BPAS - Who Speaks for Psychoanalysis

This article was first published in the Bulletin of the British Psychoanalytical Society.

Introduction.

Early in 1997 I was asked by David Myers of the Lincoln Clinic and
Centre for Psychotherapy to speak along with him, Haya Oakley, and at a
Saturday morning meeting of T.H.E.R.I.P. My brief was to be brief, speaking
for 15-20 minutes. Like Vic Sedlak, I was very pleased to have some
colleagues at the meeting. The focus of the discussion was the single
member issue in the BCP, which had still not been finally resolved. As it is
now, the issue was a hot potato, and the main charge against us (The BPAS (eds))
was that we are an elitist organisation which uses its tyrannical power to
influence our colonies in the BCP.

Mike Brearley

Who speaks for psychoanalysis? The UKCP/BCP debate.

To start plainly: in my view, in this country it is the British
Psychoanalytical Society, or if you prefer, the Institute of
Psychoanalysis, that speaks for psychoanalysis, as it has done for 78
years, rather as the BMA speaks for the medical profession (though
without its legal backing).

Many people speak about psychoanalysis, academics, sociologists
etc.; just as any number of people speak about medicine. Psychoanalysts
have much to learn from such debates, and have been too reluctant to
involve themselves in them.

Most people in the fields of medicine, psychotherapy, and psychology
accept our exclusive right to this title. It was recognised by the
medical profession several decades ago. Jungians accept it and have
their own title -'Analytical Psychologists', which we also respect. So
do psychoanalytical psychotherapists. We regard the matter as serious
enough for us to require our own students to sign a disclaimer to the
title until they have qualified.

We think that those training institutions which encourage their
graduates to call themselves 'psychoanalysts', and thus claim the right
to speak for psychoanalysis, are taking advantage of our name, despite
differences in selection, training and possibly in the nature of the
treatments offered.

For the public the whole field is confusing, and this makes it
important that care is taken with the terms used. We say that the label
'psychoanalyst' implies certain things about the training: that trainees
must have had clinical experience, whether as doctors or as other
professionals, or have carried responsibilities for the development or
welfare of individuals. If they have had insufficient psychiatric
experience, in close contact with patients, they are required to obtain
this. They must have a long personal analysis, five times a week, with a
training analyst - this is the most important part of the training. The
course also includes infant observation, theoretical and clinical
seminars over at least three years, as well as seeing two patients, five
times weekly, each under weekly supervision, one for at least two years
and the other for at least one year.

Moreover, the Institute has an effective ethical code and means of
dealing with complaints. It offers further training, after Associate
Membership, for Full Membership, and a second training, in Child
Analysis. The culture of the organisation strongly encourages further
post-graduate education, whether through more analysis or through
supervision, consultation and clinical seminars with colleagues.
The British Psychoanalytical Society belongs to the International
Psychoanalytical Association, which scrutinises standards of existing
and prospective member-organisations.

The label 'psychoanalyst' implies, in our opinion, in this country,
membership of a Society which has included amongst its members Anna
Freud, Klein, Winnicott, Bion, Segal, the Sandlers, Stewart and many
others who have pushed forward everyone's understanding of the human psyche.

However, our topic today is sub-headed 'The UKCP/BCP Debate'. What I've
said so far would apply if neither of these organisations existed.

So I take it that there's a wider question that we're debating today,
which could perhaps be formulated: 'Who should represent psychoanalysis
and psychoanalytic psychotherapy?'

I will try to say why, according to me, the BCP has been set up as a
more specialised organisation than the more generally representative
UKCP. To do this I wish to stress some of the differences between
psychoanalytic psychotherapy and many forms of therapy included in the
UKCP, in terms of which this decision makes sense.

Psychoanalytic therapists believe that everyone is self-deceived; we
don't want to know about feelings, wishes and thoughts which enter into
our relationships with other people and with ourselves. Indeed it is not
strong enough to say that we don't 'want to know'; rather we have
actively avoided knowing, and continue to do so. Moreover, these swathes
of unconsciousness are the source of much unhappiness and lack of
satisfaction in life, from depression, anxiety and a sense of futility,
to more psychotic areas of dissociation and delusion.

Of course, all of us in this room would maintain, sincerely and
virtuously, that we are eager to know ourselves, but when it comes down
to unpleasant details - a contemptuous attitude to our partners, a
momentary and instantly elided flare-up of hostility or even hate
towards our children, or an unbearable stab of jealousy when someone
pays attention to a third party and ignores us - we, like many others,
find it irritating and hurtful to be told that we are being these
things, contemptuous, hating or jealous; and then we're liable to get
self-righteous, or complaisant, or sadistic or over-humble. We resist
self-knowledge for the same reasons that we repudiated it in the first
place. These resistances are powerful, and partly explain the length and
difficulty of analytic therapy.

Secondly, the analytic therapist is concerned to foster and bear with
the feelings aroused in relation to him or her self. As you all know,
but it's worth mentioning in this context, abstinence and a degree of
detachment are called for in order to create a relatively uncontaminated
field for the patient's unconscious and childish emotions and defences
to appear in the transference.

Analytic therapists have a difficult task in eschewing gratification
for the patient, and we also have to try to avoid falling into the
temptations of various kinds of gratification for ourselves. It would
often be easier and feel more natural for us to react to patients'
suffering by plain sympathy, and to their manipulations either by
collusion or in a judgmental way. It is never easy simply to observe,
and sometimes describe, what the patient is doing or feeling, and what
is evoked in ourselves.

It is hard to bear with the archaic feelings, whether negative or
idealising and erotic, directed to ourselves, that the process releases,
without losing our analytic attitude. The therapist needs to be
perceptive, self-aware and courageous to feel and know such attitudes in
their full force, and to stay with the consequences of interpretation.
We also need to be able to tolerate our imperfections.
Since psychoanalytical therapy is based on these familiar theoretical
pillars of the unconscious, of resistance to knowledge, and of
transference, the practitioner needs qualities, both inherent and
learned or developed, which are very different from those required by
therapists who do not set themselves and their patients so radical a
task. Analytic therapy aims at an understanding of the whole person. It
is not satisfied with the removal of symptoms, an achievement which is
not sufficient for the changes looked for.
It is for such reasons that the selection, training and standards of
those working analytically need to be so particular and so thorough, and
may have little in common with those required for other kinds of therapy.

The UKCP represents a very wide range of professionals of whom only a
small proportion are involved in the kind of work I've been describing.
For those who are not analytically oriented, standards of training and
ethical attitudes to patients are of course essential and need
protecting. The public deserves all the safeguards and clarification it
can get.
However, psychoanalysts and those analytic psychotherapists who have
banded ourselves together as the BCP believe that the peculiarities of
our work are sufficiently pronounced to make us feel more comfortable in
joining together as close neighbours, who share much in theory,
technique and in the kinds of training we undergo.

Once the BCP was mooted seriously ,an obvious problem arose: Where
should lines of eligibility be drawn? Clearly some more or less
arbitrary line is necessary, to distinguish trainings which offer a
substantial enough experience of psychoanalysis or analytic therapy to
make it likely that the trained therapist will be able to perform the
task of recognising and describing the unconscious at work in the
patient, and of permitting and bearing its repetition and enactment in
the treatment.
I see no way of avoiding the drawing of lines. One advantage of
making the requirements rather stringent is that some training
organisations outside the BCP may, whether or not they wish to apply to
join it, increase the amount of treatment called for in their trainees,
and make their training courses more exacting.

We in the BCP do not wish to proselytise amongst training
organisations. We say that if others wish to join us they must meet
certain requirements in their trainings and in their ethical standards
and appeals procedures. If they are happy in the UKCP that's fine by us.
Like the UKCP the BCP is an organisation whose constituent bodies are
organisations, not individuals. BCP represents these bodies. We believe
that such representation cannot properly happen if these bodies are
members of both umbrella organisations. For the BCP and UKCP may of
course take different views on certain issues, and when this happens the
BCP cannot represent a member forcibly if that body is also being
represented by the UKCP.

BCP's member-institutions have as a whole consistently voted in
favour of this 'single member policy'. This is a vote for registration
and representation with a body which stands clearly and solely for the
interests and beliefs of psychoanalytic therapy; and reassures and
informs the public about us and our type of work.

Finally, is the BCP an elitist organisation? If this means do we
believe in something special and excellent, the answer is yes. If it
implies that we look down on other forms of therapy, or on less
intensive work, I think the answer is no. What we believe in is both
valuable and very difficult; it needs constant nurturing, research and
improvement. The whole business is, after all, quite young. We believe
that intensive psychotherapy, by an intensively trained therapist,
offers treatment of choice for many patients. It offers the best chance
of radical change.

A person who has been intensively trained along these lines may or
may not be better equipped to offer short-term and/or less intensive
treatments. He or she may be capable of perceiving unconscious dynamics,
but less good at making best use of limited time. And who can quantify
and balance out the good done by an excellent short-term therapist who
perhaps treats 100 patients a year against the good done by an excellent
analyst who sees ten?

I will end, if you will forgive me, with an analogy. It is only
partial. In the world of cricket there are those who favour one-day
cricket and those who favour five-day cricket. Others favour three-day
cricket. One-day cricket appeals to a wide audience. It is fast,
exciting and athletic. Five-day cricket is often slower, but its
aficionados claim that it offers the widest possible range of cricketing
skills, and that when such a match is close, the tension is that much
the greater. When a match stagnates, the boredom is much greater, too.
Five day therapy also offers the widest possible risk of stagnation,
whether induced by patients' resistances, or by the analyst's
shortcomings; but it also at best is a treatment for the widest possible
range of character traits and unconscious qualities.