ALWAYS READ THE LABEL! BUT WHO IS ENTITLED TO DISPLAY THE LABEL "PSYCHOANALYST"?


THE ISSUE

For many years a debate has raged below the surface of psychoanalytic institutional politics; not so much about what constitutes psychoanalysis as about who is entitled to call themselves a psychoanalyst. It is a debate which is, in many ways, unique to this country and certainly has no equal elsewhere in Europe or the wider world-community.

As a result of the failure to face this debate openly, an entirely artificial distinction has arisen in this country between the terms psychoanalyst and psychoanalytic psychotherapist. This distinction is based, not on a genuine difference between psychoanalysts and psychoanalytic psychotherapists but is tenuously based instead on a valid distinction between psychoanalysis and psychoanalytic psychotherapy, as two separate forms of psychoanalytic treatment: a distinction which is both very narrow and about which there is widespread disagreement among psychoanalytic clinicians of all schools. The claim by some has been that each form of treatment is carried out by a different type of clinician: each type having undergone a significantly different form of clinical training. The contrary argument is that both forms of treatment are carried out by the same type of clinician and that all psychoanalytic clinicians will have undergone a training programme whose essential characteristics are, in every material respect, the same. That is not to say that all training programmes are identical. Clearly they are not and differences abound in terms of both theoretical content and rigour.

Of paramount importance for understanding this issue is the fact that both psychoanalysis and psychoanalytic psychotherapy are based on the same underlying theories of psychoanalysis. There is no such thing as a theory of psychoanalytic psychotherapy. There are only the various theories of psychoanalysis.

THE ARGUMENTS

There are two opposing arguments with regard to this issue.

The wider liberal and pluralistic argument

  • That all forms of psychoanalytic treatment, ranging from psychoanalysis to the most supportive form of psychoanalytic psychotherapy, are particular forms of psychotherapy and are part of the whole range of modalities of psychotherapy.
  • That the label psychoanalyst denotes a practitioner of psychoanalysis, trained within one of the numerous schools of psychoanalytic theory: that it is a label for practitioners within the spectrum of psychotherapeutic modalities, rather than one which is outside or beyond that spectrum.
  • That while distinctions can be made within the spectrum of psychoanalytic treatment, ranging from psychoanalysis to psychoanalytic psychotherapy, no such distinction can, justifiably, be made between the terms psychoanalyst and psychoanalytic psychotherapist because:

*The training for each is, in terms of broad underlying principles (if not in detail) identical.
*The range of underlying theories is identical.
*It is not the number of sessions per week or adherence to the other technical rules of psychoanalysis (use of the couch or duration of session) which distinguishes psychoanalysis from psychoanalytic psychotherapy but rather the quality and clinical characteristics of the treatment.
*Prominence is given, in all forms of psychoanalytic treatment, to the interpretation of unconscious material.

On the basis of this argument, the two labels are interchangeable because:

  • A psychoanalyst is also a psychoanalytic psychotherapist and vice versa.
  • Those who choose to differentiate themselves with the label psychoanalyst or psychoanalytic psychotherapist, each, at different times, usually practise both psychoanalysis and psychoanalytic psychotherapy.

The narrower conservative and restrictive argument

  • That the label "psychoanalyst" is associated with only one training-organisation in this country: The British Psychoanalytical Society (BPAS). Therefore, the use of the term by anyone who is not a member of BPAS must imply that they wrongly claim to be a member of BPAS and are, in some sense, dishonest or claim to have a qualification which they do not possess.
  • That only BPAS has the power to train psychoanalysts in this country.
  • That only the International Psychoanalytic Association (IPA) has the power to approve a training programme for psychoanalysts.
  • That a psychoanalyst is a clinician who is quite separate from and therefore distinguishable from a psychotherapist (a view not supported by the Department of Health).
  • That psychoanalysis is distinguishable from psychoanalytic psychotherapy because it can only take place within a five-times-a-week setting.
  • That, because psychoanalysis differs in this way from psychoanalytically-based psychotherapy, two distinct professional labels for clinicians are required: psychoanalyst and psychoanalytic psychotherapist.

The argument would therefore be that those who predominantly practise what is asserted as psychoanalytic psychotherapy, rather than psychoanalysis, or who practise psychoanalysis but have not undergone an IPA-affiliated training, are not entitled to use the label psychoanalyst and should be obliged to describe themselves as some form of psychotherapist.

THE HISTORICAL PERSPECTIVE

The tendency in this country has been for the narrower restrictive argument to predominate. This has, until now, largely given BPAS the de facto monopoly of use of the label psychoanalyst in the UK.

It is, nevertheless, important to recognise that this monopoly has never been absolute. Quite apart from the Lacanians who have always called themselves psychoanalysts, some non-BPAS psychoanalytic practitioners in this country have also always called themselves psychoanalysts.

The predominant tendency, however, does not reflect what goes on in the rest of Europe and the world at large where, although a distinction between psychoanalysis and psychoanalytic psychotherapy is recognised, the only professional label which is recognised is the term psychoanalyst. There is no such profession as a psychoanalytic psychotherapist beyond these shores. Therefore, anyone who practises any form of treatment within the broad psychoanalytic modality is known everywhere else as either a psychoanalyst or an analytical psychologist.

That is what those who support the wider pluralistic argument now seek to establish in this country also. It might, therefore, be helpful to summarise the two opposing arguments as follows:

  • The narrow, conservative or restrictive argument; parochial in attitude, not to say founded on politics and monopoly, and
  • The wider, liberal and pluralistic argument which fits in with the more widely perceived understanding of psychoanalysis within the global community.

Less than half of those who use the label psychoanalyst throughout the world have trained with organaisations such as BPAS and which are also affiliated to the IPA.

Freud formulated the term psychoanalyst to describe a particular form of psychotherapy. He used the term psychoanalyst interchangeably with the terms analytic psychotherapist and therapist. He conceded that anyone who, in psychotherapeutic treatment, interprets transference phenomena within the context of free association and the dynamic unconscious, is entitled to call themselves a psychoanalyst.

In a letter Freud wrote to Grodeck, who expressed reluctance to call himself a psychoanalyst, Freud stated "anyone who has recognised transference and resistance as the focal points of therapy belongs irretrievably to the mad horde". Freud was, of course, referring here to the community of psychoanalysts!

The so-called "technical rules" of psychoanalysis, relied on so heavily by those who support the narrow restrictive argument, formed no part of Freud's thesis. They arose entirely from political motivation: as a convenient solution to a lack of agreement between different factions represented within IPA. These rules have served mainly as a "finger in the dyke" and their real purpose is to preserve an outward appearance of unity between groups with huge and un-reconciled theoretical differences there.

When Jung and his followers broke away from Freud, they chose deliberately to distinguish themselves with a label other than psychoanalyst and chose the label analytical psychologist.

When Lacan was ejected from IPA for challenging the invariable requirement to follow the "technical rules", neither he nor his followers ever stopped using the label psychoanalyst and have always jealously guarded their right to do so.

Apart from the Lacanians, most other psychoanalytic training organisations in this country have, until now, tended to use the label psychoanalytic psychotherapist rather than psychoanalyst; presumably out of some sense of deference to BPAS. In some psychoanalytic training organisations, however, practitioners have tended to use the two terms interchangeably.

THE HEART OF THE ARGUMENT

It is entirely legitimate to distinguish psychoanalysis from psychoanalytic psychotherapy. It is entirely inappropriate to distinguish practitioners of one modality from the other. The term psychoanalyst is an appropriate label for practitioners of either modality and particularly appropriate for those who practise both.

In "The Psychoanalyses and the Psychotherapies: The Talking Cures", Robert Wallerstein throws a fascinating light on this argument. Wallerstein was a former President of both the American Psychoanalytic Association and of the IPA. An impressive source of authority in the field!

In more than 500 pages, he sets out a closely reasoned debate on the distinctions, over time and throughout the psychoanalytic world, to be made between the so-called "pure" (whatever that might mean) forms of psychoanalysis (not just one form, please note, but several) and the different forms of psychoanalytic psychotherapy.

It is instructive to read his account. To quote Wallerstein: "one person's proper psychoanalysis is someone else's psychotherapy". He also describes "psychoanalysis and psychoanalytic psychotherapy as an almost indistinguishable continuum of techniques".

The term psychoanalytic psychotherapy and variations of the term is used on almost every page. Only once, however, does Wallerstein refer to the term psychoanalytic psychotherapist and then only indirectly, within quoted material from a British psychotherapist, who uses that term quite incidentally, rather than as part of any argument relating to the term.

The conclusion to be drawn from all this is very clear. Just because there are some valid (though nevertheless contested) differences between psychoanalysis and psychoanalytic psychotherapy, that does not automatically mean that there is any meaningful distinction between a psychoanalyst and a psychoanalytic psychotherapist. Only someone with a psychoanalytic training can possibly hope to practise either.

Anyone with a psychoanalytic training is entitled to use the label psychoanalyst, just as anyone calling themselves a psychoanalyst is entitled to call themselves a psychotherapist, if they so wish. Many, who one would expect always to call themselves psychoanalysts, do just that. When it serves their interests to do so, they do not hesitate to describe themselves as a psychotherapist or even, sometimes, as someone who offers counselling!

Nor should we allow ourselves to be sidetracked in this argument by the fact that trainings may differ from each other in regard to detail and that some may even be less or more rigorous in some respects. That is irrelevant for the purposes of this argument. What is important are the underlying principles of training which are clearly psychoanalytic and are common to all.

Neither should we take seriously anyone trying to play the numbers game in this debate. Psychoanalysis is not about the number of times-a-week practitioners train or see their patients. It is exclusively about the nature of that training and the clinical treatment.

Joseph Sandler said "if the patient can only attend (or afford to come) once or twice a week then the analyst's technique would be adapted to the patient and his special circumstances. It would still, from this point of view, be regarded as psychoanalysis, because the analyst could maintain that he had internalised a 'psychoanalytic attitude' and that is what counts".

Most psychoanalytic practitioners see their patients across all variations of times-a-week. Almost all see some of their patients once-weekly but, equally, almost all see patients twice and three times weekly, and some four or even five times weekly. That is precisely the range for most practitioners throughout the world who use the label psychoanalyst, including those affiliated to IPA.

The standards by which practitioners are to be judged in this argument are not the standards of any one training organisation or group of organisations.

CONCLUSION

The distinction between the labels psychoanalyst and psychoanalytic psychotherapist is meaningless. It is a distinction which is illusory and entirely political in nature. It is a distinction which does not exist beyond these shores. It is not a distinction which can have any meaning for members of the public and, in particular, for those who seek professional help based on what psychoanalysis has to offer them. For such people, this self-serving and artificial distinction will be entirely unhelpful. It will, at best, remain meaningless and, at worst, cause confusion: a confusion which reflects the painful tensions which now lie at the heart of the psychoanalytic community in this country.

Jacques China

Feb 2004

 

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