Kavanaugh - Developing Competencies in the Destruction of Psychoanalysis: Political, Pedagogical, and Practice Philosophies
Developing Competencies in the Destruction of Psychoanalysis:
Political, Pedagogical, and Practice Philosophies
by Patrick B. Kavanaugh, Ph.D.
(This essay was first presented as part of an invited panel at Division 39’s 27th annual Spring Meetings (’07) in Toronto. The conference theme was: On Clinical Momentum: Time, Process, and Complexity in Psychoanalytic Engagement, the organizing purpose of which was “…to challenge our received understandings of what, in our ways of being with others and with ourselves, propels the forward motion of clinical engagement.” The panelists were asked to speak to the question of Competency in Psychoanalysis: State Regulation, Self Regulation, the Integrity of the Profession, and Who Decides What Counts for Psychoanalysis?)
Although philosophy is generally thought of as the antithesis of psychoanalysis, recent years have witnessed certain foundational questions - philosophical in nature- encircling the analytic community: What is the nature of reality?...of human nature?; and, as suggested by the theme of this year’s meetings, ..of time, process, and complexity in the analytic engagement? Shaken out of our traditional ways of thinking, we are compelled to rethink such metaphysical questions as: How do we know what we think we know? And Just what is it again that we think we know? The medical model of psychoanalytic, for example, assumes a linearized and sequential time flowing like a line dependent of the events it supposedly contains and along which line events of the past occur, then those of the present, then those of the future. Indeed, all scientific processes of the modern era are assumed to occur along this invisible ‘line’ of linear time (Slife, 1995; 1993). Such linearized assumptions of time and place laid a deterministic foundation in analytic thinking in which past trauma psychically determines, of necessity, present symptoms.
In the positivist tradition, temporal succession and spatial proximity are axiomatic assumptions in arriving at causal explanations, e.g., what happens in the present and what will happen in the future results largely from what has happened in the past. As our assumptions of a linear and sequential time are brought into question, the non-linear nature of time, place, logic, and causality are fore-grounded as we consider the incredible complexity of the psychoanalytic process in which experiences of the past and future might coexist, co-determine, and co-structure the present moment of the future-past (Kavanaugh, 2003; 1999a). Philosophy converges with psychoanalysis in challenging our assumptions about the nature of time, process and complexity and how they influence: how we might listen, understand and respond in the analytic moment; our notions of science and process research; and, how we might think of competency in psychoanalysis.
This essay calls into question the question of Competency in Psychoanalysis in our industrialized cultures. Its premise is that culture and psychoanalysis are inseparable; its thesis is that our highly technocratic and industrialized culture produces: the image of the analyst, the version of psychoanalysis, and the concept and measures of competency most needed by the culture. Further, that the image, the version, the concept, and the measures are changing as we transition from the Industrial to the Information Age. Indeed, one of the unspoken presiding questions currently before the analytic community is: Do the meanings and measures of Competency in Psychoanalysis, originating in a late 19th century worldview, continue as the unchallenged templates for evaluating the analyst’s competency in the 21st century?
Cultural Context and the Question of Competency: In the emerging worldview of the 21st century, the world is seen as operating in a random fashion about which we can only speak in terms of probabilities, potentialities, and possibilities. The fixed, stable and predictable world of modernity has transformed into a world that: exists in a state of continuous flux; consists of a fabric of invisible relations; and in which world, the events of everyday life are understand as irreducibly complex phenomena (Barratt, 1993). As we enter the 21st Century, we find that the natural order of things is not as natural as we had once thought, nor is it in the order we have so readily assumed. And in the analytic culture, we have come face to face with how little we know about that which we have been so certain for so long; that which brings about change is not as obvious as it once seems to have been. Indeed, we gather this year to challenge out received understandings about what in our ways of being with others and ourselves propels the forward motion in the analytic engagement. And, our purpose in gathering invites the question, Are we not compelled to also challenge our received understandings of competency in bringing about –or, in participating in the process that brings about- such changes?
Our concept and measures of competency are deeply rooted inn the worldview of the early 1900’s in which view: the world was seen as fixed and stable; reality unchanging and predictable; and, adaptation to the status quo was the contextualizing value of psychoanalytic education and treatment. During the 20th century, adaptation to a nmind-independent and self-evident world was a largely unquestioned aspect of the natural order of things in psychoanalysis. In the fixed, stable, and predictable world of the Industrial Age, the evaluation of competency in psychoanalysis centers on the candidate’s mastery and application of received knowledge(s). In education, competency is concerned with the question, Has the candidate actually learned what the training program says they are teaching them? Prior to graduation, educational competency is determined by evaluating, through written and oral examinations, the candidates master of knowledge(s) received through their coursework, supervision, and training analysis which, often times, is the central method of teaching and learning, longstanding whispers of discontent in the analytic community notwithstanding. And practice competency is concerned with such questions as, How effectively do we do what we say we do? And, more recently, Does the treatment we offer bring about the theoretically anticipated outcome in ways that are both time- and cost-effective? Practice competency is determined by evaluating the effectiveness of the candidate’s application of this knowledge via the supervisory process and successful therapeutic outcomes of control cases.
Outcome-based education and treatment have provided the demonstrable evidences of both educational and practice competency since the founding of the Berlin Institute in 1922. And they still do as we enter the 21st century. Knowledge(s) received for the candidate’s mastery and application are premised on the linearized assumptions of time, place, logic and causality that were prevalent at the turn of the 20th century. If the concept of competency in psychoanalysis continues to rest on such assumptions, do we not fail to match our understandings of competency with out more contemporary psychologies of psychoanalysis, many of which rest on different and non-linear understandings of time, process and complexity in the analytic engagement?
Who decided what counts for psychoanalysis? …the State or the Self?
One cannot travel too very far in considering the question of Competency in Psychoanalysis before entering the intersection where the beliefs, values and attitudes of the clinical and culture interface. And in this intersection, the question arises, Who Decides What Counts for Psychoanalysis? In competency determined by state regulation? or, by self-regulation?, and How is the integrity of the profession impacted if it is the state – as opposed to the individual- that decides?
By history and politics the Institute –and more recently, the Institute in partnership with the State- decides what counts in psychoanalysis. The precedent was first established in the winter of 1923-24 when the training committee of the Berlin Society imposed standards and regulations on the learning activities and experiences of the candidates (Safouan, 2000). In so doing, the responsibility for determining the candidate’s competency shifted from the individual –where it was situated in the earlier Vienna model- to the Institute in the Berlin model. And psychoanalysis became institutionalized. Further, this precedent became integral to our pedagogical philosophy, e.g., the institution’s rationality and oversight is needed –indeed, ethically required- to ensure that the good and the right takes place in education and training; a sovereign entity must develop the rules and evaluate matters of competency in each phase of the candidate’s education and training. Otherwise, the candidate, it is assumed, would be totally incapable of developing a responsible and reasonable mode of self-instituting analytic training. Thus, in the best interests of psychoanalytic education and training –and also, to protect the public-, it is necessary for the Institute to decide what counts for psychoanalysis. And a triumph of triangulation prevailed between the training analyst, the institute, and the candidate. The other-as-third became and integral aspect of institute education and training. …And, the beat goes on as the responsibility for determining competency continues to rest with the State and our educratic institutions as we move into the 21st century.
In the summer of 2001, the Consortium, - a group consisting of, arguably, the major players in organized psychoanalysis – advanced the most recent institutional definition of competency in psychoanalysis with their adoption of national health-care accreditation standards for education and training. In so doing, they defined a rather narrow, circular, and restrictive definition of psychoanalysis. What is psychoanalysis? …a healthcare profession, or a specialty thereof. What is psychoanalytic education? … the demonstrated competence of those educational experiences taking place in an institute that meets healthcare and accreditation standards; and, Who is a psychoanalyst? … a mental health professional who successfully completes the education and training requirements and graduates from an accredited institute. And despite our celebration of diversity in contemporary psychoanalysis, all graduates must demonstrate their mastery of core competencies as a mental health professional who has acquired a ‘culture of evidence’ perspective about behavior based on scientific inquiry and reasoning, replicable methods of observation and measurement, and interpretation of qualitative and quantitative evidence. A science and pathology-driven model of understanding people continues to: provide the standards for education and training; produce the psychoanalyst as a mental health professional; and, prescribe the core competencies to be mastered and measured in order to receive a government-issued license to practice. And, the triangulation between analyst, analysand and institute legitimized in the winter of 1923-24 interweaves with an equally complex triangulation of the training analyst, the institute, and the government legitimized in the summer of 2001. …And the beat goes on as the analyst/analytic practitioner moved from the educational to the practice community.
Upon receiving a state-issued license authorizing analytic practice, evidences of continuing competencies –or, continuing professional development programs, as they are most recently referred to- are demonstrated by fulfilling mandatory continuing education requirements for license renewal. Indeed, under the social contract the state has the moral responsibility and legal authority to assume the role of protecting the public, if necessary, through such measures as legislation and regulation, developing industry-wide standards, and licensing service providers. And wrapped in the cloak of protecting the public, the state now requires: evidences of competency in the education of the analyst as a healthcare provider (the production phase); evidences of continuing competencies in the delivery of their services (the distribution phase); and most recently; evidences of the efficacy of the services provided (the consumption phase). In the current era of assessment and accountability in healthcare, the issue of competency is ultimately determined by evidence-based strategies linking outcome and cost-effective research in both education and practice (Keisler, 2000). And the State’s involvement in deciding what counts in psychoanalysis is deeply embedded in –and, endorsed by- the socio-political-ideology most dominant in the analytic culture.
Who Decides What Counts for Psychoanalysis?
the State, the Analytic Community, and Socio-political Ideology
Any given ideology contains its own distinctive worldview, forms of rationality, and set of core beliefs and values by which a political group or social movement might understand and interpret itself. In the United States, the liberal and conservative ways of thinking are two of the most prominent socio-political ideologies. They can be described as “…representing two distinct conceptions of moral authority, …of apprehending reality, …of ordering experience, (and) of making moral judgments” (Redding, 2005, 304). And further, as differing on their respective understandings of: human nature, the effective remedies for social problems, and the extent to which individuals are responsible for their own life and life circumstances. As opposed to a political conservatism, liberalism is usually seen as representing progressive values, an emphasis on community, and as supporting government-sponsored programs designed for the larger good.
In the liberal tradition the freedoms and responsibilities of both citizens and professionals are defined exclusively from within the social contract; individual freedoms, rights, and responsibilities ultimately derive from the collective interests. The liberal tradition assumes that without the elevation of the collective’s interests over the individual’s, the social contract would break down and there would be a generalized collapse of society into amoral chaos. Thus, the liberal’s worldview structures the relationship between the individual and the state in such a way that the State has the legal authority and moral responsibility to oversee matters as they pertain to the individual (Kavanaugh, 1999b). In the liberal’s worldview, the State is the Who that Decides what counts in Psychoanalysis; the State’s regulation of the analyst is: authorized by the social contract, defined by the interests of the collective, and embodied in the codification of law and ethics. And in the United States, a liberal ideology has been a most powerful voice in developing those policies that Decide what counts for psychoanalysis during the 20th century. And continues to do so as we enter the 21st century.
In their recent book, Destructive Trends in Mental Health: The Well-Intentioned Path to Harm (2005), Rogers Wright and Nicholas Cummings argue for a re-evaluation of the practices and policies of professional organizations in the mental health field. Wright and Cummings are two self-described life-long liberals with distinguished careers as psychologists and leaders in the American Psychological Association (APA). In their book, they assert that the socio-political views guiding the research, advocacy, education, and practice of the mental health professions are most often liberal. They warn that psychology, psychiatry and social work have been captured by an ultra-liberal ideology, the agenda of which has trumped science at the highest levels of decision-making in the APA. And Richard Redding, an associate professor of law at Villanova University and associate professor of psychology at Drexel University, elaborates…
Although psychology celebrates diversity, which has come to be one of the profession’s core values …and strives to be inclusive by recognizing the value and legitimacy of diverse beliefs, the profession lacks socio-political diversity. Most psychologists are politically liberal, and conservatives are vastly underrepresented in the profession. (Redding, 2005, 303)
The lack of ideological diversity in our leadership and governance bodies persists despite the ideas that are quite clearly espoused in the APA’s ethical code urging psychologists to be sensitive to those cultural differences and biases that contribute to perpetuating a socio-political point of view that might exclude or oppress the perspectives of others. And operating in opposition to the profession’s core ethical principles regarding diversity has had devastating consequences for the profession and practice of psychology.
It biases research in social policy issues, damages psychology’s credibility with policymakers and the public, impeded serving conservative clients, results in de facto discrimination against conservative students and scholars, and has a chilling effect on liberal education. (Redding, 2005, 304)
A liberal ideology has biased research on social policies that are at the forefront of the culture wars specific examples of which include: exploring the relationships between: authoritarianism and conservatism; political psychology and restorative justice; and, adolescent competence in making birth control and abortion decisions. Other areas of liberal bias in social policy research, they assert and document, include: racism and affirmative action; welfare and school busing; individual v community rights; and, gay and lesbian parenting. Wrapped in a ‘radical and extreme form of political correctness,’ a supposedly empirically- based professional organization –the APA- has been taken over by an ultra-liberal agenda. And often times, this agenda is advanced in ways damaging to psychology’s credibility with both policymakers and the public.
A series of very difficult questions awaits the analytic community: Have our psychoanalytic organizations –including Division 39- been captured by an ultra-liberal worldview? And if so, How has its agenda impacted our professional standards in education and practice? As a political ideology, conservatism is usually seen as representing traditional values, an emphasis on self-reliance, and fierce opposition to government-sponsored programs. A conservative ideology, however, is vastly under-represented in psychology --- our ethical commitment to diversity notwithstanding. Those of a conservative ideology probably oppose the state’s oversight in matters of Competency in Psychoanalysis while those of a liberal persuasion probably expect, endorse, and support the state’s oversight in Deciding What Counts in Psychoanalysis. As we enter the 21st century, we do so with a noteworthy lack of diversity in: our intellectual and conceptual foundations; our pedagogical and practice philosophies; and, the socio-political ideologies of our leadership and governance bodies. As to the question before us: the State and the Institute –as opposed to the individual- constitute the Who that Decides what Counts for Psychoanalysis.
On Developing Competency in the Destruction of Psychoanalysis:
Moving Into the 21st Century
Our traditional ways of perceiving, thinking about, and coming to know the world have been changing profoundly and irreversibly over the past century. The intellectual upheavals of the twentieth century have led to what Barratt describes as a collapsing of the master discourse that has regulates our human affairs over the past four centuries (1993). And this irreversible process of collapse has been seeping into the epistemological fabric of the analytic culture, forcing us to reconsider our largely unquestioned assumptions about the nature of reality, …of human nature, and …of time, process, and complexity in the analytic engagement.
Over the past thirty years, a synergetic process of challenging and questioning our received educational and practice philosophies has generated the rich diversity of psychologies that characterize contemporary psychoanalysis. These psychologies premise different understandings of human nature, posit different methods of knowing about people, have very different understandings of the unconscious; and, assume very different purposes and outcomes of the analytic discourse. The core competencies of a mental health professional do not match, however, with what constitutes competency in many of these psychologies. The assumptions of a healthcare model simply do not apply. By acting as if they do, the illusion is created that the demonstration of competency as a mental health professional is somehow related to –or, is the equivalent of – Competency in Psychoanalysis. And representing this illusion of competency to the public seems rather disingenuous, at best. As the monolithic psychoanalysis of modernity slowly fades into he archives of Times Past so, too, do our positivist’s understanding and measures of competency.
Questioning the assumptions underlying our received bodies of knowledge challenges the natural order of things in the analytic culture. It disturbs the complacency and certainty encouraged by our medical traditions, positivist framework, and linearized ways of thinking. And in so doing, we continue developing competency in the continuous destruction –and renewal- of psychoanalysis as theory, epistemology, ethics, education, and practice as we move into the 21st century. Our measures of competency in psychoanalysis, however, do not match –and, never have in my opinion- with the defining concept of psychoanalysis: the unconscious which, in contemporary psychoanalysis, is perhaps more precisely thought of as… the unconscious as conceptualized by: …the Freudians, the Jungians, the Kleinians, the Lacanians, the Kohutians, the Winnicotians, the relationists, the intersubjectivists, and those who speak from an existential, phenomenological, or other philosophically based paradigms – to name just a few. If it is the individual therapist or unique relationship and not the mastery and applications of received knowledge(s), techniques or procedures that propels the forward motion of the analytic engagement, are we not ethically compelled to match our educational philosophy and objectives with our respective theory of the unconscious—however it is understood to be? And given our conceptual diversity, does not the definition and measures of competency in psychoanalysis necessarily depend on the particular understanding of psychoanalysis in questions, be in Kleinian, Lacanian, Freudian, or …whichever?
In the time remaining, I would like to consider with you the following proposition: psychoanalysis as an institutional system is to the modern era as psychoanalysis as process to the postmodern. In this consideration, I will speak to: some of the characteristics that differentiate a process from an institutional perspective; a process view of psychoanalysis that rests on Freud’s initial and intuitive concept of the unconscious as representation’s other; and lastly, the question of Competency in Psychoanalysis given this understanding of psychoanalysis.
In contrast to an institutional system, psychoanalysis as process: stands outside the linear and sequential assumptions of the natural sciences; exists in a non-linear matrix of time, place, logic, and causality; and runs counter to –indeed, defies- its own institutional systematization (Kavanaugh, 2005; 2003). As process, psychoanalysis is positioned to continuously question its own received assumptions, knowledge(s), and socio-political ideologies; its discourse is a discourse on discourses which includes questioning the underlying assumptions and formations of its own discourse (Barratt, 1993). Such positionality involves -indeed, requires- the analyst be like a mind-poet who is 100% outside the process while, at the same time, be 100% inside the process. And at the same time, be neither inside nor outside as there is no outside or inside. This rather mysterious process leads to unimagined and unpredictable outcomes, limited only by its ‘possibility of possibilities.’ As process, psychoanalysis is filled with conflict, dilemma, and the paradoxical and …
Runs contrary to everything we are taught is the logical, rational, ‘scientific’ way to
acquire knowledge. Yet it is only through using such an apparently illogical and subversive method that the patient’s psychic truth can be articulated, a breakthrough not only in the treatment of pathological structures of thought and character, but a revolution in the mind’s access to its unthought forms of knowledge.
(Bollas, 1999, 63)
As process, psychoanalysis radically challenges the accepted and acceptable criteria of judgment, the entire tradition of ‘right-minded’ or ‘appropriate’ thinking, and does not posture as a modern science; that is, as professionalized, standardized and technocratic (Barratt, 1993). As process, psychoanalysis: speaks to a way of being, presencing, and knowing; envelops an emotional, intellectual and ethical attitude that guides its unique ways of thinking and speaking; and, has as its only purpose the furthering of the associative-interpretive process. In its radicality, the associative-interpretive process is a discourse that questions every act of establishment in ways that are both scientific and emancipatory, freeing the knowing and being of the human subject (Barratt, 1993). Psychoanalysis as process radically influences how we might listen, understand, and respond in the analytic moment; shapes our notions of science and research; and, suggests how we might think of Competency in Psychoanalysis in the 21st Century.
The Question of Competency from a Process Perspective: Understanding psychoanalysis as…a venture into communication via the associate-interpretive process in a contextualizing metaphor from the performance arts, e.g., the psychic theatre of the mind (Kavanaugh, 2010 (in press); 2009 (in press)), resituates its conceptual foundations in philosophy, the humanities, and the transformative and performance arts. And this understanding structure very different implications for what constitutes competency in psychoanalysis. From this perspective, competency centers on the questions: How well can the analyst be with self and other as the other (of self) speaks from the stage of their private theatre? And, How well can the analyst step out onto that stage and speak the inexplicable in ways meaningful to the other? Thus, from this perspective, practice competency is understood as,
…the implicit internalized knowledge of a language that the speaker (the analyst) possesses and that enables the speaker to produce and understand the language (being spoken by the other).
(emphasis added, Webster’s College Dictionary, 1999)
In this synthesis and practice of psychoanalysis, practice competency is inextricably linked to the complex process of listening, understanding, and responding to the language of the unconscious of self (of other) and other (of self), a language which is, at once, the primary source of knowledge in and the primal linguistic of the analytic discourse. As a performance artist (in the theatre of mind), the analyst performs her or his interpretive act in which competence is inextricably linked to the wording of the unthought known in ways that are, at once, meaningful for the client and further the associative process. In so doing, the analyst fulfills the mutually agreed upon purpose for meeting: to understand and translate the language of the unconscious of self and other in ways meaningful to the other (of self). Such translations are necessarily spoken from the analyst’s ways of being with self and other.
This synthesis of psychoanalysis rests on Freud’s initial and intuitive understanding of the unconscious as life, affectivity, or the life force, as understanding that did not –and, still does not- fit with our received philosophical, scientific, or medical paradigms. Their underlying assumptions simply do not apply. In its radical phenomenality, the concept of the unconscious understood as the life force cannot be stated, taught, or learned within our more traditional worldviews, and hearing and speaking its language cannot be mass-produced in the classroom, mass-distributed in supervision, or mass-consumed in the training analysis. Understood as life, the conceptual singularity of the unconscious places psychoanalysis outside of the classical worldview and the scientist’s symbols (Kavanaugh, 2006), Freud’s later declarations to the contrary notwithstanding (1937).
If it is the individual therapist or unique relationship that speaks to a knowing, being, and presencing of self with other then what are the meaningful measures of competency –if any? How is competency measured if the unconscious is understood as an ontology of life that emphasizes the process nature of our lived-experiences in which unrepresentability, invisibility, and formlessness are core characteristics? What are the implications for competency if the defining aspect of psychoanalytic, e.g., the unconscious as process and dynamic, is understood as representation’s other? or, the life force? Irrespective of one’s particular understanding of the concept of the unconscious, however, the more immediate questions remains: Do we continue into the 21st century conceptually tied to our received notions and measures of competency that trace their genealogy to a 19th century mechanistic view of the world and people?
The reexamination of our notions of Competency in Psychoanalysis involves the question of freedom and the freedom to question the natural order of things in the analytic culture and the analytic engagement. Developing competency in the ongoing destruction –and renewal- of psychoanalysis is premised on the questioning and challenging of our received assumptions, knowledge, and wisdoms in psychoanalytic epistemology, ethics, education, theory and practice. And there is a pressing urgency to do so. Our institutions remain rooted in a 19th century worldview and structure; our pedagogical philosophy, model and strategies have remained virtually unchanged since 1922; and, our standards of practice and care are organized around theories that gratuitously assume that people are the helpless passive victims of their life circumstances.
If, as Douglas Kirsner suggests, psychoanalysis is a basically humanistic discipline that has conceived and touted itself as a positivist science while organizing itself institutionally as a religion (Unfree Associations, 2000), then is it not time to unabashedly acknowledge to ourselves and the larger community that we form our own community of practice; hold our own views of human nature of which the unconscious is central and defining –however it might be defined; and, that we hold a process perspective in which relational phenomena are fundamentally irreducible. Further, psychoanalysis as process is not premised on assumptions that can be measured by traditional natural science criteria, however modified to appeal to business, governmental and educratic entities which think in medical model terms (Bohart, 1997). As a humanistic discipline premised on a non-linear metaphysics and postmodern constructivist epistemology, the mechanistic assumptions of the natural science model simply do not apply. From a humanistic perspective, outcome is highly ideothetic, the value of which is best judged by the participants in the process who are, ultimately, the only ones Who Can Decide What Counts For Psychoanalysis…
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(2003) The Dead Poets Society Ventures Into a Radioactive Psychoanalytic Space. The Psychoanalytic review, 90, (3) 341-361.
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Redding, R.E. (2005) Sociopolitical Diversity in Psychology: The Case for Pluralism. In Destructive Trends in Mental Health: The Well-Intentioned Path to Harm. Routledge, Wright, R.W. and Cummings, N.A. (eds), New York 303-324.
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Dr. Kavanaugh is a former president of the International Federation for Psychoanalytic Education, the Academy for the Study of the Psychoanalytic Arts, and the Michigan Society for Psychoanalytic Psychology. He has presented and published in local, national and international forums. Currently, he is the Philosopher in Residence (in Psychoanalysis) at the Center for Psychoanalytic Study (Chicago). He teaches, consults and is in the private practice of psychoanalysis in Farmington Hills, Michigan.
Dr. Kavanaugh offers a continuous series of seminars at his office for interested professionals, the theme of which is: The Stories of Our Lives. The focus of this series is on the process of listening, understanding and responding in the context of process material; the emphasis is on unconscious process and dynamic as experienced and expressed in the stories told and retold in the analytic space. For those interested, he can be contacted at: (248) 626-6460.