VICISSITUDES OF THERAPISTS' SELF-ESTEEM
I have chosen a topic that it is not easy to think or write about, one which is elusive and which is easy to satirise or to conflate with egotism. Yet I think it is an important one, one about which I have seen no extensive reflections in the psychoanalytic literature. I dare say that each of you thinks about it from time to time. I want to consider what contributes to and detracts from our self-esteem as therapists. I think most of us would be embarrassed to speak or write about how insecure we often feel. I'm old and have had some status, so I have decided to risk it.
We become psychotherapists for all sorts of reasons, among them that we have been helped by psychotherapy, that we are interested in human nature, that we want to help people, that we want to have a job in which there aren't bosses hovering about and telling is what to do. All of the above apply to me, especially the last one. I was working as a publisher and having a tough time. I found myself thinking that if all else fails, I can be a therapist where only the patient and I are in the frame and no one can interfere. I was, of course, sorely mistaken. First you have to get trained and then you have to get patients. To get automatic referrals you have to get a job in an institution, and there are precious few of those. Most of us are in private practice, which means that we rely for the most part on colleagues to refer patients to us. I know that one can put one's name in the Yellow Pages, write to local GPs, leaflet, have people sent by one's training organization and so on, but most patients come to me from personal referrals, and most of us, including me, don't get as many of those as we would like.
So the first source of self-esteem or the lack of it is whether or not we can make a go of building up a clinical practice large enough to support us and our families, if we have one, It is my impression that not very many psychoanalytic psychotherapists make as good a living as they'd like. I don't mean anything very fancy but something over, say, £25,000, comparable to a teacher or lecturer. Professors' salaries begin at £40,000, so one is doing pretty well, relatively speaking, if one makes that much.
I'll come back to the economics of practice, but I should correct my claim that making it as a practitioner is the first source of self-esteem. First, rather, comes how we feel about ourselves during training. The reactions of teachers, conveners of experiential groups and supervisors, as well as fellow trainees are extremely important. Even more so, of course, is one's experience of therapy. New ranking: therapy first, the process of training second, building and maintaining a practice third. Fourth and most obvious is how we feel about our work from day to day. I don't have anything very interesting to say about that one except to share my experience that I have big ups and downs about that. Later on I'll add professional relations, the topic which initially led me to suggest my title.
I have a patient who completed his first year of training in June. He had a teacher who seemed to find him trying. My patient finally -- and imprudently -- said in front of the whole cohort of students, 'Do you realize that every time I speak you look at your watch?' It was, of course, a bull's-eye. He later apologised, but the harm was done, and my patient has felt vulnerable ever since. At the end of the year his supervisor, whose first year this has been in that role, told him that they'd had doubts about him but had decided to let him proceed to the next year. Some guys never learn. His response was to say that this was a great relief and that (naming each of them) none of the teachers had had any idea how unconfident he he'd felt earlier in the year. She responded at once that since he had seen fit to name names she was not going to recommend his going into the next year. She then went on holiday for two weeks, and my patient had to take the matter to the watch-looker, on whom his fate was likely to depend. He was reassuring, saying that it would almost certainly be all right. When the supervisor returned she said he could proceed. Nothing more was said. You can imagine how he felt during those two weeks.
I did a two-year postgraduate training. At the end of the first year I was given their annual prize and told how gifted I was. At the end of the next year half of the people in my cohort, including me, were told that we would have to do an extra year. I was shaken and thought something must be amiss, especially since she'd been saying to other cohorts that we were the best they'd had. I was told that she had been told by one of our seminar leaders, a man who has taught for the BAP for a long time and is partial to that organization, that our postgraduates were no better than the BAP trainees who were supposed to be at a lower level of competence. Instead of standing her ground or considering his possible bias, she came home and spanked the kids. Someone who had also felt badly treated by the head of the training suggested I ask the critic about what he had been reported to say. I phoned him, and he said, 'If that remark was used to delay anyone's qualifying, I am being used as a scapegoat'. When we finally succeeded in having a meting with the head of the training to question her decision she repeated this man's reported criticism. I spoke up and said what he had said to me. The next thing I knew I was suspended and not allowed to attend any more of the weekly seminars and was given a parole officer to meet with until the end of the year. He was someone I knew, and he was kind enough to warn me that she was determined not to allow me to become a member of the organization at the end. He said that others in power thought this unfair, that they knew they were in the wrong, and I should just be patient. I somehow managed that, and I was qualified and made a member in spite of her continuing protestations. Of the remaining four who deferred to the requirement that they do another year, one bought her a present at the end of that year -- a sycophantic gesture -- and placed it and a card expressing fulsome thanks to her on the table before the last seminar. It would have been imprudent not to sign, and everyone did.
I offer these anecdotes to illustrate how fragile and shaken one can feel during training. After a period during which someone chosen by her headed the training (with no proper consultation over his appointment), the woman who headed the training when I was in dispute with the organization is currently again in charge of it more than a decade later. Fortunately, my supervisors gave me full backing in my lonely dispute. One of them, a distinguished and venerable analyst, did some other work for the organization, and his role was terminated.
I was a member of the training committee at the University of Sheffield for a number of years, and I can speak from being on both sides of the training divide. The views of supervisors are at the heart of acquiring and assessing the competence of trainees. They can do wonders in helping people acquire competence and a sense of it, or they can severely undermine self-confidence. One of my points is that judgements about competence of trainees are inevitably a matter open to severe bias, favouritism, even injustice.
The kind of competence we need is not simple. One of the main skills we need is to bear uncertainty. I had an excellent supervisor who once said that 'sometimes all you can do is hold onto the arms of your chair'. Wilfred Bion wrote a lot about not rushing to certainty. Dwelling in uncertainty is essential, so, paradoxically, being good at this job involves being patient and not rushing to judgement over the subtle matters with which we deal. This is a long way from the assertive confidence needed to sell insurance or cars. The confidence of a therapist is, one might say, the ability to be unconfident for as long as it takes. One of the things I appreciated about my training therapist is that, after a difficult session in which I fought an interpretation he occasionally said as I left, 'Perhaps you're right'.
It is all too easy and tempting to reach for a sense of omnipotence as a defence against not knowing what the hell is going on. A lot of what our patients successfully project into us, some of them militantly and relentlessly, are that we are useless and incompetent. I had a patient who would roll is eyes (or so I thought - he was on the couch) and sigh audibly at interpretations of which I was particularly proud, as if my best milk held no nourishment for him. This turned out to lie at the centre of his perverse way of thinking. His mother had always found his best not good enough and repeatedly sent him off to remedial teachers. The fact that he went on to get a First at Oxbridge never made achievement satisfying to him in work or in personal relations. The well of his sense of gratification had been poisoned. It is in situations like that that one has to go on believing that therapy can work, if not always or always with wonderful results. If it works at all in some cases, that's a blessing. It is not arrogance to think that one can reach the unreachable. We must not let the best become the enemy of the good. I once heard a therapist who had formerly been a carpenter singing the praises of 'the ordinary', the craftsman's day by day deploying of skills and competence to some useful purpose. He argued that psychotherapy is, in the best sense of the word, a craft. I should share with you that my perverse man and one or two others completely defeated me. Thank goodness for some outcomes I can put in the other pan of the scales measuring my sense of competence and self-esteem.
This is a baleful moment to do it, but I now want to mention that one's own training therapy is the most important source of the belief, which I maintain is at the core of being able to do therapy, that it works. I went into psychotherapy as a profession because I had been so profoundly helped by it to overcome depression and disappointment. Not made perfect, mind you but made better enough -- good enough -- so that life was more than just bearable or marginally worth carrying on with. My mother was suicidally depressed, and my father was a disappointed man. My struggle was not to succumb to bitterness and despair about life and its travails. I say again: I am far from happy-clappy, but I do see the point of continuing to live, love and work in spite of ample and in my experience growing evidence of the dark side of human nature, of which we have had a surfeit in recent days.
I now return to being a qualified practitioner. Among the things that sustain this for me is doing good work more often than not. I do have days when I feel hopeless and a fraud, but I also have ones when I am actually proud of myself -- of an interpretation, of how it's going with a given patient and often enough the satisfaction of seeing someone who came in a mess leave much improved and occasionally very much improved. For me these gratifications are complemented by doing supervision that seems to help people, by reading (not by any means restricted to the psychotherapy literature) and by teaching, including giving talks that sometimes seem to go down well.
Then there is, very importantly in my experience, the wider context. By this I mean what else one does: family, other relationships, including but crucially not confined to collegial ones. I heartily commend to you the first book written by one of my main analytic heroes, Harold Searles, on the role of the natural environment in his sense of the meaning of life. It is entitled The Role of the Nonhuman Environment in Normal Development and in Schizophrenia (1960). He was brought up in the Catskill region of upstate New York, and he is most eloquent in expressing the role of the external environment in his inner world. He writes, that 'region possesses an undying enchantment, a beauty and an affirmation of life's goodness which will be part of me as long as I live' (p. ix). Coupled with this for me is the need to exercise, something it becomes harder to do when you get old, slowed and arthritic, along with too many other afflictions. Shortly before he died, the great comic and character actor, Walter Matthau, said to his favourite co-star, Jack Lemmon, 'Growing old is not for sissies'. Even so, physical exertion remains a basis for one's sense of relative well-being and is more precious as fitness wanes with age.
You may be feeling that I am becoming rather general and banal, as befits an old fellow, but I am most earnest in claiming that the sorts of factors I have mentioned constitute an ensemble which makes what we do endurable and in its own cranky and quirky way elevating and fulfilling. I am now going to turn to a feature of the wider context of our work and sense of self which ought to be part of what sustains us but often has the opposite effect: the institutional context of psychotherapy. I should begin by saying that I have worked in quite a number of employment contexts, and I am sorry to say that none of them has been more congenial than trying: school, college, construction, automobile assembly, mental hospital, medical school, graduate school, academic life, political agitation, making television documentaries, publishing and working on the internet. In every one of those settings I eventually found myself wondering how on earth I had once again fallen among rogues, thieves and charlatans who got their sense of achievement by competing with the very people with whom they had come together to cooperate. (In his book, The Claustrum, Donald Meltzer writes witheringly about those who have to succeed by walking over others. I am sad to report that he died a couple of weeks ago.)
Psychotherapy is no exception to the ubiquity of trying social relations, yet one imagines that it damn well should be. Its practitioners have ostensibly spent many years sorting out their capacity to conduct human relations with civility and cooperation. Not only are they not better; in my experience they are worse that the run of places where I have worked. It's analogous to the church. Religious people and their leaders should behave better. Being well-behaved is, after all, the raison d'etre of being a member of a religious community. In my experience, on the contrary, clerics and psychotherapists are often so imbued with a sense of their superior insight and by the rectitude of their positions that they feel fully justified, if I may put it starkly, in 'killing in a higher cause'.
My chest began to tighten as I began to write this section of my talk. Over a decade ago I was asked to give some seminars to trainees at the Arbours Association on wider issues in psychoanalysis. I talked about the social dynamics of the profession, the role of politics and ideology in psychoanalytic theory and practice and, in the last of the five seminars, we explored how these issues turned up inside the Arbours Association and its training. I should say at this point that I greatly admire the Arbours and routinely advise people who ask me about trainings that it is the one I would have most liked to attend. I was not asked again to give these seminars and eventually learned that the head of the training claimed that I was attacking the training. I also learned for the first time that she and some others were then involved in an intramural dispute as a result of which a number of people decamped and sought membership in other training organizations, notably the London Centre for Psychotherapy and the Forum for Independent Psychotherapists. I don't propose to explore the minutiae of that conflict -- you might say I've learned my lesson.
My point in raising this, however, is a more general one. Psychotherapeutic institutions are prey to the same sorts of psychological and social dynamics that befall almost all institutions, e.g., factionalism, splits, scapegoating, violent projections and reprojections, denigrations, idealizations -- the whole list. Institutions are in large measure set up to diminish and contain such processes, but as Isabel Menzies Lyth and others have shown, they end up imperfectly containing the very psychotic anxieties they seek to make bearable. They turn up in the structures, rules, customs and role suctions that get hold of the members at every level. Menzies Lyth showed this in her classical work on the nursing profession, 'The Functioning of Social Systems as a Defence Against Anxiety' (1959), but her insights have since been applied to all sorts of institutions, especially including ones in the helping professions. Among the studies she has been asked to undertake is the role of the tripartite split into Kleinians, Freudians and Independents at the British Psychoanalytic Society, to which I'll allude anon.
There are so many aspects of the institutional dynamics in the profession of psychoanalytic psychotherapy, never mind psychotherapy more generally, that it is hard to know were to begin. I wish we could stop here and have an exploratory discussion, since I don't know if you feel that such issues impinge on you personally or in the wider profession. Perhaps we can explore this question in the discussion after I stop speaking.
I suppose the sensible place to begin is by alluding to the hierarchical relations among training and professional organizations in psychoanalytic psychotherapy. Opinions will differ about the lower rankings, but at the 'top' are undoubtedly the British Psychoanalytic Society with the Society for Analytic Psychology as a tolerated also-ran (I am sketching as a connoisseur of this hierarchy might). Then there is the British Association of Psychotherapists and, latterly, the Lincoln Centre, followed by the London Centre for Psychotherapy and the Centre for Psychoanalytic Psychotherapy. In a parallel hierarchy there are institutions specializing in child psychotherapy, with the Tavistock Clinic at the top, the Anna Freud Clinic and the BAP child training below. The institutions I have listed, along with a few regional ones in Newcastle, Northern Ireland and Scotland, are members of an elitist organization called the British Confederation of Psychotherapists whose originators broke away from the more encompassing organization which is now called the United Kingdom Council for Psychotherapy whose psychoanalytic section (one of eight sections when I last looked) embraces about fifteen organizations, most of them in London. The most familiar names are the Arbours Association, the Philadelphia Association, the Guild of Psychotherapists, the Association for Individual and Group Psychotherapy, the Site for Contemporary Psychoanalysis, the Institute for Psychotherapy and Social Studies, the Centre for Attachment-based Psychotherapy, the (Lacanian) Centre for Freudian Analysis and Research and a few regional societies, e.g., in Birmingham, Bristol and Sheffield.
Some of these were founded as are results of splits, e.g., the BAP split from the BPS, the LCP split from the BAP and AGIP split from the LCP (these last two partly for reasons of hank-panky among leading figures). The Site split from the PA. The FiP was created so people could remain in the UKCP while being members of the BCP (which, after a long and nasty struggle, did not allow its institutional members to have dual membership, though individuals still can). Two societies in the BCP, the BAP and the Lincoln, are in the process of negotiating with the International Psychoanalytic Association for some of their members to become psychoanalysts by a process that will take about five further years of training and vetting once the procedure gets set up and will divisively leave behind many, perhaps most, members of those societies. I suppose these will be considered second class citizens. Indeed a member of the BPS said to me recently that anyone becoming a psychoanalyst by this route will be considered second class by the members of the British Psychoanalytic Society.
Meanwhile there is an ongoing and acrimonious controversy about who can be called a psychoanalyst. By tradition in this country, though not in others, only members of the BPS call themselves psychoanalysts, as do the Lacanians, who do not loom large on the BPS's radar screen. But a few years ago some members (about 68) of the UKCP sought to call themselves psychoanalysts. After much debate and severe warnings of dire consequences from the BPS that they would withdraw from teaching or being therapists to all members of any organizations any of whose members called themselves psychoanalysts, the UKCP dropped this idea. Soon thereafter a man named Jacques China set up a new organization called The College of Psychoanalysts. Anyone who is a member of a society belonging to the psychoanalytic section of the UKCP (and some others, e.g., suitable foreign-trained practitioners) can become a member of this college, who call themselves psychoanalysts. The BPS is very cross about this development, though it has yet to carry out its dire threats. The College of Psychoanalysts has as I write about 150 members and has achieved a high enough profile to attract the attention of The New York Times and The Guardian, each of which has published a feature article on the controversy.
What's it all about? Does it matter? To whom does it matter, for example, you and me? A graduate of the Lacanian CFAR training, Professor Ian Parker, published a most revealing article in the UKCP Newsletter. He lists the criteria of best qualifications cited by the BCP to justify its position on who shall be called a psychoanalyst. For each and every one of them Parker was able to cite one or more institutes in different countries who are members of the International Psychoanalytic Association which have lesser requirements. The details do not matter in my opinion, e.g., times per week in analysis during training, ditto for training cases, number of training cases.
I think some related issues do matter, however. First, although it may not be easy or possible to specify the criteria quantitatively, I believe that some trainings are better than others, I have taught on a number of trainings and am satisfied that some are a lot better than others. However, it is very hard indeed to measure competence in matters of he heart and of character and insight. A recently-minted psychoanalyst once wrote a long and agitated email to a friend of mine who had mistakenly referred to me in an email on a discussion forum as a psychoanalyst. The analyst listed a number of things I had not done. Trouble is, I had done all of them but not at the BPS, e.g., my analyst was a training analyst at the BPS, and I had been analysed five times per week for many years. The Freud Professor of Psychoanalysis at University College, Peter Fonagy, has said publicly that being a psychoanalyst is about competence, and anyone with the requisite competence should be entitled to call himself or herself a psychoanalyst. My friend who was treated to this attack on my credentials belongs to an organization of humanistic psychotherapists whose members think the UKCP is also too elitist and bureaucratized, It is called the Independent Practitioners Network and has no hierarchy in its structure.
There are, in my experience, many reasons to complain that some members of the BPS and the BPS as a society have behaved in elitist and patronising ways. The story begins with their unwillingness to be in the same organization as the rest of the psychoanalytic section of the UKCP, claiming that theirs was a higher qualification. They and organizations deferential to them then set about drawing some other organizations into a new one, the BCP, thereby creating a caste hierarchy. The Lincoln, which was and is dominated by psychoanalysts, was removed from the UKCP without consulting its members. They voted three times to return. The analyst-controlled Professional Committee then commissioned a fourth vote including the students. A majority of those voting, now including (in my opinion) a significant number of deference voters, were against rejoining and that was the vote which was accepted by the Professional Committee. At the BAP the analysts and those deferential to them fought long and hard before they succeeded in getting the member organizations to withdraw from the UKCP. The BCP later took the precaution of declaring that no member society could belong to both the BCP and the UKCP. A decent and thoughtful leading figure at the BAP who was my informant about these ructions told me that the members of the pro-UKCP faction were 'slaughtered'.
It should be noted that one consequence of this split is that psychoanalysts are guaranteed to have as patients most if not all of the trainees at the BCP member organizations, since they are the only people accepted as training therapists (there is a tiny number of exceptions, and the list is bound to grow, albeit very slowly). They also are tapped to do almost all the teaching and running of seminars in the BCP trainings.
Another feature of the hierarchy of institutions is that psychoanalysts almost never attend conferences given by psychotherapy organizations except to give many of the papers. Usually they do not come for the whole conference but turn up to give their papers and leave straightaway.
When people move from the context of psychotherapy trainings to the world of the BPS they tend to alter their social relations. I can think of a few exceptions, but more examples of the rule. I am thinking of a man who was very involved with the Arbours before getting into the BPS training. Some years later he required the Arbours to remove his name from a list of people who had taught there. On the other side I can think of at least five psychoanalysts who have remained for many years involved with the Arbours, one deceased, Nina Coltart. The same cannot be said of other non-BCP trainings.
Compare universities. Even though there are two pre-eminent universities in this country and a small number of others (UCL, Imperial, LSE, Warwick) that stand out from the rest of the 120 universities, no one would claim that two (or even six) universities have all the best qualified and greatly admired academics or all of the departments receiving a five-star rating in the Research Assessment Exercise. The same generalization applies to teaching hospitals. Yet the BPS claims that all of its 300-plus members who are practicing in this country (of the 400 or so members) are a cut above all the psychoanalytic psychotherapists. The BCP implies that all its members are a cut above the rest of the profession of psychoanalytic psychotherapists. It is also worth mentioning that on the whole the BPS and BCP members make more money than the rest of the psychoanalytic practitioners in the country. Is this justified? In some cases, yes, but not as a generalization.
Now comes a painful point. Some of the people whose work I know and who have been trained at the less highly-regarded institutions are in my pinion not as good at practicing psychotherapy as, on average, people trained at the more prestigious institutions. It was said in The New York Times article and with some justification that some of the members of the College of Psychoanalysts are 'poseurs and wannabes'. Harsh words, but I can think of more than one (I know about 20 of them) I would not want to be in an institution with -- for many reasons going back over a long time and many encounters. But here is a point on the other side. I know analysts for whom I have little or no respect. I say this on the basis of a good deal of knowledge of them and their work and public behaviour. I have also seen in many contexts the ruthless and immoral behaviour of leading psychoanalysts both in the Lincoln and more broadly. The same can be said for some leading figures in certain psychotherapy organizations.
The only generalization I feel able to make is that there is some justification for a hierarchy of competence and status but not for castes. I should add that I know a lot more patronising and ruthless psychoanalysts than I do patronising and ruthless psychotherapists. By the way, psychoanalysts are as well involved in hierarchical social relations among themselves. When I go to a party given by an Independent I will find no Kleinians there. When I go to a party given by Kleinians there will be no Independents there. I don't get asked to parties given by members of the Freudian group, but I don't see them at the parties of Kleinians or Independents. I once went to the launch at the Institute of Psychoanalysis of a book I was publishing by a Kleinian. The President of the society at that time was an Independent. He managed to make the main speech without mentioning the book or its author by name.
I wonder if any of this matters to you or even if you experience the effects of it. One consequence at the BCP member institutions is that as things now stand its graduates do not become faculty. What about referrals? While she lived I got lots from the analyst Nina Coltart and not from any other analyst I can recall, though I have had lots from eminent psychotherapists, e.g., Joe Berke and Nini Herman. I recently had a consultation with a woman who had been urged to come to me by a patient of mine. Near the end of the session she said that she had friends who were psychoanalysts and that they had told her that on no account should she go into therapy with me. They said she had poor boundaries and that I would make her worse. (Note the boundary-maintenance of the analysts making these comments, by the way…) She said that from what they told her she inferred that I had criticised the BPS, and they would do what they could not to support my practice. Who knows what truth there was in this, but she did not come into therapy with me or pay the bill I sent her. The newly-minted analyst I mentioned earlier wrote to my friend that he should on no account pay attention to what I wrote about Freud's views on human nature, since I was not a psychoanalyst. The fact is that I am a very highly-regarded historian of the human sciences, and psychoanalysis in particular, and taught at Cambridge for many years. It seems that, nevertheless, since I did not train at the Institute of Psychoanalysis, my reputation as an historical scholar counts for nothing. That is rank arrogance.
For most of us, the main link to professional relationships is our training organization and/or our regional society. I must confess that I have not got much joy out of the professional organizations to which I belong. I and a number of others who felt ill-treated by the Lincoln in the matter of UKCP membership and other issues about democracy simply stopped taking part in the organization, including half of the cohort of trainees I was in. Although there appear to have been some reforms, the same people seem to hold the reins of power. I cannot cite the same reasons for not being active in the Forum for Independent Psychotherapists. When I first joined one of those poseurs and wannabes I mentioned earlier was prominent in the organization, so I gave its meetings a wide berth. I'd had a number of distressing encounters with his overweening egotism and did not want to have to deal with him. He has since become much less active, but he does rear his ugly head from time to time, so my aversion remains. My reason for belonging to FiP, as I said, was to find a way to be a member of the UKCP in spite of the undemocratic withdrawal of the Lincoln. One thing one can hope for from such affiliations is referrals, but I have never had a single one from any psychotherapy organization to which I have belonged.
It is my impression that many, perhaps most, psychotherapists do not get much joy or support or collegial solidarity from being members of professional organizations, though I do know of some exceptions. There is a growing literature about the dynamics of such organizations, and it is not edifying. I have in mind, in particular, the account of four American psychoanalytic societies - New York, Boston, Chicago, and Los Angeles - by Douglas Kirsner, entitled Unfree Associations. All were mired in favouritism and dubious practices in choosing training analysts. For example, in New York the most talented candidates for this lucrative role turned out to be the wives of people who were already training analysts. Isn't that a coincidence? There was also in several of the institutes fierce holding onto roles in the teaching faculties, in Chicago concerned with Kohutian versus orthodox Freudians and in Los Angeles a conflict between the orthodox Freudians and Kleinians which almost led to the society begin kicked out of the American Psychoanalytic Associations. You can imagine the effect of these intramural conflicts on the members and especially on the trainees.
We also have a few accounts of personal experiences of people who have found favouritism and related tendencies very painful in their training and professional relations. I am thinking, in particular, of the autobiographical writings of Jeffrey Masson in Toronto and of John Gedo in Chicago, both of which reveal dreadful conflicts in which those in charge maltreated those coming along in the societies. A President of the International Psychoanalytic Society, Otto Kernberg, wrote a highly amusing and highly critical article entitled 'Thirty Methods of Destroying the Creativity of Psychoanalytic Candidates'.
Of course, one of the things that institutions do is to preserve orthodoxies and inhibit originality. There have been factions and expulsions since the beginning of the psychoanalytic movement, and key figures have demanded extreme loyalty, for example, Melanie Klein and Anna Freud. The conflict between them and their followers nearly sundered the British Psychoanalytic Society in the mid-1940s. Similar stories can be told about the treatment of Theodore Reik when he emigrated to America without a medical qualification. This led Freud to write 'The Question of Lay Analysis' in which he opposed the requirement that analysts be medical doctors. Non-medical practitioners eventually successfully sued the American Psychoanalytic Association and won on the grounds that the medical analysts were 'in restraint of trade'. A separate organization was set up by Reich and other non-medicals called the National Psychological Association for Psychoanalysis (NPAP), which is still thriving.
I have had letters from a number of eminent American practitioners, called psychoanalysts in that country, detailing their professional difficulties and the challenges to their morale, always ending on a note about soldiering on regardless of the machinations of the IPA-affiliated societies and some of their members. I'll give you an example. I wrote to Michael Eigen, author of a number of writings I admire and recently elected to edit the journal The Psychoanalytic Review. He replied,
How oddly familiar this all sounds to me. When I arrived on the scene, nonmedical trainees at the NY Psa Soc had to sign a thing saying they would not practice psa, but use it only for research purposes. The medical groups tried to control psa. So nonmedical institutes started, first by T. Reik and his students, many of whom are friends, those who are still alive (NPAP). Now there are many nonmedical institutes.
As a practitioner I've fared pretty decently here. I built my base outside the medical establishment. It happened quite spontaneously. Now I'm more in demand than most of them. As an eminent APA analyst once put it to me in an aside, "You did the right thing. They're dead on the vine."
In the end, the medical establishment began to cave in here. They were dull. They approached the psyche like a business, rather than a calling. The psychologists vied for power, and they are now becoming awful too. I don't know who's worse. Probably the medical group. The fight continues, as Freud said.
So it is in your land too, along different institutional lines. Psa snobbery is ghastly. I'd like to say it's self-destructive, but prigs like this often know how to work power. But I'm still here, doing at least as well or better than most of them. And making more interesting contributions, such as they are. At least my work somehow affirms the human spirit, or means to.
I wish you well in your world with this business.
Whoever grows from the O of psa speaks for psa.
When I asked if I could quote him, he asked me to add,
Things are not static. So I wouldn't want to create a totally either-or impression. Degrees and affiliation don't make you a good or bad worker. There are people from all camps doing creative work, people in all camps that are destructive, and people from all camps that are both. How does one know them by their fruits? Too often status is substituted for the real thing. But the difficulty you are fingering is real. And you can quote me, if you like, with this present "disclaimer".
What Michael Eigen wrote helps me to make my final point: that being in opposition to a hierarchical and even caste structure can, paradoxically, enhance one's self-esteem, as in the slogan I learned in my youth: 'Don't let the bastards get hold of your self-esteem'. However, it runs the risk of tempting one to believe that it is always safe to oppose the establishment, a stance that is as simplistic as it is always to defer to them. I recently had the experience of greeting someone I had not seen in years but counted as a friend and fellow radical. He was not glad to see me, and said he was now an acolyte of the woman who had mistreated my cohort at the Lincoln. He referred to me as commonly perceived as someone who gets his identity from being in opposition. I don't think that's quite right about me, but I noted that my stance was thereby neatly pathologised and I was consequently not to be taken seriously. It is worth remembering, however, that one can do good for neurotic motives, just as one can do wrong for the best of motives. In my opinion it is always wrong to defer to arbitrary authority and to kowtow to people and institutions that seek to lord it over others.
You may be interested to read a new collection of essays Published by Karnac and edited by a recent Chairperson of the UKCP, Ann Casement, a Jungian analyst, entitled, Who Owns Psychoanalysis? I haven't read it yet, but it looks promising.
An afterthought: I sometimes have dreams about these and related matters. I am invited to train at the Institute, but people are incredulous or I am not invited. I also have dreams in which I return to my universities, Yale and Cambridge, and I am not made welcome or cannot find the exam room or have not done the work. I have even have them about high school. For a long time I feared that these dreams revealed that my sense of self-esteem was only a façade and my accomplishments were unreal to me as far as my unconscious is concerned. Then I recalled the passage in The Interpretation of Dreams in which Freud tells us that it is invariably people who have succeeded, including himself, not those who have failed, who have anxiety dreams about examinations and accolades (S. E. 4, pp. 273-76). In that company I don't feel so bad.
I have reviewed five sources of self-esteem: one's training therapy, the experience of training, building and maintaining a practice with its daily ups and downs, professional relations and the rest of one's life, including loved ones, friends, culture, nature.
Now I hope you will tell me how, if at all, these questions about the roots of and challenges to self-esteem affect you.
Text 6857 words
Talk delivered to the Wessex Psychotherapy Society, Southampton, 15 September 2004.
REFERENCES
(Place of publication is London unless otherwise specified.)
Casement, Ann (2004) Who Owns Psychoanalysis? Karnac.
Freud, Sigmund (1900) The Interpretation of Dreams. S. E. 4 and 5.
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Kernberg, Otto (1986) 'Institutional Problems of Psychoanalytic Education', J. Amer. Psychoanal. Assn. 34: 801-34.
______ (1996) 'Thirty Methods of Destroying the Creativity of Psychoanalytic Candidates', Internat. J. Psycho-Anal. 77: 1031-40.
King, Pearl. & Steiner, Ricardo, eds. (1991) The Freud-Klein Controversies 1941-45. Tavistock/Routledge.
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READINGS
The culture of British psychoanalysis and psychotherapy
Abram, J. (1992) Individual Psychotherapy Trainings: A Guide. Free Association Books.
Barham. Peter (1984) 'Cultural Forms and Psychoanalysis: Some Problems', in B. Richards, ed., Capitalism and Infancy: Essays on Psychoanalysis and Politics. Free Association Books, pp. 38-54.
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Berrios, Germann and Freeman, H. (1991) 150 Years of British Psychiatry 1841-1991. Gaskell.
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Dyne, D. (1988) 'Whither Rugby? -Towards a Profession of Psychotherapy', Brit. J. Psychother. no. 4: 148-55.
Herman, Nini (1989) 'Ilse Seglow in Her Time: Reflections on Her Life and Work', Brit. J. Psychother. 5: 431-41.
Hinshelwood, R. D. (1985) 'Questions of Training', Free Assns. no. 2: 7-18.
______ (1986) 'Eclecticism: the Impossible Project - a Response to Derek Dyne', Free Assns. no. 5: 23-27.
Lyth, Isabel Menzies (1988) 'Reflections on My Work: Isabel Menzies Lyth in Conversation with Ann Scott and Robert M. Young', in Containing Anxiety in Institutions: Selected Essays. Free Association Books, pp. 1-42.
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Pines, Malcolm (1991) 'The Development of the Psychodynamic Movement', in Berrios and Freeman, eds., 1991, pp. 206-31.
Roudinesco, E. (1990) Jacques Lacan & Co.: A History of Psychoanalysis in France 1925-1985. Free Association Books.
______ (1997) Jacques Lacan. N. Y.: Columbia/Cambridge: Polity.
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Trist, Eric and Murray, H. (1990) 'Historical Overview: The Foundation and Development of the Tavistock Institute', E. Trist and H. Murray, eds., The Social Engagement of Social Science Vol. I: The Socio-Psychological Perspective. Free Association Books, pp. 1-34.
Turkle, Sherry (1978) Psychoanalytic Politics: Jacques Lacan and Freud's French Revolution. N. Y.: Basic Books; 2nd ed., revised and updated, Free Association Books, 1992.
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Essays on Character and Morality and on The Psychodynamics of Psychoanalytic
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http://human-nature.com/rmyoung/papers/paper53.html
______ (1997) 'Psychoanalysis and Psychotherapy: The Grand Leading the
Bland',
http://human-nature.com/rmyoung/papers/pap101.html
Relations between Psychotherapy and Politics, Values and Ideology
Klauber, J. (1986) 'The Psychoanalyst as a Person', in Difficulties in the Analytic Encounter. Free Association Books/Maresfield, pp. 123-39
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Ramzy, I. (1965) 'The Place of Values in Psycho-Analysis', Int. J. Psycho-anal. 46: 97-106
Singer, Irving (1992) The Creation of Value: Volume One of Meaning in Life. N. Y.: Free Press; reprinted Baltimore: Johns Hopkins, 1995.
Young, R. M. (1988) 'Psychoanalysis, Values and Politics', http://human-nature.com/rmyoung/papers/paper91.html
Zinberg, N. E. (1967) 'Psycho-analytic Training and Psycho-analytic Values', Int. J. Psycho-anal. 48: 88-96.
Other Aspects of the Sociology of Psychoanalytic Knowledge
Apter, Gerald (1997) The Dark Side of the Analytic Moon: A Memoir of Life in a Training Institute. Bethesda, MD: International Scholars Publications/ London: Eurospan.
Bergmann, Martin S. (1993) 'Reflections on the History of Psycho-analysis', J. Amer. Psychoanal. Assn. 41: 929-53.
______ (1997) 'The Historical Roots of Psychoanalytic Orthodoxy', Int. J. Psycho-Anal. 78: 69-86
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______ (1996) 'Thirty Methods of Destroying the Creativity of Psychoanalytic Candidates', Int. J. Psycho-Anal. 77: 1031-40.
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Copyright: The Author
