The Training in Contemporary Psychoanalytic Psychotherapy
Philosophy
Psychoanalytic psychotherapy rests on the belief, voiced by Freud, that we are not masters (or, indeed, mistresses) in our own house. Instead, our conscious intentions are undermined by powerful, largely unconscious, emotional forces. For many people, and for much of the time, these forces show themselves in relatively manageable ways: we sometimes forget disagreeable appointments and we make slips of the tongue so that we find ourselves saying the precise opposite of what we intended. Above all, perhaps, we dream, and in doing so enter a strange world which yet seems to have a meaning of its own.
If we are less fortunate, we may be constantly caught up in internal conflict, or plagued by phobias or obsessions that no amount of rational thought or exertion of will seems to control, or we find ourselves in disagreeable or dangerous situations that bear a disconcerting likeness to similar situations in the past.
In Freud’s and Klein’s scheme of things, and in that of their followers, the human infant is born in a primitive and fragmented state and into an unintelligible world of conflict that is slowly made sense of, largely at first, through a mother sufficiently in tune with him, to shield him and feel with him. Inevitably this relationship is subject to attack, both from the mother’s failures in empathy and from the powerful feelings of the child, the rage and pain and terror occasioned by its helplessness.
Some of these feelings are too early to be thought or verbalised but leave their traces, often physical, on the developing psyche. Later painful feelings and events are repressed, and they too remain alive and active in that area of the psyche that is the unconscious. In our unwitting attempts to overcome the trauma they have caused us we are impelled to revisit them in a myriad of guises, repeating the pain and difficulty of our early relationships.
Psychoanalytic psychotherapy aims to make these unconscious pains and conflicts conscious. It assumes that if the patient is allowed to say whatever comes to mind, the words he uses, his metaphors, images and dreams, the connections between one thought and another will slowly reveal what has been so carefully hidden. Above all, early traumas will be repeated in his relations with the therapist who comes to represent these images, or internal objects, that the child has fashioned out of his early experience of parents and other significant adults. Powerful internal conflicts are thus externalised, made conscious and become capable of being worked through until they lose much of their compulsion. As it becomes possible to find words to express them adequately and to make sense of them, they become domesticated and tamed.
Because the work between patient and therapist is emotionally intense, the therapist needs a clear sense of herself and the capacity to create a firmly boundaried space in which the patient can feel and be safe. For this to be possible, adherence to a code of ethics and practice is absolutely necessary but not, however, sufficient. The therapist’s own therapy lies at the heart of psychoanalytic training, revealing at first hand the ways in which her unconscious mind works and enabling her to identify and understand her own areas of conflict and weaknesses, often including a self-idealisation – which will inevitably be tested in her relations with patients.
All other parts of the rigorous training that therapists undergo – carefully supervised clinical work, wide theoretical reading, infant observation and a psychiatric placement – rest on and are made sense of by the training therapy.
In designing our training, we have kept all the above considerations in mind. Our aim is not only to provide a firm theoretical and clinical basis for the practice of psychoanalytic psychotherapy, but to instil in our students an understanding of the seriousness of their work and the need for the highest ethical standards in their dealings with patients.
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