Gabriele Junker’s (Ed.) Living and Containing Psychoanalysis in Institutions: Psychoanalysts Working Together”

Reviewed by: Frances Thomson-Salo

This book about the psychoanalytic institutions that psychoanalysts are members of should be in every Society library and on curricula reading lists for group organisational dynamics/ethics seminars. That recommendation, however, wouldn't come close to conveying the breadth and depth of clinical wisdom, and challenge, of this book. The editor, Gabriele Junkers, a Training analyst of the German Psychoanalytical Association, has previously published on topics such as evaluating psychoanalytic competence, ethics, and ageing and retirement in psychoanalysis; her work has often been on the edge of challenge and confrontation, and she deserves praise in assembling this group of eight international colleagues who are inspirational in their reflective thinking and their contributions to many organisations over decades.    

The relative slimness of this book belies its multifaceted and fascinating array of integrated psychoanalytic knowledge, expertise and proposed solutions. The contributors have held many senior organisational positions including three presidencies of the International Psychoanalytical Association and all draw on a breadth of knowledge, experience, insights and positions held as they examine psychoanalytic organisations through a range of different lenses. Some accounts are refreshingly straightforwardly alive and honest, while the book raises confronting questions, so known yet often so hard to accept, with many examples of dysfunctional organisations, some observations so pertinent that it is painful to be reminded through the examples and composited vignettes of how Societies have functioned. 

     Martin Teising opens with the institutionalisation of psychoanalysis, with the formation of the IPA to promote and maintain psychoanalysis as a science, and then its recognition as the authorising body for psychoanalysis as a profession. Serge Frisch reflects on the relationships that psychoanalysts have with their Societies, concluding that Societies would benefit if discussion spaces were reserved for sharing some ‘unsolvable’ difficulties (e.g., secrets about conflicts and abuses). Gabriele Junkers’ wide-ranging chapter provides a framework for the challenge for psychoanalysts in maintaining and developing a containing institution, and in her closing remarks to psychoanalysts and institutions refers frequently to the necessity of courage as she is convinced that courage – in the sense of not retreating in the face of conflict but standing firm - is necessary to implement changes that cannot be achieved by psychoanalytic reflection alone. She would welcome greater courage in referring our anxiety about the survival of psychoanalysis to its place in our own selves and greater self-reflection on anxiety about annihilation and our own death. This is reminiscent of her own unflinching courage in facing end-of-life issues in other arenas. The six subsequent chapters examine specific aspects of institutional psychoanalytic life. Harriet Wolfe focuses on how sibling conflicts play out and are resolved in psychoanalytic institutions with the potential to be collaborative and transparent, suggesting that in thinking about conflict and loss the best rule of thumb may be to discover how the other is right, before moving to the next level of the conversation. Stefano Bolognini reflects on the positive and negative effects of every psychoanalyst’s institutional family, and how life-long participation in different kinds of groups after psychoanalytic qualification may be a “Fourth Pillar’ of education, for example, Working Parties with psychoanalysts from other organisations or continuous institutional and community participation. Philip Stokoe considers how an innate curiosity drive meets unique resistances against facing reality in psychoanalytic organisations, and how psychoanalysts could prevail against this threat by the provision of a safe and developing home for psychoanalysts and psychoanalysis with a board responsible for strategic direction and governance; he suggests that it is in governance that the psychoanalytic approach and mind is expressed and demonstrated. B. Miguel Levi illuminates some ‘dark sides’ of institutional life that stem mainly from entangled transferential networks which contribute to conflictual dilemmas raising in turn questions of psychoanalytic ethics, and specifically ethically limiting transferential powers by aiming for a more democratic institution. David Tuckett richly illustrates how psychoanalytic institutions can help psychoanalysts to function effectively as work groups focused on the three core tasks of training, advancing the standard of clinical work and outreach, challenging psychoanalysts to find the psychoanalytic attitude, the third position: the willingness to experience a situation, reflect with curiosity and empathetic neutrality from outside and then re-engage. He concludes that institutional psychoanalytic capacity is the ability within the institution to take itself as the object and create procedures to transparently show that it is taking a ‘third’ stance towards dynamics that arise, such as anxiety. Claudio Eizirik embodies the compassionate containing function of the IPA when new groups of psychoanalysts seek to become a recognised psychoanalytic group, in the IPA’s careful process of developing new groups with a strong culture of confidentiality. Gabriele Junkers’ final chapter, ‘Looking ahead’, ends with her conviction that the preservation of psychoanalysis can only be achieved by collegial cooperation with each other, and she sets out an outline for a psychoanalytic form of mediation.

    In the light of the comprehensive, well-argued richness this book offers, it is hard to suggest constructive critique so I might instead ask three questions. First, the representativeness of the authors, predominantly from the European region and whether more North American and Latin American psychoanalysts could be called on in this project. Secondly, in Societies, are ethics always taught in the curriculum, including topics of ageing and death, implications of democratic membership of institutions, etc, with sufficient discussion spaces in Societies for ethics and organisational matters? And last, given the relative ageing of the profession and ensuring a vibrant, sustainable climate in the profession and its organisations, is enough attention given to how psychoanalytic organisations could be more outward looking, which may often be sidelined when this aspect is conflictual within a Society. 

    Glen Gabbard recommended the book as a major breakthrough in discussing difficulties that psychoanalysts have in working together in institutions. Questions of ethics are key to this book – how to understand the range and variety of ethical breaches, and constructive ways of dealing with them; as a former chair of the Ethics Committee of the Australian Psychoanalytical Society I welcome the discussions.

    Reading this review is no substitute for reading the book; to be unaware of its insights about the ethical need to engage in the difficult work of tending to collegial relationships for growth of psychoanalytic knowledge is a loss. This is a book to be read and reread as part of a process to keep one’s institution, as Stokoe puts it, a safe and developing home and particularly holding fast to the ethical need to engage in the difficult work of tending to collegial relationships for growth of psychoanalytic knowledge.