Serge Frisch: A European platform representing the analytic pole: can it become a reality?

In Europe there are a number of movements 'rounding up' different organisations; to give examples:
1. In the field of psychoanalytic societies several orientations exist: The European Psychoanalytic Federation (EPF) has been in existence for more than 20 years and consists of member organisations of the IPA (International Psychoanalytic Association) that are within Europe. EPF represents without any doubt the major psychoanalytic orientation in Europe. Some Freudian societies that have not been members of IPA for long may wish to link up with IPA. It is possible that in a near future some of these psychoanalytic societies may open themselves to Lacanian psychoanalysts as it is already the case in Latin America. In the past few years the Lacanians have founded several international associations. It is difficult so far to estimate what they really represent and what is their policy since they are split in several sub groups. Some very minor streams still continue to exist such as the the Jungians, Adlerians etc. but they don't have any scientific or major political impact in Europe.

2. In the field of psychoanalytic psychotherapy EFPP attracts increasingly psychoanalytical psychotherapy societies (approximately 12.000 persons are a member of the EFPP's national networks). But other European organisations do also exist in those fields, for instance group psychoanalytic psychotherapy organisations, as well as other organisations promoting the psychoanalytic approach with children and adolescents etc.

3. Beside these 2 groups exist the non-analytical organisations. The main organisation is the EAP (European Association for Psychotherapy). This organisation tends to gather all therapeutic orientations: systemic, behaviour, humanistic therapies but also the relaxation therapists, masseurs, hypnotherapists and many others. To increase the confusion EAP even tries now to have a psychoanalytic section. The EAP proposes the same basic framework of training for all therapeutic orientations (a sort of training Esperanto?). It wants to create a specific profession - that of Psychotherapy in Europe in which it would no longer be necessary to possess a core professional training as a physician, psychiatrist, psychologist, social worker etc. to become licensed psychotherapist.

For the sake of my argument I will be somewhat schematic and not mention many other developments. However the trend I have mentioned gives the impression of armies making ready for combat. On one wing we have the psychoanalytic societies. On the other wing a great number of heterogeneous therapies whose common ground is their anti-reflective psychology orientation, with similar underlying factors of suggestion and manipulation as the major therapeutic methods, as was observed in past decades by Freud, Jones and Glover.

Where is the place of EFPP in that professional field?
I have no doubt that psychoanalytical psychotherapy belongs to what I call that analytical pole. Indeed, the psychoanalytic psychotherapy is built on the psychoanalytic theoretical and technical framework. But it has also fruitfully integrated some frameworks that are not traditionally those of psychoanalysis as can best be seen in child or adolescent psychoanalytic where family concepts are often very helpful or even in the individual approach where some developments about groups have been integrated. EFPP claims that psychoanalytic psychotherapy has a central place in institutional settings. If psychoanalytic thinking disappears from the public psychiatry, patients will be left with a lot of experts on assessment who do not see the individual person at all and who do not understand the importance of helping people to a reflective thinking to develop personal growth. Psychoanalytic psychotherapy in institutional settings has to deal with this particular social and institutional frame that will affect the therapeutic process differently from what happens in the classical psychoanalytic setting.

But I am also aware that psychoanalytic psychotherapy may run the risk of evading its psychoanalytical foundations, its "basic soul" as the psychoanalytic frame, the key role of the unconscious, the attention given to transference and countertransference. It threatens to become a repairing, directing or supporting technique and thus a more vaguely analytically oriented psychotherapy, in which suggestion might again occupy a central place.

As stated, psychoanalytical psychotherapists have a core place in the public health system. So they are continuously exposed to and have to deal with the social, political and economical constraints of health policy systems. By contrast, many psychoanalytic organisations and psychoanalysts believe that it is necessary to remain formally outside of all health and mental health policy involvement. The argument is that there is a definite risk of excessive constraints on psychoanalysis, the development of psychoanalytic thinking and that it needs to be free to practice in the most unimpeded circumstances as possible. If psychotherapy in the public sector wishes to retain its psychoanalytic foundation, it will have to work through this important and profound conflict or otherwise runs the risk of becoming just one kind of psychotherapy amongst others.

The substantial development of psychoanalytic psychotherapy societies at national and now - with the EFPP - at European level, confirms their institutional existence and has introduced a new political dimension in the therapeutic landscape of which the long term consequences cannot yet be measured.

With some notable exceptions in a few countries, psychoanalysts and psychoanalytical psychotherapists have not yet succeeded in establishing creative dialogues or relationships between the two types of societies. But it may be that in future these exceptions could multiply under the pressure from public authorities that may wish to control the vast spectrum of psychotherapies. These pressures may come for economical reasons or as a result of complaints by people with mental health problems about trained or untrained persons, or as result of changes inside the professional organisations. This will increase the current tendency in many countries towards an official status for psychotherapy in which it is difficult to envisage psychoanalytic psychotherapy willing to stay outside these political discussions. This even if many aspects of such a status might possibly not suit the "analytical pole" at all, especially if there were to be little differentiation between the training criteria of analytic and non analytical groups.
Therefore it seems vital that any compromises that psychoanalytical psychotherapists may agree to, will not empty the psychoanalytical dimension. We observe that in some countries where there is official recognition of psychotherapy, the public authorities have an increasing tendency to limit the number of sessions of refunded psychotherapy. The probability that psychotherapy will not have a great priority within health policies must sharpen our skills in cogent and effective political arguments and methods. In opposing a more exclusively economic focus within public health, it is urgent for psychoanalytical psychotherapists to firmly support a humanistic approach to psychic suffering that can not be confined to discussion in terms of numbers of sessions of psychotherapy. Psychic reality and its treatment are substantially different from somatic approaches. This view nevertheless necessitates developing moral, theoretical and clinical studies (as well as comparative and evaluative studies) that underline the importance of intensive psychoanalytic psychotherapy sometimes lasting for many years or in some circumstances where the therapy may 'live' as long as the patient.

There are differences on many levels between psychoanalysis and psychoanalytic psychotherapy and these need to be discussed more fully. This is not a negative statement towards either psychoanalysis or psychoanalytic psychotherapy. They are 2 different branches of the same psychoanalytic family. Each one of these 2 branches is represented by their own organisations at a national level, a European level and for psychoanalysis on a world level. This must continue to avoid unhappy confusions between the aims and settings of the work of psychoanalysis and psychoanalytic psychotherapy. Maintaining clarity in this situation will be dynamically stimulating and beneficial for everybody. If there is conceptual clarity it may be increasingly possible to work across these boundaries. An example may be the continuation of psychoanalysts (and psychoanalytic organisations) who fully respect the need of psychoanalysis to have its independence from state restraints, but who may also share the aims of making psychoanalytic thinking available within the public sector and may support EFPP networks. On the organisational level, I think it necessary to keep clear distinctions about objectives.

It is my view that it may not only be in the interest of the analytic pole but an absolute necessity that societies, associations or groups that rotate around the psychoanalytic psychotherapy field establish and build contacts on a European level. It is increasingly important to build bridges on an organisational level to create meeting points and clarify points of convergence and divergence between the organisations of this field. We need to keep in mind the wider social, national and international contexts within which we operate. These contacts should be on a European level to avoid the conflicts about national "petites différences" and the conflicts between organisations in the national analytical pole. It will then be more possible to reduce the chances of territorial 'war', improve the chances of healthy political solutions for more adequate treatments for patients as well as stimulating research programmes and development of psychoanalytic theory in various settings. Contributing to this outcome should be the fundamental target of EFPP during the forthcoming years.

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