Letter from Estela to Free Associations journal

Estela Welldon and Otto Kernberg in January 2014

I was thrilled to read in your last issue 16 Autumn 2014 Otto Kernberg’s important article on Innovation in psychoanalytic education. He was one of my mentors when I did my post-graduate medical studies at the Menninger Clinic in 1962 and he provided me with much understanding about myself and my own specific field of work in Forensic Psychotherapy.

This latest article confirms Kernberg’s insightfulness. For example under the subtitle of Renovation of the structure of psychoanalytic education: ” I believe that the educational stagnation and underlying authoritarian structure of psychoanalytic education derives largely from the present-day training analysis system as a major source of inhibition of the educational process” . Not many would disagree, but few in authority would dare to say so. Being open about my bias, I was turned by down by the British Institute of Psychoanalysis as a candidate three times, yet went on to become a successful forensic psychotherapist and eventually an Honorary Member of the American Psychoanalytic Association.

When we adapted psychoanalytic theories to the treatment of antisocial behaviours, including delinquency, extreme violence, perversions, etc under the rubric of Forensic Psychotherapy, we were accused of diluting psychoanalysis and the importance of unconscious processes operating in the “criminal” mind. Yet psychoanalytic psychotherapy is not a dilution but an application of psychoanalysis in different contexts. In Dr Kernberg’s words: “”A central, unifying concept of all psychoanalytic approaches is the theory of the dynamic unconscious and its influence on conscious life”. Psychoanalysis may therefore have fundamental contributions to make to other sciences as yet only expressed as hypotheses, because of the lack of empirical and interdisciplinary research within psychoanalytic educational institutions, and a neglect of investment in research.

In short, general psychoanalytic theory, psychoanalytic theory of development, and psychoanalytic theory of psychopathology need to be correlated with related contemporary scientific approaches. Kernberg says “I believe that interpretation, transference analysis, technical neutrality, and countertransference utilization constitute the basic elements of the technical psychoanalytic approach, and that the combined utilization of these four techniques are then applied to other aspects of the psychoanalytic situation, such as character analysis, dream analysis, the analysis of enactment, acting out, working through, repetition compulsion, and the analysis of termination”. We need to learn how these ideas can be translated into other contexts. From my personal perspective, this is central to the field of Forensic Psychotherapy, where we treat (or inform the treatment of) people who would never be considered suitable for psychoanalysis per se, nor who could afford it or even want it. The emphasis falls more on understanding and educating the broader system including carers, therapists and the authorities who make decisions. For me psychoanalytic concepts such as the Unconscious, transference and countertransference, splitting and projective identification are essential. The challenge is to help people gain access to these basic ideas and their application without full personal psychoanalysis.

Revising and adapting psychoanalytic training and its subsequent application requires a basic term of reference.Therefore I found it disappointing to read Kernberg’s assertion that ‘It is significant that there is no comprehensive text on psychoanalytic technique”. Dr R. Horacio Etchegoyen’s book, The Fundamentals of Psychoanalytic Technique (1991) is essential academy reading for all psychoanalysts regardless which school they belong. It is especially surprising given Kernberg’s own review of this book, which I now quote.

‘R. Horacio Etchegoyen has written a splendid textbook on psychoanalytic technique– thoughtful, extensive in its coverage, authoritative without being polemical, deep in insights that reflect the author’s clinical experience… Both beginners and experienced analysts should find this book of interest and value. The former for its overview and as a guide to original sources, the latter for being introduced to a seasoned analyst’s experience and wisdom… Above all, psychoanalytic technique is presented throughout as a scientific inquiry in progress, and the interchange of communication across alternative approaches it proposes is a creative, productive way of stimulating understanding and fostering the effectiveness of our interventions with patients. I believe this book will be recognized as a major milestone in the growing literature on psychoanalytic technique and a major crossroad facilitating the communication and mutual enrichment of alternative schools and approaches.’

– Otto F. Kernberg, MDO

This omission is my only negative critique about a scholarly and important article from Dr Kernberg.