Controversies in Contemporary Psychoanalysis: Lectures From the Faculty of the New York Psychoanalytic Institute

The only drawback of this brilliant short book is that it should have been longer. It consists of five sections, entitled Current Conflicts and the Future of Psychoanalysis, The “Common Ground” of Psychoanalysis, Alternative Theories, Psychoanalysis and the Psychoses, and Supervision. Each of the sections presents some papers followed by open discussion; the book essentially consists of lectures and debates among the faculty of the New York Psychoanalytic Institute transcribed from meetings held from 1989 through 1991. “The topics highlight controversies within psychoanalytic theory, practice, research, and education” (p. xiii). Most of the papers are very readable, as is the lively discussion that follows them, which is on a high level and deals with a whole variety of contemporary problems in psychoanalysis from the point of view of a group that bases its work on traditional Freudian theory and tends to regard Kleinians, self psychologists, object relations theorists, and others as having introduced some important ideas but lacking in theoretical depth.

The first section deals with the shift in psychoanalytic practitioners from the medical to the nonmedical and from men to women. In the opening paper, Michels states, “Increasingly analysts are going to represent the unusual mode of practice in the health professions, namely, being in business for oneself without being part of an institution” (p. 4). He goes on to point out that psychoanalysis is now one subspecialty, one technique of treatment in the psychiatric armamentarium, and is no longer the architectonic theory that defined the field of psychiatry as it was “30 years ago” (and 40 years ago when I was trained). Michels warns that “the greatest threat to the intimate relationship between psychiatry and psychoanalysis is the rapid diminution of the role of psychoanalysis in departments of psychiatry” (p. 9). For example, Shapiro points out in his discussion of Michels' paper that many individuals who have become psychoanalysts first became interested in the subject when as residents they were exposed to teachers in psychiatry who were psychoanalysts. It is indeed a great loss that psychoanalysts no longer teach medical students. At the University of Chicago's medical school, where I was trained, the basic lectures on dynamic psychiatry were given to medical students by Dr. Nathaniel Apter, a charismatic psychoanalyst with a special interest in schizophrenia. His lecture series was so inspiring that several of my class members, including myself, subsequently went into the psychoanalytic field. All this is lost today. As Michels points out, “If analysts are not involved in medicine and psychiatry, medically trained psychiatrists will not enter analysis” (p. 21).

The second section of the book is the most difficult because it initially consists of a condensed version of a previously published paper by Richards (1) that reviews the plenary papers and discussions presented at the 1989 International Psychoanalytic Congress on the theme that emerged from a paper by Wallerstein entitled “One Psychoanalysis or Many?” (2). The views of a large number of participants are summarized, and Richards concedes that the Congress was “a forum of starkly dichotomous viewpoints, of participants who believed that analysts must have a great deal in common, and participants who believed that analysts need have very little if anything in common” (p. 52). Some of the issues involved in this debate about psychoanalysis are nicely aired in the discussion that follows. For example, Nersessian objects to the repeated criticism of Freud as “dogmatic,” correctly arguing that there needs to be a kind of dogmatic paradigm in every science. This group of core and defining ideas forms a basic schema, and developments in any science involve departures from it, but, adds Nersessian, “just as a science is dead without innovations, so it is lost without its traditions and its fundamental body of acquired knowledge” (p. 57).

The third and probably most controversial section of the book is on alternative theories and whether these should be taught to candidates at psychoanalytic institutes. Esman reports that in the colloquium on alternative theories he taught at the New York Psychoanalytic Institute, “Kleinian theory is criticized for . . . its concretism, its assumption of high-level cognitive capacities in the neonate, its assumption of innate knowledge, its neglect of environmental and interactional factors of development, and so forth” (pp. 85–86). Self psychology is criticized with respect to “its dismissal of drive/defense or conflict theory, its unifocal interpersonal etiologic concepts, its idealization of empathy as a therapeutic treatment” (p. 86), and “the narrativists and hermeneuticists may have unwisely challenged the biological underpinnings of psychoanalysis and its status in the community of science with their, at times, obfuscatory effort to distinguish causes from reasons for behavior” (p. 86). At the same time, the values of these contributions are also recognized and discussed. The object relations theories of Winnicott and Fairbairn are criticized for their “lack of any systematic theory building, the downgrading of any drive/defense conflicts, the almost exclusion of later developmental considerations in their zeal to demonstrate the primacy of preoedipal concerns” (p. 87). A considerable debate then ensues as to whether these alternative theories should be taught in a psychoanalytic institute and, if so, at what level of training they should be introduced. According to Brenner, “they share one thing, and that is they all try either to ignore or minimize the importance of childhood instinctual conflict” (p. 100).

The fourth section deals with psychoanalysis and the psychoses and contains a lively debate about the extent to which neurobiology and psychopharmacology should be introduced into the psychoanalytic curriculum. This is especially problematic because of the increasing number of nonmedical trainees who do not have a background in those basic science areas from medical school or psychiatric residency.

The final section discusses the important topic of supervision, with special emphasis on the well-known “parallel process,” familiar to supervisors of psychiatric residents and student psychotherapists who are attempting to do psy~cho~analyt~ically oriented psychotherapy as well as to supervisors of psychoanalytic candidates. Stress is placed on the supervisory alliance; Baudry suggests three opening strategies for establishing such an alliance successfully. He asks the supervisee what his or her experience with supervision has been: “what he or she found most helpful, least helpful; whether he or she used notes or not” (p. 149). He asks supervisees what they would particularly like to learn and how they would assess their strong and weak points, enabling the supervisor and supervisee to jointly set up specific goals that can later be jointly evaluated as to whether they have been achieved. Finally, in some instances Baudry tries to lessen the supervisee's concern about being right or wrong by indicating that “there are very few situations in which there are clear-cut right or wrong answers” (p. 149).

I found this book to be excellent and of high quality. I felt somewhat disappointed that the section on the common ground of psychoanalysis did not include reprinted publications by authors discussed by Dr. Richards. The material he actually quotes in his paper was from oral presentations, but there are so many bibliographic references in Richards' paper that one wished to see at least some of the most salient of them reproduced here. For that reason I believe the book would have benefited by being longer. The same could be said of some of the other sections, where the inclusion of significant previously published papers might make this book grow into a standard textbook on the cutting edge of contemporary psychoanalysis. Even in its present form, Controversies in Contemporary Psychoanalysis stands as a clear refutation of those who claim that traditional psychoanalysts are totally dogmatic and not interested in discussing or evaluating postclassical theories and in integrating contemporary neurobiology and psychopharmacology with their work. This book is to be highly recommended to anyone interested in psychoanalysis, including advanced psychiatric residents, and to those who are concerned with the interrelationship of psychoanalysis and general psychiatry.