The deleterious impact of idealization and fanaticism and their underlying causes in psychoanalytic education.

Acrimony, dissension, and controversy have characterized psychoanalytic education from the beginning. The usual scapegoat for this situation has been the training analyst system. But this system is seen as just a symptom of deeper, underlying conflicts about our field and preparing for it. In particular, the tendency toward authoritarian dogmatism amongst psychoanalysts is a prime contributor. This inclination derives from the defensive idealization and fanaticism characterizing many psychoanalysts. Such idealization helps us to manage the many uncertainties that characterize our theory, our practice, and our pedagogical efforts. Various methods to address these uncertainties more directly are suggested as a way to counteract the negative effects of fanaticism.

The 'community turn': Relational citizenship in the Psychoanalytic Community Collaboratory®.

Drawn from five years of experience in the web-based Psychoanalytic Community Collaboratory, this paper explores implications of the 'community turn' in psychoanalysis for roles, methods, clinical theory, and training. With participants from many parts of the world, the Collaboratory has become a creative generator of projects including documentary films, community memorial initiatives, and mental health interventions in highly stressed communities. The Collaboratory's unique pedagogy offers valuable experiential learning about the complex intersubjective dynamics common to group and community life. Through reflection on the interpersonal dynamics of three critical incidents, we illustrate the interplay of intra-psychic and political aspects of identity--what we have termed 'relational citizenship', an intersubjective self-state in which the individual and the sociopolitical are psychically linked and where the challenges of identifying with and belonging to one or more collectivities are recognized and negotiated.

The Organizational Structure of the American Psychoanalytic Association: The Politics of Exclusion.

This article traces the history of the American Psychoanalytic Association since its reorganization in 1945. This reorganization established the hegemony of the Board on Professional Standard and the secondary status of the larger membership. It considers the centrality of the requirement of certification for becoming a member, for running for office, and for voting on bylaw amendments, all of which have since been undone, and for training analyst appointments, which continues to this day. A context for this discussion is the decline of APsaA since the 1970s and its struggle to maintain its place in American psychoanalysis and in psychoanalytic education.

¿Cómo mejorar la perspectiva integrativa de los médicos clínicos? (II): dos muestras descriptivas de grupos de reflexión "tipo Balint" / How to improve the integrative approach in clinicians (II): two descriptive samples of "Balint-type" reflection groups

Los grupos Balint significaron una importante aportación para la formación y la formación continuada del personal sanitario, y, a mi entender, del personal de todos los servicios asistenciales. En ese sentido, las ideologías, políticas y economías “neoliberales” en el ámbito asistencial proponen otro modelo de asistencia y de “formación” (¿o deformación?) de los médicos y del personal asistencial. Su progresivo avance es una de las explicaciones fundamentales para el declive en el uso de procedimientos de formación integral, formación continuada y formación para la reparatividad. En el trabajo anterior se realizó una breve descripción de la difusión y extensión de los grupos “tipo Balint” tanto a nivel nacional como internacional, así como de sus cambios técnicos. Mi perspectiva actual es que los “grupos de reflexión”, como sistemas de formación y contención del personal comunitario, siguen siendo una técnica o sistema que podría proporcionar importantes ayudas en la asistencia sanitaria y comunitaria clínica. Para contribuir a su conocimiento lo más directo posible, se incluyen dos muestras descriptivas: una transcripción completa de una sesión y un listado de los temas y aproximaciones realizadas en diversas sesiones de uno de dichos grupos

Balint groups represented an important contribution to the training and continuous education of health personnel, and, in my opinion, of the personnel of all healthcare services. In this sense, "neoliberal" ideologies, policies and economies in the health care field propose another model of doctors and health care personnel attention and "training" (or rather deformation?). Its progressive advance is one of the fundamental explanations for the decline in the use of comprehensive training procedures, continuous training, and training for reparativity. In the previous work, a brief description of the diffusion and extension of "Balint type" groups, both nationally and internationally, as well as of their technical changes, was made. My current perspective is that "reflection groups", as training and contention systems for community personnel, continue to be a technique or tool that could provide important aid in clinical health and community care. Here, to contribute to its knowledge as directly as possible, two descriptive samples are included: a complete transcription of a session and a list of the topics and approximations made in different sessions of one of these groups

Combined Training of Candidates, Scholars, And Psychotherapists: A Model of Psychoanalytic Education for the Twenty-First Century.

A new model of psychoanalytic education is proposed that will meet the challenges of educating candidates in a new century. Prospective candidates have varying opinions about the value of analytic training, opinions that reflect economic and cultural conditions different from those facing previous generations. Overall, today's graduate-level students hold less favorable attitudes toward psychoanalysis than did their counterparts in the past. The proposed model calls for combining analytic candidates, psychotherapy students, and academic scholars for two years in a Psychoanalytic Studies Program (PSP), after which candidates take their subsequent years of training in a cohort made up exclusively of analytic candidates. A curriculum that focuses on the core concepts in psychoanalysis allows students in all three categories to learn the foundational knowledge of psychoanalysis that once was widely taught in graduate mental health programs. The philosophy that underlies the model and the structure and orientation of the course sequences are presented. Implementatiion of the model having shown positive results, its strengths and limitations are evaluated against the traditional model, in which candidates and psychotherapy students are educated separately.

Beyond Progression: Devising a New Training Model for Candidate Assessment, Advancement, and Advising at Columbia.

Research over several decades has identified significant problems with the progression model-the traditional approach to assessment and advancement of psychoanalytic candidates-including candidates' anxiety and uncertainty about the methods and fairness of their assessment, avoidance of conflictual issues with patients in order to keep cases, and reluctance to share their challenges with supervisors and advisors. In light of these findings, the Columbia Center for Psychoanalytic Training and Research restructured its psychoanalytic training programs. The progression committee, the progression advisor role, candidate application to advance through the program, and routine committee discussion of candidates were eliminated and replaced by confidential mentorship and a clear and predictable system of trainee advancement. Analytic competency-a requirement for graduation-is now determined solely from detailed written feedback regarding the candidate's achievement of the Center's learning objectives. The number of months of supervised analysis required for graduation has been reduced, as has the required length of the candidate's longest case; in addition, three-times-weekly analyses are now accepted for credit. These changes are meant to increase the transparency, objectivity, and predictability of the training experience and reduce the pressure on clinical decision making and communication between trainees and faculty. An extensive evaluation of the impact of these innovations is currently under way.

Spatially Distant but Emotionally Close: A Personal Reflection on Psychoanalytic Distance Training.

Psychoanalytic training in countries with no accredited training program or official link to the international psychoanalytic community is possible only through technology. Serious controversies surround the legitimacy of distance training, based primarily on doubts about the efficacy of distance analysis. Curiously, in a discipline that prides itself on being a "talking cure," an emphasis on the embodied presence of the analytic couple emerges in the literature over and over again. In fact, though, it's through the use of language-and not through sight-that we achieve the aim of analysis. The information the analyst gathers from bodily presence is important, but even then the analyst's job is to hear the patient's unconscious communications. If an analyst, for whatever reason, is unable to hear the patient's voice and unconscious communications, the analysis is bound to fail whether the patient is in the room or on the screen/phone. Being spatially distant poses no contradictions to psychoanalysis, as long as both parties-patient and analyst, supervisee and supervisor, candidate and instructor-are willing to listen, hear, and be heard emotionally.

Becoming of Use as an Analyst: Imagining Something that was Never there Before.

Every analysis that becomes generative must be an original experience, in both senses of the word: an experience that reaches into the origins of the emotional life of the analysand and one that creates something entirely new. If the analysis goes well enough, these efforts lead the analysand to feel the oldness and newness to be an integrated whole. Analysands who have experienced an absence of intimate emotional connection early in life especially require that new psychological capacity be developed from their germinal potential as a means by which the psychoanalytic process is brought to life. In such cases, both analyst and analysand are required to find ways to expand their receptivity to sensory experience and to cultivate their imaginative capacities in a manner that make emotional growth possible. Through this process words become embodied and better able to articulate the analysand's self-experience and to create the experience of reciprocity with the analyst and with others in ways never before experienced.

Psychoanalytic training in the Eitingon model and its controversies: A way forward.

Psychoanalytic training has been an object of controversy for many years. Arguments have been intense about the details, sometimes called "requirements", and particularly over whether or not training institutes should have routine external validation. We describe these arguments and present preliminary conclusions about the core challenges psychoanalytic trainings face using a unique set of detailed observations collected during structured "conversations" inside nine European institutes. We conclude that whether a psychoanalytic training is "working" is not a matter of compliance with requirements. Rather, it is an issue of how candidates, training analysts, supervisors and committee members, confront within and between each other the consequences of the unconscious dynamics that psychoanalytic training must inevitably create. Institutional psychoanalytic capacity is to take itself as the object. Consequentially, we propose that training committees that seek to claim that their psychoanalytic training is genuinely and safely producing psychoanalysts would be ones that institute routine procedures to show to themselves, transparently, how they attend to the dynamics just mentioned and how they take a neutral inquisitive stance towards them. Fear of oversight, we suggest, is a symptom of deeper anxieties. They can be faced by creating an appropriate setting. Properly conducted visits from outsiders are welcomed.

Emergency Remote Training in Psychoanalysis and Psychotherapy: An Initial Assessment from Columbia.

The Covid-19 pandemic and the social distancing required to combat it have set in motion an experiment in psychoanalytic education of unprecedented scope. Following an abrupt shift from in-person study to remote classes, supervision, clinical work, and training analyses, the Columbia University Center for Psychoanalytic Training and Research polled its psychotherapy and psychoanalysis trainees to assess their initial experience of remote training. Most candidates found the technical aspects of online learning easy and were satisfied with remote training overall. Across all programs, most trainees considered class length and reading load about right and felt their class participation was unaffected, though they found it harder to concentrate. Most found it no harder to start a training case, felt the shift to remote supervision had no negative effect, and were satisfied with seeing their training analyst remotely. Most trainees preferred in-person classes, clinical work, and training analyses to those offered remotely, yet in light of the health risks they said they were less likely to continue training in fall 2020 if in-person work resumed. Trainees suggested several modifications of teaching techniques to improve their participation and concentration in class. These findings' implications for the debate regarding remote training in psychoanalysis are explored.

Cinco claves preliminares para el estudio del psicoanálisis (lacaniano) en la España del segundo franquismo y la transición / Five preliminary keys to the study of psychoanalysis in Spain under the later Franco Regime and the Transition

El presente artículo identifica y propone cinco claves a tener en cuenta para analizar la recepción y desarrollo del psicoanálisis en la España del segundo franquismo y la Transición: 1) la ausencia -o muy escasa presencia- de referencias psicoanalíticas en la producción psiquiátrica de los años cincuenta y sesenta; 2) las conexiones entre psicoanálisis, antipsiquiatría y estructuralismo; 3) la importancia de la llegada a España de Oscar Masotta, y su psicoanálisis "laico", en la consolidación de un discurso y una práctica psicoanalítica al margen de la IPA; 4) el peso de los psicoanalistas argentinos llegados al estado español tras el golpe de estado en su país; y 5) la importancia de la Revista de la Asociación Española de Neuropsiquiatría en difusión y trasmisión del psicoanálisis. Estas cinco claves agrupan situaciones y procesos que han sido estudiados con desigual profundidad, pero cuya consideración en conjunto parece imprescindible para obtener una visión global del proceso. Se concluye que las relaciones psiquiatría-psicoanálisis, la circulación del conocimiento, el contexto socio-político y cultural, etc., explican, entre otras cosas, las características de la recepción y desarrollo de un psicoanálisis post-freudiano en el que la orientación lacaniana tuvo preponderancia sobre otros enfoques o escuelas

This article identifies and proposes five key elements to be taken into account in analysing the reception and development of psychoanalysis in Spain under the later Franco regime and during the Transition: 1) the absence - or very limited presence - of psychoanalytic points of reference in psychiatric production during the 1950s and 1960s; 2) the connections between psychoanalysis, anti-psychiatry and structuralism; 3) the importance of the arrival in Spain of Oscar Masotta, and his 'lay' psychoanalysis, in consolidating a psychoanalytic discourse and practice outside the IPA; 4) the influence of Argentinian psychoanalysts who came to Spain following the coup d'état in their country; and 5) the importance of the Revista de la Asociación Española de Neuropsiquiatría in disseminating and communicating psychoanalysis. These five keys group together situations and processes which have been studied to varying extents, but which it seems essential to consider as a whole in order to obtain an overall view of the process. We conclude that relations between psychiatry and psychoanalysis, the circulation of knowledge, and the socio-political and cultural context, etc. explain, among other things, the characteristics of the reception and development of a post-Freudian psychoanalysis in which the Lacanian position predominated over other approaches and schools

Effect of Balint training in gastroenterology intern nurse practitioners: A systematic review protocol.

BACKGROUND: This study aims to assess the effect of Balint training (BT) in gastroenterology intern nurse practitioners (GINP) systematically. METHODS: This study will search EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from inception to the September 30, 2019 with no language limitation. In addition, we will also search grey records, such as conference abstracts and dissertations. Study quality will be checked using Cochran risk of bias tool. Statistical analysis will be performed using RevMan 5.3 software. RESULTS: This study will systematically evaluate the effect of BT in GINP and will provide evidence to judge whether BT is effective for GINP clinically. CONCLUSION: The results of this study may provide helpful evidence of BT in GINP in the clinical training.

Models for training in Developing Groups: importing the traditional into unfamiliar cultures.

The paper's central focus is on the usefulness or not of taking established and well-tried and tested models of training into cultures with different social, political and clinical attitudes. Beginning with the author's description of necessary changes introduced to ensure the revival of her own institute, the Society of Analytical Psychology, the author goes on to explore issues relevant to different aspects of training in countries where the IAAP runs its own training, known as the 'Router Programmes'. Here, analysts, teachers and supervisors visiting other cultures to offer their expertise may experience clashes in their views about the nature of the analytic attitude, not only with those they train but also amongst themselves.

L'accent central de cet article est la question de savoir s'il est heureux ou non d'importer des modèles de formation établis et qui ont fait leurs preuves dans des cultures qui ont des attitudes cliniques, sociales et politiques différentes. Commençant par la description par l'auteur de changements nécessaires introduits pour assurer le renouveau de son propre institut, la Society of Analytical Psychology, l'auteur poursuit en explorant des questions concernant différents aspects de la formation dans des pays ou l'AIPA fournit sa propre formation, que l'on appelle le Programme Router. Ici, les analystes, enseignants et superviseurs qui sont en visite dans les autres cultures pour apporter leur expertise peuvent faire l'expérience de conflits dans leurs perspectives sur la nature de l'attitude analytique, non seulement avec ceux qu'ils forment mais entre formateurs.

El foco central del artículo es sobre la utilidad o no, de llevar modelos de formación establecidos, y bien probados y testeados, a culturas con diferentes actitudes sociales, políticas y clínicas. Comenzando con la descripción de los cambios necesarios introducidos para asegurar la renovación de su propio instituto, la Sociedad de Psicología Analítica, la autora continúa explorando cuestiones relevantes a aspectos diferentes de la formación en países donde la IAAP conduce su propia formación, conocida como "Programas de Routers". Aquí, analistas, docentes y supervisores que visitan otras culturas para ofrecer su experticia pueden experimentar confrontaciones con sus perspectivas sobre la naturaleza de la actitud analítica, no solamente con aquellos a quienes forman, sino también entre sí mismos.

Observations on the Centrality of Security in Psychoanalytic Supervision: A View from the Interpersonal Tradition and Attachment Perspective.

Using theoretical concepts from the Interpersonal tradition in psychoanalysis and supported by findings from the attachment literature, the utility of attending to the issue of psychological security in supervision is considered for its potential to enable increased capacities for conducting psychoanalytic treatment.

Reflections on Supervision.

This paper explores basic tasks involved in the supervisory process, and frequent problems in carrying out these tasks. Basic tasks include clarification of mutual expectations of supervisor and supervisee; the establishment of mutual trust as fundamental for countertransference analysis; "parallel process" exploration and clarification of explicit and implicit theoretical assumptions by both supervisor and supervisee. Frequent problems include the extent of initial evaluation of patients; problems of intervening "without memory or desire"; transference and countertransference diagnoses and interpretive consequences; clarification of affective dominance; interventive shifts with severe psychopathology, and realistic goals of patient, supervisee and supervisor. Limitations to supervision include specific psychopathologies, cognitive limitations, and a generally restricted capacity for empathy by the supervisee.

Supervision for our times: countertransference and the rich legacy of the Budapest School.

In this paper I ask what an investigation of the Budapest model of supervision may add to our psychoanalytic imagination. The Budapest model confronts us with a number of crucial questions for contemporary psychoanalysis, including the question of envisioning ways of working on the countertransference of the analyst. I discuss the lack of memory that surrounds the Budapest model, and I read it in relation to the unsettling issues it stirs up, including those of authority, horizontality, and the ethics of psychoanalysis. In the Budapest model, supervision can be seen as a form of "double dreaming" or of "dreaming up of a dream". In particular, in drawing on the writings of Sándor Ferenczi and Michael Balint, I point to some principles behind the Budapest model and to the epistemic, technical, and ethical implications of their ideas. I also work toward a Ferenczian "translation" of the idea of "parallel process".

Essential elements of the work of a supervisor.

The supervisor's prime task is to consider from the very beginning the analytic ability of the analyst presenting the case; this can be assessed by observing how the colleague transcribes the clinical material and describes what is meaningful in the session. It is extremely important to understand whether the patient's suffering is neurotic, or whether he suffers from an initial psychotic disorder. In this latter case, the analyst will know that he cannot employ the same tools that he uses for the neurotic patient. It is fundamental to draw careful attention to the importance of the patient's personal history. In the process of reconstructing the past, the patient's difficulties are gradually understood by the analyst, the patient and the supervisor. Given that a memory may be distorted by present emotions and conflicts, the analyst must form meaningful hypotheses that, through reconstructing interaction with the original objects, help to comprehend the precarious equilibrium of the present. Over the course of supervision, I consistently emphasize the construction of the analytic relationship, which is based on the analyst's mind and of the patient's ability to communicate emotionally, so as to promote the analysand's mental growth.

WHAT'S NEW IN PARALLEL PROCESS? THE EVOLUTION OF SUPERVISION'S SIGNATURE PHENOMENON.

The concept of parallel process has played a central role in psychoanalytic supervision for the last 60 years, generating continuing interest in the power of the unconscious to create unexpected intersections between the analytic and supervisory relationships. I track the evolution of the concept, starting with its invention by an interpersonalist psychoanalyst, adoption by two ego psychologists, enrichment by object relations theory, and, finally, redefinition as a multi-directional dynamic by relational psychoanalysts. I then further elaborate the relational view of parallel process, illustrating its complex, multidirectional nature with an extended vignette. I discuss the relationship of enactment to parallel process and illustrate the usefulness of supervisory consultation when enactments that parallel into the supervisory relationship lead to impasse. Finally, I point to educational and neuropsychological research that suggests that working with parallel process is good pedagogy.