Israeli visit of Prof. Siv Boalt Boethius, Chair, European Federation for Psychoanalytic Psychotherapy - Summary

From 13 to 16 November, 2003, Professor Siv Boalt Boethius, of Stockholm, chair of the European Federation for Psychoanalytic Psychotherapy (EFPP), was the guest of the Israeli Association for Psychoanalytic Psychotherapy.
On the first evening of her visit, Prof. Boethius lectured at the weekly Thursday meeting of the Association on 'Differences between Psychoanalytic Psychotherapy and Psychoanalysis - Disagreements, What They Have in Common, How They Differ'. She noted in her lecture that according to Kernberg (1999), several kinds of distinctions have generally been made between psychoanalysis and psychoanalytic psychotherapy: conceptual, clinical, political, and educational. Some see the two approaches as the poles of a continuum, involving differences in degree (a quantitative difference), while others see the difference between psychoanalysis and psychoanalytic psychotherapy in qualitative terms. Today, according to Prof. Boethius, the current trend is less to draw sharp distinctions between the two approaches as to view them as opposite ends of a spectrum. She finds it interesting that while psychotherapy had originally developed from psychoanalysis, and had for many years been seen as an alternative form of psychoanalysis, today the situation is the reverse. In Sweden psychoanalysis is considered (at least outside psychoanalytic circles) as one particular form of psychoanalytic psychotherapy. The least common denominator between the two is that they both deal with an interpersonal process aimed at changing emotions, thoughts, attitudes or behaviour that can cause a person to experience an excessive degree of discomfort
Two observations have been vital to the separate developments of the two approaches. One (which Freud had already noted in 1905), is that not all patients can, or are willing to, be treated with 'classical' analytic techniques. The other is that non-analytical techniques have also had proved effect on patient symptoms.
From the standpoint of the aims of therapy, a classic debate has centered on the question of cure versus the accumulation of knowledge. Freud considered the aim of psychoanalytic psychotherapy to ultimately arrive at cure, while the aim of psychoanalysis was to achieve increased insight, both for the patient and for science in general. This distinction is believed to explain to a considerable extent why psychoanalysts have largely avoided becoming involved in any systematic empirical research. On a more profound, inner, level, however, dissimilarities are discussed in terms of content, or dynamic versus structural focus on resistances and defences. Furthermore, there are differences in emphasis on interpretations of transference, on the importance of transference neurosis, and the degree of abstinence on behalf of the therapist/analyst.
Professor Boethius went on to discuss the significant developments in psychotherapeutic research in recent decades.
The next day, the Association brought Professor Boethius together with the teaching committees of the various psychotherapeutic programmes in Israel.
Representatives of all the programmes in Israel were invited to the meeting. Those who participated were: representatives of the programmes at Tel-Aviv and Bar-Ilan universities; The Israeli Institute for Psychoanalysis, and the Institute's Hidavrut [Dialogue] programme; Centre for the Study of Psychoanalytic Psychotherapy, Geha Hospital; Tel-Aviv Institute for Contemporary Psychoanalysis; and the Israeli Institute for Analytic Group Therapy. The psychotherapy programmes of the departments of psychology, and health and welfare at the University of Haifa; the psychotherapy course conducted by The Israeli Institute for Psychoanalysis; and the Institute for Group Psychoanalytic Therapy, Jerusalem, sent regrets, but expressed the wish to be informed about and involved in future activities.
Zvi Fajerman, chair of the Association and moderator of the gathering, opened the gathering with a survey of programmes for psychoanalytic psychotherapy in Israel. Professor Boethius then spoke, in her direct and open manner, of her own personal professional development: training in psychoanalysis; work with children, as well as with families and organizations; and 15 years as director of the Erica Foundation, the centre for therapy and training in psychoanalytic psychotherapy for children and adolescents, in Stockholm. In the course of her academic work, Prof. Boethius did considerable work with groups, which contributed to expanding the scope of her interests; today, one of her main activities is clinically based research on psychotherapy, both qualitative and quantitative. Even now as chair of the EFPP, the subject is close to her heart. Prof. Boethius went on to speak, inter alia, about the EFPP, training programmes in Sweden and other European countries, and requirements for admission to the European Federation.
A lively discussion followed, in which most of the 25 persons in attendance participated. We shall bring the main, and a representative, part of the comments made. Dr Henry Shor (Tel-Aviv University) began the discussion by expressing concern over psychoanalytic psychotherapy in Israel in the light of the security and economic situation, and asked how those engaged in the field in Europe deal with the crisis that is to an extent also being experienced there. He also reflected on the similarities and differences between the Israeli Federation of Psychotherapy and the Israeli Association of Psychoanalytic Psychotherapy.
Dr Gabby Mann (Bar-Ilan University) raised the question of whether psychotherapy programmes should fulfil a strictly education role, or should also serve as bodies that grant certain professional-statutory certification. She asked about the way the matter is dealt with in Europe.
The question of 'marketing' psychoanalytic psychotherapy was raised, so that it can survive these troubled times, and attain external recognition from those upon whom we are dependent. Prof. Boethius claims that it is important that we in Israel prepare, in a sober yet creative way, for the budgetary blow that she believes we will undoubtedly be subjected to, as has occurred throughout the Western world. She emphasises again the importance she attaches to different kinds of systematic documentation of ordinary psychotherapeutic work as a prerequiste for clinically based research, and as a basic tool in integrating psychotherapeutic theory and practice. She believes that the solidification of knowledge including a better understanding of our therapeutic work, and its demystification, serve as fundamental tools in the firm establishment of psychotherapy and its confrontation of the forces that attack it.
Concerning the training process, in her view the motivation of an applicant for the training process constitutes a factor of the highest importance in consideration of his acceptance. It is very important that institutions permit those who study and teach in them to express the human and therapeutic essence within themselves, that they intensively study the therapies they give and their results, and that they serves as potential 'containers' and a therapeutic domain for the teams that work in them, parallel to this central function in psychoanalytic psychotherapy. Furthermore, open, non-critical discussion amongst students is a tool of fundamental importance in the creation of such an institutional container. The containment, she believes, is engendered mainly during supervision, which is a highly significant part in the training of therapists. She therefore believes that the supervisors to which trainees are exposed should be varied, and that what is done during supervision should be properly followed up. Furthermore, it is important to undertake studies that explore the different parts of the training process and how it is conceived by the trainees, the supervisors and the seminar leaders as the training institute.
At this point, Dr Avi Berman (the Israeli Institute for Analytic Group Therapy) changes the discussion from 'external' to 'internal' matters: the competition between the various programmes. Prof. Boethius contends that the firm establishing of the unique contribution of each institution constitutes, in her judgement, a basic tool in curtailing the destructive competition between institutions, and between psychoanalysis and psychoanalytic psychotherapy. She attaches importance to fruitful cooperation among those engaged in individual, group, and child therapy.
A discussion develops about the current criteria in Israel for certifying psychotherapists. On the one hand, the conditions for admission to masters' degree programmes are becoming quite impossible, and on the other hand, criteria for certification as a 'psychotherapist' are becoming easier all the time. The profession is 'wide open' from a legal standpoint. Hanna Reinschreiber (Bar-Ilan University) expresses her concern over the lack of a clear psychotherapy law in Israel, a state of affairs that, she contends, results in a continuing decline in the level of those admitted to psychotherapy schools and licensed to engage in the profession. Dr Rina Lazar (Tel-Aviv University) states that in her view, not only the law determines the way things are, but also the prevailing consensus. Dr Gila Ofer (Tel-Aviv Institute for Contemporary Psychoanalysis) sees specialisation as only one milestone in an ongoing learning process.
A discussion develops about the impact of competition between the schools. Dr Gabby Mann explains the policy at Bar-Ilan of admitting several art therapists each year for psychotherapy training. Dr Ofra Eshel (Hidavrut) considers such a step problematic, because such therapists lack a theoretical grounding.
Miriam Berger (the Israeli Institute for Analytic Group Therapy) mentions the fact that this is the first time that representative of the Israeli Institute for Analytic Group Therapy are participating in a forum such as the present gathering, and stresses its importance and the desperate need for dialogue amongst ourselves.
Dr Rina Lazar asks how, as Association members, it would be possible to profit from the present meeting. Such meetings had already been held in the past, and had taken up matters currently under discussion. Concerning admission criteria for schools, there is much pressure from professionals in other disciplines, such as educational psychology, for admission to psychotherapy programmes, for reasons of prestige.
Hanna Reinschreiber emphases the seriousness of the gathering and its importance, and the grave responsibility we have for the discipline of psychoanalytic psychotherapy. In her view the clinical university departments see more of such responsibility towards the profession than the psychotherapy programmes.
Zvi Fajerman asked whether those in attendance are interested in another gathering. Sandra Halevi (Hidavrut) says there is, but wonders whether there would be more scope for discussion about the content of matters and in which professionals must genuinely contend, rather than about concrete matters. Dr Dalia Freiberger (Centre for the Study of Psychoanalytic Psychotherapy) asks for time, because of her workload and anxiety about committing herself.
Zvi Fajerman announces that the Association will take the liberty of inviting those in attendance to another gathering. Prof. Boethius supports the idea about thinking and discussing together, within the programmes and in small groups, about central matters of concern.
Towards the conclusion of the meeting, the conference that the Association plans to hold on 8-9 January 2004 on the topic of training and supervision in psychotherapy is mentioned; the possibility is raised of holding a workshop at the conference of members of the teaching committees, with the aim of continuing and deepening discussion of the matters brought up at the present meeting.
The next day, Saturday, the Association executive held a concluding meeting with Prof. Boethius, at which topics brought up during her visit were further clarified. As members of the EFPP and as the representatives of the State of Israel there, they discussed strengthening ties between Israel and Europe.
Professor Boethius reviewed her visit in a very positive light, stressing how impressed she was by the quality of professional work in Israel, as reflected in the discussions at the gatherings in which she participated. Furthermore, she mentioned her own learning, and the many thoughts she takes with her to the European Federation. We, for our part, reviewed the visit and the activities we prepared in its wake with satisfaction. Also, meeting her was personally very pleasant. We thank Prof. Boethius and the members of the teaching committees who took part in the gathering, and those who encouraged it and helped to bring it to fruition. Our thoughts are now directed towards the future.

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