenge something and this can be frustrating, because you don't want to upset things. ['Upset things?']
I mean upset the leaders by questioning too much... (Second Year Trainee 2004)
John said the following:
Yes, yes, seminars are places where you regress. I mean I am not bothered by this... I kind of like sitting back and listening. But on occasion when I feel suspicious about something and I feel that the teacher just wants us to take things on board... I often opt for silence... It is rare to find in adult life a context where you are not expected to know. Everywhere you are expected to be an expert—at home, at work etc. In life you kind of have to pass about unknowing like a hot potato. (Third Year Trainee 2005)
This role asymmetry puts many trainees in an unusual and ambiguous position in respect of their customary status: while in their private and public lives they might parent a family, head a business, teach at college, or nurse the sick in hospital wards, in the seminar context they are tacitly required to divest themselves of any such 'typical' position so as to identify with their current and relatively lowly (student) standing: 'I feel I have to wear a different hat when I come to the institute' commented Jack, a second year trainee and a social worker. 'Here [in this profession] I am actually way down on the bottom rung looking up... this is how it often feels at least.' Peter, the thirty-one year-old trainee in his first year, said: 'Yes there is something frustrating at finding yourself in your early thirties having to start again. I get frustrated sometimes that there is such a long way to go... You have kind of got to humble yourself here, and accept that you know relatively little in comparison to the tutors' (Interviews 2004).
In Peter's experience there is something similar about this act of stepping from the public world into the relative modesty of 'learner status', to the act of returning to the family setting where only kin statuses such as parent, child, sibling, and grandparent matter. When entering both contexts one's usual and often higher status is left at the door. In the training setting it is the relationship of teacher and student that matters, this configuration eclipsing higher status-filled roles that trainees on other occasions will embody. Thus the status Peter enjoyed at work becomes 'latent' in the seminar—he is now an apprentice and expected to behave as such. He is not asked to lead, to decide, to direct, or to be overly assertive, but to recognise his inexperience, and, with his humility braced, to listen, to learn, and to assume the posture of unknowing.
On occasion a given student is unwilling to assume this position and tensions arise. As I shall speak of acute examples of such unwillingness in the next chapter on dissent, I shall only mention here weaker versions of opposition. In such instances a trainee's habitual status resists being placed in the 'latent' position and periodically manifests itself in strategic ways, often at liminal moments that sit at the boundaries between the external world and the classroom. These liminal points are numerous: they exist at lunch or in the pub, in the halls or during walks to cars or the local bus or train station. These liminal places often provide opportunities for personal discontent to be voiced. And status is reasserted by means of criticising the structures that engender the imbalances. For instance, Sarah, of whom I spoke earlier, would on these occasions often complain about a given analyst being too stern and intimidating, and would continue to criticise his teaching skills (although in our 'official' interview she was careful to temper her complaints despite my insistence of confidentiality). I observed that these lim-inal moments allow trainees to momentarily vent frustration without the fear of being overheard by seniors—this is to say, the type of dissent emerging in these liminal spaces is what we might call strategic dissent, since it is of a kind that does not jeopardise the trainee's position with respect to authority.
In many essentials it is true to say that the status imbalances between senior and junior professionals have analogues in many professional fields. But in the psychoanalytic community the unique component is found in how this relationship is legitimated by psychoanalytic ideas; ideas endowing the asymmetry with specific intensity and meaning. For instance, this role imbalance is perfectly consistent with, or in Rodney Needham's (1962: xxxvi) terms 'analogical to', the psychodynamic concept of personhood discussed in the previous chapter.93 As I mentioned there, personhood is not given but achieved, gradually conferred upon those who have moved progressively out of the reach of their unconscious and its distortions, to emerge with clearer perception and more self-determination. As the development of this clarity is believed to be facilitated through personal therapy, it follows that the deeper and more thorough your therapeutic experience the more likely you will possess greater quantities of that elusive quality of per-sonhood. In this sense fully initiated practitioners are generally thought to reside higher upon the spectrum of self-knowledge and development, largely because they have passed through many years of training and personal psychotherapy.94 This belief, when tacitly subscribed to by both trainee and trainer, accords the latter with a knowledge and perspicuity not yet attained by the novice. It is in this sense that the trainer is believed to possess knowledge that is off-limits or 'secret' to the trainee, since this knowledge is only accessible to those who have been fully initiated.
Knowledge Transmission
At this point it would be useful to discuss more closely the kinds of knowledge transmitted to the trainee in the seminar setting (including this 'secret' knowledge), for knowledge, after all, is something all trainees keenly seek. But as knowledge can take many forms and shapes (e.g. 'secret', 'personal', 'experiential' or 'authoritative') it will be useful to identify some of the dominant kinds transmitted in the seminar space. In order to help identify these different kinds, let me relate our discussion to Elisabeth Hsu's (1999) investigation The Transmission of Chinese Medicine—a study whose insights, when used to illuminate the therapeutic setting, may yield many profitable observations.
Hsu's study of TCM (traditional Chinese medicine) identified three kinds of knowledge transmitted from the Chinese medical doctor to the apprentice in the course of the latter's education: standardised, personal and secret knowledge. Briefly put, standardised knowledge is that comprehended 'more or less in isolation from medical practice'—it is the standard, formalised, 'textbook' knowledge ratified by a political, professional, or bureaucratic elite. Alternatively 'personal knowledge' is essentially that passed on through personal relationship—here both parties reserve the right to 'accept and reject each other on the grounds of character and personality' (p.102). The apprentice chooses a mentor if he or she believes that a relationship of mutual trust will develop. This is important as 'to what degree and what kind of knowledge... [is] transmitted depends very much on the personalities involved' (p.102). This is to say, if the relationship between doctor and apprentice is strong there is a greater likelihood that a deeper knowledge will be imparted. Finally, 'secret knowledge' is that which is intentionally concealed from the uninitiated. Not only does this concealment render more alluring that which is hidden, but it also 'legitimates the right of those who have access to [this] knowledge, secures their authority, and hinders uncontrolled distribution of knowledge' (p.52). Secrecy then, both heightens the value of the knowledge concealed and confers power on the knower. It acts as an adornment which 'intensifies and enlarges the impression of the personality by operating as a sort of radiation emanating from it' (Simmel, cited in Hsu 1999: 339).95 This intensification serves not only to draw a boundary between lay persons and practitioners, but also between apprentices and the fully qualified (p. 56).
Despite the many cultural differences between the practitioner/ apprentice relationships of both therapeutic systems, when these relationships are structurally compared there emerge a number of palpable similarities. As I have previously mentioned, the psychotherapeutic leader, whether of a session or a seminar, by virtue of having the rounder therapeutic experience is believed to possess a clearer vision of unconscious processes—namely, a developed sense as to both the hidden sources of distress and the best means for their alleviation. 'Give it time and you will understand also', says one supervisor to an inexperienced trainee, 'you can't expect to really grasp these things [the patient's dynamics] so early on'.96 Since the act of 'grasping' is thought to require a certain clinical perspicuity that can only be developed over time, inexperience bars entrance to the deeper and 'secret' insight fuller personhood confers.
As fuller knowledge is necessarily denied to the novice, it becomes a valued and honoured commodity. This endows certain leaders with a special magnetism, accentuating the abilities they possess. This fact I observed on many occasions where certain leaders, being particularly revered, seemed to possess for students a certain mana, so to speak. Of different respected seminar leaders I heard different trainees recount: 'she has such uncanny insight' or 'her understanding is extremely penetrating', or 'I trust his judgement completely'. When trainees discussed their patients in seminars, astute leaders who are thought able to unravel patients' problems were seen as individuals who can 'bring sense to disorder' or 'save your skin'. Even leaders whose popularity was questionable because they were 'difficult' or 'intimidating' were still ascribed a kind of 'special knowing' which obliged deference from trainees. In all, in many trainees I noticed a strong desire for the personhood not yet attained—a special commodity seeming to bring many benefits in its train (e.g. high status, economic reward, power in relation to the unknowing, a sense of greater expertise and confidence, etc.)
That leaders, then, are thought not simply to possess 'standardised knowledge' (i.e. textbook knowledge available to lay person and learned enquirer alike) brings us to our first point of similarity between TCM and psychotherapy: knowledge for both is not seen as primarily 'book-learned', but rather born of experience, of extended practice, of time spent under the tutorship of the learned. And since trainees have yet to acquire this experience, the knowledge it spawns remains secret to them.97
If 'secret knowledge' exists in the therapeutic community, so too does 'personal knowledge'. As Hsu observes in Chinese Medicine, in psychotherapy the most important knowledge is acquired through relationship (i.e. via the training therapy which continues up until graduation). As in TCM, the deeper the relationship the greater the value of the knowledge attained. For instance, the more trust that is established between therapist and patient, the more likely the patient will be able to explore ever deeper layers of their internality. And as such exploration is essential if the therapist is to understand the patient, an understanding essential to aid the patient's progression into full personhood, establishing such trust is critical. The equation being: deep relationship begets deep exploration; exploration facilitates deeper understanding; deeper understanding begets more accurate interpretations, a richer therapeutic alliance, and finally deeper self-knowledge.
A further dimension of 'personal knowledge' made less explicit in Hsu's study, is that for psychotherapists the value of personal knowledge is increased if the therapist with whom one relates can claim a venerable 'line of descent'. This means that as therapeutic knowledge is passed on principally through relationship, the potential exists for any given trainee to have a close affiliation (via their relationship with their therapist or seminar leader) to earlier important figures in the movement's history. For instance, Hartvig
Dahl in Janet Malcolm's (2004 [1983]: 88) Psychoanalysis: The Impossible Profession traces his therapeutic lineage via K. Menninger (his analyst) though K. Abraham (Menninger's analyst), who was a respected member of Freud's original circle. As both Menninger and Abraham are venerated figures in psychoanalytic history, Hartvig Dahl can claim a venerable lineage and thus a certain au-thority—the supposition being that the qualities which led these analysts to high therapeutic competence would have been somehow absorbed by their trainees.98 As the psychoanalyst Michael Rustin explains, because of this 'aristocratic penchant' in the culture of psychotherapy '"lines of descent" are symbolically established and remain important markers of status' (1985: 153). In psychotherapeutic culture not only is persistence over time thought to lead to deeper knowledge, but the pedigree of such knowledge is also believed to increase if the leader from whom it is gathered is of an illustrious lineage. Thus, in psychotherapy not only is personal knowledge deepened through relationship, as Hsu teaches us, but it is also heightened if one's leader is of venerable descent.99
The tacit belief, held by both trainees and leaders that full per-sonhood includes a certain 'knowledge status' which remains secret to the novice, has a consequence beyond that of rendering trainees more susceptible to the suggestions of those ensconced in positions above them. In addition this belief protects those who claim to be the only ones who can correctly transmit the craft, since it undermines the idea that psychotherapy can be mastered by reading texts alone (i.e. through acquiring only 'standardised knowledge'). If this were possible then anyone could gain expertise in the psychoanalytic craft without submitting either to personal therapy or to any institutional appraisal.100 This would undermine not only the believed natural hierarchy between the initiated and the uninitiated, and that between different schools in the genealogical structure, but also between the initiated 'guardians of the tradition' and the uninitiated lay-persons residing beyond its bounds.
So far I have examined the imbalances between senior and junior therapists, and how they are supported by psychoanalytic ideas. These ideas support the existence of 'secret' knowledge (accessed through acquiring personhood) and 'personal' knowledge (acquired through relationships and lineage) to which novices have limited access and lay-persons no access at all. Having said a little about secret and personal knowledge, let me now focus on the transmission of 'standardised knowledge'—i.e. the 'official', text-based, theoretical knowledge imparted in seminars. By inspecting what is included in and excluded from the theoretical canon, I believe we may glimpse what further dispositions institutes hope to inculcate in their trainee practitioners.
The Texts: A Bounded Entity
The American psychoanalyst, Otto Kernberg, writes:
Major challenges to psychoanalytic theory and technique occur at the boundary of our professional field, and the avoidance of investment in such boundary pursuits protects not only the purity of psychoanalytic work but also the raising of challenging and potentially subversive questions regarding the limits as well as the applications of psychoanalysis. (Kernberg 1996:
1038)
In the above statement Otto Kernberg parodies a latent attitude he considers to be widely held in training institutions; an attitude determining the kind of knowledge imparted in seminars. A useful way to gain understanding as to the precise kind of standardised knowledge transmitted in seminars is through inspecting the curricula enclosed in appendix three. These curricula are of anthropological interest more for what they exclude than for what they include.
When reviewing the curricula what is most noticeable is that all theorists listed are psychodynamic in orientation. Yet it is also true that most of these theorists have subtly dissimilar understandings of dynamic processes. Thus modern psychodynamic training is in some measure integrative (within psychoanalytic parameters), since after having mastered the essential teachings of Freud, candidates in later years must study alternative views which introduce competing and sometimes contradictory psychoanalytic ideas into their existing conceptual repertoire. At these later stages students are obliged to forge integrations, reconciliations, or establish allegiances; activities that often engender much heat and discussion in seminars. As Patrick, a third year student stated, however, these discussions are conspicuous for not transgressing certain parameters:
There are things debated and things simply not... there is a whole lot of debate about, perhaps, integrating similarities and differences between theories and points of practice, especially in the final year of training, but I have noticed that we avoid debate about whether there is an unconscious or not, about the empirical basis of inner dynamics... The meta-questions concerning the principles that all approaches share are just put out of our minds. Trainers seem not particularly interested in them. (Third Year Trainee 2005)
Patrick's statement articulates a latent taboo in seminars concerning discussing 'meta-questions'. If this taboo subtly draws bounds around and thus restricts what kind of subjects can be discussed, the process of integration that I observed is restricted in two further senses. Firstly, in the sense that only the integrations of different psychodynamic theories are explored, while there is no exploration of integrations between psychodynamic and non-dynamic therapies. This means that what is taught is mostly disconnected from developments in related therapeutic fields (e.g. in psychoanalytic institutes there are no courses taught on cognitive/behavioural, existential, humanistic or cross-cultural psychotherapy). Indeed, whatever knowledge trainees possess about these therapies I found to be derived from other private or public courses of study.
Integration is restricted in a second sense: seminar teaching does not include the study of outside academic critiques or discussions of the psychoanalytic world-view. Related disciplines of anthropology, sociology, philosophy or even academic psychology are largely ignored, and if referred to at all usually only in so far as their findings support (rather than critique) points of psychodynamic theory. That seminar education is circumscribed in like manner across trainings became clearer to me after reviewing the curricula of numerous institutes whose seminars I could not directly observe (see appendix three). In the eleven institutes I surveyed, when searching for the inclusion of relevant sociological studies of psychoanalysis, for example, I only found two institutes which appeared to include a 'social' perspective. On closer inspection of their curricula, however, I found these modules were concerned with explaining social phenomena psychoanalytically—e.g. applying psychoanalytic ideas to understand family and organisational systems, or reducing social phenomena such as 'collective mentalities' and ritual and religious practice to psychology.101 They were not concerned with social analyses of the profession itself.
Naturally it would be hazardous to draw too definite conclusions from the study of curricula alone, since the relations between a course description and what is actually taught may be tenuous. However, coupling these data with my own participatory observations encouraged the conclusion that the theoretical education of the psychotherapeutic trainee was a heavily circumscribed affair. In terms of anthropological / sociological knowledge, for instance, trainees are generally not taught to explore the limits of the profession they are entering—that is, they learn neither about the system's relationship with other social institutions, the critical interfaces between psychoanalysis and other intellectual disciplines, nor about the social roots and blind-spots of the psychodynamic model. What is generally not imparted, in other words, is any kind of social, critical or historical awareness of what trainees are participating in, how they are participating in it, and how the plight of the profession influences this participation.
This form of what we might call 'bounded learning' is not particular to the modern institute, but has a long legacy in the history of analytic training. In the early 1960s, for example, the anthropologist G. Gorer wrote an article that included the request that therapists formally supplement psychoanalytic education with anthropological / sociological knowledge:
A number of contemporary social scientists... have submitted themselves to the discipline of learning about psychoanalysis by systematic study and, often, by undergoing a personal analysis. But with very few exceptions... psychoanalysts have not shown parallel humility; they have not made any systematic study of the literature of contemporary social sciences; nor, despite the vicissitudes of their lives which have often entailed emigration, have they submitted themselves the systematic study of an unknown society, an experience which has many analogues with a personal analysis in the permanent change of focus which it produces. (Gorer 1962: 189)102
Philip Rieff, echoing this sentiment, noted that this institutional reluctance to 'step beyond the bounds' has led the trainings, as he argues,
[to] fail in their pedagogic function because they have no overall conception of what they are trying to do, nor a historical perspective on themselves. Psychoanalysis has developed a pseudo-interpretative attitude toward itself, which is the ultimate barrier to the acquisition of those critical competencies that could help a movement now almost wrecked by its own success.
(Rieff 1966: 104-5)
Rieff believed that these 'critical competencies' are only acquired if reflexivity in respect of one's discipline is developed, and if the methodological skills needed to test disciplinary claims are cultivated. Otto Kernberg, speaking in the 1990s, asks whether such critical competencies are encouraged in modern institutes. He answers in the negative, stating that the aim of psychotherapeutic education broadly remains the same:
[it] is not to help students to acquire what is known in order to develop new knowledge, but to acquire well-proven knowledge regarding psychoanalysis to avoid its dilution, distortion, deterioration and misuse. (Kernberg 1996: 1039)
Kernberg's comments support the idea that the transmission of standardised knowledge is of a very particular kind indeed, privileging vocational over academic socialisation, and favouring the instilling of dispositions that promote the conservation rather than the development of psychodynamic ideas.103 In the light of these observations it becomes difficult to agree with Michel Foucault that the psychoanalytic perspective results in 'a perpetual principle of dissatisfaction, of calling into question, of the human sciences in general' (quoted in Forrester 1994: 186). I would disagree because, in the institutes at least, the manner in which dynamic therapy is transmitted encourages no such 'perpetual dissatisfaction' in respect of its own epistemological status. In seminars the reflexive spirit whirls safely within tightly defined intellectual boundaries— that is, within a particular and accepted frame of reference (Valentine 1996: 179). Thus core psychoanalytic tenets (i.e. the unconscious, defence, resistance, transference, etc.) are taken as axiomatic, and what is doubted is only how they manifest in, or apply to, any given clinical case. In short, what seminars tend to advocate is a modernist confidence in (rather than a reflexive questioning of) the foundational tenets of psychoanalytic belief—this fact is perhaps what led Michael Rustin to characterise psychoanalysis as the 'last modernism', a fact leading Andrew Samuels (perhaps in defiance of the institutes) to call for an era of reform. In his The Plural Psyche he writes:
If our generation's job is not to be restricted to profes-sionalisation and institutionalisation, it is necessary to highlight one thing we can do that the founding parents and brilliant second-generation consolidators cannot. This is to be reflexive in relation to depth psychology, to focus on the psychology of psychology, a deliberate navel-gazing, a healthy narcissistic trip to fantastic reaches of our discipline; a post-modern psychological outlook, redolent with the assumption that psychology is not 'natural', but made by psychologists. (Samuels 1989: 216)
A Union of Interests
The fact that the majority of students are rarely critical of either the circumscription of the 'theoretical body' or the asymmetry in the relationships between leaders and trainees, suggests a union of interest between novice and practitioner, a shared interest observed in the words of the following trainee:
I have found my theoretical education invaluable. At present I am having seminars with a well-known Kleinian analyst who is very knowledgeable on transference... we are investigating with him counter-transference which to be honest has puzzled me until this recent series of seminars. Discovering the subtle ways patients can put into you disowned parts of themselves, has provided me with a whole new set of theoretical tools... I am beginning to see how easy it is to confuse what it is patients put into you with what is actually your own emotional stuff. As my training moves on I'm warming to the ideas more, coming to appreciate their sophistication... They can account for so much of human behaviour... [I ask: 'Have you become more convinced of the worth of these ideas since your training?']. I think so, the more aware of these things you become the clearer you see them happening in the consulting room. (Third Year Trainee 2004)
The comments of Peter, a thirty-one year-old male trainee, on two points at least reveal opinions shared by the majority of the students I befriended and interviewed. These are, firstly, that seminars, along with providing opportunity for new knowledge acquisition, endow the psychodynamic imagination acquired in personal therapy with conceptual dressing; and secondly, that these are sites where confidence in the psychodynamic paradigm is progressively developed.
In respect of the first point, as I argued in chapter three, it is commonly admitted that while students could imagine themselves in psychoanalytic terms before attending seminars, apart from possessing a rudimentary or 'popular' understanding of theory the majority of them remained unfamiliar with the deeper theoretical subtleties. I accounted for this by explaining that pre-training therapy is more an imaginative than didactic encounter and so does not provide occasion for deep theoretical learning.104
With respect to the second point (that seminars are sites where confidence in the psychoanalytic paradigm is progressively developed) in order to offer some insights into why this is so our first step is to notice that standardised knowledge is communicated linguistically, via texts and conversation; a fact asking us to consider the use of language in the teaching setting and how such usage facilitates the trainees' palpable movement into a speech community over the years of their training.
Language in the Seminar Setting
A pivotal part of seminar education is the requirement that trainees relate their own or their patients' experiences to the ideas being taught and discussed in seminars. For instance, each seminar usually includes a student presentation on a point of theory being taught that week. The presentation involves relating an abstract idea to an empirical instant—that is, the trainee will draw on their own work with patients, or, if still without a training case, on his or her own experience of therapy, to illustrate points of theory in action. This device is repeated in discussions of case studies, where again ideas are not abstractly considered divorced from empirical facts but are intimately related to the subjective phenomena that emerge in therapeutic sessions. For instance, the therapist's different emotional reactions to patients are linked with different species of 'counter-transference', and by these means trainees come to understand their interpersonal reactions in relation to these concepts. These methods are complemented by the advice given to trainees for whom the ideas discussed have had personal resonance—they are told to 'take their experiences to the couch'—the supposition being that the idea has stimulated a complex not yet 'worked through' by the affected trainee. One seminar leader sees being able to talk through the difficult personal material provoked in seminars as justification enough for personal therapy being a core component of training. She said:
In the classroom we obviously discuss things which promise to have a deep effect on the students. Because everything is related to the self I have seen this happen with my own students many times. You can actually see the cogs turning, the realisation: 'Oh what she is talking about goes on in me!' Because the classroom is not the appropriate place to talk about these experiences they need to take them somewhere else... especially if their experiences are uncomfortable. (Seminar Leader 2004)
By this constant attaching of human experience onto the pegs of dynamic understanding, a proficiency in the discipline's language is gradually reached—e.g. the difference between the linguistic competence of first and final year seminar students dramatically illustrates this point. Where first years are hesitant in their command of terminology, final year students wield jargon with accuracy and confidence that makes seminar conversations at this stage difficult to follow for the uninitiated. With this slow transition into a speech community, a kind of colonisation of subjectivity takes place: piece by piece subjective phenomena are imperceptibly linked to psychoanalytic precepts, till gradually these fragments are worked into a comprehensive, holistic, vision of the person. By this means experience is gradually caught in a web of concepts, the objectification of which forms a symbolic map which has emotional resonance so far as it is thought to capture the subjective workings of 'self' and 'other'. The psychodynamic imagination acquired in pre-training therapy now takes on conceptual dressing—so far as the self becomes wrapped in symbolic / conceptual meaning.105 The psychotherapist Fiona Gardner comments:
analytic thought, theory and reasoning emerge from our subjectivity... Analytical principles emerge from the theorising of subjective and specific experiences, and remain a sort of story telling... the theoretical story telling by others provides a knowledge base from where we can assess and integrate our own experiences. (Gardner 1995: 433)
The anthropological question must side-step the philosophical concern as to whether the psychodynamic/symbolic map depicts inner realities, and rather push on to consider that if it is accepted as doing so, what are the consequences for adherents. It is widely the case that therapists themselves ascribe high measures of truth to psychoanalytic ideas not least because their professional activities depend on their probability. The mastering of the idea thus holds significance beyond the reward of grasping it for its own sake, for inherent in it is a clue to the enigma of not only the troubled and suffering 'other', but the intricacies and perplexities of 'self'. For trainees, the moments of learning or 'apprehension' transpiring in seminars and in private study are thus less pedestrian events than occasions of often high emotional importance. Ideas successfully understood, embodied, and applied to self or other analysis, often arouse feelings of competence and personal worth, a sense of growing personal and professional mastery. Peter, again, said:
I really know that I have understood an idea when it has become relevant to my own life, when I can see my own problems through its lens... If I encounter something in my reading or my training that really hits me, I will take it to my therapist and discuss why I have had this reaction, why this idea has moved me... during my training I have become more proactive in my personal therapy often exploring themes in the light of the concepts I am learning. (Third Year Trainee 2004)
Asking another trainee what these concepts mean to her, she commented:
So much, because you see, they provide the bases for all the work that we do; I mean they are indispensable for making sense of what happens with patients. ['Do they provide the basis for understanding yourself?']
Well yes, because these ideas of course are not only useful for patients, but for us all, we are all patients, all suffering to varying degrees, so we can all benefit from knowledge that can help decrease that suffering.
(Third Year Trainee 2004)
An essential aspect of psychotherapeutic education is that it is based on this constant relating of precept to experience.106 Trainees become comfortable with the veracity of psychodynamic assertions not by testing the imparted ideas via the conducting or perusing of quantitative or qualitative investigations, but by making experiments of themselves, so to speak. In keeping with the aloof attitude most institutes maintain towards research-based practice, ideas largely win approval through a subjective 'self-testing'—namely, examining in therapy and private contemplation whether these ideas resonate with and make sense of private states. As Freud long ago admitted:
If there is no objective verification of psychoanalysis, and no possibility of demonstrating it, how can one learn psychoanalysis at all, and convince oneself of the truth of its assertions...There are a whole number of very common and generally familiar mental phenomena which, after a little instruction in technique, can be made the subject of analysis on oneself. In that way one acquires the desired sense of conviction of the reality of the processes described by analysis and the correctness of its views. (Freud 1975 [1917]: 44, italics added)
Relating experience to precept is the means by which the trainee not only becomes slowly proficient in the theoretical language of psychodynamics, but also increasingly convinced as to the 'correctness of [psychoanalytic] views'. Another fourth year trainee states:
Finding that there are words and concepts for your experience and that through these there is a way of making sense of oneself is empowering. For me these ideas are so compelling because they are about us [indicating to us both], they are intimately related to us...
['Do you trust these ideas?'] Now it would be a problem for my patients if I didn't; actually, I would even say that the word 'idea' is a bit of a misnomer, for me they are more like realities. (Fourth Year Trainee 2005, italics added)
Summarising Chapter Four
To tie now together the central points of this chapter, this style of learning that I have described as essentially affirmative is facilitated by the hierarchical relationship inhering between trainee and leader. A hierarchy legitimated by the idea of personhood, which holds that the fuller person embodies knowledge absent to (and thus secret from) the uninitiated. Moreover, by the judicious selection of seminar leaders and the circumscription of the curricula, tight boundaries are placed around the theoretical body; boundaries discouraging intellectual incursions that might overly challenge and thus promote doubt in the standardised canon. That seminar education thus takes place in an 'affirmative' rather than 'critical' educational atmosphere points—among other things—to community anxiety about the protection of tradition.
Chapter Five Deflecting Doubt, Maintaining Certainty
The 'affirmative' educational devices outlined in the last chapter are generally not regarded as such by the institutes in question—that is, what might be structurally apparent to the anthropologist might be, ironically, psychologically 'unconscious' to the individual member of the observed institute. This is to say that the trainees' slow progression over their training career into a speech community and into ever greater degrees of conviction as to the merit of the psychodynamic ideas, is often not seen by therapists as an outcome of a specific mode of professional socialisation, but rather as owing to the trainee's creditable progression into perceiving more deeply the 'heart of things'.
Where such progression is deemed to fall short, that is, where the trainee remains sceptical as to the veracity of psychoanalytic ideas, I shall here argue that this is invariably interpreted by the institute as something for which the trainee, rather than the paradigm or the educative process itself is responsible. In order to understand this shift of responsibility from system to self, we must first recognise that although seminar education is designed to promote confidence in the psychoanalytic imagination, this style of learning does not eradicate doubt, for doubt lives on in many trainees in one form or another. If this doubt is not adequately managed and judiciously directed, then it threatens to become a destructive force usurping the 'affirmative project'.
In the first part of this chapter I intend to explore how doubt is managed in the institute. I shall do this by describing strategies by which doubt is successfully deflected off the system (the ideas) onto other receptacles; strategies offering routes down which practitioners may channel misgivings away from the 'system' so as to protect it from censure. In the second part of this chapter I shall then illustrate through 3 case studies instances when these strategies are enacted—i.e. where trainees' doubt, being unsuccessfully deflected off the system, settles on the paradigm itself. In such instances trainees may 'dissent' from the orthodox position. I shall then show that the way in which institutes have historically dealt with such dissent, and how such dealings have shaped over time the whole structure of the therapeutic community.
STRATEGiES OF DOuBT MANAGEMENT
A now qualified and practising psychotherapist reflects on his training experience:
I was for many years being trained by R. D. Hinshel-wood in group psychotherapy. Several times a year we met with people who were being trained at the Institute of Group Analysis... One evening someone who was trained at the IGA said, rather bluntly, that the transference is to the group [i.e. the individual transfers onto the group unconscious material]. I disputed this and said that it was my experience that the transference is primarily to the therapist. It was soon clear that this was a matter of doctrine [held by members of the IGA], something I had not initially realised. When I did, I suggested that we discuss these differing points of view. This proved not to be possible. The anxiety level in the room shot up, and the meeting ended in disarray. Hinshelwood [the leader] took me aside afterwards and said that doing therapy was not like a philosophy seminar, it was more like learning surgery where 'mistakes' are—or are experienced as—life and death matters. It was not possible to stand back and reflect. I found this an important moment in my psychotherapeutic education. Having worked as a philosopher and historian for decades before training as a psychotherapist, I had not realised the urgency with which trainees cling to the 'one right way' and find it very difficult to hold ideas up to the light and ponder them. (Young 1996a: 124)
As I will explore in chapter eight, certain reasons why trainees are reluctant to doubt the 'one right way', here I shall show some of the ways in which this reluctance is institutionally supported. As I have argued, pre-training therapy largely ensures that those entering the institute are disposed favourably to the psychoanalytic project. When in the institute these trainees are then subject to educative devices that further affirm the veracity of psychoanalytic ideas by circumscribing the transmission of theoretical knowledge. This style of transmission has implications for how practitioners account for therapeutic failures, for if the ideas are indubitable who or what can be held responsible for unsuccessful treatment? The answer to this is again hinted at in the belief that it is only the fully developed or 'initiated' person who can wield and understand these ideas with mastery (see chapter four). Failures can thus be easily located in the shortcomings of the uninitiated—e.g. in the trainee's 'inexperience', or in the patient's holding to an unshakable 'resistance' or 'negative transference'.
To illustrate this point I asked ten trainees about how they accounted for therapeutic encounters that did not go as well as they had hoped. Out of the ten questioned at random only one admitted to sometimes doubting the applicability of a certain idea to a given case, while the remaining nine made comments such as: 'I would look to the relationship and ask what had occurred between us to sabotage our work'; and another: 'you can never entirely blame the patient, there is always something you could have done differently'; and further: 'some patients might not be ready for deep analysis, this should always be considered'; and finally: 'a therapist must always be ready to question what they have missed'. This is to say, none of the trainees asked held the ideas responsible for therapeutic 'failure'—the cause of failure was thus located in those subject to or those using these ideas.107
This manner of deflecting doubt from the 'system' to 'self' has its structural precedents. Evans-Pritchard (1937) called this phenomenon 'secondary elaboration' when he observed it in the Azande doctor's protection of the oracle's power: if its divining power was found wanting, the Doctor had many explanations at hand that could place responsibility for failure elsewhere—he could blame the Gods, the climate, or even himself, but never did he doubt the oracle's power. Hsu also observed something similar in Chinese medical practice where it was the word incorrectly pronounced (rather than the word itself) that could be seen as a source of therapeutic failure (Hsu 1999: 52). Likewise, in Luhrmann's study of contemporary witchcraft she found that 'Ritual didn't fail because you used the wrong invocation, but because you didn't use it properly' (Luhrmann 1989: 253). As with these other therapeutic systems, it is a latent belief in psychoanalysis that psychotherapy fails not because the ideas are wrong, but because they are either mistaken (by patients) or misapplied (by practitioners). Blaming users rather than the ideas themselves for lack of success, enables practitioners to preserve the veracity of the system in the face of therapeutic failure.
Doubt is deflected from the system in a second way. As I have tried previously to show, for many practitioners the genealogical structure is a kind of caste system which comprises institutes from the elite to the average to the below average. Robert Young (1996b), himself a psychotherapist critical of this stratification, cites some telling examples of how some of those in the higher reaches of the psychodynamic community (i.e. psychoanalysts and psychoanalytic therapists in the BPC) have in the past supported this hierarchical ordering. He cites one psychoanalyst at the UKCP's annual AGM as commenting 'that all people who were not in the BPC [i.e. UKCP psychotherapists] should be prohibited from calling themselves psychotherapists, because, as he put it, they were "charlatans"' (p. 5). He cites another meeting where there was a heated debate about whether psychoanalysts should have a veto against all decisions made in the UKCP. At a crucial moment a senior analyst stood up to exclaim that refusal to grant this would be like 'allowing the students to set their own exams'—a comment with which most agreed (p. 11). On another occasion at a British conference on the relationship between psychoanalysis and psychotherapy a collection of analysts speaking about their own tradition urged that psychoanalysis was the 'gold standard' while the therapists were 'alloys and baser metals' even 'copper' (p. 14). While these examples illustrate more overt declarations of caste beliefs, they highlight through magnification an attitude held more by some of the elite in respect of lesser trainings. I myself encountered this attitude, often in less obvious forms, on many occasions during fieldwork. When attending an induction day at the Institute for Psychoanalysis, for instance, on three occasions it was made clear to prospective candidates that their training was by far the most sophisticated, and had produced the best practitioners. As one trainer emphasised: 'there are a lot of psychotherapy trainings out there, but this is the most thorough, and of course the most respected' (London 2004).108
Hinshelwood, a psychotherapist, here comments on why this caste attitude is so prevalent in British psychotherapy, and as to why it so often includes contempt for 'lesser systems':
one of the most striking features of the profession [in Britain] is its fragmented state, in which rivalrous groups claim allegiance to different theoretical orientations, and protect themselves by arcane terminologies that restrict the possibility of interchange. Each group prises its own orientation above all others...
This intensely felt siege mentality of different groups seems to me a strong indicator of a collective defensiveness in action. It suggests to me that the mutually enhancing correctness of the members of any one group within itself displays the degree of insecurity (rather than denied insecurity) of the members. Insecurity is dealt with in this way by inculcating each other (and new recruits) into a system of mutual confirmation of the group's theoretical ideas...
This internal competitive culture is often very painful. But it is significantly relieved by identifying another group that holds to a "substandard" theoretical framework. Internal stability is thus bought by the projection of defeat and inadequacy into other groups. (Hinshelwood 1985a: 16)
Although Hinshelwood's words were written in 1985 the fragmentation he saw as fuelled by the insecurity community members feel within their own profession, is still very much a feature of the community today. A fragmentation compounded, if his thesis holds, by the growing struggle psychoanalytic therapy faces due to the rise of competing psychotherapies and its own growing marginalisation within the psychiatric profession—a struggle I highlighted in chapter one.
Robert Young (1996) has suggested that Hinshelwood's work recalls Mary Douglas' (1966) work on the anthropology of classific-atory systems. Douglas asserted that the evaluation of objects (whether material objects, persons or institutions) always takes place within a given cultural framework: e.g. whether a thing is deemed 'good' or 'bad' depends on whether it conforms to the given social order. Where it transgresses, contradicts, or straddles the bounds of the accepted order or 'system of classification'—that is, where its place in the established order is somehow 'unclear', through protection of this order it is dismissed as 'unclean' and once the object is rendered 'unclean' it is then seen as unfit for serious concern or consideration.
Applying Douglas' idea to the psychotherapeutic contexts would lead us to consider that the denigration of competing systems as 'lesser systems' might partly have its origins in the menace these 'systems' pose to those who depreciate them. By dismissing these threatening or contradictory systems as 'lesser', not only do these lesser systems become the receptacles of disowned doubt, but also any genuine claim to authority they might have is effectively dismissed. To doubt that system whose authority, if admitted, would render my own system weak, is to use doubt as a defending shield. If this application holds, the employment of such strategies of doubt management in the psychodynamic community reveals deeper concerns about the protection of tradition, and about the losses community members fear they would incur should communal boundaries be breeched.
Stories of Therapeutic Dissent
Having looked at two strategies of what I called doubt management operative in the psychoanalytic institute (i.e. 'secondary elaboration' and the 'disowning of doubt'), let me now try to ground this discussion by describing some occasions on which these strategies were enacted. The following three case studies illustrate instances where trainees' doubt, rather than being successfully deflected off the system, was directed towards either those administering the system or at moments (and especially in the first case) towards the system itself. This resulted in the trainee's active dissent from psychoanalytic leadership.
Before I turn to these cases, however, it is important to note that they illustrate what occurs when trainee doubt and opposition transcends a tolerated level. In other words, because different therapists have different degrees of tolerance with respect to trainee defiance, what has been handled in one way by these therapists and institutes might plausibly be handled very differently by others. This is to say, because in the cases that follow the toleration of trainee doubt and dissent might be deemed particularly low, even by other therapists, it stands to reason that other therapists might have managed these cases differently.
The following three case studies, then, are not trying to locate the point at which opposition becomes intolerable, for this as I have said will vary from therapist to therapist and from institute to institute. Rather they describe how opposition can be managed when it passes a tolerable point relative to the given practitioner or institute. I offer these case-studies in order to show that when opposition passes beyond this point, variously defined, it is invariably seen as dissent and institutionally managed.
A final caveat: to exact from these tales the facts most relevant to our present designs we must look beyond either the personal agendas of their authors or any sentiments they may arouse in ourselves, in order to focus on the task of revealing any structural concordances they might share. This is to say, what I believe to be most important about these vignettes resides behind their anecdotal interest in their deeper structural form.
Illustration One
This first case concerns a twenty-nine year-old trainee, John, whom I met at a series of open seminars conducted at one of London's premier psychotherapeutic departments. What alerted my attention to John were the kinds of critical questions he asked the panel of analysts leading the seminar and the earnestness with which he asked them. After befriending John I discovered some of the origins of his concern: A year before our meeting he had been accepted to train at a prestigious psychoanalytic institute, but since his pre-training analysis had been 'particularly negative' he had decided to put aside his training aspirations. The following events he recounted to me over a series of meetings which ran in tandem with our attendance at the seminars.
In John's early twenties he was in psychotherapy for two years. During this time he developed a keen interested in psychotherapeutic ideas. After this first and as he called it 'useful analysis', he spent many years working as a nurse in the NHS while researching for his PhD. He decided to enter training despite what he referred to as his 'growing healthy suspicion of certain psychotherapeutic claims', simply because his 'interest had never died'.
For the first weeks of his pre-training therapy things proceeded well. 'I played the role of the obliging patient and gave my therapist all the information he desired; I tried to be as honest as I could about my life and life-history despite not having any real need to speak about these things'. Nevertheless he spoke, for, as he said, 'I wanted to give the process a fair chance'.
He also mentioned that had his training institute not required him to attend therapy he would never have gone voluntarily, since he felt 'uncomfortable discussing my innermost at a time when I experienced no need to... I wasn't in crisis'.
After about the third month therapy started to deteriorate for the John. His sense of discomfort in the sessions grew—he felt out of step with his therapist and was reluctant to participate. He also felt that his therapist's interpretations were predictable; this constant referring to the transference, John said, was 'obvious and tiring'. John, it seemed, 'no longer wanted to play the game'.
This feeling went on for about a further six weeks until John finally decided to disclose to his therapist his doubts about whether he really wanted to train, and the fact that he felt contrived in sessions. His therapist's continued response was to interpret John's concerns psychoanalytically—e.g. the therapist detected in John a 'resistance' to the therapeutic process, and urged that they work together to find a solution to this. John again thought these responses were inappropriate for, as he put it, 'how could I accept his interpretations when my problem was that I doubted as true the theory which gave rise to them'. John said that at times he felt like a sceptic arguing with a believer, a sceptic who had all his arguments dismissed simply as 'devil's speak', that is to say, as 'rationalisations' or 'resistance'.
Because John couldn't accept his therapist's diagnosis and interpretations, and because the therapist was unwilling to diverge from his orthodox position, by the fifth month of therapy an inevitable stalemate was reached. This expressed itself in John's increased unwillingness to participate in the sessions. For example, regarding this period he said, 'I would arrive and simply sit there in complete silence, counting the minutes until the end of the session... for me', said John, 'this was an extremely painful protest'. Often the analyst would try to break this silence, sometimes with a little success. But as soon as the therapist had once again engaged John, he returned to what John called 'the analytical game'—a move to which John would again respond by retreating into silence. John felt that until his concerns were met and respected, this dynamic would perpetually remain. Such a pattern continued all the way to the end of analysis some one month later.
Let me close with John's summary of what he felt went wrong. 'I felt my therapist misunderstood my real concerns which were about my growing doubt regarding psychotherapy. This was a real issue for me because let's not forget I was about to start a full training... I had so many questions: was I suited for this profession? Did my growing scepticism indicate I had made the wrong choice? Did my questioning really point to real inadequacies with psychotherapy? These should have been seen as legitimate concerns rather than as excuses for my reluctance to participate.'109
Illustration Two
This next illustration is drawn from the psychotherapist Marguerite Valentine's published account of her own pre-training therapeutic experience, supplemented by personal correspondence with her.110 She said that writing her account was motivated by 'an experience of therapeutic failure, which left me with feelings of having been judged "pathological" or alternatively "unanalysable"'. What follows is derived from her published account:
I would now like to consider my own experience.
Both experiences of therapeutic failure were with Kleinians. When I began I had no idea what 'being a Kleinian' meant. I asked the therapist which school she followed. She replied, 'Kleinian'. No doubt being a Kleinian can mean different things. I therefore offer a particular perspective—that of the patient.
She told me firmly from the start that she 'worked with the couch'. I acquiesced with this as it seemed by her manner non-negotiable. It took some time before I began to have a sense of the kind of relationship which was slowly unfolding. Sometimes she kicked the couch as she crossed her legs. Over the months she developed a certain attitude. It was not analytic, more correctional. I was told, or rather corrected, for holding apparently distorted views and perceptions.
There was never any possibility of a dialogue. The atmosphere was punitive. Interpretations were delivered with great certainty.
She was not interested in what I call the 'real event'... The fact that I had a number of troubling and traumatic losses in my childhood seemed a matter of indifference to her. But she was interested in 'phantas-ies'—an interest seemingly in isolation from any relationship with the external world. She was highly attuned to spotting signs of idealization, grandiosity, envy, hate and competition. Once I told her how much I liked small babies. I was told categorically that I idealized them. When I developed a very painful abs-
cess on my gum and took time off to visit the dentist, I was told I was more in touch with bodily pain than with psychic pain. Furthermore, I was told I was 'teething'.
I eventually and suddenly left after an unpleasant row which she seemed to find exciting. She said triumphantly, 'At last' and at that point I became aware of her frustration with me because, as she had said, I did not 'project anything'.
After this experience, I set out to find a less dogmatic, more empathetic therapist. I was given the name of an Independent analyst. I had hoped an Independent would theoretically be open and have the quality of mind to be responsive and imaginative. 'Independent' seemed a misnomer. She practised as a Kleinian without identifying herself as such, but was 'classical' [Freudian, analytical] in terms of technique. I wanted to come three times a week. She insisted on five times because she said she was an analyst. Again there was no space for discussion. It felt as if I was there for her benefit—a feeling which became stronger, the longer I stayed.
This particular analyst specialised in 'wild analysis'.111 I often felt shocked by what she said, which felt grossly intuitive. Interpretations were delivered without reference to my thoughts, feelings or context. They made no sense. They were wild, and I found myself processing them hours later, often at night. As my insomnia increased, I eventually told her this. She said I was trying to control and blame her.
I began to question some statements but this seemed to incite her more. Interpretations were delivered as attacks. It was as if her authority and her view of the world were challenged. I was told that I was 'malign' and that I had to 'negate' everything she said. From my point of view, I felt I was fighting for my identity. Once, after struggling to make sense of a particular experience for which I felt a sense of achievement, she said 'I suppose you think you thought that, despite
me'. The atmosphere was invariably harsh, combative, and I dreaded each session.
The therapeutic framework was also not protected.
Her son once walked into the session. At other times he ran loudly up and down the stairs, slamming doors and dropping things on the floor upstairs above us.
She encouraged me to be angry. I thought a more appropriate response would be for her to protect the boundaries. It seemed another crazy situation whereby the external world, past and present, is discounted in favour of assumed phantasies and preoccupations about bodily functions and emissions. The fetishism of the 'here and now' only added to feelings of not being heard, of not being understood, and of not being seen for whom one was. Her theoretical beliefs, values and style dominated, and in this a retraumatization occurred.
Illustration Three
The final tale of woe is offered by Robert Young, who like Marguerite Valentine is now an established psychotherapist with a number of publications to his name. Here I quote him verbatim from his published account, which, unlike the first two accounts cited, which both dwelt on dissent in the therapeutic encounter, deals exclusively with dissent in the institute. Again, my analysis of this event is facilitated by my personal conversations with him:
Members of my cohort in a highly-regarded postgraduate psychotherapy training stood up to the powers that be [this is to say, as Robert told me, he complained about the students not being given sufficient say in whether the institute left the UKCP—a decision that would have greatly impacted on their professional status].112 We did this with respect to various matters about training standards and being treated as adults. Without any hint of difficulties before that day, we were told that a majority of us would have to train for longer than we had been led to expect and until
the doubts about our competence were resolved by further supervision... We remonstrated. We had been told that we were their best group ever. I had been given their prize the previous year. We were now being told that a certain supervisor whom we liked and admired was our severest critic. This was stunning. On the evening of the meeting when we had finally managed to get the senior teaching officer to meet with us to try to sort this matter out, someone suggested I phone and ask this allegedly severest critic what he had said. I did, and he replied that he had made criticisms but that if anyone was not being allowed to qualify on time because of anything he had said, he was being used as a scapegoat. When his supposed criticism of the group was repeated in the showdown meeting, I quoted what he had said to me not a half hour earlier. I was removed from the group. (I eventually came to the conclusion that his criticisms were, in part, bound up with his loyalty to the other most highly-regarded training organisation, in which he was an active teacher... )
The Chair... met with me and said that he guaranteed I would qualify if I would agree to leave the seminar and have supervision with someone new for three months until things cooled down. I went to think about it and spoke to the designated new supervisor, whom I came to regard as a benign probation officer. He said that I had not been told the whole truth: the likelihood was that I was going to qualify but not be made a member. This... move was inconsistent with the organisation's own publicity, which stated simply that completing the training led to membership. I was shocked by this deceit and made a bigger fuss, including strong backing from supervisors, who had also been grossly misquoted. The supervisor who took the strongest line (an eminent and very senior training analyst and former director of the Institute's clinic [the Institute of Psychoanalysis], who has since been made head of another prestigious psy-
chotherapy training) was dropped from the programme. Near the end of the probation period my parole officer said that they were in the wrong and that all would be well if I would only be forgiving for a few weeks longer... I kept my counsel; there was a vote in which the mendacious teaching officer tried her utmost to prevent my being made a member, but she was outvoted. In spite of these and a number of other matters where students felt unfairly treated, she remained in office for some time and was able to arrange things so that a like-minded person (and vehemently outspoken opponent of the UKCP) became her successor.113
Noticing Parallel Themes
The common thread running through these cases is the way in which dissent was managed by the analysts and subject leaders. In the first case, John felt that his concerns over entering a profession about which he harboured doubts were dismissed as 'resistances'—namely, as symptomatic expressions of unresolved conflicts. Thus John's concerns were interpreted as saying more about his 'inner world' than about the community he questioned. Likewise, in Marguerite's case her complaints were interpreted as due to 'negative transference': they were seen as issuing from her 'malign' intent, and her desire to 'negate' her therapist. Again, her protests were configured as 'symptoms', as admissions about her subjective reality. Finally, in the case of Robert, his standing up to the training institute was punished by extending the tenure of his instruction—a gesture implying that his defiance was linked to some unconscious hostility that only further training and analysis could fix.
Whether the authorities in each of these cases were right to view these protests as issuing from personal problems is of course a matter to be argued. However, as I shall later suggest, since such management of dissent can elsewhere be identified in the profession, and since some of the most eminent therapists have at one point or another been branded as 'dissenters' only to be later embraced (just as Robert's punishment was later repealed after his spirited protest)—it remains a familiar occurrence that protests are cast as symptoms of personal problems. This is to say, in all three instances it is feasible to suggest that the causes of dissent were pathologised, and thus viewed as motivations from which the individuals in question needed to be released: if smooth progression into the psychoanalytic community was to succeed, Marguerite needed to be freed of her 'malignity', John of his 'resistance', and Robert of his insurgence. Thus in each case we witness the device of 'secondary elaboration' being employed; a device placing failure on 'self' rather than 'system'.
A further point of interest is that the devices used to manage dissent in the therapeutic encounter (e.g. between therapist and patient) were also applied to manage dissent in the institute (i.e. between trainee and committee). In other words, the same device was applied in both contexts with equal efficacy. This permeation of the therapeutic ethos into the institutional setting, a phenomenon already noticed in how ideas of personhood support status imbalances between trainees and seniors in the institutes, further reinforces the idea that trainees are in some sense still 'unfinished', and are thus to be equated more with a patient than with a therapist. While on the one hand this equation follows naturally from psychoanalytic beliefs (outlined in chapters two and three), on the other hand, as we have seen, it renders trainees open to the infan-talisation and disenfranchisement that abuse of this equation can bring.
In respect of this equation on many occasions I witnessed trainees being treated as patients when outside of the therapeutic encounter: e.g. students arriving late at seminars were asked to consider their motivations for being late, as if lateness was an attempt to break the 'frame' and communicate latent hostility. (This grafting of the therapeutic 'frame' onto the seminar space, renders the patient / trainee hierarchy operative in the trainee / leader encounter.) On another occasion at a training conference that was running twenty minutes late, a senior analyst who was invited to give a seminal paper stopped short twenty minutes before the end of her talk and said that 'the session must always begin and end on time'—which meant the audience were treated as patients.114 And again, once when trainees complained that the institute had not sufficiently forewarned them that certain key courses would be dropped, it was stated that trainees were obviously not feeling 'adequately held' and that reality sometimes did not conform to expectations.
Applying techniques devised for the therapeutic encounter to the management of trainees in the institutional setting suggests that the internalisation of therapeutic 'dispositions', a process 'completed' in the senior members of the institute, penetrates into the very core of subjectivity and self-identity. In the terminology of Habermas (Eliot 1992: 105), we might say that such dispositions forge an 'inner colonisation' so far as the therapeutic imagination does not confine itself to assessing patients, but to the assessment of extra-therapeutic domains—self, institute, and society.
Dissident Responses to Pathologisation
If there are commonalities between how dissent was managed in all three case studies, it is important to note that the dissenters themselves responded to what they felt as the 'pathologisation of their protests' in quite different ways: while John experienced the same treatment to which both Marguerite and Robert were subject, unlike them he elected to discontinue training, or, as he phrased it to me, 'to shelve his desire to become a therapist'. John's protest, then, ended at the point of his leaving therapy and thus never reached wider public attention. For both Marguerite and Robert, alternatively, their defiance did not stop with their aforementioned protests. Rather both completed their training, received accreditation, and then proceeded to legitimate their original protests by publishing their stories.115
The different ways in which John on the one hand, and Marguerite and Robert on the other responded to the 'powers that be' could be formalised in a working distinction between 'resigned' and 'active' dissent. Resigned dissent is that which offers no further resistance after the initial act of protest or defection. This species of dissent is seen in John's response which fell silent after he left his therapist. Active dissent alternatively does not abate after the first insurgent act, but rather extends out over time and space: old grievances are acted upon at a future point, often being drawn into the public domain for debate and discussion. This active dissent was performed by Robert and Marguerite, both of whom later published their troubled accounts. We could add to these forms of 'active' and 'resigned' dissent the strategic dissent mentioned in the last chapter (i.e. dissent that expresses itself in safe ways—largely in liminal spaces, and thus does not directly challenge authorities). To put these forms of dissent in a scale of strength—strategic dissent is the weakest form; resigned is a stronger form, while active the strongest form.
While I know of few precedents in psychotherapeutic literature illustrating instances of resigned dissent (by definition this stands to reason), the history of psychotherapy is replete with instances of 'active dissent' to the degree that one could argue that it exists as a defining feature of the therapeutic community. To look at the historical record for confirmation of this assertion, not only did active dissent play an integral role in the inception of psychoanalysis, but it has continued to feature as a common happening throughout the entire course of its institutional development.116 To start with Freud's original circle of psychoanalysts, from this initial group the active defections were plentiful: Wilhelm Stekel resigned owing to his doctrinal differences with Freud in 1911. While later in the same year for the same reasons Alfred Adler handed back his membership taking with him Bach, Maday, Baron, and Hye. Shortly after this, the dissension having the deepest personal impact upon Freud occurred when Carl Jung resigned from the International Psychoanalytical Society in 1914, again for reasons of doctrinal discord (Jones 1955: 143-171). Subsequent therapists who suffered either momentary ostracism or outright expulsion from the IPA because their views diverged from the orthodox line, include such influential therapists as: Karen Horney, Erich Fromm, Franc Alexander, John Bowlby, W.R.D. Fairbairn, Heinz Kohut, Jacques Lacan, Harry Guntrip, Wilhelm Reich, and Harry Stack Sullivan—all individuals, we might profitably observe, evidently preferring the 'prophetic' to the 'priestly' role.
That many of these individuals managed to institutionalise their defections is also clear: Alfred Adler instituted his dissent by founding the Society of Free Analysis in 1911. Carl Jung's dissent was instituted in a series of schools spread internationally; the British counterpart being the Society of Analytical Psychology established in 1946. Karen Horney, after being stripped of the training analyst status by the IPA in 1941, founded the Association for the
Advancement of Psychoanalysis (AAP) for the dissemination of her ideas.117 Erich Fromm and Harry Stack Sullivan institutionalised their dissent in the William Alanson White Institute in 1943. Lacan's doctrinal differences found residence in the Societe Fran-caise de Psychanalyse in 1952 in Paris.118 Melaine Klein, after the 'controversial discussions' in London in the early 1940s, found a home for her vision in the Tavistock Clinic (colloquially known as the 'Klein Shrine'), before being reintegrated into the Psychoanalytic Institute's training after the 'Gentleman's agreement' in 1946.
Post-war dissensions have been just as numerous, if not more dramatic, resulting in the opening of entirely new schools of psychotherapy which reject psychoanalytic foundations—this largely accounts for the birth of many non-psychodynamic psychotherapies. Of one time psychoanalysts and psychiatrists who have founded such schools we can think of R. D. Laing and his championing of 'Existential therapy'; of Friz Perl's and his 'Gestalt psychotherapy'; of Eric Berne and his 'transactional analysis'; and of Rollo May and his 'humanist psychotherapy'—to name some of the more well-known dissenters from whom have sprung new 'schools' and training institutions.
The fact that these dissenters have often been subject to the same ad hominem dismissals as were levelled against Marguerite, Robert, and John suggests that the employment of devices that cast 'protests and symptoms' is no infrequent occurrence. Ernest Jones (1955), for instance, the first and longest President of the British Psychoanalytic Society as well as long-time apologist and friend of Freud, used these devices to explain away the many defections afflicting the early psychoanalytic community. In his seminal biography of Freud's life there is a whole chapter dedicated to the description of the early dissensions. It is useful for my current argument to explore for a moment its main assertions.
He begins his chapter by noting the widely accepted fact that real personal understanding emerges only once the patient's 'resistances' have been removed. 'When the resistances have been overcome', says Jones, 'the subject [patient] has insight into aspects of his personality to which he had previously been blind' (Jones 1955: 142). However, and as Jones then makes clear, because the forces of the mind are dynamic and are thus prone to shift unexpectedly 'it may come about that the insight first gained is not necessarily permanent and may once more be lost... this is equally true for the analyst as for the patient' (p 142). He then proceeds to say that only Freud himself has been able to achieve 'the difficult feat of making a very extensive self-analysis' (p.143), which presumably meant that Freud's insight was the more deeper and permanent. When speaking of the other analysts, on the other hand, he complains that 'none of the other pioneers had had much personal experience of their own unconscious or only in glimpses' (p. 143), a statement which implies that Jones felt their insight to be less permanent. Jones felt the proneness of early therapists to 'relapse' into non-clarity had many unpalatable consequences:
When an analyst loses insight he had previously had, the recurring wave of resistance that has caused the loss is apt to display itself in the form of pseudo-scientific explanations of the data before him, and this is then dignified with the name of a 'new theory'. Since the source of this is on an unconscious level, it follows that controversy on a purely conscious scientific level is fore-doomed to failure. (p. 142)
Thus Jones hints that the origins of rival psychotherapeutic theories are caused by 'losses of insight', the cause of which the dissenters were unaware since these causes were still unconscious. They were 'unconscious' because these dissenters, unlike Freud, had not 'much experience of their own unconscious'. Jones' comments crescendo in the following passage:
Those of us who, like myself, remained close to Freud while openly disagreeing with many of his conclusions have been described as timid and docile people who have submitted to the authority of the great Father. It is, however, possible that they should be better described as men who had come to terms with their childhood complexes and so could work in harmony with both an older and younger generation, whereas the dissidents may include those who still feel obliged to perpetuate the rebelliousness of childhood and to keep
searching for figures to rebel against. (p. 144, italics added)
It is plain that Jones in these passages is working to dismiss early dissensions as symptoms of unresolved conflicts existing in the detractors. By this means he exempts Freud and the IPA from responsibility for these schisms and places it on those still led by their 'childhood complexes'.119 The implication is that if these detractors possessed a clearer vision or greater 'personhood' by means of a 'deeper analysis', they would have realised their own folly, and, like Jones, put aside their suspicions and remained in the fold. Thus again we witness here a clear example of 'secondary elaboration' being performed.
It must be remembered that Ernest Jones was the outright leader of British psychoanalysis throughout the first half of the twentieth century; he had supreme power in overseeing how training in the Institute of Psychoanalysis was conducted. And since other psychodynamic institutes followed the example of the British Institute it is plausible that his influence went further. He decided on the curriculum, on who would deliver it, on the trainees who would receive it, and on those who would comprise the training committee and supervisory elite. Jones' power would never have been so extensive had his leadership not received full approval from the IPA, led by Freud himself. This suggests that the attitude Jones' took towards dissidents, rather than communicating a personal proclivity, was representative of orthodox position held by the centre of power in Berlin and Vienna—that is, he spoke as a true priest, not for himself but for his community.
This historical evidence of psychotherapeutic schism illustrates that there is nothing untypical about Marguerite's and Robert's active dissent, nor about the way in which it was managed by the institute. These cases only differ from the historical examples in that their consequences were more modest. Thus these cases have their structural precedents; precedents that inform us as to why the community is in a fractured state today.
While many dissenters, breaking with the orthodoxy, founded schools that often became mirror-images of the bounded orthodoxy which they opposed, other dissenters, once heretical, have been reintegrated back into psychodynamic mainstream. This process of integration is clearly seen where, for instance, Kleinian and Object Relations thinkers such as John Bowlby have been welcomed back onto the curriculum at the Institute of Psychoanalysis. It is also clear where certain psychodynamic trainings in addition to offering seminars on Lacan and Jung, have integrated into their structures different training 'streams'—e.g. within the BAP institute one can train as either a Freudian or Jungian.120 In this sense contained in heresy reside the seeds of integration.
This pressure to re-integrate once disowned movements has been helped not only by the fear of increasing community fragmentation, but also by the growing sense that long-time psychoanalytic foes must pull together in the face of an ever-growing threat—namely, the growth of non-psychodynamics psychotherapies, and the expansion of pharmacologically-based psychiatry. Schools are thus increasingly finding themselves uniting with movements whom in the past they would have opposed. Jungians, for instance, while arguing for their own school against classical psychoanalysis, when confronting non-dynamic treatments such as CBT or pharmacologically-based psychiatry, might unite with psychoanalysts to serve the broader analytic cause. This segmentary behaviour, as I mentioned in chapter one, has been helped by the foundation of the BPC: an umbrella organisation beneath whose professional canopy once divided psychodynamic units now work together for the one psychodynamic cause.
Summarising Chapters Four and Five
I have attempted to show how dissent, once transcending a tolerable level, can be managed by the powers that be—i.e. via methods of 'secondary elaboration' and the 'disowning of doubt'. I have also shown that the use of what I have termed doubt management is not confined to the consulting room, but rather can extend out into the training institute by being applied to the management of trainee doubt. Furthermore, as these devices are used to protect communal boundaries and beliefs, one upshot is that dissident schools emerge; schools which today are increasingly ordering themselves in segmentary fashion for strategic ends. From these observations we could claim that there is a strong causal relationship between how doubt is managed in the clinical setting and how the wider community has become structurally ordered. This pivots on the observation that the psychotherapeutic imagination into which trainees are professionally socialised is rarely confined to the therapeutic encounter itself, but comes to order and direct how individuals relate to each other within the institute.
Chapter Six Clinical Supervision
In the two previous chapters I described the 'affirmative' atmosphere in which the inculcation of conservative therapeutic dispositions takes place. By the circumscription of the theoretical body, by the appeal to shared concepts of personhood which legitimate role asymmetries, and by the devices of secondary elaboration, and the successful management of doubt, trainees are institutionally coaxed into embodying a professional habitus which builds upon the foundational dispositions of 'partiality' and 'imagining psychodynamically', discussed in chapters two and three. In offering these comments I have argued that instances of dissent, no matter how infrequent, always presuppose a greater force against which the mutiny is levelled—in this case, an institutional consensus born from a kind of 'social contract' of conformity, peer-fellowship, and a union of aims between novice practitioners and the initiated. I have further argued that such consensus is buttressed by the devices and preferences of psychoanalytic socialisation which finds it difficult to tolerate individual transgressions of institutional boundaries and valued beliefs.
While in the next chapter I intend to further highlight the institutional factors by which this consensual or 'affirmative' atmosphere is nurtured, in this chapter I have two central aims to first achieve: to illuminate the psychoanalytic understanding of aetiology, and to provide an insight into the next stage of training— clinical supervision.
As to why I select the topic of aetiology for especial attention this follows from the dominant place aetiological concepts assume in the therapeutic craft. The psychoanalytic understanding of causality constitutes a kind of omega point around which the whole practice of therapy—I believe—revolves, as all therapeutic action is predicated upon key assumptions about causes of distress. I believe by assessing how therapists' assumptions are subtly affirmed in clinical supervision, we will come to learn how a central disposition guiding the therapist's craft is inculcated.
The Origins of the Psychodynamic Understanding of Aetiology
Before setting down our case study of clinical supervision, let me first introduce the psychoanalytic conception of causation; this discussion will complement the case study of clinical action soon to follow.
Following the historical methodology of Collingwood (2002 [1940]), Evans-Pritchard (1961) and more recently Mark Hobart (2000), if we wish to expose the foundations of psychoanalytic ideas of causation then it would be useful to explore certain sociocultural influences bearing upon the movement's founding father. Thus we must first ask whether Freud's attitudes, values, and presuppositions were all things upon which the social circumstances of his day left their mark. In order to consider this question more closely let us first try to gain an impression of the surrounding so-cio-cultural atmosphere of the European intellectual classes in the decades before the First World War—the period during which Freud advanced most of his foundational ideas.
In Central Europe peace had largely reigned since 1871, and the middle classes were increasingly benefiting from developments in industry, trade and science; developments which were securing their social, political and moral hegemony. Universal suffrage and education were being widely instituted, promising an end to the disenfranchisement and inequality of the early nineteenth century; and from these developments (it was thought) would inevitably spring an improved situation for the underprivileged classes. Thus, despite the global inequalities which deeply marred international economic and political relations, a global inequity which appeared remote and abstract to most middle-class Europeans, the fruits of various political, ecclesiastical and economic reforms back home had put many in the middle classes into a state of considerable optimism (Fromm 1974). The era of irrational authority and social injustice was thought in abeyance, being replaced by the rule of law, democracy and the steady march of enlightenment values. In this atmosphere of general hopefulness a political and ideological positivism was taking firm root, consistent as it was with the social experience of the European middle classes.
The fact that Freud himself was a child of such enlightenment optimism I shall argue stands out in his personality. As is illustrated by many close studies of his life, Freud was a conventional man of his day; a man representative of middle-class Vienna who largely accepted the central mores of the society in which he lived.121 While at face value this representation of Freud's relationship to his social world seems inconsistent with the popular view that Freud was highly at variance with social convention, if we probe deeper we notice that Freud, apart from opposing a strong social taboo on sex, accepted most of his society's dominant values uncritically. We can infer this acquiescence from both his practice and his writing. His positivism and objectivism, his views on the patriarchal family, his dichotomising of the rational/ irrational and championing of the former, and his acceptance of the economic values of the middle classes, are all attitudes that betray themselves in his writing and way of life.122
An important consideration that these reflections raise is whether Freud's general outlook coloured how he understood the causation of suffering. This is to say, so far as Freud regarded the society from which his patients largely came as healthy (modern bourgeois Vienna), was he therefore more prone to locate the causes of personal distress in his patients' psychology rather than in the society of which he generally approved? An interesting entree into this question is to recall the reasons why Freud abandoned his theory of childhood 'seduction' (which implied a corrupt social world); replacing it with his theory on childhood 'phantasy' (one shifting the cause of distress to the realm within).
As is well known, Freud originally traced the aetiology of hysteria to actual traumatic events in childhood, usually to the child's seduction by an adult. This was often seduction of a daughter by a father, as is illustrated in the case of Katharina in his Studies of
Hysteria (1977 [1905]). It was believed that if patients could recall cathartically the original abuse then the repression and the symptom would automatically lift. Freud's use of his seduction theory lasted until around 1900 (his letter to Fliess in 1897 heralding its end), at which point he slowly embarked upon a radical reformulation of his aetiological vision. This finally led to the new conclusion, as he tells us,
...that the neurotic symptoms were not related directly to actual events but to wishful phantasies, and that as far as the neurosis was concerned psychical reality was of more importance than material reality. (Freud 1977: 34)123
In other words, the stories of trauma which his patients confessed were now not to be interpreted as descriptions of real events, as had earlier been the case, but as fantasies motivated by their childhood libidinal desires. The various disclosures of his female patients were therefore not to be read as genuine recollections, but as fabricated actions and stories. And while this did not diminish the importance of these memories, it did alter their mean-ing—for now they spoke of psychic, not social, happenings.
The question of why Freud abandoned his seduction theory has been the subject of much controversy, but as this debate is only tangential to my current concerns, let me treat it only briefly here. Certain scholars such as Jeffery Masson argued that Freud's revision ignored the considerable clinical evidence, even material from Freud's own patients, that the abuse he repudiated as fantasy was actual and real (Masson 1984: 27). Indeed Masson's claims seem to be supported not only by a thorough reading of the Fliess-Freud letters, edited by Masson (1989 [1985]) himself, but also more widely by later psychiatrists and social researchers who have subsequently revealed that childhood sexual abuse was far more prevalent than Freud supposed.124
Masson explains Freud's abandonment of the seduction theory as owing to his reluctance to further outrage the psychiatric community with his findings. And although this explanation may in some measure account for his revision, it seems improbable that it explains it entirely. For in the first place, it appears highly inconsistent with Freud's well-known disregard of conventional psychiatric explanations as well as with his evident nonchalance, often in spite of himself, concerning aggravating the psychiatric community. But more importantly it overlooks Freud's considerable social conservatism which could only have been threatened by what his own seduction theory implied: as ever more patients came to him with hysterical symptoms he was forced to conclude that not only was childhood sexual abuse disturbingly common, but that it regularly occurred in the most 'respectable' sectors of society. Even his own father seemed potentially guilty since Freud noticed hysterical symptoms in both his own brother and sister (Storr 1989: 18). In fact, in a letter to Wilhelm Fliess dated September 21st 1897, Freud clearly admitted that as hysteria was so common it could not possibly be caused by childhood abuse, since, as he says, 'surely such widespread perversions against children are not very probable' (Freud 1989: 264). Thus with the growing numbers of patients came his growing disbelief and doubt, which, rather than settling on the upright world of Vienna, settled on his own theoretical con-struct—the seduction theory that he consequently abandoned. In other words, the consequences of his seduction theory being correct were too much at variance with his social conservatism, which, apart from opposing the rigid sexual mores of the day, supported the paternal social structure which he saw as integral to civilised life.125
However we decide to interpret his discarding of the seduction theory, what is most important to note for our current argument it is that after its abandonment Freud would habitually assume that what were reported by patients as real events were actually products of phantasy—phantasies that pointed to the existence of a childhood sexual life (hence the birth of his psycho-sexual stages of development). In fact this shift in orientation was perfectly consistent with another tendency that was clearly pronounced in his early case studies—namely, Freud's need to help patients return to conformity with their social surroundings, rather than empower them to criticise or alter the potentially damaging social circumstances to which they were subject. In this sense Freud advocated adjustment to, rather than reform of, the social world in which his patients found themselves.
If we accept that Freud's attitude to the dominant mores of the day influenced his concept of aetiology, then allow me now to illustrate how by implication this orientation influenced all subsequent developments within the field of mainstream psychoanalytic psychotherapy in Britain—setting in train a discourse psycho-centric in orientation; one that cast suffering in ever more psychological terms, and one diametrically opposed to the more social vision of human suffering prevalent in much social science today.
Developments in the Psychodynamic Understanding of Aetiology
To acknowledge how Freud's psycho-centric orientation influenced later theoretical developments, we must start by discussing the distinction between 'analytical' and 'interpersonal' or 'object-rela-tions' orientations in British psychoanalytic psychotherapy. At the outset of psychoanalysis Freud's therapy was highly 'analytic', with the 'interpersonal' or 'object relations' orientation only emerging in the latter half of the twentieth century. While this new 'interpersonal' approach never constituted an overthrow of the analytic stance (it kept as axiomatic basic analytical ideas), for many analysts it gradually replaced the 'need for pleasure' as the dominant human drive, with the 'need for healthy relationship'. For those who accepted this change not only was the analytic understanding of transference and counter-transference altered, but so too was the analytic understanding of aetiology.
The key difference with the new interpersonal or object relations approach was that it particularly emphasised, as Freud did not, the child's attachment to its primary caregiver. Therapists such as Fairbairn, Winnicott, Bowlby, Klein and Balint, all unequivocally saw the origins of much pathology as arising from various kinds of loss of intimacy children had suffered with their parents—espe-cially with their mother. A special interest was therefore taken in the mother/child relationship, as its disruption was believed to damage the child's potential for maturation. Thus for the new ob-ject-relations theorists neurosis did not only spring from the repression of disturbing fantasies, but from real deprivations, from real events.
With these changes object relations analysts returned to an earlier vision of aetiology that Freud had largely abandoned along with his theory of seduction: they reinstalled a respect for real rather than imagined events as causes. But instead of seeing the traumatic events as 'sexual abuses', they also saw them as 'relational deprivations' occurring within the first few months and years of the child's life: if the child was denied sufficient 'mothering' or 'mirroring' it would develop a maimed sense of self. This could engender psychological complications in adulthood from 'schizoid' or 'narcissistic' personality traits, to obsessive/compulsive or phobic disorders, etc.
Common Aetiological Themes
While both object-relations and Freudian orientations debated how far the causes of suffering were real or imagined, both still unequivocally agreed that early childhood was the key phase of human biography. One subsequent result of this has been that both orientations have instinctively learnt largely to favour early rather than present events in their explanations of current suffering. Current troubles are seen as inevitable given the childhood history of the person in question. The present malady has its roots in a personality that was structured in childhood.
Many commentators have argued that this vision has led on occasion to a form of reductionism which has not helped psychoanalysis in the political domain. Andrew Samuels, for instance, has argued that this reductionism has been partly responsible for why government policy makers have largely ignored the insights of therapists:
In asking the world why it didn't turn up for the first session, we need to acknowledge the seemingly incurable psychotherapeutic reductionism and triumphalism that parallels that of the media. Psychotherapists write articles for newspapers about the phallic symbolism of cruise missiles going down ventilator shafts in Baghdad or they call Mrs Thatcher a restorative container for British greed... What is the point of this? Maybe the world was right not to turn up. (Samuels 2000: 8)