The making of psychotherapists an anthropological analysis j davies (2009)mxmllACADEMIC

Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic kno

T HE M AKING O F P SYCHOTHERAPISTS

J AMES D AVIES

118 Finchley Road

London NW3 5HT

© James Davies

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in writing from the publisher.

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ISBN-13: 978-1-85575-656-4

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create practitioners who will support and perpetuate the widerpsychoanalytic cause.

To say that trainees are influenced and transformed by thesepowerful, external forces, however, is not to say that trainees have

no influence over their own transformations—for indeed manytrainees do resist the smooth and total assimilation of the psycho-analytic world-view To invoke David Parkin’s (1995: 145) insightfor a moment—individuals find it difficult to completely convert tonew modes of meaning and thought, for old meanings and ideasresist total disavowal and often re-emerge for re-integration.However, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For 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assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge thatresists complete disavowal can therefore affect and colour what isHowever, those individuals in training who resist the unques-tioned assimilation of psychoanalytic knowledge, and who to someextent therefore assert their own vision of things, often encounterinstitutional opposition For these trainees there is a clear strugglebetween the official practice that they are taught to adopt, and theintegrated practice that they might privately believe For them theknowledge that the institutes impart, instead of being assimilatedpurely and completely, is often latticed or integrated with existingknowledge to create something entirely new Old knowledge that

In the end, in discussing psychotherapeutic training it goeswithout saying that questions pertaining to the truth or falsity ofpsychotherapeutic ideas are of anthropological interest only in sofar as what people believe (both inside and outside the com-munity) has a bearing upon the social reality of the community it-self.9 Thus the psychologist’s, intellectualist’s or philosopher’s con-cern about whether a given theory or belief is objectively true is re-placed here with a phenomenological concern about the social sig-nificance of beliefs that are held to be ‘true’ (Kapferer 1983: xix) AsMauss and Hubert tell us, ‘beliefs exists because they exist object-ively as social facts’ (Hubert and Mauss 1981 [1964]: 101), implyingthat the objective truth of a belief and the social consequences of itsbeing believed to be true are quite separate things In this work I

am concerned with the social implications of a set of beliefs held to

be true, not with making epistemological or normative judgementsabout their truth or falsity.10 In fact, if this study offers critical com-ments at all, then these do not pertain to the ideas the professionbelieves and expounds, but only to the institutions which purport

to protect, steward and transmit these ideas

W HY T HIS B OOK M ATTERS

In this monograph, and within the broad parameters of the tion outlined above, I wish to make use of an older and deeply in-sightful body of anthropological theory by applying it to this novelcontemporary context With this method, rather than breaking withtraditional anthropological approaches, I seek to affirm the worth

orienta-of tested anthropological ideas by reworking them in the context orienta-of

a critical ‘repatriated anthropology’ (Gusterson 1996: 3) But before

I proceed to outline why I believe this book matters, let me firstprovide a brief outline of each chapter in turn

In chapter one I provide a history of the institutional ment of psychotherapy in Britain, identifying three broad historicaltrends that have influenced the state of the community today: theexpansion of psychotherapy during the twentieth century; the pro-liferation and stratification of training schools that has accompan-ied this growth; and the growing attack psychoanalytic psycho-therapy has sustained during the last quarter of the twentieth cen-tury

develop-In chapters two and three we move into the first stage of choanalytic socialisation: pre-training therapy (i.e the personal psy-

psy-chotherapy all candidates undergo before entering the institute) Inshort, we learn that the therapeutic encounter, like any ritual en-counter, takes place in a bounded ‘psychotherapeutic frame’ whichdelimits the spatial, temporal and relational dimensions of the ses-sion We further learn how within this frame trainees come to ima-gine themselves and the world differently This cultivation of a

‘psychoanalytic imagination’ constitutes a form of ‘institutionalvetting’ ensuring that only those who have taken to the therapeuticexperience self-select to proceed into the institute

In chapter four I show how the ‘psychoanalytic imagination’ isappealed to within the institutes to legitimate the training they of-fer By studying the next phase of training, the seminar encounter, we

will see how status imbalances within institutes are legitimated byanalytic ideas, and how the transmission of ‘text-based’, ‘secret’,and ‘personal’ knowledge shields this knowledge from criticism Inshort I argue that the educative atmosphere in seminars is by andlarge more ‘affirmative’ than ‘critical’, more ‘sectarian’ than ‘aca-demic’

In chapter five we focus on how institutions manage traineedissent, describing how trainees are taught to direct their doubtsaway from the system (the ideas) and onto other receptacles (pa-tients, outsiders, competitors) I then illustrate through selectedcase studies instances where trainee doubt, being unsuccessfullyredirected, settles on the paradigm itself causing ‘dissent’ from theorthodox position How dissent has been managed historically bythe institution provides insight into why the community lies in afractured state today

In chapter six we turn to the next phase of training—clinical pervision, focusing especially on the psychoanalytic understanding

su-of aetiology By analysing an extended case study (‘the case su-ofArya’), and the socio-historical biases shaping Freud’s early think-ing, I illustrate how and why the analytic understanding of aeti-ology can be seen as limited I further show how such aetiologicalassumptions are subtly affirmed in clinical supervision, leadingpractitioners to treat patients in predictable ways

In chapter seven we will see how covert institutional pressuresmake trainees susceptible to the instruction on offer By linking the

ordeals and stresses of socialisation to trainees’ dependency onseniors, we find that the social conditions of the institute covertlyrender trainees susceptible to embodying the commitments, prefer-ences, and the expansive ideology that seniors embrace.

Finally, in chapter eight I reveal that the psychoanalytic habitusnot only supports a species of clinical practice, but a way of life.Here we acknowledge three ‘projects’ that the psychoanalytic mythsupports: the ethical, the political, and the communal By analysingthe core values analytic training inculcates, and by exploring theprofound personal meaning therapy comes to have for practition-ers, I provide the background against which the deeper signific-ance of training can be revealed—initiation into a ‘self-redemptive’, socio-political movement of wide social aspirationand influence

In all chapters I make use of a wide variety of anthropologicalconcepts to illuminate the core stages of therapeutic training Inthis sense my work is less a ‘case-study’ showing where existinganthropology is mistaken, than an ‘example’ of how existing an-thropological theory can unravel social phenomena in the psycho-therapeutic context In Jeremy MacClancy’s (2002: 11) phrase, I

‘study up’ with anthropological insights in hand, showing how dividuals are socialised into systems of meaning that support andwhich are refracted in the community’s social structure In otherwords, I show how institutes can train individuals to recreate andsustain the social structures of the community itself

in-Applying the anthropological imagination to the peutic context, along with contributing to the growing ethnograph-

psychothera-ic record of professional socialisation, I offer a novel perspective oncertain problems afflicting the psychotherapeutic profession itself.Many psychotherapists have traditionally sought to understandthe fracturing and inter-rivalry within their own community bymeans of psychoanalytic ideas To use Needham’s phrase, suchpsychotherapists have reverted to a theoretical ‘psychologism’ toanalyse community dynamics: applying ideas devised to study in-dividuals to investigate social life and institutions In this sensethey mistakenly by-pass what sociological or anthropological the-ory could tell us about their social and community dynamics.For instance, Cremerius (1990: 125) explains the inter-schoolrivalries that beset the profession in terms of unresolved Oedipal

rivalries ‘To the extent to which [they] remain unresolved,’ says

Cremerius, ‘intellectual powers are eroded and hate, jealousy andphallic rivalry define the relationships within the association(p.125) Lousada (2000: 470), alternatively, suggests that the inabil-ity of psychotherapy schools to create working partnerships is due

to their inability to form libidinal cathexis if such cathexis could

take place then partnership might ensue Frattaroli (1992: 132-42)argues that psychotherapy’s history of schism and factionalism isdue to the institutionalisation of an internalised split Freud never re-

solved between the contradictory views that neurosis is primarilyintra-psychic (repressed drives) or inter-psychic (insufficient rela-tionships) If this split could be reconciled then these divisionsmight fall away While Bruzzone et al (1985: 411), stress that the re-gression students experience in their therapy (making them usewords such as ‘mummy’ and ‘daddy’ to refer to their therapists,and use phrases such as a ‘good feed’ to refer to a good training ex-perience) is replicated during their training in the institute Stu-dents then may feel persecuted and paranoid in the institute just asthey might in therapy when in regression Finally, Figlio (1993: 326)argues that because trainees internalise key figures—such as thetherapist and the institute—when they encounter others holdingonto different (often opposing) internalised figures a mutual hostil-ity ensues

I could continue to pile up many more examples of how munity dynamics have been explained by psychotherapists interms of psychoanalytic concepts.11 This fact tells us not onlysomething about the community in question, but that therapiststhemselves, as so many expressed to me, hold deep concerns aboutthe warring and fractured state of their profession; an institutional-ised rivalry not only impeding the process of statutory regulation,but also the cross-fertilisation of ideas necessary for theoretical de-velopment and reform, and—one might add—improved practice.Not all therapists, of course, have resorted to explaining com-munity dynamics in terms of psychoanalytic ideas Some have un-derstood wider tensions in more practical terms of how candidatesare selected and trained (Cremerius 1990; Kleinman 1998); andhow creativity is discouraged in training institutes (Kernberg 2006,1996) Indeed, in recent years a new body of literature has pro-posed reforms to psychoanalytic education more broadly (Gaza-

com-Guerrero 2002a, 2002b; Kernberg 2006; Levine 2003; Mayer 2003).This literature is unified in suggesting that many of the problems itbelieves the community now faces (diminishing creativity, ongoingconservatism and interschool rivalry) must be challenged at the in-stitutional level either by divesting self-interested groups of anylegal authority to define what is legitimate or illegitimate practice(Whan 1999: 312); by introducing openness, pluralism and authen-ticity into training institutes (Samuels 1993); by diversifying andbroadening the curriculum to facilitate in candidates better em-pathetic and introspective perceptiveness (Berman 2004; Samuels1993); or by establishing institutional mechanisms by which thepower of executive and educational committees can be devolved(Kernberg 2006) Strategies such as abolishing the traditional train-ing analysis (Mayer 2003), undermining retrogressive dependencyupon the theoretical faiths of the past (Garza-Guerrero 2002b), de-veloping more objective criteria for training assessment (Tuckett2003), and strengthening the intellectual, scholarly and researchcontext within which psychoanalytic education takes place(Auchincloss & Michels 2003), have all been championed as pos-sible remedies to the demise of creativity in the institutes, and tothe rise and entrenchment of rivalrous relations between differentpsychotherapeutic schools.

While this project is not directly about making sense of suchproblems and the rivalries as well as the entrenched positions theyengender, it is my belief that an anthropology of psychotherapeuticsocialisation can bring fresh light to old troubles while avoidingbeing prescriptive or normative Anthropologists have long knownthat much human conduct is orientated to, and shaped by, the de-mands and pressures of the environments in which people findthemselves If institutes harbour definite expectations in relation towhich trainees must organise their behaviour and professionalaims, then what these expectations demand of trainees (eitheropenness or antipathy toward ‘other’ schools) will influence howthey act as professionals, and finally whether the community willmove towards a more creative pluralism or simply remain in itsfractured state Indeed, if change is to occur in the community thenwhat may require alteration are the circumstances and situationspeople have to contend with ‘[I]f this were done’, as Becker hasstated, ‘students would probably adapt to the changed situation

and develop quite different kinds of perspectives’ (Becker et al

2002: 442) What Becker, Samuels, Sinclair, Luhrmann and othershave shown is that any kind of community reform must start with

a deep reflexive inspection of the sites or places where the munity’s values, practices and beliefs are transmitted and sus-tained—and in so far as this study comprises such an investigation

com-it may thus indirectly inform and contribute to the unravelling ofthese social problems

P SYCHOANALYTIC / P SYCHODYNAMIC P SYCHOTHERAPY E XPLAINED

Before discussing my fieldwork methods, I would first like toidentify the exact kind of practitioner and training upon which myresearch is focused The most obvious confusion I must first anti-cipate concerns the differing roles of psychologist, psychiatrist, andpsychotherapist A psychologist is someone whose professional lifeinvolves researching and applying psychology (e.g in the differentfields of education, forensics, criminality, etc.) Psychological theor-ies charter different aspects of mental life such as cognition(memory, perception, learning), and behaviour (social and indi-vidual) Thus psychologists are not clinicians If they see patients atall they only do so if they have submitted to an additional doctoral

or postgraduate training in clinical psychology, in such instancesthey are referred to as ‘clinical psychologists’.12 Psychiatrists, on theother hand, are medical doctors who specialise in diagnosing andtreating mental illness They concentrate mainly on pharmacologic-

al intervention Like psychologists, some psychiatrists have had anadditional psychotherapeutic training, usually at one of the inde-pendent psychotherapeutic institutes that I have studied here, butmost have only a rudimentary training during their own psychiat-ric residency As to how much psychotherapy psychiatrists studyand employ is largely at their own and their supervisor’s discre-tion, although psychiatric departments now insist that trainees un-dertake some form of psychotherapeutic instruction during theirresidency.13

To turn now to the psychotherapist, he or she is a clinician who

is usually a trained member of a psychotherapeutic training bodyrecognised by one of the two major accrediting bodies: the BPC(British Psychoanalytic Council) or the UKCP (the United King-

dom Council for Psychotherapy) A psychotherapist need not be apsychiatrist or psychologist, and the majority of psychotherapistsare neither, although all must have some form of undergraduate or

‘equivalent’ experience (i.e in nursing, social work, or teachingetc.) The fact that the British psychotherapeutic field is wide, di-versified, and unpredictably protean, comprising myriad schoolsand contending traditions, makes the term ‘psychotherapist’greatly unspecific It denotes an array of practitioners from ‘psy-choanalysts’ to ‘cognitive behavioural therapists’ to ‘humanistictherapists’ and ‘existentialist therapists’ In Britain alone there areeight traditions of psychotherapy recognised by the UKCP, each one

comprising an assemblage of varying schools With this tangle of

di-vergent forms it is crucial to define the precise kind of apy upon which my research will chiefly focus Broadly put, I fo-cus on the training and practice of practitioners within the psycho- dynamic or psychoanalytic tradition which is by far the largest and

psychother-most established psychotherapeutic tradition in Britain

‘Psychodynamic’ psychotherapy is the term I shall use in thisbook to characterise all those psychotherapies stemming fromFreud’s original teaching Under the rubric of ‘psychodynamicpsychotherapy’ I shall include ‘psychoanalytic psychotherapists’ and

‘psychoanalysts Thus in this book I shall uses the terms

‘psychody-namic’ and ‘psychoanalytic’ interchangeably Psychoanalysts can

be distinguished from all other psychodynamic psychotherapists

in Britain by virtue of being trained at the Institute of Psychoanalysis.

The term ‘psychoanalyst’ then, in Britain today, denotes an tional affiliation rather than a species of psychotherapy distinctfrom other psychodynamic forms Where psychoanalysis is mostobviously distinct clinically is in requesting that its trainees (andoften patients) submit to five-times-weekly analysis (a practicewhich is supposed to facilitate a ‘deeper’ analysis), while otherpsychoanalytic and psychodynamic trainings request only three-times-weekly contracts or less The social significance of these dis-tinctions, and there are many, I will return to at a later point.The mainstream tradition of psychodynamic or psychoanalyticpsychotherapy includes the great pioneers of psychotherapy such

institu-as Sigmund Freud (1856-1939), Carl Gustav Jung (1875-1961),Melanie Klein (1882-1960), Karen Horney (1885-1952), Donald Win-nicott (1896-1971), Jacques Lacan (1901-81) and Erik Erikson

(1902-1994) Thus it comprises many schools which have links bothinstitutionally and theoretically As I shall focus on these institu-tional linkages at later points, here I shall very briefly focus on thetheoretical.

The common thread linking the psychodynamic or psychoanalytic tradition (in distinction from, say, the humanistic or cognitive / be-

havioural tradition) is that its numerous schools all agree that tal functioning is a ‘dynamic’ phenomenon (deriving from theGreek dunasthi ‘to have strength or power’) The psyche is seen as

men-structured into permeable segments (e.g ego and unconscious)which interact dynamically to the degree that thought, emotion,and behaviour, both adaptive and psychopathological, are believed

to be influenced by these interactions For instance, Freud believedthat we have strivings, feelings, and wishes of which we are notentirely conscious, but which we resist coming into our awareness

—mainly because we fear losing our group’s approval if suchstifled elements are felt and expressed As the ‘repression’ of thesefearful and socially unacceptable elements largely occurs in earlychildhood, childhood is posited as the key phase of human bio-graphy—hence the psychoanalytic mantra ‘the child is the father ofthe man’ That these strivings are largely repressed does not meanthat they cease to exist Rather they retain their dynamism and ifnot adequately sublimated they express themselves in distortedways Hence Freud’s explanation of neurotic symptoms asrepressed strivings that resurface in disguised forms—although wemay be aware of the suffering they bring, we may remain oblivious

as to their origins and meaning Part of the therapist’s task is tomake these forces and their meaning conscious to the patient so he

or she can be freed from the destructive compulsions they establish

in the personality

Different psychodynamic schools have emphasised the ity of different aspects of psychodynamics For purposes of clarity Ishall summarise these approaches under a broad distinctionlargely adopted by the British community today (a distinction Ielaborate in appendix one) This is between the analytical psychody- namic psychotherapists (classical Freudian psychoanalysts who

central-stress the instinct theory—e.g Freud, Ernest Jones, K Abraham),and the interpersonal psychotherapists (including the ‘Kleinians’ and

the ‘Independents’ otherwise known as the ‘object relations’

ther-apists—namely Donald Winnicott, Harry Guntrip, and WilliamFairbairn) However, such is the common ground of both perspect-ives that in the BPC they fall under the broad category of the ‘psy-choanalytic’.

T O W HOM I R ESTRICT M Y R ESEARCH

In this paper I restrict my research to the institutions of namic or psychoanalytic psychotherapy, which are largely integrative

psychody-(teaching both the analytic and interpersonal approaches) Despitethis integrative approach, which is the hallmark of modern Britishpsychodynamic and psychoanalytic training, some institutions layspecial emphasis on the teaching of one key school (e.g the LincolnCentre is integrative with a special emphasis on Kleinian therapy,while the Institute of Psychoanalysis is integrative with a specialemphasis on the analytic approach)

As my fieldwork focused on psychodynamic and

psychoanalyt-ic institutions, in what sense might my research apply to the tute of Psychoanalysis, the only institute that refers to its graduates

Insti-as psychoanalysts? I believe my research is largely applicable forthe following reasons: firstly, the model of psychoanalytic psycho-therapy training that I am investigating is based on that offered atthe Institute Most of the teachers at these schools are psychoana-lysts, while most members of their senior committees comprisepsychoanalysts Thus most of the people I interviewed and be-friended were being taught and schooled by psychoanalysts, whilemany of my interviews were conducted with analysts or withthose trained by them Furthermore, as many psychoanalyticschools are seeking psychoanalytic status (so they might join theIPA—the ‘International Psychoanalytic Association’—and call theirgraduates ‘psychoanalysts’), they are careful to bring into align-ment their methods of teaching with those of the Institute of Psy-choanalysis Finally, the major psychodynamic training institutesbelong under the same accrediting body, the BPC (British Psycho-analytic Council) which standardises trainings across the board, in-cluding the Institute of Psychoanalysis Thus structurally speakingthese trainings are largely comparable For these reasons, although

my research is strictly speaking an ethnography of psychoanalytic

socialisation, my research has considerable applicability to the derstanding of psychoanalysis.14

un-F IELDWORK AND M ETHODOLOGY

The practical and—one must say—difficult business of gaining trance to, and conducting fieldwork within, psychodynamic train-ing institutes, is something I must now address Previous anthro-pologists who have sought entrance have commonly met with re-jection Ernest Gellner’s proposal to study ethnographically theBritish Psychoanalytic Society, for instance, was never given ap-proval According to the then president, D.W Winnicott, the insti-tute would rather arrange some such investigation at a later datewith a social scientist of their specification than hand this role to aself-appointed researcher (their investigation has yet to material-ise).15 Dr Audrey Cantile’s proposal some years later was also rejec-ted on similar grounds—it seems that the institute was again re-luctant to trust a non-therapist and thus possible antagonist withresearch responsibilities.16 However, things were different for Dr D.Kirsner, himself a sociologist and psychologist, who was more suc-cessful in gaining access to institutes in the United States and Aus-tralia, perhaps because of his ‘clinical psychologist’ status Butagain in the case of the British institute he met with rejection Forthis reason his subsequent book Unfree Associations (2000), regret-

en-tably enough, is empty of data concerning the British context.While the doors of the Institute of Psychoanalysis remainedclosed to these scholars, I too, when approaching this and otherBritish psychodynamic institutes, experienced my share of stand-ing out in the cold17—a fact raising an important question: With theobvious reticence of psychoanalytic institutes to open their doors

to outside investigation, which is itself an interesting social fact,how then did I gain access? The answer is best made by my imme-diate admission that I was not always an ‘outsider’, for my storybegins with my formal training in psychodynamic psychotherapy

at a well-known training institute in London; a training that I putaside after two years to pursue other interests At the point of leav-ing, although my interest in psychotherapy and my desire to trainremained alive, I had little intention of returning to study the pro-cess anthropologically, this idea only materialised some time later

The fact that I was already affiliated with the therapeutic fession made my returning to train and my gaining access to othertrainings a more straightforward affair This does not mean thatthere were no ethical concerns regarding my return, which wasparticipatory and observational in the truest sense, but that myprevious training put stoppers on open doors that would have oth-erwise closed shut Before looking at the ethical issues surrounding

pro-my return, let me first outline the particular form pro-my participantobservation took

My fieldwork has included two years of formal training (notcounting first years of previous study) at a psychotherapeutic insti-tute in London This incorporated my attending weekly seminars

at the institute and sitting more than 200 hours of clinical sion (psychoanalytic) Accompanying these commitments I haveengaged in a full three years of individual psychotherapy Alongwith these institutional activities, in the second year of my field-work I took up the activity of seeing patients (three patientsweekly for outpatient psychodynamic psychotherapy in the NHS)

supervi-My NHS placement also included my attending weekly namic peer supervision, and frequent one-on-one supervision withthe centre’s senior supervisor (a psychoanalyst)

psychody-During the second year of my fieldwork I resided in London forten months This enabled me not only to become more immersed

in these formal commitments, and also to observe and attend inars at a neighbouring institute as a ‘guest’, but also to spendcountless hours in informal discussions with psychoanalytic train-ees At this point I was also able to conduct many hours of formalinterviews with both training and qualified practitioners, which Ihave supplemented with 200 surveys sent out to psychoanalyticpractitioners around the country Alongside my participatory activ-ities I undertook a thorough inspection of two psychoanalytictrainings, one within the BPC, and one in the UKCP This inspec-tion included interviewing trainees and tutors as to the structureand experience of training; inspecting curricula, assessment criter-

sem-ia, institutional histories and theoretical preferences, institutionalrelations with neighbouring institutes, as well as interviewingtrainees as to their experience of the training to which they weresubject

In all these encounters whenever possible I have made known

my research intentions.18 That I was both insider and outsiderseemed rarely to place me in an ambiguous position in respect of

my colleagues From those accepting me as an ‘insider’ to the fession (e.g those with whom I worked and trained) I experiencedmuch help and openness; it was only when approaching those whodid not know me that I was treated more warily (at worst, surveyswould not be filled in, interviews not granted, and requests andqueries turned down or ignored) Naturally, it could be argued thatwhat I interpreted as suspicion of my outsider status might havehad its cause in one of many variables But since how I construed

my role (as predominantly a researcher or as a member of the fession) seemed to influence people’s reactions to me, the conclu-sion emerged that where I was placed (by others and by myself)had a significant impact upon how I was received

pro-A F INAL N OTE ON N AMES

To protect the informants of this research I keep their names andthe institutes to which they belong confidential I take this measurebecause many of the informants I interviewed made disclosuresthat at the worst might compromise their relationships with seni-ors and colleagues, or jeopardise their positions in the community.Naturally, if this were a species of investigative journalism such

‘exposing’ (of seniors at least) would be a legitimate task, but as

my objectives are academic and anthropological, that is, as Iprimarily work to understand the reasons for such comments andwhat they tell us about the community, I believe such discretiondoes not affect the deeper aims of my project Also, if respectinganonymity protects informants, by promising them confidentiality

I also gave them licence to speak on matters more easily revealedfrom the safe ground of anonymity As I now find myself in the po-sition of honouring my early pledges, I revert to pseudonymswhere necessary

As for the names of various psychotherapeutic institutes, I onlymention these when not speaking from the standpoint of an ethno-grapher On other occasions when referring to historical data I usethe names of the institutes freely In other words, I do not revealthe names of my places of fieldwork, whereas when using historic-

al data from documentary sources to illustrate the institutional velopments within the community itself, I freely disclose names asany historian might Again, as was the case when approaching in-dividuals, when approaching the institutes the promise of confid-entiality was an indispensable precondition for gaining entry;which itself was a precondition, it must be added, for undertakingthis piece of anthropological research.

de-THE RISE AND FALL OF THE PSYCHODYNAMIC

efore moving headlong into the arena of therapeutic training,

in this opening chapter I shall first offer an introductory count of the expansion of British psychotherapy during the twenti-eth century By this means I shall provide some historical back-ground to the modern psychodynamic training institute whileidentifying certain historical factors which have deeply influencedthe plight of the profession today My aim is to show that our un-derstanding of therapeutic socialisation will be significantlydeepened if we relate this process to the grander movements with-

ac-in the therapeutic community, and between this community andthe wider socio-cultural scene This analysis will explore threebroad themes: the expansion of psychotherapy throughout thetwentieth century; the proliferation of training schools that has ac-companied this growth; and the growing challenge to psychody-namic psychotherapy in the last quarter of the twentieth century

B

T HE E XPANSION OF THE T HERAPEUTIC

Why psychotherapy hugely expanded during the twentieth tury is a question that resists being answered with precision andexactitude The rise of any socio-cultural tradition may just aslikely originate in the movements and actions of surrounding so-cial institutions than in any expansive forces inherent to the tradi-tion under scrutiny This makes the project of identifying clear cas-

cen-25

ual factors as to the rise of psychotherapy a complex affair theless, when chartering the ‘why’ and ‘how’ of the ascendingtherapeutic culture in Britain a number of themes present them-selves for serious consideration Some of these themes have beendiscussed by earlier commentators on this expansion Theoristssuch as C Lasch (1979); E Gellner (1985); P Berger (1965); R Sen-nett (1976) and F Furedi (2004) have emphasised the decline of reli-gion, the decline of tradition, and the decline of the political sensib-ility as contributing factors to psychotherapy’s expansion As Ishall focus more closely upon these theories in chapter eight, not-ing how their authors differ in where they precisely locate the so-cial causes of this expansion, here I shall only concern myself withwhat all such theorists accept: that such expansion has un-doubtedly occurred It is from this starting point that I shall trace

Never-an expNever-ansion which has entailed a number of highly significNever-antconsequences for the practice and training of individual practition-ers

T HE B IRTH AND E XPANSION OF B RITISH P SYCHOTHERAPY

From the first psychotherapeutic institution in Britain to the ing of the most recent institute in the present day, one characteristicstands out in the history of psychotherapy—its meteoric growthduring the twentieth century The genesis of this expansion wecould locate as early as 1910 when the first group of analysts whowere in part responding to the mounting success of psychoanalysis

found-in America, began to actively establish psychoanalytic found-institutionsoutside of Vienna (Freud 1986 [1914]: 102) This early movementcomprised a number of young physicians and psychologists whogathered around the charismatic figure of Freud with the intention

of learning and practising the new medical craft This company ofminds, not happy to leave the movement there, worked to assurethe group’s continuity and the succession of its leadership TheNuremberg congress was held in March 1910 to achieve this It washere where the IPA (International Psychoanalytic Association) wasfirst formed with the purpose of both safeguarding and proliferat-ing what had been so far achieved (Freud 1986 [1914]: 103): K Ab-raham was entrusted the chair of the Berlin group, Alfred Adler,the chair of the Vienna group, while Carl Jung oversaw the Zurich

group A year later the Munich group was set up by Dr L Seif and

in the same year the first American group was formed under thechairmanship of A A Brill In 1913 two further groups were estab-lished: Budapest formed a cell under the leadership of Sandor Fer-enczi, while in England the first group was formed by Freud’sclosest ally and tireless apologist, Ernest Jones The founding of theBritish Psychoanalytic Society in London in 1913, containing eightmembers in total, marked the inauguration of the first psycho-therapeutic institution in Britain

After this first British institute was established there was littleinstitutional expansion within psychotherapy until post-war Bri-tain As M Jacobs has told us:

Apart from the founding of the Society for Analyticalpsychologists, the founding of the Tavistock [1920] and the rise of the Portman clinic in 1939, the only sig-nificant developments mid-century were the founda-tion of the Association of Child Psychotherapists in1949 and the wider accessibility of training (and in-deed of therapy for the wider public) through thefoundation of the Association of Psychotherapists.(Jacobs 2000: 456)

In fact by 1936 all the principle psychotherapeutic organisationswere in place: the British Psychoanalytic Society (1913) (later calledthe Institute of Psychoanalysis); the Tavistock Clinic (1920), and theAnalytical Club (1936)—now called the Society for Analytical Psy-chology

During the pre-First World War period, and to a lesser extentthrough the inter-war years, that psychotherapy’s expansion re-mained modest was something largely welcomed within Britishpsychiatry Many hostilities within medical psychiatry to the new

‘talking cure’ were deeply entrenched; partly because at that timemedical education still instilled a sceptical empiricism that keptwatch on what it felt to be ungrounded methods and their prolifer-ation, and partly because these psychiatrists preferred the physical-ist leaning of traditional psychiatry that tried to effect cure throughdirect bodily intervention (Holmes 2000: 389).19

It was not until the First World-War that the initial step tobridge the division between psychiatry and psychoanalytic ther-apy was taken The war was the most significant factor in launch-ing this rapprochement as publicly funded psychotherapy was de-veloped in an effort to treat victims of shell-shock and war fatigue.Many outpatient services were opened by middle class intellectu-als who offered treatment for neuroses, while psychotic disorderswere treated in the larger hospitals (Pines 1991) In London theTavistock clinic and the Cassel Hospital were among the first insti-tutions to offer the new psychotherapeutic treatment, setting upservices in 1920 and 1919 respectively At this time psychotherapybegan to leave its imprint on psychiatry in another way as the use

of psychodynamic group therapy in military hospitals obligedmany psychiatrists to become skilled in the new psychodynamictechniques

If during these initial years dynamic therapy only made modestinroads into psychiatry, outside of medicine psychotherapy wasgaining growing favour in the public imagination By the 1920sFreud had joined the likes of Einstein and other contemporary sci-entists by being portrayed in the US and UK daily papers andweekly reviews as a charismatic scientist who was revolutionisingour understanding of human nature (Forrester 1994: 183) ThatFreud assumed this enigmatic role is supported by many retro-spective studies that detail the early expansion and growing pop-ularity of psychoanalysis These studies, as Forrester tells us, showthat during the 20s and 30s Freud took on iconic status Henri El-lenberger’s (1970) study broadly records the Euro/American ex-pansion, while Rapp’s (1988) exploration of the same expansion in1920s Britain offers a more situated analysis of the mounting fas-cination with all things Freudian Another important study byGabbard and Gabbard (1987) documents how psychotherapistswere portrayed by Hollywood from the 1930s to the 1980s, em-phasising how from the early 1930s interest in psychotherapy pro-liferated in the middle-classes The rise of therapy in cinema, asForrester puts it, constituted ‘one dream industry feeding off an-other’—a mutual exchange that served the expansion of psycho-therapy very well (Forrester 1994: 183)

The status of psychoanalytic therapy was also improved by thekind of cultural icons who gave it their endorsement In England in

the 20s and 30s many notable literary and scholarly figures tolled the uncanny attraction of the talking cure Bertrand Russell,T.S Eliot and Thomas Mann were just some of the admiring few,while W H Auden in his In Memoriam Sigmund Freud elevated him

ex-to a kind of modern Moses:

so many long-forgotten objects

revealed by his undiscouraged shining

are returned to us made precious again;

games we had thought we much drop as we grew up,little noises we dared not laugh at,

faces we made when no one was looking

(Auden 1950: 59)

Other studies chartering the rise of psychotherapy show that bythe mid-century the therapy’s allure was endemic Eva Moskowitz(1990) in her book In Therapy We Trust: America s Obsession with Self- Fulfilment shows that it was at this time when the popularity of

psychoanalys really took root in the US While N Rose’s (1990)study, which traces a like development in the UK, shows that afterthe Second World War the therapeutic ethos had gained influencewith policy-makers and business managers who were keen on con-verting the application of therapy into economic reward

Along with these more popular endorsements, there also lowed approval from many quarters of the academic community

fol-To focus on American anthropology, for example, the culture andpersonality school headed by such well-known figures as Ruth Be-nedict (1934), Linton and Kardiner (1939) and Margaret Mead(1943), embraced psychoanalytic assumptions and argued thatevery culture has a distinctive pattern of child-rearing which pro-duces a distinctive personality type—one consistent with that cul-ture Despite this kind of cultural analysis being resisted in Britishanthropology, psychoanalysis was still being publicised in Britain

by anthropologists from W H R Rivers to the current S Healdand D Parkin (1994)

P OST -S ECOND W ORLD W AR E XPANSION

As popular acceptance of psychotherapy increased after the FirstWorld War, by the end of the Second World War psychiatry’s char-acteristic hostility towards psychoanalysis was loosening in certainquarters This was partly influenced by the growing acceptance ofdynamic therapy in American psychiatry,20 not to mention thatafter the two world wars, as Lousada reminds us, ‘the disturbance,guilt, and the experience of such immense destructiveness left psy-chiatrists with much to think about’ (Lousada 2000: 471) If pre-Second World War British psychiatry was in the main hostile to dy-namic therapy, then in the post-war climate and through the 1950sits institutional fortunes were to change By the early 1960s con-sultant and psychotherapy posts had been established in a fewpsychiatric departments, and junior psychiatrists, along with train-ing in the traditional diagnostic methods, were being routinely in-troduced to psychoanalytic techniques.21 During the next decadethere was a steady increase in psychotherapy departmentsthroughout the UK, with key centres being established in Notting-ham, Oxford, Manchester, Birmingham, and Newcastle—thesejoining the slightly more established units of Edinburgh, Bristol,and London.22

The acceptance of the therapeutic was thus expanding throughthe 60s and 70s both inside and outside established institutions.This can be seen from an assessment of the statistics compiled ontherapeutic attendance around this time, statistics which, althoughnot focusing on dynamic therapies in particular, nevertheless showthat demand for some kind of talking cure was growing at a rapidrate To start with the American case, Donna Lafromboise statedthat by the 1960s 14 per cent of the American public had receivedsome form of therapy at least once in their lives, while by 1995nearly half the population had experienced some form of thera-peutic intervention And it is estimated that by the turn of the cen-tury this figure will have increased to 80 per cent.23

The impact on British society was also significant As Furedipoints out, since the 1980s (when counselling became one of Bri-tain’s little growth industries) the number of people practising thetalking cure and receiving treatment has rapidly grown For ex-ample, just as the amount of registered therapists has dramatically

increased in recent years (e.g the UKCP Register of ists grew from 3,500 in 1997 to 5,500 in 1999—see table 1), so toohas the amount of therapy hours being conducted in Britain Forinstance, an independent research carried out by Counselling, Ad-vice, Mediation, Psychotherapy, Advocacy Guidance (CAMP) con-cluded that the number of therapeutic encounters taking placeeach month in Britain was in the region of 1,231,000, a far cry fromthe handful of analytic hours being yearly practised by the earlyanalysts (Furedi 2004: 9).

Psychotherap-c 1960

(Halmos, 1978)

c 1976

(Halmos, 1978)

c 1999

(Jacobs, 2000)

c 2005

(Various sources)

Table 1 Comparative numbers of psychotherapists,

counsellors and psychologists 25The expansion of the therapeutic was reflected in the prolifera-tion of new kinds of psychotherapy being contrived As Grunbaum(1984) noted, in 1959 a study was published listing thirty-six differ-ent kinds of therapy; while a later work by Wilby (1977) reports nofewer than 200 conceptually different psychotherapies Current in-formants in the profession put the number of therapies in existencearound the 400 mark Despite the fact that only a minority of these

‘therapies’ enjoyed institutional support, their proliferation ences the growing need to accommodate the increasing interest intherapeutic intervention

evid-The growth in the years after World War Two brought a voguefor do-it-yourself therapy As Roy Porter notes, ‘pop Freudianism,exemplified in the works of Eric Berne’s (1964) The Games People

Play helped people in their quest for self-understanding’ (Porter

1996: 388) Other books such as Eric Fromm’s (1955 [1942]) Fear of Freedom, Karen Horney’s (1942) Self Analysis, and more recently

Scott Peck’s (1978) The Road Less Travelled seemed to offer new and

exciting ways of understanding old dilemmas: ‘Old fashioned gious, moral, and material principles were replaced by psycholo-gical categories’, says Porter, ‘the single example of this was the re-ception of psychoanalysis’ (Porter 1996: 396)

reli-The growing trend within post-war Britain to recast social or ligious problems in psychological terms, a trend often resisted inthe social sciences and particularly by Marxist theorists, was spot-ted as early as 1949 At this time the director of clinical research atCrichton Royal Hospital, Willy Mayer-Gross, noted that ‘duringthe last 30 years the interest in psychiatry has shifted from the ma-jor psychoses, statistically relatively rare occurrences, to milderand borderline cases, the minor deviations from the normal aver-age’ (quoted in Porter 1996: 360) Surveys that originally focused

re-on ‘abnormal’ populatire-ons when tabulating mental disorder began

to include what had not hitherto been regarded as pathological:

‘Psychiatric attention was thereby being extended to “milder” and

“borderline” cases, and mental abnormality began to be seen aspart of normal variability’ (Porter, 1996: 360) The threshold ofwhat people defined as illness dropped further in the coming dec-ades, increasing the overall volume of psychological complaints(Shorter, 1997: 289) With the expansion of the therapeutic, prob-lems that might have previously been considered economic, social,

or moral in kind were gradually interpreted psychologically, ally in terms of illness, neuroses, or other injurious psychologicalproblems Social theorists such as Littlewood and Lipsedge (1987[1982]), and Furedi (2004: 6) partly locate the higher rates of de-pression not in an actual rise in pathology, but in our tendency toover-diagnose the phenomena.26 Our cultural imagination has beensocialised to reconfigure ever more experience as ‘traumatic’ andthen to trace the aetiology of current mental states back to thesetraumatic and psychological origins.27

usu-The trend towards ‘medicalisation’ or ‘psychologisation’ of content was promoted by the interests of the pharmacological com-panies As suffering was ever more reconfigured in psychologicalterms, causes of distress were increasingly located within the per-

dis-son, and what better device to alter the very bones of subjectivitythan psychotropic intervention As the successes of drug therapybegan to be publicised and as requests for prescriptions soared, itdawned on pharmacological companies that here lay the future Asone commentator claimed, in the scramble to corner the marketthese companies would distort psychiatry’s diagnostic sense andincrease the number of illness categories: ‘A given disorder mighthave been scarcely noticed until a drug company claimed to have aremedy for it, after which it became an epidemic’ (Shorter 1997:319) The availability of treatments, both psychotherapeutic andpharmacological, led to an increase in the recognition of ‘problems’that might benefit from these new treatments This proliferation ofproblems naturally created a market for therapeutic services,which in turn endowed these services with ever more importanceand power.

Therapy expanded in ways that Freud perhaps would not haveapproved of, because its expansion in Britain was not confined tothe rise of the dynamic therapy of psychoanalysis By the 1970s thetalking cure that was once practised in a few scattered private con-sultancies, now permeated British institutions at many levels insome altered guise—universities, prisons, military institutions,out-patient units, schools, big business and corporate industry, hadall to varying degrees institutionalised some version of psychother-apy or counselling That many of these ‘new’ psychotherapies werenot authentically psychodynamic many conservative psychother-apists would continually lament, but as expansion unfurled relent-lessly, it seemed that neither their voices were heard nor theirprotests heeded After the 1970s new psychotherapies gradually in-filtrated that province once monopolised by the dynamic psycho-therapist: the domain of private practice Soon integrative therap-ists, counsellors, and clinical psychologists started establishingprivate consultancies which today far exceed in numbers theprivate clinics of psychodynamic practitioners.28 The growth ofcontending therapies also had many consequences for the more es-tablished institutions One such implication was that new tensionsand relationships were steadily forming between the growingnumber of trainings; trainings that came to order themselves into acomplex training network This complex network I shall now de-