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Opinion Article | DOI: https://doi.org/10.31579/2690-8808/125
Emeritus Professor of Psychiatry New York, USA.
*Corresponding Author: Saeed Shoja Shafti, Emeritus Professor of Psychiatry New York, USA.
Citation: Saeed Shoja Shafti, (2022) Opinion: Grasping the Unconscious Dynamism: A Prerequisite in Insight- Oriented Training J. Clinical Case Reports and Studies 3(7); DOI: 10.31579/2690-8808/125
Copyright: © 2022 Saeed Shoja Shafti, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 18 January 2022 | Accepted: 22 May 2022 | Published: 02 July 2022
Keywords: psychoanalyst; psychotherapy; psychiatric-mental health
Insight-oriented psychotherapies, like psychoanalysis, as the most systematic method, and short-term dynamic psychotherapies, as the related compressed techniques, have a shared goal, which includes restoration of insight in patient by the help of a psychoanalyst or other associated psychotherapists. While there are many psychotherapists, who introduce themselves as psychodynamic therapists, a lot of criticizers believe in futility of analytic methods (1). Though there is no absolute guarantee of the effectiveness of any therapeutic method, whether pharmaceutical or psychological, it seems that based on physiognomies of systematic methods, some positive consequences can be reasonably expectable, which can be quantifiable by available evidence and records, too. So, with respect to insight-oriented psychotherapies, too, and based on available writings, and disregard to dissimilarities between short-term techniques vs. long-term approaches, a rational number of positive outcomes is supposed for each method (2).
Insight-oriented psychotherapies, like psychoanalysis, as the most systematic method, and short-term dynamic psychotherapies, as the related compressed techniques, have a shared goal, which includes restoration of insight in patient by the help of a psychoanalyst or other associated psychotherapists. While there are many psychotherapists, who introduce themselves as psychodynamic therapists, a lot of criticizers believe in futility of analytic methods (1). Though there is no absolute guarantee of the effectiveness of any therapeutic method, whether pharmaceutical or psychological, it seems that based on physiognomies of systematic methods, some positive consequences can be reasonably expectable, which can be quantifiable by available evidence and records, too. So, with respect to insight-oriented psychotherapies, too, and based on available writings, and disregard to dissimilarities between short-term techniques vs. long-term approaches, a rational number of positive outcomes is supposed for each method (2). Anyhow, it is not deniable that some of the declared analytic sessions are more similar to simple counseling, instead of comprehensive analysis. But, why should a psychotherapist evade the methodical techniques of the first structured psychotherapeutic approach and turn an effective technique into a futile practice? In view of that, a brief description of associated curriculums seems valuable. First of all, and with respect to adult psychoanalysis, candidates usually have either a medical degree or a Ph.D. in psychology, humanities, social sciences, social work, or a master’s degree in social work. The psychoanalytic teaching program has three separate components: four years of theoretical and clinical conferences, applicant’s personal analysis, and three supervised clinical cases.
Personal analysis occurs at a minimum rate of four sessions per week by a qualified training psychoanalyst to provide enough depth and intensity in the beginner. Theoretical courses, as well, are founded on readings focused on the broad spectrum of psychoanalytic philosophy, which includes Freud, ego psychology, object relations, Klein, self-psychology and Lacan - together with contemporary progress in relational psychoanalysis, neo-Kleinian ideas, and modern-day analysis. Accordingly, clinical conferences are performed by expert psychoanalysts with an emphasis on technique. Therefore, empathic listening and electability of cases, plus psychodynamic conceptions, such as transference and counter-transference, are taught from various theoretical standpoints. As said before, each applicant is anticipated to initiate a personal analysis, which is known as training analysis, too, with a credited training psychoanalyst. Furthermore, beginners conduct their own analyses of patients under supervision, which is an important and essential part of their teaching. As a result, the candidate sees his or her own analysand four times a week, and is supervised by a training psychoanalyst once per week. Cases will be supervised by two different supervising psychoanalysts with at least 200 hours of supervision. With respect to child & adolescent psychoanalysis, besides the said packages, each candidate should conduct a four-times-per-week analysis of two youngsters – one girl and one boy. Cases are from different age groups, i.e. preschool, latency and teenage years. Also, while no less than 200 hours of supervision overall are mandatory, the applicant must be supervised by a qualified child psychoanalyst (3). Training in Psychodynamic psychotherapy, also, includes a two-year post-graduate training program, designed for psychiatrists, Ph.D. and Psy.D. psychologists (Doctor of Psychology), psychiatric nurses, Licensed Clinical Social Workers (LCSWs), Licensed Mental Health Counselors (LMHCs) and other capable specialists interested in improving their abilities in psychoanalytic psychotherapy.
The aim is to extend the clinician's comprehension of the patient's emotional life, principally as it is experienced in the therapeutic relationship. The program usually includes eight courses over a two-year period. The classes meet once per week with weekly supervision being given by competent psychoanalysts. Each applicant plans one hour per week of supervision with an institution's faculty member in the first year, and two hours per week in the second year. The guiding course is planned to emphasis intensively on the current treatment of appropriate cases. The platform teaches the learner to become familiar with unconscious mental activity, its influences on the growing process and its impact on life preferences. Description of normal and pathological development from initial stages through senescence and diagnostic assessment is part of the course, in addition to description of basic skills for commencement of treatment, understanding dynamic unconscious, resistance, acting out, exploration of unconscious fantasy and symbolism, and distinguishing and working with transference and countertransference. Also, a review of the main psychoanalytic perspectives on normal and pathological development in different stages of life with emphasis on psychosexual development and early attachment issues, is part of the program. Over again, the applicant’s own personal psychotherapy (or analysis) is an important part of the learning process.
A two-year psychoanalytic psychotherapy training program has been designed to expand the clinician's knowledge, bring up a full comprehension of dynamic issues, and uphold the ability to offer more helpful clinical service (4). Likewise, with respect to short-term dynamic psychotherapies, learners are among psychiatrists, clinical psychologists (Ph.D. or Psy.D.), Psychiatric-Mental Health Nurse Practitioner (PMHNP), clinical social workers (MSWor Ph.D. in Social Work), and other doctoral level mental health clinicians. Furthermore, apprentices with a master's degree from a credited mental health degree program are authorized if they have no less than two years of post-graduate educational and clinical training in the said psychodynamic psychotherapy. The related curriculum includes a three-year training program, containing: lectures, educational materials about unconscious mental processes, supervision of learner’s own cases by faculty, video therapy, and role play to improve expertise. There is also a fellowship program, with a duration of around 9-12 months, which offers acquaintance with psychoanalytic concepts and includes personal meetings with a tutor and contributions to fellowship conferences. Hence, the said program is open to mental health clinicians and apprentices, teachers, investigators and scholars, who are motivated to study more about psychoanalytic thoughts. Fellows are coordinated with a personal adviser, who will plan once-a-month one-to-one meetings. Involvement in a fellowship program is merely for learning purposes and does not lead to a diploma or licensure for practicing insight-oriented psychotherapies (5).
On the other hand, the fellowship program is different with non-clinical education in psychoanalysis, which offers some teaching occasions to authorities for whom a general understanding of psychoanalytic concepts could be beneficial with regard to their careers, such as attorneys, clerics, investigators, academics and teachers. This provides an interesting exchange of thoughts between clinical psychoanalysts and pros from other grounds. Non-clinical applicants participate in the same classes as clinical nominees, with the exception of psychoanalytic case work. Nevertheless, personal analysis for non-clinical applicants, as well, is highly recommended (6). Therefore, as is evident from the aforesaid curriculums, applied analytic methods, like adult psychoanalysis, child & adolescent psychoanalysis, and psychodynamic psychotherapy, include personal analysis, supervised clinical cases, along with theoretical and clinical seminars, though with different lengths and preparations. In this regard, pragmatic workout has an important role due to a number of reasons, which include achievement of dexterity for starting, maintaining and ending therapeutic sessions, proficiency in dealing with transference and countertransference, familiarity with analytic settings, turning subjective theoretical knowledge into effective practical maneuvers, and, as a final point, tangible realization of unconsciousness. Among the said didactic purposes, the last one has an important role because, without realistic understanding of unconsciousness, no psychotherapist may accept as true, wholeheartedly, the learned dynamic concepts. Simple knowledge is not equal to having confidence in educated subjects. This is a real dilemma that determines the main difference between scholastic centers and future graduates. Believing an idea demands a number of requirements, including cognitive and sociocultural backgrounds, which are not automatically prepared. For example, without a research laboratory or test center, chemistry, biology, physics, or astronomy is nothing except a series of scripts; a judgment that is not proper with respect to, for instance, history, literature, philosophy, or math.
Psychology is a mixture of theory and practice, which is echoed variously in different paradigms, like psychodynamic, behavioral and cognitive schools of psychology. While biofeedback, in the realm of behavioral psychology, can not exist without its specific gadgets, cognitive psychology and psychodynamic concepts, as well, may not materialize without enactment of specific methods. Among the approved psychotherapies, the only technique that can methodically probe the unconscious frame of mind is psychoanalysis. The other insight - oriented methods, as well, have been developed to examine unconscious mental dynamism, though less deeply, less comprehensively and less satisfactorily than psychoanalysis. While psychodynamic psychology is the outcome of psychoanalytic investigation and hypothesizing, there is a direct relationship between the program of study and the later capability of the apprentice for employment of applied methods. A learner who has never been effective in the development of insight in the analysand, has never reached awareness regarding his or her inner conflicts through self-analysis, has never undergone personal analysis, has never experienced a coach and has never grasped its difference with chair and face-to-face interview, for sure can never comprehend the real meaning of the unconscious (7).
Then again, without pragmatic comprehension, no true and enduring confidence in psychodynamic concepts is possible. Such an apprentice though inclined to accept dynamic concepts because they seem fascinating, is always in the grey zone and can not avoid uncertainty. So, eventually, he or she should pretend to have faith in the said concepts, but incomprehensibly and unsteadily, or submit to the aforesaid uncertainty and criticize them, angrily, as a series of unreachable and irrational fancies. The said problem, that is to say, the unobtainability of unconscious mental activity due to lack of fitting experience, was one of the main reasons for the creation of influential criticizers against psychoanalysis and related analytic therapies, from one hand, and the promotion of other psychotherapeutic methods which can only handle conscious or subconscious mental activities, on the other hand. Though a number of factors, like character of analyst and analyzand, time, skill, setting, curriculum, transference, countertransference and lack of expert supervision may be involved in pragmatic defeat of learner with respect to overcoming resistance, defense mechanisms and rebel Id, lack of motivation, poor knowledge and obscure goal, as well, may contribute to the said practical failure. Since an all-inclusive analysis of thought and behavior is the mainstay of all insight-oriented psychotherapies, then less analysis is equal to less success and no analysis is equal to complete failure. As a result, without objective and thorough analysis, realizing the dynamic unconscious is an illusion. Maybe, the said problem can be found in some of the learning institutes that, while they are curious with respect to dynamic concepts, lack proper insight concerning practical discerning of unconsciousness (8).
Similarly, hypothetical knowledge regarding the unconscious zone is not enough for provocation of insight in analysand, because verbal and non-verbal communication may ultimately disclose the analyst’s uncertainty concerning analysand’s unconscious mindset. The said problem is disregard to other difficulties that may be caused by countertransference. On the other hand, in educational centers where training of novices is accomplished by avowed criticizers of Freudian or classical psychoanalysis, as superficial protagonists of other psychoanalytic schools and deniers of the most important methodical texts, or by inexpert supervisors or educators who have no pragmatic experience in applied methods and are simple instructors of a number of theoretic subjects, or by pseudo-supervisors who have never learned disciplined set of courses and are self-styled practitioners, expecting graduates with thorough comprehension of learned subjects, hypothetically and pragmatically, is senseless (9). An apprentice, who can not differentiate between tangible and imagined unconsciousness, is like a driver, who can not discern the road from the sidewalk, or a predator, who is trapped in his own traps. As said by Freud, unconsciousness can not be divided and used selectively, because there is an interrelated connection between all of its dynamic forces (10, 11).
Without discovering unconsciousness by means of through analysis, which is not possible without comprehensive analysis of free associations, dreams, slips, motives, and fantasies, no true comprehension of dynamic concepts like id, ego, superego, defense mechanism, resistance, transference and countertransference, which are, directly or indirectly, partly or totally, unconscious structures, is practically possible. Such a learner, even after graduation, is incapable of helping analysand for attainment of intellectual insight regarding his or her inner unconscious conflicts. Such a pseudo-analyst can never be gratified concerning his or her own practice, whose therapeutic efforts usually have outcomes comparable to simple methods, like psycho-education, counseling, supportive psychotherapy and problem-solving techniques. Hence, such learning is nearly comparable to a fellowship program, which is planned for educational purposes only, not applied analysis. Such a problem can be true with respect to other methods, as well, like cognitive – analytic therapy, if the cognitive therapist has never realized, sensibly, the unconscious part of that hybrid method. Though, as stated by Freud, you can not influence a person who doesn’t want to be convinced, you may persuade an inapt psychotherapist to give up analytic methods and make use of other approaches which are more suitable for his or her abilities. Analyzing neutrally and systematically doesn’t mean analyzing incomprehensibly and selectively, if assisting analysand to gain insight is a sincere mission, not an ostentatious career.
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