Legal, Ethical, and Professional Issues in Psychoanalysis and Psychotherapy
On Psychoanalytic Education, National Standards,
and Mandatory Continuing Education
Patrick B. Kavanaugh, Ph.D.
In his essay, “Free Association: A Technical Principle or a Model for Psychoanalytic Education?” Michael Guy Thompson, current president of the International Federation for Psychoanalytic Education, speaks to Free Association as a model for psychoanalytic education (Psychologist-Psychoanalyst, Spring 2000, Vol. XX, No. 2). The following invited comments were written in response to his essay.
How we understand psychoanalysis is inseparable from the image of the analyst around which our pedagogical philosophies, models, and institutional forms of training are organized; pedagogical strategies are aimed at forming the Identity, Purpose, and Ethics of a psychoanalyst. As a radical pedagogical strategy, Free Association provides much more than simply an alternative to the academic model of psychoanalytic education. In my reading, it speaks to the formation of a psychoanalyst as a philosopher-historian-artist who functions with a very different Purpose and system of Ethics than does, for example, a mental health professional. The conceptual foundations underlying Free Association are situated in philosophy (phenomenology) and the humanities (an historical mode of thinking). And its understanding of educational processes is situated in the arts (the mentorship model of the art academy). As a model for psychoanalytic education, Free Association derives from a view of psychoanalysis “as inherently philosophical,” with “the cultivation of naivete” as an educational objective; and, as taking place in a milieu constituted by “an ‘association’ of equals devoted to the ‘free’ dissemination of ideas.”
Perhaps most radical in this pedagogical strategy is the underlying view of people as responsible agents who are self-directed, self-motivated, and more or less self-selecting into the training program. Each person is the responsible author of her or his professional life so that the individual makes decisions, for example, as to whom they might wish to see for analysis, when the analysis is ended, and when certification of self-as-analyst is warranted, the time-worn arguments of protecting the public notwithstanding. This authority to authorize self-as-analyst is tied directly to the question of the end of analysis, which can only be answered, in the final analysis, by the person her- or himself. The authority to translate unconscious experiences, processes, and dynamics of the other derives from one’s own experiences in and of analysis. Much can be learned in the praxis of the analytic discourse; very little, however, can be taught.
As an educational model, Free Association moves far beyond the narrowed definitional concept and meaning of free association as the fundamental rule of psychoanalysis; it speaks to the larger question of freedom and the foundational and implicit meanings of an individual’s political, social, and personal freedoms. Free Association permits, if not encourages, a venturing into the most dangerous and personal of questions: the Why of the What Is. Its seminars, for example, encourage the freedom to question the assumptions of our received knowledges, values, and pieties; the structures of our traditional social institutions; and, the constituted experience(s) of our culture, the individual and, in the analytic discourse, of ourselves as analysts and analysands. In many respects, Free Association as an educational model embraces an Ethic of Free Association in which the locus of responsibility for one’s being—and, in this instance, learning and education--resides with the subject (Kavanaugh, 1999).
In his essay, Dr. Thompson mentions that “psychoanalytic education should mirror the experience of psychoanalytic therapy, yet the analytic training experience is, in virtually every case that I know, a fundamentally different animal from the experience of psychoanalysis itself.” Indeed, it is around this very issue that a longstanding history of discontent in the analytic community has developed: the inability of our institutions to match psychoanalytic theory with its institutional forms of training (Safouan, 2000). This hidden history of discontent seems to me to be intrinsically related to the academic model of education; more specifically, its institutional structure (vertically arranged, hierarchically organized), ideological context (medicine-illness), philosophic assumptions (science-evolutionary biology), and--in this country, at least--the image of the analyst around which education is organized (a mental health professional). Further, these aspects of the academic model join together to speak an institutional discourse premised on a nineteenth century world view of people, life, and psychoanalysis. And this world view continues to dominate the conceptual foundations of our discipline, the structure of our educational institutions, and our philosophy and model of education.
As a discipline, psychoanalysis rests on conceptual foundations having their genesis in biology, their development in medicine, and their validation from the methods and assumptions of the natural sciences. As a science of mind, positivist notions of history, knowledge and truth provide the largely unquestioned assumptions for our mainstream psychologies of psychoanalysis. In this world view, psychoanalytic knowledge became scientific, objective, bounded, context-free, and cumulative. It could be recorded in books and taught in classrooms as discovered rational knowledge about the causes producing the symptoms of human being; core bodies of knowledges could be discovered, taught and mastered. And as one of the natural sciences, classical psychoanalytic theory had the tendency to order the human universe in a developmental hierarchy. Its theories, techniques of practice, and institutional model for education were grounded in the presumed natural hierarchies of the real world (Strenger, 1998). And, such grounding continues to legitimize our existing power structures and normative conceptions of people and behaviors as we enter the twenty-first century.
As a science of mind rooted in the “isms” of late-nineteenth century Germany (a culture of positivism, a militant rationalism, and a deified scientism), this same world view served to legitimize the compulsory nature of psychoanalytic training. In the winter of 1923-24, for example, the training committee of the Berlin Society imposed regulations and standards on the learning activities and experiences of the candidates (Safouan, 2000). In so doing, psychoanalysis became institutionalized and psychoanalytic education became subject to a technocratic rationality in which the institutional wisdom, oversight and discourse replaced everything in the realm of the candidate’s individual and personal choice. A triumph of triangulation prevailed (analyst-institute-analysand). And the logic and language of a technocratic rationality framed the focus of the debate about differences in thinking about education and training during the past century (two, three, or four times per week?).
The introduction of uniform and quantifiable standards for education and training in 1923-24 brought with it whispers of discontent with the academic model of education, a discontent centering on the question of the training analysis and its inherently contradictory cross-purposes and objectives. Is the training analysis the medium through which one teaches psychoanalytic theory and technique and, also, cures the infantile neurosis? And given the institutional context and discourse, how free are one’s associations when they might clash with the institutional duties, ethical responsibilities, or theoretical beliefs and realities of the training analyst? These and other such questions speak to something about the longstanding history of discontent with the academic model of education.
Dr. Thompson’s essay and others like it move far beyond simply representing an interesting point of view awaiting “academic discussion and debate,” particularly when we consider the recent preoccupations of organized psychoanalysis with developing national standards for psychoanalytic education and training. To the question, What is psychoanalysis? has come the definitive and unequivocal reply from organized psychoanalysis: Psychoanalysis is a healthcare profession, or a specialty thereof. Situated in a health-care matrix, the pedagogical principles, philosophical assumptions, and political objectives of organized psychoanalysis have led to the recent development of national health-care accreditation standards for psychoanalytic education and training (outcome-based education) in preparation for receiving a government-issued license to practice psychoanalysis…. A government-issued license to practice psychoanalysis?!?... Premised on positivist notions of history, knowledge and truth, mandatory continuing education walks hand in hand with such licensure.
Such political objectives perpetuate the illusion of a fictive unity in the analytic community’s response to the question, What is psychoanalysis? And in its response to a second and closely related question, What is a psychoanalyst? Through its institutionalized power relations in the larger community, organized psychoanalysis increasingly answers this second question by representing the Identity, Purpose, and Ethics of the analyst as exclusively those of a mental health professional who has graduated from an accredited institution. Our professional standards derive from the conceptual foundations of the healthcare matrix. When philosophical assumptions and pedagogical strategies intersect with such political objectives, the ethical, legal and political consequences directly impact each member of the learning and practice communities. Will free association in the analytic process be expected to lead to a conformity and compliance with that which constitutes appropriate as defined by the prevalent socio-political ideology (outcome-based psychoanalysis)? Will a license to practice psychoanalysis permit, much less encourage or require, a questioning of the socio-political ideology and social structures that require such licensure in the first instance?
During the past quarter of a century, the very concept and meaning(s) of psychoanalysis as theory and practice has been changing. Contemporary psychoanalysis is characterized by a rich and creative pluralism in conceptualization and theory. Currently, a world of differences exists between various theoretical and methodological positions that derive from the more contemporary orientations of existential-humanistic; relational; transpersonal; hermeneutic; philosophical; and, integrationist psychologies. These more contemporary psychologies of psychoanalysis premise different understandings as to the basic nature of people, posit different methods of knowing about people, and assume very different purposes, objectives, and understandings of the analytic discourse. And yet, the structure of our training institutions, their ideological context, and their underlying pedagogical philosophy and principles remain essentially unquestioned and unchanged since the founding of the Berlin Institute in 1920. A science and pathology driven model of knowing and understanding human being-ness continues to provide the organizing conceptualization of the purpose, the content, and the institutional format of our pedagogic enterprise. One size continues to fit all...unless, of course, it doesn't.
The creative rethinking of psychoanalysis during the past quarter of a century has yet to take up the question of education and training in ways that would match institutional structures and forms of education with the particular concept and meaning of psychoanalysis for which one seeks training (Kavanaugh, 1998). Free Association, in my opinion, addresses this question and speaks to this match between its forms of training and the formation of a philosopher-psychoanalyst. As such, it represents a significant contribution to this project of rethinking psychoanalytic education. In the larger picture, the pluralism of our contemporary times calls for a project of rethinking psychoanalytic education in the service of developing pedagogical philosophies, principles and models that match with the respective theory and understanding of psychoanalysis under consideration. For example, what are the processes and experiences that contribute to the formation of a psychoanalyst as an hermeneuticist? an existentialist? or, a phenomenalist? As a Jungian? a Freudian? or a ......? The days of a monolithic psychoanalysis are far behind us. The theoretical pluralism of our current historical moment reintroduces the questions, What is psychoanalysis? What is a psychoanalyst? and What constitutes psychoanalytic education?
For many in the analytic community, there is a fundamental disagreement with the traditional science- and pathology-driven model of psychoanalysis, its healthcare and accreditation standards, and the professional standards that derive therefrom. Their principled disagreement gives rise to a series of epistemological and ethical questions in the analytic community when the normative language of a medical-empirical discourse sets the professional standards for analytic theory, practice and education. What organization speaks in defining the essence of psychoanalysis? From what position, location or place in the culture’s matrix of meaning and power does it speak of theory, ethics, practice, or education and training? or, the professional standards thereof? From what philosophic and theoretical discourse does it represent psychoanalysis? What are the ethics involved in speaking from a medical-empirical discourse as if one is speaking objectively and rationally outside of a philosophic or theoretical discourse? Questions of ethics, power and economics arise when state licensing boards and ethics committees refuse to acknowledge systems of ethics and ways of conceptualizing human being outside of the health-care ideology and matrix.
Psychoanalysis is one of the most significant voices in our technocratic culture to maintain the importance of the complexity and uniqueness of individuality. It seems to me that its institutional forms and pedagogical philosophies must reflect and encourage this respect for the idiothetic nature of the education and training experiences of those who aspire to knowing, translating and speaking the uniqueness and complexity of its discourse. Free Associations as an educational model provides a viable alternative to the academic model. Hopefully, Dr. Thompson’s rather provocative proposal will stir further discussion and debate in the analytic community.
To read Dr. Thompson's essay see www.ifpe.org/news_01_p.8.html.
This paper was originally published in the October 2001 newsletter of the Michigan Society for Psychoanalytic Psychology. It is reprinted here by permission of the author
Dr. Kavanaugh is the past president of the Academy for the Study of the Study of the Psychoanalytic Arts and a former president of the International Federation for Psychoanalytic Education. He is in the private practice of psychoanalysis in Farmington Hills, Michigan.
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