LETTER FROM AMERICA

Who Owns Psychoanalysis?

Jeremy Holmes

Two nations separated by everything except their language - this was Churchill'sverdict on the US-UK (and probably his parental) relationship. But when it comes to theword `psychoanalyst' the linguistic divide is as great as the cultural and geographical. Inthe field of psychotherapy, where the British like adjectives, Americans prefer nouns: wehave psychoanalytic psychotherapists, they have psychoanalysts. In the US, as in Britain,the title psychoanalyst is not protected by law. There is nothing to stop anyone callingthemselves a psychoanalyst - indeed it is common to see advertisements in the Californianalternative press of the type: 'Colonic Irrigation, and Psychoanalysis - first session free!'

It is easy to sneer at such linguistic abuse - seeing it perhaps in ChasseguetSmirgelian(1985) terms as the faecal world of the oedipally envious. In Britain we tend to smile in asmug way at such absurdities knowing that it could never happen here -rather as we doabout tribal violence and religious bigotry, while turning a blind eye to what is happeningin Northern Ireland. But with the advent of registration of psychotherapists, titles havesuddenly become very important in Britain - as those caught up in the struggle between theAnalytic section of the UKSCP and the Confederation of British Psychotherapists wellknow. A lecture trip to California allowed for a closer consideration of the Americanpsychoanalytic scene and its implications for the UK.

Recently a group of senior Californian psychoanalysts decided to break away from theCalifornian branch of the American Psychoanalytic Association (APA) and to set up theInstitute for Contemporary Psychoanalysis (ICP) (Breger 1992). Their directors includeLouis Breger, Robert Stolorow and British-born and trained Victoria Hamilton;corresponding members include Christopher Bolas, Charles Rycroft and - to declare aninterest - the author. The ICP is a `free-standing' training organisation which, while fully `psychoanalytic' in its values, is not recognised by the APA. The reasons for the secessionwere numerous. Many of the leaders are psychologists still smarting from the prolongedrearguard action of the APA against the admission of non-medical members - a battle thatwas eventually `lost' only after a psychologist pursued the issue through the courts. Theywere concerned about the implicit ruling of the APA which makes it impossible forhomosexuals to be accepted for psychoanalytic training. They objected to the hierarchicaland infantilising structure of the psychoanalytic training programmes in which studentshave little say in the content of their courses, and attempts to alter this tend to beinterpreted as evidence of insufficient analysis rather than valid criticism. They had triedunsuccessfully to widen the narrow cannon of psychoanalytic authors deemed suitable forstudy, especially Bowlby,

Dr Jeremy Holmes is Consultant Psychiatrist/Psychotherapist in the Department of Psychiatry, NorthDevon District Hospital, Raleigh Park, Barnstaple, Devon EX31 4JB.

British Journal of Psychotherapy, Vol 10(2), 1993© The author

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Kohut and Lacan, all of whom were for different reasons viewed with suspicion by thepsychoanalytic establishment. They were unhappy about the system of `reporting' oncandidates by training analysts which they feel interferes with the analytic process. Theyfelt that many psychoanalysts ignored research findings, especially from work in infantdevelopment, which called into question psychoanalytic dogma, and were not prepared tolook critically at their practice in the light of outcome studies which doubted the universalapplicability or efficacy of psychoanalysis. In general they felt constricted by what theysaw as the closed and defensive world of official psychoanalysis.

The ICP is still in its infancy and it is too early to say what its ultimate standing will be,but it has so far been very successful and has attracted large numbers of talented candidatesat a time when psychoanalytic recruitment is generally in recession. For the purposes ofthis discussion the important point is that its graduates call themselves psychoanalysts, notpsychoanalytic psychotherapists. Although there appear to be no absolute rules, most havehad personal analysis four times per week; they have studied the psychoanalytic literature,both classical and contemporary, over a four year period; they have taken on a minimum ofthree training patients four or five times weekly, under supervision. They consider theyhave received a broader, freer and more stimulating psychoanalytic education than theywould have had at one of the APAappointed schools.

Are there any lessons relevant to the British situation to be learned from the story ofthe ICP? One striking point is the way in which the wider cultural and political atmosphereseems to influence even such apparently marginal spheres as psychoanalysis. The ICP hadno qualms about breaking away from its `parent' organisation; but this is in a countryfounded on the principle of succession from colonial rule. The democratisation of titles isnot difficult in a country where one of its famous jazz musicians was a `Duke', and canboast at least one `Earl' among its psychoanalytic exports to the UK! In Britain thepsychoanalytic establishment is viewed in much the same way as the rest of theestablishment, the Church, Monarchy and State - sacrosanct bodies demanding to betreated with reverence and due deference. The presence of a `top analyst' at a gathering ofpsychotherapists can have the same effect as a member of the royal family at a church fete.Let he (or she) who dares assume their title! And yet why not? What is to stop organisations- the BAP, the Lincoln or the Scottish Institute say - whose training is no less rigorouslypsychoanalytic than the Institute of Psychoanalysis - calling their graduates psychoanalysts?The answer, I suspect, is that it is just not done, it's not. . .British. And yet there is anhistorical precedent: it was the threat by the Labour Government in 1949 to swamp theHouse of Lords with newly created peers that finally broke the constitutional power of theupper house.

The British parliamentary system may have had its effect on the internal politics of theInstitute of Psychoanalysis too, also with disadvantageous effects. The `gentleman'sagreement' of 1944 between Kleinians and the Freudians was a good parliamentarycompromise, equivalent perhaps to the architecture of the House of Commons whichensures that the two front benches are separated by two swords lengths from one another.But, as British Liberals and Social Democrats know to their cost, this arrangement leaveslittle room for third parties who often have to choose between marginalisation or losingtheir heads! Has this not been the fate of the `middle group'arguably containing the mosttalented and original of the British psychoanalysts but,

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within the `two-party' politics of the Institute, often squeezed into the sidelines? Whatwould have been the result had the middle group done as the ICP in California and splitoff to form their own psychoanalytic organisation? Would British psychoanalysis be in thesequestered and at times defensive position that it is today?

Of course these are hypothetical and to some extent rhetorical questions. There arestrong counter-arguments. By staying together the British Institute has avoided some ofthe fragmentation and destructive rivalry that seems to characterise French psychoanalysis(Turkle 1987), and the different streams have cross-fertilised and learned from oneanother. It might be argued that to call for a widened use of the title psychoanalyst is tofall for the very snobbery that it is trying to undo. Psychoanalytic psychotherapy shouldnot see itself as an inferior form of psychoanalysis, but be proudly different. Perhaps it isharder to work psychoanalytically with once or twice weekly patients than five time perweek, and certainly more relevant and feasible for most patients in both the private sectorand the NHS. Many psychoanalysts, it might be argued, are practising psychoanalyticpsychotherapy rather than psychoanalysis proper, but their training has not adequatelyequipped them for this. Are not psychotherapy trainings better geared for this type ofwork?

All this skirts around the question of what the defining characteristics ofpsychoanalysis really are. It is hardly intellectually satisfying to base a definition aroundan historical occupation of a territory of discourse, still less an arbitrary number of timesper week of treatment. Since many French and Latin American InternationalPsychoanalytic Association approved trainings are based around three times per weektherapy this last bastion has been breached. Even the British society now accepts fourtimes per week.

Most therapists can think of patients they see once a week who are more `in' analysis -in the sense of working with the unconscious and in the transference - than are others whocome much more frequently. If psychotherapists can practise psychoanalysis, why shouldthey not be called psychoanalysts? Seighart (Holmes & Lindley 1989) based hissuggestions for a register of psychotherapists on the distinction between functional andindicative registration. He argued that the functions of psychotherapists were so variedthat it would be impossible to specify them and so protect (and foster) those activities by aregister. An indicative register protects the title of psychotherapist but not the activity -after all many unqualified people are enormously psychotherapeutic. A similar argumentseems to have been accepted without question within the psychotherapy movement aboutthe title psychoanalyst: many psychotherapists may be functionally psychoanalytic butonly bona fide members of the Institute of Psychoanalysis can call themselvespsychanalysts.

But should this be so? The role of the monarchy (and the established church) is underscrutiny. Increasingly it is accepted in British society that it is what you do that matters,not what or who you are. Perhaps forward-looking British psychoanalysts and analyticpsychotherapists should consider forming a free-standing organisation that can rethink thewhole issue of psychoanalytic training and title. Perhaps all members of the Confederationof Psychotherapists should entitle themselves psychoanalysts if they so wish. There is aneed for continued debate around these issues informed by European and Americanexperience; it is important that it does not degenerate into an unseemly struggle for powerand privilege. The outcome at for the moment seems uncertain. But one thing is sure, inBritain, at present, a psychoanalyst by any other name does not smell as sweet.

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References

Breger, L. (1992) Psychoanalytic ideology: theory, treatment, politics. Paper presented atIPC Inaugural Conference What is Contemporary Psychoanalysis? California.

Chasseguet-Smirgel, J. (1985) Creativity and Perversion. London: Free AssociationBooks.

Holmes, J. & Lindley, R. (1989) The Values of Psychotherapy. Oxford: Oxford UniversityPress.

Turkle, S. (1987) Psychoanalysis: nothing sacred? In Voices. Psychoanalysis (Eds. B.Bourne, U. Eichner and D. Herman). London: Hobo Press.