Unfree Associations: Inside Psychoanalytic Institutes (Book Review)

Author:  Douglas Kirsner
Publisher: London: Process Press, 2000
Reviewed By: Marilyn S. Jacobs, Winter 2001, pp. 32-33

Douglas Kirsner is an Australian academician who teaches philosophy and the history of ideas at Deakin University. In Unfree Associations: Inside Psychoanalytic Institutes, Dr. Kirsner presents a historical account of the group dynamics which occurred in four major American Psychoanalytic Association affiliated psychoanalytic institutes – The New York Psychoanalytic, The Boston Psychoanalytic, The Chicago Psychoanalytic and the Los Angeles Psychoanalytic. These reports are based upon interviews with 150 American Psychoanalytic Association psychoanalysts who were members of the institutes discussed and the author’s own research and field experiences. Kirsner characterizes his work as providing “a foundation for a critique of what has gone wrong with psychoanalysis and its institutions …”. The work also forms a rationale for Kirsner’s concluding analysis of “the trouble with psychoanalytic institutes”.

The story told is compelling and at times shocking. It is essentially a tale of power struggles with continual conflicts between all levels of members, struggles over psychoanalytic theoretical dominance, in-group/out-group passions and scapegoating, regular abuses of power, and, one would have to conclude, a consistent lack of adherence to any established ethical principles by the majority of individuals whose actions are described. In essence, there is an unending saga of unprincipled actions in the behavior of the psychoanalysts described in these stories.

The vignettes described are riveting. For example, the American Psychoanalytic Association sent a site visitation team in 1983 to the New York Psychoanalytic Institute, whose report concluded, “It is this focus on communality of purpose which we feel has been eroded, or damaged, or lost somewhere along the line at the New York Institute. The ideal of outstanding training and clinical practice of psychoanalysis remains strongly held, by firmly drawn sides and a contentious adversarial approach to issues dims, we fear, that communality of purpose”. (p. 56).
At the Boston Psychoanalytic Institute, it was reported that “The lack of objectively specified standards, the lack of objectively specified training standards, the lack of an established training procedure for those wishing to prepare for the work of doing training analyses, the attitude of secrecy about these matters – all are more appropriate to a club than to a scientific body”(Leonard Friedman, 1974). (p. 84). At the Chicago Institute, the son of a former patient sued George Pollack, Director of the Institute, for ethical violations related to charges of financial exploitation. And, at the Los Angeles Psychoanalytic Institute, it is reported that the American Psychoanalytic Association almost shut the institute down due to the bitter ideological struggles between the classical Freudian and the Kleinian orientations.

Within a 300-page myriad of such details, Kirsner depicts these four institutes as places where free inquiry is arrested and group psychology prevails. According to the author, “psychoanalytic institutes have been troubled everywhere and always” (p. 3). Institutes have been “closed, sectarian and seminarian”. Blame for these phenomena lie with the “personal, cultural and historical aspects of Freud and the development of the psychoanalytic movement” (p. 5). The explanation of this situation lies at the core of psychoanalysis and its institutions. “The nature of this complex field is suffused with uncertainty and ambiguity. … the claim to knowledge implied by qualification is far greater than the real level of knowledge” … A major aspect of this problem, … is that a basically humanistic discipline has conceived and touted itself as a positivist science while organizing itself institutionally as a religion”. (p. 232-33). Issues of training are also major problems with psychoanalytic institutes. “ … in the absence of an agreed-upon language training standards and expectations are also increasingly localized, and subject to the convictions and /or whims of the anointed. Cliques predominate and issues of power become paramount in defining whose “standards’ and what knowledge or curricula will prevail.” (p. 244).

Kirsner suggests that for psychoanalysis to change for the better, alternatives to the way that training is organized will have to be constructed. He suggests a deinstitutionalization of training and possibly abolishing the training analysis or separating it from the institute and the overall training program, thus eliminating the position of training analyst. In addition, a reorientation towards critical interdisciplinary research is essential. “ … the gap between the small base of verifiable knowledge ant eh high level of ‘pretend’ knowledge fostered by training and practice has grown to such a worrisome extent that the very question of what constitutes ‘knowledge’ is less and less posed nowadays”. (p. 250).

Much of what is described in this book is plausible and for many who have undergone psychoanalytic training realistic. However, questions arise about this study. First and foremost is the database of 150 interviews. A discussion of the sampling method is absent from the work. It may have been that those who participated in the interviews had a bias against the places where they trained or gained membership. Also, the institutes described are restricted to those of the American Psychoanalytic Association. By the 1990’s, many other types of psychoanalytic institutes were in existence in the United States and many of these were non-American affiliated. The work is clearly one sided against psychoanalytic institutes. Other perspectives do exist and would have balanced the history. The story isn’t all as negative as the author depicts and it seems as though he has a case to make and his database is as such. Another question relates to why the book was limited to psychoanalytic institutes in the United States and did not include those affiliated with the International or non-IPA affiliated institutes in other nations.

Nevertheless, this work is an important study, which should be read and considered. If the historical rendition of events is only regarded as 25% valid, it is still quite instructive as to what can and has gone wrong in this field. This reader came away with the conclusion that the best way to professionalize psychoanalysis is as a secondary specialty of ones primary discipline (i.e., psychiatry, clinical psychology or social work). Perhaps this approach would lessen the power struggles and encourage the practice of psychoanalysis as an ethically based function of the specialty under which one is licensed.

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