Dr. Jutta Kahl-Popp, Kiel, Germany: IPA Psychoanalytic Training Award 2009 Lecture, Chicago page 1 out of 12

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1 page 1 out of 12 Dr.Jutta Lütjohannstr Kiel Germany Tel.: 0431 / Jutta.Kahl-Popp@t-online.de Kahl-Popp Psychoanalytic Training Today Award 2009 of the International Psychoanalytic Association (IPA) This lecture at the IPA-Congress 2009 in Chicago is an abbreviated and condensed version of the awarded work. Learning and Educating Psychotherapeutic Competence Exemplified in Psychoanalytic Training Jutta Kahl-Popp IPA has distinguished a study of mine by bestowing the Psychoanalytic Training Today award on it. I feel deeply honoured and want to thank IPA for this award. Here I present a short account of my work. I have tried to formulate the educational and psychoanalytic premises for the concept and practice of psychoanalytic training. The structure of my work results from this task. I first describe psychotherapeutic competence as the object of learning and as the goal of psychoanalytic training. Then I investigate the question, How is psychotherapeutic (in this case: psychoanalytic) competence learned at all? From this I derive a conception of how this ability can and should be taught and learned. Starting with Sigmund Freud, in every generation of analysts complaints about psychoanalytic training can be found. The enclosed critique I have taken into account when developing my premises. I presume that You know the main criticisms about the psychoanalytic training, therefore I ll mention only some of them:

2 page 2 out of 12 - infantilization of candidates, - lack of scientific orientation, - personality cult and dogmatism, - contradiction between training structures and psychoanalytic spirit, - lack of pedagogical competence of training-psychoanalysts. 1. Psychotherapeutic competence as object of learning and as goal of psychoanalytic training Concepts and theories of psychoanalytic treatment have been developed by trial and error in clinical practice. They are not a reservoir of application knowledge, which is only to be adapted by a candidate for to become an effective psychotherapist. The complicated relation between psychoanalytic theory and clinical practice has led to a debate about psychoanalytic identity. It is at issue, what constitutes a specific psychoanalytic acting and how to mark off other methods of psychotherapy. Psychoanalytic identity, which is based on the question of who one is and which group you join, is not sufficient as object of learning and goal of psychoanalytic training. The term psychoanalytic identity admittedly characterizes psychotherapeutic acting implicitly, but is mainly meant to defensively secure the psychoanalyst s personality by group membership. Defensive securing his professional identity may prevent the psychotherapist to creatively unfold his clinical potential. I prefer the term psychotherapeutic competence, which not only asks what you represent as a psychoanalytic psychotherapist, but also what you actually can. Furthermore, I take the concept of competence for more useful, because it can be connected with epistemological and pedagogical research on professional competence and mastery. Psychotherapeutic competence from a psychoanalytic view From results of psychotherapy research, especially from a meta-analytic view, I have gained a definition of psychotherapeutic competence overarching the different schools. This definition is

3 page 3 out of 12 derived from the contextual model of thinking and can be theoretically divided into three psychotherapeutic basic abilities. 1. Psychotherapist s ability to create, by his personality, favourable conditions for a psychotherapeutic working alliance and to contribute to its maintenance (personal competence). 2. Psychotherapist s ability to frame this working alliance as a psychotherapeutic relationship (relational competence). 3. Psychotherapist s ability to realize, by a special treatment approach, the working alliance healthful for the patient (conceptual competence). All three areas of competence together make up professional competence of a psychotherapist, which can be realized only with the patient s contribution. Among the basics of psychotherapeutic competence from a psychoanalytic point of view are psychoanalytic theories of mental illness and insights on mental functioning and its impairment from a psychoanalytic, neuroscientific and evolutionary point of view. A network of interlinked abilities follows from the structure of the competence model (personal, relational, conceptual). Among personal competence, for example, I count mental plasticity, empathy, ability to stand states of not knowing and not understanding, and confidence in effectiveness of one s own treatment approach. Essential elements of relational competence are communicative intuition, the ability to establish a stable working alliance, to reflect the therapeutic relationship and implement the resulting findings, and the ability to offer patients a healthful setting as context of the psychotherapeutic relationship. Theoretical concepts such as unconscious staging neurotic conflicts in relationships, transference / countertransference, and projective identification as well as practical experiences in supervision and training analysis let psychotherapists develop specific psychoanalytical characteristics in their personal and relational abilities.

4 page 4 out of 12 Especially in conceptual competence psychotherapists express their different psychotherapeutic schools and treatment approaches. Psychoanalytic conceptual competence consists of 1. plausible psychoanalytic models of explanation for the complaints/symptoms of the patient, 2. specifically psychoanalytic approaches to solve or relieve the complaints/symptoms of the patient, 3. the psychoanalytic treatment approach s meaning for psychotherapist and patient, and 4. the psychotherapist s ability to reflect on how his personality, his treatment approach, and the working alliance are linked. Psychotherapeutic competence is a network of personal, relational and conceptual abilities, which can be differentiated and strengthened by further links. On the one hand the basic structure of this competence model is drawn up so generally that several psychotherapy approaches can be represented by it. On the other hand, by this model, the individual theoretical orientation and clinical practice of a single psychotherapist can be mapped. For example, I take those psychoanalytic clinical concepts for essential, that stabilize the psychotherapist, the patient, and their alliance and that encourage the therapist to evaluate his framing, intervening, interpreting, and its implications for the patient on the fly. I am convinced that psychotherapeutic competence in psychoanalytic practice is realized most effectively, if the psychotherapist focuses on the actual context of therapeutic interaction and on decoding the patient s unconscious evaluation (unconscious meaning analysis) of this interactional context. As one cannot derive clinical practice logically from theory, psychotherapeutic competence has two aspects, an external side of representation and an internal side of acting. 1. Descriptions of psychotherapeutic competence have an outward directed representing function. The more specifically the competence is described, the clearer the claim can be staked out against other psychotherapy approaches and schools, and against public and private financiers. Also

5 page 5 out of 12 requirement profiles for psychoanalytic training are derived from a representation of psychoanalytic-psychotherapeutic competence. 2. The internal side of psychotherapeutic competence is its dimension of acting. Psychotherapeutic competence is performed or not by exerting it. Foremost when interacting with patients, psychotherapist s abilities are activated. In clinical situations he must implicitly integrate his perceptions and tacit knowledge. While in a state of free-floating attention, the psychotherapist is directed inwards to his incorporated knowledge and experience. At the same time he is outwards cognitively and emotionally connected with the patient and focused on his communications anticipating-imaginatively. Consequently the psychotherapist s background (preconscious) awareness is activated, due to which he can offer interventions, interpretations and problem-solutions. Imagination and intuition play an essential role in gaining knowledge by implicit integration. For knowledge not yet known, newly to be discovered, the psychotherapist develops anticipatory imagination that can be confirmed by final intuition. To that extent implicit conclusions are unconscious holistic processes of cognition. In order to gain new knowledge from clinical practice the psychotherapist should integrate these processes explicitly (consciously) as well by which hypotheses are made and assumptions for interventions are derived. 2. Learning psychotherapeutic competence in psychoanalytic training From an epistemological point of view, each situation of applying psychotherapeutic competence, i.e. each therapy session, is a learning situation at the same time. The psychotherapist can not apply rules once learned, he rather has to construct his acting individually, adjusted to the situation and adaptively. Thus, the psychotherapist s learning capability is an essential qualification not only for his training, but also for his competent psychotherapeutic acting. Until today, an educational paradigm remains pertinaciously that people learned only if they were taught and that they learned only what they were taught. This conception contains unbalanced ideas

6 page 6 out of 12 about whether and how man were to be moulded especially from outside and that one could determine in advance what he might have to know to subsist in the future. Also in psychoanalytic training institutions this view is to be found. It has got the quality of a structural psychoanalytic superego complex in which psychoanalytic doctrines are solidified organizationally, institutionally and interactionally. Through an intrinsic, unreflected pedagogy, the structural psychoanalytic superego complex is handed down from one generation of psychoanalysts to the next. To understand how psychoanalytic-psychotherapeutic competence is learned, I have chosen a theory of learning implying a paradigm shift and at the same time compatible with psychoanalytic assumptions about unconscious processes. Learning does not necessarily result from teaching, but is a consequence and part of human development. Learning is a continuous process of personal changing, optimizing the adaptation and taking place consciously and unconsciously. The ability to learn can be vitiated by unfavourable attachment conditions and experiences in early childhood, existential anxiety like threats to feeling secure and death-anxiety, as well as neurotic anxieties expressed in pathogenic beliefs. Psychoanalytic insights in affect regulation, mentalisation, self-efficacy and self-reflection in early development prove that learning and learning accomplishments are embedded emotionally. From emotional evaluation of one s own actions a desire to learn can arise if, for example, in psychoanalytic training a discrepancy between the learning-object psychotherapeutic competence and the current level of the candidate s mastery is experienced. Only a conscious analysis of these emotional states leads to overcome the experiences of such discrepancy by learning. Candidates who analyze their own learning activity, learn autonomously. A proceeding self-analysis supports the autonomy of learning. One outstanding example of coherence of self-analysis and autonomous learning is Sigmund Freud. Candidates themselves and their ability to learn expansively can benefit from unconscious resources: They can intentionally study their intuition, imagination, unconcious meaning analysis

7 page 7 out of 12 and dream analysis. On the other hand, conscious and unconscious resistances may fully block learning processes or admit only defensive learning, because of conscious and unconscious pathogenic beliefs interfering with emotional evaluation of discrepancy-experiences. When learning defensively, candidates merely look for situation- or problem-solving without identifying the situation or the problem as their learning task. It is realistic to assume that the long-term and complicated process of developing psychotherapeutic competence also covers moments or phases of defensive learning. But in psychotherapy as well as in psychoanalytic training crucial development progresses result from expansive and autonomous learning processes. What makes up a good, a competent psychotherapist is mapped in professional guidelines developed, fostered, and traded by individual psychotherapists, the psychoanalytic community, and educational institutions. Professional guiding principles may get the form of superego or ego-ideal. Psychoanalytic training is lengthy and personally moving. Candidates in so-called novice-states tend to introject treatment approaches and educational personalities to shorten insecure searching and learning processes. This introjection can lead to superego-like tendencies to adopt word-for-word up to rigidly treatment rules, concepts, and schemes of interpretation. Formation of superego-like professional guiding principles is characterised by submission, obedience, rebellion, combat, and contrariness. Not for nothing the psychoanalytic community often was qualified as a sect, and not as a community of scientifically oriented clinicians. Formation of ego-ideal-like professional guiding principles is characterised by love, commitment, flexibility, variability, and orientation at reality and consistency. Candidates then may ask themselves whether treatment approaches fit to their personality and help developing them personally and professionally. The quality of a candidate s guiding principles is not only dependent on his biographical and structural preconditions, but also of how he processes the educational conditions, the pedagogical

8 page 8 out of 12 frames and interventions. Especially in supervision development of psychotherapeutic competence is in the spotlight. Supervision is not a therapeutic relationship, but a pedagogical one. Candidates expect professional guidelines, suggestions and personal inspirations by supervisors to develop their psychotherapeutic competence. Candidates and supervisors talk about the candidates treatment experiences and psychotherapeutic interventions and interpretations. This pedagogical relationship should facilitate as much security, trust and intimacy, so that candidates can honestly communicate their emotional discrepancy-experiences and process them in a way without personal insults in expansive learning processes. Supervision should be an area in which error analysis and productive shame become possible. Especially supervisors should take into account that they may temporarily have superego-like or ego-ideal-like significance for candidates. Candidates who base oneselves on supervisors or theories, normally are afraid of the unconscious processes in their patients and in themselves. Such dependence on supervisors helps them to feel safe with their patients despite their anxiety. Supervisees commute between two interaction relations, as their patients therapist and as learner in supervision. From this dual role, two levels of experiencing and processing in supervision are resulting: The supervisee reports about the ongoing treatment and at the same time processes, mostly unconsciously, the current educational interaction with the supervisor. Supervisees process unconsciously primarily the implicit meanings of supervisors pedagogical comments and spontaneous communications and how the latter handle the frame of their relationship. The way the supervisee unconsciously evaluates his supervisor s framing and communicating also influences how he as a psychotherapist creates the working alliance with his patient. From an adaptive psychoanalytic perspective, unconscious evaluation of the training-patient is the compass for supervised therapy and for supervision. For developing psychotherapeutic competence, learning theoretical concepts is not of primary importance. Theoretical work, i.e. construction, deconstruction, and assimilation of practice and theory, is beneficial if enabling the candidate, in his exchange with the patient, to grasp and

9 page 9 out of 12 interpret unconscious mental processes with regard to the patient s complaints triggered within the actual relational context. 3. Educating psychotherapeutic competence in psychoanalytic training Results of psychotherapy research have shown that general factors have greater influence on psychotherapy-success than specific intervention techniques of different psychotherapy schools. The psychotherapist s contribution is particularly arising from performing his personal and relational abilities and from the fit between his personality and his treatment approach. That s why in the center of attention of psychoanalytic training should be the development and cultivation of personal and relational psychotherapeutic competence. In addition, candidates should be encouraged to develop their own treatment approach and should be accompanied with this. This requires the training personnel s pedagogical competence. Training psychotherapists is a dialectical process of development and education. On the one hand, conventions and knowledge, as defined in training rules and curricula, have to be learned in their actual givenness. On the other hand, cognitive and emotional dissolution of conventions and knowledge is necessary to develop one s own treatment approach. In particular, due to the lack of academic connections securing good material and institutional frame-conditions, transmission of psychoanalytic knowledge in psychoanalytic education formerly has probably had much higher priority than developing the candidates psychotherapeutic competence. Professional guidelines of educating psychoanalysts normally include following trends: Educating psychoanalysts impart their own psychotherapeutic concepts to the next generation. Pedagogical thinking and acting is rather unreflected and oriented at Freud s maxim, psychotherapeutic competence were formed by experience as a training analysand and by identification with the training analyst. Guidelines of teaching-learning exchange (!) in supervision, training-analysis and theoretical instruction are imbued narcissistically; teacher s knowledge is traded for learner s followership.

10 page 10 out of 12 To become aware of their pedagogical acting, educating psychoanalysts should acquire knowledge about transfer and formation of competence and derive their practice of imparting from this knowledge. Teachers special educational challenge is to motivate candidates to process their emotional turmoil in clinical practice expansively. Supervisors and instructors without pedagogical conception tend to co-act out defensive movements of failure referring to biographical sore points or so-called residual neuroses of the candidates. They may feel their own psychotherapeutic competence called into question and therefore be tempted to relieve the candidate of feeling guilty, to reinterpret failure into success, or to justify it. For to stimulate the candidates educational process of implying that unpleasant self-experience and self-perception is a necessary element of developing psychotherapeutic competence, supervisors and training-analysts should offer their clinical failures for discussion in seminars. Moreover, supervisors should examine their interventions, where they criticize candidates overly much or nonproductively. In every training-institution legitimate attempts are made to initiate learning by teaching. Psychoanalytic education can be designed this way as well, structurally and individually. In the chapter learning, initiated by teaching, I have put together didactical principles and methods for psychoanalytic training that take into account the dialectic to serve the learner s interests on the one hand, on the other hand to lead him to contents which to learn he still has an unevolved interest. Like in psychotherapy, also in psychotherapeutic education acquiring knowledge and skills can only take place when the instructor s pedagogical offer stimulates an affinity between the candidate and the object of learning. Infant-in-family observation for example, so far mainly practised for research purposes, may serve pedagogical targets. Designed as a learning project of psychoanalytic education, candidates can have first quasi-psychotherapeutic experiences by introducing psychoanalytic framework and

11 page 11 out of 12 psychoanalytic parameters (e.g. free-floating attention, psychoanalytic attitude), which can form the basis of personal and relational psychotherapeutic competence. In empirical psychotherapeutic education research there are currently no significant results about evaluating pedagogical interventions in psychoanalytic training. So the question is unresolved, how individual supervisors and instructors can measure the impact of their acting and interventions. Up to now, I have found no better methods but the unconscious evaluation of adaptive psychoanalysis and the control-mastery theory to evaluate my work as an educating psychoanalyst. According to these concepts you can work gainfully in study groups and in individual supervision. Emotional climate, learning attitude, and flow and quality of narratives in a group can change immediately, when a supervisor has set up a correct hypothesis and interpreted accordingly. Candidates do even test, for example, their supervisor, whether he trusts in their psychotherapeutic development s potential, or he agrees with their ostensible negative self-expectations. Supervisees cognitively verify pedagogical-psychoanalytic interventions with learning leaps and new insights. In negative cases, learning blockades are growing, or supervisees development is stagnating. Interpersonal validation of instructors interventions refers to safety-feeling and wellbeing. In positive cases, narratives of helpful introjects and satisfying relational experiences are communicated. As supervisor I focus on whether my pedagogical-psychoanalytic interventions are appropriate to contribute to a benign development of candidates therapeutic relationships, and whether their therapeutic interventions and interpretations are increasingly verified unconsciously by their patients. The microscopic method, by which adaptively working supervisors offer supervisees to investigate their therapeutic interaction from moment to moment, reveals therapists difficulties and lets them sometimes experience painfully discrepancies between professional ego-ideal-visions and their actual level of development. How supervisors handle the accompanying shame affects, has crucial impact on the candidate s learning processes.

12 page 12 out of 12 Finally, for the future I wish psychoanalytic education accompanying educational research, so that candidates can frame their process of learning and developing psychotherapeutic competence in an expansive and autonomous manner, and that educational psychoanalysts can discover and develop their pedagogical competence