PART 1 - ANALYSTS AND CANDIDATES FROM THE EAST
by Annalisa Amadori, Forlì


To complete psychoanalytic training, personal analysis is fundamental. It must be carried out according to IPA criteria and should also be understood as an essential formative moment. Analysis is not only a “due” requirement for training but could be undertaken with a personal motivation to get closer in touch with oneself. We are the instrument we work with, therefore analysis helps us to know ourselves so that we can feel what happens in the relationship with the fewest possible interferences.
The distinctive feature of analysis compared to psychotherapy is the work with transference and countertransference. This can be more clearly understood by the analyst thanks to their own personal analysis. The importance of these aspects was emphasized by Winnicott with the concept of “holding” and by Bion with “containment” and “capacity for rêverie”.

Let us clarify some concepts. Transference is the process through which the patient unconsciously transfers onto the analyst’s feelings, desires, expectations and relational models originally experienced towards significant figures from the past. This creates a state of temporary dependence which aims to allow the achievement of a state of greater autonomy. Countertransference is the set of emotional, affective and unconscious reactions the analyst experiences towards the patient during treatment. It originates partly from the emotional reactions transmitted by the patient to the analyst and partly from the analyst’s reactions arising from his personal history.

Holding is a concept related to the care of the newborn which allows them to feel safe and to develop a sense of continuity in their own being. In psychotherapy the experience of psychological holding creates a stable and predictable environment, accepts the patient’s emotions without judgment. It contains anxieties and difficult experiences and fosters a climate where the patient can explore aspects of himself. Rêverie is the mother’s disposition to be open, receptive and intuitive towards the child’s mental states and to react to them with her own fantasies and associations. With the patient this means listening without rigid schemes, being receptive to emotions, tolerating uncertainty and confusion and transforming these experiences into interpretations that favor understanding.

Psychotherapy is focused on the symptom, analysis on inner conflict. Thanks to self-knowledge the analyst can make a mature object of investment in the therapeutic relationship and feel respect for the patient. It learns not to react to what the patient brings, but registering within himself what the patient evokes in order to give meaning to the contents. Analysis is made possible by the encounter between two unconscious minds. In the mother-child relationship, there are areas of fusion that allow for shared mental spaces. In this space, the mother inserts her apparatus “for thinking thoughts” and contains the child’s emotions. With growth, an internalization of this function by the child will occur, who will them be able to gradually achieve a more mature mental functioning. The experience of containment is determined by the mother through her function as a good container. When the newborn experiences primitive emotions and mental states (anxiety, fear, hunger) that he is unable to process, he projects them into the mother through projective identification. The function of containment, which also occurs with the patient, is to receive raw emotions, understand them, transform them mentally and return them in a tolerable and thinkable form.

From a technical point of view, it is necessary to let the patient’s discourse flow freely without focusing on rational aspects nor responding on a concrete level. It’s important to listen internally to the conscious and unconscious communications that the patient brings. The focus of analytical work has gradually shifted from the initial tendency to shed light on the repressed past in the unconscious to the “here and now” that is to what happens between patient and analyst.

Freud’s method of free associations is the basis of analysis and psychotherapy. In analysis, however, interactions are scarcer. The patient’s free associations allow material that is seemingly irrelevant or incongruous to be brought to light and becomes the subject of analysis and allowing one to go deeper. The analyst’s mind also functions through free associations during the session and in subsequent associations. Memories and insights from the session come to mind a posteriori, allowing further meanings to be grasped. From these aspects, we also understand how analysis is neither rationalization nor pedagogism, but the reconstruction of the patient’s history and its meanings. Reconstruction is a path taken by two people which allows new mental representations to be reached.

Analytical identity is based on three factors: the relationship with the unconscious, creativity in connecting primary and secondary processes and the relationship with language. It is understood as the capacity to play within communications made of words and silence developing the ability to use symbolic thinking. It is also necessary to listen to the patient’s silences, which may contain a level of mostly unconscious communication.

The analytical setting is a constituent element of therapy. It is formed of various aspects: first of all, it involves a concrete and organizational framework which defines the space and the time for the analysis to take place. The space is the consulting room (cozy and intimate) where the treatment occurs. The setting is characterized by the frequency and duration of the sessions using relationship criteria that also include the rules and the professional’s fees.

Secondly: the internal aspect of the setting is provided by the analyst’s ability to maintain neutrality. The analyst’s attitude necessarily requires abstinence, meaning neutral and unknown as possible so as to constitute a screen upon which the patient can project his own inner world.
The analyst must be an active and transformative mirror which ensures that analytical activity is more complex than other psychotherapies. As a patient who had experienced other forms of therapy once said: “I feel better in analysis, because it does not give me technical advice, but allows me to get emotional and to cry”.

The analyst’s narcissistic vulnerability can be perceived by the patient and utilized for the purpose of resistance. We have the task of monitoring our narcissistic investment in each patient without too much denial the aspects of fragility that this could generate. Great care is taken to create an analytical atmosphere that allows the acceptance of even the most regressed patient. Our silence and any non-verbal behavior will be implicit elements of interpretation.

B. is a twenty-eight-year-old psychology graduate. She requests analysis due to a feeling of being blocked in her life. Her parents have been separated since she was seven years old. B. and her sister continued to live with their mother, seeing their father periodically. In the early stages of analysis, B. is very proper: polite, punctual for sessions and with payments. I do not perceive a lack of genuineness, but rather a form of adherence to the therapy to find a safe place: something different from the one experienced with her own inconsistent mother. This “honeymoon” is necessary to find a good container. A change in the analytical relationship occurs when B. is absent to participate in a conference, missing some sessions and delaying payment. Upon her return, she tells me that she cannot pay because she has no more money in the bank. At my interpretation regarding the fact that this is a resistance, the patient becomes very angry, saying she did not do it on purpose. We will later analyze that her anger manifested itself because she felt scolded just as her father used to do, who distanced himself saying that he would no longer be there for her. Transferentially B. thought that I would no longer want her in analysis.

This material aims to provide an opportunity for us to talk and share ideas possibly also about your experiences. So, please, feel free to express your thoughts and associations.   

PART 2
by Paolo Fonda, Trieste

In today’s world, the freedom to choose and make decisions about the various aspects of one’s life is constantly expanding. Each individual must take on increasing responsibility for the decisions they make about their own lives. Consequently, the need for mentalization is growing, as internal conflicts demand to be represented- symbolized – thought through – worked through. The demand for psychotherapy and psychoanalysis is therefore also on the rise. Furthermore, our growing understanding of the mind is giving rise to new approaches in psychotherapy.

The spread of the need for psychotherapy even amongst the general public, who lack a deep cultural and scientific background, explains the popularity of psychotherapeutic approaches that are scientifically questionable, or based on magical thinking and manipulation. Within the growing rangeof ‘talking-based’ therapieson offer, alternative’ psychoanalysis and psychotherapies are being proposed too, some of which are of rather low quality and often driven primarily by commercial motives. There is also emerging a ‘psychological support’ provided by AI, entirely outside any alive human relationship. Consequently, there is currently a great deal of confusion in the world of psychotherapy today, and it is difficult even for us to know well ‘who is who’ (or even ‘what is what’) and to find our way around it. Let’s imagine how orient themselves all those in need of psychological help!

In this context, at the IPA we are convinced of the need to cultivate and offer treatments based on a rigorous scientific and clinical approach, whilst committing ourselves to developing our theories, our psychoanalytic tools and the training of our analysts. We focus on both our initial training and our continuing professional development within our Societies.

I shall confine myself here to considering the context in which the training of psychoanalysts takes place, rather than its actual content, leaving room for discussion should other aspects need to be explored in greater depth.

Psychoanalysis and psychotherapy
Good psychoanalytic treatment usually lasts more than five years, with three or four sessions a week. The number of people who can undergo a full course of psychoanalytic treatment (in its high-frequency form) is limited. A large area, which cannot be covered by psychoanalysis as such, is thus left to shorter psychoanalytic psychotherapies, particularly those with lower frequency and lower costs. (Although the difference lies not only in the frequency.)

Having been properly informed, patients have the right to decide which type of treatment to follow. For many reasons, including financial ones, they often choose psychotherapy rather than psychoanalysis. At the same time, many professionals opt for less demanding training in psychotherapy rather than in psychoanalysis.

The difference between psychoanalysis and psychoanalytic psychotherapy can be touched upon with a metaphor. Depending on whether one dives into the sea with 1, 2 or 3 oxygen tanks (weekly sessions), one can reach different depths. It is not always necessary to reach the maximum depth. However, the deeper therapists intend to work, the more extensive and in-depth their preparation – their training – must be.

Let me offer another metaphor: at a concert, unlike a mere listener, the conductor must be able to distinguish between simply listeningand truly hearing – not just the music, but the sound of every single instrument, especially when one is out of tune. In the same way, the psychoanalyst must learn to perceive those discordant mental layers that lie beneath the conscious mind: the unconscious, the adult and child parts, the neurotic and psychotic aspects, as well as the split-off parts, defense mechanisms and so on – in short, the entire orchestra of the mind. To remain confined to the most superficial level would be like walking on the surface of the earth without sensing the underground rivers that run through it.

Continuing with metaphors, we could compare psychoanalysis to a theatre in which it is necessary to ensure an appropriate setting – the conditions (silence, darkness…) that can make both transference and, more generally, dreaming possible and manifest.

In the tradition of Bion, we use the term ‘dreaming’ to denote a deeper form of thought. It is a mental activity in which the individual can transcend the limits of the logic of the secondary process without losing access to it. Dreaming occurs continuously, both during sleep and while awake. Just as the stars remain even when their light is obscured by that of the sun, dreaming is a continuous function of the mind that continues whilst we are awake.

Daydreaming in the psychoanalytic setting takes the form of the analyst’s experience of reverie. Without dreaming, we would remain trapped in an infinite and unchanging present throughout the analytical process.

Collaboration between psychoanalysts and psychoanalytic psychotherapists is useful, but roles must be clearly defined. It is not appropriate for ‘subs’ with a Level 1 qualification to delve into depths for which they are not equipped. However, they can work very effectively and be of great help to those patients who can benefit from work at shallower depths.

It is neither possible nor sensible to increase the number of psychoanalysts excessively, while an alliance and collaboration with competent and reliable psychotherapists could be useful.
Associations of psychoanalytically oriented psychotherapists have thus been established, with high standards of clinical practice and training (such as those affiliated with the European Federation of Psychoanalytic Psychotherapy – EFPP). IPA psychoanalysts often collaborate productively with these associations. This also helps to prevent the isolation of small psychoanalytic groups and to foster a broader community interested in psychoanalytic culture.

In psychoanalysis, thanks to longer, more frequent sessions and the deepening of the analytical relationship – which focuses on the interplay of transference and counter-transference – analysts can explore, treat and investigate broader aspects of the inner world than psychotherapists. Their experience can thus provide psychotherapists with useful insights.

Of course, psychoanalysts practice also psychotherapy. However, if analysts ‘absorb’ too much psychotherapy, they risk losing their identity and becoming psychotherapists themselves. Analysts who do not have patients in analysis lose (or fail to attain) their analytical competence and weaken the effective tension and psychoanalytic culture within their Psychoanalytic Societies.

During their clinical work, psychotherapists sometimes develop the motivation to deepen and broaden their skills and to embark on psychoanalytic training such as that offered by the IPA Societies.
It is unthinkable to plan to become a psychoanalyst without understanding this role in a broad and profound sense. One cannot be ‘a sort of psychoanalyst’! What we deal with – the human mind – is far too complex and delicate to be treated superficially. Psychoanalysts cannot limit themselves to merely ‘chatting with patients’. To trivialise psychoanalysis is to destroy it.

Psychoanalysis, as a clinical practice, as a relationship between patient and analyst, but also as a theory, can only be something ‘alive’, in relation to and evolving with the surrounding world and its reverberations within the inner world. It requires specific motivation in both members of the analytic dyad. In our relationship with our patients, we must be genuine, engaged and devoted, empathetic and honest; otherwise, we are ‘pretending to be analysts’ but ‘are not really analysts’. We cannot be like a mother who, whilst breastfeeding her baby, is distracted by reading her mobile phone. The poet Mandelš'tam reminds us: “There is nothing more terrifying for a man than the total indifference of another man towards him.”

Psychoanalysis and the IPA Societies
The IPA holds no copyright or monopoly over psychoanalysis, which now belongs to science and to humanity. However, I am convinced that psychoanalysis, as understood within the IPA, still has an important role to play, precisely because of its clinical effectiveness and its widely recognised scientific contribution, which is firmly linked to related sciences.

For more than a century, and indeed to this day, psychoanalytic societies have provided psychoanalysts with a high-quality training environment. The IPA can maintain its position only if it continues to guarantee its members excellent training and high-quality group work for ongoing and optimal professional development. The IPA’s objective must be quality, not quantity.

Our aim, therefore, is not to fill the world with IPA members. We should regard IPA Societies as philharmonic orchestras (of which there are few in each country) rather than as marching bands playing in every village; as specialised medical research centres rather than as peripheral hospitals operating in every small town.

Rigorous selection is therefore essential within IPA Societies, both of candidates and of those members who, during their professional careers, apply for promotion to the status of ‘Full Members’ and Training Analysts.

In the analytical groups, as in the global analytical movement, there is a continuous process of elaboration. Clinical work constantly puts to the test the knowledge of analysts, who must therefore constantly keep up to date, whilst also having to accept that there are things they do not know and do not understand, since analysis is always incomplete and both the analyst and their patients must learn to live with an unknown aspect.

A century ago, every analyst could read almost all psychoanalytic literature. Today this is no longer possible. Constant collaboration and elaboration within groups are necessary, as there are ever-increasing breadth and depth of thought that cannot be grasped by a single individual.

This confirms the indispensable role of psychoanalytic societies, as Stefano Bolognini also highlighted when proposing the concept of the ‘fourth pillar’ of training. To the first three pillars necessary to obtain IPA membership – training analysis, theoretical seminar teaching and supervision – he adds a fourth: lifelong learning within working groups, such as psychoanalytic societies. For lifelong learning, it becomes essential to be part of a group of competent and well-organised colleagues – an established society of psychoanalysts.

This leads to the introjection, into the psychoanalyst’s Superego and Ego Ideal, of what we might call ‘the inner chorus of colleagues’, who not only advise, dissuade and, in extreme cases, forbid, but also suggest and open new theoretical and clinical approaches.

The general development of humanity demonstrates that every advance requires at least two conditions: a rich and stimulating cultural environment (the group and its culture) and a number of exceptionally talented individuals within it.

Isolation within small groups risks becoming stifling and may limit professional development if sufficient contacts are not maintained and nurtured with larger groups, where analysts can fully develop their skills.

When, within the IPA, the transition from informal groups to Study Groups, Provisional Societies and Constituent Societies is complete, this does not mark the achievement of the final goal, but merelyj the beginning of a further phase of development, just as the end of adolescence is the beginning of a rich and productive adult life. We can say that the future of psychoanalysis is linked to the health and effectiveness of psychoanalytic societies. This compels us to carefully consider their functioning (s as well as their potential shortcomings), so that analystscan fully develop their skills within them and talented analysts can draw upon them for their own high-level scholarly output.
There are many small Study Groups or new Societies that still require a certain amount of support from the wider psychoanalytic community in order to achieve and maintain an optimal standard of training, clinical practice and scientific work.

We are aware that the training of a psychoanalyst can take almost 10 years, and that a further 10 years may be needed to establish a sufficiently robust Society, until it reaches a medium-to-optimal scientific and technical standard in the treatment of patients, as well as in the training of new analysts.

It may take even more years to develop a fertile clinical and theoretical environment in which talented analysts can conceive and write original ideas to contribute to the international psychoanalytic arena. It is a long and difficult journey, but no longer than that of any other branch of science.
The professional development of an isolated psychoanalyst is therefore inconceivable. In isolation, there is a high risk not only of incompetence but also of succumbing to narcissistic ‘guru’ posturing, which often shuns engagement with ‘peers’, limiting oneself instead to interaction with ‘pupils-followers’ who are dependent on him. Under such conditions, ethical breaches also frequently occur.

CONCLUSION
Here I have only briefly touched upon some stages in the professional development of the analyst.
In raising their own children, parents can retrace their own lives, reconnecting with and resolving their own unresolved issues, thereby also enriching their own inner lives.
In the same way, we analysts also nourishourselves with the vital energy of  our patients, candidates, as well as our newly arrived colleagues from the East. We can strengthen or re-establish our connection with the vital sources of our childhood and youth, whether personal or analytical. At the same time, patients benefit from and are nourished by our knowledge and experience. Ultimately, this is a mutual exchange, that is beneficial to both parties. Our new analytical groups, are also able to give us so much, and we hope that they, too, receive just as much from us!