Comments on the Conference

Firstly, I would like to thank you and the other organisers for what I thought was a veryworthwhile conference: sometimes very interesting, sometimes infuriating but all the timestimulating. There is no question about the excellence of the four papers that were presented.

The conference topic, perhaps inevitably, proved to be a `highly charged' one, and forthis reason alone it was useful to `give it an airing'. I feel the issues of politics and status inthe field of psychoanalytic psychotherapy and psychoanalysis are allpervasive, quite deepand mostly maintained by subtle insinuations and evasions. I found this to be very much soat this year's Rugby Conference. Therefore I welcomed your conference as a move in theright direction to initiate open dialogue.

However, I was saddened by the overwhelming emphasis on psychoanalysis, with theconcomitant, albeit perhaps unintentional, implication that psychoanalytic psychotherapy issecondary and inferior. I feel the programme sheet set the framework for this.Psychoanalysis is emphasised at the top. Psychoanalysis comes before psychotherapy in thetitle. All three sessions were chaired by psychoanalysts. Only one of the four papers waspresented by a 'pure' psychotherapist (i.e. not trained or involved in the Institute ofPsychoanalysis). On asking Bob Hinshelwood, I discovered there was absolutely no reasonfor giving the psychotherapist fourth place (1st, 2nd, 3rd and also ran?). In fact, he told me,the thought had not entered his mind. I take this to be symbolic of the whole problem - thatit can so easily be dismissed as a paranoid creation of the psychotherapists. And of coursepsychotherapists need to own their collusive contribution.

I do not know, of course, how many (if any) psychotherapists there were in theorganising committee. My fantasy is that they were all psychoanalysts, as indeed were thepanel (as on the programme). I was puzzled to hear that 20 psychotherapists had beeninvited and had refused. Why did they feel they could not accept? Why were not moreasked? Were they only invited as individuals or was the problem discussed with the chairs ofone or two of the psychotherapy institutions?

I was concerned too that the proportion of psychoanalysts in the conference membershipwas so low. There were, perhaps, no more than two or three who were not taking part in theorganisation or the programme. It is hard not to suspect that analysts in general do not feelthe topic to be of interest or concern to them. The implication of this would seem to be thatpsychoanalysts feel they have a lot to offer psychotherapists but not vice versa.

As I said in the general discussion, I doubt whether the issues can be addressedrealistically unless a programme is planned by a committee of equal numbers ofpsychotherapists and psychoanalysts and representing equal numbers of respectiveinstitutions. As I feel it is desirable and quite urgent to develop understanding, cooperationand complementarity between psychotherapists and psychoanalysts, I would suggest thatthis be done.

Two further suggestions: it might help to keep to Saturday and/or Sunday as it is hardfor many people to make time on weekdays; a carefully designed feedback sheet in theconference folders might give some useful information.

Ruth Barnett

Comments on the Conference 201

I greatly appreciated the conference. It uncovered some of the difficult and painfulthings about the relationship and if for no other reason I think that conference was a braveand necessary occasion.

It has left me with many thoughts. The main point to emerge for me was aboutpsychotherapists and their institutions, which was put most succinctly by a speaker from thefloor who pointed to the dependent and angry relationship that psychotherapists have withpsychoanalysts. In fact the conference produced dramatic confirmation of this when, in replyto a question as to why there were no psychotherapists as speakers, we were told that twentyhad been approached and all refused, the reason given being lack of confidence.

One might conclude from this that psychotherapists are just not up to it and so had betterrecognise this and stop complaining (angry dependency). But I do not think it is so simple. Ibelieve that psychotherapists, of whom I am one, have a real problem. It was expressed in anumber of different ways in the conference, for example the mutual projection of contemptand envy. It might be put like this. The theory on which psychotherapists base their practiceis psychoanalytic theory, both theory of the mind and theory of clinical practice, but theirpractice is called something different. While we can resolve this at the conscious andrational level, at another level it must give rise to fantasies about legitimacy and ownership.Thus, if I practise psychotherapy, how can I contribute to theory (which is psychoanalytical)? If I do am I trespassing, or poaching, am I acting under false pretences or what?

Put another way, it is the question of resources. I am not thinking primarily aboutmoney, although that is a consideration, but rather of history, tradition, and accumulation ofexpertise. The discoveries, the books, the achievements and the fame belong rightly topsychoanalysts since they have done the work. I think that the problem of psychotherapyorganisations is indeed very like that of the adolescent; you cannot become a grown-upwithout the help of resourceful adults, but you cannot be grown up until you have your ownresources. And so back to the question in my previous paragraph of whose resources arethey.

A solution to the problem is to agree that there is a difference between psychotherapyand psychoanalysis, in which case psychotherapists can have their own and differentresources (but it did not seem to me that the conference came up with any differences, and Ido not think that one theory can support two significantly different practices). I do notbelieve there is a difference, but I also think that the talk about difference serves to muddlethe minds of psychotherapists and contributes to the sense of doubt and dependency. It mayindeed be that the most significant difference between psychotherapy and psychoanalysis isthat psychoanalysts are confident and psychotherapists are not, and I do not mean thistrivially.

While I do not wish to defend psychotherapists I think the real difficulties need to beacknowledged. They are problems of the mind and can only be solved by psychotherapiststhemselves. Like the adolescent, we can only grow up by developing real resources, in ourcase through training, post-qualification seminars and all the other things that professionalorganisations do to further the work of their members, and fur this we may need the help ofpsychoanalysts.

Jane Kitto

202 British Journal of Psychotherapy

Of the conference I have scarely a criticism and much praise, and gratitude for the easyway in which it all went. I found it particularly helpful to have printed papers available tosave note-taking and to tax the memory less, and to allow me to look back on what wasactually said. Some mild criticisms were offered at the end and here is my reaction to them:(a) If the topic had been offered at greater length (the length it in principle deserves) I couldnot have found the time to come; (b) If there had been smallgroup discussions, the toing-and-froing would have been very time-consuming, and we would still not have known eachother well enough for their purpose to be served. However, I do think the conference wasexpensive. Did we subsidise something? If so, what? And if so, should we have been toldthat costs were more than covered and that the surplus went to ...? All costs get passed on topatients, thereby limiting still further the number of those who can afford psychotherapy. Ilike to know where my charitymoney goes. But this is a tiny frown. I feel tremendouslyclearer, and thank you and all participants at the conference.

As you know, I started with an ignorance in my mind about just what the difference wasbetween psychoanalysis and psychotherapy. Indeed, it was to learn more about this that Iregistered for the conference. Although initially disappointed that neither Sandler nor Wolfftold me what 'it' - this difference - was, I realised at the end of the first day that I had, withtheir help, come to conclusions which I found satisfactory.

Regarding the papers, I thought Sandler's paper statesman-like and humane, and Wolff'soutstandingly humane but in one respect unhelpful: it cannot be right to compare five-times-a-week psychoanalysis with once-a-week psychotherapy, and then attribute the differencenot to differences in the frequency of sessions but to 'it'- the intrinsic difference betweentherapy and analysis. Friday put me in a good mood to appreciate Obholzer's talk which putthe whole question in proportion (justly, to my mind) by placing it in a social context.Waddell's paper seemed to me flawless and very enjoyable, for me the best of the lot.

Meanwhile, the social currents among the participants had begun to be of equal interestto me, not in terms of underlying motivation or group dynamics, but in their effect on `it' -the difference.

So what conclusions did I reach? By Friday evening I had realised that there was no `it',no secret Ingredient X which analysts had and therapists had not. I think I thought therewas, before the conference, though with hindsight it seems naive. It became very clear tome that there are techniques of relating which are therapeutic, and that we are always inprocess of discovering more about these techniques and constructing theories to account forthem. Also that there are theories of psycho-dynamics and techniques of relatingtherapeutically which arise out of these theories. Psychoanalysis has a good selection ofsuch techniques and theories. Institute students of psychoanalysis have a very thoroughgrounding in this selection, more thorough than I, for instance, received. But with hard workI can make up the deficiency. However, greater and deeper knowledge of established ideaswas not what I thought of as Ingredient X, though Institute training has it and I have not. Onthe other hand, I realise that while Institute training is deep and thorough in specificconcepts and techniques, and frowns on others outside its canon (though I discovered withinterest that one may be allowed to experiment after being qualified for a good number of

Comments on the Conference 203

years), I am glad no-one frowned on me, so that a wider range of ideas and techniques wasavailable to me from the start. So, I concluded, it is a matter of swings and roundabouts, andthe harder we all work, the better we shall all be in the end. As Nelson said: No caption cango far wrong, if he puts his ship alongside that of the enemy. As long as what we think anddo gets our patients better, we can't be far wrong.

As to the social currents. Why did I think for so long that there was an `it', an IngredientX? I think, because it is so hard to know what others actually do in the privacy of theconsulting-room: we're never there to watch it. Friends and acquaintances (mostly therapistsnot analysts) all said there was a difference. Those Emperors, they said, had such wonderfulclothes. The analysts I knew looked very nice on the whole, I thought. Ah, said my friends,you should see their wardrobe. I assumed that what they had in their wardrobe wasmysteriously better than what I had in mine, not in ways I knew about (i.e. their soundtheoretical knowledge) but mysteriously. Until the conference I had not come across manyanalysts who were snooty about their wardrobe. Only therapists advertising on their behalf.But in the conference there was indeed a good deal of unconscious and unselfconsciousswanking, which was often quite ignorant of what psychotherapists actually did. (Someanalysts seemed to assume that what they did when they thought they did psychotherapywas in fact psychotherapy). Once or twice this verged on the offensive, and once or twice itcrossed the line. The four main speakers were exceptions: courteous throughout even intheir assumptions.

For instance, I never thought of psychoanalysts as parents. Why should I be saddledwith being supposed to have a child's phantasies about them? I think I should thank mytherapist/analyst for this - he did not imprint this on me. I may have phantasised about himas a parent, but this had nothing to do with him being an analyst while I was training to be atherapist. I never thanked him for saving me this muddle, and I thank him now. I don't evenknow if he thought he was doing analysis with me or therapy. I was not interested in thatquestion at that time.

Another instance - I did not like having envy imputed to me, or idealisation, or any of anumber of other motives, particularly as those who addressed us wholesale with suchinterpretations made no move to look at their own motives. Such `wild' interpretationscreate the conflictual tensions they posit. Go on telling a specific group of people that theyaren't quite as good as some others, or for that matter keep telling them they are just asgood, and most will think they are deficient in something somewhere. I believe that a properunderstanding of people's motives should be worked at in the consultingroom withthorough exploration. If it is done elsewhere, off the cuff, unasked for, for whose benefit isit volunteered? Who benefits? We had better all work harder in this area, as in others.

Josephine Klein