Introduction of the Czech Society for Psychoanalytic Psychotherapy

Ludek Vrba

The situation in the field of psychotherapy changed markedly at the beginning of the 90´ of the last century concurrently with the political and social changes, which ran through our country and also through the whole region of Central and Eastern Europe. In the Czech Republic in last decades of the 20th century psychotherapy existed almost exclusively within the health care system approved as complementary to psychiatric therapy, also as a treatment of choice. Some individuals tried stimulate interest in the different psychotherapeutic schools from the West and to develop those independently, however an eclectic view of psychotherapy predominated. This eclectic view of psychotherapy moreover offered also protection from the imposition of communist ideology, which found some of those emerging or established psychotherapeutic trends, unacceptable. While the cognitive behavioural trend was more or less ideologically supported, and the dynamic trend less so psychoanalytic psychotherapy was guite unnacceptable for the totalitarian regime. Nevertheless psychoanalysis and psychoanalytic psychotherapy always had its own supporters and active practitioners in Bohemia, even though it had to be conducted more or less unofficially and "underground".
During the communist era in Czechoslovakia psychoanalysis was one of the independent movements which maintained a rudimentary continuity with the democratic past of our countries. This continuity was important not only because it preserved a sense of a historical link with the whole European tradition, however violently the regime tried to suppress it, but mostly because this continuity was able to maintain without interruption the tradition of psychoanalytic thinking and psychoanalytic practice in the Czech countries. It succeded to keep going - even during two difficult periods of totalitarian regimes (nazi and communist) - through some individuals the personal training in psychoanalysis, that is to say that the current Czech psychoanalysts are successors in direct line, from such grand old men of psychoanalytic history as Otto Fenichel and Emanuel Windholz.
For this week-end´s forum it is surely not without interest, that much of the credit for preserving the continuity of a psychoanalytical community, belongs to one individual - who through his personal integrity and despite the persecutions in World War 2 and in the first decades of communism did not go under - and that this individual was a Russian emigrant, Bohodar Dosužkov.
Psychoanalysis - for the above-mentioned reasons - was well prepared to emerge from clandestine existence underground at the end of 80´ of the 20. century. Society starved from years of living in a totalitarian regime was very interested in all other than the official views. The professional community could begin to discuss all the individual therapeutic trends without fear of persecution. Interest in a psychoanalytic view as a means of healing the mental disorders increased rapidly. Public interest in the psychoanalytic view of the individual and society coincided with a growing awareness among many psychoanalysts that their knowledge can be applied to a much wider range of social and organisational issues and not only to their patients in the consulting room.
In 1993 Michael Šebek met with the EFPP delegates. This was a meeting of great significance as it provided the impetus for M. Šebek and his colleagues to establish the Czech Society for Psychoanalytic Psychotherapy (CSPAP) within that same year, based on the organisational structure of the EFPP. Since then the CSPAP has organised the training for candidates of all the three sections - individual, group and child. It is characteristic for the conditions in the Czech Republic (however mostly in Prague) that the first trainers in each section were psychoanalysts or psychoanalytic candidates. The inter-connectedness between the Czech Psychoanalytic Society (CPS) and the CSPAP was - on a personal level - close from the begining.
During the subsequent years the CSPAP while growing rapidly (The Society has a membership of 18 full members and 130 candidates in the three sections) it also began to look for an identity within defined limits and boundaries. Partly vis-a-vis the Czech Psychoanalytic Society (which in the meantime achieved the status of component - provisional - society in the IPA) and in part vis-a-vis the other psychotherapeutic trends, especially those of deep or dynamic orientations.
The CSPAP is now mainly a training organisation. In the individual section the society was well prepared from the beginning, trainers were recruited from among training psychoanalysts, and from among skilled psychoanalysts of advanced candidates. Interest in training in the CSPAP was and still is relatively high. This brings up the question of delimitation between CPS and CSPAP, because there seems to be an indirect dependence on the number of candidates in both societies - the more candidates there are in the CSPAP, the fewer there are in the CPS. As training question will be the topic of separate discussion within this conference I will only confine myself to give an outline of the training programme. This consists of (alike as in the other sections) an experiential part, the study of theory and supervision of the candidate´s cases concluded by a final case report. On completion the candidate may become a regular member of the Society. The program lasts for a minimum of 6 years.
In the group section the evolution was more specific. The first trainers already had experience of their own (eclectic) group trainings; some were trainers in some kind of group psychotherapy, some of them were already individual psychoanalysts or advanced candidates of psychoanalysis. Nor were they novices whether in a psychoanalytic approach and (not even) or in group practice. Nevertheless a new experience in a group was deemed necesarry which would be led by a skilled psychoanalytic group therapist. We were lucky in that a member of the Copenhagen Institute of group analysis (IGA) was at that time living in Prague for an extended period. She was able to lead two succesive training groups of CSPAP members and some of them completed the whole group-analytic training under IGA Copenhagen guarantee. The conclusion of this process was the 1st Conference on group analysis held in April 2001 in Prague and the awarding of certificates to the graduates; these certificates qualify them to establish an Institute of Group Analysis in Prague.
Just as the group section was able to make great progress in its development thanks to help from IGA Copenhagen, so the child section was lucky to make contact with Mrs Lydia Tischler and her colleagues, who started the trainning in child psychoanalytic psychotherapy for their Czech colleagues. During those years many seminars, workshops and international "schools" of child and adolescent psychoanalytic psychotherapy took place, which were either a required or optional component of the training of the first child trainers in Czechia. Some of those were open to professionals working in the health or education sector and most closely represented the "public" of the EFPP title - "in public sector" - some participants representing local and national political institutions (The Ministry of Education).
While the bulk of the work of the CSPAP is taken up with the organisation of the training in the three sections it has also established the group of professionals for work with children and families of trans-generational holocaust survivors. One such meeting is taking place concurrently in Prague.
The CSPAP is financially self-sufficient. It derives its income from member´s fees and from training incomes (trainers and supervisors in the group section, and all lecturers and heads of supervision seminars donate part of their honorarium to the CSPAP).

Psychotherapy is now a reputable therapeutic discipline in our country. A special organisation - the Czech Psychotherapeutic Society - acting as a umbrella organisation for all schools of psychotherapy represents psychotherapists (mostly those working in public health care) to the outside, looks after ethical behaviour etc. However the training in the different schools of psychotherapy is entirely within the competence of each training institute. In the Czech Republic we currently have about twenty of those training institutes of different psychotherapeutic approaches. Most of those were accredited by relevant expert committee to provide their own psychotherapy training. The CSPAP guarantees the training in psychoanalytic psychotherapy in all three sections. For graduates of those trainings there are no problems - having first obtained approval by their relevant professional boards which monitor the postgraduate education of doctors and psychologists working in health service - to work as psychotherapists. They can gain employment in In or Outpatient clinics or they can open their private practice (within the constraints of local conditions). This requires the approval of Local authorities, usually obtained without any problems. Problems can arise when the beginner-psychotherapist wants to get a contract with Health Insurance, i.e. if the psychotherapist wants to be paid by health insurance, which is mandatory for everybody. The health insurance companies regulate the volume of patient care and they are not exactly friends of psychoanalytic therapy. It is very difficult to persuade the health insurance companies that intensive therapy is both economic and efficient. They compare psychoanalytic psychotherapy with other psychotherapies, which promise to get the same results faster, more easily and cheaply. Health insurance companies unwilling to pay for all therapeutic sessions force the psychonalytic therapist to make a decision: whether to undertake the therapy and be satisfied with payment for the given number of sessions paid for by insurance company and try to make contract with the patient to pay for additional sessions himself (a solution, legally questionable or possible illegal) or to decide to be completely independent of the health insurance companies and to work only with patients who will be able to pay for their whole therapy from their own pocket. In our country there are as yet not many people who want to or can afford the cost of private therapy.
In our country the political will is absent which would determine the boundaries of health care to be paid for by manadatory health insurance to determine which therapy is and which not to be paid for by mandatory health insurance, e.g. how many sessions are to be paid. It would be much easier to make a contract with a patient if condition were transparent from the beginning rather than to having to make contracts which are encumbered by covert agreement and concealed from health and political authorities. It is possible to find a connection with the long-lasting situation of psychoanalysis in the former regime but I doubt whether such subterfuges would find favor today.
The CSPAP linked its existence to the EFPP from its inception. It took its inspiration from EFPP, based itself on the model of EFPP, took over its structure and finally became a member. The group section was the first to become a full member in 1999 and followed by the individual and child section a year later in 2000. At the delegates meeting in March of this year we could for the first time take part in all EFPP activities. Just as the only realistic way for our country to integrate with Europe is to become a member of EU so the CSPAP by its affinity to other organisations of psychoanalytic psychotherapy in Europe, has no other alternative to co-operate within EFPP.

Please, allow me to identify myself with my colleagues from Central and Eastern Europe and try to offer their/our behalf. As much as we wish to be a fully-fledged part of the European organisation we feel that there remain dissimiliarities reflecting the difference in the politico-historical development in our part of Europe during the last 50 years. This meeting while it is evidence of this distinction is at the same time an endeavour to try to reduce those dissimilarities. What then is the difference between our "western colleagues" and us?
We have different experiences with totalitarian regimes; we know them personally and very well. The consequences are surely both positive and negative, and could perhaps be helpful just because our experiences have sensitised us to hidden and invisible signs of totalitarian practices in European institutions (activities), including the EFPP.
We sometimes feel that we lag behind you - "the West" - in several respects. However, on closer acquaintance we can see that the differences are not so great. But it temps us to quickly cross to the other side to devaluate what we really can learn from you - "Westerners" - in order to avoid the narcissistic injury when we came face to face with the fact that there are still some differences between us.
Those of us - from "the East" - are and at the same time are not in the same boat. We would be glad to have the support from those others with a similar fate, but we are reluctant to help each other, while we might have chance to be the first, the privileged ones in the imaginary race for entry among those "Westerners".
Maybe we are poorer. This is not easy to accept, but it is the reality. Hopefully it could be the starting point in negotiating the conditions for mutual co-operation, where financial considerations would be minimised. It is possible to think about some - maybe differential and gradually diminishing - bonus for us from "the East"?

What I consider as most important is to develop an alliance based on what I believe is our shared experience of the psychoanalytic intellectual legacy, and comprehension and understanding of the human condition and its problems. We also share similar methods of treating patients. Awareness of those factors can also have very practical consequences. In our country there is a tendency in the higher echelons to put all psychotherapists in one sack and to obliterate the differences between them - maybe in the hope that as the saying goes "there is strenght in unity" (as is so often used in times of danger or revolution) in order to try to get a recognition within EU. (This is my understanding - of course in a very simplified way - of the way the EAP operates.) I am suspicious of those unifying tendencies (maybe as a result of knowing only too well the collective actions during totality?), mainly because I see it as an opportunity for those at the top to become more powerful and as an unjustified tolerance for therapies of very poor quality (which can thus be "lost" within the mass of such a wide range therapies). I would not like to see a lowering of the rigorous requirements, which - according to me - belong to a professional standard of the psychotherapy profession only because it will seem to be superfluous in such a disparate organisation.
I think we must maintain our psychoanalytic specialism and try to find a collective solution with our "purely psychoanalytic" colleagues rather than demarcate strict borders between us. Maybe we will find that the difference between psychoanalysis and psychoanalytic psychotherapy is not as great as against the difference between both of us and other therapies. I think that even in our poitical aims so as not to get lost in Europe it is better to act in the self-confidence that we really have something different to contribute.
This stance - I can imagine - could be useful in discussions about the European Certificate. I think that a European Certificate endorsed by the EFPP would carry more weight than a more general certificate endorsed by the EAP. More symbolically - I can imagine a numerically smaller "psychoanalytic" Europe (and also America or Asia, etc.) than widespread "psychotherapeutic" Europe. Of course, this leave open the question - how to get closer to this goal. Hopefully we will find inspiration here at our first meeting between East and West.

Prague, October 6, 2001 Ludek Vrba

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