Luc Moyson, Chair of the EFPP

The European Federation for Psychoanalytic Psychotherapy: the past, the present and the future

THE PAST

The European Federation for Psychoanalytic Psychotherapy was founded in 1991 in London.

Brian Martindale, a British psychoanalyst was elected as the first President and he formed, together with colleagues from the UK and other countries from Europe the first Executive Committee. This Board had as most important task to write the first version of the constitution, something that demanded a lot of inspiration and transpiration.
The overall aim of the EFPP has, from the start, been to contribute significantly to the wellbeing of mental health among people living in Europe and to facilitate communication between psychoanalytic psychotherapists in different parts of Europe. The EFPP is concerned with extending the availability of psychoanalytic psychotherapy and its applications in member countries, by promoting a European community network.

The founding of the EFPP must be understood in the context of the political, economic and social developments that occured in and between the European nations and the growth of Europe.
Two main reasons can be pointed leading to the founding of the EFPP:
- the European integration process and
- the crisis in the field of psychodynamic psychotherapy

a) The European Integration Process
The founding of the EFPP has to be considered from the perspective of the creation of the Single European Market and the supression of the national borders of the so-called Schengen countries. This meant that any professional was allowed to migrate in any other European country and was free to live and work there. Of course, he had to prove his professional qualification in that new country.

b) The crisis in the field of psychoanalytic psychotherapy
The initiators of the EFPP and especially the members of the UK were aware that in all parts of Europe psychoanalytic theory and treatment were being attacked by alternative short term therapies, regardless of the patients intra psychic needs and this only for economic reasons and not for therapeutic ones. Psychoanalytic psychotherapists were replaced by cognitive therapists in hospitals and universities because of "evidence based" practice..

Unfortunately, the field of psychoanalytic psychotherapy in Europe, at that time, was fragmented mostly into local or regional and seldom into national bodies. This situation was not the best way to defend psychoanalytic psychotherapy.

Furthermore, there was no cohesion in the field: the training models looked very different and even the training standards were incredibly different from country to country. No consensus could be found of what psychoanalytic psychotherapy really was.
The lack of cohesion in the world of psychoanalytic psychotherapy had a lot to do with tension fields and differences: differences between clinical psychologists and psychiatrists, academic trained and non-academic trained, psychoanalysts and psychoanalytic psychotherapists and differences between members and non-members of the IPA. In addition, of course due to the different analytic frameworks people adhere to Post Freudians, Winnicott, Klein, Meltzer, Bion, Lacan, and more recently Kernberg and Fonagay etc.

Sometimes I wonder how it was possible to gather all these people in one Association and to bridge those broad gaps.
The EFPP initiated a still ongoing discussion about training models and standards.
The EFPP training standards are agreed upon as the benchmark for national networks and we consider it as an important task to give support in the training of member countries who ask for assistance. We may say that the EFPP has brought some cohesion in the fragmented national organisations by helping the existing national bodies to discuss together and so to come closer. This was not felt as a loosening of the specificity of each society but as a mutual enrichment, full of developmental capacities.
In other countries, EFPP initiated the founding of regional societies in regions where no psychoanalytic psychotherapy organisation existed so far. In several countries, EFPP stimulated the establishment of a national umbrella organisation.

During the first years of the EFPP, the focus was mainly on the type of training needed in order to work effectively as a psychoanalytic psychotherapist. The discussion about criteria for training was an important political discussion, which engaged individual clinicians as well as training institutes in many countries. Through these discussions, several countries developed their training programmes and national networks.

THE PRESENT

Nowadays 24 countries in Europe are full members of the EFPP.
Associate members; do not yet fulfil the standards of EFPP. Observers are from those countries that are at a first stage of developing psychoanalytic psychotherapy. Only national networks can be members of the EFPP and not individuals. Membership in the EFPP is open to all European countries. Exceptionally a country situated outside the European borders may be accepted.

The Structure of the EFPP

a) The sections
The EFPP consists of 3 sections with psychoanalytic psychotherapy for: Adults, Children and Adolescents and Groups.
A fourth section for Psychoanalytic Couple and Family Psychotherapy is being developed and will become part of the EFPP during the next Delegates Meeting in March 2009. The issue of how to integrate PCFP in the EFPP has been discussed for a long time. At the Delegates Meeting in Stockholm 2005, it was decided that the fourth section would be formed, and that the working Party should include one representative from each of the three sections. It was also decided that the PCFP Working Group should get an overview of the number of organisations and persons interested in PCFP in different countries. The formal inclusion of the PCFP Section has been postponed until 2009 as it has taken more time than was originally thought to form this new section.

Each country can delegate two members in each section which means that a maximum of six delegates represent each country at the General Delegates Meeting. The delegates meet every two years during a General meeting in the country of the Chairman. During this Delegates Meeting, voting can take place about amendments to the constitution. Delegates have to been chosen in a democratic way by their national networks and will represent points of views of their countries.

b) The Executive Committee
All the members of the Executive Committee are elected at the Delegates Meeting, which assembles every two years. The election period for the members of the Executive; is four years. According to the constitution of the EFPP, the Executive Committee consists currently of three delegates from each section. An administrative secretary and a financial administrator are also part of the Executive Committee. The Executive Committee has at least two meetings a year, by preference at different locations .The Executive Committee elects the Chairman, the vice Chair, the treasurer, the honorary secretary etc.
The first Chairman was Brian Martindale (UK), then Serge Frisch (Luxembourg), and then Siv Boalt Boëthius (Sweden). Luc Moyson (Belgium) was elected as the fourth President of the EFPP in March 2007.

What did the EFPP achieve so far?

In short, the overall principle is to keep in contact with the development of psychoanalytic work in our member countries, with special regard to the conditions of work with our patients. We must not forget that the concern for our patients must be always our priority! Permanent attention to training conditions and research are also of great importance. This is not an easy task. Europe is growing and with the recently new EU member countries, the balance seems to have shifted towards the eastern part of Europe. Right from the beginning, one main area of the work has been to discuss and exchange experiences from the various types of training in psychoanalytic psychotherapy that are offered in different countries in Europe. Our aim was to reach an agreement on the level of minimum standards of training that is desirable and realistic. This discussion is an open-ended one while continuous changes in society demands constant adaptations. Huge differences in history and traditions lead to different perceptions and interpretations of what psychoanalytic psychotherapy really represents. We offer a forum in which further explorations can take place and in which we can learn from our differences.

The EFPP promotes a European Community network of psychoanalytic psychotherapists through activities such as annual EFPP conferences, the publication of the EFPP Book Series, through support of training programmes, through setting up different special interest groups and through the EFPP Website.

The EFPP Conferences

In its 17 years of existence, the EFPP organised at least one conference a year.
Besides, the, of course important theoretical value of conferences, we needed them as one of our main financial resources. EFPP was from the beginning financially healthy thanks to the surplus from conferences while the financial contribution of the member nations is hardly enough to cover the fixed costs. Thanks to conferences, many of our members made new interesting contacts with colleagues and discovered fresh fields of interest. During the first years of EFPP, each section had an annual conference and a three-section conference was arranged every fourth year. However, it gradually became clear that this was too many and it was decided that the sections should arrange their section conference in turn. National networks of particular countries often organise a local conference with the support of the EFPP to which they belong.

A special feature in the EFPP conferences is the discussion groups after each plenary session and these small groups, which stay the same for the whole conference, are much appreciated. They contribute to increase the learning as well as to enhance the contact between participants. During these big conferences, many colleagues have the opportunity to present their work in a workshop that leads to many very interesting exchanges.

Besides these section conferences there are the Francophone conferences. These conferences are important, as they are attractive for the French speaking parts of Europe. It is also one of our compromises to cope with the difficult topic of languages.

In order to support the resurgence of interest in psychoanalytic ideas and therapies in Eastern and Central European countries, EFPP has also organised conferences in some of these countries. The first Eastern and Central European Conference took place in Prague, the next in Riga and the third and last one in Tallinn. At the Tallinn conference, it became clear that there was no longer the same need for these separate conferences. The support from the EFPP through seminars and supervisions in specific countries has continued. For example, we supported short-term trainings in Kiev, Russia and Bulgaria. Any request for such trainings can be proposed and discussed in the Executive Committee.
Our next EFPP conference, organised by the group section will take place in Prague in 2009.

The EFPP Book Series

The EFPP has the tradition to see almost each Conference as an opportunity to produce a new book. This initiative resulted in the publication of already 9 volumes published by Karnac in London. Several other books are in preparation to be published in the near future. Main lectures, selected paper presentations and workshops compose the content of these volumes.

The Special Interest Groups

Also because of contacts made at conferences, several new special interest groups were founded. These groups sometimes organise small meetings by themselves or will reserve their own space at conferences.

The special interest group for Psychoanalytic Couple and Family Psychotherapy resulted in the proposal that the EFPP would create a fourth section. After a lot of discussion and reflections, the General Meeting of the Delegates voted for the formal setting up of this fourth section. We gave the responsible persons the time to develop this section to be ready to function autonomously and this fourth section will be officially established in 2009.

The special interest group for Infant Observation has already organised several meetings in the past. Their last meeting took place in Pisa, Italy in February 2008.

Another very important special interest group works on Research in Psychoanalytic Psychotherapy. Several very well experienced colleagues in the field offer a forum where exchange of information can take place. Ideas regarding research projects were discussed and the importance of inviting both clinically and theoretically based-research was agreed upon. As the pressure to "prove" the evidence based" value of our work we believe that this kind of workgroup can offer a lot to our profession in the near future. Many colleagues working in different institutes and in different universities share the same interest in research. The EFPP makes links possible and facilitates contacts and initiatives.

The special interest group for Victims of Torture and Organised Violence is a constant, on-going part of our conferences and brings this painful subject to broader international attention.

A new form of an ongoing workshop is a Peer-Review Session in collaboration with the editorial board of the International Journal of Psychoanalysis in which a review discussion was held about an unpublished paper.

Every two years EFPP organises a small workshop at a Greek Islands: Syros where a theoretical and more clinical topic is elaborated. End May 2008, the theme will be psychoanalytic psychotherapy with the Narcissistic patient.

The EFPP and the Central and Eastern European Countries

From 2004 to 2006, twelve countries in Central and Eastern Europe became members of the European Union. This development had been foreseen by the EFPP and contacts with many of these countries have been developed since the start of the EFPP. Ludek Vrba (Czech Republic) is a member of the Executive Committee and through him and others many of these contacts have developed in a very positive way. Since several years, members of the Executive Committee have been invited to give presentations, seminars and workshops or to work as Supervisors in Ukraine, Bulgaria, Russia, Poland and Serbia.
More of the Central and Eastern European Countries have developed their training standards and are joining the EFPP either as full members or associate members in the same way as other European countries do. A suggestion that was supported by many was that the next step could be different forms of continued supervision in order to enable those who have now finished their training to develop their work further and eventually be able to work as teachers and supervisors themselves.

The EFPP Website

The main channel for communication with the outside world is the EFPP website: www.efpp.org.

A considerable amount of improvement has been made since the start of the website. The website is one of the most important tools for information about psychoanalytic conferences whether or not organised by the EFPP. Very interesting articles with the possibility to react is another example of this inexhaustible medium. An important aspect of the website is the information about who are the delegates from the different sections for the different countries. It is therefore important that this list is kept up to date.

I just can recommend you to add the EFPP website address to your favourites list!

Contacts with IPA and Allied organisations

Since the start of the EFPP the connections between EFPP and the member societies of the International Psychoanalytic Association (IPA) have been a crucial issue for the Executive Committee. One positive outcome of this co-operation is that psychoanalytic psychotherapists can publish their papers on psychoanalytic psychotherapy in a psychoanalytic journal.

Several Executive members of the IPA were invited to give lectures at conferences or delegates meetings. Another way to encourage the co-operation with the IPA is Peer-review sessions with somebody from the Editorial Board of the International Journal of Psychoanalysis in Europe. In the past and during our last conference several communications and information exchange between EFPP and other allied organisations took place and we are open to continue this in the future.

THE FUTURE: some reflections about areas to defend and areas to develop

A) Some areas to defend

Critics on Psychoanalysis and Psychoanalytic Psychotherapy.
Critics of psychoanalysis are as old as psychoanalysis itself. From the publication of "the Traumdeutung", psychoanalysis was considered as non-scientific and speculative.
The spreading of caricatural ideas on psychoanalysis is enormous, not only in the popular media (films and novels) but also in the academic world. We must not underestimate the influence of the so-called Freud-bashers. It is remarkable that the empirical substructure of these accusations is hardly scrutinised!

Another remarkable finding is the complete lack of knowledge about the extensive empirical research in psychodynamic concepts and theories. The criticism that psychoanalysis is completely unscientific or that its assumptions cannot be tested empirically can, on the basis of a lot of empirical studies be rejected.

Psychoanalysis is too often, even in mental health itself, identified with the typical cure: several times a week, on the sofa, for many years. Obviously, psychoanalysis is much more than that. Different important writers such as Klein, Winnicot, Lacan, Bion, Kohut, Kernberg and Fonagy contributed not only to further theoretical developments but also to a broader clinical practice where practically the whole spectrum of possible psychopathology, by the way of adjusted methods and techniques can be approached. Nowadays, many psychoanalytic therapists work on wards for new born or elderly patients. They try to help in the first contacts between the baby and his parents, do play therapy with toddlers, help adolescents to find their way in their individuation and sexualisation processes, and you even can find them on wards for addiction problems and forensic psychiatry with more severe psychopathology.

They work in a face-to-face contact, with couples and families and with psychotherapeutic groups in ambulant, semi- residential and, in-patient settings.
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Unless the theoretical diversity, we observe on the technical level a lot of converging tendencies in which psychoanalytic psychotherapy develops as the common ground and as the therapy of choice for most kinds of psychopathology.

Psychoanalysis is not a science?
Our worldview nowadays is Newtonian and is based on some premises. One is that reality has an unchangeable ground structure. This structure is knowable by regularities which can and must be described mathematically and which can be experimentally tested. All of this makes the foundation of rational acting and leads to a technical control of the natural and human order.
By this way of reasoning, a hierarchy between sciences is installed whereby the exact or natural sciences dominate above the humanities and the fundamental above the applied sciences.
The most important illusion, which results from such a worldview, is exactly the one about the measurability and the transparency. Numbers, models and formulas are of most importance.
The so-called objective observer needs the position of the participating observer, who is involved in many networks which increases the complexity of observation.

The question, is psychoanalysis "überhaupt" a science, depends completely on the definition and this definition is already controversial between scientists themselves. If science is defined as an attempt to connect causal links between events one can wonder if the concept of causality can be applied to living creatures with a consciousness. Some epistemologists state that the assumptions of psychoanalysis neither can be confirmed, nor falsified which means that it does not fit the scientific requirements.
If science is defined as knowledge derived from experiments and measurability, then psychoanalysis can offer during the last years convincing affectivity research.
If we define science as systematic and formulated knowledge, then psychoanalysis has undoubtedly the right to scientific status.

Our experience is that the increase of knowledge and growth of technology does not help at all in coping with the complexity of the contemporary world. When science and technology do not succeed in reducing the complexity they tend to repress it. One of the most dangerous consequences of this is the exclusion of the subject and of the subjectivity.
Who wants to face the unfathomable meeting with the human is condemned to be responsive for insights that one can find outside the exact sciences: in art, literature, poetry, philosophy, and so forth or in the humanities, sciences that don't reduce human complexity but express it.

In a time where the positive sciences are idealised and where all biological insights are made absolute, this is not an evident message.

B) Some areas to develop

Research and psychoanalysis
It is remarkable that in the recent publications of psychoanalytic journals, traditional case studies and theoretical contributions gave their space to a growing number of empirical studies in which psychodynamic hypotheses or concepts are tested in a systematic way.
This is a conscious strategy concerned to give a concrete answer to the multiple critics about the empirical-scientifical status of psychoanalysis. But it is also an attempt to assure the future of psychoanalysis as a theory but essentially as a psychotherapeutic instrument in this time of evidence-based medicine The idea shared by some analysts that experimental research of psychoanalytic theories is impossible due to the complexity of "real" psychoanalytic concepts or that the results of such a research would be irrelevant, is in my opinion not acceptable. Existing research shows that a systematic testing of psychodynamic concepts by means of questionnaires and experimental research are in fact possible and can be theoretically and therapeutically relevant.

On the other hand, it is of course true that research has to connect much more, not only to the complex daily clinical experience, but also has to recognise the complexity of psychodynamic concepts. In some research, psychoanalytic terms are used in a caricaturist way. In an attempt to obtain scientific status, the danger can occur that psychodynamic concepts and theories are too much oversimplified. In addition, that the experiment, conceived originally as a means to the end of scientific knowledge, may become an end in itself.

We cannot underline enough the crucial importance of reliable conceptual research, which forms one of the strongest points in psychoanalysis. Expanding conceptual research by using insights from other scientifically disciplines like philosophy, linguistics, cultural anthropology, biology, neurosciences and history is even necessary as the systematic testing of these concepts.

Integration with…

… Neurobiology
The importance given by psychoanalysis to early development receives by data a stable neurobiological basis. It is nowadays generally accepted that the shape and the function of the brain can undergo many important changes during lifetime.
Much research now is done about memory and to illustrate how links can be made one can refer to the distinction between explicit and implicit memory, with Freud's concepts of dynamic and primary unconsciousness. Already, long obtained insights from the clinical practice of the therapy room are now made visible and acceptable by the neurobiological developments.

The last century is at least ended with the "decade" of the brain. The cognitive and neurosciences made important progress and offered insights about memory, molecular biology of the brain and about neuroplasticity. At least it was demonstrated that the structure and the functioning of the brain can be influenced by the environment. One can now visualise the anatomy but also the functioning of the brain by the neuroimaging. An advantage is that the by definition invisible world of thoughts, feelings and fantasy can be made visible and real. However, it is not because we can situate the brain activities, that we can understand them. It is the difference between "Erklären" and "Verstehen" Both kinds of comprehension do not exclude but overlap each other. Some neuroscientists, like Nobel prize-winner Eric Kandel, admire psychoanalysis for its ideas and concepts that are seen as relevant for a broader scientific society.

… The Theory of Attachment
Attachment research and psychoanalysis are interested to see what they have to offer each other. This is now easier than before because both models moved theoretically more toward each other. In the psychoanalytic theory there is much more attention towards the relationship between environmental factors and inner maturing processes. There are many findings which prove that a safe attachment offers the optimal conditions for development. The capacity to hold stable emotional relationships can be severely damaged by early affective deprivation.

Within the psychoanalytic world, there is also a movement towards intersubjectivity. The theory of attachment is, not only for the empirical pole but also for the intersubjective movement, of extreme importance.

Psychoanalysis also generally feels the need to join the academic sciences to increase it is creditibility as a science which has something to offer to other areas of science. The well developed instruments of the attachment research offer promising possibilities to support psychoanalytic work scientifically, without loosing the specific psychoanalytic way of looking and listening towards mental health.

What we finally see now is that the conclusions of researchers in the field of attachment are much more careful. And in his recommendations to introduce psychodynamic thinking within the attachment theory, Fonagy states that the theory of attachment should pay more attention to the systematic distortions of the outer world in the perception of the child.

… and Mentalisation
Mentalisation is the capacity to recognise intentions and feelings by others and by oneself, to understand interpersonal behavior in terms of mental states, and to situate all this in a psychic reality which is connected with, but also distinguished from, external reality.

It is a concept that for several years has conquered not only the psychoanalytic but gradually and also more and more the whole psychotherapeutic world. This is, for a great part, thanks to the fact that "reflective functioning" (who is closely connected with it), is one of the few psychoanalytic concepts, where from its relevance, is proved scientifically. Mentalisation as formulated by Fonagy is a concept that integrates contemporary neuroscientific, psychoanalytic and psychological developmental findings.
In the psychoanalytic treatment of more severe psychopathology, it became more and more clear that the main task was to work with the mental functioning rather than with the interpretation of intrapsychic conflicts.
A great part of the clinical population, who were not suitable for the psychoanalytic approach in a more old fashioned way, are now accepted in a theoretical founded way. In this sense, we indeed can speak about an elaboration and renewal. More concretely we need to put our statements more firmly and we must have the guts to say that in some cases , psychoanalytic psychotherapy is the therapy of choice,as for instance Kernberg does with his recommendations with borderlines.
Designing and refinement of clinical- diagnostical and therapeutical implications and clinical research are main topics for the future.

With thanks to Dr Mark Kinet's publication: "Freud and Co in de psychiatrie", Garant 2006

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